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Weekender 5/7/21

May 7, 2021 Weekender No Comments

weekender 


Weekly News Recap

  • Walmart announces that it will acquire telehealth provider MeMD.
  • Cerner begins an external search to replace Chairman and CEO Brent Shafer, who will leave the company.
  • Systems at Scripps Health remain down from a ransomware attack.
  • R1 RCM will acquire VisitPay for $300 million in casb.
  • Connecticut launches a statewide HIE.
  • CareCloud agrees to pay $3.8 million to settle federal charges that it paid kickbacks to customers who recommended its EHR to prospects.
  • Ascension Technologies files paperwork indicating that it will lay off 651 IT employees in the fall as it outsources their jobs.

Best Reader Comments

Re: Epic’s growth in Canada from three hospitals in 2016 to 146. A significant portion of that will be due to the Alberta market. Alberta has Meditech implemented (understand though that the legacy picture is fragmented into an approx. three-way tie). Alberta will never upgrade to Meditech Expanse. Instead, Epic has won the entire province. Wave 3 of a 9 wave Epic implementation project was recently completed. (Brian Too)

So Brent Shafer has accomplished what during his time as CEO? Decimated all the upper level management with his cronies who now need replaced, made all the good worker bees leave by withholding raises and layoffs, lost some huge clients while not making many new sales, underperformed for the shareholders with regards to the stock price, not made any progress on meeting existing promises to clients, not made any progress on new markets. I think Brent’s Cerner legacy is that he made life moderately worse for everyone involved except his pocketbook, but at least he didn’t implode the company. (IANAL)

Similar finance-driven decisions are made not only for support, but also for the building of software at your vendor. The more mature the product, the more likely that offshoring the build might actually result in cost savings. In the startup world, it never works because the instantaneous iterative nature of early-stage software development can’t survive the communication barriers. (mburke)

So many questions are still being asked about HIMSS21. If we show up to exhibit, who will be attending the conference for us to present to? If we get a meeting room, would attendees feel comfortable meeting up in there since it’s a closed-in space with not great ventilation? If we host an event outside of conference hours, who would show up? Will the whole conference primarily be vendors? It’s really hard to justify the ROI and it doesn’t seem like it’s going to be any easier to make that decision as the conference gets closer unless we specifically ask our target audience if they will be there. (Michelle)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. S, who asked for headsets for her students as her Houston elementary school moved to online. She reported in November, “Your generous contributions have made it possible for the students and I to communicate with each other … One of my students, Tracy, told me, ‘Now, I feel like I am part of the class.’” Ms. S also passed along a letter from one of her students:

My teacher says you’re the one who got my class headphones. I just wanted you to know how thankful I am! And pretty much all my class. I don’t really know who you are but for now on, I’ll remember that you made my classroom happy. And come on, when my teacher said there was headsets, I was shocked! I already knew it wasn’t from my school. And honestly, if you didn’t give my class headsets, I’m pretty sure we would have to bring headsets to school. I just wanted you to know how thankful my class is because of you!

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Reader Eric’s generous donation to my Donors Choose project, with matching funds from my Anonymous Vendor Executive and other sources, allowed me to fully fund these teacher requests:

  • Math stations for Ms. N’s second grade class in Tyler, TX.
  • Math games for Ms. G’s elementary school class in Chicago, IL (her response is above).
  • Math picture books for Ms. F’s elementary school class in Norfolk, VA.
  • Math activity tins for Ms. S’s head start class in Provo, UT.
  • Math tools for Ms. C’s second grade class in Los Angeles, CA.
  • STEM activity tubs for Ms. M’s first grade class in New York, NY.
  • Science tools for Ms. M’s kindergarten class in Nashville, MI.
  • Lesson plans and materials for Ms. I’s sixth grade class in Arlington, TX.
  • Lesson plans and materials for Ms. N’s elementary school class in Fresno, CA.
  • Summer practice reading and math books for Ms. R’s elementary school class in Philadelphia, PA.
  • Digital learning resources for Ms. E’s first grade class in Houston, TX.
  • Interactive math whiteboards for Ms. M’s middle school class in Pharr, TX.
  • A collection of 100+ books for the book vending machine project of Ms. H in Columbus, OH.

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Crocs will give away 50,000 pairs of shoes this week in bringing back its “Free Pair for Healthcare” program during National Nurses Week.

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The Indianapolis TV station profiles 61-year-old Jeff Bick, who was looking for something meaningful to do after taking early retirement from Eli Lilly after 30 years, so he spent three years in nursing school and is now working as an RN at Riley Children’s Health. He explains, “I wasn’t ready to retire by any means. I figured I was good for another 10 or 12 years, so what could I do that would be meaningful? My wife and I both feel like we’re lifelong learners, so you keep, you know, you keep looking for challenges. You keep looking for things that make life an adventure.”

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A hospital in Senegal builds a new maternity and pediatric building, courtesy of charitable donations and pro bono architectural services, for just $2 million. One of the designers didn’t feel right about designing a hospital for doctors and patients they had never met in an area they had never visited, so they held meetings with doctors, employees, and patients to reach an ideal design for the 150-bed addition. It emphases patient and family comfort and passive cooling. The U-shaped bricks were developed by the architect and cast on site. The contractor took it upon himself to expand the idea of testing the bricks by erecting a test wall and instead built an entire building in a small village so it could be used as a school.


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Morning Headlines 5/7/21

May 6, 2021 Headlines No Comments

Walmart Health To Acquire Telehealth Provider MeMD

Walmart Health will acquire Phoenix-based telehealth company MeMD for an undisclosed sum.

Vim Closes Investments From Walgreens, Anthem, and Frist Cressey Ventures to Build Digital Infrastructure for Higher Performing Health Care

Israel-based Vim, whose technology connects health plans to providers, raises $60 million in a Series B funding round let by Walgreens.

Cerner Corporation (CERN) CEO Brent Shafer on Q1 2021 Results

Cerner announces Q1 results: revenue down 2%, adjusted EPS $0.76 versus $0.71, beating consensus expectations for earnings but falling short on revenue.

SA hospital staff put on alert after computer glitch adds digit to medication dosages

Australia’s SA Health investigates whether patient harm has resulted from an apparent bug in Allscripts Sunrise, which it says is duplicating the last digit of medication doses in displaying a 10 mg dose as 100 mg.

News 5/7/21

May 6, 2021 News 7 Comments

Top News

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Cerner announces that Chairman and CEO Brent Shafer will leave the company. The company has hired a search firm to identify external candidates. Shafer will remain in the role until his replacement has been hired, then will serve as advisor for a year.

Shafer, who was previously CEO of Philips North America, took the top Cerner role in January 2018.

CERN share price is up 4% since Shafer took over. The Nasdaq composite index has risen 92% in that period.

Cerner also announced Q1 results: revenue down 2%, adjusted EPS $0.76 versus $0.71, beating consensus expectations for earnings but falling short on revenue.

From the earnings call:

  • CFO Mark Erceg said that as a recently hired newcomer looking back at Cerner history, he thinks that the company’s lack of focus and sub-optimal execution hindered revenue and margin growth, placing it in the bottom quartile of shareholder return among its peer group.
  • Brent Shafer said that he expects the new CEO to focus on operations rather than strategy development or portfolio management.
  • Providers engaging patients at home has emphasized the need for a unified communications strategy for reaching consumers.
  • President Don Trigg says that the entry of life sciences data competitors to Cerner’s Learning Health Network validates Cerner’s strategy and its investment in Kantar Health, also noting data opportunities with the federal government that go beyond DoD and VA.
  • Cerner thinks that the federal government’s TRICARE program will provide opportunities in value-based care for data aggregation and longitudinal records. CDC is also a prospect and signed a real-world data contract in Q1.
  • Shafer says Cerner is doing everything it can to be an attractive employer given the global competition for technology talent, emphasizing to prospective employees that they can make a difference in the world since their work involves healthcare.

Reader Comments

From Eric: “Re: Donors Choose. How do I make a donation?” I support Donors Choose, but just to be clear, your donations are your own business and I’m squeamish about soliciting them since I’m just the occasional conduit, armed with matching funds from my Anonymous Vendor Executive. However, since you asked in response to my recap of the projects I funded using reader Mike’s generous donation, the steps are:

  • Purchase a gift card in the amount you’d like to donate.
  • Send the gift card by the email option to mr_histalk@histalk.com (that’s my Donors Choose account).
  • I’ll be notified of your donation and you can print your own receipt from Donors Choose for tax purposes.
  • I’ll pool the money, apply all matching funds I can get, and publicly report here which projects I funded, including teacher follow-up messages and photos.

HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor Talkdesk. The San Francisco-based company is a global consumer experience leader for patient-obsessed providers. Its solutions provide a better way for healthcare and patients to engage with one another. The company’s speed of innovation and global footprint reflect its commitment to ensure that businesses everywhere can deliver better experiences through any channel, resulting in higher patient satisfaction, cost savings, and profitability. Talkdesk gives providers an end-to-end patient experience solution that combines enterprise scale with consumer simplicity. Thanks to Talkdesk for supporting HIStalk.

I found an interesting Talkdesk video on YouTube, showing how its contact center platform is being used for COVID-19 vaccine administration.


Webinars

May 11 (Tuesday) noon ET. “Modern Healthcare Innovation Leaders: How Top Health Systems Plan and Execute Innovation.” Sponsors: RingCentral, Net Health. Presenters: Todd Dunn, MBA, VP of innovation, Atrium Health; Paul Nagy, PhD, co-founder, Technology Innovation Center at Johns Hopkins Medicine; Roy Rosin, MBA, chief innovation officer, Penn Medicine; Patrick Colletti, founder, Net Health (moderator). This panel discussion will provide insights from innovative healthcare leaders who have embarked on the journey of planning and implementing innovation projects in their organizations and the wisdom they learned through the process. Topics will include predictive analytics and AI, potential challenges and risks of implementing innovation projects, challenges of interoperability and emerging technologies, and when to build versus buy when working with emerging and established vendors.

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


Acquisitions, Funding, Business, and Stock

Patient medical records access technology vendor Ciitizen acquires the HIE business of Stella Technologies.

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Vida Health, which offers employer-funded virtual coaching for mental and physical health, raises $110 million in a Series D funding round.

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Premier reports Q3 results: revenue up 40%, adjusted EPS $0.64 versus $0.73. Mike Alkire, newly promoted to president and CEO, said in the earnings call that the company will evolve into a technology-based healthcare solutions provider using its network, data, and machine learning. PINC shares are up 17% in the past 12 months versus the Nasdaq’s 55% rise, valuing the company at $4.3 billion.

