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Dr. Jayne Goes to HIMSS Digital – Monday

August 10, 2021 Dr. Jayne No Comments

I decided to take full advantage of the HIMSS experience and slept in a little this morning, pretending I was on Pacific time to justify some extra lounging. I’ve asked my household to do some random door-slamming to simulate the hotel experience, but they were fairly quiet and there was no dinging of elevators or rattling of ice machines either. In honor of the “reduced attendee headcount” experience, they allowed me ready access to the coffee rather than having to stand in a queue, and fortunately my morning brew was complimentary with my already-paid room.

My registration experience was confined to having to log into the HIMSS Digital app since I hadn’t used it in 72 hours on my desktop PC. Once again it asked me for a validation code that it said would be delivered to my phone but never was, although it did finally arrive via email. I picked out of a couple of on-demand sessions for my morning education, but I had a bit of a client fire to put out, so I’ll have to make it to those later.

The lunch hour was rounded out with a meeting that was supposed to happen in person in Las Vegas but ended up being via phone since we both elected not to go to HIMSS. I definitely enjoyed being able to meet with her with a sandwich on my desk versus trying to fight to get a restaurant reservation as you usually do at HIMSS.

Finally, the main event arrived, the opening session, titled “The Year That Shook the World,” including Hal Wolf’s opening speech that was followed by the keynote with Patrick Dempsey. The first eight minutes of the session included some banter by the hosts about how great Digital HIMSS is and how many safety precautions they’re taking on the set, as well as some comments about attendee door prizes including a free HIMSS membership and a Starbucks gift card.

To be honest, I was a little tuned out because I don’t do well with silly banter, and the portion of the speech by Hal Wolf felt like a buzzword salad. He covered the rise of telehealth, the need to transform current care models to one focused on value-based care, and the instability of healthcare organizations’ financial positions. I can only hear about the intersection of people, process, and technology so many times, so it was a struggle not to multitask.

HIMSS also pushed its Accelerate platform that I can only describe as a cross between LinkedIn, Facebook, and other social media platforms that HIMSS thinks is “exciting” and “incredible” but most of us think is pretty “meh.” The hosts talked about how excited they were about the platform and how “I felt like it was built just for me.” More inane banter ensued, with attempts to also engage people on social media and intermittent check-ins with their social media wall display that they have on the set.

The “Visionary Keynote” from Patrick Dempsey was an approximately two-minute “tribute” wishing us a good conference and thanking healthcare providers for our service. He’s apparently onsite for a movie in Ireland and gave a salute with his teacup. The presentation segued back to more banter between the hosts and encouragement to “break social media” using the #HIMSS21 hashtag. To be honest, 28 minutes into the presentation, they pretty much lost me. I tried to get into the panel on “Lessons Learned and Forward Strategies for Virtual Care,” but it was basically a summary of what I’ve lived for the last year and a half as well as the projects I’m currently working on. I didn’t get a lot out of it, but felt like if you weren’t knee deep in virtual care, you might have found it more engaging.

Moving into the next segment on “Getting AI Right and Guaranteeing Equity,” I had to cringe when the host couldn’t pronounce John Halamka’s name correctly. I do love Dr. Halamka’s ability to talk about complex topics in a way to make it understandable. He gave a great example why you can’t create an AI model using EKGs in thousands of Scandinavian Lutherans and expect it to work properly in Spain. He likened using the nutrition label on foods to needing a label on our AI algorithms to show the economics, ethnicities, etc. that went into creating the algorithm. Definitely one of the more engaging segments of the afternoon.

I received a couple of vendor emails inviting me to booths at HIMSS21 if I would have been there. Cisco was one of them and also offered a complimentary code for HIMSS Digital, so I would have been pretty aggravated if I paid for it rather than attending as part of my rollover registration from 2020.

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Readers at the live conference have been keeping me posted on lines at check-in, reporting growing lines throughout the day. One hotel had 30 people in line at 10:30 a.m., with only three employees working the front desk. One reader reported elevators with six-plus unrelated people in them and only 50% masking. I can’t help but imagine that the frontline healthcare providers who decided to attend are losing their minds when confronted with those scenarios.

Other boots on the ground reports include that the food at the opening reception was “actually pretty good” but that there were no performers in show girl costumes this time around. I also heard that the subterranean area of the expo center is no more, and that the new exhibit hall layout “redefines social distance” with a 100-plus degree heat and half a day’s worth of steps to get there. Kudos to my intrepid correspondent for braving the melting sun to keep me posted.

I’m still waiting for shoe and fancy mask pictures, so please send them my way!

Email Dr. Jayne.

Dr. Jayne Goes to HIMSS Digital – Sunday

August 9, 2021 Dr. Jayne No Comments

As I prepared for what would have been my departure for Las Vegas, my inbox was filling with notes from vendors that they were cancelling their in-person presence at HIMSS21. Although this represents a financial loss for those vendors, it also makes a statement that they’ve considered that public health implications might be more important than exhibiting, so I salute them.

Other meetings scheduled for later in the year are beginning to cancel outright. The American Academy of Family Physicians announced Thursday that it’s postponing its annual Congress of Delegates meeting that was scheduled for Kansas City in September, citing “local spread of the delta variant of SARS-CoV-2” along with the fact that “AAFP cannot control the vaccination status of other guests and staff at the planned meeting site.” Travel restrictions from employers and academic institutions were also cited.

Also Thursday the Urgent Care Association canceled its 2021 Annual Convention slated for New Orleans in October. They noted that “In the past two weeks… COVID volumes in urgent care centers have doubled, tripled, and quadrupled.” They also mention that projections from the Louisiana Department of Health aren’t looking good for any improvement by October. I was supposed to attend conferences in September, October, and November, but none of them are looking promising at this point.

Also in my inbox was a confirmation from a hotel reservation that I canceled back in February, when I upgraded to a different hotel. I tried to cancel it online but it told me I would have a cancellation penalty to the credit card on file, so I called the hotel. They only showed the reservation that was previously cancelled and couldn’t find the “ghost” reservation even by searching my name as well as the confirmation code. We’ll have to see if any charges ensue. I called The Palazzo to cancel my actual reservation and after a 45-minute hold was able to do so. The agent kept telling me I’d see a refund on my card despite the published cancellation policy that would forfeit my first night’s already-charged guarantee, so I’m not holding my breath for a credit.

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I had been looking forward to seeing the FDB CDS Analytics solution from First Databank, who has elected not to exhibit. They still plan to launch the product as scheduled. It aims to help organizations monitor and customize clinical decision support (CDS). Understanding how users are handling (or ignoring) alerts is key to patient safety, as is finding the right balance of alerts that won’t overwhelm but will prevent the most serious harms. Most organizations don’t know if their CDS is effective, and the solution is designed to track CDS impact over time. It’s available in the Epic App Orchard and I’ll definitely be reaching out to FDB for a demo.

I finally spent some quality time looking at the HIMSS Digital schedule and making my plan for the week, which was pretty easy since most of my time was open. There is a mix of real-time and on-demand sessions, and even the real-time ones will be available on demand a couple of hours after their conclusion. That’s good for me, because I’m pretty sure I’m going to miss the Patrick Dempsey portion of the opening keynote due to a last-minute meeting request. As in all things consulting, the billable takes precedence over the entertaining. I also identified which sessions are available for continuing ed so I can log the appropriate hours, so I felt pretty prepared for the week.

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Shoe pictures have started arriving from my most dedicated readers, including these adorable snow globe slides from Kate Spade. They’re still available in my size, if anyone is curious. I’d like them even better if there was a resin model of a coronavirus particle in the heel, so I could fantasize about crushing it every time I take a step.

What are the best shoes you’ve seen at HIMSS21? How was the registration and badge pick-up process? Since I have to live vicariously this time around, leave a comment or email me.

Email Dr. Jayne.

From HIMSS 8/9/21

August 9, 2021 News 7 Comments

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My trip to Las Vegas was thankfully uneventful, with all plane passengers I saw masked up. Uber pricing was crazy at the Las Vegas airport, showing $45 to get to the Palazzo versus Lyft’s $21. I ended up taking a cab since the rate is fixed at $27, there was no waiting, and I could see the vehicle right in front of me before choosing. I pulled up Uber for other destinations from the hotel and it was always double Lyft’s rate, which reminded me why I always use Lyft in Las Vegas. It’s hot outside, but who goes outside  during a conference that is held in the desert at connected venues?

Pondering: why does HIMSS spend money to buy airport signs? Do Las Vegas visitors really register for the conference on a whim, or do registrants require reassurance that they are in the right city?

Masking within the Venetian area is maybe 75% at best, with lots of pulled-down masks and some folks who walked right by the “masking required” signs with no mask in evidence. Compliance was close to 100% in the HIMSS areas, which offers little comfort since you can’t avoid the casinos, hotel hallways, and restaurants full of the unmasked. Overall, I would say I have felt safe since leaving home, but I frequently wanted to commit mayhem on someone who clearly doesn’t care about being responsible around others or who defiantly ignores clearly posted policy.

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HIMSS21 check-in was painless, although signage wasn’t perfect (maybe because of the hotel and convention center not being purely dedicated to the conference) and some of the “ask me” information people didn’t seem to be fully informed when I posed questions. I can’t quite figure out how to get to the Caesar’s building for educational sessions, although it seems to involve passing through the exhibit hall that was closed today to get to a bridge that was also closed today. I’m not sure why prior HIMSS conferences in Las Vegas were all contained within the Sands-Venetian complex and now the much-smaller HIMSS21 requires walks or shuttles to the Wynn and Caesar’s Forum Conference Center (not to be confused with the Caesar’s hotel since they are not adjacent), but that has dampened my already-minimal enthusiasm for attending educational sessions. I’ll probably just stick to the exhibit hall and surrounding areas this week.

No badge holders were provided this time, just a clip-on lanyard that fits onto the paper badge. I’m not too sure about the integrity of these. Names are also not printed in large font, so it will be hard to recognize masked folks. It was weird walking the HIMSS21 hallways and not being able to recognize people since you can’t see their faces. I predict that chance encounters will be greatly reduced.

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I snuck into the exhibit hall when a security guard’s attention was diverted. It has the widest aisles and booth spacing that I have ever seen. The exhibitor count has dropped another 20 or so since Friday to 709. Setup was still in progress, so it’s hard to say whether the layout will be thankfully spacious or embarrassingly sparse. Unlike previous conferences, it was quiet instead of risking being run over by heavy equipment that was loading in booth components in a superhighway-like layout.

