Readers Write: EHR Due Diligence: Five Questions That Could Save Millions

EHR Due Diligence: Five Questions That Could Save Millions
By Kem Graham

Kem Graham, MS is VP of sales for CliniComp.

Electronic health records (EHRs) have become an indispensable tool in healthcare today. As hospitals and health systems navigate the complex process of selecting an EHR vendor, avoiding hidden costs and ensuring transparency are paramount. Here are five key questions to consider when evaluating EHR vendors to maximize ROI, maintain workflow continuity, and achieve overall success.

1. How transparent is the cost breakdown?

With budgetary constraints more challenging than ever, it’s crucial to identify all contract elements comprehensively. Seek a detailed account of software, hardware, and services components, including costs for data migration, staff augmentation, medical device interfaces, and interoperability. Validate the scope of implementation, configuration, and ongoing support services. Determine any third-party costs that are not covered by the EHR vendor and confirm if there are monthly service support limits. Identify whether your organization will be billed by volume or a fixed cost solution and determine the total cost of ownership from contract signing to renewal.

2. Is the system adaptable and interoperable?

Look for an architectural framework that addresses evolving challenges in interoperability, scalability, and real-time performance data. The system should provide a comprehensive longitudinal patient record that can seamlessly cross multiple sites and environments, adapting to changing data needs over time. Seek a solution that can normalize disparate data sources for seamless interoperability, meeting both current and future innovation requirements.

3. How will it impact staffing?

Organizations often underestimate the staff that is required for EHR implementation and ongoing system management. With persistent clinical and IT staffing challenges, it’s important to understand a vendor’s staffing requirements and support services. Consider whether the new system offers a robust, out-of-the-box solution that can be customized, and how it will affect current clinical, administrative, and financial workflows. Look for a reliable and integrated system that is intuitive and user-friendly, built by clinicians for clinicians, with 24/7 end-user support to minimize the burden on staff.

4. Is System and medical device integration included?

Data migration and integration among systems, devices, and other technologies are critical components that can sometimes be costly add-ons. Understand exactly what elements are included, whether there are limitations around the EHR system’s technology, and what additional costs may be incurred to bridge those gaps. Consider future integration costs as well, such as migrating to different medical devices or vendors. Confirm that the EHR vendor does not limit the hospital’s options.

5. How will operational disruptions be mitigated?

Not all EHRs require downtime for scheduled updates, security patches, and upgrades. Seek a solution that delivers 100% uptime for maintenance, upgrades, and unplanned incidents. Investigate the vendor’s history to understand their experience in avoiding clinical dissatisfaction, poor patient care, and financial losses due to system downtime.

Choosing an EHR system is a pivotal decision with far-reaching implications on both the clinical and operational fronts. Trust and transparency are essential in fostering a successful relationship between the vendor and the hospital system. Healthcare organizations with a complete understanding of both upfront and long-term investments, including impacts on staff satisfaction, workflows, and patient care, will have the most satisfactory outcomes throughout the EHR acquisition, implementation, and utilization process.

The vendor’s success should be defined by the hospital’s success, reflecting a true partnership where the vendor acts as an extension of and integrates seamlessly into the organizational team. Transparency from the outset, and exploring all options, such as the comprehensive system as a service model, will set the system up for success for years to come.

Readers Write: AI is Here to Stay, So Don’t Miss Out on the Opportunity

AI is Here to Stay, So Don’t Miss Out on the Opportunity
By Greg Miller

Greg Miller is VP of business development at Carta Healthcare.

AI is going to take all of our jobs. At least that’s the impression one would get today from far too many media outlets. Alas, blatant scare-mongering works and generates advertising revenue.

We’ve talked recently with dozens of health system technology decision-makers who acknowledge that artificial intelligence (AI) can make their organizations more efficient and cost-effective. Yet some worry that AI will replace their employees. This isn’t just another concern; it’s the top concern that we’ve been hearing.

The prospect of losing valued employees to technology is one kind of AI-related anxiety among healthcare professionals. There’s also fear of missing out (FOMO). Healthcare IT pros are under heavy pressure from leadership to do something with AI or risk being left behind. However, these healthcare veterans have heard it all before about why they must implement a certain technology to keep up with competitors or face imminent doom. No wonder many have become immune to marketing hype.

Whether you’re in the fear of AI or FOMO camp, AI is happening with or without you. Provider organizations that fail to implement an effective AI strategy will struggle as their understaffed workforces become deeply buried under a backlog of clinical administrative tasks. As more healthcare data is generated and jobs go unfilled, healthcare organizations that lack AI capabilities won’t be able to keep up with clinical documentation.

But while many provider organization leaders fear that AI will replace humans, healthcare workers are more likely to welcome the assistance that AI can provide. In a survey from earlier this year, 77% of responding healthcare workers said that emerging technologies like AI could be useful in combating the healthcare staffing shortage.

AI implementations can optimize the return on investment for hospitals and health systems while providing a blueprint for future successful AI initiatives. There are pragmatic and safe ways for provider organizations to apply AI today that are affordable and designed to ease the administrative burden for clinicians.

One good example is using ambient listening to perform clinical documentation tasks. Physicians typically spend between 30 and 90 minutes at home completing clinical administrative work that they couldn’t finish during office hours. Ambient listening functionality can perform these essential clinical documentation tasks, improving efficiency and accuracy while vastly reducing clinician workloads and burnout.

Another strong use case for AI in healthcare is abstracting data from electronic health records (EHRs). On average, it takes an abstractor one hour to finish abstraction work for a single case. That’s a lot of costly time. In contrast, the right AI technology can perform abstractions for thousands of cases in minutes. Can a hospital or health system afford to pass up this opportunity?

It’s important to know where AI fits into your provider organization. AI is a tool and part of a process. It’s also familiar since we use AI every day in our regular lives through computers, smartphones, and other connected devices.

AI is going to help clinicians do more with the time they have. It will help physicians, nurses, coders, and clinical data abstractors by automating simple but necessary tasks. It will also help provider organizations improve efficiency, reduce costs, and enhance care quality. What AI will not do is replace medical professionals.

The already disruptive shortage of physicians and nurses in the US is expected to get worse as the nation’s population ages and our need for care services increases. Hospitals and health systems should embrace the opportunity to use AI in ways that enable their clinical staff to optimize their care for patients.

Morning Headlines 9/30/24

Epic calls on Particle Health to approve release of resolution in patient privacy dispute

Epic asks Carequality to publicly release its resolution regarding the dispute between Epic and Particle Health.

Physical therapy startup Hinge Health hires Moran Stanley as it prepares to confidentially files its S-1

Digital musculoskeletal therapy provider Hinge Health, last valued at $6 billion in October 2021, hires investment bankers to take the company public next year.

EQT to exit AGS Health, eyes $750 million valuation

The investment firm owner of US-based, 12,000-employee health IT services firm AGS Health will seek a buyer for its five-year-old investment at a valuation of $780 million.

A US Crackdown Targeted an Adderall ‘Pill Mill.’ Secretly, It Had Already Moved to China.

California-based telehealth startup Done Global, which prosecutors allege has operated as an Adderall pill mill, has reportedly moved its operations to China and shifted management to employees there to continue business as usual despite the arrest of its US executives.

Monday Morning Update 9/30/24

Top News

Epic asks Carequality to publicly release its resolution regarding the dispute between Epic and Particle Health.

Epic filed a dispute with Carequality against Particle customers, which it says were downloading patient records for non-treatment purposes in violation of Epic’s policies. Epic blocked Particle’s access to its data, naming Particle customers such as Integritort, which it claims used EHR data to assist personal injury law firms in identifying potential class action lawsuits. Also named were Reveleer (risk adjustment) and Novellia (personal health records).

