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EPtalk by Dr. Jayne 4/18/24

April 18, 2024 Dr. Jayne Comments Off on EPtalk by Dr. Jayne 4/18/24

It’s long been known that women make many healthcare decisions for their families, if not the majority of healthcare decisions. A study published last month in JAMA Network Open shows that patients who are female or who have chronic illnesses are more likely to use telehealth. The data in question is from 2002 and was part of a cross-sectional study of 5,400 adults where 43% had telehealth visits during that year. Video visits were less common among patients aged 65 to 74 and those without Internet. The authors found no differences when patients were segmented by education, race/ethnicity, or income. Other interesting tidbits included the fact that nearly 20% of patients reported technical difficulties and that 30% of telehealth visits were conducted using only audio connections.

From Doomsday Prepper: “It’s not just the bulging cans anymore. Did you see this writeup about the CDC investigating counterfeit Botox that’s giving people botulism?” I have to admit I don’t spend as much time in the epidemiology literature as I once did, but it looks like patients in the pursuit of youthful appearances may be turning to low-cost or unlicensed providers who are placing them at risk of serious illness. The Centers for Disease Control announced that it is looking into incidents in nine states where 19 people have reported serious illnesses following botulinum toxin injections. Affected patients may have visual changes, trouble swallowing, or even breathing problems. Symptoms were severe enough in 60% of the patients to warrant hospitalization. Patients can protect themselves by asking if providers are licensed and trained to administer the injections, and whether they’re using FDA-approved products obtained from a reliable source.

I’ve spent more than a decade working with organizations that span multiple time zones, so I’ve had to be continuously conscious about how I schedule meetings. Ideally, employees will specify their working hours in the organization’s calendar application, but I’ve seen several articles recently about whether “8 am meetings” should be done away with. The phrase implies that the time would be 8am for the majority of employees, but in a distributed organization 8 am on the east coast could be 5 am on the west coast, or even earlier for employees in Hawaii. Early morning meetings can make for difficult childcare arrangements – as someone who used to have to round at 6:30 am, I feel that pain acutely. Although healthcare organizations run 24×7, I’ve seen more of them opting to avoid early morning or late afternoon meetings in order to create more flexibility for employees.

Although I’m supportive of making team operating agreements around meeting hours (and even banning meetings at certain times, like Friday afternoons, when everyone’s out of brain cells) I think it’s even more important to make sure meetings are necessary, well-planned, and well-executed. One of my favorite organizations to work with has questions people have to walk through before scheduling meetings. For example, if there are multiple people from the same team invited, do they all have to be there, or can one person represent the team? Is there an agenda that includes expected discussion points and anticipated outcomes? Who will document minutes and action items so that those who are not in attendance know what happened? It seems simple, but the majority of organizations I work with have little to no framework for productive meetings. That same organization has also implemented a policy where meetings are scheduled in 20- or 50-minute increments, allowing people to check email, take care of personal needs, or just decompress when they’re subjected to back-to-back meetings. With those breaks in place, there’s an expectation that meetings start and end on time, which I’m sure everyone appreciates.

In the spirit of “what goes around comes around,” telehealth company Cerebral gets hit by the Federal Trade Commission with a multimillion dollar fine for deceptive practices around data sharing, security, and cancellation policies. In addition to the fine, Cerebral will be prohibited from using health information for advertising purposes. Cerebral is widely regarded by physicians as having contributed to overprescribing of ADD and ADHD medications and a subsequent shortage of those medications for patient use. Although they’re not getting the smackdown for that, they are being penalized for providing sensitive information to third parties including patient demographics, medical and prescription histories, IP addresses, and more.

They were also cited for mailing postcards to patients that included language revealing diagnosis and treatment information for anyone to see, allowing former employees to continue to access health records, allowing non-providers to inappropriately access patient records, and having a faulty single sign-on process that allowed patients to see the sensitive health information of other patients during simultaneous logins to the company’s patient portal. The company will pay $5 million for consumer refunds, a $10 million civil penalty, and a $2 million penalty due to inability to pay the full amount. The company will also have to place notices on its website about the allegations and its ongoing mitigation plans. It feels a little like putting Al Capone in jail for tax evasion rather than other crimes, but given the damage this company has caused to patients and their families, we’ll take it.

The American Medical Informatics Association is conducting a survey on documentation burden among health professionals. The AMIA website lists the primary goal of the survey as being “to capture perceptions of excessive documentation burden across various healthcare disciplines frequently (e.g., every six months) to trend changes over time.” The survey is open through April 26 and will reopen in August. Licensed and unlicensed health professionals who provide patient care and document in an EHR are invited to participate. The survey took less than two minutes to complete.

I didn’t know much about public health informatics until I began to prepare for the initial Clinical Informatics certification exam more than a decade ago. As I read a couple of textbooks that covered the field, I found myself fascinated by the ability to use data to drive health outcomes. Fast forward a few years and we found ourselves living in a public health research project, and informatics efforts in the field accelerated dramatically. The CDC recently updated its Public Health Data Strategy to include addressing gaps in public health data and to reduce the complexity of public health data exchange. Although we’re seeing improved funding for public health informatics efforts at the federal level, it’s still a patchwork when you look across the states. Some of the state-level efforts in public health are pathetic, which is a sad commentary on how those states value the individuals living and working within their boundaries.

What is your community doing to support public health? Leave a comment or email me.

Email Dr. Jayne.

Comments Off on EPtalk by Dr. Jayne 4/18/24

Morning Headlines 4/18/24

April 17, 2024 Headlines Comments Off on Morning Headlines 4/18/24

Medicus IT Strengthens Commitment to Community Health Centers through Acquisition of BlueNovo

Healthcare IT and professional services firm Medicus IT acquires BlueNovo, a health IT consulting company focused on community health centers.

Change Healthcare’s New Ransomware Nightmare Goes From Bad to Worse

RansomHub makes good on its threat to put stolen Change Healthcare data, including files from MetLife, CVS Caremark, Davis Vision, Health Net, and Teachers Health Trust, up for sale on the dark web.

Two Chairs raises $72M Series C in equity and debt to scale its therapist network

Hybrid mental healthcare provider Two Chairs raises $72 million in a Series C funding round, bringing its total funding to $103 million.

Comments Off on Morning Headlines 4/18/24

Healthcare AI News 4/17/24

April 17, 2024 Healthcare AI News 1 Comment

News

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Kontakt.io raises $47.5 million in a Series C funding round led by Goldman Sachs. Launched in 2013, the multi-vertical company offers patient flow analytics and optimization software and hardware that leverages AI and RTLS technologies.


Business

MemorialCare (CA) selects Abridge’s generative AI software for clinical documentation.


Research

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Researchers from University Hospitals Cleveland Medical Center, University of Southern California, and Johns Hopkins University use machine learning to develop a risk assessment model for bedsores that increases prediction accuracy to 74%, a 20% increase over current methods.

UMass Chan Medical School and Mitre launch the Health AI Assurance Laboratory, which will work to ensure the safety and efficacy of AI in healthcare through the evaluation of healthcare AI tools.

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A Gartner survey of 600 enterprise software engineers finds that 75% say they’ll be using AI code assistants by 2028. Sixty-three percent of organizations are already using the technology in some way.