That was it for my HIMSS21 experience today since the opening keynote and reception didn’t interest me. My room at the Palazzo is excellent and a good deal at $229 and I had great and well-priced happy hour beer (the locally brewed Bonanza, which was outstanding) and oysters on the half shell at its Sugarcane restaurant. I’ll probably spend all of tomorrow in the exhibit hall, leaving my day fully planned except to come up with a dinner idea that hopefully doesn’t involve the mostly overpriced hotel restaurants that are like a food court for rubes who think celebrity chefs are actually in the kitchen cooking. I confess that my favorite Las Vegas restaurants from past conferences are Home Plate, Italian American Club, and the Village Pub at Ellis Island, so my preference is inexpensive, off the beaten track, and devoid of other HIMSS conference badge-wearers. It may be also that exhibitors provide enough snacks to tide me over anyway.


Reader Comments

From Excitable: “Re: HIMSS21. You seem jaded by the conference.” I think everyone who has attended more than a handful of HIMSS conferences would say that they aren’t all that enthused at the prospect of returning or assured of the ROI for showing up. Most of the bubbly folks who tweet out their barely-contained excitement about attending are lower-level employees who don’t have a lot of experience, and for them, I understand, but don’t share, the newbie thrill of travel expense reimbursement, mugging with others for group selfies, and vendor parties. The last thing I want to do at HIMSS is to sacrifice an entire evening just to get free vendor food and drinks or to huddle protectively with other rookies.


Webinars

On-Demand Webinars:

Key Differences: Value Based Care vs. Fee-For-Service.” Part 1 of a three-part series. Sponsor: Net Health. Presenters: Bill Winkenwerder, MD, chairman, CitiusTech; Josh Pickus, CEO, Net Health. Dr. Bill Winkenwerder, former assistant secretary of defense for health affairs for the US Department of Defense, shares his unique perspective on the future of value-based care (VBC) systems in the public sector and how VBC differs from fee-for-service models in the private sector. This Part 1 webinar covers which aspects of the fee-for-service health system payment model look the most different compared to fully value-based systems (clinical, back-office, analytics, etc.)

Current Innovation and Development in Value-Based Care.” Part 2 of a three-part series. Sponsor: Net Health. Presenters: Bill Winkenwerder, MD, chairman, CitiusTech; Josh Pickus, CEO, Net Health. Dr. Bill Winkenwerder, former assistant secretary of defense for health affairs for the US Department of Defense, shares his unique perspective on the future of value-based care (VBC) systems in the public sector and how VBC differs from fee-for-service models in the private sector. This Part 2 webinar discusses what health systems should know about the transition to value-based care, including macro versus micro shifts.

Future of Value-Based Care: Predictive Analytics, Technology, Policy.” Part 3 of a three-part series. Sponsor: Net Health. Presenters: Bill Winkenwerder, MD, chairman, CitiusTech; Josh Pickus, CEO, Net Health. Dr. Bill Winkenwerder, former assistant secretary of defense for health affairs for the US Department of Defense, shares his unique perspective on the future of value-based care (VBC) systems in the public sector and how VBC differs from fee-for-service models in the private sector. This Part 3 webinar discusses the role analytics will play in the shift to value-based care and how financial and clinical ROIs for analytics-oriented products must differ when applied to FFS and VBC models.

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


Sales

  • Mount Nittany Health (PA) chooses Health Catalyst’s population health solutions.

People

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Luis Saldana, MD, MBA (StarBridge Advisors) joins Zynx Health as VP of clinical strategy.


Announcements and Implementations

First Databank launches FDB CDS Analytics, which supports tracking of the effectiveness of clinical decision support.

Premier brands its benchmarking, analytics, reporting, and clinical technologies under the name PINC AI.

GE Healthcare will offer its imaging applications and Edison Health Services platform on Amazon Web Services.


Sponsor Updates

  • EClinicalWorks releases a new customer success video, “Healow Check-In and Healow Pay are Helping Chisholm Trail Pediatrics.”
  • CoverMyMeds expands its interoperable prescription decision support technology to clinical staff with MedCheck, its newest in-workflow solution.
  • AGS Health has achieved the Leaders and Star Performers category on the Everest Peak Matrix RCM Operations – Services Peak Matrix Assessment 2021.
  • Stratum Med will offer CareSignal’s Deviceless Remote Patient Monitoring technology to its alliance members.
  • OBIX Perinatal Data System, developed by Clinical Computer Systems, will exhibit at the AWHONN Indiana Section Conference August 20 in Fishers.
  • Dresner Advisory Services names Dimensional Insight an overall leader in business intelligence in its Industry Excellence Awards.

Blog Posts


Contacts

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

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Morning Headlines 8/10/21

August 9, 2021 Headlines No Comments

Premier Inc. Brands Technology and Services Platform “PINC AI™”

Premier groups its Performance Services business and benchmarking, analytics, reporting, and clinical technologies under the new PINC AI brand.

Founders of Heal Raise $3.8 Million for New Health Tech Start-Up: HeyRenee

Heal’s co-founders raise $3.8 million to launch HeyRenee, a digital healthcare platform designed to better coordinate care for the underserved, elderly, and those with chronic conditions.

HHS’ ‘Frequent and Significant Changes’ to COVID Data Reporting Left Hospitals Behind

A Government Accountability Office report points out that HHS hampered its collection of hospital capacity data during the initial phases of the pandemic by frequently changing reporting methods without consulting stakeholders.

Cricket Health Secures $83.5 Million Series B Funding Round Supported by Industry-Leading Clinical Outcomes

Tech-enabled kidney care company Cricket Health raises $83.5 million in a Series B funding round led by Valtruis, bringing its total raised to more than $120 million.

ASGN Incorporated Announces Acquisition of Enterprise Resource Performance, Inc.

Technology and professional services company ASGN acquires Enterprise Resource Performance, a health IT consulting firm that caters to organizations within the federal government.

Morning Headlines 8/9/21

August 8, 2021 Headlines No Comments

Allscripts Announces Second Quarter 2021 Results

Allscripts announces Q2 results: revenue up 1%, EPS $0.15 versus –$0.05; adding in its earnings call that quarterly revenue in the core clinical and financial segment was flat, while the Veradigm analytics business delivered double-digit gains that it expects to continue.

Introducing Cadence, A New Health Tech Company Redefining Remote Care for the Nation’s Largest Health Systems

Remote patient monitoring vendor Cadence launches with $41 million in funding and a deal to deliver remote care to 100,000 chronic patients of LifePoint Health.

Verifiable secures $17M for its API that manages healthcare provider information

Verifiable, which offers a provider credentialing, network enrollment, and onboarding platform that is accessible via APIs, raises $17 million in a Series A funding round.

Monday Morning Update 8/9/21

August 8, 2021 News 3 Comments

Top News

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From the Allscripts earnings call, following Q2 results that beat Wall Street expectations for revenue and earnings:

  • The company expects a Microsoft Azure-hosted version of Sunrise to drive new sales due to high availability, cybersecurity, and disaster recovery and business continuity capabilities.
  • Quarterly revenue in the core clinical and financial segment was flat, while the Veradigm analytics business delivered double-digit gains that it expects to continue.
  • The company booked a $5 million recovery in its Department of Justice settlement over Practice Fusion.
  • Allscripts is solving interoperability rule requirements by having a reseller agreement with CarePort, which it recently divested.
  • The company will potentially look for bolt-on acquisitions around Veradigm, probably smaller players since those assets are expensive.

HIStalk Announcements and Requests

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Most poll respondents would rather not have contact with a health system employee who has not been fully vaccinated against COVID-19. Some comment themes: (a) you shouldn’t be working in healthcare if you don’t believe in science or have judgment too poor to opt in for a lifesaving vaccine; (b) some people are not candidates for vaccination under current guidelines and you can’t blame them for not getting it; (c) the vaccine has not yet earned FDA’s full approval; and (d) it might be OK under urgent circumstances, if employees are required to be tested regularly as an alternative, or if the respondent-patient knows the person hasn’t been vaccinated and can put a mask on. My take – you won’t be able to tell which employees have been vaccinated if health systems don’t require it for all employees, so about all you could to is ask each employee directly (kind of like the “have you washed your hands” patient interrogation effort to reduce healthcare-associated infections), then hope they answer honestly and offer to send someone else in if you object.

New poll to your right or here: Healthcare providers: is your employer mandating COVID-19 vaccination? Use the poll’s comment function to elaborate further on what proof is required, whether a history of infection or antibody test can be substituted, or whether exceptions are allowed.

It’s been nearly two years since Northwell Health and Allscripts announced via press release that they would develop a new cloud-based, voice-enabled, AI-based EHR. How about an update that might also include whether the Avenel EHR, announced by Allscripts in early 2018, will ever see the light of day?


HIMSS21 Updates

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From Dateless and Desperate?: “Re: HIMSS21. Attached is the third email I’ve received from HIMSS trying to get me to accept free registration for the digital version of HIMSS21. They must be desperate to get the numbers up. I hope you don’t fly across the country only to find minimally staffed booths with third-tier employees who can’t find their ass with both hands.” Folks who paid $895 for HIMSS20, had their registration involuntarily rolled over to HIMSS21 when it was cancelled, and then decided not to attend HIMSS21 in person probably aren’t thrilled to know that HIMSS is just giving away registrations for the virtual version. HIMSS also charged some unknown number of folks $495 or more for that same, now-free registration.

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I also noticed that someone tweeted out the complimentary registration code, so HIMSS21 digital is now like Woodstock, where some suckers bought tickets, but most attendees just crashed the gate.

Some experts say that cloth masks alone aren’t protective enough against the delta variant in indoor gatherings, suggesting instead that people either use N95 masks instead or wear a surgical mask under the cloth one. That made me wonder what kinds of masks will be available from HIMSS and HIMSS21 exhibitors.

Epic’s UGM starts Sunday, August 22. I wonder how many more people might have attended HIMSS21 if it wasn’t so close to UGM?

I’m leaving for Las Vegas Monday morning. I’m not sure if I’ll do anything HIMSS-related on Monday since I find the opening reception to be dull, but I’ll post an update of what I see in general. Dr. Jayne will be covering the virtual conference. Both of us would appreciate hearing your impressions as attendees to avoid that “blind men describing an elephant” HIMSS conference problem. I’ll be as scathing as a Fyre Festival tweeter if I get there and feel duped by small crowds and low energy that I traveled into a COVID hotbed at my own expense to see.


Webinars

On-Demand Webinars:

Key Differences: Value Based Care vs. Fee-For-Service.” Part 1 of a three-part series. Sponsor: Net Health. Presenters: Bill Winkenwerder, MD, chairman, CitiusTech; Josh Pickus, CEO, Net Health. Dr. Bill Winkenwerder, former assistant secretary of defense for health affairs for the US Department of Defense, shares his unique perspective on the future of value-based care (VBC) systems in the public sector and how VBC differs from fee-for-service models in the private sector. This Part 1 webinar covers which aspects of the fee-for-service health system payment model look the most different compared to fully value-based systems (clinical, back-office, analytics, etc.)