Epic asserts that Particle mischaracterized Carequality’s resolution and is urging Carequality to make those findings public. Particle says that Carequality had originally requested that the resolution remain confidential, but says it has no objection its release.

Particle filed an anti-trust lawsuit against Epic last week, accusing the company of leveraging its market dominance to block Particle’s entry into the payer platform market. Particle also lodged an information blocking complaint against Epic with HHS OIG.

HIStalk Announcements and Requests

The US is the only wealthy, industrialized nation that does not provide universal health insurance / healthcare, and poll respondents say that implementing that would be the best way to improve our collective health. That wouldn’t fix our issues with industrial-manipulated food and our general appetite for unhealthy behaviors, but at least it would start with fixing the symptoms and then moving upstream to the problems. Which will never happen, of course, because someone’s pocketing profit with every one of these.

New poll to your right or here: Which party seems to have a stronger case in the Particle Health vs. Epic lawsuit? This is a first reaction kind of poll since we’ve only seen Particle’s complaint and Epic’s brief response.

Webinars

October 24 (Thursday) noon ET. “Preparing for HTI-2 Compliance: What EHR and Health IT Vendors Need to Know.” Sponsor: DrFirst. Presenters: Nick Barger, PharmD, VP of product, DrFirst; Tyler Higgins, senior director of product management, DrFirst. Failure to meet ASTP’s mandatory HTI-2 certification  and compliance standards could impose financial consequences on clients. The presenters will discuss the content and timelines of this key policy update, which includes NCPDP Script upgrades, mandatory support for electronic prior authorization, and real-time prescription benefit. They will offer insight into the impact on “Base EHR” qualifications and provide practical advice on aligning development roadmaps with these changes.

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

Acquisitions, Funding, Business, and Stock

Digital musculoskeletal therapy provider Hinge Health hires investment bankers to take the company public next year. It was last valued at $6 billion in October 2021.

California-based telehealth startup Done Global, which prosecutors allege has operated as an Adderall pill mill, has reportedly moved its operations to China and shifted management to employees there to continue business as usual despite the arrest of its US executives. US-based clinicians are still issuing prescriptions, with some of them reporting minimal review of patient records. One nurse practitioner earned $43,000 in May 2024 alone by prescribing for 3,000 patients. Team members claim that the company instructed its Philippines-based customer care staff to sit in on patient appointments and shared patient information internally via WeChat, which raises concerns about potential US privacy violations. The company’s founders were arrested in June 2024 for illegal distribution of 40 million pills of Adderall, which earned them $100 million.

The investment firm owner of US-based, 12,000-employee health IT services firm AGS Health will seek a buyer for its five-year-old investment at a valuation of $780 million.

WW International (WeightWatchers) fires its CEO, who pivoted the company into digital health and GLP-1 prescribing with the $132 million acquisition of weight management telehealth provider Sequence in March 2023. Tech executive Sima Sistani took the CEO job in early 2022. 

Steward Health Care CEO Ralph de la Torre, MD – who was held in contempt of Congress last week for refusing to comply with a Senate subpoena to answer questions about corporate greed and the financial struggle of Steward’s hospitals – will resign this week.

Sales

• Sectra will implement its Sectra One Cloud enterprise imaging solution in all of Quebec’s public hospitals.

Announcements and Implementations

ChristianaCare President and CEO Janice Nevin, MD, MPH confirms its Cerner-to-Epic switch via a video announcement. Go-live is planned for 2026.

Government and Politics

US Rep. Matt Rosendale (R-MT) tells the technology modernization committee of the House Committee on Veterans’ Affairs that the VA should not have shut down its $624 million, Epic-powered MASS appointment scheduling system project in 2019 (which it later downgraded to a pilot project) in a “disastrous” decision to move to Cerner. He also wants the VA to explain its decision to turn off the its $278 million WellHive external provider scheduling system due to budget problems.

The VA expands its tele-emergency care pilot nationwide after finding that it avoided an ED trip for 59% of callers.

Ireland’s competition regulator opens an investigation into 1,000-employee global healthcare software vendor Clanwilliam to review the company’s EHR, referral, and text messaging business. Clanwilliam launched as Medicom in 1996 and renamed itself in 2014 after making several acquisitions.

Privacy and Security

The Atlantic warns that 23andMe’s rapid company decline should concern “anyone who has spit into one of the company’s test tubes” since the only asset it has left to sell is the genetic information of 15 million customers. The company is not bound by HIPAA and its privacy policies state clearly that it can sell customer data if merged or acquired. 23andMe’s market cap, which was nearly $5 billion three years ago, is down to $150 million and its entire board quit last week, leaving CEO Anne Wojcicki as the only remaining member. 

The New York Times reports that behavioral health patients are feeling “stunned, ambushed, and traumatized” after learning that their progress notes are available to other clinicians on the patient portals of hospitals that have adopted OpenNotes data sharing.

Other

A San Francisco software engineering manager is convicted of tax evasion for offsetting his three-year income of $1.2 million with a claimed $1.1 million in medical expenses for a 2010 appendectomy that actually cost him just a few hundred dollars. DOJ didn’t say where he works, but a LinkedIn search suggests Apple.

Sponsor Updates

• EClinicalWorks works with HealthEfficient to complete Hyndman Area Health Center’s (PA) UDS+ submissions to HRSA.
• Availity publishes a new whitepaper, “From Complexity to Connectivity: The Journey of Availity’s Payer-to-Payer Data Exchange Cohort.”
• Rhapsody announces that it has been recognized as Sample Vendor in Gartner’s Hype Cycle for Real-Time Health System Technologies report in the Next-Generation EMPI category.
• Redox publishes a new report, “DIY or Outsource: EHR Integration Costs for Providers.”
• Verato will present at the Reuters Total Health Conference October 8-9 in Chicago.
• Waystar will exhibit at ACEP24 September 29-October 2 in Las Vegas.

Blog Posts

• BCA Best Practices: Strategies for Success with MEDITECH Business and Clinical Analytics (Tegria)
• Embracing AI in Healthcare: Overcoming Reluctance and Unlocking Potential (Netsmart)
• Why Secure Medical Texting Works Better for Patients (PerfectServe)
• Key Areas Where Technology Should Support Optimized Workforce Scheduling (QGenda)
• Unlocking Healthcare Innovation through Digital Health Enablement (Rhapsody)
• Nurses Corner: 5 ways to improve education views (Sonifi Health)
• Smooth Sailing: A Case Study on Medication Adherence (Surescripts)
• How to Get the Most Insights From Your Data (TruBridge)

Contacts

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

Morning Headlines 9/27/24

Graybill to separate from Palomar Medical group, citing cyber attack

Graybill, a California-based primary care group, will split from Palomar Health Medical Group, citing that organization’s inadequate support following an April 2024 cyberattack that took systems offline for months.

Dimer Health raises $2.95M to cut down hospital readmissions

Dimer Health, a startup that specializes in healthcare facility discharge and post-acute care coordination, raises $3 million in a seed funding round.

VA makes tele-emergency care available nationwide, offering Veterans more virtual care options

After a successful pilot, the VA expands its tele-emergency virtual triage service to veterans nationwide through its VA Health Connect program.

Wyden and Warner Introduce Bill to Set Strong Cybersecurity Standards for American Health Care System

Senators Ron Wyden (D-OR) and Mark Warner (D-VA) introduce cybersecurity legislation that, if passed, would mandate the development and enforcement of tougher minimum cybersecurity standards for healthcare organizations, remove the current cap on HIPAA fines, and provide cybersecurity funding for select hospitals.

