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Curbside Consult with Dr. Jayne 5/1/23

May 1, 2023 Dr. Jayne 4 Comments

Over the last couple of years, I’ve been trying to learn more about marketing. It’s a critical part of what we do, whether it’s trying to promote a company, advertise a hospital, or convince patients to adopt healthier behaviors or take advantage of cancer screening tests.

When I was training to become a physician, I thought that it would be about learning all the science and figuring out how to apply that to examining patients and identifying a diagnosis and treatment. Over time, I learned that identifying the diagnosis and making a treatment plan was only half the battle. Convincing the patient to get on board with the proposed plan was a tremendous lift. I learned more about persuasive speech and sales techniques than I ever expected to know, except I was using them to try to convince patients that taking a cheap generic medication to treat their conditions would actually be a better option than the flashy drugs that they had seen advertised on television.

Working for a large health system, I also learned a lot about the ways that organizations market themselves. Sometimes this was productive, trying to increase community awareness about available services. For example, when we launched a mobile diabetes screening unit, there were multiple marketing campaigns to drive awareness and create buzz about the importance of diagnosing diabetes early. Things became more challenging when those patients were actually diagnosed but ran into insurance issues or inability to get the care they needed. I wish that the campaign to launch the mobile unit had included training for primary care offices on how to best handle the influx of patients we were seeing, especially in a startup office like mine.

I also saw plenty of counterproductive marketing efforts, such as when two hospitals that were part of the same health system launched competing orthopedic surgery marketing campaigns, both aimed at the same patient population in the geographic area where I also lived. It seemed like every time I opened the mailbox, I had a competing flyer from one of the programs. Since the flyers had the health system branding as well as the individual hospitals’ branding, I’m sure it was confusing for patients. As a physician who was on staff at both hospitals, it created plenty of confusing conversations with patients and without the requisite talking points that would  have been good for staff physicians to have at their fingertips.

This article about Mercy’s personalized healthcare marketing strategy caught my eye. I originally thought I was going to learn something about how precision marketing can help patients, but unfortunately, the first quote in the story left me somewhat baffled. The health system’s chief marketing office, Kristina Dover, stated, “One of the examples I really like to use is that a 55-year-old male OB-GYN should never see our mother-baby advertising if we’re doing our job right.” Actually, I think the midlife, male OB-GYN is exactly who should understand the health system’s mother-baby marketing strategy, because it’s his patient base that is the target of that advertising. Who better to understand a hospital’s advertising tactics than those who are expected to deliver on its promises? Expectation mismatch is a key factor contributing to patient dissatisfaction so that the care delivery team is well-served by understanding those expectations.

Other comments that Ms. Dover made were confusing. She mentioned trying to balance supply and demand through personalized advertisement, by pointing patients to service lines with openings at the time. She is quoted as saying, “We are honestly having conversations every day to say, ‘We have the access for inpatient primary care visits today, let’s increase our marketing or let’s dial back a little bit,’” which makes no sense. I wonder if she can even define what an “inpatient primary care visit” is or whether she understands that you can’t just go out trolling for inpatients as a way to increase your census. As a former emergency department physician, there were plenty of patients that I would like to have been able to admit, but factors like insurance, acuity requirements, and more were always standing in the way. How wonderful that a marketing team has found a way around all of that.

Of course, I’m being facetious, and for Ms. Dover’s sake, I’m hoping this was some kind of misquote or misunderstanding on the part of the reporter. Helping patients understand their healthcare choices is complex, and I struggle to understand how it can be reduced to an Amazon-like shopping experience regardless, given all the drivers such as insurance coverage, acuity, provider experience, accreditations, and more. It’s not exactly a retail commodity, and trying to reduce it to that level might not be the best thing for solidifying a medical home or providing continuity of care that drives outcomes. It’s been a decade since the two marketing examples I discussed at the beginning of this piece happened, but it seems like there is still plenty of dysfunctional marketing out there.

I’d like to get a better understanding of how health systems might take a more informed approach to marketing. Do they consider the opinions of patients, caregivers, providers, and employees as they create their campaigns, or are they created in corporate lock-ins or Madison Avenue-style conference rooms? Do health systems consider previewing their campaigns to their internal constituents so they are prepared for any patient questions, and if so, do they ever make changes based on feedback they receive? Maybe I’ve just been in health systems that didn’t give us a sneak peek, but I’m eager to learn what’s going on in the greater healthcare marketing universe.

I’d also like to learn other opinions on personalized marketing strategies. Are other organizations using different tactics than what the article described is happening at Mercy? Have you found that new strategies have made a difference in how patients and potential patients receive marketing messages? What do you think about hospitals moving towards consumer-focused marketing as a way to drive volumes? Are we all eventually going to be a commodity? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Christine Swisher, PhD, Chief Scientific Officer, Project Ronin

May 1, 2023 Interviews No Comments

Christine Swisher, PhD is chief scientific officer of Project Ronin of San Mateo, CA.


Tell me about yourself and the company.

My background is in healthcare, mostly in oncology, but also in building predictive models and AI as software and as a medical device. I’ve worked at Philips Healthcare, which is in the Fortune 500, as well as several startups. I’ve led from idea to FDA clearance and expansion in the US and in Europe.

I am passionate about responsible AI and what that means, to deliver AI that is impactful in healthcare and that improves the lives of patients at scale.

At Ronin, we are fortunate to have a wonderful network and partners such that we are set up to achieve our mission of improving the life of cancer patients at scale and impacting all four of the Quadruple Aim verticals. We build technology such that an oncologist and the clinical care team that cares for cancer patients can see at a glance, and understand, their patient’s journey. We look through all of the structured data, clinical notes, and documents and bring that forward, so there isn’t that 30 minutes of clicking to prepare for a visit, but help them understand their patient at a glance. We also bring in the patient’s voice to understand what’s happening to the patient outside of the hospital and render that in their clinical workflow.

We have a mobile application that engages patients, not just for having a better understanding of the patient, but to empower clinicians with predictive information so they can take actions earlier and prevent adverse events and avoidable hospitalizations or emergency department visits and also better manage symptoms so that patients can stay on treatment longer.

What is the extent of genetics and genomics data that can be used to make clinical decisions?

A lot of that is about contextualizing that information. There’s a big jump from what scientists have discovered and where we are in this, especially in the genetics field. How do we deliver that to have meaningful outcomes in clinical care? How can we contextualize that information alongside their patient record of what’s happening, their entire patient record such as comorbidities, social determinants of health, and patient-reported outcomes? What’s happening to them at home? How can we bring all that together to have a total patient understanding, including their patient preferences?

With that total patient understanding, we can make the best choice for that particular patient. It’s a critical piece of information, especially things like EGFR mutations that are so impactful for treatment decisions that they can be lifesaving. We need to bring them into care decision making.

ChatGPT feels like an overnight success, but probably isn’t to experts in the field like yourself. How will your work be changed by its capabilities and popularity?

It definitely impacts the work that we do it. In fact, I think it enables the next level of technology if we are thoughtful in how we deliver that.

It didn’t happen overnight from my perspective. In 2012, we witnessed a similar event in AI, where there was a technological breakthrough with convolutional neural networks, rectified linear units, and dropout that allowed us to have computer vision perform as well as humans for general domain tasks in classification. That particular event sparked the deep learning revolution.

From 2012 to 2020, there were about 100 FDA-cleared applications, 88 of which were computer vision or in the radiology space. That happened quickly and the characteristics of these winners that were able to deliver on deep learning at that time. Radiologists, pathologists, and recipients of this technology were skeptical, just as skeptical as they are now.

It’s slightly higher publicity now because so many people are using things like ChatGPT in their work. But it’s a lot of mirroring to what happened in the 2010s, when the AI winners in healthcare did three things. One, they prioritized interpretability and risk mitigation. Two, they focused on super-powering the clinicians versus trying to compete with them, and companies that said they were going to replace a clinician were not successful. Third is that they delivered a complete solution, and those solutions fit seamlessly into the clinical workflow. They delivered on the CDS five rights, which means that it was the right information, the right person, the right format, the right channel, and at the right time. That’s the key to success.

None of those things have really changed about healthcare in the past 10 years. There was a technological breakthrough with the transformer architecture in 2017, and then a new generalizable method, which was GPT- based models. We had a new generation of applications like ChatGPT, Stable Diffusion, Dall-E, and all of these generative AI technologies. It’s very much like what we saw in 2012.

If we can take those learnings about what success looks like, and bring those into how we think about this new innovation or new class of AI-powered applications, we’re going to be a lot more successful. I am really excited about generative AI, but I think that it has to be delivered the right way.

We heard way too much back then about big data, which is rarely mentioned using that name today. Will AI and ML help deliver that promise?

We’ve been doing things that are interesting. AI has helped identify sepsis patients earlier and to identify ischemic strokes so that patients can be treated within the golden hour. It’s been able to better detect breast cancer, lung cancer, and prostate cancer earlier. It’s already impacting people’s lives. That was with big data. It’s already living up to, maybe not at the scale that was predicted, but it is actually improving people’s lives at scale.

Now what we are seeing with this new class is new ways that we can better improve people’s lives. Generative AI can help scientists and researchers better discover new drugs, new treatments, and new therapies for cancer and other diseases.

