Monday Morning Update 10/11/21

Top News

The VA hires an independent body to review its Cerner implementation and to provide an estimate of the project’s full cost. It expects to see the results in 12 months.

The VA hopes that the review will finally capture all of its project-related expenses, including infrastructure upgrades that were omitted from previous estimates due to inconsistent cost tracking methods across its organizations.

Conducting the review is Institute for Defense Analyses, a non-profit that administers three federally funded research and development centers.

The most recent cost estimate was $16 billion versus its initial $10 billion price tag. 

Reader Comments

From Critical Mass: “Re: Optum-Change Healthcare merger. Survey your readers whether it should be allowed and why or why not.” I don’t know that many or most readers have an opinion either way and I question whether a yes-no poll would be enlightening, but feel free to click the Comments link and add your thoughts.

HIStalk Announcements and Requests

About one-fourth of poll respondents have faxed something in the past six months, most commonly to a physician’s office and rarely to a hospital. My own experience matches that of poll comments – don’t even bother trying to enlighten the front desk person why it doesn’t make sense that the practice will accept only faxes while refusing emailed scans that they could print. I think it’s probably as much laziness as anything else since it’s easier to make the sender jump through hoops in trying to set up a free online faxing service while the recipient just occasionally wanders by the fax machine to see what’s new. Office Depot still sells exactly one model of fax machine (a pretty slick Brother for $200) but you would need a plain old telephone line that is increasingly uncommon.

New poll to your right or here:  Who is most responsible for physician dissatisfaction? Remind me to run the same poll for nurses next week.

It’s nearly that time of year when I should be registering for HIMSS22 and booking somewhere to stay, but I have to say that the lackluster HIMSS21 makes me at least consider bailing for the first time in many years.

Webinars

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

Sales

• In Portugal, Unilabs chooses Sectra’s enterprise imaging solution.
• Colombia’s Clínica Imbanaco joins the TriNetX global health research network.
• SSM Health will outsource technology-focused inpatient care management, digital transformation, and revenue cycle management to Optum, rebadging a reported 2,000 SSM Health employees.

People

Heather Nelson, MHA (University of Chicago Medicine) joins Boston Children’s Hospital as SVP / CIO.

Memorial Healthcare System (FL) promotes Jeffrey Sturman, MHA from CIO to SVP /chief digital officer.

GE Healthcare promotes Catherine Estrampes, MBA to president and CEO of US and Canada.

Announcements and Implementations

China’s largest retailer, JD.com, extends its telehealth services from humans to pets. JD Pet Hospital has signed up 3,000 veterinarians who provide 24×7 online consultations and connect users to in-person providers. The company says it will attempt to solve problems such lack of industry standards, price transparency, and availability of timely services.

Other

I took a look at productivity software Notion after reading that the company’s valuation has reached $10 billion, bolstered by viral TikTok videos by users – many of them of Generation Z – who are happy to have a minimalistic team workspace tool for remote work. I don’t know how it stacks up against its many competitors, but it looks interesting. The personal version is free and a team edition is $8 per user per month.

Sponsor Updates

• Diameter Health names former Anthem BCBS executive Jill Hummel to its board as an independent director.
• CHIME announces incoming board members and 2022/2023 board officers.
• OptimizeRx joins the S&P 600 Small Cap Index.
• PatientBond surpasses company growth and patient engagement results milestones.
• Spok publishes a new infographic, “The state of healthcare communications.”
• Vocera receives high ratings for demonstrating positive outcomes in the latest KLAS report, “Clinical Communication Platforms 2021.”
• Zen Healthcare IT publishes “The Zen Guide to Mirth Connect for Vendors.”

Blog Posts

• Intelligence at Work: Avicenna.AI detects and prioritizes suspected intracranial hemorrhage and large vessel occlusion via Nuance AI Marketplace (Nuance)
• Why We Need to Go Back to the Future with Hospice (Netsmart)
• Informational parity is the key to better value-based care agreements (Nordic)
• Integrating Patient Engagement Technology Within a Care Plan (PatientBond)
• Texting Drives 600,000 Patients to Engage in COVID-19 Vaccination Scheduling at Hartford HealthCare (Upfront Healthcare)
• Integrated Delivery Networks as “Payviders” Aim to Succeed at Value-Based Care (Symplr)
• Therapeutic Drug Monitoring and the Patient Adherence Dilemma (PMD)
• PINC AI Data: Rising Healthcare Utilization and Costs Linked to Persistence of Severe Acute Kidney Injury (Premier)
• One Cancer Organization’s Journey Toward Key Compliance Efficiencies (Protenus)
• Overcoming Common HCC Coding Challenges Part 3: Making the Case to Leadership to Expand HCC Coding Efforts (RCxRules)
• Cyber Risk and Patient Safety: A Tragic Call to Arms (Clearwater)
• Allow Patient Appointment Requests from Anywhere at Any Time (Sphere)
• From Health to IT, with love (Talkdesk)
• Ready or Not, Here They Come: How to Maximize Your Tech to Meet High Patient Volumes (WebPT)
• FQHC Reduces Abandoned Calls with Call to Text Business Messaging (Well Health)

Contacts

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

Weekender 10/8/21

Weekly News Recap

• Virgin Pulse announces that it will acquire Welltok.
• Healthcare Triangle revises its $40 million IPO plans down to $21 million.
• Carbon Health acquires remote patient monitoring tools vendor Alertive Healthcare.
• Evolent Health acquires Vital Decisions.
• Cerner launches RevElate, which will be its single go-forward patient accounting system.
• Three large health systems launch Graphite Health, a non-profit that will help member organizations with digital health solutions.
• Quality measurement and clinical intelligence platform vendor Apervita shuts down.
• David Feinberg, MD, MBA takes the helm as president and CEO of Cerner.
• Cerner, reversing its previous position, will require US employees to be vaccinated by December 8.

Best Reader Comments

If all that Jobs + Woz had done had been the Apple I & II, they would have been important. Add in the Mac and they became industry leaders. Now add to that the iPhone, iPod, Apple Music, iPad, and more. Jobs also had those interesting side projects of NeXT and Pixar. Thank goodness that Jobs didn’t fade away during Apple’s low point in the 1990s. (Brian Too)

Many people, especially those with serious mental illnesses, have very brittle illness, just like a brittle diabetic. No one would think of terminating a brittle diabetic from care just because their glucose levels are under control by one or more glucose measurements. So why are we even discussing the “benefits” of “measurement based care” in making quicker transitions and terminations of care for those with psychiatric disorders for whom we know that a stable consistent therapeutic alliance is just as important (if not more so) than in other clinical contexts. Perhaps, in addition to the other barriers to using patient reported outcomes in mental health treatment, clinicians are being understandably cautious in trying to protect their patients from even greater harm and outright discrimination and victimization by insurers and others. (Concerned clinician)

I don’t know anything about Apervita, but it seems like an extremely consulting heavy business, one that wants to be product-like. In my idea of consulting’s business model, lots of senior rock star consultants are the exact opposite of what you need for product-based consulting. Implementing quality measures seems very similar to the most common type of consulting business: implementing new accounting practices and performing accounting audits. The big accounting firms know that this work does not require rock stars. It requires a few senior people to sell to the C suite and verify juniors’ work, and it needs an army of juniors to do piles of grunt work for a manageable cost, which in turn necessitates a hiring pipeline so you always have a fresh crop of juniors to replace the attrition of juniors aging into seniors, being poached, or otherwise leaving. The most successful companies in the accounting consulting market are the ones who are the best at hiring and managing lots of juniors. (IANAL)

I tend to refer to HR, legal, and marketing as the “pink ghetto.” It’s unfortunate, really. It’s difficult to be CEO when you haven’t been responsible for P&L. (Pamela)

Will having someone with informatics experience directing the Joint Commission make it more or less likely that they will continue to (1) Demand more EHR documentation that doesn’t help patients but burns out clinical staff; (2) Require use of “evidence based” scales for which the evidence of actual benefit is weak (e.g. C-SSRS); (3) Terrorize organizations with the threat of impending visits while they are just trying to stay ahead of a raging pandemic. Yes, I understand that the Joint Commission is just doing what CMS tells them to audit, but it’s also clear that they have a neat little racket going, frightening organizations into paying for their consulting services in the hope of not getting dinged in the next visit. Has anyone actually examined the evidence that the CMS conditions of participation and the other Joint Commission requirements are actually worthwhile? Perhaps health care organizations should band together and just say no to JCAHO.  (Joint question)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. C in North Carolina, who asked for headphones and teacher motivational stamp for her combined kindergarten and first grade class. She reports, “Thank you so much for your generosity to our classroom. Our school has IPads that our students use for independent reading and lessons. With kindergarten and first grade students, they are able to have the iPad read aloud to them. Unfortunately it becomes very disruptive for the students to focus on their lesson when the student next to them is listening to a lesson. The headphones allow the students to focus on their own lesson. Focusing on their own lessons and reading will allow them to be more successful in the classroom.”

