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Curbside Consult with Dr. Jayne 7/25/22

July 25, 2022 Dr. Jayne 3 Comments

This weekend marked the first time in a decade that I took a trip without my laptop. It was weird at first because my backpack felt surprisingly light, but it was good to know that I couldn’t slip into the trap of doing work even if I tried.

Now that the workplace is more mobile, and especially when some companies offer unlimited time off, it’s tempting to blur the lines between the work day and the rest of your life. It was a great opportunity to connect with old friends and focus on spending time together as we crammed as much adventure into 48 hours in the Big Apple as possible.

Of course, since we were a group of healthcare IT people, there were plenty of opportunities to discuss where the industry has gone since we all worked together at a big health system. Several in the group have moved into the non-profit space and payer space, which was interesting to learn about compared to others’ experiences in the vendor and consulting spaces. One person’s resume reads like he’s a job hopper, but in reality, he has been in the same job, but his company has just been merged and acquired multiple times. I’m not sure everyone would pick up on that just looking at his employment history.

There was a lot of chatter about the Amazon acquisition of One Medical for nearly $4 billion. Nearly everyone in the conversation was concerned about Amazon having access to patients’ protected health information, even though the company issued a statement that they don’t plan to share health information to advertise or market other Amazon products without clear permission from patients.

Several of us brought up the point that most consumers don’t read terms and conditions, even when there are limited updates to an agreement, so it’s likely that Amazon could obtain such a consent without patients full understanding what they’ve accepted. Most of us are a bit skeptical about how this is going to play out, so we’re going to have to watch it as the deal moves towards the regulatory approval it needs for closure.

Digital health startups were a hot topic throughout the weekend, and one of my traveling companions sent me an article that caught his attention. It’s from the Journal of Medical Internet Research and looks at the “clinical robustness” of companies in that sector. The background for the article notes that “health care technology stakeholders lack a comprehensive understanding of clinical robustness and claims across the industry.” That phrase caught my eye as well, since I’m constantly seeing companies that make me wonder what exactly it is that they do and why people, including investors, are so excited about them. Certainly there’s a hype factor for a lot of digital health startups, as well as a great deal of marketing, but the meaty information tends to get pretty thin when you start to dig into some of them. The article looked to assess clinical robustness along with the claims made by companies.

The authors used data from the Rock Health Digital Health Venture Funding Database, the US Food and Drug Administration, and the US National Library of Medicine. (It should be noted that three of the authors are employees of Rock Health, although the article states that no individuals involved in investments were part of the analysis.) The authors defined clinical robustness using the sum of the number of regulatory filings and clinical trials completed by each company with each having equal weight. For the companies’ claims, the authors looked at company websites. They looked at 220 digital health companies with an average tenure of 7.7 years.

The average clinical robustness score was 2.5, with a median score of 1. Companies specializing in diagnostics had the highest scores, followed by those focusing on treatment and those specializing in prevention. The authors found that 44% of the companies they looked at had a clinical robustness score of zero. There was no correlation between clinical robustness and the number of publicly made clinical claims or between clinical robustness and total funding.

There were some other interesting statistics in the article:

  • More than 1,900 digital health startups have raised more than $2 million in venture capital funding in the US.
  • In total, digital health startups have raised more than $77 billion in venture capital funding.
  • Multiple studies have shown the need for greater clinical validation.
  • Many solutions are not supported by robust clinical evidence.
  • Solutions have mixed results on cost savings and cost-effectiveness.

Additionally, the authors noted that there have been examples of misleading claims in the industry, as well as actions by the Federal Trade Commission and state attorneys general. They note the limitations of using publications as a proxy for clinical impact, especially given that there is often a lag in publications. There were also limitations in that they only looked at venture-backed startups in the US that had raised at least $2 million in funding, which may have excluded early-stage companies as well as larger technology companies. They also note the need for deeper research into the effectiveness of solutions.

I found it amusing that the article noted that “all data were stored in Microsoft Excel,” where the calculations were performed. Excel isn’t always the most sophisticated tool, but it’s gotten the job done for me more often than not.

It would be interesting to do a follow-up study to see how many of the startups that the authors looked at are even here in two, five, or 10 years and what their clinical robustness might look like over time. I suspect we may see some significance between funding and clinical strength or between time in the market and clinical outcomes. In the short term, though, it’s often difficult to demonstrate value beyond individual case studies and client profiles. It’s certainly challenging to wade through some of the content on company websites and to truly know how broadly a solution has been deployed or whether clients are happy with it.

What do you think about the idea of measuring clinical robustness for digital health tools? What markers might you use beyond those selected by the authors? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 7/25/22

July 24, 2022 Headlines No Comments

Statement of Mike Sicilia, Executive Vice President Industries Oracle Corporation Before the U.S. Senate Committee on Veterans’ Affairs Hearing on Examining the Status of VA’s Electronic Health Record Modernization Program

Oracle EVP Mike Sicilia tells the US Senate Committee on Veterans’ Affairs that Oracle will move the VA’s Cerner implementation to the cloud and rewrite Cerner’s pharmacy module, completing both tasks within six to nine months.

Pre-Visit Clinical Intake Automation Company Health Note Nabs $17M in Funding Round

Health Note will use a $17 million Series A funding round to expand its market presence and EHR integrations, and invest in additional research and development.

Ascom acquires French software developer Appliware

Ascom acquires Appliware, a France-based developer of long-term care solutions for patient monitoring and alarming.

London NHS trust cancels operations as IT system fails in heatwave

In the UK, IT and telephone system servers at one of NHS’s largest trusts go down as data center cooling systems fail to keep up with a record heat wave.

Monday Morning Update 7/25/22

July 24, 2022 News 23 Comments

Top News


Oracle EVP Mike Sicilia tells the US Senate Committee on Veterans’ Affairs that Oracle will move the VA’s Cerner implementation to the cloud and rewrite Cerner’s pharmacy module, completing both tasks within 6-9 months. Notes:

  • Sicilia told the committee to consider that Oracle’s acquisition of Cerner gives VA, DoD, and the Coast Guard “a new, vastly more resourced technology partner overnight to augment Cerner.”
  • Oracle says it will shift its top talent to working on the federal government’s Cerner challenges and is running the project from a war room that is staffed by senior Oracle engineers and developers.
  • Sicilia says that Cerner, like its EHR competitors, is running on dated architecture using technology that is up to two decades old, making it hard to manage, support, and scale. Oracle says it will quickly move the Cerner application to a “modern, hyperscale cloud data center,” the same infrastructure that Oracle uses for critical industries in financial services and utilities. That conversion will be performed at no cost to the federal government.
  • Oracle quickly fixed a database bug that caused 13 of the most recent 15 outages once the acquisition was completed and Oracle gained access to Cerner’s source code.
  • The “unknown queue” was designed to account for human error rather than to mitigate it, so it will be redesigned.
  • Sicilia says Oracle will “start over” with the Cerner pharmacy module, rebuilding it as a showcase of a cloud-optimized web application.

HIStalk Announcements and Requests


Most poll respondents aren’t too worried about negative job changes.

New poll to your right or here: Which conferences you plan to attend in person in the next 12 months? A sponsor asked if I planned to create a sponsor guide for conferences other than my usual HIMSS one, so the poll results will help me decide.

It’s an interesting phenomenon that so much of my LinkedIn feed is filled with “I’ve been laid off and need a job” posts, many of them from Olive because it laid off so many employees (450) at once. I’ve laid people off and been laid off myself and the double whammy is that not only are you out of a job, you are competing for a new position along with a bunch of your comparably skilled co-workers, most of them vastly preferring to avoid relocation. Maybe LinkedIn, combined with remote work options, will be effective in reducing the lost time between being marched out of one door (often virtually these days) and waiting for a new one to open.


