Curbside Consult with Dr. Jayne 6/13/22

I was sorry to read of Mr. H’s COVID-like symptoms, which as of his last post hadn’t yet resulted in a positive test. Especially in vaccinated patients, we’re seeing a pattern where antigen testing doesn’t become positive until five days or more after symptoms have started. Although vaccinations are still very good for preventing hospitalizations and death, I’m seeing a fair number of people with some pretty debilitating symptoms as well as a large number of patients with long-COVID symptoms. Best wishes for a speedy recovery for Mr. H.

As a physician who has spent thousands of hours staffing emergency departments and urgent care facilities, I fully support the idea of having interoperable systems to better understand patients’ medication histories. My first informatics employer stood up a private health information exchange (HIE) to help its employed physicians better share data with community physicians who also used the same EHR. It was an exciting time to learn how the connectivity needed to work and to navigate through decisions such as whether we would be an opt-in or opt-out platform in the face of changing privacy laws and state requirements that weren’t keeping up with the times. As the first HIE in the state, if was something to be proud of, but we knew it could be done better and were ready to support broader statewide efforts when they came along.

One of the major benefits of even our limited regional system was being able to see prescription histories and to identify patients who were visiting multiple physicians for controlled substances, or who were trying to refill their medications sooner than they should. Having the data made it easier to have those uncomfortable conversations with patients so that we could try to arrange appropriate follow up. From those experiences, it was natural to be a champion for Physician Drug Monitoring Programs (PDMPs) when they were first proposed. Some states were faster in creating these programs than others, and at least one state still doesn’t have a true statewide platform. As soon as one became available to me, I signed up, and before long I was using it nearly every day.

My last urgent care employer had a large number of midlevel providers seeing patients – nurse practitioners and physician assistants outnumbered the physicians nearly three to one. In my location, those providers weren’t allowed to sign up for the PDMP on their own, but required a sponsoring physician to allow them to be a delegate on their account. I thought that was unusual since those providers can prescribe controlled substances in my state as long as they have the name of their collaborating physician on the prescription, but I’m not the one who makes the rules. Several of the nurse practitioners asked me to sponsor them even though I wasn’t their collaborating physician. Apparently, the physician owners (who were the collaborating physicians for many of the midlevels) refused to sponsor them for the PDMP because they didn’t want it to create inefficiency in the workflow.

I found that approach to be short-sighted as well as non-collegial, so I agreed to sponsor a few of them who I had worked with for years and knew very well. They continued to use the system under my sponsorship until I left the practice and terminated the linkage between our accounts. It looks like their collaborating physicians still won’t sponsor them, because every two weeks I get an email from the PDMP noting that I still have open requests for sponsorship. In thinking about the fears of inefficiency, it’s likely more complex than that since the practice dispensed medications on a cash basis (including controlled substances) and was well known for making sure providers were “treating the heck out of symptoms.” Patient satisfaction was also a big push and of course it takes more time to counsel a patient about something you might find in the PDMP versus just prescribing medication. The practice also refused to install technology that would allow e-prescribing of controlled substances, so you get the picture. Attitudes like that are part of why I no longer work there, but one does still have to think about the impact of any new systems on efficiency.

An article in JAMA Health Forum addressed the topic this week, with findings that having a PDMP that’s integrated with the EHR led to increased use of prescribing recommendations by primary care clinicians. It shouldn’t be surprising to anyone that if you have a solution that makes it easy to do the right thing, people will be more likely to actually do the right thing. The researchers looked at 43 clinics and how they used the Minnesota PDMP. There were 21 clinics that had the PDMP integrated with the EHR, which reduced the need for a separate login to the outside system while also lowering the need to intentionally think about using the PDMP.

Monthly query rates for the non-integrated sites were 6.6 per clinician before the intervention versus 6.9 after. Monthly query rates for the integrated sites were 8.8 before the intervention and 14.8 after. Additionally, the findings showed a greater impact of the EHR integration on less-experienced clinicians, which they noted “may reflect a less inflexible practice style and/or faster uptake of new features in the EHR.” While the study was underway, Minnesota initiated a mandate that clinicians query the PDMP before prescribing opioid drugs, which led to an uptick in query counts in both groups, although that increase was more significant for prescribers in the intervention group.

There are several potential limitations to the study, including the fact that it didn’t directly assess opioid prescribing. The study was also limited to a single health system and its affiliated prescribers within a limited geographic range, although there was inclusion of urban, suburban, and rural areas. The study also could not identify whether queries were clinically appropriate or not or whether the PDMP queries led to providers deciding to not prescribe controlled substances when they otherwise might have. The authors do plan to look at this in a further analysis using information from the EHR.

I do hope that those who are trying to increase the adoption of EHR-integrated solutions use information like this to show that they can have a positive impact on provider workflow. They can also have a significant impact on patient outcomes when it comes to identifying patients who might benefit from an intervention with regard to controlled substances. I’m interested to see what results other organizations may have had with EHR integration and how their clinicians responded to it.

Have you integrated your state’s PDMP with your EHR? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 6/13/22

Boulder Care raises $36M to grow telehealth platform to treat opioid addiction

Substance use disorder telemedicine startup Boulder Care raises $36 million in a Series B round that brings its total funding to $50 million.

Cognosante Awarded Contract to Modernize Pennsylvania Patient and Provider Network

The Pennsylvania Department of Human Services awards Cognosante a $16 million contract to migrate the state’s Patient and Provider Network and Public Health Gateway to a new HIE platform.

IBM CEO explains why he offloaded Watson Health: Not enough domain expertise

IBM Chairman and CEO Arvind Krishna says the company sold Watson Health to Francisco Partners for $1 billion in January because IBM just didn’t have the domain expertise to keep the product viable in healthcare.

Monday Morning Update 6/13/22

Top News

Oracle Executive Chairman and CTO Larry Ellison says in a Cerner acquisition update that hospital EHRs – he names Cerner, Epic, and Allscripts – fragment records across providers because each hospital buys and operates its own, preventing providers from accessing a patient’s records in an emergency and limiting the value to public health researchers.

