News 5/5/21

Top News

R1 RCM will acquire digital payment solutions provider VisitPay for $300 million in cash.

R1’s acquisitions over the last several years have included Cerner’s RevWorks business and SCI Solutions, which it purchased for $190 million.

R1 says the acquired capabilities will allow it to lead the healthcare payments market in price transparency, flexible payment options, tailored communications, and analytics.

Reader Comments

From PitViper: “Re: attrition. Are health tech companies experiencing it? What reasons are you hearing that staff are leaving?” I’ll let readers answer whether they see this as a trend.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor NTT Data. Plano, TX-based NTT Data Services is a digital business and IT services leader, the largest division of trusted global innovator NTT Data Corporation, a top 10 provider and part of the $109B NTT Group. With the company’s consultative approach, it leverages deep industry expertise and leading-edge technologies powered by AI, automation, and cloud to create practical and scalable solutions that contribute to society and help clients worldwide. The Healthcare division within NTT Data Services is committed to improving patient outcomes by connecting the healthcare ecosystem. A recognized leader in healthcare, the global team delivers one of the industry’s most robust and integrated portfolios, including consulting, integration, interoperability, applications, data intelligence and analytics, hybrid infrastructure, workplace, RPA, cybersecurity, and business process services to help organizations accelerate and sustain value throughout their digital journeys. Thanks to NTT Data for supporting HIStalk.

I found this NTT Data overview video on healthcare digital transformation on YouTube.

Reader Mike sent a generous donation from his COVID stimulus check to my Donors Choose project, which when paired with matching funds from my Anonymous Vendor Executive and other sources fully funded these teacher grant requests:

• Math materials from Ms. L’s elementary school class in Toppenish, WA.
• Acid rain test kits for Ms. H’s high school class in Cincinnati, OH.
• Multiplication flash cards for Ms. C’s elementary school class in Oklahoma City, OK.
• Biology and science resources for Ms. A’s high school class in Crewe, VA.
• Dinosaur learning activities for Ms. D’s special education class in New York, NY.
• Math games for Ms. V’s middle school class in Hosford, FL.
• Document camera for Ms. T’s first grade class in Buffalo, NY.
• Math games and books for summer learning kits for Ms. P’s third grade class in Tucson, AZ.
• Math manipulatives for Ms. T’s elementary school class of autism students of Staten Island, NY.
• 3D printing supplies for Mr. S’s second grade class in Cleveland, OH.
• A library of 13 read-aloud science books for Ms. H’s kindergarten class in Columbus, OH.
• Virtual whiteboards for Ms. S’s elementary school class in Indianapolis, IN.

Ms. V was among the majority of teachers who emailed their thanks almost immediately, explaining that her class has missed almost two years of in-person instruction due to Hurricane Michael and then the pandemic. She says, “Sending love and much appreciation for your support. We will start our summer program the first of June. These materials will go a long way towards helping our students recover academic loss due to Hurricane Michael, followed by the pandemic. Your support is a blessing for many. Thank you again!”

Webinars

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

Acquisitions, Funding, Business, and Stock

Clinical documentation software vendor Provation acquires IProcedure, which specializes in cloud-based anesthesia documentation and perioperative data management.

Headway, which matches patients with mental health therapists in 11 states for virtual or in-person sessions, raises $70 million in a Series B funding round that values the company at $750 million.

Employer health benefits manager Collective Health raises $280 million in a Series F funding round, valuing the company at $1.5 billion.

Berkshire Hathaway CEO Warren Buffett tells shareholders that Haven, the company’s joint employee-focused healthcare venture with Amazon and JP Morgan, failed due to its inability to overcome the challenges of working with so many different stakeholders on a problem that accounts for 17% of the country’s GDP. Buffett added that Berkshire Hathaway was able to identify inefficiencies and cost savings in its own healthcare pipeline, “so we got our money’s worth.”

Allscripts seeks to sublease 56,000 square feet of the nine-story building it occupies in Raleigh, NC for which it holds naming rights. The space is not needed since CarePort Health, which Allscripts sold to WellSky, won’t be returning employees to the building.

