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HIStalk Interviews Erkan Akyuz, CEO, Lyniate

September 21, 2022 Interviews No Comments

Erkan Akyuz, MS, MBA is president and CEO of Lyniate of Boston, MA.


Tell me about yourself and the company.

I’m a software developer by trade. I started in the PACS world, the imaging world, at a small company called Mitra Imaging in Ontario, Canada. I was a developer on a product called Mitra Broker, then did some display work, and from there I went into management.

We started Lyniate as a carve-out of Rhapsody, our flagship product from Orion Health in New Zealand, in November 2018. Shortly after that, six months or so, an opportunity came to merge Rhapsody with Corepoint Health out of Frisco, Texas, and we did that merger. A primary driver behind the merger was being able to provide a more full solution to the market in all the segments, with the ease of use of Corepoint and the extensibility and the multiple platform strength of Rhapsody.

We’ve been running the company in that mode for a while. Earlier this year, we also merged NextGate’s enterprise master patient index solutions into the portfolio. In late July, we also merged CareCom, which is a terminology services provider out of Copenhagen, Denmark, into Lyniate.

What is the current state of interoperability and what challenges remain?

When I started as a developer on Broker in the late 1990s and early 2000s, we had an interoperability challenge. As developers, we used BizTalk from Microsoft. Then Orion came up with Rhapsody. So even 22 or 23 years ago, there was a core technology issue about interoperability and being able to exchange messages between EMR and the PACS systems and the modalities.

In the years that followed, I would say that thanks to companies like Corepoint and then Orion Health, the problem of interoperability has almost gone away. Even though HL7 standard adoption, or its implementation in a standard way, by healthcare was challenging, companies like Corepoint companies and Orion Health provided solutions to make integration and interoperability more efficient.

Fast forward 20 or 25 years. We still have interoperability challenges. They are less in technical nature and more semantic in being able to help people interoperate with each other. Not only to send the right version of HL7 and then receive the right version of HL7 back, but to help a doctor prescribe a prescription accurately. Then on the pharmacist side, to receive that prescription and administer the right pills so that we minimize mistakes and we improve efficiency.

Interoperability issues are much, much less technical in nature. I don’t think that we have the issues of being able to exchange data now, It is more of a multi-organizational workflow. We hear about data blocking or a site that doesn’t want to share data, but that’s an easy way out by blaming the vendor, blaming the EMR vendor, blaming the hospitals, etc. And at times, our healthcare ecosystems — from payers to providers, multiple payers to multiple providers — introduce such complexity that one vendor, one provider, cannot really solve it.

In my view, we need, as a nation or as a globally, better motivation to make data available to the systems without any hassle, without any struggle, so that it can be used in care settings where the data is not produced. If the data is produced in an acute care setting but now needs to be accessed in a social care setting, that should be easy, without many bottlenecks.

Unfortunately today, we sometimes see legal, sometimes affiliation-related, bottlenecks. A social care worker will not be able to get access or even identify where the data that they need for the patient, for the baby or the person they are providing care for, is available, how they can find it, and how they can access it. We need to do better from every angle, every stakeholder in this picture – vendors, providers, and payers — to create a federated environment by providing our data, making it available to everyone who wants to access it. From the consumer side, we need to make it easier to consume this data from federated, basic data suppliers.

What interoperability needs are coming from payers and life sciences companies?

When it comes to technical connectivity, they are able to access the data. But they don’t understand how the data is stored and structured as well as a provider. If you’re a provider, you developed your EMR structure and made decisions about how to store patient data, so you have a very good idea of how it’s done. When you access a different provider, you can’t figure out how to navigate through it. If you are coming in as an outsider, if you have never been a hospital, if you never seen an EMR, understanding this data structure is not that easy.

You are interested in one bit of information. Let’s say you have a clinical surveillance system. You would like to monitor certain diseases, and they are spread in the hospital. Let’s say you are interested in getting a notification every time a patient is diagnosed with sepsis. In today’s world, in order to get that notification, an external party — let’s say in this case, life sciences or device companies — need to have good understanding of how to find the data and create an alert so they can get a notification. Our EMR systems were not designed to create those alerts. They don’t understand it as much.

We need to make accessing and consuming data much easier than it is today. We use money exchange, like ATMs, as our goal internally. Lyniate will be done when exchanging healthcare data is like paying an electric or gas company bill, riding in an Uber, or using Venmo. There are no barriers. You can pay someone independent from what that someone does, in multiple formats — check, cash, Venmo, PayPal, Wires, Zelle, or whatever. These different protocols and mediators are able to move currency. It’s so easy that we don’t even know how gas company accesses that money, but they do it. Unfortunately in healthcare, when a life sciences company is trying to get a imaging data, sepsis data, or clinical trials data, they need to have a deeper understanding of where that data is and how they can get it.

SWIFT’s [Society for Worldwide International Financial Telecommunications] currency exchange protocol is an example. We need to be able to provide services like SWIFT to the multiple providers of that currency — with healthcare data as the currency, and multiple consumers of that currency — without being held to understand too much in the intrinsics of how I keep the cash, how you keep the cash, and how we are going to use it. We need to bring it to the fidelity of the healthcare data and make that easily accessible, independent from the affiliations between organizations. We need to implement a SWIFT-like environment to manage those transactions. I don’t think we are very close to it yet.

Who would lead the charge for a SWIFT-type exchange in healthcare?

I think it has to be a shared effort, but bringing a group together around that solution is going to be difficult. As an example, I really admire how RSNA succeeded as an organization in providing leadership, and then came DICOM. I started my career as a developer in the DICOM world. RSNA came up with the IHE [Integrating the Healthcare Enterprise] idea. Their thing was, we are not going to reinvent DICOM. We are not going to reinvent HIE. But we are going to bring the parties together who are stakeholders to use standards when it comes to exchanging data.

I was a technical representative of my company. I would go to Chicago once a year, where we would spend a week around the table with different vendors and different providers. We would discuss, how are we going to do patient information reconciliation? Let’s say the modality acquired this study and then patient information changes. Which bits and bytes of the standards are going to be used? How we are going to populate it?

IHE and RSNA led this effort to create these integration profiles, saying that if this is a workflow, then all the EMR player actors are going to do this and all the modalities are going to do that. Representatives from vendors, providers, and standards worked together to define how that integration profile will do the job. We changed our code in Connectathons, we tested all that stuff, and it worked.

Today, when you look between the modalities, PACS, RIS, and whatever systems are doing their job, then exchanging data and who’s going to do what, quite honestly, we don’t. But now it’s a system. Every year we have Connectathons. Every year we are testing integration profiles.

They need something similar on the EMR side. Let’s say HIMSS can take this leadership since they’re a strong player. They need to bring life sciences players, device manufacturer players, EMR vendors, payers, and anyone and everyone who is interacting with patient information. How do we do this? What is the integration profile? Are we going to use HL7, FHIR, or DICOM?

Let’s say there’s an integration profile called Accessing Patient Information for Clinical Trials. The life sciences players should define what they need, how they want to use it, and what format they want to consume. The EMR vendors can describe how they can access the data. Providers will offer the legal structure they require.

It needs to be a joint effort and organization. HIMSS may be a good one, or it could be the American Hospital Association. An organization needs to take the lead to pull these players from the different corners and bring them together for a common cause. IHE is a stellar example of how it can be done, and right now, IHE profiles are working like SWIFT.

I did a little bit of research about SWIFT, asking why these competing banks don’t worry about losing – or let’s say “leaking” – customers to a different bank. We always hear that patient leakage makes providers not want to share their data to protect their customer base. I learned that SWIFT is a legal entity and all its shareholders are the member banks who are using SWIFT for money exchange. Every time then there’s a SWIFT exchange, banks pay a transaction fee, and at the end of the year, they basically receive a proportion as dividends. The bank that contributes the most funds into SWIFT receives the most funds from SWIFT at the end of the year.

So in the bank world, they created the SWIFT organization and they own it. There are no third parties. In healthcare, TEFCA may be a good example. Maybe we create an organization like that and mandate it jointly by a membership, a paying membership by the life sciences, payers, and saying that we want this organization to be the SWIFT of healthcare.

Where do you see the company going in the next three or four years?

We put a vision in front of us to implement an infrastructure layer that helps not only data exchange, but also helps manage the identity of data. That’s why we merged with NextGate. Then also to help translate the content of the data so that the consumer of the data doesn’t need to worry about the format the data was stored in and the data itself will be translated for them in the unit that they would like to consume it. We also want to expand it even more than being able to store that data so that our users and other healthcare IT providers like the vendors can access this infrastructure as a platform that they can use to exchange data. Then make sure that the data that they are exchanging is trusted — coming from a trusted party and belonging to the person that they believe that it belongs to — and then interpreting it to the format that they would like. If they would like to also store it more in perpetuity, they can also store it.

Our vision is staying as an infrastructure provider for healthcare interoperability to provide a more multifaceted features, such as what we did with Rhapsody and Corepoint in data exchange, identity management and identity assurance with NextGate, and terminology mapping services in and expanding that even to the coding services with CareCom. We will continue to invest in them and expand the infrastructure based on what we are hearing from our customers.

Morning Headlines 9/21/22

September 20, 2022 Headlines No Comments

UnitedHealth Wins Court Approval of Its Change Healthcare Takeover

A Washington federal judge clears the way for UnitedHealth Group to acquire Change Healthcare, rejecting a Department of Justice lawsuit that attempted to block the deal.

Internal memo: PillPack founders will leave Amazon at the end of the month

PillPack founders TJ Parker and Elliott Cohen announce that they are leaving Amazon, which acquired the online pharmacy in 2018 for $753 million.

