News 6/25/21

Top News

Shares in Doximity, which set an IPO share price of $26 versus the expected range of $20 to 23, close at $53.00 on their first day of trading on the New York Stock Exchange, valuing the physician network vendor at $7 billion. 

Reader Comments

From Muumuu Summer: “Re: Epic. Are you hearing that they seem to be losing more employees than usual? It seems like they are bringing back a previous break-the-glass strategy by having senior people cover open positions until they can be filled, which can leave clients without a permanent person for months.” Epic clients are welcome to report their experience.

From Watcher of the Data: “Re: Avaneer and blockchain. You are dead right about this. The most amusing part of this is that blockchain won’t ‘solve’ the interoperability problem – it can become useful only once the problem has been solved.”

From Percolator: “Re: Epic’s sepsis model. Cerner has a free one that gets little use, and the company has had trouble selling models for other conditions. Every condition needs to be mapped to hospital work flow – who do you alert and how, and what is the recipient supposed to do? These models add little incremental value because (a) doctors are already very good at detecting sepsis and starting antibiotics, and (b) 90% of sepsis is community acquired before the patient is admitted. ‘Watch this patient more closely’ is not worth much, especially if doctors and nurses already suspect sepsis.” Thanks. I’ve removed identifying information since I wasn’t sure this comment was intended for public display.

From Ossify: “Re: Epic’s sepsis model. Why should anyone care what the algorithm does as long as it works?” You wouldn’t want to harm someone, either by overtreating or undertreating, because a software model was trained on a bunch of data and “learned” from facts that are clearly irrelevant or not universally applicable. Example: Epic developed a patient no-show model awhile back that incorporated the patient’s religion and body mass index in predicting whether they would show up for appointments, and researchers found that removing those features didn’t reduce the model’s predictive powers but eliminated some inequity issues. Did Epic really think those factors were relevant, or was their data science knowledge insufficient? Then there’s the “what do we do with this” issue – should appointments be double-booked in case those patients really do skip their appointments (and what happens if they don’t?) or perhaps could the information be less invasively and more constructively used to send reminders or to understand that particular patient’s possible issues with venue location, transportation, or available hours that could be resolved by suggesting a different location? AI is amazing for being able to detect data patterns that humans haven’t, but if pitched to replace or even enhance expert judgment, it’s the customer’s job to make sure that the algorithms work in their particular situation. I’m not sure the average health system has the expertise to make those evaluations, so that’s why outside review is a reasonable recommendation.

From Bagna Cauda: “Re: mental health apps. Which ones are best?” I’m skeptical that any of them accomplish much given the lack of peer-reviewed studies on their outcomes. FDA seems to lack interest in holding their developers accountable even when they are clearly being pitched for use in medical or psychological situations. It doesn’t help that psychological counseling itself may have outcomes that are hard to prove. Lastly, the nature of these behavioral health app companies is that they are pandering to investors who demand fast growth Silicon Valley style, which means their customers will have minimal human involvement and instead will interact with scalable, cookie cutter technology that offers the opposite of the human interaction that many people crave. It also seems that some vendors expect users to stop paying once the limited value of the app becomes clear, so they refocus on selling to employers and insurers (healthcare excels at separating the people who consume a service from those who pay for it).

Webinars

June 30 (Wednesday) 1 ET. “From quantity to quality: The new frontier for clinical data.” Sponsor: Intelligent Medical Objects. Presenters: Dale Sanders, chief strategy officer, IMO; John Lee, MD, CMIO, Allegheny Health Network. EHRs generate more healthcare data than ever, but that data is of low quality for secondary uses such as population health, precision medicine, and pandemic management, and its collection burdens clinicians as data entry clerks. The presenters will review ways to reduce clinician EHR burden; describe the importance of standardized, harmonious data; suggest why quality measures strategy needs to be changed; and make the case that clinical data collection as a whole should be re-evaluated.

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

Acquisitions, Funding, Business, and Stock

Providence-owned Tegria acquires healthcare AI vendor KenSci.

Subscription-based opioid use disorder virtual care vendor Bicycle Health raises $27 million in a Series A funding round.

National emergency medical services provider Priority Ambulance acquires software vendor Randseco, which offers the StatCall digital patient logistics solution that supports information exchange among ambulances, hospitals, payers, and non-medical transportation services.

CitiusTech acquires Pittsburgh-based payment technology consulting firm SDLC Partners. 

Sales

• The University of Texas Health Science Center at Houston engages ReMedi Health Solutions to offer personalization training for 2,000 clinicians in 18 specialties as it implements Epic. The company also provided an AI-powered virtual assistant for workflow help and tipsheets.

People

Healthcare IT Leaders hires Patrick Dougherty (Allscripts) as CTO.

Pallav Sharda, MBBS, MBA, MMI (Google) joins employer bundled health services platform vendor Carrum Health as chief product officer. 

Well Health hires John Knotwell, MBA (Get Bridge) as chief revenue officer and Marissa Morrison (Foursquare) as VP of people.

Sheeza Hussain (Hillrom) joins remote patient monitoring technology vendor Bifourmis as chief commercial officer.

RCM services vendor Kemberton names Deanna Gray (Millennia) as SVP of customer success.

Peter Arduini (Integra LifeSciences) is named president and CEO of GE Healthcare, effective January 3, 2022.

Virtual-first urgent care and primary care clinic HealthTap promotes co-founder and COO Sean Mehra, MBA to CEO.

Announcements and Implementations

Healthcare Triangle releases DataEZ, a cloud-based analytics service that that can manage large quantities of data, including real-world data from remote monitoring, digital health services, and clinical trials.

Medical imaging software vendor Novarad announces GA of a software-only version of its CryptoChart image sharing product that uses a QR code to access the cloud-based information.

Rehabilitation therapy platform vendor WebPT recaps its recent accomplishments – 20,000 clinic customers and a 40% market share, release of its Digital Patient Intake tool, key leadership appointments, and launch of an integrated virtual visit solution.

WellSky-owned CarePort announces a care coordination solution for ambulatory providers, which will allow them to connect patients to home- and community-based organizations directly from their EHR and to maintain two-way communication during the referral process.

3M will establish a Digital Science Community in Dublin, Ireland, employing 100 people to do R&D work for its HIS division.

MGMA and WhiteSpace Health release MGMA DataDiscovery, a physician practice performance analytics tool for medical groups.

Allscripts-owned Veradigm and pharma contract research organization PRA Health Sciences develop an EHR-based clinical research network that uses Veradigm’s StudySource platform. 

Texas Children’s Pavilion for Women launches PeriWatch Vigilance in Malawi, with the fetal monitoring system being provided at no charge by PeriGen.

Omny Health develops a de-identified EHR data repository for dermatologic pharma research, offering the data of 7.5 million patients that was collected from 1,000 dermatology providers. The company announced GA of its anonymized data research platform in early May. Co-founder and CEO Mitesh Rao, MD, MS was Stanford Health Care’s chief patient safety officer through 2017 and remains an emergency medicine professor at the Stanford University School of Medicine.

Other

England’s NHS publishes a draft data strategy that outlines NHSX’s use of data to give patients better access and control, to allow systems to share records, and to support research. It calls for the NHS app to allow patients to review test results, medication lists, procedures, and care plans and to be able to manage appointments, refill prescriptions and contact health and care staff. NHS also responded to concerns about its data-sharing plans by committing to publish a health data transparency statement by 2022.

Epic spokesperson Barbara Hernandez responds to the study in which Michigan Medicine researchers found that its sepsis alerting tool performed poorly, leading the authors to urge health systems to review the inner workings and past performance of such algorithms before using them in patient care. Epic’s points:

• Customers have access to the full model, its formulas, and its accuracy measurements, all of which are published on Epic’s UserWeb.
• The authors used a hypothetical approach that did not consider the analysis and tuning that is required before real-world deployment.
• The tool has helped clinicians provide life-saving interventions to thousands of patients that might have been missed otherwise.
• Michigan Medicine provided a positive review of the system in a UGM presentation in describing how pediatric patients are screened within two minutes of developing symptoms. 