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Wolters Kluwer Health publishes findings from a new survey focused on provider perceptions of AI. A few snippets:

  • Eighty percent believe generative AI will improve patient interactions.
  • Forty percent say they’re ready to start using generative AI in those interactions.
  • Over 50% believe generative AI will save them time when it comes to summarizing patient data from the EHR, or looking up medical literature.
  • Despite their enthusiasm for the technology, at least 33% say their organizations don’t have guidelines on how to use it.
  • Providers are more enthusiastic about the technology than patients, with the majority of surveyed consumers in a previous study reporting they’d be concerned about using generative AI in a diagnosis.

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AI-drafted physician messaging may not reduce response time to patient messages, but it does lessen cognitive burden, according to research out of UC San Diego Health. Lead researcher Ming Tai-Seale, PhD, explains: “Our physicians receive about 200 messages a week. AI could help break ‘writer’s block’ by providing physicians an empathy-infused draft upon which to craft thoughtful responses to patients.”


Other

OSF HealthCare (IL) will pilot personalized customer engagement AI assistants from Brand Engagement Network at several facilities as a part of its continuing education simulation training for its Advanced Practice Provider primary care fellowship participants.


Contacts

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

Morning Headlines 4/17/24

April 16, 2024 Headlines Comments Off on Morning Headlines 4/17/24

UnitedHealth beats on revenue despite impact from cyberattack

Shares of UnitedHealth rise on the news that the company beat Q1 revenue expectations in spite of costs incurred by the Change Healthcare cyberattack.

Sunstone Partners Announces Growth Investment in Accuhealth

Sunstone Partners invests in remote patient monitoring and chronic care management company Accuhealth.

Kontakt.io Raises $47.5 Million Series C Funding from Goldman Sachs to Fuel AI Development and Expansion into US Hospitals

Kontakt.io, which offers patient flow analytics and optimization solutions, raises $47.5 million in a Series C funding round.

RFX Solutions Closes on $9 Million in Series A Funding to Revolutionize Healthcare Compliance through SaaS Technology

Healthcare regulatory compliance software vendor RFX Solutions announces $9 million in Series A funding.

Comments Off on Morning Headlines 4/17/24

News 4/17/24

April 16, 2024 News Comments Off on News 4/17/24

Top News

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Shares of UnitedHealth rise on the news that the company beat Q1 revenue expectations in spite of costs incurred by the Change Healthcare cyberattack. The company expects to lose up to $1.6 billion this year because of the hack.

It has advanced $6 billion in payments and interest-free loans to providers impacted by the February 21 event.

Its Optum solution dashboard shows 109 of 137 applications remain down.

Federal lawmakers, meanwhile, met with cybersecurity professionals, representatives from the American Hospital Association, and providers to hear how they have been impacted by the attack, and to gauge how the federal government should respond. UnitedHealth was not represented at the meeting, though CEO Andrew Witty is expected to make an appearance before the Senate Finance Committee at the end of the month.


Reader Comments

From peanutgallery: “Re: Epic/Particle Health/Carequality. This didn’t age well …” PG is referring to a guest post penned in February 2023 by Particle Health co-founder and then CEO Troy Bannister, who proclaimed, “I’m here to spread the news that information blocking is coming to an end.” Given the current data-sharing contention between Epic and Particle Health, his statement may have been wishful thinking. Bannister left the company in January, according to his LinkedIn profile, though the company’s website still lists him as its chief strategy officer. Current CEO Jason Prestinario joined the company in May 2023. Concerned Denizen’s comment at the time now seems prescient: “[I]nteresting to read about Particle’s reputation in adhering to regulations in the networks in which they currently operate, like Carequality and Commonwell. It seems that Particle’s strategy under Troy was to gain as much ground to sell the data across the market, while ‘claiming access for the benefit of consumers,’ with no regard to regulations; the same regulations he is now touting. Will be interesting to see how the new CEO, hired by their Board, is going to change their path to destruction. Judging by his background (selling data to Pharma at Komodo Health), not holding my breath.”


Webinars

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


Acquisitions, Funding, Business, and Stock

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Kontakt.io raises $47.5 million in a Series C funding round led by Goldman Sachs. Launched in 2013, the multi-vertical company offers patient flow analytics and optimization software and hardware that leverages AI and RTLS technologies.

India-based private equity firm ChrysCapital considers selling HIM and RCM vendor Gebbs Healthcare Solutions, which it acquired in 2018 for $140 million. The potential deal could value the company at up to $1 billion.

In light of what it deems “inaccurate and incomplete announcements and reporting regarding its connection to Epic,” Particle Health issues a statement affirming that the vast majority of its customers have continued to actively receive data from Epic without interruption, and that it remains in good standing with Carequality.


Sales

  • Queen Victoria Hospital NHS Foundation Trust in England will implement EHR software from Insight Direct, which will subcontract services to Altera Digital Health.
  • MemorialCare (CA) selects Abridge’s generative AI software for clinical documentation.

People

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Darcy Corcoran joins CereCore as principal of its new cybersecurity advisory services.


Announcements and Implementations

Community Health Network implements Notable Health’s AI capabilities for automating chart review, care gap scheduling, and pre-visit planning across its 200 care sites in Indiana.

Lakes Region Mental Health Center (NH) will replace its Essentia EHR from Netsmart with the vendor’s MyAvatar behavioral health EHR June 1.


Government and Politics

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Online mental healthcare provider Cerebral will pay $7 million to settle federal allegations that it shared the personal data of users with third-party sites for advertising purposes without their consent, and that it failed to honor company cancellation policies, among other sloppy practices. In January, the company agreed to pay $540,000 to patients in New York in a settlement with the state’s attorney general, who said the company intentionally made it hard for patients to cancel their subscriptions and instructed its employees to submit fake positive reviews.


Privacy and Security

RansomHub leaks several files stolen during the Change Healthcare ransomware attack on its dark web leak site in an effort to convince UnitedHealth to pay a second ransom.


Other

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“The Pitch: Patient Safety’s Next Generation” premieres this week at the Cleveland International Film Festival. The documentary focuses on technology’s role in patient safety efforts, and features the impact UPMC Presbyterian’s Enhanced Detection System for Healthcare-Associated Transmission program has had on the hospital’s ability to identify and prevent hospital-acquired infections.


Sponsor Updates

  • CereCore becomes a partner in the Meditech Alliance Consulting Services Program.
  • Clearwater names Angie Santiago manager, consulting services – resiliency solutions.
  • AGS Health, Artera, Availity, FinThrive, and Vyne Medical will exhibit at the NAHAM Annual Conference April 23-26 in Dallas.

Blog Posts


Contacts

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

Comments Off on News 4/17/24

Morning Headlines 4/16/24

April 15, 2024 Headlines Comments Off on Morning Headlines 4/16/24

Change Healthcare stolen patient data leaked by ransomware gang

RansomHub leaks several files stolen during the Change Healthcare ransomware attack on its dark web site in an effort to convince Change parent company UnitedHealth Group to pay a second ransom.

Proposed FTC Order will Prohibit Telehealth Firm Cerebral from Using or Disclosing Sensitive Data for Advertising Purposes, and Require it to Pay $7 Million

Online mental healthcare provider Cerebral will pay $7 million to settle allegations that it shared the personal data of users with third-party sites for advertising purposes without their consent, and that it failed to honor company cancellation policies.