Current Innovation and Development in Value-Based Care.” Part 2 of a three-part series. Sponsor: Net Health. Presenters: Bill Winkenwerder, MD, chairman, CitiusTech; Josh Pickus, CEO, Net Health. Dr. Bill Winkenwerder, former assistant secretary of defense for health affairs for the US Department of Defense, shares his unique perspective on the future of value-based care (VBC) systems in the public sector and how VBC differs from fee-for-service models in the private sector. This Part 2 webinar discusses what health systems should know about the transition to value-based care, including macro versus micro shifts.

Future of Value-Based Care: Predictive Analytics, Technology, Policy.” Part 3 of a three-part series. Sponsor: Net Health. Presenters: Bill Winkenwerder, MD, chairman, CitiusTech; Josh Pickus, CEO, Net Health. Dr. Bill Winkenwerder, former assistant secretary of defense for health affairs for the US Department of Defense, shares his unique perspective on the future of value-based care (VBC) systems in the public sector and how VBC differs from fee-for-service models in the private sector. This Part 3 webinar discusses the role analytics will play in the shift to value-based care and how financial and clinical ROIs for analytics-oriented products must differ when applied to FFS and VBC models.

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


Acquisitions, Funding, Business, and Stock

Remote patient monitoring vendor Cadence launches with $41 million in funding and a deal to deliver remote care to 100,000 chronic patients of LifePoint Health. Co-founder and CEO Chris Altchek previously co-founded a publishing company, while co-founder Kareem Zaki co-founded healthcare-related companies Scope Security, Nava, and Cedar.

Nuance announces Q3 results: revenue up 13%, EPS –$0.09 versus $0.06, beating revenue expectations but falling short on earnings. The company will not host an earnings call due to the expected closing of its acquisition by Microsoft by December 31.

OptimizeRx announces Q2 results: revenue up 55%, adjusted EPS $0.10 versus $0.02, beating analyst expectations for both. Shares are up 294% in the past 12 months versus the Nasdaq’s 34% gain, valuing the life sciences provider and patient messaging company at $1.2 billion.

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Verifiable, which offers a provider credentialing, network enrollment, and onboarding platform that is access via APIs, raises $17 million in a Series A funding round. Founder and CEO Nick Macario previously co-founded a blockchain-powered digital credentials service and a company that developed a remote work platform.


Announcements and Implementations

GoodRx will provide drug discount price information to prescribers using Surescripts Real-Time Prescription Benefit.

Cerner announces a new solution, Cerner Determinants of Health, which includes a dashboard and tools that are integrated with Millennium. Jvion will also integrate its SDOH and behavior health insights with Cerner’s products. 

HL7 posts SDOH Clinical Care for Multiple Domains v1.0.0.

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Microsoft renames its Azure API for FHIR to Azure Healthcare APIs. I was interested that the graphic above shows as one of its health data sources as “social influencers of health,” which sounds someone confused SDOH with a Kardashian Instagram, but I learned by Googling that it’s actually a common term.


COVID-19

US COVID-19 deaths have reached 616,000.

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Florida’s count of hospital-admitted COVID-19 patients hits a new high. Its seven-day rolling average of new deaths per day has increased from 22 one month ago to 88 now as its overall total breaks through 40,000. Test positivity rate is at 22%. As Eric Topol points out, Florida and Louisiana have the highest per-capita cases of COVID-19 of any state or country in the world except for Botswana. In Texas, Austin’s mayor warns that the situation is “dire” as 180 COVID-19 patients fill most available ICU beds, 102 of them on ventilators, and officials in several other cities deliver the same warning about COVID-19 cases creating staff and bed shortages and prolonged 911 response times. 

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This is an insightful tweet that notes yet another lack of actionable COVID-19 data.

The Sturgis Motorcycle Rally in South Dakota this weekend was expected to draw 700,000 mostly unmasked attendees whose infections will be hard to measure since they will develop symptoms, become hospitalized, or die only after returning home. Sturgis is in Meade County, which has just 37% of its residents fully vaccinated. Chicago’s Lollapalooza festival drew 385,000 attendees last week, but required proof of vaccination or a recent negative test.

A Florida radio personality who referred to COVID-19 as a “scamdemic,” urged followers to not be vaccinated, and railed against mask-wearing dies of COVID-19 at 65. He is among several recent COVID doubters whose deathbed message was to get vaccinated.


Other

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Dr. Jayne called out Mount Sinai Health System (NY) for handing out COVID-19 challenge coins to employees on the front line, which were issued with the thanks of President and CEO Kenneth Davis, MD. Understand that Dr. Davis is personally coin-ineligible, however, since he was not actually present on those front lines in those frantic March 2020 days of trash bag-wearing nurses, as he elected to hunker down for weeks in his Florida waterfront mansion. He says his doctor told him to stay in his six-bedroom, eight-bathroom spread because he’s over 70. Decisions, decisions — he chose that $2.6 million home instead of his $2 million Long Island one or his $7 million Aspen digs. He probably doesn’t need a phony coin anyway since Mount Sinai is his own mint — he made more than $12 million in 2017.


Sponsor Updates

  • Vocera customers from Baptist Health Hardin and Metro Health – University of Michigan Health will share their respective experiences with Vocera technology during HIMSS presentations next week.
  • Wolters Kluwer Health releases Lippincott Skills for Nursing Education, combining evidence-based content with digital learning tools.
  • EClinicalWorks releases a new video featuring Prisma, “Our Health Record Information Search Engine in Action.”
  • PatientBond attends the 2021 HealthTrust University Conference.
  • PatientKeeper co-founder Sally Butta shares “The Five Lifestyle Tweaks That Will Help Support People’s Journey Towards Better Wellbeing.”
  • Protenus CEO and co-founder Nick Culbertson wins EY’s Entrepreneur of the Year 2021 Mid-Atlantic Award Winner.
  • The Slice of Healthcare podcast features RxRevu founder and Chief Innovation Officer Carm Huntress.
  • Leading children’s hospitals use interactive technology from Sonifi Health to ease pediatric patients’ anxiety.
  • SymphonyRM debuts its new Hello Health Podcast, “Where to Start with Health Equity.”

Blog Posts


Contacts

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

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Weekender 8/6/21

August 6, 2021 Weekender 1 Comment

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Weekly News Recap

  • Healthgrades sells its doctor marketplace and renames the remaining enterprise software business to Mercury Healthcare.
  • Relatient raises $100 million and announces plans to merge with Radix Health.
  • HIMSS21 remains on track for its Monday start, although minus some exhibitors that have cancelled their attendance plans.
  • Allscripts announces Q2 results that beat Wall Street revenue and earnings expectations.
  • Change Healthcare’s Q1 results beat revenue estimates, but fall short on earnings.
  • Evolent Health will acquire Vital Decisions.
  • Clarify Health acquires Apervita’s value optimization business.
  • Renown Health gives a look at its new Transfer and Operations Center.
  • Cerner’s Q2 results exceed Wall Street’s revenue and earnings expectations.
  • Epic requires its Verona employees to be vaccinated against COVID-19 by October 1, with 97% of them already meeting that requirement.
  • WellSky will acquire Healthify.

Best Reader Comments

No doubt HIMSS will stay mum about cancelations, ultimately they’re just a trade organization maintaining their position against the likes of HLTH and whatever shiny new entity shows up to try and steal the healthcare IT crown. I’m more disappointed by the exhibitors like Salesforce, Philips, and Accenture, which clearly eliminated almost all of their LinkedIn posts promoting their booth and presentations but have yet to make a statement about their presence. (LongTimeFan)

OMG, [cyberattack vulnerabilities of] pneumatic tube systems! We got rid of the last of ours in the 1999-2000 era. They were already a relic by then and ours broke down or jammed constantly. Of course, I am reliably informed that the Internet is a Series of Tubes, so maybe the pneumatic tube systems just evolved into a higher plane of existence. (Brian Too)

Since it’s positioned as a “Transfer and Operations” hub, I’m not sure that they’re claiming it will improve clinical outcomes. Seems more like the goal is increased efficiency and probably reduce redundancy across different facilities. I think the patient outcomes in other countries is more likely to be tied to better access to primary and preventative care, rather than logistics technology or lack thereof. (KatieB)

I remember having a discussion [about privacy of minors] with a public health-type person, many years ago. The topic was youth, STDs, sexual health, and how the rights of the parents intersected with the rights of the youth. My concerns were information related and not service delivery. My assumption going in was, Age of Majority was everything. Well, was I given a jolt! It turned out that the topic was complex and effectively, the youth was granted various adult-type rights and protections in stages. Yet I also remember, I was not introduced to any specific policy or plan, enumerating exactly how that happened. Which left me scratching my head a little, to be honest. It sounded more like, a clinical judgment call was being made. Perhaps they were gauging how mentally and emotionally mature the youth was? (Brian Too)

I am working on a project surrounding Adolescent and Young Adult care transitions this summer! One major barrier for my project specifically is the organization’s interpretation of a minor’s ability to consent to the Terms and Conditions of the patient portal as an individual. This bars patients under the age of 18 from creating and managing their own patient portal account, so there is no ability to teach patients how to manage their own healthcare via a digital platform. This interpretation is compounded by limitations in the patient portal with hiding and showing information dynamically based on the clinical area, such as labs related to sexual or reproductive health or notes from child and family abuse visits. Re: discussing “Healthcare Adulting 101” at age 17, my research has found that introducing the concept as early as age 12 leads to best results, with discussions happening over time until the patient leaves the practice. (JustAnIntern)

Question on the Epic requirement – is anyone seeing hospitals require vaccination for third party vendors? If so, is it self-reported or are they requiring documentation? (HITGUY24)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. C in Illinois, who asked for books for her classroom library. She reported in December, “I would love to thank you again for your generosity! The students were so excited to receive brand new books to take home during remote learning. Our school is a Title 1 school, which means a high percentage of students (93.9%) are from economically disadvantaged families  — students in families receiving public aid, living in substitute care, or eligible to receive free or reduced-price lunches. Many lack access to books at home and few have a library card. My classroom library is typically a place that my students really enjoy; however, the pandemic has forced us into remote learning. Due to your generous donation I was able to send books home for the students to use! One of my students, Anthony has already read several of the books that were provided. He was so excited that there were multiple books from the same series so he could continue to read book after book. This project has helped to enrich my student’s experiences with the printed word. They are so excited that we can read books together on Zoom meetings and discuss what we have read. Believe it or not they are sick of technology and love the opportunity to have real books to read.”

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BBC covers “Munchausen by Internet,” where would-be influencers fake illnesses and one-up each other’s list of diagnoses, post their medical records and surgery photos, or share Apple Watch readings. A Reddit group does armchair investigations of their posts to look for inconsistencies, although that has sometimes devolved into posting home addresses and other personal information. The conclusion is that nobody can assume anything about a person’s health by looking at their social media.

COVID-overwhelmed employees of Arkansas hospitals are walking off the job in the middle of their shifts. Only 37% of the state’s residents are fully vaccinated and cases and hospitalizations are climbing steeply.

