News 9/20/23

Top News

Oracle announces “the new Oracle Health EHR platform” at its annual conference, which it says will use the Oracle Cloud Infrastructure to offer a modern interface and intuitive processes.

The company says some of the announced new Millennium capabilities will be released in the next 12 months.

Oracle also announced Clinical Digital Assistant, which allows providers and patients to interact with its EHR solutions via voice commands.

Reader Comments

From Tech Bro: “Re: Bill Gurley’s comments about Epic. I have seen nothing indicating that CEO Judy Faulkner was a big Obama donor or that her donations landed her a spot on the Health IT Policy Committee.” Neither have I. Online contribution records show that she donated a couple of thousand dollars to the Obama campaign in 2008, but the big numbers that Gurley hinted at were the total donations of Epic’s employees and even those amounts were modest. Also notably incorrect in Gurley’s presentation:

• Meaningful Use did not require doctors to buy software to earn payouts – they could “meaningfully use” the EHRs they already owned. Those who bought EHRs to cash in on MU weren’t buying Epic. All hospital EHRs were certified, so no Epic demand was created by federal action.
• His assumption that ONC “took Epic’s feature set and plowed it into this spreadsheet” to create certification criteria is silly in many ways.
• The EHR vendor fines that he listed weren’t levied because their products failed to meet ONC’s certification criteria, but rather for for falsifying EHR certification test results and paying kickbacks (EClinicalWorks and Greenway Health) and taking drug company kickbacks to use the EHR to push opiate prescribing (Practice Fusion).
• President Obama did not say in an interview with Ezra Klein that creating a barrier to entry for EHRs was his biggest Affordable Care Act disappointment. He expressed regret before leaving office in 2017 that paying MU incentives still left a lot of paper records, indecipherable patient bills, and excessive data entry time for clinicians and also created interoperability challenges with the many EHRs that were being used. He also noted that providers are incented to hoard data.
• The groundwork for HITECH was put in place by Republican President Bush, who also created ONC. ARRA and HITECH were signed four weeks after President Obama took office, a full year before ACA was passed, so the suggestion that HITECH was part of ACA is incorrect.

From Code Spewer: “Re: code generators. Most of us long-timers remember the bust of CASE tools in healthcare years ago.” The empty suits who ran the crappy vendor I worked for many years ago latched onto CASE tools as a competitive imperative, as whispered into their ears by bored techies who craved resume-enhancing experience. They eventually realized that you can’t just feed an old application’s code into a generator and have it create readable, technically efficient code that can be maintained and enhanced ongoing. They also eventually figured out that competitive advantage rarely springs from technology (despite what technology bigots claim) but rather functionality that requires subject matter expertise to design.

From Biliary Duck: “Re: cloud. Some of these companies will regret betting their future on the billing benevolence of cloud providers, who are free to increase fees any time their investors need a thrill.” Health IT vendors have historically regretted making third party software and services a key part of their products. You don’t really want outside companies having outsized influence over your pricing, technology strategy, and relationship with your customers. Cloud is great for quickly scaling up and adjusting for required performance with low capital expense, but you’re trusting cloud vendors to avoid turning the financial screws after you let them become critical to your business. The same goes for outsourcing.

HIStalk Announcements and Requests

Lorre thought that maybe one or two companies would take her up on the new-sponsor offer of getting the rest of 2023 free, but since four or five signed up quickly, she has decided to extend the deal beyond my initial limit of three companies. Everybody can get 25% off produced webinars as well, which generate ongoing views on our YouTube webinar channel. Spend little more than the cost of buying coffee for HIMSS booth staffers and you’ll enjoy a year-plus connection with HIStalk’s loyal readership of industry decision-makers plus the bonus of chatting with Lorre, to whom I wisely deflect calls since my single talent is analyzing and writing, not persuasively describing those offerings that make it possible.

Webinars

September 21 (Thursday) 2 ET. “Unlock open enrollment best practices to stop future denials.” Sponsor: Waystar. Presenter: Lauren Tungate, solution strategist team lead, Waystar. Nearly half of insured Americans consider changing their insurance coverage each fall, necessitating provider safeguards to stop increased denials, find hidden coverage, and prevent uncompensated care. This webinar will crack open enrollment best practices, such as using different data sources to get an accurate picture of benefit details; leveraging automation to identify hidden coverage, confirm active insurance, and avoid lost revenue; and simplifying eligibility workflows to reduce the financial burden on patients and strain on staff.

October 25 (Wednesday) 2 ET. “Live Ask Me Anything Webinar: The Power of Data Completeness.” Sponsor: Particle Health. Presenters: Jason Prestinario, MSME, CEO, Particle Health; Carolyn Ward, MD, director of clinical strategy, Particle Health. Is fragmented data impacting your organization and its ability to scale quickly? Our experts will discuss the advantage of having a 360-degree, real-time view of your patients. Access to analytic-ready data supports proactive care by enabling rapid clinical decision-making, stratifying high-risk patients, developing and using personalized treatment plans, lowering cost, and quickly closing care gaps.

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

Acquisitions, Funding, Business, and Stock

Virtual patient observation and analytics company MedSitter rebrands to Collette Health. The company has also added new AI presence-detection capabilities to its virtual care solutions.

Summus, which offers virtual access to specialty consults, raises $19.5 million.

Telemedicine services company Avel ECare acquires Fident Health, a virtual hospitalist business based in Texas.

Veradigm reports that it is taking longer than anticipated to correct accounting errors that have led to de-listing warnings from Nasdaq, and will thus file yearly and quarterly reports later than expected. The company, which plans to ask a Nasdaq Hearings Panel for an extended file request, has revised its 2023 revenue impact from $40 million down to $20 million.

Amazon is reportedly planning a rapid rollout of healthcare-related subscription services and offering discounts on its One Medical primary care services to Prime members

Sales

• HCA Healthcare selects remote patient monitoring services from Nudj Health.
• Bryan Health (NE) will use KeyCare’s  Epic-based network of virtual care providers.
• UAE-based, publicly traded healthcare operator Burjeel Holdings signs a $34 million contract to implement Oracle Health’s EHR running on Oracle Cloud Infrastructure.
• Emirates Health Services will implement Care.ai.

People

Chad Hendricks (Medecision) joins UpHealth as VP of business development.

Deloitte hires Michael Cleary (Workday) as VP/sales executive.

Direct Recruiters promotes healthcare IT and life sciences team members Rebecca Forristall and Ben Shamis to partners.

Drew Narayan, MS, MBA (PeriGen) joins Swift Medical as SVP of sales and marketing.

Announcements and Implementations

Excelsior Springs Hospital (MO) goes live on Oracle Health.

Tampa General Hospital (FL) implements Andor Health’s ThinkAndor Virtual Hospital technology within its ICU.

A new KLAS report on virtual sitting and nursing talks up AvaSure as an established vendor of solutions that are being used by large organizations going back five years, with a total hospital count of 1,100. Customers of the newly renamed Collette Health like the system for virtual sitting, but would like to see higher video resolution and better EHR integration. Care.ai was the only vendor in which all surveyed customers are using the solution for virtual nursing. All respondents say the product they use is part of their long-term plans.

Sponsor Updates

• Total Health Care (MD) significantly reduces its patient no-show rate by implementing the EClinicalWorks Healow no-show prediction AI model.
• Emirates Health Services will implement Care.ai’s virtual nursing and Smart Care Facility solutions.
• AGS Health will exhibit at HFMA 2023 Biennial Tri-State Conference September 20-22 in Florence, IN.
• Availity sponsors the American Heart Association’s 30^th annual First Coast Heart Walk in Jacksonville, FL.
• Biofourmis releases its expanded Digital Clinical Trials solutions with its platform for biopharma and other life sciences companies.
• CHIME releases a new episode of its Leader 2 Leader Podcast, “The Importance of Cybersecurity Policy Changes and Leadership Buy-In.”
• Clearsense publishes a new case study, “Higher Physician Efficiency and Lower Costs to Patients.”
• Clearwater CFO Baxter Lee joins the Tennessee HIMSS Board of Directors.
• HIStalk sponsors participating in Meditech Live, September 20-22 in Foxborough, MA, include Access, CereCore, CloudWave, First Databank, Nuance, and CHIME.

Blog Posts

• How to Stop Revenue Leaks with Meditech Automated Financial Testing (CereCore)
• Why wouldn’t you take on fully delegated risk? (Arcadia)
• 9 Ways to Go Beyond Basic Texting and Deliver Better Conversations (Artera)
• Meet the Clinician – Kenneth Catoe (Ascom)
• Five Risks of Not Improving Clinical Data Quality (Availity)
• Are Wearables Worth the Investment? 3 Critical Areas Where They’re Proving Their Worth (Bardavon)
• Cloud Risk is Different Than Traditional IT Risk – Here’s What to Do About It (Clearwater)
• Understanding How Prescribers Use Their EHR in Administrative Workflow and Patient-Visit Workflow (ConnectiveRx)

Contacts

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

Morning Headlines 9/19/23

MedSitter Announces Rebranding, Changes Name To Collette Health

Virtual patient observation and analytics company MedSitter rebrands to Collette Health.