It’s going to enable a better understanding of the patient’s journey, just like what we are doing at Ronin, being able to dig through the 80% of the EMR that is unstructured data documents, clinical narratives, and notes and have a better understanding of patients at an individual level and at a population level. That means that we are going to be able to better predict things like mortality, progression, adverse events, toxicities from treatment, and acute care utilization like emergency department visits. Then by being able to predict them and see what caused them, we can better inform on actions. I’m really excited about the technology, as long as it’s delivered safely and ethically.

The new book “Redefining the Boundaries of Medicine” notes that medicine is based around huge population studies that may lead to the wrong conclusions when a specific intervention doesn’t appear to be effective collectively, but works on subgroups of patients who share particular circumstances or comorbidities. How would a data scientist look at that issue?

This is very core to our Ronin mission, to deliver care decisions that are personalized to that particular patient versus based on population averages. So many decisions in oncology are based on population averages. By bringing data of what happened to patients like them — what happened in terms of their progression, their quality of life, the toxicities that they experienced — we can look at the patient in a comprehensive way, thinking about their demographics, social determinants of health, their cancer and treatment specific risk factors, their comorbidities, symptoms, active problems, and biomarkers as well.

If we bring that together to then say, what happened to patients like my patient, we can provide more personalized decisions. We can also empower the care team, oncologist, patient, and caregiver with data to make that decision.

Previous technologies were implemented as advisory rather than a closed loop system that would require FDA approval. How prepared is FDA to evaluate AI technologies and are the usual retrospective studies adequate to do so?

I have two answers for that. The first is that regulatory and best practice groups are moving quickly in response to the innovation and excitement around generative AI and AI in general. Three seminal documents were released just in the past few months. The White House delivered a blueprint for an AI bill of rights, NIST delivered their risk management framework, and the Coalition for Health AI delivered their “Blueprint for Trustworthy AI Implementation Guidance and Assurance for Healthcare.”

When you look at these three documents, five themes emerge across them. You need validated, safe, and effective systems. You need protections against bias. You need privacy and security. You need interpretability and explainability. Finally, you need transparency and human factors.

Whether or not it’s FDA-cleared 510 (k) software as a medical device, a CDSS, a CLIA-validated laboratory developed test, or AI for another application that doesn’t fit it under those regulatory guidance, it’s still important that it delivers on those five principles. In fact, those actually expand past healthcare.

Those are the things where we will see guidance from groups like CHAI on how we concretely deliver on those principles. The principles have been defined, and now these groups are working very quickly to define the next steps. I also think that infrastructure cloud vendors and AI tooling vendors will, at some point, start to provide certified tools to companies like Ronin and others to accelerate our ability to deliver AI safely. That’s a huge market opportunity.

AI in healthcare, particularly with our last AI revolution in the 2010s, was most successful when it was partnered with clinicians to make them super-powered clinicians. If you look at other domains, the same thing is true. AI did not replace as many jobs as people thought it would.

You could also look at things like when we went from animators hand drawing to CGI. CGI just expanded the scope of what they could deliver, how productive they could be, and allowed them to work at a higher level with the tedious tasks taken away. It’s the same thing of going from FORTRAN to C++ to Python and how we develop AI.

If we look at how those industries are impacted, there’s as guiding principle that AI empowers people and takes the tedious things off their plate so that they can operate at a higher level and deliver higher quality. That’s true in healthcare as well.

How will the availability of complete, representative, and unbiased training data affect the market for AI technologies?

Protections against bias is a key theme in those three seminal documents that I just talked about, and something that we need to do proactively and continuously. It’s not a one-time event where you look at your patient population, see how it performs in subgroups, and then write it up in a medical journal.

It has to be part of your system, where you are continuously monitoring for bias. Then when you detect a bias incident, you need to have the systems in place to rapidly mitigate that issue. One of solutions is representative data, but we need a three-pronged approach, where the first prong is like the brakes in your car, the second prong is the seatbelt, and the last one is the airbag.

The first prong, our brake, is about preventing any foreseeable bias. So that when you are developing the model, you have representation of the populations that you intend to serve. You have subject matter experts that understand that there isn’t bias built into the actual ground truth data or the data feeding into the model. That the way it is delivered from a user experience will not exacerbate currently existing biases in the system, so that there’s a lot of voice of the customer or human-centric design that has representation of the populations that we intend to serve. That’s the brake.

The seatbelt and the airbag are two pieces. The first is that you need to have proactive and continuous monitoring for bias across important subgroups. Things like social determinants of health. Do they have access to transportation? What about their insurance and demographic groups? We need a comprehensive understanding of the different ways that we could introduce bias that causes harm to different types of groups, then detecting that and being able to diagnose any problem quickly before it causes patient harm.

Then knowing that you have a problem, the next step is to fix the problem, so having the systems in place so you can rapidly retrain a model and you have the technology or ability to mitigate bias quickly. The machine learning operations, MLOps needs both infrastructure and practice to mitigate that and then deliver that fix quickly before there’s patient harm. In addition, there are human factors in how it’s delivered so that you can mitigate risk as well.

IBM Watson Health failed at trying to do years ago what people think is possible now. What has changed?

For those that will be successful, what’s different now is the user experience and real-world validation of the technology. What is the AUC, area under the curve, of a model? All these abstract metrics that AI practitioners tend to focus on … instead of focusing on those, focus on the meaningful measures. Does the AI plus the human better prevent acute unplanned care? Does it keep patients on treatment longer with their symptoms better managed? Does it increase progression-free survival? Going back to what a meaningful measure is and evaluating the performance of your models against that, versus abstract measures, is one of those key pieces.

The other one is thoughtful, human-centric design. With those pieces together, that’s where you have meaningful impact. Companies compete too much on model AUC, accuracy, or F1 score. A 5% difference sounds good on paper, but it’s the execution of that. When you delivered in clinical workload, did you live up the CDS five rights? If that’s true, you’re going to have a bigger impact. Focusing on the meaningful measures versus the abstract measures is key.

Is there a tension between the absolutes of data science versus the frontline practice of medicine that incorporates variables that are personal, local, or perceptual?

Especially for CDSs that rely on predictive models, machine learning, or statistical methods, it’s crucially important. It is written in the FDA’s guidance that you need to share the basis of the prediction and the relevancy of the training of the development data. Both of those things need to be shared.

At Ronin, we show that in a way that is accessible to the clinician. You don’t have to have statistical knowledge or machine learning knowledge to understand that. It’s right there at the point of making the decision, the relevance of the patients that are similar that are giving this insight for this particular patient. The basis of that prediction is right there during clinical decision versus buried in a user manual or peer-reviewed publication that might be behind a paywall.

For things like generative AI and language models, we still need to innovate and develop the methods for transparency in sharing the basis of our prediction. When we look back to things like convolutional neural networks, there was innovation on how we do that. Things like saliency maps were invented and the methodology to do that. Semantic segmentation was another innovation that allowed us to provide that type of insight.

We probably will have to invent some new methods, and I’m excited and hope that we continue excited about what that will be. We would like to be a part of that, and I am hopeful that our research community will gather around this challenge.

Will we see a trough of disillusionment with generative AI?

There will probably be a realization of the challenges, limitations, and areas of success. We’re going to learn that. We’re still learning about what this technology can do. How do we really understand what’s going on underneath the hood? How do we get it to explain the basis of its predictions?

People who are skeptical now — especially if they start to use it to help with writing, as a second reader, or to write code – may start to see a lot of value in it. On the other hand, we’re going to learn about its limitations. I think we might see the more skeptical folks being more embracing, and the ones that are less skeptical becoming more skeptical, as we learn more about the limitations.

What will the next few years bring to Ronin?

We are realizing that personalized, data-driven, total patient understanding in care decisions for cancer patients empowers clinicians. We can use AI, machine learning, and data science informatics for that and to bring the patient patient’s voice into it as well, where they can say what’s happening to them outside the home and their preferences can be brought in to care decision-making, even in the data that is driving those care decisions. There’s a huge opportunity to deliver on that vision, and we are already doing it.

Morning Headlines 5/1/23

April 30, 2023 Headlines No Comments

Comparing Physician and Artificial Intelligence Chatbot Responses to Patient Questions Posted to a Public Social Media Forum

Researchers find that licensed healthcare professionals preferred ChatGPT 3.5’s responses to patient questions over those that were written by doctors 80% of the time, judging the computer responses to be more empathetic.

VA’s health record ‘reset’ has budget fallout

VA Secretary Denis McDonough tells a Senate Appropriations Subcommittee that the agency will need to tweak its $1.86 billion EHR Modernization program budget request by $400 million due to its suspension of new implementations.

CUSP Citizen Petition to Protect Patients

The Center for US Policy petitions FDA to declare Bamboo Health’s NarxCare software a misbranded medical device that should be recalled, claiming that its opioid risk score for patients is being used inappropriately to prevent pain patients from obtaining appropriate opioids.

Monday Morning Update 5/1/23

April 30, 2023 News 2 Comments

Top News


Researchers find that licensed healthcare professionals preferred ChatGPT 3.5’s responses to patient questions over those that were written by doctors 80% of the time, judging the computer responses to be more empathetic.

A study limitation is that the patient question and the physician response came from public Reddit postings rather than from actual patient interactions.

However, I would also note that the Reddit responses presumably came from doctors who had sufficient time and empathy to respond without personal benefit in the first place, which makes me think real-life responses would exhibit significantly less empathy and thoughtful thoroughness in giving ChatGPT an even wider lead.