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Israel-based Vim, whose technology connects health plans to providers, raises $60 million in a Series B funding round let by Walgreens.


Sales

  • Mary Washington Healthcare (VA) will implement Sectra’s enterprise imaging solution under the Sectra One subscription service. 
  • HHS will support development and installation of PeraHealth’s Rothman Index Risk Triage tool as a COVID-19-focused hospital triage tool.

People

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AGS Health hires Thomas Thatapudi, MBA (thegrok.io) as CTO. 

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Intelligent Medical Objects names Dale Sanders (Health Catalyst) as chief strategy officer. 

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EHR workflow tools vendor Wellsheet hires Ryan Sadlo, MBA (Podimetrics) as VP of growth.

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Clay Ritchey, MBA (Evariant) joins EMPI and patient matching technology vendor Verato as CEO.

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Patient engagement platform vendor Twistle promotes Matt Revis, MBA to president.


Announcements and Implementations

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Conversational AI platform vendor Avaamo makes its virtual assistants available on Epic App Orchard.


COVID-19

Two real-world studies find that Pfizer’s COVID-19 vaccine is highly effective against the UK and South Africa variants.

A man from Argentina admits that he probably should not have flown from Miami to Buenos Aires last week given that he had just tested positive for COVID-19. He obtained a “fit to fly” certificate from a Florida medical clinic via a telehealth visit. He was arrested and quarantined upon landing by Argentinian health officials, who found that his temperature was 101.3 degrees.

A KHN report says that the state of California has weakened its public health infrastructure by outsourcing life-and-death duties in no-bid contracts to big tech firms, most of them donors and supporters of Governor Gavin Newsom. State officials praise the public-private partnerships, while others warn that companies like Salesforce and Google are accountable only to shareholders and the deals are siphoning money away from the already gutted public health infrastructure.


Other

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Systems at Scripps Health are apparently still down after a weekend ransomware attack.

Australia’s SA Health investigates whether patient harm has resulted from an apparent bug in Allscripts Sunrise, which it says is duplicating the last digit of medication doses in displaying a 10 mg dose as 100 mg.

Kansas Heart Hospital files a federal complaint against its former CFO and COO, claiming that they conspired with the hospital president to divert $31 million through bonuses and other compensation payments. The hospital also accuses Steve Smith and Joyce Heismeyer of copying and then deleting computer files and creating a $1.5 million severance package for themselves before suddenly resigning.

Wired recaps last fall’s data breach at Finland-based Vastaamo, the “McDonald’s of psychotherapy” that shut down after hackers gained access to its full records – including psychotherapy notes – and then extorted 25,000 clients individually to keep their information private. Vaastamo had built its own EHR and decided not to pursue newly created Class A standards that would have allowed it to connect to the national health data repository, making it a lightly regulated Class B system that was intended for small organizations that keep paper records. Hackers breached the system, demanded payment that was not made, and then posted the system’s database to the internet. Finnish authorities later seized millions of dollars from Vastaamo’s owner, who they suspected covered up the breach while selling the company to an investment firm. The incident has raised questions about whether therapist notes should be entered electronically at all, much less shared with a national repository, whether EHRs are secure, and if the government should be more involved on oversight.

An opinion piece by author and former New York Times reporter Elisabeth Rosenthal, MA, MD says that “COVID-19 let virtual medicine out of the bottle” and the result could be lower-quality care, inequities, and even higher charges as startups focus on the benefits to providers and investors rather than patients. She says that evidence – lacking at present – rather than the market should drive telemedicine decisions to avoid focusing on the most profitable services.


Sponsor Updates

  • Protenus announces that its fifth annual PANDAS healthcare compliance conference – addressing patient privacy monitoring and controlled substance diversion surveillance — will be held virtually on May 11-12.
  • Cerner releases a new podcast, “The tipping point of healthcare consumerism and engagement.”
  • PerfectServe recognizes 100 outstanding nurses in its inaugural “Nurses of Note” Awards program.
  • Relatient announces that Greenway Health users now have access to its Appointment Reminder solution.
  • Fast Company recognizes Jvion’s COVID Community Vulnerability Map with an honorable mention in its 2021 World Changing Ideas Awards.
  • MedTech Breakthrough names Fortified Health Security as “Best Overall Healthcare Cybersecurity Company.”
  • Lumeon’s Pre-surgical Readiness solution and COVID-19 Remote Home Monitoring solution each win a Silver Stevie Award for Best New Product in the Healthcare Technology Solution category of the American Business Awards.
  • Meditech releases a new podcast, “How St. Luke’s doubled patient portal enrollment during the pandemic.”
  • Forbes includes Pure Storage CIO Cathy Southwick on its list of 50 innovative technology leaders.

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 5/6/21

May 6, 2021 Dr. Jayne No Comments

I was intrigued by an article in the Journal of the American Medical Informatics Association (JAMIA) that looked at “Public vs. Physician Views of Liability for Artificial Intelligence in Health Care.” The authors found that although a majority of both physicians and the public believe that physicians should be liable for errors occurring during AI-assisted care, the public was more likely to do so (66% versus 57%). Compared to the public, physicians were more likely to believe that both vendors and healthcare organizations should be liable. In summarizing the background, the authors note that there are more than 60 AI-based algorithms and devices approved by the US Food and Drug Administration. Although they didn’t find significant differences across specialties, they only surveyed internal medicine physicians, oncologists, and radiologists. The number of physicians surveyed was also fairly small – 750 physicians were invited, but only 192 responded.

Another article, also in JAMIA, reported on interviews with medical scribes and how their work might reduce clinician burnout. I’ve got a fair amount of experience with scribes, from using them in practice to helping health systems set up scribe training programs. It was a fairly small study with only 32 interviews. The authors looked at different types of clinical tasks from documenting visit notes to tracking down clinical information. I liked the way they referred to clinicians delegating these tasks to their scribes as “outsourcing.” Especially if you have an EHR that makes finding information challenging, as many of us do, it’s a heck of a lot easier to ask your scribe “what was her blood pressure at the last visit?” versus having to dig for it yourself, especially if you’re on the high-volume hamster wheel where you’re asking patients questions and synthesizing information at the same time you are conducting your examination.

Unfortunately, some organizations don’t embrace scribes fully and leave it up to individual physicians to determine if they want or need a scribe, which usually means that the cost of hiring, training, and using the scribe falls entirely on the single physician. Practices that incorporate scribes as part of the overall infrastructure can see additional benefit, including being able to have appropriately-trained scribes help perform clinical tasks (such as rooming patients or helping handle phone calls) during any downtime where the physician may be doing work that isn’t best supported by a scribe. In my soon-to-be-departed clinical gig, it was also a plus that nearly all the scribes were doing a gap year between undergraduate studies and hopefully being admitted to medical school or a physician assistant program. Across the board, they are a highly motivated bunch who seem to genuinely want to learn about clinical care and the health system. Unfortunately, that meant that nearly the entire scribe workforce turns over every spring and summer, which is a challenge.

JAMIA hit the trifecta with an article on reducing EHR-related burnout through a “personalized efficiency program.” This is the kind of work I do as a consulting CMIO – helping organizations figure out not only how to technically optimize their EHR, but how to get providers to adopt time-saving workflows. There are a variety of strategies I like to use, so I was eager to hear what kind of offerings their efficiency program included. I felt validated in my approach – their individual coaching sessions included a focus on increasing EHR knowledge and maximizing user-level customization. In the study, a good number of providers participated in the optimization sessions, 87%. However, not all participants returned both the pre-survey and post-survey, so they weren’t included in the research sample.

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This week’s Health IT Buzz blog focused on sunsetting the interoperability roadmap. It was a nice walk down memory lane, thinking back to 2015 when the roadmap was introduced and sparked plenty of comments before it was finalized. It made plenty of people nervous, especially the parts that talked about patients having expanded access to their records. Many of the milestones it laid out have been achieved. The last pandemic-filled year has been impactful on health IT and has accelerated numerous interoperability projects. Although the new developments are appreciated, let’s hope it doesn’t take a pandemic to continue moving organizations and the industry in the right direction.

As a big-time science nerd, I was excited to see that the team at Fermilab published an article that they have successfully achieved sustained, high-fidelity quantum teleportation. It’s a step closer to a quantum internet, which would revolutionize how we use and manage data. The research team — made up of folks from Fermilab, AT&T, Caltech, Harvard University, the University of Calgary, and the NASA Jet Propulsion Laboratory — plans to continue to upgrade its systems over the next several months to further refine its results.

May is Mental Health Awareness Month. The ongoing pandemic has certainly brought discussion of many mental health issues to the forefront. Among my patients, I’ve seen increases in depression, anxiety, and insomnia. Many people have their symptoms compounded by difficulty accessing both primary care and psychiatric services, and although I know the urgent care isn’t the best place to handle those issues, we can typically help connect patients with additional resources and supports. A good number of my colleagues have had their own mental health struggles during the past year. Due to the challenges with physicians having to report mental health treatment in many states, a number of them are untreated or undertreated, and that is a sad commentary on healthcare in the US and our willingness to understand that everyone is human.

I’m glad we are past the panic attack-inducing days of the early pandemic, when we didn’t know what we were dealing with or whether we would make it out the other side. There are a number of physicians and other clinicians who may be whole in body but not in spirit, and I hope the health system starts to look seriously at what needs to be done to help them heal. In the short term, I see a lot of them leaving medicine. I’m curious whether other countries that don’t have the same stressors are seeing the same outcomes. In the immortal words of U2, “we get to carry each other.” If you sense your colleagues are in need of help, do what you can to get them to a better place.

Email Dr. Jayne.

Morning Headlines 5/6/21

May 5, 2021 Headlines 2 Comments

Cerner Reports First Quarter 2021 Results, Updates Guidance, Expands Capital Return Program and Commences CEO Succession

Cerner reports a 2% dip in its quarterly revenue and announces a succession plan for CEO Brent Shafer.

HST Pathways Merges with Simple Admit to Enhance End-to-End Patient Technologies for Ambulatory Surgery Centers Nationwide

Ambulatory surgery center software vendor HST Pathways merges with Simple Admit, which offers ASC-specific patient engagement and relationship management technology.

Fitness ring maker Oura raises $100M

Smart ring company Oura will use its $100 million Series C funding round to hire staff, and continue expanding research and development beyond its initial sleep-tracking functionality.

Vida Health raises $110M in Series D round led by General Atlantic, Centene, and AXA Venture Partners

Virtual chronic care company Vida Health raises $110 million, bringing its total raised to $188 million.

