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Morning Headlines 7/27/21

July 26, 2021 Headlines No Comments

Penn Medicine Launching Center for Applied Health Informatics

Penn Medicine (PA) will launch the Center for Applied Health Informatics to develop best practices for data projects across its health system and foster informatics leadership.

Epic’s AI algorithms, shielded from scrutiny by a corporate firewall, are delivering inaccurate information on seriously ill patients

STAT sheds light on an Epic program that incentivizes customers to use its algorithms, one of which – sepsis prediction – has been found to not work as well as advertised.

Komodo Health Acquires Breakaway Partners to Improve Patient Access to Effective Therapies

De-identified patient data and analytics company Komodo Health acquires Breakaway Partners, which offers market access analytics.

Curbside Consult with Dr. Jayne 7/26/21

July 26, 2021 Dr. Jayne 2 Comments

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I learned a valuable lesson in procrastination today, as I delayed writing until after I had an unfortunate encounter with a cheese knife. It was a classic blunder because I was in a hurry, and now I get to figure out how to type with fewer digits because I forgot how much finger lacerations hurt. It’s a good thing I’m not seeing patients in person right now because proper hand hygiene would certainly be a challenge. Public service announcement: don’t cut toward yourself, folks.

I should be practicing music in preparation for a recording that’s due soon, but that’s not going to happen. In the meantime, I’m recuperating by catching up on my journal articles and some light Netflix watching, which I almost never get to do. One of the first articles to catch my eye is timely given the state of burnout among my healthcare colleagues. It deals with the evaluation of resident physicians as to their level of “grit” and its association with wellness outcomes. The personality trait of grit is defined as “perseverance and passion for long-term goals.” Grit has been associated with conscientious behavior and higher levels of hope. In healthcare, those with higher grit scores have been associated with lower burnout scores.

The article looks specifically at the association of grit scores in surgical residents with burnout, thoughts of leaving the program, and thoughts of suicide. Researchers tested residents following the 2018 American Board of Surgery In-Training Examination. Where previous studies looked at data for residents in a single institution, this approach allowed them to look at nearly all clinically active surgical residents. Although the scores varied between programs, they found that residents with higher grit scores were less likely to have burnout, thoughts of quitting, or thoughts of suicide. It also confirmed that residents overall continue to have unacceptable levels of burnout, suicidal thoughts, and thoughts about leaving their training programs.

Fast-forward a couple of years and we have a situation where physicians and other healthcare providers around the world have been pushed to the brink. Many of them are working hours that are similar to what they worked in residency or their training programs, except now they’re responsible for these larger patient loads and sicker patients rather than being in training. It’s a heavy burden to bear and this week I saw four more of my colleagues resign from medicine. Mentally it seems worse, I think, because the patients are often in the situations that they are in by choice – by refusal to vaccinate, wear a mask, or practice social distancing. It’s hard to manage the cognitive dissonance around putting yourself at risk caring for others who didn’t take basic precautions.

As a clinical informaticist, I’ve learned to tread lightly around physicians and other care team members who are stressed. It’s important to know what else has been going on in their days before figuring out the best approach to training them or working with them in meetings. For example, did the OB/GYN on the committee just come out of a disastrous delivery, and that’s why they are disengaged or sound angry? Was it a difficult day in clinic? Lately, it seems like all the practicing physicians with whom I work are stressed every single day, which makes it hard to take projects forward when you need their input. I’m seeing many more canceled and rescheduled meetings and lots of schedule juggling. I’m having to think of entirely different ways to work with some of my end users while they struggle to balance all of the different pressures that they are under.

Lately it seems like they never get a break. The younger clinicians seem particularly stressed because school is starting soon. Most of them have planned for their children to attend in-person school, and the thought that our local COVID case numbers might change that is pushing them to the brink. It’s hard to get people to want to engage with you around designing order sets or evaluating potential clinical workflows when they are worried about childcare. We’ve seen a drop-off in participation in some of our committees and work groups as well. It seems people are just not willing to spend any more time at the workplace than they absolutely have to.

It doesn’t seem like video calls are the answer due to a tremendous amount of Zoom fatigue. We are having to think outside the box on how to engage people while also respecting their need for work/life balance. It’s important that we have good representation from different types of users with different types of needs, so we’re going to have to figure it out.

As clinical users become more stressed by patient care activities, they have less tolerance for misbehaving technical systems. What used to be small annoyances that users would ignore now seem to be more disruptive. If the EHR is running slow or there are any performance lags, it causes much more angst. Any buffer of resilience has been completely eroded over the last year. Most of the clinical organizations I work with have placed new non-essential tech initiatives on hold in order to give their budgets some breathing room, and it’s probably a good thing because it also gives their personnel some breathing room. For those that are moving ahead with big projects, I’m making sure they think about how they’re going to best support their users through the transitions.

I’m curious how other organizations are coping with the stresses of our new healthcare normal. Maybe there are some change leadership Jedi tricks that I haven’t learned yet that would be of benefit. Or perhaps the solution is to just slow down and give people some breathing room so that they can focus on patient care and self-care. Or maybe there are no good answers, and we just have to continue putting one foot in front of the other each day and hope for the best.

How gritty are your clinicians, and will they be able to rebound? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Vik Krishnan, GM, Intrado Digital Workflows

July 26, 2021 Interviews No Comments

Vik Krishnan, MBA is general manager of the Intrado Digital Workflows business of Intrado Life and Safety.

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Tell me about yourself and the company.

I live in Boston with my wonderful wife and three children. I studied biomedical engineering at the University of Pennsylvania, then earned my MBA from Harvard Business School. I entered the digital health market 12 years ago through a company I founded. I have the probably unique distinction of having run two of the businesses in the market today that offer something similar to Intrado HouseCalls in terms of patient engagement.

Intrado’s HouseCalls business is a market share leader by far in automating mass patient engagement workflows. We serve 17,000 healthcare providers, including 400 of the largest hospitals that are using Epic and hundreds that are using Cerner.

Dental practices have offered just about every form of patient engagement technology for years. Why did it take practices and hospitals so much longer?

If you think about the longer tail of healthcare providers, small physician practices and dental practices, there is no disguising the revenue impact in a given week or in a given month of even a slight variation in patient volumes. A dental clinic is going to feel that. They may even go under with a couple of bad months. That’s probably why they were quicker to adopt. Also, any smaller institution in any market, including healthcare, is usually more willing to have a quicker and more simple sales cycle. There are more levels in the decision and more integration into the solution and the current systems at a larger healthcare provider.

All of those factors will come into play. I think that they have gotten there now, though, but you are right, it has taken longer.

What do patients gain as a benefit when you integrate a patient engagement platform with an EHR like Cerner or Epic?

We have to understand patient preferences. Certainly they vary by demographic type, and age, but essentially what a patient is looking for is a seamless experience. Surveys find that 90% of patients want automated patient engagement communications. Nearly 70% say that they want more communications and reminders that help them be compliant with their own healthcare needs and their own requirements.

What they don’t want to do is get a reminder — for example, about an appointment — and then realize that the scheduled time doesn’t work for them, but the only available follow-up action is to call the contact center. That’s a laborious process, not just for appointments, but for a recall campaign, for example. If somebody knows that they need to schedule an annual wellness visit, but now they have to call in and wait, that’s a challenge and a burden that can ultimately disengage the patient from the process.

What a patient would like — and this can only be achieved through deep integration with the EHR – is to solve that workflow through SMS. If the appointment I have tomorrow doesn’t work, why can I not just reschedule that through SMS through real-time integration with the EHR? If I know I need a colonoscopy and I’ve been reminded of it effectively, that’s great and I want to schedule it, too. Why can’t I just do that in an automatic way without talking to a human being?

Last point on this. This matters a lot for underserved communities as well, because there are a variety of differences to consider there. Some of those differences are around a preference that studies suggest for using SMS versus phone call and email. Some of it is around language. If a platform can use over 100 languages, you are more likely to deliver the patient experience that somebody wants if English is not their native language. That will improve communication health and patient satisfaction.

How do you capture the categories into which a given patient falls, such as those with a preferred communication method, a limit to how many messages they want to receive, or those who want to opt out entirely?

That is done effectively through both a solution philosophy and a support philosophy. The solution philosophy needs to be to use the hospital or health system’s EHR as the single source of truth. If the hospital or health system is using the EHR as a single source of truth, these toggles, these preferences, this information will be in there. It’s just waiting to be used.

Then the next step is a solution philosophy that leverages that data, integrates through real time like we do through APIs into the system, and is empowers that system and that hospital to get the most out of their EHR. Any hospital CIO or CMIO will tell you that they want the EHR to be the single source of truth. It’s harder to do that when many other solutions on the market don’t integrate through API as the way we do and instead use HL7. This creates a parallel EHR-like system of data and rules that live outside of the EHR.

That makes it more complex. It makes it harder for the hospital to manage this and these insights on the patients and their preferences. It also exposes the hospital and health systems — going a little off-topic here, but it’s important to mention — to data breaches and other risks. You use the EHR as a single source of truth, and you help through support the hospital or health system to do that. That’s ultimately how you achieve what I just described in my previous answer.

Everybody’s buzzword is “digital front door.” Do health systems that haven’t solved longstanding patient pain points – employee friendliness, parking and wayfinding, and accurate billing – create digital expectations that their physical reality can’t match?