Veradigm Inc. Provides Audit Update and Updates Financial Guidance for 2023

Veradigm reports that it is taking longer than anticipated to correct accounting errors that have led to de-listing warnings from Nasdaq, and will thus file yearly and quarterly reports later than expected.

Oracle Brings Generative AI Capabilities to Healthcare

Oracle adds new generative AI-powered Clinical Digital Assistant capabilities to its EHR solutions.

Curbside Consult with Dr. Jayne 9/18/23

Over the years, I’ve been on a number of panels and attended several forums to discuss the participation of women in clinical informatics. One of the most memorable ones was last spring as part of the CHIME track during ViVE, when the CHIME League of Women presented “Mentorship in Action.” We had a chance to understand how mentor/mentee pairs have been instrumental in boosting the presence of women in healthcare IT.

Just anecdotally, when I look at the composition of leadership teams in non-healthcare IT organizations, it seems like there are more women than I see in my own field, but I don’t have any data to back up that sentiment.

A recent article in the Journal of the American Medical Informatics Association titled “Accomplished women leaders in informatics: insights about successful careers” looked at some of the challenges faced by women in the field. Although the study had a relatively small sample size of 16, they looked at women in both academia and industry.

I wasn’t at all surprised when I read the findings: “We conducted a thematic analysis revealing: (1) careers in informatics are serendipitous and nurtured by supportive communities, (2) challenges in leadership were profoundly related to gender issues, (3) ‘Big wins’ in informatics careers were about making a difference, and (4) women leaders highlighted resilience, excellence, and personal authenticity as important for future women leaders.”

The authors also noted that “Sexism is undeniably present, although not all participants reported overt gender barriers” and that “women are underrepresented in scientific dissemination, substantially less likely to be in leadership positions, and have not achieved salary parity with men.”

I also wasn’t surprised at some of the statistics, namely that the majority of academic programs and clinical subspecialty fellowships in biomedical informatics are led by men, at 75% and 83%, respectively. The authors also note that men have also held the majority of leadership roles within the American Medical Informatics Association and have received nearly two-thirds of the awards. The article goes on to say that although the National Institutes of Health has recommended conscious effort to promote gender equality, women continue to cite gender imbalances in leadership hierarchies as barriers to advancement.

The article cites specific examples of the themes, some of which really resonated with me. Regarding the idea that careers in informatics are serendipitous, that’s exactly how I wound up in this field. I was looking for a clinical job close to home, and the one that seemed the best fit also had been identified to be a pilot for the “paperless practice” concept for a large health system. The idea that careers are nurtured by supportive communities rings true for me as well, as women made up the entire leadership team of that project, and we supported each other throughout the project’s lifecycle.

One of the major differences of that team compared to others that I’ve been on is that we understood how each other operated and how each other’s efforts supported the team’s overall goals. There wasn’t any competition, and when one of us achieved a milestone or was recognized for something we did, there wasn’t any sense of someone getting ahead or outshining the rest of the team. We shared in each other’s accomplishments as much as we commiserated when things didn’t go well. We stood up for each other when things weren’t quite right.

That concept wasn’t unique to us, as noted by one respondent who explained her strategy to address subtle sexism in meetings: “A colleague who is male will say more or less the same thing [the female said], and that’s what gets picked up on. I call it out. I say ‘Oh, it’s so great that you’ve taken her idea, and now we have it in front of us.’”

Other respondents specifically called out the lack of female participation on boards, as well as differences in how male and female colleagues were treated by leadership. I’ve certainly seen the latter over the last two decades. Sometimes it’s more subtle, such as male leaders inviting male subordinates to sporting events but not their female counterparts.

But in the most egregious situations, I’ve seen male leaders refuse to meet alone with a female subordinate because of concern for potential accusations of impropriety. Male leaders who follow the latter policy actually create an exclusion zone that prevents females from advancing. I would suggest that if they aren’t comfortable meeting with their teams privately, then maybe they’re not the right person for the leadership role.

Women cited specific situations that continue to occur, including differences between recognition of men and women, financial disparities, and women being “spoken over” in meetings. When I see the latter occur in a meeting and don’t see anyone call it out, it’s hard not to think negatively of the leader who allows such behavior to occur on their watch.

Respondents also noted the importance of “being authentic and genuine, not pretending to know something you do not know or being someone you are not, and being true to oneself” as key to being a successful leader. As far as those characteristics, the idea of not pretending to know something you don’t actually know comes up often in leadership books, specifically with references to the idea that men are more likely to project knowledge they don’t possess versus women who are more likely to admit that they need to research or investigate, with the latter being perceived in some circles as a sign of weakness.

It’s like when I was a young physician in that paperless practice. I mentioned in a media interview that having computers in the rooms was great when I needed to look something up. I thought that idea made me sound progressive and that I was seeking the best information for my patient, but in reality, I was chastised by the sponsoring hospital’s vice president for giving the idea that as a physician I wasn’t all-knowing.

The article arrived in my inbox while I had been reading “The Great Stewardess Rebellion: How Women Launched a Workplace Revolution at 30,000 Feet” by Nell McShane Wulfhart. Although the book is about the unequal treatment of female flight attendants in the early days of commercial air travel, there are still a lot of parallels with what women are experiencing today.

Women are often still expected to behave a certain way and have certain appearance standards that aren’t equally applied to their male counterparts. I’ve seen plenty of examples where a woman’s appearance or hair style are called out in a virtual meeting, where no one ever calls out the man with obvious bed head or the one who just slaps on a ball cap to remedy the situation. I’ve heard comments that women look “tired” and “stressed” on days that they don’t wear makeup, which is just a sad commentary on the state of things.

Even though some of the things I read in the article were disheartening, I’m glad that the ideas it brings up are receiving attention in academic circles. Only when we study an issue can we hope to find solutions.

How does your organization handle gender equity? Does it tolerate obvious imbalances or does it engage when people speak up? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 9/18/23

Summus Raises $19.5 Million to Expand Solutions Solving the Access Problem in Specialty Care

Summus, which offers virtual access to specialty consults, raises $19.5 million.

VA wraps first-wave EHR fixes, but employees ‘strongly disagree’ it’s ready to move forward

Though the VA has completed its first round of EHR fixes, at least one facility already live on the software is still experiencing frequent outages that force it to revert to downtime procedures.

No ransom to hackers, says Claxton-Hepburn, Carthage Area Hospital CEO

Claxton-Hepburn Medical Center (NY) and Carthage Area Hospital (NY) resume nearly normal operations while they determine if hackers were able to obtain any significant data during a ransomware attack several weeks ago.

Monday Morning Update 9/18/23

Top News

Two senators ask the Department of Defense to explain how its MHS Genesis (Oracle Cerner) system has affected the time needed to get new military recruits into basic training.

The DoD says that medically clearing new recruits takes three days longer than it did before MHS Genesis went live. However, Senators Elizabeth Warren (D-MA) and Richard Blumenthal (D-CT), both of whom serve on the Senate Armed Services Committee, note that the Navy’s recruit processing time has doubled to 60 days after Genesis was implemented.

The senators say that Genesis retrieves historic patient records comprehensively, to the point that applicants are required to obtain medical waivers for old, healed injuries. A recruiter says that one enlistee had to wait an extra two months because she had sprained her wrist as a child.

HIStalk Announcements and Requests

Doctors seeing new patients transferred their existing records into their systems electronically about one-third of time, poll respondents say, falling short of the 40% of practices that transferred nothing by any means and instead just handed patients a stack of blank forms to fill out.

New poll to your right or here: Do you know or suspect that a provider used AI in a recent encounter with you?

HIStalk sponsors who are participating in the HLTH conference – send me your details by October 2 and I’ll include them in my conference guide.

A Reader’s Notes from AHIP’s Consumer Experience and Digital Health Conference – Day 2

• Horizon Blue Cross Blue Shield says that virtual care went from 1% of behavior health claims before the pandemic to 60% and that high level of virtual care continues.
• Payers won’t covered digital therapeutics just because they are FDA cleared. They want to see positive outcomes over a meaningful population size. Value-based care may be a way to cover more behavioral health interventions.
• AI advancement may taper due to the huge amount of energy and electricity infrastructure it requires.
• Digital therapeutics fall into two categories – cleared by FDA as a medical device, and software that powers humans. FDA’s bar seems to be set lower for the first category since randomized clinical trials aren’t required to prove that the tool works.
• Peterson Health Technology Institute aims to be an independent assessor of digital health tools and has committed $50 million to the effort. Their assessment will include equity factors such as whether the tool reduces cost, if it is rolled out to Medicaid populations, and if it supports multiple languages.
• Rural areas suffer from a low provider-to-patient ratio, low access to transportation, limited broadband access, and provider volumes that are too low to support fee-for-service.
• National Coordinator Micky Tripathi, PhD, MPP says QHINs will go live in November or December, initially for provider-to-provider treatment purposes, with FHIR-based exchanged to follow in Q1.
• Former National Coordinator Don Rucker, MD, MS, MBA expressed concerns about the approach and director of TEFCA, saying that it relies too much on old standards and data formats.
• Two panelists would like to see prior authorization and payer-to-payer data exchange as future TEFCA use cases.
• Even though the conference was touted as representing consumer experience, little attention was paid to how payers will fix the consumer experience issues that we all hate, such as prior authorization and understanding your policy and benefits.