Meanwhile, one of the authors of the Epic Sepsis Model article that was published in JAMA Internal Medicine – nephrologist, assistant professor, and machine learning lab director Karandeep Singh, MD, MMSc of University of Michigan Medical School – provides further information via Twitter:

• The authors ruled out configuration and mapping errors that often create low data AUCs (area under the curve). Epic’s AUCs were much higher in its own sensitivity analysis.
• Singh notes that AUC is driven by two factors – the method of calculation (which was not a factor in their study) and the outcomes being considered (which was significantly different). Epic defines sepsis as presence of an ICD-10 code whose usage varies so much among hospitals that nearly nobody trusts it, including CDC and CMS, which don’t rely on the code to track sepsis or measure sepsis outcomes, respectively. The authors used the criteria that UM sepsis committee developed for quality measures tracking, which is a composite of the CDC and CMS definitions.
• Singh raises the possibility that Epic’s model may infer sepsis from the ordering of sepsis-related medications, with the model’s data “leakage” making it look better than it really is.
• Epic’s model identified only a tiny percentage of patients that clinicians would have otherwise missed.
• Singh concludes that UM is using the model as part of a broader sepsis intervention that includes frequent nursing checks, but will be revisiting the model’s usage.
• Singh’s recommendations to Epic, which he presented to its data science team in April, include releasing its models publicly for independent review as Cerner has done, increasing the transparency of the model’s coefficients and modeling code, and making it easier for Epic customers to run competing open models instead of limiting them to those offered by the company as “a walled-garden app store.”  

Vanderbilt University Medical Center informatics professor and department chair Kevin Johnson, MD, MS posts “Living Through Going Live,” a video recap of VUMC’s 2017 go-live on Epic.

Sponsor Updates

• Newfire Global Partners offers its team members an interoffice exchange program, such as employees from its Ukraine office working and culture-exploring on Croatia.
• Users rate Halo Health the top clinical communication and collaboration platform in G2’s latest “Clinical Communication and Collaboration Grid Report.”
• Health Data Movers publishes a new client story, “Data Conversion for Oncology EHR to Epic.”
• InterSystems announces the latest release of its Iris data platform, which includes adaptive analytics capabilities and additional SQL extensions for analytics to improve the process of implementing an enterprise data fabric architecture.
• Jvion will present at the Home Care 100 Leadership Conference June 27-30 in Marco Island, FL.
• Ellkay joins the Active Archive Alliance.
• CHIME President and CEO Russ Branzell, MBA interviews National Coordinator Micky Tripathi, PhD, MPP at the summer forum.
• Nordic and the American Medical Association publish a white paper titled “2021 E/M Transition: How Organizations Are Moving Forward Successfully.”
• Mental health patients at Citizens Memorial Hospital have chosen virtual care via Meditech.
• Everest Group recognizes NTT Data as a Leader in its SAP Services PEAK Matrix Report.

Blog Posts

• Defining the Opportunity Window for Managing Blood Glucose Levels in Hospitalized COVID-19 Patients – And How to Meet It (Glytec)
• Turning Data Into Actionable Insight: How AI is Making a Difference (Healthcare Triangle)
• Observations of High-pressure and Rapid Shallow Breathing in Mechanically Ventilated COVID-19 Patients: An Interim Assessment (Capsule)
• How SOC 2 Type II Compliance Can Improve the Patient Experience (Loyal)
• Five Ways Activity-Based Costing Can Maximize Earnings (Health Catalyst)
• International considerations for digital health passes (Intelligent Medical Objects)
• The Evolution of Healthcare Delivery Models (Avtex)
• SIIM 2021 | Visage’s Top Five (Visage)
• Why Patient Engagement is Failing Us – And What You Should Do (Lumeon)
• 3 paths payers can take to actualize value from the CMS interoperability rules (Lyniate)
• How to Ensure a Healthy Relationship with Your Epic Community Connect Partner (Impact Advisors)
• Post-COVID Rural Healthcare Outlook with Alan Morgan, CEO of NRHA (Part 1) (Medhost)

Contacts

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

EPtalk by Dr. Jayne 6/24/21

In follow up to this year’s changes to the Evaluation & Management coding requirements, the American Medical Association announces clarifications that will hopefully make the codes easier to implement. The technical corrections updates are supposed to “add clarity and answer lingering questions.” The code updates were originally designed to reduce administrative burden on physicians while making it easier to document, although many organizations still have their providers hunting for bullet points because they haven’t made the required educational efforts to ensure everyone is on board with the changes.

The technical corrections include clarification on what constitutes “major” and “minor” surgeries as well as refinement of the meaning of “discussion” between physicians and other members of the care team, adding texts and instant messaging as methods as long as the process is interactive. It also further defined the meaning of “analyzed.” At this point, the corrections only apply to codes for outpatient or office settings.

For providers who are terrified of coding audits, anything that adds clarity is certainly welcome. My former employer took E&M coding completely out of the hands of providers, locking us out of the coding screens and shifting the work to coders. Although skilled, they were not certified professional coders, so the idea that charges were going out without my review always made me a little uncomfortable and was one of the reasons leading up to my departure.

The VA’s Cerner EHR modernization project is poised to receive an additional $56 million in budgeted funds for the 2022 program year. The additional funds are slated to support implementation at additional medical centers as well as to support infrastructure upgrades. According to a May report by the Office of the Inspector General, the VA’s facilities need electrical work, HVAC upgrades, and additional network cabling. More than two thirds of the VA’s medical centers are over 50 years old, with the average age being 58.

I’m always excited to learn about how technology is impacting public health, so I enjoyed reading a recent JAMA Surgery article about the “Association of Rideshare Use With Alcohol-Associated Motor Vehicle Crash Trauma.” The authors set out to determine whether use of rideshare services decreased impaired driving, resulting in changes to motor vehicle trauma rates. They looked at data from the Houston, TX metropolitan area that included hospital data and court records on convictions for impaired driving, along with rideshare data from Uber and Google. They found that “rideshare volume had a significant negative correlation with the incidence of motor vehicle-associated trauma, and this was most evident in those younger than 30 years; a significant decrease in convictions for impaired driving was associated with the introduction of rideshare services.” That’s fantastic news for those of us who have ever had to staff a trauma bay.

I thought summer was going to be a slow time for me, but I’ve picked up some projects that are going to take a lot more of my time than I thought. Based on some of the slowdowns in 2020, I’m happy to have the work and even happier that organizations feel stable enough to go back and work on projects that were truncated or even canceled by the pandemic. Some of the things I’m working on include vaccination campaigns, chronic disease outreach, and cancer screening campaigns. (As far as colorectal cancer screening is concerned, did you know that 45 is the new 50? If you’re 45 or older, it’s time to consider a colonoscopy or stool testing.) These are the bread-and-butter kinds of initiatives that I wish more organizations would work on. I’m working with a handful of patient engagement solutions across my clients and it has been an interesting exercise to compare their capabilities.

I was glad to enjoy some blue skies recently, though, and would encourage everyone to find time to just let your brain turn off. Or, if you’re not into just sitting around watching crops grow, consider reading a book just for enjoyment or hanging out with friends you haven’t connected with in a while, even if it has to be virtual. Many of us have been working hard over the last year and a half that COVID-19 has been with us and it’s time to recharge our batteries. Although I’m very confident in the performance of vaccines against the virus as we know it now, it feels like it’s only a matter of time before some kind of other proverbial shoe drops. When it does, I want to be rejuvenated and ready for action. I’ll be taking a couple of days to do some rock climbing and other adventures and to continue to reset my brain and to get ready for whatever gets thrown at me next.

HIMSS is approaching and I received my first emails this week, asking if I was interested in scheduling meetings. Both vendors were ones I hadn’t heard of, so maybe the “new normal” HIMSS is an opportunity for smaller companies to share their messages without being buried in the noise. One of the vendors has a lot to learn about email marketing – other than the “schedule a meeting” link, nothing in the email was dynamic. I couldn’t even click on a company logo to go to a website and learn more about what the company does. The scheduling link at least took me to a part of the company’s website where I could tour, but I still don’t fully understand what they do.

In talking with some of my usual HIMSS buddies, one is moving to the Caribbean so will not attend, one is putting their final plans together, and the other is onboard with planning our annual booth crawl. I am still curious what the social scene will look like and whether there will be off-campus events with food and beverage offerings or whether most vendors are doing the Wednesday afternoon exhibit hall happy hour.

Have intel on the HIMSS social scene? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 6/24/21

These Under 30 Alums Raised $31 Million To Build A Shopify For Doctors And Dentists

San Francisco-based NexHealth raises $31 million in a Series B funding round, bringing its total raised to $46 million.

