EPtalk by Dr. Jayne 9/16/21

This was a rough week on a number of fronts, and I had to resort to some pastry therapy. I wasn’t sure what to think about sopapilla cheesecake initially, but it made my house smell amazing. I’m a big fan of butter, but I think it’s actually possible this recipe had too much, if that could even be a thing. Now to wait for three hours for it to chill, and then I’ll be able to give the final verdict.

The best thing about the week was hearing from my friends at the Office of the National Coordinator for Health Information Technology, in response to my earlier post covering topics such as information blocking, the 21st Century Cures Act, and patients’ access to their notes. They brought up some really good points in response to the post and I wanted to share them, since there are some good clarifications as well as links to resources, FAQs, and more.

Hi Dr. Jayne,

Your August 23 post was shared with ONC and we want to share some information that we hope will be helpful to your readers. Some general resources that might be helpful to your readers are:

• General resource page
• FAQs
• Recorded webinars
• September 14 provider-focused webinar

Regarding some of the specific issues raised in your post:

Re: Open Notes

• The ONC Cures Act Rule does not specifically point to “Open Notes,” which is a branded industry initiative.
• However, the rule does require availability of electronic health information (EHI), which includes notes. From April 5, 2021 through October 5, 2022, the definition of EHI is limited to eight note types, but it expands to include more notes thereafter.

Re: Types of notes

• As noted above, eight specific types of notes are included in the EHI definition through October 5, 2022, and more notes are required thereafter.
• During the current period of the more narrow EHI definition, note types are determined by the content and function of the notes, not by the names assigned by any particular organization or vendor.

Re: Health care providers subject to the rule

• The regulations apply to an array of health care providers, including hospitals and ambulatory physicians (as well as health information networks/exchanges and developers of ONC-certified health IT).
• We have a resource that providers may find helpful in assessing whether the regulations apply to them (Health Care Provider Fact Sheet).

Re: Exception for harm

• There is indeed a Preventing Harm Exception
• However, it does require an individualized determination of risk of harm and a reasonable belief that the exception is needed to substantially reduce an individual patient’s risk of harm or, as applicable, another individual’s risk of harm

Re: EHR certification

• The regulations apply to all health care providers included in the health care provider definition under the rule, regardless of whether they are using ONC-certified EHR technology.

Re: Scope of medical record

• The regulations focus on EHI, the scope of which is initially more narrow, as described above.
• EHI is the electronic portion of health information that would be included in the Designated Record Set (DRS). The DRS is defined by HIPAA regulations and includes any information in the record used to make decisions about individuals.

Finally, we’re making every effort to help the industry with this transition. Let us know how we can help!

Thanks!

ONC

I appreciate their input and the open lines of communication. It’s always good to know that the powers that be are reading and are willing to help us better understand the work that we’re all trying to do together.

I got a chuckle out of a headline in an email that talked about Epic looking to grow its Twitter presence after noticing that its customers use the platform “quite a lot.” The Wisconsin State Journal reports that Epic has created a Twitter account for its new website, epicshare.org, which is designed for client organizations to share ideas and receive information from the vendor. The site also features a “Hey Judy” page that shares “Thoughts and Stories from Judy.” So far, @EpicShares has 215 followers, yours truly included. It will be interested to see how the software giant fares on Twitter since this is its first foray into that social media space.

I was curious about a quote from Leela Vaughn, Epic senior executive, regarding patient use the site. Vaughn noted that “Anybody can be reading these and showing them to their doctor” and that the site was written in a way where they “really worked hard on getting rid of the jargon” so that it could be useful “to people who aren’t super tech savvy.” Physicians already have to worry enough about patients who take the “ask your doctor” advice seriously for every TV commercial they see for a new drug – I can’t imagine what physicians will think when their patients come in and begin quoting things that they read on an EHR vendor website. For one, the vast majority of physicians are not attuned to what Epic is doing as a company – they’re just trying to keep their heads down and see patients, while surviving the pandemic. I’d be curious to see what others think about this approach.

Mr. H previously mentioned the MyMountSinai app, designed to offer patients additional features that aren’t available in their Epic MyChart mobile app. One of the features that is included is the ability to upload COVID-19 vaccine cards. It would be interesting to know if the app allows the data from those vaccine cards to populate the patient’s medical record and function in the same way that vaccine data would function had the vaccines been natively documented in the health system’s record. I have multiple physicians on different instances of MyChart and it still surprises me that they don’t recognize each other’s data. For example, one system continually prompts me for vaccines and services that are documented in the other record, even though I know they have the capability to recognize those care elements behind the scenes. That’s the kind of information blocking we need to get rid of at the patient level, and doing so would make things easier for both patients and providers. The app also includes the ability to schedule visits with new providers and wayfinding assistance for some of its facilities.

Sobering statistics: 1 in 500 people in the US have died of COVID-19. As of Tuesday, more than 663,000 people have been lost to the disease. I remember the early days of the pandemic when we hoped that interventions might cap the deaths at 60,000 or 70,000 and how horrified we were at those numbers. Now we’re exceeding that by a factor of 10 and plenty of people don’t bat an eye. Every one of those casualties was something to someone – a mother, father, sibling, grandparent, friend, or neighbor. As a physician, I’m tired of hearing from people that this is no big deal, or that people didn’t really die “from” COVID-19 they just died “with” it, etc. Frankly, your healthcare teams no longer want to hear it. It’s exhausting and it just needs to stop.

Email Dr. Jayne.

Morning Headlines 9/16/21

Healthcare Industry Leader Zane Burke Joins Quantum Health as CEO

Former Cerner president and Livongo CEO Zane Burke joins consumer-focused care coordination and navigation company Quantum Health as CEO.

This Startup Raised $100 Million To Turbocharge Women’s Health

Women’s healthcare provider Tia raises $100 million in a Series B funding round led by Lone Pine Capital.

Definitive Healthcare stock soars out of the gate, opening 38% above IPO price

Healthcare market intelligence company Definitive Healthcare raises $420 million in its IPO.

Morning Headlines 9/15/21

Symplr to acquire Halo Health

Healthcare governance systems vendor Symplr will acquire clinician digital communications vendor Halo Health.

SymphonyRM Becomes Actium Health

Patient engagement and activation company SymphonyRM rebrands to Actium Health.

Zelis to Acquire Healthcare Transparency Leader Sapphire Digital

Healthcare payments platform vendor Zelis will acquire provider search and transparency website Sapphire Digital.

Indy-based Future Health ESG Corp. goes public, the latest in a flurry of SPACs to hit Wall Street

HC1 founder, chairman, and CEO Brad Bostic launches a $200 million SPAC that hopes to merge with a healthcare data science company.

News 9/15/21

Top News

Healthcare governance systems vendor Symplr will acquire clinician digital communications vendor Halo Health.

Previous Symplr acquisitions include HealthcareSource HR, SpinFusion, The Patient Safety Company, Vistar Technologies, Hayes, TractManager, IntelliSoft, API Healthcare, CBR Associates, Cactus Software, and Phynd.

Clearlake Capital acquired Symplr in late 2018.

Reader Comments

From Inquiring CIO: “Re: HIMSS attendee lists. I’m tired of companies using them to mine sales leads. I’ve emailed HIMSS, but haven’t received a reply. I’m not sure where companies are getting the contact info of conference registrants, but it’s a deterrent to attending.” Inquiring CIO forwarded two emails, both of which contain scammy elements. Email #1 is from someone offering to sell a list of 45,678 HIMSS20 attendees (an oddly linear number series which technically should  be zero given that the conference was cancelled) for $1,999. Email #2 is from a business development guy in India-based company who used “HIMSS conference” in their subject line and content to make a technology sales pitch. The company was not a HIMSS exhibitor. I emailed the originator, but as I expected, received no reply. I contacted HIMSS, which reiterated that (a) it doesn’t sell attendee lists, and anyone who offers one is lying and probably is just dumping a bunch of old, inaccurate industry lists together and claiming they came from an official source; and (b) while HIMSS rents attendee lists to exhibitors for short-term use immediately before and after a conference, the company in Email #2 was not an exhibitor (I pondered the irony that perhaps Company #2 bought their list from Company #1). HIMSS says its legal team would love to have a conversation with Company #2 about its use of the HIMSS name if Inquiring CIO approves.

Webinars

September 16 (Thursday) 1 ET. “Patient Acquisition and Retention: The Future of Omnichannel Virtual Assistants.” Sponsor: Orbita. Presenters: Harris Hunt, SVP growth product, Cancer Treatment Centers of America; Patty Riskind, MBA, CEO, Orbita; Nathan Treloar, MSc, co-founder and COO, Orbita. Consumers want the same digital healthcare experience from healthcare that they get in online shopping, banking, and booking reservations, and the pandemic has ramped up the patient and provider need for frictionless access to healthcare resources and services. Health systems can improve patient acquisition and retention with the help of omnichannel virtual assistants that engage and delight. Discover how to open and enhance healthcare’s digital front door to offer care that goes beyond expectations.

