Morning Headlines 4/8/21

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

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

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

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

KKR to Acquire Therapy Brands

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

Agilon health Files Registration Statement for Proposed Initial Public Offering

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

We need to do better.

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

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

Origins of Alert Fatigue

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

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

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

1. Make Alerts More Meaningful and Actionable

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

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

2. Consider the Scenario

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

3. Build it in the Workflow

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

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

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

4. Focus on Specificity

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

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

5. Optimize the CDS

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

Putting Patients First

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

HIStalk Interviews Andrew Smith, President, Impact Advisors

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

Tell me about yourself and the company.

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

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

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

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

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

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

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

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

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

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

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

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

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

Are consumer-facing technologies getting executive and budgetary attention?

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

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

Who drives that process in health systems?

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

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

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

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

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

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

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

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

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

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

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

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

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

Do you have any final thoughts?

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

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

Morning Headlines 4/7/21

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

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

Critical Event Management (CEM) Provider Everbridge to Acquire xMatters

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

Verizon Business Launches BlueJeans Telehealth for Better Connected Health

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

News 4/7/21

Top News

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

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

Reader Comments

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

HIStalk Announcements and Requests

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

Webinars

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

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

Acquisitions, Funding, Business, and Stock

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

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

People

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

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

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

Announcements and Implementations

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

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

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

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

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

Government and Politics

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

COVID-19

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

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

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

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

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

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

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

Other

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

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

Sponsor Updates

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

Blog Posts

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

Contacts

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

Morning Headlines 4/6/21

Inbox Health Raises $15 Million in Series A Financing Round

Medical billing and patient communications startup Inbox Health raises $15 million in a Series A round of funding led by Commerce Ventures.

Indian Health Service Wants IT Strategic Planning Help from Industry

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

Zipnosis Has Been Acquired by Bright Health

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

A New Day for Interoperability – The Information Blocking Regulations Start Now

ONC officials remind healthcare stakeholders that the Cures Act’s information blocking provision has taken effect.

Curbside Consult with Dr. Jayne 4/5/21

A major part of my consulting practice involves trying to help physicians become more proficient EHR users. As I evaluate their current state workflows, I usually discover a number of operational processes in their practices that are adding to their workload. Often the perception is that the EHR is causing more work when it’s really a combination of poor EHR implementation, poor EHR configuration, and continuing to try to use processes that were designed for paper even though the paper is long gone.

Increasing practice-related stresses contribute to physicians feeling like they’ve lost control of their work lives, which can ultimately result in burnout. I’m always on the lookout for strategies to help my clients beyond optimizing their EHRs and their office processes. Sometimes this involves referring them for executive coaching to discuss work-life balance and their willingness (or lack thereof) to alter their work schedules to try to reduce stress. Other times, physicians are resistant to any advice that advocates for work habits different than what they’ve grown to accept.

I ran across an article from the AMA this week that advertised four approaches to reduce the mental workload that physicians face. This was presented as a strategy for reducing burnout. Cognitive workload is a real phenomenon that a lot of organizations don’t think about. I’ve had many conversations with EHR designers and UX experts about it over the years, and certainly systems can be designed in a way to make things easier on the user. However, what users see on the screen is only a small part of the stressors they face each day.

The article cites a recent webinar with Elizabeth Harry, MD, who is senior director of clinical affairs at the University of Colorado Hospital. The first point that the article makes is that an individual’s attention is a limited resource, and that we need to “have space to actually give proper attention to things” in order to avoid making mistakes. She suggests that people use a task-based approach, where they focus on a single task for a period of time in order to saturate their working memory. An ideal time for focused attention would be 25 minutes, followed by a break during which the cognitive load would be discharged.

That sounds well and good from an academic perspective, but I’m not sure how to apply it to the typical workflow physicians face in the outpatient setting, where they’re bouncing from 10- to 15-minute visits with “breaks” in between, during when they are expected to finish documentation, field telephone messages, address medication refills, and perform numerous other tasks.

Dr. Harry goes on to suggest four strategies to address systems issues that contribute to burnout.

The first strategy is to increase standardization. She cites Steve Jobs and his standardized wardrobe as an example. She notes that building intentional habits can reduce stress and that organizations should try to standardize as much as possible across medical care unites.

I wholeheartedly agree with this idea. My urgent care employer has more than 30 locations, and all of them are built on the same blueprints except for three locations. I work at two of the three non-standard sites from time to time and find them incredibly frustrating. One site was acquired from another urgent care organization and has different cabinetry, so the drawers are laid out differently and the rooms have different configurations, which results in the physician opening random cabinets trying to find things. I’m sure that doesn’t build confidence for patients, and it definitely injects a small amount of stress into your day. The other site has the standard layout in the rooms, but the doors to the exam rooms all open opposite of how they should, resulting in some shimmying and dodging of trash cans and exam tables as you enter the room. It also makes you try to grab for a handle on the wrong side of the door as you exit, which just makes you feel foolish as well as slowing you down.

The second strategy she advocates is decreasing redundancy so that organizations have a single high-reliability process for completing a task rather than having multiple ways a process can run. She uses the example of notifying a physician regarding lab results. We need to receive results the same way each time rather than a different way each time we order labs. I think most organizations are doing a fairly good job with this, although there are some levels where redundancy is important, especially where critical patient safety situations are involved.

The third anti-burnout strategy involves consolidation of clinical data. This is where she cites EHR design as an example, setting up the workflow so that key information is located in a single space rather than requiring users to bounce around to find the information they need. Disease-specific workflows are an example of this, where users can find relevant patient history, clinical indicators, and labs all in the same place. This approach builds on the concept of reducing split attention as well as creating routines and habits.

