Monday Morning Update 3/1/21

Top News

Cigna’s Evernorth health services business will acquire telehealth vendor MDLive, the company announced Friday. Terms were not disclosed.

MDLive had raised $200 million and was reportedly valued at $1 billion early last fall, when it was considering an IPO.

Reader Comments

From Umbrella Beverage: “Re: Twilio. Was down Friday, affecting the ability of multi-factor authentication vendors (Entrust, Duo, Imprivata) to send out second-factor push or SMS notifications to phones, thus the ability of those users to access any services. Have the Russians figured out that Twilio is the center of the SMS universe?” Twilio’s incident log shows Friday downtime with “cross-platform API erors involving multiple products” that was resolved at just after noon Eastern on Friday. I’ll take this as an opportunity to provide some background on Twilio. The company offers APIs for sending and receiving phone calls and text messages, such as those for two-factor authentication, and Epic uses Twilio Programmable Video for its native telehealth offering. Twilio is huge, with 4,500 employees,  over $1 billion in annual revenue, and a $61 billion market cap. TWLO shares are like riding a rocket, up 240% in the past year versus the Dow’s 20% rise. Had you invested $10,000 on April 20, 2020 when the company’s deal with Epic was announced, you would be holding well over $36,000 in shares today. The co-founder and CEO is a multi-billionaire, of course.

HIStalk Announcements and Requests

One might quibble with the clinical and business operations of hospitals, but don’t doubt their ability to market themselves, although their owned medical practices don’t register to poll respondents any higher than independent ones (probably because they don’t always make their ownership obvious). 

New poll to your right or here: How does your employer’s company culture compare today to a year ago? Define “company culture” however you like, but in general, think of the company’s social fabric – what it encourages or discourages, how it relates to employees and customers, how well its goals align with those of employees, and how its beliefs and leadership practices are likely to make it successful for the long term. Vote, then click the “comments” link to explain whether you saw changes during the pandemic.

March 1 isn’t spring, but with the changes in weather and COVID-19 trajectory, it feels that way, especially now that baseball spring training games have started. It was one year ago Friday that HIMSS20 was cancelled, an early warning that 2020 was going to be eventful in all the wrong ways. Parts of the country that were almost cold enough to store Pfizer’s COVID-19 vaccine on the back porch last week have swung to daytime highs that are nearly 100 degrees warmer. I get the feeling that the US economy is about to rebound vigorously, although national debt, lingering and structural unemployment, political divisiveness, and income inequality are sobering long-term issues that could have major geopolitical ramifications.

I started subscribing in 2017 to a little-known app called Texture, which was like the Netflix of magazines. Apple bought the company a few months later, subscriptions automatically lapsed while Apple retooled their acquisition, and I lost interest and didn’t sign up under the newly christened Apple News+. I discovered this weekend that Mrs. HIStalk had subscribed on her own, mostly to read The Atlantic, and I Googled to find that her $9.95 per month subscription can be shared by up to six family members under Apple’s Family Sharing (which also includes Apple’s music, TV, games, and ICloud storage subscriptions – am I the only person who didn’t know about this?) I’m back in, and minor quibbles aside about lost features (easy back-issue searching, such as for Consumer Reports), it’s better now. Included are a bunch of expensive national newspapers, like the Los Angeles Times and San Francisco Chronicle; the Wall Street Journal (!!); Business Insider; PCMag; National Geographic; Consumer Reports; and 300 magazines with a nice mix of travel, food, sports, and vacuous celebrity updates. Like Texture before it, you can follow specific publications or topics, but it also brings up articles it thinks you’ll like based on your perusal habits, giving you an endlessly scrolling page of reading material that beats the heck out of killing time on Facebook looking at feta pasta recipes and faked prank videos.

Webinars

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

Acquisitions, Funding, Business, and Stock

Health Catalyst reports Q4 results: revenue up 22%, EPS –$0.16 versus -$0.21, beating estimates for both. HCAT shares are up 69% in the past 12 months versus the Nasdaq’s 54% gain, valuing the company at $2.1 billion.

From the Allscripts earnings call:

• Paul Black chose the perhaps unfortunate term of “infectious enthusiasm” to describe the company’s success in 2020.
• The company will continue to encourage on-premise clients to move to its Azure-powered hosting services.
• The Veradigm EHR and linked claims data-selling business was discussed at some length, with the company noting that while most of its data comes from the ambulatory EHRs of customers, that’s the most important to drug companies since that’s where most prescribing happens.
• CEO Paul Black reiterated that it sold EPSi and CarePort Health in Q4 because those businesses “were not receiving the appropriate valuation under Allscripts ownership.”
• Black says he does not see the just-formed Truveta organization, which includes big Allscripts client Northwell, as affecting its Veradigm business.
• President and CFO Rick Poulton says that the company’s “extensive data rights” from its ambulatory EHR customers give Veradigm an advantage over competitors who are chasing that “in vogue” business model.
• Allscripts expects the fragmented US EHR market to consolidate and the company expects to be a net winner in system replacement, while “outside the US is still a lot of greenfield.”
• Black said, in response to an analyst’s question, that client feedback on Sunrise 20.0 has been “universally positive,” but declined to specifically answer another question about the number of Sunrise clients.

Humana will offer its Medicare Advantage customers who are patients of Mercy access to the health system’s Mercy Virtual telehealth service. Also included in the agreement is a value-based care component, where Humana will pay Mercy based on outcomes instead of fee-for-service.

TriNetX appoints four new members to its board following October’s acquisition of a majority stake in October 2020, including former Pfizer Chairman and CEO Ian Read as chair.

COVID-19

FDA issues its Emergency Use Authorization to the COVID-19 vaccine of Johnson & Johnson’s Janssen subsidiary, a single-shot product that requires simple refrigeration instead of the two-shot, freezer-stored vaccines from Pfizer and Moderna. The boost in vaccine supply to 20 million doses per week, along with the new vaccine’s simple storage requirements, could add up to 25% to US vaccination capacity almost immediately. Mostly missed by the press – the first two vaccines were tested before coronavirus variants surfaced, so their efficacy against them is unknown, but the J&J vaccine were tested later and was proven to be effective against those variants (suggesting that the other two vaccines probably are also effective).

CDC reports that 73 million doses of COVID-19 vaccine have been administered out of 96 million distributed (76%), with 19% of the adult US population having received at least one dose. The pace could soon reach 3 million doses per day.

A KFF poll finds that the percentage of Americans who plan to wait and see before being vaccinated has dropped from 39% in December to 22% now. The 15% who say they won’t get it under any circumstances remains unchanged. Groups with the highest resistance to being vaccinated are Republicans and rural residents, while 25% of non-healthcare essential workers and 14% of healthcare workers fall into the “wait and see” category.

The state of California declines to renew its coronavirus mobile testing contract with Alphabet-owned Verily, which the federal and state government touted last year as a high tech approach to help Americans find COVID-19 testing. The state says the program, which cost $63 million and was operated entirely by subcontractors, didn’t serve poor areas of the state. Optum/UHG-owned OptumServe is now operating state vaccine clinics, but one county had already cancelled its contract with OptumServe, saying that its testing clinics were poorly run, performed only a few dozen tests in each 12-hour session, spent a lot of money sending negative tests results by FedEx next-day delivery instead of electronically, and were staffed by employees who were “coughing violently” and not wearing PPE.

Other

A two-year study finds that Medicare’s PAMA decision support requirement for ordering expensive advanced imaging exams – as implemented with Change Healthcare / National Decision Support Company CareSelect – improved ordering appropriateness. The authors note the limitations of their study – inappropriate use could have been reduced by other simultaneous changes, users can game CDS by choosing an invalid ordering reason, and the lack of pre-CDS implementation data – but their next step will be to have experts determine order appropriateness by reviewing EHR and imaging data.

A few Epic employees told the Madison paper that the company has told employees to stop holding discussion groups related to diversity, equity, and inclusion on company time and has eliminated a training session on identifying white privilege. The article notes that Epic, with $2.9 billion in annual revenue and 10,000 employees, is unusual for not having a chief diversity officer or other executive to manage equity and inclusion and instead created a a diversity council made up of five employees who still work in their full-time jobs.

A Florida pediatrician who was arrested on child pornography charges asks the court to let him conduct telehealth visits. He initially told investigators that he thought he was downloading photos of older girls, but finally agreed with a detective’s observation that a pediatrician should be able to recognize pre-pubescent children.

Sponsor Updates

• Meditech launches a Telemetry Appropriateness Toolkit in its Expanse EHR.
• PatientPing publishes a new case study, “How Kintegra Health is improving transitions of care and succeeding in value-based care programs through real-time ADT notifications.”
• PeriGen’s innovative perinatal technology supports the US Surgeon General’s call to action to improve maternal health.
• The Ethisphere Institute recognizes Premier as “One of the World’s Most Ethical Companies” for the 14th year in a row.
• Pure Storage announces fourth quarter and full year fiscal 2021 financial results.
• Sectra publishes a new e-book, “The radiologist’s handbook for future excellence 2021: Key technologies to amplify success.”
• Krames publishes a new infographic, “Easy telehealth tips to drive positive patient experience.”
• Vocera releases a new podcast, “The Burden and Joy of Caregiving During the Pandemic.”

Blog Posts

• How healthcare workers can overcome increased levels of stress and burnout (Nuance)
• Let your physician builders build (or architects architect) (Nordic)
• What You Need to Know: 2021 Patient Financial Responsibility Trends (PatientBond)
• Why CBO Billers and Coders Need a Charge Aggregation Tool (PatientKeeper)
• Coordinating COVID-19 Vaccination: 3 Essential Elements (PerfectServe)
• MIPS 2021 – What’s New? (PMD)
• Does Your Claim Scrubber Meet Your HCC Coding Needs? (RCx Rules)
• 5 Reasons Why You Need to Prioritize Prescription Price Transparency (RxRevu)
• 7 Lessons in Communication From a TeleNeurology Practice (SOC Telemed)
• How to master rollout of a secure messaging app (Spok)
• New Prior Authorization Rule Puts Patients Over Paperwork (Surescripts)
• How price transparency can help you drive revenue (Waystar)
• The Art of Getting Acquired: How to Prepare Your PT Clinic for Sale (WebPT)
• Well Community Outreach Enables Clinics to Secure More Medicaid Revenue (Well Health)

Contacts

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

Weekender 2/26/21

Weekly News Recap

• Allscripts and Teladoc Health release quarterly results.
• Healthcare Bluebook acquires the quality division of Quantros.
• Innovaccer raises $105 million at an implied valuation of $1.5 billion.
• Redox announces a $45 million Series D funding round.
• Google Health expands the pilot of its EHR search and data presentation tool, which it has named Care Studio.
• IBM is rumored to be looking at selling IBM Watson Health.

Best Reader Comments

When resource limited, and dealing with existing systems and a legacy of choices, “apps are dead” can sound a little blasé and soundbite-y. Now add in organizational politics, budgeting, and available skill sets. The choices get more complicated. Absent those factors though, there’s a lot to like about “apps are dead”. You get a single code base that supports all devices. Support lines tend to be simpler too. But sometimes? An old app can do a better job than the new replacement! (Brian Too)

I think the green passport idea is great. It might allow the free market to push the vaccine-hesitant to get on board when businesses and airlines start advertising special privileges for passport holders. The problem in the US, though, is that we can’t seem to get a nationwide IT system for anything unless it involves the IRS. (Bob)

We should challenge developers (I am one) to think critically. Also, bugs aren’t exclusive to coding errors. (RobLS)

Watercooler Talk Tidbits

Two Vanderbilt University Medical Center physicians publish “From Two Doctors,” a newsletter that highlights the pandemic’s unsung heroes. Assistant Professor of Clinical Medicine Michelle Izmaylov, MD is a published author of fantasy fiction books and medical essays, while Thea Swenson, MD is a medical resident who formerly worked in health IT startup marketing and product development. Both are first-generation Americans, from Russia and Vietnam, respectively. 