Reader Comments

From Zingaro: “Re: collaborative software groups. Have you heard of examples where Meditech Magic standalone clients joined a regional Cerner collaborative?” I’ll invite readers to chime in, and if you are willing to share your experience, provide your contact information offline and I’ll forward to Zingaro.

From Joint Pain: “Re: HIMSS23. Thanks for giving a shout-out to our company as one of the small-boothed folks who nonetheless worked hard at the conference.” I know how it feels to stand in near isolation in a 10×10 booth that is off the beaten track in the exhibit hall’s nether regions, not inexpensively, I might add. I’ll also make this offer – if your company exhibited at HIMSS23 in a booth that was 10×20 or smaller, I’ll give you a first-year HIStalk sponsorship discount that will cover 365 days instead of your three on the show floor. Contact Lorre since I’m just blurting this out without thinking in assuming that she will figure out details.

HIStalk Announcements and Requests


Poll respondents who attended HIMSS23 gave it decent scores. Some offered constructive criticism to beef up the health equity track, improve food and beverage options, and book more inspiring keynote speakers. I think that other than the carpet gaffe, they did a good job.

New poll to your right or here: Which HIMSS23-related recordings have you consumed for at least two hours? I’m asking as someone who has spent zero minutes and is questioning whether that makes me an outlier, given that it seemed like half the people at the conference were chasing the other half with cameras or microphones. I just don’t have the attention span to watch or hear self-indulgent interviewers and interviewees saying nothing useful when five seconds of skimming a transcription (had they made one) would have sent me fleeing. I will check out the official session recordings when they come out, although my attention span wanders there, too.


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

Acquisitions, Funding, Business, and Stock


Teladoc Health reports Q1 results: revenue up 11%, EPS –$0.37 versus –$0.47, beating analyst expectations for both. TDOC shares have lost 21% of their value in the past 12 months versus the Dow’s 3% gain, valuing the company at $4.3 billion.


  • Parkview Health chooses Sectra’s imaging cloud subscription service.
  • North Carolina HHS contracts with Optum for provider enrollment, credentialing, and data management.
  • Horizons Mental Health Center will implement Netsmart’s CareFabric platform, including the MyAvatar behavioral health EHR, as it transitions to a Certified Community Behavioral Health Clinic.



Kaiser Permanente promotes Nari Gopala, MBA to chief digital officer for its health plan and hospitals.


Genevieve Morris, MA, formerly of UnitedHealth-acquired Change Healthcare, joins UnitedHealth Group-owned Optum as VP of interoperability strategy, medical network.


Rahul Goyal, MD (Malaffi) joins Elsevier as chief medical officer.

Brian Parrish (Craneware) joins CVS-owned ActiveHealth and HDMS as chief marketing officer.

Announcements and Implementations

Artera launches self-service analytics for creating patient engagement data dashboards.

Centre for Neuro Skills goes live on Meditech Expanse.

A Sphere study finds that two-thirds of providers believe that improving patient payment collections is a top priority, with interests in specific technologies such as text message payments, point-of-service kiosks, card on file processing, and incorporating check-in and payment into digital front doors.

Government and Politics


The Center for US Policy petitions FDA to declare Bamboo Health’s NarxCare software a misbranded medical device that should be recalled, claiming that its opioid risk score for patients – which is calculated from state prescription drug monitoring program data using what CUSP says is non-transparent methodology — is being used inappropriately to prevent pain patients from obtaining appropriate opioids.


A New York Times opinion piece says that private equity is ruining the country by taking advantage of loose regulations to bankrupt acquired companies while making their own executives billionaires. A showcase example is Carlyle Group’s acquisition of nursing home chain ManorCare that was funded by piling debt onto to the chain – not to the private equity firm – then flipping its real estate to allow Carlyle to recover its investment while sticking the chain with paying high rents. Then came layoffs, cost-cutting, and poor resident care that ended up bankrupting the nursing home company, after which Carlyle avoided the resulting wrongful death lawsuits by claiming that it was an advisor, not an owner.

Sponsor Updates

  • Nym Health names Hallie Heffington (Summit Medical Billing Solutions) and Chermanda Jackson medical coding and compliance auditors, Omer Bar-Sela (Mobileye) implementation squad lead, Scott Rulkowski (Olive) customer success manager, and Niv Shashoua (HP) junior software engineer.
  • Nordic Consulting rebrands Bails & Associates, which it acquired in 2021, Nordic ERP Services.
  • Eleanor Health reduces its month-end closing time from 15 days to one day using a customized AI workflow solution from RCxRules.
  • Optimum Healthcare IT names Kevin Scahill Epic HIM analyst and Rachel Clemans ServiceNow engagement manager.
  • Methodist Le Bonheur Healthcare (TN) uses PerfectServe to streamline transfer center communications.
  • Specialty medication technology company RxLightning wins a Disruptor of the Year Mira Award.
  • SunStone Consulting will offer VisiQuate’s advanced revenue cycle analytics to its clients.
  • Pivot Point Consulting, a Vaco company, publishes its Q2 healthcare IT market report.
  • South-Eastern Norway Regional Health Authority expands its enterprise imaging contract with Sectra to include its digital pathology module.
  • Surescripts will apply to become a Qualified Health Information Network.
  • Upfront Healthcare’s latest psychographics study shows the pandemic’s impact on consumer health behaviors.
  • West Monroe celebrates its 21st anniversary.Wolters Kluwer Health will exhibit at AONL 2023 May 1-4 in Anaheim, CA.

Blog Posts


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

Morning Headlines 4/28/23

April 27, 2023 Headlines No Comments

EVisit + Bluestream Health

Virtual care platform vendor EVisit acquires Bluestream Health, which offers digital front doors and virtual workflow tools.

Teladoc (TDOC) Reports Q1 Loss, Tops Revenue Estimates

Teladoc Health reports Q1 results: revenue up 11%, EPS –$0.37 versus –$0.47, beating analyst expectations for both.

McMorris Rodgers Calls for Termination of Oracle Cerner Electronic Health Record System

Rep. Cathy McMorris Rodgers (R-WA) calls for the VA to terminate its contract with Oracle Cerner, calling it a “complete failure” that has harmed patients and employee morale.

LexisNexis Risk Solutions Acquires Human API

LexisNexis Risk Solutions acquires Human API to create a seamless method of delivering health records for life insurance underwriting and care coordination.

News 4/28/23

April 27, 2023 News 1 Comment

Top News


Virtual care platform vendor EVisit acquires Bluestream Health, which offers digital front doors and virtual workflow tools.

Click the image above to enlarge.

I interviewed EVisit CEO Sachin Agrawal a few weeks ago and Bluestream President Brian Yarnell last February.

Reader Comments

From Wormser: “Re: Google’s C4 data set training web sources. Is it good or bad that your site was used?” Probably good, but with an asterisk. I was initially happy to see that HIStalk contributed 3.4 million tokens to the model in being among the top 2,000 of 15 million sites that it scraped, at least triple that of the next-highest health IT site (HIMSS-owned Healthcare IT News). The model also prioritizes the most important and well-regarded sites, so that’s a plus. Negative: that means I’m involuntarily contributing a lot of decades-long work for free, which I rationalize that it’s free to read anyway. The top-used sites were, Wikipedia, Scribd (which is kind of a surprise), the New York Times, and the PLOS open access journals. The real story is that it’s good to question a model’s training sources and to consider the commercialization rights of the owners of that information, which will be especially important in healthcare.

HIStalk Announcements and Requests

I hate getting names wrong knowing that spellcheck can’t help me, so I was appalled to see that I mistyped the name of RxLightning CEO Julia Regan as “Julie” in our recent interview. I fixed the error, but my self-beratement continues, and I am reminded yet again that everybody needs an editor.

A friend asked for help polishing their resume and creating a cover letter, which of course I pasted into ChatGPT to create documents that left even a persnickety writer like myself with nothing to correct. I was thinking during the process that employers will have a tougher time selecting candidates based on their writing skill as a proxy for intelligence and attention to detail since ChatGPT makes everybody seem smart.


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

Acquisitions, Funding, Business, and Stock


Kaiser Permanente will acquire Geisinger Health in forming Risant Health, an independent, non-profit community hospital operator. Kaiser says it will invest $5 billion in Risant over the next five years, during which Risant will add up to six more health systems. The two organizations, both of which reported operating losses in 2022, say that Risant hospitals will benefit from Kaiser’s ability to invest in technology and preventive care.


LexisNexis Risk Solutions acquires Human API to create a seamless method of delivering health records for life insurance underwriting and care coordination.



Scott Sanner (Citra Health Solutions) joins Millennia as CEO.


Patient advocate, journalist, and “comedy health analyst” Casey Quinlan died this week of breast cancer.

Announcements and Implementations


Amazon shuts down its Halo Health wearables division and lays off its employees. The fitness tracker and subscription service was launched in August 2020 and Amazon announced its sleep tracking system Halo Rise in September 2022. The company started another round of layoffs Wednesday in its cloud computing and HR departments, pushing its total in the last few months to 27,000.

PMD – which offers solutions for secure communication, telehealth, charge capture, and RCM — launches a patient demographics management platform for medical practices

Eagle Ridge Hospital goes live on Meditech Expanse.

Rady Children’s Hospital and Sentara Healthcare implement Juniper’s AI-driven network technology to support reliable wi-fi and indoor location services.

AvaSure launches a virtual nursing application and care model, expanding its TeleSitter solution. I interviewed CEO Adam McMullin a few weeks ago.

Amazon Web Services increases its operational database workloads for Epic users by 61%, up to 42 million GRefs/s. 