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Kaiser Health News looks at Detroit’s privatization of public health going back to the early 1900s. The city’s health department went from 700 employees in 2008 to five in 2012 as white flight, auto industry turmoil, and the recession eventually led Detroit to file bankruptcy in 2013. A state-funded non-profit ran health programs with little local accountability. The city’s former executive health director says, “There’s not that much money in making sure that babies have what they need to thrive. There’s not that much money in making sure that restaurants are up to code. If there was, private industry would hop to do it.” A private developer is turning the public health department’s former home, the Herman Kiefer complex (above), into space for auto and medical technology businesses as the city rebuilds the department – whose budget is paid for by federal and state taxpayers — while struggling to address COVID-19. The city’s COVID-19 vaccination is at 34%, its COVID death rate is double the national average, and pandemic response has stalled lead poisoning programs and less than half of the city’s children have been vaccinated against measles and mumps.

A San Diego TV station asks several hospitals that were called out by a patient advocacy group for not posting their prices as required by CMS why they failed to do so, with these answers:

  • Dignity Memorial Hospital – we are working to comply over the next several months, but meanwhile enhanced our online tool to estimate out-of-pocket costs for specific insurance plans.
  • Kaiser Permanente – we provided the shoppable services list, but as an integrated delivery system, our hospitals have only one rate, which is with our own health plan.
  • UCSD Health – we developed a patient-specific price estimator, but most of our contracts don’t involve set prices and instead use a percentage of gross charges or a not-to-exceed number, neither of which are supported by the CMS-required format.
  • Sharp HealthCare — we developed a patient-specific price estimator and consumers would be confused by commercially negotiated rates because costs vary by plan and coverage.

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Mattel honors healthcare workers by creating a #ThankYouHeroes set of six Barbie dolls that are sold at Target. Mattel will donate $5 from each sale to the First Responders Children’s Foundation. The US workers depicted are Las Vegas internist Audrey Cruz, MD and New York City ED nurse Amy O’Sullivan, RN.


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Morning Headlines 8/6/21

August 5, 2021 Headlines No Comments

Mercury Healthcare Launches as the New Brand for Healthgrades Enterprise Software, Technology and Data Analytics Company, Formerly Known as Healthgrades

Healthgrades splits its business, creating a software company that will be called Mercury Healthcare and selling its Healthgrades.com doctor marketplace media business to RV Health.

Relatient Merges with Radix Health to Extend its Lead in Patient Engagement & Access; Announces $100M+ Growth Investment

Patient engagement vendor Relatient announces a $100 million investment and plans to merge with Radix Health, which offers patient-provider matching, schedule optimization, referral automation, and patient self-service tools.

Real Time Medical Systems Secures $20 Million In Series C Funding

Real Time Medical Systems, which offers a collaboration platform to connect hospitals to post-acute care partners, raises $20 million in a Series C funding round.

News 8/6/21

August 5, 2021 News 10 Comments

Top News

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Healthgrades splits its business, creating a software company that will be called Mercury Healthcare and selling its Healthgrades.com doctor marketplace media business to RV Health, which owns websites such as CNET, Healthline Media, and The Points Guy.


Reader Comments

From Doctor CIO: “Re: HIMSS21. Maybe this is the safest time to visit Las Vegas since the HIMSS is requiring vaccination and masks. Unless you will isolate at home, the HIMSS floor might be the safest places you can see people.” I agree, although the downside is that the conference hotels will be teeming with people of unknown vaccination status outside the HIMSS21 velvet ropes, airports are crowded and still iffy, the multiple HIMSS21 venues require walking among the general public, and always-risky restaurants are mandatory unless you can live on room service. Las Vegas case counts are out of control, so while I will feel comfortable in the HIMSS21 areas  — trying not to think about the possibility that attendees faked their vaccination cards or that my antibody response to the vaccine may not have been robust or long-lasting – the rest of Las Vegas is a Petri dish. While I’ll probably still go even as I constantly reconsider my options, the key issue is whether a stripped-down conference is worth attending given that we’ll be doing it again in six months (or not, depending on viral whims). I think I’m a go unless a bunch of big companies announce their non-participation Friday, which isn’t likely at this point.

From Uh Oh: “Re: HIMSS21. My company pulled out. A former colleague says his company is going, but employees aren’t allowed to leave their rooms all week except to go to the show floor. They will be allowed to eat only in the booth or in a reserved hospitality suite.” I’m fascinated that some companies have said publicly that they are sending only a skeleton crew of junior folks and leaving the executives safely at home.

From Utility Outfielder: “Re: HIMSS21. I keep hearing that more vendors are pulling out. Some that I know have done so still show up on the floor plan. I don’t think the floor plan can be considered accurate.” I don’t know that I would assume that the floor plan is being promptly updated with cancelled exhibitors, if for no other reason than it isn’t in the best interest of HIMSS to fuel a rush for the doors like last year. Still, it seems to mostly align with announced cancellations, although not all cancellations will be announced.

From Scrivener: “Re: health IT media consolidation. HIStalk will eventually be the only independent media outlet left.” TechTarget acquires Xtelligent Healthcare Media, expressing ambition to serve advertising “customers” using “intent data productization” (readers are apparently incidental widgets in this process). I can’t say I’ve ever read any of their 10 sites, but good for them for being acquired.


HIStalk Announcements and Requests

I’m just now considering what it will be like to attend an all-masked conference, which is much weirder than just masking up for a grocery store full of strangers. A lot of memorable conference experiences involve random across-the-hall eye contact with someone you know, where you recognize the face, wait for confirmatory matching eyebrow-lifts and smiles, and then launch an unplanned catch-up conversation. We will only be seeing printed names on badges this year, so let’s hope the font is large enough for that same across-the-hall identification.

HIMSS has long said that the digital version of HIMSS21 will be entirely separate in content from the live conference, but it is now waffling by deciding to stream some sessions live using its new Accelerate platform and offer others for next-day playback.

Las Vegas weather: cooling off a bit from Thursday’s high of 112 this weekend to around 106 each day and “plenty of sunshine.”

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Early in my interview with Carrie Kozlowski of Upfront Health this week, she casually mentioned, as captured by my recording of the call, “I should preface this, and this may be a first for you, I am presently trapped in an elevator, so they may release me at some point during our call.” Many folks, especially claustrophobes, would skip the call to reschedule once freed, but she soldiered through in what was indeed a first for me. I once did an interview with the CEO of a publicly traded company from a Mexican restaurant due to poor timing on my part, where I joked about the Mariachi music playing in the background, asked my first question just as the food arrived, and then muted the phone so I could crunch chips during their answer. I did another having forgotten about it until the call started, making up questions on the fly with zero preparation and conducting the conversation from the car.


HIMSS21 Exhibitor Updates

Exhibitors that have publicly stated that they won’t attend or that have been removed from the exhibitor list:

  • Ambra Health
  • Athenahealth
  • Clearsense
  • First Databank
  • Imprivata
  • InterSystems (not pulling out, but reducing its show floor presence)
  • Medicomp
  • Nuance
  • Olive
  • Premier
  • Qliqsoft
  • Tegria
  • TeraRecon

Exhibitors that readers say aren’t going, but that haven’t confirmed that I’ve seen:

  • Accenture
  • Amazon Web Services
  • Definitive Healthcare
  • Philips
  • Salesforce

Webinars

On-Demand Webinars:

Key Differences: Value Based Care vs. Fee-For-Service.” Part 1 of a three-part series. Sponsor: Net Health. Presenters: Bill Winkenwerder, MD, chairman, CitiusTech; Josh Pickus, CEO, Net Health. Dr. Bill Winkenwerder, former assistant secretary of defense for health affairs for the US Department of Defense, shares his unique perspective on the future of value-based care (VBC) systems in the public sector and how VBC differs from fee-for-service models in the private sector. This Part 1 webinar covers which aspects of the fee-for-service health system payment model look the most different compared to fully value-based systems (clinical, back-office, analytics, etc.)

Current Innovation and Development in Value-Based Care.” Part 2 of a three-part series. Sponsor: Net Health. Presenters: Bill Winkenwerder, MD, chairman, CitiusTech; Josh Pickus, CEO, Net Health. Dr. Bill Winkenwerder, former assistant secretary of defense for health affairs for the US Department of Defense, shares his unique perspective on the future of value-based care (VBC) systems in the public sector and how VBC differs from fee-for-service models in the private sector. This Part 2 webinar discusses what health systems should know about the transition to value-based care, including macro versus micro shifts.

Future of Value-Based Care: Predictive Analytics, Technology, Policy.” Part 3 of a three-part series. Sponsor: Net Health. Presenters: Bill Winkenwerder, MD, chairman, CitiusTech; Josh Pickus, CEO, Net Health. Dr. Bill Winkenwerder, former assistant secretary of defense for health affairs for the US Department of Defense, shares his unique perspective on the future of value-based care (VBC) systems in the public sector and how VBC differs from fee-for-service models in the private sector. This Part 3 webinar discusses the role analytics will play in the shift to value-based care and how financial and clinical ROIs for analytics-oriented products must differ when applied to FFS and VBC models.

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


Acquisitions, Funding, Business, and Stock

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Allscripts announces Q2 results: revenue up 1%, EPS $0.15 versus –$0.05.

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Clinical decision support vendor EvidenceCare acquires Healthcare Value Analytics, which developed the ValueBar cost transparency tool that lets physicians know the cost impact of their clinical decisions. Both companies are based in Nashville.

Care management software vendor Evolent Health will acquire Vital Decisions, which helps patients with cancer and heart disease and their providers align treatment goals, for up to $130 million.

Healthcare analytics vendor Clarify Health acquires Apervita’s value optimization business.

Change Healthcare announces Q1 results: revenue up 25%, adjusted EPS $0.41 versus $0.25, beating Wall Street revenue expectations but falling short on earnings. Meanwhile, anonymous sources report that the Department of Justice may sue to block the $8 billion cash acquisition of the company by UnitedHealth Group’s OptumInsight, which was announced in January.

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JPMorgan recovers from its Haven healthcare cost management failure by investing $50 million in Vera Whole Health, which offers primary care services to employers on a per-patient, per-month basis. Vera has primary care centers in 10 states and also partners with Central Ohio Primary Care. The care model is not unusual for Medicare programs, but hasn’t been tried at scale with employers.

Real Time Medical Systems, which offers a collaboration platform to connect hospitals to post-acute care partners, raises $20 million in a Series C funding round.


People

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Pharmacy benefits technology vendor Truveris promotes Nanette Oddo to president and CEO.

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Autonomous medical coding technology vendor Nym Health hires Melisa Tucker, MBA (Flatiron Health) as SVP and head of product.

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Industry longtimer Merrie Wallace, MSN (FairWarning) joins interpretation platform vendor Boostlingo as chief revenue officer.

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Health Data Movers hires Patrick McDermott, MBA (Pivot Point Consulting, a Vaco Company) as business development executive.