Particle Health Affirms Ongoing Connectivity With Epic Systems and Refutes Recent Reports

Particle Health announces that the vast majority of its customers have continued to receive data from Epic without interruption.

Eating disorder telehealth startup Equip raises $35M, according to filing

Virtual eating disorder treatment company Equip Health raises $35 million, according to a recent securities filing.

Chrys Capital looks to sell GeBBS at $1b valuation

India-based private equity firm ChrysCapital considers selling HIM and RCM vendor Gebbs Healthcare Solutions, which it acquired in 2018 for $140 million.

Comments Off on Morning Headlines 4/16/24

Curbside Consult with Dr. Jayne 4/15/24

April 15, 2024 Dr. Jayne 4 Comments

I spent this weekend at a class reunion for my medical school. They host a reunion event every year, but the attendees are only invited in five-year increments. It was interesting to see the breakdown of registrations. No one attended from the class of 2019, which seems expected since those physicians are likely still busy with training or are in their first few years of practice and might have trouble getting away. The class of 2009 also had no attendees, but many of the other classes had about a dozen members in attendance. The class of 1974 knocked it out of the park with 31 attendees. The oldest representatives were from the classes of 1954 and 1959, which each had one representative. My class is distinctive because we were the first one to have more women than men. I was speaking with a woman who graduated five years before me (and who happened to be one of my chief residents when I was on clinical clerkship rotations) and she mentioned that she was one of only 20 women in her class. It’s amazing that the university was able to shift the demographic that dramatically in only five years.

The weekend was full of educational events, campus tours, city tours, and several social events. One of the highlights of the week was a scholarship dinner, attended by some of the scholarship recipients as well as those who had donated to class gift funds that provide scholarships. I had three students at my table – one was in his first year of medical school, and the other two were in their third years and were knee-deep in clinical rotations. It was interesting to hear about the specialties they find most interesting and what they might plan to pursue as a career and why. Primary care is at the bottom of the list, at least among the students I talked to throughout the weekend, despite the university moving towards a “zero debt” financial aid program that is supposed to allow students to “follow their dreams without fear of student loans.” It became apparent in other conversations that the university is really pushing for students to go into academic medical careers, which are historically lower-paying than those in private practice.

Although the members of my immediate graduating class know what I do for a living, nearly everyone else I spoke to started the conversation with “Where do you practice?” and I had to explain my career as a clinical informaticist. None of the people I talked to outside of my classmates knew that clinical informatics was a board-certified subspecialty or that you could make a career out of it. Upon learning what I do, several attendees went into some pretty serious rants about how electronic health records have destroyed the practice of medicine. Fortunately, most of the social events allowed me to keep a gin and tonic in hand so that those conversations went more smoothly than they might have otherwise.

Of the members of my class attending, only two are still in full time clinical practice. The rest are either in academic positions where they only see patients one or two days per week, or they are in pharmaceutical or other industry roles where they no longer perform patient care. As someone who is trained in primary care, I’ve had plenty of times in my career where I’ve felt bad about not being in full-time clinical practice – that I’m part of the physician shortage problem. However, looking at what my colleagues are doing, I don’t feel so bad. Even when I’m not seeing patients, I’m generally working on projects that are directly applicable to patient care and helping those on the front lines be able to deliver it in a more seamless way with less burnout.

Speaking of burnout, I wasn’t surprised to learn that the most burned out member of our class is in emergency medicine. She was talking about working during the worst parts of the COVID pandemic and about not having appropriate personal protective equipment. Her comments immediately took me back to being in that same position four years ago. Others in the conversation acted like it was their first time hearing about such things, and it sounds like most of them spent the pandemic doing administrative tasks, performing research, or seeing patients via telehealth. She mentioned the push of private equity organizations into the emergency medicine staffing space and the fact that it’s driving people out of practice. Fortunately, one other class member who happens to be in a specialty heavily impacted by private equity acquisitions (dermatology) took up that charge and spoke about how that transition has nearly destroyed practices in his city. His private practice is a holdout and continues to do well, although he admits they did consider being acquired but felt it would be a bait-and-switch situation.

Our class was about 50/50 with medical versus nonmedical spouses, and in contrast to previous years, only a couple of spouses showed up to all the events. I guess by this point in their lives they figured that listening to their spouses reminisce about graduate school wasn’t the most exciting way to spend an evening, especially when a ticket purchase was required. It will be interesting to see who is still in clinical practice when we meet again in five years, and who has decided to hang up their white coats for good. Speaking of white coats, our school’s students now receive theirs during the first month of school as part of a professional initiation ceremony, complete with the class writing its own oath of professionalism and with many family members in attendance. The students I had dinner with were surprised to learn that we received ours folded up in plastic wrappers from the bookstore, only a couple of days before we went to our clinical rotations. We certainly didn’t have luxurious coats embroidered with our names and “Prominent School of Medicine” logos.

I’m glad those in charge have improved things in the intervening years, but a bit sad that they hadn’t figured it out back in my day. Our alma mater has completely revised its curriculum, integrating clinical experiences very early in the first year and encouraging students to take elective courses in areas they find interesting. Compensation has improved for those teaching, which hopefully means fewer professors that act like it’s a chore. The facilities are top notch, and I wish we had access to advanced simulation labs rather than having to practice certain skills on each other or even patients. It’s nice to see things changing for the better and I wish these up and coming students the best.

What do you think about the future of your profession? How can we do better for the coming generations? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/15/24

April 14, 2024 Headlines Comments Off on Morning Headlines 4/15/24

Texas Surgeon is Accused of Secretly Denying Liver Transplants

Memorial Hermann – Texas Medical Center abruptly shuts down its abdominal transplant program after suspicious irregularities pertaining to patient eligibility criteria within a federal database come to light.

Health records giant Epic cracks down on startup for unauthorized sharing of patient data

Epic informs customers that it has cut off its connection to Particle Health because it believes the company is using patient data in ways unrelated to patient treatment.

Virtual physical therapist Hinge Health lays off 10% of its workforce

Virtual physical therapy provider Hinge Health lays off 170 employees as it prepares for an IPO.

Comments Off on Morning Headlines 4/15/24

Monday Morning Update 4/15/24

April 14, 2024 News 4 Comments

Top News

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Memorial Hermann – Texas Medical Center abruptly shuts down its abdominal transplant program after suspicious irregularities pertaining to patient eligibility criteria come to light. The hospital believes Steve Bynon, Jr., MD, head of the program since 2011, has been manipulating a federal transplant database to deny certain patients access to the potentially life-saving procedures.

His motive remains unclear, though plenty of speculation around bribes for higher-priority spots on the list have been suggested on Reddit.

Red flags have included donor criteria that mandate impossible ages and weights, such as a “300-pound toddler.”

A Redditor points out that, “A database for such a high criticality function should have several data validation measures. Preventing data like a 300lb toddler requirement should have been done at the design level. As appalling as the doctor’s behavior here is, it’s almost just as appalling how easy it was to inject bad data in the system. I can imagine scenarios where a well-meaning provider misses a decimal point for a 30.0lb toddler and now we’re in the same boat. Why were there no data validation and data review processes?”

HHS is investigating.