Ellison says Oracle will create a national EHR database that is continuously updated via updates from provider EHRs. Providers will be able to access identifiable information if authorized by the patient, while public health researchers would be limited to a de-identified view.

Ellison says Millennium will be significantly enhanced with voice UI, AI models, and automated clinical management. He mentioned the oncology decision support work of Project Ronin, of which Ellison is a co-founder.

Much of the presentation touted Oracle’s other healthcare offerings, such as ERP, workforce management, clinical trials, and cloud services.

Cerner will operate under the name Oracle Cerner, according to several references in the presentation.

HIStalk Announcements and Requests

Poll respondents are evenly split about feeling welcome and appreciated when contacting their preferred hospital. One commenter says the hospital person always reads the appropriate script even though it’s clear their main job is as a goalie to keep people from talking to someone who could answer questions. ServiceWithaSnarl says that the academic medical center where they work as a physician faculty member at least gives everyone equally horrible service, physician or not.

New poll to your right or here: How often do you read or send work-related email and messages on evenings and weekends?

Webinars

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

Acquisitions, Funding, Business, and Stock

IBM Chairman and CEO Arvind Krishna tells attendees at a stock market analyst conference that the company sold Watson Health to Francisco Partners for $1 billion in January because IBM just didn’t have the domain expertise to keep the product viable in healthcare. The company is now focused on developing Watson’s AI capabilities for automated order-taking at fast-food chains and IT operational efficiencies.

Sales

• The Pennsylvania Department of Human Services awards Cognosante a $16 million contract to migrate the state’s Patient and Provider Network and Public Health Gateway to a new HIE platform the company will also help to develop.

People

First Databank hires Any Comeau (Greensea Systems) as SVP of sales and marketing.

Mobile Heartbeat names Annabaker Garber, RN, PhD chief clinical officer.

Matthew Grose (Optum) joins Ōmcare as CTO.

Thomas Bartiromo (Children’s Hospital of Philadelphia) joins Tower Health (PA) as VP/CTO.

Doctivity promotes Cathryn Connolley-Kluck to president and Haili Coombe to VP of client engagement and software product innovation.

Announcements and Implementations

Carilion Clinic (VA) integrates TytoCare’s telemedicine software and devices into its virtual care program.

Other

In Canada, Hamilton Health Sciences employees celebrate the seven-hospital system’s Epic go-live.

A recent study from Net Health company Focus on Therapeutic Outcomes finds that 82% of physical therapy patients with low back pain who received rehabilitation via telemedicine during the pandemic were very satisfied with their treatment results. Outcomes were found to be equally effective and visits as efficient as in-office appointments.

Sponsor Updates

• EVisit wins a silver Digital Health Award in the connected digital health: telehealth/RPM category.
• Black Book Research announces that Netsmart has earned the 2022 award for highest customer satisfaction in its annual client experience performance ratings for enterprise behavioral health EHR vendors.
• Everbridge joins the AWS Independent Software Vendor Accelerate program.
• FDB names Patrick Mulry customer success manager.
• Nordic posts a video titled “The Impact of Cloud on Patient Care.”
• Healthwise wins a merit Digital Health Award in the digital health media/publications: video category.
• Imprivata wins three awards from Cyber Defense Magazine in the categories of most comprehensive identity and access management, next gen identity security, and market leader privileged access management.
• The Empowered Patient Podcast features Medicomp Systems CEO Dave Lareau.
• NTT Data publishes a new case study showcasing how its solutions have improved Independent Health’s IT experience for employees and transforms its infrastructure services.
• Symplr partners with human resources analytics company Visier to develop healthcare workforce analytics to help organizations more effectively recruit, hire, and retain staff.

Blog Posts

• The Value of Hybrid Care for Emergency Departments and EMS (EVisit)
• Using digital patient payment solutions to expedite healthcare collections (Experian Health)
• Navigators: The Human Heart of Virtual Care Navigation (Get Well)
• Save Your Top AP Talent from Back-office Burnout (GHX)
• A “Neutral Zone” for Data Sharing Allows Researchers to Share Data for Drug Discovery While Remaining HIPAA-compliant, Preventing Data Leaks (Healthcare Triangle)
• Keys to a Successful Chart Abstraction Project (Healthcare IT Leaders)
• Is your hospital unwittingly making these healthcare downtime mistakes? (Interbit Data)
• How Collaborative IT Can Unlock Collaborative Care (InterSystems)
• Interpreting clinical terminology with NLP (Intelligent Medical Objects)
• What Rural Hospitals Can Do About Denial Management Right Now (Medhost)
• 9 questions to ask your EHR vendor (Meditech)
• Understanding Work Conditioning vs. Work Hardening in PT (MWTherapy)
• 5 Content Marketing Strategies for your Rehab Therapy Website (Net Health)
• Our Mission Together: Healthcare and Digital Transformation in the UK (Nordic)

Contacts

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

Morning Headlines 6/10/22

Oracle’s Ellison Pitches US Health Database With Power of Cerner

Oracle board chairman and CTO Larry Ellison shares the company’s plans for newly-acquired Cerner including developing a national system of anonymized digital health records and updating Millenium with voice interface, more telehealth features, and disease-based AI models.

Northside Hospital fined more than $1 million for failing to publish medical prices

CMS issues the first civil money penalties against hospitals that failed to comply with federal price transparency laws, with Georgia’s Northside Hospital system fined more than $1 million.

H1 secures an extension on its Series C to further its mission of creating a healthier future through the use of connected and accessible healthcare data

Clinical, scientific, and research data company H1 adds funding to its Series C investment, bringing the round’s total to $123 million.

News 6/10/22

Top News

CMS issues the first civil money penalties against hospitals that failed to comply with federal price transparency laws.

Northside Hospital Atlanta will pay $883,000, while Northside Hospital Cherokee will pay $214,000.