September 16 (Thursday) 1 ET. “ICD-10-CM 2022 Updates and Regulatory Readiness.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, VP global clinical services, IMO; Theresa Rihanek, MHA, RHIA, mapping manager, IMO; Julie Glasgow, MD, clinical terminologist, IMO. IMO’s top coding professionals and thought leaders will discuss the coding changes in the yearly update to allow your organization to prepare for a smooth transition and avoid negative impacts to the bottom line. The presenters will review new, revised, and deleted codes; highlight revisions to ICD-10-CM index and tabular; discuss changes within Official Coding Guidelines, and review modifier changes.

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

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

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

Acquisitions, Funding, Business, and Stock

Patient engagement and activation company SymphonyRM rebrands to Actium Health.

App-based house call and telemedicine company Remedy pivots and rebrands as CareHive, which offers telemedicine, digital front door services, analytics, and clinical navigation. Remedy laid off 82 employees last November, many of whom were hired during the previous summer’s peak of COVID-19 patients. Remedy Chief Medical Officer Ronald Dixon, MD has been promoted to CEO of the new company.

Edifecs acquires Talix, which has developed a natural language processing-enabled risk adjustment coding, retrieval, and analytics platform for providers and payers.

Digital maternity care software vendor Babyscripts raises $12 million in a Series B funding round.

Healthcare payments platform vendor Zelis will acquire provider search and transparency website Sapphire Digital.

HC1 founder, chairman, and CEO Brad Bostic launches a $200 million SPAC that hopes to merge with a healthcare data science company.

Sales

• Legacy Health (OR) selects Simplifi 797 automated cleanroom compliance technology from Wolters Kluwer Health.
• Oroville Hospital (CA) will implement CliniComp’s fetal surveillance and fetal mobile technologies.
• Saina Health integrates Sphere’s healthcare payments and security software with its InstaHealth medical record portal for multiple family members.
• Health Choice Network chooses Epic for its 44 safety net organizations in 16 states in a $400 million deal.

People

CitiusTech names Atul Soneja (Infosys) president of operations.

UC San Diego Health promotes CIO Christopher Longhurst, MD to chief medical officer and chief digital officer.

Verato promotes Arti Pandit to chief customer experience officer and names Mark Erwich (Imprivata) chief marketing officer.

B. Well Connected Health hires Gary Johnson (Atlas Health) as VP of marketing and Romy Carlson, MBA (League Inc.) as VP of partnerships.

Announcements and Implementations

Divurgent develops a Concierge Scheduling Application that gives end users the ability to schedule one-on-one personalization sessions as part of their EHR training.

Powell Valley Healthcare (WY) goes live on Cerner.

Cincinnati Children’s Hospital Medical Center develops real-time data-sharing software for medical teams and case workers that will be commercialized by Cordata Healthcare Innovations.

EHealth Exchange will award up to $550,000 in grants and incentives to its participants or eligible applicants that are innovating in the exchange of health information or establishing new technical advancements in connectivity.

Leidos will use Nuance’s Mix conversational AI development platform to create digital patient engagement solutions for health systems and federal healthcare agencies. Nuance Mix allows organizations to create conversational experiences for interactive voice response and chatbot systems.

Government and Politics

Bloomberg reports that the VA has issued an RFP for a $1 billion remote patient monitoring – home telehealth contract.

Privacy and Security

In Canada, The Ottawa Hospital apologizes to 391 employees for a software error that caused their names to be visible on an email that was sent to unvaccinated employees ahead of the October 5 mandatory vaccination date.

Children’s Hospital & Medical Center (NE) will pay $80,000 and take corrective actions to settle potential HIPAA violations related to its failure to provide timely access to all of a patient’s medical records despite multiple requests.

Sponsor Updates

• CereCore sponsors the American College of Healthcare Executives – Middle Tennessee Chapter’s annual golf outing benefitting Mercy Community Healthcare.
• The Tech Trek Podcast features Well Health CTO Thor Clark.
• Impact Advisors publishes a white paper titled “Achieving Sustainable Value from ERP.”
• Agfa HealthCare achieves the new European Medical Device Regulation certification of its Class IIa Enterprise Imaging and Xero Viewer solutions.
• The Data Masters Podcast features Arcadia Chief Product Officer Nick Stepro, “The Role Empathy Plays in Data Visualization.”
• Clearwater founder and Executive Chairman Bob Chaput publishes a new book, “Stop the Cyber Bleeding: What Healthcare Executives and Board Members Must Know About Enterprise Cyber Risk Management.”
• CoverMyMeds Pod Lead Eda Erkal and Kitchen Manager, Campus Operations Shey Jin join the Leadership Columbus Signature Program Class of 2022.
• Kyruus expands its ProviderMatch online scheduling platform to allow consumers to self-book diagnostic and preventive care appointments, and customers to offer online booking for COVID-19 booster shots.
• OptimizeRx adds a Therapy Initiation Workflow to its point-of-care medication prescription platform.

Blog Posts

• Overcoming quarantine to serve patients in a mental health crisis with telehealth (Ability Network)
• Agfa HealthCare earns #1 customer experience for VNA (Agfa HealthCare)
• Women’s Health: Reporting on a Continuum to Reduce Inequalities and Improve Outcomes (Azara Healthcare)
• Different Types of Virtual Care (Bluestream)
• Shared Care Records bringing health and care closer together (Cerner)
• Medication Management & Patient-Centered Care Coordination Across the Continuum: A Thought Leadership Roundtable (CHIME)
• Reduced to the Essentials – AI/ML Can Wait (Cloudwave)
• Navigating the Wild West of Clinical Data – RISE West 2021 (Diameter Health)
• Covid Care-at-Home: Respond to Surging Cases & Limited Beds (Dina)
• Preparing for the 2021 Virtual National Conference (EClinicalWorks)
• 4 ways to strengthen digital patient access (Experian Health)

Contacts

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

HIStalk Interviews Steve Cagle, CEO, Clearwater

Steve Cagle, MBA is CEO of Clearwater of Nashville, TN.

Tell me about yourself and the company.

I’ve been with Clearwater for about three and a half years. My background is all healthcare, over 20 years working in a number of healthcare-related firms building businesses. At Clearwater, our mission is to help our healthcare customers protect their patients and their data to help them be compliant and to develop capabilities that allow them to be more effective and efficient at the business of cybersecurity, which is becoming extremely difficult in today’s age.

We talk about pandemic fatigue. Are we experiencing cybersecurity fatigue?

We as an industry had to pivot quickly to work-from-home for employees and in patient care and patient delivery. That involved a lot of new technologies and deploying those quickly. At the same time, threat actors recognized the enormous opportunity to target the healthcare industry. The data is so valuable, and the historic underinvestment in cybersecurity, more so through the pandemic, made it a juicy target. 

There may be a bit of fatigue with regard to what we’re seeing with ransomware, unfortunately. We will have to continue to understand that, because we are probably still at the beginning of where we need from a maturity perspective in healthcare.

Has the cybersecurity significance of employee behavior changed, especially with regard to ransomware?

It’s very significant. Cybersecurity is not just about the tools that we have in place. It’s really about the people and the organization. It’s about establishing a culture where everybody in the organization understands they have a role in keeping their information safe and being vigilant. We have to continue to remind people through training and not just rely on tools. Security processes become important as well.

The top healthcare cyberattack threats remain centered around ransomware and email phishing. That’s an important part of how we need to deal with the problem.

What is the maturity level of tools that can prevent that single employee click from bringing down the enterprise?

Unfortunately, there is no silver bullet. There are some important controls that all organizations should put in place from a baseline perspective. We hear a lot about multi-factor authentication, encryption, having good protection on endpoints, and identity access management. A number of security practices should be employed. But every organization needs to have a thorough assessment and analysis of their specific risks. 

When we talk about risks, we’re talking about vulnerabilities based on the specific information systems that they use in their organization and threats and the threat actors that could exploit those vulnerabilities. We have to assess the effectiveness of those tools and other types of controls, administrative controls, physical controls. How effective are those controls in preventing that threat from exploiting that vulnerability?

We also have to think about not only the likelihood of an event being successful, but also what the impact would be to our organization. That’s a risk discussion, because when you think about what you’re going to do in your organization to optimize security, it’s about your risk tolerance. Everybody’s risk tolerance is going to be a little bit different. There’s no way that we are ever going to eliminate risk completely, but we can make better decisions about where we’re spending our limited resources and our limited time by understanding, through a risk analysis, where those risks are and what we can do about them.

Health systems have recently reported some huge costs from ransomware attacks. How do they tailor what they can afford versus the possibility of huge losses due to downtime?