Lubbock UMC experiences ransomware attack, diverts patients to other hospitals

University Medical Center (TX) diverts patients and enacts downtime procedures as it deals with a ransomware attack.

News 9/27/24

Top News

Graybill, a California-based primary care group, will split from Palomar Health Medical Group, citing that organization’s inadequate support following an April 2024 cyberattack that took systems offline for months.

Palomar disputes Graybill’s claim that some of its systems are not yet fully recovered. It also suggests that Graybill shares responsibility, noting that a Graybill physician serves as Palomar Health Medical Group CMIO.

San Diego-based Arch Health Medical Group and Graybill Medical Group joined Palomar Health to create the 170-physician Palomar Health Medical Group in November 2020.

Reader Comments

From A Frustrated Vet: “Re: VA. Happening as I write this on the House VA Technology Modernization Subcommittee: ‘Our veterans would have been much better served if the VA had not abandoned the Medical Appointment Scheduling System (MASS) in 2019. This project had implemented Epic’s scheduling system and patient portal in Columbus, Ohio, and they were working well. But the VA leaders at the time made a special effort to eliminate it, paving the way for Cerner to duplicate the work and install an inferior system. This was a disastrous decision that we are all still paying for.’ – Chairman Rosendale (R-Mont.)” Thanks. I will recap more fully in the weekend’s news once the hearing is finished.

HIStalk Announcements and Requests

Conference season is the ideal time to become an HIStalk sponsor and get year-round exposure to decision-makers instead of betting the farm on a booth rental. Lorre is likely offering incentives for new sponsors, startups, and former sponsors who return to my little fold, although she will also ensure that current sponsors, some of whom have supported me for more than a decade, don’t get shortchanged. Also for sponsors, if your company is attending HLTH 2024 in any capacity, send me your info soon to be featured in my online guide.

One last housekeeping item: hair-trigger spam filters always inappropriately unsubscribe readers from my spam-free update list. Drop your email here to stay in the loop—you won’t get duplicate emails regardless.

I got the ChatGPT update today with Advanced Voice Mode. It’s cool, though not revolutionary—it allows for natural voice conversations, pauses if interrupted, and adjusts its responses based on what you say. It’s fun that you can choose a voice with a personality that affects tone and word choice. Advanced Voice makes Alexa, Google Assistant, and Siri seem even more primitive, and it’s convenient to interact with ChatGPT via voice. The microphone stays open until you turn it off, so my phone sits beside my keyboard, ready to respond without requiring a wake word or key press.

I politely declined the interview invitation of Kat McDavitt, Lisa Bari, and Melissa Denino, the boundless energy folks who are behind the “Health Tech Talk Show.” Reasons for no-ing: (a) I avoid the spotlight like a vampire shuns sun; and (b) I say everything I know right here and don’t see the value of repeating myself. Still, I offered to help them feed the content beast by inviting potential interviewees to email them at hello@healthtechtalkshow.com. It’s refreshing not to need to stab the eject button seconds-in on a host who is long on self-importance but short on industry knowledge and a compelling style.

Webinars

October 24 (Thursday) noon ET. “Preparing for HTI-2 Compliance: What EHR and Health IT Vendors Need to Know.” Sponsor: DrFirst. Presenters: Nick Barger, PharmD, VP of product, DrFirst; Tyler Higgins, senior director of product management, DrFirst. Failure to meet ASTP’s mandatory HTI-2 certification  and compliance standards could impose financial consequences on clients. The presenters will discuss the content and timelines of this key policy update, which includes NCPDP Script upgrades, mandatory support for electronic prior authorization, and real-time prescription benefit. They will offer insight into the impact on “Base EHR” qualifications and provide practical advice on aligning development roadmaps with these changes.

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

Acquisitions, Funding, Business, and Stock

India-based Qure.ai completes a $65 million Series D funding round to expand into the US market and to pursue acquisitions.

Sales

• UAB Health System will implement Epic as its single EHR in a seven-year, $380 million project, replacing Oracle Health.
• ChristianaCare will implement Epic, replacing Oracle Health.
• Children’s Hospital of Orange County will deploy Oneview Healthcare’s Care Experience Platform on patient room TVs.

People

Susan Worthy (Amwell) joins Gainwell Technologies as chief marketing officer.

Former Cerner executive Maria Flynn, MBA, MS is named president and CEO of the Patterson Family Foundation, a $1.5 billion asset non-profit that focuses on rural health and was founded by Cerner founder Neal Patterson and his wife Jeanne, both deceased. She was also co-founder of Digital Health KC.

Announcements and Implementations

Cobb County, GA joins the Find Help social network to launch an online resource that connects residents with assistance programs.

Sonifi Health integrates NESA’s Epic-integrated virtual care system with its patient room TVs.

Meditech kicks off its annual customer leadership conference in Foxborough, MA.

A new KLAS report on smart IV pumps finds that BD Alaris recalls and the FDA’s approval of next-generation technology are driving earlier replacement and expansion decisions. EHR integration is the most important factor in purchasing, usage, and satisfaction, followed by cost and ease of use.

KLAS also takes an initial look at Epic’s Hello World integrated SMS messaging system. All interviewed organizations are satisfied, would recommend it, and would buy it again. Customers say it reduces appointment no-shows using reminders, speeds communication with patients, and is deployed via MyChart.

Government and Politics

HHS OIG finds that the use of remote patient monitoring for Medicare patients has increased dramatically, but needs additional oversight to prevent fraud as patients are not always receiving all required services and Medicare lacks the information to oversee its use. CMS agrees with OIG’s recommendations: (a) require a provider’s order for RPM that is included on claims and encounter data; (b) develop ways to identify the health data that providers say they are monitoring; (c) educate providers about billing for remote patient monitoring; and (d) identify and monitor those companies that are billing for RPM. OIG says that 43% of Medicare enrollees did not receive all three mandatory RPM components: education and device setup, collection of an adequate number of device readings, and use of the data to manage treatment.

The Senate unanimously votes to hold Steward Health Care CEO Ralph de la Torre, MD in contempt of Congress for ignoring its subpoena to answer questions about his compensation as the bankrupt company’s hospitals struggled to deliver safe, effective care. A spokesperson for de la Torre says that he has the right to not answer questions under the Fifth Amendment and won’t be intimidated by Congress. He faces prison time as the first person to be held in contempt by the Senate since 1971.

Other

Allina physicians report problems that were caused by order entry confusion resulting from the health system’s switch of in-house outpatient lab work to Quest Diagnostics last week.

I truly enjoy reading the “Hey Judy” posts on Epic Share, where she has written these ruminations for September:

• She paid her 15-year-old son – who wrote contest-winning computer games from their home basement where Judy was working on Epic — $5 to develop a programmer test after hiring Epic’s first programmer and then realizing that people aren’t always as talented as they think. Epic used that test for 18 years to choose new employees, then expanded the question bank when they leaked out.
• She describes the origins of Share Everywhere, which Dave Furhmann created (he’s now SVP of R&D) after Judy learned that Cerner hospitals couldn’t exchange information with each other.

Sponsor Updates

• Black Book Research ranks Inovalon #1 in its 2024 provider enterprise RCM analytics solutions survey, with top ratings across 12 KPIs.\
• A new KeyCare survey of 400 patients finds that the majority prefer telehealth to office visits for medical issues including urgent care, preventive care, chronic care, and specialty services.
• Black Book Research publishes the results of its 2024 supply chain customer experience survey, with Dimensional Insight taking the top spot for benchmarking and comparative analytics.
• Inovalon promotes Sandy Warford to director of product marketing.
• Five9 and Verint expand their partnership to deliver AI-driven customer experiences.
• Fortified Health Security will present and Healthcare IT Leaders will sponsor the Georgia HIMSS Conference October 1 in Atlanta.
• Linus Health unveils new tools for early dementia detection at AAFP’s FMX 2024 conference.
• Meditech customer Ontario Shores Centre for Mental Health Sciences becomes the first hospital in Canada to implement Expanse Genomics.
• MRO will exhibit at the Medical Practice Excellence: Leaders Conference October 6-9 in Denver.