Announcements and Implementations

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Medicomp launches Quippe Nursing, which allows nurses to quickly complete care documentation and planning using clinical data filtering and links to Clinical Care Classification terminology.

CoverMyMeds announces Med Check, a clinician version of its real-time prescription benefit solution that displays a patient’s previous meds, drug interactions, cash pricing, formulary alternatives, and prior authorization requirements.

Imprivata launches Enterprise Password AutoFill, which allow users to use a proximity badge tap to enter their username and password.

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Providence-owned Tegria and Cedar will offer their revenue cycle management services and financial engagement platform, respectively, to each other’s customers. Providence will implement Cedar’s post-visit patient engagement and payment platform. Cedar co-founder and CEO Florian Otto, MD, DDS, PhD was formerly sales VP for ZocDoc and founder of Groupon Brazil.

NTT Data announces a global Health and Wellbeing initiative that focused on closing care gaps in underserved communities and using technology to improve health outcomes.

Change Healthcare announces beta testing of a cloud-native solution for medical imaging in radiology practices. The company will consolidate its cloud-native enterprise imaging solutions under the name Change Healthcare Stratus Imaging.


Government and Politics

The US again ranks last among high-income countries in access to healthcare, equity, and outcomes. It’s also the only one of the 11 countries that does not have universal health insurance. The US finished last in administrative efficiency because of the time patients and providers have to spend filing medical paperwork and arguing with insurance companies.

CMS will use AI to infer a Medicare patient’s race based on their name, ZIP code, and language preference in cases where their race is not available on hospital forms. The de-identified data will be shared with hospitals for reducing inequity, but privacy advocates warn that the algorithm could unintentionally amplify the biases of its developers.


COVID-19

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US COVID-19 hospitalizations are trending sharply up and now exceed last year’s peaks in the first two COVID waves, although still falling short of January’s high. Florida has more patients hospitalized with COVID-19 that at any time in the pandemic, with Louisiana and Arkansas not far behind. Meanwhile, Florida hospitals are struggling to obtain oxygen as COVID-19 cases increase and the expiration of the public health emergency limits the supply of truck drivers who are qualified to transport oxygen.

Demand for COVID-19 tests is delaying results reporting and lengthening waiting lines once again. The positivity rate is above 9% versus June’s 2% low.

Former FDA Commissioner Scott Gottlieb, MD notes that CDC’s reporting of breakthrough case hospitalizations and death cover only January through June and thus misses much of what has happened with the delta variant, which he notes reflects CDC’s lack of near-time reporting capability for questions that require analytical methods.

Leana Wen, MD, MSc, MA says in a Washington Post op-ed piece that CDC seemed to be blaming vaccinated people for the need to wear masks again, but unvaccinated people are responsible for most of the spread and risk. She says CDC’s message should have been (a) that vaccinated parents of unvaccinated children need to wear masks indoors in public areas to avoid passing infection to their kids due to the more readily spread delta variant; and (b) the only reason to mandate that everyone wear masks indoors is because unvaccinated people can’t otherwise be trusted to wear them.

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New York will extend its Excelsior Pass COVID-19 vaccine verification to create Excelsior Pass Plus, which will interoperate with the SMART Health Cards Framework that was developed by the VCI consortium. The framework has been adopted by several states (including California), Walmart, Apple, Epic, and Cerner. VCI’s steering group includes Mayo Clinic, Mitre Corporation, Microsoft, The Commons Project Foundation, Evernorth, CARIN Alliance, UC San Diego Health, and Apple.

The drummer of the band Offspring is kicked out when he refuses to receive COVID-19 vaccine because of a history of Guillain-Barré Syndrome. Among those arranging his dismissal is molecular biologist Dexter Holland, PhD, who performed research on the molecular dynamics of HIV and who is also the band’s lead singer.


Other

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In Thailand, police arrest the director of a state-run hospital in a sting operation that was triggered by a vendor’s complaint that the director was demanding a 35% commission of the company’s $8,500 bid to install a computer system. The accused director admits that he asked for the money and accepted the marked bills, but says he planned to use it for the hospital. He has faced similar complaints in the past.

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I enjoy the LinkedIn updates of industry long-timer Steve Hau, who posted photos of new Ukraine-based team members of his Newfire Global Partners. I like seeing health IT workplace pictures.


Sponsor Updates

  • 3M Health Information Systems will offer Waystar’s revenue capture solutions to its customers.
  • Halo Health publishes a new case study, “Improving HIPAA-Compliant Communication for Accredited Home Care.”
  • Twistle publishes a case study from Ashley Clinic (KS), which saw 80% of patients achieve an average BP of 140/90 after completing a 14-day or 28-day cycle of the company’s Controlling Blood Pressure Pathway.
  • NTT Data launches a health and wellbeing initiative, and publishes a new white paper, “Improving the Health of Me.”

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 8/5/21

August 5, 2021 Dr. Jayne No Comments

A federal judge denies Elizabeth Holmes’ request to suppress patient complaints and Theranos testing results as evidence during her trial. Attorneys argued that the failure to preserve the laboratory information system database should allow the exclusion. Theranos is accused of decommissioning the database and giving investigators an invalid copy. Jury selection begins August 31 for what is sure to be an entertaining trial.

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I see a lot of error messages, but this was one of my favorites. Not even a cookie, just a crumb.

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The US Department of Health and Human Services announces the availability of $103 million in funding from the American Rescue Plan to reduce burnout and improve mental health among healthcare workers. The funding will be available over a three-year period and is targeted to consider the needs of rural and medically underserved communities. It plans to “help health care organizations establish a culture of wellness among the health and public safety workforce and will support training efforts that build resiliency for those at the beginning of their health careers.”

I take issue with the whole idea of needing to “build resilience” among healthcare workers. We are plenty resilient to begin with, but the systems that surround us have failed patients and have failed us. Telling us we need to be more resilient is not the answer – that’s a “blame the victim” strategy implying we’re somehow not “enough” for the situations we are in. Let’s fund efforts to reduce abuses in healthcare, improve caregiver-to-patient ratios, reduce or eliminate nonsense regulations and requirements that make it harder to do our jobs, and adequately fund public health and health literacy efforts in the US. Those types of transformation will really put a smile on our resilient little faces.

Feel-good story of the week: A WWII vet celebrates her 100th birthday with a helicopter tour around a ship named after her late husband. Ima Black was part of the Women Accepted for Volunteer Emergency Service (WAVES) program during World War II and for 50 years was married to Delbert D. Black, who after surviving Pearl Harbor went on to become the highest-ranking enlisted sailor in the Navy. The Navy named a destroyer after him and a Florida helicopter crew flew her not only around the ship, but showed her downtown Jacksonville to boot.

Less than feel-good story of the week: The Journal of the American Medical Association publishes an op ed piece regarding “The Increasing Role of Physician Practices as Bill Collectors: Destined for Failure.” Shifting of costs from insurance companies to “patient responsible” balances has led physicians to manage a growing share of the payment portfolio. Patients are responsible for deductibles, co-pays, and co-insurance, all of which can be confusing, not only from a healthcare literacy perspective, but from a financial literacy perspective as well. Physicians struggle with collecting these amounts due, which drives a spiral where they request higher reimbursements, which increases charges, and the cycle starts again.

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I made the difficult decision this week to cancel my trip to HIMSS21. Clark County, NV is being hit hard, with 89% of ICU beds in use. Although I’m vaccinated and at low risk for complications of COVID, my analysis had the risks outweighing the benefits. I’ve been seeing a significant number of breakthrough COVID cases in fully vaccinated (and otherwise healthy) individuals, and it’s not clear whether it’s the remoteness of the vaccine versus the properties of the now-prevalent delta variant that is responsible. One of my favorite people was just diagnosed today and I hope he recovers quickly. It doesn’t seem prudent as a healthcare provider to potentially take myself offline for patient care by attending a large event regardless of the mitigation strategies. Not to mention that masking in airports and on planes is far less than universal.

The county’s hospitalization numbers mean that the Las Vegas area is not equipped to respond to any kind of mass casualty event like it has unfortunately seen in the past. I would be pretty angry if a convention rolled into my similarly sized metropolitan area right now regardless of the economic benefit. My own personal ROI was also a factor – my client meetings have been canceled and I suspect even those exhibitors that are still attending will send skeleton crews, so it wouldn’t be productive from a business standpoint. At this point I can reuse my airfare (thanks Southwest!) while attending digitally and am only out my first nights’ hotel charge. I guess I’m also out of pocket for the sassy shoes I purchased for the Mothers in Medicine Fund reception that was wisely canceled due to public health concerns. I’ll wear them around the house Tuesday night and think about the hard-working healthcare moms the Fund is trying to assist.

I went ahead and tried to queue up my HIMSS Digital account, which requires that you submit your name and email address to receive a validation code by text and email. I never got the text and the code in the email didn’t work, so I had to go through the process again. Second time was a charm, although I was annoyed by the process and moved on to other things. I’ll have to spend some quality time with the agenda tomorrow, deciding on my sessions and dropping the Patrick Dempsey keynote onto my schedule. It still won’t be the same as seeing everyone at HIMSS, so I’m looking forward to hopefully a more “normal” HIMSS22.

On the positive side, since I won’t be out of town, I will be here for our local school board meeting where I plan to go toe-to-toe with anti-vaccination and anti-masking advocates. Our hospital admissions rates look just like they did last October so I’m supportive of anything we can do to try to crush this surge. The hospital teams are completely burned out and there are no travel nurses or reinforcements on the horizon. It’s going to be a bumpy end to the summer, for sure.

For those of you attending HIMSS21 in person, I wish you a safe and uneventful conference. Hopefully everything will be low key and you’ll be able to accomplish what you set out to do by attending. Please feel free to keep us apprised of any cute shoes you see, wild booth promotions, or general HIMSS shenanigans. We’re counting on you!

Email Dr. Jayne.

Morning Headlines 8/5/21

August 4, 2021 Headlines No Comments

Clarify Health Acquires Apervita’s Value Optimization Business, Creating One Unified Value Platform for Health Plans

Analytics vendor Clarify Health acquires Apervita’s value optimization business, which offers providers and payers cost, quality, and outcomes performance analytics combined with financial insights.

EvidenceCare Acquires Physician-focused Cost Transparency Platform Healthcare Value Analytics

Clinical decision support company EvidenceCare acquires Healthcare Value Analytics, which offers physicians real-time cost-of-care benchmarking data.

Evolent Health Announces Agreement to Acquire Vital Decisions, Expanding its Depth and Breadth in Specialty Care Management

Evolent Health will acquire advance care planning company Vital Decisions for $85 million and fold it into its clinical solutions segment.

HIStalk Interviews Carrie Kozlowski, COO, Upfront Healthcare

August 4, 2021 Interviews 1 Comment

Carrie Kozlowski, MBA is co-founder and COO of Upfront Healthcare of Chicago, IL.

