Monday Morning Update 7/19/21

Top News

The New York Times says that IBM Watson failed to achieve its goals to transform industries and make IBM successful. It says that Watson’s capabilities were oversold by IBM’s top executives – mostly former sales and services people – who ignored the warnings of the company’s scientists that it was a one-trick pony that was built purely to win “Jeopardy.”

The article notes that Watson’s healthcare “moon shot” failed in multiple health systems, as the technology was not capable of performing real-time cancer diagnosis or smart literature searches. IBM has discontinued its genomics and oncology offerings after they failed in high-profile health systems.

IBM’s Watson Health business spent $4 billion to acquire Merge Healthcare, Phytel, Explorys, and Truven Health Analytics. The company is reportedly considering selling those businesses as it lags competitors in cloud computing. Watson Health is reportedly bringing in $1 billion in annual revenue but still loses money.

NYT says Watson is “a sobering example of the pitfalls of technological hype and hubris around AI,” but says the technology has improved to the point that it can manage workhorse natural language tasks as offered by IBM’s cloud competitors, such as task automation and virtual assistants.

Reader Comments

From He’s Not Here: “Re: remote patient monitoring. Doesn’t that term contain a bit of geographic paternalism?” It does. Healthcare was historically built around the “my patients come to where I am” model, where other than for the rare house call, the provider has always sat in their building and waited for people in need to show up. I would say that in itself is not paternalistic since it’s no different than any other retail or professional business that doesn’t involve services that are provided in the home or on the road, but the idea that a patient is “remote” begs the question, remote from what? It’s the same as “after hours” care – after whose hours? Still, while some monitoring could be performed regardless of patient location, the capability must exist to react to it by dispatching humans, and that’s a last-mile problem for many patients, especially when health systems and the emergency services providers who have boots on the ground are almost always disconnected and sometimes competitive.

HIStalk Announcements and Requests

Most poll respondents presume that information blocking exists when Epic-using providers in the same area aren’t sharing patient data. My opinion is that we know that most EHRs can exchange patient data – as evidenced by at least one client of each vendor who is actually doing it – so ONC should focus on eliminating the “we weren’t aware” provider excuse via outreach and setting patient expectations to increase interoperability demand.

New poll to your right or here: Which tech company will have the most impact on US healthcare in five years? I will leave it up to respondents to define “healthcare impact.”

Dear companies – while I appreciate the option to engage with your website chatbot even though I can’t imagine a situation in which I would actually do so, please do not make it beep at me, especially every time I navigate to a new page of your site. That’s not exactly a testament to your software usability expertise.

We’re doing some pre-HIMSS summer slacking off around here lately. Jenn was vacating last week so we posted few sponsor updates, while I was day-tripping with Mrs. HIStalk Friday and elected to skip writing the Weekender. It feels good to have places to go and things to do after losing last summer to hunkering down, but sometimes having so many options available again makes me anxious that I’ll miss something.

Webinars

July 28 (Wednesday) 1 ET. “Stop running from your problem (list): Strategies for streamlining the EHR’s front page.” Sponsor: Intelligent Medical Objects. Presenters: Amanda Heidemann, MD, CMIO, CMIO Services LLC; James Thompson, MD, physician informaticist, IMO. How can clinicians mitigate the longstanding EHR problem list challenges of outdated or duplicative entries, rigid displays, and limited native EHR capabilities? The presenters will describe how to analyze current problems, create a problem list governance strategy, and measure improvement progress.

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

Acquisitions, Funding, Business, and Stock

OM1, which offers chronic disease registries and real-world data, raises $85 million in financing.

Sales

• Baystate Health (MA) expands its Cerner implementation with HealtheIntent for its physician organization and unspecified revenue cycle solutions.  

People

Gary Christoph, PhD died earlier this month of Parkinson’s Disease at 76. He spent time as CIO of HCFA (now CMS), leading it through Y2K and cybersecurity and writing many of the regulations contained in HIPAA. He also led IT for NIH and Northrop Grumman’s healthcare IT group.

Government and Politics

The Senate confirms Donald Remy, JD as VA deputy secretary, its second-highest official. He will take charge of the VA’s Cerner project. Remy, who was confirmed in a 91-8 vote, is an Army veteran and COO / chief legal officer of NCAA.

A patient advocacy group’s review of the websites of 500 hospitals finds that 471 have not posted their prices as required by federal transparency rules that took effect January 1. The group says the $300 per day penalty should be increased.

Other

A JAMA Network Open article suggests that physicians avoid the use of “stigmatizing language” in their notes since patients may see them. The authors suggest avoiding language that questions patient credibility, indicates disapproval, stereotypes race or social class, indicates that the patient is difficult, or that conveys a paternalistic tone.

Three weeks before HIMSS21, the COVID-19 resurgence in Las Vegas causes the Venetian, Palazzo, and Sands to once again require their employees to wear masks, regardless of vaccination status. The health district is also recommending that everyone wear masks while indoors, advice that will surely be ignored by 99.5% of visitors. The Nevada Gaming Control Board has not re-imposed casino masking policies so far. The HIMSS21 “no masks required” policy remains aligned with CDC and county recommendations since all attendees must be vaccinated. COVID-19 case counts, positivity rates, and hospitalizations in Southern Nevada have returned to February levels, with 78% of those new cases being accounted for by Clark County. More than half of the state’s residents have not been fully vaccinated. The situation is so significant that the public health chief of Los Angeles has advised locals, especially those who are unvaccinated, to avoid travel to Las Vegas.

Sponsor Updates

Blog Posts

• A Revenue Cycle Guide for Private Equity Firms in Healthcare (RCx Rules)
• 10 Key Facts Hospitals Should Know About Denials in 2021 (Vyne Medical)

Contacts

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

Morning Headlines 7/16/21

VA Electronic Health Records: Modernization and the Path Ahead

The VA pauses its Cerner rollout after an internal report finds significant problems, with VA Secretary Denis McDonough telling the Senate Veterans’ Affairs Committee that he will make changes in project oversight, training, implementation sequencing, and budgeting.

Waystar to Acquire Patientco to Bring True Consumerism to Healthcare, Simplifying Payment Processes for Patients and Providers

Waystar says the combined companies will offer a consumer-friendly patient payment experience.

Introducing AWS for Health – Accelerating innovation from benchtop to bedside

AWS will offer a set of services and partner solutions for healthcare, genomics, and biopharma.

OSF OnCall: A New Hospital Without Walls

OSF HealthCare opens its OSF OnCall Digital Health building in Peoria, IL, from which it offers remote patient monitoring, nurse triage, and ICU patient monitoring.

News 7/16/21

Top News

VA Secretary Denis McDonough tells the Senate Veterans’ Affairs Committee that he is putting the VA’s Cerner implementation on hold. This follows completion of a three-month project review that found serious “governance and management challenges.”

McDonough says that the VA’s first implementation at Mann-Grandstaff VA Medical Center (WA) in October 2020 did not live up to its promise of “seamless excellence in VA care,” adding that the report found “numerous patient safety concerns and system errors” as well as significant negative impact on productivity.

McDonough said he commissioned the review after hearing firsthand about duplicated prescriptions at Mann-Grandstaff and a user’s complaint that a Cerner help desk employee was unable to answer a user’s questions because he had just one week’s experience. He added that clinicians tell him that most of the integration between the respective Cerner systems of the VA and DoD happens inside their heads, not on their computers.

McDonough vowed to improve training and testing, to increase its oversight of Cerner, and to make leadership changes to get the project back on track. He also says the original plan to roll out Cerner by geographic area was a mistake and scheduling of go-lives will now be based on evidence of readiness.

The cost of the project, which was originally estimated at $10 billion when Cerner was awarded a no-bid contract in 2017, has risen to over $20 billion. McDonough has ordered a new budget estimate for the entire project, which will include the several billion dollars of infrastructure upgrades that the original estimate missed.

Committee chair Senator Jon Tester (D-MT) told the group, “I’ve had the impression for some time there are folks out there milking the cow. Every day they go out and they see this cash cow, and they’re getting every dime they can get out of it. There’s been damn little accountability. I hope Cerner’s watching this. Cerner’s not up to making a user-friendly electronic medical record, and in fact what’s transpired here is we’re going in the opposite direction, then they ought to admit it and give us the money back so we can start over.”

McDonough identified specific project issues:

• The VA lacks a specific definition of a patient safety issue and how to manage open issues.
• The decrease in productivity includes problems in revenue cycle, where much of the claims and payments process requires manual entry.
• Cost estimates did not include any issues beyond the Cerner contract, infrastructure readiness, and the project management offices.
• The VA did not create key performance indicators.
• The patient portal experience was fragmented, leading the VA to study the user experience to support “decisions on the future of the portal” that takes legal and contractual obligations into account.
• Testing did not reflect real-world workflow.