Blog Posts

• Healthcare’s Current State vs Perfection: Which is Best? (Vyne Medical)
• Revenue Cycle Management: Boosting Operational Efficiency and Productivity (EClinicalWorks)
• Addressing Healthcare Staff Satisfaction through Innovation and Support (FinThrive)
• A year of DAX Copilot: Healthcare innovation that refocuses on the clinician-patient connection (Microsoft)
• Embracing Generative AI as a Change Agent to Drive Clinical and Financial Value (Impact Advisors)
• Maximizing ROI on IT Required by CMS Rule 0057 Takes a Village (InterSystems)
• Solving Quality Issues in Healthcare Data: KONZA’s Leadership in NCQA DAV Accreditation (Konza National Network)
• NAFLD Guidelines: A Shift in Understanding & Focus (Lucem Health)
• Your Guide to HTI-1 (Medhost)
• Why We Need Proactive Technology And Human Collaboration To Combat Medicare Fraud (Medicomp Systems)
• One year in: How Suki and Meditech are transforming clinician workflows with voice AI capabilities (Meditech)
• Med Tech Solutions Broadens EHR Support Expertise (Med Tech Solutions)
• Hospital Physical Therapy: Empowering Patients Toward a Safe Transition Home (Net Health)

Contacts

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

EPtalk by Dr. Jayne 9/26/24

The hot topic around the virtual physician lounge this week was an article from the American Medical Association (AMA) that identified “Five physician specialties that spend the most time in the EHR.”

Physicians were whipped into a frenzy by the statistic that ambulatory care physicians spend an average of 5.8 hours in the EHR for every eight hours of scheduled patient care time. Even if you adjust for the time one spends in the EHR while you’re seeing a patient – for example, when you’re reviewing the chart, capturing the patient’s story, and writing prescriptions – that means a lot of clinicians are still doing loads of documentation during non-scheduled working hours.

The article cites a study that was published in the Journal of General Internal Medicine that found the highest EHR times per eight hours of scheduled patient care were: infectious disease (8.4), endocrinology (7.7), nephrology (7.5), internal / family medicine (7.3), and hematology (7.2). The lowest EHR times were: dermatology (4.3), surgery (4), ENT (4), orthopedics (3.3), and anesthesiology (2.5).

The study’s lead author, Christine Sinsky, MD, is vice-president of professional satisfaction at the AMA. She notes that, “These are specialties with complicated patients with multiple medical conditions for whom there’s a lot of visit-note documentation, lots of orders, and require a lot of communication between the patient and the physicians or the team between visits, so the inbox time is highest among those five specialties as well.” That inbox time was noted as 0.8 hours of work per eight hours of patient care, on average, but primary care, infectious disease, and endocrinology were at 1.2 hours per eight hours of patient care.

Since orthopedics spends only 0.4 hours in the inbox per eight hours of patient care, she hypothesizes that, “Many of the procedural specialties have hired staff who assist with some of the tasks of order entry, visit-note documentation and being the first responders to the inbox.” Even the lowest-paid orthopedists in my area make twice what a family physician does, so it’s a little easier for them to afford the staff to help them get through the day.

I dug into the article itself and found that it used data from more than 200,000 physicians at 400 organizations. The source was Epic’s Signal platform, which measures physician activity both within and outside scheduled working hours.

Sinsky calls on EHR vendors to reduce the burden of documentation, including the number of screens and clicks that it takes to perform specific tasks. She cites the click count that is needed to document ordering and administering a single vaccination at 32, which I agree is a tragic level of clicks. My favorite EHR took three to order (launch immunizations, click influenza, click order) and six to administer (open the order, side/site picklist, manufacturer, lot/expiration picklist, checkbox to confirm the Vaccine Information Statement publication date, click save) with an optional click or two if you needed to change the sequence number on a vaccination for a patient who had received previous doses elsewhere. I’d be interested to hear from readers how many clicks it takes in your system, and what they are beyond the basics noted above.

It will be interesting to see what this data looks like in the future, when we can have before-and-after studies that follow the implementation of ambient/AI documentation solutions. We also need to continue to look at payment models that deliver enough revenue to primary care and other specialties with complex patients so that they can hire adequate support staff. I worked for many years with a human scribe in a practice and I can vouch for the difference that it makes in how you spend your day.

I was also fortunate enough to spend a good chunk of my career working for an organization that felt that physicians needed to be seeing patients and not doing other tasks, so it was rare that a phone or inbox message came to me. When it did, it had already been managed by staff as much as possible. Not every organization shares this belief, though, and many rely on the after-hours labor of their physicians to keep the practice running.

One of the physicians in the discussion said, “They know we’ll do it even when they cut our pay, because we care about our patients even when the hospital doesn’t.” That provides more than an inkling of the level of moral injury our physician colleagues are experiencing. Another noted that her practice’s own Signal data showed that primary care physicians are doing an additional 3-4 hours of charting each night at home. She concluded, “Why are they going to pay a scribe $15 per hour when they know we’ll do the work for free?”

From there, the conversation hopped to topics such as overthrowing corporate overlords and whether lottery tickets might be a good investment for the physician on the go, so I stopped following. If you’re from an organization that’s aggressively addressing these concerns, I’d love to hear more about your efforts and what you’ve learned to date.

NCQA has released health plan ratings that might be helpful to individuals as they go through employer open enrollment plans. The ratings include 1,000 health plans, including commercial payers, Medicare, and Medicaid options. Data is from the 2023 calendar year and plans are rated on a five-point scale. The quality measures contributing to the ratings, include those on clinical quality, patient experience, and health plan structure and quality processes.

This year includes expanded quality measures that assess whether health plans capture race and ethnicity data for their members in an effort to provide relevant services. Notable quality improvements were seen in reported control of hypertension and diabetes, as well as appropriate testing for patients with sore throat. One concerning quality indicator was a decline in childhood immunizations, which should be worrisome across the board.

I looked up my own plan and found that they have 3.5 out of 5 overall, with only 2.5 for patient experience. Childhood immunizations were at 4 stars, adolescent immunizations at 3 stars, and there were plenty of 4-star scores for prenatal / postnatal care, breast and cervical cancer screening, diabetes care, and appropriate use of antibiotics.

Those scores are due to the diligence of the providers who are enrolled in the plan rather than the plan itself, so it seems weird to see the plan taking credit for it. I’ve never received any kind of health communication from my plan, and I also know that my physicians participate in plenty of other insurance plans that are also claiming credit for their good work. Only in the US do we see this kind of fuzzy logic, but at least it’s something transparent, I guess.

More stories from the patient-side trenches this week, as I started receiving bills from my healthcare adventures over the summer. I remember back in the early days of EHR/PM implementations where we were piloting real-time claims adjudication. Nearly two decades have passed and I have yet to see an office that does it.

In fact, with one of my current physicians, they didn’t send a statement to the patient until more than 60 days after the insurance posted to the account. Definitely not a revenue cycle best practice. When I received my paper bill, I looked for a way to pay it online. There wasn’t one, nor was there one on the practice’s patient portal. Not even a phone number to pay via that route. I literally had to write a paper check, which gave me a laugh when I looked at the check register and saw how long it’s been since I’ve written one, coupled with the fact that the calendar on the back of the register dates to 2017. Fortunately, the pathology lab associated with the procedure had an online payment portal, and it took me less than 90 seconds to pay up.