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Tell me about yourself and the company.

I started as a clinician, practicing as an occupational therapist in the first one-third of my career. I worked in a number of care settings and saw the opportunity to impact patient care at a bigger level. I toyed between going into public health or into business and made the decision to follow the business side. I did my MBA and have been in the healthcare IT space for almost 20 years now, mostly involving workflow applications, making things more efficient and easier for providers, care managers, and now patients and the operations teams that support them at the health systems.

Our company started about five years ago. Our focus has always been, how do we help make sure patients get the care they need? We started this company as technologies continue to evolve and as health systems continue to evolve in their adoption of technologies. We think about digital health — how can we iterate on our approach to make sure that we are helping patients get necessary care?

Health system marketing used to involve renting billboards and bragging on awards to bring patients into profitable service lines, while clinical and administrative engagement was minimal. How do you see those areas changing or perhaps converging?

The biggest change is the evolution of how we think about consumers across all industries. We are seeing that now being applied in healthcare more specifically, which is the need for personalization and to tailor the communications to the needs of the individual patient. That’s the shift that folks are making. Obviously the more relevant the information is, then the more engaged the consumer will be, the patient in this case. That’s a big change that we are seeing, going from these broad billboards and radio spots into these specific patient engagement solutions.

Most people live their lives without a lot of health system involvement, which may or may not affect brand loyalty. Are health systems segmenting infrequent versus frequent patients and communicating with them differently?

I don’t know if they are communicating to them differently. I think you are hitting on that explosion of the retailization of healthcare and what we have seen in the last five or seven years in that regard. People were focused on acquiring patients, but not keeping patients. We did a lot of analysis on that about five years ago with a couple of engagements with some big health systems, and you could see it obviously lay out in the data.

But what we have seen since then is increasing competition. That has made them rethink what loyalty is and how you build it. Going back to the personalization aspect, how do you help this person by making it easy for them to get the care that they need? And offering specific direction on how to get that care from your health system, as you have offered more services and you think about the explosion of the front door. Folks have moved in that direction on the health system side, but people don’t know which front door to walk through sometimes.

Health systems may think that most patients want ongoing engagement, while many of those patients are looking for unconnected, as-needed care episodes and to be left alone in between. Can the health system meet the communication needs of both kinds of patients?

You’re getting at, what is my relationship? Is it transactional, or is it interactive content where you’re sourcing all your information from the health system, in which case those ginormous marketing websites are super helpful?

This goes back to using the patient data. Understanding what they need to do, but marrying that with engagement data, and then this third leg of the stool — which I’ve just come to understand better over the last two or three years – of health communication. More than health literacy. If you are a person who doesn’t want that information – “just tell me what I need to come in for” versus “I need help and support because I have a chronic disease” — you are motivated differently. The information that you want to consume needs to be organized differently. How do you leverage that health communication, understanding the person and marrying that with the personalization of  “this is the thing you need” so you are providing it in a highly relevant way? I think that it is that segmentation. It’s important to take those persona-oriented segments and then bring them all the way down to the personal level so that it is a one-to-one kind of experience.

Are health systems competing for the patient’s attention with similar health messages from large, technologically savvy players such as chain drugstores and insurers?

Well, that’s a loaded question. It’s a yes and a no, right? If it takes multiple teams of people to make sure that patients get the care they need and they are focused on the outcome and the care, great.

I do think it is confusing for the patient the way our health system, our healthcare in general, is organized in the United States. Everyone can think you are their patient. To your point, I think that messaging can get a little bit mixed up. The idea, and I see health systems and digital transformation officers pushing it around, is, how do we think about this as a hub? We want this experience to be a holistic one for the patient. We want to make sure that all of the communications that we need to send, or all of the digital health tools we’ve invested in, are organized in a hub so that it is feeding the patient what they need when they need it, but then directing them where to go.

How do we avoid turning technology such as chatbots into this generation’s PBX system, where we intentionally make it hard to reach a human even if they need empathy or lack technological comfort?

I don’t support taking the humans out of healthcare. It’s important to scale the human interaction and apply it in the right places. If we have humans doing all of the tasks, those people who need the most empathy, the most concentration of discussion, and the most support will be underserved. We can digitally communicate, “Hey, Carrie, it’s time for your mammogram.” I’m fine with that transactional kind of communication in that case. But that human piece needs to be there.

I’ll go back a little bit on the last thing I said, going back to personalization. We can make an empathetic experience that is personalized and relevant and can be delivered digitally. But we’re not going to ever go — and I would never support that we go — 100%. It’s all about the best modality to reach the patient to help them get the care they need. In many cases, that might be a human being, and should be.

Are hospitals trying to make their automated outreach messages seem more human given the intimate nature of healthcare services?

It goes back to that health communications piece. Communicating with empathy and making it personalized. It’s a broad message.

We all get the exact same letter mailed to us, auto-generated about, “You need this thing.” It’s not specific to where I live. It’s not specific to other circumstances. It’s not specific to where I went last year when I needed that same care. It’s obviously some auto-generated technology.

Health systems have rich data sets that can be leveraged for these needs. You can take that rich data set, process it, and apply it in a way that says, “It’s time for you to take this action, to get this care, and here’s where you had it last year. Let’s make it easy for you. Here are some options for scheduling that care at that location right now.” Then it is actually serving me, making my life easier. I know you’ are talking about me and you know me. Then you are complimenting that human experience with that personalized experience that is delivered in a digital fashion.

How important is it to focus the messaging on “here’s what you need to do next?”

It’s the most important. It is the key. We are all doing this because we want patients to get quality care and have the best outcomes. As the incentives are realigning in the same way, with quality and value-based care, that’s great news, but ultimately we are here to make sure patients continue to get the care they need. That should be the focus.

This is where I see a lot of health systems building strong bridges between their digital transformation and digital innovation with their integrated care networks, their medical groups, and their operations leaders. They want to apply innovation and digital engagement in a way that serves the needs of the patients. I just love seeing those connections being made more and more, especially with the clients that we work with, but across the board in general. That’s where you start to make good use of technology.

We talk about a unified patient record, but that doesn’t always include communications, especially those messages that were created in a mass campaign or as a patient response to one. Should we expect to have all messages from all modalities incorporated into the EMR or a patient CRM-type system?

That’s where we sit as an organization, as we see that need. It is marrying the data from the EMR and engagement data and bringing it all together in this unified patient view of, when did they engage? What was the outreach? Who did they communicate to? Did they attend the visit? When was the visit? It’s all about the interest, again, of making sure patients are not only scheduling care, but getting the care, and we can support them.

To your point earlier, are humans going to come out of it? No. So if a human needs to interact, they should know, “Hey, Carrie, we tried to message you a couple of times. It’s really important that you get this care.” We need to apply those same things we are doing on the digital side to the human side, making sure that the patient feels like we know them and they are a member of a health system that is connected and unified in the way that we are communicating to help them get care.

Should the messages encourage people who don’t see the value of having a primary care provider to engage with one?

Having a primary care provider is a key part of ongoing health. However, I also don’t think there’s anything wrong with a young person who’s healthy using the urgent care twice a year for a UTI and a sprained ankle. That’s where the data is important, looking for trends in the use of other care settings outside primary care to identify when someone needs to elevate into a primary care relationship. 

We are doing this with one of our clients. We are looking at how many visits the patients are having with urgent care. At what point do we decide, “It looks like you’ve been to the urgent care quite a bit. It might be better for you to establish a primary care relationship to help coordinate and oversee your care.” 

But creating that relationship and forcing those visits into primary care consumes limited primary care resources. We are going to compromise the patients, whether they are older or have chronic conditions, who need that capacity to serve their needs. Retail exists for a reason. It’s a valuable part of the entire ecosystem for urgent care or whatever word you want to use to describe it.

Where do you see the market and the industry moving in the next few years?

We are supporting clients who are trying to drive patients to get the care they need. Outcome-oriented population health is a portion of that, but adhering to those visits is an important part. We are then building in how we coordinate closely with the human interaction, allowing, for example, a bi-directional chat to support making sure that the patient gets what they need and making sure the outcome is actually achieved. That is what we are focused on. All of that is grounded in making sure we have a sound, relevant, personalized patient experience. But the experience isn’t the end goal. The end goal is the outcome that the patient has, a good quality of life and an excellent health outcome.

Do you have any final thoughts?

I’m excited about where we are in healthcare. I’m not excited that we’ve been through a pandemic for the last two years, but I feel like it has been the catalyst or the accelerant to think about how we deliver healthcare differently in a way that is patient centric, but supports the patient in succeeding at being there at the center of their care or their quarterback of their care. We are enabling that in a way better way. The speed at which we are seeing change right now makes it an exciting time to be part of all of it.

Morning Headlines 8/4/21

August 3, 2021 Headlines No Comments

Delivering the Right Care, at the Right Time and Place: Renown Health Opens “Care Traffic Control Center”

Renown Health opens a Transfer and Operations Center to better coordinate care, including remote monitoring for tele-ICU and home-based programs, across 27 counties in California and Nevada.

CPSI Announces Second Quarter 2021 Results

CPSI announces Q2 results: revenue up 15%, EPS $0.42 versus $0.12, with a share uptick leading to a company valuation of $464 million.

DoJ considering lawsuit to block UnitedHealth bid for Change Healthcare

The DoJ considers filing a lawsuit that would block UnitedHealth’s attempt to acquire Change Healthcare for nearly $8 billion.

CORHIO and Health Current Introduce New Regional Organization – Contexture

CORHIO and Health Current merge to form Contexture, an umbrella organization that will oversee the respective HIEs’ work in Colorado and Arizona.

News 8/4/21

August 3, 2021 News 6 Comments

Top News

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Renown Health opens a Transfer and Operations Center to better coordinate care across 27 counties in California and Nevada.

The center, which includes remote home monitoring capabilities using technology from Masimo, will soon add remote monitoring for its tele-ICU services.

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The center will coordinate all incoming patient arrivals, match patients to beds, coordinate transportation and housekeeping services, offer ICU monitoring and telehealth visits, monitor patients at home, and provide emergency and disaster management information.


HIStalk Announcements and Requests

HIMSS21 will almost certainly go on as scheduled next week. Medicomp, Olive, and Imprivata are the only big vendors I know of that have cancelled attendance, although companies aren’t required to publicly announce their decision to stay home. I usually stick to the exhibit hall and skip the celebrity keynotes and educational sessions that often aren’t actually educational, but if there’s a must-see HIMSS21 event that has caught your eye that I should know about, tell me.

Looking ahead to next week, it’s hot as blazes in Las Vegas and COVID-19 is running rampant through unvaccinated residents and visitors. My intense dislike of Las Vegas is a benefit since I have always avoided the virus’s hunting grounds of celebrity chef restaurants, casinos, and seas of people at their worst behavior. I’ll stick to the conference areas almost entirely, attend no events, mask up everywhere, and likely forget many times to do the silly-looking but epidemiologically superior elbow bump instead of shaking hands.

