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Morning Headlines 2/16/24

February 15, 2024 Headlines 10 Comments

250,000 VA Patients Are at Risk of Receiving Wrong Medication Due to Electronic Health Records Issue

The VA Office of the Inspector General reveals that patient medication histories are not transferring between the Oracle Health EHR used at five VA hospitals and the VistA system used at the VA’s other facilities, putting 250,000 veterans at risk of potential medication errors.

Revolutionizing the Emergency Department: MUSC Health’s new frontier in patient care

MUSC Health (SC) pilots a telehealth triage service at two of its emergency rooms in an effort to help patients get care more quickly, resulting in the rate of patients who leave without being seen dropping to almost zero.

Using AI to automate healthcare claims, RapidClaims launches with $3.1M

Automated medical coding and documentation software startup RapidClaims raises $3.1 million.

News 2/16/24

February 15, 2024 News 2 Comments

Top News

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Investment firm KKR acquires a co-ownership stake in healthcare payments and analytics vendor Cotiviti from Veritas Capital for $10.5 billion. Buzz about the deal with KKR began circulating several months ago.


Reader Comments

From Beltone: “Being a well-funded, SF-based start-up doesn’t guarantee success in healthcare. Former high flyer Medallion – SaaS provider credentialing – is facing financial challenges. Laid off their US-based provider enrollment team to outsource to India, creating HIPAA and security challenges. And didn’t tell their customers. CIOs and health systems probably deserve to be told that their provider data is moving offshore and back onshore. Health systems are demanding NCQA-certified provider enrollment staffs and going offshore isn’t going to make compliance leadership happy.” The company has raised $85 million since launching in 2020, with its last funding round in 2022. At least one comment on Glassdoor suggests that the company laid off some onshore staff without warning last month.


Webinars

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


Sales

  • St Vincent’s Health Australia Private Hospitals will implement Meditech Expanse at its 10 facilities in New South Wales, Queensland, and Victoria.
  • WellSpan Health (PA) selects remote patient management technology from Biofourmis.

Announcements and Implementations

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Benefis Health System (MT) will roll out Epic next month. Hospital staff say the year-long implementation project has been good for the local economy, generating 1,900 flights, 10,000 meals at restaurants, and 3,300 nights at hotels. The economic bump will continue through the first few weeks of March, when 600 consultants descend for go-live.

Nicklaus Children’s Health System (FL) implements Kyruus Connect online appointment scheduling software from Kyruus Health.

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Synthesis Health launches with GA of a cloud-native PACS with AI-based reporting module. CEO Murray Reicher, MD founded and led PACS vendor DR Systems for 22 years before selling it to IBM Watson Health in 2015.

Cleveland Clinic leverages technology from Palantir to create an AI-powered Virtual Command Center, the initial iteration of which offers an enterprise view of patient throughput and capacity forecasts, staffing needs, and OR utilization and scheduling opportunities.


Government and Politics

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The VA Office of the Inspector General reveals that patient medication histories are not transferring between the Oracle Health EHR used at five VA hospitals and the VistA system used at the VA’s other facilities, putting 250,000 veterans at risk of potential medication errors. Though the VA says no veterans have been harmed because of the problem, the OIG says at least one veteran wasn’t given critical medication in a timely manner due to the glitch, and that the VA hasn’t notified patients that their medication records may be incorrect.


Privacy and Security

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Lurie Children’s Hospital in Chicago restores external email capabilities and most of its phone lines two weeks after a cyberattack on its communication systems. Its Epic system is still offline.


Other

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Ozarks Community Hospital (MO) abruptly transitions its Evergreen Clinic to a telehealth assistance hub, three weeks ahead of the date originally given to clinic employees. Patients in the area can now see clinicians remotely via virtual visit at the clinic, or travel to other OCH facilities further afield.

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MUSC Health (SC) pilots a telehealth triage service at two of its emergency rooms in an effort to help patients get care more quickly, resulting in the rate of patients who leave without being seen dropping to almost zero. The health system plans to add secure messaging to the telehealth service so that ED patients can communicate directly with staff.


Sponsor Updates

  • CloudWave will partner with USI Insurance Services to provide cybersecurity and IT services for USI’s PrivaSafe service.
  • Medical Risk Solutions reports a 40% decrease in patient call volume after implementing Healow Open Access online appointment booking software from EClinicalWorks.
  • First Databank names Brad Titus technical writer, Michael Cruz senior cloud operations engineer, and Kate Struthers people operations specialist.
  • Findhelp welcomes Best Buy Health, Pediatric Associates Families of Companies, Merck, and Olympic Community of Health to its network.
  • Aragon’s Research Globe ranks Five9 as a leader of conversational AI in the intelligent contact center.
  • Fortified Health Security hires Georganne Miller (Latitude Information Security) as security compliance advisor.
  • Health Data Movers joins the ServiceNow consulting and implementation partner program.
  • The Career Reconstituted Podcast features Inovalon Director of Sales Engineering Wilson Tam, PharmD.
  • InterSystems earns NCQA’s Certified Data Partner designation for a second consecutive year.
  • Net Health will exhibit at APTA CSM February 15-17 in Boston.

Blog Posts


Contacts

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

EPtalk by Dr. Jayne 2/15/24

February 15, 2024 Dr. Jayne 2 Comments

I’m always amazed when people want to use EHRs to drive non-EHR behavior, almost forgetting the concept of free will. A friend reached out to me to ask if I knew how to configure Epic EHR tools to help her track how much time she spends using the EHR on her days off, which includes work done during weekends, holidays, and when on vacation. She said she felt “blown off” by the IT team after opening a help desk ticket since they are only tracking so-called “pajama time” on scheduled clinic days. She feels that tracking the data on weekends and non-clinic days would help motivate her to work less. I explained how IT teams manage their work and how they typically focus on system enhancements that would benefit large numbers of users and explained that she’s essentially asking for a one-off behavior modification program. I offered some options for free time-tracking software on her phone, which I think would be even better, since she will have to consciously decide that she’s going to start her timer and use the EHR versus “just popping in for a moment” as she has become used to doing.

In talking through it, she never thought about using any other way to track her time – such as an old-school notebook or even a time-tracking app. I also mentioned the importance of tracking other time-sucking ways she spends her day, including social media, random internet surfing, online shopping, and more. Sometimes we just need to take responsibility for our own choices, and it’s not always the IT team’s job to figure it out or the EHR’s responsibility to track it. Of course, I know that EHRs have a way of wasting a lot of clinician time, especially if their organizations don’t have policies and procedures in place that allow clinicians to work at the top level of their licensure. However, this particular physician also admits she brings her own laptop to work so she can do things that aren’t allowed on the office computers, so I suspect the problem is much larger than her ending up doing work on the weekends.

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I recently took over a new volunteer position and was given access to a shared drive full of documents and files with the advice that “everything you need is in there.” The extremely painful process of going through the folders reminded me of how spoiled I have become working for high-performing organizations where version control information is required to be clearly present on every document. Sure, you can access that information electronically from within the applications, but for long-standing documents, that can require a lot of digging. It’s also helpful to see who authored the document, the business reason for its creation, and a high-level overview of key changes that have happened along the way. You can bet that when I hand off the materials to the next person, the documentation will be a little stronger. I’m trying to dig through them with a glass of wine in hand, but I’m afraid my cellar will be empty before I get through all of the documentation.

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Happy 30th birthday to the Journal of the American Medical Informatics Association. The publication launched in 1994 and has had significant growth during its lifespan. The journal’s 2023 statistics: 1574 submissions received with 254 accepted for publication. Here’s to the next decade of quality clinical informatics literature.

From Cube Dweller: “Jayne, I appreciate your ongoing coverage of the return to office situation. I’m one of those people who has enjoyed being in the office all along, mostly to get away from my children and have a bit of peace and quiet. Now that all these hybrid people are being forced back to the office, our management is making us have all kinds of forced fun to welcome them back. I wish they’d take a page from this article about how to not make it feel like a bad middle school mixer.” I appreciated the content of the article, which shared one company’s idea of a better way to get employees to connect. The employer profiled is Verkada, which provides security equipment. CFO Kameron Rezai created what they call the “3-3-3 program,” which offers a reimbursement of up to $30 each for employees who meet at local businesses in groups of three or more after 3pm. Rezai cited autonomy as one of the goals of the program, stating, “We trusted our employees to go out and make their own connections.”

Since the program’s inception in April 2023, the company has had good uptake, spending more than a half-million dollars from a fund that formerly paid for structured events. As someone who has felt the pressure of trying to plan workplace events that have something for everyone, this feels like a win-win. Want to go hike with your coworkers and get a beer afterwards? Check. Want to visit a local tearoom or coffee shop? Check. Chill at the local gelato shop after a long day of meetings? Check. Staffers do have to post event snapshots before they file their expense reports, which I think would be great for helping others generate ideas. This would also potentially scale to remote workers, who could arrange delivery of snacks and drinks then hop on a virtual meet and greet together. Local businesses also benefit, so that’s another plus.