How long has it been since you’ve written a paper check? How old is the calendar in your check register? Leave a comment and let’s see who gets the bragging rights.

Email Dr. Jayne.

Morning Headlines 9/26/24

Global healthcare AI innovator Qure.ai completes $65 million Series D funding round led by Lightspeed and 360One Asset

Global healthcare AI company Qure.ai raises $65 million in a Series D funding round.

Pomelo Care Acquires The Doula Network, Becoming The Only National Maternity Care Model to Offer Virtual & In-Person Care, Greatly Expanding Access Across the United States

Pomelo Care acquires The Doula Network to add wrap-around doula services to its virtual and now in-person maternity care offerings.

UAB Health System to invest in new EHR platform

UAB Health System will spend $380 million over the next seven years to implement and operate Epic.

Healthcare AI News 9/25/24

News

The New York Times covers physician use of Epic’s In Basket Art to create draft responses to patient questions that have been submitted using MyChart. Some major health systems decided not to use the technology over concerns that doctors would approve responses without reviewing them, while others thought that patients would recognize the message as AI generated and devalue it. An Epic study found that doctors are sending unedited responses to one-third of messages. Duke Health Chief Health Information Officer Eric Poon, MD, MPH says that Epic’s product creates drafts that are still “moderate in quality,” which keeps doctors vigilant in looking for mistakes, but ponders whether they will let their guard down as the AI gets smarter. A Duke colleague adds that it tried to get Epic’s product to stop giving clinical advice, but “we couldn’t take out its instinct to try to be helpful.”

OpenAI will roll out Advanced Voice to paying subscribers of ChatGPT this week. The enhancement adds speedier conversational responses, the ability to pause when interrupted, and additional voices. However, it reportedly does not support web search, custom GPTs, images, or unlimited use.

Google Cloud releases upgraded versions of its Gemini 1.5 chat-based AI assistant that it says are twice as fast at half the cost, with the capability of handling 1,000-page PDFs and hour-long videos. The company says that its Cloud and DeepMind divisions are developing new AI products and models and that developers are starting to use Gemini to create their own chatbots and voice assistants. Google has added the standalone Gemini app to Google Workspace.

The Association for the Advancement of Medical Instrumentation (AAMI) will work with the Consumer Technology Association to create standards for post-market market surveillance of non-prescription health devices  and for evaluating and assessing AI/ML products.

Business

London-based Noki.ai announces an ambient AI medical companion that can transcribe visit conversions, automate scheduling, manage forms, verify insurance, display a patient dashboard, and exchange data in FHIR format. Monthly pricing ranges from free to $299 based on functionality and usage limits.

Ferrum Health, which offers a secure platform for health systems to deploy AI, raises $16 million in a Series A funding round. Co-founder and CEO Pelu Tran founded Augmedix in 2012, which at that time hoped to commercialize the use of Google Glass for medical documentation. He dropped out of Stanford’s medical school weeks before graduating to work on Augmedix full time, then left the company in 2018 and started Ferrum.

Healthcare AI call agent developer Hippocratic AI adds $17 million to its Series A funding round that was led by Nvidia’s venture arm, increasing its total raised to $137 million.

Research

A study finds that real-time screening of medical claims using AI can reduce healthcare fraud, waste, and abuse by allowing questionable charges to be reviewed before payment instead of after. Tests found that such screening reduced claim payments by 1.2%. 

Researchers from Brigham and Women’s Hospital use AI to improve the accuracy of results from the PREVENT cardiac risk calculator by calibrating it to local populations. The authors conclude that the black box nature of AI applications can be tailored while preserving their functionality.

Other

Singapore’s health minister says that general practitioners will use AI for assessing health risks, prescribing drugs, and recommending lifestyle changes, which will eventually be powered by mandatory use of its national EHR program. Ong Ye Kung told conference attendees that, “We have medical records, we have genome data, we have lifestyle data, we have socioeconomic data, and the technology is already available. We can train very sophisticated, high parameters, AI models to identify risk factors and to predictive preventive care.” He says that Singapore’s biggest health challenge is the “buffet syndrome,” where patients are overtreated because their insurance pays.

AAMC News profiles David Fajgenbaum, MD, MBA, who as a medical student in 2010 was dying of organ failure but was saved by experimental chemotherapy. The Penn Medicine professor created Every Cure, which uses AI to score 3,000 approved drugs for their possible use in treating other conditions, which gets them into the hands of patients quickly and inexpensively. That organization was awarded $48 million in federal funding earlier this year.

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
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Morning Headlines 9/25/24

VA’s new EHR saw 826 ‘major’ incidents since its launch

A new report from the VA OIG finds that the VA’s Oracle Health-based EHR that has been implemented at six facilities experienced 826 major performance incidents between October 2020 and March 2024.

Indian Health Service aims to avoid VA’s pitfalls while adopting computer system that has hampered Northwest veterans’ care

The Indian Health Service outlines the ways in which it will avoid the VA’s mistakes with its own Oracle Health project, including requiring implementation only at those clinics that it manages directly.

Introducing the 2024 Draft Federal FHIR Action Plan

ASTP publishes a draft of the 2024 Federal FHIR Action Plan.

News 9/25/24

Top News

A new report from the VA OIG finds that the VA’s Oracle Health-based EHR that has been implemented at six facilities experienced 826 major performance incidents between October 2020 and March 2024.

Over half of the incidents — including outages, performance degradations, and incomplete functionality — occurred after the VA put further EHR go-lives on hold. Major incidents collectively impacted the system’s performance for nearly 80 days.

The VA plans to restart EHR rollouts sometime next year.

Reader Comments

From Joe Friday: “Re: Particle Health. I believe in sticking with the facts, of which I think maybe they are playing loose and fast. They claim that the Carequality Steering Committee fully agreed with their arguments and did nothing wrong. That’s a knowable fact, isn’t it? I wonder if the steering committee’s report would actually say that. And if not, I would question just how factual the entire suit is.” Particle should be able to produce documentation to support these claims:

• Particle says that both insurers and their software vendors have a right to access EHR patient treatment information. This should be an easy question for ASTP to answer.
• Epic limits the use of its data for treatment purposes, while Carequality’s policy allows it to also be used for healthcare operations and research. All of that is surely documented, assuming that any policy other than Epic’s matters when you’re getting your data from Epic.
• Epic coerced its big-investment customers to stop using Particle. Any such communication should be discoverable.
• The company says that Epic urged its customers to flood Particle with inquiries. The lawsuit cites an Epic recommendation to its clients that they email a generic company support address if they needed Particle’s technical help to audit use of their patient data.
• Epic claims that Particle admitted wrongdoing. Particle should provide the source of this information. It apparently relates to one Particle customer that Epic complained about, which Particle immediately removed from its system.
• Particle cites the Carequality Steering Committee as finding the company guilt-free, yet required Particle to conform to a corrective plan. That documentation should be readily available from Carequality, which will certainly need to get involved in the lawsuit discovery since some of Particle’s accusations involve Carequality and its board decisions. 
• Particle says that Epic turned off access to 20% of Particle’s customers “who were seemingly chosen at random.” If I remember correctly, Epic said its logs identified organizations that were retrieving a lot of treatment data without sending anything back to the network, which suggests that they weren’t actually providing treatment and thus were violating its policies.

