News 3/9/22

Top News

Epic announces Garden Plot, an Epic version for independent medical groups that is offered directly from Epic instead requiring a Community Connect agreement with a health system.

Epic provides the system in a software-as-a-service model that includes hosting, support, updates, and integrated third-party products.

Integrated products that are included in the offering are from Availity, Biscom, Change Healthcare, Healthwise, Intelligent Medical Objects, Iron Bridge, Lyniate, OSG Billing Services, Solarity, Sphere, Surescripts, and Wolters Kluwer.

HIStalk Announcements and Requests

I’m fast-roping into HIMSS22, arriving Monday evening and heading out early Thursday. Two days in the exhibit hall is it for me, the shortest time I’ve ever stuck around. The asterisked HIMSS21 almost convinced me to skip this year’s version entirely, but I’m like a migratory bird that can’t stay home.

I appreciate the many folks who have connected with me on LinkedIn in the past few days, some of them adding nice comments about how long and/or enjoyably they have been reading HIStalk.  My only viewpoint of HIStalk is as an empty screen demanding to be filled from my frequently occupied chair, so hearing from actual humans boosts me. For those who ponder the advantages of connecting (can’t we just be ROI-free online pals?), it’s a short list:

• I’ll see your postings.
• LinkedIn will notify me when you change jobs and I will list your new gig in my “People” section if it meets my criteria, even in the absence of a an official announcement.
• You’ll be connected to thousands of like-minded people, although I confess that I don’t really use LinkedIn beyond superficially and thus I don’t really know what benefits that offers.
• You can send me messages via LinkedIn.
• You’ll make me feel more relevant, which makes me more confidently snarky if you consider that to be an HIStalk feature rather than a bug.

Speaking of LinkedIn, I keep seeing cookie-cutter messages from people who have joined Chief, so I had to look up what that’s about. I wish I had thought of its business model, which combines vanity, networking, and employer-paid expensive dues:

• It’s an investor-funded private network for C-suite females who have at least 15 years of career experience.
• The company has raised $40 million from investors.
• Annual dues are $5,000 to $9,000, usually paid for by the member’s employer.
• Chief says it has thousands of members and thousands more on the waitlist.
• It offers meetups, mentorship connections, online discussion groups, and physical clubhouses in four cities.

ViVE attendees seem to be having a ball, with most of the Twitter photo evidence being beaming party photos. Despite the fact that I’m a certified curmudgeon with a mild case of FOMO, I am glad to see people happily interacting face to face after the long COVID drought. Hopefully healthcare cost, quality, and patient experience will get at least passing attention among the glossy good times and startup salivation. I’ll also say this for the conference timing and location — it has sucked all the air out of the HIMSS22 room, made direct comparisons inevitable, and possibly consumed much of the energy of the overlapping attendees and exhibitors who will do it all over again upstate next week. I thought it was a mistake to schedule ViVE so close to HIMSS (although not as disastrous as the initial HLTH conference right after HIMSS18 in Las Vegas), but HLTH and CHIME might have been thinking more strategically.

Meanwhile, ViVE announces that its next iteration will be March 26-29, 2023 in Nashville, ending 19 days before HIMSS23 in Chicago. I hadn’t paid attention to the HIMSS23 location — HIMSS banned its home town from future conferences twice, once because of nasty exhibit hall Teamsters and once for hotels giving RSNA attendees better rates. I assume HIMSS will save some much-needed cash with the Chicago home court advantage, with a slight negative being the chance of a blizzard like at the HIMSS09 opening reception there.

Welcome to new HIStalk Platinum Sponsor Optum. Optum is a leading information and technology-enabled health services business dedicated to helping make the health system work better for everyone. With more than 190,000 people worldwide, Optum delivers intelligent, integrated solutions that help to modernize the health system and improve overall population health. Optum is part of UnitedHealth Group (NYSE:UNH). Thanks to Optum for supporting HIStalk.

Here’s a recent YouTube video that describes Optum’s provider careers.

Webinars

April 6 (Wednesday) 1 ET. “19 Massive Best Practices We’ve Learned from 4 Million Telehealth Visits.” Sponsor: Mend. Presenter: Matt McBride, MBA, founder, president, and CEO, Mend. Virtual visits have graduated from a quickly implemented technical novelty to a key healthcare strategy. The challenge now is to define how telehealth can work seamlessly with in-person visits. This webinar will address patient satisfaction, reducing no-show rates to single digits, and using technology to make telehealth easy to use and accessible for all patients. The presenter will share best practices that have been gleaned from millions of telehealth visits and how they have been incorporated into a leading telemedicine and AI-powered patient engagement platform.

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

Acquisitions, Funding, Business, and Stock

Harris acquires Israel-based insurance software vendor 2Team Computers.

Former Livongo executives launch Homeward Health with a $20 million investment from General Catalyst. The startup aims to provide Medicare Advantage plan members in rural communities with primary and specialty care using local teams that provide in-person and virtual services and in-home remote patient monitoring. It is initially focusing its evidence- and value-based care model on cardiology.

Health data exchange company Consensus Cloud Solutions acquires Summit Healthcare, a health IT vendor specializing in data integration, care continuity, and workflow automation. This marks the first acquisition for Consensus, which became an independent business after parent company J2 Global split into two publicly traded companies last year.

Healthcare API developer Health Gorilla raises $50 million in a Series C funding round, bringing its total raised to $80 million.

Pro Medicus co-founder and CEO Sam Hupert says that the Australian medical imaging software vendor, parent company of Visage Imaging, won’t bid for government work because of “too many gates and hoops” in the procurement process, which is led by “bureaucrats, with clinicians very much in the background. How would a bureaucrat know what makes a good clinical desktop for a radiologist?” The company recently expanded into Europe and has contracts with seven US hospitals, which provide the bulk of its revenue. Hupert and his co-founder Anthony Hall each hold nearly $1 billion worth of shares.

Sales

• The Social Security Administration’s Disability Determination Services will use Veradigm EChart Courier software from Allscripts to automate medical records retrieval.
• Johns Hopkins HealthCare Solutions will offer Glooko’s remote patient monitoring capabilities to diabetic patients who are enrolled in its Blossom diabetes management program.
• Integris Health (OK) selects population health analytics and data integration from Loopback Analytics to enhance its specialty pharmacy program.
• Northwell Health (NY) signs a 10-year agreement with Clinithink for its NLP-enabled Clix RCM technology.
• The US Defense Health Agency chooses MediQuant’s DataArk for archiving military health records as DoD transitions to Cerner.

People

ChartSpan promotes Christine Hawkins, MBA to CEO.

Stanford Health (CA) promotes Nigam Shah, PhD to the newly formed role of chief data scientist.

EHealth Technologies names Dan Torrens (ConnectiveRx) as CEO.

Virtual patient monitoring vendor AvaSure hires Adam McMullin, MBA (FDS) as CEO.

Health System Informatics promotes Stephanie Hojan to president.

Mitre hires Stephen Ondra, MD (Cygnus-AI) as chief medical adviser.

UnitedHealth Group promotes Cara Griffin to VP of marketing.

Announcements and Implementations

CloudWave announces GA of OpSus Vault, a cloud-based data storage service that is designed to protect backups from cybersecurity threats.

Tift Regional Medical Center (GA) integrates Wolters Kluwer Health’s POC Advisor sepsis monitoring software with Cerner.

Mount Desert Island Hospital and Health Centers in Maine implements Cerner.

Tausight announces a real-time detection platform to detect, track, and analyze PHI activity.

Allscripts renames its Application Store to Allscripts App Expo and opens it to all active developers with a certified solution.

Olive announces increased investment in interoperability and intelligence capabilities in its platform.

Other

I missed this a couple of weeks ago. Several states and CMS investigate Center for Covid Control, whose 242 locations tested 400,000 samples for COVID-19 using untrained workers who ignored the manufacturer’s instructions, stored and labeled specimens improperly, faked results, and told insured patients not to list their coverage on the form (they were billing the federal government for testing uninsured patients). Some patients received negative results before they were actually tested. Its associated lab – whose mailing address is a UPS store and which apparently is owned by the same couple — billed the federal government for $120 million worth of testing for uninsured people, posting “free COVID testing” signs in decrepit empty storefronts and at pop-up sites. Owners Akbar Ali Syed (35) and his wife Aleya Siyak (29) put the company together quickly in 2020 after operating a wedding photo business, a doughnut shop, and an axe-throwing lounge. They bought a $1.36 million mansion, a $3.7 million Ferrari, and several Lamborghinis. I suspect the already ample amount of healthcare fraud has been increased dramatically by the government’s frantic attempts to manage the pandemic using poorly vetted contractors and vendors.

Sponsor Updates

• Clearsense sponsors a pre-ViVE2022 golf tournament that has raised $42,000 for the CHIME Opioid Task Force.
• AGS Health and Clearwater achieve Cybersecurity Transparent certification through a voluntary risk assessment process and program from Censinet and KLAS.
• Baker Tilly will exhibit at the 34^th Annual Roth Conference March 13-15 in Dana Point, CA.
• Bluestream Health helps long-time partner MedStar Health deliver more than 1.5 million telehealth encounters during the pandemic.
• Ellkay partners with Astrata to help health plans improve quality measurement.
• Current Health expands its support for chronic care management by adding new features to its platform, including access to more integrated, third-party devices; a single platform across all populations; and new communication tools.
• Lumeon appoints former Partners, Cerner, and Siemens executive John Glaser to its board.

Blog Posts

• ViVE 2022 – Our obligation to caregivers and patients (Cerner)
• Healthcare IT Service Desk: Automation Strategies (CereCore)
• Common Prior Authorization Hurdles and How to Overcome Them (CoverMyMeds)
• Take the Worry Out of Healthcare Cloud Migration with CTG’s Cloud Solutions (CTG)
• International Women’s Day: Gender Equity in Healthcare (Optimum Healthcare IT)
• 3 Ways That Healow Pay Helped a Growing Primary Care Practice (EClinicalWorks)
• 6 strategies on how to increase outpatient revenue (Experian Health)

Contacts

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

Morning Headlines 3/8/22

Homeward to Rearchitect Rural Healthcare for 60 Million Americans

Former Livongo executives launch technology-enabled care delivery company Homeward Health with a $20 million investment from General Catalyst.

Consensus Cloud Solutions, Inc. Provides Fourth Quarter 2021 Preliminary Results

Health data exchange company Consensus Cloud Solutions acquires Summit Healthcare, a health IT vendor specializing in data integration, care continuity, and workflow automation.

MDisrupt Lands $6 Million in Seed Funding to Build Its Digital Health Intelligence Platform

MDisrupt will use $6 million in seed funding to expand its service, which enables digital health entrepreneurs to connect with experts, and generate real-world data needed to commercialize and scale their solutions.

