Weekender 4/30/21

Weekly News Recap

• Vocera acquires PatientSafe Solutions.
• Halma acquires PeriGen.
• Allscripts Q1 beats on earnings, misses on revenue.
• Caresyntax raises $100 million.
• Lyniate acquires Datica’s integration business.
• VisuWell fires its CEO over a video showing his altercation with a male teen who wore a dress to their prom.
• J2 Global will split into two publicly traded companies, one being its Consensus EFax business.
• Accolade will acquire PlushCare for $450 million.

Best Reader Comments

I have experience with Dell offshored health IT staff. All I can say is that you get what you pay for. If you want to pay 1/4 for folks that really don’t understand what you are getting at and then re-do it because of said lack of comprehension, then it’s a good model. Half my job is interpretation between clinicians that have needs but don’t really “get” the system, and the techies who can’t grasp why solution XYZ won’t fit the needs of that clinician. Add a foreign culture and language in the middle, and it’s complicated. (PennyWisePoundFoolish)

Why would we let anyone else dictate anything around our patient experience? We required the tele platform to give us a webpage that we host and can then use it to serve up our own patient educational material and other messaging. Plus, we actively monitor to ensure that the patient isn’t spending any meaningful time on the “waiting room” page. Patient experience has to be valued and protected! (DA)

I don’t think consumer driven is even needed, just competition. For a starting point, the ACA exchange in New York State is as competitive as the health insurance marketplace can be. There is even a pretty legally simple model to scale it up. Take away tax subsidies for employer provided healthcare, make any healthcare benefits transferable to the exchange (like the Harris plan), then provide large income based subsidies for purchases on the exchange. Low wage employers will jump at the chance to shift the healthcare responsibility into the state. High income earners and unions won’t fight it since it is providing another option for them rather than taking something away. Employers will eventually stop offering core health insurance as a benefit and everyone will purchase their plan on the market. It isn’t the best outcome ever but it is competitive and it is achievable. (IANAL)

Watercooler Talk Tidbits

Readers funded toe Donors Choose teacher grant request of Ms. H, who asked for math flashcards and unifix cards for her third-grade class in the Central San Joaquin Valley of California. She reported in November, “This 20 year veteran teacher became a first year teacher all over again this year through the implementation of distance learning. This has been the most challenging time in teaching that I have ever experienced. One of the biggest hurdles I’ve had has been finding creative ways to engage children in online learning. Any teacher worth their salt knows that math manipulatives are a key component to a successful math lesson with young children. The stackable counting cubes that I was purchase with your donation have been such a gift. The kids love having something familiar and fun to ‘play’ with and I love that we have been able to use the cubes to teach place value, regrouping, and now multiplication and division. I also love that it allows the kids to handle something besides their computer for a little while.”

Joe Rogan, who was accused of being reckless in telling tens of millions of his podcast listeners that young, healthy people don’t need to receive COVID-19 vaccine, clarifies that he is not qualified to offer medical advice: “I’m not a doctor. I’m a f_ing moron.” He says he’s aware that the vaccine protects other people as well as the recipient, but says “that’s a different conversation.”

A doctor in India urges people to get vaccinated while showing the sweaty effect of wearing PPE for 15 hours of rounding. 

A nurse sues Normal Regional Hospital (OK) for firing him for posting on Facebook that a black murder suspect should be hung. The nurse says he isn’t a racist, and in fact some of his best friends are black, and that he was fired because he’s a Republican.

In Texas, the mother of a two-year-old girl who has been hospitalized for most of her life with a heart condition wages a legal battle with the hospital over stopping care it says is futile because she will never recover. The state has spent $24 million in Medicaid funds on her hospitalization.

The New Yorker describes the lonely job of medical interpreters, who work from their homes in translating conversations often involve end-of-life decisions related to COVID-19, sometimes with patient family members who live in other countries. 

The government of Japan responds to the concerns of a nurse union about the medical resources that will be consumed by the daily testing of athletes in the 2020 Summer Olympics in Tokyo, whose year-delayed start is July 23. Japan has vaccinated just 1% of its citizens and 75% of residents don’t think the Games should be held this summer. Officials will decide in June whether spectators will be allowed.

In Case You Missed It

• News 4/30/21
• EPtalk by Dr. Jayne 4/29/21
• HIStalk Interviews Micky Tripathi, National Coordinator for Health IT (Part 2)
• News 4/28/21
• Curbside Consult with Dr. Jayne 4/26/21
• HIStalk Interviews Micky Tripathi, National Coordinator for Health IT (Part 1)
• Monday Morning Update 4/26/21

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• Contact Mr. H

Morning Headlines 4/30/21

Vocera to Acquire PatientSafe Solutions

Clinical communications and workflow platform vendor Vocera will acquire PatientSafe Solutions, which offers a unified inbox of messages, alerts, and notifications that is integrated with EHR data.

Perinatal Safety Company PeriGen, Inc., Acquired by Halma plc, a Global Group of Life Saving Technology Companies

UK-based Halma acquires perinatal safety technology vendor PeriGen.

CVS Health launches $100 million venture fund

CVS Health launches a $100 million venture fund that will invest in early-stage companies that are “focused on making healthcare more accessible, affordable, and simpler.”

Privia Health Shares Pop On First Day Of Trading

Shares of national medical group and practice support technology vendor Privia Health closed Thursday with an IPO-day share price jump of 51%, valuing the ownership stake of parent Brighton Health Group at $2.75 billion.

News 4/30/21

Top News

Clinical communications and workflow platform vendor Vocera announced after Thursday’s stock market close that it will acquire PatientSafe Solutions, which offers a unified inbox of messages, alerts, and notifications that is integrated with EHR data.

Reader Comments

From Descension: “Re: Ascension. EHR is the latest to be outsourced, but not the last. Best part is that they told us they are doing it to help the poor and vulnerable, not to save money. Is it time for me to find another career since it’s tough all over and outsourced offshore health IT is the future?” I’ll invite readers to weigh in on that latter question. I honestly don’t know. While it seemed inevitable, absent major user pushback, that most technical support would be shifted to cheaper offshore providers, I wasn’t so sure about specialized areas such as EHR support. The pessimistic view is that the old saying was right – if your job doesn’t involve touching something, plenty of people outside the US would be thrilled to do it cheaper and maybe even better. Ascension is running a billion-dollar quarterly profit as its contribution to the US’s world-leading healthcare costs that make our workforce non-competitive in the first place. On the other hand, sometimes health systems that are looking for “one neck to wring” elect to indeed wring that neck by insourcing everything back in-house down the road.

From Cond-Ascension: “Re: Ascension. Has outsourced IT, starting a while back with contact center and desktop support, now all application and EHR support. EHR support is considered a non-strategic commodity to Ascension now. Folks are being asked to stay until August, where they will probably need to apply for jobs to earn severance. Ascension allows a 10% pay reduction as a suitable offer when a role is eliminated. Tons of great talent will be flooding the market.” Anyone who is looking for Epic people should pay attention.

From CIO: “Re: VisuWell firing their CEO. The actions of the former CEO were obviously atrocious on any number of levels, but VisuWell did everything a company could do. The acting CEO and board chair got on the phone with the CMIO and me to make sure we understood what they were doing, then followed up yesterday to make sure we had everything we need and were completely understanding about us taking any action we thought we needed to. I can’t think of anything else they could have done short of inventing a time machine. We aren’t changing our relationship with them, and in fact chose them initially because we felt they were a better fit in dealing with a diverse patient population than some other vendors.”

From We Aren’t the Champions: “Re: WaitButWhy. What do you think about its most recent post? It seems like an overly optimistic exercise to get something like this off the ground, especially in the US, much less to have it succeed for the long term. I’m in Canada and there’s no chance of provinces paying for comfy chairs or coffee in the waiting room.” The article, which is titled “Why going to the Doctor Sucks,” calls out limited appointment times, unfriendly front desk employees, making patients write the same information on the same clipboard forms every visit, and doctors running behind and shortchanging patients whose appointment is late in the day. It concludes that in the US healthcare non-system, patients aren’t treated like customers because they actually aren’t customers, so cold interactions and indifferent waiting areas echo the DMV or post office. The author’s wife and a friend (non-physicians) decided to start a $2,400 per year, no-insurance primary care club in which members are assigned a doctor, a wellness advisor, and a concierge coordinator. My thoughts:

• I already have this concept covered in my direct primary care doctor’s practice. I pay $75 per month to have direct access to her at all times (phone, mail, text, video, etc.), appointments are quickly available and booked for 30 or 60 minutes of uninterrupted time, in-office lab testing is included, she can provide prescription medications at cost, and simple procedures carry no extra charge. These no-charge extras save enough of my deductible alone to more than cover her annual fee.
• I keep my health insurance  to cover specialists, ED, hospitalization, etc. that might come up, of course, but I haven’t seen a PCP using my insurance for several years. 
• I don’t know what my doctor’s waiting room looks like because I’ve never seen one. She meets me at her office’s front door, we walk to the exam room, and we talk face to face with no keyboard between us. I’m the customer, so she will provide advice on whatever I need – exercise, stress, and diet are listed on her website. But she won’t just prescribe something because I ask for it (I don’t ask because I don’t like taking meds unnecessarily, but she made that clear upfront).
• Quite a few investor-backed companies are placing big bets on practices – both general primary care and specific to Medicare beneficiaries – that feature better creature comforts, a more customer-friendly environment, and more convenient access.
• These models are better for the doctor, who doesn’t need to jam their schedule full, practice substandard but profitable medicine, bow to corporate overlords like health system executives and insurers, and get stuck with patients who just want drugs. You can do the math – if my doctor has 500 members, she takes in maybe $40,000 per month of all-recurring revenue (cost varies by age), has minimal overhead, and can use just the tiny portion of EHR functionality that actually benefits the patient and her. She has to be careful about patient mix since having all Medicare-aged patients could require too much work, but she is allowed to set her panel any way she wants.
• Here’s the beauty of the screwed-up system we have. Neither patients nor doctors like it and it is so wastefully expensive that it it’s easy to find enough cost savings in a new model so that neither pays more. Those corporate overlord middlemen I mentioned are bureaucratically inclined and thus ripe for disruption, and while the cash-only membership system excludes those who don’t have the resources to pay on their own, it assures equal treatment among those who do (and leaves assistance programs for those who need them most). Our suits-to-scrubs ratio makes fat-trimming easy.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.

Acquisitions, Funding, Business, and Stock

UK-based Halma acquires perinatal safety technology vendor PeriGen. Halma, which operates many brands in the safety, environmental, and medical sectors, acquired healthcare location services vendor CenTrak in early 2016 for $140 million.

Allscripts announces Q1 results: revenue down 3%, adjusted EPS $0.19 versus $0.02, beating earnings expectations but falling short on revenue.

Castlight Health announces Q1 results: revenue down 10%, adjusted EPS $0.01 versus –$0.01. CSLT shares are up 140% in the past 12 months versus the Dow’s 40% rise, valuing the company at $288 million.