A Virginia woman’s tweet earns puzzlement and scorn for the US health system from Twitter users in other countries who understandably misinterpret the hospital’s charge description for CPT 96127,  a short mental screening questionnaire whose full description is “brief emotional / behavioral assessment.” Those Twitter users are directionally correct in their brief emotion at how our health system differs so wildly from theirs and the rest of the civilized world – a company has turned CPT 96127 into a business by selling quiz software that doctors can use to generate up to four of the charge items per patient visit.

Federal agents arrest 18 former professional basketball players who are charged with defrauding the NBA out of $4 million by submitting fake medical claims for reimbursement. They were caught because of mistakes they made in creating the claims, such as one player claiming that he had dental work in Beverly Hills during a week he was playing in Taiwan. Others may have recalled their college days when they copied each other’s claims, with multiple players declaring that they had the same dental procedures performed on the same six teeth on the same days. 

A St. Louis children’s hospital doctor follows through on her promise to a nine-year-old with aplastic anemia that if a bone marrow transplant caused the girl’s hair to fall out, she would shave her own head. She even let the patient do the honors.

In Case You Missed It

• News 10/8/21
• EPtalk by Dr. Jayne 10/7/21
• News 10/6/21
• Curbside Consult with Dr. Jayne 10/4/21
• Readers Write: The Key Ingredient to Improving Outcomes in Behavioral Health: Measurement-Based Care
• Readers Write: Obesity and Beyond: How Digital Therapeutics Are Shaping the Future of Managing Chronic Diseases
• HIStalk Interviews Bob Bailey, Founder, Healthcare IT Leaders
• Monday Morning Update 10/4/21

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Morning Headlines 10/8/21

Virgin Pulse to Acquire Welltok to Advance Health Activation Capabilities; Accelerate Expansion Across Health Systems, Health Plan and PBM Markets

Member engagement and wellness app vendor Virgin Pulse will acquire Welltok, which offers analytics-powered multi-channel healthcare communications.

Aspirion Health Resources Announces Combination with Advicare

Revenue cycle management vendor Aspirion Health Resources acquires Advicare, which resolves clinical denials.

Healthcare IT platform Healthcare Triangle slashes deal size by 55% ahead of $21 million IPO

California-based health IT vendor Healthcare Triangle revises its $40 million IPO plans down to $21 million.

News 10/8/21

Top News

Member engagement and wellness app vendor Virgin Pulse will acquire Welltok, which offers analytics-powered multi-channel healthcare communications.

Virgin Pulse, which has made several acquisitions, is owned by Morgan Equity Partners, which was reportedly shopping for a buyer for the company in early 2020 at $2 billion. It acquired the company from Sir Richard Branson’s Virgin Group in mid-2018 and merged it with digital coaching company RedBrick Health.

Welltok has raised $262 million in funding, most recently a Series E round in July 2020.

Reader Comments

From TAA-Da!: “Re: Ascension IT. Another WARN notice, now approaching 1,000 employees since August. Why does it seem like all this outsourcing is invisible to most people?” Most people pay only casual attention to layoffs and/or outsourcing unless they have direct connections to those affected or the companies involved, especially since cheap-seats opinions are unlikely to reverse the course anyway. There’s also limited benefit to recognizing a possible trend unless you, as an employee who might be affected down the road, have options for mitigating your risk. Lastly, the outsourcing pendulum often eventually swings back for at least some jobs because cost savings and quality were overpromised.

From Nordic Viking: “Re: Cerner. Seems like they are losing ground in the Nordics since the City of Jyväskylä just announced that they withdrew from the Central Finland Cerner program. It will for sure have a negative impact on the already troubled and delayed projects in the South of Sweden.”

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor OneMedNet. The Eden Prairie, MN-based company provides innovative solutions that unlock the significant value that is contained within the clinical image archives of healthcare providers. Its OneMedNet iRWD offering securely de-identifies, searches, and curates a data archive locally, bringing a wealth of internal and third-party research opportunities to providers. By leveraging this extensive federated provider network, together with industry leading technology and in-house clinical expertise, OneMedNet successfully meets the most rigorous RWD Life Science requirements. Thanks to OneMedNet for supporting HIStalk.

Webinars

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

Acquisitions, Funding, Business, and Stock

Carbon Health, which offers telehealth and in-office primary and urgent care from five locations in New York City and Columbus, acquires remote patient monitoring tools vendor Alertive Healthcare.

The private equity owner of advance care planning technology vendor Vital Decisions sells the company to Evolent Health.

Revenue cycle management vendor Aspirion Health Resources acquires Advicare, which resolves clinical denials.

Virtual medical documentation contractor Augmedix launches a $40 million IPO offering.

Sales

• Global imaging platform vendor Arterys chooses OneMedNet to provide de-identified real-world provider data for the development, validation, and regulatory approval of its solutions.

People

Hackensack Meridian Healt hires Kash Patel, MSEE (Penn Medicine) as EVP / chief information and digital engagement officer.

Helia Care, which offers a platform that connects hospitals and medical device companies for ordering, hires Gregg Smith (Sharecare Provider Solutions) as chief commercial officer.

Isabelle Stapf, MS (AppFolio) joins Well Health as SVP of product.

Announcements and Implementations

Cerner launches RevElate as its single go-forward patient accounting system following years of high-profile struggles with Cerner Patient Accounting. The company says it will begin phasing in the product to replace existing Millennium and Soarian systems in 2023. A hospital CIO sent along these notes they took during the announcement:

• RevElate is based on the Soarian Financials platform.
• Former Soarian customers were electing to keep Soarian Financials while migrating to Millennium clinicals.
• Cerner Patient Accounting support will be phased out over the next 5-6 years. New sales will stop immediately.
• Patient access, charge capture, and the charge master will remain in Millennium, while patient accounting, including contract management, will be in RevElate.
• HealtheEDW is the go-forward strategy for reporting and analytics.
• Key development partners BayCare and Charleston Area Medical Center will initially deploy the system .
• Cerner clients that are upgrading to RevElate will undergo a six-month project.
• The product will be available to the full customer base in Q1 2023.
• Demos will be offered during the CHC virtual conference next week.

Data from Premier’s PINC AI predictive modeling shows that hospital clinical labor costs have increased 8% per patient day since the pandemic began, with overtime and agency use adding $17 million in annual costs for the average 500-bed facility.

Health IoT cybesecurity vendor Cynerio launches a small-hospital subscription program to protect against malware, ransomware, and other device security threats.

Abbott’s president and CEO will keynote the CES 2022 technology show in early January, the first time that a healthcare company will take its main stage.

HLTH announces COVID-19 safety precautions for its upcoming in-person meeting in Boston – mandatory proof of vaccination via Clear, PCR testing either within 72 hours before the conference or taken free onsite, and mandatory wearing of masks.

Other

CHIME publishes its list of Digital Health Most Wired for 2021.

In Spain,  the local health service apologizes for a gynecologist who documented “homosexual” as the current illness of a 19-year-old woman. The health service says it was an honest mistake caused by documenting her sexual orientation in the wrong part of the EHR, but the woman says that a hospital employee told her that several of the doctor’s patients had lodged similar complaints.

Sponsor Updates

• Wolters Kluwer Health launches Best Care Everywhere, a mission-driven movement to build and strengthen global health equity.
• Spok will highlight the importance of healthcare communication at its Connect 21 Virtual Conference October 11-12.
• The Nurse Keith Show Podcast features Glytec Clinical Project Lead Lori Weiss, RN “The Promising Future of Cutting-Edge Diabetes Care.”
• KLAS recognizes Halo Health in its latest report, “Clinical Communication Platforms – Improved Efficiency Leading to Concrete Outcomes.”
• PatientBond achieves 15 million touchpoints in August, sending automated email, text messages, and phone calls to 2.5 million unique patients.
• OncoSpark adds interoperability to it oncology prior authorization platform in partnering with Ellkay.
• The HCI Group’s DGTL Voices with Ed Marx Podcast releases a new episode, “CIO and CMO – the Importance of this Relationship,” featuring Cleveland Clinic CMO Paul Matsen and CIO Matt Kull.
• Health Catalyst will exhibit at HLTH 2021 October 17-20.
• KLAS recognizes Impact Advisors for its advisory and implementation services in its latest report, “2021 Healthcare Consulting & Services.”
• CareSignal publishes a white paper titled “Transform Your Population Health Strategy with Scalable Deviceless Remote Patient Monitoring.”
• Imprivata and VMware partner to give clinicians password-free access to any app for smoother, more secure mobile workflows.
• Interbit Data CEO Arthur Young discusses hospital systems downtimes at the HIMSS conference.
• NextGate achieves ISO 27001 Certification for information security management systems.
• NTT Data launches a back-to-work app to support government and business COVID-19 requirements.

