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Morning Headlines 6/30/21

June 29, 2021 Headlines No Comments

Harris acquires US-based healthcare SaaS provider Ingenious Med

Harris acquires physician practice and hospital software vendor Ingenious Med.

Costs from ransomware attack against Ireland health system reach $600M

Ireland’s health service estimates it will cost $600 million to recover from a ransomware attack six weeks ago, from which it still hasn’t recovered.

VisualMED has closed its agreement with Rennova Health

Rural hospital operator Rennova Health sells its software and genetic testing interpretation divisions to VisualMed Clinical Solutions.

News 6/30/21

June 29, 2021 News No Comments

Top News

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Harris acquires physician practice and hospital software vendor Ingenious Med.


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

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Providence Ventures invests in RxRevu one year after its affiliated health system in Seattle deployed the company’s SwiftRx real-time prescription benefit software.

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Stone Point Capital acquires and combines Verisys and Aperture Health, creating a company focused on credentialing, enrollment, and provider data management. Aperture Health CEO Charlie Falcone will lead the new company.

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Utilization management software and physician services company Xsolis secures a $75 million investment from Brighton Park Capital. The company recently hired Mandy Cruz (Sunquest) as VP of customer delivery and Tim Mueller (Optum) as VP of client success.

Healthcare governance, risk, and compliance solutions vendor RLDatix acquires UK-based Allocate Software,. which offers human capital management solutions.

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Hospital IQ, an operational management software vendor based in Massachusetts, raises $25 million in a Series C funding round.

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Nearly 500 One Medical employees (excluding physicians and other clinicians) announce their intent to unionize to address the mistreatment they say they’ve suffered during the pandemic. Their complaints include:

  • The company’s mismanaged COVID-19 vaccine program, which wound up making national news after company whistleblowers alerted the media to the fact that ineligible patients – some with ties to leadership – received the vaccine ahead of eligible patients, resulting in a congressional investigation.
  • Denial of hazard payment to frontline workers.
  • The wrongful termination of 19 employees.
  • Hiring unlicensed and/or inexperienced phlebotomists.
  • Sub-par care for community members who couldn’t afford One Medical’s typical membership fees.

One Medical went public earlier this year, and acquired senior-focused primary care company Iora Health several weeks ago for $2 billion.


Sales

  • CyncHealth, an HIE that serves seven Midwestern states, selects Lyniate’s Rhapsody software to improve participant onboarding, privacy, and security.
  • Marshfield Clinic Health System (WI) will implement NowPow’s community services referral software.
  • USMD Health System and WellMed (TX) select Leading Reach’s referral communication and care coordination software.
  • The North Estonia Medical Centre joins the TriNetX network to increase its engagement with the international healthcare research community.
  • UBC will use Surescripts Specialty Enrollment service in its biopharma support services that include REMS enrollment, clinical studies and registries, and patient support services.
  • In Canada, six Ontario hospitals will implement a shared regional instance of Cerner Millennium.

People

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Chuck Podesta (UConn Health) joins Renown Health as CIO.

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Eron Kelly (Amazon Web Services) joins Inovalon as president.


Announcements and Implementations

The Multiple Myeloma Research Foundation will use data normalization services from Intelligent Medical Objects to improve clinical data from its CureCloud and CoMMpass clinical trial programs.

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A new KLAS report on security and privacy consulting services finds that Meditology, Clearwater, and CynergisTek top the list of companies that are most often viewed as partners by customers. The report notes that Impact Advisors has the highest overall performance score at 99.1 on a 100-point scale even though its security offering is less widely known. Clients of audit-focused firms such as Deloitte, EY, and PwC are more likely to seek less-prominent companies in search of  higher value or staff quality, with Deloitte customers in particular reporting problems with executive involvement, quality, delays, and its perceived use of a B-team of inexperienced employees


Other

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Ireland’s health service facilities continue to operate under downtime procedures after a ransomware attack took out their computer systems six weeks ago. The health service estimates that recovery costs will exceed $600 million.


Sponsor Updates

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  • Cerner employees assemble 300 hygiene kits, prepare 100 dental bags, and stuff 2,000 envelopes for its Care Kits and Healthe Kids Screenings programs.
  • Dina CEO Ashish Shah will speak at the Home Care 100 Leadership Conference June 30.
  • Lumeon publishes “The Future of Digital Transformation in Healthcare Report 2021.”
  • Surescripts announces that last year more than 745,000 individuals and organizations used its Clinical Direct Messaging to improve transitions of care, send immunization notifications, coordinate medication management efforts and achieve federal incentives requiring the use of secure electronic messaging.