August 10 (Wednesday) 12:30 ET. “Navigating healthcare’s data quality challenge: An actionable discussion.” Sponsor: Intelligent Medical Objects. Presenters: Alastair Allen, CTO, Better; Dale Sanders, chief strategy officer, IMO. Achieving a consolidated patient record is challenging in an environment of hospital M&A, where EHR rip-and-replace projects are expensive and HIEs and FHIR connectivity haven’t significantly accelerated progress. The underlying problem is that systems don’t speak the same language due to a lack of comprehensive, persistent clinical terminology and data standards adoption. UK-based Better offers a unique, FHIR-based approach to integrating disparate EHR data. The presenters will explore how to improve clinical data quality and how interoperable information can be used to support patient safety, reimbursement, and population health management.

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

Acquisitions, Funding, Business, and Stock

Ascom acquires Appliware, a France-based developer of long-term care solutions for patient monitoring and alarming.

Elevance Health, the former Anthem, says in its earnings call that it will develop solutions that go beyond selling health insurance, touting its Carelon health services offering in which the company’s own providers will coordinate and provide patient care. Carelon offers services for behavioral health and value-based care and operates IngenioRx, an pharmacy benefits management and home delivery pharmacy company. ELV shares are up 20% in the past 12 months versus the Dow’s 8% loss, valuing the company at $110 billion.


  • New York City Department of Health and Mental Hygiene will implement CareMesh’s national provider directory, which is available via FHIR APIs, file uploads, and web app.
  • Hawaii’s Med-QUEST Division awards NTT Data a health analytics contract.



Divurgent hires Collin Jones, MBA (RedZone Technologies) as VP of finance.

Announcements and Implementations

Clearwater launches ClearConfidence, a managed services program covering cyber risk management and compliance.

An Optum consumer survey finds that providers fall short in offering online scheduling for both in-person and telehealth visits, particularly for younger adults who are not satisfied. Half of the respondents missed a scheduled healthcare appointment in the past year, one-third of those because they forgot, suggesting that appointment reminders could help reduce that number.

Three studies show that use of Bayesian Health’s AI technology for sepsis early warning reduced inpatient mortality by 18%. Founder and CEO Suchi Saria, PhD is an associate professor at Johns Hopkins University, where she also runs healthcare AI and engineering groups.


WHO declares monkeypox as a global health emergency as world case counts rise to 16,000. US infections have risen from 200 to 3,000 in the past four weeks.


In the UK, IT and telephone system servers at one of NHS’s largest trusts go down as data center cooling systems fail to keep up with a record heat wave. The UK recorded its highest-ever temperature Tuesday of 104.5 degrees F. Clinicians are recording information by hand and asking patients to bring their own records to appointments. One doctor reports, “We are back to using paper and can’t see any existing electronic notes. We are needing to triage basic tests like blood tests and scans. There’s no access to results apart from over the phone, and of course the whole hospital is trying to use that line. Frankly, it’s a big patient safety issue and we haven’t been told how long it will take to fix. We are on divert for major specialist services such as cardiac, vascular, and ECMO.”

A widely cited 2006 research article on Alzheimer’s is found to contain what appears to be “shockingly blatant” examples of image tampering, leading to speculation that the authors may have altered data to support a hypothesis and thus sending researchers off on wild goose chases for years. In an interesting case of money driving the scientific process, the research was performed by scientists who were associated with the manufacturer of an Alzheimer’s drug, while the neuroscientist who reported the altered images was hired to do so by two other neuroscientists who were short sellers in shares of the same drug company. NIH spends $1.6 billion per year on research of amyloids for Alzheimer’s and scientists report that suggesting other causes of the condition to study pits them against the “amyloid mafia.” The only marketed drug in that category is Aduhelm, which earned the FDA widespread scientific scorn for approving a drug despite unimpressive research results.

Sponsor Updates


  • Azara Healthcare staff train for the Pan-Mass Challenge, a bike race that will raise money for the Dana Farber Cancer Institute. Azara BKRS will ride in honor of colleague Heather Budd, who lost her battle with ovarian cancer last November.
  • Northwest Clinics in the Netherlands adds Agfa HealthCare’s Rubee for AI platform to its Agfa enterprise imaging solution.
  • GHX has grown its technology group by 12% in the last year, and plans to grown another 21% by the end of 2022.
  • Baker Tilly releases a new Healthy Outcomes Podcast, “The rise of CCBHCs and the importance of quality of care measures in behavioral health.”
  • Oracle Cerner releases a new podcast, “Improving health equality and equity through digital innovation.”
  • Clinical Architecture Manager of Research & Strategy Jordan Rose becomes the co-vice chair of the HIMSS Chapter Advocacy Task Force.
  • CloudWave appoints CompuGroup Medical CEO Derek Pickell to its board.
  • ReMedi Health Solutions posts a white paper titled “How a Clinically-Driven Chart Preparation Process Improves the Continuum of Care.”
  • RCx Rules publishes a case study titled “How US Dermatology Partners Achieved Their Highest Clean Claim Rates Despite Staffing Challenges.”
  • Health Data Movers appoints former Bluetree CEO Jeremy Schwach to its Board of Directors.
  • Lyniate announces a referral partnership with Solarity, which has developed an intelligent automation engine for easier use of clinical data.
  • Nuance expands the availability of Dragon Medical One through the Microsoft Marketplace.
  • Nordic Consulting achieves ISO 27001 certification.
  • Pivot Point Consulting publishes a new case study, “A Multi-Pronged Success: AthenaOne EHR Support & Cures Act Education.”
  • PeriGen earns the 2022 Frost & Sullivan Best Practices Product Leadership Award for its maternal and infant care solutions.
  • PerfectServe publishes a case study, “Children’s Hospital & Medical Center Omaha: Centralizing Provider Scheduling Across an Enterprise.”
  • MGMA’s podcast features Surescripts Senior Product Analyst Nicholas Chambers, “How Medical Practices Improve Medication Adherence and Patient Safety.”
  • Vocera publishes a new white paper, “Smart, connected hospital framework.”
  • Wolters Kluwer Health expands its Lippincott portfolio, using open science to support the higher velocity exchange of scientific findings.

Blog Posts


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


Morning Headlines 7/22/22

July 21, 2022 Headlines 1 Comment

Amazon to buy One Medical for $3.9 billion as it expands healthcare footprint

The announcement comes two weeks after reports that primary care operator One Medical, whose share price had dropped by nearly two-thirds in the past 12 months, was exploring its options after reported acquisition interest by CVS Health didn’t materialize.

Internal document reveals more frequent computer problems at Spokane VA than previously known

The Spokane paper says that the Mann-Grandstaff VA Medical Center users have experienced more than 180 episodes of system degradation or downtime since September 2021.

VA’s $16 billion medical records overhaul could triple in cost

VA officials say its Oracle Cerner project could cost $51 billion over the next 30 years when maintenance and staffing are factored in.

Justice Department Seizes and Forfeits Approximately $500,000 from North Korean Ransomware Actors and their Conspirators

DOJ seizes $500,000 from North Korean hackers and returns the $220,000 that two US hospitals had paid in ransomware attacks.

News 7/22/22

July 21, 2022 News 7 Comments

Top News


The VA postpones this week’s planned Oracle Cerner go-live in Boise, ID due to system stability issues that the VA says make it unsuitable for larger-facility use. The VA has no other go-lives scheduled for 2022.

The Spokane paper obtained a document from Mann-Grandstaff VA Medical Center that lists 180 incidents of system degradation and downtime since September 2021, a far larger number than the VA has acknowledged.

Meanwhile, VA officials tell Congress that its implementation will cost $51 billion over the next 30 years, including maintenance and staffing, but it does not expect the $16 billion Cerner contract to run over budget unless the 10-year implementation timeline is extended.

HIStalk Announcements and Requests

Several COVID-careful relatives and friends have come down with the virus in the past week, some of whom have had it multiple times and all of whom were vaccinated. I think the term “pandemic” no longer applies (COVID-19 is now arguably endemic) and the coronavirus is no longer “novel” (most of us have been vaccinated, had COVID-19, or both, which has dramatically dropped hospitalization and death rates). A New York Times viewpoint predicts that by the end of 2022, 80% of the total infection count since 2020 will have happened in 2022 as new variants are popping up every few weeks. Experts predict 100,000 to 300,000 COVID-19 deaths in the US each year indefinitely as higher case counts overcome lower death rates. COVID has killed just over 1 million Americans.