A technology reporter whose broken collarbone left him with his arm in a sling for six weeks describes how accessibility technology helps people with disabilities. Topping his personal experience list is AI-based transcription for typing on all devices, which taught him that voice typing on his phone is three times faster than finger typing. He likes the dictation and voice control technology of Google Docs best. Runner-up accessibility winners are biometric authentication, password manager apps, and finger swipe typing.

PCP versus demanding customer: In Australia, D-list reality show celebrity Yvie Jones complains in a profanity-filled Instagram post that she saw her doctor about a lump on her neck and while there, he suggested that she see a dietician. She declared that she has been “weight-shamed by my doctors for years” and said that she and many others “would rather die than be spoken so poorly to” by doctors who “never focus on what we’re there for.” She has previously posted recaps, sometimes with photos, of her other medical issues, including case of hives following a cat allergy, peri-menopause, iron deficiency, abdominal cramping, a back problem, depression, and weight loss surgery.

NHS England urges people to ignore the medical advice of celebrity huckster Gwyneth Paltrow, who claims that her COVID-19 infection and the resulting long COVID were successfully treated with her expensive, Goop-branded nutritional products. If faux COVID cures aren’t your thing, the college-uneducated GP will be happy to sell you – hopefully delivered in an unlabeled package – an $80 candle that smells like her vagina.

In Case You Missed It

• News 2/26/21
• EPtalk by Dr. Jayne 2/25/21
• HIStalk Interviews Michele Perry, CEO, Relatient
• News 2/24/21
• Curbside Consult with Dr. Jayne 2/22/21
• HIStalk Interviews Lissy Hu, MD, CEO, CarePort Health
• Monday Morning Update 2/22/21

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 2/26/21

Allscripts Announces Fourth Quarter 2020 Results and Outlook For 2021

Allscripts reports Q4 results: revenue down 7%, adjusted EPS $0.29 versus $0.17, beating earnings estimates but falling short on revenue.

Healthcare Bluebook Now Owns Largest Healthcare Quality-Cost Database in the U.S.

Healthcare Bluebook acquires the quality division of Quantros.

USDA Invests $42 Million in Distance Learning and Telemedicine Infrastructure to Improve Education and Health Outcomes

The USDA will invest $42 million in 86 projects through its Distance Learning and Telemedicine program to help rural residents gain better access to healthcare and education.

Medisafe Secures $30M in Series C Funding to Build Future Model of Patient Support

Digital prescription support vendor Medisafe raises $30 million in a Series C funding round, increasing its total to $52 million.

Teladoc Health Reports Fourth-Quarter and Full-Year 2020 Results

Teladoc Health reports Q4 results: revenue up 151%, EPS –$3.07 versus –$0.26, beating revenue expectations but falling short on earnings that were affected by acquisition and share payout costs from its $18.5 billion acquisition of Livongo in October 2020.

News 2/26/21

Top News

Population health management technology vendor Innovaccer raises $105 million in a Series D funding round, increasing its total to $225 million and valuing the company at $1.3 billion.

The company’s co-founders are Abhinav Shashank (CEO), Sandeep Gupta (COO), and Kanav Hasija (chief customer officer).

Reader Comments

From Inquiring Minds Wanna Know: “Re: Olive Health. No HCIT firm in recent years has gotten more favorable press. Not Catalyst, Zocdoc, or any of 10 other ‘show ponies’ trotted out by leading healthcare PE outfits like Francisco Partners or Vista Equity. Is it enormous budget or a new healthcare PR firm?” The company has wrapped what seems like mundane technology in a thick layer of trendy buzzwords and Silicon Valley brashness for a business whose first funding round (of $450 million total through a Series F) was a Series A in 2013. I’m surprised that the company hasn’t arranged a quick IPO or SPAC merger to take advantage of a frothy stock market, but until that happens, the only folks who can pore over its financials are the investors who have driven its valuation to $1.5 billion. I will say this, having had many HIStalk sponsors over the years whose renewed PR efforts were followed shortly after by being favorably acquired: it’s worth the effort to get a company’s message – whether pointless buzz or meaty news — out to gain and retain the attention of prospects and investors, especially the latter when those SPACs are desperately looking for acquisitions. I am uncomfortable with companies and people that promote themselves shamelessly, but I begrudgingly acknowledge that it’s hard to be successful if nobody has heard of you. Any press, good or bad, is better than no press.

From RTW: “Re: COVID-19. The biggest need is to reopen travel and offices, agreed?” No. The biggest need is to reopen schools, whose closing was scantily supported by evidence in the first place. The economy, our future economic prospects, and the mental health of citizens will suffer as long as parents are forced to stay home with their kids who are receiving an inferior online education and missing important social services and developmental opportunities with effects that won’t be obvious for years. Some parents would rather keep their kids at home, which is fine, but most would welcome that aspect of returning to semi-normal rather than expanding restaurant and bar capacity and allowing bigger sports crowds. Much has changed and been learned in the pandemic’s first year.

From Google Clusters: “Re: Google Care Studio. Recall that Epic stopped working with Google Cloud a year ago over privacy concerns.” Epic announced in January 2020 that it was calling off further integration with Google Cloud and instead would focus on Amazon Web Services and Microsoft Azure because of customer interest. Google was at that time facing privacy criticism from its deal with Ascension to develop EHR search and aggregation tools in a project that was named Care Studio this week, but I don’t recall that Epic specifically mentioned privacy concerns in its decision. Cerner also passed on Google despite a rumored incentive in the tens of millions of dollars, going with AWS instead.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Experian Health. The company collaborates with more than 3,400 hospitals and 7,300 other healthcare organizations representing 500,000-plus providers — almost 60% of the market — to provide data-driven platforms to empower its clients to make smarter business decisions, boast a better bottom line, and foster stronger patient relationships. Its industry-leading solutions include revenue cycle management, identity management, patient engagement, and care management. Thanks to Experian Health for supporting HIStalk.

Webinars

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

Here’s the recording of Wednesday’s webinar, “Maximizing the Value of Digital Initiatives with Enterprise Provider Data Management,” sponsored by Phynd.

Acquisitions, Funding, Business, and Stock

Allscripts reports Q4 results: revenue down 7%, adjusted EPS $0.29 versus $0.17, beating earnings estimates but falling short on revenue.

Healthcare Bluebook acquires the quality division of Quantros.

Redox raises $45 million in a Series D funding round, increasing its total to $95 million.

Digital prescription support vendor Medisafe raises $30 million in a Series C funding round, increasing its total to $52 million.

Teladoc Health reports Q4 results: revenue up 151%, EPS –$3.07 versus –$0.26, beating revenue expectations but falling short on earnings that were affected by acquisition and share payout costs from its $18.5 billion acquisition of Livongo in October 2020. Teladoc said in the earnings call that it provided 10.5 million virtual visits for the year and brought on 15 million new paid members. Share price dropped 14% Thursday, valuing the company at $32 billion. TDOC shares are up 123% in the past 12 months versus the Nasdaq’s 42% gain.

EHR prescription messaging platform vendor OptimizeRx reports Q4 results: revenue up 123%, adjusted EPS $0.20 versus $0.07, beating Wall Street expectations for both. OPRX shares have risen 420% in the past 12 months versus the Nasdaq’s 42% gain, valuing the company at $930 million.

People

Kate Barimani (The Advisory Board Company) joins analytics vendor Covera Health as VP of provider partnerships.

Industry long-timer Brian Graves (Hospital IQ) joins Optum as VP of provider solution sales.

Workforce management platform vendor IntelyCare hires David Burke, MBA (QPID Health) as CFO.

Montgomery County Memorial Hospital (IA) promotes Ron Kloewer, MHA to CEO. He was CIO for 28 years before being promoted to COO in November 2020 and tapped to replace the retiring CEO next month.

Announcements and Implementations

HIMSS announces that its membership has grown by 20,000 in the past six months to 100,000.

InterSystems releases an enhancement to its TrakCare health information system that will allow UK sites to schedule COVID-19 vaccinations.

Microsoft’s April update for Microsoft Cloud for Healthcare – when was released in the fall – will include a patient self-scheduling solution for Microsoft Dynamics 365, the ability to schedule and launch Microsoft Teams virtual visits from within Epic, home health and remote patient monitoring features for Dynamics 365 and Teams, and additional Azure API for FHIR capabilities for Microsoft Cloud for Healthcare tools.

Government and Politics

A Georgia man is sentenced to six months in federal prison for falsely claiming that his former girlfriend – a hospital nurse – violated HIPAA by emailing pictures of trauma patients outside the hospital.

COVID-19

CDC reports that 66 million of 89 million COVID-19 vaccines distributed have been administered (75%). About 6% of Americans have been given both doses.

A physician-epidemiologist says that COVID-19 shaved just five days off average US life expectancy in 2020, not the one-year number that CDC published last week. Public experts use life expectancy projections that assume no change from one year to another, which have been shown to distort the impact of events that affect mortality for only a brief part of the average lifetime, such as pandemics and wars. In other words, losing a full year of life expectancy would require the same number of pandemic deaths every year for the rest of someone’s life, when in fact life expectancy will almost certainly rebound to that of previous years once the pandemic is over.

FDA’s vaccine advisory committee finds that J&J’s COVID-19 vaccine offers high efficacy across all demographics, based on the company’s study data. The J&J vaccine will likely earn FDA’s emergency use authorization in the next few days. All major vaccines (J&J, Pfizer, Moderna, Novavax, and Sputnik) offer 100% protection against death or hospitalization (hat tip on that to @EricTopol), so take whatever one you can get.

US nursing home deaths from COVID-19 have fallen by 65% in the past two months as 4.5 million residents and employees have received at least one dose of the vaccine. The drop-off is even more pronounced than of the population in general.

Washington State Department of Health cuts off COVID-19 vaccine shipments to publicly traded concierge medicine provider One Medical after complaints that it provided doses to its own executives and customers who were not eligible under local guidelines. The company also offers the vaccine to all of its employees regardless of their risk factors or exposure. Doctors report that young patients with no health issues were able to sign up for a trial membership and then book a vaccination appointment even though health workers were being waitlisted, with the company responding that upgrading its systems to screen appointments was too hard and that it won’t question someone’s declaration that they are eligible.

The Ad Council looks at COVID-19 messaging for its upcoming pro-vaccination campaign, saying that positive messages (acknowledging hesitancy concerns, vaccination as a pathway to regaining human connection, protecting family, and acknowledging personal choice) will work better than negative messages (fear tactics, referring to “the right thing to do,” overpromising, and emphasizing “back to normal” that most people won’t experience). Most interesting to me is the level of trust people place in various messengers.

Other

ECRI’s health IT patient safety workgroup publishes a white paper on reducing alert fatigue. One of its recommendations is a standard set of metrics for monitoring and optimization:

• How many alerts fired and who received them? This would be reported as the number of alerts per 100 orders or per encounter, broken out by department, specialty, and the type of user who received the alert.
• Did the alert fire appropriately?
• What did the alert recipient do? That includes think time, rates of acceptance or override, override reasons, and clinician comments.
• What impact did the alert have on recipients?