Reader Comments

From Lanman: “A provider is actually going to bet on Oracle Health (Cerner).” Lanman caught my mention last week of AtlantiCare’s decision to implement Oracle Health as a part of its Vision 2030 program. I didn’t find their current vendor with a quick search, but I think they may have already been using Cerner and maybe some old McKesson stuff.


HIStalk Announcements and Requests

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Insurance companies lead the pack when it comes to frustrations with healthcare-related organizations. Feed up in Boston would have selected insurance company, specialist, and ambulance company given that all three enabled hackers to steal his personal data.

New poll to your right or here: Do you think high-profile CEOs or founders make their companies more attractive acquisition targets? What role, if any, have you seen the cult of personality play in healthcare M&A?


Webinars

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


Acquisitions, Funding, Business, and Stock

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Epic informs customers that it has cut off its connection to Particle Health because it believes the company is using patient data in “unauthorized and unethical ways that have nothing to do with treatment.” Epic filed a formal complaint several weeks ago with Carequality, of which Particle Health is a member, over the same concerns. Particle Health insists the company has always acted in good faith, and is working with Epic to address its concerns.


People

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Benjamin Gold (Optum) joins Nym as SVP of product management.


Announcements and Implementations

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Newly opened Sarina Hospital in Australia goes live with Oracle Health as part of the state of Queensland’s facility-wide implementation.


Government and Politics

VA Secretary Denis McDonough says that the department will resume rolling out its Oracle Health-based EHR before the end of fiscal year 2025, despite the fact that the 2025 budget doesn’t include any funding for additional deployments. The department rolled out the technology to a handful of sites over a three-year period, pausing further deployments in 2023 while it worked with Oracle Health to address numerous patient safety, technical, end-user, and budget concerns.

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A litany of patient safety concerns at Hampton VA Medical Center (VA) and allegations of leadership cover-ups prompt lawmakers to ask VA Secretary McDonough to look into the hospital’s lengthy, documented history of substandard care within its surgical department. Among its transgressions, many of which have been investigated by the Office of Inspector General, is the March 2021 failure of a primary care physician to correctly enter bone scan orders into a patient’s EHR, ultimately delaying results that indicated possible metastatic bone disease.


Other

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An analysis in JAMA of 100 acute hospital websites finds that 96% share user data with third-parties. Seventy-one of those sites offer public privacy policies disclosing that practice. Of those, 40 disclose the specific third parties that receive that information.

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UC Davis pilots a digital health program for colon cancer screening that uses text messages to remind patients of screening timelines, gauges their interest in and eligibility for Cologuard at-home screening kits, and gives them an opportunity to schedule screening appointments.

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Tesla owner MaxPaul Franklin credits his car’s self-driving feature with safely getting him to a hospital 13 miles away while suffering from a mild heart attack. Other Tesla owners stress that the car’s new Full Self-Driving capability requires a certain amount of driver supervision, and thus should not be used in lieu of an ambulance. I have to wonder at what point during his day did Franklin don his Tesla T-shirt.


Sponsor Updates

  • VieCure expands its implementation of DrFirst’s medication management platform to include DrFirst’s Rcopia e-prescribing capabilities.
  • Netsmart will exhibit at NatCon24 April 15-17 in St. Louis.
  • Vyne Medical will exhibit at the NAHAM Annual Conference April 23-26 in Dallas.
  • Nym names Sheaira Williams medical coding and compliance auditor, Esti Kahanowich medical data analyst, Barak Golan dev ops engineer, Yael Golan medical data analyst, Ido Reiss NLP research engineer, and Elias Honegger EHR integration analyst.
  • PerfectServe partners with TeamBuilder to offer its predictive staff scheduling platform in conjunction with its Lightning Bolt provider scheduling software.
  • Sectra publishes a new white paper, “AI making its way into cardiologists’ hearts.”
  • Upfront Healthcare will present at the Urgent Care Association Annual Convention April 16 in Las Vegas.
  • Verato adds Smart Steward, a generative AI-based assistant for healthcare data stewardship teams, to its HMDM platform for healthcare identity data management.
  • Trualta adds Caregivers Essential Certification to its caregiver education and support platform.

Blog Posts


Contacts

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

Morning Headlines 4/12/24

April 11, 2024 Headlines Comments Off on Morning Headlines 4/12/24

SAMHSA and ONC Launch the Behavioral Health Information Technology Initiative

ONC and SAMHSA will invest $20 million over the next three years to improve health IT in behavioral health and practice settings through the new Behavioral Health Information Technology Initiative.

VA plans to restart EHR deployments before the end of FY25, secretary says

VA Secretary Denis McDonough says that the department will resume rolling out its Oracle Health-based EHR before the end of fiscal year 2025, despite the fact that the 2025 budget doesn’t include any funding for additional deployments.

Alcohol Addiction Treatment Firm will be Banned from Disclosing Health Data for Advertising to Settle FTC Charges that It Shared Data Without Consent

The FTC bans virtual alcohol addiction treatment company Monument from sharing patient health data with third-party advertising sites.

Comments Off on Morning Headlines 4/12/24

News 4/12/24

April 11, 2024 News 5 Comments

Top News

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Transcarent CEO Glen Tullman launches 62 Ventures, a $100 million venture fund that will focus on healthcare startups in the US and India. Its portfolio already includes BridgeHealthAI (health and social care), Khyaal (senior care), and Loop Health (care management and benefits).

Tullman is also the founder and managing partner of digital health fund 7wireVentures, which has invested in Transcarent and Tullman’s former employer, Livongo.

Tullman oversaw the $18.5 billion sale of Livongo in 2020 to now-struggling Teladoc Health during his tenure as executive chairman.


Reader Comments

From My2Cents: “Re: Epic interoperability. CEOs of technology companies that facilitate data exchange via Carequality claim that Epic has cut off their records requests. I think the issue is that they supposedly were sending data to companies whose Purpose of Use does not involve Treatment, Payment, or Operations (TPO). I wonder if those companies will incur HIPAA fines for knowingly providing inappropriate access to patient records?” Unverified, but being debated on LinkedIn, including by Particle Health founder Troy Bannister. He says that Epic stopped responding to certain medical requests in claiming that the recipients do not directly support treatment, which Bannister denies. Using patient data outside of HIPAA’s TPO definition requires individual patient consent. Also at issue is whether or not providers themselves asked Epic to stop sharing data with companies that they believe were misusing it, in which case Epic has to comply.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Tower Health (PA) will outsource its revenue cycle operations to Ensemble Health Partners this summer, transitioning 675 employees to the RCM company.


Sales


People

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Jay Sultan (United Generations Capital) joins Tegria as its first chief data and analytics officer.


Announcements and Implementations

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Inovalon announces GA of SDOH Market Insights for life sciences companies.


Government and Politics

ONC and SAMHSA will invest $20 million over the next three years to improve health IT in behavioral health and practice settings through the new Behavioral Health Information Technology Initiative.


Other

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Cedars-Sinai (CA) expands the capabilities of its Connect virtual care app to include pediatric and Spanish-speaking patients. The app, which launched last year, uses technology from K Health.

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UW Medicine (WA) launches a Cognition in Primary Care program to helps its primary care physicians better manage the care of patients with cognitive issues like dementia. Cognitive care protocols and shortcuts embedded in the health system’s Epic EHR have been especially helpful, according to early adopter Nina Maisterra, MD: “Until it became muscle memory, it was great to refer to dot phrases they built. In primary care, we don’t usually get content that’s this user-friendly.”

