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News 4/7/21

April 6, 2021 News 1 Comment

Top News

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The Indian Health Service seeks help from industry stakeholders with drafting a strategic plan to guide its IT efforts over the next three to five years.

The agency is in the midst of upgrading its IT infrastructure. It will use $140 million of COVID relief funds to bolster its telemedicine and EHR systems.


Reader Comments

From Inchoate: “Re: Therapy Brands. Just acquired by KKR. It is the parent of TenEleven and 18 other behavioral health-focused companies.” Unverified. The 19 companies owned by Therapy Brands sell behavioral health EHRs and systems for practice management, data collection, and electronic prescribing. CEO Kimberly O’Loughlin, MS joined the company in February 2020 after serving as president of Greenway Health.


HIStalk Announcements and Requests

Someone tweeted — and then apparently deleted —that they were annoyed by meeting organizers who omit time zones in assuming “EST” (their term). If you’re going to get preachy about time zone assumptions, be aware that it’s “EDT” rather than “EST,” implied or otherwise, for nearly eight months of the year unless you’re in Arizona or Hawaii. My annual public service announcement for the time zone impaired — just write “ET” and those of us who have a handle on it will translate for you, which is much nicer for you than appearing to be incapable of basic communication. The most entertaining aspect of social media is when people try to show off how smart they are, but create the opposite result.


Webinars

April 21 (Wednesday) 1 ET. “Is Gig Work For You?” Sponsor: HIStalk. Presenter: Frank L. Poggio, retired health IT executive and active job search workshop presenter.  This workshop will cover both the advantages and disadvantages of being a gig worker. Attendees will learn how to how to decide if gig work is a good personal fit, find the right company, and protect themselves from unethical ones.

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


Acquisitions, Funding, Business, and Stock

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Medical billing and patient communications startup Inbox Health raises $15 million in a Series A funding round.

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Minnesota insurance and managed care startup Bright Health acquires Zipnosis, which offers telemedicine services to health systems.


People

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Craig Miller, MBA (Culbert Healthcare Solutions) joins Newfire Global Partners as chief of staff.

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PatientBond hires Todd Helmink (QliqSoft) as SVP of business development.

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Brian Roy, MBA (HMS) joins ZeOmega as RVP of sales.


Announcements and Implementations

3M Health Information Systems announces GA of Social Determinants of Health Analytics, which enhances its Clinical Risk Groups with social risk intelligence from social risk analytics vendor Socially Determined.

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Verizon Business launches telehealth software for providers as part of its BlueJeans secure video conferencing service.

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A KLAS Arch Collaborative report finds that the manner in which health systems implement and support EHRs is a bigger driver of physician and nurse EHR perception than the vendor’s own delivery of functionality and support for quality care. It cites OrthoVirginia, whose efforts to improve the EHR experience of orthopedic physicians increased their “Epic is a high-quality EHR” opinion from 49% to 81% over three years.

Massachusetts General Hospital will collaborate with drug manufacturer AstraZeneca to develop and validate digital health solutions using AstraZeneca’s Amaze disease management platform, starting with heart failure and asthma management. Amaze, which was launched last month, is built on BrightInsight’s regulated digital health product development platform.

The HCI Group launches StrategyNxt, which delivers a customized digital strategy in 12 weeks for a fixed price of $250,000.


Government and Politics

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ONC officials remind healthcare stakeholders that the Cures Act’s information blocking provision has taken effect. EHR transparency is also required as of Monday, in which providers are required to give patients all of the information stored in their EHR in electronic format, including provider notes of all types as well as imaging, lab, and pathology report narratives.


COVID-19

The number of American adults who have received at least one COVID-19 vaccine dose is up to 42%, while 76% of those 65 and over have been at least partially vaccinated.

A New York Times analysis finds that COVID-19 cases are increasing, deaths are decreasing (although as a lagging indicator), and eight of the top 10 metro areas with the highest new case count per 100K population are in Michigan. Michigan’s case count is approaching its all-time high, hospitalizations are moving toward record levels, and deaths have taken an upturn after a long decline.