Sales

• Utah Navajo Health System will work with Emerge to consolidate its legacy EHR data with its Athenahealth system.
• St. Luke’s Health System (MO) selects automated operations software from Qventus to better manage patient throughput.
• Nexus Health Systems (TX), Grady Memorial Hospital (OK), and Duncan Regional Hospital (OK) select cloud hosting services for Meditech from Tegria companies Navin Haffty and Engage.

People

Moffitt Cancer Center (FL) hires Santosh Mohan, MMCI (Brigham and Women’s Hospital) as VP of digital.

Angie Stevens (Kaiser Permanente) joins Iron Bow Healthcare Solutions as chief strategy officer.

CereCore names Paul Fabrizio (NTT Data) and Mark Rowland (Nutanix) as regional sales VPs.

David Carr, RN (DeliverHealth) joins HC1 as executive director of high-value care.

Palantir Technologies hires William Kassler, MD, MPH, MS (IBM Watson Health) as its first US Government chief medical officer.

Ken Levitan, who was the CIO of Einstein Health Network from 2005-2015, is named president and CEO of that organization.

Announcements and Implementations

CEO Coalition — founded by Vocera Chairman and CEO Brent Lang and Chief Medical Officer Bridget Duffy, MD – develops a Declaration of Principles that has been signed by 10 health system CEOs who agree to principles that improve safety, well-being, and equity for healthcare workers.

A new KLAS report finds that non-US EHR activity was strong in 2020, with 135 net new deals and 23 migrations, although 30% less than in 2019. The biggest winners were Epic, Dedalus, InterSystems, and Cerner. Epic’s market share in Canada has grown from three hospitals in 2016 to 146 now, but migration to Meditech Expanse is becoming more common.

Government and Politics

The State of Connecticut launches a statewide HIE dubbed “Connie.” The exchange is the fifth such project attempted over the last 14 years, to the tune of nearly $40 million. Forty-four organizations, including Hartford HealthCare, Yale New Haven Health, and the Pro Health Physicians network, have already signed on.

COVID-19

Public health experts say that the US will probably never reach the COVID-19 herd immunity of 80% given the circulation of variants and vaccine hesitancy, but even smaller numbers will make coronavirus a manageable threat that hospitalizes and kills far fewer people. They also say that while herd immunity is a national target, disease transmission is local, and areas with lower vaccination numbers will see more spread. Meanwhile, President Biden says federal focus will shift away from mass vaccination centers to drugstores and mobile clinics in hoping to vaccinate 70% of American adults with at least their first dose by July 4.

The federal government says it will redirect COVID-19 vaccine supplies that are allocated to individual states who don’t order them to other states that want more. This variability in demand, often along political party lines, means that hospitals in low-vaccination areas will likely see a hard winter as COVID-19 infections selectively ramp back up.

FDA will reportedly authorize use of Pfizer’s COVID-19 vaccine in people aged 12-15 years as early as next week.

New York City will resume 24-hour subway service in two weeks and will also lift all capacity restrictions, including museums, concert halls, restaurants, and Broadway theaters.

Other

Scripps Health (CA) continues to recover from a weekend cyberattack – apparently ransomware that also infected its backup servers — that forced it to divert some critical care patients, postpone appointments, and take several systems offline.

A Wall Street Journal reports says that corporate benefits executives are being overwhelmed by richly funded digital health startups for which they are the target audience. Those prospects say that too many startups are offering redundant or overpriced services and urge the companies to consider merging with others or offer deals to stand out in the crowd.

Sponsor Updates

• Built In honors CarePort Head of Product Sara Radkiewicz with its 2021 Moxie Award.
• Cerner publishes a new client achievement, “North Kansas City Hospital leverages Cerner technology to expedite COVID-19 vaccine distribution.”
• A Kyruus survey finds that two-thirds of consumers think virtual care will play a role where they receive care, cost and convenience are the most common decision criteria, and 60% say their preferred method for scheduling COVID-19 vaccine appointments is online.
• Clinical Architecture releases a new episode of The Informonster Podcast, “mCODE, CodeX, and Accelerating Healthcare Innovation – Part 1.”
• The Cyber Pro Podcast features CloudWave CTO Matt Donahue.
• Modern Healthcare includes Optimum Healthcare IT on its list of largest IT consulting firms.
• KLAS rates Divurgent as a market leader for speed and matching of resources in its “April HIT Staffing 2021 Performance Report.”