CMS says that Northside Hospital Atlanta ignored its warning notice and argued that the best way for patients to obtain pricing information is to use its Price Estimate telephone line.

Northside Hospital Cherokee also ignored CMS’s warning and also intentionally removed previously posted pricing files from its website.

HIStalk Announcements and Requests

I’ve been miserably ill for five days with COVID symptoms that may not actually be COVID since antigen tests and PCR were negative. I have extreme fatigue, a temperature and cough, muscle weakness, reduced visual acuity, and brain fog. I’m sure I’ve made mistakes, so bear with me.

Webinars

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

Acquisitions, Funding, Business, and Stock

The acquisition of Nordic Consulting Partners by Accrete Health Partners reportedly cost $400 million.

Providence-owned Tegria combines six of its legacy companies to form Advata, which will focus on improving patient outcomes using advanced analytics.

People

Amwell hires Carrie Nelson, MD, MS (Advocate Aurora Health) as chief medical officer.

Surescripts names Frank Harvey, MBA (ATLS Investments) as CEO.

Julie Haluska, MPA (AllianceOne) joins HealthRecon Connect as VP of enterprise sales.

Sponsor Updates

• PatientBond publishes a new case study, “Improving Patient Satisfaction Rates for Specialty Pharmacy.”
• Pivot Point Consulting promotes Matt Curtin to managing director, enterprise client solutions.
• Symplr embeds Visier’s people analytics capabilities in its recruiting solution to support deeper insights into people management and decision-making.
• Nordic publishes a video titled “Considerations for successful EHR extensions.”
• Quil Health CEO Carina Edwards will keynote at the virtual Connected Health Summit June 16.

Blog Posts

• Making the Case for a Digital Revolution in Market Access (OptimizeRx)
• Financial Health: How to Thrive in Healthcare’s Changing Landscape (Premier)
• Driving Departmental ROI (Protenus)
• What is call center software and how does it work? (Talkdesk)
• Enabling Hospital Personnel through ServiceNow’s Powerful Access Catalog (Optimum Healthcare IT)
• How to decrease patient no-show appointments (TigerConnect)
• New eBook: Simplify Your Revenue Cycle Workflow Through Automation (RCxRules)
• 4 Private Practice Management Mistakes and How to Fix Them (WebPT)
• Evaluating Patient Communication Solutions – Realistic Timelines (Well Health)

Contacts

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

EPtalk by Dr. Jayne 6/9/22

Since there have been so many dramatic changes to many workplaces over the last two years, many companies are re-evaluating the meaning of the workweek. I always keep my eye out for articles on this topic, as well as literature from other countries where work-life balance seems to be much higher priority than it is in the US. There have been several writeups this week about a move in the United Kingdom for large numbers of workers to adopt a four-day work week. There are 3.000 workers taking part in a six-month project to assess whether shortening the work week will alter productivity, employee turnover, company revenue, and more.

The article mentions strategies different companies have taken in trying to alter the work week, including streamlining meetings and reducing inefficiencies. Kickstarter, which is small at only 90 employees, has given them Fridays off. I know of quite a few larger companies that don’t necessarily give people Friday off, but instead offer “Focus Fridays” and other themes where employees are supposed to have uninterrupted work time without meetings or distractions. For employees who are self-motivated, this can be a solid strategy. One of the health systems I worked for pre-pandemic allowed employees to work remotely one day each week and I have to say it was some of the most productive time I had, because in the pre-Zoom era, there weren’t any meetings or calls.

Another strategy that I see some companies offering as a means to improve work-life balance is that of unlimited time off. In speaking with friends that work at a large tech company where this is the norm, it can be less of a benefit than advertised, since workers who aren’t accustomed to tracking time off may not take full advantage of the paid time off that they might have received under a more traditional system. Although when these programs were initially rolled out, there was a lot of concern about people abusing it, many companies find that workers actually spend less time away from the office. I’ve worked with plenty of people over the years who only took days off when they were “forced” to in order to get the days off the books.

Other groups are offering dedicated days where employees are supposed to focus on self-care. Advocate Aurora Health is one of those, offering “renewal days” where employees are supposed to meet together for support. I found it interesting that their original program was a three-day workshop designed to focus on finding meaning in work while building skills to combat burnout, stress, and compassion fatigue but it has since been compressed into a single-day program. That seems such a parallel to everything that has happened since January 2020, where most healthcare workers are expected to do more with less even in the face of previously unheard-of stressors. I still hear about plenty of healthcare organizations that are trying to combat serious organizational issues through the application of pizza lunches and therapy dogs so I’m not sure we’re making much progress.

The University of Missouri launches a telehealth program to train rural primary care physicians in the use of Canvas Dx with the goal of supporting autism diagnoses. The tool, from Cognoa, will be added to the platform used by the University of Missouri ECHO Autism Communities Research Team. The group will explore the time it takes from a physician’s initial concern that Autism may be a factor to a diagnostic determination via Canvas Dx. Earlier diagnoses should lead to earlier interventions and hopefully better outcomes for patients and families. The study plans to recruit up to 15 clinicians to evaluate as many as 100 children at risk for autism spectrum disorder or developmental delay. As a side note: has anyone ever noticed that the MU logo contains a mule? I don’t know how many times I’ve seen the logo but never the mule.

US Representatives Madeleine Dean (Pennsylvania) and Larry Bucshon (Indiana) introduced a bill this week that aims to protect healthcare workers from violence. It is modeled after existing protections created for airline and airport workers. The Safety from Violence for Healthcare Employees (SAVE) Act would make assault or intimidation of hospital employees a crime. Representative Bucshon is a physician, so I’m disappointed that the bill appears to focus on hospital workers and not on the tens of thousands of healthcare workers in other locations where they might be even more vulnerable, including ambulatory offices and home care. Workers in those locations don’t have anywhere near the level of security or assistance found in the average hospital. As a healthcare worker who was left out of vaccine allocations because I didn’t work for a hospital (despite delivering a high volume of COVID care) it looks like we haven’t learned and will continue to propose short-sighted policies.