Blog Posts


Contacts

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

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Morning Headlines 6/29/21

June 28, 2021 Headlines No Comments

Combination of Verisys Corporation and Aperture Health Creates Market Leader in Healthcare Credentialing and Provider Data Management

Stone Point Capital acquires and combines Verisys and Aperture Health, creating a company focused on credentialing, enrollment, and provider data management.

XSOLIS Poised for Scale with $75 Million Growth Investment from Brighton Park Capital

Utilization management software and physician services company Xsolis secures a $75 million investment from Brighton Park Capital.

Hospital IQ Raises $25 Million to Meet Market Demand for its Software which Optimizes Health System Operations

Operational management software vendor Hospital IQ raises $25 million in a Series C funding round.

Curbside Consult with Dr. Jayne 6/28/21

June 28, 2021 Dr. Jayne 3 Comments

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It’s been an interesting week, and one I’d rather not repeat. I took a brief break from the healthcare IT trenches to do some volunteering at a youth camp, and the theme for the week quickly became “A Series of Unfortunate Events.”

All of our pandemic handwashing and sanitation skills were put to full use as the camp experienced an outbreak of norovirus, which is something I wouldn’t wish on anyone. The state epidemiologists had a rapid response and the camp was quick to put all participants in lockdown while they worked to determine the source of the outbreak.

Since they weren’t sure if the affected campers brought it with them or caught it at camp, all food service venues were closed. The National Guard quickly rolled in with thousands of boxes of MREs (meal ready to eat) and the dining experience was an adventure for many. I highly recommend the chili mac, although the penne with vegetable sausage crumbles wasn’t bad either. As to the Pop Tarts that were welded together by the vacuum packing process, I have no comment.

After the initial contact tracing, campers were released from the strict lockdown to do hikes and fishing with their campsite cohorts while further investigation occurred. I was surprised by how little our participants were phased by everything going on around them, although I attribute that to spending the better part of the last year and a half trying to avoid COVID-19.

After campers were tired of hiking, board games were delivered to the groups and some vicious rounds of Connect Four and Blokus ensued, followed by The Game of Life, which I didn’t know was still in production. It was great to see kids interacting with each other in non-electronic ways and experiencing some of the board games their “elders” grew up with.

The following day, we were cleared to return to activities, but food service was still stalled. Due to some just-in-time supply chain snags, the camp staff was forced to clean out local Sam’s Club and Costco warehouses for breakfast supplies. Lunch was another round of MREs, and since the majority of participants hadn’t eaten one before (let alone three), we prepared to triage additional gastrointestinal complaints. Fortunately, the norovirus cases had stabilized and the field hospital that had been configured was put to little use and we could go back to managing the sprains, abrasions, and blisters we expected. Unfortunately, at the end of the week, we had three medical evacuations by helicopter and one by ambulance, so things weren’t as quiet as we hoped.

It’s always a challenge to see how medical care is rendered in the great outdoors. I’m glad that the majority of the participants stayed healthy since so many camps were canceled last summer. There were certainly some memories created that will last a lifetime, but based on the overall experience, I was for once glad to return to my overflowing inbox. Having an actual bed instead of a cot was also a big plus.

I recently accepted a couple of new clients and am trying to sort out the schedules for the various engagements as I wind down a few projects at the end of the month. Although I’m excited for new things, I’ll miss the teams that I’ve worked with over the last year. But that’s my goal as a consultant – helping clients move forward and celebrating with them when they become self-sustaining. The baby birds are leaving the nest and I couldn’t be prouder of the work they’ve done along the way.

My mailbox contained quite a few HIMSS-related emails, including some party invites, so that added a bit of excitement to the day. I’ve scheduled a couple of Exhibit Hall Booth Crawl sessions with some of my favorite people and hopefully there will be enough excitement on the show floor that it will make for good reading material. I was less excited about my invitation to HIMSS Executives Circle events, which included a VIP luncheon with Alex Rodriguez. I’m a little skeptical about what he has to offer to the healthcare IT world in the form of a keynote address, let alone what might be discussed in a less formal setting, so I took a pass.

