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

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• 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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EPtalk by Dr. Jayne 2/18/21

I had a moment of excitement in my pre-HIMSS planning when a friend clued me in to reasonable rates at The Palazzo. I’m happy to be rebooked somewhere that is attached to the meeting facility so I don’t have to melt in the August heat on the way to the show. The HIMSS room reservation system shows that the resort fees are optional this year,  which is great for those of us who never get to experience the “resort” component since we’re frantically trying to see everything possible then write it up before collapsing every night. I also had a thrill when I came across this ad featuring a vintage booth babe. I’m a sucker for opera length gloves and a dramatic up-do, so it certainly got my attention.

People always ask what kinds of things I’m interested in looking at when I attend HIMSS. Smart glasses are back on my radar. It’s been years since Google Glass came and went, but I’ve seen two articles in the past week that featured some variation on smart glasses. Specific use cases include helping a remote clinician better visualize a patient during a telehealth consultation or using the glasses to deliver diagnostic information from AI-powered clinical support systems.

One of the articles noted the potential for patient-side wearables to capture clinical information for later review by the care team. There’s always a lot of talk about wearables, but I haven’t seen a tremendous body of evidence that they can significantly drive clinical outcomes. We’ll have to see what companies bring to the table come August.

The American Medical Informatics Association issues a call for proposals for the AMIA 2021 Annual Symposium, to be held October 30-November 3 in San Diego. A quick scan of the website showed they are currently planning for a live event “with a limited component of live streaming.” It goes on to note that the AMIA board will make a decision in June if this needs to change. For those interested in presenting, submissions are due March 10.

Although I read a number of journals regularly, I enjoy JAMIA because of its focus on informatics issues. One recent submission looks at gender representation in US biomedical informatics leadership and recognition within the biomedical informatics community. The authors assessed data on AMIA members, academic program directors, clinical informatics fellowships, AMIA leaders, and AMIA awardees. Not surprisingly, men were more often in leadership positions, including 75% of academic informatics programs, 83% of clinical informatics fellowships, and 57% of AMIA leadership roles. Men also received 64% of awards.

I’ve worked with a number of informatics organizations and have seen significant differences in how they approach the creation of a diverse workforce. While some hope it will happen by chance, others work quite intentionally to provide opportunities for groups that are traditionally underrepresented in technical fields. I recently met with a group of women informatics leaders and learned about their strategies for recruiting diverse teams. We certainly can benefit from broader perspectives.I look forward to seeing what those numbers look like in five or 10 years.

JAMIA publishes a study that examines the impact of after-work EHR use and clerical work on burnout among clinical faculty. Specifically, they looked at faculty across Mount Sinai Health System, with 43% of eligible faculty members participating. They concluded that spending more than 90 minutes on EHR work outside the workday and performing more than one hour of clerical work per day are associated with burnout. The findings were independent of demographic characteristics and clinical work hours.

I’ve spent a good chunk of my career trying to help organizations improve their workflows and am always gratified to see an organization that cares about how technology is impacting workers. Unfortunately, many groups don’t see this as a priority or are happy to watch their clinicians absorb increasing amounts of non-clinical work.

Challenges with personal protective equipment are once again in the news, as healthcare organizations have been saddled with millions of counterfeit N95 respirators. Impacted organizations include Cleveland Clinic, the Washington State Hospital Association, Jersey Shore University Medical Center, and Hennepin County Medical Center in Minneapolis.

I was discussing this article on a local physician forum and ended up talking with a local academic faculty member who couldn’t believe that community hospitals and private organizations are still struggling to provide adequate PPE. My clinical employer provides a limited number of N95 respirators to our team and makes their use inconvenient by only stocking them at a single location, requiring people to travel on their days off to pick up a new supply and to rotate that supply over an extended number of days. Some of us are providing our own respirators to avoid reuse, but the counterfeit issue is still a concern. Co-workers who don’t go through the steps are still being diagnosed with COVID-19 despite vaccination.

I have friends who are nurses at community hospitals that sometimes receive N95s only once a week since they’re not on dedicated COVID units. Others have to beg supervisors to replace their PPE when straps break, or they become wet from wear. It’s a tragedy that we are still dealing with this a year into the pandemic. I can’t help but think that if the Centers for Disease Control made N95s mandatory for patient care encounters that we would stop seeing healthcare workers being infected. Employers would be forced to raise their game and to support those employees who want the highest level of protection. But as long as they say that surgical masks are an OK alternative, we’ll continue to see cases.

Fortunately, I have enough masks to make it through the end of my current clinical situation, since I’ve officially tendered my resignation. The fact that I made the right choice was confirmed a few days later when the organization announced some fundamental changes that will significantly alter how the business operates. It will be interesting to see how many people jump ship. I was asked not to reveal my resignation to staff until a couple of weeks before I actually leave, so for all I know, there could be others in the same position. It should make for an interesting couple of months. In the mean time, I’m looking forward to having a break from work-related COVID while I figure out my next move.

The Washington Post reports that Europe’s oldest person, a 117-year-old French nun, has survived COVID-19. Lucile Randon, who took the name of Sister Andre in 1944, was diagnosed on January 16. She was born on February 11, 1904, which means she also lived through the 1918 pandemic. Her birthday celebration was slated to include foie gras, capon with mushrooms, and red wine. Best wishes to Sister Andre for an uneventful 2021.

Email Dr. Jayne.

Morning Headlines 2/18/21

MedPilot Acquired by Vytalize Health

Medicare ACO-focused practice management company Vytalize Health acquires patient financial engagement startup MedPilot.

Former Nuance CEO takes over at Qualifacts

Paul Ricci (SOC Telemed) has joined Qualifacts as president and CEO.

Derek A. Pickell appointed Chief Executive Officer, CompuGroup Medical US

CompuGroup Medical US names industry long-timer Derek Pickell as CEO.

Readers Write: CMS: Unlocking Data for Patients

CMS: Unlocking Data for Patients
By Nassib Chamoun

Nassib Chamoun, MS is founder, president, and CEO at Health Data Analytics Institute of Dedham, MA.

The digitization of medicine over the last decade has driven exponential growth in the quantity of medical data, measured in the digital footprints of billions of care events each year. Yet this data explosion has made little difference for patients, who still struggle to access, understand, and share their medical data.

Several barriers have kept patients from the benefits of their data. A lack of commonly accepted and consistently implemented software standards inhibits access to silos of data generated by providers, insurers, and electronic health record vendors. Patients also lack tools for accessing and understanding their data.

Encouragingly, each of these barriers is now crumbling as years of effort by industry, entrepreneurs, and government are beginning to bear fruit.

The Centers for Medicare and Medicaid Services (CMS) has created MyMedicare.gov, which connects 40 million Medicare fee-for-service beneficiaries to any medical claim in the last three years that CMS has paid on their behalf. Although the site provides beneficiaries with valuable information, individual patient records can run to hundreds of pages,  an overwhelming user experience. Equally important, MyMedicare.gov contains patient records only for the last three years.