Also offering testimony to the committee was Ellkay Chief Innovation Officer Marc Probst, MBA, who described the rollout of Cerner at Intermountain Healthcare when he was CIO and the keys to a successful EHR implementation. He responded to a question about what Congress should expect by urging clear goals, reductions in support tickets and complaints over time, and performance against real milestones. Asked if anything stood out for immediate action, Probst recommendation resetting expectations against original and current requirements and reviewing detailed project work plan milestones.

Reader Comments

From Rashaverak: “Re: Woman’s Hospital, Baton Rouge. This is the first I’ve heard that the sheer cost of an EHR implementation is driving a hospital’s business strategy, essentially forcing it into an affiliation or merger because it can’t afford its EHR of choice. It must be a record for Epic if the hospital’s stated cost is indeed $200 million over seven years – has Epic no shame for pricing the system at 10% of the 168-bed hospital’s total expense? That kind of pricing will keep Meditech and Allscripts around and makes the $1.2 billion that Partners spent over 10 years look like a bargain. Isn’t the goal of IT to bend the cost downward instead of upward?”

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor VitalTech. The Plano, TX-based company offers more than telehealth. More than RPM. More than population health. VitalTech is the nation’s first fully integrated virtual care platform. The company develops technologies, platforms, and hardware that empower patients to better care for their health and wellness while enabling clinicians and health systems to remotely monitor, manage, and care for patients. Its integrated digital health platform, VitalCare, aggregates and contextualizes critical data that is collected from multiple devices, EHRs, and third-party sources. Data is then pushed via the VitalCare cloud to user apps, family connection apps, care teams apps, administrative web portals, and third-party integrations in real time so actionable insights can be made. The solution enables health systems, physicians, payers, employers, senior living facilities, skilled nursing facilities, and home health providers to streamline workflows while improving health outcomes, increasing patient safety, and lowering the cost of care. The suite includes easy-to-use devices and software that increase patient engagement and compliance. Thanks to VitalTech for supporting HIStalk.

VitalTech sent over a link to this intro video and client testimonial. Holy Name Medical Center CEO Michael Maron movingly describes how contracting COVID-19 and then infecting his own family was a “burden I’ll have to bear for the rest of my life,” but he says that being monitored by VitalTech’s system at least allowed them to recover at home.

Listening: old Genesis, which I didn’t follow until pandemic times. “Firth of Fifth” and “Supper’s Ready” are as good as music gets to my ear, and while I can’t abide the treacly 1980s hits of Phil Collins, he spent the late 1970s effortlessly backing and then leading a band of individual musical geniuses by drumming the most complex time signatures imaginable. Genesis wrote and played their best music, which I predict will be as timeless as Beethoven, in their late teens and early 20s.

I’m jealous of people starting new jobs who post photos on LinkedIn of the cool company swag that was waiting at their desk on their first office day. I don’t think I ever got anything when I took a new health system job.

It’s about time to post my HIMSS21 guide describing what HIStalk sponsors will be doing there, so submit your information this week. I’ve received submissions from 19 companies, including two who aren’t actually sponsors and thus will be regretfully unrepresented.

Webinars

July 28 (Wednesday) 1 ET. “Stop running from your problem (list): Strategies for streamlining the EHR’s front page.” Sponsor: Intelligent Medical Objects. Presenters: Amanda Heidemann, MD, CMIO, CMIO Services LLC; James Thompson, MD, physician informaticist, IMO. How can clinicians mitigate the longstanding EHR problem list challenges of outdated or duplicative entries, rigid displays, and limited native EHR capabilities? The presenters will describe how to analyze current problems, create a problem list governance strategy, and measure improvement progress.

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

Acquisitions, Funding, Business, and Stock

Healthcare payments software vendor Waystar will acquire Patientco, whose technology includes patient payments, communications, and engagement.

Bloomberg reports that the private equity owner of healthcare payments analytics vendor Cotiviti is considering an IPO that would value the company at $15 billion.

Sales

• MedStar Health chooses oncology data and analytics vendor COTA to support cancer research and care.
• An unnamed drug company will use OptimizeRx’s platform to offer physicians choices when their Medicare patients risk treatment lapse due to loss of coverage.
• Blessing Hospital (IL) selects CarePort Interop to allow it to meet CMS event notification requirements.

People

Frank Nydam, MBA (VMware) joins Tausight as chief development officer.

Glytec hires Scott Bettner, MS (Hillrom) as regional VP. 

Announcements and Implementations

Non-invasive digital sensor developer Rockley Photonics announces plans for trials of “clinic on the wrist,” a combination of hardware, firmware, and cloud analytics that measures biomarkers such as body temperature, blood pressure, hydration levels, and measures of blood alcohol, lactate and glucose. The company hopes to complete testing and release the product for commercial use next year. The company is about to go public via a SPAC merger.

Amazon announces AWS for Health, a set of services and partner solutions for healthcare, genomics, and biopharma.

Applied behavior analysis EHR vendor CentralReach acquires Behavior Analysts, Inc., which offers an ABA assessment system.

Amazon Web Services selects Diameter Health as a Connecter Partner for Amazon HealthLake.

OSF HealthCare opens its OSF OnCall Digital Health building at its headquarters in Peoria, IL. Capabilities of the “virtual hospital” include remote patient monitoring, fall prevent innovations, virtual nurse triaging, ICU monitoring, and monitoring 40 telehealth carts.

A KLAS report on cardiology systems says that no individual offering stands out, as organizations have pieced together multiple systems but are re-evaluating as part of their enterprising imaging strategy. Most often considered are Philips, IBM Watson Health, and Fujifilm, while Epic is often chosen as part of its product suite even though it lacks a cardiology archive and offers weak structured reporting.

Government and Politics

ONC hopes to have the Trusted Exchange Framework and Common Agreement (TEFCA) network open for participation in the first quarter of 2022.

The companies contracted by ONC to develop draft EHR Reporting Program developer measures seek feedback by September 14, 2021.

Other

In Ireland, people complain that their names are misspelled on their government-issued COVID-19 digital travel certificates and worry that the mismatch will prevent them from boarding flights, which the government says is due to hospital, doctor, and pharmacy systems that can’t handle language-specific punctuation and characters such as the fada.

Sponsor Updates

Blog Posts

• Step Back To Move Forward on Interoperability (Cumberland)
• 5 Signs you Need a Managed Services Partner (Optimum Healthcare IT)

Contacts

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

EPtalk by Dr. Jayne 7/15/21

So many health systems placed everything on hold during the pandemic, so I was excited to hear about a health system not only taking something live but building it themselves. Holy Name Medical Center’s emergency department went live on its homegrown EHR, powered by Medicomp’s Quippe solution. I’ve had the opportunity to test drive the Quippe Clinical Data Engine multiple times in recent years and it really is an impressive solution, so I can’t wait to see how Holy Name implemented it. It will be on display at HIMSS21 in the Medicomp booth and I’m looking forward to kicking the tires. Kudos to this team for the implementation even in the face of a pandemic.

Telehealth is here to stay, and I enjoyed reading a Medscape piece on “What should I wear to see my doctor?” Telehealth has changed the paradigm for care delivery at the same time that life in general has become more casual. I still balk at the idea that my telehealth employer wants us to wear white coats, since there’s no purpose to it other than having it shout, “hey, I’m a doctor.” The article shares a couple of anecdotes about multitasking patients, one who tried to do a medical visit while multitasking on a work Zoom meeting and another where the patient was cooking a meal during the visit. Those are certainly extreme examples, but there are many more where virtual visits have clued us into situations in the patient’s environment that we wouldn’t have known if they presented for in-person care.

There are also some pretty amazing stories about physicians being too casual for patient care, including one telehealth physician who lacked a shirt during a consultation. Another provider was written up by his network for drinking beer and eating chicken wings (both visible to the patient) during a behavioral health therapy session. I’m guessing he wasn’t trying to document real-time, because the grease load on anyone’s computer keyboard wouldn’t be desirable.

I personally use my telehealth patient care days as excuses to dress up, to bring out those chunky necklaces that I normally wouldn’t wear in person for fear of toddlers grabbing onto them or the dangly earrings that typically remained in the drawer for the same reason. I still don’t wear sassy shoes, though, mostly because I’ve become entirely too accustomed to living in the Kino sandals that have been my constant companion since the first time I visited Key West. That will all change in a couple of weeks, though, as I get ready for HIMSS.

HIMSS released the details of its COVID-19 vaccine verification process. All attendees, exhibitors, and staff will have to provide proof of vaccination through one of three processes: Clear Health Pass Validation, Safe Expo Vaccine Concierge Validation, or Safe Expo On-Site Validation. I decided to try the Clear Health Pass option and the experience was less than stellar. Once I clicked on the HIMSS-provided link in my email, I had to enter my phone number so I could receive a link via SMS to download an app. After waiting 10 minutes for it to install, I restarted the process, which started over in the download phase despite having been in the installation cycle previously. After another 40 MB of downloading, there was another three minutes of installation, after which I was asked to enter a code that I didn’t have. I guessed at HIMSS and HIMSS21 and the latter was successful.