One of my healthcare providers recently notified me of a data breach that may have exposed my personal health information. According to the documentation, the organization learned that an “unauthorized person” gained access to a subset of employee email accounts over a more than three-week period. Investigators were not able to determine whether emails or attachments were actually viewed, but the emails included data on both patients and research subjects including names, birth dates, addresses, medical records, insurance information, Social Security numbers, and more. It’s not clear now many patients have been impacted but they promise to reinforce training on avoiding suspicious emails and to make enhancements to email security, so it seems obvious to me how the breach occurred. Depending on what data might have been exposed, some patients will receive credit monitoring and identity protection services. Regardless, it’s going to be unnerving for many of us for a long time to come. At this point I get a breach notification every year or two, so it seems there is a lot of opportunity for improvement among the various members of my healthcare team.

Judging from my social media feeds, many people are taking advantage of what they perceive to be a “normal” travel season. I’ve seen plenty of pictures from amazing places, but my own summer will be a little low key this year. I’m juggling some big projects and a go live, so I’ll only be occasionally off the grid. It just gives me more time though to plan the next big adventure.

What are your summer travel plans, or are you going the staycation route? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 6/9/22

Bon Secours bags Nordic Consulting Partners in $400M-plus deal

Sources report that Accrete Health Partners’ acquisition of Nordic Consulting, first announced last week, is valued at just over $400 million.

Arnot Health says technical issues resolved

Arnot Health (NY) resolves computer hardware issues that first surfaced in early May, leading to weeks of outages.

Data breach at health care organization may affect 2 million

Imaging and ambulatory surgical services provider Shields Health Care Group reports a March data breach that may impact 2 million patients.

Morning Headlines 6/8/22

Oracle Completes Acquisition of Cerner

Oracle has closed its deal to acquire Cerner for $28 billion.

Introducing Advata, a Software Company Improving Patient Outcomes Through Advanced Analytics

Providence-backed Advata launches as an RCM analytics and clinical decision support software company leveraging integrated solutions from KenSci, Colburn Hill Group, Alphalytics, Lumedic, Quiviq, and MultiScale.

Virtual addiction startup Bicycle Health rides Series B to $83M

Virtual opioid use disorder treatment provider Bicycle Health raises $50 million in a Series B funding round, bringing its total raised to $83 million.

News 6/8/22

Top News

Oracle shares see a slight uptick on the news that the company has closed its deal to acquire Cerner for $28 billion.

Webinars

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

Acquisitions, Funding, Business, and Stock

Bain Capital has acquired a majority stake in LeanTaaS, a technology vendor specializing in hospital operations and capacity management optimization. The company, founded by CEO Mohan Giridharadas in 2010, has raised nearly $238 million. Its cloud-based software is used by over 500 hospitals and 130 health systems.

People

Lyniate promotes Scott Galbari to president, COO, and CISO; and hires Mikael Andén (Intelerad Medical Systems) as EVP of sales.

Surescripts names Frank Harvey (ATLS Investments) CEO. Harvey succeeds Tom Skelton, who announced his intent to retire late last year.

Mark Costanza (Spok) joins MobileSmith as chief client and operations officer.

Announcements and Implementations

Stanford Health Care (CA) implements interactive bedside patient entertainment and hospital services technology from Sonifi Health.

Great Falls Clinic (MT) has implemented Phreesia’s patient intake technology.

LeadingReach announces GA of care coordination analytics.

Medical Center Health System (TX) rolls out a patient portal app incorporating EHR technology from Cerner and video visit capabilities from Amwell.

Government and Politics

After more than a year of training, Martin Army Community Hospital at Fort Benning in Georgia will go live on MHS Genesis this weekend.

A new report from the Australian Digital Health Agency finds that routine patient visit information is still missing from many health records within the national My Health Record system, launched in 2012 with a price tag of over $1.4 billion. Patient use has also been wanting, with just 2.69 million out of the nation’s 23 million patients accessing their information since the system’s launch. Physicians have found the software’s design to be problematic, with many preferring to instead access patient data via their hospital’s EHR.

Plans to implement a Cerner-based EHR across facilities on Prince Edward Island have come to a halt due to usability issues. The province had hoped to have all sites live by 2020. Forty-three clinics and 118 physicians have been connected to the system, with 100 more clinicians still to go. The same software has been in use at Island Health hospitals for over a decade. Two independent reviews of that $178 million implementation have been conducted based on physician complaints of poor usability and patient safety risks.

The State of Wisconsin eliminates EHR integration fees to encourage more providers to connect to its electronic prescription drug monitoring program.

Other

The latest release of the Philips Capsule Surveillance solution has received 510(k) market clearance from the FDA.

UT Southwestern Medical Center researchers have found that access to telemedicine visits and continuous glucose monitoring during the pandemic helped diabetic pediatric patients control their glucose levels and stay out of the hospital at rates similar to pre-pandemic levels.

Apple adds medication list creation, reminders, and critical interaction alert features in its latest iOS update.

A small study conducted at a stroke clinic within the UC San Diego Health system has found that patient satisfaction with telemedicine visits improved when patients were texted a log-in link when the physician was ready for the appointment, rather than queuing in a virtual waiting room. Over half of patients were seen early during the two and a half month study, while zero were seen late, resulting in time savings of nearly an hour. As a result, the health system is rolling out the text messaging option to high-volume primary care and surgical care clinics this summer. The text-to-video technology was developed by Doximity.