A Cleveland TV station profiles Peggy and Bill Schneck, who met as 17-year-old service workers at Cleveland Clinic in 1975 and were married four years later. He studied IT and is a Cleveland Clinic systems analyst, while she became an RN and is now a nursing informatics instructor.

Sponsor Updates

• Everbridge VP of Global Account Management & Customer Success MJ McCarthy wins a 2021 Stevie Award in the category of Worldwide Sales Executive of the Year.
• Meditech publishes a new success story, “Med Center Health’s vaccination process supports high volume and eliminates waste.”

Blog Posts

• Insulin Dosing Software Explained (Glytec)
• Improving Healthcare Communication: Where to Start (Halo Health)
• The CDO Influence in Patient Experience (The HCI Group)
• How to Build a Healthcare Data Quality Coalition to Optimize Decision Making (Health Catalyst)
• Use Patient Education to Spread the Word About COVID-19 Vaccines (Healthwise)
• COVID-19 Testing Strategies: 10 Lessons from Colleges (Healthcare IT Leaders)
• Meet the First Optimum Career Path Training Class (Optimum Healthcare IT)
• Technology and transformation at Marshfield Clinic Health System, a conversation with CIO Jeri Koester (Infor)
• How Can Interoperability Solutions Help Health Plans Streamline Care, Cut Costs? (InterSystems)
• In My Opinion: Understanding the clinician’s needs with Brad Naeymi (Intelligent Medical Objects)
• Revenue Cycle Practices – Part One: The Importance and Effect of Contract Maintenance (Medhost)
• ERP System Cutovers: Preparation Considerations (Impact Advisors)
• Using a vaccine workflow in the fight against COVID-19 (Meditech)
• Top 3 Predictions for the First Virtual IHE Connectathon (Capsule)

Contacts

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

EPtalk by Dr. Jayne 2/25/21

Today’s web-based entertainment was courtesy of Nuance and its Dragon Ambient eXperience product. I’ve been keeping an eye on it since seeing it at HIMSS19.

Their demo at the time involved an orthopedic visit, which tends to be a lot more straightforward than most of the visits we have in primary care. I was hoping they would show a truly complicated visit and how the system could handle it. It was encouraging the host said they would be doing an “unscripted” demo based on attendee input through a Zoom poll with randomly generated options.

However, it quickly turned into the same old orthopedic visit that they typically show. They asked the audience to have input via poll on past medical history elements, but many of what we were given to choose from were just standard conditions like hypertension or an ACL repair.

I have yet to see a demo where the system can manage the real-world things we see in practice. Where is the history of “heart surgery” where the patient has no idea what was done or what the underlying diagnosis might have been? What about the problems that were more complex than injuring your ankle while walking your dog Lucky, which was the demo they actually showed? They showed the voice recognition streaming during the demo, and there were a number of elements where it wasn’t capturing exactly, so I was curious to see what the process would be to resolve those.

The command “Hey, Dragon, show me the x-ray” brought up an x-ray example with no patient identifiers, which failed my realism test. The physician also interpreted the x-ray before examining the patient, which is a no-no for many of us. The physician used a fair number of medical words, but didn’t really explain to the patient what those meant, including the anatomical names for the affected areas.

I wasn’t impressed by their simulated assessment and plan, which didn’t entirely follow the standard of care in that the patient was given a scheduled controlled substance for her ankle sprain, which most of us wouldn’t do until the patient failed other pain management strategies such as anti-inflammatories or acetaminophen, neither of which she said she had taken.

I know I tend to be critical since I’m a practicing physician, but it’s all part of credibility. It’s hard to find the messaging to be credible when they missed the clinical mark. Was it intentional, or did they not find it important to be clinically credible? Interestingly during the interview, the clinician ordered tramadol, but when the host reviewed the medication orders, the canned display on the back wall showed Tylenol, which maybe was an indicator that it was a little more unscripted than they planned. The final note did mention both Tylenol and tramadol, however.

They cut away to videos from physicians, including family physicians and orthopedic physicians, but they didn’t really show what this would look like in family medicine. I asked a pointed question via the Q&A chat about how the system would manage vague elements like I mentioned above. Not surprisingly, it was skipped. They did mention that they have a four-hour service level agreement for note turnaround, although they noted it can be shorter in the real world. As a physician who likes to have my notes done when I walk out of the room, that would take some getting used to. They did demonstrate how the system could filter out the conversational parts of the visit in order to create a concise note, which is promising. Still, I’d love to see how it handles a complex primary care visit.

Today’s patient-side entertainment was courtesy of my local hospital, which continued to underwhelm. I’m living the nightmare shared by a number of female healthcare providers who received the early rounds of the COVID-19 vaccines. Since it’s been two months, and statistics do what statistics do, one-sixth of us over a certain age have been due for an annual mammogram since receiving their vaccines. Both of the current vaccines tend to cause swollen lymph nodes, usually in the neck or underarm, and sometimes those nodes turn up on a mammogram. It’s a widespread enough issue that mammography centers are adding questions to their intake forms asking about vaccine status and which arm was used for the administration. The Society of Breast Imaging sees this as a big enough issue that it has recommended women delay screening mammograms until at least 4-6 weeks after receiving their last vaccination. However, for those of us who were due for screening prior to the recommendation, we are now chasing down rogue lymph nodes that could be due to the vaccine or to something more sinister, such as breast cancer or lymphoma.

I had a difficult enough time scheduling my follow-up ultrasound due to my clinical schedule and the limited appointment slots. Today’s actual appointment could have served as a case study of what not to do from a technology, operational, and clinical standpoint.

It started with patients reporting 15 minutes before their appointments as instructed, only to find that they had a single registrar who was taking names and instructing people to be seated until called. The problem: six patients and five chairs in a waiting room that had been stripped of furniture for social distancing. Patients were slowly called to the desk, where they were forced to fill out the usual clinical history form (completely from scratch, once again not pre-populated from the Epic system as it could have been) standing there in front of the registrar. This delayed additional check-ins and I’m sure was frustrating to patients.

Despite arriving early, I wasn’t called back until 10 minutes after my appointment time, where I was taken to a changing room that fed a sub-waiting room with an additional four patients (although there were five chairs, but this time we got to sit around with each other in flimsy gowns). Plus, instead of watching HGTV in the main waiting room, we were treated to a screen displaying a version of the imaging center’s tracking board, showing all the patients and their appointments and how backlogged they were. Although the names were truncated like we were flying standby, it felt like an invasion of privacy since we could see all the procedures scheduled for the day. There was a Windows popup on the screen that looked like an error or alert message, and although I couldn’t see the details, I wondered if we were really supposed to be seeing it.

After finally reaching the exam room, I was treated to a brusque sonographer who acted like I hadn’t followed appropriate prep instructions (despite having received none). I felt like reminding her that even though she does this a dozen times a day, each patient was enduring the harrowing experience of wondering if they have cancer or not, so they don’t need her attitude. It was clear she was having trouble getting the images she wanted, but she finally went to review them with the radiologist while leaving me draped on the table.

When the radiologist came in, she started spouting medical terminology and I’m hoping it was because somewhere my chart was flagged as a physician because as a “regular” patient I would have had no idea what she was talking about. I guess I’m also more sensitive to the patient’s comfort than she was, because I rarely have conversations with patients while they are draped and lying on the table. At a minimum, it would have been nice to sit up and have a conversation at eye level.

I don’t think I have unreasonably high expectations. They have been shaped by the way I was trained and how I’ve seen medicine practiced for the last two decades. But it seems they’ve substantially diverged from the post-COVID reality of healthcare in my city. Patient advocacy and patient empowerment are supposed to be major factors influencing how healthcare organizations operate, but apparently for some they’re little more than buzzwords.

The perfect cap on the day was when the sonographer walked me back to the changing room, where she told me to “enjoy the rest of your day.” As I looked at the faces of the other women in the sub-waiting room, knowing that their lives might be changed dramatically today, it didn’t seem like what patients might want to hear, especially knowing that some of them would go home to sit and wait for results. Perhaps “take care and thank you for choosing us as your healthcare team” might have been a better option.

Have you experienced a decline in patient services in the COVID era? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 2/25/21

High-End Medical Provider Let Ineligible People Skip COVID-19 Vaccine Line

One Medical comes under fire after leaked internal documents show that the membership-based primary care company has let ineligible patients – some with ties to company leadership – receive COVID-19 vaccinations before other, higher-risk groups.

Redox Market Momentum Leads to $45M in Series D Raise Led by Adams Street Partners

Healthcare API developer Redox raises $45 million in a Series D round that brings its total funding to $95 million.

Ontario Systems Continues Growth

Revenue recovery software vendor Ontario Systems acquires Pairity, which offers AI-based solutions for accounts receivable management.

Innovaccer Raises Series D at $1.3 Billion Valuation, Launches Innovaccer Health Cloud to Power the Future of Health

Innovaccer confirms a rumored funding round led by Tiger Global Management, bringing its total raised to $225 million.

HIStalk Interviews Michele Perry, CEO, Relatient

Michele Perry, MBA is CEO of Relatient of Franklin, TN.

Tell me about yourself and the company.

Relatient is the 2020 KLAS category leader in patient outreach and communication. The company is located right outside of Nashville, TN. We got our start with appointment reminders back in 2014. Since then, we have built an entire patient engagement platform to help medical offices manage all the major touchpoints in the outpatient journey. Our goal is to end phone tag in healthcare.

I’ve been Relatient’s CEO since 2017. We have been growing a lot and we are excited about where we are headed as a company and the work we are doing alongside the health systems, hospitals, and medical offices we serve to improve the patient experience.

How are providers using technology to manage COVID-19 vaccinations?

Medical providers are really grabbing hold of technology right now to solve the daily operational issues related to getting the COVID-19 vaccine distributed on a mass scale.

The first thing we started hearing from health systems like Med Center Health in Kentucky and Warren Clinic in Oklahoma was that they wanted to shoot for zero wasted doses. When they came to us with those conversations, they were most concerned about patient no-shows, because the first vaccine was Pfizer’s and the whole freezer situation meant that once a vial was thawed, mixed, and ready to use, it couldn’t be set aside for another day. A patient no-show could mean doses in the trash, and no one wanted that. After they set up their vaccine departments or clinics and locations, we configured some specific vaccine reminders to help get patients to both the initial appointment and the one following it 21 days later.

Health systems learned really fast that getting the vaccine schedule filled was a huge task. It takes a lot of people to work through lists of patients who qualify and get them booked. We had used our patient self-scheduling module for some customers earlier in the pandemic that wanted to let patients self-schedule for testing. We turned this on for customers who asked for help with vaccine scheduling and then made it available for new customers, too, turning it on very quickly un-integrated for immediate scheduling.

Some other things we’re seeing providers do include the use of messaging tools to send mass communication to their patients and their staff, like when a new phase of vaccinations opens up or a new vaccine clinic. We’ve seen them use short links to maps and directions in case patients are new to their organizations and utilize text messaging for one-to-one patient conversations so they can field questions and make schedule changes without the back and forth of playing phone tag with patients.

Why do patients fail to show up for their appointments and what are the best practices to reduce the no-show rate?

It’s interesting, because we are far enough into a world where appointment reminders are the norm that patients have come to rely on them to remember and plan for their appointments. Healthcare has come a long way in this, but COVID-19 introduced a new layer of complexities to patient schedules and the load of responsibilities patients are carrying. They’ve got kids at home all the time, they’re trying to work from home, they may no longer be close to the doctor’s office during the day because of this. We have heard from a lot of healthcare leaders over the past year that patients who were afraid to come in early on added to no-shows. It kind of all comes down to keeping communication open and clear so patients know that you are open and you’re a safe place to receive care. If something changes, do they have a telehealth option that can replace the in-person appointment?