Webinars

September 21 (Thursday) 2 ET. “Unlock open enrollment best practices to stop future denials.” Sponsor: Waystar. Presenter: Lauren Tungate, solution strategist team lead, Waystar. Nearly half of insured Americans consider changing their insurance coverage each fall, necessitating provider safeguards to stop increased denials, find hidden coverage, and prevent uncompensated care. This webinar will crack open enrollment best practices, such as using different data sources to get an accurate picture of benefit details; leveraging automation to identify hidden coverage, confirm active insurance, and avoid lost revenue; and simplifying eligibility workflows to reduce the financial burden on patients and strain on staff.

October 25 (Wednesday) 2 ET. “Live Ask Me Anything Webinar: The Power of Data Completeness.” Sponsor: Particle Health. Presenters: Jason Prestinario, MSME, CEO, Particle Health; Carolyn Ward, MD, director of clinical strategy, Particle Health. Is fragmented data impacting your organization and its ability to scale quickly? Our experts will discuss the advantage of having a 360-degree, real-time view of your patients. Access to analytic-ready data supports proactive care by enabling rapid clinical decision-making, stratifying high-risk patients, developing and using personalized treatment plans, lowering cost, and quickly closing care gaps.

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

Acquisitions, Funding, Business, and Stock

A BMJ survey finds that three-fourths of UK hospital trusts still relay on paper-based charts and patient notes, concluding that the UK government failed to meet its target of eliminated paper ordering by 2024. Most of the trusts have electronic systems, but still use paper to some degree. Experts say the NHS data set is widely admired, but is less useful than it seems because it is often stored in systems whose proprietary formats do not support interoperability.

People

Jeff Cutler (Ada Health) joins Validic as chief commercial officer.

Announcements and Implementations

Google announces that Chromebooks that were released after 2020 will automatically receive updates for 10 years, while older devices can be set to receive those updates by the user or IT administrator. An individual device’s Auto Update Expiration date can be displayed from the Settings menu or looked up in an online list.

Government and Politics

Indiana’s attorney general Todd Rokita sues Indiana University Health, alleging that it failed to enforce privacy standards when OB-GYN Caitlin Bernard, MD talked publicly about an abortion she had performed on a 10-year-old. Rokita had previously filed an action against the doctor, who was reprimanded by the state medical licensing board for violating state and patient federal privacy laws, and was unhappy that IU Health publicly disagreed with the decision. Rokita says that IU Health failed to protect the child’s privacy, thus violating HIPAA. The doctor had previously sued the Republican AG in an attempt to prevent hum from obtaining the medical records of her patients for damaging her reputation, which the judge dismissed but with an opinion that Rokita’s public comments about the doctor on Fox News violated state attorney confidentiality laws.

Other

Venture capitalist Bill Gurley rails against Epic in a swaggering presentation this week, which is so full of errors and unproven assumptions that I won’t bother wasting time correcting them (example: he says ONC was formed to oversee ARRA when in fact it predated it by five years; not to mention that his summary of why EClinicalWorks, Greenway, and Practice Fusion paid millions to settle federal charges is way off base.)

[Epic] is the largest player in medical or EHR software medical records. This is their CEO, Judith Faulkner. Now in 2009, Obama put her on his health IT council. She was the only corporate representative. It should not surprise you that she’s a major donor to Obama. Obama passed the American Recovery Act that was his big piece of stimulus, kind of like Biden’s inflation act that happened recently. Tucked underneath and easy to hide in this big bill is the acronym HITECH. It’s this health information technology thing. Then they created an agency called ONC that oversaw it. Now this is the part you’re not going to believe. They came up with a brilliant idea that I have to assume she helped encourage, that doctors would receive $44,000 each if they bought software, 38 billion dollars .. You may be thinking are doctors needy, but here’s the catch. This happened because of the mortgage meltdown. Doctors own multiple homes, so they have multiple mortgages, so they probably needed the assistance … ONC decided the threshold of features you would need for your software to comply with this mandate, and I’m assuming they kind of took Epic’s feature set and plowed it into this spreadsheet. They got the Department of Justice to enforce people that didn’t have the feature set that were getting the payments, and you had three record fines – $155 million, $57 million, $145 million — against the lesser competitors of Epic. Unreal. If you’ve studied “The Innovator’s Dilemma,” the way startups disrupt is they come in with lower feature products, but a feature that really matters to the customer in a simpler product. They move up they put a brick wall there so you couldn’t come up. It’s just amazing. Obama, in an interview with Ezra Klein, said this was the most disappointing part of Obamacare … You may ask, am I am I unhappy with Judith? I’m disgusted with it, but if I were a judge in the Olympic regulatory capture competition, I’m giving her a 10.

The Metropolitan Water Reclamation District of Greater Chicago finds out from a press announcement that its CIO, John Sudduth, had been hired months before as CIO of the American Board of Medical Specialties. He held both jobs as a full-time, Monday through Friday employee without his bosses finding out for 2 1/2 months because of COVID work-from-home policies.

Not healthcare related except as an AI cautionary tale. OpenAI investor Microsoft apparently uses AI to produce crappy articles on MSN, whose content has suffered after it fired many of its human editors and started relying on wildly inconsistent syndicated articles. A now-removed article’s headline about the death of NBA player Brandon Hunter called him “useless,” strung together bizarre and incorrect details in its “story” about his career, and changed words here and there to hide its poorly executed plagiarism from other sites (it listed Hunter’s position as “ahead” instead of “forward” as originally stated in the TMZ piece it stole). The site earned unwanted attention last month after running an AI-generated travel guide to Ottawa, Canada that recommend that tourists visit the local food bank.

Sponsor Updates

• Care.ai launches a podcast series titled “Smart from the Start,” hosted by former HIMSS CEO Steve Lieber.
• Seashore MD streamlines patient booking and patient acquisition with EClinicalWorks EHR and Healow solutions.
• The “HIT Like a Girl” podcast features Nuance EVP and GM of Healthcare Diana Nole.
• Nordic releases a new “Making Rounds” podcast, “Emerging opportunities with cloud-based EHRs.”
• Ronin will present at the virtual NLP Summit October 4.
• Simnova in Italy will integrate Sectra’s medical education platform, the Sectra Education Portal, into their simulation training program.
• SmartSense by Digi names Ed Marx to its healthcare advisory board.
• Sphere publishes a new whitepaper, “Patient Payments: How Providers Can Improve the Last Mile of the Care Journey.”
• Symplr announces that its Symplr Spend Management solution has been named number one according to Black Book’s 2023 top client-rated supply chain solutions rankings.
• Verato will present at the Innovations in Value-based Care Conference September 27 in New York City.
• Wolters Kluwer Health publishes “The State of Drug Diversion 2023 Report.”

Blog Posts

• Leveraging data analytics to achieve positive outcomes (Meditech)
• Diagnosing, optimizing, and funding your next EHR implementation to combat provider burnout (Nordic)
• Avoid These Two Common EHR Implementation Pitfalls (Optimum Healthcare IT)
• The data healthtech needs to deliver to clinicians – Dr. Rob Bart (Redox)
• How Better Health Data Sharing Can Optimize Care for 4 Million Sjögren’s Patients – and My Family (Surescripts)
• Best Practices in Conflict of Interest Disclosure for Hospitals (Symplr)
• Eight Steps for Successfully Moving to Meditech Expanse (Tegria)
• Research on denial management in healthcare: 3 key takeaways from Waystar + HFMA (Waystar)

Contacts

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

Morning Headlines 9/15/23

Senators call on DOD to explain whether its medical records system is causing recruiting delays

Several senators question whether or not the DoD’s new MHS Genesis EHR has caused delays in processing new military recruits.

NHS still reliant on paper notes and drug charts despite electronic upgrades

Seventy-five percent of NHS trusts report they still rely on paper patient notes and drug charts, despite government initiatives to eliminate paper prescribing by 2024 and to implement digital health records at 90% of trusts by the end of 2023.

Apple introduces the advanced new Apple Watch Series 9

The newly announced Apple Watch Series 9 adds the ability to use Siri to request on-device health and fitness information, such as data from connected monitors, and to log health data such as weight and meds.