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

Acquisitions, Funding, Business, and Stock


Amazon will buy publicly traded primary care clinic chain One Medical for nearly $4 billion in cash, a 77% premium to ONEM’s closing share price Wednesday. The company has member-only clinics in 16 cities throughout the US. One Medical acquired Medicare-focused provider Iora Health in June 2021 for $2.1 billion. Before the acquisition announcement, One Medical shares were down 63% in the previous 12 months versus the Nasdaq’s 18% loss. Bloomberg reported on July 5 that One Medical was considering its options after CVS Health reportedly expressed interest but ultimately passed.

A CB Insights Q2 report on digital health says that the COVID-era funding boom is receding to 2019 levels, dropping 32% quarter over quarter following a 36% drop in Q1. IPO activity is nearly non-existent and SPAC exits are rare. Funding in the health IT category remained at 2021 levels, however. Telehealth cooled dramatically and digital startups that focus on reproductive health face privacy and security challenges following the Roe v. Wade decision.

Remote patient monitoring system vendor Verustat acquires One Healthcare Solution, which sells software for chronic care management, annual wellness visits, and medication reconciliation.

A recapitalization of Internet Brands values the company at $12 billion. Its health brands include WebMD, Medscape, EDoctors, and Henry Schein One.

Tech-powered online pharmacy Capsule reportedly lays off 13% of its employees.


The twice-yearly health IT investment market review of Healthcare Growth Partners – the only company whose reports I study carefully — notes that an entire generation that was raised on cheap capital and climbing valuations is watching the market come to a screeching halt. It observes that while valuations are falling, they have climbed steadily since early 2018. Points:

  • Valuations remain strong for high-quality companies, although investor criteria for “quality” have stiffened and emphasis has shifted from growth to profit.
  • Fewer investors are buying, but available capital from premium buyers has kept valuations high.
  • The cost of private debt is increasing, as lenders become cautious and raise their quality standards.
  • The industry will consolidate as smaller companies that lose access to capital are acquired by incumbent competitors.
  • HCP believes that multiples are nearing a bottom, but a return to post-COVID levels is unrealistic and sellers need to deal with a market that looks more like 2018-19.
  • Winning sectors are likely to be supply chain management, spend analytics, contract and vendor management, lead generation, and revenue enhancement.


  • MemorialCare Miller Children’s & Women’s Hospital Long Beach will implement Health Catalyst’s Twistle patient, family, and caregiver communication system in pediatric cardiology.
  • Denver community mental health provider WellPower selects Augintel’s NLP solution to extract information from provider case notes.
  • Prime Healthcare adds three hospitals to the surgical care team collaboration and coordination solution of RelayOne.



Matthew Lungren, MD, MPH (Amazon Web Services) joins Nuance/Microsoft as CMIO.

Announcements and Implementations


Apple publishes a report on its healthcare accomplishments and ambitions. Notes:

  • The company’s health efforts are focused on the personal health journey of users (data storage, fitness and health features, support for third-party apps) and medical collaboration (research enrollment, making patient data available to providers, promoting health lifestyles via Apple Watch, and supporting public health and government).
  • The release this fall of IOS 16 and WatchOS 9 will offer features covering 17 areas of health and fitness . These are activity, heart health, sleep, respiratory, mobility, hearing, mindfulness, education, COVID-19, handwashing, safety, women’s health, medications, research, health sharing, data visualization and insights, health records, and third-party apps.
  • The Health IPhone app can store 150 types of health data and tens of thousands of App Store apps use the HealthKit API.
  • The company’s work with Stanford to develop the Apple Heart Study helped it develop capabilities to allow researchers to develop medical studies at unprecedented scale.
  • Healthcare systems are using Apple technology to strengthen the physician-patient relationship and to enable care from everywhere.
  • Providers and insurers are integrating Apple Watch into their wellness programs.

Google Health develops a tool that can reduce the effort and cost of training machine learning systems on chest X-rays. The system, CXR Foundation, converts X-ray images to a numeric representation that allows models to be developed using smaller datasets and less computing power but with no loss of predictive quality. Another benefit is that it works with smaller datasets and allows building a solid model that accommodates underrepresented populations and rare medical conditions.

Oracle and Microsoft announce Oracle Database Service for Microsoft Azure, which allows customers to run applications across the cloud offerings of both companies.

Frederick Health (MD) goes live on Meditech Expanse Genomics in that includes First Databank’s embedded pharmacogenomic decision support, sending orders, and receiving inbound patient-matched results in full PDF form.

Government and Politics

The Justice Department seizes $500,000 from the cryptocurrency accounts of North Korean hackers, which includes ransom paid by hospitals that DOJ returned. A Kansas hospital paid $100,000 to regain access to its systems following a ransomware attack, while a Colorado provider paid $120,000. The incidents drove the federal government’s July 6 cybersecurity threat warning about North Korea-based ransomware hackers who are targeting healthcare and public health organizations.

Privacy and Security

An Atlas VPN review finds that three-fourths of Q1 malware attacks exploited Microsoft Office vulnerabilities, often because users had not applied security updates. Browser exploits are becoming rare because they keep themselves updated automatically.


I’ve read some insightful comments about Amazon’s acquisition of One Medical, which I’ll summarize:

  • Health systems have bought up primary care practices as a loss leader, with their real interest being forcing their owned PCPs to refer their high-profit inpatient procedure work to the health system’s acute care hospitals.
  • Telehealth companies can disrupt that process only so much in the absence of offering the in-office services that patients regularly need.
  • Amazon is gaining a national physical presence with the acquisition. It also gains a respected healthcare name.
  • Amazon’s PCPs can focus on meeting consumer needs rather than making in-organization referrals.
  • The company could also charge for its procedure gatekeeper services or bid the procedure work selectively.
  • Amazon CEO Andy Jassy said in November 2021 that the company will be a “significant disruptor” with its Amazon Care virtual primary care business. Its goal was to be a one-stop shop for health-related transactions via three health arms – Amazon Care (virtual medical advice), Amazon Diagnostics (at-home testing), and Amazon Pharmacy (the former PillPack). Amazon also offers the Alexa Together caregiver support / remote patient monitoring service that runs on Echo devices.


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


EPtalk by Dr. Jayne 7/21/22

July 21, 2022 Dr. Jayne 3 Comments

As I put together my travel schedule for the next year, I’m looking at various conferences. One that caught my attention in email was Becker’s 8th Annual Health IT + Digital Health + RCM Annual Meeting. The attention-getter was its list of keynote speakers including former President George W. Bush, former professional boxer Sugar Ray Leonard, and professional golfer Michelle Wie. It’s certainly an eclectic mix of speakers and I’m not sure how much they individually have to bring to the digital health discussion, but hopefully someone who is willing to pay the $950 admission fee will clue us in.

The costs for conferences keep rising, and it’s not always clear whether attendees receive the value offered. For comparison, the American Academy of Family Physicians charges between $695 and $895 for its Family Medicine Experience (FMX) conference. The National Association of Community Health Centers charges $1,290 for member organizations to attend its annual Community Health Institute & Expo and $2545 for non-member organization attendees. HLTH is pricing registration for in-person admission at $2,295. Typically, an employed physician might have one conference covered by their employer per year, so there are certainly some choices to be made.

I’ve been working with EHRs and consulting with vendors for more than a decade, so it’s been gratifying to see the improved focus on patient safety and greater movement towards standardization. A Viewpoint article published in the Journal of the American Medical Association last week discussed ways that we can continue to improve EHR safety and usability. The authors note that computer-based records have failed to live up to their promise particularly as related to the support of health care providers’ thought processes and that in fact the EHR creates distractions for caregivers.