Bicycle Health Raises $27 Million Series A To Expand Treatment and Access For Opioid Use Disorder Nationwide

Bicycle Health, a virtual care company focused on opioid use disorder, raises $27 million in a Series A funding round led by Questa Capital.

DrChrono Raises $12M from ORIX Corporation USA’s Growth Capital to Expand Operations

DrChrono will use a new $12 million investment from Orix to build out its telemedicine capabilities and enhance its existing EHR and practice management solutions.

Morning Headlines 6/23/21

External Validation of a Widely Implemented Proprietary Sepsis Prediction Model in Hospitalized Patients

Michigan Medicine researchers find that Epic Sepsis Model performs poorly at predicting sepsis and overwhelms clinicians with false alarms.

Digital initiatives across NSW gain funding boost from 2021-22 Budget

Australia’s New South Wales government hopes to spur a COVID-19 economic recovery by funding its digital government platform, which will include the first phase of a NSW Health EHR replacement.

SSG Sub, LLC Is Now Savista

RCM services vendor Services Solutions Group, formerly the services division of NThrive, renames itself to Savista.

News 6/23/21

Top News

The Epic Sepsis Model predicts sepsis poorly while flooding clinicians with inappropriate alerts, a Michigan Medicine study concludes.

The authors note that while hundreds of hospitals are using the Epic-distributed model, the company has divulged little about its methods or its real-world performance.

They also note that at UM, clinicians would have needed to investigate 109 Epic-flagged patients to find one that required sepsis intervention.

The article warns of “an underbelly of confidential, non-peer-reviewed model performance documents that may not accurately reflect real-world model performance.”

An accompanying JAMA Internal Medicine editorial warns that Epic’s model was developed in just three US health systems six years ago and health systems should validate and recalibrate such models before implementing them. They draw the parallel that just as clinician decision support rules are reviewed by local clinicians before they are offered for use in patient care, local data scientists should evaluate any algorithms that were developed elsewhere.

Reader Comments

From Map Bucks: “Re: pay for remote work. My health IT employer is considering adjusting pay to local conditions for those who work remotely (the company is in an expensive metro area). Does this seem OK?” It’s a complex issue. The black-and-white side of me says that companies should pay based on the job, not where the worker sits while performing it. A Dallas company might not be able to hire someone from the Bay area for what it pays locally, but that candidate always has the option to move to Texas. Companies shouldn’t pay more just because an employee chooses a long commute, a more expensive house, or to live across the state line where it costs more – that seems to be a slight creep toward socialism, as in “you need to give me a raise to perform the same work because our new child is costing us more.” I would also not put it past some employees to fake their residence to earn more, such as borrowing a relative’s New York City address. Perhaps the stickiest issue is reducing compensation for someone who leaves an expensive metro, although that doesn’t make sense to me. My hot take is that the job is worth what it’s worth and the employee is free to live wherever they want but also with the expectation that their voluntary choice doesn’t affect their paycheck.

From D.V. Wormer: “Re: Avaneer. Which problem of interoperability can blockchain really solve?” Dean Wormer, instead of being a downer who undermines the work of roomfuls of vendor marketing people, just mindlessly accept that the US healthcare system lags the civilized world in accessibility, outcomes, and cost only because we don’t use enough AI, blockchain, and robotic process automation (try not to notice that those many countries who outperform us also don’t use it and that the folks touting those technologies are the same ones who sell it). IBM is involved in Avaneer, which isn’t a strong indicator of commitment, and so far the only customers I’ve seen mentioned are also Avaneer investors. Blockchain is a hammer looking for nails that never seem to get pounded, and while healthcare has a ton of inefficiency and lack of interoperability (weren’t government-subsidized EHRs and HIEs supposed to fix those problems?), the historic safe bet is to be skeptical of companies that pre-profess their technology’s ability make it better. I’ve been in health IT enough to skew cynical, so I’ll invite more glass-half-fullers to weigh in. I’ll be as interested as the next person to see hard data from an Avaneer-using health system that saves a ton of money and passes those savings along to patients (if for no other reason, because that has never happened in our profit-motivated system).

Webinars

June 24 (Thursday) 2 ET: “Peer-to-Peer Panel: Creating a Better Healthcare Experience in the Post-Pandemic Era.” Sponsor: Avtex. Presenters: Mike Pietig, VP of healthcare, Avtex; Matt Durski, director of healthcare patient and member experience, Avtex; Patrick Tuttle, COO, Delta Dental of Kansas; Chad Thorpe, care ambassador, DispatchHealth. The live panel will review the findings of a May 2021 survey about which factors are most important to patients and members who are interacting with healthcare organizations. The panel will provide actionable strategies to improve patient and member engagement and retention, recover revenue, and implement solutions that reduce friction across multiple channels to prioritize care and outreach.

June 30 (Wednesday) 1 ET. “From quantity to quality: The new frontier for clinical data.” Sponsor: Intelligent Medical Objects. Presenters: Dale Sanders, chief strategy officer, IMO; John Lee, MD, CMIO, Allegheny Health Network. EHRs generate more healthcare data than ever, but that data is of low quality for secondary uses such as population health, precision medicine, and pandemic management, and its collection burdens clinicians as data entry clerks. The presenters will review ways to reduce clinician EHR burden; describe the importance of standardized, harmonious data; suggest why quality measures strategy needs to be changed; and make the case that clinical data collection as a whole should be re-evaluated.

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

Acquisitions, Funding, Business, and Stock

NextGen Healthcare announces that President and CEO Rusty Frantz will leave under a “mutual separation” agreement that is effective immediately. He has also left the company’s board. Frantz did not indicate the reason for his departure, but he said in a statement that leaving the company will allow him to “put 100% of my focus on my most important priority – my family.” The company has launched a search for his replacement. Frantz took the role in June 2015, with NXGN share price increasing 5% in that time versus the Nasdaq’s 181% gain.

Cleerly, which applies AI to coronary imaging to predict heart attacks, launches itself with a $43 million Series B funding round. Founder and CEO James Min, MD was a professor of radiology and medicine at Weill Cornell Medical College, where the company’s technology was developed.

RCM services vendor Services Solutions Group, formerly the services division of NThrive, renames itself to Savista.

Sales

• Arkansas Pediatric Clinic chooses Emerge data conversion and integration solutions for its migration to Athenahealth.
• FirstLight Home care joins Dina’s digital home care coordination network.
• The Ohio State University Wexner Medical Center will offer Type 2 diabetes patients access to Teladoc Health’s Livongo for Diabetes Program.

People

Industry long-timer Tim Knoll, MBA (PatientSafe Solutions) joins healthcare staff safety technology vendor Strongline as VP of sales.

Glytec hires Nausheen Moulana, MBA, MSEE (Kyruus) as CTO.

Ascend Medical hires Michael Justice, MBA (Trinisys) as CTO.

Meera Kanhouwa, MD, MHA (Deloitte) joins Ernst & Young Global Consulting Services as executive director in digital health. Her experience includes 10 years as a US Army ED physician with deployment during Operation Desert Storm.

Announcements and Implementations

Amazon launches AWS Healthcare Accelerator, a four-week virtual program for 10 startups that will learn about using AWS to develop healthcare solutions.

A new KLAS report on population health management technology vendors finds that Arcadia, Epic, and Innovaccer stand out.

Government and Politics

A federal appeals court rejects Stanford Healthcare’s argument in a $500 million Medicare billing fraud case involving records Epic-enabled upcoding and unbundling of charges.The complaint says that Stanford doubled its Medicare revenues without increasing its expenses, which the complaint says could only be done by creative coding.

In Australia’s New South Wales, NSW Health will receive $105 million from the state’s digital services initiative for the first phase of its EHR replacement project, with additional funds budgeted from its COVID-19 relief package to expand telehealth and to improve integration between ambulance services and hospital EDs.

Other

KHN notes that big US health systems are opening medical facilities in other countries, such as Cleveland Clinic spending $1 billion to open a clinic across the street from London’s Buckingham Palace Garden that will offer only profitable elective surgeries and treatments in hopes of attracting American expatriates and rich Europeans. The article questions why those systems, which don’t pay taxes, are allowed to pursue such aggressive international business moves.