Blog Posts

• Celebrating healthcare heroes During Nurses Month (Ability Network)
• How charge aggregation technology can help billing companies (AdvancedMD)
• Leeds Hospitals go live with Agfa HealthCare’s Enterprise Imaging to improve image sharing across Yorkshire (Agfa HealthCare)
• Protected: Conditions of Participation for Medicare and Medicaid Hospitals: CMS’ ‘Carrot and Stick’ Approach to Bolster Real-Time E-Notifications (Audacious Inquiry)
• Considerations for Multi-Site Research Collaboration Data Collection (Bluetree)
• Health IT Infrastructure: Tips for Ensuring a Strong Networking and Technology Foundation (CereCore)
• How Providers Can Support the Telehealth Needs of Patients in 2021 (CoverMyMeds)
• Adaptability: The Key to Healthcare Technology Planning (Dimensional Insight)
• Spanish Updates for Healow (EClinicalWorks)
• Leveraging comprehensive consumer data to improve healthcare collections (Experian Health)
• Mike Alkire: Three Objectives Guiding Me As I Step into the Role of Premier President and CEO (Premier)

Contacts

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

Morning Headlines 5/4/21

Well’s DoctorCare Expands Billing & Backoffice Services with Proposed Majority Stake Acquisition of Doctors Services Group

In Canada, Well Health Technologies will become a majority shareholder in billing and administrative services company Doctors Services Group.

After delays, CT launches its long-anticipated health information exchange

After several failed attempts over the last decade, the State of Connecticut finally launches a statewide HIE.

Payments firm Flywire makes U.S. IPO filing public

Healthcare, education, and travel payments technology company Flywire confirms its hope of a $3 billion valuation in its publicly disclosed IPO filing.

Curbside Consult with Dr. Jayne 5/3/21

HIMSS invited me to complete “a quick five-question survey” regarding attendance at HIMSS21. I’m no stranger to research around user and consumer needs, so I was curious what kinds of questions they would ask. The first question was “What are you most looking forward to at HIMSS21?” Choices included: attending world-class sessions, building new relationships, finding tech solutions, reuniting with colleagues, or other.

In the past, I’ve struggled with the quality of sessions. Part of that is due to HIMSS-related factors, including the long lead time between when the submissions are due and the actual conference. Presenters can’t show off the latest and greatest when they have to declare their intentions 10 months prior to the conference. We’ll have to see what that looks like this time since HIMSS20 was canceled and HIMSS21 was pushed back. To be honest, I haven’t paid much attention to the submission process or timeline because I wasn’t sure this year’s conference was even going to happen.

The second question was about professional goals, and to be sure, “getting material for everyone’s favorite healthcare IT blog and looking for sassy shoes” was not a choice. Maybe I should have selected the “other” block and done that as a write-in, but knowing HIMSS, there was probably tracking information attached and I wouldn’t want to give up my anonymity.

The options for this question included: attaining actionable education, building peer connections, developing my career, earning CE credits, experiencing innovation, finding new partnerships, job seeking, and problem solving. I’m not sure how well HIMSS21 will be able to deliver on some of these options given the relatively small number of exhibitors and the hybrid virtual / in-person format. Not to mention that many organizations are still under travel bans. A number of my favorite CMIOs aren’t going to be able to attend in-person for that reason. Most of the big exhibitors are staying home as well.

The third question was whether we’ve booked hotels yet, which I’ve done. I’ll be staying at one of the connected conference hotels so I can minimize my time outdoors in Las Vegas in August. I’m not fond of the heat even when people remind me “it’s a dry heat” and the best people watching in Las Vegas happens after the sun goes down, anyway. There are supposed to be sessions at Caesar’s which would involve a trip outside, so it may not help as much as I thought, but I’m playing the odds as most gamblers do.

The final question was “How can HIMSS staff make your conference experience exemplary?” At this point and specific to HIMSS21, I really don’t know. It’s going to be an interesting year and we just have to keep open minds. Thinking more broadly though, HIMSS needs to consider lowing the attendance costs for individual attendees. It’s a relatively pricey conference considering the minimal return on investment for those of us who aren’t attached to institutions that are footing the bill. Plus, as we all know, nearly all healthcare costs are ultimately passed on to the patient in one way or another, and it’s really difficult to justify attending at times.

