News 4/14/21

Top News

AI solutions vendor Olive acquires Empiric Health, which offers AI-powered surgical analytics software.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Loyal. The Atlanta-based healthcare consumer experience company is solely dedicated to the betterment of patient care and is the preferred software solution for improved care utilization among the nation’s leading health systems and hospitals. One of the first companies to offer end-to-end digital and AI-powered solutions spanning the entirety of the patient journey, Loyal makes it easier for patients to access and schedule care they need. Solutions include Connect (intelligent data management), Patient Connect (provider search and scheduling), Guide (chatbot and live chat), and Empower (reviews, star ratings, and comments). Customers include OHSU, Orlando Health, and Piedmont Healthcare. Thanks to Loyal for supporting HIStalk.

My reaction to Microsoft’s planned acquisition of Nuance for nearly $20 billion:

• About two-thirds of Nuance’s business involves healthcare, but it also offers virtual assistants to customers ranging from Best Buy to the UK government’s tax collection service and also voice print-powered biometric security.
• Microsoft is sitting on mountains of cash and seems anxious to spend it in unrelated ways in a bid for growth, having expensively acquired LinkedIn and a videogame company, while failing in its efforts to invest in TikTok or to buy the Discord messaging platform.
• Microsoft was as late the cloud as it was to the Internet, and catching up to global competitors by acquisition is neither easy nor cheap.
• Microsoft, Apple, and Samsung had reportedly considered acquiring Nuance in the past but did not make an offer, and the company drew no obvious acquisition interest until Microsoft came along.
• Microsoft could have paid a lot less for Nuance last year or the year before, suggesting that either Microsoft was desperate to increase the credibility of its recently developed Cloud for Healthcare or that Nuance’s rapid move to the cloud and strong AI story made it more appealing.
• MSFT previously paid way too much for Skype, LinkedIn, GitHub, Nokia’s smartphone business, and AQuantitative. It will pay 14 times annual revenue for Nuance.
• It’s not public knowledge what agreements, if any, remain in place for Apple’s use of Nuance technology to power Siri. Apple seems to have quietly gone its own way and may no longer rely on Nuance, but if money still changes hands, having Microsoft as a critical Apple supplier would be awkward.
• Nuance has a huge healthcare customer base, but it won’t be a slam dunk for Microsoft to sell into it given that many of those customers only run some version of Dragon Medical, don’t have a deep relationship with the company or see its salespeople, and aren’t necessarily prospects for related products. Microsoft obviously priced its offer thinking it can wring more profit out of Nuance, but it’s not clear how it will do that as an occasional healthcare dabbler (see: IBM Watson Health).
• Microsoft’s previous healthcare failures are embarrassingly legendary — HealthVault, Sentillion, Amalga, Amalga HIS (an unrelated EHR), Amicore, and COVID-19 vaccine management.
• Was Microsoft primarily looking for a strong healthcare vendor, a strong technology player in cloud and AI, or a leader in speech recognition technology that includes ambient intelligence? It gets all three for its generous acquisition price, but we’ll have to see how it packages the Nuance business and integrates it (Microsoft is usually very good at that). It also keeps Nuance out of the hands of competitors as the preferred computer interface moves to voice.
• Nuance’s healthcare ubiquity means the best Microsoft can do short term is to not screw the business up or alienate its customers. Otherwise, it’s a very public stage that cuts no slack. At least Microsoft is leaving Nuance CEO Mark Benjamin in charge for continuity, although he had no healthcare experience before taking the job three years ago.

Webinars

April 20 (Tuesday) noon ET. “The Modern Healthcare CIO: Digital Transformation in a Post-COVID World.” Sponsors: RingCentral, Net Health. Presenters: Dwight Raum, CIO, Johns Hopkins Medicine; Jeff Buda, VP/CIO, Floyd Medical Center. A panel of CIOs from large health systems will discuss how the digital health landscape is changing and what organizations can do now to meet future patient needs. Moderator Jason James, CIO of Net Health, will guide the panelists through topics that include continuum of care and telemedicine, employer-provided care delivery, consumerization of healthcare, and sustainability and workforce management.

April 21 (Wednesday) 1 ET. “Is Gig Work For You?” Sponsor: HIStalk. Presenter: Frank L. Poggio, retired health IT executive and active job search workshop presenter.  This workshop will cover both the advantages and disadvantages of being a gig worker. Attendees will learn how to how to decide if gig work is a good personal fit, find the right company, and protect themselves from unethical ones.

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

Acquisitions, Funding, Business, and Stock

Cohere Health raises $36 million in a Series B round, bringing its total funding to $46 million. The startup has developed care coordination and preauthorization software to improve communication and collaboration between providers, payers, and patients.

Sales

• Value-based kidney care software and services company Strive Health will use NextGate’s Enterprise Master Patient Index.

People

Kaiser Permanente promotes Diane Comer to chief information technology officer.

Frank Jennings (Covera Health) joins Castlight Health as SVP and chief sales officer.

The Sequoia Project hires Alan Swenson (Kno2) as executive director of health data exchange subsidiary Carequality.

Shaillee Juneja (Lumina Health Partners) joins Divurgent as principal.

Announcements and Implementations

Twenty-three hospitals in northeastern Ontario will implement Meditech Expanse as part of a new record-keeping alliance.

GetWellNetwork announces GA of GetWell Anywhere, which gives patients the ability to access engagement and educational resources from their mobile devices throughout various care stages and settings.

Government and Politics

Federal News Network digs into the problems VA clinicians have been dealing with during the transition to Cerner Millennium – a process that, despite initial reports of success, has prompted congressional leaders to call for a review before further rollouts are initiated. Users have noted an excessive number of clicks for certain tasks, data migration failures, dropped community care referrals, and needing to use Microsoft Teams to communicate with other users about EHR problems. The House Veterans Affairs Technology Modernization Subcommittee will meet later this week to review the $16 billion, 10-year project.

COVID-19

FDA asks states to temporarily stop using J&J’s COVID-19 vaccine following six reports of women who developed rare blood clots days after being vaccinated, pending CDC’s review of those cases starting Wednesday. Former FDA Scott Gottlieb, MD says consumers shouldn’t be worried since the alert was intended to remind physicians to monitor vaccine recipients more closely and report milder cases they may have been missing. 

A study finds that people who are hospitalized with the B117 coronavirus variant experience outcomes that are no worse than patients infected with other variants, while another study concludes that vaccines seem to be effective against B117.

Salesforce will allow only fully vaccinated employees to return to work in its San Francisco tower, raising questions about vaccine accessibility and the legality of mandating use of a product that has not earned full FDA approval.

China’s disease control director says the country’s self-developed vaccines offer low COVID-19 protection, leading it consider using MRNA vaccines such as those produced by Pfizer and Moderna. The official, who had previously questioned the safety of MRNA vaccines, walked back his comments afterward, saying that he was referring to all vaccines and not those specifically rolled out by China that use a more primitive vaccine platform. Another official says that China is developing its own MRNA-based vaccines.

Former CDC Director Robert Redfield, MD joins the board of Big Ass Fans, which makes unproven coronavirus claims about its $10,000 ionization fans for commercial spaces.

Other

Google will conduct a user feedback study as it prepares to develop a consumer-facing health record tool similar to Apple’s Health Record app. Three hundred patients are being recruited for the study from Epic customers in Atlanta, Chicago, and Northern California. The search engine company’s last foray into personal health records, Google Health, lasted just three years, shutting down at the end of 2011. As I opined then, “The only model Google knows involves near-universal adoption that gets advertisers salivating, not having a tiny contingent of wellness buffs and savvy chronic disease sufferers using their free online service. Ultimately, Google’s problem is that an awful lot of Americans care about reality TV and celebrity gossip more than their health. They’re more interested in patch-me-up-doc ‘healthcare’ than I-need-to-make-better-choices ‘health’ that requires proactive electronic tools. The most shocking aspect of Google Health’s announcement in 2008 was either that Google hadn’t figured that out or that they thought they could succeed anyway.”

University of Wisconsin – Madison researchers find that use of the e-prescribing transaction type CancelRx increased the percentage of successfully discontinued outpatient prescriptions at UW Health. CancelRx, which was developed by the National Council for Prescription Drug Programs, sends pharmacies an electronic notice via Surescripts to not fill a previously sent prescription, which is then acknowledged by the pharmacy. It prevents meds from being filled or refilled in the case of an allergic reaction, a prescriber error, or a change in patient status. The authors note that few providers use CancelRx. I’ve seen previous implementation reports and a common problem is that since pharmacies are rarely set up to accept CancelRx transactions, provider EHRs require modification to turn the transaction into a fax.

Sponsor Updates

• Cerner releases a new podcast, “Cerner Health Forum ’21 preview – Improving clinician efficiency and operational excellence.”
• PerfectServe has placed among the top large vendors in a new KLAS report, “Vendor Performance in Response to the COVID-19 Crisis.”
• OptimizeRx is named to the Financial Times list of “The Americas Fastest-Growing Companies” list for the second consecutive year.
• Kyruus joins the Athenahealth Marketplace Program, enabling joint customers to offer seamless online appointment scheduling.
• Premier joins a dozen organizations in urging HHS Secretary Xavier Becerra to extend the Next Generation ACO Model through 2022 and to create a permanent, full risk ACO option based on the NGACO model.
• Meditech posts a new podcast titled “Different than a tornado: How Phoebe Putney Health System navigated the disaster response challenges of COVID-19.”
• PatientBond publishes a white paper titled “Driving COVID-19 Vaccinations Using Healthcare Consumer Psychographic Segmentation: Research Insights and Solutions.”
• InterSystems makes its IRIS data platform available on AWS Quick Start.

Blog Posts

• Transforming Project Management (Agfa HealthCare)
• EHR Instance Consolidation: 3 Questions to answer before you begin (Bluetree)
• Achieving Success Under CMMI’s New Direct Contracting Model (CarePort)
• Healthcare IT Leaders, BD, and TrackMy Solutions Deliver COVID-19 Testing for Sports Marketing Leader IMG during Masters Week (Healthcare IT Leaders)
• Improving Epic In Basket Efficiency – Hot Tips to Cool Provider Frustration (CereCore)
• What I’ve Learned from Conversations about Post-Acute Care for Veterans (Central Logic)
• The 7 Expectations of Consumer-Driven Healthcare (Avtex)
• FHIRworks (Diameter Health)
• How FQHCs are Helping to Improve Healthcare Equity with COVID-19 Vaccine Distribution (Dimensional Insight)
• A Deep Dive Into Our Vaccine Administration Management Solution (EClinicalWorks)
• Emerge Improved Revenue and Quality for Multi-Specialty Group Using Natural Language Processing (Emerge)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Contact us.

Morning Headlines 4/13/21

Microsoft Acquires Nuance for $16 Billion

Microsoft will acquire Nuance for $16 billion in a deal valued at closer to $20 billion, including debt.