Curbside Consult with Dr. Jayne 3/7/22

As a CMIO, I spend a great deal of my time thinking about patient experience. Telehealth is a major focus for my organization, and in the name of patient experience, we worry about dozens of details:

• Are the colors on the website pleasing?
• Can patients easily figure out that we offer telehealth, and what hours?
• How patient-friendly is the registration process for the patient portal?
• Have we optimized the pre-visit check-in process?
• Are we asking enough questions to gather the information the physicians want, but not so much information that patients are frustrated by the questions?
• Is the connection to the telehealth platform seamless?
• Are there risks for a poor-quality visit?
• Are the post-visit instructions clear and delivered to the patient quickly?
• Is the communication back to the rest of the care team timely?

This week I had to put my patient hat on again, and it was an experience that made me wish that healthcare executives spent half the time thinking about the in-person patient experience that I’ve spent thinking about telehealth over the last six months. The opportunities for improvement spanned the spectrum of people, process, and technology.

For background: my visit was for a radiology procedure at a large academic medical center and had been scheduled six months ago. I transferred care there last year after some medical misadventures elsewhere and didn’t know exactly what to expect.

The first miss on their part was the fact that they don’t use the capabilities of their EHR and patient portal to manage basic pre-registration and appointment confirmation tasks. Instead, I had to start playing phone tag with the registration team four days prior to the procedure. I missed their first call because I was working, and then they called again before I even had a chance to listen to the voice mail. I couldn’t answer that call either, and then when I did have time to call back, I was routed through a complicated phone tree before I finally reached a human who was able to verify my insurance and demographics. I asked about arrival instructions since I hadn’t been there for this particular procedure before, and all they could tell me was to stop and ask at the information desk because the person on the phone couldn’t see what specific procedure I was scheduled for.

Two days prior to the visit, I got another call, this time with the pre-visit instructions I had been looking for earlier in the week. Because I use Google Assistant to screen calls from unfamiliar phone numbers, I could see the beginnings of the transcript and picked up. Fortunately, it was a long looping recording that I was able to listen to a second time to make sure I had all the information. It did give more information about the arrival process, including parking information and some additional details about where to arrive at the hospital. I’m not sure how the call would have worked out had I not picked up, though, since it would have rolled to voice mail partway through the recording and likely would have been cut off.

On the day of the visit, I left in plenty of time because I knew traffic would be dicey. It wasn’t as bad as I thought, but I needed every second of extra time because there was hardly any available patient parking at 8 a.m. I made it to the registration area 30 minutes before my appointment as recommended, then had to sit for another 20 because the registrars were on break.

In the mean time, I got to observe challenges other patients were facing. One gentleman was there for laboratory testing but didn’t know the name of his physician, so the staffer couldn’t figure out his orders. Apparently they can’t be looked up by patient, only by ordering physician. The patient knew the orders were from the urology department, but the staffer said they couldn’t do anything until he could give the physician’s name. The patient had to call upstairs to the office and find out what clinician’s name the orders were under, and then they could take care of him. It seemed a little ridiculous to me, but I don’t pretend to understand how their systems are set up.

Once the registrars were back from break  — which continued an extra 3-4 minutes while they watched TikTok in the waiting room right in front of me — I was called back. There must not be an indicator as to whether patients completed the pre-registration process by phone, because I was asked if I did it, and despite saying yes, I was asked all the same questions again. They asked me to sign several consents on a signature pad without offering a readable copy of the consent. Seriously, is it even a valid consent if the patient was never given the document to read? I think it’s unlikely.

The registrar handed back a blue ticket with my insurance card and photo ID, but didn’t explain what it was. I quickly figured out that it was for parking validation, but first-time patients might appreciate some explanation. I was sent on my way with a complicated set of instructions for finding my next destination deep in the radiology department.

There I was met by another receptionist who handed me two paper forms to fill out. Neither had been generated from the EHR, so they didn’t have any of my demographics or historical information. I had to fill out all the basics again, including name, DOB, address, medications, allergies, name of my PCP, name of the referring physician, and more. All of these things could have been handled through the patient portal they day before and placed into the system for the team to review had they not already existed in the EHR. At a minimum they could have printed a pre-populated form for the patient to just update in person rather than having to start from scratch.

When I turned in my clipboard, I got chastised by the registrar for not having a visitor sticker on. I had one when I initially arrived, but I guess it fell off after moving through multiple different stations and putting my tote on and off my shoulder repeatedly.

Once I made it into the actual MRI suite, I was taken to a set of lockers and verbally given a complex set of instructions on how to use the lockers, which had recently been made keyless. I was given gowns to change into, but no scrub pants like I was used to at my previous radiology department. The tech told me they quit using pants for cost reasons, and now they just give people two gowns. Having pants definitely makes for a more pleasant patient experience, so I asked about bringing my own next time. I was told that is not allowed.

After changing, I had to find my way to the IV station, where they reviewed my allergies. The screen still showed an allergy that had been retired almost a year ago during testing by an allergist at the same academic medical center, and which I had requested be removed via the patient portal as well. The nurse updated the screen (hopefully for the last time), got the IV going, and took me to an internal waiting room.

At some point in the pandemic, every other chair in that waiting room had been taped off by placing a banner around the arms to block the seat. The banners said something about social distancing, but I didn’t retain the message because I was too busy being floored by the amount of dust and dirt that had accumulated on the unoccupied chairs. We’re talking mini-tumbleweed dust bunnies here. I know people haven’t been sitting in the chairs, but I am guessing that no one has been wiping off any of the other chairs either, because I can’t imagine a worker who was tasked with wiping chairs ignoring something that looked like that. I would have taken a picture if my phone hadn’t been impounded in the locker.

I was finally taken back for my study,. After getting situated for the MRI, I had to specifically ask for a blanket to cover my bare and freezing legs. I wonder how many patients know to ask for that.

The MRI was not entirely uneventful, but I’ll leave that story for my closest friends over cocktails. After I finally made it out of the machine, the staff confirmed that I wasn’t having any other tests or procedures that day, so they could remove my IV. Good thing I wasn’t still dizzy and feeling crummy from the test because there were no chairs in the room. I had to bend over and rest my arm on a counter for the tech to pull the IV. Had I been an elderly patient or someone with a tendency to faint with procedures like that, things could certainly have gotten bad very quickly.

After that, I had to find my way back to the locker room area, where an older patient was struggling with the lockers because she couldn’t remember how to get it to unlock. There weren’t any posted instructions, so I coached her through it before retrieving my own clothes. I changed quickly because at this point, I just wanted to get out of there.

The staff had said there was no checkout process and I was free to go, but the signage didn’t clearly tell me how to get back to the initial waiting area. I made a wrong turn and wound up in a back corridor, where they were transporting an intubated patient in a hospital bed. I quickly turned around for privacy reasons and headed back into the maze of corridors, finally making it through the waiting area to the main hallway.

Upon turning left to exit, I ran into the same transport team in the main corridor wheeling the intubated patient (whose gown was hanging half off) through the main atrium, where I’m pretty sure there aren’t supposed to be patients in hospital beds. Maybe there was a broken elevator or maybe something else was going on, but I felt bad for the gentleman’s lack of privacy as well as the other patients and visitors who probably have never seen a gravely ill intubated patient and might have found it shocking. If that’s indeed how hospitalized patients are transported to MRI, then shame on the architects for their design.

After dealing with my parking ticket (the magical blue card covered only $1.50 of my fee) I was even more eager to just get out of there. There was a line at the elevator, so I took the open staircase in the elevator atrium. When a parking garage has closed-off stairs, I expect them to be a little grubby and usually poorly lit, but these steps in the open atrium were dirtier than any big-city subway station I’ve ever visited. There was trash on the ground, used masks, and enough road salt granules to make the stair treads somewhat slippery. It made me wonder when someone from hospital administration last used those stairs and what they thought about it. It also made me wonder what the big-time donors whose names are on the building would think.

Overall, I would give my patient experience no more than 3 out of 10. If I encountered the level of dirtiness I saw at the hospital at a restaurant, I’d walk out the door. As healthcare consumers, however, we are expected to tolerate it.

If you are a hospital or health system executive, I urge you to walk the proverbial mile in your patients’ shoes, in-person as well as virtually. Fix the little things like wayfinding signage and locker instructions. Offer blankets rather than waiting for patients to ask. Let patients bring their own scrub pants for MRIs if you’re not going to provide them. And for the love of all things, use the expensive EHR to the best of its capabilities rather than continuing decades-old processes. You can bet I’ll be sharing my experience fully when the patient survey arrives.

If you’re an administrator, have you walked in the patient’s shoes, and were you shocked by what you saw? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Anjum Ahmed, MBBS, Chief Medical Officer, Agfa HealthCare

Anjum Ahmed, MBBS, MBA, MIS is chief medical officer, clinical safety officer, and global director of AI and innovation of Agfa HealthCare of Mortsel, Belgium.

Tell me about yourself and the company.

Agfa HealthCare is a global solution provider of imaging IT solutions. It is part of the Agfa-Gevaert Group, which has been in the industry for over 150 years. Our prime focus over the last year has been transitioning our customers from the traditional PACS approach towards enterprise imaging. That strategy of consolidating imaging service lines has evolved across the industry. We launched our flagship platform for enterprise imaging few years ago. We were first in the industry to build a platform from the ground up. The company has R&D centers across the globe in Canada, Belgium, Austria, and China.

My role with the company is global chief medical officer. I’m also head of the portfolio for innovation, for artificial intelligence, and in making sure that we are successful in rolling out these new innovations to our strategic customers.

What maturity level does enterprise imaging have in the US, and what benefits does it offer?

The rest of the world is looking at what the US is doing. If you look back at how the consolidation of electronic health records started in the US — that transition from paper to digital and from digital to electronic health record – it made CIOs and hospital systems across the US realize that now is the opportunity to think about imaging as a service line. How the consolidation that they did with electronic health records could transform the care that they are delivering to their communities. That’s one of the reasons I would say that the US as a region was one of the early adopters of the enterprise imaging strategy. It made sense because they realized gains from electronic health record consolidation. 

The question was, why not when it comes to imaging? There were multiple approaches that the health centers and health systems in the US took. The initial approach was with vendor-neutral archives that could be a starting point for consolidating imaging from service lines that go beyond traditional radiology and cardiology into oncology, point-of-care ultrasound imaging, mammography, and breast imaging use cases. That was one aspect.

Here in North America, including where I’m based in Canada, there was also another aspect, which was that we have consolidated the imaging records, but our health systems or hospitals are on multiple PACS technologies. How do we go about bringing a uniform viewing layer? That’s where the universal viewing component for enterprise imaging also came about. We have the VNA and we have consolidated the archive of images, but how do you use or visualize that data? Besides VNA, universal viewer also became an important component for not only beginning the journey for consolidation, but also the visual layer in terms of consolidation of imaging and how you view those images.