Sponsor Updates

• Healthcare Growth Partners advised Medullan on its sale to ZS.
• University of Texas as San Antonio joins Optimum Healthcare IT’s healthcare IT apprenticeship program.
• Premier announces the 2021 winners of its Breakthrough Awards.
• Goliath Technologies offers a free Citrix Health Check.
• KLAS recognizes Arcadia as a leader in market energy and customer experience in its “2021 Population Health Management Overview” report.
• TeleConsult Europe selects enterprise imaging from Agfa HealthCare.
• Azara Healthcare names George McGovern (MedTouch) VP of finance and Charlene Grasso (Cambridge Consultants) director of HR.
• The local news profiles CareSignal’s partnership with Americares and the Greater Hickory Cooperative Christina Ministry to serve vulnerable populations.
• Cerner shares a new client achievement, “South Miami-Dade hospital reaches HIMSS Stage 6, 7 and wins Enterprise Davies Award in same year.”
• Ellkay will exhibit at the virtual AHIP Institute & Expo June 22-24.

The following HIStalk sponsors have been recognized in Black Book’s latest customer satisfaction ranking of financial software solutions:

• Enterprise patient identifier solutions – Experian Health
• Patient payment technology – Waystar
• Revenue recovery & accounts receivables solutions – Change Healthcare
• Enterprise resource planning – Symplr API Healthcare
• Hospital claims management systems – Experian Health

Blog Posts

• Scoring well in quality measures has just become more difficult (AdvancedMD)
• KLAS Research: Arcadia Stands Out Among Peers in Delivering Comprehensive Population Health Management Out-Of-The-Box Functionality (Arcadia)
• Glassdoor Names Jeremy Schwach a Top CEO (Bluetree)
• Leading Through Change in Healthcare Technology Management (CereCore)
• Want to Succeed at Value-Based Care? Launch a Chronic Care Management Program (ChartSpan)
• The Key to Denial Management in Healthcare: Intervene on the Front End (RCxRules)
• Childbirth: A Mother’s Joy and Too Many Others’ Nightmare (Obix Perinatal Data System, developed by Clinical Computer Systems)
• Campus Update: Immersing Ourselves in Local Art (CoverMyMeds)
• Learn How Analytics Can Help Pinpoint Length of Stay Opportunities (Dimensional Insight)
• Improving Patient Safety Series: Data Truncation and Special Characters (EClinicalWorks)

Contacts

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

Morning Headlines 6/22/21

NextGen Healthcare Announces CEO Transition

NextGen Healthcare announces that President, CEO, and board member Rusty Frantz has agreed to a “mutual separation” and will step down from his executive roles immediately.

AWS announces AWS Healthcare Accelerator for startups in the public sector

Amazon announces the launch of its AWS Healthcare Accelerator, a 10-week program for startups focusing on cloud-based remote patient monitoring, voice technology, analytics, patient engagement, and virtual care solutions.

BEKHealth Secures $4 Million in Funding to Expand Availability and Adoption of its AI-Powered Clinical Research Software Platform

Connecticut-based BekHealth will use $4 million in new funding to further scale its AI-powered clinical research software.

Curbside Consult with Dr. Jayne 6/21/21

I’m a little over a month past my departure from the world of brick-and-mortar patient care. Since then, I’ve been seeing patients in a couple of different telehealth venues, and it’s been a good experience overall.

Putting on my clinical hat, I would say the biggest weaknesses of the systems I use are that they don’t have the same EHR features as you would find in an in-person practice. Sometimes that makes it difficult to understand the patient’s history or their medication list, but given the transactional nature of urgent care telehealth services, it’s not insurmountable. I never thought I would say that I felt “spoiled” by having a certified EHR with all the bells and whistles, but maybe that was the case.

Most of my friends who are in traditional practice settings are still doing some percentage of their visits as telehealth, even as the pandemic eases. This applies to both specialists and subspecialists. Even surgeons are doing plenty of virtual visits, especially in the post-operative, follow up, and second opinion arenas.

Patients like the convenience, but I hear a lot of stories about physicians trying to juggle virtual and in-person appointments in the same day. There are plenty of initiatives across the US to make telehealth a permanent fixture in our healthcare system and the majority of people I’ve spoken with think this is a good idea.

The few naysayers that I’ve heard from are concerned that telehealth is becoming a way for physicians to increase their bottom line, performing telehealth visits where they previously might have a phone call with a patient. This leads to a concern that telehealth will drive up overall healthcare expenditures. Kaiser Health News cites data from PitchBook that the yearly global telehealth market could top $300 billion by 2026, nearly five times the levels seen in 2019.

I don’t doubt that there are bad actors in some organizations that claim to be offering telehealth. Certainly I’ve heard the stories about the two-minute visits and the services that essentially sound like pill mills. On the other hand, I’ve heard the stories of patients spared hundreds of miles of travel in order to get second opinions along with those who are now able to see subspecialists of a caliber not available in their home communities.

I’m trying to arrange a telehealth consultation for a family member who requires genetic testing. Their insurance carrier will only pay for the testing if it is ordered by a genetic counselor, who typically doesn’t perform a physical exam and so there’s not a lot of need for an in-person visit. The patient has had multiple physicians recommend the testing and understands the ramifications of testing, so requiring the additional visit feels like a barrier to care, especially since the patient is an hourly worker in an essential field.

There’s no question that telehealth needs to fit into the overall plan of care for patients, and that it shouldn’t be another source of fragmentation. I’m not sure how well the direct-to-consumer telehealth companies do with sending records back to the patient’s primary physician or other members of the care team. From what I hear, interoperability is pretty low unless the patient belongs to a health system who has partnered with the telehealth company.

In my past life as an urgent care physician, I frequently saw patients who had been referred for in-person care by a telehealth physician who felt that the patient’s condition wasn’t appropriate for telehealth or for specific testing, such as a rapid strep test or a COVID-19 test. Out of curiosity, I always asked which platform the patient had used, and very few of them actually knew the name of the service. Usually they arrived at it from an employer website, so I’m not sure the telehealth platforms are creating much loyalty beyond that with the employer representatives who handle the contracting.

I also saw plenty of patients who had been treated via telehealth in a manner that was inconsistent with the current standard of care. Often these patients came to urgent care because they weren’t getting better or because they had spoken with a friend or family member who said the course of treatment didn’t sound right. Those visits frequently require some degree of finesse because you don’t know exactly what happened in the previous visit or how the patient’s symptoms might have changed between that time and your visit.

Other times, however, you know the care provided didn’t pass the sniff test, especially when patients were given antibiotics that were not indicated for a given diagnosis or when they pull up their visit summary documents on their phones and the care plan can only be described as off the wall. We certainly see those issues play out from in-person care encounters as well, so it’s not necessarily a telehealth problem.

Being in the telehealth trenches allows me to do my work from anywhere, which I tried out for the first time recently. It was a little strange to pack my required white coat in my suitcase along with my sunscreen and flip flops, and I have to admit I was worried about whether I could get the right camera angles to make it look like I wasn’t in a hotel, but everything worked out. I still think that wearing a white coat to show that you are a physician (versus wearing it because it has nice pockets to hold all the things you need) is a little strange, but it’s required on my platform as a sign of professionalism. Personally, I wish the white coat would become extinct for infection control purposes, but it will probably stick around for the remainder of my career.

I see a need for large organizations, especially integrated delivery networks, to spend some time thinking through their telehealth strategies and make sure they make sense for growth and care delivery since many of them reached their current states out of desperation and necessity. There are still plenty of people out there using freestanding telehealth platforms that force physicians to do a lot of data entry and double work, and for their sake, I hope they can transition to integrated systems. The next two to five years will be interesting as far as seeing where telehealth takes us and what value it can deliver.

Ever talked to your doctor while she’s sitting on the beach? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: Addressing the Public “Infodemic” Spurred by COVID-19

Addressing the Public “Infodemic” Spurred by COVID-19
By Denise Basow, MD

Denise Basow, MD is CEO of the Clinical Effectiveness business unit of Wolters Kluwer, Health.

The novel coronavirus proliferated around the globe with lightning speed, spurring an explosion of new medical information over the last 18 months. Care teams on the front lines were desperate to get their hands on the latest guidelines to treat the influx of patients streaming through their emergency departments, but were also faced with misinformation that could potentially harm their patients.

Similarly, patients struggled to understand which information sources to trust so they could protect themselves and their loved ones. The WHO has identified this deluge of information, or “infodemic,” as a primary concern for global health.