News 9/15/23

Top News

The VA tells the House Appropriations Committee that it hopes to resume its Oracle Health implementations in the summer of 2024.

Go-live at the joint VA-DoD facility Captain James A. Lovell Federal Health Care Center remains on track for March 2024.

The VA says that restarting the rollout will require VA success metrics to improve at its live sites and for go-live at the Lovell facility be completed successfully.

In the committee hearing, Oracle EVP Mike Sicilia blamed previous VA problems on Cerner technical issues. He added that the VA’s lack of repeatable process has hampered the implementation as compared to the DoD, although he believes the VA is on track.

In a related item, Rep. Greg Murphy, MD (R-NC) said in a House Veterans’ Affairs Committee hearing that it is “inexcusable” to be rebuilding the VA’s Oracle Cerner system five years into the project, adding, “There are other systems out there that are much better.” Murphy is a practicing urologic and renal transplant surgeon at ECU Health (formerly Vidant Health), which uses Epic.

Reader Comments

From HisTalk2Fan: “Re: Larry Ellison’s comments about the Cerner Millennium rewrite made in the earnings call this week. What is your thought?” My reaction to the call in general:

• Blaming the former Cerner’s revenue recognition practices for Oracle’s quarterly financial disappointment seems to throwing the acquired company under the bus, which Oracle has also done in attributing the VA’s implementation problems to Oracle-discovered Cerner technology deficiencies.
• The oft-repeated goal to “drive Cerner profitability to Oracle standards” sounds good to stock analysts, but perhaps less so to customers or prospects who aren’t looking forward to higher bills or reduced service due to cost-cutting layoffs.
• Oracle talks about rewriting Millennium using code generators, but has said nothing about product roadmaps or the layoff-caused lack of clinical resources that would be needed to design, test, implement, and support a rewritten Cerner product. They have stopped talking about Millennium’s weak areas – like not offering a competitive RCM system — and instead talk only about moving the product to the cloud.
• Oracle talked up the development of a hands-free voice interface and increased availability of AI/ML in the December 2021 acquisition announcement, where it also pledged that Oracle would “maintain and grow Cerner’s community presence” in Kansas City.
• The company says it will announce two new contracts worth a combined $1 billion this quarter. My bet is that these are outside the US, where Oracle has said it will expand Cerner sales to create “a huge additional revenue growth engine.”
• I know little about code generators, but the idea that old code or new specs can be fed into a tool that will effortlessly spit out perfect code has never worked. And while customers might (or might not) benefit from a move to Oracle’s cloud, technology changes alone don’t often excite the market. I doubt that the decision of UPMC and Intermountain to move to Epic was driven by Millennium’s infrastructure.
• Oracle has failed to deliver (and now doesn’t mention) the promised rewrite of Millennium Pharmacy for the VA as the first step in Millennium’s transition, which it assured the Senate Committee on Veterans’ Affairs would be finished by April 2023.
• My big-picture takeaway is that the Cerner acquisition was Larry Ellison’s pet project, but now the bean counters are charged with making the healthcare cash register ring, which has been tried by big companies many times with a success rate of 0.0. Meanwhile, Oracle Cerner headlines mostly involve flagship customer attrition and Mike Sicilia slathering corporate concealer to cover its VA black eye.

HIStalk Announcements and Requests

Listening: Living Colour, whose 40-year history I had missed until a social media mention sent me to Spotify to learn more. The New York City funk metal band has remarkably kept the same lineup since 1984 other than swapping bass players in 1992. They were boxed out of entire genres that should have made them famous due to ever-changing musical tastes, record label pigeonholing, and lack of support for most black artists, but they just keep doing what they do.

A Reader’s Notes from AHIP’s Consumer Experience and Digital Health Conference

• Looks like about 300 attendees, with key themes of AI, member engagement, health equity, bringing digital solutions to the customer experience, and some discussion about analytics and interoperability.
• It’s about as low-key as healthcare conferences get (HLTH will be a shock after this). Quality is good, speakers are specific with evidence and examples, and panelists who are pressed to predict the future seem to have anxiety that no one knows what the payer world will look like in a few years.
• John Halamka says that Mayo is focused on low-risk use cases of generative AI, such as drafting appeals letters and replying to patient messages. They are thinking about use in prior authorization, but haven’t done anything. He says B2C AI tools are too risky because of hallucinations and the risk of giving patients incorrect information. He concludes that when working with AI startups, it is critical to separate fact from fiction.
• A panel says that AI-powered ambient listening and documentation is a big opportunity, but adds that the onslaught of AI tools has been hard to triage.
• California-based Manifest MedEx is using data on 36 million Californians – from EHRs, immunization registries, EMS EHRs, and claims – to promote health equity, although data normalization and consistency across data sources are challenges.
• Oscar has a platform that creates patient interventions and messages based on knowledge about that person, such as recommending that a care manager arrange a specialist referral in response to a chatbot question, while Cambia has an initiative to lower the out-of-pocket medication cost of members. They say the message must be matched to the patient, such as tailoring to the local Spanish dialect used, and sent via the patient’s preferred communication method.
• One presenter expressed concern about trends such as fewer providers accepting Medicaid, wondering if low-income patients will eventually be limited to virtual care only.

Webinars

September 21 (Thursday) 2 ET. “Unlock open enrollment best practices to stop future denials.” Sponsor: Waystar. Presenter: Lauren Tungate, solution strategist team lead, Waystar. Nearly half of insured Americans consider changing their insurance coverage each fall, necessitating provider safeguards to stop increased denials, find hidden coverage, and prevent uncompensated care. This webinar will crack open enrollment best practices, such as using different data sources to get an accurate picture of benefit details; leveraging automation to identify hidden coverage, confirm active insurance, and avoid lost revenue; and simplifying eligibility workflows to reduce the financial burden on patients and strain on staff.

October 25 (Wednesday) 2 ET. “Live Ask Me Anything Webinar: The Power of Data Completeness.” Sponsor: Particle Health. Presenters: Jason Prestinario, MSME, CEO, Particle Health; Carolyn Ward, MD, director of clinical strategy, Particle Health. Is fragmented data impacting your organization and its ability to scale quickly? Our experts will discuss the advantage of having a 360-degree, real-time view of your patients. Access to analytic-ready data supports proactive care by enabling rapid clinical decision-making, stratifying high-risk patients, developing and using personalized treatment plans, lowering cost, and quickly closing care gaps.

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

Acquisitions, Funding, Business, and Stock

RCM technology vendor Aspirion acquires AI-powered intelligent document processing platform vendor Infinia ML.

Digital therapeutics vendor Akili, which sells a videogame that is an FDA-approved treatment for ADHD, will lay off 40% of its headcount and abandon its business model that involves prescriptions and payers. The company will sell directly to consumers with no prescription required, saying that payers were standing in the way of patients receiving treatment. The company went public via SPAC merger in August 2022, with shares opening at $36 but falling to $4 within a week as another spectacular but highly profitable failure from SPAC king Chamath Palihapitiya. AKLI shares are now at 90 cents, valuing the former unicorn at $70 million. 

Politico reports that private equity acquisition of hospitals and nursing homes, financed with low-interest loans, are at risk for layoffs and bankruptcies as higher interest rates eat into their profits. Federal agencies such as CMS and the SEC are alarmed over the undisclosed debt and the involvement of PE firms like The Blackstone Group – which holds $1 trillion in assets and controls businesses that employ 12 million Americans – that walk away from acquired companies after milking quick profits and management fees.

Sales

• CommonWell Health Alliance names Ellkay as its technical service provider, where it will provide the interoperability infrastructure to support current requirements and CommonWell’s goal of becoming a QHIN under TEFCA.
• Central California Alliance for Health will implement ZeOmega’s care management solution.

People

Rhapsody hires Sagnik Bhattacharya, MS (HealthEdge) as CEO.

Thirty Madison names Gil Shklarski, PhD (Flatiron Health) as CTO.

TeleTracking hires Nigel Ohrenstein, MA (Kaia Health) as president.

Julia Bernstein, MBA (Thirty Madison) joins behavioral telehealth provider Brightside Health as COO.

Bruce Gray, MBA (HIMSS) joins WPS Health Solutions as chief information and digital officer.

Announcements and Implementations

Blue Ridge Medical Center earns Rural Emergency Hospital designation with the assistance of Medhost and its REH package.

UT Health San Antonio and UTSA launch a five-year MD/Master of Science in Artificial Intelligence degree program.

Geisinger goes live on Exo Works, which integrates ultrasound documentation with its EHR and PACS.

The newly announced Apple Watch Series 9 adds the ability to use Siri to request on-device health and fitness information, such as data from connected monitors, and to log health data such as weight and meds.

Aridhia Informatics and Replica Analytics will collaborate to offer an end-to-end research data-sharing platform for research hospitals, pharma, and global consortia.