New survey findings from the American Medical Association reveal that 51% of physician practices have lost revenue due to an inability to process patient co-pays after the cyberattack on Change Healthcare, while 80% have lost revenue from unpaid claims. Though 55% have had to use personal funds for practice expenses and 31% have been unable to make payroll, only 15% have reduced operating hours.


Sponsor Updates

  • CereCore releases a new podcast, “When Healthcare’s Toughest Problems Need an Outsider’s Perspective.”
  • Sonifi Health expands its support for virtual hospital care with telehealth partnerships and system optimizations.
  • Healthcare Choices NY uses the EClinicalWorks EHR and Healow no-show prediction AI model to reduce its no-show rate, increase revenue, and improve patient care.
  • Morris Hospital and Healthcare Centers (IL) recounts its successful Meditech Expanse implementation and resultant benefits.
  • First Databank names Kristin Buechler clinical informatics pharmacist, Erin Gosney operations manager, and David Morris senior software engineer.
  • FinThrive releases a new Healthcare Rethink Podcast, “How Do You Tailor Healthcare Affordability?”
  • Healthcare IT Leaders releases a new Leader to Leader Podcast, “Cybersecurity and Change Healthcare: Assessing the Impact of a Major Cyberattack.”
  • New research from Inovalon and Harvard analyzes Medicare Advantage plan design’s impact on healthcare utilization and health equity.
  • Black Book Research survey-takers rank Veradigm’s Practice Fusion EHR first in customer satisfaction with ambulatory EHR and practice management software.

Blog Posts


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EPtalk by Dr. Jayne 4/11/24

April 11, 2024 Dr. Jayne 1 Comment

I recently saw an article talking about the creation of chief AI officer roles at several organizations. Artificial Intelligence is here to stay and we need to be proactive about its consequences. Politico ran a great article recently that looked at the intersection of AI and medical malpractice. It cites comments from AMA President Jesse Ehrenfeld, who says that lawsuits are already being filed about the use of AI in healthcare. In speaking with some of my friends who are attorneys, they noted that there will be some interesting case law created over the coming years. Tech vendors will be pointing fingers at the clinical end users who leverage AI in patient care, and those practitioners will be pointing their fingers right back at the AI technology’s creators. Physicians are already left holding the bag for a variety of things, including patients who refuse recommended care and patients who get caught in the crossfire when insurers won’t cover recommended care. What’s one more point of liability?

From Madge in HR: “Thanks for mentioning employee handbooks last week. I think the majority of people just sign them blindly and don’t read them. It’s always interesting to me when a company deploys a new policy to the wild, but especially so when you know that the policy is the result of a recent event. My company just announced our new ‘Professional Behavior Policy.’ While it’s shocking to me that we need such a policy in place, it’s reassuring to know that the company values professionalism and is willing to require it of every employee. The prohibited behaviors that stuck out to me included: slamming doors; refusal to communicate or communicating dishonestly about business matters; obstructing, undermining, or preventing another employee’s work performance; and possession of objects that are sexual in nature. Long story short: Be nice to each other. Don’t throw a tantrum. Don’t lie. Don’t keep others down. And for the love of all that’s good and right, keep your bedroom toys out of view when you’re on a Teams meeting.” Although I agree with the intent behind these, I don’t envy those that have to handle complaints on some of the more subjective issues. Most of us have at least some experience at companies where people stretch the truth to varying degrees and where politics and blocking are a daily event. It’s sad given the fact that we’re all in an industry where the ultimate use case is about helping people.

The US Food and Drug Administration has cleared its first AI tool for sepsis detection. Developed by Prenosis, the Sepsis ImmunoScore tool was approved through the FDA’s De Novo pathway. Sepsis is a serious health condition, leading to more than 350,000 deaths annually. The tool looks at more than 20 clinical parameters including vital signs and laboratory results to help identify sepsis risk. Although other organizations, including Johns Hopkins University and Epic have built sepsis detection systems, this is the first one to receive FDA approval. The Prenosis tool sorts patients into four different risk categories but is not considered an alert system. Testing was performed on a dataset that included more than 25,000 patients.

Having spent a good chunk of my career working in emergency department and urgent care settings, a recent article about “rat snacking” really resonated with me. Although the headline was mostly about physicians, the piece applies to anyone whose work schedules disrupt traditional mealtimes. The authors define “rat snacking” as when “people consume whatever type of food they can scavenge.” Anyone who has ever subsisted on graham crackers and apple juice swiped from a hospital unit’s floor stock feels this in their bones. A local hospital recently curtailed the availability of what one nurse describes as “real food” on the night shift, citing cost control measures. Maybe they should be more aware of the literature that shows that disordered eating can lead to nutritional deficits and excess consumption. Of course, the answer is planning ahead and packing your own food, but that only goes so far when your eight-hour shift suddenly becomes 12 or 14.

The Change Healthcare ransomware debacle continues to be a thorn in the side of many physicians, as they await claims and payments to catch up. Several of my local colleagues have had to take out lines of credit or personal loans to cover office payroll and they’re eager to eventually reach resolution with their revenue cycles. Change Healthcare’s parent company, Optum, isn’t winning any friends with recent headlines about practice acquisitions that leave patients without physicians as theirs jump ship. This particular story includes a vignette of a patient who has been part of the practice for more than two decades but cannot be accommodated after the departure of his physician. The patient panels carried by primary care providers these days are more than twice the size of those that existed when I was in a traditional family medicine practice, and those bloated panels make it difficult to recruit replacement physicians.

The happenings going on at this particular organization, Oregon Medical Group, have led to the introduction of legislation designed to slow the influx of corporations into healthcare in the state. The reality of the entry of these parties into the healthcare ecosystem is that their goals are not the same as the owners they replace – often physicians. Where physician-owned organizations will generally continue to participate with low-paying payers, such as Medicaid, many corporate entities move quickly to try to push those patients out of the practice. Non-physician owners that have shareholders are motivated primarily to deliver profit to those shareholders, which can increase provider burnout and place patients at risk.

Given the challenges facing primary care physicians, I was surprised to see the number of medical students who requested to participate in my local medical society’s “Coffee with a Doc” program. I took a first-year medical student to lunch and was surprised to learn that her school is incorporating classes on “the business of medicine” as early as year one. She had some good questions about RVUs and physician payment, and I introduced her to the concept of Direct Primary Care, which apparently wasn’t included in her curriculum. I’m seeing increasing numbers of my family medicine colleagues moving in this direction, so I’m glad the topic came up. Kudos to her school for adding information to the curriculum that can help students learn more specifics about what they’re getting themselves into.

From Stage Mom: “Given your previous comments about health systems sponsoring stadiums and other facilities, I thought you would appreciate this article about a $5.4 million theater naming deal.” BayCare Health System, based in Clearwater, FL, will pay the amount over a 10-year period in exchange for naming rights at the BayCare Sound amphitheater. The agreement has an option for a 10-year renewal in 2034. BayCare also has a ballpark under its belt. According to ChatGPT, that amount of money would pay for more than a quarter million influenza vaccines, or more than a hundred thousand cervical cancer screening tests, or more than 36,000 mammograms. I wonder which the community would rather have?