I’m mentoring a young clinical informaticist, and we have a lot of conversations about study-related concepts such as statistical power, correlation, and causation. There are so many studies out there that “link” different concepts or events together, which may have a tangled web of causes. My mentee brought up a recent Epic Research study that noted that for patients in the emergency department, there was a correlation between providers having access to outside records and a reduced risk of a “code blue” event. The article notes that previous research has shown a link between the presence of outside medical records information and patient outcomes such as visit length, tests and diagnostics that are ordered, admission rates, and even charges.

As someone who has spent a long time working in the emergency department, I understand that piece – having more information helps you better understand a patient’s current state and how their various health conditions have progressed. You can also see if they had recent testing that would reduce what you need to order today, or the presence of data can make a comparison easier. From a code blue standpoint, my experience is that those events are most closely tied to the patient’s current presenting problem: major trauma, heart attack, respiratory failure, etc., and are less closely tied to chronic conditions. As a scientist, it’s fun to find things that correspond, but the best studies are those that generate actionable data that can be used to improve patient outcomes. Maybe I’m missing something here, so if you’re seeing what I’m not, please clue me in.

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My mentee is also working on a public health project that looks at foodborne illness and came across what can only be described as an attention-grabbing title: The Great Michigan Pizza Funeral. The “ceremonial disposal” of nearly 30,000 frozen pizzas occurred in Ossineke, Michigan on March 5, 1973, following a recall due to concerns about botulism-causing bacteria in mushrooms used to top the pizzas. The pizzas were placed in an 18-foot deep grave with the governor of Michigan in attendance. Later testing revealed that the mushrooms were not indeed contaminated, and that laboratory mice found dead during the initial testing suffered from an unrelated infection.

What kind of pizza would you never eat, unless it was the only food left to sustain you? Which is best – thin crust, thick, or pan? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 2/15/24

February 14, 2024 Headlines Comments Off on Morning Headlines 2/15/24

KKR paying $10.5B for Cotiviti stake

Veritas Capital sells a co-ownership stake in healthcare payments and analytics vendor Cotiviti to investment firm KKR for $10.5 billion.

Lurie Children’s Hospital restores parts of communications network knocked offline by ‘criminal threat’

Lurie Children’s Hospital in Chicago restores external email capabilities and most of its phone lines two weeks after a ransomware attack on its communication systems.

Anatomy Unveils AI-Powered Financial Automation for Healthcare Organizations

AI-powered financial automation software vendor Anatomy Financial launches with $7.6 million in funding.

Comments Off on Morning Headlines 2/15/24

Healthcare AI News 2/14/24

February 14, 2024 Healthcare AI News Comments Off on Healthcare AI News 2/14/24

News

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DeepScribe announces GA of its new Trust and Safety Suite, a set of solutions designed to give users greater visibility into the safety and reliability of its AI-powered medical scribe software.

Persistent Systems develops AI-powered population health management software that identifies social determinants of health based on EHR data and then recommends personalized care interventions.

CitiusTech develops the Gen AI Quality & Trust framework and support service to help healthcare software developers design, implement, and scale vetted AI solutions across enterprise environments.


Business

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Anatomy Financial launches with $7.6 million in funding. The San Francisco-based company has developed AI-powered financial automation software for medical and dental practices, and digital health and healthcare billing companies.

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Children’s Hospital of Los Angeles implements Vital’s AI-powered ERAdvisor software as a part of its MyVisit app.


Research

A series of studies presented at the annual meeting of American Academy of Orthopaedic Surgeons determine that the accuracy of musculoskeletal health information provided by chatbots used by ChatGPT, Google Bard, and BingAI is limited. The chatbots displayed especially significant limitations when asked to provide clinical management suggestions, omitting important steps such as ordering antibiotics before cultures.


Contacts

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

Comments Off on Healthcare AI News 2/14/24

Morning Headlines 2/14/24

February 13, 2024 Headlines Comments Off on Morning Headlines 2/14/24

OCH Evergreen Clinic transitions to telehealth hub; Employees say patients are in limbo

Ozarks Community Hospital (MO) abruptly transitions its Evergreen Clinic to a telehealth assistance hub.

Meridian Analytics Rebrands to Discern Health, Focused on Human-Centric Predictive Care

Predictive care analytics startup Meridian Analytics rebrands to Discern Health.

Revolutionary Nursing Practice TogetherTeam Virtual Connected Care comes to MercyOne Dubuque Medical Center

MercyOne rolls out its TogetherTeam Virtual Connected Care virtual nursing program at all five of its hospitals in Iowa.

Comments Off on Morning Headlines 2/14/24

News 2/14/24

February 13, 2024 News Comments Off on News 2/14/24

Top News

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ONC and The Sequoia Project designate Kno2 and CommonWell Health Alliance as Qualified Health Information Networks under TEFCA. They join Konza National Network, EHealth Exchange, Epic Nexus, Health Gorilla, and MedAllies, which were designated in December.


Webinars

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


Sales

  • Biofourmis signs four contracts with pharmaceutical companies for its digital health and decentralized clinical trial solutions.

People

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NRC Health promotes Helen Hrdy to chief customer officer.

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ClinicMind promotes Kathleen Casbarro to SVP of its new Institutional Platform as a Service division.

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Tomer Levy (Change Healthcare) joins Augmedix as SVP of engineering.


Announcements and Implementations

Children’s Hospital of Los Angeles implements Vital’s ERAdvisor software as a part of its MyVisit app.

MercyOne rolls out its TogetherTeam Virtual Connected Care virtual nursing program at all five of its hospitals in Iowa.

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UC Davis Health (CA) launches a remote patient monitoring program for patients who’ve undergone Percutaneous Coronary Interventions using text messaging software from Twilio and RPM technology from Clinii.


Government and Politics

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Air Force officials confirm that the switch to MHS Genesis has, as with the Navy and Army, lengthened the amount of time it takes to medically clear recruits due to an increase in initial, potentially disqualifying conditions that require further investigation. DoD representatives told Senate Armed Services Committee members last September that the switch to the Oracle Health-based system had added three more days to the recruitment process, though the Navy reported that up to 60 additional days were sometimes necessary.

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An Idaho Department of Health official tells state legislators that the state should withdraw from the Idaho Health Data Exchange, given that it has no legal recourse for management oversight. The HIE, which currently has 190 customers, emerged from Chapter 11 bankruptcy protection last summer after running up $4 million in debt.

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Tension escalates between the Southern Ute Indian Tribe, Indian Health Service, and Colorado Department of Public Health and Environment due to a technological glitch that has, for more than a year, prevented the Southern Ute Health Clinic from sending daily immunization data to the state registry via the IHS Resource and Patient Management System. None of the affected parties has been able to identify the problem, though the tribe has offered to cover the cost of a solution.


Privacy and Security

The Health Sector Cybersecurity Coordination Center within HHS alerts organizations to the tactics and targets of the relatively new Akira ransomware group.


Other

Australia’s Northern Territory Health temporarily suspends use of InterSystems TrakCare software at the emergency departments of Palmerston Regional and Royal Darwin hospitals, citing concerns that the software, dubbed Acacia, is slowing down access to patient records. Staffing shortages and other unspecified operational pressures also contributed to suspension of the system, which NT Health has been rolling out across its facilities since 2017.

Black Book Research survey respondents rank Surgical Information Systems as the top vendor for ambulatory surgical center software.

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Through word of mouth and dedicated facilities teams, an NHS clinician in London reunites a fellow clinician working 100 miles away with a diamond ring she’d accidentally left in her scrubs five days prior.


Sponsor Updates

  • EClinicalWorks releases a new podcast, “Boosting Data Analysis in Healthcare.”
  • CereCore releases a new podcast, “Rolling Out EHRs in the Rural Setting: An Expert Guide.”
  • Availity adds automation and process mining capabilities from Janus to its Availity Essentials Pro software.
  • Arrive Health Senior Software Engineer Edward Kerns joins Code for Good West Michigan’s board as sponsorship coordinator.
  • Censinet releases a new Risk Never Sleeps Podcast, “Deepfakes, Identity, and Insider Threats, with Jason Elrod, Chief Information Security Officer at MultiCare Health System.”
  • Clearwater and 1stResponder partner to expand cybersecurity incident response within Clearwater’s Managed Security Service Provider portfolio.
  • New research from Linus Health determines that its Digital Clock and Recall assessment within its Core Cognitive Evaluation solution outperforms the most commonly used paper-based assessment in detecting early, mild cognitive impairment and dementia, and with less ethnic and racial bias.

Blog Posts


Contacts

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

Comments Off on News 2/14/24

Morning Headlines 2/13/24

February 12, 2024 Headlines Comments Off on Morning Headlines 2/13/24

HHS Expands TEFCA by Adding Two Additional QHINs

ONC and The Sequoia Project designate Kno2 and CommonWell Health Alliance as Qualified Health Information Networks.

Air Force Confirms Medical Disqualifications Doubled after New Med-Records System Implemented

Air Force officials confirm that the switch to MHS Genesis has lengthened the amount of time it takes to medically clear recruits due to an increase in initial, potentially disqualifying conditions that require further investigation.

Headlight Launches With $18 Million in Funding and the Addition of Amazon Pharmacy Executives to Support Their Mission of Simplifying Patients’ Mental Health Journey

Hybrid mental health practice SokyaHealth rebrands to Headlight, announces $18 million in funding, and names former PillPack executive Geoff Swindle CEO.