Blog Posts

• Integrating Cyber and Physical Security can Better Protect People and Save Enterprises Time and Money (Everbridge)
• FDB Thanks Pharmacy Heroes During American Pharmacists Month (First Databank)
• With cyberattacks on the rise we must all do our part and #BeCyberSmart (Fortified Health Security)
• Rock and Roll Business Inspiration: Key Lessons from the Story of KISS (HCTec)
• Three Ways AI Can Earn Clinicians’ Trust (Health Catalyst)
• How the Right Health Education Can Save Money and Improve Outcomes (Healthwise)
• Cybersecurity Awareness Month (Optimum Healthcare IT)
• Deprescribing in Long-Term and Post-Acute Care Settings (MedAware)
• Easing password pains: How CISOS can implement real, complex passwords and keep clinicians happy (Imprivata)
• IMO resource roundup: Clinical terminology and COVID-19 (Intelligent Medical Objects)
• Patient Engagement Causes Fragmentation – Instead, Think Experience (Lumeon)
• Is Mobile a Practical Solution to Improving Chronic Disease Management? (Medhost)
• Out with the old and in with the new: Lane Regional Medical Center adopts Expanse Patient Care to make ED hand-off safer and simpler (Meditech)
• 8 Ways for PTs to Maintain a Positive Work-Life Balance (MWTherapy)
• Why Public Health Demands Robust Interoperability and Patient Identification (NextGate)

Contacts

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

EPtalk by Dr. Jayne 10/7/21

In telehealth news, California’s governor recently signed a bill (SB 306, the STD Coverage and Care Act) which requires health plans to cover at-home test kits for HIV and sexually transmitted infections (STIs). The state has had recent increases in STIs, and the bill is aimed to help reduce those numbers. Patients can self-collect samples for many STIs. Studies have shown that self-collection (even in the physician office) increases rates of adherence for recommended testing. Coverage is required for health care contracts that are issued, amended, renewed, or delivered after January 1, 2022.

If I was working at a telehealth vendor that didn’t already offer a business line that addressed this kind of testing, I’d be spinning it up right away. There are some nuances to managing these types of tests (including being able to report results to local public health authorities) but the COVID pandemic accelerated automation of these functions so that they’re much less onerous. Developers have about three months to get their functionality in gear, so it’s ready-set-go for anyone with clients in California.

The National Institutes of Health announced that its All of Us Research Program will make more COVID-19 data available for researchers. This could allow better exploration of the long COVID symptoms that some patients experience as well as help identify factors that might identify which otherwise healthy patients will do poorly if they become infected. The expanded dataset now includes data on over 300,000 patients, with nearly 80% of them representing groups that are typically underrepresented in medical research.

Having access to such a robust dataset is going to be key to ensure artificial intelligence technologies don’t have bias from the data used to train the models. A testimonial from researcher Sally Baxter, MD, MSc explains the limitations of using a single-site dataset from her own institution versus the improved performance after using the All of Us data for training the model.

In the “healthcare folks behaving badly” category, a pharmacist in Puerto Rico enters a guilty plea after administering COVID vaccine to children who did not meet the age minimum approved by the FDA. In addition to improperly vaccinating children aged 7 to 11, the pharmacist billed Medicaid for the services. Additionally, since the vaccines were part of stock provided by the US government, not only were the administrations clinically inappropriate but also “unauthorized and unlawful.” The vaccinations were identified by the Puerto Rico Department of Health, which suspended the pharmacy’s participation in COVID-19 vaccination efforts. Only a couple of dozen patients were involved, but since the dosing for that age group hasn’t yet been approved, it’s not clear what they were given and if they received the full adult dose or something else. I hope all the children involved are doing well and didn’t experience any complications from the situation.

The COVID-19 pandemic has placed a tremendous burden on provider organizations, many of whom tapped the US government’s $178 billion 2020 Congressional Provider Relief Fund. STAT news has created a database showing how much funding physicians and healthcare organizations received. Not surprisingly, large health systems and those in major metropolitan areas received large pieces of the pie. Altogether, there were 412, 591 payments, with 90% of them being below $192K. The median payment was $12,530.

Looking at the data from my state, it’s difficult to see how much some of the large health systems received since some of them are listed separately and have a number of hospitals, clinics, and affiliated entities. I found it interesting that my former urgent care employer received more funding than many of the smaller hospitals in the state, but I wasn’t surprised given the volume of care they deliver and the acuity of patients, as well as the number of employees. What I did find surprising was the number of optometry practices that received several million dollars each. Also, at the bottom of the list, there were over 200 practices that received less than $100, which I’m sure didn’t even cover the money spent filling out the application. A couple of dozen practices were between $1 and $20. I found the fact that they issued checks for $1 to be bizarre since it probably cost many times that amount to create the check and will cost the practice more than that to cash it when you figure in staff salary and the potential for bank transaction fees.

It’s always interesting to use the various available databases to see what kinds of payments physicians and other healthcare providers are receiving. One of the more well-known data sources is the Open Payments database, which gathers numbers on payments made by drug, medical device, and other companies to physicians and other covered recipients. If a pharmaceutical rep buys a physician lunch and it’s over a certain amount, it’s reportable. CMS recently released adjustments to the reporting threshold for the 2022 Program Year, based on the Consumer Price Index. In case you’re curious, anything less than $11.64 doesn’t need to be reported unless the total annual value of payments to a covered recipient exceeds $116.35. I searched for myself in the Open Payments database, which goes back to 2014. I had exactly one payment for some consulting work that I did as a clinical informaticist, looking at specs for a new diagnostic testing apparatus. I’m not sure it should have been subject to Open Payments, but I’m not about to argue it.

I’m nearly back to normal after the side effects of my recent COVID-19 booster, with only some aggravating itchy sensations remaining at the injection site. Several readers weighed in on my request for good shows to watch while recuperating. There seems to be a general theme to some of the options, with many of them being on location in the UK. Fortunately, I was able to reserve a couple of the recommendations at my local library, so I’ll be able to stay well entertained as soon as they’re ready for pickup. In the mean time, I’m venturing into the great outdoors this weekend. I’m about to start a very big project that will take up most of my time for the foreseeable future, so I’m looking forward to kicking back around the campfire and enjoying some delicacies cooked in cast iron. There’s more to fall than pumpkin spice, y’all.

Email Dr. Jayne.

Morning Headlines 10/7/21

Carbon Health Acquires Remote Patient Monitoring Company Alertive Healthcare to Expand Omnichannel Care Delivery

Nearly three months after raising $350 million in a Series D funding round, Carbon Health acquires remote patient monitoring company Alertive Healthcare.

Appriss, Inc. Closes Sale of Appriss Insights, LLC to Equifax in $1.825 Billion Deal

Appriss has sold its Insights business to Equifax for nearly $2 billion, leaving its Bamboo Health and Retail subsidiaries intact.

WindRose Health Investors Completes the Sale of Vital Decisions to Evolent Health

WindRose Health Investors sells tech-enabled advance care planning company Vital Decisions to Evolent Health, which will integrate the newly acquired business with its Clinical Solutions segment.

JMH receives ransom request; cyber attack investigation continues

Johnson Memorial Health (IN) reveals that the cyberattack that forced it to downtime procedures over the weekend was indeed a ransomware attack.

Morning Headlines 10/6/21

Central Logic Integrates Offering and Rebrands to About, Signaling Move to Maximize a Connected Network of Care

Central Logic renames itself to About as it integrates recent acquisitions Ensocare (inpatient referral to post-acute care) and Acuity Link (transportation communications and logistics management).

Leading Health Systems Launch Graphite Health, a New Member-Led Non-Profit Company to Accelerate Digital Transformation of Health Care

Intermountain Healthcare, Presbyterian Healthcare Services, and SSM Health form Graphite Health, a nonprofit that will help member organizations vet, access, and implement digital health solutions.

Augmedix Aims For $40 Million IPO

San Francisco-based Augmedix, which offers virtual medical documentation and live clinical support, files paperwork for a $40 million IPO.

News 10/6/21

Top News

Quality measurement and clinical intelligence platform vendor Apervita shuts down.

Chief Informatics and Innovation Officer Blackford Middleton, MD, MPH, MSc said in a LinkedIn post that the company was unable to complete a second funding round. It had raised $60 million since December 2012 through a Series A.

Apervita sold its value optimization business to Clarify Health in August 2021.

Reader Comments

From Executive Channel: “Re: females as VPs of HR, legal, and marketing. We would likely see the same phenomenon in IT if technology jobs  weren’t dominated by men.” Health system support departments such as IT don’t contribute directly to profit and loss except as a cost center, which is why executives of those areas aren’t usually seen as prime candidates for broader roles in areas that have dozens or hundreds of insiders who are ready to move up the ladder. Most of the big bumps in CIO compensation and job responsibility over the years came from consolidation into ever-larger health systems and horizontal expansion of CIO responsibility in taking over other support departments such as biomedical engineering, telecommunications, informatics, analytics, and quality reporting (headcount and budget responsibility drive pay in health systems). The few former CIOs who are now COOs or CEOs of large health systems gained experience in other positions, which I would anecdotally observe usually involved only a short stay in IT as part of being moved around for executive grooming — a long stint as a CIO in a single health system likely means you’ve topped out there. It’s not quite the same in vendorland, where CTOs of tech-heavy startups are often co-founders in companies where technology is a core competency rather than a supporting function.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Interbit Data. The Natick, MA-based company’s software automation solutions ensure that clinicians and hospital staff have easy, secure, and reliable access to patient and financial information so they can get back to quality patient care and stay in touch. Its products integrate with any HCIS platform to distribute reports that help care teams stay informed. It is the pioneer and best-practice leader in downtime business continuity, providing reliable access to patient information at the point-of-care during downtimes, as well as during more challenging cyber crises. Using its software automation solutions, hospitals can be more efficient, streamline workflows, and improve overall patient care and safety. It provides secure, reliable, and cost-effective solutions that help 800 healthcare facility customers worldwide remain connected. Thanks to Interbit Data for supporting HIStalk.