Will health systems keep slapping their name on everything, or will they start to put their non-profit profits to better use? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/11/24

April 10, 2024 Headlines Comments Off on Morning Headlines 4/11/24

Tower Health and Ensemble Health Partners Announce Strategic Revenue Cycle Partnership

Tower Health (PA) will outsource its revenue cycle operations to Ensemble Health Partners this summer, transitioning 675 employees to the RCM company.

Physicians struggle to keep practices afloat after Change cyberattack

New survey findings from the American Medical Association reveal that 51% of physician practices have lost revenue due to an inability to process patient co-pays after the cyberattack on Change Healthcare, while 80% have lost revenue from unpaid claims.

Bayer and Google Cloud to Accelerate Development of AI-powered Healthcare Applications for Radiologists

Bayer and Google Cloud will collaborate on developing AI solutions for radiologists.

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Healthcare AI News 4/10/24

April 10, 2024 Healthcare AI News Comments Off on Healthcare AI News 4/10/24

News

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Google opens Gemini 1.5 Pro to developer preview via API, which includes native speech understanding and a file handling API. The system was tested with a 400-page transcript from the Apollo 11 mission, about which it could answer questions and details from conversations and images using up to 1 million tokens.

Meta says it will release its Llama 3 open source LLM within one month, with double the parameter size of Version 2 and about the same as Open AI’s GPT-4.


Business

Bayer and Google Cloud will collaborate on developing AI solutions for radiologists.

Northwestern Medicine and Dell’s AI Innovation Lab create an LLM solution for drafting x-ray reports. They are also working on a predictive model for the EHR.

All of India’s major hospital chains are using AI, with Apollo Hospitals testing it for patient monitoring, cardiovascular disease prediction, symptom checking, radiology workflow, and in-room automation. Apollo says that some of the technologies have earned US FDA clearance.


Research

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Researchers document the steps that were involved in Duke University Health System’s design, development, and maintenance of the AI-powered SepsisWatch system. They hope to illustrate the lessons that were learned in developing algorithms, involving stakeholders, and setting up an organizational structure.

Researchers find that an algorithm can predict hospital-acquired pressure injury with 74% accuracy, extending EHR-calculated Braden Scales into an early warning system that could save a 500-bed hospital up to 90,000 labor hours and $18 million in expense each year.


Other

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Penn’s medical school names Marylyn Ritchie, PhD, former director of biomedical informatics, its first vice dean of AI and computing. University of Pennsylvania Health System also promotes former radiology chief Mitchell Schnall, MD, PhD to SVP of data and technology solutions, with a focus on AI.

International health leaders list four action areas that should be addressed to fully realize AI’s healthcare potential:

  • Identify high-priority data elements that are needed for AI applications and ensure that availability of those elements is reliable.
  • Test AI tools to ensure that they are safe and effective within specific patient populations and are free of bias.
  • Standardize business processes so that data can be shared between institutions, such as connecting encounter data to outcomes, and explore privacy-preserving data sharing approaches.
  • Advocate for paying for value (quality, safety, health, and costs) to align the financial incentives for using AI.

Contacts

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

Comments Off on Healthcare AI News 4/10/24

Readers Write: Payment Card Fees Explained

April 10, 2024 Readers Write Comments Off on Readers Write: Payment Card Fees Explained

Payment Card Fees Explained
By Heather Randall, PhD

Heather Randall, PhD is chief compliance officer of TrustCommerce, a Sphere company.

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The recent comments from HSA Card User and Mr. H on 3/11/24 shine a light on an increasingly common trend on the addition of fees to your invoice, restaurant bill, sporting event, concert, or medical bill. Many businesses are adding new fees in an attempt to cover their operational costs, which continue to increase. These fees can be frustrating for consumers, and if not done in compliance with the Card Brand Operating Rules, can actually expose businesses that are trying to incorporate these fees to fines and penalties.

When discussing card fees, it is important to understand that there are different fees, and card brands maintain different rules for each type of card fee. For example, these three types of fees each have a different purpose.

  • Convenience fee. A charge that is added when the business offers the cardholder an alternative payment channel that is, in fact, a convenience. For instance, a healthcare practice may accept payments in office, but may offer patients the ability to pay online. In that case, the ability to pay online is considered a convenience and a fee may be added to that payment channel. Convenience fees may not be charged in a face-to-face transaction or by a business that operates solely online.
  • Service fee. A fee that is charged by a merchant or entity in the government or education sector, or a processor that enables payments for such a merchant. The merchant must pass a special identifying value in the transaction message to validate that it is eligible to charge such a fee. Such merchants may include municipal utility providers, tax assessment offices, registrar’s offices, and similar entities.
  • Surcharge. A surcharge is a fee that is added to a total invoice amount to cover the entity’s cost of processing the transaction. Surcharges are capped at a certain percentage by the card brands and some states. In addition, there are a handful of states in which surcharges are illegal, and several others in which there are significant regulatory requirements around how a surcharge is to be implemented and communicated. Surcharges cannot be charged on a debit card transaction.

Another important note is that an organization can only charge one of these fees, depending on the card brand. For example, if a patient is paying a medical bill through a portal, the practice can charge either a convenience fee or a surcharge, but not both.

Surcharging in particular is a nuanced process. Maintaining balance between the different card brand approaches to compliant surcharging — and cash discounting, which is also an emerging trend — and state laws is tricky at best. This is particularly true given the recent settlement between Visa/Mastercard and several merchant groups. That settlement included some changes to the ways in which surcharge will be managed by the brands. It remains to be seen what the impact of that settlement will be on the practical realities of imposing such a fee.

The long and the short of it is that merchants can use a number of fees to offset the costs of operations, but they must be used in a way that is compliant with state laws and industry rules. Doing so can be extremely complicated and can court significant consequence if not implemented correctly. Any business investigating leveraging convenience fees, service fees, or surcharges is well advised to speak with their merchant service provider or acquirer before implementation.

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Readers Write: Creating a Patient-Centric Practice: How to Minimize Wait Times and Increase Patient Satisfaction Scores

April 10, 2024 Readers Write Comments Off on Readers Write: Creating a Patient-Centric Practice: How to Minimize Wait Times and Increase Patient Satisfaction Scores

Creating a Patient-Centric Practice: How to Minimize Wait Times and Increase Patient Satisfaction Scores
By Sherilyn Giauque

Sherilyn Giauque is principal product manager at AdvancedMD of South Jordan, UT.

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By reducing wait times, healthcare providers elevate the patient experience and improve healthcare outcomes, while also driving greater efficiencies across the practice. 

The amount of time a patient spends waiting to see a healthcare provider has a direct impact on the patient’s perception of the practice and level of care they receive. The longer a patient spends waiting — either to schedule an appointment or to see their healthcare provider once they arrive at the practice — the more likely they are to seek out a new physician or simply stop receiving care. 

When scheduling an appointment, the average wait time to get into a medical office is 26 days. That means that many patients are waiting nearly a month just to see their healthcare provider. Research conducted by Duke Health revealed that every 10 minutes that a patient spent waiting to see their healthcare provider led to a 3% decrease in patient satisfaction scores. 

If you’re searching for new ways to build a patient-centric practice that prioritizes patient care and outcomes above all else, here are five tactics that can help you reduce the amount of time your patients spend waiting to see you. 