According to the WHO, the definition of an infodemic is “too much information, including false or misleading information in digital and physical environments during a disease outbreak, which can cause confusion and risk-taking behaviors that can harm health; it can also lead to mistrust in health authorities, undermining the public health response.”  

Consider that on January 31, 2020 there were 50 studies published on coronavirus within 20 days, which was remarkable progress. Today, there are more than 150,000 studies on coronavirus, with some estimates as high as 400,000 if we include preprint journals and other gray literature.

It is critical that someone make sense of all this information for it to be useful in treating patients, as there is a significant margin for error when considering the immense pressure to do so as quickly as possible to save lives.

While much of my career has focused on getting the latest evidence-based information into the hands of the clinician community to foster the best care everywhere, we can’t forget that patients are a critically important part of the healthcare team. They need the right information as well, and this information should align with the evidence their care teams are using to make treatment decisions.

Fortunately, there is a clear path for combatting misinformation that can lead to an infodemic, and it is critical that the healthcare community understands and embraces it now to mitigate future occurrences:

1. Listen to communities – of clinicians and patients – for the specific questions and concerns that they have.
2. Get the facts into the hands of those communities so they can accurately evaluate risk, particularly around new vaccines in the case of COVID-19.
3. Foster broad understanding of the internet’s ability to produce good and bad information to build resilience to misinformation.
4. Provide tools that empower communities to act, such as education on how to distinguish fact from fiction and everything in between.

Across the world, everyone from government and public health officials to healthcare providers, community leaders, and individual patients need help determining when it’s appropriate to act (or not act) based on the scientific evidence. Everyone should have access to evidence-based information that informs their decisions, and technology should help facilitate, not hinder, that access. We can and we must learn from the COVID-19 infodemic to improve future public health response.

Readers Write: Don’t Cut Corners in Hybrid Cloud Protection

Don’t Cut Corners in Hybrid Cloud Protection
by Pascal Geenens

Pascal Geenens is director of threat intelligence with Radware of Mahwah, NJ.

In the past few months, several high-profile ransomware attacks on healthcare facilities in Las Vegas, Oregon, and New York have resulted in delayed or suspended surgeries and interruption of other patient care, not to mention the loss of millions of dollars to the facilities themselves.

Ransomware is but one of several attack strategies that malicious actors have employed against healthcare facilities. For example, the number of distributed denial-of-service (DDoS) attacks targeting hospitals has also increased since the beginning of 2021.

Healthcare and security teams face incredible challenges following the pandemic. Although keeping patient data available and secure is critical, it is increasingly difficult due to the array of attack vectors and cybersecurity knowledge required to mitigate them. In addition, several mergers of healthcare providers have introduced additional complexity in networks that can overwhelm security teams.

Remote access and online services, such as streaming doctor/patient consultations and online electronic medical records (EMR), have seen exponential growth. Healthcare organizations have had to manage and secure large volumes of patient data and provide 24×7 access to critical applications to ensure a quality user experience and the ability to protect lives. As a result, healthcare remains one of the highest at-risk industries from cybercriminals.

Much of the issue can be traced to the transition — accelerated by COVID-19 — to public clouds, network-connected devices, and the move towards online and application-based services, which mean more vulnerabilities and data breaches. When healthcare services and applications go down, healthcare providers suffer productivity and operational losses, negative customer experiences, and intellectual property losses.

Based upon the results of several industry surveys, don’t expect this race to the cloud to revert. Hybrid cloud configurations are here to stay. Because of the new reality, IT administrators and hackers now have identical access to publicly hosted workloads, using standard connection methods, protocols, and public APIs. As a result, the whole world becomes an insider threat. Workload security, therefore, is defined by the people who can access those workloads, and the permissions they have.

The question then becomes, should healthcare enterprises focus protection on-premises or the cloud? The answer is unequivocally both.

Part of the reason is because another aspect to consider when moving applications to the cloud is the connectivity and accessibility of those applications. When the internet connection from the hospital is suffering from a degraded or total loss of connectivity, all activities come to a grinding halt. Protecting connectivity only with on-premises equipment leaves organizations too vulnerable. On-premises detection and mitigation alone prevented 85% of DDoS cyberattacks, but the other 15% required cloud DDoS protection. Because of the latency introduced by cloud DDoS protection, enterprises sometimes rely only on on-premises protection.

This is a mistake, because even though only 15% of attacks required cloud protection, those attacks represented 92% of attack volume and 84% of the packets. In hybrid deployments, the cloud handles the volumetric attacks while on-premise will typically handle low-and-slow and low-volume DDoS attacks, as well as anomalies and intrusions.

While healthcare organizations face unprecedented challenges, cutting corners in cyber protection isn’t a viable option. Especially during a rapid and complex transition to the cloud, enterprises can’t afford to neglect either on-premises or cloud protections.

Morning Headlines 6/21/21

Social network for doctors Doximity targets $4 bln valuation in U.S. IPO

Physician network operator Doximity files documents for an IPO that will value the company at $4 billion.

Letter urges closing Humber River’s ER until IT systems fixed after cyberattack, but hospital says it’s safe

ED doctors at Humber River Hospital in Toronto, Canada urge hospital leadership to close the ED until IT systems are restored from a June 13 ransomware attack.

Improvements Needed in Adding Non-VA Medical Records to Veterans’ Electronic Health Records

A VA OIG report finds that VA’s use of community care staff to scan patient records that are created by non-VA providers introduces errors due to a lack of standardized procedures, insufficient training, and lack of quality checks.

Monday Morning Update 6/21/21

Top News

Physician network operator Doximity files documents for an IPO that will value the company at $4 billion.

The company reported $207 million in revenue in its most recent year, with $50 million in net income.

CEO and co-founder Jeffrey Tangney, MBA, who also co-founded Epocrates, controls 60% of company shares, a stake that will likely be valued at over $2 billion.

Reader Comments

From Joel Klein: “Re: University of Maryland Capital Region Medical Center. It opened on June 12, relocating all patients who were at Prince George’s Hospital Center, which will close. Essentially, this was an Epic go live plus a simultaneous hospital move. A week in, things are fairly stable. Thanks as always for doing this blog. Super helpful.” Congratulations to the team there and to Joel, who is SVP/CIO at University of Maryland Medical System and a practicing ED physician. UM Capital Regional Medical Center is in Largo, MD and replaces the 75-year-old Prince George’s Hospital Center in Cheverly, MD, which I believe was running Cerner.

HIStalk Announcements and Requests

Many poll respondents think technology has improved healthcare mostly in the areas of consumer convenience, accessibility, and safety, but don’t think it has helped in important outcomes areas.

New poll to your right or here: Which action was most responsible for your getting the job you hold now? Poll choices are limited by practicality, so feel free to add a poll comment if your hiring was by other means.

Webinars

June 24 (Thursday) 2 ET: “Peer-to-Peer Panel: Creating a Better Healthcare Experience in the Post-Pandemic Era.” Sponsor: Avtex. Presenters: Mike Pietig, VP of healthcare, Avtex; Matt Durski, director of healthcare patient and member experience, Avtex; Patrick Tuttle, COO, Delta Dental of Kansas; Chad Thorpe, care ambassador, DispatchHealth. The live panel will review the findings of a May 2021 survey about which factors are most important to patients and members who are interacting with healthcare organizations. The panel will provide actionable strategies to improve patient and member engagement and retention, recover revenue, and implement solutions that reduce friction across multiple channels to prioritize care and outreach.

June 30 (Wednesday) 1 ET. “From quantity to quality: The new frontier for clinical data.” Sponsor: Intelligent Medical Objects. Presenters: Dale Sanders, chief strategy officer, IMO; John Lee, MD, CMIO, Allegheny Health Network. EHRs generate more healthcare data than ever, but that data is of low quality for secondary uses such as population health, precision medicine, and pandemic management, and its collection burdens clinicians as data entry clerks. The presenters will review ways to reduce clinician EHR burden; describe the importance of standardized, harmonious data; suggest why quality measures strategy needs to be changed; and make the case that clinical data collection as a whole should be re-evaluated.

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

Sales

• Post-acute care services provider Charter Healthcare chooses Netsmart’s MyUnity EHR along with its solutions for electronic visit verification and referrals. 