My inbox also had its usual complement of LinkedIn invites from people I don’t know who are clearly trying to sell me something, so there was plenty of deleting going on. (Sorry, Fruit Street, you might as well give up at this point.) The usual ads from Office Depot and Staples didn’t entice me to buy anything, nor did Lenovo. Next, I perused messages from my professional organizations and there I found something that caught my eye. ONC has launched an initiative for the public to complete the sentences “Because of interoperability, before/by 2030 [who] will [what]” or “Because of interoperability, _____ before/by 2030” as a part of its Health Interoperability Outcomes 2030 project.

ONC plans to use the public feedback to inform a prioritized set of interoperability outcomes and a road map for what health interoperability can achieve over the next decade. I’ve definitely got a few ideas to throw into the mix:

  • Because of interoperability, I will be able to carry my complete medical record on my phone by 2030.
  • Because of interoperability, by 2030 a new physician will have complete access to my records before I even walk in the office door or pop up in their telehealth queue.
  • Because of interoperability, by 2030 I will never be asked again for a fax number.
  • Because of interoperability, by 2030 I can update my records across disparate care delivery organizations with a few keystrokes rather than a dozen visits and phone calls.
  • Because of interoperability, by 2030 I can see all my own images and films.
  • Because of interoperability, we need to have a unique patient identifier before 2030.

The last one is my favorite, but unfortunately that goal has become more political than patient centric, so we’ll have to see how long it takes. The public can visit the Health Interoperability Outcomes 2030 page to submit a response, or use Twitter to tag #HealthInterop2030 to @ONC_HealthIT if they want to go the social media route. Submissions will be accepted through July 30, so get those creative juices flowing.

What are your goals for the next decade, personally or professionally? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 6/28/21

June 27, 2021 Headlines No Comments

UF Health restores records system a month after ‘cybersecurity event’

UF Health (FL) restores its EHR at its Leesburg and The Villages campuses after nearly a month of ransomware-caused downtime.

Kindbody Announces Largest Fertility Raise in History with $62M Series C Funding

Kindbody, a provider of fertility services using proprietary technology, raises $62 million in a Series C funding round that brings its total raised to $122 million.

Hims & Hers Deepens Dermatology Investment, Acquires Apostrophe

Online health and wellness company Hims & Hers Health acquires Apostrophe, which offers tele-dermatology and online prescriptions.

Monday Morning Update 6/28/21

June 27, 2021 News 1 Comment

Top News

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Health Catalyst will acquire patient engagement technology vendor Twistle, which it says will allow it to offer a comprehensive population health management solution to healthcare providers and life sciences companies.

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SEC filings indicate that Health Catalyst will pay up to $170 million for Twistle, which has $8 million in annual revenue and will lose an expected $3 million in 2022.


Reader Comments

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From William Pay: “Re: Doxo. Our hospital is getting complaints from patients about Doxo. The consumer bill pay network is paying for Google search results for specific hospital names.” Doxo came up in the top handful of my Google results for some randomly chosen hospital names plus “online bill pay.” The link leads to specific webpages that Doxo has created for those hospitals. Each hospital’s Doxo page clearly says that Doxo has no connection to that hospital. Doxo has generated 185 complaints on the Better Business Bureau website, quite a few of them from people who had problems with fees or delayed payment resulting from their use of Doxo to pay their hospital bills. Several business and city government websites have warned their customers against using Doxo, with some of them directly calling Doxo a scam.

From Informatics MD: “Re: Epic Sepsis Model. The published work is important and highlights the need for internal validation, but their experience is not shared by our institution or others we’ve interfaced with since. The implication is that health systems implemented the model without validation or careful oversight. We validated it in a unique, limited setting (the ED) and found its performance to be acceptable enough to proceed with cautious implementation through a controlled quality improvement intervention. Our results are forthcoming, although we can’t discuss them yet due to standard journal embargo policy.”


HIStalk Announcements and Requests

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Personal connections enabled half of poll respondents to get their present jobs.

New poll to your right or here: Should companies pay remote workers based on their local cost of living?


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

Shares of Doximity closed at $55.98 on Friday, valuing the physician social network platform vendor at $10 billion. The company booked $207 million in revenue and $50 million in net income in the latest fiscal year. CEO Jeff Tangney has beneficial ownership of $3 billion worth of shares.