Sponsor Updates

• AGS Health will exhibit at CHIACON22 Convention & Exhibit June 12-15 in Riverside, CA.
• Baker Tilly publishes a new case study, “Product value communication results in new payer coverage for diagnostic testing coverage.”
• Cerner publishes a new client achievement story, “Clinicians at pediatric health system save charting time following ambulatory optimization.”
• CHIME releases a new CHIMEcast Podcast, “Challenge, Change, and Resilience with Michael Jefferies.”
• Clearwater names Mike Scheerhorn (Everly Health) to its compliance and privacy consulting team.
• Current Health has been named the 2022 Frost & Sullivan Company of the Year in the global virtual home care platform industry.
• CarePort adds predictive analytics for post-acute care planning after discharge to its CareManagement and Insight solutions.
• Patient privacy monitoring company Protenus updates its website.
• OptimizeRx completes integration of TelaRep’s one-click prescriber connectivity solution with its Therapy Initiation and Persistence Platform.
• Diameter Health partners with Smile CDR, giving customers the ability to implement Diameter Health’s Fusion technology for upcycling data along with Smile CDR’s clinical data repository capabilities.

Blog Posts

• Value-based Care Can Be More Than a Buzzword: Thoughts on Health Plan Priorities (Diameter Health)
• What Will the Future of Healthcare Look Like? (Experity)
• Recent HIPAA Breaches: How to Avoid an Email Breach & Secure Your Practice (AdvancedMD)
• Where Interoperability is Succeeding in Healthcare (Arcadia)
• Leveraging Care Coordination for Success Under the CMS Kidney Care Choices Model (Bamboo Health)
• Physician opinion: Quality metrics fail to measure improved outcomes (Bravado Health)
• Health Literacy and the Patient Portal: Start Assessing Your Community and Facility (CereCore)
• Why Nurses Are Joining the Great Resignation and What Can Be Done (ConnectiveRx)
• Navigate Common EHR Challenges with Stewardship from an Experienced Partner (CTG)

Contacts

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

Morning Headlines 6/7/22

Aledade Raises $123 Million Series E to Accelerate Growth in Medicare Advantage and Support Primary Care Physicians With Expanded Services

Tech-enabled practice management company Aledade secures $123 million in Series E funding, bringing its total raised to nearly $420 million.

LeanTaaS Announces Growth Investment by Bain Capital Private Equity to Fuel Leading AI-Driven Platform for Hospitals to Achieve Operational Excellence

Bain Capital has acquired a majority stake in LeanTaaS, a software vendor specializing in hospital operations and capacity management optimization.

Minneapolis women’s telehealth clinic Visana Health raises $2.6 million

Virtual women’s healthcare company Visana Health raises $2.6 million in a seed funding round.

Curbside Consult with Dr. Jayne 6/6/22

It’s been a long week, and I’ve spent a good bit of it trying to process the recent episodes of violence against healthcare workers in Tulsa and Los Angeles. The Tulsa incident had a particular impact on me since I did some EHR optimization work for Warren Clinic in the past. As the news reports unfolded, and before we knew exactly where the shooting occurred, I wondered if any of the staff that I worked closely with had been impacted. Although it turned out that I hadn’t worked with any of the victims, it was still devastating to learn of the loss of dedicated healthcare professionals who had given so much to their patients and who still had many more years of service ahead of them.

Hearing of the stabbing in Los Angeles later in the week was almost too much to bear. Those who see patients in person go to work every day knowing that it’s going to be difficult, but generally they don’t expect to be shot or stabbed on the job. I’ve worked in plenty of “tough” clinical locations. At one hospital emergency department, I had to park in a secure garage that was lined with chain link fence, essentially creating a cage. You had to have a badge to get in or out via car and accessed the hospital through a secure elevator that either took you directly into the ED or up to the ICU waiting room. I often wondered what would happen if the power went out, but fortunately it never did during the years I worked there.

Patients and visitors to that facility had to go through metal detectors. I had a security guard posted at my clinical workstation in the event things became contentious. Sometimes my patients were handcuffed to their gurneys since they were being evaluated to ensure they were “fit for confinement” after being arrested by local law enforcement.

Additionally, the emergency department exam rooms all had two doors on different sides of the room so that there was always a way for you to get out. I’ve worked in large urban trauma centers, locked psychiatric emergency units, and critical access hospitals where all kinds of unusual cases have come through the doors. I’ve had patients become agitated and aggressive before, and I was even stalked by a patient, but even in those circumstances I never actually imagined that I was at risk of being shot, stabbed, or killed while trying to help patients.

Violence against healthcare workers is at an all-time high. It’s not just physical violence or homicide, but more often includes verbal abuse and threats. The Bureau of Labor Statistics indicates that healthcare and social assistance workers have the highest rates of injuries due to workplace violence. In fact, workers in those industries are five times more likely to be injured at work than workers overall. Incidents of workplace violence have been rising nearly every year since they were tracked, beginning in 2011. Although the Occupational Safety and Health Administration has guidance for employers, there are no federal requirements for healthcare organizations to protect their employees from workplace violence.

Some states have addressed the issue. A Wisconsin law makes battery against certain healthcare workers a felony. There has been some action at the federal level, but nowhere near enough. Personally, I’d like to see healthcare organizations have to report their statistics just like college campuses do – collecting detailed information about violent incidents and reporting their numbers annually. At my last in-person physician gig, my employer had numerous episodes of workplace violence and no clear mitigation strategy. Incidents were hushed up and employees were discouraged from discussing them for fear that staff wouldn’t want to pick up shifts at certain locations. There certainly wasn’t any kind of post-event debriefing for those impacted by violent incidents. Everyone was just expected to pick up and carry on, which is exactly the opposite of what is needed.

Those incidents seemed to escalate during the initial phases of the pandemic, when everyone was scared and uncertain. They became worse as certain unapproved treatments were pushed on social media, and patients would become aggressive when told we would not prescribe ivermectin or other drugs that had been shown to not only have no benefit but to have significant risks. Patients argued with us about their diagnoses despite having positive lab results and told us directly to our faces that we didn’t know what we were talking about and that we were either lying or part of a vast conspiracy. One of the worst things I had to deal with during the pandemic was patients who refused to wear a mask in the exam room, or who would take it off as soon as I walked out the door, to fill the room with their exhaled breathing so I could walk back into a cloud of virus. To have to deal with that hour after hour, day after day, and to not be able to confront it for fear of lowering patient satisfaction scores was one of the things that contributed to my departure.