Comments Off on Morning Headlines 2/13/24

Curbside Consult with Dr. Jayne 2/12/24

February 12, 2024 Dr. Jayne 2 Comments

Several of good friends from medical school hold significant physician leadership roles. I always enjoy catching up with them and hearing what is going on at their hospitals, as well as trading ideas for solving the different kinds of challenges our organizations are facing. Sometimes one of us has already been through an issue and there’s no sense in reinventing the proverbial wheel when you don’t have to.

Although my colleagues are knowledgeable about their own departments as well as those that they have to work with closely, they don’t always have the broad view of hospital operations that I have as an informatics leader. I think that when working with large enterprise EHR implementations, clinical informatics leaders are just conditioned to make sure that we are thinking about every part of the hospital as well as systems that aren’t even under our roofs, such as emergency medical services, transfer infrastructure, and more.

Regardless of region or state, everyone is facing hospital overcrowding. When there aren’t enough inpatient beds available, patients start backing up into the emergency department. The root cause of the inpatient bed shortage is multifactorial. Sometimes physical beds are lacking, and sometimes there are actual beds open but the shortage is one of staffed beds. There just aren’t enough personnel to keep a unit open.

Although many disciplines are in short supply, including respiratory therapy, the major issue I see in my region is still a nursing shortage. Hospitals in our area are still playing games with nurse compensation and have instituted staffing policies that negatively impact nurses and their families. Of my friends who are nurses, all have left hospital care except one, and I guarantee if she worked on a medical/surgical unit, she would leave, too.

Unless people are actually impacted by these shortages, they don’t tend to get engaged around the policy work that is needed to solve the problems. I was excited to see NBC News bring some of these issues to light this week, as it reported on the potential end of funding for Hospital at Home programs at the end of this year and how that end might worsen already tragic emergency department (ED) overcrowding.

CMS created the program, which is officially called Acute Hospital Care at Home, in 2020. The program allows hospitals to deliver high-acuity care to patients in their homes, where they receive visits from community paramedics and are connected via technologies such as video visits and home-based monitoring systems. The programs can help boost ED throughput by admitting patients back to their homes rather than potentially having to board them in the ED while they wait for a physical hospital bed.

Although more than 130 health systems have been approved to participate, it’s difficult to understand how many are truly bought in or what level of resources are being dedicated to program initiatives. Even if they are participating, hospitals may be left dangling at the end of the year unless Congress votes to extend funding for the program. Although some private payers are participating, CMS still provides the majority of funding for programs.

Even for those organizations that have embraced Hospital at Home programs, their impact is incremental. Atrium Health, for example, is treating 60 patients per day in its program in North Carolina and hopes to ramp that up to 100 patients per day by the end of 2024, which is a fraction of its total count of inpatients. If Hospital at Home programs are sunset, patients who might have been referred to them are instead going to need regular inpatient beds, which will further worsen the situation in systems where those programs had been successfully making a difference.

Policymakers need to look at other causes of ED overcrowding. In addition to the shortage of staffed beds on medical/surgical units, there are fewer beds available in nursing homes, psychiatric units, and rehabilitation facilities. Mental health services are in short supply everywhere, with families sometimes bringing loved ones to the emergency department because they feel they have nowhere else to turn. Telehealth solutions can help mitigate this to some degree, identifying patients who might qualify for outpatient management or who need help navigating the system, such as obtaining medication refills or finding a new provider for ongoing care. Progressive states are looking at the upstream causes of the mental health crisis and are allocating money to community programs, but other states seem to be just looking the other way.

The report also mentioned other pitfalls of our state-by-state patchwork of healthcare solutions. It looked at data from Massachusetts hospitals, including data on patients who are boarded in the emergency department while they wait for beds in the hospital. It profiled the venerable Massachusetts General Hospital, which has been boarding at least 45 patients at a time for more than a year, and in January of this year hit a count of 103 boarders with 220 people across the state in the same situation. The hospital considers this to be a “capacity disaster” and has asked the state to approve additional beds to help the situation.

They have also instituted a Hospital at Home program and have created a Discharge Lounge to help speed patient departures from the hospital building. Patients can wait there for their caregivers to pick them up, rather than remaining in a standard hospital room. That intervention helps 125 patients per month leave more than 60 minutes earlier, which will add up over time and as the program is expanded. The hospital is also providing transportation services to help patients leave when they don’t have reliable transportation.

Other solutions that can help make beds more available include virtual nursing care, where offsite nurses can work with patients and families to deliver patient education and discharge teaching, freeing up bedside nurses to deliver care that must be rendered by an in-person nurse. Virtual nursing programs in my community are keeping nurses that have been placed on light-duty restrictions active in patient care, rather than sidelining them. The technologies can also be used as a “phone-a-friend” solution for early career nurses to bring in a second set of nursing eyes to evaluate a particular patient. Having been a newly minted intern, I appreciate the idea of using technology to consult dedicated virtual resources rather than having to interrupt colleagues who are already knee-deep in patient care of their own.

The NBC News report goes on to note that Massachusetts is “unique” in the way that it keeps statistics on emergency department boarding, and that many states are lacking high-quality data on the problem. I know my own state doesn’t do a good job of tracking it, let alone communicating it, which means that citizens in our communities have no idea there’s as big of a problem as there actually is. The majority of my neighbors and friends in the community think that because COVID is “over” and there aren’t daily stories on the news about how bad things are at the hospitals, that everything is fine. That is, until a loved one sits for 17 hours in the waiting room before they see a physician. But it’s unclear if those experiences translate to actions, such as lobbying one’s legislators.

Demographics are shifting in the US, with increasing numbers of elderly patients and more of us who are living with chronic conditions. We are not spending enough money on preventive care, health promotion, or disease prevention, so the problem is likely to get worse before it gets better. Let’s hope that stories like this help to raise awareness and generate change so that we don’t continue in the downward spiral in which many of us feel trapped.

Does your organization support Hospital at Home activities, and how are they going? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 2/12/24

February 11, 2024 Headlines Comments Off on Morning Headlines 2/12/24

Staggering Rise in Medicare Bills Suggests Medicare Scam

The National Association of Accountable Care Organizations analyzes Medicare’s claims database to alert the federal government that 450,000 of its beneficiaries were billed for urinary catheters in 2023 versus the usual 50,000 in previous years, running up $2 billion in suspicious charges.

Virgin Pulse and HealthComp Introduce Combined Company as Personify Health

Virgin Pulse and HealthComp, which merged in November 2023, name the $3 billion business Personify Health.

AI cannot be used to deny health care coverage, feds clarify to insurers

CMS tells Medicare Advantage insurers that they can use AI and algorithms to assist them in making coverage determinations, but they must make sure that the tools use complete information and they can’t use technology alone to deny hospital admission or downgrade to observation stay.

Comments Off on Morning Headlines 2/12/24

Monday Morning Update 2/12/24

February 11, 2024 News 9 Comments

Top News

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The National Association of Accountable Care Organizations analyzes Medicare’s claims database to alert the federal government that 450,000 of its beneficiaries were billed for urinary catheters in 2023 versus the usual 50,000 in previous years, running up  $2 billion in suspicious charges.

Pretty in Pink Boutique — whose Medicare registration is for a house address in El Paso, TX and whose phone rings to an auto body shop — billed Medicare for at least $267 million in just over a year for catheters.

Patients and doctors who reported suspicious activity to CMS say they never got a response. Dozens of NYT commenters said the same, that the CMS person either expressed resignation with the status quo or lack of motivation to add to their workload.


Reader Comments

From Jerry Aldini: “Re: Oracle Health. Interesting comments on the Cerner Reddit.” Examples, all unverified:

  • “Oracle thought Cerner was worth buying for Larry’s little healthcare data hobby, but once everything is converted to OCI, nobody would ever want to buy what Cerner was ever again. So when Larry is no more or gets bored, it’s the end of the story.”
  • [On the company’s pledge to rewrite Millennium using AI] From everyone I’ve talked with, it is vaporware, and even then demos went to crap pretty quickly. I’m just riding this out until all clients abandon ship.”
  • “Maybe Congress would like to know more about Larry’s new wonderful AI software engineer and how it means that they can maintain a multi-billion-dollar system for America’s service people and veterans with nothing even remotely resembling what would be considered a normal software engineering company. Like, why bury the lede, Larry? You’ve successfully removed the need for high-cost, hard-to-find employees to maintain software. This is a coup for the entire tech industry. Forget the EMR, let’s hear about the AI, that’s where the money is.”

HIStalk Announcements and Requests

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Most poll respondents think that the former Cerner business has become less competitive since Oracle acquired it.

New poll to your right or here: Do you own shares or equity in a health IT-related company? You can use the poll’s comment function to describe times when you made or lost big money from a health IT investment.

Help me out by signing up for spam-free updates and connecting on LinkedIn.