HIStalk Interviews Charles Tuchinda, MD, President, Zynx Health

May 5, 2021 Interviews 1 Comment

Charles “Chuck” Tuchinda, MD, MBA is president of Zynx Health, EVP and deputy group head of Hearst Health, and executive chairman of First Databank. Hearst’s healthcare businesses include First Databank, Zynx Health, MCG, Homecare Homebase, and MHK.

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Tell me about yourself and your job.

I’m a driven physician who is hell-bent on making healthcare better. I  want to figure out how things work and how to innovate, which applies to many things in my life. This weekend, as a random example, I actually tackled my first brake job and successfully replaced the brake pads on an old car.

I’m the president of Zynx and I still have some responsibility over FDB, and more broadly, additional responsibilities across Hearst Health. Zynx has been on a mission since 1996 to improve the quality, safety, and efficiency of care. We help people make better decisions that lead to better health through evidence. That’s something you see playing out in the world today.

How much of a physician’s decision-making can be directly supported by available evidence, and why does medical practice sometimes fall outside available evidence?

This question will continue to grow in terms of the body of knowledge and the evidence that helps us think about what we need to do. 

Let me come at it a few different ways. When you look at our process of processing evidence and synthesizing it, we search across a bunch of different literature sources and we filter these things based upon the quality of the study, the type of study. Often, we are looking at over 13,000 studies, so we read and distill them and then we grade them and prioritize them. Then we generate a core piece of knowledge that we call Zynx Evidence that helps us as a foundation for all of the clinical decision support that we make.

But if I step back away from our process and I think about healthcare overall, there’s just so much information, or I should say data, that is available now. The challenge as a clinician is that you have to synthesize it. There’s so many competing interests. You are expected to practice and handle a high volume of visits. You’re expected to practice with high quality of care. You are measured on whether you can reduce readmission or shorten the length of stay.

As clinicians, we are expected to draw upon so much data and synthesize it so quickly. That calls out for partners, information, and tools to help you be the best version of yourself, to do the best that a clinician can do. In the future, we are going to see clinical decision support continue to advance, first to support the healthcare professionals and elevate their practice, and in the long run, to elevate and empower the average patient to make the best possible healthcare decision.

People talk about gaps in terms of the knowledge base. There will always be gaps, because there’s a frontier of knowledge out there that is growing and expanding. But we live in an era now when a lot of the healthcare information can be captured, stored, and analyzed, so the body of knowledge is going to continue to grow. That will make it more important to understand what the standard is. What do we already know about how to go about and do things in a better way?

How difficult is it for physicians to assign the proper weight to their personal experience with looking at someone else’s research that covers a large population?

It is challenging. I remember medical school very well. I went to Johns Hopkins and was infused with knowledge around what the research and evidence shows, essentially defining the right standard of care, at least in the eyes of the medical school I went to. Then when I went to the floor and started meeting with patients, trying to help people do what I believed was the right thing, based on the way I was educated. That turned out to be a big challenge, getting people to do what is likely to be in their best interests for better health.

You also see that challenge with clinicians. Clinicians have different experiences. When they graduated from school, there was a certain level of knowledge and a certain practice pattern. The challenge is that clinicians and the patients they see influence what they think is the best way to practice. What’s tough is that there’s always people out there doing more research, studying more people, coming up with better ways.You have to look at that, synthesize it, make sure it’s right, and make sure it’s right for your situation. Then if you are constantly trying to improve yourself, you’re going to want to bring that into your practice and your day to day. That’s a challenge that has been described in the literature as something that takes, unfortunately, a decade plus for some new knowledge, from the time it’s discovered, to be put into practice and benefiting a large population.

It’s tough. And when you look at the differences in care and the disparities, it’s not only about knowing the difference between the standard of care and what actually happened, it’s also a lot about convincing people and changing minds and helping them access and make good choices.

Will the less-structured, more timely way that new research and clinical findings were disseminated during the pandemic influence the distribution of clinical information in the future?

Yes, absolutely. The pandemic highlighted the fact that reliable information is more important than ever. In the early days, you saw that the volume and velocity of information coming out had increased dramatically. Lots of headlines and a lot of observations. There was this urgent need for scientific or rigorous medical knowledge. You also saw public health entities trying to make decisions with the best available information they had at the time.

It was this nexus of, I want some good information, but I don’t know if it’s out there. Then a flood of information with unclear significance. That’s when it’s important to trust your process. Go back, look at the source, look at the study design, try to figure out if it’s rigorous. Once you feel like you have distilled a few things that work, the other challenge is getting it into practice. How do people apply it? How do you implement it into their workflow? The pandemic really highlighted that need. It’s a good and a bad thing.

In the early days of the pandemic, a lot of health systems sent some of their staff home. They became productive, worked on some change management type stuff where they said, hey, I’m home, I might not be able to go in at the moment, but I can work on updating the system, or I can figure out a protocol. In several health systems, we saw that people drove change at a much better and faster rate than ever before. That gives me a lot of hope, because if folks have the right information and are empowered to make a change in their practice patterns, they will.

Implementing standardized order sets was a contentious topic a few years ago. Now that the implementation dust has settled, what is the status and future of order sets?

The order set market has evolved dramatically, and Zynx has evolved to match it. We have been partnering with clients to serve their needs. The classic market, when EHRs were being deployed, was to populate the EHR with a lot of point-of-care CDS, your traditional order set, a tool and a content inside the EHR system. But now as people primarily have EHRs deployed, you see a shift to optimizing the information you have, updating it. That means a greater need for collaboration software to drive your clinical teams to work together, to examine the changes that they think that they should put into place, and to make decisions and track an audit trail. 

Zynx provides tools to help do that. We even have a platform where we can interrogate the configuration of an EHR and compare it to our content library to suggest spots where there might be gaps in care or vice versa, like some extra orders that you don’t really need that might be considered waste. Maybe they shouldn’t be done when you’re an inpatient, they should be done when you’re in clinic or in follow-up afterwards.

The new frontier for us is looking at clinical practice patterns, the actual ways that clinicians are taking care of patients. Our content team has written business logic rules to interpret that order stream and identify opportunities where clinical practice patterns may not match the standard of care or the evidence-based interventional suggestions. Those are things that we want to highlight as a way to drive clinicians to change their behavior and get better results.

What is the value of slicing and dicing the universe of aggregated data to allow physicians to do a “patients like this one” crowdsourcing-type review?

I would say that there is some utility to that, although I don’t know if that would be my go-to source of rigorous information to begin with. 

When I look at that type of guidance, I map it out in a way where I first want to look for any sources from well-known publications, from experts, from sources that I believe are free from bias with good, rigorous study designs and see if they have done their best to control and observe an impact related to an intervention. That is your traditional, solid, core, evidence-based recommendation. The reality is that there’s not an evidence-based recommendation for everything a clinician might do, and then you need to look for other ways to take care of patients and decrease variability. You might look for some expert opinion, and short of that, you might start to look at practice patterns that are aggregated.

The danger of going to practice patterns right away and crowdsourcing an intervention is that you are going to propagate common practice. Common practice presumably is OK, assuming that the common practice was a good thing. But it also then means that people are going to be entrenched where they are. If there was a breakthrough or new discovery, that won’t be common practice. That’s why I wouldn’t say you go to common practice first. You would go to whatever the latest and greatest leading evidence would suggest that’s rigorous, and try to change behavior and try to change clinical practice to that. But short of that, go to the experts, And if you’re completely lost, then I would consider looking at what else have other people done and what we know about this path in terms of helping people out.

How should an expert’s gut feeling about what seems to work be incorporated into more rigorous, evidence-based recommendations?

My hierarchy would start with trying to find evidence-based recommendations that are based on the best studies. Short of that, I would go to experts, because they presumably specialize in it, probably have a comprehensive knowledge of the disease process going on or the treatment protocol. Then the common practice piece I would put below that, because experts are outnumbered by just the number of generalists. My worry is that maybe an expert who has studied this, who does know the cutting-edge stuff, has the better way to do it, but it’s not showing up if you use an algorithm to just source common practice. Then you don’t have anything else to go with, I probably would look pretty hard, before just treating someone willy-nilly, to get a good recommendation.

It makes me think of the “do no harm.” I’d rather make sure that the things I’m suggesting are sensible rather than just suggesting random things, which then might start to fall in the category of waste. It’s a hierarchy that I think most clinicians, when they practice, come into. You saw it play out with the pandemic. We saw some early treatments look like they might be promising. I might even argue that they became common practice for a period of time. Then people studied them and realized, wait, this is no better than placebo. This is not leading to a better outcome. Those practices largely died out.

Artificial intelligence seems to be focused more on diagnosis rather than treatment, probably because the diagnosis endpoint is better defined. Do you see a role for AI in clinical decision support?

I’s really early days on artificial intelligence. I’m a huge fan of artificial intelligence, but I want there to be a lot of rigor in it. I worry a little bit about the hype around the shiny new object and the fact that that might sway people to try things before you really know how well it works.

When I look at AI in healthcare, one of the reasons we see it in the diagnostic area is that AI for imaging, in particular, is quite good. That’s built on a lot of imaging research that came from other industries, and when you apply it to healthcare, we get good results. There are thousands of studies that have been reviewed by humans and labeled appropriately, so when you train an AI system on that type of information, you can get and characterize the way it performs rather well.

When you look into other areas, especially around treatment and around maybe other diseases, it’s harder to know, because you want to have a large body of information to validate it against. This is one of the topics that we track very closely at Zynx and across Hearst Health, because we want to really understand how well an AI algorithm might perform and how you can judge that. Do you judge that by knowing the makeup or the composition of the AI algorithm, the layers of the neural network, or do you judge that by the input data that you gave it? When you look at the input data, do you want to have a diverse population of folks with a lot of differences, or do you want to have something that’s more uniform?

All these things are still not quite answered. We don’t have a great standard to prove that an AI algorithm is rigorous and it needs to work on a population that looks like this. I think we’re going to get there soon. We have that in other areas emerging. When you test new drugs, you want to test it on a specific population. They may vary by age. They maybe vary by comorbidity. We need to be doing that type of rigorous testing on the AI algorithms. It’s early days, so I think we are getting a lot of tools implemented. But I’m hopeful that we’ll come up with a good process and then have really good, reliable tools to use.

What is the status of electronically creating and sharing a patient’s care plan, and the challenge of defining who of potentially several types of caregivers is quarterbacking the patient’s overall care?

We are proud that we were recognized by KLAS as being Best in KLAS this year for order sets and care plans. That’s a great honor, and we were rated very highly across all the categories that KLAS surveyed our clients for. We have over 1,200 clients and it’s growing. These health systems use the order sets and care plans to help their clinicians work more efficiently.