Still, I’m here, and although no one has tried to directly kill me at work, it’s certainly on my mind that what happened last week could have happened to any one of us at any time. Along with many of my colleagues, we’re feeling a certain level of survivor’s guilt after seeing so much loss in the healthcare community over the last few years. Although we’ve gotten better at protecting ourselves from disease, the steps that we need to be taking to protect ourselves from workplace violence are less than clear. Regardless, healthcare employers owe it to their teams to assess the safety and the workplace and the wellbeing of those in it. Every healthcare organization should be offering employee assistance programs to those who are struggling with the recent tragedies and increasing violence.

Readers may be asking themselves what all this has to do with healthcare IT. If you’re a frontline IT support person who works in clinical areas, the answer to that is clear. It’s also a heads-up about what the people you’re trying to support might be going through. If they seem on edge or preoccupied, there’s a good chance that they are one of both of those. I’m sure that if I were seeing patients in person, I’d be less interested in learning about new features or workflows that are about to be deployed than I would be in learning how the hospital plans to keep me safe. Even if you’re not working in a clinical area, you’re not immune to workplace violence. All of us should be standing together to demand solutions that ensure we all make it home to our families at the end of the workday.

Email Dr. Jayne.

Morning Headlines 6/6/22

Software glitch at hospitals caused patients to receive inaccurate test results

In Israel, at least five hospitals report that physicians have been sent inaccurate lab test results due to a software problem.

DeliverHealth Opens Its New Headquarters And Experience Center In Clearwater, Florida

DeliverHeatlh, which specializes in healthcare documentation, coding, and revenue integrity software and services, relocates its Madison, WI headquarters to Clearwater, FL and opens a customer experience center in the same facility.

Leading Healthcare Artificial Intelligence Company Raises $20m Series A Extension

Sleep data interpretation and analysis software vendor EnsoData adds $20 million to its Series A funding round, bringing the round’s total to $29 million.

Meriplex Acquires Healthcare-based MSP, LightPoint

Managed IT and cybersecurity firm Meriplex acquires LightPoint, a managed services provider with a niche in healthcare IT.

Monday Morning Update 6/6/22

Top News

Harris acquires EHR training vendor Sedona Learning Solutions, which will operate as a division of the company’s IatricSystems.

HIStalk Announcements and Requests

A reader emailed me an interesting point about the historical drivers of EHR use. Meaningful Use incentives made medical practice adoption widespread, but hospitals were more motivated by the shame of the IOM’s 1999 report “To Err is Human” and Y2K, with the resulting system implementation and replacement activity taking the industry into a three-horse EHR race of Cerner, Epic, and Meditech.

Poll respondents report quite a bit of employer-paid time off, with a surprising 29% indicating that their PTO is unlimited. Commenters suggest that maybe unlimited PTO isn’t the big gift that it seems – employees can’t tell if they are using too much compared to everyone else, and in the absence of someone else to cover their work, it’s just waiting for them when they return anyway. One commenter questions whether for-profit companies that change from accrued PTO to unlimited might be cleaning up their books in anticipation of selling the company.

New poll to your right or here: Do you feel welcome and appreciated when you contact your preferred health system by telephone, email, or in person?

Thanks to these companies for recently supporting HIStalk. Click a logo for more information.

Webinars

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

Acquisitions, Funding, Business, and Stock

Shares in the Global X Telemedicine and Digital Health ETF mirrored the Nasdaq’s performance in the past month, dropping 7%. EDOC shares are down 35% in the past 12 months versus the Nasdaq’s 11% loss.

Sales

• Allina Health signs a $20 million contract to implement Visage 7 Workflow and Visage 7 Viewer from Visage Imaging.

People

Dan Dwyer (Cecelia Health) joins Wildflower Health as SVP of sales.

Other

In Israel, at least five hospitals report that physicians have been sent inaccurate lab test results due to a software problem.

Sponsor Updates

• EClinicalWorks releases a new podcast, “A Bridge to the Future of Behavioral Health.”
• Pivot Point Consulting promotes Gisela Cuddihee to senior manager of engagement management and Tom Slowe to senior manager of engagement management, training, and activation.
• Premier Chief Pharmacy Officer and Group VP of Supply Chain Jessica Daley and Group VP of Life Sciences Denise Juliano join CancerCare’s Board of Directors.
• Vocera publishes a new case study, “UnityPoint Health – Allen Hospital: Relieving Nurse Burden and Strengthening Safety.”
• Visage Imaging will exhibit at SIIM 2022 in Kissimmee, FL June 9-11.

The following HIStalk Sponsors have achieved top customer rankings, according to a recent Black Book financial solutions survey:

• Experian Health – EMPI, hospital claims management systems
• VisiQuate – RCM analytics
• Premier – ERP
• Relatient – patient financial communications & satisfaction solutions
• Change Healthcare – financial technology digital transformation consultants

Blog Posts

• An Ounce of Prevention (Nordic)
• New England HIMSS 2022: What Does the Future Hold for Health IT Innovations? (Diameter Health)
• Making the Case for a Digital Revolution in Market Access (OptimizeRx)
• 3 Ways a Patient Engagement Strategy Makes a Difference for Your Pharmacy (OmniSys)
• Payor Strategy for High Value Behavioral Health Networks (Owl)
• 5 risk factors for COVID-19 breakthrough infections (Cerner)
• How COVID-19 Changed the Relationship Between Healthcare and Life Sciences (PatientBond)
• Nurses of Note Awards 2022: Retired Interior Designer Embarks on Second Career as a Nurse (PerfectServe)
• Symplr Roundtable Explores Health Plan Challenges with No Surprises Act (Symplr)
• What’s cloud got to do with it? (Nordic)
• Financial Health: How to Thrive in Healthcare’s Changing Landscape (Premier)
• Driving Departmental ROI (Protenus)
• Cloud: this is enterprise imaging (Sectra)
• On the Hunt for Network Anomalies (Surescripts)
• Webside Manner: The Key to Improving Patient Experiences (TigerConnect)
• Ascend 2022 Recap: 5 Takeaways from WebPT’s 9th Annual Business Summit (WebPT)
• Evaluating Patient Communication Platforms – Researching Vendors (Well Health)

Contacts

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

Morning Headlines 6/3/22

A Message from Carbon Health CEO Eren Bali

Tech-forward medical care provider Carbon Health lays off 250 employees, about 8% of its workforce, citing “changing market conditions.”