The other key piece or best practice is the combination of communication methods and the ability for a patient to respond to a reminder. We’re patients ourselves and we get reminders from our own medical providers that either don’t ask for our confirmation or response or only allow a confirmation. If a patient has to call your office to cancel an appointment, they’re likely to hit the phone tree or get put on hold and hang up. This is where a lot of patient no-shows still come from, and there are well-established practices to avoid this.

Patients want self-scheduling and virtual waitlists more than just about any other technology. Has the pandemic affected adoption?

Definitely, and for a few reasons. Part of the increase in adoption has been resource constraints. Medical offices had to furlough employees, like many other industries. When they started to recover from that, they got hit with COVID-19 cases of their own and often found themselves short-staffed. The need for self-schedule and waitlists that can backfill last-minute cancelations is growing as there are fewer resources to do these things manually.

Additionally, Accenture recently reported that two-thirds of patients said they are likely to switch providers who don’t meet their expectations for handling COVID-19, and we know that patient access is a piece of these expectations. More than 30% of patient appointments are scheduled after normal clinic hours.

As I mentioned earlier, managing vaccine and testing schedules has also been a big burden to medical practices. Solutions that can lighten this burden and empower patients to self-select are win-win.

Can medical practices compete with the consumer-facing technology that is offered by urgent care centers, health systems, and chain drugstores?

Absolutely. Medical practices have the potential to offer the most personalized care if they can keep up with the innovation of larger organizations. They can do this with a cohesive digital strategy that works alongside and enhances their portal strategy. When solutions aimed at expanding access and convenience — like self-scheduling, two-way patient-practice conversations, and registration — are only available to portal users, a significant portion of a provider’s patient base never experiences those benefits.

Which health IT sectors will be the winners and losers in the next few years as COVID-19 becomes better controlled?

This is the winning question, right? COVID-19 won’t be a crisis forever, but some of the things we’ve learned during this time will stick around long term and we’re better for it.

Telehealth is one that is here to stay, but it won’t stay at the levels medical providers have used over the past year. Providers are now operating hybrid care models, where patient care is delivered in-person and via telehealth, so they need tools and workflows to help support this model of care delivery. I expect telehealth vendors to continue refining and expanding their technology as medical providers lean away from general video conference platforms that filled the immediate need early on.

The health IT sectors that help answer the question, “How do we get patients the right care, in the right place, at the right time” will be the winners. Interoperability will be a must as care becomes more dispersed, and digital communication tools and patient messaging will be crucial to helping patients navigate the journey.

You kind of hit on this already when you asked about consumer-facing technologies, but it’s key because patients are consumers, and these are the tools and kinds of access they’re looking for. My point is those technology sectors that require a lot of the patient — apps to download, portals to log into, additional accounts to create, and passwords to remember – will find less and less room over the next few years.

Morning Headlines 2/24/21

Our Care Studio pilot is expanding to more clinicians

Google Health expands the pilot of its EHR search and data presentation tool, which it has named Care Studio.

Enforcement Discretion Regarding Online or Web-Based Scheduling Applications for the Scheduling of Individual Appointments for COVID-19 Vaccination during the COVID-19 Nationwide Public Health Emergency

The HHS Office for Civil Rights won’t penalize certain potential HIPAA violators for their use of COVID-19 vaccine scheduling tools during the nationwide public health emergency.

DirectTrust Announces Implementation Guide for Event Notifications via the Direct Standard

DirectTrust publishes an implementation guide for sending ADT event notifications via the Direct Standard.

News 2/24/21

Top News

Google Health expands the pilot of its EHR search and data presentation tool, which it has named Care Studio.

The system provides a centralized view and search capability of patient information that is stored one or more EHRs.

Ascension was the pilot site, for which Google earned the attention of Congress a year ago for how the company intends to use and protect patient information. Google has made assurances that it does not own patient data, doesn’t sell it, and won’t use it for advertising purposes.

Clinicians from unnamed sites in Nashville, TN and Jacksonville, FL will use an early release of Care Studio and provide feedback about its usability, usefulness, and workflow integration.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor RCxRules. The Burlington, VT-based company, founded in 2010, helps healthcare organizations succeed with both value-based care and fee-for-service billing models. Its unique, predictive rules engine ensures compliance with healthcare’s complex regulatory and reimbursement rules. Integrating with leading EMRs and PM systems, RCxRules software addresses issues before they affect revenue, delivering claims with the most accurate financial and HCC data — every time, guaranteed. Thanks to RCxRules for supporting HIStalk.

Listening: a grab bag of obscure 1960s psychedelia, which is mostly new to me. The naively optimistic flower children who formed forgotten bands 50-plus years ago are now dying off without fanfare. Little-known groups I’ve discovered: The Fallen Angels, Kaleidoscope, and The Peanut Butter Conspiracy (in addition to one of my all-time favorites and not obscure at all The Love). I am contemplating a foray into collecting LPs and 45s for the first time since I suspect a lot of this trippy vinyl is moldering in basement junk boxes and deserves better. It is sweetly sad to think of someone’s great-grandma passing away in her 80s without her family knowing that, if only for a few weeks, she was a sun-drenched Renaissance faire goddess with flowers in her hair, whose heartfelt, unskilled folkie crooning soundtracked the personal summer of love for thousands or millions of people who are struggling, as she did, to reconcile the sunny days of youthful exuberance and seeming immortality with the realization that the clock is running out. “Legacy” is an uncomfortable topic for me since I envy artists whose work will continue to be discovered and appreciated by new generations.

I ran across the best acronym-based group name ever, the Paediatric International Patient Safety and Quality Community, aka PIPSQC (“pipsqueak.”)

Odd grammatical quirk, almost entirely heard in 20-somethings: pointlessly expanding “thank you” to “thank you so much.”

Webinars

February 24 (Wednesday) 1 ET. “Maximizing the Value of Digital Initiatives with Enterprise Provider Data Management.” Sponsor: Phynd Technologies. Presenters: Tom White, founder and CEO, Phynd Technologies; Adam Cherrington, research director, KLAS Research. Health systems can derive great business value and competitive advantage by centrally managing their provider data. A clear roadmap and management solution can solve problems with fragmented data, workflows, and patient experiences and support operational efficiency and delivery of a remarkable patient experience. The presenters will describe common pitfalls in managing enterprise information and digital strategy in silos, how to align stakeholders to maximize the value of digital initiatives, and how leading health systems are using best-of-breed strategies to evolve provider data management.

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

Acquisitions, Funding, Business, and Stock

Tech-enabled insurance startup Oscar Health plans to raise over $1 billion through its IPO, scheduled to take place next week. Like competitor Clover Health, the Alphabet-backed company has yet to show a profit, despite having raised $1.6 billion since launching in 2012. Analysts, however, are quick to predict a $6.7 billion valuation.

Precision medicine technology vendor Tempus will collaborate with Texas Oncology-owned Precision Health Informatics to advance clinical research and personalize patient care. Both are for-profit companies.

Sales

• Jackson Hospital and Clinic (AL) will implement CPSI subsidiary TruBridge’s RCM software and services.
• Mercy Iowa City selects Spok Go clinical communications software.

Announcements and Implementations

Southeast Health (AL) implements Epic.

RxRevu develops SwiftMx, giving providers access to medical price transparency and coverage information via EHRs from vendors like Cerner.

General Leonard Wood Army Community Hospital (MO) employees prepare to go live on Cerner as part of the DoD’s MHS Genesis Cerner roll out.

CommonSpirit Health uses VeeMed’s tele-ICU physician services across its Dignity Health and Catholic Health hospitals.

Jupiter Medical Center implements Artifact Health’s mobile app for physician queries.

A new KLAS report looks at the EHR experience of medium to large home health agencies, finding that MatrixCare Home Health leads the market, while Epic Dorothy follows closely as used mostly by health system-owned agencies. Homecare Homebase is widely used, but receives the lowest rating for quality of support. WellSky’s customers report lower satisfaction as the company grows and acquires, while users of Netsmart’s acquired products (Homecare Advisor and Homecare) say development has slowed as the company focuses on its MyUnity Enterprise platform.

DirectTrust publishes an implementation guide for sending ADT event notifications via the Direct Standard.

Government and Politics

TeleICU provider RemoteICU sues HHS for not allowing US-licensed physicians who live outside the US to bill Medicare for telehealth services.

In Canada, New Brunswick’s auditor general says that the province’s EHR rollout failed, where $21 million was spent on a system that fewer than half its physicians are using and that does not integrate with hospital systems. The New Brunswick Medical Society partnered with private company Accreon to create Velante to sell the software, then kept pumping money into the failing program and adding switchover subsidies until the exclusive deal ended in 2019. Velante is closing and the software vendor, Intrahealth Canada, will take over support.

COVID-19

J&J says it will ship 20 million doses of its single-shot vaccine in the US by the end of March if it receives FDA’s emergency use authorization, earlier than expected.

Other

HIMSS said early this month that it would provide more information on HIMSS21 on February 19. I didn’t see any specific announcement, but the FAQ now says that registration will open in early March. HIMSS will also run an extra-cost, single-day “CIO Summit” that will be followed by a “curated CIO experience” now that CHIME has pulled out. Exhibitor count is at 410 versus 1,300 at HIMSS19.

St. Margaret’s Health-Spring Valley (IL) reverts to paper-based processes after its IT team discovers a data breach, forcing it to shut down all of its Web-based systems.

An AMA article touts the use of Xcertia app development guidelines — developed by AMA, HIMSS, and other groups — even though the Xcertia project was shut down in August 2020. HIMSS said at the time that the effort would continue with oversight by a HIMSS work group.

Sponsor Updates

• AdvancedMD shares the product enhancements that will be made available during its Winter 2021 Release.
• Black Book Market Research includes Impact Advisors among the top-rated RCM services and optimization consultants.
• Cone Health (NC) expands its use of PatientPing’s real-time event notification software to include community providers.
• PeriGen affirms that its technology supports the US Surgeon General’s call to action to improve management of maternal health.  
• CereCore relocates its Nashville headquarters to, in the near future, better accommodate its workforce and partners.
• Cerner releases a new podcast, “How diverse, community-based hospitals are a lifeline to saving clinical research.”
• The Chartis Group publishes a new brief, “Partner with Purpose: How to Build a Winning Playbook to Guide Health System Partnership Strategy.”
• Columbus CEO includes CoverMyMeds Senior Manager of Employee Engagement Lachandra Baker in its Future 50 initiative.
• Wolters Kluwer Health highlights the top four challenges facing CMS Administrator nominee Chiquita Brooks-LaSure.
• Quil becomes a HealthShare Exchange MarketStreet partner.
• Medical Marketing & Media includes OptimizeRx SVP and Principal of Agency Channels Angelo Campano to its “40 Under 40” list.

Blog Posts

• How Healthcare Leaders are Leveraging Patient Engagement Software to Distribute COVID-19 Vaccines (AdvancedMD)
• What if? (Ascom)
• ECR 2021 – Explore the on-line opportunities (Agfa HealthCare)
• The Shift to Home Health Care – and Setting Your Organization Up for Success (CarePort)
• Epic Testing: Tips for Taking Testing Virtual (CereCore)
• Understanding Social Determinants of Health and Their Integration with EHRs (ChartLogic)
• Engaging hard-to-reach patients (EClinicalWorks)
• 5 Reasons Why You Need to Prioritize Prescription Price Transparency (RxRevu)

Contacts

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

Morning Headlines 2/23/21

Alphabet-backed Oscar Health eyes as much as $6.7 billion IPO valuation

Tech-enabled insurance startup Oscar Health hopes to raise over $1 billion through its IPO early next month.