The US is pretty mature, I would say, in comparison to what’s happening in the rest of the globe, where the enterprise imaging strategy may initially be focused on bringing the new technology into radiology or cardiology, point-of-care ultrasound imaging, and GI endoscopy. Multimedia images related to surgical procedures is also something that is being spoken about.

The next wave in enterprise imaging will be led by digital pathology. If you think about holistic clinical care in terms of oncology, and along with a lot of talk about precision health and precision medicine, bringing in histopathology, digital pathology data, and seamless collaboration with other imaging records is something that we are already hearing about in the US as a region when it comes to enterprise imaging adoption.

A recent KLAS report noted that Europe is leading the adoption of digital pathology. What are the opportunities and challenges of rolling it out in the US?

I have noticed that as well. We saw the rollout of digital pathology for certain use cases in Europe in 2015 or 2016. Obviously there are regulatory challenges when we compare North America to what was done in Europe, but the biggest challenge is that there are no standards that have been adopted for digital pathology, unlike what we had in radiology with DICOM imaging and all those standards.

The other challenge with pathology was the use of scanners to scan the glass slides and convert those glass slides into digital data. That is unlike radiology imaging, where you have modalities that are generating digital data. In pathology, you still use microscopes that are being read manually. Every scanner vendor generates proprietary formats for data ingestion. That was a challenge with some of these labs that were transitioning from glass slides to digital. Should they stick to one scanner vendor, or if they have multiple clinical use cases, they might be in a multiple scanner environment, which means multiple storage solutions for each of those scanners. That is where they started exploring whether a data management strategy would be an entry point into digital pathology with enterprise imaging. That is something that UK also took when these new RFPs or tenders were coming out over the last couple of years.

Data management became a very relevant ask. Rolling out enterprise imaging outside radiology, how would you manage data from these multiple scanners that generate proprietary data in the absence of DICOM standards? That challenge had to be addressed. VNA is vendor-neutral, so there must be a strategic approach in how that data could be managed with digital pathology acquisition.

Besides the data management aspect, there is also the departmental workflow when you go digital with pathology, similar to radiology and cardiology workflows. Pathology has its own requirement in terms of the departmental model. The question was, how are we going to develop these modules within enterprise imaging similar to radiology in the pathology workflow?

The third aspect is the visual layer. Should it be a universal viewing platform? Should it be a radiology desktop kind of a solution for pathology?

This is how the industry evolved. We have seen recently in our regulatory clearances that have been coming out in the US certain use cases to consider for digital pathology. That’s one of the reasons I’m saying that there are lots of lessons learned in how Europe started with their adoption of digital pathology based on certain clinical use cases, data management acquisition, and the visualization layer. Those are the three components that will help drive the adoption of enterprise imaging further into digital pathology.

EHRs made it possible for clinicians to work from anywhere. How is the profession of radiology changing as their work becomes digital and enterprise imaging becomes more prevalent?

We witnessed that during the pandemic. Enterprise imaging is a modular platform. As part of that modular platform, we have the image exchange portfolio. Besides image exchange, there is the federated image exchange network, so that you don’t need to physically move the data. Our customers started asking us when they started working from home how they could access this desktop on their home environment with the all the tools they require. Little did the customers realize that when they invested in that enterprise imaging platform, which brought them image exchange and collaboration capabilities, it took just a click of a button to enable those collaborative workflows.

When I talk about collaboration, I talk about real-time collaboration. One benefit of building that enterprise imagine platform strategy is that you’re not sending data across to external systems, where you could be exposed to someone interfering or accessing that information. Because you have created this secure system with enterprise imaging on a single platform, you are enabling access to your users if they’re at home to leverage the same capabilities with the same viewing platform on a thin client. We have Xero Universal Viewer, which is cleared for diagnostic reading. It has built-in capabilities and real-time chat collaboration similar to WhatsApp. Within this tool, you can see your colleagues who are online, you can share interesting cases with them, and you can share securely, including with other users who may not be part of your enterprise. It generates a secure image exchange kind of a workflow.

Another thing I spoke about was the federated image exchange. Federated image exchange means that you do not need to push and pull images from one storage to another archive. We could  set up Xero universal nodes so that users are able to view our stream images from an external, non-Agfa PACS, for example. That’s one of the benefits that we have seen our customers appreciating — they were able to build these networks of communication and collaboration not only within their Agfa enterprise imaging environment, but also outside Agfa’s enterprise imaging portfolio, so that they can view those images on a common viewing platform.

The clinical community, radiologists in this case, have realized that these tools are actually much more helping and facilitating in terms of how they view cases and how can they be more productive if they are not on premise. From an IT perspective, we have gone live at certain hospitals in the US during the peak of the pandemic in a rollout of the technology that was also managed remotely. That’s where we saw a lot of collaboration, not only from a clinical perspective, but between the IT segment of the community as well with our customers, where our IT and project management got involved with the customer IT to remotely deploy some of these solutions.

The hype a couple of years ago was that AI would replace radiologists, which has moderated into thinking about how AI can support radiologists. What is the most promising use of AI in imaging to improve patient outcomes?

We started working on AI in 2015 and 2016, when there was all this discussion about whether AI would be of any use in medical imaging. We partnered with some early adopters and explored certain clinical use cases. My first question to our customers was, what problem are you trying to solve? Let’s park AI on the side and first identify those clinical challenges that your healthcare organization is trying to address. Then we can decide whether it is AI or whether it is deep learning, machine learning, automation, or pixel intelligence. What kind of technology could we apply in helping you address those clinical challenges?

We identified certain use cases associated with chronic diseases such cancer care, where we thought — and customers agreed with us — that automation could perhaps help to them in early disease detection or even automating some of the manual tasks that radiologists are performing in some of these clinical applications. When we announced our AI strategy, we called it augmented intelligence, the intersection of machine learning and advanced applications where clinical knowledge and medical data converge on a common platform. AI replaces clinical knowledge or clinicians, while augmented intelligence works with the clinical audience and facilitates their work.

We worked with our clinical users and early adopters to say, let’s define KPIs and see what outcomes we are able to improve. At Agfa, we want to focus on the workflow side of the things. We are an enterprise imaging solution provider and our customers would expect us to use AI data from several AI applications that are being developed in the market and leverage that data to do something. Some of those companies that were creating hype around replacing physicians with AI have disappeared from the market because the claims that they were making were not addressed in use cases.

There are 100-plus AI startups out there. We decided to focus on workflow, because in developing our own AI applications, we realized that a lot more needs done than just reading pixels and images. An AI algorithm developer has developed something very nice, so how can we as Agfa utilize it? We developed this framework for AI that we call RUBEE, whose goal is to embed clinical intelligence into the user’s workflow from five perspectives.

Number one is that AI generates a lot of data. How do you utilize that data and how do you visualize it? How do you show it to the clinical user? Instead of having a radiologist or a clinician use multiple applications or viewers, we have embedded those visual findings from AI into the enterprise imaging portfolio, whether it is the desktop or whether it is the Xero Universal Viewer that I spoke about.

The second and third aspects are the workflow orchestration and triage. With workflow orchestration, AI generates abnormality findings, abnormality scores, measurements, or some other aspects. With the RUBEE engine, we are able to orchestrate certain workflows and automate certain tasks that radiologists are spending time today doing.

When we released our AI package to one of our first early customers, they said that reading a particular CT scan went from taking 15 minutes to being finished in seven to eight minutes. With RUBEE, all the tasks that they were doing have been automated. They know that at the top of the list, these are the abnormal cases that they need to start their work with, these are the measurements that the AI algorithm has generated. With RUBEE, they can see where those specific cases are. We can distribute some of those cases to certain groups of radiologists who are concerned about that specific clinical scenario. That’s where the visualization, workflow orchestration, and triage help achieve certain productivity.

The fourth aspect is automation of all hanging protocols. Radiologists spend a lot of time — when they are reading certain exams, currents, priors, and certain cases — going back and looking at certain prior scans in comparison with what they are seeing now. RUBEE, based on AI findings, automates certain hanging protocols so that radiologists do not need to find a relevant prior scan for this particular patient. Early adopters told us that this is useful and they have appreciated the time savings.

The fifth element of our RUBEE strategy is, how do you communicate reports and results? AI is generating visual findings and you are orchestrating and triaging. How can you save me some time in generating reports? That varies in North America versus UK and Europe, where the use cases are different. In the North American region, we have seen customers are using specific reporting solutions, so we can provide a feed from report that is generated by AI to the reporting engine. In Europe, where customers are using the built-in module for reporting with enterprise imaging, we have created structured reporting within radiology, so that we can extract certain drop-down menus within the report itself. It becomes then easy for radiologists to do a one-click signoff to agree with the report or disagree with the report and generate their own findings.

Morning Headlines 3/7/22

Microsoft + Nuance: Better together to transform business and healthcare outcomes with AI

Microsoft closes its $19.7 billion acquisition of Nuance.

Athenahealth Whistleblower Wins Fees In $18M Kickback Case

A federal judge awards a whistleblower $390,000 for helping the federal government recoup $18.3 million from Athenahealth for paying kickbacks to doctors and other EHR vendors to recommend AthenaClinicals.

Philips and the Philips Foundation provide support for the people of Ukraine

Philips and its foundation will provide a 24-bed mobile hospital and mobile check-up units to Ukraine, and provide financial assistance to displaced citizens.

Monday Morning Update 3/7/22

Top News

Microsoft closes its $19.7 billion acquisition of Nuance.

Reader Comments

From Craptacular: “Re: chief digital officer. Did you see this article claiming they are more important than the health system’s CEO?” I did not, but I’ll throw out this challenge to the author, a doctor-turned-salesperson who has never been a CEO or CDO – prove your premise with an example in healthcare, or any other industry, where the CDO is paid more than the CEO. I’m all for improving the healthcare experience with consumer-facing technology, but the motivation of big-profit health systems is more preservation of the status quo rather than its disruption, thus limiting the CDO’s star power.