The fourth strategy involves reducing interruptions. Dr. Harry notes that physicians need to have agreements with their support staff about what merits an interruption and what doesn’t. Interruptions can disrupt important thought processes, and she again advocates for physicians to have blocks of time where they can focus.

This may be a possibility for outpatient visits in certain subspecialties that are allowed longer appointments for complex consultations, and might be even more of a possibility where physicians own their own practices and can control their own schedules. However, I can’t see how it would be much of an option for specialties where physicians are expected to juggle multiple patients who are having acute problems simultaneously, such as in the emergency department or in the intensive care unit. In those settings, our attention is constantly drawn away from what we’re looking at and towards something that is potentially less stable or more serious.

The reality is that inability to focus doesn’t just lead to stress for physicians and caregivers, but it also leads to poor care when patients don’t have our complete attention. Having time to focus has become a luxury and our patients deserve better.

What are your organizations doing to help physicians achieve greater focus, and is it helping reduce burnout? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Rob Culbert, CEO, Culbert Healthcare Solutions

Rob Culbert is founder and CEO of Culbert Healthcare Solutions of Woburn, MA.

Tell me about yourself and the company.

I started with IDX in the 1980s and worked with them for almost 10 years before switching over to the consulting side of the world. I started Culbert Healthcare Solutions in 2006, so it’s our 15th anniversary, although we didn’t get to celebrate it yet because of everything that’s going on in the world. We have been able to continue our passion for working with healthcare providers around the country, helping them improve the patient experience, improve financial performance, and solve strategic business problems.

How has the pandemic affected your business?

Initially, it was a shock, as was to everybody. It changed our business on a dime. For the first time in my consulting and work experience in 30-plus years, in April and May, we had zero invoices with expense reports on them. I never have experienced that in my life.We had a lot of things in place to be able to flip over to remote work. We had some projects pause, some ended, and some new ones kicked in, but we were able to make that transition as best we could.

We are a pretty conservative company and privately held, so we focused on making sure that we kept our people and took great care of the customers that we had and the new ones that had needs. We tried to be as creative as we could be to help them through their own crises. While I don’t think any of us are out of the woods yet until this thing really gets behind us, we have been able to weather the storm and continue the good work we try to do.

How are hospitals and health systems looking differently at their relationship with patients?

Pre-COVID, we dedicated a lot of effort to helping organizations improve patient access. There are lots of systems and functionalities out there. When you are doing a large-scale implementation like Epic, Cerner, or Allscripts, you don’t get to become an advanced user overnight. A big portion of our work has been helping to look at the patient access functionalities. It’s all about making sure that the physicians and the clinical staff have all the tools in place to be able to maximize utilization, to be able to have the right information to take good care of the patient before, during, and after the visit, and make that as seamless as possible. Some of that was for financial improvement. A lot of it was to prepare for changes and and the way payers pay providers for their work.

When COVID came, it was an easy process to flip to being as touchless as humanly possible. We had several engagements where there could have been pauses on the project, given all the uncertainty. But in the areas of patient access, customers said, keep going. The work that you have done so far has made those practices able to change on a dime. How do we deal with nobody in the waiting room? How do we remove all of the in-person touches that typically have happened? They were able to more easily adapt their schedules to follow best practice COVID protocols.

Are you seeing a lot of provider interest in buzzy technologies such as AI, robotic process automation, and life sciences research?

We are. Machine learning is, as with robotics and data analytics, a term everybody uses that means different things to different people. But everybody is dying to start using the data more effectively to make their jobs better. Especially during COVID, but we had started seeing it in the last few years. 

There’s a lot more for-profit investment firm interest in healthcare technologies. When a for-profit entity is looking to acquire a healthcare technology or provider, their approach to evaluating it, doing the due diligence, and then the speed of moving to realize the full value of that investment is different than what we historically have been used to in healthcare. It’s a welcome change, and in many cases, a needed change. It has been quite a transformation to see how more investor-led organizations are changing healthcare, much more that we saw in the first two-thirds of our healthcare career.

How will consolidation of both companies and health systems change the experience and outcomes of patients?

Unfortunately, the complexity of healthcare technology that we are trying to optimize is overwhelming for smaller organizations. It is more difficult and challenging for them to take full advantage of that technology, whether it’s from an expense standpoint or a skills perspective. There are definitely opportunities for larger organizations to be able to offer more complex technology with better support and more cost effectiveness. Economies of scale definitely make a difference.

There are different motives for some of the getting bigger. Some of it is to spread costs amongst the larger population. For others, it’s a business opportunity to be able to leverage that cost and provide a better service.

We have definitely seen cycles where there was lots of coming together, then there was lots of splitting apart. We’ve seen it come and go. This time, because of the complexity of the electronic data and the opportunities to streamline the healthcare process for the benefit of patients, it will be rocky in some cases, but the end game is going to be positive.

What is driving the sudden emergence of the chief digital officer title?

It’s a huge positive. When EHR implementation started, you had a lot of physician champions. The CIO was very much about managing risk and managing costs for those systems. It was much harder in the beginning to prove an ROI compared to the traditional revenue cycle system that makes your revenue cycle cheaper and more effective.

The concept of chief digital officer is different. It’s not just about managing the Epic system or the bread and butter system. It’s about managing the experience of the patients for the benefit of providers, so that they can have access to the information they need to do their job in a cost-effective and well-informed way.