In recognizing the need for a better patient experience, CMS released Blue Button 2.0, an open Applications Programming Interface (API) that allows developers to build apps to help patients access their medical information and decide which apps – if any – can access their personal data.

CMS is further catalyzing this ecosystem of developers and users with its Interoperability and Patient Access Rule, released in May 2020, whereby millions of people covered by commercial insurance, Medicaid, and Medicare Advantage plans will soon have access to their medical histories. While enforcement is somewhat delayed due to the COVID-19 pandemic, the CMS rule also expands the types of information available by requiring healthcare providers and electronic health record vendors to give patients access to certain clinical information, such as lab values, through the third-party applications of their choice.

Blue Button 2.0 and the Carin Alliance (a non-profit devoted to enabling consumers and their authorized caregivers to access more of their digital health information with less friction) are enabling dozens of third-party apps to extract data from large documents and reformat it in a way that lets users and their caregivers quickly understand their medical histories and conditions.

These apps focus primarily on assembling health information from a variety of sources and presenting it more simply to patients. Other tools offer advanced analytics, including highly personalized risk information, to help patients make more data-enhanced healthcare choices.

For example, a patient in her 80s could ascertain the probability of requiring hospitalization from heart disease in the next 12 months and plan accordingly. In the future, risk profiles may also be combined with data from real-time monitoring tools, such as smart watches and smart speakers, to provide more customized insights and enable deeper, more impactful conversations between clinicians and patients.

What’s exciting is that the combined initiatives of open standards, improved data access, and a thriving app ecosystem have established the foundation for sustained innovation. Add an inrush of entrepreneurial talent and venture capital investment and we will likely see numerous new software innovations that accelerate the transformation of huge quantities of difficult-to-use data into usable insights for patients.

HIStalk Interviews Jon-Michial Carter, CEO, ChartSpan

Jon-Michial Carter is co-founder and CEO of ChartSpan of Greenville, SC.

Tell me about yourself and the company.

ChartSpan was founded in 2013. We were focused on driving patient engagement. Almost everything that happens in healthcare is built and designed for providers, with patients having the ultimate end experience. As chronic care management began to evolve in 2015, we realized — as a company that was very much focused on the patient experience — that this was an area that we would excel in. We started small. My brother and I and one other person founded the company. Within five years, we became the largest provider of chronic care management solutions in the country based on active monthly enrolled patient population.

I come from the technology world as an operator with deep experience in finance operations and sales. My brother, in contrast, was a 20-year practicing clinician. We made a great partnership in that he focused on the clinical side of things and I focused on the operational side of things. It has been a big reason that we have been successful.

How many providers, and what kinds, are offering CCM, and how many of them engage companies like yours for outside help?

Chronic care management is a Medicare program where providers are encouraged to telephonically and/or electronically engage with patients on a monthly basis. You engage with patients on the patient’s terms. You go to them when it’s convenient and you go to them when they’re at home.

The thought is that if a patient has two or more chronic conditions, and they are not yet high acuity, they are not a candidate for case management. We preventatively reach out to them every month. The data shows that we dramatically improve outcomes and reduce costs for those patients. You want to get those patients when they are low risk or rising risk, not when they become high utilizers of the system. That’s the entire focus of chronic care management. If you look at the CMS claims data, it is delivering extraordinary results.

In regards to what type of providers utilize the service, initially it was focused almost entirely on primary care, internal medicine, and geriatrics. That began to expand over the last couple of years. There are few specialty areas that we don’t have as customers providing chronic care management services to their patients.

How do practices market CCM to their patients to convince them to sign up and pay their part of the cost?

With COVID, a lot of Medicare patients are hesitant to go out in public, much less sit in a waiting room with other sick patients. We have seen a 30% increase in enrollments from our legacy customer patients. That’s encouraging, because the value for the patient is convenience. Our job as a turnkey service provider for our physicians and providers is not to practice medicine. That’s what they do. We act as an extension of the provider, dealing with the low-level care coordination activities that are so important to prevent the exacerbation of a patient’s chronic conditions.

For instance, we assist in making sure that they have appointments, that they have transportation to get to those appointments, and that they’re getting their medication refills. We assist them in having those medications delivered, or get transportation to get across town, to get to the pharmacy to get them. We make sure that we have the provider’s care instructions and that we understand exactly what the care goals are for that patient and are, reinforcing those and making sure that the provider’s instructions are being followed.

We have a bi-directional feed with our clients. We are extracting the CCDA out of the EHR. We are agnostic and work with every single EHR in the country. Then we push back our clinical data set wherever they want it in their EHR, whether that’s in a particular file or discretely in a patient record. On the billing side, we do the same thing. We push the billing to the billing department, to the practice management system, so that it’s easy to build those E&M encounters once we have had a compliant engagement with a patient on any particular month.

What issues do providers have when they do CCM on their own?

I have met with hundreds of practices and health systems that have attempted to do chronic care management on their own. I have never met one that was profitable. I have never met one that was able to achieve the volume of enrollment or revenue that they had hoped for. 

Here’s why. Everybody with a nurse and a spreadsheet thinks they can do chronic care management, and they are wrong. The clinical encounter is the most predictable part of CCM, but it’s not the hardest part. The hardest parts are all the operational complexities in the periphery. It includes enrollment. By the way, clinicians are traditionally terrible at enrollment. Compelling patients to be in the program. It’s solicitous in nature, and it’s almost uncomfortable. I know, because in the early days, we tried to have clinicians do enrollment and it was a miserable failure.

Enrollment is hard because 85% of your patients have a co-pay. You have to be articulate about defining what the value is in the program. You need data feeds that show you who the primary and secondary insurer are so you know what the co-pay and financial obligations are for the patient. That alone is one of the most difficult operational processes that you have to deliver with chronic care management.

But there’s many more. You are constantly doing data reconciliation. You have millions of patients churning into Medicare and millions churning out of Medicare every day. Churn is the name of the game. If you don’t know, from a data perspective and from a business process perspective, how to manage the daily churn that occurs in a Medicare program, you shouldn’t get into this business.

That stretches way beyond the clinical encounter. You’ll never get to the clinical encounter if you’re not doing your data reconciliation, churn management, patient marketing, enrollment, quality assurance, and billing support services. The clinical encounter is the depth of what most health systems think about when they think about chronic care management, and they are terrific at the clinical encounter. If that was all there was, then we would have a lot more people doing it and they would be a lot more successful. The problem is all the other operational components around the clinical encounter. Few people understand how to master that.

These Medicare patients with multiple chronic conditions probably have multiple active providers. Who decides which of them provide CCM services to that patients and what happens when the patient changes providers?

Being compliant requires that you consent the patient, and that must be documented. Once the patient has given consent to the provider, then that provider is the chronic care management provider of record. No other provider can come in unless the patient unenrolls and then gives consent to the next provider.

What are the best practices of performing CCM and the Annual Wellness Visit remotely?

From a CCM perspective, we do telephonic, and then we rolled out a multimodal approach last year, and it has been extremely successful. I would say 20% of our engagements on any given month are through SMS text messaging. There’s a fallacy in thinking that portals and apps are the way to go. Those are dead. Apps are dead. You don’t make patients go to your proprietary software to have an encounter. You go to where the patient is.