A summary of reader comments (paraphrased slightly by me) on Allscripts selling just about all of its non-Veradigm business to Harris:

• The sale price of $700 million was stunningly low. Harris has years of profits ahead by collecting maintenance fees and reducing costs as customers go through the time-consuming steps to replace the former Allscripts products.
• Northwell represents 12.5% of the 2021 revenue of Allscripts, about $188 million. Companies can provide service when they have one big customer like Northwell paying the bills, but that doesn’t work if you have only small health systems to bankroll support and development.
• Harris probably won’t enhance the acquired products, but maybe it is better than Allscripts at keeping the lights on instead of focusing on acquisitions and Veradigm. “Allscripts users will get the cheap corporate experience that comes from harvesting dated enterprise software investments. And they’ll avoid the unfocused, hostile, hot garbage experience that comes from being used as a component to complement another more strategic corporate investment.”
• The last publicly traded EHR company bites the dust.
• The projected revenue drop isn’t surprising, but the company’s projection of a 10-15% drop in EBITDA may suggest that Allscripts has been aggressive on financial engineering around depreciation and amortization, especially on legacy hardware.
• “I could never figure out what leadership was doing on the Allscripts side of the house. DbMotion was declining year-over-year in sites, their Population Health Analytics solution was finally put down after years of not being able to calculate the most basic of conditions or generate a cohort list. The DbMotion solution itself was extremely expensive to configure and maintain, and the resulting data was often — troubled. The Community Integration Agent (CIA) that fed it from the Allscripts product was written by the same team that wrote Avenel. Avenel was a bowl of spaghetti that couldn’t do basic EHR functions nor even Alexa-level transcription. TouchWorks was a hot mess, being passed back and forth between continents, having outside contractors rewriting the middle tier only to have to rewrite it again, then to let the entire team go that worked on the uplift the week it was released.”
• Who wants to take bets that the company will rebrand to Veradigm by the next HIMSS conference and bury the name Allscripts for good?

HIStalk Announcements and Requests

The most common healthcare financial problems that poll respondents had – of those who had any at all – were unexpectedly high out-of-pocket costs or insurance paying less than expected.

New poll to your right or here, which I like to run every couple of years: What’s better about your life now compared to a year ago?

To those sunning in Miami, my sponsors are doing stuff at ViVE they want to tell you about. I would also appreciate getting on-the-ground reports and photos. I’m interested in how ViVE intersects with the co-located but separate CHIME Spring Forum, which is open only to CHIME members and foundation partners, as Russ Branzell explained to me a few weeks ago. Attendee and exhibitor composition, exhibitor satisfaction, and general buzz are the most important aspects of both ViVE and HIMSS for 2022, especially since it’s the first ViVE and the first real HIMSS conference since 2019. I’m curious to see how ViVE’s “hosted buyer” program plays, in which providers must attend eight one-on-one vendor sales pitches to get in free instead of paying $2,500. I’ve been a buyer attendee of similar conferences over the years and it was a great experience for me (expensive accommodations, food, and events for free for attending a few awkwardly misguided pitches) but the vendors didn’t seem to be getting much value in return.

On a HIMSS22 downer note, I’m crestfallen after scanning the exhibitor list that MedData won’t even have a booth, much less use it to bake the scones of the gods.

LinkedIn users – I invite you to connect with me (I approve all non-scammy connection requests) so I can keep up with what you’re up to. While you’re there, please check your headshot and replace it if it’s tiny, grainy, taken at your wedding 10 years ago, or features a distracting background or the obvious presence of poorly cropped out others. We all have phones, so there’s not much excuse for not taking 60 seconds to take and post a clear, identifiable picture on your profile. Omission makes you look careless or ashamed of your appearance, while poor photo quality suggest sloppiness or failure to master basic Internet concepts, both of which are puzzling for someone who bothered to post a profile in the first place. It is surprising how many times I Google for a decent headshot to accompany a job change or company announcement and the Internet comes up blank.

Folks have mentioned some of their HIStalkapalooza memories on Twitter this week. Here’s video from the 2012 version, which I enjoyed more than any other because ESD was a magnificent sponsor, their folks did an amazing job making exactly what I wanted happen, and the scale was manageable. Do you see yourself or anyone you know? I was also checking out photos from the 2015 edition and reviewing the final one in 2017. I just realized that this is the first year since it ended that nobody has emailed me asking for tickets. Update: Lorre read this and let me know that she just received a request to attend this year’s event even though the final one was five years ago, which is actually kind of flattering.

Welcome to new HIStalk Gold Sponsor CTG. The Amherst, NY company is a leading provider of digital transformation solutions and services that accelerate clients’ project momentum and achievement of their desired IT and business outcomes. With more than 35 years of experience in the healthcare industry, it has earned a reputation as a faster and more reliable, results-driven partner focused on improved data-driven decision-making, meaningful business performance improvements, new and enhanced customer experiences, and continuous innovation. CTG has operations in North America, South America, Western Europe, and India. Thanks to CTG for supporting HIStalk.

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

Webinars

April 6 (Wednesday) 1 ET. “19 Massive Best Practices We’ve Learned from 4 Million Telehealth Visits.” Sponsor: Mend. Presenter: Matt McBride, MBA, founder, president, and CEO, Mend. Virtual visits have graduated from a quickly implemented technical novelty to a key healthcare strategy. The challenge now is to define how telehealth can work seamlessly with in-person visits. This webinar will address patient satisfaction, reducing no-show rates to single digits, and using technology to make telehealth easy to use and accessible for all patients. The presenter will share best practices that have been gleaned from millions of telehealth visits and how they have been incorporated into a leading telemedicine and AI-powered patient engagement platform.

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

Acquisitions, Funding, Business, and Stock

Shares in the Global X Telemedicine & Digital Health exchange-traded fund dropped 4.5% in the past 30 days versus the Nasdaq’s 4% decline. EDOC shares are down 11% since the fund’s July 2020 inception versus the Nasdaq’s 26% gain. Its 10 biggest holdings are Illumina, DexCom, Agilent Technologies, Tandem Diabetes Care, Labcorp, Cerner, UnitedHealth Group, Nuance, Omnicell, and Change Healthcare.

People

Lisa Potter (Data Innovations) joins JTG Consulting Group as chief growth officer.

Stephanie Sames, MBA joins Harris-owned PulseCheck as EVP.

Rx. Health hires Neri Cohen, MD, PhD (GBMC HealthCare) as CMIO.

Announcements and Implementations

Vanderbilt University Medical Center describes in a JAMIA article its Clickbusters program that reduced Epic clinical decision alerts by 15%. The ultimate alert success measure is of course whether the clinician changed their behavior as a result of a warning or suggestion, although it gets somewhat murky after that since choosing a “why I’m doing it anyway” drop-down reason is often driven by the easiest-selected choice rather to provide a useful explanation.

QGenda launches ProviderCloud, a scheduling-centric provider operations platform that brings together several of its systems.

Kootenai Health will go live on Epic this month.

Google-owned Fitbit recalls its Ionic watch that was manufactured from 2017 to 2020 after dozens of reports of burn injuries that were caused by an overheated battery.

Philips and its foundation will provide a 24-bed mobile hospital and mobile check-up units to Ukraine. The company will also provide financial assistance to displaced citizens and collect employee donations for a humanitarian relief fund.

Government and Politics

Spokane’s VA hospital warned users on Thursday to stop using its recently implemented Cerner system and to “assume all electronic patient data is corrupted / inaccurate.” The problem forced Mann-Grandstaff VA Hospital to stop new admissions, suspend the filling of prescriptions, and to review whether surgeries could be performed safely. The VA says the system went back online Friday morning. Rep. Cathy McMorris Rodgers (R-WA) says she was told that the problem was a VA database update that was performed to communicate patient demographics with Cerner, which suggests that the Cerner system itself might not have been the problem. At least one veteran reported seeing another patient’s information when they logged in to the patient portal. The VA’s second go-live is set for March 26 and another round is scheduled for June.

A federal judge awards a whisteblower $390,000 for helping the federal government recoup $18.3 million from Athenahealth for paying kickbacks to doctors and other EHR vendors to recommend AthenaClinicals. The company was accused of providing luxury trips to sporting events to decision-makers, paying customers to refer prospects, and paying competitors who were discontinuing their EHR to recommend Athenahealth as a replacement.

Other

A New York Times article notes that customer service chatbots – known for creating a “spiral of misery” of poor understanding and scripted replies — are becoming more helpful and capable of carrying on more human-like conversations. It provides an example in insurer Anthem, whose mobile app is 90% accurate in answering questions about co-payments and medications. Anthem’s long-term plan is to use AI to merge claims, clinical, and fitness tracking data to provide personalized health advice, such as offering people with diabetes the “patients like me” best suggestions for diet, exercise, and medications.

Sponsor Updates

• PerfectServe Values Awards winners include Sales Manager Joe Faso for collaboration, Enterprise Solutions Manager Alex Van Buren for integrity, Customer Solutions Director Cameron Shahnazi for innovation, Customer Success Advisor Courtney Allnutt for service, Deployment Manager Phil Towne for purpose, People Operations & Office Coordinator Kerry Mathews for inclusion, and VP of Customer Solutions Lois Hester for leadership.
• Premier releases a new episode of The Conductiv Podcast, “How Henry Ford Health System is Leading the Way in Supplier Diversity.”
• In England, the National Pathology Imaging Co-operative expands its use of Sectra’s pathology solution.
• Talkdesk is named Cloud Innovator of the Year and Cloud Innovator of the Decade in the 2021-22 Cloud Awards.
• Volpara Health will exhibit and present at NCBC 2022 Annual Interdisciplinary Breast Center Conference March 10-11 in Las Vegas.
• Wolters Kluwer Health adds BioDigital’s 3D anatomy platform to its Ovid medical research platform for an immersive teaching and learning experience.

Blog Posts

• EVisit to Unveil “eAnalyze” Reporting Dashboard at HIMSS22 (EVisit)
• AI and RWD in HCP Engagement – Here’s the Secret to Effective Execution (OptimizeRx)
• Building with empathy: the path to health assurance (Olive)
• The Risks and Rewards of Medicare Advantage Plans (PatientBond)
• 5 Ways to Encourage Employee Engagement in Healthcare (Symplr)
• How to Answer ‘Yes’ to CMS’ New Maternal Morbidity Structural Measure (Premier)
• Attending ViVE? Don’t Miss Quil’s Activities! (Quil Health)
• Are We There Yet? How Payers Can Accelerate the Journey to Value-Based Care (Redox)
• From Founding to Funding: RxRevu’s Relentless Focus on the Provider (RxRevu)
• 5 benefits to recording contact center calls (Spok)
• ViVE, The Industry’s New Health Information Technology Event (Optimum Healthcare IT)
• How unified communications foster employee collaboration and build better customer experiences (Talkdesk)
• Technology Must Be Intentionally Designed to Appreciate Our Differences (Tegria)
• The 2022 Healthcare Workforce Rescue Package (Vocera)
• The Role of the Front Office in Patient Retention (WebPT)
• From Radiology to Urology, Accurate Patient Matching is Critical to Patient Safety (Verato)
• New CMS 2022 Guidelines: Delivering SAFER Care to Drive Better Outcomes (Zynx Health)

Contacts

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

Morning Headlines 3/4/22

CancerIQ Raises $14M Series B Funding to Improve Access to Innovations in Cancer Early Detection and Prevention

Cancer risk assessment software vendor CancerIQ raises $14 million in a Series B funding round.

GTCR Announces Acquisition of Experity

Private equity firm GTCR acquires urgent care health IT vendor Experity.