Other

The government of China cracks down on doctors who accept illegal commissions from drug companies for selling their products to patients, supplementing their “very small” salaries with “red envelope” money that can make up a significant part of their income. A previous study also found that one-third of patients had bribed their own doctor to get better treatment.

The Philadelphia newspaper notes that Children’s Hospital of Philadelphia paid its CEO $7.7 million in 2021, exceeding the amount of charity care the hospital provided in the three previous years combined.

Sponsor Updates

• EClinicalWorks publishes a new customer success story, “Unlock Healthcare Benefits with Healow.”
• CereCore releases a new podcast, “Liverpool Women’s CIO on the EPR Implementation Journey.”
• Arcadia announces that ACO using Arcadia Analytics outperformed the market in Medicare Shared Savings Program bonuses by nearly 20% on average in 2022.
• Elsevier Health publishes its Clinician of the Future 2023 report, highlighting the new ways in which technology will provide relief for healthcare workers.
• InterSystems will sponsor HackMIT September 16-17 at MIT in Cambridge, MA.

Blog Posts

• How to Reach the CMDB Summit (Optimum Healthcare IT)
• The Secret to Exceptional Customer Support: A Look into Dimensional Insight (Dimensional Insight)
• Connecting Californians: Supporting Medicaid Members via CalAIM (Findhelp)
• What’s the Difference Between a Call Center and a Contact Center? (Five9)
• Stretching your cybersecurity budget: 6 ways to do more with less (Fortified Health Security)
• Why am I going to attend HLTH next month? (Get-to-Market Health)
• The Value of Using the Right Health Education Videos for Patients (Healthwise)
• Three Keys to Unlocking Provider Productivity (Impact Advisors)
• Unleashing the Cure: RPA 2.0’s Impact on Healthcare and Aerospace & Defense (Keysight Technologies)
• Master Denial Management: 4 Essential Techniques for Healthcare Providers (Medhost)

Contacts

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

EPtalk by Dr. Jayne 9/14/23

Updated COVID-19 vaccines should be available soon, following approvals by the US Food and Drug Administration and the Centers for Disease Control and Prevention. They’re recommended for everyone age six months and older, so I anticipate that quite a few IT folks will be scurrying around to add the vaccine to EHRs near and far.

Although many healthcare folks seem to have stopped following the data, hospitalizations have been increasing recently, but might be leveling off. I’ve been traveling and have definitely seen an uptick in masking, with the most recent trip revealing about 5% of passengers and 20% of service workers being masked. The latter are less likely to have paid time off than other categories of workers and are likely to have negative impacts from illness, so it makes sense. Of the people who are masking, most seem to be wearing higher-filtration masks rather than basic surgical masks, and I didn’t see any cloth masks. Of note, two of my recent flights have been less than half full, so it appears the summer travel season is indeed winding down.

As far as masking in healthcare environments, I’ve seen a couple of articles addressing the topic. A recent opinion piece in the Annals of Internal Medicine suggests that healthcare organizations should make decisions that place patient safety first and should consider masking “as part of routine healthcare policies.” They suggest that care delivery sites “should be mindful of continuing areas of uncertainty while integrating the lessons learned into our hospital-based practices to prevent harm to vulnerable patients rather than reverting to suboptimal pre-pandemic behaviors.” I appreciate the fact that they called out the notion that the good old days weren’t necessarily that good in many care locations. In addition to vulnerable patients, there are plenty of vulnerable healthcare workers out there who deserve a safe work environment.

Regardless of the COVID case counts, the reality is that a lot of hospitals and health systems are still stressed. Some of the urgent care centers in my area have been closed for an extended time period due to lack of staffing, and many of my former colleagues have retired or left practice for other pursuits. My hospital colleagues tell me they’re still having staffing issues especially in labor and delivery, and apparently there’s a shortage looming for anesthesia medications, so it might be a bumpy winter.

I visited the local Costco for my flu vaccine this week and it was a seamless process, although I skipped the hot dog and soda combo and instead went for the sample of Kinder Bueno chocolate on the way out the door. There’s also a new vaccine out for Respiratory Syncytial Virus (RSV) intended for pregnant women as a way to protect their newborns, so I anticipate people are updating their EHRs and clinical decision support reminders to promote that one during patient visits as well.

This month’s issue of the Journal of the American Medical Informatics Association features an interesting back and forth about so-called EHR “gag clauses,” in response to a recent article that looked at whether those clauses had negatively impacted the inclusion of screenshots in peer-reviewed literature. Informatics guru Ross Koppel submitted a letter to the editor noting that informatics experts had been pushing for removal of those clauses since 2009. He also mentioned that informaticists may still be living in a climate of fear that vendors will punish them for publishing screenshots, regardless of moves by ONC or anyone else to remove such gag clauses. He concludes by stating, “Ethical vendors should have welcomed feedback about problematic EHR screens, rather than punishing medical informaticists who sought to improve those EHRs by demonstrating their dangers to patient safety.”

The authors of the original article responded to Dr. Koppel, agreeing with his comments but also pointing out that ONC and scientific journals should encourage the inclusion of screenshots in submitted articles and also that such screenshots should be included in safety bulletins and other documents covering EHR issues. They suggest that research needs to be done to understand why screenshots aren’t being included, and one way to do this would be to ask authors whether they’re aware of policy changes that prohibit gag clauses. They conclude by calling out Dr. Koppel’s comment that “…we should all be troubled by EHR vendor actions to prohibit sharing screenshots and that the EHR vendor insistence that the gag clauses are necessary for protecting intellectual property (IP) is meaningless if the IP is protecting poor design.” For those of us who have worked in EHRs that range from suboptimal to downright dangerous, that’s pretty much a mic drop right there.

As medicine has become more complex, the need for patient advocacy has increased. I was surprised to see a recent research letter in JAMA Internal Medicine about the prevalence of industry ties in patient advocacy organizations. The authors looked at the top 50 US patient advocacy organizations (ranked by revenue) and looked at ties between their senior leaders and the pharmaceutical or medical device industries. They found that a whopping 74% had board members or senior leaders with prior or current industry ties, with half of the organizations having conflicts of interest among paid staff or executives.

Although past ties are certainly worrisome, having a current conflict of interest seems particularly concerning. I appreciate the authors’ methodology. They used publicly available data from GuideStar to identify the high-revenue patient advocacy organizations and investigated the LinkedIn profiles of those listed on the organization websites. They also used other readily available sources such as annual reports, public tax documents, personal websites, and publicly posted biographies.

The authors listed some limitations, including “incomplete disclosure of board members, senior paid staff, or executive employment history, as well as the possibility of omissions from website profiles, limited (and likely underestimating) our characterization of industry ties.” Overall, they raise the concern that industry is influencing the advocacy organizations’ positions on patient education, policy making, and treatment guidelines. Definitely something to think about when you’re following the money in the complex web of the healthcare industry.

What do you think about conflicts of interest in patient advocacy organizations? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 9/14/23

Aspirion Acquires Infinia ML, an established leader in AI and Machine Learning

RCM technology vendor Aspirion acquires AI-powered intelligent document processing platform vendor Infinia ML

VA Going ‘Back to the Drawing Board’ for EHRM Deployment Schedule

The VA will develop a new deployment schedule for its EHR Modernization program, likely resuming in the summer of 2024 provided the scheduled March 2024 roll out of the Oracle Health system at the Captain James A. Lovell Federal Health Care Center goes well.

Carenostics helps clinicians prioritize at-risk patients

Carenostics,a clinical decision support software startup initially focused on chronic kidney disease, raises $5 million in seed funding.

Readers Write: Navigating the Early Days of Healthcare AI Integration

Navigating the Early Days of Healthcare AI Integration
By Michael Burke

Michael Burke, MBA is founder and CEO of Copient Health of Atlanta, GA.

Have you tried using any of the AI tools that have taken the world by storm recently? This article will probably be more helpful if you have some knowledge or experience with ChatGPT, Google Bard, Anthropic Claude, or any other LLM/chat model tool.

If you haven’t already, try asking one of these tools a specific question or give it an assignment to produce a specific document and see where it leads. You may be surprised at just how useful the results can be.

If you’ve used these tools to answer questions or generate content (e.g., a legal document, a policy document, an email, or an article like this one), you have some sense of their potential. Imagine what could be done with a tool that leveraged an LLM like ChatGPT on your hospital’s data. The software vendors you use are all either investigating or actively releasing tools powered by LLMs to leverage your data. At Copient Health, we are, too.

It’s my belief that these tools will fundamentally change the way you interact with those vendor systems and ultimately, in both the way that you do your work and the results that you get.