Announcements and Implementations

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HIMSS announces that Dwight Schrute from “The Office” (actor Rainn Wilson) will keynote at HIMSS21. HIMSS says he will deliver a hilarious, insightful talk full of anecdotes and warmth.


Government and Politics

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Britain’s Health Secretary Matt Hancock resigns after a tabloid publishes photos of him kissing a health advisor-lobbyist in early May before indoor cross-household contact was allowed under national COVID-19 restrictions. He and the advisor, who he appointed, are married to others. The government is investigating whether the photos were intentionally leaked. Hancock’s replacement will be former Chancellor and Home Secretary Sajid David. 


Other

UF Health (FL) restores its EHR at its Leesburg and The Villages campuses after nearly a month of ransomware-caused downtime.


Sponsor Updates

  • Divurgent launches a Customer Experience Program focused on creating additional value for its clients before, during, and after an engagement.
  • Vocera announces that its solutions are used in six out of 10 children’s hospitals included in the latest US News & World Report honor roll.
  • EClinicalWorks releases a new customer success story, “Record Retrieval Made Easy with Prisma.”
  • Optimum Healthcare IT adds The University of Texas at San Antonio Alumni Association to its Optimum CareerPath apprenticeship program.
  • Summit Healthcare publishes a new client use case, “Cody Regional Health Enlists Summit Healthcare’s Integration Services to Support Epic Migration.”
  • EY announces that Protenus co-founder and CEO Nick Culbertson is an Entrepreneur of the Year 2021 Mid-Atlanta Award finalist.
  • Parity.org includes Quil Health on its 2021 Best Companies for Women to Advance list.
  • Ascom expands its Unite software ecosystem with the addition of the new Unite Collaborate communication application.
  • Twistle publishes a new case study, “ChristianaCare: Improving Detection and Management of Postpartum Hypertension.
  • Well Health receives a Rising Star Award as part of the 2020-2021 South Coast Business & Technology Awards.
  • Vyne Medical releases a new podcast, “The New Era of Patient Access and Revenue Cycle.”

Blog Posts


Contacts

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

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Weekender 6/25/21

June 25, 2021 Weekender No Comments

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Weekly News Recap

  • Health Catalyst announces its acquisition of Twistle.
  • Doximity shares surge on their first day of NYSE trading, valuing the company at $7 billion.
  • Tegria acquires KenSci.
  • Researchers say that Epic Sepsis Model performs poorly in identifying potential cases of sepsis.
  • GE Healthcare names Pater Arduini as its next president and CEO.
  • England’s NHS publishes a draft patient data strategy.
  • NextGen Healthcare announces that President and CEO Rusty Frantz will leave the company.
  • Amazon announces a four-week, virtual AWS Healthcare Accelerator program for startups.
  • California launches a digital COVID-19 vaccination record system.
  • ONC invites colleges and universities to apply for its $80 million public health IT workforce program.

Best Reader Comments

As former CIO, I am wondering if all of the billions (trillions?) spent on EMRs, etc. have really improved care / outcomes. Based on the very simple measure of life expectancy, I would say no. I am sure that billing and documentation has improved and the industry has amassed warehouses full of data for interesting studies. I know that I will be critiqued for use life expectancy as the single measure, but it is easily available and is a fundamental outcome. This should be embarrassing for a country that already had the highest cost and low life expectancy compared to other advanced economies. (Former CIO)

If you step outside the hyped world of AI/ML, a hospital system would not implement a new clinical protocol (for example, if this were a written risk-stratification model for sepsis) without it first being testing, validated, published, and even then they usually want to wait for the Professional Societies to back the protocol before widely accepting and integrating it into practice. Please explain then why hospitals are just blindly accepting these AI/ML algorithms, when there is already a standard for approving clinical decision-making tools? I suspect a large part of the issue here is that there is still not enough medical involvement / integration into the IT/IS departments at many hospitals. Their governance models still view IT and the EHR as a cost center and not a strategic asset to the organization, and think the enhancements that are being added during EHR upgrades are all functionality updates, when in fact they are slipping more and more clinical content and tools into the upgrades. (HITPM)