McKesson Signs Agreement to Acquire Rx Savings Solutions

McKesson will acquire Rx Savings Solutions, which offers an app that recommends cost-saving prescription changes to members, for  up to $875 million in cash.

News 9/21/22

September 20, 2022 News 7 Comments

Top News


A Washington federal judge clears the way for UnitedHealth Group to acquire Change Healthcare, rejecting a Department of Justice lawsuit that attempted to block the deal. DOJ had argued that the acquisition would give UnitedHealth’s insurance business access to the claims data of competing payers, which would increase healthcare costs.

The acquisition price is $7.8 billion versus the $13 billion that was reported when the acquisition was first announced in January 2021.

The approval requires Change Healthcare to divest its ClaimsXten claims payment and editing software business to TPG Capital for $2.2 billion.

UnitedHealth will merge Change with its Optum Insight analytics and consulting business.

Reader Comments

From Bonedigger: “Re: executive coaching. What advice do you have to make that a career?” My advice would be to choose something else, at least based on my experience with a few health IT folks who tried the executive coaching biz and failed quickly. Senior-level people may overestimate the value of their experience in unrelated work such as consulting, teaching, and coaching, but many organizations prey on their vanity by selling them coaching education and certifications. They still have to find customers (which is the hardest part, like in all businesses), develop the right chemistry, and do good enough work to be retained. The fact that few of them hired coaches for themselves isn’t much of an endorsement.

HIStalk Announcements and Requests

A memory of a long-ago health IT executive sent me back to Vince Ciotii’s remarkable HIS-tory series, which turned into several hours of “where are they now” Google searches of the folks he mentions in it. I interviewed Vince for the last time in September 2019 and asked him what his epitaph would say, and he replied that the series was his proudest work in 50 years as a health IT executive. Vince’s own final chapter was written upon his death in September 2021.


September 22 (Thursday) 1 ET. “ICD-10-CM 2023 Updates and Regulatory Readiness.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, marketing director, IMO; Julie Glasgow, MD, marketing manager, IMO. The yearly update to ICD-10-CM is almost here. Prepare your organization for a smooth transition, and avoid any negative impacts to your bottom line, with an in-depth look at the upcoming changes. Listen to IMO’s top coding professionals and thought leaders discuss the 2023 ICD-10-CM coding changes. This webinar will review additions, deletions, and other revisions to the ICD-10-CM code set and how to make sure you get properly reimbursed.

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

Acquisitions, Funding, Business, and Stock


Search firm investor Starfish Partners acquires Direct Recruiters, which specializes in staffing solutions for a variety of industries including healthcare IT and life sciences.


Online prescription startup Peak stops offering its ketamine-based psychedelic therapy for drug-resistant depression and anxiety to new patients, and will cease operations at the end of November.


Enterprise imaging company Intelerad Medical Systems acquires image exchange vendor Life Image for an undisclosed sum. Intelerad now boasts one of the largest image exchange networks, having acquired competitor Ambra Health last year.


PillPack founders TJ Parker and Elliott Cohen announce that they are leaving Amazon, which acquired the online pharmacy in 2018 for $753 million with little impact since.


McKesson will acquire Rx Savings Solutions, which offers an app that recommends cost-saving prescription changes to members, for  up to $875 million in cash. Founder and CEO Michael Rea, PharmD started the company in 2009 after working as a pharmacist for Walgreens and OptumRx.

Transcarent launches a medication price transparency program to give self-insured employers more control over their prescription benefits.


The 28-year-old founder of digital shopping cart vendor Bold – who quit the CEO job in January 2022 days after a fundraising round that valued the company at $11 billion – will become founder and CEO of Love, a Kickstarter-like crowdsourcing and clinical studies platform for homeopathic products. The company will sell digital tokens, which allows investors to vote on which studies to fund. Ryan Breslow – who avoids meat, gluten, caffeine, alcohol, supplements, and after-dark lights and electronic screens – says, “I think my superpower is that I’ve never done health before.”


  • Albany Med Health System (NY) will implement Epic in 2024.
  • Children’s Healthcare of Atlanta selects real-time location systems software from Vizzia Technologies.
  • The VA renews its VistA-integrated dialysis EHR contract with DSS in a five-year, $27 million deal.


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Orb Health names Lisa Simon, CPA (Monongalia Health System) CEO; Gordon Jaye, MS (Aspirion) SVP of transformation and patient engagement; and Eric Van Portfliet (Firstsource) CTO.


William Cavanaugh, MBA (Lyniate) joins Concord Technologies as president.


DMEscripts hires John Brady (Anthem) as CEO.

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Global Healthcare Exchange promotes Tina Murphy to president and CEO. She replaces Bruce Johnson, MBA, who will become executive board chair.

Announcements and Implementations

Johns Hopkins Medicine’s Office of Telemedicine announces that it has conducted 1.5 million telemedicine visits with 420,000 patients since March 2020. The office plans to expand emote patient monitoring capabilities to include ambulatory and complex care and the availability of virtual consults between Johns Hopkins facilities.


West Cecil Health Center (MD) implements Bluestream Health’s virtual care platform-as-a-service.

Verato launches a Universal Identity platform that consists of Verato Patient Journey and Verato Provider Data Management. 

Epic implementations in Denmark and Finland are “still troubled” years after go-live, according to authors of an article in the International Journal of Medical Informatics who say that usability has not been optimized, clinical time to perform tasks has increased, and clinician dissatisfaction is at 32%. The authors noted these issues, which are common in large implementations:

  • Project participants failed to pay attention to the extent of user changes that were involved and issues raised in Denmark’s first go-live were not addressed before the second.
  • Grand expectations are needed to generate project enthusiasm, but may gloss over real-life concerns when realities intrude.
  • Tax-supported Nordic healthcare does not require billing insurers, but Epic’s US-centric clicks and worfklows that support it could not be configured away. Translation of user interfaces from English to Danish and Finish also caused problems, especially with search functions.
  • Both countries spent years configuring Epic for their requirements, with Danish regions focusing mostly on standardization and the Finnish region on local preferences. The authors say that “neither approach has resulted in a well-liked system.”
  • The EHR rollouts, which increase documentation requirements, created clinician stress. The plan to lay off medical secretaries to save money and then transfer their documentation work to physicians was a key issue.
  • The authors recommend following up promptly with users who report problems, assume that a return to productivity will take at least 3-12 months and likely longer in these countries, and be cautious about changing work processes that clinicians oppose.


A large group of expert authors proposes to reduce deviations in best-practices patient care by using EActions, which are validated expert systems that are designed to manage a specific clinical task or condition by considering existing patient information to the point that no clinician review is required. The authors distinguish between using such closed-loop technology to make evidence-based treatment decisions – which is possible once a diagnosis has been made – instead of for generating a diagnosis, for which AI is not sufficiently mature. Rules-based treatment for acute respiratory distress syndrome is replicable because if-then rules can adjust ventilator settings and order labs just as clinicians would do, while treating heart failure is not replicable (and thus not suitable as an EAction) because the logic is more complex than simply matching if-then rules to existing data points. The authors predict that implementation of EActions will reduce clinician burden and EHR data noise, allowing comparative effectiveness clinical research questions to be addressed by learning healthcare systems as a by-product of delivering evidence-based care.


Fast Company names Kaiser Permanente as its 2022 Design Company of the Year for its app redesign, which KP says was associated with an 80% increase in online appointment booking, a doubling of website visits, an increase of digital experience satisfaction from 86% to 92%, and an 84% digital registration rate of members. KP says it is piloting a feature in which the app will offer location-based notification of available services to campus visitors.

NIH awards a $2.7 million grant to Eko to develop a machine learning algorithm to detect pulmonary hypertension using its smart stethoscopes

Government and Politics

Anonymous US Army recruiters complain that the DoD’s Cerner system, which was supposed to speed up the time required to get new recruits processed and in uniform, has instead lengthened the timelines to the point that parents are complaining and recruits are changing their minds about enlisting. The recruiters say new policies and capabilities force them to wait to receive medical records relating to Cerner-flagged histories from providers, which can take weeks. Army officials say that the problem isn’t Cerner, it’s that recruits are often taking antidepressants and ADHD drugs and thus require a heath review that may get them disqualified for service. Anonymous online commenters complain that it was easier in the good old days because recruits could simply lie or plead ignorance about their medical histories.

A lead story in the New York Times says that the lack of public health data limits US response to outbreaks, observing that state and local health departments remain stuck in a world of fax machines, manual data entry, and phone calls. CDC’s attempts to quantify the spread of the Omicron variant of COVID-19 required it to ask Kaiser Permanente to analyze its own patient data. The lack of data has limited the government’s ability to make decisions about boosters and to understand breakthrough cases. The federal government is requiring hospitals to show progress toward automating CDC case reports as triggered by EHR diagnoses, but only 15% hospitals have accomplished that.



A South Dakota paper profiles Sanford Health’s plans for its recently announced $350 million Virtual Care Center and the impact it will have on local and regional patients, as well as nearby health systems: “We would like to be a partner in that,” says Horizon Healthcare CIO Scott Weatherill … We’re definitely drinking the Kool Aid on this, and we fall back on telemedicine readily to continue to provide care, keep our clinics open, and offer additional services to our patients.”

Cooper University Health Care’s MD Anderson affiliate will get a new $2 billion building that will add 100 beds to its Camden, NJ campus.

A Surescripts analysis finds that prescription pick-up rates increased by 3.2% when prescribers used the company’s Real-Time Prescription Benefit, which also saved an average of $38 per prescription.


Paging Dr. Weird News Andy: a man in India is hospitalized for three weeks as doctors remove a 7.5-inch deodorant can from his colon, whose presence he declined to explain.