Net Health’s Tissue Analytics for Wound Care Granted Breakthrough Device Status by FDA

Net Health’s wound imaging and analysis software, Tissue Analytics, earns FDA designation of Breakthrough Device Status, the first time an EHR company has been given that distinction.

Harris Continues Healthcare Growth with Acquisition of Sedona Learning Solutions

Harris will incorporate newly-acquired Sedona Learning Solutions, which offers hospitals custom health IT learning solutions and consulting services, into its IatricSystems business unit.

News 6/3/22

Top News

Newly launched digital holding company Accrete Health Partners – a spinoff of Bon Secours Mercy Health — acquires Nordic Consulting Partners, with no financial details provided.

Accrete is led by BSMH Chief Digital Officer Jason Szczuka, JD.

Webinars

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

Acquisitions, Funding, Business, and Stock

Oracle clears regulatory review of its acquisition of Cerner, with completion of the tender offer expected on Monday, June 6. Oracle’s update emphasizes “our new, easy-to-use systems” whose primary user interface will be hands-free voice technology and the “huge growth engine” that will result from Oracle expanding Cerner’s user base to additional countries. Oracle Chairman and CTO Larry Ellison and other Oracle executives will discuss the acquisition in a June 9 webinar titled “The Future of Healthcare.” 

Online mental health startup Cerebral will lay off an unstated number of employees this month as it undergoes a federal probe into its prescribing practices.

Tech-forward medical care provider Carbon Health lays off 250 employees, about 8% of its workforce, citing “changing market conditions” such as reduced demand for its COVID-specific services and the investor market shifting to an emphasis on profit rather than revenue growth. The company has raised more than $500 million, with valuation reaching at least $3 billion last year. The headcount reduction was reportedly focused on corporate staff.

Sales

• VHC Health will implement Certify Health’s facial biometrics positive patient ID at all its locations, starting with pilot programs in radiology and cardiology this month. 

People

Bamboo Health hires Guy Mansueto, MM (PartsSource) as chief marketing officer.

Sachin Agrawal, MSc (RLDatix) joins EVisit as president.

Southeast Health (AL) promotes Ravi Nallamothu, MD to chief health information officer.

Brightwork, Health IT hires Tabitha Lieberman (Providence St. Joseph Health) as president of EHR and healthcare applications.

Huron promotes Ronnie Dail to COO.

Announcements and Implementations

Net Health’s wound imaging and analysis software, Tissue Analytics, earns FDA designation of Breakthrough Device Status, the first time an EHR company has been given that distinction.

A new KLAS Arch Collaborative report finds that health systems fall short in meeting user expectations for EHR reliability and system response time, which are key factors for driving clinician EHR satisfaction. The report notes that system speed, which is one of the lowest-satisfaction user issues, is interpreted by users as an indicator of poor EHR reliability. Many clinicians who are dissatisfied with EHR speed or reliability also mention hardware issues and slow log-in times.

Government and Politics

A VA OIG report says that the year-ago implementation of Cerner at Mann-Grandstaff VA Medical Center (WA) has caused gaps in performance, quality, and access metrics, with employees questioning whether the hospital can pass an upcoming Joint Commission accreditation survey. Employees are performing laborious workarounds and making best guesses since the hospital is reporting only 13 of the VA’s 103 organizational performance metrics. OIG listed challenges such as Cerner’s failure to deliver metrics reports, lack of VA resources and training, and the VA’s failure to assess EHR metrics before go-live.

Privacy and Security

FBI Director Christopher Ray tells attendees of a cybersecurity conference that its intelligence uncovered a planned cyberattack against Boston Children’s Hospital by Iran-sponsored hackers last year, which the hospital blocked with the FBI’s help. The hospital’s systems went down for a week in 2014 from a cyberattack by a member of the Anonymous hacker group that was related to a custody battle involving a teenage patient.

Other

KHN looks at proposed “right-to-repair” laws for power wheelchairs, of which the two largest suppliers are owned by private equity firms. Users of malfunctioning wheelchairs, replacement of which is limited by insurance to every five years, face software and hardware locks, restricted access to parts and manuals, failure of lower-quality products with no coverage for preventive maintenance, and months-long waits for replacement parts as suppliers wait for insurance approval.

In Canada, members of the equity, diversity, and inclusion committee of Hamilton Health Sciences say that Epic – on which HHS will go live this weekend in a $140 million project – does not capture information such as race, ethnicity, disability, gender, sexual orientation, language, and length of time in Canada. The hospital says it will enhance the system after go-live.

Sponsor Updates

• EClinicalWorks publishes a new customer success story, “How Online Booking is Helping a Cardiology Practice.”
• Cerner secures 331 new, expanded, and extended customer contracts in the first quarter of 2022.
• CTG donates needed supplies to FeedMore WNY to support their work in local communities.
• FDB hires Abby Yu as a clinical informatics specialist.
• Black Book names Netsmart as the top-rated post-acute ambulatory health solutions vendor in customer satisfaction.
• Meditech adds an Obstetric Hemorrhage Management Toolkit to its Expanse EHR.