California will fully reopen activities and businesses on June 15, as long as vaccine remains available and hospitalization rates remain low.

The White House announces that every US adult will be eligible to be vaccinated by April 19, eliminating individual state phases.

CDC finally confirms that “deep cleaning” businesses is pointless since infections are spread by air, recommending instead that employees wash their hands regularly and use hand sanitizer only when soap an water aren’t available. This is a significant change as businesses reopen their indoor services and many people are still phobic about getting COVID-19 from items they touch.

A new COVID-19 vaccine is being tested in Brazil, Mexico, Thailand, and Vietnam that stimulates more potent antibodies while also being cheaply manufactured using chicken eggs, same as flu vaccine. Phase 1 trials will be completed in July. The developer of the vaccine platform is structural biologist Jason McLellan, PhD of University of Texas at Austin, of whom a Gates Foundation officer says, “He should be proud of this huge thing he’s done for humanity.

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Northwell Health will expand a program to place Amazon Echo Show two-way video devices in COVID-19 patient rooms to allow providers to communicate with them without using PPE. Physicians can initiate a conversation from their own device and patients can just start talking without pushing buttons using Alexa’s “drop in” option. Northwell said a year ago that it would add 4,000 of the devices to the 2,800 it had already deployed.


Other

A study of EHR usage at Yale-New Haven and MedStar Health systems finds that ambulatory physicians spend five hours on the EHR (Epic and Cerner, respectively) for every eight hours of scheduled clinical time, with 33% spent on documentation, 13% in inbox management, and 12% on orders. The authors warn that the use of system audit logs to compare the proposed seven EHR use metrics across vendors and provider organizations in a normalized manner will be challenging.

A former IT security support coordinator of Trillium Health pleads guilty to computer fraud, charged with using his administrative access to read employee emails and social media accounts. Trillium says it spent $150,000 to determine the extent of his hacking, also noting that his computer contained thousands of photos of employees, their credit cards, and their driver licenses. He could be sentenced to up to five years in prison and fined $250,000.


Sponsor Updates

  • Elsevier adds MIPS measures validated by MDinteractive to its STATdx radiology diagnostic decision support solution.
  • The Canisius Wilhelmina Ziekenhuis Hospital in the Netherlands goes live on Agfa HealthCare enterprise imaging.
  • Premier signs an agreement with Ascom, giving its members special, pre-negotiated pricing and terms on the company’s nurse call systems.
  • Vocera Chief Marketing Officer Kathy English is selected as a Hall of Femme honoree for 2021.
  • Cerner publishes a new client achievement story, “Cancer center improves chemotherapy infusion efficiency after transition from paper records to EHR.”
  • Change Healthcare wins a 2021 Cloud Computing Product of the Year Award from Cloud Computing Magazine for its Enterprise Imaging Network.

Blog Posts


Contacts

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

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Morning Headlines 4/6/21

April 5, 2021 Headlines No Comments

Inbox Health Raises $15 Million in Series A Financing Round

Medical billing and patient communications startup Inbox Health raises $15 million in a Series A round of funding led by Commerce Ventures.

Indian Health Service Wants IT Strategic Planning Help from Industry

The Indian Health Service seeks help from industry stakeholders with drafting a strategic plan to guide its IT efforts over the next three to five years.

Zipnosis Has Been Acquired by Bright Health

Minnesota insurance and managed care startup Bright Health acquires Zipnosis, which offers telemedicine services to health systems.

A New Day for Interoperability – The Information Blocking Regulations Start Now

ONC officials remind healthcare stakeholders that the Cures Act’s information blocking provision has taken effect.

Curbside Consult with Dr. Jayne 4/5/21

April 5, 2021 Dr. Jayne 4 Comments

A major part of my consulting practice involves trying to help physicians become more proficient EHR users. As I evaluate their current state workflows, I usually discover a number of operational processes in their practices that are adding to their workload. Often the perception is that the EHR is causing more work when it’s really a combination of poor EHR implementation, poor EHR configuration, and continuing to try to use processes that were designed for paper even though the paper is long gone.