There are only two places that they ubiquitously are, on their phone and on their phone — telephonically on their phone and texting on their phone. We go to where the patient is. That’s why our engagement rates are off the charts. You don’t want to force them to have to open your app and enter their username and password. We have seen, through Meaningful Use, single-digit engagement rates for View, Download, and Transmit healthcare records. Our focus is doing what’s convenient for the patient.

That started telephonically, and now we’ve extended that to SMS text messaging. A patient has to opt in and give consent. We do it in a secure, encrypted, HIPAA-compliant way. But as Boomers age into Medicare, that youngest cohort in Medicare has a preference for texting versus telephonic engagement. It’s important that we go to where patients want us to go in regards to how they want to engage and communicate.

Does that dispel the notion that older patients are less interested than younger ones in using their phones to help manage their affairs, including healthcare?

Differentiate between phone and what we often think of as a computer. As we age, more and more of us are more comfortable with computers and using smartphones. We certainly see lower engagement levels around technology for older Americans. Data I saw last week shows that smartphone usage in 80-plus people is dramatically lower than 65-plus among ChartSpan’s cohort. It’s still a problem, and it’s a real problem, but it’s becoming less so over time as more and more people age into Medicare. Those people are coming from a world where they had to be able to manage digital tools like smartphones and computers.

You’re focused on a specific Medicare-paid service that CMS could change. How do you position the company accordingly?

We have been working hard on legislation that would remove the barrier of a co-pay. CMS released retrospective claims analysis for two years of CCM billing and it was eye-opening. It showed that for a patient who has been in the program for a year, taxpayers and Medicare save $74 per patient per month. After the reimbursement, they save 41 cents on the dollar, roughly $31 net. Keep this in perspective. There are 63 million Medicare and Medicare Advantage patients, and CMS says 68% are eligible for a CCM program. That’s 43 million patients. Take 43 million times $31 a month and you’ve just cut billions of dollars a year in spending that goes back to Medicare and taxpayers.

Congress is paying attention. There is a bill, H.R. 3436, that we have been working hard on over the last couple of years. We are trying to get this pushed through Congress and we think it has a decent chance this year. It would remove the co-pay. Why are we tripping over pennies to get the dollars? Why are we going to charge a patient $8 when taxpayers save $74? Let’s just save the $66 and move from hundreds of thousands of patients enrolled to millions, and let’s focus on improving at scale outcomes for patients and reducing costs.

We spent the first part of our company’s history focused on one thing, and that was chronic care management. We were deliberate in that. We said until we are truly the best in the world at what we do, we’re not going to expand into any other offering. I don’t know that you ever wake up and look in a mirror, and say, “I’m the best.” But we feel like, certainly from a size standpoint, that we are the largest, and we certainly think we’re the best.

We looked at other opportunities where we could grow the business. Our customers told us over and over that we should focus on Annual Wellness Visits. I didn’t understand that. An AWV seems so simple — a self-reported, 10-minute questionnaire by a patient. There’s no co-pay. How in the world are four out of five Medicare patients walking into the doctor’s office multiple times a year and never getting one of these done? If you look at any ACO, it’s one of their core operational components to do AWVs. It saves, on average, nearly 6% in cost on an annual basis for a typical Medicare patient.

What we figured out was that it had nothing to do with the questionnaire. It had to do with the fact that there was poor technology and poor processes around how AWVs are done. Again, according to claims data, only 19% of Medicare and Medicare Advantage patients got an AWV last year. When we studied that, we saw that there’s a 41% no-show rate for AWV appointments. Candidly, patients come to the doctor when they’re sick, not when they want to prevent something. So if you are scheduling preventative care appointments, you’re going to lose a ton of money in no-shows.

We designed a SaaS-based product that turns a sick visit into a well visit. When the patient comes to the doctor’s office, they’re predisposed while in the waiting room to fill out paperwork. Seize that moment. Give them a ChartSpan AWV. In 10 minutes, they will complete that AWV, which doesn’t interrupt the workflow of the provider and doesn’t put a burden on the practice. They hand it to the front desk. That patient report is either printed or emailed to the patient and the provider report is uploaded into the EHR.

What we also realized around AWVs is that the questionnaire is simple. The thing that’s largely ignored around AWVs is the upstream and downstream data component around that. When I say upstream, I mean that there’s not an AWV in the country that’s checking the HETS database in real time to even know if that patient is eligible. Furthermore, if you’re missing demographic data as so many patients are, there’s no query system that reconciles that missing data and prompts, in real time, the front desk to say, “Hey, we’re missing a Medicare ID,” or, “We’ve got a change of name.” Fix it and then hit the HETS database in real time so that you actually know if that patient is eligible and which AWV code they’re eligible for. We built all that.

On the downside, the real value of an AWV is the aggregate care gap identification data that comes from an AWV. Quality managers are having to figure out, how do I port that into my population health system? How do I make sense of this? We spent a lot of time investing and building the backend data that allows a quality manager to go in and say, “Of all the AWVs today, this week, this month, this year, where do I have care gaps for fall risk assessments?” or whatever the quality measure may be. That data then needs to become actionable at the patient level. We built that as well. It’s a really sophisticated AWV product and we are really proud of it. We don’t think there’s anybody in the marketplace who has anything like what we have.

Morning Headlines 2/17/21

CloudMD to Acquire VisionPros, a Rapidly Growing Digital Eyecare Platform with a Robust Suite of Digital Vision Care Tools

Canada-based CloudMD will acquire online eyeglass, contact lens, and online vision test vendor VisionPros for up to $80 million in cash, shares, and performance earn out.

Healthcare-focused SPAC Digital Transformation Opportunities files for a $250 million IPO

Digital Transformation Opportunities, a Bellevue, WA-based blank-check company focused on working with businesses in healthcare IT, plans to raise $250 million in an IPO.

Fastest Growing EMR Provider Medfar Raises Nearly $25 Million Investment Led by Walter Capital Partners

Canadian EHR vendor Medfar Clinical Solutions raises $25 million in an investment round led by Walter Capital Partners.

News 2/17/21

Top News

Online scheduling and telehealth vendor Zocdoc receives $150 million in growth financing from Francisco Partners.

The company says that its pricing change two years ago – from a flat per-provider subscription to a per-booking model that angered some doctors who had to pay more and who expressed concern about possible kickback implications – has grown its network by 50% in some states.

Zocdoc has raised $376 million through a Series D round.

Co-founder and former CEO Cyrus Massoumi sued the company last fall, claiming that three officers – two of whom he says he was going to replace – conspired to orchestrate his ouster after eight years. He said in the lawsuit that the company was in steep decline, couldn’t raise further capital, and had resorted to taking on debt at high interest rates. The lawsuit was dismissed by a New York court that said the suit would need to be filed in Delaware instead.