Health2047 Spins Out Emergence Healthcare Group to Empower Independent Physician Practices

AMA commercialization subsidiary Health2047 spins out Emergence Healthcare Group, a turnkey practice management and health IT company focused on independent practices.

CloudMD to Acquire Oncidium, One of the Largest Healthcare Providers to the Employer Market in Canada

In Canada, ambulatory health IT company CloudMD acquires workplace healthcare provider Oncidium for $80 million.

Curbside Consult with Dr. Jayne 4/12/21

Lots of chatter in the hospital world this week following a recent Washington Post article that said wealthy hospitals were benefiting from COVID-19 provider relief funds. Some of the data coming out of the larger health systems has been pretty stunning, although hospitals claim they are still struggling. The Post published a letter to the editor from American Hospital Association President and CEO Rick Pollack, who alleged that the Post was cherry-picking data and that the original piece didn’t truly reflect the challenges that hospitals are facing.

I don’t disagree that the pandemic wreaked havoc on many healthcare organizations. For others, the availability of relief funds (including those from the Paycheck Protection Program) may have spurred spending in ways not exactly intended by the programs that provided them. Specific to the Paycheck Protection Program, whose funds came in the form of a potentially forgivable loan, there is certainly room to use the funds for things other than paychecks, since the forgiveness terms only require that 60% of the proceeds must be spent on payroll costs. The terms do require that “employee and compensation levels are maintained,” which certainly didn’t happen at my soon-to-be-former employer, who received $5.5 million in PPP funds but furloughed a good portion of the physicians and cut support staff shifts throughout the month of April 2020.

I was personally furloughed for almost two months with zero compensation, which led to some surprise when the local paper reported the company had taken that amount of PPP funding. Business has been booming since May 2020 with COVID-19 testing and an uptick in sick visits, and it didn’t stop the organization from opening additional locations even before it took on investors. Having personally experienced this type of accounting shenanigans (not to mention the absence of a paycheck for a while), I’m not that sympathetic when I see healthcare organizations posting sizable profits, yet crying poor when they’re called out on it. None of the employed nurses I know received raises during the pandemic, even though travel nurses were paid two to three times the typical nursing salary to provide coverage when times were tough. Organizations in my area weren’t generous with hazard pay or overtime, either.

I also find it somewhat questionable that certain health systems are charging administration fees for COVID-19 vaccines they are delivering, despite using mostly volunteer labor to perform the services. Even in the absence of labor and supply costs (since many of the supplies are provided with the vaccines) some of them can’t claim real estate or utility costs since they are using space donated by local businesses and community organizations. I could see some incremental technology costs if they’re needing computers to run the process, and I certainly support charging a fee if they’re paying people to administer the vaccines, but there are just so many elements of the process that feel a little off as the situation unfolds.

The pandemic has brought into focus many of the more unsavory aspects of our profit-driven healthcare non-system in the US. However, I don’t see a lot of forces aligning to try to change things in the short term. We’re still struggling with disparities in accessibility of in-person care, and even with telehealth we’re seeing that the greatest utilization was among patients in affluent or urban areas. A recent study looked at insurance claims for more than six million patients in the US who received coverage through employer-sponsored health plans. The data was drawn from January 2019 through July 2020 and represented nearly 200 employers across all 50 states. Where in-person patient visits declined at the onset of the pandemic, there was a significant (nearly 20 times) increase in telehealth services. Although telehealth didn’t fully offset the missed patient visits, it certainly helped many patients through the worst months.

The study found that the most notable increases in telehealth visits were in counties with low levels of poverty – 48 visits per 10,000 people. In comparison, counties with high levels of poverty averaged 15 visits per 10,000 people. There was also a difference comparing urban to rural areas – 50 versus 31 visits per 10,000 people, respectively. Pediatric virtual visits were also lower than adult visits (50 versus 65 visits per 10,000 people). The US government is trying to mitigate some of these factors, providing funding for increased broadband services to enable telehealth, including the Telehealth Broadband Pilot, which promises $8 million in improve connectivity in Alaska, Michigan, Texas, and West Virginia.

The authors conclude that there is much to be done to better understand the forces impacting telehealth utilization and to assess what the rates and disparities look like in the future. They call for greater reimbursement for telehealth services and updates to clinical guidelines to encourage telehealth practice.

I agree wholeheartedly, and additionally, I’d like to see more focus on how to make physicians successful with telehealth. Prior to the pandemic, the majority of our experience with telehealth was either with relatively minor acute problems, delivered either by large telehealth-specific vendors or through smaller health system pilots, or through facilitated subspecialty consultations where a patient and their “host” provider would consult remotely with a subspecialist, often at a tertiary center. As the pandemic unfolded, we saw the urgent care services delivering more primary care services, such as medication refills, while brick-and-mortar providers began to scale up their telehealth offerings.

Even as the pandemic eased last summer, a number of my colleagues continued to do more telehealth visits than in person, citing lack of personal protective equipment and the risk of infection. Even now that they’re vaccinated, they still haven’t returned to the office, and are delivering more and more primary care services remotely. That’s a dynamic that certainly needs exploration since the compensation models being used for those visits vary dramatically across organizations. I enjoy delivering telehealth care and am about to add virtual primary care to my bag of tricks, so we’ll see how that goes. I plan to offer some pretty non-traditional hours for my visits, so I’m curious to see what kind of patient demographic I attract. I have just about 80 hours of in-person care left on my schedule and am definitely ready for the next adventure.

What does your hospital or health system have to say about its profitability and acceptance of COVID-19 relief funds? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Charlie Harp, CEO, Clinical Architecture

Charlie Harp is CEO of Clinical Architecture of Carmel, IN.

Tell me about yourself and the company.

I have been developing software in healthcare for a little over 30 years. I’ve worked for companies like SmithKline Beecham Clinical Labs, First Databank, Zynx Health, and Covance Central Labs. Back in 2007, I started Clinical Architecture to address what I thought was an unmet need in the healthcare industry, which was doing a good job of managing how information moves, how we deal with terminology, and how we deal with content. It’s designed to enhance the way we support patients in healthcare and look at information.

What are the challenges of using provider-generated data for operational improvement, benchmarking, analytics, and life sciences research?

There’s a handful of issues with the data that we collect in healthcare. If you talk about just standard structured data — and let’s even include unstructured data — one of the big challenges is that every single application in every single facility tends to be its own little silo of terminology. Code systems that are created in these places by the people who work in those places are usually local. They are not always following the best practices in terms of how they are described.

Public health organizations, large IDNs, or payers that go to collect all that information — even if it’s delivered in a standard container, like a CCDA or an HL7 transaction – experience semantic impedance. To be able to utilize all the disparate codes and put them into a common nomenclature or common normative terminology that you can do analytics and BI and all those things on, you’ve got to do work. You’ve got to introduce work to get the data from its original state into something you can use.

The other challenge we have is that if you look at the standards where we ask people to codify things with standard terminologies, not all mappings are created equal. You deal with that “whisper down the lane” effect with structured data, where they might have mapped it to a SNOMED code or an ICD-10 code for delivery through something like a CCDA or FHIR bundle, but there’s a certain amount of uncertainty baked into whether or not they broadened the term, they narrowed the term, or maybe somebody made a mistake and mapped to the wrong term. There is what I call uncalibrated uncertainty when it comes to the structured data.

The other problem we have is that between 60% and 83% of the data we know about a given patient from any place is bound up in unstructured notes. At the end of the day, what the provider relies on is their notes, not necessarily the structured data, because most of them realize that structured data has a lot of uncertainty in it.

What is the role of artificial intelligence in recognizing terminology problems faster and perhaps resolving them faster?

What we do is a form of deterministic artificial intelligence. We’ve trained our product over the last 10 years to understand certain clinical and administrative domains. When it gets a term like “malig neo of the LFT cornea,” our product parses that apart semantically and turns it into an expression — malignant neoplasm of the left cornea. We use that when we are doing things like mapping, so that we can do about 85% of the work.

If things are really terrible, and I’ve seen some really terrible things come through an interface, then obviously you have to pick up the phone. But in that scenario, what you’re dealing with is deterministic artificial intelligence, where a human being, a subject matter expert, has trained a piece of software to think like they do.

Machine learning is really pattern recognizers. They don’t set a course, they just observe something,. I always warn people that there’s a certain lemming effect of machine learning, where people could be doing a lot of wrong things and the machine learning doesn’t know right from wrong. It just knows patterns. When it comes to doing the transformation of data, the challenge is filling in the gaps of what’s not there. Most of the time when somebody’s struggling with mapping something, whether it’s a drug, lab, or condition, the core part of the struggle is there is something missing. There’s not enough information for them to determine where it should land in the target terminology.

Another challenge is that the terminologies that we use for standards are prescriptive. They are pre-coordinated. Somebody sits in a room, and they come up with a term like “Barton’s fracture of the left distal radius.” They say that, and that’s the term. Let’s say that you’re coming from ICD-10, you have Barton’s fracture of the left distal radius, and you’re mapping it to SNOMED. Let’s say that SNOMED doesn’t have laterality for Barton’s fracture. Most systems that we have today can’t handle post-coordination, where they can glue multiple things together and land it in the patient’s instance data. They have no choice but to choose a broader concept, so they choose Barton’s fracture and the other information left by the side of the road.

Even if we had the smartest artificial intelligence platform in the universe, you can’t map to something that doesn’t exist. The way we deal with structured data in terminologies today is that we use these single codes in our standards. If you can’t find an exact match, what do you do?

What are the risks of companies that assume that FHIR solves their interoperability problem only to find that terminology issues are creating incorrect or incomplete information?

FHIR is a great advancement, but it struggles with what a lot of standards struggle with — it’s a snapshot. We are evolving FHIR and we are using FHIR, but if you look at the old ASTM standard, HL7, FHIR, OMOP, or any of these canonical models, it’s good if we can have agreement that these are the elements we are going to share. When you ask me for a lab result, here’s a standard container that I can give to you. It’s less verbose in many ways than some of the things that we did in HL7, especially Version 3, but it does deliver things in a nice package. It’s good for us to have agreement in how we package things up.

The issue with terminology is a lot of these systems that we use in healthcare, in inpatient and in outpatient, have homespun terminologies. There is no way to get around doing this semantic interoperability. For a long time, we didn’t care, because we didn’t try to collect that data and use it in a longitudinal, analytical way.

FHIR is good. I wouldn’t get rid of FHIR. FHIR is a great advancement. It brings us to consensus on how we package things up, what things are important for a particular type of resource. The fact that people are excited about doing it and they are opening up some of these systems to share data in real-time ways that they never did before is pretty cool. But when I get a FHIR resource that describes a lab test, and it’s using the local lab code, problem ID, or drug code, it’s tough to map it to make sense of that data and do something good.

People coming from other industries say, why is it so hard in healthcare? A big part of it is the systems we built and the platforms we are in. That metaphor of fixing a 747 in flight is very true. You can’t go in and just rip the rug out from under a hospital system and expect that everything is going to be OK. It’s an incremental steppingstone of evolution to get where you need to go. People can suggest that we just get away from all these local terminologies, but that’s going to take a decade, easily. If we can get it done, it’s going to take a decade. We just need to have better solutions and better ways of dealing with this interoperability problem.