Increasing practice-related stresses contribute to physicians feeling like they’ve lost control of their work lives, which can ultimately result in burnout. I’m always on the lookout for strategies to help my clients beyond optimizing their EHRs and their office processes. Sometimes this involves referring them for executive coaching to discuss work-life balance and their willingness (or lack thereof) to alter their work schedules to try to reduce stress. Other times, physicians are resistant to any advice that advocates for work habits different than what they’ve grown to accept.

I ran across an article from the AMA this week that advertised four approaches to reduce the mental workload that physicians face. This was presented as a strategy for reducing burnout. Cognitive workload is a real phenomenon that a lot of organizations don’t think about. I’ve had many conversations with EHR designers and UX experts about it over the years, and certainly systems can be designed in a way to make things easier on the user. However, what users see on the screen is only a small part of the stressors they face each day.

The article cites a recent webinar with Elizabeth Harry, MD, who is senior director of clinical affairs at the University of Colorado Hospital. The first point that the article makes is that an individual’s attention is a limited resource, and that we need to “have space to actually give proper attention to things” in order to avoid making mistakes. She suggests that people use a task-based approach, where they focus on a single task for a period of time in order to saturate their working memory. An ideal time for focused attention would be 25 minutes, followed by a break during which the cognitive load would be discharged.

That sounds well and good from an academic perspective, but I’m not sure how to apply it to the typical workflow physicians face in the outpatient setting, where they’re bouncing from 10- to 15-minute visits with “breaks” in between, during when they are expected to finish documentation, field telephone messages, address medication refills, and perform numerous other tasks.

Dr. Harry goes on to suggest four strategies to address systems issues that contribute to burnout.

The first strategy is to increase standardization. She cites Steve Jobs and his standardized wardrobe as an example. She notes that building intentional habits can reduce stress and that organizations should try to standardize as much as possible across medical care unites.

I wholeheartedly agree with this idea. My urgent care employer has more than 30 locations, and all of them are built on the same blueprints except for three locations. I work at two of the three non-standard sites from time to time and find them incredibly frustrating. One site was acquired from another urgent care organization and has different cabinetry, so the drawers are laid out differently and the rooms have different configurations, which results in the physician opening random cabinets trying to find things. I’m sure that doesn’t build confidence for patients, and it definitely injects a small amount of stress into your day. The other site has the standard layout in the rooms, but the doors to the exam rooms all open opposite of how they should, resulting in some shimmying and dodging of trash cans and exam tables as you enter the room. It also makes you try to grab for a handle on the wrong side of the door as you exit, which just makes you feel foolish as well as slowing you down.

The second strategy she advocates is decreasing redundancy so that organizations have a single high-reliability process for completing a task rather than having multiple ways a process can run. She uses the example of notifying a physician regarding lab results. We need to receive results the same way each time rather than a different way each time we order labs. I think most organizations are doing a fairly good job with this, although there are some levels where redundancy is important, especially where critical patient safety situations are involved.

The third anti-burnout strategy involves consolidation of clinical data. This is where she cites EHR design as an example, setting up the workflow so that key information is located in a single space rather than requiring users to bounce around to find the information they need. Disease-specific workflows are an example of this, where users can find relevant patient history, clinical indicators, and labs all in the same place. This approach builds on the concept of reducing split attention as well as creating routines and habits.

The fourth strategy involves reducing interruptions. Dr. Harry notes that physicians need to have agreements with their support staff about what merits an interruption and what doesn’t. Interruptions can disrupt important thought processes, and she again advocates for physicians to have blocks of time where they can focus.

This may be a possibility for outpatient visits in certain subspecialties that are allowed longer appointments for complex consultations, and might be even more of a possibility where physicians own their own practices and can control their own schedules. However, I can’t see how it would be much of an option for specialties where physicians are expected to juggle multiple patients who are having acute problems simultaneously, such as in the emergency department or in the intensive care unit. In those settings, our attention is constantly drawn away from what we’re looking at and towards something that is potentially less stable or more serious.