When you look at how it works at the point of care with care plans specifically, we help guide the interdisciplinary team on the assessments and the goals that they should set for each patient based on the disease condition and the severity of illness. Then we help them perform the right interventions, the tasks to drive that patient to heal and to do better.

Our future and our innovation work has been around translating a lot of those care plan items to patients themselves. We think that patients could be engaged in their care, and to some degree, do some self-care. That should be aligned with the care plan from the care team. Some of these interventions seem pretty straightforward, like make sure you show up for an appointment, make sure you assess a certain thing, know the goal that your care team has set for you so that you can follow up on that.

We think that by increasing the engagement and the participation of patients themselves, people get to better outcomes and are able to receive care in different venues, not necessarily only in an acute-care hospital setting. I’m excited about that. That’s a new area for us, where we tie the two together. We are looking forward to building that and seeing where that can lead us.

Do you have any final thoughts?

Practicing medicine is pretty tough today. There are a lot of competing interests between quality and volume and reducing readmissions and shortening length of stay. The challenge for clinicians is they are expected to draw upon more data and synthesize more things than they ever have, so there’s a need for tools.

I see a future where clinical decision support will continue to advance and help professionals elevate their practice. Ultimately this is going to make patients healthier, and we’re going to all benefit from it. I wish it was as easy as replacing my car’s brake pads. I mean, that would be great. But healthcare is complex, and there’s a lot of different things that factor into getting a good outcome. But I’m very hopeful.

Morning Headlines 5/5/21

May 4, 2021 Headlines No Comments

R1 Announces Agreement to Acquire VisitPay, the Leading Provider of Patient Financial Engagement Solutions

R1 RCM will acquire digital payment solutions provider VisitPay for $300 million in cash.

Headway Raises $70 Million in Series B Funding to Unlock Access to Affordable Mental Healthcare for Every American

Headway, which matches patients with mental health therapists for virtual or in-person sessions, raises $70 million in a Series B funding round.

Provation Acquires IProcedures

Clinical documentation software vendor Provation acquires IProcedure, which specializes in cloud-based anesthesia documentation and perioperative data management.

Ciitizen Acquires Key Technology and Creates New Healthcare Data Infrastructure for Improving Patient and Doctor Information Access

Consumer health software vendor Ciitizen acquires HIE company Stella Technology for an undisclosed sum.

News 5/5/21

May 4, 2021 News 9 Comments

Top News

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R1 RCM will acquire digital payment solutions provider VisitPay for $300 million in cash.

R1’s acquisitions over the last several years have included Cerner’s RevWorks business and SCI Solutions, which it purchased for $190 million.

R1 says the acquired capabilities will allow it to lead the healthcare payments market in price transparency, flexible payment options, tailored communications, and analytics.


Reader Comments

From PitViper: “Re: attrition. Are health tech companies experiencing it? What reasons are you hearing that staff are leaving?” I’ll let readers answer whether they see this as a trend.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor NTT Data. Plano, TX-based NTT Data Services is a digital business and IT services leader, the largest division of trusted global innovator NTT Data Corporation, a top 10 provider and part of the $109B NTT Group. With the company’s consultative approach, it leverages deep industry expertise and leading-edge technologies powered by AI, automation, and cloud to create practical and scalable solutions that contribute to society and help clients worldwide. The Healthcare division within NTT Data Services is committed to improving patient outcomes by connecting the healthcare ecosystem. A recognized leader in healthcare, the global team delivers one of the industry’s most robust and integrated portfolios, including consulting, integration, interoperability, applications, data intelligence and analytics, hybrid infrastructure, workplace, RPA, cybersecurity, and business process services to help organizations accelerate and sustain value throughout their digital journeys. Thanks to NTT Data for supporting HIStalk.

I found this NTT Data overview video on healthcare digital transformation on YouTube.


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Reader Mike sent a generous donation from his COVID stimulus check to my Donors Choose project, which when paired with matching funds from my Anonymous Vendor Executive and other sources fully funded these teacher grant requests:

  • Math materials from Ms. L’s elementary school class in Toppenish, WA.
  • Acid rain test kits for Ms. H’s high school class in Cincinnati, OH.
  • Multiplication flash cards for Ms. C’s elementary school class in Oklahoma City, OK.
  • Biology and science resources for Ms. A’s high school class in Crewe, VA.
  • Dinosaur learning activities for Ms. D’s special education class in New York, NY.
  • Math games for Ms. V’s middle school class in Hosford, FL.
  • Document camera for Ms. T’s first grade class in Buffalo, NY.
  • Math games and books for summer learning kits for Ms. P’s third grade class in Tucson, AZ.
  • Math manipulatives for Ms. T’s elementary school class of autism students of Staten Island, NY.
  • 3D printing supplies for Mr. S’s second grade class in Cleveland, OH.
  • A library of 13 read-aloud science books for Ms. H’s kindergarten class in Columbus, OH.
  • Virtual whiteboards for Ms. S’s elementary school class in Indianapolis, IN.

Ms. V was among the majority of teachers who emailed their thanks almost immediately, explaining that her class has missed almost two years of in-person instruction due to Hurricane Michael and then the pandemic. She says, “Sending love and much appreciation for your support. We will start our summer program the first of June. These materials will go a long way towards helping our students recover academic loss due to Hurricane Michael, followed by the pandemic. Your support is a blessing for many. Thank you again!”


Webinars

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


Acquisitions, Funding, Business, and Stock

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Clinical documentation software vendor Provation acquires IProcedure, which specializes in cloud-based anesthesia documentation and perioperative data management.

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Headway, which matches patients with mental health therapists in 11 states for virtual or in-person sessions, raises $70 million in a Series B funding round that values the company at $750 million.

Employer health benefits manager Collective Health raises $280 million in a Series F funding round, valuing the company at $1.5 billion.

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Berkshire Hathaway CEO Warren Buffett tells shareholders that Haven, the company’s joint employee-focused healthcare venture with Amazon and JP Morgan, failed due to its inability to overcome the challenges of working with so many different stakeholders on a problem that accounts for 17% of the country’s GDP. Buffett added that Berkshire Hathaway was able to identify inefficiencies and cost savings in its own healthcare pipeline, “so we got our money’s worth.”

Allscripts seeks to sublease 56,000 square feet of the nine-story building it occupies in Raleigh, NC for which it holds naming rights. The space is not needed since CarePort Health, which Allscripts sold to WellSky, won’t be returning employees to the building.


Sales

  • Utah Navajo Health System will work with Emerge to consolidate its legacy EHR data with its Athenahealth system.
  • St. Luke’s Health System (MO) selects automated operations software from Qventus to better manage patient throughput.
  • Nexus Health Systems (TX), Grady Memorial Hospital (OK), and Duncan Regional Hospital (OK) select cloud hosting services for Meditech from Tegria companies Navin Haffty and Engage.

People

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Moffitt Cancer Center (FL) hires Santosh Mohan, MMCI (Brigham and Women’s Hospital) as VP of digital.

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Angie Stevens (Kaiser Permanente) joins Iron Bow Healthcare Solutions as chief strategy officer.

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CereCore names Paul Fabrizio (NTT Data) and Mark Rowland (Nutanix) as regional sales VPs.

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David Carr, RN (DeliverHealth) joins HC1 as executive director of high-value care.

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Palantir Technologies hires William Kassler, MD, MPH, MS (IBM Watson Health) as its first US Government chief medical officer.

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Ken Levitan, who was the CIO of Einstein Health Network from 2005-2015, is named president and CEO of that organization.


Announcements and Implementations

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CEO Coalition — founded by Vocera Chairman and CEO Brent Lang and Chief Medical Officer Bridget Duffy, MD – develops a Declaration of Principles that has been signed by 10 health system CEOs who agree to principles that improve safety, well-being, and equity for healthcare workers.

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A new KLAS report finds that non-US EHR activity was strong in 2020, with 135 net new deals and 23 migrations, although 30% less than in 2019. The biggest winners were Epic, Dedalus, InterSystems, and Cerner. Epic’s market share in Canada has grown from three hospitals in 2016 to 146 now, but migration to Meditech Expanse is becoming more common.


Government and Politics

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The State of Connecticut launches a statewide HIE dubbed “Connie.” The exchange is the fifth such project attempted over the last 14 years, to the tune of nearly $40 million. Forty-four organizations, including Hartford HealthCare, Yale New Haven Health, and the Pro Health Physicians network, have already signed on.


COVID-19

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Public health experts say that the US will probably never reach the COVID-19 herd immunity of 80% given the circulation of variants and vaccine hesitancy, but even smaller numbers will make coronavirus a manageable threat that hospitalizes and kills far fewer people. They also say that while herd immunity is a national target, disease transmission is local, and areas with lower vaccination numbers will see more spread. Meanwhile, President Biden says federal focus will shift away from mass vaccination centers to drugstores and mobile clinics in hoping to vaccinate 70% of American adults with at least their first dose by July 4.

The federal government says it will redirect COVID-19 vaccine supplies that are allocated to individual states who don’t order them to other states that want more. This variability in demand, often along political party lines, means that hospitals in low-vaccination areas will likely see a hard winter as COVID-19 infections selectively ramp back up.

FDA will reportedly authorize use of Pfizer’s COVID-19 vaccine in people aged 12-15 years as early as next week.

New York City will resume 24-hour subway service in two weeks and will also lift all capacity restrictions, including museums, concert halls, restaurants, and Broadway theaters.


Other

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Scripps Health (CA) continues to recover from a weekend cyberattack – apparently ransomware that also infected its backup servers — that forced it to divert some critical care patients, postpone appointments, and take several systems offline.

A Wall Street Journal reports says that corporate benefits executives are being overwhelmed by richly funded digital health startups for which they are the target audience. Those prospects say that too many startups are offering redundant or overpriced services and urge the companies to consider merging with others or offer deals to stand out in the crowd.


Sponsor Updates

  • Built In honors CarePort Head of Product Sara Radkiewicz with its 2021 Moxie Award.
  • Cerner publishes a new client achievement, “North Kansas City Hospital leverages Cerner technology to expedite COVID-19 vaccine distribution.”
  • A Kyruus survey finds that two-thirds of consumers think virtual care will play a role where they receive care, cost and convenience are the most common decision criteria, and 60% say their preferred method for scheduling COVID-19 vaccine appointments is online.
  • Clinical Architecture releases a new episode of The Informonster Podcast, “mCODE, CodeX, and Accelerating Healthcare Innovation – Part 1.”
  • The Cyber Pro Podcast features CloudWave CTO Matt Donahue.
  • Modern Healthcare includes Optimum Healthcare IT on its list of largest IT consulting firms.
  • KLAS rates Divurgent as a market leader for speed and matching of resources in its “April HIT Staffing 2021 Performance Report.”