I am an India-phile, fascinated with the culture, food, and business and technology advances of the world’s largest democracy. I also enjoy regional English usage. I collected these examples from HIStalk-related emails with people from India that featured words and terms that are accurate, just not commonly used here:

  • Prepone – the opposite of postpone, to describe moving an event earlier.
  • Revert back – not a redundant expression, but rather to ask for a reply, as in “kindly revert back.”
  • Cent percent – 100%.
  • Full stop – Indians were using this term long before trendy Americans embraced it in referring to the period at the end of a sentence, or to some, the more emphatic break at the end of a paragraph that signals a new train of thought.
  • Mention not – this is a great alternative to the wishy washy “you’re welcome.” I might start using this with hopes of displacing the dreaded “no problem,” although saying “mention not” after the person has already “mentioned” doesn’t quite fit.

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Welcome to new HIStalk Platinum Sponsor TruBridge. The Mobile, AL-based company connects providers, patients, and communities with innovative solutions to support financial and clinical solutions, creating real value in healthcare delivery. By offering technology-first solutions that address diverse communities’ needs, it promotes equitable access to quality care and foster positive outcomes. Its industry-leading HFMA Peer Reviewed RCM suite provides visibility that enhances productivity and supports the financial health of organizations across care settings. It champions end-to-end, data-driven patient journeys that support value-based care and improve outcomes and patient satisfaction. It supports efficient patient care with EHR products that integrate data between care settings. TruBridge clears the way for care. Thanks to TruBridge for supporting HIStalk.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Omnicell announces Q4 results: revenue down 13%, EPS –$0.32 versus –$0.64, beating Wall Street expectations for both. OMCL shares have lost 49% in the past 12 months versus the S&P 500’s 26% gain, valuing the company at $1.4 billion. The CFO said in the earnings call that customers are cautious about implementing new workflows because of IT and nursing staff shortages, while the CEO said that big health systems aren’t ready to implement innovation until they develop strategies for dispensing medication across their broad footprints.

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Virgin Pulse and HealthComp, which merged in November 2023, name the $3 billion business Personify Health.

Marathon Health, which bought Cerner’s employer occupational health clinics in August 2023, acquires Everside Health, expanding its services to 680 health centers in 41 states.

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Aptar Digital Health, a division of Aptar Pharma, will take over the digital health solutions of Biogen, which address neurological and rare diseases.


Sales

  • England’s Torbay and South Devon NHS Foundation Trusts chooses Epic.

People

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University of Tennessee Medical Center names Lynnette Clinton, MBA (BayCare) as SVP/CIO.


Announcements and Implementations

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Amenities Health launches plug-and-play provider search and scheduling for a health system’s public-facing website, extending its mobile app experience.

AdventHealth brings the last five of its 48 hospitals live on Epic, completing its conversion from Cerner. AdventHealth announced that it would implement Epic in early 2020, displacing the Cerner system that it had installed in 2002.

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Sparked, Australia’s national FHIR accelerator, opens the draft of its Australian Core Data for Interoperability Release 1 for comments.


Government and Politics

CMS tells Medicare Advantage insurers that they can use AI and algorithms to assist them in making coverage determinations, but they must make sure that the tools use complete information and they can’t use technology alone to deny hospital admission or downgrade to observation stay. CMS also warns that MA insurers should make sure that their systems are free of bias.

A North Carolina health news site observes that Atrium Health wields its status as a “unit of local government” to get tax breaks, the power of eminent domain, and anti-trust immunity that allowed it to acquire 40 hospitals in four states, after which it merged with Advocate Aurora Health to form the country’s third-largest non-profit health system with $27 billion in revenue.


Other

In India, a review finds that 11 of 40 of Bangalore tele-ICUs in rural “spoke hospitals” are not functional due to lack of Internet connectivity, lost software copies, and clinician shortages.

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Medical malpractice physician Jeff Willis, MD, MHA notes that 28 states give full practice authority to nurse practitioners and another 10 are considering it. He says that while the NP lobby was smart to take advantage of the primary care crisis to expand practice, he ponders that it’s a broken healthcare system that created the need and that it raises malpractice issues. A commenter says that several states also allow advanced practice chiropractors to do physician-like work, while another says that NPs are important in rural areas because doctors won’t work there given low volumes that drive RVU-based compensation. A physician commenter says that the rural idea sounds nice, except a lot of the NPs chase the money that comes from running IV bars, Botox shops, and med spas in urban areas.


Sponsor Updates

  • Kellum Medical Group (TX) leverages the Sunoh.ai AI medical scribe as part of its EClinicalWorks EHR implementation.
  • Amenities adds online patient scheduling to its Digital Front Door Platform.
  • Availity achieves the CAQH Committee on Operating Rules for Information Exchange (CORE) Eligibility & Benefits, Claim Status, Payment & Remittance, Prior Authorization & Referrals, and Health Care Claims Operating Certification seals.
  • Health Data Movers joins CHIME as a member.
  • QGenda and Spok will exhibit at the AHA Rural Health Care Leadership Conference February 11-14 in Orlando.
  • Waystar will exhibit at Nymbl.Con 2024 February 14-16 in Scottsdale, AZ.

Blog Posts


Contacts

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

HIStalk Interviews Russ Richmond, MD, CEO, Laudio

February 9, 2024 Interviews Comments Off on HIStalk Interviews Russ Richmond, MD, CEO, Laudio

Russ Richmond, MD is co-founder and CEO of Laudio of Boston, MA.

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Tell me about yourself and the company.

I’m a lifelong entrepreneur. I’m also a physician, and through that and other activities, I’ve walked the halls of over 100 hospitals and I understand how they run. I have focused my life on building solutions software for hospitals.

I’m the founder and CEO of Laudio, which is an AI-enhanced platform for the frontline leaders or frontline managers in health systems. We support these frontline leaders with workflow that saves them time and drives improved employee retention and engagement, operational efficiency, and improved patient experience.

How much health system employee burnout and turnover can be tied to manager-level behavior rather than organization-wide policies like compensation?

Our best guess is that 60% to 70% of the employee’s engagement, which is the proximal metric for turnover, is influenced or driven by their direct reporting relationship with their manager. Health systems assume that it is always compensation related. I’m not saying that compensation isn’t a very important thing, but we know that frontline workers attach much more to their managers than they do to the overall organization. We know that by improving the bond between a frontline worker and their manager, we can greatly influence their propensity to stay engaged and employed at that organization.

People often say that they love the company, but can’t stand the boss.

People don’t quit jobs, they quit managers. Managers have a tremendous amount of influence on the mental wellbeing of their employees, and anyone who has had a bad boss knows that well.

But what we have learned inside health systems is that they have a special issue, which is that the frontline managers have very large spans of control. It’s not uncommon to see team sizes of 50, 70, or 100 direct reports into a manager. That really stretches the bandwidth of that manager to do traditional management.

The biggest lever is to increase the frequency of timely, relevant connections between the managers and their teams in a way that feels personalized, in a way that makes a big team feel smaller. That in and of itself can drive a tremendous improvement in engagement and retention. If a manager takes the time to have a one-on-one interaction with their team member every month, the likelihood of that team member quitting falls by over 40%. It’s just that the managers sometimes don’t have time to do that.

Beyond that, it’s the intuitive things, and a few counterintuitive things, that make a difference. First, managers showing that they care about the wellbeing of their employee when they do interact with them. How is their schedule? Have they worked too many shifts in a row? Are they forming relationships on the unit and inside their teams? Celebrating or recognizing good work done? These are the types of actions that managers can take that can make a real difference. 

Then somewhat counterintuitively, even when managers interact with team members on accountability-related issues — like corrective action with a worker who is always coming in late — that actually drives an increase in retention. Because all of a sudden, the frontline worker knows that someone is paying attention to them, that someone cares about whether they are there on time.

It can be a wide array of interactions, but the key is that they have to happen, happen regularly, and happen in a way that’s not a bulk email, not pro forma, but in a caring, personalized way.

What is the disconnect between what executives expect and what managers do?

Many executives don’t appreciate the challenge these frontline managers are up against. Huge spans of control, extending to the number of systems that they need to interact with and operate, the administrative burden that they face, and just getting their regular work done in terms of documentation, getting data into the right place, and setting the schedule. Because they are disconnected from that everyday reality, it’s harder for them to support and coach these frontline leaders. It’s harder for them to connect their agenda, which may be system-wide performance improvement, with the everyday actions of the frontline leader.

Laudio solves for that. It connects the overall system wide agenda — say, improving retention of full -time employees, reducing contract labor, or improving HCAHPS scores — with specific daily actions that frontline managers can take that and that fit into their workflow in an efficient way. That’s where we have focused our efforts on solving that problem.

How does a health system define its goals and then package up individual tasks that frontline managers should be doing?

We have live API integrations into the systems around these managers. That includes the HR information systems, like Oracle or Workday. That includes the time and attendance systems, like UKG. That even includes Epic, where we get patient geolocation information. The data aggregation is handled through our platform. 

Once we have the data in one place, it’s just a matter of working with the senior leaders in the health system around their priorities. Some of them have priorities, especially in today’s day and age, around reducing turnover or reducing incremental overtime. In that case, we are pushing those types of actions through Laudio. Some of them have priorities in saving their frontline leaders time, because they can see that they are overburdened. In that case, we are working with the frontline leaders on automating their work and creating more operational efficiency. Some of them have priorities in patient experience or quality, and in those cases, we are emphasizing those workflows.