A comprehensive list of all use cases is impossible because we’re so early in the process, but here are a few obvious low-hanging fruit uses that are relevant for software vendors:

• LLMs are already powering chart notes that are built in real time from patient conversations.
• Dashboards and reports will become unnecessary, because you will always have the specific data or chart that you need just a query away. The LLM can even proactively push the appropriate information in the appropriate format for the appropriate context.
• You can forget about manuals, indexed help systems, or frustrating first-generation chat bots that perform poorly. LLM-powered solutions are better at finding what you’re looking for using a similarity search of a vector database.
• You might even abandon memorizing complex commands or menu hierarchies and ask the LLM to accomplish the task instead.

But ChatGPT and other public-facing LLMS were trained on public data. How can they be leveraged for use cases that require knowledge of private data?

The answer to that question used to take a lot of time, money, and a team of data scientists to train your own LLM, or at least fine tune an existing open source model. That has changed dramatically, mostly in the last 6-8 months, based primarily on a term that you may have heard: “prompt engineering,” and one that you probably haven’t: “in-context learning.” Here’s a quick summary:

LLM models are text-in, text-out black boxes. But the text-in doesn’t have to be limited to a simple question. It can include prompts of background information, examples of questions and answers to similar scenarios, chunks of data, or simply directing the LLM to “think step-by-step.”

These are all basic forms of prompt engineering. The LLM temporarily “learns” from this prompt data, at least enough for your current conversation. LLMs can be used as an inwardly-directed service to decide what data or tool to use based on the prompts that it receives. This design pattern has demonstrated better results than the more cumbersome fine-tuning approach for the smaller data sets that we’re talking about.

An entire ecosystem of software tools has emerged to support the use of these pre-trained LLMs on private data. These tools convert the challenge from what was once an arcane AI data science problem to a data engineering problem, primarily built around prompt engineering and in-context learning.

Here’s an illustration of how quickly these tools have evolved and been adopted. One of the most widely used tools in the ecosystem, LangChain, was first introduced in October last year as an open source project from two college students. In a few months, its use expanded globally. The founders incorporated and raised $20 million in venture funding from Sequoia Capital. Since last October, they have garnered 60,000 GitHub stars, which is a measure of its popularity among software developers. For context, Python, the language the LangChain toolset is written in, has fewer stars over a significantly longer time period: 51,500 stars over six years. ChatGPT itself captured one million users in just five days.

This head-spinning rate of change gives an advantage to startups, given their rapid iteration and integration of new tools and ideas. Some large healthcare software vendors that are infamous for relying almost exclusively on internally developed tools find themselves in a challenging situation. It’s impractical for them to build their own LLMs, as they would likely never rival the performance of commercially available options, and it would take forever. And since they are not used to relying on third-party software as part of their solution, they aren’t prepared for the rate of change at which these solutions are evolving.

For instance, just yesterday, LangChain had 18 separate commits (i.e., changes) to their codebase. That’s fast! Adapting to rapid changes and advancements requires a new level of agility.

We’ve recently heard announcements and partnerships from big tech and big healthcare IT. It will be interesting to see if these announcements produce real value in the near term, or if they are just a way to buy time for the vendor to figure out this rapidly evolving space.

Healthcare AI News 9/13/23

News

A Harrisburg, PA TV station covers UPMC’s use of Abridge to create transcripts of doctor-patient encounter conversations. UPMC VP/CMIO Salim Saiyed, MD, says he has never had a scribe, but the system is like having a real-time scribe whose accuracy is 95%. He adds that the physician can focus on the patient instead of the computer and spends less “pajama time” completing documentation after hours.

Mass General Brigham and GE HealthCare will collaborate to develop an AI algorithm that will optimize radiology patient scheduling as part of GE HealthCare’s commercially available Radiology Operations Module.

OpenAI will hold its first developer conference on November 6 in San Francisco.

Business

RCM technology vendor Aspirion acquires AI-powered intelligent document processing platform vendor Infinia ML. Aspirion says it will run Aspirion as an R&D development shop that will be run by Infinia ML executive chair Nick Giannasi, PhD,  who was previously chief AI officer of Change Healthcare.

Crunchbase News leads off its list of “failed and struggling AI-focused unicorns” with Babylon Health, which it notes mentioned “AI” 25 times in its SPAC filing, raised $600 million at a valuation of billions, then filed bankruptcy last month.

Notable launches a conversational AI tool that helps patients find doctors, schedule appointments, create directions to a location, pay bills, and request prescription refills. It is fully customizable (including tone of voice), can converse in 130 languages, and can have its training extended by uploading training manuals or other documents.

A former Google AI researcher raises $100 million from big-name Silicon Valley investors for Inceptive, his startup that will use AI to develop drugs and vaccines.

Research

Researchers note that ChatGPT has accumulated 1,000 PubMed citations in nine months, which predicts its future influence even though one-third of the cited articles were opinion pieces. Google needed 14 years to hit the 1,000-citation mark.

Other

Attorneys note the healthcare regulatory risks of using AI:

• Running afoul of privacy laws when training AI systems using patient data.
• Using AI to replace rather than support clinicians, which could be construed as the unlicensed practice of medicine.
• Providers deviating from the standard of care based on AI recommendations, creating malpractice risk.
• Reducing physician supervision of lower-level employee who instead use AI, which could fail to meet payer requirements.
• Running afoul of the Anti-Kickback Statue if using vendor-developed AI algorithms that favor use of their products.
• Inadvertently practicing unlawful discrimination by using algorithms that use factors such as race, color, national origin, sex, age, or disability.

The Today show features a mother whose son’s chronic pain and other symptoms had baffled 17 doctors who had seen him over three years. She pasted notes from his MRI into ChatGPT, which provided a diagnosis of tethered cord syndrome, a deformation that limits the movement of the spinal cord and is related to spinal bifida. He is recovering from surgery to repair the condition.

Contacts

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

Morning Headlines 9/13/23

Bain & Company and KLAS study finds 80% of US healthcare providers are accelerating spending on IT and software with AI top of mind

A study of 200 provider executives finds that most health systems increased their spending on software and IT significantly in the past year, with revenue cycle management and clinical workflow optimization being the top investment areas.

Senate confirms deputy secretary at VA

The Senate confirms Army veteran and VA Chief of Staff Tanya Bradsher as deputy secretary, where she will be responsible for the VA’s Oracle Cerner implementation.

HSHS, Prevea restore health records system

Hospital Sisters Health System and affiliate Prevea Health restore their Epic system after a cyberattack forced both organizations to downtime procedures two weeks ago.

News 9/13/23

Top News

From the Oracle earnings call, following a Q1 revenue miss, slowed cloud sales, and lowered expectations that sent shares down 13% on Tuesday:

• The company expects to sign two new Cerner contracts that are valued at over $1 billion in total in the current quarter. (Readers: who could this be? New customers, which would suggest an Epic displacement, or a new cloud contract for existing Cerner clients?)
• Chairman and CTO Larry Ellison says that healthcare AI requires vast amounts of training data, including image information, and Oracle’s new vector database will contain anonymized EHR training data that will be good for its database business.
• Ellison answered an analyst’s question about the one-year anniversary of Oracle’s acquisition of Cerner, saying that the move to “a new Millennium” involve rewriting the software one piece at a time using the Apex code generator, with the first step being hardening the system and moving customers to the cloud.
• Ellison says that cloud-based revenue recognition has caused “a bit of a revenue headwind” since Cerner previously recognized a chunk of revenue at contract signing.
• CEO Safra Catz added that Oracle is “always looking to save as much money as we can and spend as little” while modernizing the Cerner system and, as she has repeatedly said, working to “drive Cerner profitability to Oracle standards.”

Reader Comments

From Digital Health CEO: “Re: our news on your site. We get a lot of positive social channel feedback on our mentions on HIStalk, which still has the best reach in healthcare.” Thanks. This is a actual comment from a non-anonymous CEO just in case anyone suspects made-up self promotion. It’s a good audience, skewed hard toward decision-maker careerists.

From Keep Me Anonymous Health System CIO: “Re: the Cerner input you requested. Here’s mine.” A summary:

• Millennium is a decent inpatient EHR that works after expending the effort, while ambulatory has improved and our providers are receptive to using it.
• Millennium Patient Accounting significantly lags Epic in functionality, ease of use, and analytics.
• The Soarian-based RevElate system that is supposed to replace PA is a better product than Millennium PA, but there’s only one GA option to integrate it and that requires interfaces. Integrating workflows is difficult and requires dual maintenance, such as charge masters and providers. It is still being developed with implementation partners, so the expected benefits have yet to be proven.
• I’ve seen no positive improvements since the Oracle acquisition. Oracle Health (or is it Oracle Cerner?) has had multiple rounds of layoffs, going beyond duplicative functions such as HR and marketing in getting rid of the core workforce, which is baffling. They lack the bench strength to executive anything timely and customers find it difficult to get knowledgeable people for supports and projects.
• The last round of layoffs eliminated most, if not all, of their clinical experts, such as physicians and nurses.
• Most of Oracle’s promises to improve the Cerner project involve infrastructure and moving to the cloud, but Cerner’s remote hosting was its most reliable service. Oracle is fixing something that is not broken and that holds little value to customers.
• I’ve seen no roadmap for system development.
• Oracle promises to rewrite the EHR, but I’m not sure who will redesign it given the lack of clinical bench strength.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Notable Health. The San Mateo, CA-based company is the leading automation platform for patient engagement and staff workflows. Deployed at over 3,000 sites of care, Notable automates over a million repetitive workflows every day across scheduling, registration, intake, referrals, and authorizations. The result: personalized, streamlined care for patients, the elimination of burdensome manual work for caregivers, and improved financial health for healthcare providers. Notable is backed by leading investors, including ICONIQ Growth, Greylock Partners, F-Prime, Oak HC/FT, Maverick Ventures, and 8VC. Find out why healthcare providers of all sizes, including Intermountain Health, Medical University of South Carolina, North Kansas City Hospital, and more have partnered with Notable to redefine what’s possible in healthcare. Thanks to Notable Health for supporting HIStalk.