Blog Posts


Contacts

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

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Morning Headlines 5/4/21

May 3, 2021 Headlines No Comments

Well’s DoctorCare Expands Billing & Backoffice Services with Proposed Majority Stake Acquisition of Doctors Services Group

In Canada, Well Health Technologies will become a majority shareholder in billing and administrative services company Doctors Services Group.

After delays, CT launches its long-anticipated health information exchange

After several failed attempts over the last decade, the State of Connecticut finally launches a statewide HIE.

Payments firm Flywire makes U.S. IPO filing public

Healthcare, education, and travel payments technology company Flywire confirms its hope of a $3 billion valuation in its publicly disclosed IPO filing.

Curbside Consult with Dr. Jayne 5/3/21

May 3, 2021 Dr. Jayne No Comments

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HIMSS invited me to complete “a quick five-question survey” regarding attendance at HIMSS21. I’m no stranger to research around user and consumer needs, so I was curious what kinds of questions they would ask. The first question was “What are you most looking forward to at HIMSS21?” Choices included: attending world-class sessions, building new relationships, finding tech solutions, reuniting with colleagues, or other.

In the past, I’ve struggled with the quality of sessions. Part of that is due to HIMSS-related factors, including the long lead time between when the submissions are due and the actual conference. Presenters can’t show off the latest and greatest when they have to declare their intentions 10 months prior to the conference. We’ll have to see what that looks like this time since HIMSS20 was canceled and HIMSS21 was pushed back. To be honest, I haven’t paid much attention to the submission process or timeline because I wasn’t sure this year’s conference was even going to happen.

The second question was about professional goals, and to be sure, “getting material for everyone’s favorite healthcare IT blog and looking for sassy shoes” was not a choice. Maybe I should have selected the “other” block and done that as a write-in, but knowing HIMSS, there was probably tracking information attached and I wouldn’t want to give up my anonymity.

The options for this question included: attaining actionable education, building peer connections, developing my career, earning CE credits, experiencing innovation, finding new partnerships, job seeking, and problem solving. I’m not sure how well HIMSS21 will be able to deliver on some of these options given the relatively small number of exhibitors and the hybrid virtual / in-person format. Not to mention that many organizations are still under travel bans. A number of my favorite CMIOs aren’t going to be able to attend in-person for that reason. Most of the big exhibitors are staying home as well.

The third question was whether we’ve booked hotels yet, which I’ve done. I’ll be staying at one of the connected conference hotels so I can minimize my time outdoors in Las Vegas in August. I’m not fond of the heat even when people remind me “it’s a dry heat” and the best people watching in Las Vegas happens after the sun goes down, anyway. There are supposed to be sessions at Caesar’s which would involve a trip outside, so it may not help as much as I thought, but I’m playing the odds as most gamblers do.

The final question was “How can HIMSS staff make your conference experience exemplary?” At this point and specific to HIMSS21, I really don’t know. It’s going to be an interesting year and we just have to keep open minds. Thinking more broadly though, HIMSS needs to consider lowing the attendance costs for individual attendees. It’s a relatively pricey conference considering the minimal return on investment for those of us who aren’t attached to institutions that are footing the bill. Plus, as we all know, nearly all healthcare costs are ultimately passed on to the patient in one way or another, and it’s really difficult to justify attending at times.

I precepted a nursing student today, and due to a relatively slow urgent care day, she didn’t get a lot of clinical experience. She did learn how to work through an EHR downtime, though, and I was grateful that we weren’t completely slammed with patients when it crashed. Fortunately, this outage lasted less than half an hour and we still had access to our PACS, so we could keep seeing patients. It was nostalgic to pull out the paper script pad, though. She also learned a fair amount about healthcare finance, as one of my clinical assistants is working on a health administration certificate and wanted to pick my brain about operational structures at for-profit versus not-for-profit organizations.

Most people that fall into the student category tend to be younger and have had fewer interactions with the healthcare system. They have not experienced the sticker shock of receiving an out-of-network explanation of benefits statement for a hospitalization and may not have had the experience of receiving multiple bills from all the different vendors and clinicians involved in a diagnostic procedure. Most people go into healthcare fields because they want to help patients, and I think understanding the sausage-making that goes on behind the scenes is critical to their education. Understanding the costs of healthcare helps them appreciate why patients may not fill their prescriptions or make the specialist appointments that we recommend.

We also had a good conversation about health insurance and how most patients have their coverage tied to their employers, which is something most students who are still on their parents’ coverage or using student health services at their universities might not understand. She was surprised to learn that sometimes patients stay in jobs they don’t like strictly because of insurance benefits and not wanting to change because of the risk of having to change to new providers or a different care team just because their coverage changes. My state requires all high school graduates to take a personal finance class, and although the curriculum covers things like homeowners’ insurance and auto insurance, there’s not much discussion of healthcare expenses. Since I’ll have some free time after I finish up my last urgent care shift on Friday, maybe I should volunteer to teach a session on understanding health insurance, how to read an explanation of benefits statement, how medical billing works, and how to navigate referrals and prior authorizations. Failure to understand those elements can have an impact on your personal finances, indeed.

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Back to thinking about educational conferences, my friends at West Virginia University are offering a seminar that seems like a much better use of limited conference dollars, focusing on point-of-care ultrasound. It’s being hosted at a resort that caters to whitewater rafting enthusiasts, and attendees can take advantage of the whitewater at the New River Gorge National Park. Having run this section of the river in 2019, I would rather be there than Las Vegas. See if you can spot me in the photo – I’m the one in the helmet.

What are your favorite conference locales? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews David Baiada, CEO, Bayada

May 3, 2021 Interviews No Comments

David Baiada, MBA is CEO of Bayada Home Health Care of Moorestown, NJ.

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Tell me about yourself and the company.

We are going on 50 years as a provider of home-based healthcare services. We are based in the Philadelphia area, in southern New Jersey. The business was started by my dad who, at the age of 27, was an aspiring social entrepreneur before the term really existed. Through mission-centered, people-oriented focus on culture, connectedness, and service, we have — little by little over a long period of time, almost entirely through organic growth — become one of the largest providers in the country, with about 30,000 employees across 24 states and eight countries.

Because of our scale in a quite fragmented industry and our diversity of services, we deliver eight different types of service, depending on where we are in the country or in the world. Our long-term orientation as an entrepreneurial, not-for-profit organization is focused on long-term sustainability and continued growth adaptation to the market. That makes us a little bit different in terms in the ways that we invest in and position ourselves to continue to make an impact in the communities we serve.

What is changing about home health and the involvement of health systems in it?

While the delivery of services in the home is clearly not a new phenomenon, the societal attention and perpetual reflection on safety and health at home has been clearly spotlighted over the last 12 to 14 months. Never has there been a time where literally every single American is staring at the TV every night thinking about, how do I stay safe and healthy in my house? 

That has created a bit of an awakening for the healthcare industry. Maybe we can deliver a high-quality service at scale at a lower cost in the place that people prefer, which is their living room or their home versus an institution, where appropriate. Maybe we can use technology to deliver certain types of services and interventions virtually or by video.

All of these things are not new. We’ve been working in the home for centuries. We have been delivering remote monitoring and virtual care for a decade or more. But the last 14 months clearly have created a bright spotlight on the power and opportunity that exists with the things that we can do in the home.

What impact did the pandemic have on the home care model and on your business?

The most important thing we saw is the validation that these amazing people — nurses, therapists, home health aides, and others who have chosen a profession to take care of people in the community — rose to the occasion. They are used to walking into the unknown, whether it’s COVID-19 or any other type of illness or environment. Clinicians that have chosen this profession rose to the occasion, and it was super inspiring to watch people, when appropriately prepared with PPE and clear protocol, walk into the unknown and navigate whatever was necessary to take care of people, whether it’s the thousands of COVID-positive patients that we took care of or the unknown of what was happening in that home related to risk and potential infection or otherwise.

The business implications were all over the map. The biggest implication is that volumes are up and down for different parts of the country with infection rates. That created, and continues to create, a wet blanket of ambiguity and unpredictability of what might happen tomorrow with protocol and infection risk. Then you compound that with the ambiguity, complexity, and unpredictability of what’s happening in their personal lives, with their kids and families, school, travel, and all these other factors. Ambiguity and unpredictability has been a major force, not just in our organization, but in our lives more broadly.

Does scale help you recruit and retain employees for the hard job of going into the homes of clients, especially given the reimbursement challenges?

We have dealt with cycles of shortages in different labor markets, whether it’s geographic or different types of workforce, for decades. We have now clearly entered a phase where the cycle is no longer a cycle, it’s a perpetual of supply shortage. The demand for our services — along with other macro factors like population, demographics ,and aging – has taken us into a cycle of permanent shortage for all types of in-home care delivery, nursing and home health aides in particular.

We are spending a lot of time, using our scale as you alluded to, to differentiate as an employer, to be more sophisticated in how we find people and how we create opportunity for them. We have a diverse, large organization with lots of different types of services, which creates lots of opportunities for people that are interested in doing new things, trying new settings, and picking up new skills. Our scale helps with that for sure.

But a lot of this is about figuring out how to create an environment in which people feel supported and engaged so that they stay. That really is a part of how we think about this challenge, which again is no longer a cycle. The demand for our services will continue to increasingly outstrip the supply of caregivers for decades, so this is the heart of the matter for us.

What services or technologies could help family members who unexpectedly take on the role of primary caregiver?

Virtual care and remote monitoring are a huge opportunity for family caregivers. It reduces the burden of having to get to a doctor’s appointment and creates the ability to monitor signs and symptoms proactively to avoid risk. There’s lots of incredible technology that is emerging and being adopted more quickly in sophisticated ways for both virtual care and remote monitoring. That’s a huge benefit to the family caregiver.

Another example is what I will bucket as care coordination and transparency tools. We have worked with, and continue to work with, a lot of partners to experiment around how to make it easier for family caregivers to understand what’s going on and why and the interaction of all these different silos in the healthcare system. Everything from scheduling of appointments to messaging with providers to history and medication reconciliation. There’s just so much to manage when you have a sick, at-risk, or vulnerable parent or loved one. If you have ever had to navigate the system, it’s really complex, and some of the technology and tools out there are trying to break down that complexity and simplify it for the family caregiver. I think they are making an impact.