I precepted a nursing student today, and due to a relatively slow urgent care day, she didn’t get a lot of clinical experience. She did learn how to work through an EHR downtime, though, and I was grateful that we weren’t completely slammed with patients when it crashed. Fortunately, this outage lasted less than half an hour and we still had access to our PACS, so we could keep seeing patients. It was nostalgic to pull out the paper script pad, though. She also learned a fair amount about healthcare finance, as one of my clinical assistants is working on a health administration certificate and wanted to pick my brain about operational structures at for-profit versus not-for-profit organizations.

Most people that fall into the student category tend to be younger and have had fewer interactions with the healthcare system. They have not experienced the sticker shock of receiving an out-of-network explanation of benefits statement for a hospitalization and may not have had the experience of receiving multiple bills from all the different vendors and clinicians involved in a diagnostic procedure. Most people go into healthcare fields because they want to help patients, and I think understanding the sausage-making that goes on behind the scenes is critical to their education. Understanding the costs of healthcare helps them appreciate why patients may not fill their prescriptions or make the specialist appointments that we recommend.

We also had a good conversation about health insurance and how most patients have their coverage tied to their employers, which is something most students who are still on their parents’ coverage or using student health services at their universities might not understand. She was surprised to learn that sometimes patients stay in jobs they don’t like strictly because of insurance benefits and not wanting to change because of the risk of having to change to new providers or a different care team just because their coverage changes. My state requires all high school graduates to take a personal finance class, and although the curriculum covers things like homeowners’ insurance and auto insurance, there’s not much discussion of healthcare expenses. Since I’ll have some free time after I finish up my last urgent care shift on Friday, maybe I should volunteer to teach a session on understanding health insurance, how to read an explanation of benefits statement, how medical billing works, and how to navigate referrals and prior authorizations. Failure to understand those elements can have an impact on your personal finances, indeed.

Back to thinking about educational conferences, my friends at West Virginia University are offering a seminar that seems like a much better use of limited conference dollars, focusing on point-of-care ultrasound. It’s being hosted at a resort that caters to whitewater rafting enthusiasts, and attendees can take advantage of the whitewater at the New River Gorge National Park. Having run this section of the river in 2019, I would rather be there than Las Vegas. See if you can spot me in the photo – I’m the one in the helmet.

What are your favorite conference locales? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews David Baiada, CEO, Bayada

David Baiada, MBA is CEO of Bayada Home Health Care of Moorestown, NJ.

Tell me about yourself and the company.

We are going on 50 years as a provider of home-based healthcare services. We are based in the Philadelphia area, in southern New Jersey. The business was started by my dad who, at the age of 27, was an aspiring social entrepreneur before the term really existed. Through mission-centered, people-oriented focus on culture, connectedness, and service, we have — little by little over a long period of time, almost entirely through organic growth — become one of the largest providers in the country, with about 30,000 employees across 24 states and eight countries.

Because of our scale in a quite fragmented industry and our diversity of services, we deliver eight different types of service, depending on where we are in the country or in the world. Our long-term orientation as an entrepreneurial, not-for-profit organization is focused on long-term sustainability and continued growth adaptation to the market. That makes us a little bit different in terms in the ways that we invest in and position ourselves to continue to make an impact in the communities we serve.

What is changing about home health and the involvement of health systems in it?

While the delivery of services in the home is clearly not a new phenomenon, the societal attention and perpetual reflection on safety and health at home has been clearly spotlighted over the last 12 to 14 months. Never has there been a time where literally every single American is staring at the TV every night thinking about, how do I stay safe and healthy in my house? 

That has created a bit of an awakening for the healthcare industry. Maybe we can deliver a high-quality service at scale at a lower cost in the place that people prefer, which is their living room or their home versus an institution, where appropriate. Maybe we can use technology to deliver certain types of services and interventions virtually or by video.

All of these things are not new. We’ve been working in the home for centuries. We have been delivering remote monitoring and virtual care for a decade or more. But the last 14 months clearly have created a bright spotlight on the power and opportunity that exists with the things that we can do in the home.

What impact did the pandemic have on the home care model and on your business?