St. Margaret’s Health – Spring Valley breached by cyber security attack

St. Margaret’s Health-Spring Valley (IL) reverts to paper-based processes after its IT team discovered a data breach over the weekend and shut down all of its Web-based systems.

Conversion Labs Begins Trading Under New Company Name, LifeMD, and Ticker Symbol, LFMD

Conversion Labs rebrands to LifeMD to reflect its transition to direct-to-consumer telemedicine and online prescription delivery.

Curbside Consult with Dr. Jayne 2/22/21

I’m not sure if I’ve ever met Nordic Chief Medical Officer Craig Joseph, MD in person, but he’s definitely on my list of “people I’d like to have a cocktail with” at some point. His Twitter posts @CraigJoseph always have interesting tidbits, such as a recent white paper from ECRI’s Partnership for Health IT Patient Safety. He notes, “Lots of smart people with clinical and EHR vendor chops outline specific actions to consider.”

I checked out the paper, titled “Optimizing Health IT for Safe Integration of Behavioral Health and Primary Care.” It resonated with me because this is an issue I’ve had to deal with for years – navigating the intersection of those two disciplines while trying to coordinate care while maintaining privacy. Many organizations, including some of my current clients, choose to keep primary care and behavioral health records siloed. This results in fragmentation of care and lack of understanding around whole-person factors that drive both physical and mental health.

It lays out clear reasons why primary care and behavioral health need to be integrated:

• 80% of behavioral health patients will visit a primary care provider (PCP) at least annually.
• 50% of behavioral health disorders are treated in primary care settings.
• 48% of appointments for psychotropic medications are with non-psychiatrist PCPs.
• 67% of people with behavioral health disorders don’t get behavioral health treatment.
• 30-50% of patients referred from PCPs to outpatient behavioral health don’t keep their first appointment.
• Two-thirds of PCPs report being unable to access outpatient behavioral healthcare for their patients.

Additional barriers for mental healthcare access include provider shortages, health plan barriers, and coverage issues. In my major metropolitan area, we recently opened a dedicated mental health emergency department unit that is staffed full time by specialist providers. The community accepted it readily because we know we don’t do the best job for patients needing non-medical services who present to other care venues, such as the emergency department or urgent care facilities.

Even for health systems or provider-side organizations that want to try to integrate the behavioral health and primary care realms, EHRs aren’t always supportive. Psychiatry notes, therapy notes, and documentation from social workers are often kept under separate access where the primary medical team can’t see them. Especially when we’re dealing with medical conditions that can have significant behavioral components, it would be useful to be able to see all the information about the patient. The white paper does a nice job explaining different levels of integration, from “coordinated” care to that which is “co-located” to fully “integrated” care. Right now, many primary care practices are struggling to deliver even minimally coordinated care.

One of the major participants in the creation of the paper was the HIMSS Electronic Health Record Association (EHRA). I have some experience with EHRA from a past life and know many of the members of the project’s working group to be knowledgeable individuals with a deep understanding of EHRs and care delivery. EHRA has a code of conduct for EHR and health IT developers that addresses the need for collaboration described in the paper.

However, working as someone outside of an EHR vendor, I’ve found it nearly impossible to access the materials that we relied on when I was on the vendor side. This forces those of us who work on homegrown or in-house systems to re-invent the wheel trying to determine best practice as we develop our technology. Since this is a partnership with ECRI and this paper exists, I take that as positive signs. Still, non-commercial developers are going to have to do a lot of figuring out on their own unless there are maneuvers to standardize at the federal or payer levels.

The paper talks about standardizing screening and documentation tools so that data is consistent across an enterprise. Although this would be good, many patients may receive their care across multiple organizations. I cared for a patient the other day who receives medical care primarily through a county health clinic because she doesn’t have health insurance, but receives a telehealth benefit from her employer, so she’s using that for urgent care services and psychotherapy. She came to our urgent care because she needed stitches and we have an affordable self-pay program. Given the vast differences in the systems used by those entities coupled with the relative immaturity of our state’s HIE, there’s no way there will be coordination any time soon.

There are also legal barriers to sharing of data under both HIPAA and 42 CFR Part 2, especially around sensitive health information. Many organizations find these restrictions daunting and either don’t have the wherewithal or the manpower to try to tackle them, especially while simultaneously coping with a pandemic and the generalized dysfunction of healthcare delivery in the US. Patients also struggle to understand the protections and restrictions and become frustrated when we try to explain why we have to ask the patient to summarize their care because we can’t access the information that we need without recreating the proverbial wheel.

The document has some great appendices, including a literature review and tables of evidence used during its creation. The summaries of EHR challenges and existing workarounds were fascinating case studies in dysfunction: lack of integration between the EHR and tablet devices used for patient-completed screeners and surveys; copy and paste to add the same note to the PCP and behavioral health EHRs; printing and scanning of medication lists from the behavioral health EHR to the medical one; and more. My favorite is “Reliance on patient or clinical recall for inaccessible clinical information – providers describe this as ‘flying blind.’”

Due to my employer’s lack of integration with our state HIE or nearby health systems, I’ve been flying blind for the last six years, except for when patients use their phones to access MyChart and then hand them over. That’s been useful in a number of medical situations, but I have to admit I’ve never seen psychiatry notes or therapy notes in any of those encounters, and I usually can’t see a full medication list history to know what’s been tried in the past — only current medications are typically displayed.

The paper also contains pages of recommendation tables, some of which push back on ONC, CMS, and other agencies to provide easily accessible standards for developers to use when creating documentation. It also calls on ONC to drive adoption and implementation guidance for APIs to improve integration. There is also a bid for the federal government to incentivize patient care organizations to implement standardized tools. There’s a great swim-lane diagram of an ideal IT-enabled workflow for safe integration. It will be interesting to look back at this paper in a couple of years and see how far we’ve come or whether we’re still living in the land of siloed documentation.

Has your organization done work to support integration of primary care and behavioral health? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Lissy Hu, MD, CEO, CarePort Health

Lissy Hu, MD, MBA is co-founder and CEO of CarePort Health, powered by WellSky, of Boston, MA.

Tell me about yourself and the company.

I’m a physician by background. CarePort connects hospitals with post-discharge providers, such as nursing homes, home health agencies, hospice, community-based providers, and all of the services that patients need after a hospital stay.

What activity are you seeing around hospitals sending ADT notifications to the patient’s other providers now that the deadline is getting close?

We’ve spent the last couple of years helping hospitals and post-acute care providers navigate that initial transition from the hospital into post-acute. Instead of a fact-based or manual process, where the discharge planner at the hospital picks up the phone and calls around to all the different nursing homes in the area asking if they have a bed, we have a network of hospitals and post-acute providers on our platform that can send these referrals electronically and that can communicate back and forth.

Over the last two years, we’ve seen more interest in closing that loop or that round trip. For the ADT piece that you referred to, not just how to get patients out of the hospital efficiently and share information back and forth in that transition, but being able to understand, when a patient lands in a skilled nursing facility, how long they are there, especially if a patient then goes back into the ED or gets admitted. We are seeing a new level of collaboration between acute and post-acute, especially as folks are starting to realize the importance of post-acute and how much that drives outcomes, both from a cost and quality standpoint.

We’ve learned that open hospital beds aren’t managed like a grid, where COVID-19 patients are moved between hospitals based on individual hospital capacity and clinical capability. Are hospitals showing an interest in sharing open bed information with each other?

On the bed availability piece, you are right. There’s not a centralized information piece out there, and we are seeing more interest in wanting that level of visibility. We are seeing it not only on the hospital side, I would say, but interestingly, on the post-acute side as well.

One of the things that has been so interesting about COVID-19 and the pandemic is that we sit in the middle, in terms of the hospital and the post-acute. We see the impact on both sides. Even in April and March of last year when things were really kicking off in the New York area, what we were seeing was that the hospital capacity and their capacity to take patients is very much tied to their ability to discharge patients into that next level of care, in terms of that post-acute.

People will start to see that it’s not just about the hospital bed — it’s around capacity and that flow across the entire continuum. New York hospitals were having a hard time getting their patients out of the hospital and into post-acutes, because a lot of these post-acute providers changed their admissions policy with COVID-19 in their vulnerable population. That hesitation to take on new patients backed things up from the hospital. What I’ve been encouraging our customers to think about is that visibility into the hospital beds is helpful and it’s necessary, but you also need to think about that next step. Where does that patient go? Because it is a pipe that’s connected.

We also saw in New York a high number of nursing home deaths that were possibly caused by forcing them to accept their residents back into the facility following discharge from a COVID-19 hospital stay. How will that situation change permanently and will technology play a part?

That highlights two things. First, the interdependency between hospitals and post-acute providers. It also highlighted to a lot of people the dual roles that nursing homes play in our society.

On the one hand, they are residential facilities for the elderly, the vulnerable, and those who can’t be in their own homes, so they are these long-term care settings. On the other hand, we rely on them as post-acute settings, where folks who have gotten a hip or knee replacement or are recovering from surgery go for a couple of weeks, almost like a step-down unit, to recover, to rehab before moving on to home with home health or back into the community. That was the challenge of New York and really all across the country — we need places for people to recover that aren’t the hospital.

At the same time, these facilities traditionally have been these residential facilities for the elderly and the vulnerable. How do we balance that? Does that get split apart? The role that technology can play is facilitating that transition as much as you can with high-quality information. In our products, we looked at facilities that could take COVID-19 patients, that had a separate wing, isolation wings, and a separate admissions processes. We tag those in our system so that the discharge planner at the hospital will know. We transmitted COVID-19 results that were pending from the hospital to the post-acute care provider.

Those were all COVID-specific changes that we did in part because we had to help our customers, but also because the market is moving to increased interoperability between the hospital and the post-acute care providers. There is a need to share more and more information, especially as we are seeing sicker and sicker patients going into post-acute because of length-of-stay pressures in the hospital.

Your product helps hospitals and families select a skilled nursing facility, with CMS star ratings being one factor. Were those ratings predictive of which SNFs had a lot of COVID-19 deaths, and will consumers look at different criteria after the pandemic is controlled?

The biggest change we’ve seen is a shift away from facility-based care towards more home-based care. There have always been patients who clearly need to go to a facility, or who clearly can go home. But in the middle ground of patients are those jump ball patients that could go home, but maybe they are just sick enough or frail enough that they need to go to a facility. We’ve seen a lot of this shift, where patients who might have gone to a facility in the past are now going home.

The other change is that going home instead of to a facility is a more difficult discharge. When you go to a facility, you’ve got your dialysis, you’ve got your infusion, you’ve got your nursing care. All of that is set up for you. When you go home, the discharge planner has to set up all of those pieces a la carte.

We saw hospital admissions go down, so we were expecting referral volume to go down. We found that when we looked at 2020, our referral volume went up by almost 20%, even though total admissions to hospitals were down. I think a lot of that can be explained because of the complexity of setting patients up at home and the need to set up more and more services. A lot of people are saying that COVID probably accelerated some of that, but that trend of more patients opting to go home was already there.

That was a  roundabout answer to your question about whether patients are picking facilities differently. The shift to home was probably the number one trend that we saw. But in terms of patients picking facilities differently, I think people are paying more and more attention to the quality of nursing homes. COVID highlighted some of the problems with those ratings that a lot of folks in the industry have already raised. I hope this will push CMS for more transparency, more data on the quality of these nursing homes. Right now, for example, they are considering adding COVID-19 vaccination rates of staff and patients to that rating. That is an excellent idea, given what we know about the vulnerability of that patient population. 