We see a lot of hospitals navigating what seems like a simple concept. Digital front door seems like a specific concept, just like patient engagement seems like a specific concept, but ultimately it involves a more comprehensive solution with lots of departments and stakeholders at the hospital involved. We typically see hospitals and health systems find this process, both front door and digital engagement, to be complex and difficult.

The concept of digital front door can encompass many things. It could encompass what the website looks like. Is there a chat bot or web bot on the website? That’s for inbound. Patient engagement is often thought about as being outbound, but the way we think about it is two way. We want to facilitate, and we do, two-way patient interactions. Sometimes these will be around something specific that is happening. We want to inform a patient about an annual wellness visit, the need to get a mammogram, or something pre-post-procedure, appointment, or thereafter. But sometimes these things will be inbound. It’s not because of something the hospital wants, it’s because of something the patient is seeking. They may be on the hospital’s website, for example, and want to be able to take an action that doesn’t involve calling the hospital contact center.

We see complex RFP processes. We see hospitals engaging consulting firms to solve these problems. I certainly have recommendations on how to solve these problems, but I want to acknowledge it is a complex process and decision that is difficult for hospital decision-makers to navigate.

Is it possible to address all these patient needs, including pre- and post-procedure instructions and communication with the patient’s family, through a single technology or vendor?

It is. This is an important concept to mention. We see an evolution underway right now in the market in terms of how hospitals and health systems are viewing patient engagement. Virtually all understand that they need to send SMS reminders, for example, about appointments and related communications. Many today still view those particular use cases as point solutions, or value may be measured, for example, through no-show rates or through transactional pricing. 

Some, to your point, have understood that they need a patient engagement platform, not a point solution. More broadly, a solution, a platform that is not just solving any one of those things, but that integrates, for example, in real time, not just with their EHR, but with other systems like the contact center. One that truly automates a wide range of two-way patient engagement workflows.

When you think about making a solution decision versus a platform decision,vit can be a more complex decision. But the ROI for that platform will be measured by increased revenue delivered, decreased operational costs that the hospital has to bear, and increased community health and patient satisfaction. Some hospitals and health systems are going through that process, and that frankly is the solution that we provide. Those are the types of customers that we serve and the needs we try to solve, but that’s how you get there, and that’s the difference between the solution and the platform.

To what degree are hospitals using patient-reported outcomes, such as automating a daily inquiry about the patient’s pain, medication effectiveness, or mobility?

Let’s talk about a mass notification solution and then a patient engagement platform and what the difference is.

Let’s say a hospital has a mass notification system to inform patients about the need to have an annual wellness visit. They have some success rates. Great. They get some revenue and community health has improved. Nice job.

Now if they have a patient engagement platform that truly integrates in real time, it can automatically identify which patients need to be informed about an annual wellness visit. It can drive those interactions, but it can also capture those patients, for example, who say, “I actually declined, I don’t want to have an annual wellness visit.” You can record that information and report it in real time back to the EHR.

At some point, that patient will come in and  talk to a physician, maybe their PCP, about something else. The PCP, through a platform — not just a mass notification system — will have that information in the EHR that will allow them to know the decision the patient made and have a conversation with them about why they made that decision. This is about holistic care, which ultimately drives patient satisfaction and improves community health. Doing that actually also improves the hospital’s satisfaction scores and care quality scores, just knowing why if somebody didn’t want to do something, why that was and what happened after.

I’ll give you another example of an outcome through a platform, not a mass notification system. We worked with one of our customers, Kettering Health Network, to automate the process of collecting patient self-reported data, which was manual. That saved Kettering Health Network, through automated SMS, nearly $1,000,000 in annual spend. There’s a financial outcome that a platform can deliver. There is a community health and patient outcome that a platform can deliver. You cannot get those outcomes through a more basic mass notification tool.

Do health systems and practices do a good job of not overwhelming patients with poorly designed or poorly targeted messages?

For our solution, we adopted a concept of augmented intelligence. You can broadcast every message to every patient about everything, which will probably create the dissatisfaction and disengagement that you just described. You can also ask a patient to go log in somewhere to a portal, download an app, and go log in there and get whatever information that the hospital wants the patient to get. Every study shows that if you ask a patient to log in somewhere, they’re less inclined to do it. They probably don’t know their login and they will never get that message. The message may not even be tailored to them. 

An augmented intelligence patient engagement platform integrated into the EHR knows when a patient needs to hear what and when. Once one of those automated workflows is set up by hospital staff, it runs. It can be monitored and reported on, but it doesn’t need to be manually managed. A platform like that will reach out to patients about the right thing at the right time and collect responses. That makes it more tailored, more personalized, and ultimately more effective.

What changes do you expect to see in your business over the next few years?

We have adopted a process of continual innovation. The biggest hump to get over — and we are increasingly doing this in our new logo deals and also our customer base —  is that it’s not a point solution that you need. What you’re getting from us now and what you need to adopt from us now is a true augmented intelligence patient engagement platform.

But once they make that leap, and many of our customers already have made that leap with us, then it is not hard after that to continue to add new workflows that increase automation and ultimately help healthcare providers, hospitals, and health systems do three things — increase their revenue, decrease their operational burden and costs, and improve community health and delight patients and increase their satisfaction. Once the customers we serve and the customers that we are adding are over that hump, they will continually add more and more automated workflows that we are delivering.

Do you have any final thoughts?

I’ve described the concept of a point solution and a platform. While we excel at delivering some of those point solutions, our mission in this business is to offer the platform. If a healthcare provider in your audience is interested in a true platform that digitally transforms their organization and does what I’ve described, I would urge them to reach out to Intrado or to me personally.

Morning Headlines 7/26/21

July 25, 2021 Headlines No Comments

Sema4 Closes Transaction with CM Life Sciences, Debuts as Publicly Traded AI-driven Genomic & Clinical Data Platform Company

Clinical data and genomic platform vendor Sema4, a Connecticut-based venture of Mount Sinai Health System, goes public via a SPAC merger at a valuation of around $3 billion.

System C buys medicines management specialist Wellsky

British health IT company System C acquires medication management vendor WellSky International.

Caregiver Support Company Cariloop raises $15 million in Series B funding to expand help for families and ease caregiving crisis

Digitally-enabled caregiving support company Cariloop raises $15 million in a funding round that brings its total raised to just over $24 million.

UPMC reaches $2.65 million settlement with employees over data breach

UPMC will pay $2.65 million to settle a class action lawsuit that charged it with failing to protect employee information that was stolen and used in a phony tax refund scam.

Monday Morning Update 7/26/21

July 25, 2021 News 4 Comments

Top News

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Clinical data and genomic platform vendor Sema4, a Connecticut-based venture of Mount Sinai Health System, goes public via a SPAC merger at a valuation of around $3 billion.

A health IT connection is President and COO Jamie Coffin, PhD, whose history includes time with Dell and IBM.


Reader Comments

From Exit the Kraken: “Re: HIStalk fan club on LinkedIn. Seems like a lot of company promotion going on there.” Some of the HIStalk “fans” use the group to pitch competing sites or advertise their non-supporting companies in a way that seems distasteful, but I guess that’s the nature of PR-seeking LinkedIn users. I’ll take it as a compliment that my readership is larger and more influential to the point that folks abandon their pride in an attempt to reach it.


HIStalk Announcements and Requests

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Poll respondents expect Amazon to be the strongest healthcare market participant in the tech world, although I probably shouldn’t have listed it among pure tech companies since their competitive advantage mostly lies elsewhere. Eddie T. Head throws down the “you heard it here first” gauntlet in boldly speculating that the winner will be Oracle after they buy Cerner.

New poll to your right or here: Who is most responsible for the VA’s Cerner rollout challenges?

I didn’t get many responses to my inquiry about folks who had planned to attend HIMSS21 but recently changed their mind, which may or may not mean that there aren’t many of them. A couple of folks say their employer has banned travel, a mom who is breastfeeding her new baby and would have had to bring them along says it’s not worth the exposure given the rise in the Delta variant, one says they fear being infected even with vaccination even though it likely wouldn’t be fatal, one is under UK travel restrictions, and one says they won’t give personal information such as vaccination status to HIMSS.

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Meanwhile, hospitals in Las Vegas – along with those in other low-vaccination states like Missouri, Florida, Louisiana, and Arkansas — say they are straining with high numbers of COVID-19 patients, most of them young and unvaccinated. Cases in Clark County have jumped fivefold in the past month and hospitalizations are reaching peaks that approach last year’s summer surge. Only 39% of county residents are fully vaccinated. That number is almost certainly underestimated since it would not include the many visitors who unknowingly take the virus home during its 2-14 day incubation period.

The challenge for HIMSS is that unlike in Orlando, the Las Vegas conference areas cannot be secured from unvaccinated outsiders since hotels were intentionally designed to force people to pass through the casinos to reach conference areas, guest rooms, and restaurants. Still, that incidental contact is unlikely to support respiratory spread, so the danger zone is outside the cordoned off HIMSS21 areas where exposure is extended (bars, restaurants, casinos, shows, etc.) Vaccinated attendees are unlikely to become infected and any breakthrough infections should be mild, but while vaccinated people are less likely to spread COVID-19 to some unknown but likely significant degree, hospitals may decide the risk isn’t worth it for their employees and keep them home.