I found this explainer video for Interbit Data’s NetDelivery on YouTube.

Webinars

October 6 (Wednesday) 2 ET. “Solving Patient Experience Challenges Through a Strong Digital Front Door.” Sponsor: Avtex. Presenters: Mike Pietig, VP of healthcare experience, Avtex; Jamey Shiels, MBA, VP of consumer experience, Advocate Aurora Health; Chad Thorpe, care ambassador, DispatchHealth. Patients expect healthcare providers to offer them the same digital experience they get when banking, shopping, and traveling. This webinar will describe how two leading healthcare providers created digital front doors that exceed patient expectations, improve patient outcomes, drive loyalty and acquisition, and future-proof their growth strategies in competitive markets.

October 6 (Wednesday) 1 ET. “A New, Streamlined Approach to Documentation and Problem List Management in Cerner Millennium.” Sponsor: Intelligent Medical Objects. Presenters: Deepak Pillai, MD, physician informaticist, IMO; David Arco, product manager, IMO; Nicole Douglas, senior product marketing manager, IMO. The IMO Core CSmart app, which is available for Cerner Millennium in the Cerner code App Gallery, helps providers document with specificity, make problem lists more meaningful, and improve HCC coding. This webinar will review the challenges and bottlenecks of clinical documentation and problem list management and discuss how streamlined workflows within Cerner Millennium can help reduce clinician HIT burden.

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

Acquisitions, Funding, Business, and Stock

ManpowerGroup finalizes its acquisition of IT staffing and services provider Ettain Group, which acquired Leidos Health in 2019. Ettain will merge with ManpowerGroup’s Experis IT talent and solutions business and will operate under the Experis name.

Sales

• Cancer Treatment Centers of America will implement Lyniate’s Corepoint interoperability platform.
• Rochester RHIO selects Direct Secure Messaging capabilities from Secure Exchange Solutions.

People

Commure promotes Ashwini Zenooz, MD to CEO. She replaces industry long-timer Brent Dover, who will remain as an advisor.

Michael Wagner, MSA (MPRO) joins Honor Community Health as CIO.

QS Systems hires Kendall Stanley (Inovalon) as VP of sales and marketing.

Radiology Partners promotes Jennifer Beaumont to SVP of regional support services and clinical practice integration (she was SVP of IT) and hires Mark Logan (IBM Watson Health) as SVP of IT clinical technologies.

Patient and employee experience platform vendor Qualtrics hires Adrienne Boissy, MD (Cleveland Clinic) as its first chief medical officer.

Announcements and Implementations

Central Logic renames itself to About as it integrates recent acquisitions Ensocare (inpatient referral to post-acute care) and Acuity Link (transportation communications and logistics management).

Privia Health implements Kyruus ProviderMatch to enable patients to find and book appointments with physicians.

Sparrow Health (MI) adds a proof of COVID-19 vaccination feature developed by Epic to its MySparrow patient app. It enables users to display a QR code, download a PDF, or export verification to a health wallet.

Intermountain Healthcare, Presbyterian Healthcare Services, and SSM Health form Graphite Health, a nonprofit that will help member organizations vet, access, and implement digital health solutions.

Microsoft releases Windows 11 as a free upgrade for eligible Windows 10 PCs and on new PCs that have it pre-installed. My two-year-old laptop passed Microsoft’s Windows 11 readiness test, so I’ll give it a few weeks and then upgrade.

New Cerner President and CEO David Feinberg, MD, MBA will kick off the two-day virtual Cerner Health Conference 2021 next week.

Mackinac Straits Health System will affiliate with MidMichigan Health to address its IT needs and to implement Epic.

A new KLAS report on point-of-care references for clinical decision support finds that market share leader Wolters Kluwer is loved by physicians who learned to rely on UpToDate in medical school, but health systems say it’s the most expensive of available solutions and they sometimes switch to a cheaper alternative. Users of IBM Watson Health, especially pharmacists, like its NLP search feature even though the company scores poorly in customer support. Elsevier and IBM Watson Health both suffer from content delivery that can run months behind, users report. Ebsco earns the highest overall score with deep content at a fraction of the price of competitors.

Privacy and Security

In Indiana, Johnson Memorial Health and Schneck Medical Center recover from apparently unrelated cyberattacks that forced the organizations to take their IT systems offline.

Other

Business Insider looks at problems in Apple’s healthcare organization, most of which have been described previously:

• Employees say people were disciplined for disagreeing with their bosses over the way health data is being used to develop products and the questionable quality of that data.
• The company expected the Apple Watch to spawn a subscription-based health program in which consumer data would be shared with their physicians, but the engineers who developed Watch designed its features for consumers rather than patients who are seeking medical care. The Watch can identify conditions, but isn’t as strong at measuring them.
• Apple uses its AC Wellness employee clinic as a healthcare workshop, but the company is questioning its cost compared to similar programs such as that of Crossover Health.
• Apple has talked to health plans about selling its HealthHabit app that allows its employees to track fitness goals and blood pressure, but poor user engagement has caused Apple cut back on the project roadmap and to reassign its employees.

Steve Jobs died 10 years ago at 56, having kicked a dent in the universe that outlives him.  

Sponsor Updates

• Availity integrates TruthMD’s MedFax healthcare data solutions with its initiatives for provider data management.
• Olive will hire an additional 300 employees by the end of this year, increasing its employee base by 30%.
• Wolters Kluwer Health CEO Stacey Caywood earns a Bronze Stevie Award in the category of Female Executive of the Year – Business Products.
• EClinicalWorks publishes a new customer success story, “Using Prisma to Help Staff and Close Care Gaps at Centerpoint Health.”
• CareSignal has partnered with Innovaccer to offer deviceless remote-patient monitoring to organizations and payers participating in value-based care on the Innovaccer Health Cloud.
• Change Healthcare will host its 2021 Virtual Innovation Summit October 12-13.
• CHIME releases a new Digital Health Leaders Podcast, “A Conversation with Sarah Richardson, FCHIME, CHCIO, SVP and CIO, Tivity Health.”
• Clearwater expands its customer training content and security awareness capabilities through a new partnership with cybersecurity education company Infosec.
• CloudWave publishes a new whitepaper, “Enterprise Imaging in the Cloud.”
• CoverMyMeds will present at Epic’s App Orchard Conference October 6.
• A new KLAS report, “Clinical Communication Platforms 2021,” recognizes Vocera as a top-rated vendor in health systems with enterprise-wide deployments.
• Diameter Health Chief Architect Sam Schifman will present at the John Snow Labs NLP Summit October 6.
• Engage publishes a new case study, “From Chaos to Control: How Exeter Hospital Addressed Their Disaster Recovery Challenges.”
• EClinicalWorks will host its national conference virtually October 7-8.
• EZDI wins at the HIC2 in India for the use case “Digital Clinical Assistant for Integrating with Legacy EHR.”

HIStalk sponsors named top-ranking outsourcing vendors in 2021, according to Black Book Research’s latest survey, include:

• Credentialing & Privileging – Symplr/TractManager
• Cybersecurity – Fortified Health Security
• Database Support & Analytics – Health Catalyst
• ERP Support – Pivot Point Consulting
• IT Tech Support – Cerner
• Medical Imaging Systems – Agfa HealthCare

Blog Posts

• How to Get Your SNF Survey-Ready (Ability Network)
• Five Technology Disruptions in Healthcare That Will Stock Post-Pandemic (Ascom)
• After 20 years, one thing stands out. It’s all about multi-payer collaboration. (Availity)
• How Healthcare Organizations are Implementing Innovative Virtual-first Care Models (Bluestream)
• Digital Transformation Starts with Data (CereCore)
• 5 healthcare trends rounding out 2021 (Cerner)
• Solving Healthcare Business Challenges with New Service Models: A Thought Leadership Roundtable (CHIME)
• Highlights from the DIUC21 Keynote (Dimensional Insight)
• Post-Acute 2.0: New Services Needed to Deliver Care at Home (Dina)
• How providers can streamline care to prepare for a “twindemic” of COVID-19 and flu (Experian Health)

Contacts

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

Morning Headlines 10/5/21

Ettain group, a Leading Provider of Talent Solutions, is Now Experis, a ManpowerGroup Company

ManpowerGroup finalizes its acquisition of IT staffing and services provider Ettain Group, which will merge with the company’s Experis business.