What levels of integration, continuity of care, and accountability are you seeing between hospitals and home care organizations?

It has been emerging for a while, but in the past 18 months and certainly the last 12, the dialog in the health system boardroom around the strategic importance of home and community-based care delivery, the extension of the health system’s brand into the home, the seamlessness of the transition from acute to home — it’s moving way up the strategic priority list. You are seeing a lot of health systems say, we need to be really good at this. Some, to the extreme, are saying, we are going to start reducing inpatient beds over time.

All this is part of a broader shift, too. Payment could unfold over time where health systems are taking on an increasing percentage of the risk dollar, in which case when at risk for total cost of care, they are now properly incentivized to think creatively about how non-acute or less-expensive remote, virtual, and home-based care can help them create better experiences and better outcomes at a lower cost. We have a whole channel, a joint venture of structures with health systems that are designed specifically in this context. How do we jointly own home and then Bayada-managed home-based care delivery capabilities for a health system to give them instant access and continuous innovation around best-in-class, world-class, home-based care?

What new technologies are important to your business?

What I like about what’s happening in the market, and this spotlight on the importance of home-based care in the continuum in an increasing way, is that it is inviting a lot of capital and innovation to the challenges we face.

When we talk about challenges related to health system integration and extension of their capabilities into the home, one of the most fundamental challenges that health systems face — and it has an impact on Bayada as a home-based provider — is how a transition works. How do you coordinate someone’s transition from a hospital bed to their living room and all of the steps and coordination that happens along the way? They may have a stop at a skilled nursing facility. They may need new medications, but they have no transportation to get them. They may need coordination and conversations between multiple specialists.

All these things happen in silos. You are constantly repeating lots of different information to different people in the system. Platforms like Dina’s care-at-home platform and network are trying to create seamless transitional care, and that provides benefits to the patient and their family. They get empowered with an understanding of what’s happening. It has benefits to the health system that is trying to ensure that this person has a path home in a timely way. It has benefits to us as a home-based provider, because we then are empowered with historical information context before we enter the house, which helps us create a better service and keep them safe at home, which then ultimately creates a virtuous cycle because we’re avoiding unnecessary readmission and other types of further risk.

Dina is a great example of solving a complex but straightforward problem. When someone arrives at a hospital, how do you make sure that the transition out of the hospital back to home with any steps in between happens in a way that’s actually productive versus super frustrating?

What impact are you seeing from private equity’s increasing investment in healthcare, especially in home care, long-term care, and hospice care?

Our industry was, for a long time, a textbook definition for a cottage industry — highly fragmented, mostly local and small proprietor-owned or not-for-profit organizations. When sophisticated investment and capital comes into an industry, it usually increases the level of competition, which hopefully means that the services and the quality of services goes up for the patient, for the end user. It’s probably too early to tell about how that impact will play out, but in general it is drawing a lot of attention.

Also, third-party investors, financial sponsors like private equity firms, have a lot of relationships and a lot of credibility. The ability for them to put money to work to innovate, but then also put relationships to work to help ensure that those that control the funding and that control the future of healthcare delivery and regulation have adequate visibility and exposure to the power of home-based care. That’s a benefit. A rising tide raises all boats. This is a huge industry with a lot of people that are vulnerable and need a lot of help, and the more sophisticated, competitive innovation, the better.

What changes do you expect in home care over the next three to five years?

The percentage of healthcare services that can be and will be reimbursed and supported from a regulatory perspective to be delivered in the home will continue to increase meaningfully. That will be empowered by better capabilities from organizations like ours. Better technology that makes this delegation of services more palatable, which would include things like virtual care delivery and telemedicine, et cetera. Then ultimately it will be made possible by regulatory evolution and adequate reimbursement. Home care has been an underfunded segment of the system, and to empower scalability of some of this innovation that will enable increases in home-based care for the appropriate types of services, regulatory and reimbursement structures have to evolve, too.

Ultimately, the outcome is that a higher percentage of services will be delivered in the home than they are today, which ultimately is what’s right for the patients as their preferred setting with better outcomes and lower costs.

Morning Headlines 5/3/21

May 2, 2021 Headlines No Comments

Miami-Based CareCloud Health, Inc. Agrees to Pay $3.8 Million to Resolve Allegations that it Paid Illegal Kickbacks

CareCloud will pay $3.8 million to settle a lawsuit that was brought by an employee whistleblower who said the company paid kickbacks to its users to gain referrals to boost its EHR sales.

Scripps Health targeted by cyberattack

A cyberattack over the weekend forces Scripps Health (CA) to divert some critical care patients, postpone appointments, and take its patient portal offline.

VA Explores Potential Future Emerging Technology-Centered Acquisitions

The VA posts a request for information for partnerships in a variety of innovative technologies that could be applied to areas that include emerging technology to transform clinical care delivery and advanced clinical decision support.

Ascension Technologies to lay off 651 out-of-state workers

Ascension Technologies will lay off 651 out-of-state IT employees between August 8, 2021 and December 10, 2021 as it outsources their jobs.

Monday Morning Update 5/3/21

May 2, 2021 News No Comments

Top News

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Miami-based CareCloud will pay $3.8 million to settle a lawsuit that was brought by an employee whistleblower who said the company paid kickbacks to its users to gain referrals to boost its EHR sales.

The United States joined the suit, alleging that CareCloud’s Champions marketing referral program violated the False Claims Act and Anti-Kickback Statute by offering clients cash and credits to recommend its EHR to prospects. Those clients also signed agreements to not say anything negative about the company’s EHR.

The government says the company violated the False Claims Act because the kickback payments rendered false Meaningful Use and MIPS incentive payments.

Former CareCloud manager Ada de la Vega will receive $800,000 of the settlement as the filer of the qui tam lawsuit.

Publicly traded health IT software and revenue cycle management vendor MTBC acquired CareCloud for $40 million in January 2020, then renamed itself to CareCloud in March 2021.


HIStalk Announcements and Requests

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Most poll respondents hold ownership or shares of a health IT-related company, most of those involving a present or former employer.

New poll to your right or here: Which information would you accurately provide to gain access to a vendor’s white paper? (multiple answers OK). I did a similar poll years ago and given that 75% of respondents said they would either leave immediately or enter phony info, I confirmed my suspicious that making prospects complete a bunch of fields to gain access to a white paper or webinar is a big mistake no matter what the marketing folks think.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Vocera announces Q1 results: revenue up 20%, adjusted EPS $0.09 versus –$0.14. VCRA shares are up 96% in the past 12 months versus the Dow’s 39% rise, valuing the company at $1.2 billion.

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Spok announces Q1 results: revenue flat, EPS –$0.12 versus –$0.24. SPOK shares are unchanged in the past 12 months versus the Nasdaq’s 57% rise, valuing the company at $199 million.

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From the Allscripts earnings call:

  • The company sold one new Sunrise client in the quarter, Mercy Iowa City.
  • President / CFO Rick Poulton says bringing in consultants a year ago to scale back company costs is paying off.
  • The company expects to focus on cost in its core clinical and financial solutions, and even though it’s not a high-growth market, it expects to be a net winner.
  • Allscripts expects new business to nearly exclusively involve cloud-based systems, as on-premise customers will probably move to cloud hosting in the next 18-24 months.
  • CEO Paul Black says that Microsoft is getting into healthcare in a big way and customers will be interested in being able to implement cloud-based AI and voice capabilities more quickly as a result.
  • Asked about drug companies buying EHR advertising based on the company’s Veradigm business, Black said that Practice Fusion taught Allscripts about what kinds of advertising and clinical decision support was OK or not OK. He added that it’s easier to push ads with Practice Fusion than the company’s other EHRs because it is cloud based, but overall a big part of buying Practice Fusion was learning more about selling drug company advertising. The company also says that it sees opportunities to create revenue from users of its personal health records. 

The Global X Telemedicine and Digital Health ETF is up 3.3% in the past month versus the Nasdaq’s 6.3% increase. It’s up 27% since its July 2020 inception, lagging the Nasdaq slightly.


People

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Protenus hires Jay White (Blackboard) as VP of engineering.

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Loyal names Rachelle Montano, MS, MBA, RD (Perficient) as VP of clinical strategy.

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In England, NHS Digital names Simon Bolton (NHS Test and Trace) as interim CEO. He replaces Sarah Wilkinson, MBA, who will leave the role in June.


Government and Politics

The VA posts a request for information for partnerships in a variety of innovative technologies that could be applied to areas that include emerging technology to transform clinical care delivery advanced clinical decision support, clinical simulation training, and service transformation through design thinking.

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CloseLoop.ai wins CMS’s Artificial Intelligence Health Outcomes Challenge, which includes a prize of up to $1 million. Geisinger finished second and will receive up to $230,000. The contest looked at AI solutions that can predict health outcomes for Medicare beneficiaries.


COVID-19

CDC reports that 56% of US adults have received at least one dose of COVID-19 vaccine and 40% are fully vaccinated.

India becomes the first country to exceed 400,000 new cases in a single day, also experiencing a 21% test positivity, full hospitals, and a vastly understated official daily death toll of 3,500 that will surely increase as a lagging indicator of widespread infection. President Biden joined several EU countries in restricting travel from India starting this week as experts worry about introduction of new coronavirus variants such as B1617.

Turkey goes into its first COVID-19 lockdown as its infection rates reach the highest in Europe, while Iran’s daily death toll hits highest-ever numbers. Brazil continues to record the world’s highest rate of COVID-19 deaths per million people. Global COVID-19 cases and deaths have risen for several straight weeks even as Western countries with high vaccination numbers trend down and begin a return to normal.

The federal government implements an easy way for people to find available COVID-19 vaccine – text a ZIP code to 438829 (“getvax” on the phone keyboard) and a list of locations is immediately returned. Vaccines.gov has also been relaunched to make finding COVID-19 vaccine easy.

Pfizer will ship COVID-19 vaccine to Canada starting this week from its Kalamazoo, MI plant, which also sends doses to Mexico. 


Other

Epic’s campus was running on 18 backup generators for a few hours Friday night a widespread, raccoon-caused power outage occurred on Madison’s west side.

In India, private hospital beds in Bangalore are being overbooked because of problems with the government’s software, forcing them to turn away patients who in some cases have died shortly after of critical medical problems.

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Ascension Technologies files WARN act paperwork with the state of Missouri indicating that it will lay off 651 out-of-state IT employees between August 8, 2021 and December 10, 2021 as it outsources their jobs.