From there, I went through multiple terms of use screens and consents, which I know the vast majority of users don’t or won’t read. From there I had to scan both sides of my driver’s license and then take a picture of myself, which rivals my passport for hideousness due to the app’s smile detection feature which forces you to basically frown. From there, I had to go through another selfie process, which converted my picture to a line drawing and seemed tricky to try to fit my face into its weird oval frame.

The next step was adding my vaccination information, for which I had to go through another consent then an electronic authorization to release data to Clear. From there I was instructed to log into MyChart and went through another disclaimer, followed by four panels of information regarding consent and release. Finally, I was asked to give permission to the HumanAPI app to release every scrap of data in MyChart, including allergies, the name of my physicians, demographics, documents, health goals, implants, lab results, medications, problems, orders, procedures, immunizations, vitals, appointments, clinical notes, encounters, referrals, smoking status, and OB/GYN status. It asked to allow sharing for the next 90 days.

I denied permission and went back to the option to submit a photograph of my vaccine card and to key in the vaccine information and dates. After less than 30 seconds, I received my validation, and I didn’t have to share a boatload of PHI to do it. The overall process took 26 minutes, which was way too long, and I imaginethat  if I had actually read all the consents and disclaimers, it would have been close to an hour. I’m sure everyone involved (except the patient/consumer) is making at least a little money on the sale of the personal data that thousands of people will release without thinking too much about it. Just say no to the API, folks.

Amazon Care has asked major health payers to cover its services on par with other in-network care options. Reported targets include Aetna, Premera Blue Cross, and Blue Cross Blue Shield of Massachusetts. Amazon Care was originally piloted with Amazon’s Seattle-area employees, but the company has tried to expand the product since March of this year, not only nationwide to Amazon staff, but also to other employers. Based on the challenges with getting coverage for telehealth, let alone some of the asynchronous services the platform purports to offer, it will be interested to see how long it takes for the big payers to bring the service into the fold let alone provide payment parity.

A recent article in JAMA Network Open looks at the ability of wearables such as Fitbit and Apple Watch to identify the long-term effects of COVID-19 infections. The data is from the Digital Engagement and Tracking for Early Control and Treatment trial (DETECT) which was led by researchers at the Scripps Research Translational Institute. More than 37,000 people enrolled in the study, which ran from March 2020 to January 2021. Subjects used the MyDataHelps research app to report symptoms and COVID-19 test results and shared data from their devices. Researchers concluded that when they looked at wearable data and symptom data together, they could detect COVID-19 cases more accurately than looking at symptom data alone.

A follow-up trial looked at Fitbit users with fever, cough, body aches, and COVID-19 test data. It found pronounced changes in COVID-19 positive patients compared to others. Symptoms included increased sleep, decreased walking, and higher resting heart rates. On average, the COVID-19 positive patients took 79 days for their resting heart rates to normalize compared to four days in the non-COVID-19 group. Definitely food for thought for all those who are still refusing vaccination and especially for those who think that COVID-19 is a hoax.

COVID-19 is on the rise in my area in a big way, and my former colleagues are being slammed. My former partner had 38 people on the wait list at urgent care this morning. Of those patients, 15 were COVID-19 positive. The most tragic story of the day was a family who came in for testing after seeing pictures of their COVID-positive cousin in the ICU on social media after they were all together for a July 4 event. The cousin didn’t even call family to notify them, just posted on social media. It sounds like they were beside themselves and I’m sure the positive results didn’t help things.

Speaking of social media, I’ve written before about some of the lesser talked-about aspects of social media, such as its role in the grieving process and how strange it feels for “memories” to pop up that might not be happy ones. I definitely had some strong emotions at the memory that popped up for me today, which was a picture of my mask-damaged face during a lengthy shift in the emergency department. It was a stark reminder of all that we’ve been through in the past year.

It also gave me pause because we’re still not learning the lessons we need to learn to deal as effectively with this pandemic as we need to. Many of us who read the medical literature and have close relationships with researchers understand that we’re literally one “variant of concern” away from being back at square one with this virus. There’s a constant sense of waiting for the other shoe to drop, and for some of us, I’m not sure we’ll ever be able to feel the sense of relief that we had in a pre-COVID world.

A close friend of mine is a counselor and executive coach who works predominantly with physicians. He agrees that there are thousands of us who meet the diagnosis criteria for post-traumatic stress disorder but who have not addressed it with employers or sought treatment, and in reviewing the criteria during our discussion I’m betting a lot of clinicians don’t know they have it. I’m curious to know if employers are doing any specific outreach to help manage these pandemic-driven symptoms in the workforce, or to know more about the experiences of those who may have reached out for help.

What’s your experience with pandemic-driven PTSD? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 7/15/21

TEFCA Will be Live in 2022

ONC hopes to have a new nationwide network open for participation in Q1 2022.

Woman’s Hospital seeks to partner with large system to boost technology access

The 165-bed Louisiana hospital is considering affiliating with another hospital to be able to implement Epic for less cost than buying it directly, which it estimates would require $200 million over seven years.

Request for Public Feedback on Draft Developer-Reported Measures

The companies contracted by ONC to develop draft EHR Reporting Program developer measures seek feedback by September 14, 2021.

Kno2 raises $15 million to accelerate its disruption of healthcare’s interoperability status quo

The network aggregrator will use the proceeds of its Series A funding round to expand its connectivity and workflows while increasing its partner base that integrate via its APIs.

Morning Headlines 7/14/21

HHS Updates Interoperability Standards to Support the Electronic Exchange of Sexual Orientation, Gender Identity and Social Determinants of Health

ONC releases the United States Core Data for Interoperability version 2.

Truveta Grows to Represent More Than 15% of all U.S. Patient Care with Three New Health Provider Members, closing Series A with $95 Million in Funding

Truveta raises $95 million in a Series A funding round and adds members Baylor Scott & White Health, MedStar Health, and Texas Health Resources.

Harris acquires ADL Data Systems, a long-term and post-acute care software solutions provider

Harris acquires ADL, which has been providing software to nursing homes and other long-term care providers since 1977.

Michelle O’Connor Named MEDITECH President and CEO

The company announces the promotion of Michelle O’Connor, which took place several weeks ago.

‘The party is winding down’: States and insurers resurrect barriers to telehealth, putting strain on patients

Telehealth visits are dropping sharply as relaxed provider laws and improved payment return to the more restrictive normal and state-by-state physician licensure again becomes a significant barrier.

News 7/14/21

Top News

ONC releases USCDI v2, which provides interoperability standards for the optional exchange of social determinants of health, sexual orientation, and gender identity.  

Reader Comments

From Shoot the Messenger RNA: “Re: post-COVID hospitalization. This is interesting work using Epic Cosmos.” A study of 8.6 million vaccinated patients using Epic’s Cosmos customer data set finds that only 0.049% tested positive afterward and just 0.018% (1,600 people) were hospitalized for COVID-19 after being fully vaccinated. Also interesting is that the study was performed  as a Dual Team Study as defined by Epic Health Research Network, where two groups are assigned the same study, work independently, and then present their work only if their conclusions are the same. Another EHRN study I noticed while looking up the first one found that most adults didn’t experience a significant weight change during the pandemic, and nearly as many patients lost weight as gained weight. These types of studies have limitations, however – they cover only patients of Epic users and researchers can see only the information that resides in Epic. The first study must have determined vaccination status as reported by patients since many or most health system patients would not have received their vaccinations from a hospital, while the second study is limited by definition to patients who had an encounter in which their weight was captured. Just about all of our inferential research data sources are imperfect due to lack of data sharing, the presence of valuable information only in freetext form, and the unreliable proxy of using billing codes to infer clinical status and activities.

From Conference Confrere: “Re: HIMSS21. Will I wish I was leaving early if attendance or energy is down?” Maybe, which is why I booked a flight out Thursday night instead of Friday morning, limiting my time in Las Vegas to three nights. I left my hotel reservation for four nights, figuring that will allow me a more leisurely departure for my red-eye flight late Thursday. But I may find that I’ve seen everything interesting in the first couple of days and end up just hanging around. Meanwhile, Las Vegas and Clark County are experiencing a mini-outbreak of COVID-19, with 1,600 new cases over the weekend, an 11% test positivity rate, and the lagging indicator of hospital admissions going up. Nevada’s vaccination rate is under 50%, visitors from everywhere are packing casinos and restaurants unmasked and undistanced, and you’ll struggle to avoid potential exposure outside the HIMSS21 protective bubble if that even works. US cases are up 94% in the past two weeks.