Some of the vendors will hate me for saying this, but there is no one technology that does it all. We constantly see customers trying to take full advantage of the collection of technologies to be able to do as good a job as they can for the patient experience. That ranges all across the board. We have seen companies like CueSquared , which provides a mobile pay technology to allow patients to view and pay their statements on their phone. The world of self-pay has changed dramatically over the years, but that’s just one small example.

That digital experience has been interesting to watch, because a lot of organizations have created a serious digital approach to their world. Where does this fit into the patient experience we want? That’s where technologies get dropped and that’s where technologies get put in. Technologies that prioritize what’s important to the patient and help provide the patient great service, which might not have been given a look in the past because they aren’t a module within the larger system, are getting opportunities. They are doing some pretty cool things with it.

How will the cancellation of HIMSS20 and the delay in HIMSS21 affect the industry?

I don’t think it has had a negative impact on our company. I say that because the whole world has had to change on a dime. Everybody recognizes that as much as those in-person conferences can be invaluable for learning and networking, it just is impossible. But I’m still amazed by the amount of virtual opportunities that have, as best they can, replaced the in-person conference for now, the explosion of using Zoom, Teams, and GoToMeeting to be able to try to have some of that face-to-face.

One of our strengths as a company is that we have deep relationships with the industry and our customers. For those organizations that we know and they know us well, it was easier to go into a remote engagement opportunity. We were known quantities, there was a trust, and there was a relationship in which you knew that both sides were going to get good value. We were going to kill ourselves to make that remote process work, given historically that it was always an in-person or on-site type of opportunity.

For those that don’t know us and vice versa, it’s harder to build that trusting relationship. We have slowly started to see some of our engagements where there has been a strong desire to at least have some sort of on-site presence. Some of those have gone very smoothly. We have been creative, such as people staying over a two-week window as opposed to coming Monday and leaving for home Friday, to get through the window of time to build that relationship. And, to manage the COVID travel policies of the state that the consultant is going to and the state that they are coming from. That has probably been the toughest one for us, to make sure that we are managing those travel requirements between the two states.

We are starting to see many of our consultants getting the vaccine. We have had opportunities where they have qualified for the vaccine based on the work that is being asked of them. So far, that has made life a lot easier. Many of our consultants have no issue with traveling, because they have been doing it almost their entire careers. Others have been nervous about it, but we have been able to manage those nerves because we have been able to keep a fairly large percentage of our business on a remote basis. Each month that we are able to continue waiting for the world to be ready for the ongoing travel, then that concern will keep going down.

We are on the 10-yard line of hopefully the vaccine helping us to get to the other side of this thing. Just a little more patience is what we expect. Our people and clients have been flexible around managing that in a good way.

Do you have any final thoughts?

I am hopeful for everything that is going on with the vaccine and all the lessons learned to get us through this thing. Every customer and every business that we work with has had to adapt. We are at the top of that list as well. As hard as this year has been, it has been an exceptional learning experience. We are doing things that we probably never would have thought to do prior to COVID. In many cases, those things are incredible positives.

I am very positive in terms of the outlook. While this hurt everybody, we are going to benefit tremendously for years to come from some of the changes that were forced upon us. Creativity will stay with us in a good way for a very long time.

Morning Headlines 4/5/21

Bank of America Acquires Axia Technologies, Inc.

Bank of America acquires patient payments technology vendor AxiaMed for undisclosed terms.

Notice of Data Privacy Incident

Aspirus joins other health systems in notifying patients that its vendor MedData exposed their protected health information on a public-facing website.

SOC Telemed Reports Fourth Quarter and Full-Year 2020 Results

SOC Telemed, which went public via an SPAC merger last fall, announces Q4 results: revenue down 13%, adjusted earnings –$3.9 million versus $0.2 million.

Monday Morning Update 4/5/21

Top News

Bank of America acquires patient payments technology vendor AxiaMed for undisclosed terms.

AxiaMed’s Payment Fusion offers software vendors the ability to integrate the company’s patient payment solutions with their applications.

Bank of America is developing proprietary merchant services for its clients after dissolving its decades-old joint venture with First Data last year following that company’s $22 billion acquisition by financial services technology vendor Fiserv.

HIStalk Announcements and Requests

Here’s your top five finishers for US capital of healthcare technology, which I intentionally left undefined.

New poll to your right or here: What is your COVID-19 vaccination status? I ask specifically about timing since HIMSS21 is in August, so that’s the next in-person event data for many of us. I’m double Pfizered, so I’m good to go.

Thanks to the following companies that recently supported HIStalk. Click a logo for more information.

Webinars

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

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

Acquisitions, Funding, Business, and Stock

SOC Telemed announces Q4 results: revenue down 13%, adjusted earnings –$3.9 million versus $0.2 million (the company did not release per-share earnings). The company went public in a SPAC merger on November 2, 2020, with share price dropping 32% since then versus the Nasdaq’s 21% gain, valuing the company at $469 million.

The Global X Telemedicine & Digital Health exchange-traded fund was down 3.4% in the past month versus the Nasdaq’s 1% drop. The fund is up 26% since its July 30, 2020 inception versus the Nasdaq’s 23% rise. Its top holdings are Guardant Health, Nuance, Omnicell, Agilent Technologies, Illumina, and Labcorp.

Sales

• Plexus Research joins the TriNetX global health research network.

COVID-19

Daily US vaccinations exceeded 4 million for the first time Friday, pushing the total of Americans vaccinated to over 100 million. CDC says that 23% of adults and 55% of senior citizens have been fully vaccinated, while 40% of adults have received at least one shot.