From Patients Paying the Price: “Re: Oracle Health to Epic conversions. Been a part of a handful of these over the past few years. More often than not, it seems like the legacy systems are poorly implemented and the root cause is hospital/IT leadership. I’ve seen only one instance where I would definitively say that the vendor was at fault. You would think that spending one-fourth of the 8-9 figure price tag of these systems on optimization, hiring more senior employees, and spending the time on governance and training would yield better results. Maybe it’s an easier sell to the board than a harder-to-quantify optimization cycle, that CIOs want a sexy project instead of getting into the day-to-day work of improve patient care and user experience, or maybe I’m just being overly cynical and this is an expected outcome of the implementation rush from the Meaningful Use days of yore. Probably all of the above, but it makes me wonder if these new installs will go any better or they’ll be ripped and replaced in another 10 years for something ‘better.’ At the end of the day, we all know who is actually paying for all of this (patients) and you have to wonder if the cost will pay dividends back.” Health systems try to forget that they have perpetually promised that expensive technology will make American healthcare better, faster, and cheaper.

From Readers Take Note: “Re: scrubbing personal information from the interwebs. You mentioned a service that you liked so much that you upgraded to the annual plan. Could you repost the company’s name?” I’ve used Optery for three years and just upgraded to its extended plan at renewal for $149 per year that covers 186 data brokers (I ended up paying $120 using some promo code I found online). Signing up for a free account shows you which sites are displaying your details, while the subscriber dashboard shows the shocking level of detail that Optery has removed from web searches. You could find and contact those sites yourself, but that would be a lot of work and regular rechecks.

HIStalk Announcements and Requests

I also published today:

• Responses–What Companies Should I Consider for a Mid-Career Sales Job?
• Particle Health Versus Epic Lawsuit Summary

Webinars

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

Acquisitions, Funding, Business, and Stock

Hancock Regional Hospital (IN) will transition 49 employees to its RCM vendor Revology.

AssureCare, a population health management company focused on the health and human services sector, acquires competitor Clinigence Health.

Seven directors resign from 23andMe’s board, citing differences of opinion on the company’s future. Co-founder and CEO Anne Wojcicki, the only remaining board member, has expressed strong interest in taking the company private amidst declining revenue and a sharp drop in valuation, which has plummeted from $3.5 billion to under $200 million. 23andMe is also facing $30 million payout to settle a lawsuit that accused the company of failing to protect the records of 7 million customers whose information was breached in 2023.

Scribenote, which has developed an ambient documentation system for veterinarians, raises $8 million in seed funding. The brother-and-sister company cites studies that find high burnout rates of veterinarians whose heavy case loads require after-hours medical records completion. Scribenote’s system costs $165 per DVM per month for unlimited records.

A Time article says that reduced payments from pharmacy benefits managers have helped drive drugstore patient satisfaction down 10% in 2024 alone. The article describes the pharmacy customer experience as “miserable” due to understaffed and closed stores, merchandise that has been moved behind lock doors due to shoplifting, and excessive workload that has left some stores with inexperienced pharmacists. Another factor was that the pandemic encouraged consumers to buy prescriptions and merchandise online, which they learned saved them money.

Sales

• Ballad Health will implement Andor Health’s ThinkAndor virtual care technology to unify its virtual care services across facilities in four states.
• Surescripts will use Clear’s identity verification software to enhance ongoing identity validation within its network.
• CareRing Health selects WellSky’s EHR, analytics, and services.
• Wellsheet will add Wolters Kluwer Health’s UpToDate clinical decision support tool to its Smart EHR UI clinical workflow application.

People

Prolucent names Jason Phibbs, MA (Press Ganey) VP of growth.

David Carmouche, MD (Walmart Health) joins Lumeris as EVP and chief clinical transformation officer.

Episode Solutions names Kyle Cooksey (Monogram Health) president.

Paul Burke (Zelis) joins Reveleer as chief product officer.

Announcements and Implementations

Long Island Community Hospital (NY) rolls out MyWall interactive bedside tablets using technology from OneView Healthcare as part of an enterprise implementation across NYU Langone Health.

Government and Politics

HRSA awards contracts to to five federal contractors to overhaul the national Organ Procurement and Transplantation Network’s systems that are provided exclusively by United Network for Organ Sharing (UNOS).

ASTP publishes a draft of the 2024 Federal FHIR Action Plan. 

The Indian Health Service says that it will avoid the VA’s mistakes with its own Oracle Health project:

• The IHS system was competitively bid, unlike the VA’s $10 billion, no-bid contract.
• IHS’s $2.5 billion project will be managed by government contractor GDIT, where the VA allowed Oracle Health (Cerner at that time) serve as its own prime contractor.
• IHS will invite participation of tribes and urban Indian organizations and will require implementation only at those clinics that IHS manages directly.

Other

A transplant surgeon at Memorial Hermann Health System admits to state health authorities that he changed patient data to move specific transplant candidates higher on the list.

Sponsor Updates

• Ascom employees volunteer at the Salvation Army Thrift Store in Raleigh, NC, helping to organize, sort, tag and put items on display for resale.
• Dronning Ingrids hospital in Greenland will implement Sectra’s enterprise imaging software.
• AdvancedMD staff win numerous medals, raise $2,600 for the Utah Food Bank, donate 22 units of blood to the American Red Cross and the local blood donor center, and win the Heart & Soul Award during the Salt Lake County Corporate Games.
• Availity releases a new episode of its Availity on Air Podcast, “A New Approach to Prior Auths with Elevance Health.”
• Capital Rx releases a new episode of The Astonishing Healthcare Podcast, “The Rise of GLP-1s & Partnering to Manage Chronic Diseases, with Vida Health.”
• The Empowered Patient Podcast features CliniComp SVP of Client Services Sandra Johnson, “Innovation in the EHR Landscape to Break Down Data Silos and Improve the Healthcare Provider Experience.”

Blog Posts

• Key Insights From the 2024 KLAS Digital Health Investment Symposium (Tegria)
• Meditech Expanse 2.1 to 2.2: What Will Nurses Think? (CereCore)
• Driving Revenue Cycle Success with Intelligent Automation (AGS Health)
• Learn How Top PE-Backed Medical Groups Scale Their Team’s Expertise (Alpha II)
• Increase revenue by complying with current Medicare waste/charge billing requirements (Altera Digital Health)
• Hiring for Culture Fit: Why It Matters and How to Do It Right (Direct Recruiters)
• From the Last Go Live to the First Upgrade (Divurgent)

Contacts

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

Responses–What Companies Should I Consider for a Mid-Career Sales Job?

I am grateful for these responses to the reader’s question from this week’s Monday Morning Update: “ I’m a mid-career sales health IT lifer, with experience in both large and niche vendors as a generalist and with clinical applications. I’m looking for a new sales position. What companies have you seen that are solving important problems, have differentiated themselves, and can execute?”

HSi-corp.com.

Redox, Validic.

DexCare — critical problem solving, great tech, tremendous CEO.

Clariti Solutions.

Wolters Kluwer. We have an open sales role in the West to sell Drug Diversion and Clinical Surveillance software, Sentri7. We will have two openings posted in October for sales roles selling our Pharmacy Compliance suite, including Simplifi+ IV Workflow.

Cardamom is planning to hire into a sales role in 2025.

Waystar, InstaMed, a J.P. Morgan company.

Couple of things to think about with this question after being laid off recently and running through interviews and multiple discussions with different vendor HIT organizations and recruiters. When you are middle aged, most companies want you mainly for your contacts. I say stay away from these companies.

Make sure you are solving a problem that customers see value in, not because the company you are representing thinks their is one.  Talk to other sales executives on the team and ask what does a typical day and week look like. Dig into the management culture and the executive team. This is super important to see how they operate.

Service organizations are tricky as you are usually trying to displace another vendor. Software companies are great if you hit them the right time and they have a good portfolio of products.