The other thing, when it comes to semantic interoperability, is that the onus is on the receiver. The people who are pushing data out have already used it. They are pushing it out to someone else because they have to, but they don’t have to suffer the consequences of it not being accurate or complete or not being coded perfectly. At that point, it’s out of their hands. The onus is always on the receiver of the data who wants to use it to make sure that it is usable.

I always request, when I’m doing some kind of a transaction, give me the original data, even if it’s not a standard. The original data is what the provider chose. It’s what the people said. I’m not going through some third party that picked the closest thing they could find in a list of standard terms. You can give me the standard term you think it is. That could help me a lot, because if they are right, I can use it just like that and I’m good to go. Having the original data eliminates some of that hearsay effect.

We have seen this with our product Symedical, where we have data, like say lab data. We saw a code of CA-125 come through Symedical and people mapped it mapped it to calcium. CA-125 is a cancer antigen test. It has nothing to do with calcium. Because Symedical looks at patterns, says, “CA-125 isn’t calcium. It’s a cancer antigen test.” We were able to fix that and put it in front of a human and say, “It came in as calcium, but this is what we think it is” and they were able to correct that. Those are the kinds of things we’re going to have to do.

A lot of people think that doing that mapping of data is a project, but in reality, that’s a lifestyle choice. It’s like mowing your lawn. You can’t just do it once and walk away. It requires somebody to be keeping an eye on that all the time, because the other thing that can happen is people can change a code. It doesn’t happen with the standards, typically, but it happens with proprietary code systems.

Our mission at Clinical Architecture is maximizing the effectiveness of healthcare. A lot of what we do when it comes to machine learning is not necessarily say, “This artificial intelligence will come in and replace what you do.” It’s really saying that this thing will do a lot of the heavy lifting. It will eliminate a majority of the work. But we never suggest that we can eliminate humans from the equation when we are talking about doing this semantic interpretation of what Human A created and what Human B created, because I create a code, it’s local, I have another person map it to a standard, and that standard comes into System B. The first thing that has to happen is the person in System B has to map it to their local code if they want to use it. 

That’s just point-to-point exchange. If I’m pulling data into an aggregation environment and trying to do some kind of analytics on it, it’s probably easier, because if I’m smart, I’ve probably chosen a standard and maybe extended that standard a little bit to accommodate the outliers. But it’s just one of those things where when we start utilizing longitudinal data from multiple sources, having mechanisms in place to look for things that are uncertain and allow me to rule them in and rule them out is going to be a pretty big deal. Also, looking at unstructured data for high-value information that I can use to improve that picture.

The other thing is using things like inferencing logic, where I can take the things that I know about the medical world and look for data that can’t be true and call it into question. I’m not a clinical person, so bear with me, but if I have a  patient who says they are a cardiac hypertroph and they have a procedure that says they have an ejection fraction of 25%, that can’t be true. There are situations it just can’t be true. If I have a patient who is on insulin and has a hemoglobin A1C of 7%, but there’s no mention in their structured medical data that they are diabetic, it might be in the note, but it might not be in the structured data.

We are trying to do things as we enter into this value-based, population health, analytics world. Look at the public health emergency we just dealt with in 2020. Being able to leverage that data in a meaningful, competent way is going to be critical as we continue to move healthcare forward.

Do you have concerns about drug companies aggregating de-identified EHR data from hundreds or thousands of hospitals and then making significant clinical or commercial decisions based on what they see?

Whether it’s the CDC looking at COVID or pharma looking at a particular situation or looking for cohorts to enter into a clinical trial, the first step is getting the structured data, taking whatever the original people entered into the system, and doing a good job of finding the best possible target. 

The other challenge you have is that because mapping is difficult, people don’t want to do it. Or they say, I’m only going to map the top 50, or I’m going to only map these three things I care about. You can’t really think about it that way, because the things that you are not mapping are a mystery to you. You have to try to map everything, even if you only care about 10 things. Mapping everything makes sure that those 10 things aren’t missing, because they could be if you don’t map everything. If you map everything, then at least you’ve got a picture of the data. 

If you have what originally came from the site, then you eliminate that third party that may have mapped it to a standard incorrectly. It’s good to have that data because it gives you hints at what they thought, but having the original data lets you analyze what the original thing said. Take my earlier example where you have Barton’s fracture of the left distal radius. I convert it to SNOMED, it’s Barton’s fracture and I’m going to land that in my data repository as Barton’s fracture. If I have the original term, let’s say terminology on my side has laterality and anatomic location, I can say, they said Barton’s fracture in SNOMED, but when I look at the semantic payload and the words that are in the original term, I’ve got the exact same thing in my database here as a term. It has a different code, but it says exactly the same thing. I can make sure that I’m not losing information in that transaction. Always try to get original data because you run the risk of terminological hearsay.

As a benefit of people who are aggregating data, as opposed to the old episodic way we dealt with healthcare, is that you get a probabilistic cloud of information about John Doe. When you get all that information, you could use machine learning or AI to help essentially reinforce things. It’s kind of like diagnosing a patient, I imagine. I’ve never done it, but you are looking at all this information and you are looking for things that corroborate or things that indicate that maybe this isn’t true. A lot of the time we just pull everything together and slam it into a list of problems and medications. We are still wrapping our heads around this whole notion of time in healthcare data. Healthcare comes from a very episodic place. We have never really sat down and looked at how should we look at longitudinal information when it comes to diseases, drugs, and labs, so that we can look for this flow of evidence that tells us what’s going on. When you start aggregating, it creates opportunities to do that.

We need to make sure that we are thinking about these problems of how we normalize information, how we look for information that’s missing, how we take information — not necessarily the big word salad output of NLP, but how we mine unstructured data — for things we really care about and make sure we’re integrating them into our information that we’re collecting for patients.

We didn’t have the idea of a data steward position in healthcare, but it will evolve as we enter the post-COVID era. We didn’t have a great handle on why and what was happening. The job of a data steward is to periodically have software that tells them “this data doesn’t look right,” so that we are constantly curating and improving the patient data, ideally involving the patient in that process, so we can have more confidence in that data.

I don’t know if people will say this out loud, but we don’t have a huge amount of confidence in our data,  in part because of all that uncertainty. Most people, whether they realize it deliberately or whether it’s just kind of this itch in the back of their brain, wonder if this data is good. Having a data steward function and having mechanisms that are constantly measuring and monitoring the quality of that data can dramatically improve our ability to have data that we can rely on to make better decisions.

Do you have any final thoughts?

This last year has shined a light on how important information is in what we do in healthcare. It’s not more important than taking care of patients, but we can create high-quality, actionable data as a by-product of taking care of patients. We can feed a cycle that allows the software to do a better job of helping providers, public health experts, and researchers be more effective and yield better results. I’m optimistic that we are on a trajectory to get to that place.

Microsoft Acquires Nuance for $16 Billion

Microsoft announced this morning that it will acquire Nuance for $16 billion, a 23% premium over the company’s share price at Friday’s close. The total deal value, including debt, is nearly $20 billion.

Microsoft says the acquisition represents its latest step in advancing an industry-specific cloud strategy. It says the acquisition will double its healthcare total addressable market to $500 billion.

Microsoft CEO Satya Nadella said in the announcement, “Nuance provides the AI layer at the healthcare point of delivery and is a pioneer in the real-world application of enterprise AI. AI is technology’s most important priority, and healthcare is its most urgent application. Together, with our partner ecosystem, we will put advanced AI solutions into the hands of professionals everywhere to drive better decision-making and create more meaningful connections, as we accelerate growth of Microsoft Cloud for Healthcare and Nuance.”

The deal is expected to close by the end of the year.

Morning Headlines 4/12/21

Orange County Hospital Seeks Divorce From Large Catholic Health System

Hoag Memorial Hospital Presbyterian is attempting to leave the 51-hospital Providence system, saying the chain’s use of Epic to standardize treatments for cost effectiveness often conflicts with the judgment of its clinicians.

Microsoft in advanced talks to buy Nuance for about $16 billion, announcement could come Monday

Insiders say Microsoft will acquire Nuance for $16 billion, making it the company’s second-largest acquisition after its $27 billion purchase of LinkedIn five years ago.

Health and Human Services Awards TeleTracking with Six-Month Task Order for Continued COVID-19 Capacity Reporting

HHS extends TeleTracking’s COVID-19 hospital operating data collection and reporting for a third six-month term, presumably for another $10 million.

Google is exploring a health record tool for patients

Google is conducting a user feedback study as it prepares to develop a consumer-facing health record tool similar in functionality to Apple’s Health Record app.

Monday Morning Update 4/12/21

Top News

US News & World Report highlights the legal efforts of Hoag Memorial Hospital Presbyterian to leave the 51-hospital Providence system, saying the chain’s use of Epic to standardize treatments for cost effectiveness often conflicts with the judgment of Hoag’s clinicians.

A Hoag cardiologist says the hospital can’t set its own treatment choices and instead is “bogged down by a bureaucracy that requires 51 hospitals to vote on it.”

Providence says the hospital knew that collaborative standardization was part of the affiliation deal.

Hoag also says that Providence illegally imposes restrictions on reproductive care by adhering to tenets set by the Catholic church, which controls four of the country’s 10 largest health systems.

Providence doesn’t own the hospital, but appoints a legal majority of its governing body. It says it will allow Hoag to disaffiliate if it pays an undisclosed amount that Hoag says is unreasonable.

HIStalk Announcements and Requests

Eighty percent of poll respondents have received at least one dose of COVID-19 vaccine, while 95% plan to be vaccinated by HIMSS21.

New poll to your right or here: Which has contributed most to your overall health? Readers who resent the “one best answer from the list” form of a poll (as opposed to a survey or personal interview) will wail about not being able to choose more than one answer, that health factors are inextricable, or that the provided answer choices are subjective, but work with me.

Webinars

April 20 (Tuesday) noon ET. “The Modern Healthcare CIO: Digital Transformation in a Post-COVID World.” Sponsors: RingCentral, Net Health. Presenters: Dwight Raum, CIO, Johns Hopkins Medicine; Jeff Buda, VP/CIO, Floyd Medical Center. A panel of CIOs from large health systems will discuss how the digital health landscape is changing and what organizations can do now to meet future patient needs. Moderator Jason James, CIO of Net Health, will guide the panelists through topics that include continuum of care and telemedicine, employer-provided care delivery, consumerization of healthcare, and sustainability and workforce management.

April 21 (Wednesday) 1 ET. “Is Gig Work For You?” Sponsor: HIStalk. Presenter: Frank L. Poggio, retired health IT executive and active job search workshop presenter.  This workshop will cover both the advantages and disadvantages of being a gig worker. Attendees will learn how to how to decide if gig work is a good personal fit, find the right company, and protect themselves from unethical ones.