They state that “…the term electronic health record” is a misnomer… It is not designed primarily to capture and present a patient’s record as efficiently and effectively as practical.” They go on to recognize what we all know – that “…the EHR has many stakeholders, including physicians, health system executives, educators, regulators, and patients whose needs influence EHR capabilities. In the US, requirements for reimbursement, regulatory compliance, and administrative workflow automation often take precedence over clinical efficiency and effectiveness.”

I don’t think anyone who has been working in the healthcare IT space for any length of time would disagree. We’ve all been stymied by EHRs that won’t let us document things the way we need for the patient in front of us. For example, one EHR I worked with didn’t have the capability for the physician to set a default follow up instruction of “within 24 to 48 hours.” The system’s designers insisted that a date be used, which doesn’t necessarily support what the urgent care physician is trying to say when they want a patient to see a specialist quickly but not necessarily on a certain date. As a result, the physician ends up free-texting what they want on every single patient rather than taking advantage of labor-saving features – which costs much more time and money in the long term. There are also organizational impediments to efficiency, such as when EHR decision makers refuse to let clinicians personalize their workflows because of a fear of increased maintenance or support costs.

The Centers for Medicare & Medicaid Services published a final rule stating that hospitals should review their systems using the Safety Assurance Factors for EHR resilience (SAFER) Guides so that they can evaluate usability and safety of clinician systems. The authors call for greater focus on minimizing the cognitive load created by EHR workflows. When there is too much mental effort needed to complete a given task, user performance suffers. The authors propose a SMARTER Guide to improve EHR cognitive support:

  • Synthesizing information and supporting goal-oriented search.
  • Monitoring care decisions, taking patient data and care setting into account, and suggesting better alternatives.
  • Automating routine tasks.
  • Recognizing trends toward or away from idealized patient models.
  • Translating important user actions into documentation.
  • Exposing contextually relevant data; and
  • Reliably and consistently performing these functions.

It will be interesting to see how some of these elements are incorporated into technology over the next few years, and whether technology begins to better serve clinicians or whether it continues to be a distraction.

As an avid outdoor adventurer, sustainability and environmental protection are high on my priority list. I enjoyed this article in the Journal of the American Medical Association that looked at the use of informatics to assess healthcare systems with regard to climate impact and environmental footprint. The authors note that healthcare delivery  — including facilities, pharmaceuticals, and more — accounts for approximately 5% of global carbon emissions and propose informatics efforts to monitor healthcare’s carbon footprint. Other contributors include supply chain (production and transportation of supplies) along with staff travel and waste disposal. The authors propose synthesizing economic activity data alongside life cycle assessment models for products and processes.

Most of the organizations cited in the article are located in the UK or Australia. I would be interested to see how US organizations are looking at the problem. One of the aspects that was mentioned was one that I’ll admit I hadn’t thought very much about in the context of sustainability – wasteful clinical practices. This includes unnecessary imaging, duplicate tests, medication overprescribing, and unneeded surgeries. Many patients in the US feel that greater technology use leads to better outcomes and that medications are a much better solution than more environmentally friendly treatments such as lifestyle modification. Often the decisions made for hospital purchasing are focused strictly on cost without consideration of environmental impact, so there will need to be significant changes in priorities in order to see downstream impacts on climate or the environment.

One of my favorite readers clued me in to this publication on health worker burnout from US Surgeon General Vivek Murthy. He cites Hawaii Pacific Health’s “Getting Rid of Stupid Stuff” initiative as an example of identifying and mitigating workflows that staff felt were unnecessary or poorly designed. The effort led to a savings of 1,700 nursing hours per month across the organization.

A specific example of burnout-generating work is the prior authorization process. Although I understand the need to reduce ordering of unneeded treatments and tests, I’ve long proposed some kind of golden ticket for those of us who order judiciously. In my time as a traditional family physician, I never had an order that failed to be authorized, which meant I was following guidelines. With years of that kind of track record under their belts, why should physicians be subjected to unneeded scrutiny? To be certain, all those unwarranted prior authorization process cost the payers more money than they saved.

Should providers who follow guidelines and control costs be rewarded by reduction in administrative burdens? Would such a move serve as an incentive for clinician behavior? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 7/21/22

July 20, 2022 Headlines No Comments

How Apple is empowering people with their health information

A new Apple report proclaims the company as “an intelligent guardian for [consumer] health and safety,” dividing its products between health and fitness (the Health app and the Apple Watch) and medical community collaboration (ResearchKit for study recruitment, Health Records to give patients access to provider data, Apple Watch for health system integration, and the company’s work in building COVID-19 apps and features).

Simplified Transfer Learning for Chest Radiography Model Development

An article published in the journal Radiology describes how Google Health has used advanced machine learning methods to pre-train chest X-ray networks that convert images into numerical vectors, which allows high-quality models to be created from 600-fold less data that can detect abnormalities and perform better in underrepresented populations and rare conditions.

Invitae to Lay Off Over 1,000 Workers Amid Restructuring, Leadership Transition

The medical genetic testing company will lay off 1,000 of its 2,900 employees, restructure, eliminate non-core operations and geographies, focus on profitable business lines, and shuffle its executive leadership and board.

VA scraps last EHR go-live date in FY 2022, amid IG accounts of patient harm

The VA postpones its last remaining 2022 go-live on Oracle Cerner, saying that the system isn’t ready to be used in larger facilities because of stability issues.

Morning Headlines 7/20/22

July 19, 2022 Headlines No Comments

Columbus tech company Olive lays off 450 employees

Healthcare automation vendor Olive AI lays one-third of its total headcount, saying that economic realities have forced it to “reconcile missteps” related to its aggressive expansion.

New! USCDI v3 Published

ONC publishes the the latest version of the United States Core Data for Interoperability (USCDI).

DiMe Releases Toolkits to Improve Sensor Data Integration and Power Better, Faster Global Healthcare and Research

The Digital Medicine Society releases four toolkits for integrating data from wearables and digital sensing products.

News 7/20/22

July 19, 2022 News No Comments

Top News


Healthcare automation vendor Olive AI lays off 450 employees, one-third of its total headcount, saying that economic realities have forced it to “reconcile missteps” related to its aggressive expansion.

The company was valued at $4 billion a year ago.

The company says it will sharpen its focus on revenue cycle for providers and utilization management for payers, which generate 80% of its revenue.

Olive shares CEO Sean Lane with Olive spinoff and Medicaid care management technology vendor Circulo, which laid off 25% of its workforce one month ago.


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

Acquisitions, Funding, Business, and Stock


GE Healthcare, which is separating itself into three publicly traded companies that each focus on a high-growth sector, will name the healthcare business GE HealthCare when it spins off in early 2023.


An internal email that was shared on Reddit – and confirmed by Oracle as authentic by the Kansas City business paper — outlines significant changes in the former Cerner business that is now owned by Oracle:

  • The business is now called Oracle Health, one of Oracle’s Global Industry Units (GIUs), with no mention of whether the Cerner name will continue to be used. 
  • Former Cerner President and CEO David Feinberg, MD, MBA will become chairman of Oracle Health, with unstated responsibilities and reporting structure.
  • Former Chief Client and Services Officer Travis Dalton, MPA, who led Cerner Government Services, will run Oracle Health as its general manager.
  • Former CTO Jerome Labat and other Cerner technology executives will report to Oracle EVP Don Johnson, the company’s cloud executive who will now oversee Oracle Health engineering.
  • Corporate functions such as IT, finance, legal, and HR will be moved to Oracle teams.



California health information network Manifest MedEx promotes Erica Galvez to CEO.


Tanner Health promotes Abe Manasrah, MS to VP/chief data officer.


Industry long-timer Ron Strachan, MSA, whose SVP/CIO roles have included WellStar Health System and McLaren Health Care, offers advisory and interim CIO services in his newly founded company Optimize Health IT.

OneMedNet hires Joe Walsh, MBA, MA (AllStripes) as chief commercial officer.

Announcements and Implementations

Loyal integrates Google Business Messages – the  asynchonrous chat function that is built into Google’s search and map tools — with its digital platform, allowing users to carry their conversations forward from Google searches to a hospital’s website or patient portal without losing the discussion.