University of Vermont is a great example and Scripps Health incurred about $112 million in lost revenue and other expenses. What stood out there was that their insurance covered only covered a fraction of that. That was the same for University of Vermont, if I’m not mistaken. There was a time where we would hear, “We have insurance and we can cover that if we need to.” But it’s not just about the financial aspects — it’s about patient safety, it’s about brand and reputation, it’s about mission to provide safe and effective care. When you hear about health systems diverting ambulances to other hospitals, you’re talking about precious minutes where those patients who need emergent care aren’t getting that care as quickly as they could be.

There is a cost perspective. Those costs are getting to be more expensive. Insurance premiums are going up – we are hearing more than 50%. We are hearing from CFOs about limits on what will actually be covered in terms of their insurance policies and needing potentially to buy multiple insurance policies. Insurers are becoming more prescriptive when it comes to specific security controls that are in place, and the security questionnaires are getting to be more extensive.

Certainly we need to look at all those implications. For many healthcare organizations, there has been historically an under-investment relative to what we see in other industries. At the same time, healthcare is going through this digital transformation. We are deploying all these new technologies. We will need the appropriate amount of investment in security as well to ensure that we can keep our applications secure and keep patients and patient data safe.

What can health systems do about the risk introduced by their business associates and vendors?

Through the first half of the year, somewhere around 40-plus percent of healthcare breaches resulted from business associates, third-party vendors, or other third parties that have electronic protected health information that was entrusted to them by a covered entity, a provider or a payer. Healthcare is shifting to cloud, using third-party service providers, generating a lot more data, and sharing and accessing that data from many more endpoints. As we continue on that journey, the threat landscape and the vulnerabilities that are created through that type of model are going to increase.

Every covered entity under HIPAA needs to ensure that they have a business associate agreement with their third parties, but that’s really not enough. We are seeing healthcare providers and healthcare payers turn up the dial in terms of what they expect from third parties, from their vendors, and from anybody that wants to do business with them who is going to receive that electronic protected health information or other sensitive data. It is still the covered entity’s responsibility to ensure that data is being protected.

What role will the federal government play in health system cybersecurity?

There have been some good efforts, public and private partnerships. The Cybersecurity Act of 2015 resulted in the establishment of the 405(d), the cybersecurity working group and task force. They recently came out with a good best practices guide that has, for small, medium and large organizations, the top 10 cybersecurity practices that can be used as a baseline. That’s been a great effort that is supported by 150 or 200 members. In January of this past year, there was legislation H.R. 7898, which basically said that healthcare organizations that are implementing or have implemented best practices — which include the NIST Cybersecurity Framework or 405(d) best practices — should not necessarily have a safe harbor, but should be looked at a little bit differently from regulators when it comes to audits or potential fines and penalties after a breach.

We have had some good momentum coming into the year. We’ve seen some good activity from the Biden Administration to work with private industry and to some communication that we’ve seen suggests that there will be more support. The recent executive order that required additional security practices and controls to be in place from government contractors hopefully will also transcend to the healthcare industry. Obviously there’s a lot of technology providers out there that support the VA, for example. 

There’s some good movement there. We would like to see more. The healthcare industry just lacks resources, dollars, and people. Those are things that the government can do to support healthcare, as a critical infrastructure industry, to respond to the challenge.

What developments will see in healthcare cybersecurity over the next few years?

The challenge of cybersecurity will continue to be more complex. That’s a result of the increased adoption of new technology and the vulnerabilities that come along with that. For the future, organizations have to develop core competencies in cybersecurity and in risk management in particular as part of cybersecurity. They have to get good at identifying, prioritizing, and responding to risk, and doing that in a methodical way and a programmatic way.

We are already seeing a lot of movement at the board and leadership levels, conversations that weren’t there before, when cybersecurity was considered to be an IT problem. It’s not an IT problem, it’s a business problem, and it could potentially be one of the largest risks to the overall organization.

Morning Headlines 9/14/21

After layoffs and pivot, Austin health care startup reemerges as CareHive

App-based house call and telemedicine company Remedy pivots and rebrands as CareHive, a digital health company that offers telemedicine, digital front door services, analytics, and clinical navigation.

Babyscripts secures $12M to roll out its virtual maternity care model

Digital maternity care software vendor Babyscripts raises $12 million in a Series B funding round led by MemorialCare Innovation Fund.

Edifecs Announces Acquisition of Talix

Edifecs acquires Talix, which has developed a natural language processing-enabled risk adjustment coding, retrieval, and analytics platform.

HIStalk Interviews Coby Skonord, CEO, Ideawake

Coby Skonord is co-founder and CEO of Ideawake of Milwaukee, WI.

Tell me about yourself and the company.

Ideawake helps large healthcare systems or providers create a highly engaging experience to capture, evaluate, and implement ideas from frontline employees. The biggest customers we work with in the healthcare space are UnityPoint, Advocate Aurora, and Sanford Health.

To what degree are health systems underusing their workforce as a source of ideas for innovation and improvement?

We are seeing a large uptick in getting better utilization of frontline staff, especially once they implement our system. A lot of the time when we come in, there’s a large underutilization, because things they tried in the past, like running one-off contests, didn’t work all that well. A lot of the time, systems are built on top of SharePoint or another solution that’s already internal. Since you don’t run these often inside of the system, things will fall through the cracks and you don’t get the results that you want. There’s no action plan after the fact. 

Once we come in, we see much better utilization. It’s easy to get started, but it takes a couple of cycles of running these challenges to get a lot more adoption across the large swaths of the organization. We normally like to start pretty small.

How much does using a technology platform democratize the process to avoid having the highest-ranking person choose their favorite idea?

One hundred percent. You hit on a great point. The best ideas to improve patient experience and process come from those who are closest to the patient every day. To your point, we democratize the process of capturing ideas. We do this in a couple of ways, but it empowers anyone at the front lines of the organization, regardless of role or title, to make their voice heard based upon the quality of their idea versus their job title.

What kinds of ideas are health systems looking for?

It’s all over the board. About half of our use cases, or challenges as we call them, are around continuous improvement. General process improvement within the system ties a lot to quality improvement programs. That’s pretty much exclusively how Sanford Health, as an example, uses the system.

You can also go to the other end of the spectrum, which would be product innovation or solutioning, which is split pretty evenly. How might we better attract millennials? How could we reduce patient anxiety before, during, and after care takes place? We’ve seen challenges that focus on solutions to better enable the aging in place trend that’s happening in the market.

The challenges focus on the major categories of healthcare trends that are being talked about from a consulting perspective. What trends will affect us? Then, putting those in the  form of a question and asking frontline staff for input on them.

Is this a way for health system executives to avoid paying consultants to simply talk to their employees and then report back a summary of what they said?

I like to say that we are more fun than consultants. The system is gamified. Users earn points as they submit ideas. There’s a leaderboard and you can offer prizes. Unlike having consultants interview employees, we create a transparent experience that allows for peer-based recognition. Employees can like each other’s ideas.They can track their idea from when it’s submitted to when it’s decided upon and ultimately implemented. You complete the loop of, hey, I gave input and something came out of it.

Health system executives sometimes solicit employee input on such decisions as choosing an IT system or how to implement it, but then override the frontline employee vote. How do health systems handle cases where a popular idea isn’t considered workable?

We do our own primary research. It’s important to complete the loop and to make sure that there’s transparency around where ideas go and why. We did a survey of 700 employees throughout the continental US, who told us that the number one reason that people who had ideas stopped sharing them – 20% of respondents – was because they didn’t hear feedback on where a previous idea they shared went and why it went there.

As far as prioritization, certain ideas that flow to the top from the frontline staff might not be workable for several reasons. But we have a transparent prioritization process where leadership who reviews the top ideas can say why something will or won’t work. That is communicated back to frontline staff automatically.

How do health systems decide who they want to participate and then encourage them to do so?

Our philosophy is the more, the merrier. We believe in the wisdom of crowds and the power of large numbers when you have the ability to sift through the ideas automatically using our technology. Our rule of thumb is if you’re under 5,000 participants when you get started, you can target that entire population. If we go over 5,000 or you have a complex network with a lot of locations that span several states, we’ll normally roll it out to a specific service line across several locations, or do it in a region and then expand out from that. But overall, we believe that everybody has ideas to improve quality of care and outcomes, so we try to make sure that everybody is involved.

Would the best prospect be a health system that has a track record of innovation, or should they just have a general interest or a specific idea to try?

Most health systems have some type of quality program in place. We see the easiest way to get started is making that quality improvement process more collaborative. Many health systems, regardless of their organizational makeup or culture, have that baked into the culture. We can help significantly improve the results. 

From there, looking at the innovative side of things. Innovation is happening in healthcare all over the place. If you don’t innovate, you will be left behind. Look at Blockbuster to Netflix, taxi cabs to Uber, or Amazon Care. Where primary care is getting disrupted now is on the fringe, but events and trends will continue. Health systems will have to be innovative and center their overall care model around the patient, continuously getting that patient input and feedback. If your culture doesn’t support it yet, then the best place to start is quality. But if you hear words around patient-centric care, and investment is going on around patient-centric care, we would be a great fit.