The reality is that inability to focus doesn’t just lead to stress for physicians and caregivers, but it also leads to poor care when patients don’t have our complete attention. Having time to focus has become a luxury and our patients deserve better.

What are your organizations doing to help physicians achieve greater focus, and is it helping reduce burnout? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Rob Culbert, CEO, Culbert Healthcare Solutions

April 5, 2021 Interviews No Comments

Rob Culbert is founder and CEO of Culbert Healthcare Solutions of Woburn, MA.

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Tell me about yourself and the company.

I started with IDX in the 1980s and worked with them for almost 10 years before switching over to the consulting side of the world. I started Culbert Healthcare Solutions in 2006, so it’s our 15th anniversary, although we didn’t get to celebrate it yet because of everything that’s going on in the world. We have been able to continue our passion for working with healthcare providers around the country, helping them improve the patient experience, improve financial performance, and solve strategic business problems.

How has the pandemic affected your business?

Initially, it was a shock, as was to everybody. It changed our business on a dime. For the first time in my consulting and work experience in 30-plus years, in April and May, we had zero invoices with expense reports on them. I never have experienced that in my life.We had a lot of things in place to be able to flip over to remote work. We had some projects pause, some ended, and some new ones kicked in, but we were able to make that transition as best we could.

We are a pretty conservative company and privately held, so we focused on making sure that we kept our people and took great care of the customers that we had and the new ones that had needs. We tried to be as creative as we could be to help them through their own crises. While I don’t think any of us are out of the woods yet until this thing really gets behind us, we have been able to weather the storm and continue the good work we try to do.

How are hospitals and health systems looking differently at their relationship with patients?

Pre-COVID, we dedicated a lot of effort to helping organizations improve patient access. There are lots of systems and functionalities out there. When you are doing a large-scale implementation like Epic, Cerner, or Allscripts, you don’t get to become an advanced user overnight. A big portion of our work has been helping to look at the patient access functionalities. It’s all about making sure that the physicians and the clinical staff have all the tools in place to be able to maximize utilization, to be able to have the right information to take good care of the patient before, during, and after the visit, and make that as seamless as possible. Some of that was for financial improvement. A lot of it was to prepare for changes and and the way payers pay providers for their work.

When COVID came, it was an easy process to flip to being as touchless as humanly possible. We had several engagements where there could have been pauses on the project, given all the uncertainty. But in the areas of patient access, customers said, keep going. The work that you have done so far has made those practices able to change on a dime. How do we deal with nobody in the waiting room? How do we remove all of the in-person touches that typically have happened? They were able to more easily adapt their schedules to follow best practice COVID protocols.

Are you seeing a lot of provider interest in buzzy technologies such as AI, robotic process automation, and life sciences research?

We are. Machine learning is, as with robotics and data analytics, a term everybody uses that means different things to different people. But everybody is dying to start using the data more effectively to make their jobs better. Especially during COVID, but we had started seeing it in the last few years. 

There’s a lot more for-profit investment firm interest in healthcare technologies. When a for-profit entity is looking to acquire a healthcare technology or provider, their approach to evaluating it, doing the due diligence, and then the speed of moving to realize the full value of that investment is different than what we historically have been used to in healthcare. It’s a welcome change, and in many cases, a needed change. It has been quite a transformation to see how more investor-led organizations are changing healthcare, much more that we saw in the first two-thirds of our healthcare career.

How will consolidation of both companies and health systems change the experience and outcomes of patients?

Unfortunately, the complexity of healthcare technology that we are trying to optimize is overwhelming for smaller organizations. It is more difficult and challenging for them to take full advantage of that technology, whether it’s from an expense standpoint or a skills perspective. There are definitely opportunities for larger organizations to be able to offer more complex technology with better support and more cost effectiveness. Economies of scale definitely make a difference.

There are different motives for some of the getting bigger. Some of it is to spread costs amongst the larger population. For others, it’s a business opportunity to be able to leverage that cost and provide a better service.