Because we are a platform that surrounds the frontline leader, it’s just a matter of, from an organizational level, determining what to emphasize first and foremost. Then once we are seeing good results there, we can move on to the next area.

I’m still thinking about a hospital manager having 100 direct reports covering a 24-hour schedule. Is healthcare unusual in that regard?

Yes, it is unusual. I have not seen another industry like it. Normal executive span of control is between six to maybe 12 people. Even when you get to 20 people, which is a low span of control inside an acute care facility, you are way beyond that. 

I think it comes from the guild-based practice of medicine, where practitioners were meant to be individual contributors in an era that wasn’t as team-based and wasn’t as technically challenged. We live with it today, and it has become a more or less a permanent part of the economics of health systems. They have a hard time affording span-breakers and hiring more managers, because most health systems are working to reduce their labor expenses. It becomes what can we do for our managers to give them more capacity to take on these larger team sizes and to still drive the results that we need in the system.

I would assume that a lot of those folks were promoted into management because of their own job performance among peers rather than having managerial aspirations or talents.

That’s correct. Managers in health systems are almost never hired horizontally from other organizations outside of healthcare, and very rarely are they hired horizontally inside a facility or organization. What you see almost all the time is individual frontline workers getting promoted into being a frontline manager when their manager leaves, which we call a battlefield promotion.

In the context of a battlefield promotion, it’s difficult to ensure that that new manager has acquired all of the management best practices, skills, and training that will be needed to be good at that job. It’s a very different job than the one they had been doing. This is where we believe that software can at least be part of the solution, and that we can hardwire a lot of the management best practices through our system and also introduce best practices as they are discovered so that they can become immediately diffused to the managers versus waiting for them to go to get a master’s in healthcare administration or to take some type of a training program that that health system may offer.

Software has a tremendous advantage in supporting especially new managers, but all managers, to quickly acquire some of the skills they need to do a great job.

Do managers get adequate employee feedback from hallway conversations, or is a formal feedback mechanism required?

It is very difficult for a manager in a hospital to get accurate feedback, because they are managing a unit that is working 24×7 while working 40 or 50 hours of the week. They are not regularly interfacing with the entire employee base. When they are, it’s often in the context of putting out a fire. I put that in quotes, such as handling on a patient issue, a physician complaint, or a near-term operational priority like a staffing gap. 

Employee voice tools effectively gather feedback regularly and efficiently. They help managers understand their unit better by highlighting only the key issues that require action. This saves time and enables quick responses to important matters. It’s a great use of technology.

What are early warning indicators for burnout that an overburdened manager can detect so they can at least take action to retain an employee?

Health systems are collecting a lot of employee-specific data continuously all the time. The problem is sorting the signal from the noise, figuring out what is relevant, and then in the context of a busy unit, finding the right way to connect on it. 

Our software helps prioritize and identify the individuals who need the manager’s attention most, using AI and risk models. Then we connect the manager to the evidence-based best next action with that frontline employee. That can vary dramatically, depending on the core issue. It could be helping them iron out their schedule if they have an unusual working pattern where they are always on weekends or something undesirable. It could include helping them think about their promotional pathway and clinical ladder to give them a longer-term view in the system. It could be reviewing complimentary feedback from their patients and recognizing them for a job well done. It really depends on the situation and the individual worker. 

Where Laudio has a real advantage is that since we are collecting all this information, we are understanding what the managers are doing with it and the actions that we are taking. We have created an evidence-based dataset of which actions can support the workers the most. We publish a new use of evidence every week in a part of our website called Laudio Insights, where in a non-commercial way, we are trying to promote the practice of what we call evidence-based leadership. Everyone can benefit from what we are learning around what makes the most difference for managers and how they can use this evidence to practice differently.

What are your company priorities over the next few years?

Continuing to focus on helping create management actions that will drive new levels of impact in health systems. We can handle the data aggregation and analysis that is done automatically in our machine. We are starting to turn our frontline managers into super-powered frontline managers and make them more efficient.

In the future, we want to continue to pull new and different data sources into our system to help them to achieve new horizons of impact. This could include things like the supplies that are used inside each unit. It could include all of the sensors that are in patient rooms around handwashing or whether the patients are being rotated on their beds. We see a future where more and more of this data and information is integrated into a single source of recommendation for the manager so that they can make the impact happen without having the analysis, risk modeling, and data aggregation get in the way.

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Morning Headlines 2/9/24

February 8, 2024 Headlines Comments Off on Morning Headlines 2/9/24

Unlearn Raises $50 Million Series C to Optimize Clinical Research With AI-Powered Digital Twin Technology

Unlearn, which creates digital twins that allow smaller and faster clinical trials, raises $50 million in a Series C funding round.

Lurie Children’s Hospital says a ‘criminal threat’ forced the shutdown of its network

Initially deemed a network outage, Lurie Children’s Hospital confirms that the January 31 cybersecurity incident that forced it to take its communications network offline was caused by a criminal threat actor.

Official: Idaho should consider withdrawing from Health Data Exchange

An Idaho Department of Health official tells state legislators that the state should withdraw from the bankrupt Idaho Health Data Exchange, given that it has no legal recourse for oversight.

HHS Finalizes New Provisions to Enhance Integrated Care and Confidentiality for Patients with Substance Use Conditions

HHS announces new provisions to the Confidentiality of Substance Use Disorder Patient Records that address one-time patient consent, redisclosure, accounting of disclosures, use of records in legal proceedings, and breach notification.

Comments Off on Morning Headlines 2/9/24

News 2/9/24

February 8, 2024 News Comments Off on News 2/9/24

Top News

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CMS approves the use of HIPAA-compliant secure texting platforms for sending patient information and patient orders in hospitals and critical access hospitals.

Previous guidance from late 2017 allowed texting patient information if a secure platform was used, but prohibited texting of patient orders in all situations.

HHS separately announces new provisions to the Confidentiality of Substance Use Disorder Patient Records that address one-time patient consent, redisclosure, accounting of disclosures, use of records in legal proceedings, and breach notification.


Reader Comments

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From Moon Pie: “Re: Best in KLAS. Notice that Oracle Health finished last for overall software suite?” I did notice. I don’t know if Oracle cares, but $28 billion is a lot to have spent to buy the last-place finisher. Oracle Health also took the bottom spots in the health system-owned ambulatory EHR and practice management system categories. Scores for Oracle Health’s patient accounting and patient systems were even more abysmal, bottoming out at 48.6 for mid-sized hospitals, a full 30 points behind second-place finisher Meditech. This is like when GE Healthcare took quite a few top-performing companies from first to worst after buying them. At least Oracle Health’s EHR beat Altera Digital Health’s Sunrise by a lot for large hospital EHR, although it’s a hollow victory when neither are selling much to big hospitals.


HIStalk Announcements and Requests

I published “HIStalk’s Guide to ViVE 2024,” which includes information about my sponsors that are participating. I’ll leave the collection form for HIMSS24 open a bit longer.

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I haven’t run a Donors Choose teacher photo in a while, so here’s one from Ms. P in Kansas, a school librarian who was excited to receive 10 STEM books from a reader’s donation and matching funds from my Anonymous Vendor Executive. She reports, “We are a large elementary school in a rather poor area and so it was nice to get these new books and make them available to our students to check out. We have a lot of smart, curious students and so they will enjoy these books and the hands-on projects that they can create by following the directions. We are so grateful for Donors Choose contributors. Your investment in our library is an investment in the future. Thank you so much.”


HIStalk Sponsors Named Best in KLAS

  • Agfa HealthCare – imaging universal viewer.
  • Arcadia – value-based care managed services (now Guidehealth).
  • Dimensional Insight – data and analytics platform.
  • EVisit – non-EHR virtual care platform.
  • Findhelp – social determinants of health networks.
  • FinThrive – insurance discovery.
  • Fortified Health Security – security and privacy managed services.
  • Healthwise – patient education.
  • Impact Advisors – overall IT services firm; ERP implementation leadership; financial improvement consulting
  • Meditech – acute EHR small; patient accounting and patient management small.
  • MRO – release of information.
  • Nuance – clinical documentation integrity; front-end EHR speech recognition; image exchange.
  • Optimum Healthcare IT – go-live support.
  • PerfectServe – physician scheduling.
  • Pivot Point Consulting, a Vaco Company – managed IT services; technical services.
  • QGenda – nurse and staff scheduling.
  • Rhapsody – integration engines.
  • Sectra – PACS large; PACS small.
  • Symplr – time and attendance.
  • Tegria – application hosting.
  • Waystar – patient financial engagement.
  • WellSky – personal care services and private duty nursing.

Let me know if I missed anyone or if you need sponsorship information.


Webinars

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


Acquisitions, Funding, Business, and Stock

Unlearn, which creates digital twins that allow smaller and faster clinical trials, raises $50 million in a Series C funding round.

Private Equity Stakeholder Project publishes a list of the 460 US hospitals that are owned by private equity firms. Texas is the state leader by far with 97.