Sponsor Updates

  • Oracle Cerner publishes a new business brief, “How a Real-Time Health System Addresses Challenges.”
  • Agfa HealthCare embarks on an upgrade enterprise imaging project with UC Christus Health Network in Chile.
  • IDC MarketScape includes Agfa HealthCare in the Leaders Category in its “European Enterprise Medical Imaging 2022 Vendor Assessment.”
  • AGS Health publishes a new case study, “CAC Implementation improves hospital revenue by $1.03MM.”
  • Arrive Health names Nikki Heider marketing manager.
  • Therapy Brands renews its partnership agreement with OptimizeRx, which gives users of its e-prescribing platform access to diagnosis support, affordability, access, and adherence resources.
  • Baker Tilly releases a new Healthy Outcomes Podcast, “Trends, issues, and updates in the senior service industry.”
  • Biofourmis will present at the Academy of Physicians in Clinical Research Annual Meeting October 7 in Fort Lauderdale, FL.
  • Black Book Market Research publishes its latest “State of Global Healthcare Technology” report, which reveals adoption trends, market dynamics, and top-rated vendors across 55 countries.
  • Divurgent announces a refocused mission, vision, and advisory services.

Blog Posts

Sponsor Spotlight

ChartSpan recently released new clinical claims data on the effectiveness of Chronic Care Management programs. If you are looking for a partner in high-quality value-based care programs that actually deliver results, contact us today.

(Sponsor Spotlight is free for HIStalk Platinum sponsors).


Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
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Morning Headlines 9/20/22

September 19, 2022 Headlines No Comments

Telemedicine Company That Pushed Ketamine on TikTok Announces Its ‘Closure’

Online prescription startup Peak stops offering its ketamine-based psychedelic therapy for drug-resistant depression and anxiety to new patients, and will cease operations at the end of November.

Zócalo Health Closes $5M Seed Funding

Zócalo Health will use $5 million in seed funding to launch its virtual primary care services for Latino patients in Washington, Texas, and California by the end of the year.

Starfish Partners Acquires Direct Recruiters Inc. (DRI)

Investment firm Starfish Partners acquires Direct Recruiters, which specializes in staffing solutions for a variety of industries including healthcare IT and digital health.

Readers Write: Does Cryptocurrency Have a Future in Healthcare?

September 19, 2022 Readers Write 6 Comments

Does Cryptocurrency Have a Future in Healthcare?
By Curtis Bauer

Curtis Bauer is chief product officer of Sphere of Nashville, TN.


Cryptocurrency seems to have found itself used in some capacity in just about every industry. Well, every industry except healthcare.

Healthcare has been hesitant to adopt cryptocurrency, such as the well-known bitcoin, primarily because of cryptocurrency’s various nuances that are not inherent with more traditional forms of electronic payments. Those nuances include volatility, lack of consumer demand, increasing government regulation, and most importantly, challenges with reconciliation.

To understand cryptocurrency and its future in healthcare, you must first understand the underlying technology. Cryptocurrency is built on what is known as blockchain technology. Blockchain can be difficult to understand, in part because blockchain is not a plug-and-play technology, a silver bullet standalone technology solution, or an app that can be easily installed.

Blockchain is a decentralized, distributed, peer-to-peer network. As opposed to a system in which applications are controlled by one entity, a blockchain network enables control to be shared across a group of decentralized computers and networks.

Blockchain is built on distributed ledger technology, which creates a record of transactions over time while allowing for tracking and analysis, documenting the transfer of ownership, and ultimately serving as a means for proving ownership. The advantages of blockchain include the elimination of a need for third-party intermediaries to verify transactions and a high level of security.

As it relates to healthcare, although there are significant challenges that need to be overcome before cryptocurrency will ever become mainstream, there is a strong likelihood that the underlying blockchain technology will become a staple in the world of payments and other business segments that have a need for authenticating transactions and minimizing the risk for fraud.

Blockchain is changing the world in several ways, as there are 300 million estimated global cryptocurrency users, according to a report from the US Department of Health and Human Services’ Office of Information Security. Consider bitcoin, which is itself just one of thousands of cryptocurrencies in existence. Approximately 17% of the US adult population owns bitcoin. It has a global market cap of $775 billion. It is accepted by more than 15,000 businesses for payment globally.  Crypto-economics, which is a field of economics based on blockchain technologies, is now a recognized academic field. Non-fungible tokens, which are also built on blockchain, are selling for millions of dollars.

Yet if blockchain and cryptocurrency are so innovative, exciting, and cutting-edge, then why have they been so slow to penetrate the healthcare market? There are several reasons, and they begin with the extreme volatility of cryptocurrency.

The value of cryptocurrency fluctuates wildly in short periods of time, sometimes by the minute. In general, cryptocurrency lacks the stability of traditional government-issued currencies, and that is unlikely to change any time soon.

Similarly, given cryptocurrency’s extreme volatility, exchange rates with other types of currency are constantly in flux. For example, between the time a transaction is agreed upon and the buyer obtains the product, the cryptocurrency-to-dollar exchange rate may have substantially changed.

The next problem is regulation. The federal government views cryptocurrency not as legal tender, but more like a piece of property or even gold from a tax perspective. Every time cryptocurrency is bought or sold, it must be reported to the Internal Revenue Service, so attempting to use cryptocurrency similar to cash or credit cards becomes a tax and accounting nightmare. Healthcare providers who begin to accept cryptocurrency would be subject to the same accounting and income tax implications when they move to convert or exchange the cryptocurrency back into fiat money or government-issued money that is not backed by a physical commodity, such as gold or silver.

Finally, there is the Catch-22 situation of consumer and merchant demand when it comes to cryptocurrency. Consumers are reluctant to embrace it because merchants don’t accept it, and merchants are hesitant to devote time to learning how to accept it because so few consumers use it.

The credit card is likely to remain king well into the future for healthcare transactions, making cryptocurrency unlikely to make much of an impact on healthcare any time soon, and possibly ever. But the blockchain technology that undergirds cryptocurrency is another story. Due to the premium that the technology places on security and transparency, there are two notable use cases for blockchain in healthcare.

  • Patient record-sharing. The healthcare industry has traditionally faced substantial barriers in ensuring patient access to all their health records across all service providers in order to have a complete view of medical histories, while ensuring their records are secure. However, blockchain-based medical record systems can be linked into existing medical record software and act as an overarching, single view of a patient’s record without placing patient data on the blockchain. This approach provides patients with a comprehensive, single source for accurate medical records.
  • Supply chain transparency. Blockchain is ideal for enhancing the transparency of the healthcare supply chain, particularly for pharmaceuticals. To combat prescription counterfeiting, the industry must be able to track each package’s end-to-end movement from the point of origin, including manufacturers, wholesale, and transportation. Blockchain enables stakeholders throughout the prescription drug supply chain to verify the authenticity of medicines, expiry dates, and other important information.

For healthcare transactions, the credit card is likely to remain king for some time. In that regard, one concrete step providers can take now is to steal a page from retail and focus on minimizing shopping cart abandonment. In other words, providers must ensure a convenient and easy buying experience that enables patients to quickly submit payment. To this end, providers should store payment information electronically for patients, so payment is fast and seamless when they log into patient portals and practice websites.

Though cryptocurrency will likely continue to grow in popularity across many sectors, it’s unlikely that healthcare will embrace it as a mainstream payment option any time soon.

Curbside Consult with Dr. Jayne 9/19/22

September 19, 2022 Dr. Jayne 3 Comments

One of the more thought-provoking articles I’ve read this week was in the Journal of the American Medical Informatics Association. Of course, the title caught my eye: “Do electronic health record systems ‘dumb down’ clinicians?” The abstract was compelling as well, although I was able to read it only after entirely too many clicks were needed despite my AMIA membership.

The abstract discusses a panel that was held at the 2021 AMIA Symposium and sponsored by the American College of Medical Informatics. The panel sought to answer the title question, looking at how the incorporation of EHRs might be negatively impacting care delivery. Discussions centered on how less-than-optimal EHR workflows might impact clinician efficiency, thought processes, and knowledge both during system use and during the longer term.

In broader coverage of the topic, the journal goes beyond the panel discussion, starting with the evolution of EHRs including both homegrown and commercially developed products. It notes that although early EHRs improved safety and efficiency compared to paper-based systems, “several critical perspectives were lost.”

The authors note that data showing impacts on patient outcomes were lacking and that most studies have focused on the processes involved in delivering care. Since early systems were concentrated among a small number of academic medical centers, there wasn’t much portability across institutions. They go on to explain how the Meaningful Use program and the HITECH Act of 2009 incentivized provider organizations to not only expand EHR use in the marketplace. but also to focus on a core set of functions that would lay the groundwork for broader improvements in care.

Having been part of an organization that was already knee-deep in EHR implementation and adoption before Meaningful Use came along, I can attest that it actually slowed us down, because we had to focus on ensuring that prescribed workflows were followed versus being able to customize or configure workflows that worked best for our clinicians. It’s validating that the article notes some of the same negatives that were created in the name of progress.

A series of great quotes are included in the piece. They’re attributed to a New England Journal of Medicine article that was penned by John Halamka and Micky Tripathi in 2017. They are quoted as saying that the HITECH Act had some less-than-ideal consequences. “We lost the hearts and minds of clinicians … We tried to drive cultural change with legislation. In a sense, we gave clinicians suboptimal cars, didn’t build roads, and then blamed them for not driving.” One of my favorite family physicians and clinical informaticists, Jan Lee MD, used to refer to this as “paving the cow paths” when physicians actually needed high-speed roads with no obstacles.