DoctorsManagement, LLC Announces Strategic Integration With Hawaii-Based Healthcare Coding Consultants of Hawaii

DoctorsManagement, a consulting firm based in Knoxville, TN, merges with Healthcare Coding Consultants of Hawaii.

Carbon Health Unveils Carbon for Research, a Clinical Trial Research Program to Drive Healthcare Advancements

Primary and urgent care company Carbon Health launches a clinical trial research program that will focus on medical devices, diagnostics, therapeutics, and vaccines, including Merck’s new COVID-19 antiviral treatment pill.

Curbside Consult with Dr. Jayne 10/4/21

It’s been a rough weekend at Casa Jayne, with some bothersome side effects from my end-of-week Pfizer booster.

Don’t get me wrong — even with side effects I still like the vaccine odds better than the odds for naturally occurring COVID-19, and I’d do it again in a heartbeat. This time around it was a family affair, as my parents were able to get appointments within a few minutes of mine, so we got to spend some quality time in the observation room together. I was grateful that they were able to get their boosters on a beautiful sunny fall day rather than having to drive through snow and ice and stay in a hotel across the state, as they did for previous vaccines. It was good to catch up in person rather than by phone or text. My dad mentioned that the local farm and home store has a sign that warns people not to use ivermectin on humans. I’ll stick with my FDA-approved drugs (whether they’re under an Emergency User Authorization or not) any day. Except for one person who had a recent “breakthrough” case, we’ve all avoided infection. Now just crossing my fingers for a speedy approval for the Moderna booster for my grandparents, followed by quick scheduling at their retirement community.

Because most of my symptoms involved my dominant arm, I didn’t get much done over the weekend that didn’t involve reclining on the sofa with a pillow under my arm. Big thanks to the hospital auxiliary who made “cough” pillows post-op patients the last time I ended up in an operating room – it was the perfect size for a post-vaccine prop. I did however get a lot of reading done. I finished one novel, downloaded three more freebies, and started going through mountains of email.

One email reminded me to read the HealthIT Buzz blog from ONC, which had some good information on how ONC plans to better communicate with stakeholders. Moving forward, ONC plans to have additional options for communication and education, including more frequent FAQ postings; plainer language on blog posts aimed at non-legal, non-technical audiences; regular leadership blogs reviewing progress on implementation of the regulation; active outreach for public events and stakeholder meetings; and my favorite – “focused posting of Myths vs. Facts on social media to dispel inaccurate information and direct stakeholders to authoritative resources in a timely manner.” Maybe we need a cross between MythBusters and TikTok for ONC to reach both seasoned healthcare informatics folks as well as the newest generation in the workforce.

Another email took me deep into the rabbit hole that is the Theranos trial. There are so many summaries and recaps out there, I certainly had my choice of news sources. I do think that the delay in holding the trial, partially due to the pandemic and partially due to legal maneuvers, might be helping Elizabeth Holmes as she tries to defend herself. There have been many specific questions about individual recollections of conversations and events which occurred years ago, and when those recollections don’t match emails which are later entered into evidence, it certainly reflects on the credibility of the witness testimony.

The overall picture is one of desperation at Theranos, where they so wanted their solution to succeed that they were willing to go to great lengths to make it look like it was performing better than it was. In reading about some of the patient impact, my heart breaks for the women who had erroneous tests of the pregnancy hormone human chorionic gonadotropin. In one case, the patient’s values were off by a factor of 10, leading her to believe she was experiencing a miscarriage. Although she later received a corrected value, it’s hard to undo the level of anguish that someone experiences when receiving the news that she did. Some medical practices figured out quickly that there was trouble at Theranos, but others continued to use the lab, magnifying their exposure for inaccurate results.

The Theranos trial is also a good reminder that work email is not a safe place, and phone records might not be either. There were plenty of emails between Holmes and her boyfriend, former Theranos Chief Operating Officer Ramesh “Sunny” Balwani, that some might find fairly cringeworthy when viewed in the light of day and with consideration of the current situation. Holmes apparently found him to be her breeze, in the desert, her water, and her ocean. They also texted about being able to “love” and “transcend” even in the middle of a major whistleblower investigation. None of the documents I came across included any sexting, so at least we can be grateful for that. But it’s a reminder of how people might want to be careful and avail themselves of other modes of communication than non-secure texting.

The last email that caught my attention was from local government, letting me know that county council meetings would no longer be available on YouTube due to its recent push to remove videos that spread certain types of medical misinformation. The “public comment” portions of the meetings have been so chock-full of conspiracy theories, bad science, and false claims that they ran afoul of the terms of service. YouTube will still allow what it calls “personal testimonies,” but will not permit content that promotes vaccine hesitancy or promotes misinformation. Commentary that vaccines cause cancer, infertility, or contain microchips will also be banned.

Although my vaccine yet again failed to improve my wireless connectivity or make me magnetic, I’m glad I was able to get one quickly and close to home. It was good to have some downtime, albeit forced, because I had loads of end-of-quarter work earlier in the week and probably needed a mental break more than I would admit. I caught up on some TV watching as well – “Blue Bloods,” “Endeavour,” and “Inspector Lewis” to name a few. I’m on a bit of a crime drama kick, I suppose. Of the three, “Endeavour” is my favorite, although it’s so full of details you have to be careful if you’re nodding off while watching, because it will lead to a lot of rewinding.

What’s your favorite TV show for sofa-based recovery time? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: The Key Ingredient to Improving Outcomes in Behavioral Health: Measurement-Based Care

The Key Ingredient to Improving Outcomes in Behavioral Health: Measurement-Based Care
By Jason Washburn, PhD

Jason Washburn, PhD is a professor at Northwestern University Feinberg School of Medicine in Chicago, IL.

The burden of mental disorders is well known. Mental disorders are common, resulting in significant disability and contribute to — and complicate — chronic health conditions. Most mental disorders are untreated, and the COVID-19 pandemic has only further highlighted significant disparities in access to treatment. Effective pharmacologic and psychological treatments are available, yet outcomes in routine practice are often weaker than what is found in randomized controlled trials. 

Measurement-based care (MBC) can improve the outcomes of routine mental health practice. MBC involves routinely and systematically evaluating mental health symptoms, ideally before or during a clinical encounter, to both inform and direct mental health treatment. For example, in 2015, a randomized controlled study of MBC in the treatment of depression found a much higher remission rate among the MBC group compared to usual treatment (73.8% vs. 28.8%). 

What accounts for the impact of MBC on outcomes? MBC can help providers track the response of their patients to treatments, alert providers to when patients need to adjust treatment, and aid clinical decision making. For example, MBC can facilitate changes in dosage and medications, improve case conceptualization, identify the need to change treatment modality and targets, or to increase or decrease service frequency and intensity. MBC can also facilitate communication between patients and providers, improving the therapeutic relationship and shared decision making. 

Patients like MBC. Patients accept MBC practices and report that it improves their care. When implemented correctly, providers also like MBC, recognizing its many benefits and utility in treating patients. Although providers often express fears about the burden of MBC, successful implementation of MBC usually results in little to no barriers or burdens for providers. 

Despite the clear benefits of MBC, routine use of MBC remains rare. The available evidence suggests that less than 20% of psychiatrists, psychologists, and master’s level providers use any meaningful level of MBC. Why do so few providers use MBC? 

Concerns with the practicality of implementing MBC is one of the primary barriers to utilization of MBC. Practical concerns can include the time required to complete measures, the administrative burden of administering measures, and disruptions to patient flow and processes. Another barrier is the reliance of providers on clinical judgment. Even when providers recognize that MBC is likely to improve their treatments, providers may fall back on their clinical judgemnt when the infrastructure for MBC is not available. Unfortunately, clinical judgment is not always accurate: One study found that providers were only able to accurately detect deterioration in their patients 21.4% of the time.  

Although adoption of MBC has been slow, technological solutions hold promise for accelerating the integration of MBC into routine mental health care. Many – if not all – of the perceived and actual barriers associated with MBC can be addressed through technology infrastructure that supports fully automated MBC systems. Automated MBC systems can be integrated into existing clinical workflows, including the electronic health record, providing a seamless experience for both the patient and the provider. 

Accelerating the adoption of MBC, especially through automated systems that provide access to outcome data at the individual and organizational level, will not only improve care, but increase access to care. Given that MBC is associated with faster response to treatment (e.g., 4.5 weeks in MBC group vs. 8.1 weeks in usual care), the increased efficiencies gained in using MBC allows for greater throughput of patients and increased access. By monitoring remissions rates, MBC can also help to identify when patients no longer need a specific level of care, facilitating quicker transitions to lower levels of care and termination, thereby increasing access for new patients to enter the system. 

The available evidence is clear: MBC holds promise in improving mental health care. To actualize the potential of MBC, however, providers and the organizations that support them must make MBC a routine expectation in the provision of mental health treatment.