Surgery analytics vendor Caresyntax raises $100 million in a Series C funding round.

CVS Health launches a $100 million venture fund that will invest in early-stage companies that are “focused on making healthcare more accessible, affordable, and simpler.” The company cites previous success in its direct investments, such as Unite Us and LumiraDx.

Shares of national medical group and practice support technology vendor Privia Health closed Thursday with an IPO-day share price jump of 51%, valuing the ownership stake of parent Brighton Health Group at $2.75 billion. CEO Shawn Morris holds shares worth $144 million.

Online pharmacy operator Capsule raises $300 million in a funding round that values the company at more than $1 billion. The pharmacy fills and delivers prescriptions in six cities.

Sales

• Orange County, NC selects Everbridge’s vaccine distribution platform.
• UK’s Guy’s and St. Thomas NHS Foundation Trust will use Nuance Dragon Medical One to support its Apollo service transformation project, integrated with Epic.
• Cigna will offer virtual mental health services to its behavioral health members from Ginger, of which Cigna is an investor.
• Seattle Children’s moves its Epic system to the healthcare cloud of Virtustream, which is owned by Dell Technologies.
• American Health Communities will implement live video consults for residents of 28 skilled nursing facilities in Tennessee using videoconferencing, live bio-analytics, and instruments from Let’s Talk Interactive.

People

Tonya Hongsermeier, MD, MBA (Lahey Health) joins Elimu Informatics as VP / chief clinical innovation officer.

NTT Data hires Michael Petersen, MD (Accenture) as chief clinical innovation officer.

Announcements and Implementations

Omnicell’s EnlivenHealth division will use Twilio’s customer engagement platform to expand its retail pharmacy offerings that include personalized communication by IVR, texting, chatbots, email, and a mobile app.

AHIMA creates DHealth, a catalog of digital health products whose developers have attested that they meet security and privacy standards. 

The US Army’s General Leonard Wood Army Community Hospital (MO) goes live with MHS Genesis / Cerner, the first facility to use the system for in-processing of newly arrived trainees. Above is Major Cynthia Anderson, chief nursing information officer, overseeing use of the mass readiness module that was developed for military medicine and is used at GLWACH to process 100 trainees per hour.

A small interview-based study of VA facilities looks at why timely follow-up on abnormal test results doesn’t always happen:

• Rotation of medical residents, who may be sent results after they have left.
• Lack of ownership of secondary findings.
• Providers ignoring or not seeing EHR alerts with no standardized follow-up defined.
• Lack of current contact information on file for the patient.
• Communications breakdown caused by referrals to another facility.
• Providers covering for each other.
• Uncertain responsibility for reviewing results that were pending on discharge.

COVID-19

A new, small study finds that COVID-19 vaccines manufactured by Pfizer and Moderna are 94% effective in reducing COVID-associated hospitalization of those who are over age 64.

California’s COVID-19 case rate is now the lowest in the country.

Some experts say that President Biden missed a chance to reduce vaccine hesitancy in his Wednesday address to a joint session of Congress, where audience members were spaced, masked, and asked not to make physical contact. A better approach, some say, would have been to allow only vaccinated attendees and then permit them to behave in a 2019-like manner to send the message that vaccination can end the pandemic and return life to normal.

Pfizer expects to release a protease inhibitor for experimental use in treating early-stage COVID-19 by the end of the year, potentially keeping people with early symptoms out of the hospital.

The Public Health Company — which will advise businesses, providers, and public health organizations on public health issues using data, containment best practices, and genomic epidemiology – launches with an $8 million seed funding round. Its scope includes, beyond COVID-19, healthcare-acquired infections, antimicrobial-resistant infections, and foodborne infections. The co-founders are a California public health physician executive and a former Goldman Sachs partner. The business case involves the cost of avoidable business interruption, including supply chain and labor issues.

Other

A University of Missouri study finds that nurse workload is doubled when patients are seen in virtual visits rather than in-office appointments, as nurses have to review, document, and act on blood glucose and blood pressure readings multiple times each week instead of the average in-person visit frequency of every three months.

China’s government is considering allowing prescription drugs to be sold online, which a state-controlled magazine says is a warning shot to public hospitals that profitably overprescribe drugs, including IV drips and antibiotics. The article notes that the government tried to fix the problem in 2017 by mandating that doctors and hospitals sell drugs to patients at their cost, but the providers wormed around that requirement by manipulating cost data and retaining rebates. The country does not have a system to make prescriptions universally accessible and Internet-based sales raises issues of prescription authenticity and supply chain safety. 

Sponsor Updates

• Medicomp Systems releases a new “Tell Me Where It Hurts” podcast, “Reimaging Healthcare Through NLP.”
• Meditech offers a new case study, “How Meditech and Interlace Health support integrated electronic patient consent.”
• KLAS recognizes GetWellNetwork as a top-performing vendor for COVID-19 response.

Blog Posts

• Is Electronic Protected Health Information (ePHI) Getting Outside Your Healthcare Organization? (Fortified Health Security)
• What is Digital Health – Healthcare Industry Transformations of 2021 (Gyant)
• The Impact of COVID-19 on Clinical Communication and Collaboration (Halo Health)
• Developing the Next Generation of Healthcare IT Professionals (Optimum Healthcare IT)
• EHRs in Urgent Care Clinics (HCTec)
• Charge Capture Optimization: Target Five Hotspots to Boost the Bottom Line (Health Catalyst)
• 2021 Infor User Group Conference is a Wrap! (Infor)
• Proof-of-Concept Study Shows CGM Benefit in Patients with COVID-19 (Glytec)
• Five Ways Independent Physicians Can Capture and Keep More Revenue (Ingenious Med)
• Data complexity and its impact across the health IT sphere (Intelligent Medical Objects)
• How Top Health Systems are Scaling COVID-19 Vaccine Scheduling with Kyruus (Kyruus)
• Looking Back and Leaping Forward: How Unprecedented Times Shaped the Way of the Future for Health Seekers’ Online Experience (Loyal)
• What payers and providers need to know about the ONC and CMS information blocking rules (Lyniate)
• Time is Almost Up! Are You ADT Notification Compliant? (Medhost)
• EHRs as healthcare, not software: Highlights from Meditech at the CHIME21 Spring Forum (Meditech)
• 7 Signs It’s Time to Update Your PT Billing System (MWTherapy)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Contact us.

EPtalk by Dr. Jayne 4/29/21

The big news around the virtual physician lounge this week is the decline in COVID-19 vaccination rates. President Biden is pushing for small businesses to make use of tax credits to support paid time off for employees seeking vaccination.

At this point, anything we can do to incentivize people to become vaccinated is welcome. The more the virus continues to spread, the more it can mutate, which counters the progress we’ve made. Some employers understand this. Supermarket chain Kroger has offered cash incentive payments for employee vaccinations, as has hospital Houston Methodist and several health systems. Some decry this as coercion, but the reality is that someone won’t get a vaccine if they really don’t want one, based on a $100 cash payment. The incentives are also rewarding those who do the right thing, as additional vaccinations help strengthen the workforce and reduce burden on co-workers.

I remember when I received my first vaccine, we thought it would really be something if we got a million doses in arms. That would really be an indicator of safety and effectiveness. Now that we’re at the 200 million dose point, it’s clear that the risks of the vaccines are minimal. Even with the questions around the Johnson & Johnson vaccine and the potential for increased blood clots, these vaccines are remarkably safe and effective. Based on what I’ve seen with the COVID-19 illness in my patients, the vaccine is much more desirable. On the home front, I’m just waiting on a couple of second doses within my family, and then I’ll really be able to breathe a sigh of relief. It’s been a long year, for sure.

Healthcare workers have been at the tip of the spear, not only fighting the pandemic, but also dealing with increasing numbers of unstable patients and sometimes public hostility. The Journal of the American Medical Association published a recent article on “Navigating Attacks Against Health Care Workers in the COVID-19 Era.” Initially, health workers were on the receiving end of discrimination as well as violence. Several colleagues were asked not to attend church or told that their children couldn’t participate in activities because they were potentially in contact with COVID-19 patients. There are also social media attacks – I’ve experienced them personally, although what I’ve encountered has been on the mild side compared to that experienced by others.

During my career, I’ve experienced patients ranging from “creepy stalker” to verbally abusive to downright threatening. Fortunately, the only physical threats have occurred within the hospital emergency department, so I had security staff at the ready. Still, there’s always that worry that a disgruntled patient or drug seeker will be waiting for you at the end of your shift. Hospitals and larger facilities may have security staff that can help mitigate this risk, but for healthcare workers in small practices or isolated environments, we’re pretty much left with the buddy system to help keep each other safe.

Uber sent me an email this week, inviting me to schedule my COVID-19 vaccine at a nearby Walgreens through the Uber app, while also being able to book a ride. Of course there were caveats about vaccine availability and whether Uber Reserve service is available in my area, but it’s still a good option for people who might not otherwise be able to get a vaccine scheduled. In my area right now, there is an overwhelming surplus of vaccines and a lot of hesitancy, so anything that gets people to think about the process is okay in my book.

I was excited to hear that Meditech is integrating genomics into its EHR. If you are an EHR vendor thinking about incorporating it, there are some serious options not only for documenting the data for how they enable clinicians to use it. The most basic need is to be able to document specific genes that patients have in a discrete fashion so that they can be used by clinical decision support algorithms. That’s critical for those genes associated with diseases where the mere presence of the gene changes the need for preventive screenings or management. Systems need to be able to track what type of genes are present, whether they are sex linked or not, and whether patients have a single copy or two copies of a given mutation. They also need to be flexible enough to manage new discoveries, such as when a gene is found to have a new level of clinical importance.

For its Expanse Genomics solution, Meditech is partnering with First Databank. To be honest, I didn’t know how far First Databank had gotten into the world of genomics. I always enjoy stopping by the FDB booth at HIMSS and remember vaguely hearing about them moving into pharmacogenomics. Certainly, some specialties are going to be more drawn to the value of integrating genomics than others. Many of my primary care colleagues are concerned about being able to keep up with the basics of making sure all their patients are receiving preventive screenings and that diagnoses are managed optimally, let alone being able to manage the impact of genomics on precision medicine.

I was particularly excited to hear about the Expanse solution being able to import genomic data and integrate it into the patient record in what sounds like a discrete fashion. My own recent genomic results are sitting in a PDF within the chart and aren’t even accessible to me as a patient through the patient portal. My physician was supposed to mail me a copy (snail mail – shocking, I know) but the results never arrived, so they did send me a PDF version. Good thing, since when I look in the patient portal, it just says “see outside report.” If my physician’s EHR can’t even display the results, there’s no way it can use them to tell me how often I should get a colonoscopy or how my risk changes depending on what is found during the procedure.

It will be interesting to see how long it takes other EHR vendors to get on board with a similar solution, as well as how long it will take existing Meditech clients to embrace the new content.