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The security membership group ISC West just wrapped up its conference at the Sands Expo & Convention Center (which, by the way, will be renamed to The Venetian Expo on September 2) with about 11,000 attendees – less than half the usual number – so we will see if any superspreading is reported (actually, it’s unlikely to be detected since contact tracing just isn’t done here). That conference did not require vaccination proof or masks – video from there (above) shows basically nobody masked — and instead relied on the usual pointless hygiene theater of obsessively disinfecting surfaces and pushing hand sanitizer after checking temperatures at the door.


Webinars

July 28 (Wednesday) 1 ET. “Stop running from your problem (list): Strategies for streamlining the EHR’s front page.” Sponsor: Intelligent Medical Objects. Presenters: Amanda Heidemann, MD, CMIO, CMIO Services LLC; James Thompson, MD, physician informaticist, IMO. How can clinicians mitigate the longstanding EHR problem list challenges of outdated or duplicative entries, rigid displays, and limited native EHR capabilities? The presenters will describe how to analyze current problems, create a problem list governance strategy, and measure improvement progress.

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


Acquisitions, Funding, Business, and Stock

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Digital front door systems vendor Qure4U raises $25 million in funding.

CHIME’s fall healthcare CIO boot camp will be held in San Diego October 23-26. I should interview a freshly graduated participant one of these days since I suspect people who haven’t worked as an IT executive would find the content interesting.


Announcements and Implementations

UPMC will pay $2.65 million to settle a class action lawsuit that charged it with failing to protect employee information that was stolen and used in a phony tax refund scam.


Sponsor Updates

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  • Pivot Point Consulting sponsors and participates in the Wellspan York Health Foundation Benefit Golf Tournament.
  • Fortified Health Security releases a new video, “Cyber Insurance Requirements Have Changed. Are You Prepared?”
  • Authority Magazine interviews Nordic Advisory Services Practice Lead John Distefano.
  • The HIMSS Podcast, “What We Learned About Health IT During the Pandemic,” features PatientKeeper VP of Product Management Cathy Donohue.
  • Pure Storage expands as-a-Service offerings designed to support business outcomes.
  • RxRevu publishes a new whitepaper, “How Accurate Prescription Data Can Drive Valuable Decision Making at the Point of Care.”
  • Masstricht University Medical Center, Laurentius Hospital, and VieCuri MC in the Netherlands jointly select Sectra’s digital pathology solution.
  • Spok releases a new video, “Go ‘beyond’ secure texting in healthcare.”
  • Tegria publishes a new case study featuring Val Verde Regional Medical Center and Engage’s work to implement a remote-hosted EHR during COVID time pressure.
  • Waystar appoints former JP Morgan executive Heidi Miller to its Board of Directors.

Blog Posts


Contacts

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

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Weekender 7/23/21

July 23, 2021 Weekender 1 Comment

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Weekly News Recap

  • The VA tells the House Veterans Affairs Committee that it won’t bring any more sites live on Cerner for at least six months.
  • A law firm files an information blocking complaint against a hospital, Meditech, and Ciox Health, claiming that it could not get a machine readable PDF of a client’s medical records.
  • WebMD acquires The Wellness Network
  • The New York Times says IBM Watson failed to achieve its goals of business transformation and IBM rejuvenation, noting specifically that Watson’s healthcare “moon shot” failed in multiple health systems.
  • The Senate confirms as VA deputy secretary Robert Remy, JD, whose job responsibilities include overseeing its Cerner project.
  • A study of 500 hospital websites finds that 471 of them have not posted their prices as federal transparency rules require.
  • Clinical data and registry vendor OM1 raises $85 million.
  • As HIMSS21 approaches, a COVID-19 resurgence in Las Vegas causes the Venetian, Palazzo, and Sands to again require employees to wear masks.

Best Reader Comments

If the insurance company maintains the same standard of what is medically necessary, then won’t eliminating prior authorization translate directly into increased denials? … It seems like the law ultimately makes things more convenient for providers and shifts the burden of fighting insurance companies to patients. (IANAL)

Having worked at one of the four start-ups that IBM purchased and then destroyed, it’s prime material for a case study. Bringing in IBM resources (including senior IT) that couldn’t spell healthcare and were now in charge was the beginning of the end. No ability to focus on the right problems, selling software that didn’t exist, making promises that were impossible to fulfill, etc. (tchips)

I have been an IBM “partner” in two companies, a position I would not wish on my worst enemy. “Their clients are their clients, and my clients are their clients” type of attitude. Ever since introduction 20+ years ago, I kept saying that Watson was a hammer looking for a nail. The main premise was its use in diagnostics, and I’m sorry, but well-experienced and well-read physicians can achieve similar or better conclusions than the box with the blinking lights, which at best could only suggest possible diagnoses.(Dr. Moriarity)

I think HIMSS will ultimately be at the whim of the hospitals. Should they universally re-enforce travel bans (if they haven’t already), the vendors will catch wind of it and a few of them will seize the moment as a PR opportunity to make a splashy statement about why they’re pulling out this year … Hopefully it won’t come to this and we can all enjoy the annual industry soirée safely, but I think it’s fair to say we’re beginning to see some cracks in the foundation. (LongTimeFan)

I can see imaging solutions being close to being ready [for IBM Watson-like solutions]. With a plethora of training material associated with a diagnosis, the solution could train in pretty good order. But how are you going to train it to practice oncology? (Brody Brodock)

There’s also only one vendor that can deliver basic interop out of the box with very little effort, and even richer interoperability with a some terminology mapping. Kind of sad that this project [the VA’s Cerner implementation] is doing so poorly in this area when that is allegedly why Cerner won out. (Elizabeth H. H. Holmes)

[Penalties for hospitals failing to post prices] shouldn’t be about the dollar value. If you operate in the United States, you should do your best to follow the law. What you’re seeing here is widespread malfeasance by health systems. Regulators should come down hard on them in response. (IANAL)

[IT projects reducing cost] is a goal, I think it’s somewhat dangerous to assume this in every single instance. Personally, I’ve long said that these EMR/EHR implementations often raise expectations of what can be accomplished. And those raised expectations sometimes increase rather than decrease costs. Expectations are a matter of politics. Thus, regardless of what the budget said, you may find expenditures beyond the budget. It only takes a sufficiently highly placed executive to demand that their expectations be met. (Brian Too)

Large scale project PM’ing 101 – never, ever put the software vendor in as the prime on any large contract. Especially when it involves large-scale systems integration with all kinds of third parties. At least VA is seeming to acknowledge that end goal. (John Bob


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. D in Nebraska, who asked for COVID-related sanitation supplies and health books for her Head Start class. She reported in December, “As this fall has been full of uncertainty, we have had to shift learning styles several times, but having the items from this project in my classroom has given me a small peace of mind that the kids will be safer and healthier thanks to you. Most of all, the air purifier is such a blessing. This purifier has a setting that our classroom air is recirculated once per hour. This helps myself and all the parents to know that the germs are being filtered out. Thank you doesn’t seem like enough to say, but know your generosity has definitely not gone unnoticed.”

A ProPublica review finds that 40% of the employees of nursing homes and long-term care organizations have not been vaccinated against COVID-19, which killed huge numbers of those residents before the vaccine became available. Twenty-three facilities reported vaccination rates of under 1%.

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A North Carolina doctor is named as one of the “Disinformation Dozen” who are responsible for 73% of the anti-vaccine content on Facebook. Rashid Buttar, DO posts conspiracy theory videos claiming that COVID-19 vaccines cause infertility and that wearing masks and 5G cell networks cause COVID-19. Some of the videos to which he linked generated commissions for himself. The doctor has been reprimanded twice for unprofessional conduct and cited by the FDA for illegally marketing unapproved drugs. It would be interesting to fact-check his CV, which lists impressive educational, military, and athletic accomplishments before he specialized in chelation therapy.

A Colorado couple will pay $5,000 more than they expected for the birth of their son under the 1970s-era “birthday rule,” which says that when parents have separate health insurance plans, the delivery cost is covered by the policy of the parent whose birthday falls earlier in the year. That is the husband in this case, whose lower-paying insurance has forced the couple to sign up for a three-year payment plan.

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Like a flight whose seats are oversold, a UK medical school offers accepted students $14,000 and a free first year of rooming if they will defer their high-demand spot for a year.

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A 96-year-old woman who is believed to be the oldest working nurse in the country retires from MultiCare Tacoma General Hospital after a 70-year career. The advice of now-retired OR nurse Florence “SeeSee” Rigney to fellow nurses is “don’t ever think that you know it all.”


In Case You Missed It


Get Involved


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Morning Headlines 7/23/21

July 22, 2021 Headlines No Comments

Moving Forward: Evaluating Next Steps for the Department of Veterans Affairs Electronic Health Record Modernization Program

The VA tells the House Veterans Affairs Committee that it won’t bring any more sites live on Cerner for at least six months.

Achieve Partners Backs Healthcare IT Provider to Launch Major Apprenticeship Program

Achieve Partners, which invests in skills development technologies and businesses that can create American jobs, acquires staff and consulting services vendor Optimum Healthcare IT.

Imprivata Adds Privileged Access Management (PAM) to Industry-leading Digital Identity Capabilities by Acquiring Xton Technologies

Imprivata acquires Xton Technologies and will incorporate its privileged access management solutions into its digital identity framework.