The most important thing we saw is the validation that these amazing people — nurses, therapists, home health aides, and others who have chosen a profession to take care of people in the community — rose to the occasion. They are used to walking into the unknown, whether it’s COVID-19 or any other type of illness or environment. Clinicians that have chosen this profession rose to the occasion, and it was super inspiring to watch people, when appropriately prepared with PPE and clear protocol, walk into the unknown and navigate whatever was necessary to take care of people, whether it’s the thousands of COVID-positive patients that we took care of or the unknown of what was happening in that home related to risk and potential infection or otherwise.

The business implications were all over the map. The biggest implication is that volumes are up and down for different parts of the country with infection rates. That created, and continues to create, a wet blanket of ambiguity and unpredictability of what might happen tomorrow with protocol and infection risk. Then you compound that with the ambiguity, complexity, and unpredictability of what’s happening in their personal lives, with their kids and families, school, travel, and all these other factors. Ambiguity and unpredictability has been a major force, not just in our organization, but in our lives more broadly.

Does scale help you recruit and retain employees for the hard job of going into the homes of clients, especially given the reimbursement challenges?

We have dealt with cycles of shortages in different labor markets, whether it’s geographic or different types of workforce, for decades. We have now clearly entered a phase where the cycle is no longer a cycle, it’s a perpetual of supply shortage. The demand for our services — along with other macro factors like population, demographics ,and aging – has taken us into a cycle of permanent shortage for all types of in-home care delivery, nursing and home health aides in particular.

We are spending a lot of time, using our scale as you alluded to, to differentiate as an employer, to be more sophisticated in how we find people and how we create opportunity for them. We have a diverse, large organization with lots of different types of services, which creates lots of opportunities for people that are interested in doing new things, trying new settings, and picking up new skills. Our scale helps with that for sure.

But a lot of this is about figuring out how to create an environment in which people feel supported and engaged so that they stay. That really is a part of how we think about this challenge, which again is no longer a cycle. The demand for our services will continue to increasingly outstrip the supply of caregivers for decades, so this is the heart of the matter for us.

What services or technologies could help family members who unexpectedly take on the role of primary caregiver?

Virtual care and remote monitoring are a huge opportunity for family caregivers. It reduces the burden of having to get to a doctor’s appointment and creates the ability to monitor signs and symptoms proactively to avoid risk. There’s lots of incredible technology that is emerging and being adopted more quickly in sophisticated ways for both virtual care and remote monitoring. That’s a huge benefit to the family caregiver.

Another example is what I will bucket as care coordination and transparency tools. We have worked with, and continue to work with, a lot of partners to experiment around how to make it easier for family caregivers to understand what’s going on and why and the interaction of all these different silos in the healthcare system. Everything from scheduling of appointments to messaging with providers to history and medication reconciliation. There’s just so much to manage when you have a sick, at-risk, or vulnerable parent or loved one. If you have ever had to navigate the system, it’s really complex, and some of the technology and tools out there are trying to break down that complexity and simplify it for the family caregiver. I think they are making an impact.

What levels of integration, continuity of care, and accountability are you seeing between hospitals and home care organizations?

It has been emerging for a while, but in the past 18 months and certainly the last 12, the dialog in the health system boardroom around the strategic importance of home and community-based care delivery, the extension of the health system’s brand into the home, the seamlessness of the transition from acute to home — it’s moving way up the strategic priority list. You are seeing a lot of health systems say, we need to be really good at this. Some, to the extreme, are saying, we are going to start reducing inpatient beds over time.

All this is part of a broader shift, too. Payment could unfold over time where health systems are taking on an increasing percentage of the risk dollar, in which case when at risk for total cost of care, they are now properly incentivized to think creatively about how non-acute or less-expensive remote, virtual, and home-based care can help them create better experiences and better outcomes at a lower cost. We have a whole channel, a joint venture of structures with health systems that are designed specifically in this context. How do we jointly own home and then Bayada-managed home-based care delivery capabilities for a health system to give them instant access and continuous innovation around best-in-class, world-class, home-based care?

What new technologies are important to your business?

What I like about what’s happening in the market, and this spotlight on the importance of home-based care in the continuum in an increasing way, is that it is inviting a lot of capital and innovation to the challenges we face.