Are for-profit companies interested in paying health systems to participate in product evaluation or development?

We haven’t seen too much of that yet. In my past life, with the inception of the company, we were doing something similar that was entrepreneur focused versus enterprise focused. What we see most commonly now is an enterprise reaching out with an open call to startups for solutions, instead of just focusing internally on employee ideas.

Do health systems invite patients to be part of the process?

We are seeing the first iteration of that right now. It has been talked about for a long time. There’s a hesitancy to go directly to the patient or to replace some of the things that are in place currently, but it is something that we are starting to see. We should have our first rollout to those in early 2022. We just need to work through some obstacles such as security and compliance and making sure there are no concerns about HIPAA. When you go internal to employees, there’s a lot less concern. Sometimes there is more of a fear about working with patients, but we have the technology to do fully anonymized feedback.

What is the future of health system innovation?

Employee engagement and employee experience were already critical, but with COVID-related attrition rates, retention strategies are becoming even more important. Our system is being leaned upon more because of the need to engage employees and empowering them with a voice. That trend will grow. Most health systems think that their culture doesn’t support innovation, but every culture inside or outside of healthcare can support it. It’s a matter of where you start it. There will always be a leader in a region who will support the initiative. The sooner that leaders realize that, and more and more are realizing it now, the easier it will be to bring innovation and patient-centered care into the mainstream.

Curbside Consult with Dr. Jayne 9/13/21

As a family physician at heart, I’m always looking for ways to help my clients meet their patients where they are, whether it’s through designing communications strategies, enabling patient-centered care platforms, or delivering more effective and culturally competent care. I was interested to see an article in the Journal of the American Medical Association that looked at whether emoji could improve communication between patients and their care teams. The initial thinking is that using emoji might help patients communicate symptoms and concerns.

On initially launching into the article, I was concerned about a potential of the approach. People don’t always have a common frame of reference for what emoji are supposed to depict. I recall one older family member who thought for quite some time that a certain brown and somewhat pointy emoji was a chocolate kiss rather than something more scatological in nature. Upon further reading, the authors suggest that various medical disciplines should have their own unique sets of icons as well as using healthcare-specific emoji. The idea is that using icons can make communication more accessible for children with developing language skills, people who speak languages other than English, and patients with communication challenges.

The authors propose using emoji as part of a method of point-and-tap communication that could be used quickly, as well as to augment hospital discharge instructions that patients and families often find confusing. They see emoji as powerful because they are standardized, universal, and familiar even though some users might have a bit of a learning curve as I noted previously. I was surprised by some of the data in the article, including an estimate that five billion emoji are used each day on Facebook and Facebook Messenger alone. Curation of emoji is managed by the nonprofit Unicode Consortium and there are over 3,500 emoji in the Unicode Standard.

The article went through a history of some of the existing emoji that could be considered useful in medicine, including the basic body parts such as ear, hand, leg, and foot. Additional “medical” emoji didn’t come into play until 2015 and those included the syringe and pill, followed a year later by male and female health workers. I used the opportunity to put my new phone through its paces and was only able to find the latter two by searching for “health” and the little stethoscopes around their necks are so microscopically tiny that I admit I had to use reading glasses to see them.

In 2017, Apple collaborated with the American Council of the Blind, the Cerebral Palsy Foundation, and the National Association of the Deaf to add various emoji, including the mechanical arm and leg (which I have on my new phone) and the hearing aid and white cane (which I do not). Several others were introduced in 2019 including the stethoscope, blood drop, bone, tooth, and microbe. The authors worked in conjunction with the United Kingdom’s National Health Service to introduce the anatomical heart and lung emoji, which I have as well.

Several other emoji are under consideration and are pictured in the article, including: intestines, leg cast, stomach, spine, liver/gallbladder, kidneys, pack of pills, bag of blood ready for transfusion, IV fluids, CT scanner, EKG tracing, crutches, a weekly pill dispenser, and one I couldn’t identify. I had overlooked the description for the graphic and it turns out that the one I couldn’t identify was supposed to be a scale, and the one I thought was a coronavirus was actually supposed to be a white blood cell. Maybe those emoji aren’t as standardized and familiar as the authors think they might be.

The authors hope to advocate for a “more comprehensive and cohesive set of emoji” but are also researching how the healthcare community could better leverage an expanded set of medical emoji. There’s certainly precedent for using icon-based systems like the Wong-Baker FACES Pain Rating Scale for helping patients quantify the intensity of pain they’re experiencing. The authors note, though, that many visual analog scales like the Wong-Baker scale are trademarked, but emoji are open source.

The last proposed benefit that the authors specifically call out is that related to advancing telemedicine. They propose that using emoji to describe symptoms via online messages can be helpful. As a practicing telemedicine physician, I’d have to say the devil would be in the details as far as how much information you could obtain via emoji and whether it would make it more challenging than eliciting the information during a focused interview. They note that there are challenges with using emoji, including patients without access to technology, those who are not facile users, and overall low health literacy that would preclude the use of anatomical emoji.

Speaking of anatomy, the article taught me something I didn’t know. Emoji skin tones are based on the Fitzpatrick pigmentary phototype skin classification system, which reflects how much melanin is present in different skin, how sensitive it is to UV light, and the relative risk of skin cancer.

The authors conclude by calling on the healthcare community to “take the lead by formalizing a unified perspective on emoji relevant to the field, including important gaps and solutions.” Given the pressures faced by healthcare providers right now, I’m not sure that evolving a representative set of emoji is at the top of anyone’s priority list, but it’s certainly something to think about in the context of overall communication with patients, caregivers, and colleagues.

We’ve come a long way as communications have evolved from voice pagers to numeric ones and then from alphanumeric pagers to emoji. I think I can safely predict that the ways in which we communicate will continue to evolve over the next several decades. As they do, I hope they become more efficient and reliable as well as having improved abilities to convey information. Maybe a few years from now, instead of lamenting the performance of our voice-to-text, we’ll be talking about using voice-to-emoji or maybe even some modalities we haven’t thought of.

What do you think about expanding the use of emoji in the delivery of healthcare? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 9/13/21

Policies to Promote Shared Responsibility for Safer Electronic Health Records

Researchers call for additional EHR safety actions beyond CMS’s recent mandate that hospitals self-assess annually using the SAFER Guides framework.

Spok Holdings Announces it is Conducting a Strategic Alternatives Review

Spok’s board is reviewing strategic alternatives for the company, including a potential sale, following unsolicited interest in acquiring some or all of its shares.

Cerner to Continue VA EHR System Deployment Under $134M Task Order

The VA awards Cerner an 18-month, $134 million task order for its EHR rollout.

Monday Morning Update 9/13/21

Top News

Researchers Dean Sittig, PhD and Hardeep Singh, MD, MPH call for additional EHR safety actions beyond CMS’s recent mandate that hospitals self-assess annually using the SAFER Guides framework. Their JAMA Network piece recommends that hospitals and EHR developers share the responsibility for EHR safety since hospitals can’t develop EHR features themselves to meet the SAFER Guides standards:

• EHR developer teams, including clinicians, should self-assess their EHRs annually and report their results as part of the federal government’s certification process. They should ensure that their product can be configured to meet SAFER recommendations and deploy it with the appropriate default settings.
• ONC should convene an expert panel each year to develop any SAFER updates that are needed. That panel would also publish a list of developer non-conformity with an analysis of appropriateness.
• EHR developers should create EHR configuration guides for their product and share them with customers and their certification body. This would ensure that customers understand how to configure the EHR to meet SAFER recommendations and emphasize the safety consequences of failing to do so.

The SAFER Guides for EHR safety were developed in early 2014 by Sittig, Singh, and Joan Ash, PhD, MLS, MS, MBA. CMS requires hospitals to self-assess their compliance with the guides annually, starting with the EHR reporting period in CY 2022.

CMS is planning to require that Eligible Professionals annually attest that they have reviewed the “High Priority Practices” elements of the SAFER Guides, although their involvement would likely be limited to pressing their EHR vendors to comply.

ONC submitted much-publicized plans for an EHR safety center in its 2015 budget request, but funding was not provided.

HIStalk Announcements and Requests

Many poll respondents have been laid off in their career and quite a few were forced into a job they didn’t want or were fired, but demotions and forced relocation were uncommon.

New poll to your right or here: Which annual conference would you attend if limited to one?

Webinars

September 16 (Thursday) 1 ET. “Patient Acquisition and Retention: The Future of Omnichannel Virtual Assistants.” Sponsor: Orbita. Presenters: Harris Hunt, SVP growth product, Cancer Treatment Centers of America; Patty Riskind, MBA, CEO, Orbita; Nathan Treloar, MSc, co-founder and COO, Orbita. Consumers want the same digital healthcare experience from healthcare that they get in online shopping, banking, and booking reservations, and the pandemic has ramped up the patient and provider need for frictionless access to healthcare resources and services. Health systems can improve patient acquisition and retention with the help of omnichannel virtual assistants that engage and delight. Discover how to open and enhance healthcare’s digital front door to offer care that goes beyond expectations.