The Columbus business paper profiles AndHealth, a chronic disease reversal telehealth company that was created by CoverMyMeds co-founder Matt Scantland. The company reports that its migraine patients had 70% fewer missed days of work. I interviewed him in February 2022.


A new KLAS report on health system capacity optimization management finds that LeanTaaS and Epic lead, while Qventus shows positive impact in the perioperative area. Users of Epic’s applications (Grand Central, Cadence, OpTime, MyChart, Cogito, Slicer Dicer, and Cognitive Computing) report strong out-of-the-box functionality that they home will be enhanced with AI/ML, actionable reporting and visualization, and a more consistent mobile experience, especially for Android devices.

Government and Politics

The VA, DoD, and Coast Guard experience another Oracle Cerner EHR downtime Tuesday, with the cause of the four-hour outage attributed to a failed database process.

Rep. Cathy McMorris Rodgers (R-WA) calls for the VA to terminate its contract with Oracle Cerner, calling it a “complete failure” that has harmed patients and employee morale. She says that “there is no coming back from the mess that the Department of Veterans Affairs has made with this deeply broken system.”

Privacy and Security

Six people, five of them former employees of Methodist Hospital in Memphis, plead guilty to HIPAA violations for selling the names of patients who were involved in car accidents to personal injury lawyers and chiropractors.



Apple provides updates to its Hearing Study, which uses its Noise app for the Apple Watch to warn users of potentially harmful noise levels. It has found the one in three US adults are exposed to excessive noise levels, often involving traffic, machinery, and public transportation. I would imagine that many restaurants and bars would be embarrassed by their quantified noise levels, where one loud table can create a sonic escalation in which everyone is suddenly shouting. Surveys have show that while bad service tops the annoyance list of restaurant diners, noise levels are ahead of bad food, which is ironic given that some restaurants pride themselves on creating a noisy environment that conveys energy and hipness (65 dB is the maximum for comfortable conversation).

Sponsor Updates

  • Flagstaff Surgical Associates (AZ) upgrades its EClinicalWorks software and implements Healow Pay and Healow Check-In.
  • Elsevier launches an enhanced version of its ClinicalKey decision support tool, which includes an extensive drug compendium, mobile app, and deeper EHR integration.
  • Consensus Cloud Solutions joins the AWS Independent Software Vendor Accelerate Program.
  • GHX names 87 healthcare provider and supplier organizations to the 2022 GHX Millennium Club.
  • HCTec will invest in expanding its operations in Hohenwald, TN, creating 100 jobs over the next five years.
  • Clinical Architecture posts Episode 26, Discussing Data Quality, of “The Informonster Podcast.”
  • Specialty medication technology company RxLightning wins a Disruptor of the Year Mira Award.
  • Healthjump will exhibit at the NAACOS Spring Conference May 3-5 in Baltimore.
  • Meditech congratulates 44 customers included among The Chartis Group’s Top 100 Critical Access Hospitals and Top 100 Rural Community Hospitals.
  • Mobile Heartbeat’s MH-Cure clinical communication platform now integrates with Akkadian Provisioning Manager, enabling zero-touch provisioning for users.
  • Google Cloud’s new Claims Acceleration Suite uses Myndshft prior authorization software to enable quick and seamless submission of PA requests.

Blog Posts


Mr. H, Lorre, Jenn, Dr. Jayne.
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EPtalk by Dr. Jayne 4/27/23

April 27, 2023 Dr. Jayne No Comments

Lately, it seems like my travel is never uneventful. The trip home from HIMSS added to my recent adventures.

I scored my usual exit row seat and everything went normally during the emergency briefing. However, we had a delay on the tarmac and one of the passengers in the exit row in front of me started asking “have we left yet?” followed by chanting “let’s go, guys, let’s go, guys” over and over before ultimately quieting down. After we reached altitude, though, his behavior became more erratic and he was bothering the passengers next to him while asking over and over if we had taken off yet.

The flight attendants were on top of it, arriving in a group to invite the passenger to move to a seat in the back of the plane near the galley. He acted a bit disoriented, but was able to follow instructions, although the lead flight attendant had to tell him several times to stand up, grab his backpack, and follow them. As he passed by my row, there was a strong smell of alcohol, which made me wonder whether he chugged his drink at the gate to comply with the rules to keep alcohol in the terminal or whether there was something medical going on.

It was a short flight and the police were happy to meet us upon landing and escort the gentleman to an alternative destination, but I hope he was OK. I’ve got a few more flights planned for the next three months and I’d really like to have just one where nothing noteworthy happens.

While I was flying, a couple of readers sent me some pics on the last day of HIMSS:


Biofourmis had custom branded sneakers. Thanks to a reader for sending this picture along.


Spa Girl says she saw these in a shop on the Magnificent Mile and thinks I need these for my next beach trip. They are undeniably cute, but probably not the most practical for travel. I could see wearing them around the house with a plush robe, however, in the mode of a Hollywood starlet.

As long as the Wi-Fi works properly, I’ve found that I’m pretty productive on the plane. While cleaning up email, I spotted this article about the ongoing debate about policies that require workers to return to the office. The piece mentions a bizarre call where Clearlink CEO James Clarke questions his own employees’ ability to manage work/life balance. Apparently, there has been some confusion within the company over the last couple of months as to whether employees would be asked to return to the office or whether they had been hired under the assumption of a remote-first culture. The first group of employees asked to return include those who live within 50 miles of the company’s Utah headquarters.

During a company town hall meeting to explain the changes, Clarke went on a rant about employees that had not used their laptops for a month, which is as much a management issue as it is an employee issue in my book. Did those employees’ supervisors not notice that they weren’t working, or was Clarke just making this up? He went on to ask employees to increase productivity by “30 to 50 times” normal and challenged employees to outwork him. He went further to praise an employee who had gotten rid of the family pet as a result of the change to in-person work.

Not wanting to exclude anyone in his unhinged speech, he also criticized working mothers specifically and working parents in general, saying “only the rarest of full-time caregivers can also be productive and full-time employees at the same time.” Sounds like it’s time for the HR department to provide some education and the company’s executive leadership to consider an alternative direction.

Another article that caught my eye was about a golf cart accident at Wake Forest Baptist hospital in North Carolina. The tragic crash resulted in the death of a patient and injuries to the cart’s two other occupants. The cart had been used to transport patients and visitors between the facility and parking structures. An investigation is underway, but I hope it will prompt other facilities to look at how they’re using different modes of transportation on campuses. No one wears a seat belt on a golf cart, and in the event of a sudden stop or a collision, it’s not a lot different than being on a motorcycle as far as being ejected is concerned, except that you’re probably not wearing a helmet. The articles I saw didn’t specify whether the fatally injured party was a rider or was struck by the cart. My sympathies go out to the family of the deceased and those involved in the incident who will be forever impacted.

A recent article in JMIR Human Factors looked at the use of speech recognition technology in the exam room. This wasn’t the fancy AI-driven kind of speech recognition, but rather the old school dictation-style voice recognition approach that many of us have used in our careers. In the study, physicians completed the Assessment and Plan portions of the patient’s after-visit summary while still in the exam room with the patient. The summary was then printed and a survey performed. Compared to “usual care” without an in-room dictation, patients felt that providers were better at addressing patient concerns and felt that they better understood the providers’ advice. The authors concluded that patients have a positive perception of speech recognition use in the exam room.

I first saw this approach in probably 2011 or 2012, while shadowing one of the Oklahoma Family Physician of the Year recipients. He dictated every visit in the presence of the patient and gave them the chance to ask questions, and it had been part of his routine for years. It’s difficult to believe that more than a decade has gone by without more people using this fairly straightforward strategy.

As a clinical informaticist, I see plenty of examples of clinicians and their teams struggling to adopt strategies that have been proven to improve efficiency and reduce documentation burden. Nearly every health system I’ve worked with has a super-user program and many also have robust physician champion programs. However, there are always physicians who don’t want to take advantage of those options. I see people who will do the same inefficient workflows over and over because they don’t want to take an hour or two to personalize EHR features or save their own default Review of Systems or Exam templates. I see providers manually typing differential diagnosis paragraphs that they could save and use as a base for future notes when seeing common conditions. They say they’re too busy to save them as quick phrases, but I would argue that they’re too busy to not take the time to make their future lives easier. I’m not sure what the answer is or how to motivate some of the more resistant providers, but I’m open to ideas.

What good ideas can be found in your bag of EHR optimization tricks? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/27/23

April 26, 2023 Headlines 4 Comments

UK’s TympaHealth sounds out $23M to expand its hearing diagnostics startup

London-based TympaHealth will use $23 million in new funding to begin marketing its digital ear and hearing healthcare platform to primary care providers, retailers, and pharmacies in the US.

VA’s new EHR hits another outage, as agency reconsiders FY 2024 request for project

The VA’s Oracle Cerner system experiences a nearly four-hour outage when one of its databases became unresponsive due to a failed background process.

Amazon closing Halo health division, lays off staff while offering hardware refunds

Amazon announces that it will shut down its Halo health wearables division at the end of July.

Healthcare AI News 4/26/23


Apple is developing a paid, AI-powered health coaching service called Quartz that uses the Apple Watch to encourage healthy behaviors. The company will also release a dedicated version of its Health app for the IPad.

Google merges its DeepMind and Brain team from Google Research into a single unit called Google DeepMind, which the company says will accelerate its progress in using AI to solve humanity’s biggest challenges.