Qure4u Announces Close of $25M Growth Equity Investment to Accelerate Innovation in Digital Health Solutions

Qure4u, which offers automated patient intake, engagement, and virtual care services, raises $25 million in a funding round led by Volition Capital.

News 7/23/21

July 22, 2021 News No Comments

Top News

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The VA tells the House Veterans Affairs Committee that it won’t bring any more sites live on Cerner for at least six months. From the hearing (in addition to misstating the Eastern time zone as “EST” above):

  • Rep. Matt Rosendale (R-MT) said that despite the VA’s assurance, “we’re going to find out the proof is in the performance. If the army of crackerjack management consultants, and tiger teams, and advancement teams, and adoption coaches, and change management experts can’t make headway with the situation in Spokane, the reason is probably pretty simple. The software just isn’t any good, folks. Either that or it isn’t good for the VA.”
  • VA OIG told the committee that VA’s modernization committee reported that 89% of users passed proficiency tests with a score of at least 80%, but OIG found an earlier draft stating that just 44% passed at that level, indicating that the report was altered before submission. The VA says it will consider disciplinary action if its investigation shows it to be warranted.
  • Acting Deputy Secretary Carolyn Clancy, MD told the committee that “we will not be scheduling any deployments in the next six months” as the VA reviews infrastructure requirements and develops a new rollout schedule that will be driven by site readiness.
  • Rep. Mark Takano (D-CA) expressed skepticism that the VA gave Cerner the minimum passing grade of “satisfactory,” questioning whether it did so just to avoid having the contract cancelled.
  • Rep. Jim Banks (R-IN) expressed frustration with the project’s overall cost, noting that VA OIG’s list of missed items could swell the budget to $21 billion and also recalling that former VA CIO Roger Baker originally gave a number of $30 billion. The original project estimate was $10 billion.
  • The VA is reviewing Cerner’s patient portal and its contractual obligations, with Dr. Clancy predicting that the end result will be a combination of Cerner’s product and the aspects of My HealtheVet that veterans like.
  • Rep. Rosendale pressed Cerner executive Brian Sandager on why Cerner’s bid was so far off the mark even though the company was the sole-source bidder and thus the presumed expert. Sandager blamed changing requirements and lack of access to VA staff because of the pandemic.

Reader Comments

From Banned Book: “Re: Cerner. Seems like a lot of execs are moving on lately.” Maybe, but Cerner is a huge, publicly traded company with deep talent, and some of those folks have been around long enough to realize that maybe they’ve peaked at Cerner and need to move out to move up. The lackluster company performance over the past few years that led to Brent Shafer’s announced departure and his uncertain replacement is likely accelerating the exodus. I don’t think it’s necessarily a poor reflection on the company or an indication of executive dissent – it’s a hot health IT market out there and well-funded startups need some adults in the room.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor Upfront Healthcare. The Chicago-based company navigates patients to the care they need as new digital services, sites of care, and non-traditional competitors reshape the way they expect to interact with their health system. The company delivers superior outcomes through personalization, in which advanced analytics is used to adapt communication channel and content to eliminate barriers to patient engagement. The frictionless experience requires no download or login as it guides patients to the services they need to close care gaps, attend visits, reschedule in a single click, enroll in services, improve medication adherence, follow up after a transition of care, prepare for an episode of care, and schedule open referrals. It provides the contact center and care team with a unified view of patient communications for all modalities (SMS, email, digital voice, etc.) and can be launched from the EHR or CRM with integration using API, HL7, SMART on FHIR, and batch files. Co-founder and CEO Ben Albert, MBA is an industry long-timer who founded what is now Crimson Care Management. Thanks to Upfront Healthcare for supporting HIStalk.


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Were you planning to attend HIMSS21 but have changed your plans in the past couple of weeks? Tell me why. The beginning of the end for HIMSS20 was companies – including health systems – that banned travel due to the alarming rise in COVID-19 cases and readers keep asking me if that could happen again.

If you attend HIMSS21 in person instead of watching the virtual version, you’ll miss the virtual-only keynote of “Grey’s Anatomy” star and TV doctor Patrick Dempsey. His credentials are a bit shy of being a real doctor — he dropped out of high school to join the circus, and once he became famous on TV years later, his high school just gave him the diploma he didn’t earn.

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Dann Lemerand, who started the HIStalk Fan Club on LinkedIn in mid-2008, says it has 4,000 followers. I can’t make a strong argument for joining since you don’t get anything for doing so, but at least you’ll be rubbing virtual elbows with some pretty high-level industry folks who signed up. I really should review my LinkedIn connections and recommendations for an emotional lift in those moments where I question the wisdom of sitting in an empty room filling an empty screen.


Webinars

July 28 (Wednesday) 1 ET. “Stop running from your problem (list): Strategies for streamlining the EHR’s front page.” Sponsor: Intelligent Medical Objects. Presenters: Amanda Heidemann, MD, CMIO, CMIO Services LLC; James Thompson, MD, physician informaticist, IMO. How can clinicians mitigate the longstanding EHR problem list challenges of outdated or duplicative entries, rigid displays, and limited native EHR capabilities? The presenters will describe how to analyze current problems, create a problem list governance strategy, and measure improvement progress.

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


Acquisitions, Funding, Business, and Stock

Staff and consulting services vendor Optimum Healthcare IT is acquired by Achieve Partners, which invests in skills development technologies and businesses that can create American jobs. Achieve will expand Optimum’s paid health IT apprenticeship program.

Imprivata acquires Xton Technologies and will incorporate its privileged access management solutions into its digital identity framework.

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Bon Secours Mercy Health makes an unspecified investment in healthcare analytics vendor Trilliant Health.

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Digital health vendor B.well Connected Health raises $32 million in a Series B funding round, increasing its total to $59 million.


Sales

  • Health engagement company Higi chooses Ellkay for platform integration with its healthcare partners.
  • Laboratory data integration services vendor Diagnostic Support Services chooses Lyniate Corepoint to enable advanced interoperability.
  • Winton Hills Medical & Health Center (OH) selects Emerge’s ChartGenie data conversion solution for its move to Athenahealth along with the company’s ChartScout and ChartPop products.

People

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Ted Pfeiffer, MBA (Sg2) joins healthcare consulting firm The Greeley Company as VP of product innovation.

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Syntellis Performance Solutions, the former Kaufman Hall software division, names Flint Brenton (Centrify) as CEO. He replaces Kermit Randa, who will leave the company now that it has been taken independent with investments from Thoma Bravo and Madison Dearborn Partners.

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Mike Nill (Cerner) joins Rx Savings Solutions as strategic advisor.


Announcements and Implementations

Vocera announces Edge, a cloud-based clinical communication and collaboration solution for smartphones.

Google Cloud offers a private preview of Healthcare Data Engine, which creates real-time views of longitudinal patient records. The company says the product can map 90% of HL7v2 messages to FHIR out of the box.

Canon Medical Systems will rename its health IT division, which includes Vital Images, to Canon Medical Informatics.

Document Storage Systems (DSS) launches a commercial division called Juno Health, which will offer an EHR and solutions for e-prescribing and emergency services.

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Highlights from the just-issued “Semi-Annual Market Review” of Healthcare Growth Partners, which as usual drew me in to read every word instead of the quick skim I envisioned:

  • The company estimates that digital health company valuations have risen 30% since the pandemic began, with high-performing companies seeing even bigger premiums.
  • M&A is on track to jump 43% this year, while investment value is on pace to rise 85%.
  • HGP sees four factors driving this activity: excess financial market liquidity, impending increases in the capital gains tax, the obvious appeal of digitizing and virtualizing healthcare, and the fear of missing out (buyers) and of losing it all (sellers).
  • SPACs are popular with lower-revenue companies and share price of those less-mature companies is more volatile due to their appeal to inexperienced investors and lower share supply. Digital health IPO stocks have increased significantly in price, while SPAC stocks trade below offer price on average.

Government and Politics

A Georgia law firm files an ONC information blocking complaint against Doctors Hospital of Augusta, Meditech, and Ciox Health, claiming that the patient records the firm requested on behalf of its malpractice client were not provided as an OCR-readable PDF file.

ONC seeks feedback on use of the HIPAA Security Risk Assessment tool.


Other

Rep. Marjorie Taylor Green (R-GA) tells a reporter who asked if she’s been vaccinated for COVID-19 that the question is “a violation of my HIPAA rights.” She is likely not the only member of Congress who thinks HIPAA is something it isn’t.

University of Vermont Medical Center discloses how ransomware took its systems down for a month and cost it at least $50 million – an employee took a hospital laptop on vacation and used it to open an email from their homeowners’ association, which had been hacked and whose email contained malware. When the employee came back to work and connected to the hospital network, the malware was spread.

HIMSS says it expects a smaller attendance for HIMSS21 than in previous years, but says that paid professional attendance has reached 75% of the 2019 total. First-time attendees make up 40% of the total registered. The exhibit hall will host 750 companies, 200 of them first-timers. HIMSS says that it is “mindful” of COVID-19 case numbers and recognizes that some registrants may not be able to attend due to various travel policies. A conference update says that all venue and hotel staff will be masked per recent Southern Nevada Health District guidance, while masks are encouraged but not required on the HIMSS21 campus since attendees must prove they’ve been vaccinated to enter.