We have definitely seen cycles where there was lots of coming together, then there was lots of splitting apart. We’ve seen it come and go. This time, because of the complexity of the electronic data and the opportunities to streamline the healthcare process for the benefit of patients, it will be rocky in some cases, but the end game is going to be positive.

What is driving the sudden emergence of the chief digital officer title?

It’s a huge positive. When EHR implementation started, you had a lot of physician champions. The CIO was very much about managing risk and managing costs for those systems. It was much harder in the beginning to prove an ROI compared to the traditional revenue cycle system that makes your revenue cycle cheaper and more effective.

The concept of chief digital officer is different. It’s not just about managing the Epic system or the bread and butter system. It’s about managing the experience of the patients for the benefit of providers, so that they can have access to the information they need to do their job in a cost-effective and well-informed way.

Some of the vendors will hate me for saying this, but there is no one technology that does it all. We constantly see customers trying to take full advantage of the collection of technologies to be able to do as good a job as they can for the patient experience. That ranges all across the board. We have seen companies like CueSquared , which provides a mobile pay technology to allow patients to view and pay their statements on their phone. The world of self-pay has changed dramatically over the years, but that’s just one small example.

That digital experience has been interesting to watch, because a lot of organizations have created a serious digital approach to their world. Where does this fit into the patient experience we want? That’s where technologies get dropped and that’s where technologies get put in. Technologies that prioritize what’s important to the patient and help provide the patient great service, which might not have been given a look in the past because they aren’t a module within the larger system, are getting opportunities. They are doing some pretty cool things with it.

How will the cancellation of HIMSS20 and the delay in HIMSS21 affect the industry?

I don’t think it has had a negative impact on our company. I say that because the whole world has had to change on a dime. Everybody recognizes that as much as those in-person conferences can be invaluable for learning and networking, it just is impossible. But I’m still amazed by the amount of virtual opportunities that have, as best they can, replaced the in-person conference for now, the explosion of using Zoom, Teams, and GoToMeeting to be able to try to have some of that face-to-face.

One of our strengths as a company is that we have deep relationships with the industry and our customers. For those organizations that we know and they know us well, it was easier to go into a remote engagement opportunity. We were known quantities, there was a trust, and there was a relationship in which you knew that both sides were going to get good value. We were going to kill ourselves to make that remote process work, given historically that it was always an in-person or on-site type of opportunity.

For those that don’t know us and vice versa, it’s harder to build that trusting relationship. We have slowly started to see some of our engagements where there has been a strong desire to at least have some sort of on-site presence. Some of those have gone very smoothly. We have been creative, such as people staying over a two-week window as opposed to coming Monday and leaving for home Friday, to get through the window of time to build that relationship. And, to manage the COVID travel policies of the state that the consultant is going to and the state that they are coming from. That has probably been the toughest one for us, to make sure that we are managing those travel requirements between the two states.

We are starting to see many of our consultants getting the vaccine. We have had opportunities where they have qualified for the vaccine based on the work that is being asked of them. So far, that has made life a lot easier. Many of our consultants have no issue with traveling, because they have been doing it almost their entire careers. Others have been nervous about it, but we have been able to manage those nerves because we have been able to keep a fairly large percentage of our business on a remote basis. Each month that we are able to continue waiting for the world to be ready for the ongoing travel, then that concern will keep going down.

We are on the 10-yard line of hopefully the vaccine helping us to get to the other side of this thing. Just a little more patience is what we expect. Our people and clients have been flexible around managing that in a good way.

Do you have any final thoughts?

I am hopeful for everything that is going on with the vaccine and all the lessons learned to get us through this thing. Every customer and every business that we work with has had to adapt. We are at the top of that list as well. As hard as this year has been, it has been an exceptional learning experience. We are doing things that we probably never would have thought to do prior to COVID. In many cases, those things are incredible positives.

I am very positive in terms of the outlook. While this hurt everybody, we are going to benefit tremendously for years to come from some of the changes that were forced upon us. Creativity will stay with us in a good way for a very long time.