Alphabet CEO Sundar Pichai says in the company’s earnings call that Google is investing heavily in AI, but downplays the potentially negative effect that it will have on search advertising. Microsoft CEO Satya Nadella says in his company’s earnings call that Bing has gained market share following early incorporation of AI in its search, and calls AI’s impact “a generational shift in the largest software category – search.”

OpenAI adds the ability for ChatGPT users to turn off chat history to avoid having their conversations used for model training.


Life sciences technology vendor Trinity Life Sciences offers its customers AI-driven insights powered by WhizAI. The conversational AI and visualization platform will provide analytics for Trinity’s enterprise reporting platform, allowing users to type or ask business questions to generate visualizations and dashboards.

PricewaterhouseCoopers will spend $1 billion over the next three years to automate parts of its tax, audit, and consulting services using ChatGPT and Microsoft Azure.

3M Health Information Systems will use AWS services, including machine learning and generative AI, to further enhance its clinical documentation and virtual assistant solutions that include ambient intelligence.

NIH awards Case Western Reserve University and University Hospitals a $6.2 million grant to study the use of AI to predict cardiovascular disease from the calcium scoring of CT images.


Unfold AI, an FDA-cleared prostate cancer management platform from Avenda Health, is being used in an unnamed US research hospital to offer treatment selection, planning, guidance, and follow-up.

Federal regulators will enforce existing civil rights laws when generative AI tools perform “digital redlining” in introducing bias into decisions about hiring, credit, and housing. EEOC Chair Charlotte Burrows says that rapid AI development is a “new civil rights frontier.”


An analysis of the use of AI-powered conversational assistants for support inquiries shows a 14% increase in the number of issues resolved per hour, mostly improving the performance of inexperienced workers who are supported by the stored knowledge of their more experienced peers.


The Verge notes the legal situation created by a viral song hit that was created using AI, prompting Drake’s record label to warn that training AI using the music of its artists is a breach of copyright laws. Skeptics question whether it was actually a record label PR stunt. The legal issue is that Google-owned YouTube pulled the track due to a take-down notice from the record label, but the record label doesn’t own the song, which then pits Google’s AI-enriched search against YouTube’s music partners about what constitutes fair use.

A HIMSS23 panel warns health systems that hackers will be launching AI-powered cyberattacks, predicting the rise in AI-operated ransomware and ChatGPT-crafted phishing emails that sound more authentic, but with security technology vendors also using the technology to build smarter defenses.



Pharma bro and ex-con Martin Shkreli rolls out a medical chatbot called Dr. Gupta that he says will be a “replacement for all healthcare information” that will leave WebMD “dead in the water.” He says the new large language model was trained in data from the web and from online medical journals, using both GPT 3.5 and GPT-4 to improve performance with some sacrifice in response speed. Users can ask five questions for free, then sign up for a $20 per month subscription to Dr. Gupta. When asked about HIPAA concerns related to users submitting PHI to an online chatbot, Shkreli suggested on Twitter to read the terms to decide whether to use it. Meanwhile, Twitter has suspended Shkreli’s account, although his original post on Substack remains, where he argues that healthcare is expensive because of the artificially constrained supply of healthcare professionals. Shkreli also wrote a 200-page novel using ChatGPT. 

A Washington Post study of the 15 million websites on which Google trains its C4 data set places HIStalk at #1,996, representing 3.4 million of the data set’s tokens.

Resources and Tools

  • DocLime – allows analyzing documents stored in PDF form to generate summaries, answer questions, or provide research citations.
  • Zain Kahn, “The AI Guy,” lists ways to prompt ChatGPT for learning. Examples: “”Proofread my writing above. Fix grammar and spelling mistakes. And make suggestions that will improve the clarity of my writing” and “I want to learn about [insert topic]. Identify and share the most important 20% of learnings from this topic that will help me understand 80% of it.”


Mr. H, Lorre, Jenn, Dr. Jayne.
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Send news or rumors.
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Readers Write: HIMSS23 Recap

April 26, 2023 Readers Write No Comments

HIMSS23 Recap
By Mike Silverstein

Mike Silverstein is managing partner of the healthcare IT and life sciences practice of Direct Recruiters, Inc. of Solon, OH.


The HIMSS Global Health Conference & Exhibition was held April 17-21 in Chicago, where over 40,000 professionals gathered for educational sessions, visited vendor booths, and networked. Our company was excited to get back to HIMSS as a larger group and share these observations.


AI and tools such as ChatGPT are getting adopted into healthcare quickly. There were a few innovative companies already showing off their new ChatGPT features, which was extremely cool. We anticipate this trend continuing, with ChatGPT having strong use cases in many areas of healthcare tech. We’re just at the tip of the iceberg.

We noticed a pivot towards partnerships. With hospitals struggling, tech companies are putting a big focus on partnerships. Fundraising remains in a slowdown. However, we continue to hear about investments being made for companies going from seed to Series A or to A to B, not in later stages. Series B/C companies are conducting more inside rounds to sustain cash needs.

Direct-to-provider meetings seemed to be relatively slow. We saw a continued trend of companies who sell direct to providers that were looking at ways to break into the health plan space. As hospitals are taking a long time to buy and are very ROI-driven, RCM services are staying strong.

Interoperability has been a theme for over a decade now in healthcare and remains today. Conversation has shifted from inside the four walls of the hospital to how technology receives data and information from what is available globally. A “Designated Record Set” is pushing for provider compliance to ensure their technology integrates with all systems (HIE extender).

Hiring seems to be ramping back up, especially looking into Q3 and Q4. The emphasis remains mostly in revenue-generating roles at the moment. There is also a need for senior finance and accounting. Product and operations roles are hardest to come by.

General Observations

From an overall size and attendee standpoint, the conference seemed to be back to pre-COVID levels. It was key to have pre-booked meetings, but even then, some companies were no-shows. Microsoft’s booth (and Nuance), and surrounding areas were always packed with people. It was great to see a renewed energy at HIMSS despite the ups and downs of the industry over the past few years.

Constructive Feedback

The main hall was split into two sides. The north side felt a bit forgotten, and some did not venture out much to the booths on the fringes. In addition, there seemed to be a lack of places to sit, grab a good coffee, and most importantly, charge your phone.

The last piece of feedback is to bring back the carpet. We noticed one person trip and fall (luckily, they were OK) because of the lack of carpet-to-carpet transition at one of the booths.

Overall, our team is excited about the connections made and the new technologies we saw at HIMSS. We are energized by the passion and innovation of the industry as a whole and look forward to what’s to come.

HIStalk Interviews Julia Regan, CEO, RxLightning

April 26, 2023 Interviews No Comments

Julia Regan, MBA is co-founder and CEO of RxLightning of New Albany, IN.


Tell me about yourself and the company.

I’m a long-time health tech innovator. I carried a bag in pharma and started my career in sales. Early on in my career, in the infancy of health technology, I worked for a manufacturer organization. I fell in love with the opportunity to connect different people, roles, and responsibilities across the healthcare continuum to try to create a better experience and world for patients.

The specialty medication market is one of the fastest growing spaces in the industry for drug spend, representing 52% of dollar volume with high-cost medications such as biologics, infusion meds, cell gene therapies, and even those involving personalized medicine. RXLightning brings that specialty medication process and journey for patients and providers into the digital arena.

Our end-to-end platform automates multiple steps of this process while connecting doctor, patient, specialty pharmacy, and drug manufacturers and  their support teams. Our digital platform, for the first time, creates visibility into the experience. The goal is to reduce administrative burden and waste in the healthcare system for the providers and those organizations that are working to help patients, but ultimately to get patients on therapy quicker in a more affordable way.

What is the overlap between specialty medication prescribing and prior authorization?

Prior authorization is definitely a component of gaining payer access and approval for these medications. But it’s not just the prior authorization, it’s also the cost component, which for these medications could range from tens of thousands of dollars up to a million dollars. Because the cost is so high, there’s an affordability component. Drug manufacturers create programs to help patients get access to therapy, helping go through that benefit investigation and that prior auth process, and also more affordability programs. That could be a bridge program, where patients get samples of the drug while they are navigating the access barriers; free drug for people who can’t afford it; and research around foundations and grants. It’s everything from access through affordability as well. We are a little different than the PA, but the PA is still a component of the journey.

What is the manual process that you replace?

If a specialty pharmacy is used, the doctor will send the prescription to the pharmacy and then wait. The pharmacy will reach out to them and say that a prior authorization required, so they will either complete a paper form or use a digital solution. The next step involves affordability. The pharmacy traditionally works through that process, but because the prescription doesn’t have any of the clinical information or patient financial information, there’s just a lot of back and forth among the pharmacy, the provider’s group, the payer, and even sometimes the manufacturer and their programs. This paper-based system is slow and creates inefficiencies due to missing information or ineligible information.  

RXLightning has created a technology solution for just under 1,300 medications that turns those processes into a single solution that walks a provider through that process digitally and also allows them to track their patients throughout. Instead of using Post-its, Excel, or manual processes that live outside the EHR, our technology system tracks that journey with a CRM type of tool.  

Why do manufacturers choose the specialty drug distribution model and what information do they require?

Because of restrictions and cost, a lot of parties along the way want validation that the clinical steps that are required for approval for a given patient have been documented. The traditional prescription information is one component, but it’s also contact information and caregiver information. Sometimes it includes the clinical history, not only from medications, but also height, weight, allergies, and medications that have been tried and failed. Many components that are part of that traditional prior authorization process are part of these referral forms and enrollment forms.