Microsoft announces a digital contact center platform that is powered by tools from Nuance, Dynamics 365, Teams, and Power Platform.

Teladoc Health’s Livongo chronic condition management business will place its fees fully at risk for improvements in measures for hypertension, diabetes, and weight management.

Holzer Health System goes live on PeraHealth’s Rothman Index Trend and Mobile to monitor patient condition.


The non-profit Digital Medicine Society releases four toolkits for integrating data from wearables and digital sensing products.


A new KLAS report on remote patient monitoring concludes that interest and investment is growing in a fragmented market, but RPM’s future will be driven by insurer payments. The offerings of Health Recovery Solutions and Vivify Health have the highest usage, but the latter suffers from steadily declining customer satisfaction due to low support quality and poor EHR integration. Organizations say they need better EHR integration to streamline clinician workflows and capture billing data, also hoping that patient ease of use will improve. Most of the RPM activity is tentative exploration by large health systems who plan to support their RPM programs through insurance billing or by reducing costs under value-based care contracts.

Government and Politics

ONC publishes USCDI Version 3.

HHS OCR settles 11 cases in which providers failed to give patients copies of their medical records in a timely manner, assessing civil money penalties that range from $3,500 to $240,000. One medical practice refused to provide medical records to a patient who had an outstanding balance, another claimed that a patient’s durable power of attorney did not include access to medical records, and Memorial Hermann Health System paid the largest penalty of $240,000.

Privacy and Security

Fortified Health Security’s mid-year cybersecurity report finds that malicious attacks make up of 80% of breaches and organizations that use cybersecurity tools that use AI/ML can detect and contain breaches faster than those that don’t use automation.

Sponsor Updates


InterSystems UKI supports its employees during record-high temperatures and the resulting school closings by inviting the families of employees to spend the day in its air conditioned offices.


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


Morning Headlines 7/19/22

July 18, 2022 Headlines No Comments

GE Unveils Brand Names for Three Planned Future Public Companies

GE, which is separating itself into thee public companies that will focus on the growth sectors of healthcare, energy, and aviation, will name the healthcare business GE HealthCare when it spins it off early in 2023.

Cerner integration with Oracle will include new roles for Feinberg, Dalton

Former Cerner CEO David Feinberg, MD will become chairman of the new Oracle Health Global Industry Unit, while former Cerner Chief Client and Services Officer Travis Dalton will become general manager.

Eleven Enforcement Actions Uphold Patients’ Rights Under HIPAA

HHS OCR settles 11 cases in which providers failed to give patients copies of their medical records in a timely manner, assessing civil money penalties that range from $3,500 to $240,000.

Biden’s FTC Has Blocked 4 Hospital Mergers and Is Poised to Thwart More Consolidation Attempts

The Federal Trade Commission, noting the market dominance of the largest health systems and the failure of mergers to reduce costs, signals that it will more aggressively investigate planned hospital mergers and acquisition of physician practices.

Curbside Consult with Dr. Jayne 7/18/22

July 18, 2022 Dr. Jayne 2 Comments

I spent part of the weekend hanging out with some longstanding healthcare IT friends. There was plenty of catching up to do. It was great to hear about everyone’s newest projects and what they think will be hot in healthcare over the coming years. We all used to work together, but now everyone is scattered to the winds at various health systems, consulting firms, payers, and vendors. A couple of have even retired and I enjoyed hearing about their many adventures and how much they’re enjoying not being part of the madness anymore.

Several of us have had experiences helping or parents or other relatives navigate the healthcare system in recent years, so there were plenty of conversations about the usefulness of various patient portals and how our loved ones are or are not using the information available to them. One hot topic was patients having access to their notes from medical visits. Although most of the folks I was speaking with were eager to see their own documents, probably due to the fact that we’ve spent so much of our careers dealing with EHRs and other clinical IT systems, very few of their parents show an interest in reading their medical notes.

The clinicians in the conversation voiced concerns about patients being able to see their notes and “how bad they really are” due to EHR-related note bloat. There were few concerns about patients reading things they would find worrisome or being offended by discussion of hot button issues such as obesity, smoking, alcohol use, or drug use. Nearly all felt that the benefits of transparence outweighed concerns, although one clinical informatics nurse lamented the fact that many of the clinicians that she supports write notes that can be described as “terrible,” including typos, sentence fragments, and disordered thought processes. I certainly feel for that physician’s patients if they try to access their information.

With that conversation fresh on my mind, I was happy to see a link in my email to a recent article in the Journal of the American Medical Informatics Association that looked at the impact of patient access to notes on clinical documentation. The authors set out to examine whether recent rules that require patient access to clinical notes have had unintended consequences, such as increasing physician documentation burden. They used what they describe as “a national, longitudinal data set consisting of all ambulatory care physicians and advance practice providers using an Epic Systems EHR” to specifically evaluate the length of clinical notes and the time spent documenting in the EHR.

As background, the 21st Century Cures Act language that required that healthcare organizations provide access to notes was implanted on April 5, 2021. The authors used “de-identified clinician-week level EHR audit log metadata extracted by Epic’s Signal software” to look at aggregate data from January 3 to May 29, 2021. This data covered over 340,000 unique clinicians for 21 weeks and excluded inpatient data. Analysis models controlled for the number of visits that clinicians were performing each week as well as other factors that might impact individual productivity. The authors also checked their data by looking at only primary care physicians and also by stratifying to compare physicians against midlevel providers. During the initial post-rule period, there was no statistically significant change in note length or documentation time.

Interestingly, providers spent more than 12 minutes creating each note, which is significant given the fact that a large number of visits delivered in the US are scheduled for approximately 15-minute appointment times. In the discussion, the authors acknowledge that they were looking at the potential for short term impacts and that more work is needed to evaluate whether there are long term impacts on having patients access their notes. Although I like how the authors approached the problem as well as their use of a large and available dataset, I wonder how many of the organizations in that dataset were actually releasing their notes at the time of the study. My own health system didn’t start releasing notes to patients for at least six months after the rule went into effect, although they did release content retroactively, which was a surprise to me as a patient.

Now that I have access to my notes, I look at them often. I have found their content to be largely fictional. My last preventive health visit contained two full pages of screening questions that were never asked during the visit as well as exam elements that weren’t performed. There were also inaccuracies in my responses to questions, along with what I find to be a very annoying disclaimer that the documentation “was created with voice recognition software and may contain errors or omissions.” Seriously? I can’t imagine having a patient see that information in one of my notes, and it definitely makes me think less favorably about the clinician I saw, especially since I wasn’t happy with the visit in real time.

I wonder how many patients are actually looking at notes that are available and whether they’re communicating with clinicians when they find problems. I know I don’t have time to deal with trying to get a correction, so I’m going to just let it be even though those inaccuracies will likely propagate themselves across other entries in the future. Even thinking about trying to correct it is tiresome.

I would love to see research looking at how many health systems are actually releasing their notes, how many have communicated to patients that the notes are available, and how many are encouraging patients to use the information to better their health. I suspect that the results of those kinds of efforts would be rather interesting.

The authors note that they are also unable to quantify non-note work that may have increased due to the availability of patient facing notes, such as increased patient phone calls or portal messages. I know that when I put on my CMIO hat to approve patient-facing documentation, I always try to make any default language as clear as possible to avoid creating confusion. However, I’ve seen plenty of notes where clinicians go crazy with free text and create plenty of confusion that I will never be able to influence.

Who’s ready to look at this data again, and see what it looks like 12 to 18 months into the process? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: The Changing Dynamics of Today’s Healthcare IT Labor Market

July 18, 2022 Readers Write 1 Comment

The Changing Dynamics of Today’s Healthcare IT Labor Market
By Mike Silverstein

By Mike Silverstein is managing partner of HIT & Life Sciences for Direct Recruiters, Inc. of Solon, OH.


Whether you are a health system, a health tech company, or an employee of either, the last two years have been a roller coaster. COVID-19 has had rippling impacts across all aspects of the HIT talent market, and the potential economic correction is compounding those ripples.