Morning Headlines 4/5/21

April 4, 2021 Headlines No Comments

Bank of America Acquires Axia Technologies, Inc.

Bank of America acquires patient payments technology vendor AxiaMed for undisclosed terms.

Notice of Data Privacy Incident

Aspirus joins other health systems in notifying patients that its vendor MedData exposed their protected health information on a public-facing website.

SOC Telemed Reports Fourth Quarter and Full-Year 2020 Results

SOC Telemed, which went public via an SPAC merger last fall, announces Q4 results: revenue down 13%, adjusted earnings –$3.9 million versus $0.2 million.

Monday Morning Update 4/5/21

April 4, 2021 News 1 Comment

Top News

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Bank of America acquires patient payments technology vendor AxiaMed for undisclosed terms.

AxiaMed’s Payment Fusion offers software vendors the ability to integrate the company’s patient payment solutions with their applications.

Bank of America is developing proprietary merchant services for its clients after dissolving its decades-old joint venture with First Data last year following that company’s $22 billion acquisition by financial services technology vendor Fiserv.


HIStalk Announcements and Requests

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Here’s your top five finishers for US capital of healthcare technology, which I intentionally left undefined.

New poll to your right or here: What is your COVID-19 vaccination status? I ask specifically about timing since HIMSS21 is in August, so that’s the next in-person event data for many of us. I’m double Pfizered, so I’m good to go.

Thanks to the following companies that recently supported HIStalk. Click a logo for more information.

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Webinars

April 21 (Wednesday) 1 ET. “Is Gig Work For You?” Sponsor: HIStalk. Presenter: Frank L. Poggio, retired health IT executive and active job search workshop presenter.  This workshop will cover both the advantages and disadvantages of being a gig worker. Attendees will learn how to how to decide if gig work is a good personal fit, find the right company, and protect themselves from unethical ones.

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


Acquisitions, Funding, Business, and Stock

SOC Telemed announces Q4 results: revenue down 13%, adjusted earnings –$3.9 million versus $0.2 million (the company did not release per-share earnings). The company went public in a SPAC merger on November 2, 2020, with share price dropping 32% since then versus the Nasdaq’s 21% gain, valuing the company at $469 million.

The Global X Telemedicine & Digital Health exchange-traded fund was down 3.4% in the past month versus the Nasdaq’s 1% drop. The fund is up 26% since its July 30, 2020 inception versus the Nasdaq’s 23% rise. Its top holdings are Guardant Health, Nuance, Omnicell, Agilent Technologies, Illumina, and Labcorp.


Sales

  • Plexus Research joins the TriNetX global health research network.

COVID-19

Daily US vaccinations exceeded 4 million for the first time Friday, pushing the total of Americans vaccinated to over 100 million. CDC says that 23% of adults and 55% of senior citizens have been fully vaccinated, while 40% of adults have received at least one shot.

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I noticed this cool patch on the arm of a female airman whose Air Force unit was participating in FEMA-operated mass vaccination clinic and asked if I could take a photo. She was deployed from the 335th Air Expeditionary Group, Medical Operations Squadron, which has also provided COVID-19 support to hospitals.

Brazil digs up old graves to make room for the soaring number of bodies from new COVID-19 deaths, 67,000 in March 2021, as the country has vaccinated just 2% of its population and its hospitals are running out of oxygen and ICU beds. President Jair Bolsonaro replaced one-third of his cabinet and all of the country’s military commanders last week, raising concerns that he is preparing for a military coup to remain in office as opponents urge impeaching him for mismanaging the pandemic.

Florida Governor Ron DeSantis issues an executive order that bans the use of COVID-19 vaccination passports in the state, blocking government offices from issuing them and businesses from requiring them. He cites freedom and privacy concerns, saying that “individual COVID-19 vaccination records are private health information and should not be shared by a mandate.” He also notes that some citizens may have infection-acquired immunity and that some may decline to be vaccinated for health or religious reasons.