September 16 (Thursday) 1 ET. “ICD-10-CM 2022 Updates and Regulatory Readiness.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, VP global clinical services, IMO; Theresa Rihanek, MHA, RHIA, mapping manager, IMO; Julie Glasgow, MD, clinical terminologist, IMO. IMO’s top coding professionals and thought leaders will discuss the coding changes in the yearly update to allow your organization to prepare for a smooth transition and avoid negative impacts to the bottom line. The presenters will review new, revised, and deleted codes; highlight revisions to ICD-10-CM index and tabular; discuss changes within Official Coding Guidelines, and review modifier changes.

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

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

Acquisitions, Funding, Business, and Stock

Spok’s board is reviewing strategic alternatives for the company, including a potential sale, following unsolicited interest in acquiring some or all of its shares.  The company notes that more than 5% of its shares have been recently acquired by Acacia Research, which licenses company patents to pursue litigation, and its partner, activist hedge fund Starboard Value. Cerner gave in to pressure from Starboard in early 2019, adding four board seats with two of those new members being nominated by Starboard. Starboard sold Cerner shares quickly afterward as it usually does with its corporate targets, taking advantage of the short-term price jump to reduce its 1.2% position in Cerner. CERN shares have since risen 19% versus the Nasdaq’s 91% gain. Spok Holdings share price has been flat in the past year, valuing the company at less than $200 million.

Sales

• The VA awards Cerner an 18-month, $134 million task order for its EHR rollout.

People

Medecision promotes Terri Steinberg, MD, MBA to EVP / chief portfolio officer.

Announcements and Implementations

Upfront Healthcare creates the Bartosch Institute for Patient Activation Research.

Health Catalyst launches a research network to allow health systems to establish relationships with drug companies and pharma-related research organizations.

The VA has migrated to Nuance Dragon Medical One.

A new KLAS report on EHRs in the Middle East and Africa finds that Cerner leads in performance and has improved relationships and services quality, Health Insights has improved satisfaction by migrating all customers to its web-based platform but hasn’t made a sale since 2019, and the sales success of InterSystems has caused some growing pains as customers report challenges in reaching its experts.

COVID-19

A CDC review of COVID-19 cases, hospitalizations and deaths in 13 US jurisdictions from April through July 2021 finds that while the vaccine’s effectiveness at preventing infection has dropped with the delta variant, its protection against hospitalization and death has not changed. However, the underlying numbers suggested that hospital and death percentages aren’t drastically different among infected people regardless of vaccination status.

A Minnesota family physician who is running as a Republican candidate for governor calls for creating a “health freedom sanctuary state” where state residents would be free to ignore federal masking and vaccination requirements. The campaign of Scott Jensen, MD, who says he has not been vaccinated and doesn’t plan to be, has been banned from advertising on Facebook for posting COVID-19 misinformation. Another state Republican candidate and physician, dermatologist Neil Shah, MD, is campaigning against federally mandated vaccination, saying that asymptomatic spread is rare and that the government is working with the medical industry to “destroy science.” 

California releases its digital vaccine record system source code into the public domain. It uses the SMART Health Card framework, which can connect to a state immunization registry, CVS, Walmart, Sam’s Club, and hospitals that use Epic or Cerner.

Eric Topol, MD summarizes the White House’s new vaccine-centric COVID-19 plan versus a more comprehensive one. He has tweeted most frequently about the need for better CDC data and analysis, the need for a Green Pass system for air and train travel, and making at-home rapid tests free to help keep schools open.

Other

Executives and employees of DeepMind, the AI company that Google acquired in 2014, worked on secret plans to break away from Google over several years because they don’t trust the search engine giant. Insiders say they were worried about placing their work within the Google bureaucracy and started hiding their research for fear that Google’s internal AI group was using it without giving credit.

Sponsor Updates

• OptimizeRx welcomes Andrew D’Silva as SVP of corporate finance.
• The Edinburg Center expands its use of NetSmart’s CareFabric platform with additional features that include new financial functionalities, integrated reporting tools, and navigation features.
• Olive appoints Eileen Naughton (Google) to its Board of Directors.
• Jvion drives adoption of prescriptive intelligence and clinical AI with new peer-reviewed results, platform integrations, and SDOH solutions.
• Premier and 11 leading health systems have acquired a minority stake in Exela Pharma Sciences to secure supply of pharmaceutical products and support domestic production.
• Pure Storage offers a case study, “Hong Kong Cancer Fund Expands Services and Enhances the Digital Experience for Patients.”
• Talkdesk has earned the number-one spot in 11 G2 Fall Reports for 2021, and has earned G2 accolades in categories related to telecom services for call centers, contact center workforce, auto dialer, speech analytics, and contact center quality assurance.
• Upfront Healthcare, Relatient, and Well Health join Panda Health’s digital health marketplace in the new category of Unified Patient Messaging.
• Vocera releases a new Caring Greatly Podcast, “Streamlining EHR Work to Improve Clinician Well-Being – Annie Ideker, MD.”
• West Monroe Senior Managers Kirsten Lentz and Ken Goebel win M&A Advisor’s Emerging Leaders Award.
• VitalTech EVP of Sales & Marketing Ernie Iance will present at the Virtual Ziegler Link Age Fund Symposium September 9 in Chicago.

Blog Posts

• Length of stay declines persist following the initial COVID surge (Olive)
• PatientBond Insights Accelerator Driving Healthcare Revenue & Market Share (PatientBond)
• Better Learning and Development Habits Build Better Healthcare Teams (Symplr)
• How Can Natural Language Processing Improve Healthcare? (PMD)
• Gear Up for the Mandatory Radiation Oncology Model with Three Key Activities (Premier)
• The Challenge of Ensuring Compliance at Scale as Resources Shrink, Violations Rise (Protenus)
• Let’s Get Personal – How Healthcare Organizations Can Build Personalized and Innovative Solutions at Scale (Quil)
• Overcoming Common HCC Coding Challenges Part 2: Understanding Payer Feedback and Turning it Into Action (RCxRules)
• Texting in Healthcare: The Benefits, Best Practices & HIPAA Rules (Relatient)
• Bringing Better Data to the Room Where It Happens (RxRevu)
• Who is responsible for data security management and compliance? (Spirion)
• Contact Centers are Growth Centers (Talkdesk)
• How Remote Patient Monitoring Can Reduce Healthcare Inequities (Twistle)
• Tools of the Trade: Decoding Common Front Office Puzzles Through Tech (WebPT)
• Frequently Asked Questions About Healthcare Integration Platforms, Interfaces, & Zen (Zen Healthcare IT)

Contacts

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

Weekender 9/10/21

Weekly News Recap

• Intelerad acquires Insignia.
• Sanford Health (SD) will use a $350 million donation to develop a virtual care center.
• Period and ovulation tracking app vendor Flo raises $50 million, valuing the company at $800 million.
• TransUnion is reportedly seeking a buyer for its TransUnion Healthcare business for up to $2 billion.
• Invitae announces that it will acquire Ciitizen for $325 million.
• A review finds that 34 of 36 systems that use AI for breast cancer screening are less accurate than a single radiologist.
• The VA renews its CliniComp contract for another five years.
• Four of six traveling nurses at a California hospital quit on their first day when faced with using Meditech, which the hospital is replacing with Epic.
• Baxter announces that it will acquire Hillrom for $12.4 billion.
• Accenture acquires Gevity.
• Healthcare Triangle announces plans for an IPO that will raise up to $50 million.

Best Reader Comments

I would assume someone from Amazon would have some story about how they significantly made Providence cheaper and faster, but maybe hiring people from out of industry to shake things up is just as ineffective as outside companies shaking up healthcare. (Cynical Consumer)

Although I haven’t worked for public, for-profit companies, I’ve also had that universal experience where you start the first day, don’t know the organization, barely know a soul, and where a good argument can be made for several months that you don’t deserve to be there. That made for some really ugly first years. The executive class likes to have us convinced that they are smarter and more deserving than the rest of us. Many of them are fairly intelligent. I simply reject that someone coming from outside can just drop in and be more effective than someone who knows the company, how it operates, and what might really be going well or poorly. (CEO Supply Chain Issues)

Watercooler Talk Tidbits

I missed this from a few weeks back. Miami-based MSP Recovery, which recovers inappropriate Medicare payments for which Medicare does not have primary payment responsibility, will go public via a SPAC that will value the company at a mind-boggling $33 billion. Founder and CEO John Ruiz stands to make $23 billion in the deal, which will be the second-largest in SPAC history. MSP uses analytics to buy portfolios of claims (click the image above to enlarge), and if it succeeds in collecting a payment, the insurer that overpaid gets half, lawyers get 40%, and MSP keeps the rest. Ruiz’s own law firm represents MSP, so it takes half of the 40% legal cut as well. MSP’s pitch deck shows a $37 million loss this year that it says will balloon to more than $5 billion in profit by 2026.