Overall, it has pushed patients and their families to consider that choice with wanting more information and better information. Hopefully that pressure from patients and their families will give us even more transparency than what we have today.

WellSky said when it acquired CarePort that it would invest significantly to expand CarePort’s capabilities. What changes do you expect to see?

Luckily when we went through this process of parting from Allscripts and choosing our next home, we had a choice, which is important. When we spoke with WellSky and we talked about our shared vision, I wanted to be very specific around what that meant, rather than amorphous corporate jargon about synergies. I was impressed with WellSky because they had been thoughtful about the process. Given the price that they paid, it makes sense that they were thoughtful, speaking in the realities of the world. 

Specifically, in terms of the benefits to our customers, there were probably three things that we looked at and valued. The first is, as we are seeing more of a shift towards home-based care, our clients are asking us to connect more and more with these home-based providers. WellSky is in one in four home health agencies in the US. Being able to add those agencies to our network, both as referral partners and to add visibility in terms of that ADT and deeper clinical data, was valuable out of the gate for our customers.

The second piece was that WellSky has a network that goes beyond home health and delivering medical services into the home. They have a huge network in the social determinants of health space. Again, as we are seeing more of a shift home, there are more concerns around how the patient is going to get their meal. How do we think about the non-medical parts of their care that we can support in their home? That was another piece that the WellSky network added for our customers.

The third piece was funding. The deal closed on December 31, 2020. We started the year with 200 people and we are already in the process of trying to hire 50 more people to our team.

You’ve said that you want CarePort to be a place where smart women want to work. How do you make that happen?

It all starts with the culture that you build. When I was in business school and in medical school — and I’m almost embarrassed to admit, even when I was taking classes on corporate culture and team dynamics — those soft classes almost felt less important in some ways than the finance and accounting classes. The hard business classes, if you will. I have to say that my biggest learning in these last eight or nine years since I founded CarePort is that it’s the opposite. Team building, figuring out how to manage, figuring out how to set up a positive culture where women are valued, where you enable everyone to speak up — that’s the hardest part about building a company.

At our scale, the lesson that I’ve learned is that it’s not even just about you and maybe the senior people in the team. You have to be hiring people at the manager level, at the director level, all down through the org, to make sure that those managers embody the competencies that they need to meet the roles and responsibility of that job, but the right culture and the right attitudes as well. That’s how you build a culture at scale. It’s not just from the leader, the CEO, the founder, the visionary. You have to staff in your company at all levels with people who want a positive working environment for women, who value the contributions of women, and who understand some of the complexities and challenges that women face. When you’re building a company and trying to recruit, all those things are difficult to prioritize. But really, that’s how you bake this into your DNA. You have to find people at all levels who embody that.

How did you protect that goal while being acquired twice?

You have to be thoughtful about why you’re doing the acquisition. To be fair, some companies just don’t have that choice. For us, luckily, we’ve always had optionality, because we’ve been doing well and we’ve had supportive backers, first from venture capital, then Allscripts. For me, when I evaluated an acquisition and whether we should do it versus do nothing and continue on our current path — because that was always an option that was available to us — there are two lenses that I always thought about. One is, do I see a tangible benefit to the customer? If the answer is no or it’s amorphous, then immediately we shut the conversation down. Because ultimately, if it’s not good for the customer, it’s not good for the business, end, period, stop.

But the second lens, once you get through that hurdle, is, is it good for the team? What is the feel of the culture of the other organization? What is their leadership like? What is that working environment? Is it a place where I could see my team thriving? Because as a founder, some of these people have been with me since the very, very beginning. They left higher-paying jobs with more security, they had families, and they came to a startup where there was none of those guarantees. I feel a tremendous responsibility to my team to make sure that they are taken care of and that my customers are taken care of. Not every company has this choice, but because I’m still here, because we’ve been doing well, because we have this choice, I wanted to optimize around both of those fronts and I was able to.

Do you have any final thoughts?

I’m excited about the future of acute and post-acute care. We have seen even more so than when we last talked, given the changes caused by COVID-19, the interdependency between acute and post-acute. In the next couple of years, I’m seeing payers become more involved in that relationship as well, as payers are trying to think about post-acute and think about how to work with post-acute. Those are some of the things that I’m excited about. Also, having patients who are more engaged, who have more data available to them. Those things will be important for patients who need post acute-care, a number that will only increase.

Morning Headlines 2/22/21

Des Moines University telehealth center could create hundreds of jobs

Des Moines University, in partnership with a local health system, will develop a $4 million telehealth training center that will create 678 jobs.

Spok Reports 2020 Fourth Quarter and Full Year Operating Results

Spok reports Q4 results: revenue down 5%, EPS $-$2.44 versus -$0.50.

New Columbus, Ohio Insurtech Company, Circulo, Raises $50M to Disrupt Medicaid

Columbus-based Medicaid Managed Care insurer Circulo raises $50 million in funding and announces that it will use software from Olive and share its CEO Sean Lane.

Monday Morning Update 2/22/21

Top News

The Wall Street Journal reports that IBM is considering selling IBM Watson Health.

Observers estimate that IBM Watson Health has $1 billion in annual revenue, but loses money.

The grab bag of acquired businesses that may be sold off to private equity or in one or more SPAC mergers include Merge Healthcare, Phytel, and Truven Health Analytics. IBM spent billions on the acquisitions that one of its former executives called a “bet the ranch” move that followed Watson’s game show win on “Jeopardy!”

IBM’s new CEO hopes to catch up to rivals in cloud computing after IBM paid $34 billion to acquire Red Hat in mid-2019.

Reader Comments

From Jeff: “Re: Change Healthcare acquisition by UHG/OptumInsight. Ronald Hirsch, MD of R1 RCM says consensus is that UHG will modify the criteria to their advantage, resulting in fewer patients meeting criteria for inpatient admission and therefore being held in an outpatient observation status.”

From GeddyAlexNeil: “Re: Change Healthcare acquisition by UHG/OptumInsight. I’ve worked at Optum, McKesson, and GE. This combination seems either brilliant or a total mismatch. In the Bill Miller era when I worked there, Optum was generally pretty good in their acquisition hit rate (Catarmaran, Alere, Humedica, and MedExpress). There’s also been some that at the time were well thought out, but the market shifted and/or they miscalculated (Picis). My opinion was they they have a thoughtful approach and historically done a good job integrating the new company into the fold, unlike McKesson. New leadership is here, however. Change is a behemoth saddled with the likes of HealthQuest (yes, it is still around at Emory and AU Medical Center), but first and foremost, it is almost impossible to send a claim today that doesn’t travel through the Change clearinghouse at some point. There has to be value that Optum sees in owning the EDI infrastructure that is Change. The Optum as we know it today was built on the back of the clinical services in the fringe (homecare, urgent care) and the PBM business. This was Ingenix, the code book company and the company whose electronic version of codes were built under the hood of every EMR/PM system in the country before it was Optum. Above all else, Optum is the sister company of one of the top payers that providers love to hate. And if I’m not mistaken, Optum is now larger than its insurer sister by several billion. Optum also represents a disproportionally large percentage of UHS quarterly earnings.”

From The Nazz: “Re: apps are dead. I would say at least that modern web technology makes possible to deliver the same functionality via a web page.” I’ve ditched other apps than the Washington Post one. Accuweather inexplicably decided to make its app landscape mode only on the IPad, so I replaced it with The Weather Channel but really don’t need either. I use Amazon’s website over the app at times since the IPad app won’t let you buy Kindle books. I like the Kindle app for reading books, the Walmart app for online grocery ordering, Waze for driving, and the Sonos app for playing music literally every day, but it’s a bunch of seldom-used icons after those. I think people are right that patients don’t need or want specific apps – MyChart is amazing on the browser and I’m fine with the Walgreens web page instead of their app. All I need is password management and rarely speech recognition and IOS provides those (LastPass is great on the desktop, but speech recognition isn’t as convenient there).

HIStalk Announcements and Requests

External electronic records weren’t reviewed in just over half the most recent encounters of poll respondents, although they would not have been useful in about two-thirds of those visits anyway.

New poll to your right or here: Which of your local care providers has earned your most positive brand perception? How that brand perception was created – by experience or otherwise – is up to you, as is the distinction among types of services offered. It would probably be the hospital-owned practices for me even though I’m happy with my direct primary care physician as well — it’s just that the former has spent a lot more energy and money to create a brand image than my one-woman physician practice.

Webinars

February 24 (Wednesday) 1 ET. “Maximizing the Value of Digital Initiatives with Enterprise Provider Data Management.” Sponsor: Phynd Technologies. Presenters: Tom White, founder and CEO, Phynd Technologies; Adam Cherrington, research director, KLAS Research. Health systems can derive great business value and competitive advantage by centrally managing their provider data. A clear roadmap and management solution can solve problems with fragmented data, workflows, and patient experiences and support operational efficiency and delivery of a remarkable patient experience. The presenters will describe common pitfalls in managing enterprise information and digital strategy in silos, how to align stakeholders to maximize the value of digital initiatives, and how leading health systems are using best-of-breed strategies to evolve provider data management.

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

Acquisitions, Funding, Business, and Stock

Business Insider reports that Walmart has changed its 2018 plan to spend $3 billion to open 4,000 clinics by 2029, with new company teams now focusing on e-commerce as it has opened just 20 clinics in more of an experiment than a commitment.

Spok reports Q4 results: revenue down 5%, EPS $-$2.44 versus -$0.50.

Just-formed, Columbus-based Medicaid Managed Care insurer Circulo raises $50 million in funding and announces that it will use software from Olive and share its CEO Sean Lane.

Sales

• Mon Health System (WV) chooses PatientMatters IntelliAdvisor consulting services to direct its pre-access service center.

People

Seattle Children’s promotes Eric Tham, MD, MS to interim SVP of its research institute.

WellStar Health System hires Hank Capps, MD (Novant Health) as EVP / chief information and digital officer.

Announcements and Implementations

A KLAS review of ERP implementation firms finds that among software vendors, Workday offers strong software knowledge but falls short on guidance, while Infor’s improvements have significantly improved the client experience. The large number of recent Workday implementations has led to shortage of experienced resources across all firms, including Workday itself. Among consulting firms, Accenture and Huron stand out, while Deloitte and KPMG get mixed reviews from customers. Less-complex implementations are managed well by Avaap, Bails, and ROI Healthcare Solutions, while Chartis Group and Impact Advisors are newer to ERP work but are showing early success. Healthcare IT Leaders earns the highest score of ERP staffing firms.

COVID-19

US COVID-19 deaths will cross the 500,000 mark early this week. All major metrics are sharply down. The count of hospitalized patients dropped below 59,000, about the same as at the worst point in the spring and summer surges.

Researchers find from re-examining  originally submitted FDA vaccine data that both the Pfizer and Moderna products have first-dose efficacy of 92%, suggesting that the best use of the available vaccine supply would be to get first doses into as many people as possible, then worry about second doses later, to cut the time to reach herd immunity in half.

New research published in The Lance finds that the Oxford / AstraZeneca COVID-19 vaccine is more effective when the second dose is given 12 or more weeks after the first dose versus the usual four weeks.

Israel rolls out its “green passport” program in which gyms, theaters, hotels, concert halls, and synagogues will partially reopen only to people who have either been vaccinated for COVID-19 or who have recovered from previous infection and thus are not eligible to receive the vaccine. People can download the Health Ministry’s app, then create passport certificate with a QR code. The data sources will apparently be the Health Ministry’s vaccination records and treatment records from the country’s HMOs.