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

Acquisitions, Funding, Business, and Stock

Reuters reports that Microsoft is in advanced discussions to acquire Nuance for $16 billion, with an agreement possibly being announced on Monday. The reported offer is $56 per NUAN share, a 23% premium to Friday’s close.

A private equity publication sets the value of KKR’s acquisition of a majority position in Therapy Brands, which sells 19 behavioral health EHR/PM systems, at $1.25 billion.

Sales

• HHS extends TeleTracking’s COVID-19 hospital operating data collection and reporting for a third six-month term, presumably for another $10 million.

Announcements and Implementations

Varian and Google Cloud will develop a diagnostic platform for organ segmentation for radiation therapy, training Google’s NAS technology on Varian’s treatment planning image data.

FDA approves GI Genius, an AI-powered tool that highlights possible lesions in real time during colonoscopies.

MIT highlights the work of its Data to AI Lab on Cardea, an open source framework that uses FHIR to connect to EHR data to answer on-the-fly questions, for now focusing on resource allocation. The team notes that hospital decisions are too critical to simply present a black box answer, so Cardea will show the strengths and weaknesses if the model, then allow the user to start over.

COVID-19

CDC reports that 45% of American adults have received at least one dose of COVID-19 vaccine, along with 78% of senior citizens. Slightly interesting is that the three states with the lowest vaccination rates per capita are contiguous and are often challenged in other public health areas – Mississippi, Alabama, and Georgia, with Mississippi in particular being flooded with available vaccine doses that few residents want.

Hospitals in COVID-overwhelmed Michigan are banning visitors, cancelling elective procedures, and re-implementing pandemic surge plans, as two dozen hospitals have reached 90% capacity and 15% of the state’s hospital beds are housing COVID-19 patients. Six counties in metro Detroit are reporting their highest numbers of COVID-19 patients since the first weeks of the pandemic last year. State health officials received 58 outbreak reports from restaurants and stores in the past week, warning bluntly that “indoor dining is one of the riskiest things you can do.”

Meanwhile, the White House says it won’t surge COVID-19 vaccine supplies to Michigan because population-based distribution is the only fair way to allocate supply, especially since new outbreaks could occur elsewhere.

Pfizer requests that FDA expand the Emergency Use Authorization for its COVID-19 vaccine to those who are 12-15 years old, citing Phase 3 clinical trials data of its effectiveness.

A large study finds that people who have had COVID are 84% less likely to be re-infected over at least seven months.

Early reports showed that few people with chronic respiratory disease were being admitted with COVID-19, leading to speculation that inhaled glucocorticoids might be an effective treatment. A small randomized trial concludes that early administration of inhaled budesonide to COVID-19 patients reduced the need for urgent interventions and reduced recovery time.

The New York Times profiles 66-year-old Kati Kariko, PhD, whose early messenger RNA work at Penn failed to draw research dollars and resulted in her moving from lab to lab and never earning more than $60,000 as a low-level, untenured PhD whose job was always at risk. Moderna and Pfizer finally took notice and used her technology to develop their COVID-19 vaccines.

Other

In Canada, a man has struggled since January to remove an incorrectly entered drug overdose from his electronic medical record after the real OD patient, who didn’t have ID, gave paramedics a name and birthdate similar to his own. The health authority says it has removed the entry, but Kevin Robinson says that while the overdose no longer appears on his patient portal display, his doctor says they can still see it.

Cape Cod Healthcare (MA) goes through the technical and legal steps that were necessary to accept donations in bitcoin, as requested by a donor who has transferred $800,000 to the hospital in two transactions. The hospital converts the bitcoin to dollars that it banks immediately, concerned that unlike other forms of donations, its value could swing dramatically.

Sponsor Updates

• PatientBond completes its study on COVID-19 vaccinations.
• PatientPing publishes a new white paper, “Real-time, Right Partner: How One SNF Chain Uses Real-Time Alerts to Succeed in Value-Based Care.”
• PerfectServe publishes the complete guide to “Clinical Collaboration Systems for Hospitals.”
• Pure Storage is a 2021 Customers’ Choice in the “Gartner Peer Insights Voice of the Customer: Distributed File Systems and Object Storage” report.
• Spirion wins three gold wards in the 2021 Cybersecurity Excellence Awards and four Globee Business Awards in the 2021 Cyber Security Global Excellence Awards.
• The Chartis Group names Michael Brown (MD Anderson Cancer Center) director in its Oncology Solutions Practice.
• Vocera earns Cyber Essentials Plus Certification in the United Kingdom.
• Waystar earns HITRUST CSF Certified status.
• Wolters Kluwer Health launches the open access journal Otology & Neurotology Open as part of its publishing collaboration with Otology & Neurotology Inc.

Blog Posts

• How provider orgs need to respond to 2021’s cybersecurity threats (Capsule)
• Leveraging AI to improve patient safety in the emergency department (Nuance)
• ONC 2021 Annual Meeting: Moving towards meaningful communication (Nordic)
• 5 Steps to Take Now: FCC Released 7 Day Application Window for $250M COVID-19 Telehealth Funding (Pivot Point Consulting)
• Reduce Claim Denials with Real-Time Eligibility (PMD)
• After COVID-19, Many Challenges Will Remain (Medsphere)
• Switch to Value-Based Model Saves California Hospital $7 Million (Premier)
• How Smart Rules Can Help Close the Gap Between Clinical Documentation and Coding (RCxRules)
• How New Rules Enable Informed Decision-Making and Patient-Centered Care (RxRevu)
• HIPAA-Compliant Messaging in the Age of COVID-19 (Spok)
• How COVID-19 is Changing Search Marketing (Krames)
• A Health IT Expert on Navigating the System to Find the Best Drug Cost (Surescripts)
• Niagra Health Reduces Number of Injuries in Code White Emergencies by 20% – Staff Feel Safer While They Work (Vocera)
• 5 Fast and Cheap Ways to Fix Your Clinic’s Marketing (WebPT)
• Time Consuming Administrative Processes Cost Healthcare $39 Billion Annually (Vyne Medical)
• Making the Case for Evidence-Based Chronic Condition Management Clinical Decision Support (Zynx Health)

Contacts

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

Weekender 4/9/21

Weekly News Recap

• KKR acquires a majority interest in behavioral health EHR/PM vendor Therapy Brands.
• Firefly Health raises $40 million.
• A magazine article questions the claims and effectiveness of behavioral therapy apps.
• Massachusetts General Hospital will collaborate with drug manufacturer AstraZeneca on digital health solutions for disease management.
• The Indian Health Service seeks help with developing a strategic plan for IT.
• Bright Health acquires Zipnosis.
• The federal government’s information blocking and EHR transparency rules take effect.
• A two-system study of EHR usage finds that ambulatory physicians spend five hours on the EHR for each eight hours of scheduled clinical time.
• Bank of America acquires AxiaMed.

Best Reader Comments

I can’t believe after all these years I am still downloading summaries from patient visits that tell me nothing I didn’t know before walking in the door. I already know my Rx med, patient medical / surgical history, VS, etc. What I WANT is a summary of what the doc and I discussed because I don’t always remember all the details and occasionally have needed to refer to it. This is NOT what was intended when this whole notion of implementing EHRs (not to mention paying docs for doing that!) was first started. (JT)

Standardize and automate. Do as much of this as you can, and no more. (Brian Too)

I don’t understand why these health insurance + digital whatever always go for the low cost market. In the Firefly Health article, they say their cost is so much lower (doubtful). But I imagine the people who would want a digital insurance care plan are not the same people who are looking for bargain basement health insurance. (IANAL)

In primary care at least, so much easier when the horse brought doc to the house where they stayed until the crisis resolved. The physician was not interrupted at all. As a country doc by training, I knew we were going down a slippery slope when consultants started saying that all patients needed to be in gowns before doc would encounter them. And now, it is all about productivity first rather than quality. (Kevin Hepler)

Watercooler Talk Tidbits

Readers provided the New York elementary school class of Ms. F with hands-on math kits, from which she created individualized math toolboxes to accommodate COVID-19 requirements. She says, “Thank you so much for donating to my classroom and supporting us for this year and years to come. We use our materials for math on a day to day basis. It truly has helped us transition to a new type of learning. Thank you so much for all of your help. My students are so grateful as well, they are still talking about the kind person who has helped out and donated to us in a time of need. Thank you so much for everything! We appreciate you.”

The Department of Defense profiles Army Captain Tineisha Nagle, MSN, APRN, who was deployed under a FEMA program to support ICU staff at Yuma Regional Medical Center (AZ). She graduated from the United States Naval Academy with a degree in ocean engineering and then earned bachelor’s and master’s degrees in nursing, served 12 years in the Marines including deployment to Iraq as a lieutenant, and recommissioned to the Army Reserves, where she is completing her first year as a critical care nurse.

A Minnesota hospital nurse who was fully vaccinated for COVID-19 in January is stuck in quarantine in a Playa del Carmen, Mexico hotel room after testing positive in preparing for her trip back home from vacation. She is restricted to a small room that is guarded around the clock, but at least she bought the hotel’s $30 insurance policy that covers room and meals for 14 days for guests who test positive.

A Michigan baby who is nearly two years old goes home for the first time, having spent her first 694 days hospitalized in the pediatric cardiothoracic ICU with a congenital heart condition that required four open heart surgeries. It’s probably best to focus on the feel-good aspect and not the size of the University of Michigan bill or who ultimately will pay it.

In Case You Missed It

• News 4/9/21
• EPtalk by Dr. Jayne 4/8/21
• Readers Write: Improving Adherence, Affordability, and Experience with Better Point-of-Care Data
• Readers Write: Medication Decision Support Alerts Don’t Need to Go Away, They Need to Get More Specific
• HIStalk Interviews Andrew Smith, President, Impact Advisors
• News 4/7/21
• Curbside Consult with Dr. Jayne 4/5/21
• HIStalk Interviews Rob Culbert, CEO, Culbert Healthcare Solutions
• Monday Morning Update 4/5/21
• Katie the Intern 4/2/21

Get Involved

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

Morning Headlines 4/9/21

Emids Acquires Quovantis Technologies in Latest Expansion of Human-Centered, Design-Led Product Development and Software Engineering Capabilities

Emids acquires software design and development vendor Quovantis Technologies.

Vesta Healthcare Announces $65M in Growth Capital to Transform Care for High Needs Members and their Caregivers

Vesta Healthcare, which offers clinical services and a digital health platform to support high-needs members and their home caregivers, raises $65 million in growth capital.

MediSolution acquires Quebec-based Intégration Santé

Harris subsidiary MediSolution acquires Quebec-based, MIRTH-focused healthcare integration services vendor Intégration Santé.

Canvas Medical Raises $17 Million to Accelerate Value-Based Care Platform Growth

San Francisco-based EHR vendor Canvas Medical raises $17 million and announces a partnership with Anthem and its providers.

News 4/9/21

Top News

Investment firm KKR acquires a majority interest in Therapy Brands, which sells behavioral health EHR/PM systems under 19 nameplates.

Thanks to reader Inchoate, whose tip allowed me to run a rumor of the acquisition a couple of days ago before the deal was announced.