Amazon will lay off several hundred people in its One Medical and Amazon Pharmacy businesses as part of a company cost-cutting campaign. Insiders say that Amazon executives want One Medical to save an additional $100 million this year. They also report tension between Amazon’s leadership and One Medical that is likely to lead to the departure of some of One Medical’s executives.

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Neura Health expands its direct-to-consumer virtual neurology clinic for headaches and and migraines to include sleep disorders, epilepsy, concussion/TBI, stroke recovery, and tremor. Members pay $300 per year for access to $189 video visits with a neurologist within two days, 24/7 care team access, and health coaching. Its clinicians can issue prescriptions in 22 states, and insurance is accepted.


People

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Ed Lee, MD, MPH (The Permanente Medical Group) joins Nabla as chief medical officer.

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Healthcare IT Leaders promotes Ben Hilmes, MHA to CEO. He replaces Bob Bailey, who will remain executive chairman.

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Mary Langowski, JD (Solera Health) joins Walgreens Boots Alliance as EVP and president of the company’s US healthcare business.

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Rob MacNaughton, MBA (Redesign Health) joins Calibrate as CEO.

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Erik Smith (Stanson Health) joins Sprinter Health as VP of enterprise partnerships. 


Announcements and Implementations

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Mile Bluff Medical Center (WI) goes live with Meditech’s AI-powered Expanse search and summarization, powered by Google Health.

DirectTrust creates a standards body for interoperable cloud fax to support identity assurance, standards-based exchange of metadata, and federated standards for security. It is looking for members from several sectors.

Companies designated as notable performers in “Best in KLAS Software & Services 2024”:

  • Epic – top overall software suite.
  • Athenahealth – overall physician practice vendor.
  • Impact Advisors – overall IT services firm.
  • Evergreen Healthcare Partners – overall implementation services firm.
  • Chartis – overall healthcare management consulting firm.
  • The population health management solution of Lightbeam Health Solutions was the most improved software product, AGS Health’s Extended Business Office Services had the most improved services solution, and EClinicalWorks was named as the most improved physician practice product.

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Elsevier launches Complete HeartX, an educational tool for Apple Vision Pro.

The National Library of Medicine posts a guest piece on AI from OHSU informatics professor William Hersh, MD, in which he calls for conducting randomized controlled trials or systematic reviews of RCTs.


Privacy and Security

Computers, telephones, and Internet remain down at Lurie Children’s Hospital after a January 31 cyberattack.

Montefiore Medical Center pays $4.75 million to settle HHS OCR charges that one of its employees stole and sold patient information over six months in 2015. That’s a lot of money and a lot of time between the event and the settlement.


Sponsor Updates

  • The Blue Bonnet Family Medicine Health and Wellness Clinic in Texas attributes a 10% increase in patients seen to its use of EHR and AI assistant technology from EClinicalWorks.
  • The Point-of-Care Partners Podcast features KONZA National Network, “TEFCA Chronicles – Konza’s Journey to Becoming a QHIN.”
  • Riverside Doctors’ Hospital Williamsburg successfully deploys Upfront Healthcare’s platform for orthopedic total joint care journeys, achieving positive results in a number of areas.
  • First Databank becomes a Silver Corporate Partner of AMIA.
  • FinThrive will present at the HFMA Revenue Cycle Conference February 28 in San Diego.
  • Health Data Movers joins the ServiceNow consulting and implementation partner program.
  • The NerdMDs Podcast features KeyCare CEO Lyle Berkowitz, MD.
  • Linus Health publishes a whitepaper, “Expanding Cognitive Screening & Assessment: A Practical Guide for PCPs.”

Blog Posts


Contacts

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

Comments Off on News 2/9/24

Health IT Market Review 2/8/24

February 8, 2024 News Comments Off on Health IT Market Review 2/8/24

Christopher McCord, MBA, CFA is managing director of Healthcare Growth Partners , an investment banking and strategic advisory firm in Houston, TX. I follow the company’s reports and invited Chris to contribute a summary of their latest analysis.

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We’ve been ardent followers of HIStalk since our inception in 2005, hanging on to every post of insightful and in-depth reporting on the health IT landscape. We can’t stress enough its value as a resource for anyone wanting to stay informed about the latest trends and developments in the industry.

To that end, we’re excited to share some highlights from our latest “Health IT Market Review.” This report delves into key areas like mergers and acquisitions, investment flows, and market valuations, offering data-driven insights gleaned from our own experience and research. We believe it’s a valuable resource for anyone looking to understand the current state of the health IT market and its future trajectory.


Key Takeaways

  • M&A activity rebounds. Deal volume surpasses pre-pandemic levels, up 50% in Q4 2023 as compared to Q4 2022 and trending up in January, but valuations remain below historical norms, ~25% lower than the pre-COVID average and 57% off their COVID peak (based on multiples of revenue).
  • Investment declines. Investment in health IT continues to decline, falling to $743 million in January 2024, levels not seen since 2017.
  • Public market struggles. The number of public health IT companies has contracted from 68 to 53, and 13 are at risk of de-listing due to non-compliance.
  • Future outlook. Despite the challenges faced in 2023, positive signals abound, mostly fueled by anticipated decreases in inflation and interest rates.

First, we’ll attempt to describe how we, the collective health IT enthusiasts, got here in a few sentences.

The past decade in health IT was shaped by a potent cocktail of regulatory and economic forces. Starting with the American Recovery and Reinvestment Act’s HITECH Act, which incentivized Electronic Medical Record (EMR) adoption, and followed by the Affordable Care Act, significant regulations fueled an initial boom. The 21st Century Cures Act later evolved Meaningful Use into a more dynamic data platform, now laying the groundwork for AI integration.

Simultaneously, a decade of near-zero interest rates and quantitative easing inflated the US money supply, creating an environment where a generation of professionals became accustomed to expansionary policy and rising valuations. The COVID-19 pandemic further amplified these trends, dramatically validating the investment thesis in digital health across sectors like telehealth, mental health, and drug discovery.

The pandemic’s vivid demonstration of health informatics’ value undoubtedly contributed to a period of heightened investor confidence in the sector. It’s no wonder investors felt invincible.

The current market presents a dynamic interplay of forces, largely a byproduct of the complex macroeconomic and interest rate environment. While health IT M&A activity has witnessed a surprising resurgence, now exceeding pre-pandemic levels in terms of volume (but not value), new investments still show a declining trend. Valuations remain below pre-COVID levels, but are rebounding after hitting a floor in the first half of 2023.

Where does it go from here? The following charts and commentary delve into this critical unknown, leveraging data and experience gleaned from our own journey, to help you piece together your own market mosaic.

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After hitting a Q4 2022 nadir, 2023 US health IT M&A and buyout volume rebounded to levels higher than pre-COVID. The last quarter of 2023, with 84 transactions, marked a 50% surge compared to Q4 2022. The upward trend was maintained in January, with 30 US health IT transactions during the month, annualizing to 360 deals versus 319 in 2023.

While M&A volume has rebounded, M&A deal value sits at the lowest levels since 2017. This is attributed to a confluence of factors: rising capital costs, broader macroeconomic concerns, a tech-specific valuation reset, and a more cautious approach by investors – all concerns that are showing signs of dissipating.

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The following is what we think is the most important piece of data – valuation trends of health IT M&A and buyout transactions. The HGP Health IT Transaction Index sits at 3.6x revenue, a 22% discount from its pre-pandemic 4.6x average and a 55% discount from the peak of 8.1x seen during the COVID hype cycle. Despite the valuation gap, there are positive signals in both the data and macroeconomic picture. Notably, the standard deviation of transaction valuations has widened over recent months, meaning that more transactions are trading at both higher and lower multiples than the average, which is a promising signal that the average has room to move up.

The recent wider band of valuations reflects healthier market activity and perhaps and revival of traditional SaaS transactions, while the lower band generally represents the sale of distressed assets and divestitures of prior acquisitions. For those unfamiliar with valuation multiples, we’ve added an explanation at the end of this piece.

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Enterprise SaaS (multi-industry, not pure health IT) currently trades at a discount to pre-COVID averages, trending down from 8.8x to 6.5x forward revenue. The current 26% discount is even more staggering compared to its COVID peak of 18.8x, representing a 66% discount. The overarching question weighing on the market is whether valuations will revert to the mean and the definition of that mean. Low interest rates raised valuations, high interest rates lowered them, and the general expectation is that valuations will find the reversion to the mean as interest rates return to the FOMC’s “Neutral Rate”, generally defined as 3-3.5% (compared to February 2024’s 5.25-5.5% rate).

Recent transactions signal that investors see opportunity at these valuations. For those looking for points of reference for health IT valuations, Thoma Bravo’s acquisition of Everbridge, a critical event and communications vendor, is a legitimate comp. On February 5, Thoma Bravo announced a $1.5 billion go-private of Everbridge. The purchase price implies a 3.2x and 15x multiple of forward (2024) revenue and EBITDA, respectively, for a company with a <5% growth rate, 73% gross margins, and a 22% EBITDA margin, noting that the business traded for over 20x revenue during the post-COVID euphoria and posted growth rates 30-40% at that time. While today’s investors may be valuing profitability more over growth, this valuation would indicate that growth matters.