The article goes on to discuss in detail how EHRs might impair clinicians in the short term. Although there are many beneficial features in modern systems, including allergy checking, order sets, and often a treasure trove of patient information, there are also interruptive alerts and distractions. Sometimes users are unwilling to question information supplied by the EHR, and alert fatigue can cause users to ignore warnings and alerts that might in fact be useful. The article gave specific examples, ranging from hundreds of thousands to millions of interruptive alerts where only a fraction (2-4%) were accepted. The way that EHR notes are organized can obscure the details of a patient’s situation. The use of copy-and-paste functionality in progress notes was specifically called out as potentially misleading and dangerous.

As far as long-term impacts of EHR use, the authors noted that standardization of EHR documentation has led to less-granular terms being used during the creation of History and Physical documents. At one institution, EHR templates reduced the possible descriptors from 1,800 to 360, meaning that some clinician documentation might be hidden from view by other clinicians. An unintended consequence of this might be the shrinking of clinical vocabularies used by medical trainees. As those trainees become faculty, and older faculty members retire, the broader vocabularies are ultimately lost, and notes become less optimal. Additionally, after using templates to order certain treatments, such as total parenteral nutrition, clinicians lost the ability to order these treatments manually. The authors note that this can be dangerous during system outages or when clinicians move to a less-automated environment.

The panel also discussed solutions, which fell into four general categories: institutional and end-user readiness and competency; EHR design and capabilities; regulatory policies and healthcare system-vendor partnerships; and decoupling clinical documentation from billing and regulatory requirements so that clinical notes contain only that information necessary to care for the patient.

I think you would be hard-pressed to find a clinician in the US that wasn’t in support of the latter suggestion. Technology could be a great booster of the latter as well. I’d much rather have a photo of a rash in a chart than a rambling description of someone’s idea of a “lace-like reticular rash with mild to moderate erythema and occasional popular features.” Unfortunately, in many situations, the words will get you paid, but a photo will not.

As far as the other categories, the panel called for improved EHR training, expanded downtime simulations, and greater incorporation of learning about EHRs during undergraduate and post-graduate medical education. Medical students and residents need to understand the “why” behind various parts of the EHR as much as they understand the data that they’re keying in. They call for greater clinician involvement in the design and validation of EHR systems and improvements to alert messages to ensure that such interruptions are clinically important and obtain enough clinically relevant information for clinicians to take action.

It will be interesting to see how EHRs evolve over the next five to seven years. More interesting will be assessing the approaches taken by health systems in how they implement and optimize EHRs. I still see far too many organizations that think that installing an EHR is some kind of “set it and forget it” process.

Physicians constantly complain about the impact of EHR upgrades, but in the last conversation I was in about that topic, not a single physician admitted to having seen any kind of upgrade documentation or educational materials that told them what to expect or what benefits might arise. It feels like those kinds of communications might be casualties of the rampant understaffing I see in many organizations. Gone are the days when we used to send a member of the EHR implementation to every office to make sure clinicians knew what to expect and that their questions were answered. I’m sure the materials are probably out there on some intranet site that physicians have long forgotten how to access.

On the whole, I don’t agree with the premise that EHRs have made us dumber, but I do think they have impacted our workflows tremendously, and not always for the better. There certainly is room for improvement and evolution of technology, but everything comes at a cost. When hospitals are trying to figure out how to keep beds staffed, they are less concerned about things like EHR adoption or end-user satisfaction.

Do you think EHRs have dumbed-down clinical practice? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 9/19/22

September 18, 2022 Headlines 1 Comment

AMA: Physicians propelling health care’s digital transformation

An American Medical Association survey of digital health solution use finds that 80% of physician respondents used telehealth systems in 2022 versus 14% in 2016, with use of remote monitoring tools increasing from 12% to 30%.

Intelerad Acquires Life Image, Establishing the Clear Medical Image Exchange Market Leader and Path to a Global Open Image Exchange Network

Enterprise imaging company Intelerad Medical Systems acquires enterprise image exchange vendor Life Image.

Judge Rejects Pegasystems Motion to Overturn $2 Billion Jury Verdict

A state court orders low-code platform vendor Pegasystems to pay $2 billion to competitor Appian in a trade secrets case.

Monday Morning Update 9/19/22

September 18, 2022 News No Comments

Top News


An American Medical Association survey of digital health solution use finds that 80% of physician respondents used telehealth systems in 2022 versus 14% in 2016. AMA has surveyed the same group of doctors in 2016, 2019, and 2022 about digital health.

Use of remote monitoring tools increased from 12% in 2016 to 30% in 2022.

Telehealth and remote monitoring technologies were also ranked highest in physician enthusiasm. Beyond telehealth, enthusiasm for digital solutions has been mostly stagnant since 2019. Still, nearly 60% of respondents believe that technology can improve chronic disease management and preventative care.

Older doctors and specialists are more likely to see no advantage to digital health, but number of doctors aged 51 and over who see a digital health advantage is growing.

(click the graphic to enlarge).

Reader Comments


From LongLiveA4HealthMatics: “Re: Allscripts. Is rebranding its EHR to Veradigm EHR. Looks like the push to sanitize the word Allscripts from the company that is still called Allscripts has begun.” The email to customers says that ”the commercial brand for Allscripts will be Veradigm, while the corporate entity will remain Allscripts.” The logic behind the change, which was hinted at months ago, was not stated. MDRX shares are up 18% in the past 12 months versus the Nasdaq’s 24% loss, valuing the company at $1.8 billion.

HIStalk Announcements and Requests


The employers of two-thirds of poll respondents require their workers to be vaccinated against COVID-19, and of those that don’t make it mandatory, one-fourth of them previously did but reversed themselves.

New poll to your right or here, which addresses the unproven but wildly over-discussed concept of “quiet quitting”: How much effort and sacrifice are you willing to put into your job now versus two years ago?


Welcome to new HIStalk Gold Sponsor Cordea Consulting. The Edmond, OK-based company, which was founded in 2008 by CEO Jen Jones, specializes in the full life cycle of health IT solutions, exclusively serving the healthcare industry by working with clients to develop and implement systems, plans, and strategies. It offers advisory services (strategy, cost optimization, change management, IT governance, innovation programs); IT leadership services (program and project management, interim leadership, executive placement); and implementation and support (upgrades, go-live support, training, report writing, EHR data conversion and integration). A recent client survey finds that 100% would recommend the company, whose consultants average 12 years of real-life healthcare experience and many of whom are clinicians who know how to use informatics to improve patient care. Thanks to Cordea Consulting for supporting HIStalk.


September 22 (Thursday) 1 ET. “ICD-10-CM 2023 Updates and Regulatory Readiness.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, marketing director, IMO; Julie Glasgow, MD, marketing manager, IMO. The yearly update to ICD-10-CM is almost here. Prepare your organization for a smooth transition, and avoid any negative impacts to your bottom line, with an in-depth look at the upcoming changes. Listen to IMO’s top coding professionals and thought leaders discuss the 2023 ICD-10-CM coding changes. This webinar will review additions, deletions, and other revisions to the ICD-10-CM code set and how to make sure you get properly reimbursed.

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



Oracle promotes Greg Aaron to group VP/GM of investor owned and emerging markets of Oracle Cerner.

Government and Politics

A JAMA-published study of telemedicine encounters by Medicare patients in the first half of 2021 finds that 423,000 involved an out-of-state provider, two-thirds of whom had seen the same patient in person previously. Nearly 60% of the out-of-state visits involved patients who lived in a county within a few miles of a state border. The authors conclude that restoring licensure restrictions that were eased during the pandemic would have the biggest impact on people who live near a state borders, those who live in rural areas, and patients who need primary care or mental health treatment.

A state court orders low-code platform vendor Pegasystems to pay $2 billion to competitor Appian in a trade secrets case. Pegasystems was accused of hiring an employee of a government contractor to give it access to Appian’s software so it could enhance its own system and teach its sales team. A circuit judge rejected the motion by Pegasystems to overturn the verdict, then tacked on another $24 million in attorney fees and 6% in annual interest. Pegasystems says it will appeal.



A social media celebrity posts her sister’s medical bill in which a medical practice charged her $40 – without offering consolation or inquiry – because she cried.

Sponsor Updates

  • Arcadia makes its de-identified EHR and integrated claims data available on the Snowflake Marketplace.
  • Psychiatric practice Talkiatry expands its use of EClinicalWorks technology to include Healow TeleVisits.
  • Premier releases a new episode of its InsideOut Podcast, “Merging the quality and access gap in healthcare.”
  • Relatient releases a new episode of its Dash Talk Podcast, “The End of the Phone Tag Era: Advancing Consumer Experience in Healthcare.”
  • ReMedi Health Solutions publishes a new white paper, “Best practices for improving patient care through clinical chart abstraction.”

Blog Posts


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


Morning Headlines 9/16/22

September 15, 2022 Headlines No Comments

Prealize Health Announces Acquisition of CentraForce Health’s Social Determinants of Health (SDoH) IP

Analytics vendor Prealize Health acquires the social determinants of health intellectual property of former partner CentraForce Health.

Tabula Rasa HealthCare Announces Leadership Transition

The two co-founders of medication technology vendor Tabula Rasa Healthcare, who are also husband and wife pharmacists, resign their executive and board positions under pressure from the hedge fund that holds a 25% stake in the company.

Columbus health IT firm Enzee raises $1.5M from Rev1, others to expand hospital software

Quality assurance and compliance software vendor Enzee raises $1.5 million in a seed funding round.

The DEA is investigating Done over ADHD drug prescriptions

The DEA is reportedly investigating ADHD telehealth vendor Done, which like competitor Cerebral, has been accused of overprescribing Adderall and other addictive drugs by taking advantage of COVID-relaxed telehealth rules.

Twilio to lay off 11% of workforce

Cloud communications software company Twilio, which powers Epic’s telehealth service, will lay off 11% of its workforce as part of a restructuring plan.