From Pinhead: ”Re: company pins. I’m seeing a resurgence of those lapel adorners.” Me too, even though I never understood why people would so deeply identify with the faceless company that sends them paychecks that they would be bursting to tell the uninterested world. It is fascinating to me that people who claim to be fiercely independent free thinkers pigeonhole themselves publicly by wearing garb that provides free advertising for their favorite employer, political cause, or sports team, encouraging the world to ignore everything else about them. Mrs. HIStalk reminds me that people who ask “what do you do” are really asking “what’s your job, so I can stereotype you” so they can avoid considering you to be something more than your job, so I suppose wearing a company lapel pin makes the impersonality more efficient. 

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Mach7 Technologies. The South Burlington, VT company’s philosophy is based on a simple premise: legacy radiology solutions were not designed to carry healthcare organizations into the future. From its first line of code, its solutions were designed to meet the imaging needs of the entire healthcare enterprise. Its data management, workflow, enterprise and diagnostic viewing, teleradiology, PACS, mammography, and other solutions are focused on integration, workflow, scalability, and performance to ensure that imaging data can be made available wherever it is needed. Mach7 is focused on the future of healthcare. It gives healthcare organizations unprecedented technology independence and flexibility to deploy its solutions according to their needs, whether in their individual components or unified into a comprehensive end-to-end enterprise imaging platform. Its solutions bridge an organization’s legacy solutions to meet the full spectrum of multi-disciplinary imaging needs, and position them to grow, adapt, and innovate. The company’s unique approach to enterprise imaging empowers healthcare organizations of all sizes to increase their efficiency, achieve profound operational cost savings, leverage their existing IT investments, improve the experience for patients and medical professionals, and support healthier outcomes. Stop by booth #4243 at HIMSS21 to learn more. Thanks to Mach7 Technologies for supporting HIStalk.

The Clear Health Pass app – required for attending HIMSS21 – is still showing “pending verification” of my COVID-19 vaccination card, which I had to submit as a photo since by provider wasn’t listed for a direct connection. Beats me whether it will get me into the conference.

I’m watching the slow but perhaps inevitable morphing of LinkedIn into Facebook (perhaps intentionally) as I’m getting force-fed more posts about politics, lame philosophical manifestos, sports, and personal and family bragging. I can always unfollow or mute someone, but I’m wondering if the folks who “like” one of those non-business posts or add a comment to them realize that the feeds of their connections are then polluted with unwanted junk?

Webinars

July 28 (Wednesday) 1 ET. “Stop running from your problem (list): Strategies for streamlining the EHR’s front page.” Sponsor: Intelligent Medical Objects. Presenters: Amanda Heidemann, MD, CMIO, CMIO Services LLC; James Thompson, MD, physician informaticist, IMO. How can clinicians mitigate the longstanding EHR problem list challenges of outdated or duplicative entries, rigid displays, and limited native EHR capabilities? The presenters will describe how to analyze current problems, create a problem list governance strategy, and measure improvement progress.

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

Acquisitions, Funding, Business, and Stock

Recently formed Truveta, whose health system members sell their de-identified patient data to drug companies and providers, raises $95 million in a Series A funding round. The company announced new members Baylor Scott & White Health, MedStar Health, and Texas Health Resources.

Israel-based medical imaging AI vendor Aidoc raises $66 million in a Series C funding round.

Health IT services firm HCTec acquires managed IT solutions company Talon Healthy IT Services, which offers healthcare help desk services.

Healthcare analytics vendor VisiQuate raises a $50 million equity investment.

Harris acquires long-term and post-acute care software vendor ADL Data Systems, which it will combine with its Collain Healthcare LTPAC EHR business.  

CrossBridge, which offers technologies that address the cost and outcomes of treating patients who have chronic inflammatory diseases, acquires the PACER rheumatology disease management software from its developer Geisinger.

Sales

• UNC Health will deploy the radiology module of Sectra’s enterprise imaging solution, integrated with Epic and replacing several legacy vendors.
• Stamford Health will implement the Route solution of Appriss Health-owned PatientPing for sending ADT event notifications.

People

Olive promotes Rohan D’Souza to chief product officer.

Meditech officially confirms the months-ago promotion of President and COO Michelle O’Connor to president and CEO. She replaces Howard Messing, who remains on the company’s board.

Cerner SVP of Client Relationships Ben Hilmes, MHA joins Adventist Health as SVP / chief integration officer.

David Butler, MD (Calyx Partners) joins The Chartis Group as principal, informatics and technology.

Sonifi Health hires Mark Dyer (DaytoDay Health) as SVP of sales.

Leidos promotes James Perea, MBA to VP of VA health solutions.

Glytec promotes Jordan Messler, MD to chief medical officer.

Glenn Keet (Clinithink) joins Ciitizen as VP of HIE strategy.

Tegria promotes Justin Jozwik of its Bluetree Network business to managing director, international.

Riverside Healthcare (IL) hires Kirk Larson, MHSA, MBA (Rochester Regional Health) as VP/CIO.

Announcements and Implementations

Holy Name Medical Center’s ED goes live on Holy Name’s self-developed EHR, which is powered by Medicomp’s Quippe Clinical Data Engine. They will demonstrate the system at HIMSS21.

HealthShare Exchange and Audacious Inquiry extend the ENShare encounter notification service outside the HSX network in the Philadelphia area.

Patient transport software vendor Cheyenne Mountain Software renames itself to Motient.

KLAS’s first report on healthcare’s use of public cloud providers covers Amazon Web Services, with 11 responding organizations saying that AWS has saved them time and/or money. Respondents say that AWS offers strong product quality and development, but less-effective service and support, mostly waiting for customers to proactively engage rather than reaching out to them. Click the graphic above to see KLAS’s nicely done framework for healthcare cloud solutions. Future reports will address Google Cloud Platform and Microsoft Azure.  

Other

Stat covers the sharp drop in telehealth visits as state emergency declarations expire and insurers phase out coverage. The article notes that as doctors are once again being prohibited from conducting virtual visits for patients who are located in states where they aren’t licensed, some of the doctors are asking their patients participate in a virtual visit by driving across the state line to the first available retail store parking lot. Providers favor a telemedicine-only national license that would allow doctors to care for established patients regardless of that patient’s location.

Hospitals sue the manufacturer of the Da Vinci surgical robot for forcing them to purchase maintenance services and replacement parts at inflated prices that generate the bulk of Intuitive Surgical’s $4 billion in annual revenue. Company engineers have threatened hospitals that they will turn their expensive machines into “paperweights” if they buy parts or services from competitors, while one hospital says the company remotely shut down a machine in the middle of a surgery upon hearing that the hospital was talking to a third party about a service contract. Intuitive Surgical’s market cap is $113 billion despite a lack of evidence that machine-assisted surgeries deliver better outcomes. Axios reporter Bob Herman notes that the lawsuit is “one monopoly fighting another.”

Sponsor Updates

Blog Posts

• Use Personal Referrals to Boost Your Network and Build Your Career (Healthcare IT Leaders)

Contacts

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

Morning Headlines 7/13/21

Mytonomy Raises $25 Million Series B Funding to Transform Patient Engagement

Video-based patient engagement vendor Mytonomy raises $25 million in a Series B funding round.

HCTec Acquires Talon Healthy IT Services

Health IT services firm HCTec acquires managed IT solutions company Talon Healthy IT Services, which offers healthcare help desk services.

Charlesbank To Make A Strategic Investment In Clearlake And SkyKnight-Backed symplr

Charlesbank will make an unspecified “significant strategic investment” in Symplr.

Readers Write: Artificial Intelligence Drives a New Medication Management Philosophy

Artificial Intelligence Drives a New Medication Management Philosophy
By Erick Von Schweber

Erick Von Schweber is CEO of Surveyor Health of Foster City, CA.

There are times when advances in technology enable a radical re-envisioning of both what we do and how we do it. Medication management is at that stage, thanks to ongoing developments in artificial intelligence.

Metaphorically, will healthcare use these newfangled mechanical horses to pull its current wagon, or will it open up to radically new possibilities enabled by new technology? Several areas of AI inspire our imaginations. Let’s consider the philosophical inversions made possible.

Clinical pharmacists performing medication management interventions today spend most of their time poring over patient records, mentally integrating what they read. Then, with little time to ponder the patient’s situation, they go on to writing notes and elaborate documentation that few providers will read in entirety, if at all. Yet probabilistic AI reasoning engines coupled with semantic interoperability integrate multifaceted data without glossing over nuances, driving graphical user interfaces providing information visualizations that clinicians understand in seconds – the mental model is on-screen. The clinician can now understand the entire problem space and visually design a solution.  