Spokane VA hospital grinds to a halt after computer system corrupts patient data

Mann-Grandstaff VA Medical Center (WA) has taken its Cerner EHR offline after a service outage due to an issue with patient demographic data forced it to revert to downtime procedures.

News 3/4/22

Top News

Allscripts will sell its Hospitals and Large Physician Practices business segment to Canada-based Harris for up to $700 million in cash. The segment includes Sunrise, Paragon, TouchWorks, Opal, Star, HealthQuest,and DbMotion. It generated 2021 revenue of  $928 million.

The deal is expected to close in Q2.

From the investor call:

• The company sold the business because it has shrunk for three straight years and will likely continue to do so; Veradigm is growing 6% to 7% organically; and managing unrelated businesses under a single corporate structure was becoming increasingly hard.
• Allscripts hopes to “unlock value” of its shares, whose price it feels is discounted compared to peers, by “separating pieces of the company.”
• The business had adjusted EBITDA of $145 million on revenue of $928 million. Management expects the unit’s revenue to drop 3-4% in 2022 and EBITDA to shrink 10-15% year over year.
• The unit being sold generates 60% of the company’s revenue and one-third of its free cash flow.
• Allscripts will use its expected after-tax proceeds of $600 million for share repurchase and potential M&A related to Veradigm.
• Interesting: the investor slides are copyrighted and footnoted as Veradigm, with the name Allscripts only appearing on the title slide.

Reader Comments

From Former Eclipsii: “Re: Allscripts. So just under 12 years after buying Eclipsys for $1.3 billion, nine years after picking up DbMotion, and five years after acquiring Paragon from McKesson, Allscripts is selling its various parts for a loss? When I was at Eclipsys, we had looked at buying Allscripts and decided it wasn’t worth the effort.” Allscripts reportedly paid $235 million for DbMotion and $185 million for Paragon, so Allscripts spent $1.72 billion in acquisition costs alone for businesses that it is selling years later for $700 million, less than one year’s revenue. But wait, there’s more – it threw in former flagship TouchWorks as well. Last week’s earnings call made it clear that Allscripts was unhappy that its share price undervalues the company, a complaint that it makes just about every quarter, and that Veradigm is its future. I would be interested in hearing the reaction of Allscripts customers to the acquisition announcement. Also, what happened to the puffy 2019 announcement that Allscripts and Northwell would develop a next-generation EHR following the never-left-the-ground flop of Avenel?

From Mark Words: “Re: Allscripts. I predict that Harris / Constellation will acquire Meditech next since its business model is exactly what Constellation looks for – mission-critical software, high recurring revenue, and a somewhat stable market position in a mature market. Not to mention that Meditech is pretty strong in Canada and Harris already owns Iatric Systems, which has strong Meditech focus.” I agree it would be a good target. Constellation’s business model would support paying around $400 million for Meditech, which I doubt would entice its owners to sell.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Baker Tilly. Baker Tilly US, LLP is a leading advisory CPA firm, providing clients with a genuine coast-to-coast and global advantage in major regions of the US and in many of the world’s leading financial centers. On March 1, Baker Tilly merged in Orchestrate Healthcare, a multi-year Black Book and Best in KLAS awarded healthcare IT consulting firm. Combined with Baker Tilly’s legacy healthcare practice, their combined practice brings providers solutions for financial sustainability, integration and interoperability, EHR implementation and optimization, healthcare analytics, information security, and healthcare IT staffing. The company’s healthcare IT consultants are seasoned professionals with both a broad range of experiences and a deep understanding of how to listen, analyze, and innovate for process improvement. With over 1,400 healthcare IT engagements from Orchestrate and more than 3,100 healthcare clients from Baker Tilly, the company’s team of healthcare specialists excels at what they do, so your organization can excel at what you do. Baker Tilly is an independent member of Baker Tilly International, a worldwide network of independent accounting and business advisory firms in 148 territories, with 36,000 professionals and a combined worldwide revenue of $4 billion. Thanks to Baker Tilly for supporting HIStalk.

I’ve updated my guide to what HIStalk sponsors will be doing at ViVE next week. You can also download a PDF version. Want to make me look good? Let them know at the conference that you saw them listed.

Speaking of which, HIStalk sponsors who are participating in HIMSS22 should fill out my form by end of day Friday, March 4 to be included in my guide for that conference.

And speaking of HIMSS22, six exhibitors will staff booths of at least 4,000 square feet – EClinicalWorks, Epic, Microsoft, Cerner, IBM, and Athenahealth.

Don’t try this at HIMSS22: I’ve noticed several ViVE-related meetings and social events that will be held on boats. I’ve been on a couple of these in years past and they were fun, although choose your host carefully because you’ll be captive for hours.

Webinars

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

Acquisitions, Funding, Business, and Stock

Cognizant develops a remote patient monitoring solution using Microsoft Cloud for Healthcare.

Cancer risk assessment software vendor CancerIQ raises $14 million in a Series B funding round.

Israel-based research data discovery platform vendor MDClone raises $63 million in a Series C funding round.

Sales

• University of Rochester Medical Center selects Spok Care Connect to replace its operator console and support clinical communications at Strong Memorial Hospital.
• Behavioral health staffing and services provider EvolvedMD will implement NeuroFlow’s patient registry and mobile technology to enrich collaboration with HonorHealth’s 24 locations.
• Orbita and OnCall Health choose Lyniate to solve data-sharing challenges.
• Health Gorilla will incorporate clinically validated social determinants of health scores from LexisNexis Risk Solutions in its Health Interoperability Platform.
• Respiratory remote patient monitoring platform vendor Spire Health chooses Redox for EHR integration.
• Hospice of Wichita Falls will implement WellSky’s hospice and palliative care solution.
• Opioid use disorder virtual care provider Bicycle Health will use Bamboo Health’s Pings and Spotlights for real-time insights into ED and inpatient care utilization.
• Healthwise will integrate First Databank’s Meducation multilingual monographs into its digital point-of-care and patient education solutions.

People

John Chelico, MD, MA (Northwell Health) joins CommonSpirit Health as SVP/CMIO.

Harmony Healthcare IT hires Tamara Korbel, MBA (PDS) as SVP of operations and client experience.

Christine Yang (Stanford Health Care) joins Alameda Health System as VP/CTO.

Laurence Kessler, MPH (NThrive) joins Healthrise as SVP of growth and partnerships. 

Announcements and Implementations

Styker-owned Vocera announces Minibadge, a hands-free, voice-driven communications device for mobile healthcare workers.

Diameter Health releases a technology and services solution for HIEs and data aggregators that are undertaking NCQA’s Data Aggregator Validation program.

CareMesh implements FHIR-based integration of its Navigate clinical program management system with Epic and Cerner. 

VCU Health System went live on Epic on December 2021 with the assistance of CTG, which provided legacy system support, go-live preparation, data conversion, optimization, training, and at-the-elbow support.

CVS Health launches a Health Dashboard to allow people who received COVID-19 vaccination from CVS Pharmacy or MinuteClinic locations to access their record and print a QR code. The company says the dashboard will be expanded beyond vaccination and COVID test records.

Government and Politics

I missed this a couple of weeks ago: a federal jury convicts a Palm Beach, FL psychiatrist for billing private health insurers $110 million for drug urine screenings at a sober living living facility that was taking kickbacks to refer patients. The doctor, who was also the sober living facility’s medical director, wrote standing orders for the facility in exchange for a monthly fee and then had the patients sent to his office so he could bill several tests per week per patient at up to $9,000 per test. We hear a lot about insurers that are powerfully armed with big data capabilities, but how hard would this have been to detect given the dollar volume, the obviously frequently repeated tests, and the fact that it’s South Florida? Maybe this supports the argument that insurers have limited zeal for chasing fraud since it’s easier to raise premiums.

Sponsor Updates

• Cerner President and CEO David Feinberg, MD joins Humana’s board.
• Bicycle Health, a virtual care company specializing in treatment for opioid use disorder, expands its use of Bamboo Health solutions to include Pings and Spotlights solutions for real-time insights into ED and acute inpatient care utilization.
• Impact Advisors celebrates its 15th anniversary.
• Jvion will exhibit at the Rise Summit on Social Determinants of Health March 20-22 in Nashville.
• Kyruus publishes a new infographic, “The Growing Role of Health Plans in the Search for Care.”
• Nordic Consulting has received certification from HITRUST via the risk-based, two-year validation process.

Blog Posts

• Duty of Care for Business Travelers (Everbridge)
• 6 Components of a Vulnerability Threat Management Program (Fortified Health Security)
• A Renewed Appreciation for the Work Commute (HCTec)
• 9 Ways to Address Healthcare Staffing Challenges using Human Capital Management (Healthcare IT Leaders)
• The Importance of Epic Community Connect Service Level Agreements (Impact Advisors)
• The developer experience: how to nurture and retain existing tech talent (InterSystems)
• Managing HCCs for the right reimbursement (Intelligent Medical Objects)
• Will We See You at the ViVE Conference? (LexisNexis Risk Solutions)
• Leveraging AI Principles from Financial Fraud Detection to Identify Medication Errors (MedAware)
• Is Double Documentation Delaying the Delivery of Surgical Care? (Medhost)
• Privileged access management helps mitigate insider threats before they happen (Meditech)
• What is a SOAP Note in Physical Therapy? (MWTherapy)
• How Vanderbilt is improving the physician and patient experience with virtual assistant technology (Nuance)
• Why healthcare leaders should embrace the cloud (Nordic)

Contacts

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

EPtalk by Dr. Jayne 3/3/22

Plenty of HIMSS exhibitors are talking about ways they can support clinicians including through virtual scribes and artificial intelligence. Burnout remains a hot topic, with Medscape ranking the most burned-out specialties. Based on comments from my physician friends, they’re in agreement that burnout is everywhere, with 100% of them using the word “exhausted” at least three times in casual conversation. Medscape surveyed physicians from June to September 2021, so these are pre-Omicron numbers. Top causes of burnout included too many bureaucratic tasks, lack of respect, long work hours, lack of autonomy, insufficient pay, EHRs, and government regulations. Topping the list:

1. Emergency medicine (no surprise due to COVID).
2. Critical care (also no surprise due to COVID).
3. OB/GYN.
4. Infectious disease tied with family medicine.

Beleaguered medical practices have been in the news over the last two years, but there is some encouraging news of a potential rebound. Kaufman Hall’s latest Physician Flash Report shows higher patient volumes helping drive revenue growth in 2021. Physician work relative value units (wRVUs) grew more than 20% per full-time equivalent physician compared to the last quarter of 2020. Primary care practices in particular showed a 13% increase. These increases are partly attributed to patients presenting for care after deferring it during 2020 and early 2021. Unfortunately, expenses also grew, with the metric of total direct expense per physician rising 16% versus 2020 numbers. Word on the street is that physician groups are still cutting salaries and asking physicians to do more because of ongoing staffing shortages. I don’t see these factors positively impacting burnout rates anytime soon.