Then there are REMS medications, which are in the FDA’s Risk Evaluation and Mitigation Strategy because of serious safety concerns. Those have different criteria around authorization codes and compliance that in some cases must be submitted monthly.

Another component is consent, opting into different programs for the patient to share information from a HIPAA compliance perspective, as well as the provider consent to allow another party to work on behalf of them to help navigate through that experience. Also for sharing household income information if they are looking at grants, foundations, or free drug programs.

How laborious is the provider’s process and how long does the patient have to wait for approval before starting the drug?

The work of going through access, affordability, and patient data collection isn’t done while the patient is in the office. A patient who is sick now may have financial constraints with affording a medication that can change their life or even save their life. The provider has to call the patient and ask them to fill out forms. They either have to come in to the office or have it mailed to them, which could get lost.

That paperwork process can take weeks or months. With RxLightning, we see it done sometimes in less than 10 minutes. We communicate and capture the patient consent and information via text and email. The majority of referrals are completed in less than an hour compared to the 2-3 weeks it was taking before. 

What is the implementation process? Do you work individually with providers in a health system, or do they need to reach consensus as a group?

Our platform is extremely flexible and nimble, so we can support all of the different scenarios that are out there. If a large health system wants to install it, we go through a corporate business associate agreement, because PHI and patient data is being entered into our system. We traditionally go through security assessments, and we are HITRUST certified.

We have crawl, walk, or run approaches to implementation. We have a standalone portal that providers and users can be up on within minutes once we get through the business associate agreement and security assessment, if it’s required. The crawl approach is that we use our standalone portal and power it with Secure File Transfer Protocol, or SFTP, data exchange. That’s really just around how we are going to exchange information, pulling exports out of the EHR, having that load patients into our system, and then pushing the data from our system back into the EHR.

Our run is being able to do fully single sign-on capabilities or API integrations with the EHR and embedding our platform into those systems. That requires an implementation group and technical support from the health system. Our standalone platform is completely free to provider groups. 

How are insurers managing biosimilars? Are they asking patients to change their specialty drug prescriptions or do they require a different process?

That’s a really interesting question, and I don’t think there’s a exact answer. Each payer is going to create their clinical policies into their rules based upon what their clinical team assesses coverage should look like. There are multiple steps in this process, and our platform does pharmacy referrals. If a health system doesn’t have access to limited distribution and it’s at a single-source distribution pharmacy, they can send the clinical information and package it up over to that pharmacy. Then we close the loop back to the health system pharmacy with the details so they can create a better experience for the patient.

We handle the investigation, pricing, and coverage. There is a PA component of our platform that could be used. It’s very modular, though, so if they already have a solution in one of those, we could plug those into the platform. Then we handle all of the foundation, grant, free drug, and affordability components in our platform. What we’ve looked at is that across that end-to-end experience, we’ve created a tool where it’s up to the health system, providers, and users on how they want to navigate through it and use it. 

Regardless of what the payer criteria are or the decision-making, around the biosimilars, for example, offices can use our platform to navigate those decision points, and complete the processes for all of them in one location, to navigate the patient quickly and efficiently to a therapy that the payer is going to cover and approve.

How have market conditions affected your strategy?

They haven’t impacted our strategy. So many inefficiencies exist across this journey that health systems and provider groups need a solution. RxLightning has approached it from a brand- and drug-agnostic perspective. We haven’t isolated it to one therapy, one disease state, or a limited portion of drugs. We’ve opened it up and said that we are going to try to solve this process for all of these medications across all of these different steps, which today is being done by different vendors or organizations, most of the time on paper. Organizations see that our platform solves many inefficiencies on their team and the work that they are doing. RxLightning helps alleviate provider burnout  because it makes this process so efficient.

It’s not just about the efficiencies upstream, because when you use paper and faxes, inefficiencies happen while you are awaiting a response. The communication back to the provider’s offices creates call lags and call volumes and it’s sometimes uncontrollable for organizations. We work to plug into the different destinations across this journey — manufacturers, different specialty pharmacies, different parts of the process — to close the loop with information back.

If a provider has a patient who needs a cancer medication and can’t afford it, they can go in our system, see all the grant information, and make a decision whether to apply for a grant. If the grants aren’t of open and foundations aren’t open, they can do the manufacturer’s program. We will provide the response back around the approvals or the denials so they don’t have to constantly look, make phone calls, or answer phone calls. That gives transparency through that whole process while also allowing the patient to see updates across the journey.

What will be important to the company over the next few years?

We are looking to expand our provider base. We know that when our platform is used, it saves much time for offices and helps patients get on therapy much quicker in a more affordable way. We are used by some of the largest healthcare systems today, so growing that base and then providing all the digital connectivity points into the drug manufacturer programs, the hubs, and the specialty pharmacies to have a 100% digital, interoperable ecosystem that exchanges information is critical to the success for the industry, patients, providers.

Morning Headlines 4/26/23

April 25, 2023 Headlines No Comments

Tegria Acquires Meditech hosting and services firm Sisu Healthcare IT Solutions

Tegria acquires Sisu Healthcare IT Solutions, which offers Meditech-certified hosting and services.

Virtual nursing startup raises $1.5M to pivot and address hospital staffing crisis

Nurse Disrupted will use $1.5 million in new funding to expand its virtual nursing services to hospitals.

GE HealthCare Technologies Non-GAAP EPS of $0.85 beats by $0.06, revenue of $4.71B beats by $80M

GE HealthCare reports Q1 results: revenue up 8%, adjusted EPS $0.85 versus $0.96, beating expectations for both but sending shares down 9%.

GoodRx Expands Executive Team With New Interim CEO

GoodRx co-founders Doug Hirsch and Trevor Bezdek transition from co-CEOs to chief mission officer and chairman, respectively, upon the appointment of Scott Wagner (GoDaddy) as interim CEO.

News 4/26/23

April 25, 2023 News No Comments

Top News


Tegria acquires Sisu Healthcare IT Solutions, which offers Meditech-certified hosting and services.

HIStalk Announcements and Requests

Listening: Amanaz, which was part of the Zambia’s Zamrock movement of the early 1970s. When the country gained its independence in 1964, radio stations were required to play 95% Zambia-originated music, and bands met the sudden musical demand with Western-influenced blends of Afrobeat, garage rock, and psychedelic fuzz. Zamrock faded away with Zambia’s economic problems and massive AIDS devastation that continues today, but the 50-year-old music is enjoying a resurgence. Quality varies, but I like all forms of music that reflect the exuberant, non-commercial spirit of the times, whether it’s doo wop, early gospel, or punk.

I asked conference services vendor Freeman how it handles exhibit hall carpet. They referred me to their corporate sustainability practices page, which only says that they offer carpet that can be repurposed.


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

Acquisitions, Funding, Business, and Stock


USPTO grants cyber risk management company Clearwater a patent for the Predictive Risk Rating capability within its IRM|Analysis software.

GE HealthCare reports Q1 results: revenue up 8%, adjusted EPS $0.85 versus $0.96, beating expectations for both but sending shares down 9%.


  • Allina Health (MN) will offer patients Epic-based virtual care through KeyCare.
  • Lexington Medical Center (SC) will implement healthcare and social services referral software from Unite Us.
  • Jefferson Health (PA) selects Ada Health’s symptom assessment and care navigation technology.
  • The University of Miami Health System and the Miller School of Medicine will roll out Clear’s identity verification technology for patients and employees.
  • OhioHealth will implement EVideon’s Vibe Health smart room technology at its Pickerington Methodist Hospital in December.



Tabula Rasa HealthCare promotes Brian Adams to president and CEO.


Adam Mariano (HighPoint Solutions) joins LexisNexis Risk Solutions as president / GM of healthcare.

image image image

Artera names Karri Alexion-Tiernan (TigerConnect) VP of product marketing; Joanne Chen, PhD, MS (Strive Health) VP of data; and Mark Thomson, MS (TigerConnect) VP of customer success.


Cancer remote patient monitoring technology vendor Veris Health hires Gary Manning (PhysIQ) as president.


Reperio Health hires Naomi Levinthal, MS, MA (Memora Health) as chief growth officer.

Announcements and Implementations


Children’s Mercy Kansas City opens a 6,000 square-foot Patient Progression Hub, which uses AI-powered technology from GE HealthCare to monitor patient flow, manage staffing, and coordinate care.


Fortified Health Security consolidates its managed security services into the new Fortified Central Command platform.


AvaSure develops a Virtual Nursing application and Care Model to support six current virtual nursing implementations.

WellSky expands the capabilities of its CarePort care transition solutions.

Government and Politics

The VA establishes an Artificial Intelligence Institution Review Board and an AI Oversight Committee for its clinical and research operations.