How is your system currently handling genomics? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/29/21

Caresyntax Raises $100 Million to Make Surgery Smarter and Safer

Surgical data analytics vendor Caresyntax announces a $100 million Series C funding round led by PFM Health Sciences.

Kaia Health grabs $75M on surging interest in its virtual therapies for chronic pain and COPD

Digital therapeutics company Kaia Health raises $75 million in a Series C funding round, bringing its total raised to $123 million.

Outcomes4Me Raises $12 Million in Oversubscribed Series A to Fuel Expansion of AI-Powered Cancer Patient Empowerment Platform

Breast cancer patient navigation app developer Outcomes4Me raises $12 million in a Series A funding round.

UCM Digital Health Raises $5.5 Million Series A Led by Armory Square Ventures

UCM Digital Health, which offers emergency telemedicine, care coordination, and remote care services, secures $5.5 million in a Series A funding round led by Armory Square Ventures.

HIStalk Interviews Micky Tripathi, National Coordinator for Health IT (Part 2)

Micky Tripathi, PhD, MPP is National Coordinator for Health Information Technology.

FTC recently warned companies and developers about using AI algorithms that are biased, intentionally or not. What government involvement do you expect, if any?

We actually just had a discussion about this yesterday within ONC, starting to talk about that, among a set of issues that are related to health equity. That is certainly a part of it.

I don’t have a great answer right now. We are just at the beginning of it. We are just starting to start to think about what the issues are and what federal agencies have involvement in this. You named a couple in FDA and FTC. I’m sure there are others who aren’t necessarily involved from a regulatory perspective, but could be involved from a use perspective. If you think about CMS using algorithms, VA, DoD, IHS, I mean it certainly could be all over the place with different federal agencies that are involved in healthcare in one way, shape, or form.

Next is the question of, how do we think about bias? There is certainly a piece that is related to help disparities for minoritized, marginalized, underserved communities. That’s a huge piece, one of the things that I was addressing. There are also more general questions of bias. If you think about bias from a statistician’s perspective, it is anything that would bias an inference that one is making using a set of tools. You can imagine, for example, general questions about algorithms that are trained within certain environments. What applicability do they have to other environments, and  what inherent biases are involved in that? How do we measure those or parametrize the learning foundation that a set of algorithms was developed on, and how applicable are they in other circumstances? How do you set some parameters around that to give some assurance that you are addressing as many of those sources of bias that are possible, recognizing that there could be a whole bunch of other ones that are harder to detect?

For example, if we all wanted to move to a world of quality measurement that relies less on structured data elements – which impose a certain burden on providers and provider organizations to standardize that data and to supply that data – and move to a world where that can be complimented by, and perhaps eventually substituted by, a more algorithmic-based approach with more computable types of approaches applied to with natural language processing and other kinds of things, that raises the question of, if the algorithm has been trained to do certain types of detections — let’s say for safety, or is trained to do performance measurement in certain ways – in an environment like the Mayo Clinic or a large set of academic medical centers, is that applicable in other hospital settings? How would one know that it is applicable in some ways? If you are going to start paying people based on the results of that, we are going to have to develop a set of answers to those kinds of questions.

What is ONC’s role in reducing clinician EHR burden?

We have a clinical team that is working closely with CMS on clinician burden. We co-wrote a report that was released at the end of last year. We spend a good amount of time thinking about that with respect to everything that we do, especially as we hear about all of the concerns that people have about health information technology and burdens that have been imposed.

Part of the adoption trajectory is that no technologies are perfect, and the only way to make technologies better is for users to use them. Anything that is designed purely by a set of software engineers without having a good base of users banging away at it and providing that ongoing feedback is not really a reality when you think about the systems that we think of as being the most highly usable. All of those are improved, sometimes dramatically, with the input and the feedback they get from thousands and millions of users. That is true in health IT as well.

So part of that is growing pains, and part of that is things that are imposed on the technologies from the outside. The EHR gets blamed for things that it’s really just the vehicle for, like prior authorization requirements and more documentation requirements. There’s a sense that it’s easy because it’s in the system and is automated, so I have more of it required now than I did in a paper-based world. Users sometimes blame those things on the EHR, when in fact they are being imposed through that vehicle and then pushed through that vehicle separate from the question of the burden imposed by the technology itself.

At the end of the day, it doesn’t matter what the source is. That’s why we spend a fair amount of time worrying about both the technology and usability as well. What is it that we are asking to be forced through that system and are asking users to be able to do?

What will ONC’s priorities be over the next two or three years?

One is certainly coming out of the pandemic and helping the CDC and other federal partner organizations. Working a lot with the CDC on establishing the public health infrastructure of the future and how we think about that as more of a public health ecosystem. Thinking about EHR systems as being sources of information, with a variety of other sources of information, that can be brought together on demand in a more dynamic internet sort of way to be able to respond to crises as part of an ecosystem rather than being siloed systems. That’s a lot of work.

There’s a lot of investment into these systems going on right now because of the pandemic, working hard to say, how can those address the current need as well as the investments toward what the future needs are going to be? We have under-invested in public health infrastructure for too long, which is partly why we are where we are, so that will certainly be a focus area.

Now that the applicability date for information blocking has passed, working with industry to iron out the wrinkles. Compliance is obviously hugely important and there are penalties and real rules, but I really want and hope and expect that we are going to be able to move beyond that to say, I’m not doing it because I have to do it — which means that people will meet the letter of it and perhaps not go further — but I’m doing it because there’s an opportunity here, a new paradigm for the way we think about healthcare. There’s a new paradigm for the way we think about engaging patients. There’s a new paradigm for the opportunities that sharing information presents back to me. Yes, I have to make more information available, but that also means that other organizations have to make more information available to me. I have the opportunity to be able to demand that more of that information be made available to me than I did in the past, and I should be thinking about that.

There are a lot of wrinkles that we have to iron out for sure. We are trying to do that with FAQs, and with something as complicated as healthcare, you put out a regulation and a million questions start coming, all of them legitimate. There’s that twist on it, and, oh, here’s a circumstance that we didn’t think thoroughly about and now we have to give an interpretation of that. There’s certainly a whole bunch of that that we need to get past, and that’s all understandable. But I want to be able to help the industry get to that next level as quickly as possible.

We are paying a lot of attention to structured data right now, which is the USCDI, the United States Core Data for Interoperability, and those elements that are required to be made available for the first 18 months through APIs. But we should also not lose sight of where the puck is headed here, and that is toward that more general construct of EHI, which is electronic health information. That is the electronic representation of the designated record set, which is in theory — I’m putting air quotes around this – “all of the patient’s data.”

We know that all is a very slippery term because there’s a lot of information contained in a hospital system, especially for a complex patient. Defining “all” could be very tricky and may not be what someone wants. But going back to the earlier part of our conversation when we were talking about algorithms, when you start to think about all of that information being made available now, it’s the information beyond what is structured. The idea is that we shouldn’t be waiting for data to be standardized and structured before we say that it should be generally available, in part because if that is rate-limiting, it’s going to take us a long time to get there.

The standards work slowly and methodically. That is saying that that information just needs to be made available in whatever form it exists, then let the users figure out what they’re going to do with it. But the obligation to make it available is preeminent. That speaks to algorithms and what we’re going to be able to do with that data. Who is going to be ahead in making sense of that data once it’s available and being able to do high-value things with that information?

I’ve been trying to talk to as many people as I can about  remembering that is coming. How are you going to position yourself for that? What are the tools that you are going to bring to bear? How do we start to develop those tools and those capabilities to be able to take advantage of that?

Equity is a huge priority. Thinking about that from a design perspective, meaning all the way down at the core, so that disparities are not an afterthought or a hope for output of the system, but something that is baked more into the fundamentals of the way data is collected and the way data is aggregated and analyzed. Some of that relates to the bias questions that we were talking about before, and ultimately, what actions we want that information to be able to inform. Because there’s no data collection for the sake of data collection — data collection has got to be geared toward a specific set of decisions that you’re going to make and a specific set of actions that you want to take one way or the other. We haven’t had enough of that. We need to think about health equity and the data that we want to be able to get to help inform health equity.

The last thing is interoperability as it relates to networks. TEFCA — the Trusted Exchange Framework and Common Agreement — is a really important part of thinking about that as we enable these networks to finally be able to rationalize interoperability across the network, so that as a user, that is all deprecated into the background. When I’m on my AT&T phone, I don’t think for one second about how it magically connects me to a Verizon user or an Orange user in Europe. But right now, unfortunately, providers do have to think about that. I’m hoping that we can get TEFCA to a place where it pushes all of that to the background so that we no longer need to think about that, and we have interoperability for users that just happens in the background and no one needs to worry about the engineering piece on the front end.

Morning Headlines 4/28/21

Glytec Raises $21 Million To Set the Standard for Hospital Insulin Dosing and Glycemic Management

Insulin management software vendor Glytec raises $21 million through debt financing and investment.

Lyniate Acquires Datica Integration Business, Launches Lyniate Envoy to Make Effortless Interoperability a Reality

Healthcare interoperability company Lyniate acquires Datica’s health data integration assets and integrates them into its new Envoy offering.

Patient ID Now Coalition Releases Framework for a National Strategy on Patient Identity

Patient ID Now, whose coalition includes AHIMA, CHIME, and HIMSS, publishes a framework for a national strategy on patient identity.

Leidos Partnership Delivers MHS GENESIS Health Record to 12 New States

Leidos Partnership for Defense Health brings 10,000 clinicians live on MHS Genesis / Cerner in a wave deployment that covered locations in 12 states.

News 4/28/21

Top News

Telemedicine software vendor VisuWell fires CEO Sam Johnson in response to a widely circulated video that appears to show him publicly harassing an 18-year-old boy who had worn a dress to their prom.

Johnson says the video was edited to misrepresent a situation in which he asked a group of loud teens in a Tennessee restaurant to tone it down in the presence of families and children.

VisuWell says Johnson was terminated immediately, removed from the company’s board, and will not serve in any advisory role. It has appointed President and COO Gerry Andrady to lead the company.

Johnson was previously founder and CEO of Relatient and held sales executive positions with Misys and Greenway Health.

Reader Comments

From @anotherdrgregg: “Re: prescriptions that are a waste of my time. Nearly all of them. Ask me to write a prescription for three reasons: (a) payment, in which you can buy your own wheeled walker but you need me to prescribe it if you want Medicare to pay for it; (b) liability, where the mechanism used to impose accountability (liability) is the prescription; and (c) stewardship, which mostly involves only society-influencing medications such as antibiotics and opiates.” It’s fascinating that the prescription process, at least for cash-paying patients, is that they, their doctor, or both decide on what meds to take and the doctor then writes a sticky note (oversimplifying the prescription process) that gives someone else permission to sell them the product. The prescription is the presumed evidence of clinical decision-making that may or may not have added any value, especially in the many cases where patients demand what they want and the doctor dutifully complies knowing that harm is unlikely and that their patient satisfaction or retention numbers will suffer otherwise. Drug companies also have an incentive to keep their wares as prescription-only so that insurance will pay for them, the price can remain high in the absence of store shelf competition, and they can track who is using their product for marketing purposes. I also wonder how much value is added by state pharmacy laws or insurance requirements that make doctors issue new prescriptions every 6-12 months when the patient has been taking that chronic med for years with no problems or dose changes. Incentives would be aligned if doctors simply recommended products, then patients would either then buy or not with their own money. In other words, if healthcare worked like every other industry.