When we talk about challenges related to health system integration and extension of their capabilities into the home, one of the most fundamental challenges that health systems face — and it has an impact on Bayada as a home-based provider — is how a transition works. How do you coordinate someone’s transition from a hospital bed to their living room and all of the steps and coordination that happens along the way? They may have a stop at a skilled nursing facility. They may need new medications, but they have no transportation to get them. They may need coordination and conversations between multiple specialists.

All these things happen in silos. You are constantly repeating lots of different information to different people in the system. Platforms like Dina’s care-at-home platform and network are trying to create seamless transitional care, and that provides benefits to the patient and their family. They get empowered with an understanding of what’s happening. It has benefits to the health system that is trying to ensure that this person has a path home in a timely way. It has benefits to us as a home-based provider, because we then are empowered with historical information context before we enter the house, which helps us create a better service and keep them safe at home, which then ultimately creates a virtuous cycle because we’re avoiding unnecessary readmission and other types of further risk.

Dina is a great example of solving a complex but straightforward problem. When someone arrives at a hospital, how do you make sure that the transition out of the hospital back to home with any steps in between happens in a way that’s actually productive versus super frustrating?

What impact are you seeing from private equity’s increasing investment in healthcare, especially in home care, long-term care, and hospice care?

Our industry was, for a long time, a textbook definition for a cottage industry — highly fragmented, mostly local and small proprietor-owned or not-for-profit organizations. When sophisticated investment and capital comes into an industry, it usually increases the level of competition, which hopefully means that the services and the quality of services goes up for the patient, for the end user. It’s probably too early to tell about how that impact will play out, but in general it is drawing a lot of attention.

Also, third-party investors, financial sponsors like private equity firms, have a lot of relationships and a lot of credibility. The ability for them to put money to work to innovate, but then also put relationships to work to help ensure that those that control the funding and that control the future of healthcare delivery and regulation have adequate visibility and exposure to the power of home-based care. That’s a benefit. A rising tide raises all boats. This is a huge industry with a lot of people that are vulnerable and need a lot of help, and the more sophisticated, competitive innovation, the better.

What changes do you expect in home care over the next three to five years?

The percentage of healthcare services that can be and will be reimbursed and supported from a regulatory perspective to be delivered in the home will continue to increase meaningfully. That will be empowered by better capabilities from organizations like ours. Better technology that makes this delegation of services more palatable, which would include things like virtual care delivery and telemedicine, et cetera. Then ultimately it will be made possible by regulatory evolution and adequate reimbursement. Home care has been an underfunded segment of the system, and to empower scalability of some of this innovation that will enable increases in home-based care for the appropriate types of services, regulatory and reimbursement structures have to evolve, too.

Ultimately, the outcome is that a higher percentage of services will be delivered in the home than they are today, which ultimately is what’s right for the patients as their preferred setting with better outcomes and lower costs.

Morning Headlines 5/3/21

Miami-Based CareCloud Health, Inc. Agrees to Pay $3.8 Million to Resolve Allegations that it Paid Illegal Kickbacks

CareCloud will pay $3.8 million to settle a lawsuit that was brought by an employee whistleblower who said the company paid kickbacks to its users to gain referrals to boost its EHR sales.

Scripps Health targeted by cyberattack

A cyberattack over the weekend forces Scripps Health (CA) to divert some critical care patients, postpone appointments, and take its patient portal offline.

VA Explores Potential Future Emerging Technology-Centered Acquisitions

The VA posts a request for information for partnerships in a variety of innovative technologies that could be applied to areas that include emerging technology to transform clinical care delivery and advanced clinical decision support.

Ascension Technologies to lay off 651 out-of-state workers

Ascension Technologies will lay off 651 out-of-state IT employees between August 8, 2021 and December 10, 2021 as it outsources their jobs.

Monday Morning Update 5/3/21

Top News

Miami-based CareCloud will pay $3.8 million to settle a lawsuit that was brought by an employee whistleblower who said the company paid kickbacks to its users to gain referrals to boost its EHR sales.

The United States joined the suit, alleging that CareCloud’s Champions marketing referral program violated the False Claims Act and Anti-Kickback Statute by offering clients cash and credits to recommend its EHR to prospects. Those clients also signed agreements to not say anything negative about the company’s EHR.