Sponsor Updates

  • InterSystems announces that Forrester has recognized its Iris data platform as a leader in “The Forrester Wave: Multimodel Data Platforms, Q3 20201.”
  • Wolters Kluwer Health releases the second edition of its “Future of Technology in Nursing Education” survey.
  • EClinicalWorks releases a customer success video featuring Zeid Medical Group, “Using Prisma and Interoperability for Better Records.”
  • Upfront Healthcare partners with Firstsource to offer personalized patient navigation.
  • Redox launches an Amazon HealthLake Connector offering and announces its support for the Amazon for Health initiative.
  • Healthcare IT Leaders, BD, and TrackMy Solutions provide COVID-19 testing services and support to Camp Barney Medintz.
  • Fortified Health Security releases its “2021 Mid-Year Horizon Report.”
  • Goliath Technologies publishes a new case study, “Central Maine Healthcare Drastically Reduces Citrix & Cerner Clinician Time to Remediation.”
  • Healthcare Growth Partners advises MDTech in its sale to EverCommerce.

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 7/22/21

July 22, 2021 Dr. Jayne 4 Comments

When I was deep in the primary care trenches, I used to fantasize about insurance companies that would allow you to skip their prior authorization process if your track record had no previous denials. That might become a reality in Texas, as a recently passed law takes effect this fall in which physicians who have a certain track record can be exempted from prior authorization process. They will need to demonstrate that 90% of their treatments in the previous six months met payer criteria for medical necessity. Now we’ll have to see whether EHR vendors update their clinical decision support algorithms to capture whether a physician has to deal with prior authorizations or not. Still, it’s a victory for patients who won’t have care delayed and for physicians who can reduce overhead spent on needless bureaucracy.

I’m lamenting the fact that both of my local medical schools have apparently decided that the pandemic is over, canceling virtual access to Grand Rounds and other presentations. For those of us who practice in the community or who aren’t near the medical campuses, being able to attend sessions from a distance was a tremendous boost. I attended more lectures in the last year than I had in the previous five years. Hopefully, some of my out-of-state sources will continue offering virtual options.

I admit that sometimes trying to do a virtual / hybrid offering can be challenging, but at a minimum they should record the sessions and allow people to access them later. They’re already doing those kinds of recordings for medical school lectures (and had been doing so long before the pandemic) so the technology is largely in place. Why wouldn’t you want to get your message to as many physicians as possible? Seems puzzling to me, but maybe some readers have more insight.

Surgeon General Vivek Murthy takes aim at health misinformation this week, urging communities, health professionals, and tech companies to help patients understand the reality behind COVID vaccines, treatments, and overall status of the disease. His call to action takes the form of a Surgeon General’s Advisory like those that were used in the past to address smoking and other serious health threats. The document calls on researchers to better qualify the damage done by health misinformation. It also calls on tech companies to monitor misinformation and to protect health professionals from harassment.

Banner Health is on the naughty list with many of its employees this week for issuing a commemorative coin to those who supported the health system’s pandemic efforts. A Banner spokesperson stated they hope it “will be a reminder in years to come of what we were able to achieve together during this once-in-a-lifetime event.” This rings hollow because we’re certainly not out of the woods yet and their putting the efforts in the past tense doesn’t reflect that many of the impacted workers are still grinding it out in the trenches as COVID infections keep rising. Also, some of us don’t want to remember what it was like in the worse parts of the year, because it gives us great anxiety and increases our stress levels. I’d be interested to see the statistics on whether the coin ended up in a random junk drawer for employees or whether it went straight to the trash.

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HIMSS21 is trying to lure attendees to its digital edition with Dr. McSteamy himself. One of my shoe-loving BFFs clued me in on the advertising campaign, noting “who at HIMSS thought it would be better to highlight an actor overall those other great speakers?” I get the philanthropist angle, but I’m guessing they went for the eye-candy factor, since the rest of the lineup includes healthcare leaders, innovators, and CEOs. I didn’t even get the email hyping Patrick Dempsey’s participation, so thanks again for keeping me informed. For those with more insight into the whole HIMSS21 situation, I’d be curious to hear your anonymous reports about the truth of registration numbers or the proportion of attendees who plan to participate in-person versus digitally. Everyone I’ve reached out to is being tight-lipped about the registration numbers.

Now that he’s not busy with Haven — the defunct effort by Amazon, JPMorgan Chase, and Berkshire Hathaway which failed at fixing healthcare like so many others before it — Atul Gawande, MD is being nominated for assistant administrator for the United States Agency for International Development’s (USAID) Bureau for Global Health. Gawande will need to be confirmed by the Senate, but tweeted that “With more COVID deaths worldwide in the first half of 2021 than in all of 2020, I’m grateful for the chance to help end this crisis and to re-strengthen public health systems worldwide.” USAID is tasked with advancing US interests abroad, but I sure hope there is a focus on advancing public health systems within the US. They’re under attack, and if anyone doesn’t believe we’re headed towards a dystopian universe, check out what’s happening in Tennessee, where the legislature has bullied the Department of Health into stopping vaccine outreach for teens, even for flu shots or other proven lifesaving vaccines.

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I spent a few days out of town this week and was happy to be somewhere less-COVIDy than my home state. In case you’re interested, free vaccinations are available at the Orlando airport. The US has already administered 337 million doses, with 161 million individuals being fully vaccinated. With everyone unmasking these days, it’s clear to most of us in healthcare that vaccines are going to be the only way out of this thing without an ever-climbing body count. We are now almost a year past when the Pfizer clinical trial started, with more safety data in the first year of this vaccine than any vaccine in the history of vaccines. If you’re still holding out, remember this: your choice isn’t necessarily between vaccine and no vaccine. Unless you’re going to stay in your house with no visitors or wear a delightfully snug N-95 mask everywhere you go, it’s more likely that your choice is between vaccine and COVID-19. Let’s fight this thing, folks.

Email Dr. Jayne.

Morning Headlines 7/22/21

July 21, 2021 Headlines No Comments

Carbon Health Secures $350 Million to Expand Omnichannel Primary Care Nationwide

Tech-enabled primary care company Carbon Health raises $350 million in a funding round led by Blackstone.

B.well Connected Health Secures $32 Million to Accelerate the Digital Transformation of Healthcare

B.well Connected Health, developer of health management apps for consumers, patients, and employees, raises $32 million in a Series B funding round.

CarePoint Health Opens Doors to Healthcare Innovation Center

CarePoint Health (NJ) opens a Healthcare Innovation Center within Bayonne Medical Center to bring clinicians, vendors, investors, and other collaborators together to develop new technologies.

HIStalk Interviews Don Woodlock, VP of Healthcare, InterSystems

July 21, 2021 Interviews 4 Comments

Don Woodlock is VP of healthcare at InterSystems of Cambridge, MA.

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Tell me about yourself and the company.

I have been in healthcare IT my whole career. I went to school next door to where I am now, at MIT. I joined the company IDX and worked there for 14 years building applications, basically billing, scheduling, and managed care. I joined GE Healthcare for 14 years doing imaging IT –radiology, cardiology, and labor and delivery type imaging. I’ve been at InterSystems for four years.

InterSystems focuses on two areas. One is a data platform. We have software companies, maybe most famously Epic, that build their applications on our technology. Then we have an interoperability product line called HealthShare that many of your readers would use. We have an EMR that we sell outside the US called TrakCare.

Northeastern companies such as InterSystems, Meditech, and IDX had a lot of influence on today’s health IT market going back into the 1960s and 1970s. What does that impact look like from the inside?

There’s a technology similarity, but the most important similarity — at least in the original IDX – is the private company, customer-obsessed model. Epic still has that, InterSystems still has that, and IDX had that while I was there. It was a small group of individuals who were really excited about health systems and were focused on that. They didn’t want to bring their companies public. 

That model and culture is familiar to me. I had a 14-year deviation when I went to GE Healthcare, but when I joined InterSystems, it completely reminded me of IDX, that same kind of friendly, customer-focused outlook. Maybe there’s a Boston-y culture to the whole thing. It’s a nice place to be.

Technologists from outside of healthcare may know little about Caché. Can you explain its benefits?

That market has come around a little bit more. This multi-model, key-value store wasn’t popular at all in the early days when the technology got started, and was not popular during the relational days. But in the last five to 10 years, there has been more variety in the way people see databases and different models. Caché’s power comes from this key-value model, which makes it scalable and efficient. You can build an application that scales and micromanage the way your data is actually stored. That’s part of Caché’s secret sauce.

How are the company’s integration and interoperability solutions used?

Our integration engine is used by 39 of the top 100 hospitals and health systems. Your readers may know it under the name Ensemble, but we market it now as HealthShare Health Connect. It translates from HL7 to FHIR to X12, from whatever format to another format. It scales really well and is the next generation of that category.

The broader HealthShare is a data aggregation, unified care record platform. It got started in the state HIE market a long time ago. We more often use it for health systems that want to aggregate data across all their different EMR systems. We also market it to payers, life sciences companies, and regional health authorities outside the US. It focuses on unifying patient data and making it useful for point-of-care, analytics, research, and many other use cases.