People

San Joaquin County, VA promotes Mark Thomas, MBA (San Joaquin General Hospital) to county CIO.

Julie Bastien, MBA (Press Ganey) joins EVideon Health as VP of marketing.

Industry long-timer Mike Ruotolo (Office Practicum) joins prescribing technology vendor TroyRx as VP of sales.

Lisa Wild, MA (Kaiser Permanent) joins Ellkay as VP of payer market sales.

Primary care doctor and physician informatician Kennedy Ganti, MD is installed as president of the Medical Society of New Jersey. He is also president-elect of New Jersey HIMSS.

Announcements and Implementations

California launches its digital COVID-19 vaccination record system, built on the open source SMART Health Card Framework of VCI, whose members include Cerner, Epic, Meditech, Allscripts, HIMSS, and The Sequoia Project.

Sweden’s Region Västernorrland goes live on Sectra imaging.

Government and Politics

A VA OIG report finds that VA’s use of community care staff to scan patient records that are created by non-VA providers introduces errors due to a lack of standardized procedures, insufficient training, and lack of quality checks. The small review of records from seven VA facilities found that 44% of scanned mental health records contained errors that were caused by inaccurate document titles, indexing records to the wrong referral or veteran, and duplicate record entry.

ONC invites colleges and universities to apply for its public health IT workforce program, supported by $80 million in American Rescue Plan funds. ONC expects the program to train 4,000 people from underserved communities over four years.

Delegates at the American Medical Association Special Meeting call for doctors to be given more flexibility if they believe that the release of a patient’s health information – under ONC’s Cures Act information blocking requirements – would cause physical, mental, or emotional harm. They are especially concerned about doctors releasing the reproductive health, mental health, or substance abuse information of adolescents to parents or proxies as the regulation requires.

Privacy and Security

ED doctors at Humber River Hospital in Toronto, Canada urge hospital leadership to close the ED until IT systems are restored from a June 13 ransomware attack. The ED has gone to paper records and patients are experiencing long delays. The hospital opened in 2015 as North America’s first all-digital hospital and upgraded to Meditech Expanse in 2019.

St. Joseph’s / Candler (GA) is hit by a ransomware attack Thursday, with systems not yet recovered.

Other

The local paper profiles Peoria, IL-based OSF OnCall Digital Health, whose 800 employees operate a “hospital without walls” for OSF HealthCare and offer services to other organizations.

Sponsor Updates

• Hillrom posts an interview with SVP and Patient Support Systems President Paul Johnson, MBA on the company’s digital health vision.
• Wolters Kluwer Health offers Ovid users access to OrthoEvidence, an evidence-based summary provider for orthopedic specialists, surgeons, nurses, medical residents, and students.
• OptimizeRx discusses its 2021 strategic operating plan, which has been aligned with the pharma industry’s market-sizing opportunity across fast-growing specialty therapeutic areas.
• Well Health names Marissa Morrison (Foursquare) VP of people.
• PatientPing publishes a new use case spotlight, “How Eleanor Health utilizes PatientPing’s real-time ADT notifications to proactively and promptly engage members and coordinate care.”
• Premier honors with Community Enhancement Collaboration, a nonprofit dedicated to fighting food insecurity, with its annual Monroe E. Trout Premier Cares Award and a $100,000 cash prize.
• Redox releases a new podcast, “Crashing Primary Care and Dialysis with Dr. Andrew Schutzbank.”
• Spirion expands its Sensitive Data Platform portfolio with new SaaS solution offerings that simplify the protection of sensitive data across the enterprise.

Blog Posts

• Decoding Digital Health: Leverage Digital Health to Drive Improved Patient Outcomes and Commercial Success (OptimizeRx)
• Achieving Improved Patient Care Through Adversity: Hospice of Washington County and Care Synergy Discuss Challenge and Solution (Netsmart)
• Primary care is an essential part of a usable healthcare system (Nordic)
• Enhancing Your Find-a-Doc Solution to Increase Patient Volume and Loyalty (PatientBond)
• What are Comparative Billing Reports? (PMD)
• How to Solve Gaps in Care and Recover Patient Volume (Relatient)
• Informed and Unburdened: A Future System That Centers Patients on a Budget (Surescripts)
• How chatbots are changing – and improving – customer service (Talkdesk)
• Lessons from ISPOR 2021: The Increasing Acceptance of Real-World Data and Real-World Evidence in Regulatory Decision Making (TriNetX)
• 3 Top Benefits of Defining ROI for Patient Engagement (Twistle)
• How Video Conferencing is Improving Patient and Family Communication (Vocera)
• What Role Do Key Performance Indicators Play in a Practice, and Which Ones Should PTs Care About? (WebPT)

Contacts

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

Weekender 6/18/21

Weekly News Recap

• Former Athenahealth CEO Jonathan Bush launches health developer platform vendor Zus Health with a $34 million Series A funding round.
• Google Health is reportedly downsizing.
• A Wall Street Journal report says that Apple’s plan to run a wearables-focused virtual primary care service hasn’t been successful and the company is shifting its emphasis to selling Apple Watch.
• ONC publishes the first draft of its patient address standardization specification.
• AMA says EHRs should not present drug company advertising.
• Ambulatory surgery center software vendor HST Pathways acquires patient price transparency vendor Clariti Health.
• A security services vendor COO is indicted on federal charges of launching a cyberattack against Gwinnett Medical Center (now Northside Hospital Gwinnett).

Best Reader Comments

Doesn’t look like the stock market has given up on CERN yet. Still near all time highs. (Bob)

I found the prices published by a health system I currently have a billing dispute with. Will be interesting to see what they say when I ask them why my insurance company’s payment was insufficient for the services they provided when it is 4x the minimum negotiated charge. (Price Transparency?)

While the [DoD and VA Cerner] systems may be of the same origin, they are not the same today, and so there is that specific problem of non-identical systems. Additionally, the origin data is not anywhere near identical in schema, dictionary, enumeration, etc., so that will be a broader problem. Lastly, they haven’t exactly settled the solutions at this point, so they are driving at a moving target. Failing early might not be a bad strategy, but if someone isn’t setting that expectation, then someone is going to be mighty surprised in very short order. (AnInteropGuy)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. M in Kentucky, who asked for a license to a learning platform to use in both in-person and remote classes. She reports, “”Your donation of the Nearpod Learning Platform has made a huge difference in the learning process for my English as a Second Language (ESL) students. Through this platform I have been able to modify their assignments to enable them to express their learning through drawing, matching, games, and voice recordings in addition to the tradition format of typing. The difference has been so great that my administration purchased Nearpod for the rest of our school. Now ALL students, not just ESL students are going to benefit. Thank you for helping me start this movement and show other how everyone can learn with the right tools and support.”

The charity RIP Medical Debt buys and forgives $278 million of hospital debt from Ballad Health, relieving the medical payment obligations of 82,000 low-income patients that in some cases go back decades. The charity says it works directly with hospitals that can turn bad debt into revenue without pursuing aggressive collection, address a major social determinant of health, and refine their charity care programs.

A federal court sentences a New York doctor to 57 months in prison for taking drug company bribes in return for prescribing Subsys fentanyl spray. Jeffrey Goldstein, DO took $200,000 in “speaking fees” for giving slide sessions for which attendee sign-in sheets were often forged and enjoyed an evening at a strip club in which drinks and lap dances were provided by company reps. He was the sixth-highest subscriber in the speaking program, generating $800,000 in sales in a single quarter of 2014 versus prescribing the drug just once before signing up for the speaking program. Federal agents also reported that during the speaking events, Goldstein drank heavily and used marijuana and cocaine with his staff. 

An Alabama nurse is fired and may have lost his license after he is shown in TikTok videos he posted as “@conservativecoy1776” where he says that COVID-19 isn’t dangerous and Anthony Fauci was paid to create it, claims that racism is an overreaction to what was actually a small number of slaveholders, and laughs at video of a patient who cried after receiving a high doctor bill in saying, “Hey, buddy, you better get used to saying that s***.” He made the mistake of recording some of his videos in a hospital room wearing his employee badge, which identified him and his employer, Baptist Health in Montgomery.

Emory University apologizes to a medical school applicant it rejected in 1959 with the explanation that the school was not authorized to admit “a member of the Negro race.” Marion Hood, MD says it was OK because he experienced discrimination every day and didn’t really expect Emory to admit him, but he was accepted and graduated at Loyola and then returned to Atlanta to open an OB-GYN practice that he ran for 34 years until he retired in 2008. Emory won its challenge of Georgia’s segregation laws in 1962 and admitted its first black student the next year. 