From March 2020 until June 2020, if you had a job and your employer would let you work from home as COVID-19 spiked, you considered yourself lucky. As an HIT recruiter, it was a scary time that brought me back to my start in 2008, when there were more candidates than positions, and my HIT software company clients were canceling hiring plans indefinitely.

Everyone was trying to adapt to a fully remote working situation. Health systems around the country were pausing elective positions and moving all available administrative roles from on-premise to remote. What is interesting is this felt like something very temporary at the time, but it has proved to be a historic inflection point in employees’ relationships with their employers and patients’ relationships with their doctors.

Today, if you are a health tech company and you don’t offer a virtual work environment or at least a hybrid schedule, it is almost impossible to help you find top talent. If you are a health system / health plan and don’t offer telehealth visits, live chat, virtual scheduling, online payments, and on-demand answers to clinical questions (aka digital front door), your patients/members are going to find a provider / payer that does. This consumerism dynamic signaled an opportunity for an industry disruption that attracted billions of dollars of private investment in the space and led to the craziest talent land grab I have experienced in my 14 years in healthcare recruiting.

Interviews moved to video, speed became a necessity, and companies who had coffers of fresh funding changed the playing field. If you were an experienced healthcare professional, you had an unparalleled opportunity to leverage your career and have multiple employers bidding for your services. If you were the incumbent, you quickly had to adapt from your employees being grateful for keeping them employed to figuring out what you are going to do to allow them to grow professionally, both in responsibility and finances, while allowing them to be with family and have personal flexibility.

In the past handful of weeks, I have started to feel those dynamics change once again. As inflation has driven up the price of our day-to-day and the Fed has raised interest rates to combat it, employers are starting to draw some lines in the sand. Salary offers are starting to level out and working from an office is creeping its way back into job requirements. The workforce still feels like they have the upper hand, but I think we are going to see a correction like what looms in the housing market. Companies are beginning to get advised by their investors to tighten their belt, and I have heard from several industry leading startups and growth companies that fundraising has gotten more challenging with valuations coming down to earth. From a labor market perspective, that means fewer open roles in the back half of the year, and as a result, a leveling out in terms of job offers.

As a guy who makes a living by matching candidates with employers, this is a little nerve-wracking. The good news is, I think healthcare has changed for good, and because it isn’t getting any cheaper, tech companies that can help lower the cost of healthcare, provide easier access, and improve the quality will continue to have a very bright future and need talent. I also believe at my core that talent wins the day and is always a phenomenal investment. The companies that will thrive regardless of what the economy does are the ones who hire the best people and focus on giving them great support.

There are still countless problems to solve in our industry, and the net-net is healthcare continues to be a terrific place to work, earn, and invest in as we head into the second half of 2022.

Readers Write: Four Keys to Patient Engagement for Complex Care Plans

July 18, 2022 Readers Write No Comments

Four Keys to Patient Engagement for Complex Care Plans
By Jeff Pigatto

Jeff Pigatto is VP and global head of Salesforce practice at Infostretch of Santa Clara, CA.


For 78% of healthcare providers, the COVID-19 pandemic has made patient engagement more important than ever, according to an industry report. Industry leaders recognize the need to improve patient engagement to reduce patient leakage, especially for those with complex care plans. Without robust engagement, patients are more likely to fall through the cracks.

To boost patient engagement, leaders need a plan. I’ll offer four key elements of a patient engagement strategy.

Use a cloud-based single system of engagement

Patients with complex treatment plans often face uncoordinated care, even when they are seeing in-network providers. Some providers, with the help of expensive back-office operations, still rely on paper-based systems to record patient information. Others may use digital tools, but they often depend on local storage and lack key system integrations. In both cases, providers can’t efficiently share patient data. As a result, the patient experience suffers.

Without streamlined data-sharing tools, patients often have to complete similar intake forms at separate care centers. That’s a tedious process,  and a vulnerable one. Complex care patients often have emotionally fraught conditions. When they have to divulge sensitive information again and again, they may grow frustrated, uncomfortable, and unsatisfied. That creates a problem for providers. Dissatisfied patients may turn to other care options or may not receive the care they need, which worsens the patient leakage problem and impacts revenue generation.

With a cloud-based data-sharing system, providers can ensure that all in-network providers have the same access to patient data. This limits duplicate form completion, meaning patients have to divulge information less often. Key software integrations can further simplify patient data management. The result for in-network providers is a streamlined patient experience that’s more compelling than out-of-network options.

Offer proactive patient interaction

A provider will often issue an in-network referral and assume patients will follow through. But patients are human. Schedules quickly change, and people can be forgetful. If providers don’t engage in proactive and consistent outreach, patients will receive slower access to the care they need. That means providers lose out on revenue. With proactive patient interaction, providers can maintain patient engagement while minimizing gaps in care.

An effective patient interaction model includes:

  • Scheduling appointments immediately after referral.
  • Enabling form completion before care visits.
  • Providing a pre-appointment patient checklist.
  • Sending regular reminders about care visits and uncompleted forms.
  • Emailing patients follow-up actions after each visit.

With consistent updates, patients will know that providers are serious about their care experience. What’s more, they’ll be more likely to remember the steps needed to stay in network.

Emphasize patient education

For many complex care patients, it’s expensive to manage their long-term health. Between repeated clinical visits, treatment, and therapeutics, the costs quickly add up. Over time, patients may see providers as putting profit over care. They might start looking for a more human-centered wellness experience,  and that might be out of network. But consistent patient education can help. When patients feel empowered to manage their health, they can:

  • Stabilize or improve their conditions.
  • Follow their care plans more effectively.
  • Reduce the risk of readmissions or emergency room visits.
  • Lower the overall cost of care.

Providers benefit, too. Through patient education, they can prove they’re focused on helping patients heal. That approach could be exactly what patients need to stay with their current provider.

Here’s what patient education looks like in practice. Consider a patient who’s on a weight management plan for diabetes. Every few weeks, their provider can send plain-language materials showing how exercise helps improve insulin sensitivity. If the patient has a smart watch, their provider can suggest downloading a step-tracking app that syncs with the provider’s patient data management system. Then, the provider can use that data to keep tabs on anomalies. If the patient’s steps drastically dip between months, the provider can ask about barriers to wellness management  and help strategize solutions. The result: the patient’s long-term health will likely improve, insurance claims and out of pocket expenses will reduce, and providers can maximize their value.

The patient engagement tactics we’ve looked at so far work together to prevent patient leakage, but they can be tedious to manually implement and maintain. That’s why I recommend a fourth key element of a patient engagement strategy:

Automate patient journeys

When providers use digital tools to automate every stage of the patient journey, they can save time, reduce human error, and minimize manual labor. In the long term, automation can help providers save on labor costs. Patient journey automation might look like:

  • Automatically contacting patients to schedule their next care visit.
  • Automatically delivering a pre-visit checklist at Day 7 before each visit.
  • Sending automated patient follow-ups at Day 1, Day 7, and Day 30 after each visit.

Automating patient journeys can support existing patient engagement efforts to help providers reduce leakage.

Pandemic pressures have made patient engagement a cornerstone of efficient access to complex care. But the pandemic is also expanding the traditional range of complex care patients. In fact, new research suggests that between 20 and 25% of those who catch SARS-CoV-2 will have some form of long COVID. It can last several months and may require a complex care plan. The prevalence of long COVID amounts to what some call a “mass disabling event.” Alongside existing complex care patients, providers must invest in a long-term patient engagement strategy that accounts for an expanding chronically ill population.

HIStalk Interviews Diana Nole, EVP/GM, Nuance

July 18, 2022 Interviews No Comments

Diana Nole, MBA is EVP/GM of the healthcare division of Nuance, a Microsoft Company, of Burlington, MA.


Tell me about yourself and the company.