From Pee-on Analyst: “Re: Ascension. Conducting meetings to announced a country-wide outsourcing of at least all acute and outpatient EHR support to India and Tech Mahindra. Cerner, Epic, Athena, everything. Positions eliminated as of August 8.” Unverified, but reported by two readers.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Protenus. The Baltimore-based company’s artificial intelligence platform reduces risk and saves resources for the nation’s leading health systems by detecting and preventing compliance violations, such as breaches to patient privacy and incidents of clinical drug diversion. Compliance analytics provide healthcare leaders full insight into how health data is being used and issues alerts of inappropriate activity to privacy, pharmacy, and compliance teams. Protenus, KLAS’s category leader in patient privacy monitoring for 2020, helps its partner hospitals make decisions about how to better protect their data, their patients, and their institutions. The company’s “2021 Breach Barometer” report has been widely featured by national news organizations. Thanks to Protenus for supporting HIStalk.

Listening: Yusuf / Cat Stevens performing the moving “Father and Son” in 1970, when he was 22. He recorded a new version and a tremendous live video last year at 72. 

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.

Acquisitions, Funding, Business, and Stock

Insulin management software vendor Glytec raises $21 million through debt financing and investment.

Remote cardiac monitoring company Vector raises $12.5 million in a Series A funding round. Its technology enables cardiologists to receive, manage, and analyze data from a patient’s cardiac device and integrate with their EHRs.

Healthcare interoperability company Lyniate acquires Datica’s health data integration assets. Lyniate has incorporated Datica’s API capabilities into its newest product, Envoy, which enables customers to develop, maintain, and monitor data-exchange connections across organizations. Datica’s website suggests that the company will continue to offer its Next Gen Compliance Platform.

Sweden-based telehealth services and health center operator Kry raises $312 million in a Series D funding round that increases its total to $568 million.

Sales

• Region 1 Disaster Health Response System will offer Bluestream Health’s telehealth services to hospitals during disasters or public health emergencies.
• Lehigh Valley Health Network (PA) selects LexisNexis MarketView, business intelligence software incorporating de-identified medical claims data.

People

Crossings Healthcare Solutions promotes Marlon Ali, MD to CMIO.

Cindy Gaines, RN (Philips) joins Lumeon in the newly created position of clinical transformation executive.

ConnectiveRx promotes Jim Corrigan to CEO. He succeeds Harry Totonis, who will become chairman of the board.

Claus Jensen (Memorial Sloan Kettering Cancer Center) joins Teladoc Health as chief innovation officer.

Announcements and Implementations

Northern Maine Medical Center goes live on Cerner.

Black Book Research names Cerner as its top-rated inpatient EHR vendor as well as earning the highest client experience scores in academic medical centers.

Leidos Partnership for Defense Health brings 10,000 clinicians live on MHS Genesis / Cerner in a wave deployment that covered locations in 12 states.

Life sciences communication solutions vendor OptimizeRx announces new partnerships that will expand its EHR reach within Epic, Cerner, and Athenahealth.

CloudWave and Ettain Health will partner to offer their combined IT infrastructure and consulting solutions, respectively.

Patient ID Now, whose coalition includes AHIMA, CHIME, and HIMSS, publishes a framework for a national strategy on patient identity.

COVID-19

Former FDA Commissioner Scott Gottlieb, MD says in a Wall Street Journal article that CDC needs to loosen its mask recommendations and gathering size limits now that US infection levels are dropping, the number of people who have either been vaccinated or recovered from COVID-19 is significant (in the 60% range), and warm weather has moved people outdoors where it’s safe. CDC announced new guidance immediately after the article ran in which fully vaccinated people don’t need to wear masks at small outdoor gatherings or when eating outside, although CDC still recommends wearing masks in crowded outdoor settings, such as concerts.

CDC reports that 54% of American adults have received at least one COVID-19 vaccine dose and 37% are fully vaccinated. However, the daily number of doses administered has dropped significantly since their April 1 peak of more than 4 million.

Other

At least 40 health systems in the US have been impacted by last week’s cybersecurity breach at Swedish radiation software vendor Elekta.

A real estate journal says that HIMSS got a fantastic deal on new Chicago headquarters space because of pandemic-driven discounts and concessions, with its sublease from Gartner Research of 30,000 square feet that has never been occupied being one of the largest downtown.

A great YouTube music video randomly popped up my way as employees from LexisNexis Risk Solutions Group cover “Times Like These” in support of Hope and Homes for Children. It’s not a cheesy, poorly produced corporate gimmick — in my mind, this version is musically and visually better than the Foo Fighters original from nearly 20 years ago or the chart-topping, all-star version that supported COVID-19 charities from April 2020. The video appropriately ends with the message, “In loving memory of those we have lost from COVID-19. May their love, laughter, memories, and music play on in our hearts forever.”

Sponsor Updates

• Cerner releases a new podcast, “Cerner Health Forum ’21 preview – A healthier bottom line.”
• Diameter Health co-founder and CEO Eric Rosow wins a 2021 Connecticut Entrepreneur Award in the Entrepreneur (Scaling Company) category.
• Consulting Magazine recognizes Divurgent Chief Strategy Officer and EVP of Consulting and Innovation Sam Hanna as a global leader of consulting in the excellence in innovation category.
• Securance Consulting recognizes Engage as a Meditech hosting “Best Practice” consulting firm, and awards it an overall five-star rating for the sixth consecutive year.
• Wolters Kluwer Health adds Picmonic’s visual mnemonic lessons to its Lippincott® CoursePoint+ digital course solution for nursing education.
• CloudWave and Ettain Health partner to offer hospital customers bundled cloud solutions and consulting services.
• OptimizeRx announces new partnerships within Athenahealth, Cerner, and Epic networks, plus increased exposure to oncologists across the country.
• Baylor College of Medicine (TX) adds Sectra’s digital pathology module to its Sectra enterprise imaging system.

Blog Posts

• How new legislation and policies impact SNF infection prevention and control (Ability Network)
• Even the Best Technologies Fail: The Value of Professional Services (Access)
• Flipping the script – Peer Learning in Enterprise Imaging (Agfa HealthCare)
• How COVID-19 shed light on the mobile technology needed in senior living (Ascom)
• Five Ways Independent Physicians Can Capture and Keep More Revenue (Ingenious Med)
• Streamlined Referrals and Better Patient Care with Technologies for Home Health (CarePort)
• Tom Kurtz’ CIO Perspective on The Future of Telehealth & Importance of Team Agility (CereCore)
• The Power of Adaptability (ConnectiveRx)
• One Year In: COVID-19 Impact on Prescriptions, Pharmacists & Providers (CoverMyMeds)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Contact us.

Morning Headlines 4/27/21

Healthcare platform Privia Health Group sets terms for $351 million IPO

Medical group management and health IT development company Privia Health hopes to raise $351 million in its forthcoming IPO.

Queensland hospitals and aged care facilities crippled by cyber attack

In Australia, facilities within the UnitingCare Queensland system have reverted to paper-based procedures after a weekend ransomware attack forced its IT systems offline.

Vector Raises $12.5 Million in Series A Funding to Accelerate the Adoption of Digital Health and Remote Care in Cardiology

Remote cardiac monitoring company Vector raises $12.5 million in a Series A funding round led by Updata Partners.

Curbside Consult with Dr. Jayne 4/26/21

Even though I’m a relative insider, I read HIStalk regularly so I can keep up. The recent Monday Morning Update contained a couple of reader comments that really got me thinking. The first was a mention of healthcare costs and the technologies that promise to lower them. Mr. H noted that “healthcare savings rarely trickle down to the actual patients – they just swell the profits and executive payroll of billion-dollar health systems, insurers, and employers…” Based on my experiences over the last few years, I have to say I agree.

Payers and patients alike are drawn in by the convenience and relative cost savings of certain care venues, such as urgent care centers. The marketing around this usually involves the fact that they are “cheaper than the emergency room,” which although true, doesn’t necessarily make them the most economical venue. My soon-to-be-former urgent care employer posts charges that are typically one-sixth that of what you would see for similar services delivered in a hospital emergency department. That seems like a good deal until you realize that the services are still significantly more expensive than they would be if they were delivered by a primary care physician.

Due to the care setting and the need to practice more defensive medicine than that practiced by primary physicians, patients are likely to receive more services than they would in a lower-acuity environment. As an independent facility, we don’t have access to patients’ recent labs or tests unless they want to hand us their phones so we can access the patient-side MyChart accounts. We also don’t know the patients as well as their primary physicians, so we don’t know how likely they are to follow up as we recommend, so we might recommend subspecialty follow up as a backup plan when there might be more cost-effective options. Patients certainly have higher up-front costs with co-pays when they visit urgent care rather than a primary physician, and although it’s cheaper than the emergency department, it costs more than it needs to.

Although we hoped price transparency would help drive patients to more economical care settings, we failed to fully understand how patients value convenience. There are certain conditions that need to be managed immediately, such as lacerations or serious injuries, but the vast majority of patients seen in our urgent care could be managed within a day or two by a primary physician with no difference in outcome for the patients. However, patients typically don’t want to wait. Patients are also concerned about access issues and even getting in to see their primary physician since there’s not only a shortage of appointments, but of providers in general. Our culture is one of instant gratification and patients want their problems addressed right away. Sometimes it seems strange, though, because they often haven’t even tried over-the-counter remedies that might have helped them before making the decision to seek care.

That ties nicely to the second reader comment, about the US Food and Drug Administration requiring prescriptions for many items despite the fact that they’re fairly straightforward or even available without a prescription in other countries. I agree with Mr. H that the need for prescriptions has driven growth in telehealth and online pharmacies, who end up becoming de facto prescription mills because they rarely deny the patient’s request. Even as a face-to-face physician, taking a solid history and performing a thorough physical exam doesn’t typically change the outcome when a patient with sporadic bladder infections and early minimal symptoms comes in asking for antibiotics or when a parent brings in a symptom-free child with a COVID-19 exposure. Now that we’re more than a year into the pandemic, we are just getting to the point where patients can buy testing kits over the counter without a prescription. It remains to be seen whether that will make any difference in how the pandemic rolls forward.