With interoperability, we are in the middle of a nice, big change from HL7 — which is more of a “copy data from here and put it there” model, that copy-and-paste model — to FHIR, where you have applications that can work together and can request information from each other. It’s a much better interoperability model and it also opens up a lot of innovation, where you can treat your EMR data as a FHIR repository and build applications on top of that more easily. We are at the beginning of a next era in interoperability that will be quite fruitful and useful to our industry.

What market exists for helping life sciences companies use provider EHR data for research, real-world evidence, and product monitoring?

We’ve had a lot of increased activity with life sciences companies. There’s the research side, which is running successful trials. Using real-world data helps you with study planning. I’m looking for diabetics over 50 on this medication — how many people can I find in my population that is used for site selection? What organizations should I approach to run my trials? Then there’s the patient recruitment process, having real-time interoperability of information so that my principal investigators at the different sites can identify patients as soon as they enter the system.

This market has been aided by more healthcare information being digitized. It has also aided by regulatory agencies that are more open to real-world data being part of a research submission.

Then there’s the commercial side. You have a drug or a therapy and you want to get it out to the market, so you need to understand that market. A broader array of data helps you understand where your patients live, what other medications they are on, and what other problems they have. Having this data enables a life sciences company to more effectively operate these days, and I think that most of pharma is recognizing that now.

How has product demand and the company’s strategy changed with healthcare’s move to the cloud?

The cloud enables innovation. On-premise is like our waterfall software development process, while cloud is more like agile, lean, and a minimally viable product. It enables you, as a health system that wants to innovate, to spin up a FHIR repository, spin up a development stack, and try a proof of concept. To build a small application and not necessarily have to have pre-thought all of that and to buy a lot of hardware. You can focus on that stable environment.

You can more easily innovate and adapt in a cloud-based environment. That’s in addition to operating a data center better and more effectively with a cloud partner. The interesting part of the cloud is the innovation and the ease of starting up and taking advantage of newer technologies.

Our predominant model of healthcare applications, like HealthShare, is to offer it as a service. Customers may choose on-prem, but generally speaking, most of our new projects are us managing the entire environment for a customer. Then we are starting to introduce cloud-based services. Earlier this week, along with Amazon’s launch of HealthLake, we launched our HealthShare Message Transformation Service, which allows HealthLake to speak HL7. You can see it in the AWS marketplace. You can spin it up today and start using it.

We anticipate that more and more of our offerings will look just like that. We’ll offer it in the cloud stores. Customers can spin it up and start using it. The amount of friction needed to get started with InterSystems technology will be lower.

Healthcare users may not be aware that InterSystems has customers in other industries.

InterSystems is a multi-vertical company. We have a lot of experience in healthcare, but we are building up a more robust financial services business. The majority of trades that happen in the US stock exchanges go through InterSystems technology. We have another interesting customer who is basically the NASA of Europe. The European Space Agency tracks all the bodies in the sky using InterSystems technology. We have a lot of neat customers in other verticals as well.

TrakCare is a fully functional EHR that is in the top three in the world. We sell in 28 countries. The root of that business was a customer of ours named TrakHealth in Australia that had built an application on our technology. We became closer and closer with TrakHealth and eventually acquired them and made them part of InterSystems. We have a big business in the UK, Italy, Australia, New Zealand, China, the Middle East, and Chile. We enjoy having a global EMR product, but having a level of what we call local editions that tailor it for these specific markets.

Would you ever develop or acquire domestic healthcare applications, or do you have agreements with customers such as Epic to avoid competing with them?

We don’t have an agreement, but we feel like the EMR market in the US is pretty well saturated and pretty well taken care of, including by our good partner Epic. We don’t have any plans to launch TrakCare in the US. I don’t think it would add a lot to the market, honestly.

It must be unusual for a company that is approaching $1 billion in annual revenue to be owned outright by a single person, Terry Ragon in the case of InterSystems. What are the advantages of that form of ownership and how does it influence the company’s long-term plans?

There’s nothing like the private company model when the company is profitable and doing well. I enjoyed my time in GE Healthcare, but you have this other stakeholder, which is the shareholder and quarterly earnings concerns. That’s another kind of stakeholder that you need to worry about, please, and perform for in addition to customers, which is this other sphere. That was the only sphere I ever cared about, honestly. It’s nice to be in a private company with the one owner. It’s a simple model, where I can focus on customers all day long and not really worry about the rest.

We don’t have any concerns about the long run. We haven’t made it a priority to figure out the long-run transitions. We’re happy now. My boss, the CEO and owner, comes in every day. I just met with him earlier. We have a fully staffed senior leadership team, a 1,600-person-strong company, and a great customer base. We are enjoying ourselves pleasing customers.

How will the company’s healthcare strategy change in the next few years?

We are migrating more and more to analytics. That is natural in our industry. We’ve collected all this data, we’ve digitized our workflows within health systems and providers, and now we want to get more out of that. A lot of our customers are migrating to using their data for analytics. The types of things we do around interoperability, data aggregation, and normalization are all useful for the analytics use case. We have been focusing on a lot of projects and offerings in that respect.

Even our underlying data platform historically has been that online transactional processing system, and more and more customers want to build analytics solutions on it. We’re adding a number of features around self-service analytics, Python, integration, and embedded machine learning, a number of things that are more analytics-oriented to our product line. That is a big part of the future.

The other would be what we talked about concerning cloud. Having more and more of our offerings be click-click services that you get in, start up, and start to use instead of larger decisions that involve a larger monolithic type of implementation.

Do you have any final thoughts?

It’s not InterSystems related, but I wanted to thank you for publishing HIStalk. I’ve been in health IT for 33 years and I have been a dedicated reader of your publication since it started. Healthcare IT is such a community, and while my former colleagues and I from other companies run into each other all the time, it is nice to read about folks and see what is happening across the industry. HIStalk is one of the most important things that bind us all together. It has been a joy to read, and I look forward to it every day.

Morning Headlines 7/21/21

July 20, 2021 Headlines No Comments

WebMD Acquires The Wellness Network, Expanding Point-of-Care Services to Health Systems and Hospitals

WebMD acquires The Wellness Network, which offers advertising-supported patient education videos and broadcast channels for hospitals.

Massachusetts eHealth Collaborative Fulfills Mission; Completes Final Dissolution

The Massachusetts EHealth Collaborative dissolves and distributes its assets to six public charities, saying that it has completed its work and fulfilled its mission related to interoperability, standards development, and health IT policy.

Validation of an electronic trigger to measure missed diagnosis of stroke in emergency departments

An EHR trigger analysis of the VA’s corporate data warehouse finds that nearly one-third of patients who were admitted for stroke had been discharged from the ED with seemingly benign headache or dizziness in the previous 30 days.

News 7/21/21

July 20, 2021 News 2 Comments

Top News

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WebMD acquires The Wellness Network, which offers advertising-supported patient education videos and broadcast channels for hospitals.


Reader Comments

From A Concerned Citizen: “Re: HIMSS21. Will it be cancelled, or just set records for poor attendance? Between the delta variant and the White House report that ranks Las Vegas the most dangerous of all metropolitan areas, registration must be falling quickly.” A couple of readers said their employers have instituted policies that will prohibit their planned attendance. I was about to say that it’s too close to the conference kickoff to contemplate shutting down the live component, but then I recalled that HIMSS20 was cancelled March 5, four days before it would have started. A virtual-only conference is the backup plan, but I don’t think that HIMSS could survive losing its main money-maker for two consecutive years. I predict the show will go on, even with an attenuated audience.

From Tom Paine: “Re: IBM Watson. Former CEO Ginny Rometty is to blame for overhyping it. It was presented as the great hope for IBM, while more important initiatives like the cloud fell further behind.” Rometty should have been skeptical about the Watson hype given that her degree was in computer science and electrical engineering and her IBM background was mostly spent in technical roles. IBM is usually late to parties at which competitors have already taken the best seats, so maybe the draw of being an early entrant into AI was appealing. The company’s biggest Watson mistake was probably choosing healthcare as its showcase, a hill that many swaggering tech companies have died whimpering on. 


HIStalk Announcements and Requests

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I found the Clear Health Pass app frustrating to use for HIMSS21 vaccination verification, especially since my submission is stuck in “pending verification” status. I strongly recommend using Safe Expo Vaccine’s online option instead, as recommended by reader Susan Newbold. The submission page is 1990s clunky, but it took seconds to submit photos of my driver license and vaccination card and then just another 1-2 minutes to have it confirmed by email.

More evidence of the decline of US journalism – it seems that every news website now features cursory “product reviews” that hope to entice readers to click to buy, generating an affiliate commission for the site. The link is almost always to Amazon because it pays those commissions reliably and people are more likely to buy from Amazon anyway, meaning that non-Amazon products are ignored along with other sites that offer the same item cheaper.


Webinars

July 28 (Wednesday) 1 ET. “Stop running from your problem (list): Strategies for streamlining the EHR’s front page.” Sponsor: Intelligent Medical Objects. Presenters: Amanda Heidemann, MD, CMIO, CMIO Services LLC; James Thompson, MD, physician informaticist, IMO. How can clinicians mitigate the longstanding EHR problem list challenges of outdated or duplicative entries, rigid displays, and limited native EHR capabilities? The presenters will describe how to analyze current problems, create a problem list governance strategy, and measure improvement progress.