VA OIG finds that a Massachusetts VA hospital’s failure to follow proper procedures allowed a veteran to lie dead in a stairwell 20 yards from his room for a month before being found. The stairwell wasn’t searched because even though it is on VA grounds, it is operated and maintained by a homeless services group. OIG also notes that the veteran was a resident rather than a patient, so “missing patient” rules weren’t followed.

Jackson Health System (FL) places a NICU nurse on leave after she posts photos and seemingly derogatory comments of a baby whose birth defect exposed its intestines.

In Spain, a chance DNA test reveals that hospital employees accidentally switched two newborns after their birth 19 years ago. A 19-year-old is suing the regional health department after a child support complaint resulted in DNA tests that indicated she had been raised by the other girl’s parents.

A North Carolina doctor fresh off a seven-day ICU shift caring for COVID-19 patients stands by his Facebook bluntness toward unvaccinated people, saying, “There are some complete idiots who when shown death in the face will just cling to their crazy belief that it’s a conspiracy or they’re trying to use the vaccine to do mind control or whatever, or just some jackass theories … even some of the ones who are dying, are like, I still don’t believe this is a thing. How can you not believe this is a thing when you’re dying?”

New Zealand Prime Minister Jacinda Ardern, when asked by a reporter about a COVID-19 inpatient who was caught having sex in the hospital, gamely responds, “I would say generally, regardless of the COVID status, that kind of thing shouldn’t generally be part of visiting hours.”

In Case You Missed It

• News 9/10/21
• EPtalk by Dr. Jayne 9/9/21
• Readers Write: What’s Fueling Interest in Healthcare ERP?
• Readers Write: Embracing a Smarter Future in Healthcare
• Readers Write: How Payers Can Leverage Data Pipelines for 5-Star Results
• HIStalk Interviews Jay Colfer, CEO, Fivos Health
• News 9/8/21
• HIStalk Interviews Stephen Hau, CEO, Newfire Global Partners
• HIStalk Polls 2007-2012
• Monday Morning Update 9/6/21

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 9/10/21

Leading UK Enterprise Imaging Provider, Insignia Medical Systems, Secures Investment from Intelerad

Canada-based Intelerad acquires enterprise imaging provider Insignia Medical Systems.

New gift to Sanford Health will fund virtual care center

Sanford Health (SD) will develop a virtual care center using a $350 million gift from donor Denny Sanford.

Flo Announces $50 Million Series B Funding Round; Bringing Company to $800M Valuation

Period- and ovulation-tracking app developer Flo raises $50 million in a Series B funding round.

News 9/10/21

Top News

Canada-based Intelerad acquires enterprise imaging provider Insignia Medical Systems.

Insignia, whose offices are in the UK, has 250 UK customer sites.

Reader Comments

From Beeswax: “Re: interviews. It is amazing how many companies are acquired shortly after you interview their CEO. Too bad you aren’t getting a finder’s fee from the buyers!” The #1 reason I lose sponsors is that they get acquired. However, I assume that (a) the acquirer wasn’t just watching my interviews to decide who to buy instead of doing their own market research; and (b) companies may seek exposure to signal their acquisition interest in a robust investment market. Still, it’s like being a HIMSS conference exhibitor who knows that three positive outcomes can result — sales, creating partnerships, and making connections that can result in acquiring or being acquired.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Bluestream Health. The New York City-based company offers a simple yet powerful virtual-first care platform that works the way you work. Through a best-in-market connectivity, integrated interpreting, and a full range of clinical workflows, the platform delivers expert patient care through the virtual care experience. With Bluestream Health, customers get 10 times the visits at one-third the cost. That’s no exaggeration. It is helping major healthcare customers like NY H+H and Medstar boost visits and improve the bottom line. What sets Bluestream Health apart is how easy is to tailor the solution to how your organization works. APIs make it easy to configure to your clinical workflows and integrate with your systems. Add live interpretation services to address the needs of non-native speakers An intuitive user interface and no downloads mean that it’s incredibly easy to use for patients and physicians alike. Download the company’s white paper to learn how upgrading from telehealth to a virtual care solution can simplify the tech stack and increase profits. Thanks to Bluestream Health for supporting HIStalk.

Reader Bill send me a generous donation to support Donors Choose, to which I applied various matching funds, including those of my Anonymous Vendor Executive, to fully fund these classroom projects:

• Hands-on math lessons for Ms. B’s middle school class in Center, TX.
• A financial literacy kit for Ms. S’s middle school class in Baltimore, MD.
• A financial literacy kit for Ms. R’s pre-school special needs class in Indianapolis, IN.
• STEM kits for Ms. A’s elementary school STEM classes in Lithonia, GA.
• An Apple TV to support virtual and in-person instruction for Ms. D’s elementary school class in Pharr, TX.

I’m no longer shocked that many Facebook users aren’t technically bright enough (or ambitious enough) to use Google. Postings in Facebook groups are always full of shameless demands that someone else do their web work for them, such as (a) business postings that elicit indignant “Where is this place?” comments that one click would have resolved, (b) “anybody know” type group posts where someone can’t figure out how to Google to find a lunch restaurant or check a store’s business hours, and (c) users who complain about how Facebook works when it’s obviously a user issue (i.e., you can’t share a “lost dog” post from a private group). It’s a testament to the appeal of Facebook that it attracts loyal users / customers / addicts who can’t or won’t navigate the web or can’t use a keyboard to correct obvious speech recognition errors.

Wondering: have Patrick Dempsey or A-Rod inspired anyone to improve healthcare quality or cost since HIMSS21?

Webinars

September 16 (Thursday) 1 ET. “Patient Acquisition and Retention: The Future of Omnichannel Virtual Assistants.” Sponsor: Orbita. Presenters: Harris Hunt, SVP growth product, Cancer Treatment Centers of America; Patty Riskind, MBA, CEO, Orbita; Nathan Treloar, MSc, co-founder and COO, Orbita. Consumers want the same digital healthcare experience from healthcare that they get in online shopping, banking, and booking reservations, and the pandemic has ramped up the patient and provider need for frictionless access to healthcare resources and services. Health systems can improve patient acquisition and retention with the help of omnichannel virtual assistants that engage and delight. Discover how to open and enhance healthcare’s digital front door to offer care that goes beyond expectations.

September 16 (Thursday) 1 ET. “ICD-10-CM 2022 Updates and Regulatory Readiness.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, VP global clinical services, IMO; Theresa Rihanek, MHA, RHIA, mapping manager, IMO; Julie Glasgow, MD, clinical terminologist, IMO. IMO’s top coding professionals and thought leaders will discuss the coding changes in the yearly update to allow your organization to prepare for a smooth transition and avoid negative impacts to the bottom line. The presenters will review new, revised, and deleted codes; highlight revisions to ICD-10-CM index and tabular; discuss changes within Official Coding Guidelines, and review modifier changes.

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

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

Acquisitions, Funding, Business, and Stock

Health information exchange platform vendor Vyne acquires Ahana Health, which offers a connected care solution that allows providers to collaborate with each other and their patients. Vyne will incorporate the solution into its cloud-based Refyne product, which streamlines the exchange of medical documentation between providers and CMS.

Credit reporting agency TransUnion is reportedly seeking a buyer for its TransUnion Healthcare business for up to $2 billion.

Teladoc will integrate Proximie’s surgical and diagnostic procedure recording technology into its Solo hospital platform to support virtual surgical mentoring, proctoring, and support.

Dermatology diagnosis app vendor LuminDx changes its name to Piction Health.

Denmark-based Corti.ai, which offers AI analysis of patient encounters for guidance, documentation and quality improvement, raises $27 million in a Series A funding round.

Provider collaboration platform vendor CareMesh announces Transitions for EHR-integrated referral management.

Sales

• The Verland Foundation chooses the SmartCare EHR of Streamline Health Solutions.
• Temple Health chooses Gozio Health’s mobile platform for patients.

People

WellSky hires Andy Eilert, MBA (Evernorth) as president of emerging markets.

Clinical communications platform vendor Diagnotes promotes Sherry Henricks, MBA to CEO. She replaces founder Dave Wortman, who will remain on the board.

Remote patient monitoring system vendor Optimize Health hires Todd Haedrick (Covetrus) as CEO. He replaces Jeff LeBrun, who will move to chief strategy officer and retain his board chair position.

Altruista Health hires Dan Vnuk, MS (Cotiviti) as CTO.

Woebot Health names Sheetal Shah (SymphonyRM) as SVP of commercial.

Long-time Meditech executive Roberta Grigg, who retired in 2001, died last month at 79.

Announcements and Implementations

MarinHealth goes live on PatientKeeper’s physician charge capture.

Sanford Health (SD) will develop a virtual care center using a $350 million gift from donor Denny Sanford.