Readers Write: Obesity and Beyond: How Digital Therapeutics Are Shaping the Future of Managing Chronic Diseases

Obesity and Beyond: How Digital Therapeutics Are Shaping the Future of Managing Chronic Diseases
By Joseph Rubinsztain, MD

Joseph Rubinsztain, MD is CEO and founder of ChronWell of Sunrise, FL.

As the COVID-19 pandemic took a collective toll on patients’ mental and physical health in the United States, our obesity problem only intensified. Even before the pandemic, 42% of Americans were obese, while two in five recently surveyed reported to gaining an average of 29 pounds since the pandemic began.

Despite the risks of serious disease associated with high blood sugar, hypertension, high cholesterol, and excess abdominal body fat, the pandemic’s disruption to daily routine seemed to spark trends of unhealthy eating and inactivity. What’s more, studies show that having a BMI over 30—which defines obesity—increases the risk of being admitted to hospital with COVID-19 by 113%, of being admitted to intensive care by 74%, and of dying by 48%.

Obesity, as it turns out, is the greatest risk factor contributing to the burden of chronic diseases in the US. It is closely linked with metabolic syndrome, a cluster of conditions that increase risk of heart disease, stroke, and diabetes. What’s worse, research suggests that nonalcoholic fatty liver disease (NAFLD), a “hidden” condition that’s strongly associated with obesity, is on the rise. It causes accumulation of liver fat and ultimately inflammation and scarring if left undetected and untreated.

While the burden of chronic diseases in the US has never been heavier, providers are struggling to provide the continuous support patients require to make much-needed lifestyle changes to improve their health. Physicians can suggest interventions like increased exercise and a healthy diet, but patients across the board struggle to maintain lifestyle changes because treatment plans fail to integrate into their lives in any meaningful way. Providers simply don’t have the staff or bandwidth to repeatedly nudge, support, educate, integrate, and encourage new and sustainable habits in such a high percentage of their patients.

There is, however, a solution that can automate and simplify the process with evidence-based outcomes: digital therapeutics (DTx). These technologies deliver interventions driven by high quality software programs to prevent, manage, or treat a range of medical disorders and diseases. Used independently or complementing medications, devices, or other therapies to optimize patient care and health outcomes, DTx is leveraged directly by patients, or, perhaps most optimally, in concert with physician guidance as part of a prescribed care plan.

Using remote monitoring technology and mobile access points, DTx continuously connects patients and their care teams through methods such as text communication / alerts, on-demand education, exercise coaching, diet reminders and advice, digital assistance, general care coordination, and procurement of medical supplies, to name a few. By streamlining these functions and guiding behavioral change, DTx deliver a personalized care plan to fit specific patient needs in between physician visits, encouraging compliance to treatment plans and overcoming hurdles through reliable partnership and continuous motivation.

Quality algorithms process patient information about clinical presentation, medical history, blood biomarkers, diagnostic imaging exams, laboratory tests, and social determinants of health (SDOH), for example, to generate optimal personalized interventions. Built on specific metrics and outreach methods, these evidence-based interventions create tailored goals and guided treatments that drive higher compliance and better outcomes. Through automation and intelligent integration, physicians are alerted to specific concerns and patient needs with minimal friction so the care team can intervene when needed. DTx becomes a digital extender for managing chronic care cases more efficiently and continuously, enhancing the patient-physician relationship.

As we witnessed the increased use of digital health tools over the past 18 months, acceleration of DTx has become prominent, with notable innovation on the certification, reimbursement, and regulation fronts in the US. Digital therapeutics will help build the roadmap to agile, personalized treatment of chronic conditions, presenting opportunities to provide better, smarter care.

HIStalk Interviews Bob Bailey, Founder, Healthcare IT Leaders

Bob Bailey is principal and founder of Healthcare IT Leaders of Alpharetta, GA.

Tell me about yourself and the company.

I’ve worked for 25 years in enterprise IT professional services firms that I have owned and operated. Our company is focused on enterprise applications, deployments, clinical information systems, business information systems, and a practice we’ve launched for COVID called Healthy Returns.

How has your business changed during the pandemic?

Our business changed dramatically as work-from-home became a strategy that we all had to get our arms around. Specific to our industry, a lot of our projects went offline by definition. We had to rethink who we are and what we do. Healthy Returns was a nice practice that we were able to establish in finding a way to be helpful to the communities we’ve served for the past 10 years. That has been a lot of fun and it has become a great success, so we are happy with that.

But it was clearly a time where we all had to sit back, reflect, and think about the business we have today and what might it look like tomorrow, then pivot in a number of directions to get it back on track. As the revenue came offline in the systems, a lot of these projects just started to disappear. It was a challenging time.

What changes are you seeing in the kinds of people who want to do consulting work?

I would say that we’re a work-from-home winner, our industry being professional services and software support. It has opened up wonderful opportunities for consultants, by and large, because they have so much more flexibility in their personal and work life. To us, it has been a tremendous uplift to employee morale internally and also externally for those that are working on behalf of our clients.

What services are health systems most commonly seeking?

We are a heavy Epic firm, as a good two-thirds of our revenue comes from the word Epic. There continues to be a dominant stance for that company, and therefore, a lot of work that we do on behalf of Epic-related clients and also due to continuing consolidation within the industry. We have also seen a tremendous uptick over the last two years in the business systems applications such as Workday, ServiceNow, Oracle, and Infor. Our business was built to support both the clinical systems and the business systems that an enterprise would have to implement and support. We are in the mid-innings, in a baseball analogy, of the overall business systems refresh that is going on in the health system.

Your mentioning Epic made me think of the consulting services arm it was launching a few years ago. To what extent do big software vendors support third-party consulting?

Epic and Epic Boost do a very good job inside of their customers, who then become our customers. Oftentimes we’re working side by side. We don’t see that as a threat to our business, but rather as complementary. If you look at Cerner, they traditionally have had a professional services organization on the ground implementing their software and we work very closely with them as well.

The key to working well with those two large vendors is understanding how they like to support their customers, what they want to do in addition to the software license sale itself, and then how we can cohabitate with them. We have found working with both firms to be a pleasure over the last 10 years. It’s a different set of challenges between those two organizations when you’re working with them, but once you understand what they’re looking to do and then how you can work with them, it becomes harmonious. Success for the client is what we’re both interested in. It has been good for us as a business.

What is the future of conferences such as HIMSS and Epic UGM?

In the healthcare enterprise, we talk about digitization. I think digitization of the conference world is a healthy thing, because we can get together more frequently and with less cost. It’s good for the customers. It’s good for the end clients of the software firms. It’s good for the vendors, in our case, the services firms. That’s healthy.

On the other hand, we are humans and we need to see each other and be around each other. The conference of old, let’s say HIMSS using that as the example, will never be as large as it once was. That’s actually a good thing. But we need to have a little bit of both.

How is the CIO role changing?

We were talking with a client recently who brought in a chief technology officer, who works for the CIO, from the retail industry. We have a number of those scenarios across the system now, where it used to be the CIO and his or her staff was always from the healthcare space, because it’s a unique space today. The good news is that we are starting to see that turnover and we’re starting to see a lot of the outside influences. When we talk about consumerism and healthcare, that’s an interesting thing to say. but does the CIO over the last 20 years really understand what to do about that? These outside influences that are coming in at leadership levels is helpful to that.

But clearly the CIO’s role was changing dramatically. The CIO has to think not only about traditional security, which is an incredibly complex topic, but now they have to think about the same thing for their at-home workforce. It’s a huge challenge. How do we secure Tim’s office, Bob’s office, and the devices they are working on? In addition to digitization, it’s the security piece, both inside the four walls and also now with the work-from-home piece of it.

A lot of the CIOs historically are clinically oriented, as they should be. They are driven to satisfy the chief medical officer and the clinicians with the applications that we bring to life. In today’s world, there’s this massive shift going on to large business systems implementations. They require a totally different set of personnel and leadership techniques. That’s the HR line of business or the finance line of business versus the clinical line of business that they are accustomed to supporting. That CIO seat is a challenging one these days.

How do you balance the value of bringing in outside experts in technology or consumerism who suddenly find themselves trying to understand the complexity of healthcare?

I’ll use as an example B.J. Moore, a friend at Providence who I’ve known going back to his Microsoft days, when he ran their finance division and we were helping them at the time with call center software called Siebel about 20 years ago. Since he came to Providence, you see them moving light years ahead of so many other organizations that are in healthcare. They are acting like a large enterprise, a large corporation, as relates to technology. Providence has been a long-time client of ours as well and they have tremendous healthcare domain expertise inside their IT organization. What they were missing was somebody with a vision to say, what do we do in this new world? How do we turn on the consumer? How do we interact with the patient? How do we treat the clinicians in a different way, to engage them and pull them into these systems that are so important for a place that large? How do we look at our EMR and how do we think about running that EMR as a mature client to reduce the cost of ownership? How does cloud impact our budgets and how can it help us scale our business and secure the business in ways that we’ve never thought about? Those influences are terrific and he has done a wonderful job.