Reader Comments

From Data Broker Not Broke: “Re: Truveta selling anonymized patient data to drug companies and researchers. Is that ethical?” Not in my opinion, especially since those patients get nothing in return and can’t opt out. The hospitals that collect their information as a by-product of selling them medical care don’t even have to let them know beforehand because of HIPAA’s covered entity-friendly “treatment, payment, and operations” terms. Facebook, Google, and other sites violate our privacy in mostly harmless ways and they at least give us their product free in return (try asking those 14 Truveta health systems for some medical freebies). Unlike those apps, though, the information is anonymized and is not used to display something to its owner, so it’s not really visible. We will all be paying in other ways – the deep-pockets drug company customers who are writing the checks to Truveta members will simply jack up their drug prices a little bit more or pocket the higher margins of not having to spend as much on clinical studies. We might as well acknowledge that the wholesome-sounding “medical research” is really just product R&D for drug and device companies, often funded by taxpayers and given to those companies at no cost to sell expensively back to us.

From Huckleberry: “Re: Clubhouse app as an audio-only social network. Have you tried it?” I have not tried it or found reasons to even though I know it’s the latest shiny object. It seems that many platforms initially succeed because early adopters who have a lot of expertise and insight develop a quick following, but then everybody and his imitative brother piles on to fill the endless space with junk just because they can, causing the best of them to move on to seek better company. We’ve seen it with blogs, vlogs, Facebook, Twitter, Medium, podcasts, newsletters, vanity book publishers, YouTube, Google Hangouts, Periscope, and more, where the platform’s best and worst feature is that it democratizes content creation. I expect Clubhouse will get its 15 minutes before it becomes yet another low-value wasteland. Online text is the only medium that allows me to consume it my way – skim quickly or study slowly and click original source links that will be missing in every other format. As to Clubhouse, I don’t know of many folks who could hold my attention for more than a couple of minutes as they babble away in real time. The most interesting people aren’t wasting their time pontificating incessantly to the masses.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Sectra. With more than 30 years of innovation and approaching 2,000 installations worldwide, Sectra is a leading global provider of imaging IT solutions that support healthcare in achieving patient-centric care. Sectra offers an enterprise imaging solution comprising PACS for imaging-intense departments (radiology, pathology, cardiology, orthopedics), VNA, and share and collaborate solutions. The company is leading the way in digital pathology with multiple, fully digital installations throughout the world. Sectra is top-ranked in “Best in KLAS” and #1 in customer satisfaction in US, Canada, and Europe PACS. Thanks to Sectra for supporting HIStalk.

Something jogged my memory of Bats Global Markets, a Kansas City-based stock exchange that was started by former Cerner employee Dave Cummings in 2005. I wrote about it many years ago and I see that it was acquired in early 2017 for $3.2 billion. Cummings remains sole owner of Tradebot, a high-frequency stock trading platform he started in 1999 that at one point was making him $140 million a year in profit. The company holds shares for an average of 11 seconds, had at one point enjoyed a four-year run of positive daily profits on trades, and accounts for 5% of all US stock trades. Cummings has credited his success to the mentorship of Neal Patterson, former chairman and CEO of Cerner. My keyboard’s zero key probably doesn’t have enough click life left to express his net worth. 

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

Canada-based CloudMD will acquire online eyeglass, contact lens, and online vision test vendor VisionPros for up to $80 million in cash, shares, and performance earn out.

Population health management platform vendor Innovaccer is rumored to be arranging funding that will value the company at more than $1 billion.

People

Dental software vendor Henry Schein One promotes former telemedicine executive Mike Baird, MBA to CEO.

CompuGroup Medical US names industry long-timer Derek Pickell as CEO. He comes from EMDs, which CGM acquired in late December 2020 for $240 million, and replaces Benedikt Brueckle, who is now CFO.

Michael Campana (Conduent) joins Health Triangle as VP of marketing.

Announcements and Implementations

Sutter Health will eliminate 277 jobs, most of them in IT.

COVID-19

In Israel, a study of 600,000 people who have received two doses of Pfizer’s coronavirus vaccine finds a 94% drop in symptomatic infections and a 92% reduction in severe illness. The study was the first to show a high level of vaccine efficacy specifically in people 70 and over.

New York Governor Andrew Cuomo admits for the first time that the state’s nursing home COVID-19 death counts were underreported by 40% by omitting long-term care residents who died in hospitals. Cuomo says he delayed giving the information to state legislators for fear it would trigger a federal civil rights investigation.

The remote, 2.2 million population Brazilian city of Manaus has seen COVID-19 consume nearly all of its hospital and ICU beds and depleted oxygen supplies, with dozens of Brazilians dying of asphyxiation over two days in January alone. Few planes there can transport oxygen, so it must be shipped in a week-long boat trip up the Amazon River. Brazil President Jair Bolsonaro, who has said that COVID-19 is a “measly cold” and a media hoax intended to harm him politically, says it isn’t the federal government’s job to send oxygen to Manaus. Brazil’s COVID-19 death count is at 240,000, second globally only the US’s 486,000.

A Virtua Health spokesperson clarifies reports that bugs in its COVID-19 vaccine self-scheduling system created many duplicate appointments. The scheduling system did not have a defect — it just failed to prevent people from making multiple appointments. The 70% number doesn’t refer to the number of duplicates of the 300,000 total appointments, but rather that of those duplicate appointments it contained, 70% were created  in error because users weren’t sure how to schedule both first- and second-dose appointments or didn’t wait for the confirmation email before scheduling again, allowing 5,000 appointment slots to be opened after calling each of those users to verify their intentions.

Walmart begins scheduling COVID-19 vaccination appointments at some of its stores.

X Prize founder and entrepreneur Peter Diamandis, MD, MS says he “screwed up” by holding an illegal in-person California summit last month for several dozen wealthy executives who paid more than $30,000 each, saying they would be safe from COVID-19 because of mandatory pre-event and then daily testing and onsite vitamins and doctors. Three weeks later, at least 24 attendees of Abundance 360, including Diamandis himself, have tested positive. Diamandis, who co-founded coronavirus vaccine company Covaxx, admits that he didn’t force attendees to wear masks, but claims the event wasn’t actually a conference but rather a broadcast with a small live audience since most attendees were virtual. Zero of the 35 audiovisual production staff, all of whom wore masks, tested positive.  

Other

Two hospitals in France are hit by ransomware in a single week, while a third cut off network connections to one of its IT suppliers that had been attacked.

Sponsor Updates

• Beyond profiles Goliath Technologies as a “Top 5 Citrix Solutions Provider, 2021.”
• Black Book Market Research includes Impact Advisors on its list of top-rated RCM advisory firms.
• Cerner will sponsor and present virtually at Health Datapalooza February 16-18.
• The local business paper interviews Diameter Health CEO Eric Rosow.
• Elsevier advances nursing education by offering innovative virtual reality healthcare simulations to schools across North America.