In Canada, Bayshore HealthCare launches an after-hours symptoms management app that allows cancer and palliative care patients to connect with a nurse instead of visiting the ED. The CareChart app offers online and telephone triage, self-assessment ahead of virtual visits, and real-time information submission to the patient’s care team.

UK-based real-world data analytics platform vendor Sensyne Health launches Sensight, which provides AI research capability using de-identified data from hospitals in the US and UK for $35,000 per user per year.

Government and Politics

The fraud trial of Theranos founder Elizabeth Holmes began Wednesday. A traffic ticket issued that same day to her husband – who is a 27-year-old heir to a hotel chain fortune — revealed that she is commuting to court from an estate that is listed for sale at $135 million.

COVID-19

The US COVID-19 death count has reached 650,000, about the same number of American deaths as in the Civil War or in the 1918 influenza epidemic. The US fully vaccinated rate is #52 among the world’s countries at just over 52%.

More than 50 Georgia hospitals, including Grady Memorial, are postponing elective surgeries and turning away ambulances because of COVID-19 patient loads. Governor Brian Kemp rejected calls to halt elective surgeries in all state hospitals and to extend licensure waivers, adding that he will issue no new mandates and instead asks the federal government to limit the hourly rates of staffing companies as “states are forced to outbid one another using federal coronavirus relief dollars in order to obtain adequate hospital staffing.”

Idaho’s state government activates “crisis standards of care” that allow hospitals to ration their services. Patients whose likelihood of survival is lower will be denied ICU beds and hospitals can admit patients to classrooms and conference rooms. Less than 40% of the state’s residents are fully vaccinated, trailing only Alabama, Mississippi, and Wyoming.

FDA notes that it has authorized more than 400 COVID-19 tests, including 13 rapid at-home ones. It would be helpful to see FDA issue plain-language advice on those 13 – cost, where to get them, advantages and disadvantages, etc. I got a text message while writing this that my latest four-pack of $10 BinaxNow tests was dropped off at my door from Walmart.com, but they are sold out of them again. I’m all for the free market, but I would rather see a single manufacturer’s test sold for $1 and available everywhere rather than making it confusing and expensive to the point that nobody bothers. Other countries are doing this far better.

A randomized controlled trial of hospitalized COVID-19 patients finds that using convalescent plasma did not improve outcomes and may have worsened them. FDA issued its Emergency Use Authorization in the pandemic’s early days, with HHS Secretary Alex Azar touting it as a “very historic breakthrough” as evidenced by a single retrospective study that was published as a pre-print.

Microsoft indefinitely postpones a return to in-person work in the US, providing no date to replace its original October 4 target. Amazon, Facebook, and Google had already delayed in-person work until 2022, meaning that many of their employees will not have worked in company offices for two years.

Texas, Missouri, Louisiana, West Virginia, and Wyoming are submitting detailed COVID-19 health equity data for less than one-tenth of their total cases, with erratic reporting causing data to be missing for 20% of US cases. Two-thirds of the submitted information is also unusable because of fields left blank or filled in as “unknown.” CDC collects where patients live, whether they were hospitalized or died, and demographic information. The most commonly missing information includes race / ethnicity and symptoms experienced.

Other

Pune, India’s efforts to connect hospitals for real-time COVID-19 data sharing via HL7 hits a bump when the the pilot project hospitals decide not to share their information.

Illinois-based Edward-Elmhurst Health and NorthShore University HealthSystem announce plans to merge.

Providence Chief Digital Officer Aaron Martin, MBA – who worked 10 years ago for Amazon’s on-demand publishing group – says Amazon and other tech companies aren’t exiting healthcare for good, but instead are changing their approach. He makes these points:

• Amazon’s failures often turn into successful pivots, such as an auction platform that turned into its third-party sales platform and the Fire phone that died quickly but created Alexa.
• Healthcare is decades behind other industries as it continues to use technologies that create data silos.
• Amazon will probably succeed in mail-order pharmacy and eventually pharmacy benefits management, although Amazon Care is a less-sure undertaking because of the complexity involved.
• Walmart may use its large pharmacy footprint to expand into care delivery.
• Microsoft is sticking to its technology offerings in selling cloud services, competing with Google and Amazon.
• Google still has fitness trackers and other projects, but de-centralizing its healthcare efforts into individual operating units may de-emphasize its focus.
• Apple has the Watch that could be used for remote patient monitoring, although it is IOS-only and expensive.
• The big change could occur with acquisitions like Microsoft buying Nuance.
• Health systems should not assume that disruption is no longer needed now that the big tech threat has diminished. They will always come back and they are learning from their failures.

Sponsor Updates

• LexisNexis Risk Solutions will sponsor the Whole Person Care Virtual Summit September 21-22.
• The Bulls ‘n Bears Podcast features Mach7 Technologies CEO Mike Lampron.
• Meditech shares preparatory guidance for COVID-19 vaccine booster shots.

Blog Posts

• The Most Essential HIT Partnership in a Health System Portfolio (Halo Health)
• Get a Better Night’s Sleep: What Healthcare Leaders Should Know About Blockchain (Healthcare Triangle)
• COVID Boosters & Beyond – Automated Patient Engagement (Intrado)
• What’s in a variant? Part II – Making sense of data through harmonization (Intelligent Medical Objects)
• New Study Shows How Clinical AI Can Improve End-of-Life Care for Cancer Patients (Jvion)
• Best Practices for Managing Seconds-to-Minutes Emergencies (Medhost)
• Must EHRs become platforms? (Nordic)
• 5 ways Expanse addresses the next big challenges in healthcare (Meditech)
• Mentorship 101: How Newfire’s Culture of Support Leads to Career Growth & Success (Newfire Global Partners)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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EPtalk by Dr. Jayne 9/9/21

Lots of chatter in the healthcare community about the percentage of workers having “breakthrough” infections despite being fully vaccinated. Various investigations are looking at causes, including waning immunity, the increased transmissibility of the delta variant, and more.

It still boggles the mind that a year and a half in, we have not come to consensus on the fact that all healthcare workers need to be wearing high-level personal protective equipment. None of the hospitals in my area are providing adequate N95 respirators for their healthcare workers, the vast majority of whom are expected to see all patients wearing a surgical mask. The reality in our community is that a good number of people walking into healthcare facilities are indeed COVID-19 positive, so those on the front lines really need better protection. I was in an outpatient office today and staffers were wearing cloth masks and not even surgical masks – it is hard to believe that anyone thinks that’s appropriate in a healthcare setting. At times, it seems like embracing the new normal is instead a race to the bottom.

I booked my HIMSS22 hotel reservations today, despite the HIMSS website being completely confused as to what year we’re talking about. The HIMSS rate for my hotel of choice was $60 per night less than the rate on the hotel’s website, and with the post-COVID-19, less-draconian HIMSS cancellation policy, booking it through OnPeak was a no-brainer. The only reason I thought about booking my hotel was the fact that I received an email asking for HIMSS22 proposals. 

I’m glad I got in at a reasonable room rate, although I wish there were more hotels closer to the convention center. I don’t mind getting my cardio in on the way to the conference, but my feet are definitely tired at the end of the day. Back to the call for proposals – they are due by September 20 and can be submitted for general education Sessions, preconference symposia, and preconference forums. Interested applicants can visit the HIMSS website, but don’t be thrown off by the ongoing presence of the HIMSS21 logo.

For those of you responsible for maintenance of the back end of EHR, practice management, and revenue cycle systems, the American Medical Association this week released its Current Procedural Terminology code updates for 2022. There are over 405 changes this time, around including nearly 250 new codes, 60 deletions, and nearly 100 revised codes. There are updates to vaccine codes and additions for remote patient monitoring and care management for patients with chronic conditions. Organizations need to look at the list of changes and determine how it impacts their physicians, coders, and other personnel. It’s not as simple as updating the codes in the tables of the IT systems – often changes are needed to workflows and education for end users is definitely a good idea. The changes take effect January 1, 2022.

Teladoc health announces open nominations for the She Powers Health awards, which are designed to “shine a light on diversity and inclusion initiatives across the healthcare industry that address the disparity of women in executive and board positions.” The third annual awards reception will occur at the HLTH 2021 conference. There are two awards, with the first being the Individual Award, which recognizes someone “who has not only made a significant impact on peoples’ health, but who also has recognized, empowered, and championed women and the important role they plan in enhancing care and transforming the healthcare industry.” The second award is the Rising Star Award, targeted at a member of the under-30 crowd “who has made an impact on peoples’ health, empowers women in the workplace, and is a champion for diversity and change, while still early in their career.” Nominations close September 17, 2021.

Jenn tipped me off on a recent job posting. The Centers for Medicare & Medicaid Services has posted for a chief experience officer. The chief experience officer is expected to work with CMS stakeholders to improve customer experience delivery and to develop and implement strategies for CMS to use as part of its routine development process. Additional responsibilities include promoting continuous change and developing a voice of the employee program to promote retention, recruitment, engagement, and productivity. The salary range is commensurate with government employment, so I suspect the position will attract those who are truly motivated to serve as opposed to those who seek C-level titles for other reasons. If you are interested, apply quickly, as Friday is the closing date for applicants to submit their materials.