I’ve been with the company just a little over two years, but I have been around healthcare IT for about 15 years, which makes me a little bit further along than just a novice, I like to say, because it’s such a complex industry. Since we last spoke, Nuance has become a Microsoft company. Nuance is a technology pioneer, focused on conversational AI and ambient intelligence and working on how to put things into the intelligence, into the workflow. We are heavily focused on reducing the administrative burden of clinical documentation. Our offerings are used widely throughout the US and globally.

Microsoft’s Cortana doesn’t have the adoption of competing voice assistants from Amazon, Apple, and Google. Was that part of its interest in acquiring Nuance?

There were probably a few levels of interest. We are heavily into the deep workflow of clinicians and the patient experience. We try to understand heavily with our customers and our partners what’s going on in terms of patient care and this focus on the Quadruple Aim. We have a deep presence. We are in 77% of the US hospitals and I think we were quoted as being in 80% of radiology. In healthcare, it’s about how the technology is being used to actually enhance patient experience, physician experience, et cetera. There was the actual technology that we have, but even more so, the relationships that we have and the clinical care. Then, the deep relationships that we have with our EHR partners and other partnerships were very much of interest to them.

Now that Nuance and Cerner are owned by highly competitive technology giants, how will Nuance’s relationship with Cerner customers work?

We deeply value these relationships, as you can imagine. Our solutions have to work within the workflows that our physicians, nurses, and radiologists use. We have had ongoing conversations with Cerner since the acquisition. Clearly, we are deeply committed. We have continued to advance our solutions, such as DAX integrating with Cerner’s virtual scribes. There’s a lot of opportunity here, and certainly we don’t want to disrupt that.

That has been a very key theme of our conversations with Microsoft, that they value that. They are deeply committed to their partnerships and the systems integrators that they work with. That’s a core backbone of who they are. We continue to advance — whether it’s Cerner, Athenahealth, Epic, et cetera — these relationships, because the only way that we can be efficient in the way that we deploy our technology is to do it with them.

Oracle says that it will use its own voice AI product as the primary user interface to the Cerner clinical systems it now owns. What challenges do you see in that approach?

We obviously always know that there will be competition out there. We have been at this for a long time. Medical technology and terminology is very different from just straight conversation. We have invested deeply over many, many years and have many years of experience. We respect that others will come along, and that’s why we constantly are working on our own technology advancement and why we have moved from our medical technology and things like Dragon Medical, which is used by so many people, into more of the ambient environment, which is even more complex. You have to keep pushing yourself, and competition helps you move along because you need to stay ahead of that if you are going to survive and be effective.

I can’t speak specifically to what Oracle’s plans might be, but certainly for us, we are deeply invested in continuing to advance our Dragon portfolio, our DAX portfolio, and other things with our partnerships that we have and investing in the technology. Now we have a phenomenal owner in Microsoft that can help us advance those solutions while also having the cloud infrastructure and cybersecurity infrastructure that they bring to the table to help complement the first-party applications that we have.

What new capabilities does the cloud bring to healthcare?

We have deeply been invested in cloud. The big reason that we are trying to help our healthcare customers move into the cloud is that, historically, we have had a lot of on-premise solutions. It as always challenging to do upgrades, and you want to get the innovation out there as fast as possible. But we also know healthcare has significant worries about privacy and security. We are evolving at a good pace. Certainly with someone like Microsoft, we have deep investments on that side. Once you get everything in the cloud, then we have a good infrastructure to start to unlock other kinds of use cases for the information that resides within the cloud, under the constraints of doing what we’re supposed to be doing as good stewards of the data.

As we have started to think about the combination of our two companies, we think about analytics, reporting, and how you do communication. A lot of things in healthcare are about getting the communication to the right player and the care team. How do you use communication tools to be able to do that? 

Also, things that help enable different kinds of care settings. I’ve heard people talk about the hospital at home. We certainly have seen virtual care advance during COVID, not just with telehealth, but other types of thinking and capabilities. That is helpful because it tries to get at a better physician experience, a better patient experience, while also hopefully reducing cost and not sacrificing quality at all.

Hospital consolidation that creates larger, more tech savvy health systems has generated ideas around scaling patient engagement, call centers, and other centralized consumer-facing technology. Where do you see that progressing?

I think we learned a lot during COVID about what people would accept. We have a tremendous ways to go with consumerization and what you can do to engage patients while also recognizing that you have to deal with accessibility. Not everybody has access to things such as the internet. We also have learned that, so we have to be careful. We have made advancements in basic blocking and tackling, such as outreach around reminders. As a patient, come in and get your mammogram, get your annual exam, get your preventative care. That makes a huge difference. But other settings are starting to be considered, such as better management of clinical trials with a virtual patient clinical trial cohort.

With regard to the care setting, not just telehealth, what can you do in monitoring a patient with a more chronic condition at home? Maybe that is more integration with med tech, home devices, and things where you can identify if and when a patient needs to come in for a visit or to have follow-up. Always trying to prevent that rising risk of issues with the patient. There are definitely opening thoughts around other areas beyond just the typical reminders and telehealth. more sophisticated things that are going to be coming.

Voice assistants are being enabled to support consumer health needs at home, including remote monitoring. How do you think that will progress?

Voice assistants, definitely. We probably have seen more initially on the roadmaps with physicians. The physicians can use “Hey, Epic” or “Hey, Cerner” or “Hey, Dragon — bring up this, bring up that.” It’s much quicker than clicking, because you can speak faster than you might type or click certain things.

But you are also right that in a conversational way, it is easier for a patient who doesn’t know exactly what they’re supposed to be looking for, or how they get basic information. We’ve had some solutions where it’s just simple things that the patient is looking for, such as, “Remind me about this situation that I should be taking care of,” or “Where is the valet parking at the appointment I’m going to?” Just basic interactions that used to flood the healthcare system with basic conversational questions. Those kinds of things can be done now through easy to use, consumer-oriented types of applications, but specifically for healthcare.

DAX has been out for a couple of years. How is it being used and what work remains?

It has been about two years since DAX was announced during COVID. It almost matches the exact timeline. Definitely we would view it as being at the Slope of Enlightenment, where our customers and partners are proving the benefits and use cases within their organizations. Initially, people would start with groups of 25 physicians. Now we are starting into the hundreds, and we have implementations that are well into the thousands. What they are trying to prove is who the right user for it is and where the most opportunity is.

We started out with certain specialties where we thought it would be easy to use and produce a good ROI. We have seen that family medicine and internal medicine have more of an opportunity to use the system than anywhere else. That is where the burden of clinical documentation creates the highest levels of burnout and where we have a shortage, either already in existence or coming.

We published some great opportunities with our customers on what they are seeing. They get better patient experience input, since the patient feels like the physician is talking to them face to face and focusing on them. They understand what they are supposed to do when they leave a visit. As to the physician experience, they are less burned out. They have more of their own time. They can get home. They can take on more patients if they want. Even though it has been two years, we are still in the early days, but definitely have proved a significant ROI for those who are using it.

What has changed in the months since the acquisition closed and what changes do you expect?

I would say that not a lot has changed. At Nuance and at Microsoft, we continue to remain focused on our customers. We continue to deepen relationships with our EHR partners. We are now part of the Microsoft organization. We are a Microsoft company. What we have done since the close in March is to focus on what our shared vision looks like. Our customers are looking for that. They are optimistic. They realize the big, complex challenges that face healthcare, and they really want to have Nuance and Microsoft look together at how can we enhance the ability of clinicians to care for their patients and deliver better outcomes, where technology helps to enable it instead of getting in the way.

We are focused on that right now, and we are involving customers and partners in those conversations. When you think about the combined power of Nuance and Microsoft, where do you see opportunities, and where do you think we should work on this? That’s what we’re focused on, so that we can begin to unlock some of the opportunity that spans both of our companies over the course of the next year.

Another thing we are excited about at Nuance and Microsoft is a partnership with The Academy around an AI collaborative. It’s early days, just announced recently, but it’s an effort to bring together clinical and operational executives not only from provider organizations, but from payer, med tech, and life sciences. We will create a dedicated sandbox for us to experiment with AI and have them, as users of AI, tell us where it will work or not work to guide some of this collective vision that that we are working on.