In this scenario it’s not a matter of man or machine, it’s the collaboration of man and machine, each doing what they do best. Some processes will automate the routine, such as production of documentation, freeing the clinician to spend time doing what only the trained, expert human mind can. Like a financial analyst, they can use that time running what-if simulations to inform their options.

This cooperative interplay between clinician and AI opens up a potential inversion of the customary workflow. Lacking AI, medication optimization today means the clinician attends to each medication in isolation, doing their best to address any issues specific to that therapy and its relational effects with other individual therapies, one at a time (such as duplications and interactions). This traditional workflow leads to Whac-A-Mole, where a considered solution to one issue creates more issues, frequently requiring back-tracking or outright starting over. By visually modeling the entire problem space and assisting the clinician in seeing how to address it fully, AI enables a more productive workflow.

For people outside the AI research community, it’s easy to believe that ML (machine learning) is AI, but the field is far broader. Where ML is about identifying patterns in existing data sets, other areas of AI, such as AI planners, Bayesian probabilistic reasoners, and combinatorial optimization engines, imagine numerous possible scenarios – therapeutic courses of action – then figure out which are viable, which present conflicts, and which make superior tradeoffs for both the patient and the healthcare system. Human cognition inextricably involves both learning and imagination, and in AI circles, imagination, creativity, and metaphor are the vanguard. Indeed, the next steps toward creating an AGI (artificial general intelligence) that operates at near human cognitive levels are focused more on imagination.

We urge those in medication management to free themselves from the bounds that prior generations of technology have restricted them to. It’s time to imagine the future of medication management. 

Curbside Consult with Dr. Jayne 7/12/21

Sometimes a headline catches my eye, as did the one for this article about workers “epiphany-quitting” their jobs. For many, the COVID-19 pandemic has brought life into sharp focus and has accelerated decisions around what families find valuable and what can be done without. It’s been interesting to watch the flow of people both into and out of healthcare as people search for different work-related attributes: more meaning, better compensation, increased security.

One of my favorite co-workers at my former clinical employer was a seasoned professional sports mascot. He had worked for an NFL franchise before relocating and then hired on with the local baseball team. During the changes of the pandemic season, he saw the mascot workforce reduced from four to two, and despite being a pro at the signature strut and being able to do a backflip in a full-head costume, he decided he needed a change. He signed up for an emergency medical technician course and the rest is history. One of his favorite parts of being an EMT was being able to interact with people directly rather than through pantomime and oversized gestures. It was easy to see he enjoyed being around people and making them feel comfortable, even in stressful situations.

For him, moving into healthcare was about predictability and steady employment after having things pulled out from under him. It was a way to feel like he was controlling his own future, and especially with forecast shortages of healthcare workers, it’s probably a pretty solid bet. He was relatively lucky due to his age (mid 20s) and lack of family responsibilities. Not all workers are in that same situation, and I saw plenty of other co-workers leave healthcare because they couldn’t meet family responsibilities. One of my favorite medical receptionists quit because she couldn’t find reliable childcare to cover the 12-hour shifts that often stretched to 13 or 14 hours. Instead, she started providing in-home childcare, which allowed her to spend more time with her daughter as well as to help out young families in similar situations.

One of my favorite scribes was in the process of applying to physician assistant school when not only the pandemic hit, but one of her parents was diagnosed with a terminal illness. She decided to defer the application process to allow for more time with her family and also requested to go part-time at work. Although the company had a track record of refusing to allow people to go part-time unless they were enrolled in school, the pandemic forced them to adapt. Given the time needed to train a scribe and having someone willing to work in the uncertainty of a pandemic, it was a good solution for everyone.

Not everyone’s employers were that flexible, however. I watched a couple of nurses leave the workforce because part-time employment wasn’t an option and working 12-hour overnights on the COVID wards had simply worn them out. It was gut-wrenching to see these women quit jobs that they liked and would likely have stayed with had they been able to achieve flexibility, while the hospitals paid double or triple their salaries to travel nurses to cover the responsibilities.

Another friend who stayed in her ICU role out of a sense of duty and calling is still bitter about the bonuses paid to travel nurses who actually did less work than the employed nurses since they weren’t approved to use certain kinds of devices or equipment in patient care. She recently took a six-week “job swap” sabbatical where she moved to another part of the hospital and out of the ICU, which has allowed her to recharge to some degree. Still, she’ll be an empty nester in a couple of months, and I wonder if that sense of calling will still be there or if she will put the ICU behind her once and for all.

Even in healthcare technology roles, I’ve seen a change in some of the language used in promoting positions and during the interview process. Companies are more likely to advertise their flexibility and options to help workers achieve work-life balance. I see more mention of programs to allow employees to interact on non-work topics. such as support groups for employees caring for aging parents or small children, or as part of diversity efforts.

However, for every bit of flexibility, it seems another company is swinging the pendulum the wrong way. My local health system is hiring IT workers, but even though the positions are officially tagged as remote, they require relocation to the company’s headquarters state “for tax purposes.” Maybe the hospital just doesn’t want to deal with the paperwork, but they’re losing quality candidates and hiring manager friends are disgusted by the situation.

The sense that workers are evaluating their situations and deciding whether various aspects of their jobs are worth it or not is playing out across a number of industries. Due to the stressors that the pandemic has placed on healthcare organizations, however, it feels like we are experiencing it more acutely. I was having a discussion with one of my favorite revenue cycle folks recently, and in follow up she sent me an op-ed piece that I missed back in December when I was so busy trying to keep my head above water at the urgent care. It’s by Claudia Williams, former White House senior advisor and former director of health information exchange at the US Department of Health and Human Services. Although the question it asks is “Do hospitals need a chief burden reduction officer?” I would argue that the concept reaches beyond the hospital walls. Instead, we should be asking whether any organization would benefit from someone whose main role is to reduce burdens and look for ways to streamline work.

Williams cites the “must-do list of priorities for health systems in 2021” as including the following: recover the bottom line, provide frontline care for the pandemic, address health inequities, reduce provider burnout, and prepare for value-based care. Nearly all of these goals are impacted by frustrating (and often outdated) processes, multiple sets of reporting requirements that might be at odds with each other, rising costs, and the somewhat unpredictable factors of dealing with an ongoing pandemic for the foreseeable future (and perhaps indefinitely). Williams proposes a new title to join the chief experience officers, chief growth officers, and other recently created roles: that of chief burden reduction officer.

I think it’s a fantastic idea having someone who could work across multiple disciplines and service lines to identify solutions that could benefit everyone. They could unlock the potential of all the technology solutions that have been purchased over the last decade and help get rid of paper workflows once and for all. They could help streamline the patient experience as well as the clinician experience so that the two elements work together rather than at cross purposes. A chief burden reduction officer could also work with governmental agencies to help develop policies that make sense not only philosophically, but in their actual execution. No more of the “great ideas, poorly executed” that we’ve all experienced.

One of my favorite lines in the piece is this: “Health systems deeply disrespect patients when they waste their time.” The same goes with their treatment of employees (whether they call them as such or try to use cutesy titles such as associate or co-worker). An employee whose time is wasted is one who could be using that time for patient care, professional development, stress reduction, or a number of other worthwhile pursuits. Williams sums this up beautifully in the closing sentences of the piece: “All of these processes – the email, the paper, the intake form, the chart download, the fax – they are fundamentally wasteful of this beautiful human energy that we desperately need to transform healthcare. We are a nation facing multiple health crises. We need to free precious human time to address them.”

It’s a great way to think about the challenges in front of us. Who’s ready to take the leap and employ their first chief burden reduction officer? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 7/12/21

Training Deficiencies with VA’s New Electronic Health Record System at the Mann-Grandstaff VA Medical Center in Spokane, Washington

A VA OIG review of the VA’s first go-live finds that inadequate training contributed to a decrease in user productivity, as poor training design and ineffective Cerner trainers left users unsure of how to use the system to perform their jobs.

Practicing Clinicians’ Recommendations to Reduce Burden from the Electronic Health Record Inbox: a Mixed-Methods Study

Surveyed physicians recommend improvements to EHR inbox functionality, some of them involving redesigning the system to work more like email.

Biden calls for efforts to lower drug prices as part of executive order to foster competition

A White House executive order directs the Justice Department and FTC to review hospital merger guidelines and for the federal government to move forward with mandatory hospital price disclosure.