Sponsor Updates

  • Experity publishes a new report, “The Effect of COVID-19 on Reimbursement in 2020.”
  • Spok Go improves emergency department outcomes at TidalHealth.
  • Mozzaz will integrate Jvion’s AI insights on modifiable clinical risk and social determinants of health into its virtual care platform.
  • Krames takes home 34 Hermes Creative Awards.

Blog Posts


Contacts

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

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Weekender 4/30/21

April 30, 2021 Weekender No Comments

weekender 


Weekly News Recap

  • Vocera acquires PatientSafe Solutions.
  • Halma acquires PeriGen.
  • Allscripts Q1 beats on earnings, misses on revenue.
  • Caresyntax raises $100 million.
  • Lyniate acquires Datica’s integration business.
  • VisuWell fires its CEO over a video showing his altercation with a male teen who wore a dress to their prom.
  • J2 Global will split into two publicly traded companies, one being its Consensus EFax business.
  • Accolade will acquire PlushCare for $450 million.

Best Reader Comments

I have experience with Dell offshored health IT staff. All I can say is that you get what you pay for. If you want to pay 1/4 for folks that really don’t understand what you are getting at and then re-do it because of said lack of comprehension, then it’s a good model. Half my job is interpretation between clinicians that have needs but don’t really “get” the system, and the techies who can’t grasp why solution XYZ won’t fit the needs of that clinician. Add a foreign culture and language in the middle, and it’s complicated. (PennyWisePoundFoolish)

Why would we let anyone else dictate anything around our patient experience? We required the tele platform to give us a webpage that we host and can then use it to serve up our own patient educational material and other messaging. Plus, we actively monitor to ensure that the patient isn’t spending any meaningful time on the “waiting room” page. Patient experience has to be valued and protected! (DA)

I don’t think consumer driven is even needed, just competition. For a starting point, the ACA exchange in New York State is as competitive as the health insurance marketplace can be. There is even a pretty legally simple model to scale it up. Take away tax subsidies for employer provided healthcare, make any healthcare benefits transferable to the exchange (like the Harris plan), then provide large income based subsidies for purchases on the exchange. Low wage employers will jump at the chance to shift the healthcare responsibility into the state. High income earners and unions won’t fight it since it is providing another option for them rather than taking something away. Employers will eventually stop offering core health insurance as a benefit and everyone will purchase their plan on the market. It isn’t the best outcome ever but it is competitive and it is achievable. (IANAL)


Watercooler Talk Tidbits

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Readers funded toe Donors Choose teacher grant request of Ms. H, who asked for math flashcards and unifix cards for her third-grade class in the Central San Joaquin Valley of California. She reported in November, “This 20 year veteran teacher became a first year teacher all over again this year through the implementation of distance learning. This has been the most challenging time in teaching that I have ever experienced. One of the biggest hurdles I’ve had has been finding creative ways to engage children in online learning. Any teacher worth their salt knows that math manipulatives are a key component to a successful math lesson with young children. The stackable counting cubes that I was purchase with your donation have been such a gift. The kids love having something familiar and fun to ‘play’ with and I love that we have been able to use the cubes to teach place value, regrouping, and now multiplication and division. I also love that it allows the kids to handle something besides their computer for a little while.”

Joe Rogan, who was accused of being reckless in telling tens of millions of his podcast listeners that young, healthy people don’t need to receive COVID-19 vaccine, clarifies that he is not qualified to offer medical advice: “I’m not a doctor. I’m a f_ing moron.” He says he’s aware that the vaccine protects other people as well as the recipient, but says “that’s a different conversation.”

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A doctor in India urges people to get vaccinated while showing the sweaty effect of wearing PPE for 15 hours of rounding. 

A nurse sues Normal Regional Hospital (OK) for firing him for posting on Facebook that a black murder suspect should be hung. The nurse says he isn’t a racist, and in fact some of his best friends are black, and that he was fired because he’s a Republican.

In Texas, the mother of a two-year-old girl who has been hospitalized for most of her life with a heart condition wages a legal battle with the hospital over stopping care it says is futile because she will never recover. The state has spent $24 million in Medicaid funds on her hospitalization.

The New Yorker describes the lonely job of medical interpreters, who work from their homes in translating conversations often involve end-of-life decisions related to COVID-19, sometimes with patient family members who live in other countries. 

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The government of Japan responds to the concerns of a nurse union about the medical resources that will be consumed by the daily testing of athletes in the 2020 Summer Olympics in Tokyo, whose year-delayed start is July 23. Japan has vaccinated just 1% of its citizens and 75% of residents don’t think the Games should be held this summer. Officials will decide in June whether spectators will be allowed.


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Morning Headlines 4/30/21

April 29, 2021 Headlines No Comments

Vocera to Acquire PatientSafe Solutions

Clinical communications and workflow platform vendor Vocera will acquire PatientSafe Solutions, which offers a unified inbox of messages, alerts, and notifications that is integrated with EHR data.

Perinatal Safety Company PeriGen, Inc., Acquired by Halma plc, a Global Group of Life Saving Technology Companies

UK-based Halma acquires perinatal safety technology vendor PeriGen.

CVS Health launches $100 million venture fund

CVS Health launches a $100 million venture fund that will invest in early-stage companies that are “focused on making healthcare more accessible, affordable, and simpler.”

Privia Health Shares Pop On First Day Of Trading

Shares of national medical group and practice support technology vendor Privia Health closed Thursday with an IPO-day share price jump of 51%, valuing the ownership stake of parent Brighton Health Group at $2.75 billion.

News 4/30/21

April 29, 2021 News 11 Comments

Top News

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Clinical communications and workflow platform vendor Vocera announced after Thursday’s stock market close that it will acquire PatientSafe Solutions, which offers a unified inbox of messages, alerts, and notifications that is integrated with EHR data.


Reader Comments

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From Descension: “Re: Ascension. EHR is the latest to be outsourced, but not the last. Best part is that they told us they are doing it to help the poor and vulnerable, not to save money. Is it time for me to find another career since it’s tough all over and outsourced offshore health IT is the future?” I’ll invite readers to weigh in on that latter question. I honestly don’t know. While it seemed inevitable, absent major user pushback, that most technical support would be shifted to cheaper offshore providers, I wasn’t so sure about specialized areas such as EHR support. The pessimistic view is that the old saying was right – if your job doesn’t involve touching something, plenty of people outside the US would be thrilled to do it cheaper and maybe even better. Ascension is running a billion-dollar quarterly profit as its contribution to the US’s world-leading healthcare costs that make our workforce non-competitive in the first place. On the other hand, sometimes health systems that are looking for “one neck to wring” elect to indeed wring that neck by insourcing everything back in-house down the road.

From Cond-Ascension: “Re: Ascension. Has outsourced IT, starting a while back with contact center and desktop support, now all application and EHR support. EHR support is considered a non-strategic commodity to Ascension now. Folks are being asked to stay until August, where they will probably need to apply for jobs to earn severance. Ascension allows a 10% pay reduction as a suitable offer when a role is eliminated. Tons of great talent will be flooding the market.” Anyone who is looking for Epic people should pay attention.

From CIO: “Re: VisuWell firing their CEO. The actions of the former CEO were obviously atrocious on any number of levels, but VisuWell did everything a company could do. The acting CEO and board chair got on the phone with the CMIO and me to make sure we understood what they were doing, then followed up yesterday to make sure we had everything we need and were completely understanding about us taking any action we thought we needed to. I can’t think of anything else they could have done short of inventing a time machine. We aren’t changing our relationship with them, and in fact chose them initially because we felt they were a better fit in dealing with a diverse patient population than some other vendors.”

From We Aren’t the Champions: “Re: WaitButWhy. What do you think about its most recent post? It seems like an overly optimistic exercise to get something like this off the ground, especially in the US, much less to have it succeed for the long term. I’m in Canada and there’s no chance of provinces paying for comfy chairs or coffee in the waiting room.” The article, which is titled “Why going to the Doctor Sucks,” calls out limited appointment times, unfriendly front desk employees, making patients write the same information on the same clipboard forms every visit, and doctors running behind and shortchanging patients whose appointment is late in the day. It concludes that in the US healthcare non-system, patients aren’t treated like customers because they actually aren’t customers, so cold interactions and indifferent waiting areas echo the DMV or post office. The author’s wife and a friend (non-physicians) decided to start a $2,400 per year, no-insurance primary care club in which members are assigned a doctor, a wellness advisor, and a concierge coordinator. My thoughts:

  • I already have this concept covered in my direct primary care doctor’s practice. I pay $75 per month to have direct access to her at all times (phone, mail, text, video, etc.), appointments are quickly available and booked for 30 or 60 minutes of uninterrupted time, in-office lab testing is included, she can provide prescription medications at cost, and simple procedures carry no extra charge. These no-charge extras save enough of my deductible alone to more than cover her annual fee.
  • I keep my health insurance  to cover specialists, ED, hospitalization, etc. that might come up, of course, but I haven’t seen a PCP using my insurance for several years. 
  • I don’t know what my doctor’s waiting room looks like because I’ve never seen one. She meets me at her office’s front door, we walk to the exam room, and we talk face to face with no keyboard between us. I’m the customer, so she will provide advice on whatever I need – exercise, stress, and diet are listed on her website. But she won’t just prescribe something because I ask for it (I don’t ask because I don’t like taking meds unnecessarily, but she made that clear upfront).
  • Quite a few investor-backed companies are placing big bets on practices – both general primary care and specific to Medicare beneficiaries – that feature better creature comforts, a more customer-friendly environment, and more convenient access.
  • These models are better for the doctor, who doesn’t need to jam their schedule full, practice substandard but profitable medicine, bow to corporate overlords like health system executives and insurers, and get stuck with patients who just want drugs. You can do the math – if my doctor has 500 members, she takes in maybe $40,000 per month of all-recurring revenue (cost varies by age), has minimal overhead, and can use just the tiny portion of EHR functionality that actually benefits the patient and her. She has to be careful about patient mix since having all Medicare-aged patients could require too much work, but she is allowed to set her panel any way she wants.
  • Here’s the beauty of the screwed-up system we have. Neither patients nor doctors like it and it is so wastefully expensive that it it’s easy to find enough cost savings in a new model so that neither pays more. Those corporate overlord middlemen I mentioned are bureaucratically inclined and thus ripe for disruption, and while the cash-only membership system excludes those who don’t have the resources to pay on their own, it assures equal treatment among those who do (and leaves assistance programs for those who need them most). Our suits-to-scrubs ratio makes fat-trimming easy.

Webinars

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


Acquisitions, Funding, Business, and Stock

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UK-based Halma acquires perinatal safety technology vendor PeriGen. Halma, which operates many brands in the safety, environmental, and medical sectors, acquired healthcare location services vendor CenTrak in early 2016 for $140 million.