Out of all the companies I talked to, QGenda seems like a great company. Not too big, has a good name and organizations like their products. Also the recent Harris buy makes them more attractive. I also talked to RhythmX AI. AI is so hot right now and this company may make progress.  If interested in revenue cycle, SmarterDX has a very cool solution that finds cash and they go at risk.

Carta Healthcare. We are looking for exceptional sales talent.

DrFirst. Innovative minds and culture create exciting products and services.

iCare.com.

Artera.io.

Artisight is one of the coolest companies I have come across in awhile

Bayesian Health is red hot. In terms of general hygiene, I would suggest your reader make sure:

• Company has a strong plan to work with or around Epic. Anything in between is a dog’s breakfast.
• Have a solid exec team, not just one or two impressive leaders. What they are all trying to do is hard. They need enough good people steering the ship to make it.
• The product is truly differentiated, has a clear ROI, and their product vision is readily understandable.

Particle Health Versus Epic Lawsuit Summary

Case Summary

Particle Health applies analytics to patient data that it retrieves from external sources to provide insights to payers, providers, and software developers. The company is suing Epic, accusing it of using its EHR market dominance to hinder competition in the payer platform market by blocking Particle’s access to essential medical records and by undermining its customer relationships.

Specific allegations include Epic cutting off access to Particle’s customers without reason, spreading false information about Particle’s security vulnerabilities, and delaying the onboarding of Particle’s new clients. The legal claims include antitrust violations under the Sherman Act, as well as tortious interference and defamation under state law.

Particle is asking the court to enjoin Epic from anticompetitive behavior and to compel it to pay damages to Particle.

Complaint Summary

Particle says in its federal antitrust lawsuit that it recognized in 2023 that payers are offering treatment-related services under value-based care arrangements, which it says constitutes data access for treatment purposes. It says that payers are then free to use the same data for secondary purposes under federal requirements.

The lawsuit centers around a 2023 incident when Epic learned that a Particle customer was sending data to Blue Cross Blue Shield of Michigan, after which Epic allegedly coerced clients into severing ties with Particle. By March 2024, Epic began cutting off Particle customers’ access to EHR data, offering to reinstate access only if they stopped using Particle’s platform.

Additionally, the complaint says that Epic spread false information in claiming that Particle improperly disclosed PHI and admitted wrongdoing, which the company denies. Epic also coerced its customers to overwhelm Particle with privacy-related inquiries.

Epic took the dispute to Carequality in accusing three Particle customers (not Particle itself) of misusing data, but the Carequality Steering Committee — where Epic holds influence — found the claims to be unfounded, although it still imposed a corrective action plan because of Epic’s powerful role.

Particle says that Epic’s actions caused its revenue to drop to one-third of projections and also harmed patients whose treatment information, specifically from the OneOncology network, was made unavailable to health systems.

Epic’s Response

“Particle’s claims are baseless. This lawsuit attempts to divert attention from the real issue: Particle’s unlawful actions on the Carequality health information exchange network violated HIPAA privacy regulations. Particle’s complaint mischaracterizes Carequality’s decision, which in fact proposes banning Particle customers that were accessing patient data for impermissible purposes. Epic’s software is open and interoperable, allowing healthcare organizations to easily share data under HIPAA and all relevant regulations. Epic will continue to protect patient privacy and vigorously defend itself against Particle’s meritless claims.”

A previous Epic statement said that one of Particle Health’s customers is Integritort, which it says was identifying potential participants in class action lawsuits while claiming that it was retrieving data for treatment purposes. That company’s home page states, “Our advanced platform retrieves and analyzes real-time medical records, ensuring accurate and up-to-date information for each case. This not only minimizes the risk of fraudulent claims but also expedites the legal process, benefiting both plaintiffs and defendants.”

Morning Headlines 9/24/24

Epic Systems’ ‘Stranglehold’ on U.S. Medical Records Harms Patient Care: Lawsuit

Particle Health files a federal antitrust lawsuit against Epic that alleges the Wisconsin-based company is using its dominance in the EHR market to edge Particle out of the payer platform market.

Hancock Health transitioning nearly 50 employees to work for third-party vendor

Forty-nine Hancock Health (IN) employees will transition to working for Revology, the hospital’s RCM vendor, in November.

Women Leaders Across Tech, Entertainment, Sports, Media, and Fashion Come Together to Invest in Midi Health

Women’s virtual care company Midi Health adds $5 million to its now $63 million round of Series B of funding, bringing its total raised to over $88 million.

Curbside Consult with Dr. Jayne 9/23/24

I spent several hours this weekend fighting with healthcare technology systems that haven’t been adapted to play nice with the new ways that some of us work as physicians.

In the past, many physicians left training and took jobs with a private practice, an employed practice model, or with an academic medical center. If they saw patients at a hospital, they likely went through a credentialing process that involved voluminous paper forms and actual humans that read through the applications and resolved any questions or discrepancies. There was likely a designated person who managed physician credentialing with the insurance plans that the practice worked with. In my experience, they typically worked from the hospital’s credentialing forms, but may have had supplements of their own. Once again, there was someone you could contact who would be shepherding your applications through the system.

As healthcare organizations started to get squeezed in the 1990s and began participating with more insurance plans, organizations started turning to third-party credentialing services as a way of economizing. Rather than paying someone in the practice to run credentialing efforts, they could pay an outside company to do it, hopefully faster and cheaper. The better companies assigned a designated person or two to work with a specific practice, but others just assigned credentialing tasks to a pool of people who may not have any kind of ongoing relationship with a practice.

Still, most physicians had a primary practice location and a couple of hospitals, so it wasn’t that complicated. Some physicians might have done moonlighting work at other facilities, but that was an exception rather than a rule.

Fast forward a couple of decades. A significant proportion of physicians are not employed in the traditional sense. Hospitals and staffing organizations are doing everything possible to try to not have their workers classified as employees even though they probably should be. Many more 1099 jobs are out there.

Some physicians prefer the 1099 world. They enjoy working as locum tenens physicians for the flexibility in time and location of different contracts. In the telehealth world, the majority of physicians who are doing the work are 1099 contractors, and many work for multiple platforms in trying to cobble together enough work to support themselves. That means that the burden of managing credentialing across multiple organizations falls to the physicians themselves, often without any specific training for it.

I’m dealing with three credentialing systems. All assume that I have a traditional office practice and that they are my sole side gig. The systems ask for different documents, but don’t necessarily have a mechanism to upload multiples of the same document, such as copies of medical liability coverage.

They are relatively inflexible with managing employment date information. Many of my clinical positions have not specifically been employment, and positions overlap when you’re a gig worker. The systems don’t account for this, resulting in discrepancy flags. The systems sometimes don’t understand that your medical liability insurance policy is only in effect on the days you work and isn’t in force all the time when you’re working infrequently at an urgent care or emergency department.

These systems are technically part of the healthcare IT ecosystem because they are mandatory if you’re a physician who is going to see patients, but they make even the worst EHR look like a walk in the park. I’m sitting here wishing we could have the health information exchange equivalent for credentialing, with some kind of interoperability so I could port data from one system to another without having to do triple entry.

Maybe there could be just a single system that I interact with and that can route the information to the different provider systems. Who knows, maybe something like that is already out there and I just don’t know it. I’m just trying to stay active as a physician and I’m not a credentialing professional.

None of the systems offer online chat or resources outside of business hours. One of them allows you to send emails to a generic mailbox with the hopes that your question will get to the right person. The other two require questions to be submitted through a ticketing system, and I’m not even sure if I’m choosing the right descriptors or qualifiers to get my issues to the right person. Either way, there isn’t a single person at any of these organizations who knows me from anybody, so I’m not hopeful that my issues will be resolved.