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


Acquisitions, Funding, Business, and Stock

The Massachusetts EHealth Collaborative dissolves and distributes its assets to six public charities. The organization says it has completed its work and fulfilled its mission related to interoperability, standards development, and health IT policy.


Sales

  • Georgia-based ACO TC2 will implement Jvion’s Avoidable Admissions technology.
  • St. Bernard’s Hospital (AR) selects NICUtrition clinical decision support software from Astarte Medical.
  • North Mississippi Health Services will implement Picis Total Perioperative Automation software with Envision Analytics from Picis Clinical Solutions.

People

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Adam Laskey (Cerner) joins EverCommerce as GM of EverHealth.

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VitalTech names Chad Haynes (Cerner) as chief commercial officer.

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John McCullough (Cleveland Clinic) joins The Chartis Group as principal in its Informatics & Technology practice.

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Patricia Daiker, RN (Dragonfly Lights) joins Orb Health as VP of clinical operations.

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Signify Health names Sam Pettijohn (Cerner) chief growth officer and Erin Kelly (CVS Health) chief commercial officer.

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Industry long-timer Scott Weingarten, MD, MPH (Cedars-Sinai) joins Medicare Advantage insurer SCAN Group as its first chief innovation officer, where he will launch its geriatric primary care medical group.

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Shayna Schulz (Blue Shield of California) joins Grand Rounds Health and Doctor on Demand as COO.


Announcements and Implementations

Illinois Bone & Joint Institute begins implementing Epic at its facilities in Illinois and Indiana.

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McLaren Health Care implements Medi+Sign’s automated patient communication technology across its network in Michigan and Ohio.

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Covenant Health rolls out tele-ICU services at its facilities in Tennessee using technology from Hicuity Health.

InterSystems develops HealthShare Message Transformation Service, enabling users to convert existing data formats to FHIR standards to populate Amazon HealthLake.

Amazon’s AWS machine learning blog profiles Medhost’s migration of all its data to AWS to provide patient access and to support advanced analytics and compliance needs. 

Wolters Kluwer announces EmmiEducate, which delivers patient educational material.


Other

JAMA-published research finds that medical debt is the largest source of debt in collections in the US, now totaling $140 billion from the 18% of Americans who hold medical debt that has gone to collection. Total medical debt is likely larger since hospitals are increasingly suing patients rather than selling their debt to collections agencies at a discount. The total also does not include balances owed on credit cards or payment plans. Medical debt is increasing faster in the 12 states that do not participate in the ACA’s Medicaid expansion program (AL, FL, GA, KS, MS, NC, SC, SD, TN, TX, WI, WY).

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And EHR trigger analysis of the VA’s corporate data warehouse finds that nearly one-third of patients who were admitted for stroke had been discharged from the ED with seemingly benign headache or dizziness in the previous 30 days. The authors approached the study not to prove the existence or extent of diagnostic errors, but rather to (a) highlight the need to validate the data that appears to prove such problems for such issues as miscoding; and (b) use it as a springboard for reviewing ED workflow and clinician diagnostic methods to reduce future harm from missed diagnoses.


Sponsor Updates

  • InterSystems and University Hospital Sharjah celebrate a decade of successful partnerships for digital transformation.
  • Infor and Change Healthcare announce their support for the AWS for Health initiative.
  • Kyruus describes the use of its ProviderMatch platform by AtlantiCare (NJ).
  • Diameter Health has been selected by AWS as a Connector Partner for Amazon HealthLake.
  • CereCore welcomes Michael Gagnon (NTT Data) as its first Enterprise Fellow.
  • Diameter Health publishes a case study featuring HealtheConnections, “Improving Ambulatory Clinical Quality Measurement Using a Consolidated Patient View.”
  • The Lifelong Customer Podcast features Dimensional Insight VP of Marketing Kathy Sucich.
  • Elsevier Clinical Solutions releases a new Clinical Insights Podcast, “How Well are COVID-19 Vaccines Working in the Real World?”
  • Experian Health announces that its Enterprise Health Patient Identifier Solution and Hospital Claims Management Systems have been deemed top-rated solutions in Black Book’s 2021 “Top Client-Rated Financial Solutions Achieving Accelerated Digital Transformation in the Nation’s Healthcare Systems.”
  • EClinicalWorks releases a new podcast, “How Population Health Solutions Improve Patient Outcomes and Experiences.”

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Contacts

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Morning Headlines 7/20/21

July 19, 2021 Headlines No Comments

Quit Genius Raises $64M to Expand Access To #1 Digital Clinic for Substance Addictions

Quit Genius, a virtual care company specializing in treatment for substance addiction, raises $64 million in a Series B funding round.

Verisys Acquires Credentials Verification Organization Services From Advantum Health

Verisys, which recently announced its merger with Aperture Health, acquires Advantum Health’s Med Advantage Credentials Verification Organization business.

DuPage Medical Group outage resolved, but ‘minimal delays’ may remain

DuPage Medical Group, the largest independent groups in Illinois, recovers from a nearly week-long network outage that impacted several systems.

HIStalk Interviews Tom Skelton, CEO, Surescripts

July 19, 2021 Interviews 1 Comment

Tom Skelton is CEO of Surescripts of Arlington, VA.

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Tell me about yourself and the company.

I’ve been in healthcare IT for a long time now. Believe it or not, it has been 40 years. The focus of my career has been digitizing healthcare, predominantly from the perspective of providers. Over time, it moved into different segments.

Surescripts has been around for 20 years now. It was stood up to solve some of the nation’s most significant problems. That was e-prescribing at the time, but we’ve expanded and broadened since then. We have never wavered from our purpose, which is to serve the nation with the single most trusted and capable health information network. Our focus remains patient safety, lower costs, and higher quality care.

How did use of the Surescripts network change with the pandemic?

Our focus has always been on either the prescribing process or informing care decisions and providing information to the caregivers, usually at the point of care. We saw a number of things occurring during COVID. There was a huge change in the telehealth landscape. Lots of new entities were springing up, and even within established entities, large health systems were innovating in the world of telehealth. We saw a much greater use of the network.

The other thing that happened was there was a greater focus on public health type information and the need to inform federal, state, and local agencies what was going on in the world of COVID. Folks repurposed some of our solutions to do that. For example, our clinical direct messaging offering was never intended to do that type of reporting, but that’s what people did with it. 

We think that that’s an example of how innovation is going to occur in the world of interoperability. We are all accustomed to certain use cases. We think that the consumers of those use cases are going to make those things valuable in ways that maybe we didn’t anticipate or intend.

What has the company learned in not just allowing healthcare participants to exchange information, but making the external information actionable?

It used to be that establishing a connection was a huge issue. It still takes a lot to do that and get it right, but that’s getting easier and easier. As it does, there’s a greater focus on the quality of the information that is being moved and how it appears in a natural workflow for the consumer of that information. Surescripts and our network alliance are focused on enhancing the quality of that information.

It’s making sure that the standards that exist — and there are many of them – are being implemented in a way that everybody agrees on how to utilize them and how to populate the individual fields or to populate the data elements. So that when it hits the workflow of a physician, pharmacist, or any clinician, it is appearing in a way that they can consume it and use it to enhance the care that that patient is being given. We see a lot of time and energy being put in to that.

Direct messaging seemed like it was going nowhere for a long time. How have you seen the Direct concept as well as your specific Direct platform progressing?

It’s interesting that you make that observation. That solution has been around for a while. It’s one of the few general solutions that exist in the world of interoperability. You are right that when it first came out, because it wasn’t use case space specific, people weren’t sure what to do with it. Over time, they are finding solutions here and finding that it can be an effective way to share information, provided that the sender and the recipient are on the same page in terms of what’s being said. We certainly saw that during COVID.

We are seeing a lot of work with that as we are working with health plans and helping them to do outreach to the physician community. These are the types of solutions that we are bringing to bear to help inform those care decisions that the prescribers, providers, and clinicians are making.

How do you see the information exchange market between providers and life sciences companies evolving?

Those companies have a a significant role to play here. They are major players in what goes on with the patient. They are obviously very interested from their own standpoint about what’s happening with the brands that they are putting out there. They want to know how their products are being used and what the adherence rates are. They want to make sure they are communicating with the prescribers. In many cases, they want to have access to the patient.

They have a great interest in the whole world of interoperability. We see that and understand that need. That’s one of the challenges we will face as interoperability grows. Life sciences wants access. Health plans want access. PBMs want access. One of the challenges for clinicians will be to make sure they are getting the right information without being overwhelmed with information.

How do healthcare networks add value?

An individual network can add value in many places. A lot of networks in healthcare are doing great work, whether it’s in the clinical world like we are, or whether it’s in the administrative world like some of the other folks.

Moving that information and helping to connect the ecosystem is a pretty daunting task. We have two million healthcare professionals. We are sharing actionable intelligence for 320-plus million patients. We are processing over 17.5 billion transactions a year. The role of the network continues to be not only facilitate that connectivity, but to ensure the reliance, the resiliency, the quality, basically the trust between the sender and the recipient and making sure that people that are requesting information are who they say they are and are entitled to that information and really do represent the patient that they’re requesting the information about.

There’s a lot that goes on there to maintain trust across the ecosystem. All of that contributes to how networks add value.

What influence will the Trusted Exchange Framework and Common Agreement have?