I’m surprised at how many companies and people have touted their HIMSS21 attendance on LinkedIn and Twitter, spelled everything correctly, then embarrassingly ended with “#HIMMS21.”


Webinars

On-Demand Webinars:

Key Differences: Value Based Care vs. Fee-For-Service.” Part 1 of a three-part series. Sponsor: Net Health. Presenters: Bill Winkenwerder, MD, chairman, CitiusTech; Josh Pickus, CEO, Net Health. Dr. Bill Winkenwerder, former assistant secretary of defense for health affairs for the US Department of Defense, shares his unique perspective on the future of value-based care (VBC) systems in the public sector and how VBC differs from fee-for-service models in the private sector. This Part 1 webinar covers which aspects of the fee-for-service health system payment model look the most different compared to fully value-based systems (clinical, back-office, analytics, etc.)

Current Innovation and Development in Value-Based Care.” Part 2 of a three-part series. Sponsor: Net Health. Presenters: Bill Winkenwerder, MD, chairman, CitiusTech; Josh Pickus, CEO, Net Health. Dr. Bill Winkenwerder, former assistant secretary of defense for health affairs for the US Department of Defense, shares his unique perspective on the future of value-based care (VBC) systems in the public sector and how VBC differs from fee-for-service models in the private sector. This Part 2 webinar discusses what health systems should know about the transition to value-based care, including macro versus micro shifts.

Future of Value-Based Care: Predictive Analytics, Technology, Policy.” Part 3 of a three-part series. Sponsor: Net Health. Presenters: Bill Winkenwerder, MD, chairman, CitiusTech; Josh Pickus, CEO, Net Health. Dr. Bill Winkenwerder, former assistant secretary of defense for health affairs for the US Department of Defense, shares his unique perspective on the future of value-based care (VBC) systems in the public sector and how VBC differs from fee-for-service models in the private sector. This Part 3 webinar discusses the role analytics will play in the shift to value-based care and how financial and clinical ROIs for analytics-oriented products must differ when applied to FFS and VBC models.

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


Acquisitions, Funding, Business, and Stock

CPSI announces Q2 results: revenue up 15%, EPS $0.42 versus $0.12. CPSI shares are up 28% in the past 12 months versus the Nasdaq’s 37% rise, valuing the company at $464 million.

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Registry data and analytics company CorEvitas acquires Vestrum Health, which offers data culled from retina care-focused EHRs for research, analytics, and commercialization. CorEvitas rebranded, quite understandably, from Corrona earlier this year.

CORHIO and Health Current merge to form Contexture, an umbrella organization that will oversee the respective HIEs’ work in Colorado and Arizona.


Sales

  • Health Recovery Solutions selects Lyniate’s Rhapsody integration technology to enhance customer connectivity with its remote care solutions.
  • Eastside Health Network will use Arcadia’s analytics to improve the value-based care performance of its provider network in Washington.
  • Idaho Health Data Exchange selects Orion Health’s Amadeus HIE platform.
  • St. Vincent Health (CO) implements Infor’s CloudSuite Healthcare for resource management.
  • Ashley Clinic (KS)  will use Emerge’s ChartGenie, ChartScout, and ChartPop data conversion and integration technologies during its EHR conversion later this year.

People

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The Missouri Hospital Association hires Jon Dolittle (Mosaic Medical Center – Albany) as president and CEO. He was a senior business developer for Cerner from 1998 to 2009.

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Mads Kvalsvik (Madaket Health) joins UCM Digital Health as CTO.

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WellHive hires Chris Faraji (Salesforce) as EVP.


Announcements and Implementations

ChartSpan provides bi-directional data exchange between its chronic care management platform and provider EHRs using Ellkay’s integration capabilities.

First Databank will offer its clients RxRevu’s prescription cost and coverage solution, allowing physicians to choose cost-effective medications based on patient pharmacy benefits in their EHR workflows.

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PadInMotion rebrands to Equiva and announces GA of its new health relationship management software, which combines patient engagement, care management, and marketing capabilities.

CitiusTech develops Medictiv, a open healthcare AI model directory of more than 250 ready-to-use models for data science and digital health teams.

Memorial Sloan Kettering Cancer Center establishes MSKCC India, a virtual care service for cancer patients in India that will use telemedicine technology from India-based IClinic and oncology expertise from New York City-based MSKCC providers.

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Surescripts announces GA of Care Event Notifications and enhancements to its Medication History for Populations service.

Data privacy vault vendor Skyflow announces a PHI-specific, API-delivered Healthcare Data Privacy Vault.

UNC Health extends its mobile app functionality, which was developed with Gozio Health, to include MyChart access, visit scheduling, and wait time display.

Cerner is named as the hospital category winner in the ECR Now FHIR App Challenge for electronic case reporting for COVID-19 and other diseases of public health interest. Cerner’s solution sends a near real-time Electronic Initial Case Report to the Association of Public Health Laboratories AIMS platform, whose development was funded by CDC. The solution is open source and has been made available by Cerner to non-Cerner clients and EHRs.

Sphere launches a patient self-scheduling tool called Book My Doc that extends its Health IPass revenue cycle management and patient engagement platform.


Other

This would be an embarrassing way for a hospital to get hacked. Security researchers warn of vulnerabilities in Swisslog Healthcare’s Ethernet-connected pneumatic tube systems, which are used in 3,000 hospitals worldwide. A new firmware update offers fixes for all but one of the known issues.


Sponsor Updates

  • Surescripts makes its Medication History for Populations service available to Lightbeam Health Solutions customers.
  • The Chartis Group announces 13 promotions – three directors and 10 principals.
  • CloudWave sponsors the New Bridge Medical Center Foundation 2021 golf outing.
  • EZDI releases a new case study, “Auburn Community Hospital Improves Bottom Line – Impact Totaling $1.03MM by Implementing EZDI’s CAC.”
  • RxRevu partners with First Databank to expand the delivery of its prescription coverage and cost data as a supplementary service to FDB’s network of clinical drug information customers.
  • UnityPoint Health expands its use of SOC Telemed’s Telemed IQ telemedicine software and psychiatrists to an additional four hospitals in Iowa.

Blog Posts


Contacts

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

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Morning Headlines 8/3/21

August 2, 2021 Headlines No Comments

ChrysCapital-backed GeBBS Healthcare Acquires Aviacode

RCM vendor Gebbs Healthcare Solutions acquires Aviacode, which offers medical coding and compliance services.

Juno Medical Raises $5.4M in Seed Financing to Reimagine Primary Care for the 99%

New York City-based Juno Medical will use $5.4 million in seed financing to expand its clinic footprint, virtual care services, and price transparency capabilities.

Vestrum Health Joins CorEvitas

Registry data and analytics company CorEvitas acquires Vestrum Health, which offers data culled from retina care-focused EHRs for research, analytics, and commercialization.

Curbside Consult with Dr. Jayne 8/2/21

August 2, 2021 Dr. Jayne 5 Comments

Like most of us, it’s been a long time since I’ve attended an in-person conference. Often, the sessions aren’t terribly memorable, and once I get home, I rarely consult my notes.

One of the exceptions was a presentation I attended at the American Medical Informatics Association Annual Symposium some years ago, where the topic covered patient portal use among children and adolescents. I remember the speakers talking about how their institution did the difficult work of defining what elements could be shared, which should be shared, and how to best set up various age and proxy restrictions for the best outcome.

Fast forward, and now we’re dealing with not only the limitations of patient privacy and EHR capabilities, but the impact of interoperability and information blocking rules. JAMA Pediatrics had a good viewpoint article about this last week. Working with patients who are minors can be challenging, especially as they move through the adolescent years and become candidates for certain healthcare services that can be kept confidential to some degree, such as pregnancy, sexual health, mental health, and related care. It’s always been a fine line that we’ve had to walk, because although we can restrict that information in the medical records, parents and guardians may still receive the bills and insurance correspondence.

For those who might not be in the data-sharing trenches, the article provides a nice overview of what HIPAA and HITECH have required as far as making records available. It also summarizes the 21st Century Cures Act and information blocking rules. As far as information blocking goes, there is a subset of situations where information blocking might be allowable, including technical infeasibility, preventing harm, and privacy. Those caring for minors might need to use one of these exceptions to protect patient confidentiality, especially considering that states have differing requirements as far as protecting restricted categories of information such as mental / sexual health services and contraception.

Clinicians have to understand those state rules and what parents might be able to see, and they also need to fully understand what features their EHRs might provide to help them with this daunting task. Some EHRs I’ve worked with allow users to mark specific data elements as “sensitive” and block release; others require the user to create separate encounter notes where an entire visit’s documentation is blocked from release. Less-savvy users might not understand these nuances, leading to negative consequences for patients, not to mention increased liability for themselves and their institutions.

The article also notes that the flow of data must also protect information provided by caregivers who might have a need to keep certain history elements from the patient, such as adoption status, genetic diseases, or other pieces of family history that a patient might not be mature enough to absorb. Another tricky area noted by the authors is the maternal data that is contained in a newborn’s EHR chart. This information often includes sensitive testing (HIV, hepatitis, sexually transmitted infections) as well as information on maternal drug and alcohol use, intimate partner violence screening, and more. Disclosing the mother’s protected health information to other caregivers can be a problem if not handled carefully.

The article mentions benefits of information sharing and jogged my mind on some of those aspects from the AMIA presentation. When I was in a traditional family medicine practice, we often spent the majority of the 17-year-old well visit discussing “Healthcare Adulting 101” so patients could understand their health information and how to best access it as they headed to college or otherwise into adulthood. With the rise of patient portals, adolescent patients may be able to schedule their own visits, request refills, and more. Education is needed so they understand the difference between urgent messages, non-urgent needs, and the best ways to navigate our often-chaotic healthcare system.

For adolescents with complex medical histories who have the ability to participate in self-management programs, having access to their information can be valuable and can help them get the best outcomes. Patients can partner with their parents for co-management, but organizations must be careful that common policies (such as reducing parental access to the chart during the teenage years) do not inadvertently hamper successful family dynamics. It’s quite a tightrope that that care teams walk at times and I thought the article was a good reminder for the rest of us. Unfortunately, since it appeared in a pediatric-specific journal, I’m not sure how much external visibility it will get.

The piece paired nicely with another article that I ran across, this one about using artificial intelligence systems to sort through electronic health records. The study looked at the amount of time that clinicians spent reviewing clinical data during patient visits and whether an AI system could help organization patient information prior to review. The study was small, with only 12 gastroenterologists participating. Each participant received two clinical records, one in the standard format and one that had been optimized via AI. They were then required to search the record to try to answer more than 20 clinical questions. The AI-optimized records allowed physicians to answer the clinical questions faster with equivalent accuracy. Nearly all the physicians stated they preferred the optimized records to the standard.