Morning Headlines 7/18/22

July 17, 2022 Headlines No Comments

Senior Staff Gave Inaccurate Information to OIG Reviewers of Electronic Health Record Training

A VA OIG report says that VA project executives provided it with misleading information about employee training on Cerner.

Scoop: Veritas buys RCM firm Coronis Health

Axios reports that private equity firm Veritas Capital has acquired physician billing and RCM company Coronis Health, reportedly with the intention of buying another privately held RCM company and combining the two.

R1 RCM Announces 10-Year End-to-End Revenue Cycle Management Partnership with Sutter Health to Drive Improved Financial Performance

Sutter Health signs a 10-year RCM outsourcing contract with R1 RCM, which will hire 1,150 Sutter employees.

Do Cancer Centers Push Too Many Tests?

A New York Times review of 600 cancer center websites finds that they often tout the benefit of tests, often highly profitable radiology exams, in ways that conflict with medical evidence and recommendations.

Monday Morning Update 7/18/22

July 17, 2022 News 1 Comment

Top News


A VA OIG report concludes that the VA’s use of an “unknown queue” in its Cerner system caused multiple events of patient harm in which orders failed to reach their intended care location. Notes from the report:

  • The system failed to deliver 11,000 orders in which clinicians chose a service location that didn’t match the type of service that they were ordering.
  • The system did not notify the clinicians that their order had not been delivered, and in fact assured them that their order had been accepted.
  • The VA learned of the unknown queue’s existence when it opened its first Cerner trouble ticket about the problem four days after go-live, after which the VA instructed staff to monitor the queue and cancel and re-enter the problem orders.
  • Cerner says that a a VA leader had approved the use of the unknown queue in January 2020, but that leader and their supervisor say they weren’t aware of it.
  • Cerner created a provider alert for their undelivered orders in February 2022, but the VA said that the solution wasn’t adequate.
  • The OIG did not accept the response to its report from VA Deputy Secretary Donald Remy because it failed to address the report’s key finding that patients were harmed.
  • Remy says that Cerner and the VA were both aware of the queue’s existence before go-live, but OIG says it was provided with no evidence to support that statement and that users weren’t informed about the queue until a year after go-live.
  • OIG says it it is “troubling” that Remy absolves Cerner for failing to educate VA about the unknown queue and instead blames VA users for the negative outcomes it caused.
  • OIG also notes that both the Deputy Secretary and EHRM IO executive director were aware of the patient harm that resulted, but in their testimony to Congress, they insisted that no harm had occurred.

A second new VA OIG report looks at the VA’s Cerner training:

  • VA project executives sent misleading information to OIG in to a “careless disregard for the accuracy and completeness of the information.”
  • VA showed OIG a training evaluation plan without disclosing that the plan had not been reviewed, approved, or implemented.
  • OIG was given a slide that showed the user proficiency pass rate at 89% instead of the actual 44%, then explained the error as being due to removing a small number of outliers who had taken and failed the test up to 29 times. VA had not calculated the numbers until it received OIG’s request.

HIStalk Announcements and Requests


It’s pretty much an even split between C-level executives working from home or from the office. I’m surprised – I thought more of the C-suite would have returned to the office.

New poll to your right or here: How worried are you that your employer will lay you off, demote you, or force you to relocate in the next 12 months?


Thanks to new HIStalk Platinum Sponsor West Monroe, which is upgrading from Gold. The digital services firm was born in technology but built for business, partnering with companies in transformative industries to deliver quantifiable financial value. It believes that digital is a mindset—not a project, a team, or a destination—and is  something that companies become, not something they do. That’s why it works as diverse, multidisciplinary teams that blend management consulting, digital design, and product engineering to move companies from traditional ways of working to digital operating models and create experiences that transcend the digital and physical worlds. Thanks to West Monroe for supporting HIStalk.


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

Acquisitions, Funding, Business, and Stock

Private equity firm Veritas Capital acquires Coronis Health, which offers physician billing and RCM. Axios speculates that Veritas will acquire one of several potentially available privately held RCM company and combine it with Coronis Health.

A fascinating Brookings report looks at Medicare Advantage insurance market, which is good timing since the eye-popping paper valuations of some tech-focused players are being shredded in a more scrutinizing stock market:

  • MA represents 46% of all Medicare beneficiaries.
  • Two-thirds of enrollment is concentrated among five big insurers – UnitedHealth Group, Humana, CVS/Aetna, Kaiser Permanente, and Anthem.
  • These large companies have other businesses that provide services to their MA plans, such as Humana-owned Kindred’s home health and hospice services and three of the five that operate pharmacy benefit managers. Profits in those related businesses are shielded from medical loss ratio requirements, which places smaller insurance competitors at a disadvantage..
  • Nearly all of the plans bid rates that are lower than Medicare fee-for-service, but plan payments are 104% of Medicare spending in generating net profit margins of 5%. However, big insurers have accounting flexibility when they operate multiple insurance product lines and related businesses that sell services to their MA plans, so their true profit and pricing competitiveness are hard to determine.


  • Bedrock Management Services chooses CareCloud Remote solution for home healthcare practice groups, which it will implement at 33 locations in seven states.
  • Starting Point Behavioral Healthcare will implement Owl’s measurement-based care platform,  which offers evidence-based measures and predefined measure bundles to give clinicians actionable insights.
  • Sutter Health signs a 10-year contract to make R1 RCM its exclusive provider of enterprise revenue cycle management services, with 1,150 Sutter employees being assigned to R1 RCM.



Tanner Health (GA) promotes Bonnie Boles, MD, MBA to SVP/CMIO.


Joe Bajek (Centura Health) joins Lifespan as VP/CTO.


So many lessons to be learned here. A company that runs a video game operator in which players can earn cryptocurrency by battling Pokemon-like characters loses $620 million in crypto when one of its engineers falls for a fake job offer on LinkedIn. North Korea-based hackers posed as job recruiters on LinkedIn, got a bite from an engineer at game developer Sky Mavis, took the engineer through several rounds of interviews, and then sent him a generous offer letter in the form of a PDF that was loaded with spyware that gave the hackers access to the company’s blockchain network.

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  • Volunteers from Arrive Health (formerly RxRevu) help Denver-based mental health provider WellPower prepare its ADA-accessible garden space at its Dahlia Campus for Health and Well-Being Market Farm.
  • Quil publishes a new white paper, “Bridging the Gap Between Patient Engagement Solutions, The Provider Experience.”
  • Relatient will offer TriZetto Provider Solutions customers access to its Dash patient scheduling and engagement suite of solutions.
  • Talkdesk publishes a new report, “The Future of AI 2022: Progressing AI Maturity in the Contact Center.”
  • Clearsense posts “Top 5 Spots to Check Out in Madison at the Epic UGM.”
  • TigerConnect releases a new episode of The Connected Care Team Podcast, “A Conversation on the Next 10 Years of Healthcare Transformation.”

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Morning Headlines 7/15/22

July 14, 2022 Headlines No Comments

Making Electronic Health Records Both SAFER and SMARTER

Informatics leaders call for expanding use of the SAFER guides to align health systems and EHR vendors in improving safety and usability, and for developing a similar set of SMARTER guides to protect the cognitive attention of clinicians.

Healthcare Triangle Announces Closing of $6.5 Million Private Placement

Healthcare cloud and data transformation vendor Healthcare Triangle closes a $6.5 million private placement.

The New Electronic Health Record’s Unknown Queue Caused Multiple Events of Patient Harm

A new report from the VA’s Office of Inspector General confirms that an “unknown queue” within the VA’s Oracle Cerner system led to 150 adverse patient events.

HPG, a Leader in EHR Technology Integration, Acquires HIT Consulting Services Provider HDS

EHR consulting firm Healthcare Performance Group acquires competitor Health Data Specialists.

Canvas Medical Achieves ONC Certification, Raises $24MM to Power Clinicians and Developers Building and Scaling Digital Health Companies

EHR and developer tools vendor Canvas Medical raises $24 million in a Series B funding round.

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