I noticed this cool patch on the arm of a female airman whose Air Force unit was participating in FEMA-operated mass vaccination clinic and asked if I could take a photo. She was deployed from the 335th Air Expeditionary Group, Medical Operations Squadron, which has also provided COVID-19 support to hospitals.

Brazil digs up old graves to make room for the soaring number of bodies from new COVID-19 deaths, 67,000 in March 2021, as the country has vaccinated just 2% of its population and its hospitals are running out of oxygen and ICU beds. President Jair Bolsonaro replaced one-third of his cabinet and all of the country’s military commanders last week, raising concerns that he is preparing for a military coup to remain in office as opponents urge impeaching him for mismanaging the pandemic.

Florida Governor Ron DeSantis issues an executive order that bans the use of COVID-19 vaccination passports in the state, blocking government offices from issuing them and businesses from requiring them. He cites freedom and privacy concerns, saying that “individual COVID-19 vaccination records are private health information and should not be shared by a mandate.” He also notes that some citizens may have infection-acquired immunity and that some may decline to be vaccinated for health or religious reasons.

Google creates a memorable public service announcement that urges people to get vaccinated against COVID-19.

Other

Aspirus joins other health systems in notifying patients that its vendor MedData exposed their protected health information on a public-facing website. The revenue cycle services vendor was notified by DataBreaches.net in early December that claims data had been found in an open source data repository, although the company did not remove the files immediately and patient letters weren’t sent until last Wednesday. MedData says that a former employee, a developer, saved files to their personal folders on the website. The other health systems involved so far include Memorial Hermann, OSF Healthcare, SCL Health, and University of Chicago.

Sponsor Updates

• Black Book Market Research names Spok a top-performing behavioral health and mental healthcare industry vendor in the secure provider communications platform category.
• Kyruus completes its acquisition of HealthSparq, paving the way for seamless, cross-channel care navigation.
• Netsmart shifts one of its divisions to permanently working from home while it transitions the rest of its 2,400-member workforce back to the office.
• Pivot Point Consulting celebrates its 10th anniversary.
• Health Data Movers appoints Monica Gupta and Alyssa Rapp to its board.
• PMD releases a new video, “Meet our CEO – Philippe d’Offay.”
• CRN gives Pure Storage a five-star rating in its “2021 Partner Program Guide.”
• Relatient publishes a new e-book, “The Expert Guide to Patient Engagement Software.”
• Vocera receives FIPS 140-2 certification for its Smartbadge, required to support secure wireless communication in VA and DoD healthcare facilities.

Blog Posts

• Spok Summit: 4 sessions to help solve communication challenges across your health system (Spok)
• How AI technologies improve the patient experience (Nuance)
• Growing from strong foundations (Nordic)
• BPCI-Advanced: Unpacking the Model Year 4 Changes (PatientPing)
• Premier Data: The State of PPE Supply One Year into COVID-19 (Premier)
• Vaccination Data Integration 101: What Healthcare Products Need to Know (Redox)
• 4 questions health care marketers should ask about emerging social platforms (Krames)
• Medication Adherence Takes an Information-Sharing Village (Surescripts)
• Chronic COVID: The New Long-Haul Patient Market (WebPT)
• How to Improve Health Literacy Through Communication Technology (Well Health)

Contacts

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

Katie the Intern 4/2/21

Hi, HIStalk! Long time, no write. Things have been really busy, but I am still making time to write some columns here and there. 

This week’s column focuses on B.well Connected Health, a healthcare technology company that provides a platform for healthcare consumers to stay connected to their providers and their data in a digital, personalized health experience. I spoke with CEO Kristen Valdes, who founded B.well in 2016 as “a way to transform the way consumers interact with the healthcare delivery system by giving them access to all of their health data in one place.”

Valdes has been an executive in the healthcare field for over 20 years, working in digital health and helping to start one of the first private Medicare Advantage plans in the country. When her daughter began facing an undiagnosed medical issue, she began to see holes in the healthcare information delivery system and felt that she could create a business to fill those needs. 

“When my own child was born with a very significant autoimmune condition, here I was, this healthcare industry expert, and I could not navigate the system on behalf of my daughter,” she said. “She had a near-fatal incident because two EMRs couldn’t communicate with one another.”

It took seven years to get her daughter properly diagnosed, and seeing the failures in the communication of healthcare systems drove Valdes to create a technology company that could mend the breaks. B.well was founded as a system to allow users to have access to their in-person, digital, and virtual care at all times and to share that information with whomever they want. 

“We are a B2B business. We sell into health systems, insurance companies, and pharmacies as a way to aid them in their digital transformation towards the consumerization of health,” Valdes said. “B.well finds a way to connect services that businesses offer into consumer lives, even though 99% of the time, they are outside of the doctor’s office.”

Consumers need to navigate their medical needs and B.well wanted to make it easy for users to have access to all their data, records, appointments, recommendations, and more, all in one place, Valdes said. Though it is not an EHR, B.well is bi-directionally integrated with EHRs.

The process of creating a delivery system started with many questions, including how such a system could get access to healthcare data and give it back to users. “You cannot engage someone in a personalized way if you don’t know anything about them,”  Valdes said. “Data is critical to the consumer.”

Valdes had to make sure that the technology would not impact an EHR’s flow. The integration of B.well is there to connect consumers to their records and information. Regulations were put into place with technology standards that allowed open API interfaces, an important piece to the puzzle. Open API interfaces unlock the ability to push and pull information seamlessly between systems, Valdes said. 

The B.well team did surveys and analyses to see where the user pain points in healthcare data are, creating a basic features list based on the results. Users wanted a simple, affordable system that allows quick and easy access to providers and simple directions for when they need to do something. 