Monday Morning Update 7/12/21

Top News

VA OIG looks at training deficiencies in the VA’s first Cerner rollout at Mann-Grandstaff VA Medical Center, in Spokane, WA, noting:

• The VA Office of Electronic Health Record Modernization is charged with the implementation, but the involvement of VHA, which houses all of the system’s users, is not clear.
• Training design was internally called “button-ology” because it focused on telling users which buttons to push to get a desired outcome, with little context provided to users who then failed to understand how to use the system.
• Users struggled because the classroom training didn’t focus on workflow.
• The system that was made available for user practice did not match the VA’s actual system.
• Cerner’s classroom trainers were not capable of answering questions and raised facility concerns because they lacked a clinical background and EHR knowledge. Users complained that Cerner’s trainers would defer many basic questions to the “parking lot,” which became a running joke among employees being trained.
• All of the 30 super users said their training was a waste of time that left them demoralized, distrustful of Cerner and the VA project team, and less prepared to help users than before the training.
• Leaders did not fully understand Cerner’s role-based permissions and how to manage staff who required multiple role assignments, causing users to be assigned to the wrong training classes.
• VA contracting officials scored Cerner’s training work as “satisfactory,” the minimum level that meets contractual requirements.
• The post-live decrease in user productivity and morale was attributed to EHR training factors.
• The project’s change management group withheld some OIG-requested training evaluation data and altered other data before sending it.

Reader Comments

From Uniquely Qualified: “Re: company reps. My BS detection tip – it’s not actual knowledge they are selling if the answer to every problem is that company’s solution.” That’s true for life in general. I immediately tune out anyone whose industry viewpoint, politics, worldview, sports team loyalty, or entertainment choices are unwaveringly consistent and represent so much of their identity that they belittle those whose opinions differ. Anyone who can’t find an occasional good point being made by someone from the “other side” of any given issue is either a self-serving deceiver or intellectually comatose hack. Salespeople should believe in their product, but surely they can see as plainly as the rest of us that it is imperfect and sometimes fails to achieve the promised results for reasons that may or may not be under the company’s control. I started HIStalk 18 years ago for that reason – the lame publications were paid cheerleaders for advertisers and would studiously ignore the real-life challenges I saw every day working in hospital IT. My experience is that good companies get better by paying attention to constructive criticism from experienced outsiders, while bad ones sputter indignantly and shoot the messenger.

From Mr. Softy: “Re: Microsoft 365 Business Basic. I’m a user and the pros are that it’s a good deal, I strongly prefer Teams over Google Meet, performance is good, it’s easy to set permissions for a growing team, and the company’s support agents have been prompt and helpful. Cons are that you only get web versions of the Office apps and those lack a good number of advanced features of the desktop versions, Google has a more comprehensive feature set, the products could use some polish, and Microsoft sometimes makes security recommendations that aren’t available to users of the Basic plan.” Thanks much for that review.

HIStalk Announcements and Requests

The expensive technology that is being used by providers and insurers is doing little to make poll respondents healthy and happy.

New poll to your right or here: If two Epic-using providers in the same area don’t share patient data, would you assume they’re guilty of information blocking? Looking at it another way, if we know that every Epic client can theoretically share information with all the others, then what reasons other than intentional information blocking would explain why they aren’t? (you can elaborate on that in the poll’s comments).

Welcome to new HIStalk Platinum Sponsor Clearsense. The Jacksonville, FL-based company’s data platform-as-a-service integrates data from any source, maintains line of sight from source to target, and jumpstarts the ROI of existing business intelligence tools without the need to hire specialized staff. Its DataHub operates as the central nervous system for healthcare data to automate data curation, preparation, normalization, and governance to allow it to be used meaningfully and with full transparency. Customers benefit from strong privacy and security, ease of use, an end-to-end solution from a single partner, accelerated data maturity, and the Clearsense Data Science Workbench that empowers citizen data scientists in delivering data science on demand. Sign up for a private meeting with the company at HIMSS21 or attend its lunch and learn. Thanks to Clearsense for supporting HIStalk.

A YouTube cruise turned up this Clearsense overview video on YouTube.

Can we all agree to dress comfortably and casually for HIMSS21? Not only are most of us readjusting to venturing out again and frowning that our dressy clothes seem to be a bit snug these days, Las Vegas hit 117 degrees Saturday. The health IT industry won’t collapse if we attend a conference in shorts and tee shirts, so I’m calling for a clothing truce. Conferences should be like schools that provide mandatory uniforms so that people won’t waste time and money trying to impress each other with a few ounces of thread.

Another Las Vegas issue – COVID-19 test positivity is at 10%, COVID-19 metrics have risen to February levels, only half of residents have been vaccinated, and travelers come and go from all over the place within the incubation period. As Andy Slavitt tweeted, “Whatever happens in Vegas isn’t staying in Vegas.” It’s still a life-threatening pandemic, just one that is limited mostly to the unvaccinated.

Webinars

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

People

Industry long-timer and Cerner SVP of Consumer and Employer Solutions David Bradshaw resigns.

Health policy attorney and disability rights advocate Erin Gilmer, JD died by suicide last Thursday.  

Announcements and Implementations

The University of Illinois Urbana-Champaign launches a self-paced, online “AI in Medicine” certificate at a cost of $750.

Toronto General Hospital goes live on Vocera Smartbadge in three of its ICUs.

Government and Politics

A White House executive order calls for the Justice Department and Federal Trade Commission to review guidelines for hospital mergers, which economists say have increased healthcare costs. The order also calls for HHS to support existing rules to limit surprise medical bills and to require hospitals to disclose their prices.

Other

A study of physician recommendations to improve EHR inbox notification design and workflow identifies these broad user suggestions:

1. Limit inbox messages to issues that are actionable to patient care and that are relevant to the receiving clinician.
2. Make the EHR inbox more like email by giving users explicit control of deleting messages; providing the equivalent of an email trash folder for retrieving deleted messages; allowing messages to be turned into a reminder or to-do item; and allowing users to send themselves reminders that are tagged with a future date.
3. Reduce the number of clicks required to manage messages by adding tools such as macros, templated text, preference lists, and routing lists. Other suggestions included the ability to add comments to a previously reviewed message without reopening it and including EHR information within relevant messages to avoid navigating the patient’s record, such as with medication refill requests and reviewing lab results.
4. Redesign inboxes to support team-based care, such as allowing support staff to triage the inbox and for care team members to message each other within the system.
5. Employers should support the time required to manage inbox messages without interruption.

A review of how PCPs in 349 ambulatory healthcare organizations use Epic finds that total daily EHR time was 95 minutes for pediatric clinicians, 121 minutes in general medicine, and 127 minutes for family medicine clinicians. After-hours time ranged from 24 to 34 minutes daily. Pediatric clinicians spent half as much time managing their inbox, receiving only one-fifth as many prescription messages, one-third as many patient messages, and half as many team-related and results messages compared to family medicine and general medicine clinicians.

A Kaiser Health News healthcare reporter reviews price worksheets to compare the charges of two health systems – the publishing of which is required by a CMS rule – and finds that it can’t be done due to the timing of charges, bundled billing practices, and the omission of physician charges. The reporter says that it’s nearly impossible to calculate the cost of one person’s medical procedure, much less to compare that cost among hospitals. He also notes that imaging and surgery centers, which usually charge less, aren’t required to publish their prices.

A Texas man is sentenced to 48 months in federal prison after being found guilty of stealing patient information from a provider’s EHR and then packaging it into physician orders that he sold to durable medical equipment providers, which netted the man an two co-conspirators several million dollars in kickbacks.

Sponsor Updates

• Quil publishes a new white paper, “Home as Healthcare Hubs.”
• Nuance has been named a “Best Company to Sell For” by Selling Power for the second consecutive year.
• The CEO Blindspots Podcast features OptimizeRx CEO Will Febbo.
• PeriGen hosts a Go Live Luau at Banner Health.
• RxRevu publishes a new white paper, “How Accurate Prescription Data Can Drive Valuable Decision Making at the Point of Care.”
• Talkdesk publishes a white paper, “Building a patient-centric healthcare contact center.”

Blog Posts

• The 6th “R” in Medication Administration (OptimizeRx)
• How to Prepare for the Next Healthcare Crisis (PatientBond)
• Reduce Physician Burnout: Improve the Provider Experience with PatientKeeper’s Clinical Communications Suite (PatientKeeper)
• Who Are Ransomware Attackers and What Are They After? (Pure Storage)
• Tips for Querying a Physician to Improve HCC Coding Accuracy (RCxRules)
• Telemedicine’s Two Separate – and Different – Worlds for Hospitals (SOC Telemed)
• Extending Your Payments Reach Beyond the EHR (Sphere)
• 10 interesting facts about nurses (Spok)
• Script Migration Success Story: Henry Schein MicroMD (Surescripts)
• You Can’t Just Say: “Tomorrow, we’re going to be a High Reliability Organization” (TransformativeMed)
• The 5 Key Benefits of Remote Patient Monitoring (Twistle)
• Why Using Word Templates for Your PT Documentation is a Terrible Idea (WebPT)
• Auto-Indexing Technology Connects Data to Patient (Vyne Medical)

Contacts

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

Weekender 7/9/21

Weekly News Recap

• FDA clears AliveCor’s phone-attached EKG sensor and app to allow professionals to calculate QTc interval for diagnosis of irregular heartbeat.
• Intelerad acquires Heart Imaging Technologies.
• A second OIG review of the VA’s Cerner project warns again of unbudgeted infrastructure costs of several billion dollars.
• Sophia Genetics announces IPO plans.
• UC San Diego Health adopts the SMART Health Card.
• Three institutions form Texas Health Informatics Alliance and announce its first conference.