Blog Posts

• Six Strategies for Preventing Administrative Burnout (Ingenious Med)
• Legacy System Considerations for Cerner Tools and Applications (Optimum Healthcare IT)
• The Right Balance: Technology & Patient Care (AdvancedMD)
• KLAS Latin America PACS 2021 Performance Report: Agfa HealthCare’s Platform Leads Spanish-Speaking Market (Agfa HealthCare)
• EHR Quality Improvement: 3 Ideas for Eliminating Waste (CereCore)
• Social media driving patient engagement during COVID-19 [Survey] (Meditech)
• Ready for Your Workday Implementation? Don’t Overlook These Key Roles (Healthcare IT Leaders)
• Three Ways Every Provider Can Improve Healthcare for Their Patients (ChartSpan)
• Clearing the Path to Medication Access with Technology (CoverMyMeds)
• Engineers Build New Tools to Support Care-at-Home Models (Dina)
• How healow Check-In is transforming healthcare (EClinicalWorks)

Contacts

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

Morning Headlines 2/16/21

Zocdoc Announces $150 Million in Growth Financing from Francisco Partners

Online provider search and appointment-booking app Zocdoc raises $150 million in a private equity round led by Francisco Partners, bringing its total raised to $376 million.

Healthcare startup Innovaccer to enter unicorn club, in talks with Tiger Global for $100-$150 million funding

Sources say analytics and interoperability vendor Innovaccer will soon raise between $100 million and $150 million from investor Tiger Global.

RapidSOS Raises $85M Series C Led by Insight Partners to Scale Emergency Response Data Platform

RapidSOS, a software vendor specializing in aggregating and sharing emergency-related data with first responders, raises $85 million in a Series C funding round.

Curbside Consult with Dr. Jayne 2/15/21

Like many parts of the US, my city has spent the weekend heading deeper into the polar vortex. I’m not a big fan of sub-zero temperatures, let alone wind chills in the negative double digits. We’re expecting snow throughout the night and into the morning, which will make for less-than-fun conditions driving to work in the morning. While some of my physician colleagues were scrambling to move their in-person patients to virtual visits, I reminded them that some of us have to work in person regardless of the weather.

I’m a bit tired of being an all-purpose clinical safety net for practices that don’t want to or otherwise can’t see patients in person, and especially having to see those patients without any supporting medical information. That’s one of the pitfalls of being part of an independent organization. We don’t have access to anyone’s broader medical records, unless you count patients who log into MyChart and hand you their phone. Our state charges exorbitant rates for independent physicians to participate in its health information exchange, so we don’t have that data, either.

Back when I was a community-based family physician, I used to call ahead when I referred patients to urgent care or to the emergency department to let them know what I was thinking and why I was sending the patient. It doesn’t seem like anyone does that any more. Half the time when I try to call a patient’s personal physician to discuss their case, either I don’t get a call back or they act bothered that I even called in the first place. I’ve had a total of two physicians thank me for calling them about their patients in the last six months. One of them was an orthopedic surgeon who not only gave me advice on how to handle the patient’s unique problem, but made the patient an appointment for first thing in the morning while she and I were on the phone discussing the case.

I try to keep positive situations like this one at the top of my thoughts when I’m dreading tomorrow’s bone-chilling and potentially dangerous trek. Due to the pandemic, plenty of people are out of practice driving in poor conditions, so who knows what it will look like. I’d much rather be at home working on technology projects. I have some interesting ones in the works. One takes me into a world where I haven’t had a lot of experience outside the clinical realm, and that’s the perioperative services arena. I’ve been contracted by a health system that is trying to be proactive about the significant number of surgeries that patients have delayed during the pandemic. As COVID-19 numbers begin to fall across the region, they are looking at the best ways to bring those patients back into care.

As you can imagine, a number of the cases are orthopedic in nature – hip and knee replacements, shoulder reconstructions, and the like. For those patients whose procedures were on the books at one time and were rescheduled or canceled during the pandemic, outreach is fairly straightforward. The challenge is identifying the patients who never made it to the surgical scheduling team. Perhaps the procedure had been discussed with a surgeon, some of whom are employed by the health system, so we have access to medical records and can begin to identify those patients depending on how the visits were documented and whether the procedure recommendations were captured in discrete data. Others had surgeries recommended by community-based physicians who are on staff at the system’s hospitals, and identifying those patients is more challenging.

Beyond identifying the patients and their respective procedures, there are several other related projects that I’m being pulled into. They look at various details including surgical scheduling, staffing for perioperative personnel, equipment management, sterilization and central supply processes, and more. One sub-project looks at the surgical instrument preferences for various procedures across surgeons and how they might be standardized. That’s where it gets exciting for me, because I get to try to look at relationships between surgical outcomes and a number of factors, including level of standardization, number of cases performed at the different facilities, staffing, and how those factors might influence each other.

Right now, I’m overseeing the gathering of the data from various sources and its aggregation into a central database. We’re designing the questions we need to ask and looking at known pain points in the processes, from scheduling to day of surgery to follow up. This is where it’s fun to be the outsider, because I don’t know any of the people or the personalities and I’m eager to let the data speak for itself.

I don’t know that Dr. X has been on staff for 30 years and that people tolerate his quirkiness because he’s considered the elder statesman of his subspecialty. I am not swayed by people’s claims that their patients require special equipment different than that used by all their peers. I don’t know any of the stories about why one hospital has been allowed to operate outside the system’s standards or why everyone else is in alignment. I’m eager to see what stories emerge as the data begins to tell its tale. I can also look at data that overarches the procedures and surgeons, such as operating room turnover time, housekeeping data, central supply factors, length of stay data, surgical complications, readmissions data, and more.

The other element that excites me about this project is having support staff to work with who know the system from the inside. It’s not the usual “let’s outsource this” type of project of which I am usually on the receiving end. I get to work with people across the health system who possess deep experience in quality improvement projects and clinical transformation work and are similarly motivated to try to find ways to improve the process as well as patient experiences and outcomes.

I knew this was going to be an interesting project, but now that I’m really involved, I feel like a kid in a candy store. What projects are you most looking forward to this year? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Kelly Feist, Managing Director, Ascom

Kelly Feist, MBA is managing director of Ascom Americas of Morrisville, NC.

Tell me about yourself and the company.

I started my career as a bedside clinician. I worked for 10 years at a couple of acute care hospitals in Florida in the respiratory care department, covering intensive care units, emergency departments, and neonatal ICUs. I have a strong appreciation for what a clinician experiences each day and their need for not just information, but information that is actionable and easily interpretable.

I joined Ascom on April 6, so my first day was after the pandemic started, which is an interesting way to start with a new company. I was drawn to the company because it is going through a transition and a transformation, moving from capital equipment to  focusing more on workflow, clinicians, and patients. Our healthcare information and communication technology helps clinicians deliver bedside care in an effective way, managing communications between clinicians and from patients to clinicians. We start at the bedside with the patient in the center with nurse call, and then move out to mobility devices. It’s an end-to-end, integrated workflow that becomes increasingly important as we find new ways to manage clinical care while trying to limit contact.

What are the challenges and benefits of collecting and presenting information from hospital monitors to clinicians on mobile devices?

It’s not just hospital monitors, but also ventilators and laboratory test results. A vast amount and a vast variation of information can be presented on mobile devices in the clinician’s hand. It’s not just the information, but the actionable information. We can deliver so much information when we digitize a workflow that was previously analog. We can put a mobile device in the hand of a nurse at the bedside that can receive alerts from all of these different devices — ventilators, patient monitors, lab systems, and so on. A lot of information can hit that handheld and overwhelm the nurse.