Especially at the beginning of the pandemic, and through the first couple of peaks, in the absence of over-the-counter testing, it made sense to have large-scale clinics that would test patients based on a standing order rather than having patients see their own physicians. Now that most of those clinics are closed, at least in my area, patients are forced into the urgent care system due to lack of options. A friend shared her husband’s Explanation of Benefits with me for a recent COVID-19 test. The charge was $1,900, which is absurd. This included the physician visit, the facility fee tacked on by the hospital since it owns the urgent care, and the cost of testing for not only COVID-19, but also influenza. Due to having a fever in the office and not having taken any medications for it, the patient was also charged an exorbitant amount for a couple of ibuprofen tablets. To add insult to injury, her husband went to the “wrong” urgent care and it was out of network, so they’re on the hook for the full amount of the charges without any payer-negotiated discount.

It certainly would be a lot cheaper if we had a viable public health infrastructure and could channel these patients appropriately, not only to reduce their costs, but the overall cost to the nation. Or in the absence of that, if we could start to manage people using less-costly resources, such as over-the-counter testing. But as long as the big healthcare systems and for-profit organizations stand to lose out on what they perceive as their piece of the pie, it will be difficult to truly drive change no matter what technologies we create. Even though many of us think disruptive technologies are cool, they scare the living daylights out of good portions of the healthcare industry.

Still, I’ll keep plying the clinical informatics trade in the patient engagement sector and in the telehealth trenches. Even if we’re making incremental change, it’s still movement in the right direction. I’ll also keep lobbying to address some of the fundamental issues, such as the shortage of primary care physicians and lack of support for their efforts. I’ll also continue to advocate for increased funding for public health infrastructure and the technology needed to support population-based health.

What are your thoughts on healthcare savings being pushed to the patients, or on increased availability of over the counter products? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Micky Tripathi, National Coordinator for Health IT (Part 1)

Micky Tripathi, PhD, MPP is National Coordinator for Health Information Technology.

What has surprised you most about working for the federal government?

The extraordinary amount of work that it takes to align the federal partners, working within the federal government. I don’t think I appreciated that as much when I was on the outside, where all my interactions with ONC were with things that were externally facing. I always knew that there was a role that ONC plays in coordination of the federal partner activities, but now that I’m on the inside, I appreciate how much there is, how hard it is, and how much opportunity there is. 

More and more of them are discovering that they can do things with electronic health records. As we start to move to an ecosystem that has FHIR-based APIs, they’re starting to see the value in that, which is both a blessing and a curse. The good news is that they are seeing it, and the bad news is that they are seeing it, because keeping all of that aligned is a growing challenge.

Within HHS alone, CMS creates and consumes a lot of data, FDA is looking at real-world evidence and post-marketing surveillance, and CDC has data-driven public health activities. Is there a big table where all of HHS’s groups figure out an overall HHS data strategy?

ONC chairs the Federal Health IT Coordinating Council, which brings together all the federal partners who have health IT activities going on. The last time I looked, that was probably 30 to 40 federal agencies across the government participating. I’m trying to energize that so that it has focus on particular topic areas where we can make forward movement. That’s a place we can exercise a little bit more to get more coordination.

Some of it is just reaching out and having bilateral conversations, figuring out where there’s a connection of dots to say, wait a minute, I just heard the same thing from four different agencies. Let’s try to get them together and start to think about how we’re going to think about this together.

ONC’s initial work with Meaningful Use was focused on increasing EHR adoption, and now as a by-product, we have real-time data available to support pandemic-driven clinical, operational, and research needs. Are we just starting to realize how much information we have immediately available?

I think that’s right. We had high level, gauzy ideas about the learning healthcare system. I’m not saying that to deprecate it. You would be able to tap into different types of data in more of an ecosystem kind of approach. We never really operationalized that, or we were never really forced to operationalize that. Part of it was probably because until very recently, like the last couple of years, we were were focused on laying the foundation, with that always being a part of the goal. But now here we are with a pressing and urgent need that has really tested the system.

As we look ahead, and as you pointed out with FDA and others thinking about real-world evidence and other kinds of opportunities, that is starting to come into play. It is now more more specific. That said, we are just at the beginning of thinking about how to do that. If you look at the pandemic, for example, we made very little use of the EHR systems that are in place. We hadn’t built the ecosystem around it to tap into that information in ways that are more functional than one-way reporting for what public health needs to be able to do in a pandemic. That’s the next chapter.

We’ve seen pandemic-related technology failures, such as rarely-used contact tracing apps, failed vaccine management and scheduling systems, and reliance on paper cards to prove vaccination status. How does HHS look at the role of consumer technologies as part of public health?

In all of those areas, there is a lot of opportunity for a lot of potential, and potential and opportunity with the maturity of that kind of ecosystem. Part of the challenge, probably with all of the examples that you raised, is that if you are going to think about those from a consumer access perspective — and a couple of them arguably could be thought about that way, like contact tracing and the vaccination credentials, with scheduling being a little bit harder – you would want to leverage the maturity of patient experience. Patients are familiar with the idea that there are use cases where they have, at their fingertips, control of health data. They can interact, both in terms of getting data as well as interaction bi-directionally or in a more synchronous way than they are able to today.

We are at the very beginning of the beginning. Most people don’t realize that they can download records onto their phone, for example. Because of the way that health information technology has rolled out over the years, and because it’s new in terms of EHR penetration, for whatever reason patients don’t naturally think of apps as being the way that they can interact with healthcare, even though they do that in every other walk of life, such as Uber or ordering food or whatever, where they turn to their favorite apps. Until now, that has been an unnatural act for them. I think that will be more of a natural thing in the next few years and we’ll probably get a better reception for these kinds of capabilities.

We will also face a challenge in that we want to make the opportunity available to patients, but we still don’t have the answer of how many patients actually want to have that kind of interaction with healthcare. To me, that’s an open question. I don’t think that that undercuts at all the obligation on us as an industry to make all of that data available in the easiest possible ways possible for individuals so that they can take that opportunity where they want it. But I do think it’s still an open question of how much they patients themselves want to be in the driver’s seat for that.

We haven’t seen much evidence that supposedly empowered healthcare consumers will vote with their feet in leaving providers who don’t practice transparency or interoperability. That means the only available recourse is for a patient to recognize then their provider isn’t following the rules, then take the trouble to report them for possible government action.

There are real questions about whether healthcare will be a consumer good that conforms more to neoclassical economics and markets than not. That is a testable hypothesis that we will see. But I agree that there could be challenges there in terms of consumers wanting or being able to act in that way, because of the complex economics of healthcare and the complex ways in which people decide on their care. And how willing or able they are to break out of that to do consumer search, and thinking about healthcare as something that you do real search for based on value, cost, and quality in the same way that you do with other kinds of goods and services.

My kids certainly approach healthcare differently. They are much more willing to go out get healthcare on the spot market, as it were. Whereas when I think of my own care, I’m in a system and I’m going to stay in that system because I’m concerned about interoperability not happening. I’m voting with my feet to say, I’m going to go to a place where I know that all of my records will be in the same place. It’s multi-specialty and all the specialists are are tightly connected to a hospital in a very good hospital system. I’ve basically voted with my feet to say that I want to make sure that I’m in a system in which I know that interoperability is going to happen.

Whereas my kids are much more willing to just be in the spot market and say, I’ll just find a doctor based on some kind of scheduling app or whatever it is. I’ll go see them, and then I’ll go somewhere else. Now of course they have few needs and lightweight needs, and maybe their views will change once they get older and they have more acute needs or more ongoing needs. But we should all leave open the possibility that we’ve got a generation of digital natives who may genuinely think about this differently.

The providers in that spot market that you mentioned are likely to be in urgent care or telehealth companies that probably need the patient information that big health systems have, who in turn aren’t as interested in getting data from those spot market providers. How do you address information blocking if it is mostly big health systems that aren’t willing to share?

That’s all a part of information blocking. There is a requirement for them to share that as the first instinct, and to only have good reasons for not sharing. It is precisely designed to address that.

Going back to that expectation of a younger generation, although we don’t want to paint people with too-broad strokes, there is an expectation that interoperability is happening in the background. My kids, even if they are on those spot markets, have an expectation that their information is being shared behind the scenes, and may they have less tolerance for that information not being there. Then, through their own searches, they may discover places where that’s happening versus not happening because of efforts that are going on or not going on behind the scenes to get that information to the right place. There is certainly a regulatory angle to that, which is about information blocking, but there could be a consumer demand angle for that as well.

How do you educate consumers who perhaps have never actually seen interoperability in action that they should have those expectations and that providers who don’t share information are not complying with federal requirements?

Interoperability is happening that is invisible to patients. They expect that more of it is happening, by and large, than is actually happening, which is always eye-opening to some people. Their ability to have apps with features they are used to in other parts of their lives might be a way of being able to expose in a more direct way whether interoperability is happening.

Some of the more innovative payer systems do these kinds of things, with apps and functionality where users can track the progress of prior authorization and referral notes. Those can start to put in front of the consumer the basic kinds of customer service things that they see happen when they go to Home Depot and Amazon, but that they don’t see happen in healthcare. That can make it a more explicit what’s happening behind the scenes and can point out where some of those things aren’t happening behind the scenes. I don’t think that happens overnight and that’s fairly spotty what I just described, but it’s not hard to imagine that if you start opening that up, that starts to give more visibility and more of a window into what’s going on behind the scenes. But right now it’s all been under the covers.

Who do you expect to file information blocking complaints, consumers or other providers?

We are open to all, obviously. I find it hard to believe that a large number of patients would be coming forward with those kinds of complaints about provider-to-provider exchange, simply because they may not be aware of it. You can imagine more coming forward with complaints about their own access to their own records, which is also an important part of information blocking. The more savvy have an expectation of getting access to their own records. I can imagine more of them filing a complaint about information blocking because their records should have been transferred from the ED to their primary care physician and weren’t.

That seems like a less likely scenario to me, but again, that could change. We’ll see what happens. Because of institutional knowledge and the awareness in the industry, more of the complaints are going to come from organizations, whether it’s vendors, providers, networks, or those who are covered by them or who have an expectation of what the opportunities might be with information blocking, and then try to test it and find that it’s not there the way they perceive it should be there. I think that’s going to be more of what we see, but we’re still very early.

Morning Headlines 4/26/21

J2 Global Announces Plan to Separate Into Two Leading Publicly Traded Companies

J2 Global will separate into two publicly traded companies, one of them being Consensus, which will offer the healthcare-focused EFax cloud fax and messaging business.

OSF HealthCare patient information computers back online after two-day outage

OSF HealthCare (IL) brings its computers back online, including its Epic system, after an unexplained two-day outage that started early Friday morning.

Accolade to Acquire PlushCare

Health and benefits solutions vendor Accolade will acquire PlushCare, which offers virtual primary care and mental health treatment.

Symplr Launches Symplr Directory as Part of End-to-End Provider Data Management Portfolio

Symplr renames the provider data management platform of Phynd, which it recently acquired, to Symplr Directory.

Yale New Haven Health says at least 200 patients were impacted by data breach

A cybersecurity breach at software vendor Elekta has impacted operations at 40 health systems.