Google creates a memorable public service announcement that urges people to get vaccinated against COVID-19.


Other

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Aspirus joins other health systems in notifying patients that its vendor MedData exposed their protected health information on a public-facing website. The revenue cycle services vendor was notified by DataBreaches.net in early December that claims data had been found in an open source data repository, although the company did not remove the files immediately and patient letters weren’t sent until last Wednesday. MedData says that a former employee, a developer, saved files to their personal folders on the website. The other health systems involved so far include Memorial Hermann, OSF Healthcare, SCL Health, and University of Chicago.


Sponsor Updates

  • Black Book Market Research names Spok a top-performing behavioral health and mental healthcare industry vendor in the secure provider communications platform category.
  • Kyruus completes its acquisition of HealthSparq, paving the way for seamless, cross-channel care navigation.
  • Netsmart shifts one of its divisions to permanently working from home while it transitions the rest of its 2,400-member workforce back to the office.
  • Pivot Point Consulting celebrates its 10th anniversary.
  • Health Data Movers appoints Monica Gupta and Alyssa Rapp to its board.
  • PMD releases a new video, “Meet our CEO – Philippe d’Offay.”
  • CRN gives Pure Storage a five-star rating in its “2021 Partner Program Guide.”
  • Relatient publishes a new e-book, “The Expert Guide to Patient Engagement Software.”
  • Vocera receives FIPS 140-2 certification for its Smartbadge, required to support secure wireless communication in VA and DoD healthcare facilities.

Blog Posts


Contacts

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

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Katie the Intern 4/2/21

Hi, HIStalk! Long time, no write. Things have been really busy, but I am still making time to write some columns here and there. 

This week’s column focuses on B.well Connected Health, a healthcare technology company that provides a platform for healthcare consumers to stay connected to their providers and their data in a digital, personalized health experience. I spoke with CEO Kristen Valdes, who founded B.well in 2016 as “a way to transform the way consumers interact with the healthcare delivery system by giving them access to all of their health data in one place.”

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Valdes has been an executive in the healthcare field for over 20 years, working in digital health and helping to start one of the first private Medicare Advantage plans in the country. When her daughter began facing an undiagnosed medical issue, she began to see holes in the healthcare information delivery system and felt that she could create a business to fill those needs. 

“When my own child was born with a very significant autoimmune condition, here I was, this healthcare industry expert, and I could not navigate the system on behalf of my daughter,” she said. “She had a near-fatal incident because two EMRs couldn’t communicate with one another.”

It took seven years to get her daughter properly diagnosed, and seeing the failures in the communication of healthcare systems drove Valdes to create a technology company that could mend the breaks. B.well was founded as a system to allow users to have access to their in-person, digital, and virtual care at all times and to share that information with whomever they want. 

“We are a B2B business. We sell into health systems, insurance companies, and pharmacies as a way to aid them in their digital transformation towards the consumerization of health,” Valdes said. “B.well finds a way to connect services that businesses offer into consumer lives, even though 99% of the time, they are outside of the doctor’s office.”

Consumers need to navigate their medical needs and B.well wanted to make it easy for users to have access to all their data, records, appointments, recommendations, and more, all in one place, Valdes said. Though it is not an EHR, B.well is bi-directionally integrated with EHRs.

The process of creating a delivery system started with many questions, including how such a system could get access to healthcare data and give it back to users. “You cannot engage someone in a personalized way if you don’t know anything about them,”  Valdes said. “Data is critical to the consumer.”

Valdes had to make sure that the technology would not impact an EHR’s flow. The integration of B.well is there to connect consumers to their records and information. Regulations were put into place with technology standards that allowed open API interfaces, an important piece to the puzzle. Open API interfaces unlock the ability to push and pull information seamlessly between systems, Valdes said. 

The B.well team did surveys and analyses to see where the user pain points in healthcare data are, creating a basic features list based on the results. Users wanted a simple, affordable system that allows quick and easy access to providers and simple directions for when they need to do something. 