The challenge is to identify what information is truly actionable and how that information is escalated so that the nurse can respond in an efficient and informed way to solve the patient’s problem. You can’t overwhelm people with a lot of information and then expect them to decide what’s important and what can wait. The value that we deliver is helping them understand how they should be prioritizing that information so that care providers aren’t overwhelmed by a new workflow that now happens to be digitized. Just because we can digitize it doesn’t mean we should.

Is technology such as AI, which is a term I hesitate to use, improving the ability to automatically prioritize information instead of having each facility or each user set up rules?

I share your reluctance to use the term AI. It is overused, and applying it in a way that makes sense is easier said than done.

I think about whether a hospital already has rules and policies in place. For example, does the facility have a policy for early warning scoring, where they have determined the parameters that can help identify a patient who is at risk for deterioration over time and then raise a flag before they become symptomatic? If that protocol exists, we can program it into the software aspect of our solution. We will raise the flag and create and escalate the communication in an automated way for the care provider to ensure that the patient who is at risk is identified quickly.

Most people don’t realize that the first indicator is typically an increase in respiratory rate. If we see it increase, or see the lactic acid test results increasing, the software can raise the flag, create the communication to the care provider, and escalate it in an automated way. That pays dividends. Healthcare facilities want to spend their capital equipment dollars on something that delivers measurable ROI. That becomes important in making their clinicians more efficient, keeping their patients safe, and increasing their own capacity if they can release patients or discharge them sooner. It’s a lot to say that, but we have done studies that have shown that at the very least, a well-designed, well-executed protocol decreases unplanned ICU admissions, for example.

How much of the nurse’s work can now be performed untethered, working from a mobile device that they carry at all times instead of being tied to a nursing station, a wall-mounted computer, or a computer on wheels?

As we are working with customers who are deploying these solutions, we find that the idea of the nursing station is going away. The push is to move the nurses and the frontline care providers closer to the patient and away from a centralized nursing station. This is the first real change that mandates finding new and better ways to manage that workflow.

It’s easy to think that we can apply technology to a workflow and change behavior because the technology exists, but the hardest thing to do in a clinical environment is to change the behavior of the care providers. Behavior change is always the hardest thing to affect. But if we can take our technology and support existing behaviors and make them more efficient, then we all win. The patient wins, the care provider wins, and the company wins.

That’s what we are focused on. As care and nurses move away from centralized nursing stations to something that is more distributed, it becomes important to have a communication device that pushes alerts to your hand. It allows instant communication to the care provider who knows that there’s a problem. Typically there’s also a secondary escalation path, so if that person is busy and can’t leave what they are doing, they can press a button and move it on to the next person, who can then respond. This allows us to build in safety nets.

I don’t think it’s reasonable at this point to think that all clinical documentation that goes into an EHR, for example, will go through a mobile device. Anyone who tries to type emails on their IPhone or their Android device understands why that is a challenge. But we can support the use of the EHR. Our goal at Ascom is not to compete with EHRs that are in place, but rather to support workflows and behaviors that enable and facilitate better use of the EHR. If we can close some workflow gaps at the clinician level and get the data into the EHR for a continuous health record, that is important. If we support the implementation of the EHR and make it successful, we can affect real change in the clinical process, and ultimately the outcome of the patient.

How can technology replace the continuous communication that occurs at the nursing station?

The mobile device becomes important. How well does it integrate into the overall workflow? How easy is it for the staff to communicate to one another, either voice-to-voice or via secure text message, or to receive alerts? When we think through an alerting process, there’s alerting the primary caregiver. But if that primary caregiver can’t respond, there has to be a secondary alert target, and then even beyond secondary, what we would call a catch net solution. Making sure that there’s a Plan A, a Plan B, and a safety net becomes important, because that central station doesn’t always exist any more. And even if it does exist, it isn’t always staffed 24/7.

We have to make it possible for communication to happen in an expedited way that fits into the workflow and meets the needs of the clinician where the clinician is. We are accomplishing that with mobility solutions, the software that drives the mobility solutions, and even starting at the bedside with the nurse call system so that the patient can communicate their needs as well.

What are the best practices in using technology to enable patients to communicate directly with staff to improve satisfaction, but avoiding overwhelming the employees who have to respond?

A care environment typically has registered nurses who are responsible for a level of care, and then often healthcare technicians or licensed nurse practitioners. If we can segregate the requests that come from the patient — based on need, priority, and criticality — to the right provider of those services, then we can get a faster response to the patient.

Patient satisfaction is incredibly important to our care providers, to the facilities that they work for, and to us. If we can make it a little bit more streamlined so that when the patient has a request — it could be, “I need a glass of water” — there’s a way for that patient to communicate and it can go to the LPN. It can go to a targeted recipient that can provide that service without them taking up time of the nurse who might be working with another patient on something that is more critical. But if it’s a critical need, the communication goes to the nurse. We can filter where the request goes based on priority to make sure that the patient gets the response they need in a timely manner.

What are the company’s goals in healthcare over the next few years?

Healthcare is our biggest growth opportunity. For my region in the US and Canada, it’s where the majority of our revenue comes from. The pandemic has shown how impactful we can be to the healthcare community.

As an example, when I started, field hospitals were springing up all over the place, such as at the Javits Center in New York City and McCormick Place in Chicago. They needed to give all patients in beds access to nurse call functionality. We were tapped to provide a lot of the technology for those field hospitals, and it felt good to be able to serve the community in a way that had impact. A lot of the field hospitals didn’t get a lot of census, but the fact that we were able to meet the needs of the community when those needs occurred was important.

Workflows have changed because of the pandemic and we are trying to decrease contact where we can to keep both patients and staff members safe. Ascom can play a big role in that. Those workflow adaptations aren’t all going to go away when the pandemic is over. We have to keep innovating on how we make communications more streamlined, more effective, how we get them to the right person, and how we ensure that priority items are escalated appropriately. Those will remain important. With virtual visits and other changes, we will need to monitor patients at home effectively. Ascom can play a part in that realm as well.

Do you have any final thoughts?

The workflow changes that we are experiencing as a result of the pandemic aren’t going to go away. Keeping the patient and clinician provider at the center of what we do will make healthcare delivery more efficient, and that will make us successful as a company. Focus on the patient and the provider.

Morning Headlines 2/15/21

Dexcom Launches Inaugural Venture Capital Fund

Continuous glucose monitoring device vendor Dexcom launches a venture capital fund that will identify and invest in opportunities to supplement its core business.

Vocera Announces Fourth Quarter 2020 Financial Results

Vocera announces Q4 results: revenue up 14%, adjusted EPS $0.28 versus $0.15, beating Wall Street expectations for both.

Sutter Health’s layoffs to total 277, mostly in IT

Sutter Health (CA) files documents with state regulators outlining its plans to fire hundreds of IT workers.