Lorre is offering three companies a sweet deal – sign up as a Platinum sponsor and she will include the rest of 2023 for no extra charge. Contact her to see if three other folks beat you to it.

A mostly forgotten memory for DoD-Cerner watchers, which I recalled while fondly re-reading the DoD series written for HIStalk by the mystical Dim-Sum. Part of the ultimately successful Leidos proposal to DoD was the involvement of Intermountain Healthcare.

Webinars

September 21 (Thursday) 2 ET. “Unlock open enrollment best practices to stop future denials.” Sponsor: Waystar. Presenter: Lauren Tungate, solution strategist team lead, Waystar. Nearly half of insured Americans consider changing their insurance coverage each fall, necessitating provider safeguards to stop increased denials, find hidden coverage, and prevent uncompensated care. This webinar will crack open enrollment best practices, such as using different data sources to get an accurate picture of benefit details; leveraging automation to identify hidden coverage, confirm active insurance, and avoid lost revenue; and simplifying eligibility workflows to reduce the financial burden on patients and strain on staff.

October 25 (Wednesday) 2 ET. “Live Ask Me Anything Webinar: The Power of Data Completeness.” Sponsor: Particle Health. Presenters: Jason Prestinario, MSME, CEO, Particle Health; Carolyn Ward, MD, director of clinical strategy, Particle Health. Is fragmented data impacting your organization and its ability to scale quickly? Our experts will discuss the advantage of having a 360-degree, real-time view of your patients. Access to analytic-ready data supports proactive care by enabling rapid clinical decision-making, stratifying high-risk patients, developing and using personalized treatment plans, lowering cost, and quickly closing care gaps.

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

Acquisitions, Funding, Business, and Stock

Online Medicare Advantage insurance sales firm Health IQ, which raised $200 million from big-name investors, files Chapter 7 bankruptcy with $1.3 million in assets and $257 million in debt. Co-founder Munjal Shah and some of Health IQ’s leadership are now involved with Hippocratic AI, which has raised $65 million from Andreessen Horowitz and which lost big on Health IQ.

Sales

• Infirmary Health (AL) selects chronic care management and virtual care software and services from Wellbox.
• Community Health Systems (TN) will use Mindoula’s virtual behavioral healthcare service as a part of its primary care offerings.
• In England, Barking, Havering and Redbridge University Hospitals NHS Trust will implement Oracle Cerner in a $55 million project.

People

CereCore names James Lobban (Meditech) regional VP of business development.

Edifecs names practicing VA staff physician Summerpal Kahlon, MD, MS (Change Healthcare) chief medical officer.

Julia Goebel (Symplr) joins Komodo Health as head of marketing.

Surescripts hires Lynne Nowak, MD (Lark Health) as its first chief data and analytics officer.

Kristen Lalowski, RN (VillageMD) joins LetsGetChecked as EVP of product.

Fivos Health promotes Eric Nilsson to CEO.

Announcements and Implementations

Geisinger will expand its in-home chronic care management program, which includes equipment setup by Best Buy’s Geek Squad and data collection and monitoring by Best Buy-owned Current Health.

Broadmeadows Hospital and Northern Hospital in Melbourne, Australia go live on Oracle Health as part of Northern Health’s systemwide implementation, first announced in late 2020.

In Oregon, Blue Mountain Hospital and its Strawberry Wilderness Community Clinic implement Oracle Health’s CommunityWorks EHR.

A study of 200 provider executives by Bain & Company and KLAS Research finds that most health systems increased their spending on software and IT significantly in the past year, with revenue cycle management and clinical workflow optimization being the top investment areas while patient engagement has moved up the list. Two-thirds of the respondents say they will look first at their existing vendors, especially their EHR supplier, when looking for new functionality. Few organizations have an AI strategy, but 50% are either developing one or will do so soon.

Government and Politics

The Senate confirms Army veteran and VA Chief of Staff Tanya Bradsher as deputy secretary, where she will be responsible for the VA’s Oracle Cerner implementation.

Privacy and Security

Prospect Medical Holdings works to determine if patient information within its 16 hospitals was breached in a reportedly $1.3 million ransomware attack by the Rhysida group nearly six weeks ago. Prospect is also still working to bring all of its hospital systems back online.

Hospital Sisters Health System (IL) restores its Epic system after a cyberattack forced it to downtime procedures two weeks ago. Affiliate Prevea Health (WI), which was also a part of the attack, has yet to bring its systems fully back online.

Other

HealtheLink, an HIE serving Western New York, will use a $1 million grant from ONC to gather advance care planning documents and make them digitally available to providers within its network.

University of Utah Health research finds that poor EHR user experience strongly correlates with EHR-related patient safety concerns, particularly in the areas of medication alerts related to drug-drug interactions, patient allergies, duplicate orders, and excessive dosing.

Sponsor Updates

• Artera names Nicole Ossey (Knock) VP of people.
• DePaul Community Health Centers reduces days in accounts receivable by more than 50% with RCM solutions from EClinicalWorks.
• The Agile Giants Podcast features Arcadia CEO Michael Meucci.
• Nordic releases a new episode of its In Network podcast in partnership with Amazon Web Services, “Making Rounds: Emerging opportunities with cloud-based EHRs.”
• Ascom Americas will sponsor the Hack the Building 2.0 Hospital Edition September 18-22 in Columbia, MD.
• Bamboo Health will exhibit at NAACOS 2023 September 20-22 in Washington, DC.
• CloudWave will exhibit at the Torch Fall Conference September 25-28 in Round Rock, TX.

Blog Posts

• Five key features telehealth patients want: Insights for healthcare developers (Wolters Kluwer Health)
• The Next Big Thing for Healthcare IT Service Desks – Support with Clinical Context (CereCore)
• Leveraging Analytics in the Revenue Cycle Management Maturity Journey (AGS Health)
• Optimum’s ServiceNow Store Opens (Optimum Healthcare IT)
• How Arrive Health is Creating a Better Prescribing Experience, Including Eliminating 87% of RTPB Noise (Arrive Health)
• Decreasing falls and cutting costs in the LTACH setting (AvaSure)
• Driving Operational Efficiency + Patient Outcomes: Clearsense 20/20 (Clearsense)
• 7 Ways to Ensure Your Incident Response Plan is Incident-Ready (Clearwater)

Contacts

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

Morning Headlines 9/12/23

Oracle comes up short on revenue but touts AI cloud contracts

Oracle’s quarterly revenue falls short of analyst expectations, with Cerner’s revenue growth slowed by its “accelerated transition” to the cloud.

Cano Health Announces Plans for Regaining Compliance with NYSE Stock Price Criteria

The NYSE puts troubled primary care company Cano Health on notice for listing noncompliance, given that the average closing price of a share of its Class A common stock was less than $1.00 per share over a consecutive 30 trading-day period.

Thoma Bravo Weighs $1 Billion Private Credit Loan for NextGen Acquisition

Private equity firm Thoma Bravo considers arranging $1 billion in private financing for its acquisition of ambulatory health IT company NextGen Healthcare.

CT hospitals unsure if patient records were breached in cyberattack

Prospect Medical Holdings is working to determine if patient information within its 16 hospitals was breached in a ransomware attack by the Rhysida group more than a month ago.

Curbside Consult with Dr. Jayne 9/11/23

I was recently in a meeting of healthcare executives where the topic in question was how to best leverage technology when working with “older patients.” Compared to my physician experiences with the senior population, I found some of their attitudes to be not only outdated, but their opinions to be inaccurate. I heard statements such as “retirees are technologically naïve” and “most of them don’t have smartphones.”

I’d like to see those executives join me in an exam room when a Medicare-age patient pulls out their phone and logs into their patient portal to provide data that I can’t otherwise access. They might also find themselves educated when a patient pulls out their phone to show me pictures that their grandchildren texted to them.