News of the weird: If you’re a physician, this headline is definitely going to catch your eye – “Healthy Man Dies After Mistakenly Drinking Equivalent of 100s of Coffees.” The patient in question had a misadventure using caffeine powder in his pre-workout drink, resulting in caffeine toxicity. He suffered cardiac arrest and was taken to a hospital, where he ultimately died. A coroner’s report listed his caffeine level at four times that which is considered deadly.

I’ve received several recruiting emails over the last couple of weeks for “a leading Government Systems Integrator” who is in need of multiple clinical informaticists. The opportunities are for a full year with up to 50%  travel “depending on the phase of the implementation.” The job involves “performing assessments and evaluation of workflows and content to support the deployment of EHR systems, facilitate process change and provide change management consulting as well as working with hospitals and/or ambulatory and clinical business units to support deployments. Cerner experience is required, so I’ll give you fewer than two guesses at who is now trying to hire the informaticists to address issues that could have been avoided had they employed the right resources in the first place.

A United States Government Accountability Office report to Congress last month found that the Department of Veterans Affairs didn’t adequately ensure the quality of migrated data as it populated the new Cerner system. Clinicians reported challenges in accessing the migrated information as well as concerns with its accuracy. The GAO watchdog noted that “the challenges occurred, in part, because the department did not establish performance measures and goals for migrated data quality.” As a result, the system being deployed “does not meet clinicians’ needs and poses risks to the continuity of patient care.” There were also apparently concerns with ensuring that clinicians knew what data was migrated and how to find it as well as not having appropriate security rights to see critical patient care data, such as immunizations.

Other concerns included data duplications, errors, and inclusion of a greater amount of data than clinicians actually needed. The bulkiness of the transferred data made it harder for clinicians to find what they were looking for. I’ve worked on more EHR data migrations in my career than I care to remember, and making sure the data is not only accurate but winds up in a place where clinicians can actually use it is critical. The GAO’s findings also illustrate the importance of training to ensure end users can hit the ground running. Role-based training would have been particularly helpful here, as would ensuring adequately trained and staffed super users to support clinicians who may not have fully absorbed all the material during training.

The GAO recommended that the VA adopt performance measures and goals so that data quality meets clinician needs in future deployments. It also suggested that the VA “use a register to improve the identification and engagement of all relevant EHR modernization stakeholders to address their reporting needs.” As a consultant, ensuring stakeholder alignment is critical to the success of any project. I still see way too many projects that don’t adequately balance technology, operations, clinical, and other needs while trying to solve complex problems. I thought a project of this magnitude and visibility might have done better, but it just goes to show that the more things evolve, the more they stay the same.

In travel news, Cleveland Clinic is examining an opportunity to open a patient lounge at Cleveland Hopkins International Airport. The facility would allow construction of a nearly 400-square-foot space to replace seating and Rock and Roll Hall of Fame murals. Staff would help coordinate travel to the hospital and provide support for families and caregivers. Approximately 3,000 patients seek care by flying to Cleveland each year from across the US and from more than 180 countries. The Mayo Clinic has its own welcome center at Rochester International Airport, so hopefully Cleveland Clinic will be able to keep up with the destination healthcare Joneses.

I’m finalizing my HIMSS travel plans and also my evening social plans. Invitations are still a little slow, but that’s to be expected given the concerns about the decline of in-person attendance. Orlando can be a tricky destination for party planning since many of the desirable venues are away from the convention center and hotel areas. At HIMSS19, there was one night when cell service issues created rideshare outages, which was extremely frustrating. Traffic is always horrible, and to be honest, the convenience and location of multiple event venues is one of the reasons I actually like Las Vegas as a HIMSS location (as long as it’s not in August).

What’s your favorite HIMSS venue? Leave a comment or email me.

Email Dr. Jayne.

Allscripts Sells Its Hospitals and Large Physician Practices Business to Harris

Allscripts will sell its Hospitals and Large Physician Practices business segment to Canada-based Harris for up to $700 million in cash.

The segment includes Sunrise, Paragon, TouchWorks, Opal, Star, HealthQuest,and DbMotion. Its 2021 revenue was $928 million. Allscripts will retain Practice Fusion, Professional, and Veradigm.

The companies expect the deal to close in Q2.

Harris is a subsidiary of Toronto-based, publicly traded Constellation Software, which acquires and operates mission-critical software companies with strong recurring revenue. It has sold just one of its 500 acquisitions in its history of more than 25 years. It historically has paid below-market rates for its acquisitions, 0.8 times annual sales, which is the value of this acquisition. It typically runs businesses under their own brand identity and leaves management intact. Constellation’s market cap is nearly $40 billion.

Some of the healthcare software units of Harris are Iatric Systems, QuadraMed, Ingenious Med, Obix by Clinical Computer Systems, and Picis. 

Morning Headlines 3/3/22

Constellation Software’s Harris Operating Group Acquires Allscripts Hospitals and Large Physician Practices Business Segment

Allscripts will sell its hospitals and large physician practices business segment, including its Sunrise, Paragon, and TouchWorks solutions, to Harris for up to $700 million.

Synapse Medicine raises $28 million for its medication intelligence platform

French medication decision support startup Synapse Medicine will use $28 million in new funding to open a spate of global offices, including one in New York City.

Ro acquires sperm collection and testing startup Dadi for $100 million

Online pharmacy and virtual care company Ro acquires at-home sperm collection, testing, and storage startup Dadi for $100 million.

Morning Headlines 3/2/22

Our Next Chapter: Announcing a $50 Million Growth Capital Round Led by THL & Strategic Partnership with Premier, Inc.

Automated healthcare operations technology vendor Qventus secures $50 million in growth capital from investors that include Thomas H. Lee Partners and Premier, which announced a partnership with the company last month.

Cigna Announces Significant Increase to Share Repurchase Program and Capital Deployment

Cigna will provide an additional $450 million to fund its Cigna Ventures venture capital arm, which will be used for investments in analytics, digital health, and care delivery.

Conifer to Remain Part of Tenet with Strong Path Forward

Tenet cancels plans to spin off its Conifer Health Solutions revenue cycle management business due to improved Conifer profit and expectations for increased revenue growth.

News 3/2/22

Top News

Amazon announces that Alexa users can access virtual care from Teladoc Health on its Echo devices. The audio-only service, prompted by the command, “Alexa, I want to talk to a doctor,” connects users to a Teladoc call center. Visits may be covered by insurance or will otherwise cost $75, the same cost as initiating a virtual visit directly through Teladoc.

Teladoc’s stock jumped on the news, which caused some to speculate that Amazon might eventually acquire the telehealth company. Teladoc Health CEO Jason Gorevic said last year that he didn’t consider Amazon a threat to Teladoc’s business since Amazon Care’s business was overrated given its limited client base. That base has since expanded beyond the company’s employees in select markets to nationwide services for its employees and other employers.

Teladoc beat Wall Street expectations with its latest quarterly figures, though its share price has dropped 76% in the past 12 months.

Meanwhile, Teladoc warns in its annual report that its October 2020 acquisition of Livongo has created integration challenges that “will continue to be a time-consuming and expensive process” that could disrupt its business. The company suggests that it will take a non-cash goodwill write-down of between $800 million and $4 billion on the Livongo business in Q1. TDOC, whose market cap is $12 billion, paid $14 billion for Livongo 16 months ago.

Reader Comments

From Cannulater: “Re: HIMSS22. Can you provide a link to your exhibitor tips document that I’ve heard about?” I guess it’s that time of year again. Here you go.

From Ali Cart: “Re: paying for play. How much do you charge for doing an interview?” Zero. Companies can buy only two things from me — an annual sponsorship and webinar promotion – both clearly labeled, neither including editorial involvement. Sites that require payment to interview executives, run vendor-cozy propaganda, and promote white papers apparently hope that readers won’t identify that content as thinly disguised ads, but it’s a credibility karma killer for me. I’ve exited several sites and social media groups lately where the organizer tried to monetize it on the sly by having their ego or wallets stroked silently under the table. Sell space if you want, just have the guts to label it as paid content so we know where objectivity is in question.

From Be There or Be Square: “Re: ViVE conference. Why aren’t you attending?” In a nutshell, it’s too close to HIMSS and too hard (and expensive) to attend anonymously. Attendee reports are welcome.

HIStalk Announcements and Requests

The HIMSS22 web page shows that 74 of the 85 official hotels are sold out of rooms. The exhibitor list includes 945 companies. Sounds pretty bangin’ unless those numbers don’t end up matching the on-the-ground experience.

Webinars

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

Acquisitions, Funding, Business, and Stock

Cloud-based healthcare supply chain software company GHX will fold newly acquired Syft, a vendor of AI-powered inventory control and end-to-end supply chain management software and services, into its value-based care division.

Virtual reality-based healthcare company XRHealth raises $10 million, bringing its total raised to $35 million. CEO Eran Orr, a former Israeli Air Force executive, founded the company in 2016 after experiencing long rehabilitation processes.

Qventus secures $50 million in growth capital from investors that include Thomas H. Lee Partners and Premier, which announced a partnership with the company last month. Qventus, which has raised nearly $100 million, offers AI-powered software to help hospitals automate operations and patient flow.

Healthcare benefits and management platform vendor Nayya raises $55 million in a Series C funding round.

Cigna will provide an additional $450 million to fund its Cigna Ventures venture capital arm, which will be used for investments in analytics, digital health, and care delivery. Cigna says it will focus on repurchasing shares rather than M&A in 2022, but will consider strategic investments and bolt-on acquisitions.

Tenet cancels plans to spin off its Conifer Health Solutions revenue cycle management business due to improved Conifer profit and expectations for increased revenue growth.

Sales

• AZ Sint-Maria Halle in Belgium selects Sectra’s enterprise imaging software.
• The Epsom and St. Helier Hospitals Group will implement Cerner at their four facilities in southwest London.

People

Floyd County Medical Center (IA) hires Cristina Thomas, MBA (The HCI Group) as interim CIO. The hospital is preparing to implement Meditech Expanse in the fall.

Health Gorilla promotes Karla Mills, MS, MBA to COO.

Liza Duncan (Ingenious Med) joins Cloudmed as VP of sales.

David Horrocks, MBA, MPH (CRISP) joins the New York EHealth Collaborative as CEO.

Daniel Chavez, MBA (HealthTech Solutions) joins Santa Cruz Health Information Organization as executive director.

Chuck Suitor, MS retires from MD Anderson Cancer Center after a 26-year IT career, most recently as AVP/CTO.

Swisslog Healthcare, owned by KUKA Group, promotes Cory Kwarta, MBA to CEO of Swisslog Healthcare TransLogic and Hans Schuler, MBA to CEO of Swisslog Healthcare Medication Management. Global CEO Stephan Sonderegger will leave the company.  