Even though the study was small and really needs to be redone with a larger number of physicians across multiple specialties and with multiple samples per physician, it got me thinking. What if you could use AI optimization to tackle the pediatric data- sharing problem? What if AI could be used to augment clinician efforts to seek out and appropriately tag or restrict sensitive information? Could AI-enabled tools run in the background while physicians are documenting and alert them to state laws about the information they’re adding to the chart, and do so right at the point of documentation? What if our systems could actually allow us to work smarter and could help make it easier to do the right thing the majority of the time? I think that’s the goal that most of us have in clinical informatics, although it’s often difficult to deliver those advantages to our users.

For those of you in the pediatric informatics trenches, how well are the tools available to you doing? Are they making it easier to manage information sharing or more difficult? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Ashish Shah, CEO, Dina

August 2, 2021 Interviews No Comments

Ashish Shah is co-founder and CEO of Dina of Chicago, IL.

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Tell me about yourself and the company.

I started with Dina six years ago. I was previously the CTO and head of product for Medicity and was there eight years, before and after the acquisition by Aetna. Dina offers an AI-powered care-at-home platform and network that supports hospitals and health plans as they transition to monitoring patients in the home and other post-acute settings. We call this Care Traffic Control.

We’ve talked before about my father, who passed away suddenly shortly after Aetna acquired Medicity. I was a healthcare executive who had helped thousands of hospitals connect to ambulatory care sites, but that didn’t improve my dad’s situation. He had home health aides and spent time in senior centers, but those caregivers had no way to share information.

What effect has the pandemic had on the demand for at-home care as well as the company’s business?

The pandemic shined a bright light on what we need to do and accelerated it even further. Prior to the pandemic, Dina was 100% focused on organizing all of the resources outside of traditional facility-based healthcare, whether that was post-acute rehab facilities or in-home services. We knew we needed to do a better job to support the silver tsunami, the 10,000-plus people each day who are turning 65 years old. 

We would get a lot of head nods, and that was important, but COVID unfortunately accelerated that tsunami and gave us a glimpse of what it’s like when the traditional healthcare system is overrun. That cemented our place in the market. Clearly, complex things will continue to happen in the high-quality facilities. That’s never really going to change. There may be some automation and further optimization that takes place, but that’s still the right care setting for the right types of things.

Virtual care, whether it’s telehealth or some combination of remote patient monitoring, became critical. But these things need to be complemented by a third important delivery vehicle, which is in-home care. Not just traditional home health, but mobile lab and imaging, courier services, and a host of other capabilities that can be brought to you. The world was trained on things coming to you through the pandemic, not just in healthcare, but in all aspects of life. So in many ways, it made it super obvious for everyone. Now the race is on to equip the industry as fast as we can.

How do you see that shift away from the four walls of a hospital or a clinic being a threat, an opportunity, or both to the traditional health system?

It’s tricky. It’s hard to be a health system leader today because you have your feet in two different boats, two different business models. It’s hard to look away from how healthcare has been financed to date in a fee-for-service world. That creates some real challenges. Many health system operators were challenged in COVID by not having a consistent revenue flow, either through capitated payments or other at-risk payments.

It was interesting that in a industry that doesn’t have enough labor as it relates to physicians or nurses or other support staff, some organizations had to contemplate reducing headcount. I guess it was necessary to make the money work, but it was definitely challenging to witness that.

The opportunity as we hopefully come out of COVID is to accelerate health plans and providers having conversations around creating predictable revenue streams that are more based on value-based care type programs. The art is to make sure that there’s no attrition in revenue. In many ways, it’s the same type of conversation from 10 years ago when I was at Aetna. But now that we’ve had COVID, that took it from a theoretical concept to something that we need to solve as an industry.

What does the typical care network look like for a senior who has one or more chronic conditions and how do the members that participate in that care network coordinate or communicate with each other?

It’s very, very complicated. A typical senior or somebody whose health is complex could be on seven plus medications. They may need support with activities of daily living. That’s a non-medical home care service, which is different than a certified Medicare home health type service that may provide skilled nursing and physical therapy, really an extension of a service that you would get in a facility, but now being delivered in a home. So complex med management, personal care support with activities of daily living, perhaps some skilled needs that are required. That’s not even including primary care and specialty interactions as well.

A lot of what we are looking to do is to coordinate all of those logistics so that you can match or exceed the experience that you would receive in a facility. The market definitely wants it, but it’s easier said than done.

How does that care team structure or those care decisions differ for someone who is covered by a Medicare Advantage or a Medicaid Managed Care plan instead of traditional Medicare or Medicaid?

When I work with many folks on the home care side of things, they’re so passionate and they are wonderful organizations. But one of their biggest challenges and obstacles that they face is, how do we ultimately get that care financed that they know that the market needs and that creates value? I love what Medicare Advantage plans and Managed Medicaid plans are doing right now.

I’ll start with Medicare Advantage, because it’s a little bit more progressive and new relative to Managed Medicaid, which has been doing some of these things for some time. Medicare Advantage has introduced the concept of supplemental benefits — the extras, if you will, above and beyond Medicare fee-for-service — that will allow the Medicare Advantage plan to innovate and introduce new offerings like non-medical home care, nutrition support, transport, or other types of things that are not covered by a traditional Medicare plan. In the effort of delighting the member, addressing in some cases social determinants of health or other healthcare needs that can bend the cost curve, but also help that member meet their healthcare objectives. Really neat programs. We are in the early phase of this, but this is bringing online non-medical services or social determinant-oriented services that are being paid for, that are attracting members, but also change the outcome story.

Medicare, and CMS in particular, were wise to hatch the program years ago and then continue to invest in it and then allow the free markets to innovate. They have a  program called VBID, value-based insurance design, that is a vehicle for registering and testing for new types of benefits. If they work, then they ultimately graduate into the scope of things that MA plans can reimburse for. So it’s a really neat program.

On the Managed Medicaid side, in-home services, for example, are covered under what’s called LTSS, long-term support services. This is the goal of trying to meet the member in their home and community and unlocking alternatives to traditional long-term nursing home care. It’s a neat program that has been around for a while, but there’s some complexity in trying to manage that.

We’ve seen insurers that range from tech-heavy startups to Optum go big into Medicare Advantage, and some of those companies are providing health services directly. How will that change traditional hospital care, home care, and long-term care?

For Medicare Advantage plans, it’s bringing members online in a race or land grab moment that hasn’t existed before. The only option if you were a senior before was to be on Medicare fee-for-service. You could have bought your own private health plan, but now with Medicare Advantage plans, there’s a race to go manage outreach to these members, unlock a superior experience, and turn on new benefits that we know can change the arc of healthcare and the finance of healthcare.

Three years ago, 25% of Medicare-eligible members enrolled in a Medicare Advantage plan. Now we’re north of 40%, so it is growing rapidly. Many solid organizations are innovating. I think it’s wise that they are trying to establish a direct connection with the person to better understand their needs. Some go as far as delivering the care themselves, while others have invested in care coordinators or counselors who take a more proactive role in navigating that member through all of their needs. It is neat to see.

There are a lot of innovative organizations out there. Not just on the MA side of things, but organizations that partner with MA plans, like Oak Street Health, for example, or Iora, showcasing for the market a brand new community or home-based delivery model. I think we will continue to see that scale because it makes sense. Not to mention that people like it, which is sometimes hard to say about things that we do in healthcare, to get people to actually say that they enjoy the experience.

A problem has always been that outside the 9:00 to 5:00 window, people who weren’t hospitalized or in a SNF had to call 911 or go to the ED to have any changes in their health evaluated, including those that turn out to not be urgent. Have those insurers who have skin in the game addressed the unnecessary use of those services?

It’s clearly a problem that people have been studying for a long time. We’ve tried a lot of different things, from raising awareness to your health plan or the ACO to let them know that when somebody is in a emergency department. But in many ways, that’s too late, even though it creates intervention opportunities.

I’ll give you an example of a company like Dispatch Health. We know some of the folks there — we overlapped inside of the Aetna portfolio companies going back, so we are fans of them, the company, and the model. They took a new approach. They started by bringing urgent care to you rather than having you come into an ER, which was costly and had a lot of other ramifications. Not to mention that maybe you didn’t actually need to be an emergency room. They’ve started to chip away at the problem by redeployment of almost like a paramedic model to your home to manage triage for routine things, then escalate and navigate you to another site of care if it’s needed. In some cases, it may not be needed. In some cases, it may translate into something that leads to a telehealth encounter with a specialist that they bring into the mix.

There’s a lot of creative solutions that are coming into place. It’s not one size fits all. It’s not whether it will be telehealth, or in-person visits, or home care. The challenge for us as an industry over the next five to 10 years is to bring the best of all of that together with the right care at the right place at the right time. It sounds cliché, but that’s the challenge that we all have, and that’s what Dina is working on.

How do you see the company changing over the next several years as these market conditions change?

We no longer have to convince people why we exist. In the early days when you start a company, that’s a lot of the discussion. Tell me about the problem that you’re trying to solve, tell me why is it a really big problem, and tell me why it’s a big market opportunity. It was clear to many, including our early investors, when we talked about the aging demographics in the country and globally. COVID has expanded our market opportunity to include all people that are struggling with some sort of healthcare-related need. 

For us, it’s really about execution.To simplify our story, we use terms like “care traffic control” to create a visual of equipping hospitals and health plans with the infrastructure to be able to move from monitoring patients in ICU units and in hospital beds and shift that paradigm to coordinating, navigating, activating, and monitoring patients in their homes and communities. The solution we put into the market is a network of resources that are medical and non-medical in nature. We’ve got lightweight technology that allows us to engage with patients and families and understand what’s happening when a healthcare person is not in front of them. We do a lot with data. We bring all that information back to create opportunities to proactively delight that person and meet their needs on a continuous basis.

The organizations that are attracted to that today are health plans, like MA plans or Managed Medicaid, but also large provider groups that have started to go down their path to value-based care. I think that in five to 10 years, this will be everywhere. I don’t think it’s farfetched to think that every home is going to operate like a virtual primary care clinic, where it’s not just your residence, but an actual site of care that the healthcare ecosystem knows how to interact and work with.

It’s exciting. It’s what I wanted for my family before. I can see the convenience for it in this day and age. Our challenge is to make it happen now.

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Reader Comments

  • Susan K Newbold: Thank you for honoring our dear Dr. Virginia K. Saba. She was a colleague, educator, mentor, and friend to many. Her i...
  • Matthew Holt: Wow that Fruit Street guy's web site is impressive!!...
  • Brian Too: ... "and Save Millions!"...
  • Ralphie: RE: The WSJ Article: I think one of the takeaways from that article is that operations, both clinical and business, nee...
  • HITPM: Fast Forward 10 years...new WSJ.com Headline - "Decentralized IT Departments are Dead - Centralized IT Could Solve Fragm...

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