News 9/16/22

September 15, 2022 News No Comments

Top News


Epic launches a life sciences program that will match providers and their patients with clinical trials.

Reader Comments

From Due App: “Re: Oracle Cerner’s new pharmacy app. EVP Mike Sicilia told the Senate on July 20 that a beta version will be available 6-9 months, which would be April 20, 2023 at the latest. Larry Ellison now says it will be finished within year. Odds of either happening?” Delivery by either date would be aggressive, even if progress is already quietly being made. That probably means accepting the existing product’s design as sufficient and refactoring it using the Oracle Apex low-code development platform to improve application performance and maintenance. That approach would bypass endless design sessions and make the project a purely technical exercise that hits Oracle’s sweet spot, allowing enhancements to be addressed later. The biggest challenge might be integration with legacy Cerner apps. Rewriting apps from scratch provides little user value and makes sense only if the underlying platform is outdated, developers are hard to find, and system maintenance and performance are lagging. Replatforming is easier when the same vendor that owns the app also owns the technology and cloud technology. Still, it always takes longer than expected, so consider the dates a target.

HIStalk Announcements and Requests


Welcome to new HIStalk Gold Sponsor HealthTech Resources. The Phoenix-based company has served providers and payers for 20 years. Its mission is to help people and companies achieve their goals by providing the highest quality of outsourced employment and human resources services, taking the time to understand the needs and long-term growth objectives of large health systems, academic medical centers, public health plans, and more to empower them to focus on what they do best. The company is proud to concentrate specifically on healthcare, not only because this singular focus strengthens its service offerings, but also because it plays a role in supporting innovation within electronic health records, healthcare enterprise architecture, and the digital systems that help improve how people work and how people heal. Its employees enable improved care and treatment methods for patients, and improved workflows for essential workers allows them to focus more on what matters most, their patients. Thanks to HealthTech Resources for supporting HIStalk.

Another advantage of obtaining Mrs. H’s new contact lens prescription from a somewhat sketchy online exam that I just realized – the PDF prescription can be used throughout its one-year life by simply uploading it to any lens seller. You can also stock up on as many lenses as you would like by ordering before the prescription expires. Neither is true of a medication prescription.


September 22 (Thursday) 1 ET. “ICD-10-CM 2023 Updates and Regulatory Readiness.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, marketing director, IMO; Julie Glasgow, MD, marketing manager, IMO. The yearly update to ICD-10-CM is almost here. Prepare your organization for a smooth transition, and avoid any negative impacts to your bottom line, with an in-depth look at the upcoming changes. Listen to IMO’s top coding professionals and thought leaders discuss the 2023 ICD-10-CM coding changes. This webinar will review additions, deletions, and other revisions to the ICD-10-CM code set and how to make sure you get properly reimbursed.

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

Acquisitions, Funding, Business, and Stock

The two co-founders of medication technology vendor Tabula Rasa Healthcare, who are also husband and wife pharmacists, resign their executive and board positions under pressure from the hedge fund that holds a 25% stake in the company. Shares of TRHC that peaked in mid-2018 at $88 are now worth under $5 following several unprofitable acquisitions and lowered sales projections, valuing the company at $129 million.

A study finds that drug makers file a “patent thicket” of post-approval patent applications to extend their US monopolies beyond their initial 20 years of patent protection. Three expensive, top-selling drugs – Humira, Eliquis, and Enbrel – have been available from cheaper competitors for years in Europe but not here, with Enbrel’s biosimilar not expected to be sold here until 2029, 13 years after it was first sold in Europe.

Analytics vendor Prealize Health acquires the social determinants of health intellectual property of former partner CentraForce Health.


  • North West London Integrated Care System chooses InterSystems HealthShare Health Connect Cloud via an AWS cloud deployment for interoperability.
  • Washington County Hospitals and Clinics (IA) will implement Epic using a $753,000 grant from the US Department of Agriculture.
  • Thailand’s new Srisawan Hospital will implement InterSystems TrakCare and IRIS for Health.



Industry long-timer Bruce Brandes, MBA (Teladoc Health) joins as president.


InterSystem hires Andy Zook, MBA (SAS) as VP of North American sales.

image image

Virtual care technology vendor Wheel hires Sameer Merchant, MS (Autodesk) as CTO and Steve Manning (Autodesk) as SVP of product.

image image

Amwell hires Vaughn Paunovich (UnitedHealth Group) as EVP of enterprise platforms and Matthew McAllister, MBA (Amazon) as chief product officer. 


Mark Dunnagan (Smartlink Health Solutions) joins Chess Health Solutions as VP of health informatics.

Announcements and Implementations


Relatient launches Dash Chat, which allows patient inquiries that are entered as live chat from the practice’s website to be answered by providers and staff, reducing call volumes.

A survey of medical alert system users and caregivers finds that fall detection is the most-desired feature, affordability and battery life are key considerations, and 91% are more confident when performing daily activities knowing that they can reach immediate assistance. Two-thirds of users say they have used their system to get help. Thirty percent use in-home systems, while the rest use a home/mobile bundle, a watch-powered system, or a mobile device.

Epic will use Milliman MedInsight’s analytics in its Value-Based Performance Management module that will be released next year.

WebPT releases WebPT Billing, an integrated billing solution for the in-house billing teams of rehab therapy organizations. It’s the same solution that the company uses for its own outsourced physical therapy RCM service.


KLAS asks 16 healthcare executives to review previous reports to choose the top emerging solutions that are most likely to disrupt their respective Quadruple Aim categories, with these topping the list:

  • Improve outcomes – Atlas, which connects health systems with philanthropic aid.
  • Reduce the cost of care – AvaSure, which offers remote patient monitoring.
  • Improve patient experience – DeliverHealth, which provides a digital front door solution.
  • Improve clinician experience – Nuance’s Dragon Ambient Experience.

Government and Politics


The DEA is reportedly investigating ADHD telehealth vendor Done, which like competitor Cerebral, has been accused of overprescribing Adderall and other addictive drugs by taking advantage of COVID-relaxed telehealth rules. Surely the doctors who took the money of these companies did so knowing that they were expected to ignore accepted medical practice, which doesn’t pay as well.

NIH announces an $8 million prize competition for developing home-based or point-of-care diagnostic devices, wearables, or remote sensing technology to improve postpartum care in underserved areas.

Privacy and Security

OakBend Medical Center (TX) is still restoring IT systems that went down in a September 1 ransomware attack.



I believe this press release has mistake’s.

Sponsor Updates

  • Newly named Oracle Health GM Travis Dalton is interviewed by the company about Oracle’s vision, the changes with Cerner over the years, and the client opportunities that the acquisition creates.
  • Nordic posts a new episode of DocTalk titled “Remote patient monitoring for chronic disease management.”
  • Everbridge adds external risk intelligence monitoring to its Control Center physical security management system.
  • Healthcare IT Leaders publishes a client profile featuring Northeast Georgia Health System.
  • CereCore and BridgeHead will jointly offer comprehensive data management services.
  • Meditech will host Meditech Live 2022 September 20-23 in Foxborough, MA. HIStalk sponsors supporting the event include CloudWave, CereCore, and Interbit Data.
  • Divurgent publishes a white paper titled “Digital Acceleration in Healthcare: Guiding Speed and Direction for Digital Health.”
  • NeuroFlow’s behavioral health technology platform has earned HITRUST Implemented, 1-year Certification.
  • Clearsense unveils a new website and updated company brand.

Blog Posts


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


EPtalk by Dr. Jayne 9/15/22

September 15, 2022 Dr. Jayne 2 Comments

A colleague recently asked me what I thought about “quiet quitting” and the attention that the concept has been getting recently in the mainstream media. There has been quite a bit of discussion around it in physician-specific social media groups, alongside discussion of burnout and the role of self-care in a post-COVID workplace.

Many workers in healthcare are still being asked to come in to work when they are sick, despite the fact that they have designated sick days allocated for such a thing. They are pressured that if they call off sick, they’ll be burdening their teammates. Others are told that they can only call off if they find a replacement, which really shouldn’t be the employee’s job.

By most definitions, quiet quitting is the idea that a worker only does what is required of them based on their job description. This means no extra work, no volunteering for additional projects, and in the case of many clinical workers, no picking up of extra shifts. Hospitals have been short staffed for years and the COVID pandemic only exacerbated a problem that was already there. During the first year, everyone was motivated by a sense of needing to pull together, to help humankind, and to be there for their co-workers, but after two and a half years in the grind with ever decreasing support and appreciation, people are simply done with it.

Hospitals (and medical practices, and other clinical organizations) have always had the ability to create safety nets for their workers. It’s easy to come up with excuses not to. I remember trying to implement a “float pool” for our medical group’s ambulatory practices more than a decade ago, similar to what hospitals had in place at the time. Staff could volunteer to be part of the pool on their days off and they would be paid a small amount to remain on call in the event they were needed to cover a shift. If they worked, they would receive their usual rate of pay. Instead, the group’s leadership balked at paying people “for doing nothing.” They failed to understand that it wasn’t about what the float pool member was doing, it was about what they were not doing on their day off in exchange for being on call.

The administrators decided instead to ask for people to volunteer to pick up extra shifts if there were shortages, and then if they had no takers, they offered various hourly incentives. Guess what? Staff learned not to pick up extra shifts until the incentives reached a certain level, which ultimately cost more than what someone would have been paid to be on call. Once a clinical staffing pool reaches a certain size, it’s a virtual guarantee that someone will be out sick on any given day, so the economics would have favored the float pool approach. Additionally, creating a float pool would have ensured people were ready to work on a given day rather than offices having to hope and pray that someone would volunteer, and then to cope with the scrambling that inevitably ensued when someone rolled in an hour or more after the practice opened.