In Case You Missed It

• News 6/18/21
• EPtalk by Dr. Jayne 6/17/21
• News 6/16/21
• Curbside Consult with Dr. Jayne 6/14/21
• Monday Morning Update 6/14/21

Get Involved

• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Morning Headlines 6/18/21

Zus Health Closes $34M Series A Led by Andreessen Horowitz (a16z); Participation from F-Prime Capital, Maverick Ventures and Others

Digital health developer platform vendor Zus Health, founded by former Athenahealth CEO Jonathan Bush, raises $34 million in a Series A funding round.

Google Health reportedly downsizing away from consumer focus

Google Health reportedly reduces headcount by at least 20% in a reorganization in which 170 employees have been moved to the Fitbit and Search product teams.

Form Health Secures $12M Series A For Obesity Telemedicine Platform

Boston-based Form Health will use a $12 million Series A funding round to expand its obesity-focused telemedicine service beyond the 16 states it currently serves.

News 6/18/21

Top News

Digital health developer platform vendor Zus Health, founded by former Athenahealth CEO Jonathan Bush, raises $34 million in a Series A funding round.

The company apparently abruptly changed its name from Zeus Health, which I noted a couple of weeks ago is already in use by a medical device investment company.

The press release explains that Zus is “pronounced Zoos like the father of Athena” although it declines to use the actual word “Zeus.”

Six of the company’s eight executives spent time at Athenahealth.

A lengthy Zus testimonial is provided by the CTO of Firefly Health, whose executive chairman is Jonathan Bush.

Reader Comments

From End Gamer: “Re: Cerner. I think we ex-Cerner executives have a fair bit of insight due to our deep network and rapid information exchange. The company’s first failure was the drag on leadership when Neal was sick – an interim CEO should have been named within six months. In the subsequent CEO search, at least two candidates turned the job down before Brent arrived. The Board absolutely dropped the ball here. As to the future, I don’t think it matters who gets the job. The ship has taken on too much water and Epic is beating the daylights out of Cerner in the US (and soon overseas). The all-in bet on Federal programs has committed Cerner’s IP org to the detriment of the client base. I would expect that someone that wants to get big in healthcare could buy the company, but regardless, the Cerner that we were part of is gone, as are its traditions, its passion, and its potential.” I would opine that one thing that Cerner did right with Brent’s hiring was attempting to diversify into new areas – such as data sales and new federal business – in recognizing that the Epic juggernaut was going to be hard to stop, especially as Cerner was losing clients because of its revenue cycle fumbling. I haven’t seen product line revenue and contribution breakouts, so I don’t know if Cerner is still mostly an EHR vendor or its growth has significantly shifted to areas where Epic doesn’t compete.

HIStalk Announcements and Requests

HIStalk sponsors who are exhibiting at or attending HIMSS21 – tell me about your participation by July 23 and I’ll include your company in my HIMSS guide.

Webinars

June 24 (Thursday) 2 ET: “Peer-to-Peer Panel: Creating a Better Healthcare Experience in the Post-Pandemic Era.” Sponsor: Avtex. Presenters: Mike Pietig, VP of healthcare, Avtex; Matt Durski, director of healthcare patient and member experience, Avtex; Patrick Tuttle, COO, Delta Dental of Kansas; Chad Thorpe, care ambassador, DispatchHealth. The live panel will review the findings of a May 2021 survey about which factors are most important to patients and members who are interacting with healthcare organizations. The panel will provide actionable strategies to improve patient and member engagement and retention, recover revenue, and implement solutions that reduce friction across multiple channels to prioritize care and outreach.

June 30 (Wednesday) 1 ET. “From quantity to quality: The new frontier for clinical data.” Sponsor: Intelligent Medical Objects. Presenters: Dale Sanders, chief strategy officer, IMO; John Lee, MD, CMIO, Allegheny Health Network. EHRs generate more healthcare data than ever, but that data is of low quality for secondary uses such as population health, precision medicine, and pandemic management, and its collection burdens clinicians as data entry clerks. The presenters will review ways to reduce clinician EHR burden; describe the importance of standardized, harmonious data; suggest why quality measures strategy needs to be changed; and make the case that clinical data collection as a whole should be re-evaluated.

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

Acquisitions, Funding, Business, and Stock

The Wall Street Journal says that Apple’s health ambitions mostly haven’t panned out, although the article’s sources don’t seem solid. Apple planned to develop its own primary care service that would be powered by wearables data, but has since returned to its focus on selling hardware, particularly the Apple Watch. Insiders question the quality of the data generated by its clinics to guide product development, including the HealthHabit health coaching app, which has delivered poor user engagement among Apple employer testers. Company executives say data shows that HealthHabit improves blood pressure in 91% of its hypertensive users, while competing programs Hello Heart and Livongo deliver in the 30% improvement range, leading insiders to worry that Apple’s results are being overstated based on faulty data.

Google Health reportedly reduces headcount by at least 20% in a reorganization in which 170 employees have been moved to the Fitbit and Search product teams.

KHN reports that publicly traded hospital chain HCA is turning many of its hospitals into trauma centers, taking advantage of the ability to bill ED patients an “activation fees” of up to $50,000 each time the trauma team is assembled, sometimes when a routine ED visit is all that was needed. One man’s arm gash was billed at $52,000 instead of a reasonable $3,500. HCA’s activation fee in Idaho is $29,000 versus the state average non-HCA activation charge of $2,500.

Sales

• Aspen Valley Hospital will implement Epic as the board approves the $15.4 million expense to replace Meditech. The 25-bed hospital’s previous agreement with University of Colorado Health for a Community Connect fell through, but it says that Epic no longer requires rural hospitals to partner with a larger health system.
• Community Health Network will implement advance care planning document sharing from Vynca.

People

Virtual reality clinical training vendor Health Scholars hires Scott Johnson (CirrusMD) as CEO.

Gregg Shibata (Echo Health Ventures) joins Quil as VP of payer market development.

IdentifyIOT hires Jeff Powell as VP of healthcare sales.

Shannon Freiermuth (DrFirst) joins Change Healthcare as VP of strategic clients.

Industry long-timer John Goodrow, MBA (S&P Consultants) died Monday at 51.

Announcements and Implementations

Vyne Medical launches the cloud-based Refyne platform, whose initial capability is electronically transmitting supporting provider documentation in CMS’s Electronic Submission of Medical Documentation and Electronic Medical Documentation Request initiatives.

People who received COVID-19 vaccine from Walmart or Sam’s Club will be provided with a digital copy of their record using Health Pass by Clear.

Major Health Partners (IN) goes live with Meditech Expanse Patient Care as an early adopter.

Government and Politics

ONC publishes the Version 1.0 draft of the Project US@ Technical Specification, which hopes to create a unified specification for patient addresses that can also support patient record matching. The comment period will open soon. It is a surprisingly complex issue given the country’s language diversity, the imprecision of some addresses outside of urban areas, and the need to accommodate the different standards of Puerto Rico and the military.

A Defense Department MHS Genesis roundtable lists care improvements enabled by its Cerner implementation – real-time clinical decision support for newborns, improved tracking of service member health between duty station transfers, a reduction in visits for prescription management, and enhancing recruit readiness. The military says that the system improves care by standardizing workflows and processes.

Other

A Mayo Clinic study finds no association between COVID-19 vaccination and cerebral venous sinus thrombosis. Researchers used Nference’s AI software to review real-world evidence from several hundred thousand vaccinated patients, including lab results, unstructured clinical notes, and structured health records. Mayo and Nference launched Anumana in April 2021 to commercialize ECG analysis algorithms.

As just about everybody predicted, hospitals are declining to publish their insurer-negotiated prices as required by a federal law that took effect January 1, instead opting to pay the paltry $300 per day fine for failing to do so. Whoever came up with that fine amount must not have ever looked at a health system’s revenue.

An AMA Board of Trustees report finds that the top five EHRs don’t display drug ads, but it warns that such advertising should not be allowed at all in EHRs and electronic prescribing systems, citing abuses by Allscripts-owned Practice Fusion. The AMA House of Delegates changed its policy to require direct-to-prescriber EHR advertising to comply wiith AMA’s direct-to-consumer advertising guidelines. The policy also prohibits displaying brand name products first in drug lookups and encourages displaying the generic product first.