Blog Posts

• 3 Technologies for Health Education Explained (Healthwise)
• Virtual Care Terminology: Telemedicine, Telehealth, and Hybrid Care Defined (EVisit)
• 5 Questions to Assess Your Strategic Digital Direction (GHX)
• Reducing Physician Burnout with EHR Optimization: 3 Examples (Healthcare Triangle)
• The future of HIPAA-compliant faxing (Interbit Data)
• An ounce of prevention (Nordic)
• What Rural Hospitals Can Do About Denial Management Right Now (Medhost)
• Preparing for Hurricane Season (Optimum Healthcare IT)
• 5 easy ways to improve HCAHPS scores through patient satisfaction (Meditech)
• Understanding Work Conditioning vs. Work Hardening in PT (MWTherapy)
• The Great Resignation and Understaffing Are Here. Can Automating Prior Authorization Help You Cope? (Myndshft)
• Making Wound Care Without Walls a Reality (Net Health)

Contacts

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

EPtalk by Dr. Jayne 6/2/22

Surprise, surprise: research shows that patients understand their health records better when they are not full of abbreviations. The study, published in JAMA Network Open, showed improved comprehension when certain abbreviations and acronyms were spelled out. Although study subjects had previous exposure to healthcare organizations, their initial understanding of some common abbreviations was below 40%. Looking at a set of 10 common abbreviations, expanding them increased comprehension from 62% to 95%. The authors urge clinicians to consider that patients may not understand abbreviations and medical terminology. Abbreviations aside, it’s important to understand the low level of health literacy across the US and the need for most patient-facing communications to be written at or below the sixth-grade level.

I recently had another trip into the Patient Zone, and even as a healthcare provider, I found some of the things I encountered confusing. I know how to navigate the system and I still have a post-visit issue that remains unresolved three days later. The office was running significantly late, so I got to listen to quite a few inappropriately overheard conversations. One involved a staffer who kept confusing two “sound-alike” medications to the point where I wanted to step out to the clinical station and correct her. Losartan is for blood pressure, Loestrin is an oral contraceptive. I later found out that she wasn’t working in her usual clinical location because they had floated people to the office to cover shortages. Still, I hope that no one was harmed on their watch. I received some wonky directions from people in the office and it makes more sense if they were temporary staff, but the average patient might not know to question it.

I’m also trying to put myself in the shoes of patients who are receiving immediate lab results via their patient portal accounts. The clinician I saw warned me, “you’ll probably see your results before I will” and she wasn’t kidding. Barely six hours after I left the office, I started receiving a flurry of “new result available” alerts. I’m not sure how the labs were ordered, but each component of the blood work was coming back as an individual result with its own notification. It was unnerving to say the least, especially since the ones I was really waiting for weren’t among the first to return. As a physician, I know what the results mean, but as a patient I can imagine it might be very frustrating. My guess is it won’t be until sometime next week before I receive an official interpretation, once all the results have returned. I’ll be interested to see how the rest of the process goes, and if my pharmacy benefit manager will ever sort out the erroneous script that was sent. I tried to resolve it, but they were never able to find the provider’s name in their system (despite me being able to see the erroneous script from the patient-side login) so I’m betting at some point I wind up driving to the office to pick up a paper script and fax it in myself.

Needless to say, there’s a long way to go for some healthcare organizations to really embrace the idea of patient-centered design. There have been a lot of healthcare futurists over the last decade who have said that patients will vote with their feet and drive their healthcare dollars towards organizations that deliver care that is personalized and consumer friendly. Pre-pandemic I still saw the majority of patients choosing their care based on insurance coverage with very little consideration of quality metrics or anything else. Now, with all the staffing shortages and physicians leaving patient care in droves, patients seem to just be getting in wherever they can. In my area, one of the largest health systems has over 4,000 patients on its wait list for a particular specialty, which now refuses to accept any referrals from outside the health system. That doesn’t seem terribly patient-centric to me. The organization blames its inability to recruit for the shortage of clinicians. I guarantee that if they raised their salaries above 25th percentile they’d be able to recruit.

After reflecting on these recent experiences, I wasn’t sure I was in the right frame of mind to read yet another article about a “man on a mission” in healthcare. One of my shoe-loving friends has a huge crush on Glen Tullman though, so I figured I better keep up so she and I have something to chat about. The premise of Tullman’s latest venture, Transcarent, is leveling the playing field for patients as they try to meet their healthcare needs. He calls out the fact that the health insurance industry is one that doesn’t operate in the best interests of its customers. The article calls out the fact that when insurance companies profit, each dollar represents care that patients didn’t receive. Tullman proposes giving those dollars back to large, self-insured employers who are footing the bill for coverage.

It will be interesting to see if Transcarent is able to succeed where other companies have failed. Haven tried to do this a few years ago for employees of Amazon, Berkshire Hathaway, and JPMorgan Chase. So far, more than 100 companies have signed up, eager to see savings on their healthcare spending. Transcarent makes its money by taking a cut of that savings, which is achieved through pre-negotiated pricing for services as well as by directing patients to lower-cost alternatives. Corporate customers are gravitating to the approach as are health systems, some of which are financially backing the endeavor. Walmart is jumping in with a recent agreement to become a preferred provider, offering primary care, mental health, and dental services. The article was enough to hook me, so I’ll be following along as the company expands. They’ve already hired some really smart people, and I’m eager to see if they’ll be able to move the needle.

Happy 19th Birthday HIStalk! I didn’t have time to do proper pastry therapy, so this option from my neighborhood Costco will have to do. Even though white cake is my favorite, you really can’t go wrong with a cake that is filled with their signature mousse.

What’s your favorite birthday pastry? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 6/2/22

Oracle Purchase of Cerner Approved

Oracle has gained the antitrust approvals necessary for its proposed $28.3 billion acquisition of Cerner, now set to take place next week.

SoftBank-Backed Telehealth Firm Cerebral Announces Layoffs

Amidst federal scrutiny and the recent ouster of its founder and CEO, Cerebral announces that it will lay off an undisclosed number of employees by July 1.

Moxe Health Raises $30M Series B to Further Advance Interoperability

Health data exchange vendor Moxe Health raises $30 million in a Series B funding round led by Piper Sandler Merchant Banking and Vensana Capital.

Accrete Health Partners Acquires Nordic Consulting Partners

Accrete Health Partners, a digital health holding company that launched in May, acquires Nordic Consulting for an undisclosed sum.