These types of bad decisions have only been magnified in the last two years. Just look at travel nursing during COVID surges. A major driver behind that was the unwillingness of hospitals to appropriately compensate existing staff nurses. I had friends who quit their medical / surgical nursing jobs and then worked as “travel nurses” in a hospital less than five miles away for a significant salary bump. Hospitals went way over budget paying traveling and locum staff, when they could have avoided having those nurses quit if they addressed underlying drivers of low employee satisfaction. Those nurses who stayed put are now increasingly burned out and quiet quitting is the order of the day.

The other reality in our post-COVID world is that people’s priorities simply have changed. If they’re struggling with childcare, they’re not going to volunteer to work extra hours. Families with two wage earners where one has a significantly higher earning potential have redone the math and determined that it doesn’t make sense for both partners to work when there are children requiring care. People seem to be retaining some of the hobbies that they cultivated during the early days of the pandemic and want to ensure they’re spending time on activities that make them feel good and in which they find value.

It will be interesting to see how organizations respond to the shifts in productivity that will result from quiet quitting. Some high-profile companies have already signaled that they’ll just fire people, which doesn’t seem like the way to become employer of choice.

I had some travel this week, which always makes for good people watching. For the first time since spring of 2020, I actually had difficulty getting a space at my favorite airport parking garage. The airport was hopping, although many of the stores remain closed during peak times. I’ve learned to pack a lunch if I have any hopes of eating something that is healthy and convenient. I would estimate that 80% of the people waiting in the gate areas are on either laptops or phones, so I wonder what they would think about this study that looks at the relationship between chronic blue light exposure and accelerated aging.

Researchers at Oregon State University looked at the impact of such exposure on fruit flies. Where previous studies had looked at the consequences of light-related stress on retinal cells, newer studies have examined whether exposure to blue light caused reduced lifespan and degeneration of organs such as the brain. The authors looked at flies that were genetically altered to not have eyes, in an effort to study metabolism and cellular pathways. Some flies were kept in constant darkness and others in constant blue light, for varying durations. The authors noted that those kept in blue light for longer durations had changes in metabolism including impairments in cellular energy production. There was also neurodegeneration in the blue light group, with decreased levels of certain chemical transmitters in the brain.

The study found that if the impacted flies were placed in darkness, their lifespan could be brought back to normal. Reading the paper sent me straight back to my freshman year in college, where the fruit fly lab convinced me that I no longer wanted to be a biology major even though that was what pre-meds were expected to do. Even though I never want to see another diagram of a metabolic pathway, it was interesting to see how much research has evolved over the intervening years. The next step in research of this type would be to look at the impact of blue light on cultured human cells, which have similar metabolites.

Only time will tell the fullness of consequences that we’ll experience from prolonged screen time. I’m perfectly happy to spend my free minutes in the outdoors, reading an actual paper book, or doing some retro hobbies. I’m taking a stained-glass class next weekend, so we’ll have to see how that goes.

Do you have a pandemic hobby that you’ve kept? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 9/15/22

September 14, 2022 Headlines No Comments

Epic Launches Life Sciences Program, Unifying Clinical Research with Care Delivery

Epic debut its new Life Sciences Program, designed to help providers better match patients with clinical trials, increase trial efficiency, and offer data-driven insights into medication administration.

Pharos Capital Invests in Renal Care 360º, Capitalizes New Chronic Kidney Care Management Platform

Kidney care practice management and predictive analytics company Renal Care 360º secures an undisclosed amount of funding from Pharos Capital Group.

BabyLiveAdvice Announces $1.1M Seed Investment to Improve Maternal-Infant Health Outcomes

Maternal virtual care company BabyLiveAdvice raises $1.1 million in seed funding.

Morning Headlines 9/14/22

September 13, 2022 Headlines No Comments

Oracle Announces Fiscal 2023 First Quarter Financial Results

Oracle reports Q1 results: revenue up 18%, with Cerner contributing $1.4 billion to quarterly earnings; EPS $0.58 versus $0.89, meeting Wall Street expectations for revenue but falling short on earnings.

Kyruus Announces Acquisition of Leading Digital Patient Engagement Company, Epion Health

Provider search platform vendor Kyruus acquires Epion Health, which offers patient engagement solutions.

Our Mission to Redesign Health for Everyone

Startup builder Redesign Health closes a $65 million funding round, reportedly valuing the company at nearly $2 billion.

News 9/14/22

September 13, 2022 News 8 Comments

Top News


Oracle reports Q1 results: revenue up 18%, EPS $0.58 versus $0.89, meeting Wall Street expectations for revenue but falling short on earnings.

Notes from the earnings call:

  • Unfavorable foreign currency exchange rates cost the company $0.08 in adjusted EPS.
  • Cerner contributed $1.4 billion of Oracle’s quarterly revenue, 12% of its total.
  • Cloud revenue increased significantly, representing 30% of total revenue.
  • CEO Safra Catz says that Oracle’s quarterly margin of 39% will increase “as we drive Cerner and its profitability to Oracle standards and continue to benefit from economies of scale in the cloud.”
  • The company says it has migrated Cerner’s back office systems to its Oracle Fusion ERP system.
  • CTO Larry Ellison says Oracle Cerner’s first newly developed application will be released within 12 months, developed with Oracle’s new Apex low-code tool and running on Oracle Cloud Database. He says Apex has security and fault tolerance built in, with the stateless application immediately failing over to another data center when problems arise.

Oracle offers a free OCI Cloud Tier that includes Apex Application Development and SQL Developer. It also offers a 10-minute tutorial on using Apex to transform a spreadsheet into a secure, scalable, multi-user web application.

Reader Comments

From Home Boy: “Re: Oracle. You should interview EVP Mike Sicilia, who is basically in charge of Cerner at this point.” I requested an interview with him a few weeks from Oracle’s press contact, who didn’t respond.

From Saving Private Orion: “Re: contact lenses. Your wife’s experience with the eye doctor’s receptionist is a reminder that most of what is awful about US healthcare isn’t the provider.” I agree. Nearly all of my healthcare frustration has been caused outside the exam room. Small practices often hire unwisely and manage poorly, and while hospitals often get better people, they drown them in customer-unfriendly policies. I would bet that clinicians are even more annoyed than patients in those environments since they have to live every day under the same management that created the patient-facing problems.

From Reese: “Re: Emerge. Customers say all modules and applications have been down for over two weeks with no root cause or ETA. Rumor is it’s legal trouble between Emerge and third-party database provider MongoDB, which has taken the systems offline.” Unverified, but reported by a couple of readers, one of whom summarized, “Practices that relied on Emerge for historical clinical documentation and imaging studies are SOL.”

HIStalk Announcements and Requests

I remember when your first day on a new job involved desk-side teammate introductions and lunch out with the boss instead of jumping on a video call while caressing a mailed box of company swag.


September 22 (Thursday) 1 ET. “ICD-10-CM 2023 Updates and Regulatory Readiness.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, marketing director, IMO; Julie Glasgow, MD, marketing manager, IMO. The yearly update to ICD-10-CM is almost here. Prepare your organization for a smooth transition, and avoid any negative impacts to your bottom line, with an in-depth look at the upcoming changes. Listen to IMO’s top coding professionals and thought leaders discuss the 2023 ICD-10-CM coding changes. This webinar will review additions, deletions, and other revisions to the ICD-10-CM code set and how to make sure you get properly reimbursed.

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

Acquisitions, Funding, Business, and Stock

Provider search platform vendor Kyruus acquires Epion Health, which offers patient engagement solutions.


Healthcare analytics company PurpleLab raises $40 million in a Series B funding round. The company had reportedly explored putting itself up for sale earlier this year.


St. Elizabeth Healthcare (KY) launches an innovation center with a $25 million venture fund that it will use to invest in new healthcare companies and technology.

Startup builder Redesign Health closes a $65 million funding round that reportedly values the company at nearly $2 billion.


  • Digital health solutions vendor BrightInsight chooses Lyniate Envoy for interoperability.



Seattle Children’s promotes Eric Tham, MD, MS to SVP and chief research operations officer.


UC Davis Health hires Vimal Mishra, MD (American Medical Association) to lead digital transformation and care at home.


Sean Brindley (Olive) joins Intelligent Medical Objects as VP of strategic partnerships.

image image

Telehealth genetic counseling company Genome Medical lays off 23 employees and announces the departure of its founder and CEO Lisa Alderson, MBA, who will maintain an advisory role. Chief Customer Officer Jill Davies, MSc will replace Alderson. Davies was co-founder and CEO of GeneMatters, which Genome Medical acquired last year.


Mark Anderson (Accenture) joins Beth Israel Lahey Health as VP of EMR clinical strategy and implementation.


ShiftMed hires Greg Rakas (Pearl Health) as VP of enterprise sales.


Heath Chester (Infor) joins Lyniate as SVP of sales.


Arcadia hires Michael Tiffany, MBA, MSPT (EarlySense) as SVP of operations.

David Gascoigne (GNS Healthcare) joins OneMedNet as COO.

Announcements and Implementations

Houlton Regional Hospital (ME) will go live on Meditech Expanse on October 1.


Cody Regional Health (WY) will deploy Epic through a partnership with St. Vincent Healthcare.

Edifecs develops automated, point-of-care prior authorization technology.

Government and Politics


The 81st Medical Group at Keesler Air Force Base (MS) and the 96th Medical Group at Eglin Air Force Base (FL) will go live on MHS Genesis September 24.