#1: Take a strategic approach when managing waitlists that minimizes the impact of no-shows while optimizing daily schedules 

Double-booking and triple-booking appointments with high no-show rates can help eliminate unnecessary downtime for both the admin and clinical staff while keeping your practice operating at full capacity. Be sure that waitlists can be easily accessed and updated by your admin team, with automated notifications built in to alert patients when an appointment slot becomes available. 

#2: Give patients access to digital intake forms that can be completed online to streamline patient check-in processes

By taking advantage of digital intake forms, your practice can eliminate the need for patients to fill out paperwork while waiting to be seen. Online forms also help reduce errors and minimize the amount of time your admin team spends entering patient data—all while providing a smooth patient experience. 

#3: Take advantage of a unified medical office software platform that includes integrative EHR, practice management, and patient engagement solutions

Now more than ever, practices need highly integrative technology solutions that seamlessly connect all sides of the business. An effective all-in-one EHR, practice management, and patient engagement platform comes equipped with key features that can help reduce wait times, including: internal wait-list management capabilities, rooming features to move patients through the office as quickly and efficiently as possible, automated appointment reminders, and customizable intake form templates.

#4: Allow patients to schedule visits and manage their healthcare experience via intuitive self-service tools

Patients who have more control over their healthcare experience and more flexibility when it comes to scheduling appointments tend to be more satisfied with their healthcare providers. Providing your patients with self-service tools and access to an online portal where they can access billing records, make payments, schedule appointments, and review lab results not only streamlines patient-centric workflows, it helps reduce workloads and improves the entire patient journey, shrinking wait times and improving patient satisfaction. 

#5: Prioritize onboarding programs for new staff and keep employees well-trained on the practice’s technology stack and workflow best practices

Making sure your staff understands best practices around workflow processes and is up to date on your technology solutions is key to building a thriving, patient-centric practice. Taking the time to properly train both admin and clinical staff enables efficiencies throughout the practice, removing bottlenecks and ensuring smooth transitions as patients move from a waiting room, to an exam room, to the checkout desk. 

The reality is that long wait times are not only detrimental to the patient experience, they can be devastating for anyone who is suffering from a chronic illness who is in need of prescriptions or advanced treatment programs that require accelerated timelines. Improving wait times not only elevates the patient experience and improves healthcare outcomes, it has a positive effect on your entire practice, driving efficiencies throughout the office.

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HIStalk Interviews Paula Scariati, DO, Physician Informaticist and Author

April 10, 2024 Interviews 3 Comments

Paula Scariati, DO, MPH, MS is a physician informaticist, EHR governance consultant, and author of the book “EHR Governance: A Practical Guide to User Centric, Consensus Driven Optimization.”

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Tell me about yourself and what you do.

I’m an preventive medicine and public health doctor. I fell in love with the promise of what technology could do to make patient care and access better, so much so that I left the private practice that I had in San Diego 15 years ago to formally retrain in informatics.

But nothing that I learned in my academic studies really prepared me for my first job as a physician informaticist in a large, enterprise healthcare system. Providers were frustrated by poorly designed software, inefficient workflows, and low-value tasks. EHR governance was immature, and was often driven by well-meaning executives who didn’t really use the EHR. End-user requests were low priority and frequently lost to follow up.

In short, the processes were slow, poorly coordinated, and had lots of bumps, detours, and do-overs. It was intense. The tipping point came when a large region that was part of the enterprise threatened to return to paper, and there was a crisis. Out of that crisis, a methodical, user-centric, Agile approach to EHR governance was born.

How has EHR governance changed now that most health systems have chosen and implemented an EHR?

Governance has matured organically over time. In the beginning, back when most organizations went live, it usually meant that a process was stood up at the end of go-live, where that critical mass of requests that were made during go-live, but not necessarily addressed during go-live, were handed over into a queue.  That was the focus of early governance work, the robust adoption of a new system with well -integrated workflows.

But once those I’s were dotted and T’s were crossed, the focus of governance then shifted to optimization. That work included end users adopting new tools and refining interfaces. This organization was looking for more effective, efficient care. It took probably several years for that to unfold. 

Then the organization moved on to the next phase of EHR governance, which I call transformation. It’s at that point where the organization’s governance framework would be well established and trusted. It has become part of the cultural norm of organization. There’s now a pathway, hopefully an Agile pathway, for conducting pilots or proof of concepts, which allows the organizations to quickly vet new technologies, modules, and features. There’s also an established system for communicating and socializing change.

I’d like to believe that over these last 15 years, many organizations have found a level of transformational maturity in their EHR governance processes that works well for their healthcare system and their culture. However, I’ve also spoken with so many leaders and organizations where EHR governance never got a strong footing, or where well-designed governance processes were fouled by mergers and acquisitions or major leadership changes.

Do health systems incorporate the participation of medical staff technology naysayers in addition to the “friendlies” who will reliably support most executive decisions?

EHR governance needs to be led, and it needs to be led by somebody who is well respected and has the power to make changes when they need to. That right person needs to be embedded in a consensus-driven governance process. That process needs to listen closely to everybody. People who say they’re doing a good job, but especially the people who tell them that they are not.

Sometimes that negative feedback is more representative of the truth. Sometimes it isn’t representative at all, but it’s the canary in the coal mine, meaning that that person has the unique ability to see a real problem before others do. Occasionally, it might be a disruptor who has a less-than-kind intention, who can in good faith be ignored. 

But it is important to remember that a solid EHR governance structure is a two-way street. Communication goes out, but communication also comes back in. You need to be listening to the voice of the end user. Because when that is done well, a responsive governance process can throttle and balance an organization between that need for change and that problem with inertia or the status quo. Every organization has a different level of tolerance. A good system will recognize that and reduce the amount of fatigue and burnout that an organization will have because it is keeping to close on what’s going on.

Early EHR decisions were often made without thorough physician involvement, or by departments that wanted to make their own jobs easier by using the EHR to push more work onto physicians. Are some of those decisions being revisited or are physicians being asked directly how the EHR hurts or could help their work?

I think it’s safe to say that every organization that adopted an EHR back in 2009, which is when HITECH was enacted ,would have been thrilled if the software was mature and user friendly. But we have to remember that every vendor’s core EHR product was initially designed to meet Meaningful Use metrics, and that went on for seven years. Nowhere in there was a mandate for the user interface to be friendly or for the user experience to good. 

That exists even today. Our former Meaningful Use metrics have now morphed into the Promoting Interoperability Programs and eCQMs. This is all the basis for driving value-based care, but it took a number of years for that emerging body of literature on the unintended consequences of EHRs, note bloat, provider fatigue, and burnout to elevate the importance of the end-user experience and push it to the forefront. Physicians were rightfully frustrated and local decisions were made, decisions were made by the vendors, but they weren’t made with the idea of how to improve the user experience. They were made, how do we meet this metric? How do make this quality metric or safety metric get reported so that we can obtain Meaningful Use dollars? 

There was also a lot of frustration on the part of physicians because they were now being asked to play well with others in the sandbox. They were asked work with their colleagues and other teams to come to a consensus on how to design their user interfaces and workflows. This was a difficult task for some specialties, such as cardiothoracic surgeons who might be used to having their own unique way of doing things. This is where having fair, transparent, equitable governance processes is incredibly helpful. It levels the playing field and it sets consistent expectations.