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Allscripts announces Q1 results: revenue down 3%, adjusted EPS $0.19 versus $0.02, beating earnings expectations but falling short on revenue.

Castlight Health announces Q1 results: revenue down 10%, adjusted EPS $0.01 versus –$0.01. CSLT shares are up 140% in the past 12 months versus the Dow’s 40% rise, valuing the company at $288 million.

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Surgery analytics vendor Caresyntax raises $100 million in a Series C funding round.

CVS Health launches a $100 million venture fund that will invest in early-stage companies that are “focused on making healthcare more accessible, affordable, and simpler.” The company cites previous success in its direct investments, such as Unite Us and LumiraDx.

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Shares of national medical group and practice support technology vendor Privia Health closed Thursday with an IPO-day share price jump of 51%, valuing the ownership stake of parent Brighton Health Group at $2.75 billion. CEO Shawn Morris holds shares worth $144 million.

Online pharmacy operator Capsule raises $300 million in a funding round that values the company at more than $1 billion. The pharmacy fills and delivers prescriptions in six cities.


Sales

  • Orange County, NC selects Everbridge’s vaccine distribution platform.
  • UK’s Guy’s and St. Thomas NHS Foundation Trust will use Nuance Dragon Medical One to support its Apollo service transformation project, integrated with Epic.
  • Cigna will offer virtual mental health services to its behavioral health members from Ginger, of which Cigna is an investor.
  • Seattle Children’s moves its Epic system to the healthcare cloud of Virtustream, which is owned by Dell Technologies.
  • American Health Communities will implement live video consults for residents of 28 skilled nursing facilities in Tennessee using videoconferencing, live bio-analytics, and instruments from Let’s Talk Interactive.

People

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Tonya Hongsermeier, MD, MBA (Lahey Health) joins Elimu Informatics as VP / chief clinical innovation officer.

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NTT Data hires Michael Petersen, MD (Accenture) as chief clinical innovation officer.


Announcements and Implementations

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Omnicell’s EnlivenHealth division will use Twilio’s customer engagement platform to expand its retail pharmacy offerings that include personalized communication by IVR, texting, chatbots, email, and a mobile app.

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AHIMA creates DHealth, a catalog of digital health products whose developers have attested that they meet security and privacy standards. 

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The US Army’s General Leonard Wood Army Community Hospital (MO) goes live with MHS Genesis / Cerner, the first facility to use the system for in-processing of newly arrived trainees. Above is Major Cynthia Anderson, chief nursing information officer, overseeing use of the mass readiness module that was developed for military medicine and is used at GLWACH to process 100 trainees per hour.

A small interview-based study of VA facilities looks at why timely follow-up on abnormal test results doesn’t always happen:

  • Rotation of medical residents, who may be sent results after they have left.
  • Lack of ownership of secondary findings.
  • Providers ignoring or not seeing EHR alerts with no standardized follow-up defined.
  • Lack of current contact information on file for the patient.
  • Communications breakdown caused by referrals to another facility.
  • Providers covering for each other.
  • Uncertain responsibility for reviewing results that were pending on discharge.

COVID-19

A new, small study finds that COVID-19 vaccines manufactured by Pfizer and Moderna are 94% effective in reducing COVID-associated hospitalization of those who are over age 64.

California’s COVID-19 case rate is now the lowest in the country.

Some experts say that President Biden missed a chance to reduce vaccine hesitancy in his Wednesday address to a joint session of Congress, where audience members were spaced, masked, and asked not to make physical contact. A better approach, some say, would have been to allow only vaccinated attendees and then permit them to behave in a 2019-like manner to send the message that vaccination can end the pandemic and return life to normal.

Pfizer expects to release a protease inhibitor for experimental use in treating early-stage COVID-19 by the end of the year, potentially keeping people with early symptoms out of the hospital.

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The Public Health Company — which will advise businesses, providers, and public health organizations on public health issues using data, containment best practices, and genomic epidemiology – launches with an $8 million seed funding round. Its scope includes, beyond COVID-19, healthcare-acquired infections, antimicrobial-resistant infections, and foodborne infections. The co-founders are a California public health physician executive and a former Goldman Sachs partner. The business case involves the cost of avoidable business interruption, including supply chain and labor issues.


Other

A University of Missouri study finds that nurse workload is doubled when patients are seen in virtual visits rather than in-office appointments, as nurses have to review, document, and act on blood glucose and blood pressure readings multiple times each week instead of the average in-person visit frequency of every three months.

China’s government is considering allowing prescription drugs to be sold online, which a state-controlled magazine says is a warning shot to public hospitals that profitably overprescribe drugs, including IV drips and antibiotics. The article notes that the government tried to fix the problem in 2017 by mandating that doctors and hospitals sell drugs to patients at their cost, but the providers wormed around that requirement by manipulating cost data and retaining rebates. The country does not have a system to make prescriptions universally accessible and Internet-based sales raises issues of prescription authenticity and supply chain safety. 


Sponsor Updates

  • Medicomp Systems releases a new “Tell Me Where It Hurts” podcast, “Reimaging Healthcare Through NLP.”
  • Meditech offers a new case study, “How Meditech and Interlace Health support integrated electronic patient consent.”
  • KLAS recognizes GetWellNetwork as a top-performing vendor for COVID-19 response.

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 4/29/21

April 29, 2021 Dr. Jayne No Comments

The big news around the virtual physician lounge this week is the decline in COVID-19 vaccination rates. President Biden is pushing for small businesses to make use of tax credits to support paid time off for employees seeking vaccination.

At this point, anything we can do to incentivize people to become vaccinated is welcome. The more the virus continues to spread, the more it can mutate, which counters the progress we’ve made. Some employers understand this. Supermarket chain Kroger has offered cash incentive payments for employee vaccinations, as has hospital Houston Methodist and several health systems. Some decry this as coercion, but the reality is that someone won’t get a vaccine if they really don’t want one, based on a $100 cash payment. The incentives are also rewarding those who do the right thing, as additional vaccinations help strengthen the workforce and reduce burden on co-workers.

I remember when I received my first vaccine, we thought it would really be something if we got a million doses in arms. That would really be an indicator of safety and effectiveness. Now that we’re at the 200 million dose point, it’s clear that the risks of the vaccines are minimal. Even with the questions around the Johnson & Johnson vaccine and the potential for increased blood clots, these vaccines are remarkably safe and effective. Based on what I’ve seen with the COVID-19 illness in my patients, the vaccine is much more desirable. On the home front, I’m just waiting on a couple of second doses within my family, and then I’ll really be able to breathe a sigh of relief. It’s been a long year, for sure.

Healthcare workers have been at the tip of the spear, not only fighting the pandemic, but also dealing with increasing numbers of unstable patients and sometimes public hostility. The Journal of the American Medical Association published a recent article on “Navigating Attacks Against Health Care Workers in the COVID-19 Era.” Initially, health workers were on the receiving end of discrimination as well as violence. Several colleagues were asked not to attend church or told that their children couldn’t participate in activities because they were potentially in contact with COVID-19 patients. There are also social media attacks – I’ve experienced them personally, although what I’ve encountered has been on the mild side compared to that experienced by others.

During my career, I’ve experienced patients ranging from “creepy stalker” to verbally abusive to downright threatening. Fortunately, the only physical threats have occurred within the hospital emergency department, so I had security staff at the ready. Still, there’s always that worry that a disgruntled patient or drug seeker will be waiting for you at the end of your shift. Hospitals and larger facilities may have security staff that can help mitigate this risk, but for healthcare workers in small practices or isolated environments, we’re pretty much left with the buddy system to help keep each other safe.

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Uber sent me an email this week, inviting me to schedule my COVID-19 vaccine at a nearby Walgreens through the Uber app, while also being able to book a ride. Of course there were caveats about vaccine availability and whether Uber Reserve service is available in my area, but it’s still a good option for people who might not otherwise be able to get a vaccine scheduled. In my area right now, there is an overwhelming surplus of vaccines and a lot of hesitancy, so anything that gets people to think about the process is okay in my book.

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I was excited to hear that Meditech is integrating genomics into its EHR. If you are an EHR vendor thinking about incorporating it, there are some serious options not only for documenting the data for how they enable clinicians to use it. The most basic need is to be able to document specific genes that patients have in a discrete fashion so that they can be used by clinical decision support algorithms. That’s critical for those genes associated with diseases where the mere presence of the gene changes the need for preventive screenings or management. Systems need to be able to track what type of genes are present, whether they are sex linked or not, and whether patients have a single copy or two copies of a given mutation. They also need to be flexible enough to manage new discoveries, such as when a gene is found to have a new level of clinical importance.

For its Expanse Genomics solution, Meditech is partnering with First Databank. To be honest, I didn’t know how far First Databank had gotten into the world of genomics. I always enjoy stopping by the FDB booth at HIMSS and remember vaguely hearing about them moving into pharmacogenomics. Certainly, some specialties are going to be more drawn to the value of integrating genomics than others. Many of my primary care colleagues are concerned about being able to keep up with the basics of making sure all their patients are receiving preventive screenings and that diagnoses are managed optimally, let alone being able to manage the impact of genomics on precision medicine.

I was particularly excited to hear about the Expanse solution being able to import genomic data and integrate it into the patient record in what sounds like a discrete fashion. My own recent genomic results are sitting in a PDF within the chart and aren’t even accessible to me as a patient through the patient portal. My physician was supposed to mail me a copy (snail mail – shocking, I know) but the results never arrived, so they did send me a PDF version. Good thing, since when I look in the patient portal, it just says “see outside report.” If my physician’s EHR can’t even display the results, there’s no way it can use them to tell me how often I should get a colonoscopy or how my risk changes depending on what is found during the procedure.

It will be interesting to see how long it takes other EHR vendors to get on board with a similar solution, as well as how long it will take existing Meditech clients to embrace the new content.

How is your system currently handling genomics? Leave a comment or email me.

Email Dr. Jayne.

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Reader Comments

  • Vikas Chowdhry: Will AI (I prefer the term Machine Learning - ML) magically fix all the incentives that have been created in the US heal...
  • Brian Too: I dunno. Seeking an answer in AI for America's healthcare woes seems a little desperate. LIke, adding one magic new in...
  • meltoots: You forgot that politics will have to be programmed in your AI. On both sides of the aisle, misinformation, doing things...
  • IANAL: So what should Cerner do though? They have some market issues because the largest potential or current customers have at...
  • Ghost of Andromeda: That's exactly the opportunity here! Cerner is struggling and could really use someone who knows how to execute with dis...

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