My personal background is that I come from corporate business services for many years and started in healthcare when I created Healthcare IT Leaders 10 years ago. We are happily at our 10-year anniversary right now, so I have a perspective that is a little different than others that have been in the industry for 20 or 30 years. I think it’s wonderful. You need more of that kind of thinking, particularly now as we’re trying to get out to the consumer and make your life and my life that much easier before, during, and after our encounter with said health facility.

Providence has gone deep into providing commercial services as an IT vendor under the Tegria umbrella, while Ascension has decided that IT is not its core business and is outsourcing almost all of it. How are health systems defining IT as core competency?

Whatever industry you’re in, you’re going to have people that think about that question differently. You look at back to what Mercy was doing years ago and today, and look at what Providence is doing today. And then to your point, Ascension, with much different philosophies on core competencies. Providence and Rod Hochman and his team there are very much leaders and visionaries in how they are thinking about healthcare and healthcare IT services. They are looking at it as ways to increase revenue, being as important as it is when you’re an organization that large. Ascension is obviously an incredibly large place as well with a totally different viewpoint on this.

I’m not 100% sure what the right or wrong answer is, but I think you will see both of those models persist depending on the leadership in an organization. I like what Providence is doing. On one hand, it is competitive to what we do, but on the other hand, it’s collaborative. We work together to support Providence in partnership with Tegria. In my view, that’s all good.

Going back to Ascension, no question, that’s a great strategy.  We know a lot of the people there and the leadership and they’re doing wonderful things on behalf of all their clinicians and the patients that they serve. That model is working very well for them as well.

What near-term changes do you expect that will affect healthcare and your business?

Our business was created to satisfy the most important element in the IT organization, which is the clinical information system. But then after Meaningful Use came and went, we turned the chapter on clinical systems in 2017. We will always be there to do the good work we do, but we put a lot of focus and investment in business systems because we knew there would be this natural refresh cycle. When I look out three to five years, from our company perspective, we want to be an organization that is understood by the CIOs to be able to handle the clinical systems and the business systems.

More and more, this Healthy Returns practice becomes important with President Biden’s recent mandate on how you test, trace, and maintain the credentials of employees, vendors, and patients. We start to get into consumerism and pulling all this data together to say, it’s safe for Tim to enter a building and it’s safe for Bob to enter a building based on our policies as a health system. That will persist long after COVID comes and goes because we will never, ever allow ourselves to come offline to the extent we have during COVID times.

Over these next three to five years, those three elements and cornerstones of our business will continue to be dominant trends in the eyes of the CIOs, CFOs, and CMOs that we support.

Morning Headlines 10/4/21

On CEO’s first day, Kansas City’s Cerner rolls out vaccine mandate for all U.S. workers

Cerner announces that it will require all US employees to be vaccinated by December 8, and has extended its return-to-office date to January 10, 2022.

Ensemble Health Partners Files Registration Statement for Proposed Initial Public Offering

Cincinnati-based hospital RCM vendor Ensemble Health Partners files IPO paperwork with the SEC.

NextGen Healthcare President and CEO David Sides Issues Open Letter to Shareholders

New NextGen Healthcare President and CEO David Sides urges shareholders to disregard founder Sheldon Razin’s disruptive efforts to take over the board by voting for company-approved candidates ahead of its October 13 meeting.

Monday Morning Update 10/4/21

Top News

David Feinberg, MD, MBA takes the helm as president and CEO of Cerner.

Predecessor Brent Shafer ends his three years and eight months with CERN shares down 6% versus the Nasdaq’s 101% gain.

Reader Comments

From Hmmm…: “Re: HR, legal, and marketing. Do readers think they aren’t important because women are in those roles? They are major players in our organization and are heard and respected.” It’s not a lack of respect for the person or the position, but those jobs have limited headcount and budget and aren’t usually where CEOs are groomed as compared to sales, product development, and finance. I occasionally look at the executive team composition of big health IT companies, so here’s a few that I randomly chose today. Only two companies didn’t have a female VP of marketing, HR, or legal — one because its sole female executive works in another area, the other because it has no female executives. How does your company stack up?

• Allscripts – 10 men, five women (including female VPs in HR, legal, and marketing)
• Athenahealth – nine men, three women (including female VPs in HR and legal)
• Cerner – nine men, five women (including a female VP of HR)
• Change Healthcare – 10 men, three women (including female VPs of legal, HR, and compliance)
• Definitive Healthcare – nine men, one woman
• Cognizant – 10 men, two women (including a female VP of HR)
• Greenway Health – seven men, six women (including female VPs of legal, HR, marketing, and compliance)
• HCI Group – seven men, zero women
• Health Catalyst – 17 men, 12 women (including female VPs of marketing, HR, diversity, and learning)
• Infor – 12 men, three women (including a female VP of marketing)
• McKesson – three men, three women (including female VPs of HR and legal)
• Nuance – eight men, three women (including female VPs of legal and HR)
• Olive – eight men, three women (including a female VP of marketing)
• Premier – eight men, one woman (including a female VP of HR)
• Teladoc Health – 10 men, four women (including a female VP of marketing)
• Transcarent – seven men, six women (including female VPs of legal and HR)

HIStalk Announcements and Requests

A big majority of poll respondents see no value in state-by-state clinician licensing.

New poll to your right or here: Have you faxed something in the past six months, and if so, what was the most recent example?

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

It bugs me that Googling my name turns up all kinds of sketchy “people finder” data broker sites that list my age, current and previous addresses, family members, and sometimes email address, phone numbers, and voter registration information. I read about Optery and gave it a try and it has automatically found and removed most of the entries (more than 100 of them). It’s free for finding the sites, for which you then request removal manually without paying anything, or $10 per month to have Optery automatically submit removal requests for the top 80 sites (or up to $25 per month for 150 sites). The privacy benefit is obvious, but scammers also use the information displayed by these data brokers for stealing identities and placing fraudulent orders.

Welcome to new HIStalk Platinum Sponsor Availity. The Jacksonville, FL-based company is where healthcare finds the answers needed to shift focus back to patient care. It works to solve communication challenges in healthcare by creating a richer, more transparent exchange of information among health plans, providers, and technology partners. As one of the nation’s largest health information networks, Availity facilitates billions of clinical, administrative, and financial transactions annually. Its suite of dynamic products, built on a powerful, intelligent platform, enables real-time collaboration for success in a competitive, value-based care environment. Thanks to Availity for supporting HIStalk.

Webinars

October 6 (Wednesday) 2 ET. “Solving Patient Experience Challenges Through a Strong Digital Front Door.” Sponsor: Avtex. Presenters: Mike Pietig, VP of healthcare experience, Avtex; Jamey Shiels, MBA, VP of consumer experience, Advocate Aurora Health; Chad Thorpe, care ambassador, DispatchHealth. Patients expect healthcare providers to offer them the same digital experience they get when banking, shopping, and traveling. This webinar will describe how two leading healthcare providers created digital front doors that exceed patient expectations, improve patient outcomes, drive loyalty and acquisition, and future-proof their growth strategies in competitive markets.

October 6 (Wednesday) 1 ET. “A New, Streamlined Approach to Documentation and Problem List Management in Cerner Millennium.” Sponsor: Intelligent Medical Objects. Presenters: Deepak Pillai, MD, physician informaticist, IMO; David Arco, product manager, IMO; Nicole Douglas, senior product marketing manager, IMO. The IMO Core CSmart app, which is available for Cerner Millennium in the Cerner code App Gallery, helps providers document with specificity, make problem lists more meaningful, and improve HCC coding. This webinar will review the challenges and bottlenecks of clinical documentation and problem list management and discuss how streamlined workflows within Cerner Millennium can help reduce clinician HIT burden.

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

Acquisitions, Funding, Business, and Stock

Shares in the Global X Telemedicine and Digital Health exchange-traded fund dropped 6% in the past month versus the S&P 500’s 4% loss.

Redox announces that its network grew by 291 new integrations in Q3, with 78 digital health companies going live at 208 provider organizations. It was the first live integration for 22% of those companies.

Sales

• Novant Health chooses Visage Imaging to replace multiple legacy PACS in a $30 million contract.
• HNI Healthcare will integrate the RCxRules Revenue Cycle Engine into its VitalsMD mobile charge capture platform.
• L’Institut de Cancérologie de l’Ouest, a leading provincial cancer center in France, joins the TriNetX global health research network.

People

Well Health hires Robin Hackney, MBA (FairWarning) as SVP of marketing.

Ed Stelmakh, MBA (Otsuka Pharmaceutical Companies) joins OptimizeRx as CFO/COO.

COVID-19

Reported US COVID-19 deaths have hit 700,000, as one in 125 Americans aged 65 and older have died of it.

Cerner announces — on new CEO David Feinberg’s first day of work — that it will require all US employees to be vaccinated by December 8, 2021. The company also extended its return-to-office date to January 10, 2022. Cerner had said on August 1 that it would leave vaccination decisions up to individual employees. Meanwhile, Epic reports that less than 0.5% of its headcount – which translates to under 50 employees – left the company instead of being vaccinated by its October 1 deadline.