Physicians are just about the only professionals who are expected to enter data into a computer system while doing their jobs, and often the data that they are recording doesn’t benefit them or their patient directly. Is AI or the use of scribes likely to change that?

Forcing physicians to become data entry clerks has been one of the greatest failings of EHR adoption process being driven by Meaningful Use. AI will get the keyboard off the physician’s lap, which will go a long way toward restoring the doctor-patient relationship. In fact, the highlight of HIMSS24 was the latest iteration of ambient voice technology married to artificial intelligence. These types of software capture the doctor-patient encounter verbatim and then use AI -driven logic to digest that information into a succinct, readable node. It’s amazing, and I think it’s just the beginning of what AI that is thoughtfully utilized in healthcare can do. 

However, there’s a lot of pressure on AI to solve all the problems that we have. It would be very nice if it can do that. I’m waiting and hoping that that will be the case. Some people say five years. I am a big fan of following Eric Topol’s voice in the matter, and I think he’s more optimistic than most in terms of how quickly this will unfold. But either way, I think it’s going to go a long way to help correct a lot of the problems that we’ve encountered as a result of how our initial work with EHRs has happened over the last 15 years.

How does the art of medicine coexist with the use of technology to standardize processes and guide medical decision-making?

When we first started digitizing medical records, a good deal of folly took what was on paper and just made it digital. We didn’t really use the knowledge that we had of how to make the EHR better, stronger, and faster than paper ever could be. But now, we see that the science underlying medicine grows exponentially every day. Just look how much medical literature is published each day. Then there’s the patient’s genomic data and now their phenomic data and so much more. It is absolutely impossible for any one provider or provider team to keep pace without using electronic tools that can securely capture, store, and make some good sense of it all.

What I see on the horizon is that good clinical decision support tools and analytics are going to expand the horizon of the physician. But the road to getting there is going be bumpy. We haven’t really taught our physicians or given them tools in a way that are user friendly. That’s where governance comes in, helping us to figure out how much we can change, how quickly we change, and vetting stuff ahead of time so that we determine what kinds of problems it may have and then deploy it using that group of early adopters who likes to do that type of initial pilot or proof of concept work, and help them to become the agents of change within our organizations.

Epic’s implementation model involves a rigid methodology and the assumption that C-level hospital executives will follow the recommendations of vendor employees who might have been sitting in a college classroom a year or two before. Did that level of prescriptive vendor involvement change the way that hospitals implement technology?

I gave a talk yesterday and user experience with Epic.The takeaway is simple — incentivized behavior change is more effective, and Epic was very smart. Early on, they recognized that organizations didn’t know what they didn’t know, and so they led. They were prescriptive. They trained and deployed resources. They didn’t nickel and dime their customers, but the level of support that came with them had a larger price tag and, in the end, better customer satisfaction. I’ve spoken with a number of organizational leaders that have used Epic and other EHRs, and they consistently they tell me that they find the Epic model to offer added value.

The takeaway is that incentivizing behavior change, being prescriptive — especially in an environment where people are learning something new, where they don’t know what they don t know — is a valuable way to deploy something. 

Is governance different in Epic-using health systems, either because they are self-selected as large, academic medical centers or because they are influenced by Epic or its other customers?

Epic had its origins in the ambulatory world. A number of Epic installations are organizations that have brought together large groups of ambulatory providers. We used to call the ambulatory world the wild, wild West, because in the inpatient world, a large, complex go-live has a lot of moving parts, while the ambulatory world, each individual practice has its own way of doing things. When you try to bring that together under a governance structure, it’s a little bit more challenging to get people to talk to each other or get them to agree on a certain interface or workflow.

In my experience, maybe not in everybody’s experience, taking the time to draw on a group of leaders to represent a specific region or practice and bringing them together to drive the change that you call governance is critical. 

Another good example of that is watching what is happening now with the go-live for the VA. Very, very bold. They are trying to have the whole VA system and the Department of Defense be on a single instance of Oracle. That’s a bold undertaking from a governance perspective, in terms of having everybody work together and use that same platform in a similar fashion.

Implementation of AI is more of a blank slate than bringing up an EHR since health systems can set up just about any logic and workflow they want, good or bad. How will AI governance work?

I wouldn’t necessarily say that we have a blank slate today. We’ve now been through over a decade, almost 15 years following HITECH, of doing EHRs. Some organizations have been on that same EHR, while others have gone through a second go-live with another EHR. Some have gone through mergers and acquisitions.  

What I see, and what I keep hearing from the different organizations that I speak with, is that physicians and other healthcare providers and users are tired of that “unlearn something old, learn something new” unlearn-relearn technology cycle that we’ve entangled our healthcare providers in. Our human nature is more inclined towards inertia and the status quo than it is to these iterative cycles of rapid change. For example, I may offer a physician a better, more efficient way to do something, but it’s not that unusual for them to decline, saying they would rather keep their current process and workflow even if it is broken. 

I see what’s coming forward with AI as incredible. It’s going to be another technical revolution. But I’m concerned that we now have a large amount of change fatigue, and in some cases burnout, from all of the change that we have been throwing at providers for the last decade and a half. They predict that the way we practice medicine will completely change in the next five years, and that is both exciting and frightening. But solid AI governance processes are the key to helping organizations throttle how they unfold that technology so that we have a legacy of innovation and equity, not burnout and the dissolution of the doctor-patient relationship.

More physicians on the medical staff are employed directly by health systems now instead of being based in the community or contracted through an external company. How has that affected the integration of physicians into technology decisions or their ongoing technology training?

I always found that group of community-based doctors to be an outlier in how we handled them during our lives. Their office often used a different EHR than the one in the hospital where they worked. It wasn’t a given that you would automatically just bring them up in their practice on the same EHR. They would use some sort of interface in their office to be able to use their office-based EHR that was interfaced to the hospital EHR. That was a clunky way of thinking about things, and something that I really had wish we had been more forward thinking about in terms of continuity of care across the continuum of care in medicine.

I would not say that it’s a big difference in terms of how we engage with them. Often they were powerful because they brought  lot of money into the organization, so there was a high level of sensitivity to making sure that their EHR worked well for them. But engaging them in governance and in consensus was the same as it was for any other group.  Again, with that added caveat that when we were looking at workflows, it was the hospital-based workflows and not necessarily how it would always work for their EHRs within their office.  But we often would go out and do a visit into their offices just to make sure that there was something that was working well and that it wasn’t double entry, or that something was inclined to making more errors than not.

How do you see the role of the CMIO changing?

I am hopeful that CMIOs over the last decade and a half have shown that they are strong leaders. I would love to see them elevated from what is oftentimes a “small C” in the organization to a “large C,” where they have a seat at the table with the CEO, CMO, and CIO. They do in some organizations, and some they don’t. But there has been recognition of the expertise that they bring to the table, as well as an evolution in what the CMIO is expected to be able to do, that has caused that role to be elevated to a higher level. 

As we move towards more AI -driven technological revolution in healthcare, that voice, that person, and that expertise is going to be critical. Over time, roles have been renamed. They have become the chief digital officer or chief AI officer. It may go that way instead of just changing the world of the CMIO to embrace a broader swath of what is technology. They may create these other roles that are more specialized. Either way, the CMIO has been elevated in stature and importance within every organization that is seeing just how much technology touches every aspect of healthcare.

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