Sponsor Updates


  • AdvancedMD employees in Utah volunteer at the St. Vincent De Paul Dining Hall, Utah Food Bank, Clementine Ranch, and Encircle during its day of service.
  • Agfa HealthCare joins the AWS Partner Network.
  • Baker Tilly releases a new Healthy Outcomes Podcast, “Insights into the credit ratings of hospitals and health systems.”
  •’s virtual nursing solution is added to Google Cloud Marketplace.
  • Surescripts posts a data brief titled “How Are Care Teams Evolving to Fill Primary Care Gaps?”
  • Meditech is featured in an episode of HealthData Management’s video series titled “The Journey Beyond: Exploring uncharged territories.”
  • Bamboo Health publishes a new case study, “Leveraging Real-Time Patient Data to Keep In-Home Care in Home.”
  • KLAS honors CenterX with its 2023 Points of Light Award for improving prior authorization efficiency and easing administration burden for providers and payers.
  • Nordic posts a podcast titled “Designing for Health: Interview with Chris McCarthy, Part 2.”
  • Clearwater uses the Cyturus Third Party Risk Management module of the Compliance & Risk Tracker as its primary platform to support its Vendor Risk Management managed services program.
  • Mubadala Health in Dubai will use Oracle Cloud Infrastructure to run its Oracle Cerner EHR.

Blog Posts


Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
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Book Review: Redefining the Boundaries of Medicine

April 25, 2023 Book Review 2 Comments


image image

Redefining the Boundaries of Medicine” is a Mayo Clinic Press book that was written by Paul Cerrato, MA (senior research analyst and communications specialist, Mayo Clinic) and John Halamka, MD, MS (president, Mayo Clinic Platform). The authors have collaborated previously on three books and several journal articles.

The book is written for readers who are knowledgeable about the “only in the US” healthcare mix of research, medical practice, consumerism, and hardcore capitalism where money has an outsized influence on both individual health and the business of healthcare. Its dense typography and layout is hardly inviting, but it provides an excellent history of how we got to where we are in healthcare (hint: often illogically, stubbornly, and parochially) and how healthcare can be improved.

The book delivers what its title promises. The authors are predictably precise in their citations and conclusions, and they are on the provider front lines rather than ivory tower academics. In addition, Mayo Clinic Platform is working actively to apply data science and technologies to healthcare.

I admit that I wasn’t aware of the previous books that these authors co-wrote and wasn’t exactly sure what Mayo Clinic Platform does or what happened with John Halamka after he left BIDMC three-plus years ago. But I think these authors might be the go-to-experts that the healthcare industry needs as it rushes headlong into artificial intelligence and re-examines itself with an opportunity (or requirement) to change dramatically.

Here are some of the notes I took.

Artificial Intelligence

The book leads off with a chapter on artificial intelligence, where the authors observe that the human brain cannot process the amount of new information from journals and conferences, much less apply it at the bedside, and can’t analyze all available information to arrive at an accurate diagnosis. AI is also better than humans in analyzing diagnostic images, although system training must be carefully designed in an environment that has never-ending changes in scanning technology, coding and terminology, EHR configuration, changed institutional practices or order sets, and a changing patient mix that may not be applicable elsewhere.

A fascinating idea is that all broad research, whether powered by AI or not, overgeneralizes to the entire population instead of digging into patient subgroups. For example, a large study on the effect of lifestyle modification on cardiovascular disease was abandoned when no differences were seen between the intervention and control groups, suggesting that lifestyle doesn’t matter. However, applying sophisticated analytical technique found that lifestyle intervention actually worked in two subgroups that were otherwise lost in the large numbers: patients whose diabetes is poorly controlled and in those with well-controlled diabetes who self-report their health as good.

They also note that FDA’s approval of AI devices is inconsistent and often involves retrospective and/or single-site studies.

The authors conclude AI algorithms need to be more equitable and better validated before being placed into clinical use.

Medical Knowledge

Medicine’s history in the US involves paternalistic physicians; diagnosis and treatment protocols that were based on GOBSAT (good old boys sat around the table); and slow acceptance of research findings in favor of personal experience, anecdotes, and opinions lacking evidence.

Randomized controlled trials, especially those that conclude that a therapy was not beneficial, have weaknesses such as too-small sample size and inclusion criteria that may introduce bias or reduce clinical usefulness. RCTs should be supplemented with real-world evidence and cohort studies. 

The “heterogeneity of treatment effect” acknowledges that treatment benefit and risk can vary widely among patients. Patients know their conditions and see the effects of treatments firsthand, so N-of-1 trials comparing active treatment with placebo are a good idea.

“Patients like mine” data can help support decisions in the absence of RCT or observational studies now that EHR data is widely available, although it may require experts to turn patient data into actionable evidence.

Rethinking Medical Expertise

The public questions the value of medical expertise. Experienced clinicians use Type 1 thinking, in which pattern recognition can lead to quick conclusions involving common conditions as “disease scripts.” But sometimes it fails dramatically when a patient’s symptoms fall outside the norm. Type 2 reasoning starts with a hypothesis that is refined via logic and critical thinking, which can be more accurate and avoid bias and thinking shortcuts, but takes too long to conduct in high-volume settings.

The authors cite previous studies that found that peer-reviewed journals often rejected research that turned out to be important, questioning whether that publishing process is the best way to gestate new ideas.

Replacing “One Size Fits All” with Personalized Medicine

Full genomic sequencing is increasingly useful. Some experts say it should be performed at birth, whereas now newborns are screened for a small number of genetic disorders.

Large studies on using the antiplatelet drug clopidogrel for blood clots found that the drug outperformed aspirin in just two of each 100 patients, but the real challenge is to identify those two instead of incurring the cost and risks of giving it to everyone.

“Normal” lab ranges are just a statistical convention, and each person’s “normal” may be different and deviation from it may not indicate the presence of disease. Insurance will often pay for only drugs and treatments that appear effective for broad segments of the population.

Researchers search for one or two primary causes of a disease, such as HIV as a cause of AIDS or striving to control the blood sugar of diabetics, and immediately refocus all research on those causes. The outliers are rarely studied, such as the people who are exposed to HIV but don’t develop AIDS and why that might be. Correcting the condition for a given patient doesn’t necessarily deliver the expected benefit.


Too many clinicians still practice the “doctor knows best” model when patients don’t agree with their evidence-based interventions. Policy decisions are rarely made on science alone since beliefs and core values will usually win.

FDA knows that most drugs that it approves offer only slight benefit, but consumers aren’t capable of analyzing studies, especially when faced with direct-to-consumer advertising. The public is easily confused by correlation versus causation and relative value versus absolute risk, such a miracle drug that reduces the risk of some disease by 50% that really means that one person instead of two out of 1,000 patients will get it, which is hardly impressive. Schools do not teach critical thinking skills and the US doesn’t follow the lead of other countries that teach media literacy.

Interdisciplinary Patient Care

Researchers and clinicians need to communicate better. Experts say that NIH-funded research focuses on silos for particular conditions of interest without looking at how they relate to, or are affected by, other factors, which is an outdated understanding of medicine. DARPA might offer a better model.

Clinician fragmentation increased with the growth of specialty medicine, medical group consolidation and insurance programs networks that separated people from their specific doctor.

More than three-fourths of chronic diseases are caused by or exacerbated by lifestyle choices that can’t be easily explained or encouraged in the allotted 15-minute office visit.

Patient-generated data should be fed into EHRs.

You will be stimulated by the ideas the authors express in this book if you are comfortable reading journal abstracts and understand clinical practice, especially if your specialty is informatics. It seems like a slim read at under 200 pages, but is packed with information in being free of self-aggrandizement and pontificating (and again, the typeface is pretty crammed, so it’s got more content than you might think). If you or your organization want to be considered disruptive in healthcare, the authors are giving you great ideas of where you might focus.

Morning Headlines 4/25/23

April 24, 2023 Headlines No Comments

CompuGroup Medical Buys Majority Stake in German Digital Healthcare Platform m.Doc

Germany-based CompuGroup Medical acquires patient communication software vendor M.Doc, also based in Germany, for an undisclosed sum.

ClaimsXten Becomes Lyric, Welcomes Raj Ronanki as Chief Executive Officer

Claims payment and editing software business ClaimsXten rebrands to Lyric and names Raj Ronanki (Elevance Health) CEO seven months after its sale by Change Healthcare to TPG for $2.2 billion.

Children’s Mercy Kansas City, GE HealthCare Launch Nation’s First Pediatric Hospital Operations Center to Improve Patient Care

Children’s Mercy Kansas City opens a 6,000 square-foot Patient Progression Hub, which uses AI-powered technology from GE HealthCare to monitor patient flow, manage staffing, and coordinate care.

Curbside Consult with Dr. Jayne 4/24/23

April 24, 2023 Dr. Jayne 1 Comment


As a primary care physician at heart, I know how important it is for patients to learn how to make better food choices. A friend clued me in to the Plateful app, which helps consumers make better choices by providing information that may be more understandable than the typical “Nutrition Facts” label. Once a user scans the UPC found on a packaged food, or uses the PLU code on a fruit or vegetable, the app displays a Nutrition Value and an Eco Value, each of which ranges from 0 to 100. In addition to the numbers, star values also display to help users understand the relative value of a food choice.

The Nutrition Value is based on the Tufts Food Compass Score, which was validated over nearly two decades. I wasn’t familiar with it before seeing the Plateful app. This isn’t surprising given the huge lack of nutrition education at medical schools when I was in training. I think we had a four-hour block to cover the entire topic, and you can bet that people paid less attention to it than they did to competing educational priorities like the surgical skills lab or cramming for the USMLE licensing exams. If I remember correctly, it was tacked on to the end of second year almost as an afterthought.

Although medical education has become more well-rounded since then, I’d bet that nutrition still gets less coverage than it probably should. Some of the most damaging chronic health conditions, including coronary artery disease, stroke, diabetes, and certain cancers can be impacted by nutrition, but it seems that our society would much rather spend its healthcare dollars on pills and injections rather than addressing the root causes of the diseases.