Best Reader Comments

Regarding AmazonCare, calling it “value-based care” is generous. Telehealth companies used to charge per-member per-month. Insurance companies started to figure out that telehealth companies weren’t doing much. Even worse is that as the insurance companies added members, the cost to the insurance company rose linearly, but the cost to the telehealth company barely changed since so few of those members actually used the telehealth service. Insurance companies also did internal measurements on the value of “urgent care” style telehealth and realized it wasn’t really substituting for primary care visits and wasn’t driving down long term costs. In urgent care style telehealth, people use it for the sniffles, while before, they would just ride it out. Increased healthcare convenience means people use more healthcare, not less. That isn’t an interesting service for insurance companies. So about five years ago, insurance companies forced telehealth companies away from per-member per-month. Many initially tried straight charging per visit and some still do, but that style of telehealth is a race to the bottom, low-margin business. Your HR department that buys your benefits is less savvy to this stuff than insurance companies, so it is easier to make money off employers directly, but selling to them one by one requires a lot of sales people. (IANAL)

I was heavily involved in the original IBM/Epic bid for the DoD. When we lost and found out what Leidos / Cerner had bid, we were mystified. Either they had low-balled, had missed some major infrastructure pieces, or had some “secret sauce” that we just hadn’t figured out. Well, I think we’re finding there was no secret sauce involved. (Bob Smith)

[Epic Care Everywhere] internal structures and mechanisms have been built. There’s a whole support structure to enable information sharing. Therefore, when two compatible Epic HIS systems aren’t sharing data, it’s entirely a customer-side issue. Maybe they aren’t mature enough to share data (after all, I’d consider external data sharing to be an “advanced”’ HIS function, and less of a priority than internal needs and priorities). Or maybe, someone at the customer has specifically decided they don’t want to share data. After all, if setting up Care Everywhere is relatively easy and is fully vendor supported, one has to start to question what the hold-up is. (Brian Too)

I find it funny that slews of provider organizations are coming out saying sepsis AI doesn’t work because they’ve all upcoded sepsis diagnoses. Seems like some great candidates for a Medicare audit. Maybe they can use the sepsis predictor to predict overpayment! (Sepsis predictor)

The Supreme Court decision in the TransUnion case this week makes it pretty clear the lawsuit against Google isn’t going anywhere. If the court doesn’t consider you to be harmed when a credit reporting agency mistakenly informs you that you’re on the terrorist watch list, they’re definitely not going to consider you harmed by having some personal info undisclosed in a log file somewhere. (Dan)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Mr. G in Kentucky, who requested a camera for his school’s yearbook club. He reported back in December, “With school being in and out because of COVID, they have not gotten the opportunity to use it as much as they would like. However, earlier in the school year, we were lucky enough to take some action shots at a couple of our football games. This provided a great opportunity for some hands on learning with more than one student at a time. This is something that I am greatly appreciative of as a teacher! The students were able to take many great shots that will look great in our yearbook. We all thank you from the bottom of our hearts to allow us the opportunity to grow and have amazing opportunities for us to improve our school.”

I found through frustration that scanning your COVID-19 vaccination card into the HIMSS21 Clear Health Pass app works only by positioning your phone skinny side up (portrait mode) instead of the wide-side up (landscape mode) that I expected since that’s how my bank’s mobile deposits work. I finally got that to work, although the app shows my status as “pending verification” with no definition of what that means.

A Tennessee doctor whose medical license was previously suspended for possession of controlled substances will face the state board again, this time for inappropriately administering COVID-19 antibody tests to determine whether patients are actively infected. The doctor, who had started an in-home COVID-19 testing program, was accused by patients of not wearing a mask or gloves, not performing a physical exam, and falsifying medical records in documenting work he didn’t actually perform.

Riverside Regional Medical Center (VA) medical resident Eleanor Love, MD starts Richmond-based The Simple Sunflower, which asks newly married couples for their wedding flowers after the ceremony, repackages them into individual vases, and delivers them to hospitalized patients in Richmond, starting with those in palliative care. 

In Case You Missed It

• News 7/9/21
• EPtalk by Dr. Jayne 7/8/21
• HIStalk Interviews B.J. Schaknowski, CEO, Symplr
• News 7/7/21
• Monday Morning Update 7/5/21

Get Involved

• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Morning Headlines 7/9/21

FDA Clears Personal ECG Device for Measurement of QTc Interval, a Critical Marker for Patient Safety

FDA issues 510(k) clearance for the use of AliveCor’s $149 KardiaMobile 6L by healthcare professionals to calculate QTc interval from its EKGs, a value used to diagnose certain disorders of electrical conductivity that can cause irregular heartbeat.

Intelerad Acquires Raleigh-Durham Based Heart Imaging Technologies, A Clinical Workflow Automation Leader

Intelerad acquires medical image management technology vendor Heart Imaging Technologies.

More Underestimated Infrastructure Costs Could Raise VA EHR Price Tag $2.5B

A second VA OIG review of the infrastructure cost of implementing Cerner adds another several billion dollars to the project’s likely final cost, which could reach $21 billion.

News 7/9/21

Top News

FDA issues 510(k) clearance for the use of AliveCor’s $149 KardiaMobile 6L by healthcare professionals to calculate QTc interval from its EKGs. That value is used to diagnose certain disorders of electrical conductivity that can cause irregular heartbeat.

The company also offers a service to measure QT intervals.

I was an early user of KardiaMobile and am surprised every day that the company hasn’t been acquired by Apple or some other remote monitoring / wearables vendor given its strong history of working within FDA’s regulatory framework.

AliveCor has raised $154 million in funding, including a $65 million Series E round in November 2020 whose participants included the venture funds of Qualcomm and Omron.

HIStalk Announcements and Requests

I’m trying to understand the mental process that leads people to think that “app” should be spelled “APP.” Short words need more caps?

I received a robocall whose caller ID showed Clackamas, OR, so I’ve changed my fake LinkedIn location to the closest town to that it would allow, Happy Valley, OR. I looked it up and found that Tony Award nominee Hailey Kilgore was born there. I saw her in “Once on This Island” on Broadway few years back, so maybe that was her calling me to catch up.

Webinars

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

Acquisitions, Funding, Business, and Stock

Intelerad acquires medical image management technology vendor Heart Imaging Technologies.

Marketing company Finn Partners acquires health IT-focused communications and marketing firm Agency Ten22, whose founder and CEO Beth Friedman will join Finn as senior partner.

Sales

• Knox Community Hospital (OH) chooses Hicuity Health to provide tele-ICU and cardiac telemetry services.
• Specialty drug management vendor Magellan Rx Management will offer its members live behavioral health support and wellness coaching from Heuro Health.

People

Edifecs promotes Venkat Kavarthapu, MBA to CEO. He replaces founder Sunny Singh, who will move to board chair.

Industry long-timer Jamie Trigg, MSITM (Virginia Mason Medical Center) joins CommonSpirit Health as national system director of Cerner.

Payer software vendor HealthEdge hires Ryan Mooney (Cotiviti) as EVP/GM of its payment integrity product division.

Bon Secours Mercy Health names Jason Szczuke, JD (Cigna) as its first chief digital officer.

Kansas City-based worker compensation technology vendor Bardavon Health Innovations hires Ed Enyeart (Cerner) as CFO. He was recruited by former Cerner President Zane Burke, who joined Bardavon’s board in January 2021.

Government and Politics

A second VA OIG review of the infrastructure cost of implementing Cerner adds another several billion dollars to the project’s likely final cost. OIG notes, however, that the two infrastructure cost reports its office performed were conducted separately, so overlap is likely. The cost of the project, which was initially estimated at $10 billion and then $16 billion, could be as high as $21 billion if the estimates for cabling, user devices, and interfaces do not overlap. The VA – which OIG says underreported costs in its poorly documented estimates — agreed to all of OIG’s recommendations, which include having an independent cost estimate performed and ensuring that any additional project funding that is required is made available.

Announcements and Implementations

Philips and Cognizant will co-develop digital health solutions for Philips HealthSuite.

A AHRQ-funded Regenstrief study finds that EHR alerts that are intend to reduce prescribing of dementia-linked anticholinergics in older adults are nearly never read by providers or medical assistants, so their effectiveness could not be measured. The authors conclude that human-based interventions might work better than computer-issued nudges for reducing anticholinergic prescribing.