Reader Comments

From Crass Credential: “Re: listing job changes. Why don’t you include fellowship credentials, such as FACHE?” I’m not a bit interested in (and thus don’t list) someone’s fellowship activities, certifications, or expensive weekends spent at a big-name school’s non-degree executive program. I always include an earned master’s or doctorate and, depending on what I’m writing about, I will generally mention past military service, but the rest tells me more about someone’s check-writing experience than their intellectual capability or perseverance.

HIStalk Announcements and Requests

I use LinkedIn mostly just to look up credentials, but top of increasingly irrelevant (and sometimes political or personal) posts, now I’m gritting my teeth at user writing that tries to humble-brag using this overly dramatic format:

Dramatic emphasis is being attempted.

With one sentence per line.

We hear about their setbacks and how they bravely overcame them.

To become simultaneously wonderful and humble, and you can do it, too.

Imitative marketing haiku writing for dummies. #lame.

Webinars

April 20 (Tuesday) noon ET. “The Modern Healthcare CIO: Digital Transformation in a Post-COVID World.” Sponsors: RingCentral, Net Health. Presenters: Dwight Raum, CIO, Johns Hopkins Medicine; Jeff Buda, VP/CIO, Floyd Medical Center. A panel of CIOs from large health systems will discuss how the digital health landscape is changing and what organizations can do now to meet future patient needs. Moderator Jason James, CIO of Net Health, will guide the panelists through topics that include continuum of care and telemedicine, employer-provided care delivery, consumerization of healthcare, and sustainability and workforce management.

April 21 (Wednesday) 1 ET. “Is Gig Work For You?” Sponsor: HIStalk. Presenter: Frank L. Poggio, retired health IT executive and active job search workshop presenter.  This workshop will cover both the advantages and disadvantages of being a gig worker. Attendees will learn how to how to decide if gig work is a good personal fit, find the right company, and protect themselves from unethical ones.

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

Acquisitions, Funding, Business, and Stock

Virtual-first, employer-focused primary care provider Firefly Health raises $40 million in a Series B funding round. The company says it can save employers 30% of their healthcare costs by directing employees to less-expensive settings, reducing their use of specialists, and controlling unnecessary referrals. It operates in four northeastern states. The company’s executive chair is Athenahealth co-founder Jonathan Bush.

Vesta Healthcare, which offers clinical services and a digital health platform to support high-needs members and their home caregivers, raises $65 million in growth capital.

Privia Health, which offers medical practices administrative services, technology, and its own medical group, files SEC documents to launch an IPO.

Signify Research examines the just-completed acquisition of DXC’s provider business by Dedalus for $450 million. It notes:

• DXC was created in 2017 by the merger of CSC (which had previously acquired ISoft following its NPfIT struggles) and the enterprise services business of HPE.
• Dedalus had previously acquired a majority position in France-based Medasys and the EHR and integrated care business of Agfa Health.
• The combined entity is the largest EHR vendor in Europe, with annual revenue of $600 million. It offers legacy EHRs such as Lorenzo, I.CM, I.P.M., MedChart, Swift, Patient Care, and others.
• The analysis says that Dedalus needs to retire its legacy solutions quickly and move customers to newer platforms without upsetting them, which it notes is not easy.

Fierce Healthcare covers the new Advocate Aurora Enterprises investment arm of the Advocate Aurora health system (the health system reported $558 million in profit for 2020, boosted by $786 million in federal COVID-19 relief funds, so this your taxpayer dollars at work.) Points:

• AAE acquired in-home senior care franchisee Senior Helpers for a reported $180 million last week.
• It recently led a $25 million funding round in Foodsmart, which offers telenutrition visits, meal planning, and online meal ordering and grocery lists.
• Its investments will focus on established companies that address independent aging, parenthood, and quackery-rich “personal performance” (integration of mind, body, and nutrition.)
• AAE will explore investments in digital health since its health system revenue is limited by Medicare and Medicaid payments.

Emids acquires software design and development vendor Quovantis Technologies.

Harris subsidiary MediSolution acquires Quebec-based, MIRTH-focused healthcare integration services vendor Intégration Santé.

Sales

• National post-acute care services provider AccentCare will implement Jvion’s clinical AI CORE to reduce avoidable readmissions that are related to social determinants of health.
• Springfield Clinic (IL) will implement RCxRules HCC Coding Rule Set to identify HCC coding gaps in value-based contracts.
• Tucson Gastroenterology and Midland Cardiac Clinic choose Greenway Health for revenue cycle management.
• Health First (FL) will use the ThinkAndor Vaccine Management Toolkit for vaccine distribution.
• University Hospitals of Cleveland chooses VisuWell’s browser-deployed telehealth platform. VisuWell CEO Sam Johnson is an industry long-timer with experience at Misys, Greenway, and Relatient.
• Stanford Health Care will implement real world evidence-based guidelines from Atropos Health. The company was incubated through last October at the health system’s innovation program, uses Stanford-licensed technology, and was based on Stanford’s Clinical Informatics Consult service. The company’s product uses aggregated, anonymized EHR data to provide personalized evidence for decision-making in individual patients.

People

Nick van Terheyden, MBBS (Incremental Healthcare) joins ECG Management Consultants as digital health leader and principal.

Ken Boyett, MBA (TeleTracking) rejoins Healthcare IT Leaders as managing director of provider solutions.

AGS Health appoints Eileen Voynick as board chair.

Diameter Health names James Bradley, MS, MBA as its board chair.

Lumeris hires Jean-Claude Saghbini, MS (Wolters Kluwer Health) as CTO.

Announcements and Implementations

Meditech announces Expanse Patient Connect, which uses Well Health’s text, phone, email, and chat messaging solution to send patients reminders, instructions, and follow-up instructions that can be accessed from Meditech’s patient portal and app.

COVID-19

University of Michigan begins cancelling surgeries to make room for accelerating COVID-19 admissions.

A study finds that 34% of COVID-19 survivors were diagnosed with neurological or psychiatric illness within six months, most commonly anxiety and mood disorders. They also found that 7% of patients went home after being admitted to the ICU with COVID-19 had a stroke within six months and 2% were diagnosed with dementia.

CDC reports that 42% of US adults and 76% of senior citizens have received at least one dose of COVID-19 vaccine.

The Washington Post tests New York State’s IBM-developed Excelsior Pass “vaccine passport” that allows those who have been vaccinated or who recently tested negative to gain admission to public spaces by voluntarily presenting their phone-based green checkmark. It notes challenges:

• Account setup via a website takes a fair amount of time, technical know-how, and a decent Internet connection.
• It’s easy to set up a fake pass.
• Users still have to present an ID along with the phone pass, which some will be reluctant to do.
• Test results aren’t always uploaded to the state database quickly, especially by private providers, so users may still need to present their paper results to attend events that occur shortly after being tested.
• The system is a voluntary alternative to simply showing a vaccination card or test result.

People are selling forged COVID-19 vaccination cards on sites such as Etsy, Ebay, and Facebook, potentially violating trademark and identity theft laws while raking in cash from unvaccinated people who want to travel or attend events. It’s not just anti-vaxxers – some buyers are writing in phony first-dose dates in hopes of fooling pharmacies into giving them priority access to their “second” dose of the vaccine. I can’t imagine that the folks who are charged with checking the plain-looking cards will have the ability or time to weed out the fake ones – it’s not like currency or a driver’s license that contains a lot of counterfeit-detecting features.

Other

Forbes profiles Epic in a click-baity article titled “The Billionaire Who Controls Your Medical Records.” The article opines, not very convincingly, that the company’s “build it alone” approach could become its biggest liability after the pandemic as people may continue to avoid hospitals. It also says, equally unconvincingly, that new federal rules giving patients some control of their medical records could erode the “health-data oligopoly” of Epic and Cerner. Then it was off to a rehash of easily Googled information cobbled into a non-story with a few harmless quotes thrown in. The writer apparently interviewed Judy Faulkner, but either didn’t ask the right questions or didn’t get the right answers since it’s the same-old, including the obligatory wonderment at its campus.

Johns Hopkins Bloomberg School of Public Health researchers find that non-profit hospitals spend even less on providing charity care than their for-profit counterparts, averaging $2.30 for each $100 in expenses, but in some cases less than $1.00. The authors conclude that non-profit hospitals, which are subsidized by tax revenues and are exempt from paying most taxes, “have their cake and eat it, too.” They also note that IRS doesn’t have specific requirements for the amount of care or community benefit that tax-exempt hospitals provide, they have no incentive to increase it. They suggest that hospitals be competitively ranked by the amount of charity care the provide and a reworking of the tax exemption rules to align charity care with tax status.

Radiation treatment appointments at four Rhode Island hospitals are rescheduled when radiation oncology cloud vendor Elekta is hit by a ransomware attack. The hospitals said the company restored its systems within a day.

New York Magazine examines “the therapy app fantasy,” in which the large number of mentally ill and suicidal Americans have drawn investors to “slickly marketed companies promising a service they cannot possibly provide.” The author notes that most apps don’t really offer therapy at all, but instead tout the benefits of relaxation games, journal-keeping, mood trackers, and chatbots. She says that actual therapy apps are unlike healthcare in general because the patient is the customer, but those customers don’t know what they need. She also observes that companies like Ginger and Lyra sell their services to employers, which allows those companies to address employee unhappiness while continuing to treat them poorly. Users report overloaded therapists, messaging therapists who don’t respond, and claimed 24/7 therapist availability that really means you can send a text message any time that may not get answered anytime soon. Therapists complain that the companies don’t set clear expectations, don’t have enough therapists to handle the workload, and pay them below-market rates based on factors other than time, which mostly attracts less-discriminating therapists who are moving, working multiple jobs, or caring for their children. .

Sponsor Updates

• SOC Telemed earns The Joint Commission’s Gold Seal of Approval for Ambulatory Health Care Accreditation.
• Wolters Kluwer Health adds two new payer solutions to Health Language’s reference data management capabilities.
• Experity publishes a new case study, “Experity Meets CRH Healthcare Where Consumers, Retail, and Healthcare Intersect.”
• Gyant publishes a new case study, “Hackensack Meridian Health Achieves 89% Screening Completion Rate with Virtual Assistant.”
• HCTec and Impact Advisors will exhibit at the virtual CHIME Spring Forum April 15-17.
• Optimum Healthcare IT joins the ServiceNow Partner Program.
• East Alabama Medical Center goes live on the enhanced physician documentation system of Crossings Healthcare Solutions, decreasing transcription expense by 95%.
• Cardinal Health will offer oncology practices Jvion’s CORE population health decision support system as part of its Navista Tech Solutions suite.
• Health Data Movers appoints Monica Gupta and Alyssa Rapp to its Board of Directors.
• InterSystems has joined the Gartner Peer Insights Customer First program for its adherence to transparency and integrity in managing the Gartner Peer Insights review process for customers.