A nine-month follow-up study of COVID-19 patients, most of them with mild disease, finds that 30% had persistent symptoms, most commonly fatigue and loss of sense of smell or taste.

CDC Director Rochelle Walensky, MD, MPH says that schools can safely open regardless of the degree of community spread of coronavirus as long as they require masks and distancing among students and staff.

Other

An AMIA study finds that its 2009 policy meeting underestimated the degree of EHR-caused burnout while overestimating the impact of HITECH-powered identify theft and fraud alerting. Most of the recommendations from that meeting have resulted in little, if any, action.

Adventist Health says its CommonWell to Carequality connection has allowed it to exchange patient information with 340 health systems, sending 8 million documents and receiving 44 million.

Sponsor Updates

• CareSignal publishes a case study titled “Remote Monitoring to Support Members’ Chronic and Behavioral Health.”
• OptimizeRx will present at the virtual SVB Leerink 10th Annual Global Healthcare Conference February 25.
• Nordic publishes a new white paper, “2021 E/M Updates: EHR Workflow and Operational Considerations.”
• PatientPing’s national network of ACOs earns over $260 million in savings under the Next Generation ACO model.
• Pure Storage updates its flagship Purity software for FlashBlade and FlashArray to accelerate Windows applications, deliver ransomware protection across file, block, and native cloud-based apps; and make hybrid storage for departmental and data center workloads obsolete with a third-generation FlashArray//C all-QLC platform.
• Redox releases a new podcast, “The PCC Takeover.”
• Health Catalyst seeks speaker and showcase proposals for its virtual Healthcare Analytics Summit September 21-23.
• ReMedi Health Solutions works with the Houston Food Bank to provide over 2,000 meals to the Houston community.
• Sectra publishes a new case study, “One for all – native support for automated breast ultrasound in Sectra’s expanded breast imaging PACS.”
• TriNetX publishes a new case study, “TriNetX Helps Cuyahoga County’s MetroHealth System in Ohio Strive for Clinical Research Leadership Through Data Sharing.”
• Sam Hupert, MD CEO of Visage Imaging parent company Pro Medicus, shares his thoughts on the company’s 2020-21 final results.

Blog Posts

• Inspired by Greatness: How Healthy Competition Moves the Quality of Care Forward (Nuance)
• Innovate4Outcomes: Innovating Digital Strategies to Engage Patients for Improved Outcomes (OptimizeRx)
• Healthcare Information Blocking Final Rule: A Brief Overview (Netsmart)
• What Will Hospital Readmissions Look Like in 2021? (PatientBond)
• Make Your Data Not So Lazy (Pivot Point Consulting)
• Rocky Relationships: When You Should Consider Breaking Up with Your Billing Company (PMD)
• Eight Ways the Premier Healthcare Database has Fueled Leading COVID-19 Research (Premier)
• The Neapolitan Ice Cream of File and Object Storage (Pure Storage)
• Popular Open-Source FHIR Libraries (Redox)
• How TelePsychiatry Helps Hospitals Alleviate Psychiatrist Shortages (SOC Telemed)
• 5 reasons hospitals value encrypted pagers (Spok)
• Clearing the COVID-19 Vaccination Path for Pharmacists (Surescripts)
• Why Your Clinic Website Needs a Patient FAQ (and How to Write One) (WebPT)
• Effective Patient Communication: The Key to Virtual Patient Triage (Well Health)
• Caution! Six Reasons Why Major, Big-Brand Cloud Hosting Options are Not Integration Engine Ready (Zen Healthcare IT)

Contacts

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

Weekender 2/19/21

Weekly News Recap

• Intelerad acquires Lumedx.
• IBM considers selling IBM Watson Health.
• Former Nuance CEO Paul Ricci joins Qualifacts as president and CEO.
• Zocdoc receives $150 million in growth financing.
• Innovaccer is valued at $1 billion based on a reported new investment.
• Dexcom launches a venture capital fund.
• Sharecare’s SPAC deal values the company at $4 billion.
• GAO recommends that the VA stop its Cerner implementation until critical issues are resolved.

Best Reader Comments

“Apps are dead.” I’m curious what healthcare readers think about that comment. (Matt Ethington)

Syringa Hospital. Why in the world is a board involved in this level of operations? They should only be approving, or not, the CEO’s financial outlay for the acquisition. If the CEO can’t get the leadership team on the same page, the board has another, bigger problem. (Jamey)

There are probably less than 100 employees at this hospital. There just aren’t that many management staff above line managers. The board is probably composed of community leaders who may have some experience in the area either in IT or just organization in general. It isn’t easy running 15 bed rural hospitals on shoestring budgets. (IANAL)

The developer’s opinion and the comment represent the age-old battle between developer’s who view the system as “working as designed” and the users who are just trying to make an appointment. In this case, I’m betting the specification did not mention that users should not be able to make multiple appointments for the same dose. The developers either missed the difference between the two doses or just let anyone make as many appointments as possible. Clearly the system was not working as required. I loved the comment it allowed our technical folks who don’t normally interface with customers the opportunity to do that … what a rewarding experience. (AllHatNoCattle)

Agree that if the clinician isn’t checking the transcription, then that is on them. With the number of scribes and “speech processors” out there, I have yet to find one that is much above 95% per word accuracy — the more complicated the word, the lower the accuracy. With a word count of 171, which eight were recorded incorrectly in this missive? (AnInteropGuy)

For the “lung cancer” versus “tongue cancer” mistake, I’d think that something suggesting the correct diagnosis could have helped. “Note indicates lung cancer, lung cancer not documented as patient diagnosis.” No idea how difficult that would be to not trigger on false positives, but it could help fill out a patient’s problem list and medical history. (AI what?)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. D in Kentucky, who asked for online instruction resources for home using during “COVID days.” She reports, “My class is very grateful to receive this generous gift. I have become a full-time virtual teacher with more than 50 students. These supplies have helped lessen the cost of that I would have had to purchase for my students.”

I read most news on my tablet and find myself avoiding the Washington Post even though I subscribe to it because I despise the app’s layout, navigation options, and inability to view reader comments. Not to mention that there’s no way to forward an article to my email so I can remember to mention it in HIStalk. I found a better way — place the browser link on the IPad’s home screen and skip the app. The navigation is better, “send to” works, comments display, and it feels a lot more like something worth paying for.

The New York Times covers the thousands of medical school graduates who aren’t chosen for the limited number of US medical residency slots, leaving them with an average of $200,000 in student loans and no ability to work as a doctor. The US has at least 10,000 such graduates, many of them Americans who went to medical schools in the Caribbean or other countries whose chances of landing a residency are about 50%. Medical schools have increased their enrollment, but residency positions — which are funded by CMS – remain capped. Experts say the offshore medical schools that recruit American students sometimes overstate the history of their graduates being matched and thus eventually employed.

Hospitals in Texas are collecting buckets of rainwater and using portable toilets as storm-related water shortages affect even the largest facilities. Patients are being double-roomed and boarded in hallways, dialysis patients are showing up in hospital EDs because dialysis centers are closed, patients who are ready for discharge can’t leave, and hospital employees are sleeping over because they can’t get home. Hospitals are also seeing patients with carbon monoxide poisoning due to improper use of generators and heaters. About 100 hospitals in southeast Texas declared an internal disaster in hoping to avoid receiving new patients by ambulance. Meanwhile, the CFO of a natural gas company owned by billionaire Dallas Cowboys owner Jerry Jones giddily tells investors with Enron-level greed and indifference to the misery of others that the weather “is like hitting the jackpot” as the company is selling natural gas “at super premium prices.”

New York-born Indian-American actress, film maker, and former physician Lakshmi Devy, MD serves as the writer, director, and lead actor in “When the Music Changes,” which address rape and assault. She previously made “Daro Mat” (which translates to “Don’t Be Afraid,”) a short film that is available on YouTube.

Missouri Baptist Medical Center COVID-19 ICU nurse, family nurse practitioner, and first-time mother Mandi Tuhro, RN, MSN describes the challenges of watching patients die, trying to find time to pump breast milk, feeding her son overnight, and dealing with the fact that at 30 years old, “there’s not a single facet of my life right now that I’m not needed, and that is a heavy feeling.”

Clark County, Indiana health officer and Colts fan Eric Yazel, MD writes a letter to the team’s general manager every year to offer his service as quarterback. He’s perhaps not the perfect candidate, as he admits to the GM: “A less visionary GM might be given pause by my age (44),  mediocre BMI, and relative lack of any athletic experience.” The GM called him back this year just to be nice, but Yazel ignored the call because it came from a Houston area code and “I thought it was the Texans calling. I will listen to some other options, but I am not going inter-division.”

In Case You Missed It

• News 2/19/21
• EPtalk by Dr. Jayne 2/18/21
• Readers Write: CMS: Unlocking Data for Patients
• HIStalk Interviews Jon-Michial Carter, CEO, ChartSpan
• News 2/17/21
• Curbside Consult with Dr. Jayne 2/15/21
• HIStalk Interviews Kelly Feist, Managing Director, Ascom
• Monday Morning Update 2/15/21
• Katie the Intern 2/12/21

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 2/19/21

Leading Imaging Software Company Intelerad Medical Systems Announces Acquisition of LUMEDX

Imaging vendor Intelerad acquires Lumedx, which offers cardiovascular information systems and analytics.

Carevive Closes Oversubscribed $18M Series C Equity Raise

Cancer care management software vendor Carevive raises $18 million in a Series C funding round.

IBM Explores Sale of IBM Watson Health

Sources say IBM is considering selling its IBM Watson Health business, which includes Merge Healthcare, Phytel, and Truven Health Analytics.

Olive founder Sean Lane raises $50M to start Medicaid managed care company

Olive CEO Sean Lane will soon launch Circulo, a managed care company that will leverage Olive’s AI, automation, and data analytics.

Google to open first Minnesota office to advance Mayo Clinic cloud partnership

Google will open an office in Rochester, MN to better facilitate its work with Mayo Clinic, which includes projects related to engineering, AI, and machine learning.

News 2/19/21

Top News

Imaging vendor Intelerad acquires Lumedx, which offers cardiovascular information systems and analytics. 

Reader Comments

From Editorial Ed: “Re: job seekers. You should publish every week or two a list of people who let you know that they are out of work and looking for health IT jobs. Just use a table format limiting it to name, last job and company, position being sought, and a link to their LinkedIn profile.” I’m not opposed to the idea, although I have a lot of readers and it might get out of hand.

From Pondering Partnership: “Re: Change Healthcare – Optum Insight merger. Would like to see a survey of your readers about whether they see this as positive or negative, why, and whether they will stop doing business with either company.” I got no responses when I asked previously, so here’s one last chance for customers of either company to weigh in by contacting me with their anonymous thoughts.  

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Healthcare IT Leaders. The Alpharetta, GA-based company is a national leader in IT workforce solutions, connecting healthcare organizations with experienced technology talent for implementation services, project management, consulting, and full-time hiring. Areas of focus include EMR, ERP, WFM, RCM, and CRM. KLAS #1 rated for Business Services (Best in KLAS 2020) and highly-KLAS rated for HIT implementation and staffing, the company has ranked on the Inc. 5000 five consecutive years and has been named a Best Place to Work by the Atlanta Business Chronicle and one of America’s Best Professional Recruiting Firms by Forbes. Its COVID-19 practice, Healthy Returns, offers comprehensive onsite COVID-19 testing, contact tracing, and vaccination support. Thanks to Healthcare IT Leaders for supporting HIStalk.