Monday Morning Update 4/26/21

Top News

J2 Global will separate into two publicly traded companies, one of them being the healthcare-focused Consensus.

Consensus will offer the healthcare-focused EFax cloud fax and messaging business that it positions as an interoperability platform to integrate systems and workflows. That business has annual revenue of $340 million and a 35% EBITDA margin.

J2 Global operates Internet brands that include IGN, Mashable, Oookla Speedtest, Medpage Today, and PCMag.

Scott Turicchi, J2’s president and CFO, will move to CEO of Consensus.

Reader Comments

From Super Saver: “Re: healthcare costs. I see a lot of technologies that promise to lower them. Not necessarily for consumers, though.” Agreed. My experience is limited to healthcare systems, but few of the technologies we implemented to reduce cost ever really did so, especially if the savings involved labor that we just moved to some other area. It’s also safe to say that healthcare savings rarely trickle down to actual patients —  they just swell the profits and executive payroll of billion-dollar health systems, insurers, and employers in the absence of a competitive, consumer-driven market where reduced costs would support lowered prices to gain market share.

From Alhambra: “Re: new job. Thanks for the recent mention. I’ve never had so many people reach out to me with the same screenshot letting me know I’m famous!” Thanks. Along those lines, I sometimes warn folks I’m interviewing that few people realize how many readers are out there, and that it’s possible that the interviewee will get a lot of emails and LinkedIn messages when the interview runs. Some have told me they got hundreds of messages within a few hours and one closed a long-delayed sale the next day that the customer attributed to being reminded by the interview. Many types of business would moan that customers – readers, in my case – rarely offer testimonials and word-of-mouth advertising, but I actually kind of like being a secret, guilty pleasure. Sometimes an industry luminary emails out of the blue to tell me they are a regular reader, direct feedback I appreciate as a solitary filler of empty screens.

From Are Ex: “Re: prescriptions. Here’s a brilliant comment.” I agree. FDA’s prescription-only requirements to require certain items to be used only under a doctor’s supervision are a bit paternalistic and anti-consumer, although they have created a vigorous market in telehealth, online pharmacies that offer minimally vetted prescriptions paired with shipment of their particular wares, urgent care centers, and even hospital EDs who are happy to write that prescription at a high cost with little actual value added. COVID-19 has brought the issue to the forefront, as consumers were not trusted to buy their own testing kits even though getting a prescription did little to improve their chances of safe, effective outcomes. We are one of the least-healthy industrial nations in the world, so it would be interesting to see how our rigorous prescription requirements compare to healthier ones, especially when obtaining said prescription is often a financial rather than a clinical exercise. Also interesting would be a poll of doctors of which prescriptions they write that they consider a waste of time versus the patient being allowed to buy it themselves.

HIStalk Announcements and Requests

The top discretionary reason of poll respondents to attend HIMSS21 is socializing.

New poll to your right or here:  Do you hold shares or an ownership stake in a health-related technology company?

My brilliant idea of the week: some company should pay telehealth providers for the privilege of running ads on video visit screens for the patient to watch until the provider starts their encounter, kind of an Outcome Health model of cramming drug company advertising into waiting and exam rooms. I thought of this while being interrupted endlessly by YouTube targeted ads that injected themselves at the most inopportune moments of the concert video I was trying to watch. 

Webinars

April 27 (Tuesday) noon ET. “The Modern Healthcare CMIO: Best Practices for Implementing Digital Innovations.” Sponsor: RingCentral, Net Health. Presenters: Nathan Gause, MD, assistant professor of medicine and orthopedic surgeon, University of Missouri Healthcare; Ehab Hanna, MD, MBA, VP/CMIO, Universal Health Services; Subra Sripada, MSIE, partner, Guidehouse; Jigar Patel, MD, VP/chief medical officer, Cerner Government Services. This panel of CMIOs will discuss how their organizations are leveraging digital medicine to improve patient outcomes and provider workflows. Topics will include AI and analytics, effectively implementing AI solutions, establishing data governance and oversight for AI-powered products, care and treatment changes on the horizon, and interoperability of large EHR systems.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.

Here’s the recording of last week’s webinar, “Is Gig Work For You?”

Acquisitions, Funding, Business, and Stock

Health and benefits solutions vendor Accolade will acquire PlushCare, which offers virtual primary care and mental health treatment. Accolade will pay $450 million, mostly in stock, for the company that had $35 million in 2020 revenue. Accolade acquired telemedicine second opinion startup 2nd.MD in March for $460 million.

Sales

• UT Health East Texas at Ardent Medical Services chooses TheraNow’s telehealth platform to provide telemedicine and remote physical therapy treatment.

People

Relatient hires Raj Bhavsar, MS (ConnectYourCare) as CTO.

Patient engagement and behavior change technology vendor The Affective Computing Company hires one of its investors and advisors, Matt Dobski (Amwell) as president. The company will also start styling itself as Affective.health.

Announcements and Implementations

Vermont Care Partners and four member agencies go live on Netsmart’s MyAvatar behavioral and addiction services EHR.

Long-term care pharmacy provider ExactCare connects to CarePort to offer hospitals coordinated medication management.

Symplr renames the provider data management platform of Phynd, which it recently acquired, to Symplr Directory.

Southern Sun Pathology, Australia’s largest skin cancer lab, goes live on Sectra digital pathology.

COVID-19

FDA approves resumed use of Johnson & Johnson’s COVID-19 vaccine, declining to limit it use to specific ages or gender, but with a label warning about possible rare blood clotting disorders. CDC’s advisory panel has identified 15 cases and three deaths due to the blood clotting issue of eight million doses that have been administered in the US, most of the cases involving young women. Critics say the pause accomplished little beyond making people unnecessarily wary of the J&J product and COVID-19 vaccines in general.

CDC reports that 8% of people who got their first dose of the two-shot Pfizer and Moderna COVID-19 vaccines haven’t completed their vaccination by the date due. Reasons: fear of side effects, the believe that one shot offers enough protection, lack of transportation or work time off, and providers cancelling second-dose appointments because of shortages of the vaccine that the patient received in their first dose. Still, the 92% second-dose follow-up is historically high.

Experts say that India’s COVID-19 death toll is 2-5 times higher than the official reports, as local officials and hospitals are reportedly being pressured to attribute suspected COVID-19 deaths to other conditions or to simply label all death certificates as “sickness.” A New York Times audit of funeral facilities in the city of Bhopal found more than 1,000 deaths in a 13-day period versus the officially reported 41 as crematories are operating around the clock. India is the world’s largest vaccine manufacturer, but less than 10% of its residents have received a dose. Daily new cases have jumped from 13,000 in March to 350,000. Brown University public health school dean Ashish K. Jha, MD, MPH urges in a Washington Post opinion piece that the US provide assistance to the world’s largest democracy and ally by sending excess testing kits, PPE, oxygen, drugs, and vaccine doses, particularly the 30 million stockpiled doses of AztraZeneca’s product that has not earned FDA’s authorization and is likely never going to be used here given ample supply of alternatives. 

University of Oxford researchers report results of clinical trials of a malaria vaccine candidate, with the new product being the first to hit WHO’s goal of 75% efficacy. The commercial partner is US-based Novavax, whose COVID-19 vaccine will likely reach the US market soon after recent clinical trials results showed a 96% efficacy. The company is also working on a combination vaccine that incorporates its COVID-19 and flu vaccine candidates.

Other

The second-highest paid CEO of a publicly traded US company made $200 million in compensation in 2020, that being Amir Dan Rubin, CEO primary care practice chain 1life Healthcare (One Medical). Trading began in late January, with shares up 227% since in valuing the company at $12 billion.

Sponsor Updates

• GigaOm names Pure Storage’s FlashBlade a leader in its latest report on high-performance object storage.
• Vocera’s customer success team wins the Business Intelligence Group’s 2021 Excellence in Customer Service Award.
• The Federation of Royal Colleges of Physicians in the UK approves Wolters Kluwer Health’s UpToDate clinical decision support for continuing professional development.

Blog Posts

• Abdali Hospital’s vision for the future of healthcare technology (Nuance)
• 4 Must-Know Clinical Practices for Revenue Cycle Success (Netsmart)
• CHIME Spring Forum thoughts: Create great user experiences for all the users (Nordic)
• How Providers Build Loyalty Through Transparency (PatientBond)
• Put Together the EHR and ERP Integration Puzzle (Pivot Point Consulting)
• How Baptist Health South Florida is Leading the Way in COVID-19 Therapeutics (Premier)
• Accelerate Real-Time Genomic Surveillance and Analytics (Pure Storage)
• How to Achieve Clean Claims with Less Effort (RCxRules)
• Expanded Vaccination Data Integration Capabilities (Redox)
• How TeleICU Solves the Challenge of Cost-Effective ICU Staffing (SOC Telemed)
• Hospital smart rooms: What to consider (Sonifi Health)
• Save the Date for Connect 21: Innovation. Interaction. Inspiration. (Spok)
• Moving Value-Based Care Forward (Surescripts)
• What is unique about real-world data from TriNetX? (TriNetX)
• Automating claim status checks to accelerate cash (Waystar)
• PT Perspectives: What Clinicians Are Saying About the Lasting Legacy of COVID-19 (WebPT)
• Well Health’s Top 10 Remote Moments (Well Health)
• Interoperability in healthcare: 5 ways to unlock value from new requirements (West Monroe)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Contact us.

Weekender 4/23/21

Weekly News Recap

• Home monitoring platform vendor Current Health raises $43 million in Series B financing.
• Consumer data aggregation vendor Seqster raises $12 million in a Series A round.
• Hospital operators HCA and Tenet beat Wall Street estimates on quarterly revenue and profit.
• FDA says it will use the term “MIMPS” (medical image management and processing system) instead of PACS in referring to medical imaging systems.
• Cedars-Sinai is using facial recognition software to identify patients with a history of violence or drug fraud.
• FCC will open applications for its $250 million COVID-19 Telehealth Program on April 29.
• FTC warns businesses that using or selling AI algorithms that are racially based or discriminatory – intentionally or not – violates federal law.
• FDA excludes eight software functions that previously invoked its regulation as a medical device.

Best Reader Comments

There are many ways to find out if a supplier/vendor has positive references and can deliver. Just ask for a full list of their clients contracted with during a period of time and randomly call. Don’t let the vendor just give the references as that will prove nothing. Just do some routine homework. (Bigdog3011)

I’m more optimistic about Oscar selling consumer facing software to insurers and doing some outsourced business process for insurers than I am about Oscar as an insurance company. (IANAL)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Coach K, who has been teaching PE at his Arkansas school for 25 years. He asked for a GoPro camera to make exercise videos for his 625 K-6 students whose classes are being held both in-person and online. He reports, “I simply cannot begin to express our gratitude that has resulted from your selfless giving. Oftentimes, our students come from very poor backgrounds and rarely do we have the resources like the GoPro camera to help our students learn. Because of your gift, we were able to use the camera and tools that you sent to make our virtual lessons more clearly to our students. Donors like you are the real champions of public education. You see the need and rise to the occasion time and time again. Our students were thrilled when the box arrived and they knew that we would continue to make Physical Education together because we had the necessary tools that once were lacking. Again, thank you for your kindness and generosity.”