The Commons Project releases a free SMART Health Card Verifier App for IOS and Android that will allow businesses and other organizations to scan a COVID-19 vaccination card that uses the SMART standard to determine its validity and display vaccination details.

Other

I ran across information for Microsoft 365 Business Basic, which seems like a great deal for $5 per user per month, with no mention of a minimum number of users. It includes web versions of Office apps, 50 GB of mailbox storage with Exchange, 1 TB of OneDrive storage and sync, a full implementation of Teams that includes webinars and 300-user meetings, and some elements of SharePoint that I don’t quite understand. No desktop app versions are included, but I’m pondering getting a lot of storage plus a Webinar platform for just $60 per year, which also includes 24-hour support.

Business Insider says that prospective business customers of its Amazon Care virtual service want it included as a benefit in their health insurance plans, but those insurers are balking, possibly because Amazon is recommending value-based contracts and the insurers would rather pay under fee-for-service deals.

Eric Bricker, MD of First Stop Health notes a trend in physicians selling their medical practices to private equity firms, as follows:

• The PE firm offers the physician owners of the practice a lump sump of cash and offers to take over its billing and collections.
• The practice agrees to pay the PE firm up to 40% of future annual revenue.
• The PE firm takes advantage of its now-larger group practices to squeeze insurers for higher payments.
• Healthcare costs increase, but the doctors in the practice who weren’t owners – most of them younger — make less, allowing the PE firm to pocket the difference.

Sponsor Updates

• Impact Advisors receives a high overall score in the KLAS “Security & Privacy Services 2021 Report.”
• Redox enables its customers to create digital health apps using Unqork’s no-code platform that are interoperable with any organization in the Redox Network.
• Healthcare Triangle achieves Google Cloud affiliate Partner status.
• CereCore welcomes Michael Gagnon as its first Enterprise Fellow, where he will provide technical direction in IT solutions, cloud, and disaster recovery management.
• VirtualHealth adds Healthwise’s educational healthcare content to its Helios care management platform for payers.
• Vocera will relocate and expand its San Jose headquarters early next year.

Blog Posts

• Why Healthcare CIOs Should Consider ServiceNow (Optimum Healthcare IT)
• Five Essential Tips for Using E/M Modifier 25 (Experity)
• Important Facts That Frequent Users of NSAIDs Should Know (First Databank)
• How Goliath Technologies is Complimentary to Cerner Lights on Network (Goliath Technologies)
• Addressing the Decline in Clinician Trust During the COVID-19 Pandemic (Halo Health)
• A Five-Step Audit for Peak Charge Capture Performance (Health Catalyst)
• Clinical terminology enables better patient care (Intelligent Medical Objects)
• 4 Tips for Successful EHR Interoperability (Lyniate)
• Tips for Querying a Physician to Improve HCC Coding Accuracy (RCxRules)
• Online Bill Pay is Key to Receiving Timely Payments from Self-Pay Patients (Medhost)
• Meditech’s Nurse Forum 2021: From “New Normal” to “Better than Normal” (Meditech)
• Standardizing Patient Addresses: ONC’s New Specification to Improve Record Matching (NextGate)
• Cooking Up the Future of Healthcare Technology (NTT Data)

Contacts

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

EPtalk by Dr. Jayne 7/8/21

It’s always good to hear about true interoperability in action. The Surescripts Clinical Direct Messaging platform has sent over 7 million COVID-19 immunization notifications from retail pharmacies to primary care providers. Now if only we could get health systems to share amongst themselves so that patients could have one cohesive record, that would be great.

I have multiple Epic charts in practices that are literally across the road from each other, but because they belong to competing health systems, they don’t recognize each other’s data. I know that Epic is capable of sharing, but the systems aren’t ready for that. Information blocking, anyone?

The World Health Organization issues its first global report on the use of AI in healthcare. Titled “Ethics and governance of artificial intelligence for health,” it includes six guiding principles for the regulation and governance of AI that are fairly straightforward and frankly are in line with what we should be doing in all facets of healthcare IT:

• Protect human autonomy.
• Promote human well-being and safety and the public interest.
• Ensure transparency, explainability, and intelligibility.
• Foster responsibility and accountability.
• Ensure inclusiveness and equity.
• Promote responsive, sustainable AI.

The report does note that we need to be cautious about overestimating the benefits that AI can provide, particularly if resources are diverted from core investments needed to achieve universal health coverage. I thought it was a nice way of saying, “watch out for shiny object syndrome.” When you’ve got people in the world who lack basic hygiene and sanitation, clean water, and immunizations, it’s sometimes difficult to think about spending millions of dollars on advances like AI.

During the last few weeks, I’ve seen multiple articles looking at the impact of the COVID-19 pandemic on various preventive screenings. One article looked specifically at screening test volumes through the National Breast and Cervical Cancer early detection program. In analyzing data from January to June 2020, the authors found that the pandemic reduced screening rates among low-income women covered by the program. This is not at all surprising to those of us who have been in primary care. When push comes to shove and women are under stresses, they tend to put themselves last because they’re busy caring for their family members. The pandemic added extra layers of stress, including economic burdens, distance learning, and greater care responsibilities for elderly relatives or those at high risk for complications due to COVID-19.

Several of my clients have asked me to assist them with campaigns to reach out to patients for preventive screenings. The more sophisticated clients can trigger scheduling of the services through text messages, but some still require patients to call in or access a patient portal to schedule.

Although they’re excited about the capabilities of their patient engagement platforms, I have to keep reminding them that getting the patients engaged and scheduled is only part of the battle. They need to be making operational changes to make it easy to actually have the tests performed. This means leveraging technology investments to streamline in-person registration processes and history updates. The facility where I had been getting my mammograms is one of my clients and my last experience was so unfortunate that I transferred care elsewhere.

What could they do to better serve their patients? First, leverage the EHR. Use the system’s capability to generate pre-populated patient information forms so patients merely have to update their history rather than filling out a bunch of redundant information, including name and date of birth on every page. Use the data already in the system regarding primary care physician, ordering physician, and date of last exam to make it clear that you already know a good chunk of what’s going on with the patient.

Second, streamline the “COVID hygiene theater” processes that are still going on in many medical facilities, including excessive distancing and unwarranted surface cleaning that slow patient flow or create unneeded levels of concern regarding infection control.

Third, figure out how to schedule so that you can run on time. Use the data from your systems to fully understand your throughput so people can have timely testing and get back to their other responsibilities. Getting a mammogram or a pap test shouldn’t be an all-day affair, but in many places, it is, which adds additional barriers for patients in hourly jobs or patients who might not have protected time off.

Props to Steve Edwards, president and CEO of CoxHealth in Springfield, MO. He tells those who are spreading vaccine misinformation to “shut up.” Even better is the thread where his mother, a 90-year old retired operating nurse, says “I have always told you not to tell people to shut up, but this it is okay.” Ready to rumble, indeed.

I recently heard the phrase “innovation through imitation” used and kind of chuckled at it, but the more I think about it, the more it applies to entirely too many initiatives. The most recent example I’ve seen is the recent announcement that Dollar General plans to jump into the healthcare fray with a push to expand health offerings across rural communities in the US. The press release summarizes the company’s plan to “establish itself as a health destination” by stocking “an increased assortment of cough and cold, dental, nutritional, medical, health aids and feminine hygiene products” in stores. To further this effort, they’ve hired a chief medical officer, Albert Wu, MD, formerly of McKinsey & Company.

I hope one of the first thing Dr. Wu does is to consider bringing the company’s press release writers into the world of inclusive language by using modern terminology such as “menstrual care products” to describe some of the offerings they plan to stock. News flash: transgender men and nonbinary people may menstruate, and the continued use of “hygiene” around menstrual products perpetuates myths that menstruation is somehow unclean. According to the press release, Dr. Wu went straight from his anesthesiology residency to being a consultant at McKinsey, so I’m betting his missed out on the subtleties that many of us learn to appreciate through decades in practice. I’m a little embarrassed on his behalf about the way it was worded, as well as about some of the things in his LinkedIn profile, but I wish him the best in his efforts.

What do you think would be the most helpful strategy for building greater healthcare infrastructure in rural communities? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 7/8/21

Xifin Enters Radiology RCM Services Segment with Computerized Management Services Acquisition

Health IT and RCM vendor Xifin acquires Computerized Management Services, which offers RCM services for radiology groups and imaging centers.

Novo Holdings A/S Invests in US Healthcare IT Company Availity

Availity, which offers RCM, clearinghouse, and digital provider engagement services, secures a strategic minority investment from Novo Holdings.

Opioid addiction treatment apps found sharing sensitive data with third parties

Researchers find that 10 opioid addiction treatment apps available for Android collect and share a user’s information with third parties, prompting privacy and security concerns.