Announcements and Implementations

ChartSpan adds remote patient monitoring program enrollment services to its chronic care management offerings.

Hamilton Health Sciences will go live on Epic in June across its 10 facilities in Ontario, replacing Meditech.

Clearwater announces GA of a 405(d) HICP Assessment solution, software, and consulting service that will help providers that have experienced a breach demonstrate that federally-recognized cybersecurity practices have been in place for at least 12 months.

Meditech makes Expanse Ambulatory available to independent and physician-owned practices.

Government and Politics

ONC has received 249 valid information blocking claims submitted through its reporting portal since the regulation took effect on April 5, 2021, with about two-thirds of those issues being reported by patients and most of them involving providers. The most common complaint of both patients and providers was being excessive charges or delays in obtaining patient information, with providers additionally reporting problems getting their EHR vendor to assist with migrating data to a replacement system. ONC will update its status page monthly, although it won’t indicate whether investigations have been opened or concluded.

Sponsor Updates

• Amazon features AdvancedMD in an AWS case study, “AdvancedMD Reduces Time Spent Managing SQL Server Backups by 85% Using Amazon FSx.”
• Actium Health releases a new Hello Healthcare Podcast, “Why Good Brands Go Stale ft. Jared Johnson.”
• Bluestream Health publishes a new case study, “Heritage Valley Health System Needs an Embedded Virtual Care Solution.”
• Current Health publishes a white paper, “Rapid Evaluation of the Virtual Ward at Croydon NHS.”
• Dina will exhibit at the Rise National Conference March 7-9 in Nashville.
• Ellkay will present at the Rise National Conference March 7-9 in Nashville.

Blog Posts

• ECR 2022 – Bringing innovation to you (Agfa HealthCare)
• What I’ve Learned About Leadership as A Woman, A Respiratory Therapist and a Business Executive (Ascom)
• UDS “Season” 2021/2022 is in the Books! (Azara Healthcare)
• Summary of “988 is Coming!” webinar focused on the new mental health crisis number and how states are preparing (Bamboo Health)
• The Real Reason Behind the Growth of Decentralized Clinical Trials? It’s the Patients (Biofourmis)
• Healthcare IT Service Desk: Driving Beyond Customer Satisfaction (CereCore)
• Additional EHR Data Privacy Key for Consumer Data Sharing (ChartLogic)
• The Solution to Remote Patient Monitoring’s Fatal Flaw That All Providers Should Know About (ChartSpan)
• Fax, Phone, and EPA: Why Do Care Teams Balance All Three? (CoverMyMeds)
• UMass Memorial Health: In-Home Hospital Care Focused on Equity (Current Health)
• The Network EHR, Prisma, and Beyond (EClinicalWorks)
• Protecting patient identities as QR codes open up new cybersecurity risks (Experian Health)

Contacts

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

Morning Headlines 3/1/22

Teladoc spikes on partnership with Amazon for virtual care on Alexa

Teladoc Health’s stock jumps on the news that Amazon has tapped it to provide virtual consults to Alexa users via its Echo devices.

Office Practicum to Offer the Market’s First “Whole Child” Digital Healthcare Platform

Pediatric health IT vendor Office Practicum acquires RemedyConnect, which offers telemedicine, an after-hours answering service, and website and marketing services for pediatric practices; and pediatric behavioral health EHR and RCM vendor NextStep Solutions.

Global Healthcare Exchange Enhances Automation, Data Analytics and Inventory Management Capabilities with Acquisition of Syft

GHX will fold newly acquired Syft, a vendor of AI-powered inventory control and end-to-end supply chain management software and services, into its value-based care division.

XRHealth Secures $10M in Funding to Expand Virtual Reality Healthcare Treatment in the Metaverse

Virtual reality-based healthcare company XRHealth raises $10 million, bringing its total raised to $35 million.

Readers Write: It’s Time for the EHR to Give Back to Clinicians

It’s Time for the EHR to Give Back to Clinicians
By David Lareau

David Lareau is CEO of Medicomp Systems of Chantilly, VA.

Recently, a colleague (who just happens to be an MD) relayed a story after accompanying his 93-year-old mother to a routine check-up for wet macular degeneration. She had been recently discharged from the hospital after an episode of atrial fibrillation, for which she was put on an anticoagulant. At the retinal specialist appointment, the patient access / intake representative was told of her A-fib episode and the medication change, which was dutifully entered into the medical record.

Fast forward to 10 minutes later and 50 feet down the hallway in the exam room. The retinal specialist enters and asks if the patient is ready for her regular injection in her eye. Naturally, the patient’s MD son raises the red flag and asks if she had consulted the medical record. The doctor acknowledged that she had, but didn’t see what had changed.

Granted, very few folks have an internist son who can accompany them and act as a personal medical record interoperability specialist. But the message is clear. Here we are, some 40 years into the EMR age, and many of the same old interoperability and usability issues that plague these systems are still with us.

Fortunately, progress has been made and is escalating. It’s been a quiet, behind-the-scenes process, but it’s happening. In 2003, the government approved national terminology standards, including SNOMED and RxNorm, and others have followed. Then, in 2009, with the HITECH Act, some $40 billion were distributed to promote and expand the use of electronic health records. And in 2012, the FHIR standard first emerged as a way to exchange information. The groundwork was laid, and this has accelerated in the last three years with increasing adopting of FHIR. The potential for incremental innovation and the acceptance that things need to change is encouraging.

Over the past few years, the COVID-19 pandemic has shown that clinicians need better data. People have become comfortable with virtual visits. As a result, physicians, particularly those in primary care treating Medicare patients, are losing much of the high-touch environment of the past and need faster access to better data. But the industry has been slow to adopt the sharing of information because there was no mandate. This all changed with the advent of the 21st Century Cures Act.

The widespread adoption of FHIR over the past two or three years has enabled us to diagnostically connect information that has spread throughout disparate systems. And now with the Trusted Exchange Framework and Common Agreement (TEFCA) to establish the infrastructure for information exchange, it’s increasingly possible to find clinically relevant information, transmit it, and access it at the point of care.

Ultimately, dramatic change will be driven by the management of chronic conditions within Medicare Advantage, the government’s move to value-based care. Reimbursing providers for how well they manage conditions and control costs will accelerate the need to provide clinicians with the clinical information connected to the diagnoses they’re trying to treat.

Medicare Advantage now accounts for 42% of all Medicare patients, a figure that the Congressional Budget Office predicts will rise modestly to 50% by 2030 given no changes in policy or structures. Meanwhile, the Centers for Medicare and Medicaid Innovation recently issued a statement saying that their aspirational goal was that 100% of Medicare patients be on these managed plans by 2030. They admit they won’t get reach this goal, but that tells us that they are not completely comfortable with the current policy. They want to accelerate the adoption of Medicare Advantage, which is really all about managing patients’ chronic conditions.

This is important because commercial payers historically have followed the Medicare model for reimbursement.

For all the advances and progress in interoperability and usability, challenges remain. There’s been a lot of talk about AI, machine learning, and letting the computer figure it out. These are promising technologies, and there are initiatives underway involving ambient listening and clinical notes. Despite progress on this front, clinical notes remain just the way they were several years ago––a bunch of text. It may be advancing, and it’s helping the clinician to do their work, but it’s not really giving anything back to clinicians. That is one of the things missing in our industry. Systems have been designed over the years to simply collect billing data, as opposed to giving something back to the clinician that uses them.

This raises the question of usability.

If you think back to the story about my colleague’s mother, the system was so unusable that the clinician had a hard time looking at an updated problem list. Usability is coming to the forefront because clinicians are simply getting tired. They talk about it. There are studies showing that systems that are not usable or clinically relevant, or giving something back, are burning physicians out. We can, and must, do better.

Usability, interoperability, the Cures Act, and TEFCA are all converging along with the accompanying data tsunami (and, yes, it will be a tsunami) to change the way we use healthcare data. Thankfully, we have a FHIR standard that appears to be the platform for interoperability going forward. And there are technologies available and in the works to make the flood of data usable at the point of care. Clinicians to need to be able to see that data and act upon that data.

With the move to value-based care changing the focus of the industry to “How do I best manage this patient and get better outcomes for each of their clinical conditions?” we see a wave of innovation being unleashed. That wave is spreading to existing systems and infrastructures, and it enables the industry to respond.

Modernizing these systems so that they give something back to the provider at the point of care is the goal. We are excited about the possibilities for innovation and the acceptance that things need to change.

Curbside Consult with Dr. Jayne 2/28/22

I spent the week wading into the world of post-operative care at home, as I stayed with a friend who is recovering from surgery. I know plenty of people in healthcare who are enthusiastic about discharging patients quickly and getting them home to recover. It certainly cuts down on the risk of hospital-acquired infections and can help patients psychologically as they return to a familiar environment. However, it can be challenging for people who don’t have family or other support, and I think we sometimes overlook those factors when we’re considering hospital at home and other initiatives.

My friend is a physician who had the misfortune to severely injure her knee on an escalator at a London tube station several months ago. She initially had difficulty being scheduled for an orthopedic evaluation due to the rise of COVID cases last autumn, and once she jumped through all the hoops and was able to get an MRI and a definitive diagnosis, her health system had stopped performing any elective surgeries. Her planned recovery was complicated by the fact that she needed to be non-weight-bearing for six full weeks, compounded by the fact that she is single and has no family in the town where she practices. She also lives in a two-story home, so had to think about that in her recovery plans as she worked to figure out what her strategy might be. Even though she is a physician, she hadn’t had surgery before and wasn’t sure what to expect regarding post-op pain or other potential complications.

Her large, multi-state health system has a hospital near her parents, so she was able to have her local physician arrange for an orthopedic surgeon in the other city to review her studies. Following a telehealth visit, he agreed to perform the surgery once scheduling opened up again. In the mean time, due to the physicality of her job (she is also a surgeon), she was unable to do her usual work duties, which was stressful. Once the hospital started scheduling elective procedures, she was finally able to get on the schedule due to a cancellation. The operating surgeon’s office arranged to have a variety of medical equipment delivered to her parents’ house, including a wheelchair, walker, ice circulating machine, continuous passive motion machine, and more. By the day prior to surgery, only half of it had arrived, which created stress for everyone. On the day of the procedure, her parents had to decide who would stay home and wait for the rest of the equipment and who would accompany her, which added to the stress.

Fortunately, the procedure went well, and by the time she arrived back at home, nearly all the equipment had arrived. For someone non-medical who isn’t used to making follow-up calls, having to track down the rest of the supplies would likely have been more stressful than it was for her. She wasn’t having to use a lot of opioid pain medications, so she could advocate for herself on the phone, but not everyone is in that situation postoperatively. At least the magic ice machine had arrived, so she was able to rest without worrying about changing out ice packs. The next day, when she got ready to use the passive motion machine, she noticed a discrepancy between the instructions she had been given before the procedure and those in her discharge instructions, which led to a call to the surgeon’s office and difficulty getting a straight answer. She also began doing injections of blood thinners due to her forecast immobility. As a physician, not a big deal, but probably more challenging for other patients.