Massachusetts General Hospital will proceed with a delayed $1.9 billion project to build new patient towers that will net the hospital 94 new beds beyond its current 1,043.

Ohio police arrest a nephrologist who physically attacked a cardiologist in St. Elizabeth Boardman Hospital (OH) who had accused him of inappropriately discontinuing a patient’s medication. A nurse and another hospital employee had to break up the fracas.

A federal judge orders a Spokane, WA neonatologist remain in jail on charges of several crimes he tried to arrange on the dark web. Ronald Ilg, MD tried to hire someone to kidnap his wife for a week so he could travel to Mexico with his girlfriend, offering $40,000 in bitcoin for someone to take on a “rush job” that involved giving his wife daily doses of heroin and planting used needles with her DNA so he could frame her. He offered a bonus if the kidnapper could convince her to drop her divorce proceedings, move back in with him, have sex with him at least three times in a two-week period, and promise to keep quiet about the kidnapping. The doctor had allegedly previously tried to hire someone on the dark web to break the hands of a former employee for $2,000. Meanwhile, the girlfriend who accompanied him to Mexico said the doctor forced her to sign a master-slave contract in her own blood and gave police a recording she had made of the doctor beating her. After being questioned, the doctor was found unconscious in his house next to a suicide note, but he was OK. Police obtained evidence of the money transfers from Coinbase and found his dark web name and password written on a sticky note in a search of his house, which they used to read his messages.

In Italy, a 67-year-old hospital employee is being investigated for skipping work for 15 years, having been paid $650,000 despite never having showed up to his newly assigned job. Police say the employee threatened his manager to stop her from disciplining him, and when she retired, nobody noticed his absence. Police are also investigating six managers of the hospital as part of an investigation into absenteeism and fraud in Italy’s public sector, which includes women clocking in their husbands and employees punching in before heading out for a day of shopping or napping.

A Florida nurse inadvertently broadcasts herself giving a patient a gluteal injection while waiting on her Zoom-based grand theft case to begin.

In Case You Missed It

• News 4/23/21
• EPtalk by Dr. Jayne 4/22/21
• Readers Write: Hospitals Shouldn’t Skimp on Meeting May’s ADT Deadline
• News 4/21/21
• Curbside Consult with Dr. Jayne 4/19/21
• Readers Write: The Disaggregation of Healthcare and Its Implications for Care Coordination
• Monday Morning Update 4/19/21

Get Involved

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• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Morning Headlines 4/23/21

Current Health Closes Oversubscribed $43M Series B Financing Round to Scale Remote Care Management Platform

Home monitoring platform vendor Current Health raises $43 million in Series B financing.

Medchart Raises $17M to Meet Demand for Frictionless Digital Business Practices Across North America

Medchart, which provides patient-authorized information to attorneys, to patients themselves, and eventually to researchers, raises $17 million.

Seqster Raises $12M Series A to Accelerate the Adoption of its Healthcare Data Interoperability Technology

Seqster, which aggregates data from EHRs, wearables, and consumer genomics companies for payers, providers, and researchers, raises a $12 million Series A funding round.

News 4/23/21

Top News

Home monitoring platform vendor Current Health raises $43 million in Series B financing.

The company says its revenue grew 3,000% last year. Its platform is FDA-cleared for performing virtual clinical trials with remote monitoring and video visits.

EHR integration – using HL7, FHIR, or Redox – is available for Epic, Cerner, Allscripts, and Athenahealth.

The CEO completed a master’s in computer engineering and left medical school in Scotland to start the company in 2015 with his co-founder and CTO, who had just completed a PhD in computing science.

The company styles itself as a “mission control” for health systems to transition care to the home. It lists as customers Mayo Clinic, Mount Sinai, Geisinger, Massachusetts General Hospital, Britain’s NHS, and drug companies AztraZeneca and Amgen.

Reader Comments

From Iza Vendor FoSho: “Re: HIMSS. Selling software now as a competitor to its corporate supporters?” HIMSS-owned Healthbox announces Idealy, a system that accepts internal submissions for innovation projects, then allows participants to score them and solicit feedback. HIMSS strays into commercial and potentially competitive territory fairly often, as do many member organizations that collect support dollars from those competitors, but this doesn’t sound like a product that steps on exhibitor toes. The target audience seems to be those big health systems that aspire to play with the big boys in the investment and innovation world, the track record of which is spotty (that’s like asking the DMV to develop photo portraiture software).  

From Ivan Issue: “Re: resume. Please review mine.” Suggestions, which I’ll generalize beyond yours specifically having looked at many LinkedIns:

• Don’t refer to yourself in the third person, aka “Mr. Smith,” as though you convinced an all-knowing deity to craft your CV.
• Personalize your “About” section beyond the usual stilted “accomplished, seasoned executive with demonstrated experience …” It’s funny how people think their overview sounds more professional when written as droning, incomplete phrases that are devoid of personality, the admirable brevity of which is often cancelled out by the barrage of tired buzzwords that follows. This is exactly what you wouldn’t do in an interview.
• Don’t list self-assigned, pretentious labels in your LinkedIn description, such as “thought leader,” “visionary,” or “change agent.” It’s mildly effective when others brag vaguely about you, but annoying when you brag vaguely about yourself. I have never seen a self-proclaimed “thought leader” whose thoughts I would allow to lead me.
• Leave out anything under “Education” that isn’t an actual degree from an accredited college or university. Nobody cares where you prepped except your fellow preppies and they already know, while weekend seminars and degrees that were sought but not attained for whatever reason don’t inspire a lot of confidence about determination.
• Include a high-resolution headshot that doesn’t include a cropped-out ex-spouse, wedding formalwear, or a vacation background. Don’t crop or shrink the image since LinkedIn does that while allowing a full-view display by clicking. Use a straight-on view that covers neck to top of head, with no artsy-craftsy poses or filters. Do not under any circumstances fail to include a photo unless you have beliefs about graven images – we all have camera-capable phones, so photo omission suggests issues with self-esteem.
• This is probably just a me thing, but it’s hard when trying to sort out an executive’s career wanderings when the list includes board assignments, volunteer work, trying to get consulting gigs while looking for a job, etc. instead of actual paid jobs working for someone else.
• Be careful about listing a bunch of licenses and certifications that aren’t relevant to the position you hold or want to hold. Health system CEOs who are looking for CIOs don’t care about your CPHIMS or MCSE.
• Spell and capitalize correctly, advice that I’m ashamed to have to offer to executives who surely could have afforded a paid proofreader or commanded an underling who writes well to review their draft.

HIStalk Announcements and Requests

I’m reacting negatively to the overused term “sat down with” in trite reference to interviews, where given limitless quantity (and clearly limited quality) I gag through it several times per day. I say go for the “Madonna with the fake British accent” affectation and call it having a natter, a chin-wag, or a palaver.

Webinars

April 27 (Tuesday) noon ET. “The Modern Healthcare CMIO: Best Practices for Implementing Digital Innovations.” Sponsor: RingCentral, Net Health. Presenters: Nathan Gause, MD, assistant professor of medicine and orthopedic surgeon, University of Missouri Healthcare; Ehab Hanna, MD, MBA, VP/CMIO, Universal Health Services; Subra Sripada, MSIE, partner, Guidehouse; Jigar Patel, MD, VP/chief medical officer, Cerner Government Services. This panel of CMIOs will discuss how their organizations are leveraging digital medicine to improve patient outcomes and provider workflows. Topics will include AI and analytics, effectively implementing AI solutions, establishing data governance and oversight for AI-powered products, care and treatment changes on the horizon, and interoperability of large EHR systems.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.

Acquisitions, Funding, Business, and Stock

Goldman Sachs predicts that even though interest in SPACs has cooled off since the first quarter – when 55 special-purpose acquisition companies were formed, creating a deal-making frenzy that exceeded even the dot-com boom – they could drive $900 billion worth of M&A deals over the next two years. It notes that 394 SPACs are looking for companies to take public, armed with $129 billion of equity capital and a two-year deadline to land a dance partner. It will be interesting to see how many seemingly successful health IT companies are lured into going public by the siren song of a SPAC – with the only surefire money-maker in the transaction being the SPAC’s sponsor – and then wilt under quarter-by-quarter investor pressure, mandatory operational transparency, a divergence of customer demands versus market realities, and the never-ending quest to convince investors that all-important growth will last forever. Not to mention that when the boom inevitably busts, either selectively or broadly, some unicorn-anointed companies that could not have survived IPO scrutiny will be suddenly living a less-rosy life filled with disillusioned investors, squirmy executives surreptitiously eyeing the exit, and curmudgeonly bystanders like me providing a constant reminder that the wisest investors – notably insiders – cashed out their stake at first opportunity before irrational exuberance collided with reality.

London-based Proximie, which offers a live, mixed-reality telesurgery collaboration platform for clinicians performing OR and cath lab procedures, raises $38 million in a Series B funding round.

Medchart, which provides patient-authorized information to attorneys, to patients themselves, and eventually to researchers, raises $17 million in seed and Series A funding. It hopes to expand its information work to researchers.

Seqster, which aggregates data from EHRs, wearables, and consumer genomics companies for payers, providers, and researchers, raises a $12 million Series A funding round.

HCA Healthcare announces Q1 results: revenue up 9%, EPS $4.14 versus $1.69, beating Wall Street expectations for both. Shares are up 87% in the past year versus the Dow’s 48% rise, valuing the company at $67 billion. HCA received $9 billion in federal COVID-19 relief funds last year, but returned all of it in October, saying the financial urgency of its 180 hospitals had passed and that returning taxpayer dollars was “appropriate and the socially responsible thing to do.”

Tenet Healthcare announces Q1 results: revenue up 6%, EPS $1.30 versus $1.28, beating expectations for both. Shares are up 172% in the past 12 months, valuing the hospital operator at $6 billion.

Sales

• Cerner chooses life insurance data vendor MIB Group to sell consented access to its 54 million patient medical records, adding to MIB’s list of EHR partners. 

People

Analytics vendor Cotiviti hires RaeAnn Grossman, MSP (Wick Healthcare Group) as EVP of risk adjustment and quality.

Chrissy Braden Worth, MBA (Helix) joins Apple in a business development and partnerships role.

Industry long-timer Mitch Morris, MD (OptumInsight) joins EMed as chief operating officer.

Announcements and Implementations

PMD adds medical billing and collection services to its revenue cycle platform offerings.