A paper in Spokane, WA profiles the healthcare plight of veteran Charlie Bourg, who discovered that his delayed cancer diagnosis was caused by a system defect within the Mann-Grandstaff VA Medical Center’s Cerner EHR that put his primary care doctor’s follow-up appointment and urology referral in a scheduling queue limbo for months. An Oracle Cerner rep says the EHR isn’t responsible for Bourg’s now-terminal condition: “Our findings show that nothing related to the EHR’s functionality or performance had anything to do with the care this veteran received and was unrelated to their diagnosis or treatment. The Oracle Cerner EHR is successfully in use at many thousands of health care facilities across the United States without incident. We remain a committed partner to VA to ensure its EHR system, and everyone who uses it, is able to provide the best possible care that our veterans deserve.”


A HBR article whose authors include health IT emeritus John Glaser says that we need better tools to improve outcomes using ever-increasing amounts of health data. It’s a big problem, they say, that quality measurement is limited to using insurance claims — which focus on revenue-generating information within a snapshot of care long after the fact — as their foundation. The authors list four imperatives:

  • Reduce the cost and improve the timeliness of data collection by adopting software and wearables to generate information as a byproduct of managing care.
  • Incorporate wearables data, patient-report outcomes measures, environmental data, and social determinants of health.
  • Enhance EHRs to give clinicians better real-time support that is personalized to each patient’s needs and desires.
  • Standardize clinical measures, reduce paper-based quality measure description, automate the work of human data abstracters, and audit and clean data using automated tools.

Sponsor Updates


  • Availity associates, friends, and family raise nearly $3,000 for the American Heart Association during the 2022 First Coast Heart Walk.
  • King Abdulla Medical City in Makkah upgrades to the consolidated Agfa HealthCare Enterprise Imaging platform.
  • Arcadia publishes a new white paper, “Risk Adjustment – Simplified.”
  • Baker Tilly grants $10,000 to Leaps & Bounds Pediatric Therapy.
  • Bamboo Health names Caitlin Kolar (One Home Health Agency) account growth director and Rob Duarte (Clif) business development representative.
  • Clinical Architecture will exhibit at SNOMED CT September 29 and 30 in Portugal.
  • ConnectiveRx will present at Hub and Specialty Pharmacy Models West September 14-15 in San Diego.
  • Current Health will exhibit at DPharm September 13-14 in Boston.
  • Ellkay will exhibit at Mayo’s Leveraging the Laboratory September 21-22 in Rochester, MN.
  • Enlace Health donates $10,000 to an East Kentucky community grocery store affected by flood damage.
  • Surescripts publishes a new data brief, “Specialty Medication Experience: Obstacles & Opportunities.”
  • Wolters Kluwer Health makes its Lippincott ClinicalPulse CME platform available in an audio format.

Blog Posts


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Morning Headlines 9/13/22

September 12, 2022 Headlines No Comments

Technology Company Akido Labs Launches New Medical Network Focused on Preventive Care for Chronic Disease

Akido Labs acquires Chaparral Medical Group to create a medical network that will leverage Akido’s predictive analytics-focused Care Delivery Platform.

PurpleLab, Inc. Raises $40M in Funding from Primus Capital

Healthcare analytics company PurpleLab raises $40 million in a Series B funding round.

St. Elizabeth launching Innovation Center

St. Elizabeth Healthcare (KY) launches an innovation center with a $25 million venture fund that it will use to invest in new healthcare companies and technology.

HIStalk Interviews Luke Bonney, CEO, Redox

September 12, 2022 Interviews 2 Comments

Luke Bonney is co-founder and CEO of Redox of Madison, WI.


Tell me about yourself and the company.

I’ve been working at Redox, on Redox, for just about seven years. That’s a long time and a lot more gray hair. Redox is the platform to make healthcare data useful for healthcare’s builders, the people building and scaling healthcare technology.

What have been the most significant interoperability advancements of the past few years?

Our world at Redox is all about how to make healthcare data useful for builders, who to us are the people building and scaling technology and healthcare. We obsess about these people, because through enabling the people who are building technology, everybody will benefit. Patients will benefit, providers will benefit, and you and I will benefit. Great builders build great technology that drives incredible experiences. Those experiences are what drive outcomes. That’s where we need to see meaningful change in healthcare. How do we drive and inspire outcomes?

At Redox, we are constantly obsessing about imagining a world where people can build and scale healthcare technology and be completely unencumbered by the nastiness and complexity of healthcare data, which I know sounds crazy because it is nasty and complex. But we think about a world where with a couple of clicks, people could compose experiences for their users. That’s what we obsess about.

Over the last couple of years, we have continued to focus on healthcare data access and integration. Today, working with Redox means that you have access to existing connections to over 2,500 healthcare organizations across the US and now in Canada. We have integrations with dozens of major payer organizations. We have expanded to not just be focused on clinical data, but financial and payer data, connections into existing clinical networks like Carequality, CommonWell, and a whole bunch of HIEs. We are now connected to 50 out of 50 state public health departments.

We have a lot to be proud of that we’ve focused on in the last couple of years. When we talk to our customers, they say they work with us because we help them focus their engineering efforts and their product efforts on building a truly differentiated product by taking all this nastiness off their plate. We also help them accelerate their sales cycle. We help them get live and implemented faster at all these different locations.

Today, it’s all about data access and integration. As we look to the future of Redox, we will focus on additional problems where we can make healthcare data useful and valuable for builders.

Looking at the industry, I would go to the pretty exciting impact of regulation. I know that might sound weird since regulation is almost always a nasty word, but when it comes to 21st Century Cures, I am definitely in the camp that 21st Century Cures is a game changer, and in a good way. It is definitely not perfect, like any regulation that runs 700 or 800 pages, but it absolutely redrew some of the major goalposts and expectations around healthcare data. The requirements around info blocking and enabling FHIR are good. I think they are incremental. Access is only one component. Standardization and normalization of data are equally if not more important when we think about downstream use cases. We have seen a huge amount of positive change in the impact in the payer world and the payer landscape.

The saying we use at Redox is that what Meaningful Use was for providers, 21st Century Cures, and specifically the CMS patient access rule, is for payers. It has been a major forcing function for payers to modernize their technology. 21st Century Cures is fundamentally making healthcare a friendlier place for builders and innovators by curbing a lot of the power of major incumbents. From where I sit, that is fundamentally a very good thing.

Explain TEFCA and how it changes your business and the industry.

Where I’m super excited about 21st Century Cures, I think TEFCA is a different situation. Had TEFCA been regulated in a way similar to 21st Century Cures, with clear incentives and/or penalties,  we would be a huge fan, because we are fundamentally aligned with the world that TEFCA imagines.

To just state what that is, TEFCA has two core components. It’s a technical framework and a legal framework that allows networks to communicate with one another. It imagines what they think of as a network-of-networks environment. We love that. We think that that would fundamentally change the landscape.

However, as it stands right now — and this is where I think there is huge opportunity — TEFCA completely optional. It provides the framework. In an industry where large change is so typically aligned to hefty incentives, reimbursements, and penalties, TEFCA doesn’t have any of that. Maybe the long story short there is that we believe in TEFCA, we believe in the future it imagines, but we don’t have strong confidence that it’s going to meaningfully shift the industry because of how it is structured.

Having said all that, there’s a number of products we support, connectivity to Carequality, CommonWell, and other networks that we support. But we’re just not convinced it’s the game changer.

ONC is reluctant to apply a heavy hand and instead wants to clear the way for market forces to drive advancement. Where would that market pressure come from to make TEFCA universal?

TEFCA has the framework around what’s called a Qualified Health Information Network, a QHIN. Without going into the tactical details of what qualifies as a QHIN, a couple of networks fit that mold at a high level. CommonWell and Carequality would be classic examples. They support a use case, which is the treatment of care or the transition of care use case, where data is exchanged. The classic example is that your primary care doctor is in New York, you’re in Florida, and you get in a bike accident. CommonWell and Carequality allow that record to get pulled from New York to Florida so that the doctors treating you there have your medical history. That’s a clear use case with appropriate incentives for hospitals and clinics to participate.

It’s harder to imagine future use cases where those alignment of incentives occur, where people would meaningfully come to the date table and agree to share data. There’s some compelling stuff around payments and patient payments where there could be meaningful market pressure.

Your question is a really interesting one because while the painted future is interesting and exciting, it’s hard to imagine a path to get there simply through pressure from market conditions. This is where we need to think about the actual incentives of these organizations, their willingness to share data, and whether they see it as the right thing given the specific use case.

Has the original interoperability idea of paying those who contribute data and then charging for its use gone by the wayside?

I don’t think that model is off the table. I just don’t think it has seen a ton of traction. Where there is traction involves life sciences companies that want to pay for large, de-identified data sets for R&D purposes. But beyond that, there just hasn’t been a ton of traction. That is not at all me saying that we should disqualify that or put it to the side. If there was, I think that would be super exciting. Those are the questions that will be interesting to track. Is it going to enable that world or not? Do we see the early signals that something like that could emerge?

Technology vendors, startups, and health systems themselves are finding it profitable to broker a data connection between providers and life sciences companies. Will additional use cases emerge?

I think we are early days. There’s a ton of opportunity. Costs are high to administer clinical trials. The match rate, how easy is it or hard is it to identify patients to enroll in the clinical trials, is still super high and inconsistent. The data itself is part of it. Another huge part of it is decentralized clinical trials, where there’s a ton of innovation. 

We are early days. That’s a fun and interesting spot to look for for innovation. Drug companies have lots of money that they are willing to put to work.

Do we have now, or will we have in the future, a healthcare technology ecosystem?

There has always been an ecosystem. It’s the question of how big and how impactful that ecosystem is.

Going back to the conversation around 21st Century Cures, you can look at a lot of interesting data. Look at the total amount of funding over the past five years that has gone into digital health. It has been one of the fastest growing categories compared to any other technology sector over the past five years. That’s an incredible sign that people everywhere see healthcare as not just a place where innovation is needed, but for anybody who has been a patient or provider, that innovation is needed and possible.