University of Ottawa Heart Institute researchers withdraw their pre-print article that incorrectly concluded that one in each 1,000 COVID-19 vaccine recipients develops myocarditis. The authors admit that a miscalculation, which was pointed out by readers, overstated the risk by 25-fold. The article was shared widely by anti-vaccine people and groups who, not surprisingly, did not share its retraction.

Merck says its investigational oral antiviral molnupiravir has reduced COVID-19 hospitalizations and deaths by half, to the point that the company and FDA agree to suspend the trial and apply for emergency use authorization. Some worry that availability of a $700, five-day oral treatment will convince people to avoid vaccination or to take the medication unnecessarily, some experts note that similar antivirals haven’t proven to be all the useful for COVID-19 when administered to large numbers of patients, and others note that the 50% improvement reflects the study’s less-dramatic drop in hospitalization and death from 14% to 7% among high-risk people with mild to moderate infection.

Scientists in England conclude that people who are vaccinated against COVID-19 are less likely to spread it even if they are infected.

FDA’s vaccine advisory committee will meet several times this month on significant topics – October 14 (Moderna boosters), October 15 (J&J boosters), October 15 (mixing and matching boosters), and October 26 (Pfizer vaccine for children 5-11).

Sponsor Updates

• OptimizeRx publishes a new report, “Addressing Unmet Patient and Provider Needs in Diabetes: New Opportunities Through Pharma through Technology.”
• Netsmart releases a new CareThreads Podcast, “Hospice: It’s Time to Go Back to the Future.”
• Olive will hire an additional 300 employees by the end of 2021, expanding its workforce by 30%.
• The “HIT Like a Girl Podcast” features PatientKeeper VP of Strategy & Innovation Sally Buta.
• Greater Houston Healthconnect uses InterSystems HealthShare to create the largest known COVID-19 outcomes study.
• Symplr releases a new case study, “Mount Nittany Health Embraces Symplr’s Controls & Checks for Peace of Mind.”
• Sectra will be recognized with a Spine Technology Award for its implant movement analysis service at the annual meeting of the North American Spine Society in Boston.
• EClinicalWorks releases a new customer success story, “How Healow Retooled the Front Office During COVID-19.”

Blog Posts

• ClariPi’s CT denoising solution uses AI to provide the best image quality possible, even from low-dose or ultra-low-dose CT scans (Nuance)
• 5 Patient-Centric Use Cases for Predictive Analytics in Healthcare (Olive)
• What is Health Coaching: How Providers Can Implement Programs (PatientBond)
• Three Ways Premier Members are Driving Pharmacy Innovation During COVID-19 (Premier)
• Top Children’s Hospital Leaves Legacy Privacy Monitoring in the Past (Protenus)
• Driving Tech Innovation and Capabilities for Medical Practice Contact Centers with AWS and Amazon Connect (Relatient)
• Credentialing by Proxy for Telemedicine: 7 Things to Know (SOC Telemed)
• Why is endpoint data protection so important? (Spirion)
• Re-Envisioning the Future of Specialty Pharmacy (Surescripts)
• Actium Health – A Clear Plan for Every Patient (Actium Health)
• Talkdesk Phone – Calling is cool again (Talkdesk)
• There’s No Place Like (Healing At) Home (Vocera)
• FAQ: How to Get the Best M&A Deal for Your Company – Before the Window Closes (WebPT)
• Why health payers need insight democratization to unlock the value of data (West Monroe)

Contacts

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

Weekender 10/1/21

Weekly News Recap

• Microsoft invests in Truveta, the health system-owned data-selling company.
• Walgreens is rumored to be considering the acquisition of Evolent Health.
• A GAO report says three big donors of President Trump violated federal law by exerting improper influence on VA decisions, including their recommendation that the VA sell patient data.
• Walmart announces that it will implement Epic across all of its health and wellness business lines.
• ONC finds that third-party health apps have been slow to adopt the HL7 FHIR standard as mandated by the Cures Act.
• Clinical research network vendor Elligo Health Research raises $135 million in a Series E funding round, with existing investor Cerner participating.

Best Reader Comments

I have long noticed when you run updates on promotions that the women featured are most often in HR, marketing, maybe legal, or some lesser important department. Rarely are they sales, CEO, or finance. Sorry, but there is still a very rampant Bro Culture out there. Don’t believe me? Ask your female staff! (JT)

I have asked Truveta if they will allow me to be removed from de-identified data sets and I have asked two participating healthcare organizations if they would remove me from their data submissions to Truveta. Only one organization responded, and they did not address the question. (Concerned_Patient)

A $20 billion valuation for Athena seems strange when you look at comparable companies. If I had to pick some companies that are in the same business as Athena, I would pick Allscripts, NextGen and R1 RCM. Adding up the valuations of those companies is maybe $8 or $9 billion. It’s hard to gauge Athena’s growth since they went private and everybody seems to have stopped publishing stats on outpatient EMR vendors. I get the sense their business improved, but more because the company started to be run more efficiently, not that they are blowing the other vendors out of the water on market share. (IANAL)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. S in California, who asked for headphones to support distance learning for her elementary school class. She reported in December, “Your generous donation has made an impact on my students’ lives. Due to distance learning, focusing has become a major challenge, as not all students have equal access to a calm, quiet, and safe learning environment. Access to headphones has made the task of focusing much easier. My students are incredibly thankful to you.”

A woman sues Springhill Medical Center (AL), claiming that ransomware-caused downtime prevented doctors and nurses from noticing test results that would have told them that her unborn baby’s umbilical cord was wrapped around its neck. The baby was born in July 2017 with brain damage and died in April 2020. She says the hospital should have disclosed its IT problems so she could have gone elsewhere for delivery. The hospital has made 678 objections for 88 document requests from the woman’s attorneys, arguing that its records are protected by Alabama medical liability laws. The woman’s lawyers say the records are needed to prove the hospital’s assertion that the downtime didn’t affect patient care.

Cox Medical Center (MO) will issue panic buttons to 400 nurses and other employers after assaults by patients tripled to 123 in 2020, causing 78 injuries. The article didn’t mention the product, but I think it is Midmark’s real-time locating system Clearview badge.

Hedge fund billionaire Leon Cooperman and his wife donate $100 million to Saint Barnabas Medical Center (NJ), for which the 597-bed hospital which will rename itself Cooperman Barnabas Medical Center. Cooperman hopes their donation will “improve the human condition.” The couple donated $25 million to the hospital in 2017 to create a 241,000 square foot expansion that was named after them.

Federal agents seize 600,000 counterfeit 3M N95 masks from a Detroit storage facility for which an unnamed hospital had paid $3.5 million to a China-based company that has been distributing counterfeit masks all over the US.

An investigative report finds that financially struggling Griffin Health (CT) has earned $51 million in COVID-19 testing fees as part of its $138 million contract with the state as the primary contractor for nursing home testing. The proceeds provided 25% of the hospital’s total revenue for 2019 as it was paid $55 per test, double the amount of five other hospitals that signed similar contracts. The hospital says it paid $80 million of the money to a laboratory because it didn’t have capacity to process the samples.

Sharp HealthCare ophthalmologist and informaticist Tommy Korn, MD writes on LinkedIn that he is using the macro capabilities of his IPhone 13 Pro Max to document patient care in the EHR, to show patients what he is seeing, and to support telehealth consultations. 

Staff at Las Palmas Medical Center (TX) celebrate the return of orthopedic surgeon and active-duty Army surgeon Richard Purcell, MD, who spent three months in Afghanistan treating victims of the Kabul airport bombings.

In rural Australia, the local transportation department denies a doctor’s request to have his NIssan GT-R sports car registered as an ambulance. Michael Livingston, MBBS hoped to install emergency lights and sirens on his car for responding to emergencies that can be 30 or more minutes away, saying that his speedy response makes other drives think he is challenging them to a race. He holds an emergency pass that allows him to exceed the speed limit when responding to a confirmed emergency. The Western Australia Department of Transport expressed concerns that the car lacks bars in the front to protect the occupant from kangaroo or livestock collisions, noting that, “A dead or severely injured doctor is of no benefit to the current emergency, your community, or any future patients.”  

In Case You Missed It

• News 10/1/21
• EPtalk by Dr. Jayne 9/30/21
• News 9/29/21
• Curbside Consult with Dr. Jayne 9/27/21
• An HIT Moment With … Ajay Kapare
• Readers Write: Curating Information to Reduce Physician Burnout
• Readers Write: Achieving Health Equity through Improving Diversity in Nursing
• Monday Morning Update 9/27/21

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Morning Headlines 10/1/21

Microsoft and Truveta announce strategic partnership to accelerate Truveta’s vision of saving lives with data

Microsoft makes an unspecified investment in Truveta, the data-selling company that is owned by 17 large health systems.

Evolent Health stock jumps after report of possible Walgreens takeover

Walgreens is considering the acquisition of care management technology vendor Evolent Health.

Vital Raises $15M Series A Funding Led by Transformation Capital to Advance Digital Transformation for Emergency Departments Across the Country

ED patient flow and status communications platform vendor Vital raises $15 million in a Series A funding round.