“We started with consumers first and architected what they would want to see out of the healthcare system. Then we reverse engineered that into the data holders and stakeholders of healthcare where all the information as mapped that would be needed to pull together,” Valdes said. “That’s where we determined that a net-neutral platform for consumers was possible.”

B.well also helps providers move their focus into population health as they adjust from fee-for-service models to value-based care. When physicians can see data in real time and track which patients are going to appointments and filling medication accurately, they are able to see their results and adjust care based on outcomes. 

“Because we connect consumers to their data with their consent, we also empower them to share that data back to their provider if they choose,” Valdes said. “Healthcare providers have not historically had the visibility to that information, nor have they had the ability to see the interactions with the healthcare system that happens outside of their own offices. As we shift to value-based care is, it’s much easier to help a provider take risk, meaning that they are going to be responsible for someone’s health outcome.” 

Outcomes are important in value-based care, and to get real results, engagement is necessary. B.well sports a 64% engagement rate versus the industry average 17%, meaning that users both engage and take action towards their health by using the B.well technology system. B.well knows that consumers do not want to log in to a health application once a day, but they will respond when messages are relevant. 

“The way that we define engagement is that consumers not only log in to the application, but they actually take an action towards bettering their health,” Valdes said. “Because we have access to a consumer’s data, we only target them with information and nudges at the point of time that it’s appropriate in their care.” 

B.well also recently partnered with Mastercard as a way to enhance the safety of ID verification for B.well’s services. To verify identity and increase the safety of data and information sharing and matching, B.well will use Mastercard’s biometric tech to validate the identity of users. This has already been implemented in B.well’s use of Mastercard through ThedaCare’s Ripple health management tool.

“In-person encounters are not always the first encounter we have in healthcare,” Valdes said. “We partnered with Mastercard to improve digital identity beyond what healthcare offers today.” 

—–

That’s it for today! I enjoyed learning about a healthcare delivery system that interacts with EMRs and EHRs to better connect users to their healthcare data and information. Thanks for reading! 

Katie The Intern

Email me or connect with me on Twitter.

Weekender 4/2/21

Weekly News Recap

• HIMSS acquires healthcare supply chain-focused SCAN Health.
• Cerner finalizes its $375 million acquisition of Kantar Health.
• VA Secretary Denis McDonough expresses concern about productivity at its first live Cerner site and the possibility that the project’s cost could exceed its $16 billion budget.
• Net Health acquires Casamba.
• MTBC rebrands to CareCloud, taking the name of a previous acquisition.
• The Department of Justice asks for more information about Optum’s proposed $13 billion acquisition of Change Healthcare.

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. M in Illinois, who asked for Mini Magic Boards for online sessions of elementary school class. She reports, “This fun and engaging writing tool has been used during our remote learning lessons and during our preschoolers’ asynchronous time as well. They really love to use it, as it gives them an opportunity to practice their writing skills beyond a pencil and paper. We’ve used it to practice writing numbers, letters, their name, drawing shapes, and more. It has made a big difference during our lessons and students have shared photos of how they’ve been using it at home as well. Thank you again for helping us get this writing tool in our preschoolers’ hands and get them excited about learning remotely.“

The one consistent aspect of the US healthcare non-system is maximizing profit. A nine-state group of anesthesiologists sues UnitedHealthcare, claiming that the giant insurer used its clout to steer surgeons away from using the group’s services. United responded by saying that the private equity-owned US Anesthesia Partners, which is not in United’s network, was demanding to be paid double or triple the median rate. The practice countered by claiming that the insurer’s parent company UnitedHealth Group offers its own medical services,  has 50,000 physicians on staff, and holds partial ownership of Sound Physicians, an expanding business that offers emergency and anesthesiology services.

Adam Litwin, MD,  who served prison time 20 years ago for impersonating a surgical resident for several months at UCLA Hospital – he forged prescriptions, although he didn’t participate in surgeries – fails to match for medical residency for the second time following his 2018 graduation from a for-profit medical school in the Caribbean. One factor in his getting caught at UCLA was that he wore a white jacket adorned with a silk-screened image of his own face, which he claims other doctors envied. Googling “Saint James School of Medicine” turns up fascinating stories from former students and a published US residency match of 6% to 20% over several years.

A former Atrium Health paramedic who is awaiting trial for fatally poisoning his wife with eye drops he had added to her glass of water is arrested for intentionally setting fire to an in-flight medical helicopter, which was forced to make an emergency landing. Josh Hunsucker refused to give permission for his wife’s body to be autopsied and quickly cashed out her life insurance, but a blood sample that was taken for her organ donation was found to have high levels of tetrahydrozoline, the decongestant in Visine that apparently triggered his wife’s heart attack due to her previous heart problems. Authorities think he was copying a murder in which a former VA nurse killed her husband with Visine two years after he recovered from an injury sustained when she used a crossbow to shoot an arrow into his head.

Jacksonville, FL police arrest a man who was injecting people with Chinese-labeled Botox while drinking malt liquor and champagne, posing as an oral surgeon at an advertised a “Botox and Bubbles” event at an aesthetic spa. At least his price was right – he charged $350 versus the typical $1,200 cost. Googling “Botox & bubbles” turns up thousands of similar events at aesthetic practices, although they are focused on marketing the service rather than delivering it on the spot.

In Case You Missed It

• News 4/2/21
• EPtalk by Dr. Jayne 4/1/21
• HIStalk Interviews Josh Schoeller, CEO, LexisNexis Healthcare
• News 3/31/21
• Curbside Consult with Dr. Jayne 3/29/21
• Monday Morning Update 3/29/21

Get Involved

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

Morning Headlines 4/2/21

SCAN Health Transitions to HIMSS

HIMSS acquires SCAN Health, which offers healthcare supply chain traceability events, a supply chain maturity scale, business case competitions, and design competitions.