Prior to the procedure, my friend had suspected that two weeks with her parents would be more than enough family bonding, so she arranged for friends to help during the next few weeks after she returned to her own home. She had set up an inflatable guest bed in her first floor living room, and fortunately her home has a full bathroom on the first floor. Unfortunately while she was away, the bed had sprung a leak, leading to an emergent online order and a Target run by her next caretaker. After getting that situated, she had to figure out logistics for navigating the house in a wheelchair when the house hadn’t been adapted for it. Doorways were too narrow, the laundry room was impassible, and there were a couple of other challenges they had to work through. She would have liked to use the walker more, but was having some wrist pain after a slip while transferring, prolonging the use of the wheelchair. Fortunately, her friend was able to stay for several days until I arrived for the handoff.

By the time I came on the scene, they had figured out quite a few ways to further adapt things, including just storing dishes on the countertop versus using cabinets and rearranging the refrigerator to make things more accessible. As a physician with a good income, ordering takeout or grocery delivery wasn’t an issue, but we discussed how a lot of our patients don’t have that option. Not everyone can put their frequent flyer miles to use and fly someone across the country to stay with them or have the relative luxury of paying a neighborhood kid to manage trash and recycle cans. Not to mention, what if she had been the primary caregiver for children or another adult? Without this level of support, patients might elect not to have a procedure, especially if they don’t have paid sick time to cover the entirety of their recovery.

Because of the nature of the procedure and her pre-existing good health, my friend wasn’t eligible for any kind of home health or other services. Due to the pandemic, her physical therapy was delivered via video visit, removing another possibility for personal contact. Although I did enjoy following along with the video PT and seeing what another EHR’s technology looked like, it made me think quite a bit about what this experience looks like for other patients who might not be as tech savvy or medically aware. She was also fortunate to not have any postoperative complications, so it was relatively smooth sailing while I was there. She’s not scheduled for an in-person physician visit for another two and a half weeks and I was surprised that the orthopedic surgeon’s team hadn’t followed up with her to see how she was doing.

I handed off over the weekend to one of her physician colleagues, who came to stay for a couple of nights while her own family was out of town. Those days will get my friend to the end of the four-week milestone and she’s feeling more confident about being alone, although still worried about what would happen if she fell and no one else was around. Hopefully the rest of the six weeks will be uneventful, but we both know that’s when the real work starts, as she has to start using her leg again and figuring out how to get the strength back to spend long hours in the operating room. While I was there, she got to experience a taste of what being a CMIO looks like and admits she doesn’t envy the eight hours of calls and meetings each day. I’m glad I was able to help, but it did give me quite a bit to think about as I help my clients with their telehealth and in-home care strategies.

Have you experienced hospital at home, or a prolonged recovery? What did you think, and how did your caregivers fare? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Kevin Field, President, Clearsense

Kevin Field is president of Clearsense of Jacksonville, FL.

Tell me about yourself and the company.

I joined Clearsense in 2017. Prior to that, I spent nine years working at Epic as a implementation executive, where I oversaw major EMR implementations here in the US as well as international. It was a fun time helping these healthcare organizations go through the adoption of enterprise systems to help with their medical records and the processes around that.

When I looked at healthcare IT as a whole, I started recognizing that there was a whole lot of data that we were collecting — certainly within the hospital, but also outside — and we weren’t necessarily taking full advantage of everything that we could do with it. Clearsense is focused on being able to intelligently take all of that data that exists within that ecosystem of health and applying it in a meaningful way to change the way that we can operate in healthcare. That can be through operational-type use cases or improvements, clinical, financial, and even population health. We are focused on how we can make it easier to work with all of that data and get it into the right hands to drive change.

What are the most common use cases you are seeing?

Data exists in a lot of areas. People are trying to get to more of that prescriptive medicine and thinking about ways to impact the care itself. But there’s a lot of operational improvement that can be a good starting point. We see a lot of healthcare organizations start with rationalizing their applications. It sounds so simple, and it’s not nearly as enticing as some of the more advanced predictive types of use cases, but it’s a practical one, helping organizations take a look at their current portfolios to be able to offload a lot of that data. We work with them to make sure that they can maintain the integrity of it, because there’s still a whole lot of valuable information that exists when you’re looking at these historical systems. We see a lot of groups starting with being able to shut off some of the historical applications and be able to recoup or avoid some of the costs that come alongside of that. That’s a great starting point for a lot of groups.

As they continue to evolve, though, it’s really as big as you can think. You can start to apply this data for research, to advance the ways that you can get from a data-driven hypothesis to applying that in an operational setting. That could be anything from throughput to advanced heart failure, any sort of use case set that applies to this area. But what we focus on, and where our industry needs to focus first and foremost, is how to build trust in data. Before you can do any sort of analytical work, before you can do any sort of meaningful work, you have to build up that trust. That’s the foundation.

Are health systems struggling to effectively use the data that they capture in their IT systems?

Unfortunately, when healthcare systems were forming and data was being designed, there was no master plan. Every single application that these hospital groups operate has come up with its own way to identify data and be able to aggregate and and organize it. That has left is mounds and mounds of data spread across hundreds if not thousands of applications within these provider groups, but no way for them to create a source of truth. It’s a confusing area when you start to look at this data.

A lot of healthcare provider groups have captured a lot of data, but maybe they don’t exactly know what they can do with it, or how to get it organized. Step 1 is being able to build up data literacy, the ability for people to understand data, understand definitions, understand what’s possible with it, be and able to challenge it and look deeper into it. If you’re able to start to work in that capacity, then you have the ability to create initiatives around normalizing that data or curating that data and starting to develop some level of truth in that data so you can apply it.

How does healthcare stack up to other vertical markets in its performance on data maturity models?

Certainly if you look outside of healthcare, there’s a lot of good literature and good practice of ways to build up that data maturity. A lot of organizations are starting to look at that more seriously. Some maturity models are specific within healthcare as well. Even some of the advanced or healthcare groups that we talk to, if they are being honest with themselves, have pretty low maturity levels.

Much of the time, healthcare organizations are trying to get meaningful information out of reports.  That’s foundational for the rest of the work that takes place. There’s a lot more that is possible when look at that data in a way that is more forward-looking, more universal, or taking into consideration the data that exists in other systems. There’s a lot we can solve for if we put all that data together appropriately and apply the right lens.

Groups are starting to think about how to evaluate themselves on data maturity. Some groups are hiring chief data officers or chief digital officers and starting plans for a data maturity program. But the reality is that data maturity is an evolution. It will be an ongoing cultural shift for these organizations. It’s about building a culture around data for an organization, understanding the value of it, and then building practices around it to continue to evolve and mature. There’s never moment of, “Hey, we’ve reached the top of data maturity and we’re good now.” It’s a constant evolution.

What is the role of data scientists in health systems?

Data science will be critical for the future of healthcare. We’ve seen that in other industries, where they bring data science as a practice and a staple to drive things forward. Healthcare’s challenge is that there’s not a large number of data scientists who are healthcare specific. Even if healthcare organizations can get those individuals into their systems, providing them access to the data in a way that is meaningful is a challenge. The velocity which they can operate is also challenging.

We’re going to see a lot more healthcare organizations becoming interested in data science. The next step for it to be widely adopted is making it more accessible. We’re going to have to work to continue to have technologies and processes come in that allow for data to be more trusted and more centrally available, and also for data science type initiatives to be more approachable. There are some good examples out there if you look up technologies that are starting to evolve and emerge that can be applied in that space. 

That’s going to be what allows us to shift the way that we think about data and healthcare — having people taking a look at it, look for trends, understand what could be coming up or what events are happening, and then ultimately being able to look backwards through that so we understand the drivers so that we can prevent those or catch them earlier. Transparency and trust, again, in data and in the models being created are going to be key for adoption for data science and healthcare.

The challenges I’ve seen are getting information into the hands of frontline decision-makers quickly and avoiding turning the process into a mysterious black box where some IT basement guru manipulates raw information in unknown and potentially unsound ways. How does that fit into the culture of using data and the tools needed to manage it?

A lot of that comes from being able to establish lineage in data, which is critical. When I say lineage in data, by the time you are serving up some insights or results out of a data set or analytical workflow, you have to be able to show exactly where that data came from. If you want somebody to consume it, you have to be able to build that trust up with them and be able to trace that data back to the source. Lineage is absolutely critical and key.

While you’re working on the governance of the data and decision-making on that data, it’s important that the people making decisions on data — what fields are trustworthy and which systems are providing the right information – are making those decisions along with the appropriate data stewards in the healthcare organization. If you are working with a radiology department and radiology data, it’s important that the people from that group have input to understand exactly which data elements are most relevant or which systems are most accurate. By the time you are able to have that output, if you’re not getting those decisions made by some of the true operational owners and the business owners, it makes it challenging for people to trust it.

A lot of orchestration has to take place. Lacking of any sort of black box has to be part of that. Having those IT groups or data scientists who are working in the basement interacting and understanding the data that they’re working with and the people that they’re ultimately serving it up to. If you involve them in the process, there’s a lot better chance for trust and adoption.

What C-system health system roles are being given responsibility for data and analytics?

I’m seeing a couple of flavors. There is a spectrum of CIOs. There are CIOs who are more the traditional type who have come to own a lot of the technologies and applicationse. Maybe that’s the world that they continue to operate in. There is another grouping of CIOs that I’ve noticed recently that have realized or recognized that a lot of the healthcare organization’s data sits within the systems that they own, and they are becoming more strategic and more of that operational driver. I’m seeing chief data officers or chief digital officers typically reporting directly to a CEO or a COO. 

From a data science perspective, organizations are looking at ways to get data scientists more decentralized so that individual business units don’t have to wait in an IT queue to have their initiatives prioritized and to get results. Having access to the appropriate data and technologies to get better or more timely results and to to get those results ongoing as applied to specific areas will be important.

What developments will be important to healthcare and to your company in the next few years?

We are going to get data into the hands of the people who are using it. We’re going to build up a culture around data literacy and applicability that will change the way that we operate. We operate so frequently on historical information or reports or looking backwards. As technologies catch up and as a culture of working with data catches up, people will be more proactive and more capable of working with data to solve problems.

It was in the 1990s when latex gloves were adopted into healthcare setting as standard practice. That seems almost shockingly recent. When we look back on today from the future, we will recognize that we had the answers to a lot of our most challenging healthcare problems or questions and just needed to apply the appropriate lens. The future is heading to getting that lens on the data to have new perspective on the problems that we have today and coming up with data-driven ways to provide results.