Speaking of job postings, I’m working with a client right now who picked the wrong team for a project and now is trying to clean up the mess. It’s a case study in the need to really understand the skill sets you need for your team to be successful and to make sure that everyone has the minimum skills needed to move the project forward. Just because a physician is “interested in technology” doesn’t necessarily mean they’re suited for a role on a technical team. You can be the most brilliant clinician in the world, but if you can’t figure out how to work with Confluence and Jira, it’s going to be difficult to keep up on an agile team.

Despite training, they are struggling, and I’m almost to the point of recommending that we hire the equivalent of a scribe to assist them with their daily tasks. Paying for an intern or assistant would be cheaper than burning hours at a physician rate, for sure. On the other hand, they mastered biochemistry and passed their board exams, so I’m cautiously optimistic.

One of my other projects this week has been shopping for a new phone. My trusty Motorola is being rendered obsolete by upgrades to my carrier’s network, so despite the fact that it meets all my needs and doesn’t give me any trouble, I have to retire it. Several of my friends are trying to get me to cross over to the land of the iPhone, but I’ve been happy with Android ever since giving up my beloved Blackberry, so I think I’ll stay put on platform. I’ve heard the changeover to the phone I selected is easy and straightforward, so wish me luck as I’ll be working through it this weekend.

What’s the best or worst thing about upgrading your phone? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 9/9/21

Azalea Health Acquires Data Analytics Vendor dashboardMD to Deliver EHR-Based Business Intelligence

EHR and practice management vendor Azalea Health acquires DashboardMD, a healthcare analytics company based in Miami Lakes, FL

Vyne Medical Acquires Ahana Health and its Connected Care Solution to Support Collaboration in Patient Care Planning and Delivery

Health data exchange and communication management company Vyne Medical acquires Ahana Health and its connected care technology.

TransUnion seeks buyer for healthcare business

Credit reporting company TransUnion has reportedly begun fielding offers for its healthcare RCM business, with several bids coming in as high as $1.6 billion.

Readers Write: What’s Fueling Interest in Healthcare ERP?

What’s Fueling Interest in Healthcare ERP?
By Clifton Jay

Clifton Jay, MS is president of HealthNET Consulting of Burlington, MA.

I had to laugh when I Googled “ERP in healthcare” and got “Exposure and Response Prevention (ERP) is a form of psychotherapy!”

ERP stands for enterprise resource planning, which has manufacturing roots, yet is not a common term in healthcare. It covers what we might call general financials, including materials management (aka supply chain since the pandemic), finance (accounts payable, general ledger, etc.), and human resources / payroll. Then there are ERP’s extended functions of customer relationship management (CRM), contracts management, and decision support / analytics.

People have asked me, why would my hospital need customer relationship management? The easiest example would be that a CRM could be used for patient engagement. Now this also starts to create a mixture of what’s considered part of the EHR versus the ERP, which might affect integration or single platform thinking.

But back to my main point — what’s fueling the interest in healthcare ERP today? By my observation, there are three main drivers – age, evolution, and M&A. As you consider what to do regarding ERP, I pose some food for thought.

• Age. Many hospitals and healthcare organizations are still using the general financial systems that they installed 20 years ago, and many of these systems are showing their age, such as old-style report writers, interfaces, and setting up on the chart of accounts that we all started with in 1974 (I still have a copy of the AHA guidebook.) This raises questions, such as, is it time to replace the ERP software? If so some or all? Or, keep doing bolt-on new applications such as business intelligence visualization / dashboard tools and contract management systems?
• Evolution. New generation ERPs (most of the traditional vendors have come out with highly rebuilt systems and there are also new players) tend to be built upon single platforms that eliminate interfaces and redundant master files, making it easier to perform analytics across data silos which resonates like the “one patient – one record” mantra of EHRs. It is a large undertaking to revamp the ERP because it involves everything and everybody, from the EHR (remember that the orders / charge masters drive revenue), IT, and finance / operations. The question is, what’s the value of a single source of truth, access to information, and streamlined operations? I have not seen a tangible ROI. The “value analyses” that the vendors use seem to be too conceptual and vague to me. If someone has some tangible ROI, e.g. time saved in report writing, accounting time, supply chain costs or standardized payrolls, I would love to see it.
• M&A. Mergers and acquisitions and multi-entity organizations create a need for enterprise-wide accounting, contracts for goods, supplies, and services, and standardized pay practices. Again, I had to laugh but was truly impressed when I reviewed a mapping table for multiple GLs with seriously different COAs. I’m not an accountant, but it looked like a cost accountant’s nightmare to me. Additionally, centralizing functions would also lead to having these departments use single software systems. It raises a question of how much are we torturing our users in having to use cobbled-together systems?

I hope these comments might add some perspective as you plan and strategize on systems that support your users, your enterprise, and ultimately your patients.

Readers Write: Embracing a Smarter Future in Healthcare

Embracing a Smarter Future in Healthcare
By Brian Patty, MD

Brian Patty, MD is senior clinical advisor of HC1 of Indianapolis, IN.

A principal issue stalls the mainstream use of precision health in the US. Despite substantial national investment in strategies aimed at advancing high-value care, the industry struggles to establish a standardized and effective manner of bringing data together and sharing it.

Consequently, the healthcare industry continues to suffer from the lack of interoperability of data systems that should be achieving significant ROI through personalized care delivery. Instead, low-value care continues to rack up substantial waste associated with unnecessary services, low-value, high-cost drugs, and missed prevention and therapy opportunities.

Precision health provides immediate relief to this unsustainable course. Yet with the exception of certain specialties, these effective and efficient models of care have remained elusive for the vast majority of providers due to lack of timely data within the provider workflow. There is good news emerging on this front, though, amid rapid technological breakthroughs that enhance access to the unique genetic makeup of individual patients.

Precision Health Insight Networks (PHINs) are advancing personalized medicine by drawing on the latest technological advancements to transform previously disconnected health data into actionable information that drives specific optimal care decisions targeted to each individual patient. This type of infrastructure demonstrated its promise on a focused national scale during the pandemic, when COVID-19 data was leveraged to organize and normalize hundreds of millions of lab test results—including demographic data—from more than 20,000 order locations.

Enabling massive volumes of critical data to flow into a single dashboard, PHINs equipped public health agencies and healthcare organizations with detailed hyper-local lab testing insights that were simply unavailable or excessively delayed through government reporting. Healthcare authorities accessing this dashboard were able to drill down to real-time state, county, and sub-county views of COVID-19 testing rates, de-identified test results, key demographics, a side-by-side view of viral and antibody testing, as well as local-risk and age-group trending.

Similar to the concept of personalized medicine, PHINs enabled optimal decision making and promoted proactive, effective response on the local level by equipping public health officials with granular information such as where local hospital and ER resources would likely be overwhelmed in the coming three to six-week period. Precision Healthcare is now positioned to launch off this initial success by using PHINs to unearth the insights from siloed data (including individual gene mapping) that already exist across multiple EHR, laboratory, and pharmacy systems.

Consider the potential impact of precision prescribing alone:

• Trial-and-error and one-size-fits all prescribing results in more than 2 million adverse drug reactions (ADRs) a year.
• 15.4% of hospital admissions are attributed to drug-related adverse reactions
• 26% of readmissions are drug related (and preventable) 

Plavix perfectly illustrates how precision prescribing can improve patient outcomes and contribute to highly effective, high-value care. The antiplatelet medication is a frequently prescribed post coronary intervention for its ability to reduce clotting, strokes, and recurrent cardiovascular events. However, up to one-third of the population has a genetic makeup that changes how it is absorbed or metabolized, so there is wide variation in its efficacy. Depending on someone’s genetics, dosing may need to be doubled or even tripled the normal dose, or Plavix may not work at all. In others, lower doses are required to prevent life-threatening bleeding, which may occur as a side effect specific to an individual’s genome and the subsequent cellular production of enzymes that metabolize the drug.

PHINs bring together data and deliver patient specific insights to frontline physicians at the point of prescribing. These providers simply don’t have the time to research or access the massive volumes of new data that is continually emerging. Providers also may not know that genomic testing has been done on their patient by another provider, or that those results impact the drug(s) they are planning to prescribe.

When knowledge is infused into the patient care process at the right time to inform physicians, medical outcomes are improved and patient satisfaction increases. Clinicians are likewise relieved of the impossible task of individually staying on top of the latest pharmacogenetic or testing protocols. The data organized by PHINs deliver the right care insights at the right time for the right patient.

Of all the lessons learned from the COVID-19 pandemic, one rises to the top: keeping critical patient and public health data locked away in disconnected databases and data siloes is not only ineffective and inefficient, but potentially deadly. Present-day care models are no different. The good news is that US healthcare can change its unstable trajectory by embracing the power of PHINs and mainstreaming precision health practices.