Blog Posts

• Quarterly Pivot: What’s Ahead for Healthcare IT Trends in Q2 2021 (Pivot Point Consulting)
• Six ways your CDI technology should be working with you (Nuance)
• What It Takes to Improve IT Alerting and Incident Management (Everbridge)
• ECRI Publishes New Guidance to Reduce Alerts in CPOE Systems (First Databank)
• Why the Pandemic Sparked Improvement in Real-time Patient Dashboards (Glytec)
• Addressing the Impact of COVID-19 on Nurses (Halo Health)
• “Constant Onslaught of Data:” The Tricky Balance Clinicians Face in Sorting Through Noise (Healthcare Triangle)
• CIO Success and Failure (The HCI Group)
• Deliver Data to Decision Makers: Two Important Strategies for Success (Health Catalyst)
• Information blocking: Ensuring patients’ secure and convenient access to health information (Imprivata)
• How Smart Rules Can Help Close the Gap Between Clinical Documentation and Coding (RCxRules)
• How to Deliver an Experience Your Patients Want and Expect (Avtex)
• Go beyond ‘thinking outside the box’ to completely ignoring it (Infor)
• Why Do Hospitals Transfer Patients? (Central Logic)
• Four symptoms of an unhealthy medical dictionary (Intelligent Medical Objects)
• What is HL7? (Lyniate)
• How Medhost Helps Reduce Physician Burnout (Medhost)
• How to Hire the Best Marketer for Your Practice (MWTherapy)
• Digital Identity, the Next Frontier in Healthcare (NextGate)

Contacts

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

EPtalk by Dr. Jayne 4/8/21

The big conversation around the virtual physician lounge this week was about the ONC information blocking rule that took effect this week. The majority of non-informaticist physicians who I spoke to really don’t understand what is required and have been receiving varying degrees of information from their employers and professional societies. The American Academy of Family Physicians had a nice article that summarized the situation for those who might not have been following for the last several years. AAFP points out the difference between HIPAA, which allows sharing of protected health information, and the new rule, which requires information sharing unless a short list of exceptions applies.

The exceptions identify when organizations can legitimately decline to fulfill a request for information, or when the surrounding procedures can be excepted. For most of the physicians I spoke with, their biggest use of the exceptions will be under the “do not harm” provision, which applies to adolescents being treated for things like pregnancy, sexual health issues, or mental health diagnoses. I was on an outstanding webinar earlier this week, presented by the American Medical Informatics Association. Natalie Pageler, MD, MEd from Stanford Children’s Health presented on strategies for managing the sharing of data within pediatric populations, where there are concerns not only about sensitive information, but also the capacity of the minor to consent for sharing. If you’re an AMIA member, it’s well worth tracking down the recording.

In the short term, organizations have to provide access to certain types of information: consultations, discharge summaries, histories, physical examination notes, imaging / laboratory / pathology reports, procedure notes, and progress notes. Additional types of information will be mandated in the fall of 2022, and penalties are in the future as well.

I have a few pointers for physicians who are concerned about patients reading their notes. First, write your plans like you would talk to a patient in the office. Avoid medical jargon and be clear on what you discussed with the patient and what the next steps might be. Physicians who dictate their notes in front of the patient have been doing this for decades. Second, make sure your office has a policy and/or process for when patients contact you with concerns about something they saw in a note. Should they come in for an appointment, schedule a telehealth visit, or wait for a return phone call? Decide this now before there’s a time-sensitive issue in front of you. I’m interested to hear from readers who have had significant fallout from this week’s change, so if you’ve got a great story, let me know.

I always scoop up cut-rate Easter candy and take it to my clinical team, because every urgent care shift is better with the addition of chocolate. We joked about having to go to the local Walgreens to get the best selection of candy, and of course the topic turned to retail pharmacies and their role in COVID-19 vaccination policy. Pharmacy appointments are widely available in my area at the moment, which seems somewhat surprising since my office was recently allocated a measly 100 doses (yes, one hundred) of Johnson & Johnson vaccine despite the fact that we see 2,000 patients a day and could be a force to be reckoned with if the state decided to give us adequate vaccine.

Others have noted the issues with retail pharmacies playing such a big role, including Politico, which featured a discussion of pharmacies using vaccine-related patient data for marketing and other purposes. I was trying to find an appointment at Walgreens or Walmart for a family member, but was stopped when I found that they require you to register for an account before searching for vaccine appointments, which means they have your email address. I didn’t want to create a new account for them in case they already had one, and certainly didn’t want anything tied to my own email. Privacy and consumer advocates are calling on state governments to investigate how the data is used and are asking retail pharmacies to avoid using the data for marketing purposes. At this point, patients are more interested in getting a vaccine wherever they can and probably aren’t reading the fine print when they sign up. We’ll have to see how this plays out in the longer-term.

I had a recent client project around home monitoring of blood pressure, weight, and blood sugar, so I was excited to see this article in the Journal of the American Medical Informatics Association regarding the impact of patient-generated health data on clinician burnout. There is a ton of data out there that patients want to provide us – information from wearables, home glucose monitors, blood pressure cuffs, and more. Many physicians are terrified to let this information into their EHRs for fear it will overwhelm them with data as well as that it might increase their liability. For many conditions it’s not so much the individual data points that are important, but the ranges in which a patient’s data typically falls or how often they have outlier values. For certain conditions such as heart failure, however, individual daily values are important, and action has to be taken if there are dramatic changes from day to day.

The authors identified three factors that they believe contribute to burnout related to the integration of patient-generated health data within the EHR. These factors are time pressure, techno-stress, and workflow-related issues. They suggest mitigating techno-stress through several interventions: ensuring that healthcare providers have clear roles and responsibilities for monitoring and responding to patient-generated data; improving the usability of data integrated in EHR; and greater education and training. They go on to suggest reduction of time pressure through standardized EHR templates, greater financial reimbursement, and incorporation of artificial intelligence and the use of algorithms to review data. Regarding workflow issues, they suggest better usability, policies around reviewing data and responding to patients, and identifying the types of data that are best suited to inclusion in EHR. All of these are easier said than done, so I’d love to hear from readers who have tried to tackle this particular issue.

How is your organization handling patient-generated health data? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/8/21

This Startup Raised $40 Million To Build A ‘Mini-Kaiser Permanente’ And Lower Employee Healthcare Costs

Virtual-first primary care company Firefly Health raises $40 million in a Series B round of funding led by Andreessen Horowitz.

Privia Health Announces Filing of Registration Statement for Proposed Initial Public Offering

Practice management company Privia Health files paperwork with the SEC for an IPO.

KKR to Acquire Therapy Brands

Investment firm KKR has acquired a majority interest in Therapy Brands, parent company of 19 behavioral health IT businesses.

Agilon health Files Registration Statement for Proposed Initial Public Offering

Senior-focused primary care company Agilon Health hopes to raise nearly $1 billion in its forthcoming IPO.

Readers Write: Improving Adherence, Affordability, and Experience with Better Point-of-Care Data

Improving Adherence, Affordability, and Experience with Better Point-of-Care Data
By Christie Callahan

Christie Callahan is chief operating officer of RxRevu of Denver, CO.

As healthcare leaders continue to focus on patient outcomes, preventive care, and total wellbeing, it is essential to keep cost at the center of the discussion. Affordability and access continue to be major barriers to care, with over half of Americans saying they have received a medical bill that they did not have the funds set aside to pay for, and more than 10% of adults reporting delaying or skipping care because of financial reasons.

While there are segments of the population that are uninsured or underinsured (a separate issue to discuss), even those with insurance coverage are unable to proactively manage their healthcare costs. Lack of data and pricing information often causes consumers to forgo care altogether or become frustrated with the burdensome process of researching coverage and cost details.

There is no question that a lack of transparency causes a negative healthcare experience, and nearly everyone knows somebody who has been overwhelmed or surprised by medical bills. The challenge is that the work required to effectively diagnose and treat a potential new condition is often extensive, and the costs aren’t understood until the work has been completed.

Many new regulations and solutions center around patient price transparency. But are we approaching the problem in the right way?

Patients on their own are often incapable of making specific choices about care options without the help of a provider.

Let’s use a simple drug order as an example. Common chronic conditions require near-perfect medication adherence to manage the condition appropriately. While costs can be quite low, if the wrong medication is prescribed, or the patient fills the prescription at the wrong pharmacy, costs can quickly escalate. In this case, a new prescription must be ordered by the provider, requiring additional research by the care team, an additional visit to the pharmacy, and additional time when the patient is not on the medication.

Policies like the Hospital and Health Insurance Price Transparency Rules and the No Surprises Act mandate that plans and providers disclose negotiated rates and cost estimates over the course of the next few years. These rules allow patients, and sometimes providers, to view coverage data and have conversations around the cost of available options to improve affordability.

However, in the prescription drug space, CMS created more specific rules for EHR vendors and Medicare Part D plans, mandating the availability of real-time prescription benefit tools for providers and creating a wave of interest and acceptance of point-of-order solutions. By focusing regulation and technology capabilities on driving transparency for the patient and the provider at the point of care, together they can better manage spend and find affordable care options.

It is essential that we give providers the right tools to view a full picture of their patients and allow for condition and cost management conversations to occur. We need different-in-kind solutions that can make a meaningful difference in the exam room and help drive comprehensive conversations and decisions.

What can be done to accelerate implementation, acceptance, and use of solutions like this?

What is most important today is starting a conversation around how we can better support providers, as we continue to ask them to do more in the exam room.

First, we need better tools and data at the point of care.

• Solutions must be fully integrated into care workflows so providers can quickly and easily take action without feeling burdened by cumbersome tasks. There is often value in partnering with clinical system vendors who are instrumental in ensuring a consistent provider experience through the normalization of patient data and their ability to maximize payer coverage.
• Every patient is unique, with unique insurance coverage, financial situations, and conditions. Therefore, the data displayed within the EHR can no longer be inaccurate, incomplete, or estimated. It must be patient-specific, detailed, and displayed in real time.
• Solutions must allow for broader engagement and support from care team members. Payers and PBMs must be willing to allow access to patient data to create an open network for care providers, regardless of role.S

Second, we need to better align incentives across healthcare stakeholders.

• When patients stay healthy, payers are the primary beneficiary. There continues to be an opportunity to shift that value to providers, as they are best equipped and have the most responsibility to impact patient outcomes. Price transparency tools, in particular, can help care teams better manage risk, as well as better participate in cost-based incentive models.
• Interoperability and price transparency policies have seen recent acceleration. But more can be done to create a truly interconnected and open ecosystem where care teams have access to robust, accurate coverage data and, with patients, are able to deliver the lowest-cost care in real-time.

There has been tremendous progress in healthcare through technology and interoperability innovations, improvements in the ways provider teams manage difficult diagnoses, and advancements in personal health tracking. But high healthcare costs continue to be a top issue for many. While the issue of cost is incredibly complex, if we aren’t able to have informed cost conversations at the point of care, we risk delaying the shift to value and perpetuating a pattern of negative healthcare experiences for patients and providers alike.