The government says the company violated the False Claims Act because the kickback payments rendered false Meaningful Use and MIPS incentive payments.

Former CareCloud manager Ada de la Vega will receive $800,000 of the settlement as the filer of the qui tam lawsuit.

Publicly traded health IT software and revenue cycle management vendor MTBC acquired CareCloud for $40 million in January 2020, then renamed itself to CareCloud in March 2021.

HIStalk Announcements and Requests

Most poll respondents hold ownership or shares of a health IT-related company, most of those involving a present or former employer.

New poll to your right or here: Which information would you accurately provide to gain access to a vendor’s white paper? (multiple answers OK). I did a similar poll years ago and given that 75% of respondents said they would either leave immediately or enter phony info, I confirmed my suspicious that making prospects complete a bunch of fields to gain access to a white paper or webinar is a big mistake no matter what the marketing folks think.

Webinars

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

Acquisitions, Funding, Business, and Stock

Vocera announces Q1 results: revenue up 20%, adjusted EPS $0.09 versus –$0.14. VCRA shares are up 96% in the past 12 months versus the Dow’s 39% rise, valuing the company at $1.2 billion.

Spok announces Q1 results: revenue flat, EPS –$0.12 versus –$0.24. SPOK shares are unchanged in the past 12 months versus the Nasdaq’s 57% rise, valuing the company at $199 million.

From the Allscripts earnings call:

• The company sold one new Sunrise client in the quarter, Mercy Iowa City.
• President / CFO Rick Poulton says bringing in consultants a year ago to scale back company costs is paying off.
• The company expects to focus on cost in its core clinical and financial solutions, and even though it’s not a high-growth market, it expects to be a net winner.
• Allscripts expects new business to nearly exclusively involve cloud-based systems, as on-premise customers will probably move to cloud hosting in the next 18-24 months.
• CEO Paul Black says that Microsoft is getting into healthcare in a big way and customers will be interested in being able to implement cloud-based AI and voice capabilities more quickly as a result.
• Asked about drug companies buying EHR advertising based on the company’s Veradigm business, Black said that Practice Fusion taught Allscripts about what kinds of advertising and clinical decision support was OK or not OK. He added that it’s easier to push ads with Practice Fusion than the company’s other EHRs because it is cloud based, but overall a big part of buying Practice Fusion was learning more about selling drug company advertising. The company also says that it sees opportunities to create revenue from users of its personal health records. 

The Global X Telemedicine and Digital Health ETF is up 3.3% in the past month versus the Nasdaq’s 6.3% increase. It’s up 27% since its July 2020 inception, lagging the Nasdaq slightly.

People

Protenus hires Jay White (Blackboard) as VP of engineering.

Loyal names Rachelle Montano, MS, MBA, RD (Perficient) as VP of clinical strategy.

In England, NHS Digital names Simon Bolton (NHS Test and Trace) as interim CEO. He replaces Sarah Wilkinson, MBA, who will leave the role in June.

Government and Politics

The VA posts a request for information for partnerships in a variety of innovative technologies that could be applied to areas that include emerging technology to transform clinical care delivery advanced clinical decision support, clinical simulation training, and service transformation through design thinking.

CloseLoop.ai wins CMS’s Artificial Intelligence Health Outcomes Challenge, which includes a prize of up to $1 million. Geisinger finished second and will receive up to $230,000. The contest looked at AI solutions that can predict health outcomes for Medicare beneficiaries.

COVID-19

CDC reports that 56% of US adults have received at least one dose of COVID-19 vaccine and 40% are fully vaccinated.

India becomes the first country to exceed 400,000 new cases in a single day, also experiencing a 21% test positivity, full hospitals, and a vastly understated official daily death toll of 3,500 that will surely increase as a lagging indicator of widespread infection. President Biden joined several EU countries in restricting travel from India starting this week as experts worry about introduction of new coronavirus variants such as B1617.

Turkey goes into its first COVID-19 lockdown as its infection rates reach the highest in Europe, while Iran’s daily death toll hits highest-ever numbers. Brazil continues to record the world’s highest rate of COVID-19 deaths per million people. Global COVID-19 cases and deaths have risen for several straight weeks even as Western countries with high vaccination numbers trend down and begin a return to normal.