According to data from The Senior List, 98% of people older than age 60 have mobile phones, which splits to 81% smartphone users and 17% basic mobile phone users. Approximately 75% of seniors text at least once daily, with most indicating that texting is a preferred communication method.

A whopping 65% of adults in that age group spend three hours or more on their phones daily, and seniors have an average of 25 apps installed on their phones. The most popular apps are those addressing weather, shopping, social media, games, and news. Health tracking apps are present in around 49% of seniors’ app installations. As far as app use, social media leads the way as far as percentage of app usage, with Facebook being the favorite followed by Amazon, Google, and The Weather Channel. The data in question was gathered in 2021, and based on what I see in the community, I woud guess that smartphone use and app utilization have both grown since then.

One of the health system executives kept citing “the data” indicating that smartphones and seniors don’t mix, but didn’t have an actual citation. He said he had seen “multiple research studies in the news this week,” so I decided to try to figure out what he was talking about. I found a couple of articles in the lay press from mid-August that talked about COVID, seniors, and text messages not mixing, but they all linked back to the same scholarly article, so I hardly consider that an overwhelming amount of new research.

The study in question looked at text messages sent to more than 17,000 Medicare-age seniors during the initial distribution phase of the COVID vaccine. Patients were sent a text invitation to receive the vaccine, but 28% reported technical problems. The authors dug deeper into 4,200 responses, coding them based on issues experienced by the recipients. Approximately 7% of seniors had issues responding to the text invitation, including responding in the wrong format, delays in responding, or inability to get help when they requested it.

Based on the results, researchers recommended interventions including the use of natural language processing, flexible response formats, and improved feedback processes when conducting such text-based campaigns in the future. Based on my experiences as a consulting CMIO during the pandemic, I would also recommend that organizations look at the scripting they are sending out and whether the text of the messages is contributing to the confusion.

I was hired by a couple of organizations during the pandemic to support their efforts reaching patients, and some of the draft language that I was sent to proof-read or polish had definite room for improvement. Common themes I encountered during that time included reading levels that were too high, complex sentence structure, and questions with responses that didn’t have an appropriate response choice listed.

It should also be noted that some of these patients might have been receiving competing or conflicting messages from different organizations that added to the confusion. For example, they could have received different messages from their primary care physician, a subspecialty physician, a health system where they’ve had diagnostic or laboratory testing, a senior center, a retail pharmacy, and an insurance carrier. Duplicative messages might just have been ignored, confounding the data.

The article lists the specific language that was used as part of the campaign studied, and even I found it confusing. Recipients were prompted to select from three options, which were presented to them with a request to indicate their choice by keying in either “A” or “G” or “D” which were presented in that order. The offering of such choices ordered in that manner is counter to some key usability and patient engagement principles, especially in a population where recipients might be more conditioned to choose from an ordinal list – “ABC” or “123,” for example, rather than “AGD.”

The article noted that “the response options letters in the message were chosen from a set of letter groups and assigned at the time of delivery based on the next message service’s automated batch-processing system,” which is a statement I don’t really understand.

Had this script come across my consulting desk, I might have made it even simpler with yes/no questions and a bit more branching. Although it may have created complexity for those configuring the system, it would have been more straightforward for the potential patients receiving it.

Those patients who wanted to schedule online were told to enter their email address and that they would receive a link within two days. That requires additional steps for the recipient versus just providing a link right in the text exchange.

The study authors looked at some of the “non-conforming” messages that patients sent that the system was unable to process. Some of them included statements recognizing typographical errors (such as “Sorry, I sent wrong response, D is the response”) and requests to just go to a website. Others included statements around the patient having already received a vaccine or auto-generated replies that were sent because the patient was driving when the text message was received.

The authors also noted that the campaign wasn’t optimized to address the needs of patients whose primary language wasn’t English. Other limitations included medical records anomalies that may have led to the generation of messages to the wrong recipients.

It should also be noted that many of these campaigns were being done in the heat of the moment due to unpredictable vaccine availability. On some of the campaigns where I assisted, clients offered a premium for rush turnaround of content. Several of the outreach programs were built in a couple of days, and one was actually configured in less than 12 hours. Health systems were under immense pressure at the time and might not have had the luxury of constructing a campaign compliant with usability best practices.

Those all add to the idea of not using this type of data (which is now two years old in addition to the other flaws noted) to throw the proverbial baby out with the bath water as far as understanding how seniors will interact with technology. It will be interesting to see follow-up studies on the topic.

Does your organization do anything specific when tailoring campaigns to different demographic groups? Have you considered specific testing on your target audience? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: It’s Time for a National Patient Identifier

It’s Time for a National Patient Identifier
By Gregg Church

Gregg Church is president of 4medica of Marina del Rey, CA.

Congress has the power to make healthcare safer and less expensive for patients, payers, and providers. It can do this by removing the ban that prohibits using federal funds for the development of a unique national patient identifier.

The patient identifier system would give each patient a single ID that would follow them through their healthcare journey, regardless of provider or payer, while still protecting their private information. It would reduce medical and billing errors and denied claims, while eliminating countless hours insurers and hospital systems spend resolving patient matching errors. It would also aid medical research and make it easier for our healthcare system to respond effectively during national emergencies, like the COVID-19 pandemic.

The federal ban on a national patient identifier was born from good intentions. Former US Rep. Ron Paul in 1998 added the provision to the Labor-HHS appropriations bill. The physician and libertarian cited concerns about patient privacy and the dangers of the federal government collecting and centralizing medical records. His son, Sen. Ron Paul, also a physician and libertarian, now leads the opposition with the help of the ACLU and other groups.

Congress has come close to ending the ban. For the past four fiscal years, the House has removed it from its version of the appropriations bill; the Senate did likewise the past two years. Each year, however, it has been reinstated in the final budget.

In 2021, Patient ID Now, a coalition of more than 40 healthcare organizations, including the American College of Surgeons, American Heart Association, American College of Cardiology, The Joint Commission, and American Health Information Management Association, was formed to push for a nationwide strategy to address patient identification.

The group noted that the ban was put in place 25 years ago at a time when patient records were still largely kept in manila folders. It’s now a hindrance to the necessary digitization of healthcare. While concerns over patient privacy are real, a national patient identifier could be implemented in such a way that it protects patients.

I like to believe that much of the opposition to a universal patient identifier is due to a lack of awareness of the volume of incomplete, duplicate, missing, and overlaid medical records and the problems they cause.

Imagine if your personal finance records had a roughly one in five chance of being duplicated or mixed up with someone else’s accounts by financial institutions. Think of the chaos and damage and the ensuing demands to fix the problem.

Duplication of patient records is one of the most serious problems with healthcare data quality, and it’s more common than many think. Duplication rates are as high as 30% in some healthcare organizations, and a 10% rate is common. Up to half of patient records are not matched in transfers between healthcare systems. 

Patients are endangered by low-quality records, particularly duplicate and overlaid records, in which the data for two patients is mixed.

Approximately 70% of care decisions are based on lab tests, which are performed by techs working in relative isolation from the care team. Labs frequently create duplicate records while entering patient information into computers. That bad data can then be multiplied and disseminated throughout a hospital system and between systems.

Clinicians working from bad data can misdiagnose, prescribe the wrong course of treatment, and order duplicate tests, which delay necessary treatment.

Black Book in 2018 surveyed health technology managers about problems with patient identification processes. It found that the cost of medical care due to duplicate records averaged $1,950 per patient per inpatient stay and more than $800 per ED visit.

Those surveyed also estimated that 33% of denied claims were due to inaccurate patient identification or information. That cost the average hospital $1.5 million in 2017 and the US healthcare system more than $6 billion annually.

That unnecessary expense could be eliminated with a standard patient identification system.

True interoperability among patients, providers, and payers is a goal of the healthcare industry, one that could be made more achievable through a patient identifier system that allows for the disruption-free exchange of patient records.

While recent improvements in patient identification processes, such as hospitals adopting Enterprise Master Patient Indexes and the use of machine learning, have improved record matching, it’s barely keeping pace with the explosion in medical records and the sharing of data among different healthcare organizations.

Adopting a national patient identifier would be a significant step toward building a safer, and more effective and affordable healthcare system. It’s time for Congress to listen to the experts and remove the ban. We’ll all be better off for it.

Morning Headlines 9/11/23

Walmart Explores Buying Majority Stake in ChenMed

Walmart reportedly considers acquiring a majority stake in Medicare Advantage primary care clinic operator ChenMed.

US indicts nine alleged members of Russian cybercrime gang that targeted hospitals

The Department of Justice indicts nine men with ties to a cybercriminal group that has accumulated $100 million in ransomware payments from US hospitals.

Ranking Member Cassidy Seeks Information from Stakeholders on Improving Americans’ Health Data Privacy

HELP Committee ranking member Senator Bill Cassidy, MD (R-LA) solicits solutions to protecting patient privacy related to wearables, smart devices, and apps, none of which are covered by HIPAA.