Revelstoke’s Carrus Acquires Archetype Innovations

Healthcare training software vendor Carrus acquires EHR training program company Archetype Innovations.

Cerner Finalizes Acquisition of Kantar Health

Cerner wraps up its $375 million acquisition of Kantar Health, a data, analytics, and real-world evidence and research consulting subsidiary of New York-based Kantar Group.

News 4/2/21

Top News

HIMSS acquires SCAN Health, which offers healthcare supply chain traceability events, a supply chain maturity scale, business case competitions, and design competitions.

The company, which is funded by the Canadian government, is hosted by the University of Windsor’s business school.

SCAN Health was launched in 2017 with a four-year, $1.6 million government grant that ended this year.

HIMSS Analytics was one of SCAN Health’s partners and financial supporters.

HIStalk Announcements and Requests

Today’s best Internet meme — April 1 is the only day on which Americans will question whether something they read on the Internet might be untrue.

I took advantage of some special Donors Choose matching funds and those of my Anonymous Vendor Executive to fully fund these teacher requests:

• A financial literacy kit for Ms. P’s fifth grade class in Fayetteville, NC.
• Mice and headphones for Ms. G’s elementary school class in Sharon, WI.
• Science and math materials for Ms. H’s elementary school class in Houston, TX.
• Hands-on math tools for Ms. M’s elementary school class in Houston, TX.

I took a short, solo, family-related trip this week, the first time I’ve been on an airplane in quite a while. Every person I saw was appropriately masked, all flights were full (one was even oversold with a $900 offer to take a flight three hours later), and the airports were jammed with restaurant lines that looked 100 people long. It was like before COVID, which actually felt pretty good. People-watching yielded two instances where teen passengers showed up in pajamas, which reminded me of that years-ago fad where college students would head out to restaurants at 2:00 on a weekend afternoon in their PJs for breakfast. I have a feeling that the pent-up demand for travel, restaurants, and entertainment and sports events is about to explode as more people get vaccinated. Here’s a tip for Southwest passengers with Group C boarding who are doomed to a middle seat – take the seat between two folks who are conversing, or where one of them is a child. It’s almost always two family members, one of whom will move to the middle so they can sit together and leave you with the aisle.

Webinars

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

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

Acquisitions, Funding, Business, and Stock

The Center for Health Affairs sells its CHAMPS Oncology business, which helps providers with cancer registry participation, to clinical data solutions vendor Q-Centrix.

Acute telemedicine technology and solutions vendor SOC Telemed completes its $194 million acquisition of competitor Access Physicians. 

Sales

• University Hospitals of Cleveland will implement Epic, according to a reader-forwarded internal email. It will replace Allscripts Sunrise.
• Southwest Medical Center (KS) chooses Healthcare Triangle for cloud disaster recovery services.

People

Matthew Smith (Ensocare) joins Kno2 as VP of sales and strategic partner alignment.

Sharecare hires David Guthrie (PatientPoint) as CIO/CISO.

Walmart Chief Medical Officer Tom Van Gilder, MD, JD, MPH will leave the company next month.

Announcements and Implementations

Samsung integrates GetWellNetwork’s solution with its healthcare-grade smart HTVs, eliminating the need for external hardware.

Netsmart is named the highest-satisfaction behavioral health ambulatory EHR vendor by Black Book Research, which also found that only 18% of respondents feel they are technically ready to engage electronically for care coordination, patient record exchange, and population health. 

Beth Israel Deaconess Medical Center will use Google’s Care Studio EHR search tool, expanding a pilot project that started at Ascension.

Audacious Inquiry publishes a guide to the new CMS Conditions of Participation requirement for hospitals to send ADT notifications to the community providers of those patients.

COVID-19

Results from the ongoing Phase 3 clinical trial of Pfizer’s COVID-19 vaccine indicate that protection lasts for at least six months and it works against the South African variant. It was also found to be 100% effective in the small number of trial participants that were 12 to 15 years years old. The study has raised no safety concerns, clearing the way for eventual full FDA approval beyond the vaccine’s Emergency Use Authorization.

CDC reports that 21% of US adults have been fully vaccinated, as have 51% of those 65 and over, as 100 million people have received at least one dose.

Nursing homes report that COVID-19 cases are down 98% and deaths down 95% from their peak on December 20. The CMS data does not break out totals by vaccination status.

FDA issues Emergency Use Authorization two at-home, antigen-based COVID-19 rapid tests that don’t require a prescription, Quidel’s QuickVue At-Home and Abbot BinaxNOW. The tests are intended for serial screening, where an individual who does not have COVID-19 symptoms needs to be tested several times. FDA’s decision took nearly a year, keeping the tests from being sold when they could have had a major impact. Availability and price have not been announced and it’s not clear how self-test results can be used to prove COVID-19 status.

The Washington Post reports that despite dire predictions, some of the country’s richest health systems boosted their incomes in 2020, reporting big surpluses that were increased even more by federal COVID-19 bailouts. Baylor Scott & White Health reported its biggest-ever operating margin as it booked $815 million in profit for 2020, aided by $454 million in taxpayer-funded relief. UPMC tripled its 2019 margin with an $836 million profit that includes $460 million in bailout funds, while Mayo Clinic’s predicted $3 billion revenue loss ended up being increased revenue and a $728 million profit, including $338 million in bailout funds. Big health systems are either lousy at forecasting or good at manipulating politicians.