There’s a variety of mechanisms that the regulatory bodies are putting out there to help facilitate interoperability, whether it’s increased focus on standards, something like TEFCA, or whether it’s the information blocking legislation that was put through and is out there. All of that has value and helps to move it forward. It’s incumbent upon all of us in healthcare that are moving this information to tell our stories effectively as well.

One of the great challenges in the market is that each of us has an anecdote that we can tell that indicates that interoperability is not perfect. But we’re all moving a lot more information than we ever have, and it’s on us to share that information so that everybody understands how far along in the journey of interoperability we are and how far we’ve come. There’s still a long way to go, but a lot of good progress has been made.

The creation of those networks also creates business value. We’ve seen high levels of health IT investment activity and company valuations, but Surescripts has been quiet in terms of acquisitions or market transactions. Why is that?

We were founded to stand up one of the earliest networks in the market, particularly as it relates to clinical. Our goal here is a bit different than the goals of some of these other folks. We’re not chasing EBITDA. We’re not chasing an exit. That’s not what it’s about.

What it’s about for us is establishing, operating, and innovating on an existing platform that is neutral in the ecosystem, that is designed to facilitate the movement of that clinical information. Our growth has been driven by organic investment and continues to be driven by organic investment. We think that that’s a fabulous way to go. We think it also gives us the ability to take the long view and to make investments that other organizations may not be willing to make, and we think there are advantages there.

Where do you see the company in the next three to five years?

We are looking at what’s going on in the market and seeing many of the same things as everybody else. We’re seeing an increase in chronic conditions. We’re seeing the impact of high-cost specialty drugs. We’re seeing doctors facing ever-increasing rates of burnout. There’s a lot going on around us.

Our focus will be, number one, to sure that we optimize the prescribing process. We’ve got a lot of work to do in the area of specialty. We need to stay focused on that. We need to remove friction. We need to do things that advance and improve adherence and make it easier for all Americans to get the medications that they need.

The second thing for us comes back to that getting information to the provider community at the point that they need it. Solving that need for informing care decisions by giving them the actionable intelligence that they need and continuing broad-based connectivity for clinicians all across the market.

We remain purpose-driven. That’s who we are and we are very comfortable in that world. Our goal is to continue transforming these interactions among clinicians, pharmacists, and patients.

Do you have any final thoughts?

We’ve seen a lot of investments in the market. We’ve seen a huge influx of capital. We think that shows the amount of opportunity that there is here.

We think there’s a tremendous amount of room for innovation. We are excited about that. We see a continued acceleration of the trends that enabled virtual care. We think there’s going to be a lot of innovation to come that will help further information sharing across the healthcare ecosystem. The pandemic accelerated that and we look forward to continuing that over the next three to five years.

Curbside Consult with Dr. Jayne 7/19/21

July 19, 2021 Dr. Jayne No Comments

Due to changes in licensure waivers as states decide that the pandemic is over, despite the fact that we’re not even close, my telemedicine work is becoming rather spotty. Unlike some of my colleagues, I don’t have a dozen state licenses, so I’m limited on the patients I can see.

For part-time people like myself who the telehealth vendors hire as independent contractors, it’s difficult to justify the effort to obtain multiple state licenses, not to mention the ongoing costs. Licensure in the US is a patchwork across the states. Although some belong to an interstate compact, others don’t, which makes it even more confusing.

Looking at my nearby colleagues, however, nearly everyone is practicing some flavor of telemedicine, whether it’s some evening moonlighting or as part of expanded offerings on behalf of their practice. I’m always interested to hear about telemedicine experiences from my proceduralist colleagues, so I enjoyed reading this article in JAMA Surgery last week. It specifically addresses the use of telemedicine in surgical subspecialties, proposing that telemedicine will go beyond being a “pandemic adaptation” and will continue to evolve. The article outlines the timeline of increasing telehealth surgical services – initially when elective surgical procedures were suspended and surgeons began to use the technology for preoperative, follow-up, and emergent surgical care visits, but then later in 2020 as COVID-19 cases began to spike.

The authors note that current telehealth technology can make it difficult for surgeons to physically assess their patients and may impede interpersonal communication. However, many patients are able to report specific data points, such as vital signs and pain scale that are often gathered during a visit, and patients are certainly able to tell a physician whether it hurts when they move or touch certain parts of their body as well as what their current level of activity might be.

They cite several potential advantages for telehealth surgical services, including improved access, continuity of care, and reduced disparities. Additionally, patients may have less travel time and expense. Although the authors don’t specifically mention it, I know from personal experience that surgical telehealth consultations have opened up availability for second opinions across the US. One of my close friends was able to have consultations with multiple renowned surgical oncologists in a matter of days, which might have been weeks to months had she needed to travel. Of course, that doesn’t take into account the time she would have missed from work or the travel expenses.

The article goes on to focus on three factors that will most impact the degree to which telemedicine will replace and/or supplement in-person visits.

First, they note that “with interpersonal relationships being a core attribute of high-quality surgical care, perhaps more targeted implementation of telemedicine is required.” They propose established patients as “an attractive subset” for postoperative visits or routine follow up. My only major surgery was somewhat emergent, and I certainly didn’t have the opportunity to form an interpersonal relationship with the surgeon, who came to the hospital early on a Sunday morning to remove a gallbladder that had gone rogue. The next morning, I was seen by a nurse practitioner from the office, handed a script for 10 Percocet, and hustled out the door. A post-op incision check took less than 90 seconds, and I honestly can’t remember if there was even an exam or if it was just a visual inspection of the surgical sites. The idea that our physician-patient relationship was a core attribute of anything kind of makes me laugh.

Second, they note that “substantial technological innovation is still needed to enhance surgical diagnostic capacity of telemedicine.” They propose the use of remote monitoring and wearables to provide supplemental biometric data such as heart rate, sleep time, activity levels, and electrocardiogram data. They note a need to process the data “in clinically meaningful and easily presentable ways” to “accelerate their use in clinical practice.” I don’t disagree with that. None of us want to see hundreds of disparate data points that might be out of context. However, this bullet might relate better to some surgical subspecialties than others.

Third, and I think most of us agree with this, “given the direct relationship between insurance coverage and adoption of health care innovation, continued coverage for telemedicine services and further refinement to the existing policies are needed to sustain this mode of health care delivery.” They go on to mention that payers are already rolling back coverage for telehealth services not related to COVID-19, and if it hasn’t happened by the time this piece comes out, it’s likely that Medicare will soon end coverage for audio-only telehealth visits. This is going to be the end of telehealth services for many patients, especially those who struggle with technology or who might not have the capability of executing a video visit.

A few messages down my inbox was another article about telehealth. Specifically, “how to bring warmth to your virtual care visits.” This piece from the American Medical Association seeks to answer the question: As the US health care system remakes itself into one that includes more virtual visits, how can physicians maintain the empathy and “human touch” that are so crucial to a strong patient-physician relationship?” It summarizes comments from the AMA’s Telehealth Immersion Program, which is designed to help physicians implement, improve, and build their telehealth efforts.

The speakers quoted in the piece have some good points, such as seeing things in the context of a video visit that they wouldn’t have seen in-person – such as fall hazards in the home, companion animals, etc. However, they note the need to focus additional effort on communication skills and relationship management. Most of the tips offered though are the same we’d recommend for physicians struggling with in-person communication – communicating clearly, showing respect, taking time, and displaying empathy. I didn’t find anything new or earthshaking in the article, but then again, I rarely do when the AMA is the source.

One thing that I think health systems and other entities need to think about when they’re talking about expanding telehealth is balancing the convenience factor with the need to support physicians. For example, if an in-person visit typically has a support staff member who documents the chief complaint, assesses and documents vital signs, reconciles medications, and updates histories, then there’s no good reason to simply shift that work back onto physicians. Unfortunately, that’s what we see in a lot of telehealth practices. Some of it is because organizations are still using telehealth solutions that are not fit for purpose or integrated with the EHR, and other times it’s because organizations are just taking advantage of their clinicians.

Those organizations that offer more transactional or direct-to-consumer telehealth services need to be careful about expanding those offerings without thinking about their providers. Many telehealth-only physicians moved into that sector because they prefer the transactional nature of that model of care. Simply put, they don’t want to go back to doing the things they hated in practice, such as tracking gaps in care, refilling medications, reviewing pages of blood pressure logs, and more. If they’re asked to take on additional responsibilities, they’re likely to ask for greater compensation, which will be interesting in an industry with a fairly thin margin.

All in all, it’s clear that telehealth is here to stay. I’m sure it’s going to continue to evolve, although I don’t have a crystal ball to know which way things might go next.

What do you think about the evolution of telehealth in the US? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 7/19/21

July 18, 2021 Headlines No Comments

What Ever Happened to IBM’s Watson?

The New York Times says that IBM Watson failed to achieve its goals to transform industries and make IBM successful, noting that Watson’s healthcare “moon shot” failed in multiple health systems.

Real-World Data & Technology Company OM1 Closes $85 Million Financing To Make Healthcare More Measured, Precise, And Pre-Emptive

OM1, which offers chronic disease registries and real-world data, raises $85 million in financing.

Intermountain Healthcare Provides Notice of Data Security Event

Intermountain Healthcare (UT) announces that PHI from four of its clinics may have been compromised during an April cyberattack on care management software vendor Elekta’s systems.

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