Coming from the overhyped world of AI/ML, I would tease apart validation of the model and validation of protocol. No model will be 100% accurate, so validating a model comes down to “sufficiently accurate” (trading off precision and recall) and some sort of explainability. In our work on sepsis models, we achieved AOC over 0.8 with the ability to see precisely which parts of the medical record led to the conclusion. We did not commercialize it, not because it was invalid, but because it needed to drive a clinical protocol that added value. And that’s the issue. First, practitioners’ intuitive sense is really good, so any model has to find marginal incremental cases that they’d miss. Second, you need to design, validate, and implement a clinical protocol for what to do when the model alarms. This has a poor ROI. (Dan G)

They [Doximity] display pharmaceutical ads to doctors. Similar to how Practice Fusion made money, but Doximity has lower risk because ad fraud is harder to bring lawsuit or regulatory action against compared to pushing oxy via EHR decision support. (IANAL)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. C in Mississippi, who asked for an IPad and accessories to allow her to create videos of her classroom instruction for students who need extra review or if COVID-19 forced her school to close. She reported in December, “Thankfully we have not had to teach virtually so far, but having an IPad makes it possible for me to record classes that students can use for review if they need extra help on a particular objective. I enjoy having a fun way to intervene with struggling students by having them play educational games on the IPad that reinforce and review skills we are learning each day. School has changed so much this year and technology has become such an important part of our school day. Thank you for making this project possible.”

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Casamba founder and executive chairman Ronnie Amrany buys a waterfront house on Hollywood, FL that sets the record for the highest price paid in that area at $6.9 million. Net Health acquired the therapy EHR vendor in March 2021.

Eleanor Slater Hospital (RI) COO/CFO Christopher Feisthamel takes advantage of an obscure state HR law to avoid repeat attempts to lay him off. Rhode Island’s “leave to protect” provision allows a state employee to hold up to three state jobs at the same time, and if fired from one, they can return to their previous job and “bump” whoever holds it. More than 1,600 state employees have leave-to-protect status, making it hard to fire them.

St. Vincent Hospital (MA) bans activist members of the Catholic Worker Movement from hospital property after they perform an “exorcism of the demon of corporate greed” in the lobby against hospital owner Tenet Healthcare to support striking nurses.

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In India, friends of a man who was receiving COVID-19 vaccine record a video showing a distracted nurse removing a disposable syringe and injecting it without first drawing up the vaccine. Nobody noticed until one of the friends looked at the video later. The nurse has been removed from duty and the man will be brought back to receive his first dose.


In Case You Missed It


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Morning Headlines 6/25/21

June 24, 2021 Headlines No Comments

Health Catalyst Announces Agreement to Acquire Twistle

Population health and analytics firm Health Catalyst will acquire patient engagement and clinical workflow company Twistle.

Social network Doximity valued at over $7 billion as shares jump in debut

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.

Tegria Acquires KenSci to Help Healthcare Organizations Derive New Insights From Data

Providence-owned Tegria acquires healthcare AI vendor KenSci.

CitiusTech Acquires SDLC Partners, Extends Payer Market Leadership

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

News 6/25/21

June 24, 2021 News 11 Comments

Top News

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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

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Providence-owned Tegria acquires healthcare AI vendor KenSci.

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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

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

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

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

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

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

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

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


Announcements and Implementations

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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.

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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.

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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

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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. 

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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

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  • 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


Contacts

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

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EPtalk by Dr. Jayne 6/24/21

June 24, 2021 Dr. Jayne No Comments

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.

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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

June 23, 2021 Headlines No Comments

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

June 23, 2021 Headlines No Comments

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

June 22, 2021 News 15 Comments

Top News

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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

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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.

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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.

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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

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

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

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

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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

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

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


Government and Politics

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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

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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


Contacts

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

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Morning Headlines 6/22/21

June 21, 2021 Headlines No Comments

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

June 21, 2021 Dr. Jayne No Comments

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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

June 21, 2021 Readers Write 1 Comment

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.

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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

June 21, 2021 Readers Write No Comments

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

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

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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.

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Reader Comments

  • HIT Girl: Yeah? I guess? The real problem is, nobody is going to pay for the things that help doctors take better care of their...
  • skeptical of skeptics: Got it. So what do you suggest?...
  • skeptic: Cerner at the VA it's a chronicle of a death foretold. Complaints started from day 0, years ago - physicians, nurses, ...
  • John Moore: Wow, that Spokane article on Cerner sure was a hatchet job, but I guess it helps sell more papers, helps the publisher g...
  • Robert David Lafsky: "What Cerner does best is capture billable events via exhaustive questions and back-and-forth as you input things.... Th...

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