Regenstrief Institute modifies the open source EHR OpenMRS to meet the needs of Indianapolis first responders who expected to treat more COVID-19 patients in triage center. The team’s work, which took one week, allowed the EMS to register patients and collect their basic clinical information that could be sent to the state’s HIE. The system was never used, however, as the expected demand never materialized.

USPTO awards Medsphere a patent for its Multi-Disciplinary Treatment Plan solution.

PatientKeeper integrates its mobile app with Meditech Expanse, offering users access to patient lists, vital signs, lab and other test results, clinical notes, med list, allergies, and order status. 

Tech-aspirational health insurer Oscar launches +Oscar, which is some kind of health plan and member engagement platform that it poorly described. The announcement used the word “stack” eight times, which discouraged me from studying the announcement more than the first few times in my ultimately failed attempt to comprehend it.

CAQH publishes a repository of validated payer FHIR endpoints and third-party apps, allowing payers and developers to find information exchange connections.

Change Healthcare launches InterQual 2021, the latest version of its evidence-based screening tool. It adds four new Medicare criteria modules and new guidance covering COVID-19 treatment, social determinants of health, and the appropriate use of telehealth.

KLAS publishes a report covering health IT staffing firms.

COVID-19

Johnson & Johnson publishes results of its Phase 3 clinical trial of its COVID-19 vaccine, which showed a 67% efficacy 28 days after vaccination, 77% in severe and critical cases, and 64% efficacy against the South Africa variant after 28 days.

Former FDA Commissioner Scott Gottlieb, MD says in a Wall Street Journal opinion piece that the government did the right thing in pausing the use of J&J’s vaccine while reports of rare blood clots are investigated, but FDA rather than CDC should have been put in charge. CDC’s advisory panel adjourned last week without making a decision, while FDA is accustomed to assessing emerging data and advising physicians on benefits and risks.

President Biden says the government’s goal of administering 200 million doses of COVID-19 vaccine in 100 days has been met, calling on employers to use available tax credits to get their workers vaccinated. CDC reports that 52% of American adults have received at least their first shot, although numbers are declining for the first time as concerns about vaccine hesitancy begin to outweigh vaccine distribution worries.

A second wave of infection has pushed India’s cases and deaths to record highs, hospitals are swamped, and oxygen is in short supply. Thursday’s count of new cases in India reached 315,000, the highest ever reported by any country since the pandemic began.

An oxygen tank leak kills at least 22 patients at a public hospital in India that is treating 150 COVID-19 patients. Oxygen is running out everywhere, as the above SOS tweet from Delhi’s health minister makes clear (a tanker arrived at 1:30 a.m. with 30 minutes to spare). The government started building new oxygen plants in October, but none have apparently been finished, with shortages so severe that states are hijacking shipments that are headed elsewhere.

The National Institute of Allergy and Infectious Diseases will launch a study to determine whether the two-dose COVID-19 vaccine cycle works when the products are made by different companies. The study, which hopes to have data available by fall, will also look at whether booster doses are necessary.

Other

A good observation by AuntMinnie.com – FDA’s announcement this week of the definition of eight classification regulations says it will no longer use the term “PACS.” FDA will now refer to imaging systems as “medical image management and processing system,” which is equally acronym-friendly as “MIMPS.”

I snickered at the breathless announcement of respiratory monitoring vendor Respiratory Motion about its new logo, about which it quoted (falsely, I’m sure) its CEO who supposedly spontaneously ejaculated this in delight: “That is the symbol of action and spirit to construct a positive brand culture with different values: innovation, trust, reliability, discovery, and experiences.” In case that wasn’t eye-rolling enough, we get a pointless animation and an insider’s view, incorrectly punctuated, of how the magnificent logo was developed: “The brand name’s letters RM are exceptionally modified. With the modified crossbar and a higher contrast promoting the depth and upward movement. The balance of two simple ‘RM’ letterforms in the beginning and the end constructed the stability and solidity of the logotype.” I can almost make out the “RM” if I squint, but darned if I can spot innovation, trust, reliability, discovery, and experiences. Marketing is like many things in life – those who are good at it don’t need to convince you.

Sponsor Updates

• Everbridge announces that Steve Forbes, chairman and editor-in-chief of Forbes Media, will keynote its Spring 2021 COVID-19: Road to Recovery virtual leadership summit May 26-27.
• Inc. profiles CarePort Health CEO Lissy Hu and her journey through two acquisitions.
• Forbes names Cerner to its 2021 list of “America’s Best Employers for Diversity.”
• The HIMSS SoCal podcast features Healthcare Triangle VP of Technology Joe Grinstead.
• Impact Advisors is named as one of Modern Healthcare’s Largest IT Consulting Firms for 2021.

Blog Posts

• You’ve Invested Millions for an EHR Your Clinicians Don’t Like. Don’t Replace it – Just Fix it. (Medicomp Systems)
• Supporting the COVID-19 vaccination process with technology and data (Cerner)
• Efficiently Accessing Waveform Data Can Yield Stronger Clinical Research and Outcomes (Capsule)
• What an Emergency Mass Notification System is and Why it Matters (Everbridge)
• 5 Reasons to Conduct Yearly Penetration Testing (Fortified Health Security)
• Vital Change Management is Often Forgotten (Optimum Healthcare IT)
• Glucommander Named 2021 Medical Design Excellence Awards Finalist (Glytec)
• Industry First Citrix Cloud Connector Module (Goliath Technologies)
• The History and Evolution of Conversational AI (Gyant)
• Health Literacy & Care Team Communication: Where We’re Falling Short (Halo Health)
• Predicting Denials to Improve the Healthcare Revenue Cycle and Maximize Operating Margins (Health Catalyst)
• Second Round of Funding for FCC COVID-19 Telehealth Program Announced (Impact Advisors)
• Are Adverse Drug Effects Equal Opportunity Risks? (First Databank)
• Ingenious Med: Supporting a Comprehensive Productivity Optimization Program for a Top US Physician Company (Ingenious Med)
• Part 1 – 2021 Hospital National Patient Safety Goals Series: Identifying Patient Safety Risks (Medhost)
• A Conversation with Carl Smith, CIO, King’s Daughters Medical Center (Meditech)
• 7 Signs It’s Time to Update Your PT Billing System (MWTherapy)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Contact us.

EPtalk by Dr. Jayne 4/22/21

Clinical informaticists and genomics experts are excited about the recent announcement that the US will spend $1.7 billion to create a national network to track coronavirus variants. The main components of the plan include funding to help the CDC and state health agencies expand gene mapping; identification of six academic centers to research gene-based surveillance; and creation of a National Bioinformatics Infrastructure for sharing and analysis of data around emerging pathogens. The proposed budget is significant in that it provides funding to build systems for the future, not just for the current crisis. I look forward to seeing the transformative discoveries that could be produced by this kind of initiative.

Healthcare workers have been significantly impacted by the COVID-19 pandemic, whether it’s physically, emotionally, or economically. A research letter in the Journal of the American Medical Association looks at symptoms and functional impairments tjat are found in healthcare workers who had mild cases of COVID-19. More than a quarter of patients who had the disease had at least one moderate to severe symptom that lasted for at least two months, while 15% reported at least one moderate to severe symptom that lasted for at least eight months. The most common symptoms were fatigue, shortness of breath, and change in the senses of taste or smell. The study mentioned in the letter did have some limitations, but since healthcare workers became infected on the leading edge of the pandemic, they do make an interesting research population. It will be interesting to see the percentage of subjects who continue to have long-term symptoms and what kinds of interventions might help people recover more quickly.

The American Medical Association offers up some tips on how physicians can improve their telehealth skills. The issues they cite, such as eye contact and lighting, continue to be problematic, not only for physicians, but for many of the video meetings I attend on a daily basis. With this in mind, I offer up Dr. Jayne’s tips for successful video calls:

• Make sure your camera is stationary. Use a stand, prop it up, put it on a table, but don’t let it move during the call. I continue to get vertigo when people’s cameras are bouncing around, particularly when it’s obvious they have their laptop balanced on their thighs. The worst is when people walk around the house with the camera on. Pro tip: no one wants to see your laundry baskets.
• Ensure that the camera is at a good height for eye contact. I’ve seen up enough people’s noses in the last 13 months that I’m considering a second career as an ear, nose, and throat specialist. I also can recognize the office spaces of many of my colleagues just by their ceiling fans.
• Figure out your lighting and your background. If you’re sitting in the shadows, it can be distracting. Having a window behind you isn’t generally a good idea unless you have an additional light source in front of you to balance it out. You don’t have to buy anything special – I’m repurposing a floor lamp that I purchased for sewing to help even out the lighting when I get too much natural light coming from the wrong direction.
• Check your microphone. Look at the audio settings within your meeting app and make sure your microphone isn’t set so low that it can’t pick up your voice. Experiment with background noise reduction settings if excess noise is an issue in your workspace. Some of the conferencing platforms have added fairly sophisticated settings that can allow you to adjust these settings with some specificity. I recently attended an all-Zoom musical recital, and you could really tell who followed the instructions to configure their accounts and who didn’t.
• Keep any battery-powered accessories charged and have a backup plan. I’m so tired of people’s headsets dying on afternoon calls.
• If you’re going to use in-app backgrounds, make sure they work technically and professionally. Some app/background combinations cause weird video artifacts like hairstyles disappearing or making it look like you’re just a disembodied face. Consider neutral choices – although being on the bridge of the Enterprise might seem cool, your clients might not share your enthusiasm. If using personal pictures or designs for backgrounds, make sure they’re professional. I recently saw a “taco Tuesday” themed background that was highly offensive and had to have a sidebar conversation with the presenter.
• If you’re going to share your screen, make sure you understand how it works if you have multiple monitors, multiple windows, or multiple apps open. If you’re sharing a video with sound, be sure you know how to make it work. Practice is a good idea! And to be safe, make sure any browser tabs that you don’t want the audience to see are closed. I’ve seen more than my share of cringeworthy content, including a couple of things I will never be able to unsee.
• By this point in the game, it should go without saying: LEARN HOW TO USE THE MUTE BUTTON. We all have those moments where we forget to unmute ourselves and wind up talking into the void, and I understand. I’m with you. But when the lawn service appears outside your window or family members have invaded your space, be considerate enough to mute before someone has to ask you to do so.

Of course, this last bullet point goes for non-video calls as well. If you’re not sure about making the most of your conferencing tools, don’t be shy about asking for help. Especially if your struggles negatively impact the meetings you attend, your co-workers will be grateful.

Many of us in healthcare IT are science nerds in general and have been watching the adventures of NASA’s Ingenuity Mars Helicopter in anticipation of the first powered, controlled flight on another planet. After a delay during a test sequence, the four-pound helicopter took flight on Monday. Although Ingenuity’s first flight was only 39 seconds, that’s three times longer than the first flight undertaken by the Wright Brothers. The helicopter paid tribute by carrying a piece of fabric from the original Wright flyer. Science is cool, y’all.

What scientific advancements do you think hold the most promise for humanity? Leave a comment or email me.

Email Dr. Jayne.