We’ve been saying for a long time and with a straight face that there is an ecosystem. Now it is probably more apparent to a growing audience. But we also think that it’s necessary. Like many other industries, there isn’t a single person or a single company that will meaningfully move the needle. It needs to be many people working on many problems.

That is one of the fundamental viewpoints we carry. It’s about empowering this entire class of builders. It hasn’t happened overnight, but it’s much more significant than it was yesterday, and I think three years from now, it will be twice as big. It is super exciting.

Now that cloud has finally found its healthcare footing, including technology companies like Oracle and Microsoft acquiring big health IT vendors, where does it go from here?

I’m glad you asked this question. Big tech is making serious moves in healthcare. For those of us who have been in this space for a while, we’ve seen different moments where bets were getting placed. I now have conviction — and not just me, but others — that fundamentally, healthcare delivery in the US is going to look different three to five years from now because of the impact of Amazon, Microsoft, and Google.

The other thing I would say is that it’s not just big tech, but also groups like CVS, Walmart, and others that are making big moves, such as Amazon buying One Medical and CVS’s purchase of Signify. An interesting detail that stuck out to me when Amazon purchased One Medical is that alongside that, they announced that they are winding down what they had previously been calling Amazon Care, which was their initiative around a nationwide telemedicine offering. That tells me that that Amazon, in this case, is moving out of testing different hypotheses, having multiple bets, and solving for optionality and they are moving into a more unified, aligned approach now that they have been in market for a little while. This is a trend that I see across big tech. They have spent some time studying healthcare and now they are making their big bets.

It’s not just the cloud. It’s the technology companies that offer the cloud that are super interesting. When it comes to big tech and the ongoing shift to cloud infrastructure, this has been a core part of the Redox thesis from the very beginning. Hospitals, clinics, payer organizations, and life sciences groups are all right now making massive investments in their cloud infrastructure. It’s because what they all have is data, and what they are realizing is that these big tech companies and their cloud infrastructure has the most robust functionality when it comes to driving value from that data.

I see big changes. The dollars being spent will threaten some incumbents in the space, because change is always scary. But I also think if we all take a step back and look at it from the viewpoint as a patient, I’m incredibly excited, because this is what has happened in other industries and the end result is ultimately a more user-friendly, consumer-friendly experience. It’s real. it’s big. We are in the midst of it right now, and three to five years from now, healthcare is going to look different.

How will  today’s financial market activity change the industry?

On the one hand, healthcare is, and will continue to be, relatively resistant to recessions. As we know, the demand for healthcare doesn’t closely associate with the state of the economy. I would say that overall demand hasn’t changed a ton. Where we do see impact is more specifically related to capital markets and the fact that valuations have come down significantly. Companies that need to fundraise in the short term are finding it harder. This is concentrated in some of the startup and SMB folks. This means that a category of customers and builders in the space that are tightening belts to extend runway. There’s some of that in the short term.

In the long term, I don’t see it having major, major impact. Any time we have a cycle like this, in some ways, it’s pretty natural. It will impact some more than others. We are watching it closely, but overall impact to us hasn’t been significant. We have it pretty balanced. We support SMBs all the way up to the Fortune 5.

As we all know, this story is also not done. It will be interesting to see how this unfolds over the next couple of quarters and year because there are tons of investment dollars available. It will be interesting to see when those investment dollars start to come back into the market. History can help us learn from other experiences, such as recessions, 2008, and the dotcom bubble bursting. It’s not totally uncharted, but we are paying attention to it pretty closely.

What will be important to the company over the next couple of years?

Most important for us is to continue to obsess about our customers. You heard me refer to them as builders. We are early days with the impact that builders are going to have in healthcare. It has never been more apparent to me that now is a great time to be a healthcare builder. We will continue to obsess about the people we support and continue to obsess about the use cases that we support. Doing that means we need to continue to power broader and broader sets of data to exchange. 

We’ve broadened from being clinically focused to many types of data. Today, Redox is focused on data access and integration. As we look into 2023 and 2024, the interesting opportunity for us is to start to support more and more of that healthcare data journey on its path to ultimately being useful. We are working on some exciting things that you will start to hear from us later this year and early 2023. It will enable a whole other class of builders.

With all the craziness going on in the world right now, there has never been a better time than right now to be a health tech entrepreneur. Now more than ever, healthcare as an industry is primed for change. My closing statement is to all of the builders out there. Don’t wait on the sidelines. Come on, let’s do it. There’s plenty of work and plenty of opportunity for impact.

Curbside Consult with Dr. Jayne 9/12/22

September 12, 2022 Dr. Jayne 1 Comment

I was glad that Mr. H mentioned Friday’s opinion piece by former VA Secretary David Shulkin MD. With a title like “State lines should no longer be barriers to health care,” I was hooked.

Going through medical school, I had a passing exposure to the idea that one would need a state-specific license when they went into practice. Mostly this exposure came by watching the anguish that your supervising residents went through as they tried to obtain licenses so that they could earn extra money by moonlighting at rural emergency departments or by covering nights or weekends on the medical center’s newly created hospitalist service. The medical center had a variety of services to support the application process, including access to fingerprinting courtesy of campus police and notary services from the medical school office of student affairs.

Once out in practice, that process becomes more difficult. Especially in a post-COVID world, the process may require making various appointments in person and during normal business hours, which isn’t terribly helpful if you’re a busy physician. Although some states are members of the Interstate Medical Licensure Compact which can expedite this process, a significant number of states have yet to opt in. This can mean going through the licensure process from scratch – providing various transcripts, reports of test scores, copies of certificates, and more.

One state where I applied demanded a copy of my high school transcript, which didn’t seem terribly relevant for someone with a medical degree and a couple of decades experience under her belt. I had a very interesting conversation with the registrar at my high school who eventually found it on microfilm. It looked like something that couldn’t possibly be a legitimate document, with each semester’s results being contained on an address label-like sticker that was applied to a single sheet of copier paper that had my name handwritten on the top. But it had the all-important embossed school seal, so I guess that made it official.

Still, and especially since this was a state that bordered my own, I thought it should be easier since the same standards of care that apply on one side of the line apply to the other. They are called “community standards of care,” not “state-specific standards of care.”

I had been practicing telehealth part time when COVID hit, and the relaxation in licensure requirements boosted my volumes. Almost overnight, I could see patients from 17 states, and as more states relaxed their rules, our wait times for on-demand telehealth visits decreased dramatically. As the pandemic eased, however, many states ended these programs, thereby limiting their residents to a smaller pool of clinicians.

One of the reasons that was cited by multiple states was the concern that easier access to telehealth would result in higher healthcare expenditures and the states didn’t want to be on the hook for that. States were also lobbied by their own state medical boards, in the context of the boards wanting to be able to ensure quality care and discipline physicians. Those boards also receive licensing fees from the physicians who want to practice in a given state, so I’m sure that was a factor.

We knew it would take time to see whether patients would return to in-person care or if they’d continue flocking to telehealth visits. Although many of us have witnessed changes in our volumes, the evidence was largely anecdotal. This week also brought us some research, as the journal NPJ Digital Medicine published a study looking at “The impact of expanded telehealth availability on primary care utilization.” The authors looked at 4 million primary care encounters from 939,000 unique patients from three health systems during the period between 2019 and 2021. They found little change in overall primary care utilization as telehealth services became more broadly used. They noted that “our results suggest the availability of telehealth is not resulting in additional primary care visits, rather, telehealth is serving as a substitute for certain in-person encounters resulting in no overall increase in primary care utilization. Further, it seems telehealth was mostly utilized for patients whose medical needs required multiple primary care visits during each year, suggesting that these telehealth encounters enabled follow-up for patients with chronic illness.”

They noted that additional studies are needed to determine the impact of expanded primary care access on other types of visits, such as urgent care or emergency visits. The authors also noted some limitations to the study, including the inability to determine if patients received additional primary care services from other facilities outside the study dataset. They also could not assess the quality of telehealth encounters compared to in-person visits.

I would also note that although the study looks at visit volume, it doesn’t take into account the differences in the costs of different types of visits. I’ve seen lots of institutional data that shows that telehealth urgent care visits are extremely cost effective, with one organization reporting a savings of nearly $150 for each patient encounter that was handled virtually versus at one of their brick-and-mortar urgent care clinics.

Now that states are cracking down on licensure, it makes it difficult for organizations to maintain the flexibility they need to care for patients. I can barely practice telehealth urgent care now because I’m not licensed in enough states. As an independent contractor, I’m not about to shell about big bucks, and a bigger amount of my time, to obtain additional licenses, so I’m effectively a wasted resource in the primary care / urgent care space.

David Shulkin calls for the states to adopt a model that stretches the boundaries of care, much like the Veterans Administration has done. Many organizations continue to lobby state legislatures to allow continued licensure flexibility, and some states have created lower-cost, telehealth-specific licenses that allow continued practice with more acceptable overhead. Shulkin uses motor vehicle driver licensure as an example, with operators being obligated to follow the laws of the state they’re in regardless of where their license was issued. In that kind of model, physicians would agree to abide by the laws of the patient’s state.

Such flexibility would not only help telehealth programs, but would also help in-person care. Organizations that require support from locum tenens physicians would have access to larger pools of physician candidates and would experience fewer delays in a physician arriving onsite. Ultimately patients would win, which should be the goal of 99% of what we do in healthcare. This would be administrative simplification at its finest.

Unfortunately, I know how state medical boards think, and I don’t see them running to jump on this particular bandwagon. Still, a girl can hope. Maybe some day I’ll be able to see more than two patients a day again.

What do you think about cross-state licensure? Will we see improvement in this decade? Leave a comment or email me.

Email Dr. Jayne.

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