Readers Write: Medication Decision Support Alerts Don’t Need to Go Away, They Need to Get More Specific

Medication Decision Support Alerts Don’t Need to Go Away, They Need to Get More Specific
By Bob Katter

Bob Katter, MBA is president of First Databank (FDB) of South San Francisco, CA.

It’s no secret that clinicians are inundated daily with alarms and alerts that interrupt their workflows and cause cognitive overload, contributing to the industry-wide problem of clinician burnout. The National Academy of Medicine (NAM) even declared clinician burnout to be an “epidemic,” citing improved usability and relevance of health IT as one of six goals focused on addressing our current healthcare crisis.

While medication alerts are only a portion of a comprehensive clinical decision support (CDS) system, they contribute significantly to clinician alert fatigue. Clinicians are presented with an abundance of low-specificity and interruptive medication alerts and may even overlook critical alerts while sorting through the noise. This contributes to physician burnout and likely compromises patient safety.

We need to do better.

The good news is that given the wealth of patient information now available in electronic health record (EHR) systems, low-value and non-specific medication alerts can become a thing of the past. Medication alerts displayed to clinicians today can be patient- and workflow-specific, resulting in greater relevancy and efficiency.

Health systems and hospitals should focus on replacing non-specific medication alerts with more targeted alerts based on information from the patient’s chart, while delivering these alerts at the most actionable points in the clinical workflow. This approach helps reduce clinicians’ alert burden and fatigue, increases efficiency, and results in better clinical decisions and patient outcomes.

Origins of Alert Fatigue

Drug-allergy and drug-drug interaction alerts were among the first types of CDS alerts introduced in the heyday of EHR implementations. They were required as part of the Centers for Medicare & Medicaid Services (CMS) EHR Incentive Program, commonly known as Meaningful Use, and remain part of the mandatory functionality in 2015 Certified Electronic Health Record Technology (CEHRT). But they can be made better.

The number of data sources and the amount of healthcare information flowing into EHR systems has increased exponentially since the original introduction of these systems in the 2000s. With the level of patient-specific data, clinical guidelines, research findings and other critical information now available, EHRs can and should deliver more relevant and targeted medication information.

Here is how we could flip the script on medication decision support to create greater specificity, reduce alert fatigue, and ultimately improve patient safety and outcomes.

1. Make Alerts More Meaningful and Actionable

Decision support alerts that rely on medication lists alone are helpful but often limited in the insight they offer clinicians. We can create more relevant prescribing guidance by factoring in not only standard demographic information, but also other patient-specific context, including lab values, genetic test results, patient care setting, clinical risk scores, and comorbidities.

Due to advances in diagnostics technology and in IT systems interoperability, this information is more easily accessible than ever, creating opportunities to support more precise guidance and better outcomes. A deeper dive into patient information can help clinicians evaluate risks for complications such as hyperkalemia or QT prolongation. It can also help quantify patient risk for issues such as opioid addiction and a whole host of adverse drug events.

2. Consider the Scenario

Building context around medication alerts should also include the clinical scenario. When a patient has just undergone heart surgery, for example, standard care guidelines typically recommend administering multiple medications post-surgery that would not normally be taken together. Although some of these medications may interact, which could be problematic in another context, these interactions can be monitored and managed in an acute care setting. In this case, surfacing standard interaction alerts would not increase patient safety but would create unnecessary noise.

3. Build it in the Workflow

In another study of CDS usage, one of the obstacles to clinician adoption cited was “disruption to workflow,” a common complaint about medication alerts. When evaluating drug risks, clinicians may need to search through the EHR or log in to a lab results portal to verify the information and to ensure that the alert is relevant. This slows them down and distracts from patient care.

Health systems should present relevant alerts with adequate supporting data when and where they are needed in the workflow. For example, when a patient’s potassium levels have reached a specific threshold due to an ongoing drug-drug combination therapy, the EHR should initiate an alert at the right point in the workflow when the issue can be best addressed.

This is not meant to say, however, that alerts presented at the point of ordering cannot be useful in some cases. For example, a general reminder to order a blood test to check potassium levels when ordering a certain drug therapy can be followed by a patient-specific alert later in the workflow to adjust the dosage once the lab results are returned.

4. Focus on Specificity

According to a recent study, clinicians are more likely to accept and act on CDS guidance when presented with patient-specific alerts based on EHR data.

Reducing quantity and repetition of alerts is also important, considering a recent study of clinicians found the likelihood of alert acceptance dropped by 30% for each additional reminder received per encounter. Reducing generic alerts and improving the patient specificity of the remaining alerts would go a long way toward improving the acceptance rate.

5. Optimize the CDS

Health systems should continually analyze how their clinicians are interacting with alerts and whether the alerts are doing more to protect patient safety or to distract providers. By reviewing the data generated during the medication ordering process, health systems can predict how clinicians will respond to specific alerts and strive to generate only those alerts that help clinicians make better decisions and ultimately protect patient safety.

Putting Patients First

The bottom line is that medication alerts do not need to go away, they need to get more specific. By taking a deeper dive into the relevant information about a specific patient, at the appropriate point in the clinician’s workflow, decision support can deliver more meaningful and actionable insights. If such a patient-specific approach were to be deployed across the industry, we could significantly reduce the cognitive burden that these systems place on clinicians while simultaneously improving medication-related patient safety.

HIStalk Interviews Andrew Smith, President, Impact Advisors

Andrew “Andy” Smith is president and co-founder of Impact Advisors of Naperville, IL.

Tell me about yourself and the company.

I’ve been in the healthcare IT field for 30 years. I started Impact Advisors with my brother 14 years ago.

How are CIOs spending their time and energy as the pandemic seems to be winding down?

This is not a unique thought, of course, but what an interesting year it has been. Needs evolved over the course of the year. At the beginning of the pandemic, basically all work stopped and CIOs were redirected into pandemic response, supporting their caregivers. There was a brief respite in the August timeframe, where everybody thought that the wave was over and they could get focused back on business as usual. The second wave hit, everything shut back down, and now over the last two months or so, it appears that the world is starting to open up a little bit. CIOs are focusing back on their agenda.

What’s interesting, though, is that when I talk to our CIO clients, they all remark similarly that the one thing they appreciated about the pandemic was that the pace changed and the expectations changed. Things that they thought were going to take three years took three months or three weeks. The common thought they have now is, how do we keep that kind of execution and pace going? Because now they are all a year behind on much of their agenda. I’ve seen a real uptick, in terms of interest, pace, and the agenda they are hoping to accomplish over the next year.

Did work of the CIO and IT departments gain internal respect as they were freed of the shackles of multi-year, multi-stakeholder projects and just told to quickly bring up technologies such as telehealth and chatbots under crisis conditions?

Yes, exactly. The consensus-building, governance, and bureaucracy that held back a lot of these technology advancements went by the wayside, and it became streamlined. They needed to stand up a telemedicine program overnight, and for most of our clients, their telemedicine programs increased by a hundredfold. That didn’t require an executive steering committee and three sub-levels of subcommittees to get there, which is typically how we make those decisions, for all the right reasons.

Much of the technology work is really just the point of the spear of huge change management efforts, and big change management takes consensus, time, and evolution. We didn’t have that liberty or that luxury, so we had to move quickly. The real question is, how do we balance those two ends of the continuum with this need for speed with a need for cultural change and adoption? That is going to be the interesting thing to watch.

Will they pick up existing budgets and priorities given that the pandemic overlapped fiscal years and the associated budgeting process?

That’s a really great question. I’m not sure I know that the answer to it, because we are figuring this out. Capital and operating budgets have been upended and redirected.

Again, I hope that we can move at a different pace. Many of our clients have had to lock themselves down. I’ve heard our clients say, “When it’s budget time, I can’t afford to miss a meeting. Otherwise, it could cost me millions of dollars of budget.” You hope we get into a new rapid cycle of opportunity identification, benefits analysis, and then move into execution very quickly.

I fear that we may fall back to the bureaucratic ways of old and the staid pace. But I hope that one of the outcomes of this pandemic is that we get comfortable moving quicker and reacting quicker and understand that the industry is moving at a different pace, and that we need to react to it with supporting technologies and change management.

How will the demand for consulting services change over the next couple of years?

We feel blessed in that respect, because we have a broad set of service offerings, and that starts with our advisory and strategy. We are working with our clients to solve a lot of these problems, where many companies have to react to the market and the client demand. It feels like we are trying to help figure this out alongside our clients, which is nice because that means we can develop our service lines, methodology, and tools in lockstep and even in advance of where we see the demand in the industry. We have evolved the company quite a bit over the last year in reaction to this, and we’ll continue to do that.

Are consumer-facing technologies getting executive and budgetary attention?

Yes. Digital health is one of our most active service lines right now, as you would fully suspect, and that would include telemedicine. This is going to become a competitive advantage or disadvantage, and our clients are all worried about it. When the pandemic hit and they had to rapidly stand up telemedicine programs, they did that with bubblegum and duct tape and tried to figure out how to make that work. They were using FaceTime, Zoom, and all sorts of different technologies to cobble together a solution. They have all been circling back to say, “OK, how do I create a standardized foundation for this?”

The technology isn’t that interesting, quite honestly, but it’s all of the foundational elements, the process elements, and the care delivery elements that are so different. The challenge our clients are going to have is that if you try to layer digital health on your existing inpatient ambulatory infrastructure, that’s not going to be a real recipe for success. You need to think about this in a disruptive way of how to connect with the consumer in the community and how to interact with them in a way that’s convenient for them. You almost have to build a separate infrastructure. You need to think about this with an entrepreneurial mindset. But all our clients are worried about it.

Who drives that process in health systems?

A really interesting question, and I know you have some perspectives on this because I’ve seen you interview others around the concept of a chief digital officer or a chief patient experience officer. It is not a singular person, most commonly. It’s not typically the CIO, although the CIO is a major component and evangelist for some of these technologies. It could be the chief marketing officer, or one of those newer types of “chief” titles like chief experience officer, chief digital officer, or chief transformation officer. The real concern about that is that if you bifurcate that from the CIO and the technology, you’ve got an opportunity to layer complexity or miss an opportunity to streamline these things, to make it easier for the consumer and the caregivers.

Will people from outside healthcare be brought in since other industries are ahead of ours with consumerism?

Yes. We have seen that as a growing trend. The concern about that is that we have seen many waves of people from outside of healthcare coming in to rescue us. They don’t have a keen awareness or understanding of the complexities.

It’s a very odd industry we serve, where the consumer may be disintermediated from the bill they are paying or the cost of the services they are consuming. Although this is changing, in a lot of respects, the caregiver isn’t always completely controlled by the delivery system. It’s just a very strange industry that we serve. It doesn’t follow regular economic laws. I get concerned that people come in and think they can solve healthcare with a lot of outside industry experience.

But contrary to that is that we have been subject to a lot of groupthink inside healthcare, with fixed mindsets and the idea that we can’t do things differently because of the way it was in the past. Instead of standing up digital health, we’ll build a new building. That’s very dangerous thinking, too. The answer is somewhere in the middle. You need to infuse a lot of new thinking and also understand the restrictions or the models that work inside healthcare.