The federal government implements an easy way for people to find available COVID-19 vaccine – text a ZIP code to 438829 (“getvax” on the phone keyboard) and a list of locations is immediately returned. Vaccines.gov has also been relaunched to make finding COVID-19 vaccine easy.

Pfizer will ship COVID-19 vaccine to Canada starting this week from its Kalamazoo, MI plant, which also sends doses to Mexico. 

Other

Epic’s campus was running on 18 backup generators for a few hours Friday night a widespread, raccoon-caused power outage occurred on Madison’s west side.

In India, private hospital beds in Bangalore are being overbooked because of problems with the government’s software, forcing them to turn away patients who in some cases have died shortly after of critical medical problems.

Ascension Technologies files WARN act paperwork with the state of Missouri indicating that it will lay off 651 out-of-state IT employees between August 8, 2021 and December 10, 2021 as it outsources their jobs.

Sponsor Updates

• Experity publishes a new report, “The Effect of COVID-19 on Reimbursement in 2020.”
• Spok Go improves emergency department outcomes at TidalHealth.
• Mozzaz will integrate Jvion’s AI insights on modifiable clinical risk and social determinants of health into its virtual care platform.
• Krames takes home 34 Hermes Creative Awards.

Blog Posts

• Sharing Perspectives: Women in Tech at Nuance (Nuance)
• Let’s Make Connections, Not Assumptions (Netsmart)
• 3 Steps to Follow When Patients Don’t Pay Bills (PatientBond)
• PatientKeeper’s Mobile App Can Help Improve Patient Care and Interprofessional Collaboration (PatientKeeper)
• 3 Best Practices for Implementing Unified Patient Communication Platform (Pivot Point Consulting)
• Grab Your Healthcare by the Data, Part 1: Collecting Your Records (PMD)
• In Providers’ Words: What’s Working and What’s Not in Value-Based Care Today (Premier)
• Search Redox Engine Traffic for up to 45 Days (Redox)
• TelePsychiatry Rising to Meet Mental Health Surge (SOC Telemed)
• Spotlight: Health IPass Platform for 100% Mobile Patient Intake and Payment (Sphere)
• How EHRs Can Help Prescribers Talk Dollars and Sense with Patients (Surescripts)
• Musings from a PT Marketing Director: How to Create Campaigns that Actually Convert (WebPT)
• A 2021 Guide to Choosing a Patient Engagement Platform (Well Health)

Contacts

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

Weekender 4/30/21

Weekly News Recap

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

Best Reader Comments

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

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

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

Watercooler Talk Tidbits

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

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

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

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

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

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

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

In Case You Missed It

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

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 4/30/21

Vocera to Acquire PatientSafe Solutions

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

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

UK-based Halma acquires perinatal safety technology vendor PeriGen.

CVS Health launches $100 million venture fund

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

Privia Health Shares Pop On First Day Of Trading

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

News 4/30/21

Top News

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

Reader Comments

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

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

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

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

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

Webinars

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

Acquisitions, Funding, Business, and Stock

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

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

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

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

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

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

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

Sales

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

People

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

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

Announcements and Implementations

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

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

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

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

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

COVID-19

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

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

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

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

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

Other

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

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

Sponsor Updates

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

Blog Posts

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

Contacts

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

EPtalk by Dr. Jayne 4/29/21

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

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

Morning Headlines 4/29/21

Caresyntax Raises $100 Million to Make Surgery Smarter and Safer

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Morning Headlines 4/28/21

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

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

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

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

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

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

Leidos Partnership Delivers MHS GENESIS Health Record to 12 New States

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

News 4/28/21

Top News

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

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

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

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

Reader Comments

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

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

HIStalk Announcements and Requests

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

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

Webinars

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

Acquisitions, Funding, Business, and Stock

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

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

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

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

Sales

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

People

Crossings Healthcare Solutions promotes Marlon Ali, MD to CMIO.

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

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

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

Announcements and Implementations

Northern Maine Medical Center goes live on Cerner.

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

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

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

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

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

COVID-19

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

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

Other

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

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

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

Sponsor Updates

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

Blog Posts

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

Contacts

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

Morning Headlines 4/27/21

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

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

Queensland hospitals and aged care facilities crippled by cyber attack

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

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

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

Curbside Consult with Dr. Jayne 4/26/21

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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