I spend the majority of time in my clinical informatics work, but I felt that even as a part-time clinician, I could provide deliver solid care to patients and allow busy primary care physicians to offload some straightforward acute patient needs. But I’m coming to realize that it might be time to hang up my stethoscope. There’s a bit of an existential crisis that goes along with that, but I know plenty of clinical informaticists who no longer practice.

I’ve reached out to some of my colleagues about what it might mean to stop practicing and have heard interesting stories about their own decisions. One stopped practicing at a time when his certifying board still required a single-day examination in person. He knew that seeing patients sporadically in a niche practice probably wouldn’t allow him to pass the exam without significant burden. Since most insurance companies won’t allow physicians to be on their panels if they’re not board certified, that was the end of his practice.

Another CMIO friend stopped practicing when he relocated to join a new health system that didn’t feel that medical practice was important to the role and did not offer options for patient care. His subspecialty isn’t suitable for telehealth work, so that was the end.

A third colleague stopped practicing because he felt like he was always burning the candle at both ends with both his industry job and trying to keep up patient hours without feeling fulfilled in his clinical role.

I’d be interested to hear from readers involved in credentialing. Is there some secret code that I have yet to crack, or an easier way to manage being a roving part-time physician? For physician informaticists who have given up clinical care, what was your thought process? Were there any gotcha moments that you wish you would have been warned about?

Do you have advice about continuing work versus hanging up your stethoscope? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: EHR Optimization: The New EHR Life Cycle

EHR Optimization: The New EHR Life Cycle
By Nathan Koske

Nathan Koske, MBA is director of Meditech professional services for CereCore.

Modern EHRs are significant investments that constantly change and require ongoing maintenance and improvement to realize value and benefits for patient care, satisfaction, and hospital operations. How can your optimization efforts be strategic ones? Let’s examine key ingredients for successful EHR optimization so that your healthcare organization can be prepared for the transition and understand the components of this ongoing life cycle. 

Optimizations are typically most successful when they are started one to two months post go-live. Even if you are amid an EHR implementation, it’s not too early to start making plans for optimization. Organizations often simply can’t fit everything into an implementation, making optimization efforts something to consider from the start.  

Regardless of the type of optimization you are planning, it is important to give your users sufficient time to become familiar with the product, as well as wind down from the grueling process of going live with a new EHR environment.  

Your new EHR offers capabilities that may spark ideas, and clinicians may have a new lens to explore what’s possible and how that can improve workflows and patient care. This adjustment period is important in helping users realize what is needed instead of reacting to what was just different from their previous system.  

The population of data into the live system is another big factor into that adjustment period. Simply put, some things you can’t optimize until the data and/or workflows exist. After the first month or so of use, users will also be able to identify which workflows actually need to be evaluated for improvement versus functionality that may benefit from more education. Focusing on workflows that need to be improved will go far in yielding value in your optimization efforts.  

Conduct a formal assessment of your current EHR environment as a first step in launching an optimization project. Review the system and workflows and gather feedback from everyday users within a formal process.  

A holistic EHR assessment can identify areas of improvement that weren’t apparent during earlier phases in the life cycle. It is important to understand that although the goal of both your organization and your EHR software provider is a solid implementation, the viewpoints and responsibilities are different. An experienced EHR partner can help you assess and bridge the gaps, whether that is a specific skillset or translating software speak into clinical operations reality. The scope of an EHR assessment can vary depending on the perspective of the stakeholder involved. 

Take these actions to assess your processes and inform your optimization priorities:  

• Start by rounding and talking to users about features that they may not understand fully. Quick wins are often gained by showing users how to do something on the spot. 
• Interview users from various departments and roles and ask them about pain points. What’s not working well? 
• Review system configuration details. 
• Observe users to identify opportunities for streamlining workflows. 
• Document all pain points and optimization opportunities and set a time to prioritize them. 
• Determine the EHR functionality that you have contracted for from your EHR vendor. When reviewing your list of functionality, it is crucial to determine what is being underused or possibly not used at all. 
• Collect your findings into a concise document that is grouped by impact areas such as patient safety, revenue, regulatory, user satisfaction, and patient satisfaction. Organizing this information will also help you prioritize findings and determine next steps. 

A thorough assessment of your EHR could produce optimization documents that contain a significant number of findings. The results may be overwhelming to leaders and project team members. Don’t get discouraged. It’s natural for EHR implementations to need optimization.  

Prioritizing the assessment findings will require strategic decisions, but in the end, your organization should walk away with a roadmap that will guide optimization projects and future investments.  

For example, you may need to weigh the benefit of certain optimization items based on whether it could improve physician productivity or just make life easier for clinical staff. Or, it could make sense to prioritize an optimization that would generate revenue because a manual process wasn’t leading to consistent revenue capture. Patient safety or potential regulatory compliance items are usually high impact items to consider, too.  

During the assessment prioritization review, the leadership team could decide to attack all high priority findings or those identified as low-hanging fruit as a way to make quick progress. It is often beneficial to break down the level of effort by service line or department to prevent putting too much strain on your healthcare system.  

IT teams should be prepared to have conversations with your leadership team and key stakeholders about the additional investment (time and money) and skillsets that will be needed to move forward with optimization efforts. For instance, Epic offers tools and recommendations for optimization, but you may need to request budget for those types of things or additional resources. When you request budget, It’s important to communicate how this technology aligns with and contributes to the organization’s goals.. It may be clear to IT that if we execute this initiative, we’re going to get to the anticipated goal, but that might not be clear to operations. It’s important to draw those lines of connection. 

The strategic roadmap that results from the EHR assessment and optimization prioritization session will identify and help articulate the value that can be realized by the organization, and the true benefits are achieved through skillful execution.  

Once you have tackled your optimization roadmap, it’s time to kick off the optimization phase of your EHR journey. At this point, change management principles are critical for implementation and ongoing success. Regardless of what system you’re on, change management is pivotal to optimization success. Inform users about how to use the system in a new way, or even train them if it’s a significant change, so that they will begin the new approach rather than continuing to do the same thing that they’ve always been doing the same way that they’ve always been doing it. 

Take these actions to help make your optimizations a reality:  

• Assign specific staff to the optimization project. The optimization phase should be treated like any project, so you should assign a project manager to oversee the process. 
• Develop a clear project timeline. The project manager should set important milestones and outline go-live dates for new functionality in departments. 
• Communicate with staff about the optimization project and hold a kickoff. 
• Establish communication and project meeting cadences that make sense for those involved. Maintain a project plan to keep everyone on track. 
• Determine if any of the optimizations or new functionality being implemented will require end-user education and develop a training plan. 

The EHR is the lifeblood of any healthcare organization. Optimization that goes beyond basic maintenance and focuses on continuous improvement can provide significant tangible and intangible benefits across the organization. 

Morning Headlines 9/23/24

Hippocratic AI Receives Investment From NVentures to Build Generative AI Healthcare Agents

Healthcare AI call agent developer Hippocratic AI adds $17 million to its Series A funding round, increasing its total raised to $137 million.

In Historic Step, HRSA Makes First Ever Multi-Vendor Awards to Modernize the Nation’s Organ Transplant System and End the Current Contract Monopoly

HRSA awards contracts to Arbor Research Collaborative for Health, General Dynamic Information Technology, Maximus Federal, Deloitte, and Guidehouse Digital to overhaul the national Organ Procurement and Transplantation Network.

Cardinal Health to acquire Integrated Oncology Network, a physician-led independent community oncology network

Cardinal Health will acquire Integrated Oncology Network for $1 billion and incorporate its member practices and practice management and growth services into Cardinal’s Navista oncology practice alliance.