OCR Settles Sixteenth Investigation in HIPAA Right of Access Initiative

HHS OCR settles its 16th HIPAA Right of Access case, with Sharp HealthCare paying $70,000 for taking seven months to send an electronic copy of a patient’s records to a third party.

Sharecare and Falcon Capital Acquisition Corp. Reach Agreement to Combine, Creating Publicly Traded Digital Health Company

Sharecare will merge with SPAC Falcon Capital in a deal that will value the newly combined company at $3.9 billion.

Monday Morning Update 2/15/21

Top News

A new GAO report recommends that the VA stop its implementation of Cerner until all known critical issues have been addressed.

The VA agrees in principle, but says it won’t stop the rollout and instead will test and mitigate risks.

Most of the GAO’s data came from work performed last fall. VA has since closed most of the high-severity issues that GAO noted. Just 55 of the previous nearly 400 issues remain open.The VA says it will have all issues resolved by January 2022.

Next up for go-live is Puget Sound Health Care System in Q4 2021. 

Reader Comments

From DAX Facts: “Re: Nuance’s DAX ambient clinical intelligence. Users have told me that their hospitals are finding it hard to generate ROI because just freeing up physician time doesn’t necessarily result in more visits or revenue. What are your thoughts on how much value DAX adds and how that will be reflected in its pricing?” I’ve been wondering that myself, especially after last week’s Nuance earnings call in which DAX consumed a lot of company and analyst discussion that I assume reflects financial expectations. DAX customers mentioned in the earnings include Duke Health, San Joaquin Hospital, Mercy Health, Rush, WellSpan, Connecticut Children’s, and Cooper Health. I would be interested in firsthand experience at a macro level, i.e. how do physicians like it and is the expectation that it will pay for itself? Let me know and I’ll keep you and your organization anonymous, of course. I’ll also add that hospitals aren’t good at turning newfound employee free time into anything more than a less-stressful workday, which offers some burnout benefits but doesn’t excite CFOs who have to write the checks.

From Damocles: “Re: Cerner’s bankrupt client who owes $63 million in an arbitration judgment. You are correct that it was Belbadi Enterprises. Cerner is still pursuing taking possession of a Vancouver, WA property that was held by a subsidiary by way of the company’s former CEO. Cerner hired forensic accountants and investigators who found that the company moved money back and forth with that subsidiary, even though Vandevco / Belbadi claimed that no tie exists. Also stiffed were consulting firms who were hired to install Cerner for the UAE’s Ministry of Health and Populations, which were left with unpaid bills when MOHP signed a direct contract with Cerner and cut Belbadi out of the deal. I’m sure it’s a sensitive issue since Belbadi is still an active entity in the UAE and the former CEO is a member of one of the ruling families, even though he lined his pockets with money that should have gone to Cerner and other vendors.” It’s good to be king, or in this case, brother of your country’s minister of justice and the 10th richest UAE citizen.

From IHeartHIStalk: “Re: counterfeit N95 masks from China. Meanwhile, small US manufacturers can’t find mask buyers.” The New York Times profiles DemeTech, a family-run Miami business that invested tens of millions of dollars in mask manufacturing equipment and spent nine months earning federal approval to sell N95 masks, but now the owner can’t find buyers for the 30 million masks he has in inventory and he is laying off employees. Despite vows to “buy American,” health systems, medical supply distributors, and state governments don’t want to change their buying habits or spend a bit more on masks that are made in this country. Manufacturers are also being hurt by Facebook and Google advertising bans that were intended to thwart mask profiteers. Big players like 3M and Honeywell, spurred by the Defense Production act, are selling 120 million masks each month, mostly to distributors that resell to hospitals who need more than twice that number.

HIStalk Announcements and Requests

Poll respondents would be most concerned about credit card or payment information in the event their medical records were disclosed. The good news there is: (a) I would hope that most PM/EHR systems don’t retain credit card information or store it via a payment processor’s secure system; and (b) you can always cancel a credit card and start over with no repercussions, unlike having your medical information disclosed to the world. Behind credit card information is behavioral information, and far behind that is a list of social habits. After that, most people don’t really care.

New poll to your right or here: In your most recent physician or hospital encounter, were your electronic records from one or more other providers reviewed?

I dropped by Walgreens Friday to procure vital medical supplies (Valentine’s Day cards, candy, and stuffed animals) and saw that they are giving COVID-19 vaccine shots by appointment. It was a bit jarring after reading and writing so much about the vaccine over many months to see unexcited employees calling people up from their waiting area chairs to get their injection. Chain drugstores are all about the foot traffic that generates high-margin impulse sales (like Valentine’s Day cards, candy, and stuffed animals) and COVID-19 vaccinations will see dozens of millions of people traipsing through their aisles to the back of the store in two visits. Sometimes a business’s biggest challenge, and a profitable one if they can pull it off, is to get people into their store for the first time.

Welcome to new HIStalk Platinum Sponsor Gyant (pronounced “giant.”) The San Francisco-based company’s empathic, intuitive virtual assistant guides patients through the complexity of their digital healthcare journeys, driving more meaningful patient-doctor engagement. It reduces clinical strain and support staff overhead, improves outcomes, and exceeds patient expectations. The company’s conversational AI learning loop handholds patients from the virtual front door through their entire clinical journey by integrating deeply into EHR workflows and driving higher levels of efficiency that improve patient outcomes and make them feel truly valued. Thanks to Gyant for supporting HIStalk.

Here’s a Gyant explainer video I found on YouTube.

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

Listening: new from reader-recommended Starcrawler, some LA teen punk rockers who sound kind of like L7 meets the New York Dolls and Iggy and the Stooges. That’s a lot of musicality and 1970s influence from kids who are barely old enough to drive. Their live shows are apparently pretty nuts.

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

Continuous glucose monitoring device vendor Dexcom launches a venture capital fund that will identify and invest in opportunities to supplement its core business. The fund will focus on sensing technology, analytics, remote patient monitoring, and population health management.

Vocera announces Q4 results: revenue up 14%, adjusted EPS $0.28 versus $0.15, beating Wall Street expectations for both. Shares jumped 25% Friday following the announcement, with VCRA shares up 76% in the past 12 months versus the Dow’s 6% gain, valuing the company at $1.7 billion. Vocera said in the earnings call that Q4 bookings were the highest in the company’s history as COVID-19 has elevated hospital priority for communication and workflow solutions that keep employees safe.    

Announcements and Implementations

Well Health announces that its COVID Vaccination Self-Scheduling is available to providers through self-scheduling partners. The system allows scheduling both appointments, maximizes doses through appointment optimization, follows up for second doses, and provides secure message to patients regardless of whether they are registered in the EHR.

Government and Politics

HHS OCR settles its 16th HIPAA Right of Access case, with Sharp HealthCare paying $70,000 for taking seven months to send an electronic copy of a patient’s records to a third party. OCR originally closed the case after giving Sharp technical assistance, but the patient filed a second complaint two months later when the records had still not been sent.

COVID-19

US COVID-19 cases and hospitalizations continue their steep downward trend, with just 69,000 hospitalized patient versus nearly double that number just a few weeks ago. Still, the numbers are higher now than in the spring and summer surges.