The Tufts Food Compass looks at 54 attributes across nine categories, including: ingredients, nutrient ratios, vitamins, minerals, fiber/protein, lipids, phytochemicals, additives, and processing. Foods with a higher Food Compass Score are associated with more favorable Body Mass Index, blood pressures, lipid profiles, and fasting blood glucose values as well as being associated with lower all-cause mortality rates. The validation studies were performed with a nationally representative sample of nearly 48,000 adults aged 20-85 in the US.

As you may guess, whole foods get higher scores, where heavily processed or additive-laden options get lower scores. Consumers are encouraged to use the app to scan similar foods and compare them. One of the use cases mentioned on the app’s website is comparing two loaves of bread to see which one has a higher Nutrition Value. The Eco Value looks at a food’s relative level of environmental friendliness, with a nod to climate, land, and water impacts. Foods with an Eco Value of more than 50 are more associated with a sustainable food system. While reading the website, I was surprised to learn that some foods that are conventionally thought of as healthy are actually less great for the environment due to water and climate impacts.

According to the website, parent company Opsis Health has more cool tools on the horizon, including the ability to take a picture of a plateful of food and have it converted to detailed nutrient information. That’s going to be a lot more accessible to most people than weighing or measuring food, which is often the first step in trying to take control of your eating habits. We’ve had so much portion inflation in the US that people often have no idea what a realistic serving of anything is any more. (I had to guess the weight of the amazing bone-in pork chop I had in Chicago, so I’m among the masses who might benefit from this innovation.) Turning your phone into essentially what is a 3D food scanner sounds a lot cooler than logging things into Nutritionix or MyFitnessPal or any of the other tools that are out there.

In learning more about Plateful and the company, I liked the website’s clean look and bright colors, and the amazing food photos as well. I also liked the fact that I had to dig pretty deep before I saw mention of AI as being part of the upcoming solution. It seems like many other companies are entirely in-your-face with AI-this and AI-that, so it was refreshing to find that it’s part of the solution but they’re not leading with it. I’m looking forward to following them over the coming months to see how the solution evolves and will definitely have fun doing some food comparisons in the coming months.


For the chocoholics out there who may be wondering, my go-to “survival chocolate” vendors were pretty much neck and neck, with the Hu Kitchen Salty Dark Chocolate (vegan, paleo) leading with a slightly higher Nutrition Value while the Ghirardelli Intense Dark Sea Salt Almond squares squeaked by with a higher Eco Value. I give them both five stars for their mental health boosting properties, so it would be a toss-up to choose one over the other. As the Plateful website says, “Lower NV foods, eaten on occasion, can fit into a healthy eating pattern if the majority of foods you eat over time are nutritious.” Sometimes you just need a little bit of dark chocolate to get you through the day.

It would be interesting to learn about the business model for the coming solution and whether it will be presented as a consumer-driven offering or whether it will be made available as part of an employee benefits plan or as part of a payer-based offering. The latter two would be smart as potential enhancements to reduce overall healthcare costs. I don’t have a frame of reference for what kind of databases are out there to create the library of UPC codes, PLU codes, and nutritional values, let alone what the R&D lift looks like for the “scan your plate” app that will be coming. I always enjoy learning about something that’s not in my usual lanes of EHR, HIE, and patient portal, so learning about this was a welcome diversion. Knowing that it may be able to help patients with healthy food choices, which is one of the solutions to healthcare crisis of our times, was a bonus.

Is your organization doing anything to promote nutrition education or healthy eating? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Frank Harvey, CEO, Surescripts

April 24, 2023 Interviews 1 Comment

Frank Harvey, RPh, MBA is CEO of Surescripts of Arlington, VA.


Tell me about yourself and the company.

I have been interested in healthcare since I was six years old. My father used to take me on Saturday mornings to the soda fountain at the local pharmacy. I was interested in what our local pharmacists were able to do with patients and the members of the community. From that time on, I’ve wanted to be in healthcare, specifically as a pharmacist.

I’ve been in pharmacy throughout my career. I have been fortunate to be a part of life sciences, with Lilly and Hoffman-LaRoche, and companies such as Liberty Medical and Mirixa, which is a medication therapy management company. I ran my own venture fund for bit. I was excited to get the opportunity to come to Surescripts because it’s such a wonderful company. Surescripts is a mission-driven health information network that is focused on enhancing the prescribing process and forming care decisions. Our mission is to continue to lower the cost of healthcare, improve patient safety, and improve the overall quality of care.

How has the role of the pharmacist, along with the technologies and data that are part of their work, changed?

During COVID, pharmacists really raised their level and used the full scope of practice of their degree. It was critical during that time, because in many cases, physicians weren’t available because they were tied up with so many COVID patients. Pharmacists stepped in to do much more, such as administering vaccines and  counseling chronic care patients.

We expect pharmacists to continue operating through the full scope of their license, particularly because there’s such a shortage not only of primary care physicians, but also of endocrinologists and rheumatologists. We’re seeing a burnout of physicians and many of them are retiring. Pharmacists will have the opportunity to step up their level of their practice to be operating more at the full scope of their license.

How has the Surescripts network changed over time?

When Surescripts first came into being over 22 years ago, prescriptions were transferred back and forth, either by patients carrying the prescriber’s handwritten prescription to a pharmacy or having it called in. Surescripts was put in place to make that process electronic, as the first health interoperability network, if you will. Now the vast majority of prescriptions go from the physician to the pharmacy electronically through our health information network. 

We have continued to expand far beyond that to help with price transparency and to support pharmacists and physicians being able to message each other electronically, with no more faxes or having to jump on the phone. We’ve continued to focus on enhancing the prescribing process and informing the care decisions that physicians, nurse practitioners, and PAs make by providing medication histories of the patients to the physician.

Has the launch of a competing e-prescribing network changed your strategy?

No. We will continue to focus on being a mission-driven company and will continue to enhance the prescribing process and informing that care decision. Competition is always good. We welcome competition that helps move our mission forward. Whether it’s Surescripts doing it or other companies doing it, we’re happy about that.

How will you continue to enhance the Surescripts network?

Even in the last four years, we’ve improved the quality of prescribing, the prescriptions coming across, by about 85%. We continue to focus on enhancing that prescribing process. The other thing we continue to work on is ensuring that, from an administrative standpoint, we’re providing the right information at the right time to physicians, so they don’t have to cull through volumes of information to get to what’s important at care decision time.

How much emphasis is placed on inserting the connectivity result into the prescriber’s EHR workflow?

It is really critical that it’s in the workflow. We’re integrated in every EHR across the country. Last year, over 2 million practitioners prescribed over 7 billion transactions. All of those were integrated into the electronic health record that the physician was working with.

An example is that at the time of prescribing, when the physician is with the patient, transparency apps allow the physician to see not only the therapeutic alternatives, but also the pricing of each based on the insurance coverage that the patient has. It allows a physician to make the right therapeutic decision for the patient as well.

Are you seeing benefits for both the prescriber and the patient?

Absolutely. That’s one of the most important things about having a real-time prescription benefit tool in the physician’s EHR. They can see everything about the prescription and the therapeutic alternatives. Before, they would write a prescription without understanding the price consequences. The patient would take it to the pharmacy, find that they couldn’t afford that medication, and then ask the pharmacy to call back to have the prescription changed to a different medication that they could afford. Integrating that into the overall workflow cuts down a lot of demonstrated burden of the physician, the pharmacy, and the physician staff.

Have you seen statistics documenting outcomes improvement since cost issues might have led to the patient either not having the prescription filled or taking it in lower doses to stretch it out?

We absolutely have. Most recent studies shows that the prescription pickup rate increases by 3% to 5% with use of a price transparency tool with real-time prescription benefits. The patient knows what they are facing from a pricing standpoint, they’re more likely to pick it up, and the doctor is more likely to have written a medication that is affordable to the patient. The most expensive medications are the ones that the patient never picks up, because they never get their health condition taken care of. These tools help the patient.

How has the federal government influenced interoperability?

Micky Tripathi and his team have done a tremendous job. They have so much energy behind their efforts. Interoperability is so critical in being able to get that full patient’s record. A new proposed rule focuses on advancing that interoperability and improving transparency, supporting the access and exchange of electronic health information. 

The role that Micky and his team have played has been critical to moving us forward more rapidly than would have happened without their participation, their urging, and their hard work over a long time. We are a great example of what interoperability does, with 21.7 billion transactions a year across all of our products. We are looking forward to everything that’s happening with TEFCA.

What will the company’s strategy be over the next few years?

We are going to continue to focus on what has been our bread and butter, which is our mission of improving the quality of care, improving patient safety, and lowering cost. We will do that by broadening the areas that we work on across enhancing prescribing as well as informing care. We are looking to work to help broaden the care team, to enable the care team as it expands and pharmacists take a more active role, to make sure that they’ve got the right data to make the right decisions and can communicate that information back into the health record. We will continue to lobby for the right legislation to be in place to enable and empower pharmacists to do what they’re able to do, in partnership and collaboration with physicians, nurse practitioners, and physician assistants.

Healthcare in this country is at a critical phase. We are seeing the continued burnout of our healthcare practitioners and a lack of enough healthcare practitioners, particularly in rural and urban areas. We have areas where patients may have to travel 100 miles to see a physician. It will be important that pharmacists can play a larger role. I believe that we will see, over the next five years, that the healthcare team will continue to evolve, and that will be the best thing for the patient.

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