People who have had COVID-19 need just a single dose of the Pfizer vaccine to reach maximum immunity, researchers find.

A Baltimore company that manufactures both J&J and AstraZeneca vaccines as a subcontractor ruins 15 million doses of the one-shot J&J product when its workers confuse the two products and mix them together. The company, Emergent BioSolutions, was called out last year for selling the federal government $626 million worth of COVID-unrelated national stockpile items, such as anthrax vaccine, that consumed more than half of the stockpile’s budget during high demand for PPE. The most recent US anthrax attack was 20 years ago, when five people died, and the stockpile contains enough doses for 10 million people. The company bought the vaccine patent from the State of Michigan, then raised prices to the federal government six-fold, as that product plus smallpox vaccine increased its revenue to $1.5 billion as it used its clout to halt the development of better and cheaper vaccines by competitors. President Trump had appointed one of the company’s former consultants to run the office that oversees the stockpile. The company’s market value is over $4 billion. 

In England, a study of discharged COVID-19 patients finds that they were admitted four times as often and died eight times more frequently compared to the control group. The rates of respiratory disease, diabetes, and cardiovascular disease were higher and not limited to elderly patients. Nearly 30% of the discharged patients were readmitted and 12% of them died.

Houston Methodist will give its 26,000 employees until mid-April to either get at least one dose of a COVID-19 vaccine have their religious or medical exemption approved. The health system says 83% of employees have been vaccinated and it is mandatory for new employees. The American Hospital Association says it expects most hospitals to hold off from making vaccination mandatory until FDA gives them its full approval instead of Emergency Use Authorization.

Sponsor Updates

• Vyne Medical launches a podcast series, with the first episode covering “The Future of Healthcare IT in a Post-COVID Era.”
• Utah Business names Health Catalyst CEO Dan Burton “CEO of the Year 2021.”
• Wolters Kluwer Health is named publisher of the American College of Medical Quality’s “American Journal of Medical Quality.”
• InterSystems joins the Vulcan FHIR Accelerator Program to expand interoperability in life sciences.
• Black Book Research
• PerfectServe’s Optimized Provider Scheduling powered by Lightning Bolt achieves top customer satisfaction rankings in the latest Enterprise Physician Scheduling report from KLAS.
• President Bill Clinton will keynote the Everbridge COVID-19: Road to Recovery Executive Summit May 26-27.
• Azalea Health Innovations integrates its AzaleaONE EHR with PatientPing for event notification.
• G2 names Halo Health a leader in its “Clinical Communication and Collaboration Grid Report for Spring 2021.”
• The HCI Group releases a new “DGTL Voices with Ed Marx” podcast, “How IT Saves Lives.”
• Imprivata and Emerging Global Technologies partner to bring innovative digital identity technology to healthcare providers in the Middle East.
• Kyruus publishes a new case study, “How Baystate Health Increased Online Accuracy and Access with a Comprehensive Provider Data Foundation.”
• LexisNexis publishes a new white paper, “Knowledge-Based Authentication Simplifies MyChart Patient Portal Enrollment.”
• Meditech publishes a new case study, “Princeton Community Hospital improves response time and physician efficiency with Meditech Expanse and Teknicor.”
• Medicomp Systems releases the first episode of its “Tell Me Where It Hurts” podcast with Jay Anders, MD.

Blog Posts

• Premier Data: The State of PPE Supply One Year into COVID-19 (Premier)
• Ask the Experts: What is Auto-indexing and how does it work? (Vyne Medical)
• Will Oregon’s Prescription Labeling Law Start a National Trend? (First Databank)
• Prove User Behavior is Root Cause of Citrix Latency Using ICA/HDX Channels (Goliath Technologies)
• Increase Profitability for Healthcare Organizations: Four Top Tips (Halo Health)
• Integrating Hyperledger Fabric and SAP to Blockchain Your Supply Chain (Healthcare Triangle)
• The Right Way to Build Predictive Models for the Most Vulnerable Patient Population (Health Catalyst)
• Cooking and Consulting with Joe – Week 3 – Shakshuka (Health Data Movers)
• How a problem-centric view of clinical data promotes a patient-centric healthcare system (Wolters Kluwer Health Language)
• The Healthcare IT Travel Life: How It Started vs. How It’s Going (Impact Advisors)
• Truly Unique (Infor)
• What can established healthtech companies learn from startups? (InterSystems)
• Enhancing data quality initiatives across the health IT ecosystem (Intelligent Medical Objects)
• How to Improve Clinical Workflow: 30 Expert Tips (Lyniate)
• Improve Operations and Clinical Care with E-Learning (Medhost)
• One physician’s reflection on National Doctors’ Day (Meditech)

Contacts

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

EPtalk by Dr. Jayne 4/1/21

March 30 marked Doctors’ Day in the US. The date was selected in honor of the anniversary of the first use of general anesthesia in the US, when Dr. Crawford Long used ether prior to a tumor surgery. The US formalized the date in 1990, when President Bush signed a joint resolution created by the 101st US Congress. My practice did nothing to celebrate, so I marked it on my own by scrolling through some photos of my physician exploits. By far one of my most challenging (and rewarding) experiences as a physician was staffing the 24th World Scout Jamboree in 2019. I never thought I would be practicing in a tent, but it was an experience I’ll never forget.