My latest widespread but puzzling new conversational grammar quirk: people who say something like “customers ask what does our product do” instead of “customers ask what our product does.” I started hearing that kind of sentence construction recently and it has spread to probably 80% of such usage. 

Webinars

February 24 (Wednesday) 1 ET. “Maximizing the Value of Digital Initiatives with Enterprise Provider Data Management.” Sponsor: Phynd Technologies. Presenters: Tom White, founder and CEO, Phynd Technologies; Adam Cherrington, research director, KLAS Research. Health systems can derive great business value and competitive advantage by centrally managing their provider data. A clear roadmap and management solution can solve problems with fragmented data, workflows, and patient experiences and support operational efficiency and delivery of a remarkable patient experience. The presenters will describe common pitfalls in managing enterprise information and digital strategy in silos, how to align stakeholders to maximize the value of digital initiatives, and how leading health systems are using best-of-breed strategies to evolve provider data management.

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

Acquisitions, Funding, Business, and Stock

Cancer care management software vendor Carevive raises $18 million in a Series C funding round. 

Sales

• Several counties in Florida go live on Everbridge’s vaccine distribution solution and the state of West Virginia will use the system to coordinate vaccinations through a pharmacy chain.
• Nine hospitals choose CloudWave’s Opsus Cloud for hosting and disaster recovery services, while another 10 have engaged the company to build local data center cloud edge platforms.
• Tift Regional Medical Center (GA) chooses Wolters Kluwer Health’s POC Advisor for sepsis detection and treatment.

People

Nathaniel Weiss, former CEO of LiveProcess and Standard Molecular, launches VelloHealth, which offers real-time care coordination software for serious mental illness.

Gretchen Tegethoff, MSIST (CoverMyMeds) joins Ellkay as regional vice president of strategic relationships.

Paul Ricci — who retired from Nuance in 2018 and then took an interim CEO role at SOC Telemed until the company went public via a SPAC in October 2020 – is named CEO of behavioral health EHR vendor Qualifacts. He replaces David Klements, who remains on the board.

Law firm McGuireWoods expands its digital health team by hiring three partners: Jonathan Ishee, JD, MPH, MS (Vorys, Sater, Seymour, and Pease); Janice Walker-Suchyta, JD (Seyfarth Shaw); and Andrea Linna, JD (Honigman). McGuireWoods deals with corporate transactions and private equity deals. Ishee earned an MS in health informatics in 2004 and is an assistant professor of biomedical informatics at UTHealth in Houston.

Cardiologist, inventor, and Nobel Peace Prize antiwar activist Bernard Lown, MD dies at 99. He co-invented the defibrillator, created one of the first cardiac ICUs, formed a non-profit group that launched a satellite to deliver medical training to doctors in Africa and Asia, and created the Lown Institute that ranks hospitals on their civic leadership, inclusivity, avoidance of overuse, and pay equity.

Announcements and Implementations

Capsule Technologies releases its Generation 3 Vitals Plus patient monitoring and clinical documentation solution in its Medical Device Information Platform. It allows hospitals to perform continuous monitoring and remote clinical surveillance outside the ICU. Philips acquired Capsule last month for $635 million.

TriNetX adds COVID-19 vaccination data to its platform and real-world data set, which will allow researchers to perform their own studies of de-identified EHR patient data to look at comorbidities, reinfection, and outcomes.

CarePort will use the provider directory of MedAllies to allow users to comply with CMS’s ADT notification Condition of Participation.

Particle Health announces a FHIR API that will allow developers to create products that can search the information of 270 million patients.

Amwell releases Hospital TV 100, a kit that turns existing hospital TVs into telehealth endpoints. Intermountain Healthcare has deployed 1,200 of the units.

The Consumer Technology Association launches an ANSI-accredited standard for the use of AI in healthcare, which consists only of definitions for a few dozen terms such as “algorithm” and “big data” as agreed on by 50 big-name organizations and companies.

COVID-19

CDC reports that 56 million COVID-19 vaccine doses have been administered of 72 million delivered (78%) and 15 million people have received both doses.

CDC will spend $200 million to increase the number of coronavirus samples that are genetically sequenced as surveillance for the spread of variants.

Former FDA Commissioner Scott Gottlieb, MD predicts a less-active COVID-19 spring and summer because infections and vaccinations have raised protective immunity to 40%.

Overall US life expectancy dropped by a full year in the first half of 2020, while that of the black population was reduced by 2.7 years. The life expectancy of black Americans is now six years less than that of whites.

The Los Angeles Times features its owner – billionaire Patrick Soon-Shiong, whose NantWorks conglomerate owns ImmunoBio, which is developing a coronavirus vaccine – as the host of a video series that covers COVID-19. One of his interviewees is a South African geneticist who is an ImmuneBio partner, which was not disclosed in the discussion, as they discussed the logistical shortcomings of existing vaccines. NantWorks also owns health IT vendor NantHealth.

KHN reports the plight of the rural 25-bed St. James Parish Hospital in Louisiana, which does not have an ICU and at times cannot find a hospital closer than 600 miles away that will accept a transfer. The hospital has seen 70% of its employees decline COVID-19 vaccination

Johnson & Johnson, the world’s largest healthcare company, will have only a few million COVID-19 vaccine doses available in the next few weeks when FDA could approve its use. The US government paid the company $1 billion to develop the vaccine in exchange for 100 million doses after having given it $456 million in March, but J&J says that most of the promised first-half doses won’t be available until June. The company’s vaccine requires one dose instead of two and can be stored in refrigerators rather than in freezers.

Mount Sinai Health System (NY) halts its use of convalescent plasma to treat COVID-19 patients, saying that it has shown no clinical benefit in repeated clinical trials.

The state of Iowa cancels its contract with Microsoft for a COVID-19 vaccination appointment system, deciding that it would be to hard to combine the several existing systems that are being used by health departments and pharmacies.

A man in England is offered COVID-19 vaccine early after his doctor’s office enters his height incorrectly as 6.2 centimeters instead of 6 feet 2 inches.

Other

France’s president, Emmanuel Macron, announces a $600 million program to improve cybersecurity in the public and private sector, saying that two recent hospital ransomware attacks show how serious the threat is.

The CEO of Medicare Advantage insurer Clover Health – which is facing reviews by the Department of Justice and the SEC as well as short-seller pressure – unleashes a profanity-filled tirade against a Forbes reporter who wrote an article whose headline he didn’t like. Vivek Garipalli became a paper billionaire when Clover went public via a SPAC last month, valuing the company at nearly $4 billion. Clover offers physicians its Clover Assistant to manage patient care, paying them a fee of $200 every time the software is used during a patient visit. The money-losing company, which operates in some counties of seven states, did not report prior to going public that it is the subject of a Department of Justice False Claims Act investigation for improperly inducing patient referrals. Clover’s board includes folks who have a health IT connection – Flatiron Health co-founder and former CEO Nathaniel Turner and former Allscripts and Livongo executive Lee Shapiro.

Kaiser Family Foundation uses Epic Health Research Network to find that hospital admissions dropped to a low of 69% of expected admissions in the first week of April 2020, but have remained at above 90% since June 2020, leaving the full-year reduction in admissions at 8.5%. Non-COVID-19 hospitalizations started dropping again with November 2020’s COVID-19 surge, suggesting that people are deferring or forgoing care, possibly because of hospital capacity constraints. Fewer care-seekers boosted the gross margins of insurers, as their medical loss ratios were lower. 

In observation of the death of Bernard Lown, MD this week, here are the Lown Institute’s 2020 Shkreli Awards from last month for egregious healthcare profiteering and dysfunction, in the spirit of pharma bro and federal inmate Martin Shkreli:

1. Private equity-owned physician staffing companies spent millions to squash surprise billing legislation while cutting physician pay and accepting $60 million in CARES Act interest-free loans.
2. Hucksters, some of them physicians, pushed fake COVID-19 cures.
3. Connecticut internet Steven Murphy, MD offered to run public COVID-19 testing sites for several towns, then billed the insurance of patients for large panels of tests for other infections at an estimated cost of up to $2,000 per person.
4. Hospitals punished their clinicians who wore masks, claiming they didn’t need them and would scare patients.
5. Brigham and Women’s CEO Elizabeth Nabel, MD wrote an op-ed defending high drug prices while not disclosing that Moderna paid her nearly $500,000 in 2019 for serving on it board, after which she sold $8.5 million of the vaccine maker’s stock.
6. Executives of the four big drug companies that developed COVID-19 vaccines declined to participate in a WHO program to share information to develop and distribute treatments, vaccines, and diagnostics.
7. Nursing homes failed to protect their residents from COVID-19.
8. Four California health systems refused to accept transfers of poorly insured COVID-19 patients even though they had available beds.
9. Moderna, which had 100% of its $1 billion in COVID-19 vaccine development costs covered by the US government, set the highest price of all companies that offer a vaccine.
10. FEMA’s PPE task force airlifted PPE in from other countries, but instead of distributing it to states, gave it to six private medical supply companies to sell to the highest bidders.

Sponsor Updates

• OmniSys uses Virtustream’s Enterprise Cloud and XStreamCare Services to ensure its pharmacy customers can meet the demands of COVID-19 vaccine management.
• WellSpan Health (PA) expands its Nuance Dragon Ambient Experience deployment to improve care access and patient and provider experiences.
• SymphonyRM names former Intermountain Healthcare CIO Marc Probst to its board.
• Healthcare Growth Partners advised Symplr on its acquisition of Phynd Technologies, which closed earlier this week.
• In the UK, InterSystems makes COVID-19 vaccination appointment scheduling available through its TrakCare system.
• Loyale Healthcare publishes a new industry analysis, “Growth in Healthcare Spending will Decelerate Post-COVID: How Hospitals Should Plan.”
• Meditech publishes a new case study, “NMC Health decreases antibiotic use through Meditech’s Antimicrobial Stewardship Toolkit.”

Blog Posts

• Nurses Share Pandemic Case Studies: Inpatient Glycemic Management During COVID-19 (Glytec)
• Burnout Exacerbated by COVID-19 – How to Reverse the Trend (Halo Health)
• The Future of Virtual Care (The HCI Group)
• King’s Daughters Medical Center is LIVE with MEDITECH Expanse Patient Care (Meditech)
• COVID-Accelerated Trends Improve Consumer Experience Across Multiple Industries (HCTec)
• The Key to Better Healthcare Decision Making (Health Catalyst)
• Cooking and Consulting with Joe – Week 2 – Aussie Sausage Rolls (Health Data Movers)
• The Healthcare Moonshot: Care Journey Orchestration and Why It Could Be Your Organization’s Launch Pad (Lumeon)
• Educate Your Orthopedic Patients with Human-Centered Digital Programs (Healthwise)
• Six Strategies for Preventing Administrative Burnout (Ingenious Med)
• How Personalization Can Improve the Patient Payment Experience (InstaMed)
• Cracking the codes: A 101-level guide to healthcare’s major coding systems (Intelligent Medical Objects)
• Risk vs. Vulnerability – The Real Reason Traditional Predictive Analytics Will Always Fall Short (Jvion)
• Appointment Reminders – An Effective Way to Curtain No-Shows (Medhost)
• 6 Tips for a Successful Physical Therapy Telehealth Visit (MWTherapy)
• Five Reasons to Start a Worksite COVID-19 Testing Program (Healthcare IT Leaders)
• Top 7 Tips for Choosing the Right Healthtech Partner (Newfire Global Partners)

Contacts

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