Sponsor Updates

• Premier recognizes Atrium Health with its Alliance Excellence Award for saving $100 million in supply chain costs and $140 million in clinical optimization savings using the PremierConnect cloud-based performance improvement platform.
• EClinicalWorks releases a new video, “EClinicalMessenger: Improving Healthcare Through Better Communications.”
• Arcadia announces that its Arcadia Analytics platform earned the highest ratings in the inaugural Cybersecurity Preparedness Evaluation from KLAS and Censinet.
• West Monroe expands its leadership team and promotes eight employees to partners.
• First Databank will exhibit at the NCPDP Annual Technology & Business Conference June 29-30 in Scottsdale.
• Halo Health publishes a new case study, “Improving Efficiency, Secure Communication at Thomas Hospital, Infirmary Health.”
• Imprivata receives a 2021 Fortress Cyber Security Award in the authentication and identity category from Business Intelligence Group.
• Infor will host its Inforum customer even November 9-11 in Las Vegas.

Blog Posts

• Why Patient Engagement Is Failing Us — and What You Should Do (Lumeon)
• How Regulatory Compliance Supports Optimal Patient Care and Higher Earnings (Health Catalyst)
• Attract More Patients with Health Education – 4 Ways to Up Your Online Game (Healthwise)
• Epic UGM 2021 Planning Guide: UGM is In-Person (Healthcare IT Leaders)
• Preference cards 101: The key to maximizing OR utilization (Intelligent Medical Objects)
• Optimizing Rural and Community Hospital IT Implementations During Times of Uncertainty (Medhost)
• Harnessing Healthcare’s Data Explosion with AI-based Natural Language Processing (Medicomp Systems)
• What to expect at Meditech’s 2021 Nurse Forum (Meditech)
• Measuring Employee Performance in Your Physical Therapy Practice (MWTherapy)

Contacts

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

EPtalk by Dr. Jayne 6/17/21

Today’s big news is the Supreme Court’s dismissal of a major challenge to the Affordable Care Act. This is the third time that the healthcare law has been upheld. This challenge was based on the concept that since the individual penalty portion was eliminated in 2017, the entire law should be struck down. The court voted 7-2 to block the suit, stating that the plaintiffs did not have appropriate standing to bring the case. I don’t think that we’re done with challenges to the Affordable Care Act, but I know that patients who count on its provisions are breathing a sigh of relief.

I ran across a great op-ed piece recently that focuses on how “humans are getting in the way of digital health.” It cites the piecemeal application of technologies as a major barrier to transformation as compared to other industries like banking or logistics, where everyone involved jumped on the bandwagon. Other challenges include a lack of technology education and training for the people who need to use digital health along with teaching stakeholders to assess the value of new technologies so that they can add the right systems at the right time. The author calls for meaningful provider education through structured training, including peer-to-peer training, formal education, and inclusion of evidence-based guidelines. These seem like they would be basic tenets for successful clinical / digital transformation, but there are a lot of organizations missing the boat.

I went to visit a new PCP this week. We used to work together and he knows my informatics background, so he was happy to give me a tour of my Epic chart after I asked if he could see the results of my recent genetic testing. It turns out they are buried as scanned documents. He noted that the governance and quality control on the scanning can be a bit lacking at times. Having done numerous quality improvement projects and revisions to organizations’ document management systems, I know what a pain it can be when documents are filed or tagged in the wrong place. Hopefully, the majority of their results are coming in electronically at this point, but I’m sure there’s plenty of scanning going on with referral letters, consultation letters, hospital discharges, and more.

He happily reviewed the blood pressures I had logged in the Withings Health Mate app on my phone. We both agreed with liked the display because it shows averages in numerical form that can be filtered by month as well as a graphically-based view that gives a red / yellow / green view of the ranges for a patient’s values. That’s the kind of data we need to be incorporating for remote patient monitoring rather than burdening physicians with thousands of data points that need to be sifted through. He agreed with me that my crazily high blood pressure a couple of months ago was likely due to a combination of work stress and too much ibuprofen. I enjoyed watching my lab results arrive throughout the afternoon and all was well, so I’m good for another year.

Business Insider reports that Google is shrinking its health team, reassigning 130 workers from its health division into other areas of the company such as Search and Fitbit. The company restated its commitment that Google Health “will continue to build products for clinicians, conduct research to improve care and make people healthier, and to help ensure all health-related projects at Google meet the highest standards.” The count of those employees has now dropped to 570 from a March headcount of 700.

The publication also reports that Walmart Health has filed documents to expand its virtual care solution to 16 additional states, doubling its count. I don’t know anyone who has used the company’s telehealth offering, but would be interested to share (anonymously, of course) any reader experiences. The company’s brick-and-mortar offices are limited to a handful of states, so we’ll have to see how long it takes them to cover the entire US for telehealth.

Meanwhile, CNBC reports that Amazon Care has signed multiple corporate clients who plan to make use of its telehealth services. They’re holding announcement of those names until later in the summer, but I’m extremely curious – if anyone has rumors they would like to report anonymously, we would be happy to entertain them. The program was launched in 2019 as an internal employee benefit and includes virtual urgent care visits, free telehealth consults, and fee-based in-home visits for testing and vaccinations.

Having been part of the healthcare IT industry for a while now, I’ve been exposed to various company cultures. Some have included some hard-partying aspects and a fair amount of alcohol consumption. One vendor I worked with had an open beer tap in the office on Fridays, while another frequently referred to its staff as “a drinking company with a software problem.” That seems to have become a bit more tame in recent years, but I came across an article mentioning concerns that increased alcohol use could be a secondary consequence of the pandemic. Especially with work from home, juggling household responsibilities, economic worries, and the stress of the pandemic itself, alcohol use is on the rise. Given pandemic precautions, it will be interesting to see what the level of alcohol consumption looks like at HIMSS. Hopefully as things return to normal, consumption will stabilize. Still, let’s look out for each other, and if you see one of your colleagues struggling, offer your support.

Fast Company skewered Epic recently over the rollout of the Deterioration Index clinical prediction tool, which is designed to help physicians determine when patients can be moved into or out of higher levels of care. The authors note that the Index was deployed without independent validation or peer review and that physicians cannot see how the raw data is used to calculate the score. There are concerns about the potential for bias in the model based on the underlying data sets upon which it was created. Other worries involve the risks of medical trainees relying too heavily on the index rather than developing their own clinical intuition. The authors call on Epic to release the underlying logic for peer review along with the anonymized data sets used during the internal validation process.

I’d be interested to hear from clinical informaticists whose institutions use the tool. How do you think it’s working, and have you identified any issues? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 6/17/21

Walmart Provides Digital COVID-19 Vaccine Record

Walmart offers pharmacy customers who receive the COVID-19 vaccine the ability to digitally store their vaccine records via their Walmart.com accounts using technology based on the Vaccination Credential Initiative’s Smart Health Cards standard.

HHS Releases Project US@ Draft Technical Specification Version 1.0 for Comment

ONC releases the Project US@ Draft Technical Specification Version 1.0 for public comment as part of its work to develop a healthcare standard for representing patient addresses.

Ksana Health Secures $2M Seed Round to Launch Advanced Mental Health Monitoring Platform

Behavioral health app startup Ksana Health raises $2 million in seed funding and joins Anthem’s digital incubator.

Stillwater Medical Center Reports Major Computer Outage, Officials Confirm

Stillwater Medical Center (OK) recovers from a computer outage that forced it to cancel appointments and briefly shut down its emergency room.

Morning Headlines 6/16/21

HST Pathways Announces Merger with Clariti Health for Enhanced Patient Price Transparency Resources as Part of its End-to-End Premium Technology Solution

Ambulatory surgery center software vendor HST Pathways acquires patient price transparency vendor Clariti Health.

Tiger Global-backed Bright Health aims for over $14 bln valuation in U.S. IPO

Bright Health, which sells Medicare Advantage insurance in 13 states with claims of technical capabilities, targets its IPO at a $14 billion valuation.

Protenus Raises Series D After Doubling Revenue While Reducing Risk for Health Systems

Healthcare compliance analytics company Protenus raises $21 million in a Series D funding round, bringing its total raised to $57 million.