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Going deeper into valuation, HGP keeps tabs on the distribution of revenue and EBITDA multiples for M&A and buyout transactions, summarized in the following charts since 2017. Notably, while the COVID period represents 25% of the period (which we define as Q3 2020 – Q1 2022), this period represents 37% of transaction multiples, a reflection of the outsized share of transaction activity that occurred during this time. HGP believes the exclusion of the COVID period best represents valuations in the current market environment, which is described in more detail in our full report.

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Investment in health IT continues to slide, falling to levels not seen since 2017. Activity fell further in January 2024, with $743 million ($8.9 billion annualized) invested in 21 companies (252 annualized) in the US. The median investment round declined from $20 million in 2021 to $11.5 million in 2023, still above a pre-COVID average of ~$8 million.

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Not surprisingly, the COVID cycle saw the rise and fall of $100 million+ investment rounds. Despite the decline, the number of mega-rounds is higher today than pre-COVID, likely a result of larger private equity funds that were raised during the COVID cycle.

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The health IT public market scene has undergone major transformations since the end of the almost three-year drought of health IT IPOs that ended in 2019. Following a surge of activity that was supercharged by the rise in SPAC popularity in 2021, the market reversed course, almost inversely mirroring the 2019-2021 flurry of new entrants with seven de-listed companies in 2022 and 10 in 2023. Of the remaining 53 constituents, 13 trade below or dangerously near $1, risking de-listing due to noncompliance.

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We believe many emerged from this year stronger and nimbler, and many are encumbered by challenging capital structures because of recent market dislocations. Inflation and interest rates are projected to fall, and valuations may benefit from money supply to risk assets. Private equity dry powder sits at all-time highs at $2.5 trillion globally, and money market funds are sitting on a record $6 trillion in assets. These funds will likely be drawn down as rates fall, stimulating demand and supporting valuations for both private and public equities, with further stimulation as the credit markets get back into swing. Despite stubborn inflation, a presidential election year, and uncertain geopolitical backdrop, the economic and overall picture in the US is more positive and stronger than this time last year, injecting a much-needed dose of confidence into the market for the year ahead.

About Valuation Multiples

Compared to complex discounted cash flow methods, the most common way to value a business relies on revenue and EBITDA multiples. These multiples offer a standardized way to compare companies based on their financial performance. They’re valuable for comparing businesses, assessing potential investments, understanding industry trends, and negotiating deals. Investors compare companies to multiples derived from market data of publicly traded companies and similar recent acquisitions in the same industry.

These “multiples” are essentially valuation benchmarks. They’re applied to a company’s revenue or EBITDA to estimate its value. While popular for its simplicity and market data reliance, this method requires finding truly comparable companies, which can be challenging due to differences in size, maturity, and market position. Additionally, several factors beyond these multiples, like revenue models, growth potential and customer retention, can influence valuation. By analyzing these factors and their impact on multiples, investors can gain valuable insights into a company’s relative value and make more informed decisions.

Comments Off on Health IT Market Review 2/8/24

EPtalk by Dr. Jayne 2/8/24

February 8, 2024 Dr. Jayne 3 Comments

I appreciate the fact that my health system of choice promptly shares visit notes with its patients. I’m less appreciative, however, of the fact that some physicians continue to refuse to follow documentation best practices, which have been designed for patient safety and improved patient experience.

As always, I dutifully completed the electronic check-in process well in advance, verifying my insurance coverage and ensuring that my pharmacy was up to date. When bringing me back to the exam room, the first thing the medical assistant asked for was my pharmacy information. She didn’t log into the EHR using the workstation in the room, but was instead working from a sheet of paper.

It would be one thing if the paper had my information printed and she was simply verifying, but this didn’t seem to be the case since she asked me to provide the address and phone number. I politely declined, stating that I had just updated them in the EHR the day prior.

I’ve been to this office many times before, and the physician has never used the EHR in the room. She uses a scribe and is good at verbalizing the exam so that the scribe can capture it. However, the practice continues to use templated documentation that doesn’t reflect the work that was done during the visit. My most current documented a “comprehensive Review of Systems” which was not performed and included a reference to “see scanned document completed by patient” which doesn’t exist, since I certainly didn’t complete one. I wonder if the physician understands that documenting work that wasn’t actually done is fraud.

As always, I noted my concerns when the inevitable Press Ganey survey arrived, so hopefully someone will see it and take action. In the mean time, I’ve decided to leave the practice, not only due to this, but due to poor appointment availability and annoyances with the billing processes, such as refusing to collect your co-pay at the time of service, leading to more work on my part down the road. This practice is crying out for process improvement work, but it’s unlikely that will commence any time soon.

From Public Health Nerd: “Re: the recent Senate hearing on social media’s impact on youth mental health. Here’s some data for your consideration.” The statistics provided included a dramatic increase in teens who report “persistent feelings of sadness or hopelessness,” especially among girls. There has also been an increase in diagnoses of depression and increased suicide rates among teens. Although rates of social media use correlate with these changes, it’s difficult to prove causation, especially considering all the other changes happening at the same time, including community violence, rising income disparities, racial tensions, global conflict, and high-conflict political processes. More studies are definitely needed.

From Coffee Klatch: “Re: return to office programs. Keep up the good work exposing them as the power grab that they are. If companies want people to come to the office without complaint, they need to make it a place people want to visit. Nearly all of my colleagues use travel mugs, which don’t fit into the new coffee makers that our company purchased. I tried to bring a ‘shortie’ travel mug, but it was too wide. We all end up using paper cups to transfer coffee to our mugs. So much for the company’s commitment to sustainability initiatives, since we’re creating more greenhouse gases driving to the office and now using a bunch of paper cups we didn’t need before.” I’m sure some people thing this is a small thing, but it’s just one more example of how decision makers who are out of touch with their workforce are contributing to employee resentment and potential turnover.

I’m sure no one was surprised to hear the news of Amazon’s planned job cuts at its One Medical and Amazon Pharmacy units announced earlier this week. Executives who may have had lesser degrees of healthcare experience prior to entering our industry often find out quickly that it’s much harder to get those big wins and revenue bumps than they were used to with their previous employers. Amazon promises to continue to hire providers for frontline care delivery, but it looks like they’re primarily focused on building their midlevel provider workforce rather than hiring physicians.

I’ve had several patients follow up with my practice in recent months after receiving interesting diagnoses from online practitioners who conducted asynchronous evaluations that resulted in what was ultimately a misdiagnosis. Sometimes a picture is worth a thousand words, but other times you really need to have a conversation with the patient to fully understand what is going on. Our society puts the responsibility of making sure their provider is high quality largely on the patient, which is hard to do when you’re placed in an anonymous queue and have no idea who you are going to see until they are actually participating in your care.

Last week was Groundhog Day, when many in the US traditionally look towards a rotund woodland mammal for predictions on upcoming weather. Since reaching a point in my career when I have the flexibility to provide behind-the-scenes medical support for events and gatherings, I tend to keep an eye out for how that plays into any large happening.

This year, officials predicted that up to 30,000 people might try to see the venerable Punxsutawney Phil, gathering in the cold dark morning at Gobbler’s Knob, Pennsylvania. Planners had approximately 20 professionals from five emergency response organizations standing by. In the past, problems have included hypothermia (not unexpected in years when the wind chill has been well below zero), cuts and scrapes, medical emergencies from patients who didn’t take their medications due to the early start of the event, falls, and even the occasional heart attack. There have also been issues with intoxication, even given the typical 4 a.m. arrival for some attendees. I guess it’s never too early to get the party started when groundhogs are involved. Props to Allegheny Health Network and Punxsutawney Area Hospital for their onsite support.

Does your area have a local groundhog, and what was its prediction? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Larry Kaiser, Chief Marketing Officer, Optimum Healthcare IT

February 8, 2024 Interviews Comments Off on HIStalk Interviews Larry Kaiser, Chief Marketing Officer, Optimum Healthcare IT

Larry Kaiser is chief marketing officer of Optimum Healthcare IT and its sister company Clearsense.

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Tell me about yourself and your work.

I have been in healthcare IT for just over 20 years now. I started with Keane, which was acquired by NTT Data in 2010. They sold two EHRs. I started as the RFP manager and then moved up to running the marketing department. In 2016, I shifted to Optimum Healthcare IT, where I launched the marketing function from the ground up, built that, and helped grow the organization to about $160 million in revenue. I left Optimum to go to our sister company Clearsense for a couple of years. Now I am back at Optimum as we look at the next level of growth in the organization that is not centered on core EHR services. That includes ServiceNow services, Workday staffing and implementation, and cloud migration and cloud services.

How would you describe a marketing organization to someone who doesn’t know much about it?

Marketing is something different every single day. That’s what makes marketing interesting. That’s what makes it exciting. 

In the case of Optimum, where I was building an organization, I could look back on my experience at Keane and NTT Data over 10 and a half years. I saw how things were done from a corporate perspective and from a divisional perspective, how different people did different things, and learned from that. When you’re building a marketing department from the ground up, you have lots of examples of what worked and what didn’t work. You need to start very basic.