CDC reports that 51 million COVID-19 vaccine doses have been administered of the 70 million distributed (72%), split nearly evenly between the Pfizer and Moderna products. 

UK scientists find that the B117 coronavirus variant is not only more infectious, which was previously documented, but it also appears to be 30% to 70% more lethal given limited study so far. If that finding holds after further research, spread of the variant could disproportionally increase hospitalizations and deaths even beyond just causing a higher number of infections. In Canada, Newfoundland and Labrador is already seeing a B117-fueled outbreak and has escalated mitigation measures.

New Jersey’s vaccine hotline stops booking appointments after callers report that they were given incorrect information. The state says it will provide extra training for the hotline’s 2,000 agents and is working out software problems with vendor Microsoft. The state had weeks of outages with its online registration system, warning that Microsoft’s Vaccine Management system may never work. The state says Microsoft doesn’t have enough support people and some of them are offshore and thus unavailable during US working hours.

In yet another example of COVID-19 vaccination software shortcomings, FDA is still trying to bring up its BEST system for monitoring vaccine side effects using real-world evidence. BEST will eventually be able to review the medical records of 100 million people in real time, but it relies on EHR and claims data that aren’t always filed for no-charge vaccinations. The system is also so new that FDA hasn’t yet calculated the rates of background problems with people who haven’t received the vaccine, so they can’t easily identify unusual events. For now, the federal government is using several other systems that don’t share information, including the 30-year-old FDA/CDC VAERS system for self-reported vaccine problems.

Virtua Health finds a bug in its vaccination self-scheduling system when it notices that 70% of its 300,000 appointments are duplicates, requiring 10,000 phone calls to work out the duplications but freeing up 5,000 open slots by doing so. They didn’t indicate the software they use, but the signup form uses Epic MyChart. UPDATE: A Virtua Health spokesperson clarifies that the scheduling system did not have a bug, it just didn’t prevent people from making multiple appointments. The 70% number doesn’t refer to the number of duplicates of the 300,000 total appointments, but rather that of those duplicates, 70% of them were made in error due because users weren’t sure how to schedule both first- and second-dose appointments or didn’t wait for the confirmation email before scheduling again.

New York Governor Andrew Cuomo’s top aide admits that the state withheld data about COVID-19 deaths in nursing homes because it feared an investigation by the federal Justice Department. The state’s nursing homes have had 15,000 COVID-19 deaths, nearly double the previously reported total, which the state did not confirm until faced with a court order. Cuomo issued an executive order in March 2020 that required nursing homes to readmit their residents following their hospitalization for COVID-19 treatment, but state health officials have claimed – without providing details – that the high rate of nursing home deaths was caused by infected employees and not the residents themselves.

The federal government has not developed a plan to allocate COVID-19 vaccine for the 6,000-employee US Public Health Service, telling them that they should visit military treatment facilities that are sometimes turning them away in confusion about whether they are eligible (all of them are, per the Pentagon’s priority list). Public Health Service officers are being deployed to deliver care to COVID-19 patients and to work on mass vaccination programs.

The Atlantic explains how the small, poor country of Bhutan controlled coronavirus so well that it has recorded just one COVID-19 death:

• The country can’t afford to run an expensive US-style health system, so it focuses instead on public health and prevention.
• Within two weeks of China’s first report to the WHO of an unknown pneumonia outbreak, Bhutan drafted an emergency plan and started screening people at airports.
• With six hours of discovering its first confirmed COVID-19 case in early March – an American tourist – the Yale-educated epidemiologist who is its health minister had 300 possible contacts traced and quarantined.
• The government issued clear daily updates.
• Bhutan banned tourists, closed schools and public institutions, closed entertainment venues, and urged mask-wearing and distancing.
• The government paid for hotel accommodations and meals for those who were quarantined.
• The first positive case outside of quarantine triggered a national three-week lockdown in which the government delivered food and medicine to every household.
• The king’s relief fund provided financial assistance to those who had lost income, created a national registry for vulnerable citizens, and sent packages of medical items to every resident over 60.

Other

Stanford researchers find that higher-ranked children’s hospitals that have their own EHR instead of sharing one with an adult hospital perform better in rankings. I can offer many reasons for this correlation that go beyond the article’s suggestion that these hospitals don’t treat children as “small adults” or that their systems are all that different given that they use the same couple of vendors. I’m also skeptical that EHR’s configuration and use has a measurable effect on objective quality measures (did those hospitals show improvement after they implemented their systems?) I would also question whether rankings derived from self-reported US News & World Report surveys are reflective of quality. Maybe the most important unanswered question is whether children’s hospitals that deploy their own standalone EHRs are able to configure them differently (or are more likely to do so) than those that follow broader rules because they share a system with an adult hospital. That would make a better study – take a few ordering pathways that peds hospitals do differently (medication dose range checking, growth charts, use of patient identifiers, etc.) and see if they are implemented differently in standalone versus shared EHRs, and if they are, determine whether that’s because of EHR limitations or corporate choice.

Informatics experts in Switzerland say there’s no such thing as “your electronic medical record” there, as some clinics are still using paper records and fax machines and the system is fragmented by having both government-run and private systems. Cantons even used fax machines to send COVID-19 case information to the federal government for tracking. Data stored in silos, the experts say, will stand in the way of using promising AI applications.

Sponsor Updates

• OptimizeRx announces the pricing of the previously announced underwritten public offering of 1,325,000 shares of its common stock at $49.50 per share.
• Cerner supports mass COVID-19 vaccinations around the world.
• Redox releases a new podcast, “From Buzzword to Buzzer-Beater: How SDOH stands to take COVID head on.”
• TriNetX will work with German hospital organization VUD to build a collaborative network of university hospitals and medical schools as part of the TriNetX global health research network.
• Well Health makes COVID-19 vaccination self-scheduling capabilities available through multiple industry-leading partners.

Blog Posts

• Optimizing telehealth with AI-powered technologies – protect your patients and revenue (Nuance)
• New E/M documentation changes: Where does your organization stand? (Nordic)
• What “The Brady Bunch” Can Teach Healthcare Organizations About Blending Workforces as Part of M&A (Pivot Point Consulting)
• The Case for Mobile-Based Telehealth (PMD)
• MSSP 2020 Expenditure and Utilization Reports and Calculators May Be Misleading (Premier)
• Care Journey Orchestration Tackles Healthcare’s Biggest Operational Challenges (Lumeon)
• Design Considerations for Healthcare Products that Require EHR Integration (Redox)
• Email Appointment Reminder Templates That Will Help Your Patient Engagement (Relatient)
• Denver Startup Helps Combat the High Cost of Prescription Drugs (RxRevu)
• TeleNeurology Offers Real-Time Clinician Collaboration (SOC Telemed)
• When no news might be missed news: Closed loop reporting in healthcare (Spok)
• AHA Guest Blog: What heart and stroke patients should know about COVID-19 vaccines (Krames)
• Top billing mistakes and how to fix them (Waystar)
• Give to Get: The How and Why of Patient Loyalty Programs (WebPT)

Contacts

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