When you said “build a new building,” my first thought was that a progressive health system would sell an existing building and use the money move services to where consumers are. Along those lines, considering the rise of digital health and virtual hospitals, who will set the direction that defines exactly what a health system looks like?

The healthcare system of the future will continue the evolution we’re on, which is that health systems are looking to manage the breadth that they provide, give a closed ecosystem, so that they can care for their communities. They’re going to look to contract in broader ways for the health of the population. Now we’ve been saying that for decades, but we’re going to be right one of these days. That makes too much sense that we’re going to get into these Kaiser or Mayo-like health systems that are going to be resplendent across the entire nation. That just makes too much sense for it not to be true. There’s always going to be a need for a physical footprint for high-acuity people. But more and more of the care is going to move outpatient, more and more of the care is going to move to the home, and more and more of the care is going to move to a virtual environment.

What I fear is going to happen is that the haves and the have-nots are going to continue to become more disparate. That’s going to be a real problem, in terms of health equity, rural care, and the underserved. That’s trend that we need to be careful about, because the haves are willing to invest and gain some efficiencies, and the have-nots aren’t getting reimbursed at the level they need to continue to invest and evolve.

While we were all setting up vaccination sites and figuring out telehealth, federal rules took effect that covered price transparency, information blocking, and ADT notification. Are hospitals ready to address those?

They are aware of it. We did quite a number of advisory projects last year just to make sure that our clients are prepared for it, so I know it’s on their radar screen. I know they are reacting to it. My suspicion is they’ll be able to thread the needle, but your broader point is absolutely accurate. A lot of things have been changing.

There’s been a lot of scrutiny on information sharing and that trend is going to absolutely continue. We need to continue to move to pure interoperability and data sharing for the benefit of the consumer.That’s going to require a lot of change from the vendor landscape and from the health systems. I’ve talked to a lot of health systems and we, as an industry, still view that relationship between the health system and the patient as parochial. We view our knowledge of that patient, that consumer, as a differentiator. That thinking is probably going to have to break down over time and we will have to differentiate in other components, such as efficiency, cost, safety, and quality.

What level of interest are you seeing in robotic process automation?

There is this new uptake of RPA, which looks a lot to me like the screen scraping technologies that we used to talk about 10 years or so ago, Those certainly have their place and can be effective, but they are somewhat brittle technologies. If any of the underlying systems change, it’s a labor intensive process to identify and mirror your systems to it. The next evolution of RPA needs to be more dependent on AI and machine learning to fulfill the promise of robotic process automation, not just serve as a veneer on top of a screen scraping technology with its benefits and limitations.

Do you have any final thoughts?

In the last year, we’ve been through a black swan event. There was this period of rapid change, much of it negative. But we need to work hard to preserve the positive elements of it — the speed of change, the adoption of consumerism, and digital health. It’s an exciting time to be in our industry. We are starting to fulfill the promise of these big, monolithic EMRs. We have installed these and now can start to turn this data into information. 

I’m excited about what the next 10 years are going to bring. We have an opportunity to pivot the healthcare delivery system, and I’m excited that we will be along for the journey.

Morning Headlines 4/7/21

AstraZeneca Announces Collaboration with Massachusetts General Hospital to Accelerate Digital Health Solutions

Massachusetts General Hospital will collaborate with drug manufacturer AstraZeneca to develop and validate digital health solutions using AstraZeneca’s Amaze disease management platform.

Critical Event Management (CEM) Provider Everbridge to Acquire xMatters

Public warning and vaccine distribution management vendor Everbridge acquires XMatters, a digital services management company, for $240 million.

Verizon Business Launches BlueJeans Telehealth for Better Connected Health

Verizon Business launches telehealth software for providers as part of its BlueJeans secure video conferencing service.

News 4/7/21

Top News

The Indian Health Service seeks help from industry stakeholders with drafting a strategic plan to guide its IT efforts over the next three to five years.

The agency is in the midst of upgrading its IT infrastructure. It will use $140 million of COVID relief funds to bolster its telemedicine and EHR systems.

Reader Comments

From Inchoate: “Re: Therapy Brands. Just acquired by KKR. It is the parent of TenEleven and 18 other behavioral health-focused companies.” Unverified. The 19 companies owned by Therapy Brands sell behavioral health EHRs and systems for practice management, data collection, and electronic prescribing. CEO Kimberly O’Loughlin, MS joined the company in February 2020 after serving as president of Greenway Health.

HIStalk Announcements and Requests

Someone tweeted — and then apparently deleted —that they were annoyed by meeting organizers who omit time zones in assuming “EST” (their term). If you’re going to get preachy about time zone assumptions, be aware that it’s “EDT” rather than “EST,” implied or otherwise, for nearly eight months of the year unless you’re in Arizona or Hawaii. My annual public service announcement for the time zone impaired — just write “ET” and those of us who have a handle on it will translate for you, which is much nicer for you than appearing to be incapable of basic communication. The most entertaining aspect of social media is when people try to show off how smart they are, but create the opposite result.

Webinars

April 21 (Wednesday) 1 ET. “Is Gig Work For You?” Sponsor: HIStalk. Presenter: Frank L. Poggio, retired health IT executive and active job search workshop presenter.  This workshop will cover both the advantages and disadvantages of being a gig worker. Attendees will learn how to how to decide if gig work is a good personal fit, find the right company, and protect themselves from unethical ones.

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

Acquisitions, Funding, Business, and Stock

Medical billing and patient communications startup Inbox Health raises $15 million in a Series A funding round.

Minnesota insurance and managed care startup Bright Health acquires Zipnosis, which offers telemedicine services to health systems.

People

Craig Miller, MBA (Culbert Healthcare Solutions) joins Newfire Global Partners as chief of staff.

PatientBond hires Todd Helmink (QliqSoft) as SVP of business development.

Brian Roy, MBA (HMS) joins ZeOmega as RVP of sales.

Announcements and Implementations

3M Health Information Systems announces GA of Social Determinants of Health Analytics, which enhances its Clinical Risk Groups with social risk intelligence from social risk analytics vendor Socially Determined.

Verizon Business launches telehealth software for providers as part of its BlueJeans secure video conferencing service.

A KLAS Arch Collaborative report finds that the manner in which health systems implement and support EHRs is a bigger driver of physician and nurse EHR perception than the vendor’s own delivery of functionality and support for quality care. It cites OrthoVirginia, whose efforts to improve the EHR experience of orthopedic physicians increased their “Epic is a high-quality EHR” opinion from 49% to 81% over three years.

Massachusetts General Hospital will collaborate with drug manufacturer AstraZeneca to develop and validate digital health solutions using AstraZeneca’s Amaze disease management platform, starting with heart failure and asthma management. Amaze, which was launched last month, is built on BrightInsight’s regulated digital health product development platform.

The HCI Group launches StrategyNxt, which delivers a customized digital strategy in 12 weeks for a fixed price of $250,000.

Government and Politics

ONC officials remind healthcare stakeholders that the Cures Act’s information blocking provision has taken effect. EHR transparency is also required as of Monday, in which providers are required to give patients all of the information stored in their EHR in electronic format, including provider notes of all types as well as imaging, lab, and pathology report narratives.

COVID-19

The number of American adults who have received at least one COVID-19 vaccine dose is up to 42%, while 76% of those 65 and over have been at least partially vaccinated.

A New York Times analysis finds that COVID-19 cases are increasing, deaths are decreasing (although as a lagging indicator), and eight of the top 10 metro areas with the highest new case count per 100K population are in Michigan. Michigan’s case count is approaching its all-time high, hospitalizations are moving toward record levels, and deaths have taken an upturn after a long decline.

California will fully reopen activities and businesses on June 15, as long as vaccine remains available and hospitalization rates remain low.

The White House announces that every US adult will be eligible to be vaccinated by April 19, eliminating individual state phases.

CDC finally confirms that “deep cleaning” businesses is pointless since infections are spread by air, recommending instead that employees wash their hands regularly and use hand sanitizer only when soap an water aren’t available. This is a significant change as businesses reopen their indoor services and many people are still phobic about getting COVID-19 from items they touch.

A new COVID-19 vaccine is being tested in Brazil, Mexico, Thailand, and Vietnam that stimulates more potent antibodies while also being cheaply manufactured using chicken eggs, same as flu vaccine. Phase 1 trials will be completed in July. The developer of the vaccine platform is structural biologist Jason McLellan, PhD of University of Texas at Austin, of whom a Gates Foundation officer says, “He should be proud of this huge thing he’s done for humanity.

Northwell Health will expand a program to place Amazon Echo Show two-way video devices in COVID-19 patient rooms to allow providers to communicate with them without using PPE. Physicians can initiate a conversation from their own device and patients can just start talking without pushing buttons using Alexa’s “drop in” option. Northwell said a year ago that it would add 4,000 of the devices to the 2,800 it had already deployed.

Other

A study of EHR usage at Yale-New Haven and MedStar Health systems finds that ambulatory physicians spend five hours on the EHR (Epic and Cerner, respectively) for every eight hours of scheduled clinical time, with 33% spent on documentation, 13% in inbox management, and 12% on orders. The authors warn that the use of system audit logs to compare the proposed seven EHR use metrics across vendors and provider organizations in a normalized manner will be challenging.

A former IT security support coordinator of Trillium Health pleads guilty to computer fraud, charged with using his administrative access to read employee emails and social media accounts. Trillium says it spent $150,000 to determine the extent of his hacking, also noting that his computer contained thousands of photos of employees, their credit cards, and their driver licenses. He could be sentenced to up to five years in prison and fined $250,000.

Sponsor Updates

• Elsevier adds MIPS measures validated by MDinteractive to its STATdx radiology diagnostic decision support solution.
• The Canisius Wilhelmina Ziekenhuis Hospital in the Netherlands goes live on Agfa HealthCare enterprise imaging.
• Premier signs an agreement with Ascom, giving its members special, pre-negotiated pricing and terms on the company’s nurse call systems.
• Vocera Chief Marketing Officer Kathy English is selected as a Hall of Femme honoree for 2021.
• Cerner publishes a new client achievement story, “Cancer center improves chemotherapy infusion efficiency after transition from paper records to EHR.”
• Change Healthcare wins a 2021 Cloud Computing Product of the Year Award from Cloud Computing Magazine for its Enterprise Imaging Network.

Blog Posts

• Healthcare 2.0: How to Compete in ‘The Patient Experience Economy’ (Avtex)
• Three ways to simplify denial management and achieve cleaner claims (Ability Network)
• Change Management & 5 Common-Sense Lessons Learned (Access)
• An Introduction to Direct Contracting, One of CMMI’s New Programs (CarePort)
• Health Literacy’s Effect on Adherence Throughout the Patient Journey (CoverMyMeds)
• Honoring All Our Doctors (EClinicalWorks)
• Q&A: Optimize reimbursements by submitting cleaner claims (Experian Health)

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