When I joined Optimum, it had a logo and a website that was built on the 2012 version of Drupal and had never been updated. This was in 2016. The first thing we had to do was to look at our public-facing presence and determine what we wanted to be. That started all sorts of internal conversations with many subject matter experts on how we should portray ourselves, the services that we offer, and start molding those together in a fashion that had never been done.

We worked on the website and the website content, getting it to a modern platform. Then we focused on pieces of collateral and slowly worked our way through that. Then we worked on thought leadership and exploring different types of white papers and case studies to allow us to show that we know what we’re talking about and to promote the successes that we had as an organization. From there, it goes off into many different areas, such as partnerships with industry organizations such as CHIME and HIMSS.

It’s really just understanding and taking an inventory. The marketing plan I put in place focused on several things across the board, looking through all of those, understanding from an organizational perspective and having all of those conversations, and then taking all that knowledge and executing it. Every day, I was doing something different. Having never been on the services side versus the product side, every day was an education for me, and I would learn something every single day. That allowed me to work through this process methodically to strengthen the brand position, promote that thought leadership, fuel that demand and lead generation, and ultimately educate the employees on what we would be doing  to grow the organization.

Have shortened attention spans changed the way that you create content?

Analytics plays a big role in that. If you talk to any marketers, whether it’s healthcare or any space, it’s all about the analytics. If I’m producing articles for a blog that will be mentioned on LinkedIn, X, or HIStalk, I have the necessary coding within those URLs to understand how many times it’s being clicked and who is looking at it. That helps drive the kind of content that we create. If we create infographics and find that traffic to those pages, clicks, and downloads are high, we will shift our attention to that.

White papers have traditionally been that lone piece of gated content that an organization will put up on their website. The challenge with that is when people fill out a form to download it, they will put Mickey Mouse for a name or a fake email address, because probably nine times out of 10, the form doesn’t check the email address and just opens the PDF for any entry. Emails sent by your marketing automation bounces back, but that person has already obtained that piece of content. It’s a challenge, in this day and age of cybersecurity threats and people’s phones and emails being hacked.

Social platforms are doing different things. LinkedIn offers newsletter capability. At Optimum, we have found that over the last couple of years, fewer people are filling out a short form that asks for name, organization name, and email address to subscribe to our thought leadership in their inbox. People don’t want to give their personal information.

This week, we launched Optimum Pulse, our new newsletter. That goes out to our 55,000 followers, and we’re up to 4,200 subscribers. Our strategy on our website now is that instead of asking you for your personal information to subscribe, we will put a link out for people to subscribe to our content on LinkedIn. Each week, we will publish a newsletter with a little preview and a link to our website. That link will be appropriately tagged for tracking. That will give us insight into what pieces of content are working.

From a white paper perspective, we haven’t published one in several years, for similar reasons. We didn’t have the bandwidth, because we’ve been so busy. They really weren’t being downloaded too much. We shifted to more case studies, blog articles, and when we had the bandwidth to do it, more video. We did lots of spotlights on some of our Optimum CareerPath students, and that has resonated in the market. Our target market of CIOs for the Optimum CareerPath program likes to view those videos of the people who have gone through and have had success.

It’s a challenge and it’s a constant struggle. It’s a constant monitoring of all those analytics to figure out what content your audience is reading.

How do you differentiate between brand awareness versus lead generation?

First and foremost, I don’t think brand recognition ever really goes away. That’s always going on. I’m of the belief that your public-facing website should be touched at least once every 18 months to update the look and the feel of that website to keep it fresh. That’s something that we’re doing at Optimum right now.

From a lead generation perspective, or demand generation perspective, for our basic core EHR services, our brand is recognized so much that we don’t really have to do demand generation in that space. People come to us, and that’s fantastic. But in the new areas of growth — ServiceNow services, Workday implementation and staffing, and cloud migration services – we are having to start from the ground up and focus on demand generation programs and developing those, because we’re not known for those things right now. That has been ongoing for the last several months.

For our ServiceNow practice, we hired a specific firm that specializes in ServiceNow demand generation. They are helping us develop the necessary content to start doing that demand generation.We will learn from that and probably do a little duplication of what they’re doing for the other practices as well. It’s definitely a shift as the organization grows into new areas and needs to focus on demand generation for them.

I’ve noticed on LinkedIn some health tech folks whose title involves “growth marketing.” How is that different from marketing in general?

That’s a toughie right there. A growth marketing individual is someone who is 100% focused on doing the B2B strategic, data-driven approach to building a pipeline in conjunction with your sales team. I’ve seen that same title a lot out there as well.

At Optimum and Clearsense, we have not necessarily had that individual. The marketing department is working with sales to generate the pipeline, qualify the leads, and make sure that everybody is doing what they need to do to move that opportunity through the buying cycle of the pipeline. Every organization will have a different cycle it goes through. I think it’s an extension, similar to saying that you’re a social media marketer or an influencer. It’s a small piece of the overall picture. It’s probably more like an inside sales rep, ultimately.

How do companies plan their involvement with health tech conferences?

I’ve been doing HIMSS for 20 years. For 16 or 17 of those years, we had one conference in healthcare IT, and that was HIMSS. If you didn’t go to HIMSS, you really weren’t relevant in the space. 

Because of COVID and how some things were handled, CHIME and HIMSS were no longer associated, and they went off and did the ViVE conference. The second year was much better than the first year. Clearsense went into that conference in 2021 in a rented booth from them and we really didn’t know what to expect. As a young organization promoting our SaaS product, we didn’t know who was coming. It was a little bit smaller, but year over year, it grew. Having CHIME associated with it brought our target market to that.

HIMSS was really struggling. I think that had a lot to do with how they handled the 2020 show. It wasn’t until last year when, all of a sudden, HIMSS appeared to be relevant again. At Clearsense, we had no idea what to expect at HIMSS last year. We were very pleasantly surprised. Our booth traffic was just as robust as it was at ViVE, to the point that we had a wait list to get demos of our product.

Clearsense is a product company. We are heavily invested in ViVE from various sponsorships. We built our own booth because financially it made more sense to build it and store it than to rent a booth every year. HIMSS is less of an investment, but I could see that investment growing in the future if the trend of growth and recovery for HIMSS continues.

As to HLTH, I have never personally attended. We explored the possibility of exhibiting at HLTH this year. I sought the opinions of many people. The folks at HLTH and I are friendly. They shared the breakdown of attendees. It’s more tailored to provider and payer now, where the angel investors aren’t as prevalent. But then when I have conversations with people, they tell me the exact opposite from their attendance. We chose not to invest in HLTH.

We are a main sponsor of ViVE, but we don’t have a booth. We have a pretty hefty investment in ViVE. Several years ago, we were no longer a HIMSS sponsor, but with these new areas of growth, it’s an area that I think we need to start investing in again because all the players are at HIMSS, such as AWS, ServiceNow, and Workday.

For both of our organizations, ViVE is number one, HIMSS is number two, and HLTH is a distant third, just based on the attendance.

Have you received any early indication of how the HIMSS conference will change now that Informa Markets is running it?

It’s too early to tell. The running joke in the industry is that maybe the aisles will have carpeting again this year.

Most of the HIMSS people that I was friendly with have moved over to the new company. In the questions I’ve been asking and the conversations that I’ve been having, we won’t see major change in HIMSS until 2025. What that change is, I don’t know. They haven’t really said what it will look like. Apparently HIMSS is still dictating the education at the show and Informa is doing the show itself. We’re all sitting back and waiting to see how it’s going to change.

HIMSS24 is too close to the acquisition to make changes for this year. It will be interesting to see what it becomes and whether they can return it to its glory of many years ago. I’m not going to say that it’s not relevant now, but they are playing second fiddle to ViVe now, unfortunately.

Companies reduced their spending to weather the investment and economic downturn. How will they restore the marketing function as conditions improve and companies have to reestablish their competitive position?

2023 was a tough year in general for healthcare IT companies, whether you sell services or products. Historically, marketing is usually the first to go and the last to get rehired. Organizations that had a strong financial footing may have done some some RIFs, some layoffs, but they didn’t eliminate the department across the board. I have seen some organizations cut their entire marketing department, which Is interesting to me because you still need to maintain your brand. You still need to maintain the marketing activities that you were doing in order to grow pipeline. Marketing and sales go hand in hand.

This year and going into 2025, I think you will see a slow reinvestment in marketing. A number of articles from well-known publications have said that from their research and conversations, providers are opening their purses up again. When providers start buying again, an organization has to have marketing to successfully engage with them. Probably by the middle of this year, I think you’ll see an uptick in healthcare IT marketing expenditure to bring teams back in. It will happen methodically. An organization that cut everybody will probably bring in a leader first and have that person assess where they were before, where they are now, what needs to be addressed, and what roles need to be brought in. Then you’ll see a trickle down effect of them slowly ramping up their marketing departments again.

I’m very much plugged into the healthcare IT marketing organizations. I can open up my my browser to X and I have a chat with about 15 other healthcare IT marketing folks from various organizations. We have a chat every day, and just this morning, someone said their entire team was let go. We are seeing that a little bit, but by mid-year, you will see a real push to reestablish those teams.

Comments Off on HIStalk Interviews Larry Kaiser, Chief Marketing Officer, Optimum Healthcare IT

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