This week also included the ONC 2021 Annual Meeting. I initially had high hopes of making a number of the sessions, but was quickly sidelined as I had to put out some fires with my clients. I was able to catch bits and pieces of some of the presentations but will have to use the on-demand recordings to see the rest of the ones that were on my must-see list. From the sessions I made it to, predictable themes included the use of health IT in the COVID-19 response and interoperability. Major pushes for the former include a basic FHIR approach for vaccine scheduling that could make it easier for patients to find vaccine compared to the “Hunger Games” approach that many patients are experiencing as they compete for scarce spots.

National Coordinator Micky Tripathi credited the health IT industry with making progress on interoperability. He also noted that ONC is helping the White House with plans for vaccine passports. There was also discussion of how health information exchanges fit within the context of nationwide health networks such as the CommonWell Health Alliance. The meeting had over 2,000 attendees in an all-virtual environment and I heard mention of several post-meeting happy hours and get-togethers, also virtual.

I did a little bit of traveling last week. Even though it was a mid-week trip, my overall impression was one of very few business travelers and mostly leisure travelers, despite the CDC’s recommendation against leisure travel. Fewer seasoned business travelers makes for a messier boarding and deplaning experience, for sure. Most passengers were well behaved and kept their masks on and I didn’t see any flight attendants having to give people extra warnings. My work took me to New Orleans, where I spotted this great mini-pharmacy kiosk. Since many of the patients I see in urgent care haven’t tried any home remedies before coming in, maybe we need strategies like this to encourage people to try a Tylenol or a Claritin before running to the doctor.

One of my best friends is a surgeon. We have been having ongoing conversations about the role of telehealth in his practice versus mine. A recent JAMA Surgery article reported on a study that showed a rise in new patient visits being conducted via telehealth in surgical subspecialties, at least during the first wave of the COVID-19 pandemic in April 2020. The study was conducted in Michigan and found that almost 40% of new patient visits were telehealth-based (compared to 1% pre-pandemic) and decreased as the first peak of the pandemic began to subside.

My last visit to a surgeon could definitely have occurred via telehealth since the physical examination performed was cursory at best and added nothing to the case, other than forcing me to sit for 20 minutes waiting in an awful pink gown that was four sizes too big. As a patient just seeking a second opinion about my MRI and ultrasound results, I could have avoided the hour-long round-trip commute, dealing with the parking garage, and taking more time off work than I wanted to.

Speaking of that visit, it also included some genetic testing, and I was a bit surprised at how the process went compared to previous testing I had done in 2017. The practice didn’t give me any kind of anticipatory guidance on what to expect other than to tell me that results would be back in two weeks (which actually took three). A few days after I had my blood drawn, I received a text from the lab vendor offering me a preliminary cost estimate for my labs, which the surgeon had told me verbally would be fully covered by my insurance. When I followed the link, I had to verify some basic demographic information, then was taken to a page that told me it actually couldn’t give me the estimate due to insurance issues.

When the results were available, I received a MyChart message rather than a phone call from the physician, who claimed that they had a wrong number in the chart and therefore couldn’t reach me. After confirming that every single phone field in Epic has my cell number, I wondered if she even tried to redial after reaching someone else. The message let me know my results were “fine” except for a mutation I already knew I had, and she told me to make sure I’m getting colonoscopies, which I already do, and which she should know since we discussed both the mutation and my recent scope at the visit.

All of that data should be in the EHR from previous visits, so I was left with the impression that she wasn’t fully contemplating my case when she sent the results. Since the outside labs can’t be displayed in MyChart, I’m still waiting for a paper copy of them to be sent to my home. After a previous medical misadventure when the ordering provider missed an abnormal result and told me results were “fine,” I’m not closing the book on this one until I have the paper copy in hand. Just when I think healthcare can’t get any more disorganized or that I can’t have yet one more less-than-optimal patient experience, I continue to be surprised.

Also in the journals this week was a paper on “Factors associated with opting out of automated text and telephone messages among adult members of an integrated health care system.” The authors looked specifically at the volume of messages as a predictor of opting out. They found that patients who received 10 or more text messages or two or more interactive voice response messages were more likely to opt out of receiving future messages. As anyone who has ever opted out of a consumer loyalty program knows, text fatigue is real. Healthcare providers should consider message volumes carefully and make sure they’re balancing what they send with the desired outcomes.

Back to telehealth, a recent piece discussed the realities of telehealth contacts and the things physicians observe in that context. Physicians are able to observe clues from the home environment or interact with families in ways they haven’t been able to previously, sometimes leading to more effective care. I’ve certainly seen some eye-opening situations during telehealth interactions, but as part of a nationwide telehealth-only organization, have even less ability to intervene than I might if I was a traditional primary care physician performing telehealth visits with my own patients. My organization doesn’t have the ability to connect patients with social services or home health referrals, so usually we end up referring patients to brick-and-mortar providers in a process that can take months if the patient doesn’t already have a PCP. We’ll see if payers continue to cover telehealth services as the pandemic dynamics change. Everyone is concerned about the potential for fraud, so we’ll just have to see how things go.

What’s your prediction for the ongoing availability of telehealth services? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/1/21

CirrusMD Announces $20 Million in Series C Funding

Text-based telemedicine company CirrusMD raises $20 million in a Series C funding round led by Blue Venture Fund.

Q-Centrix Introduces the First Enterprise Clinical Data Management Platform

Clinical data management company Q-Centrix acquires Champs Oncology, a Cleveland-based software and services vendor focused on cancer registry programs.

Governor Lamont Announces Funding To Integrate Remaining Electronic Health Records With Prescription Drug Monitoring Program

Connecticut Governor Ned Lamont allocates $1.3 million in CMS funding to help providers connect their EHRs to the state PDMP via Appriss Health’s PMP Gateway interface.