“We started with consumers first and architected what they would want to see out of the healthcare system. Then we reverse engineered that into the data holders and stakeholders of healthcare where all the information as mapped that would be needed to pull together,” Valdes said. “That’s where we determined that a net-neutral platform for consumers was possible.”

B.well also helps providers move their focus into population health as they adjust from fee-for-service models to value-based care. When physicians can see data in real time and track which patients are going to appointments and filling medication accurately, they are able to see their results and adjust care based on outcomes. 

“Because we connect consumers to their data with their consent, we also empower them to share that data back to their provider if they choose,” Valdes said. “Healthcare providers have not historically had the visibility to that information, nor have they had the ability to see the interactions with the healthcare system that happens outside of their own offices. As we shift to value-based care is, it’s much easier to help a provider take risk, meaning that they are going to be responsible for someone’s health outcome.” 

Outcomes are important in value-based care, and to get real results, engagement is necessary. B.well sports a 64% engagement rate versus the industry average 17%, meaning that users both engage and take action towards their health by using the B.well technology system. B.well knows that consumers do not want to log in to a health application once a day, but they will respond when messages are relevant. 

“The way that we define engagement is that consumers not only log in to the application, but they actually take an action towards bettering their health,” Valdes said. “Because we have access to a consumer’s data, we only target them with information and nudges at the point of time that it’s appropriate in their care.” 

B.well also recently partnered with Mastercard as a way to enhance the safety of ID verification for B.well’s services. To verify identity and increase the safety of data and information sharing and matching, B.well will use Mastercard’s biometric tech to validate the identity of users. This has already been implemented in B.well’s use of Mastercard through ThedaCare’s Ripple health management tool.

“In-person encounters are not always the first encounter we have in healthcare,” Valdes said. “We partnered with Mastercard to improve digital identity beyond what healthcare offers today.” 

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That’s it for today! I enjoyed learning about a healthcare delivery system that interacts with EMRs and EHRs to better connect users to their healthcare data and information. Thanks for reading! 

Katie The Intern

Katie

Email me or connect with me on Twitter.

Weekender 4/2/21

April 2, 2021 Weekender 1 Comment

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Weekly News Recap

  • HIMSS acquires healthcare supply chain-focused SCAN Health.
  • Cerner finalizes its $375 million acquisition of Kantar Health.
  • VA Secretary Denis McDonough expresses concern about productivity at its first live Cerner site and the possibility that the project’s cost could exceed its $16 billion budget.
  • Net Health acquires Casamba.
  • MTBC rebrands to CareCloud, taking the name of a previous acquisition.
  • The Department of Justice asks for more information about Optum’s proposed $13 billion acquisition of Change Healthcare.

Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. M in Illinois, who asked for Mini Magic Boards for online sessions of elementary school class. She reports, “This fun and engaging writing tool has been used during our remote learning lessons and during our preschoolers’ asynchronous time as well. They really love to use it, as it gives them an opportunity to practice their writing skills beyond a pencil and paper. We’ve used it to practice writing numbers, letters, their name, drawing shapes, and more. It has made a big difference during our lessons and students have shared photos of how they’ve been using it at home as well. Thank you again for helping us get this writing tool in our preschoolers’ hands and get them excited about learning remotely.“

The one consistent aspect of the US healthcare non-system is maximizing profit. A nine-state group of anesthesiologists sues UnitedHealthcare, claiming that the giant insurer used its clout to steer surgeons away from using the group’s services. United responded by saying that the private equity-owned US Anesthesia Partners, which is not in United’s network, was demanding to be paid double or triple the median rate. The practice countered by claiming that the insurer’s parent company UnitedHealth Group offers its own medical services,  has 50,000 physicians on staff, and holds partial ownership of Sound Physicians, an expanding business that offers emergency and anesthesiology services.

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Adam Litwin, MD,  who served prison time 20 years ago for impersonating a surgical resident for several months at UCLA Hospital – he forged prescriptions, although he didn’t participate in surgeries – fails to match for medical residency for the second time following his 2018 graduation from a for-profit medical school in the Caribbean. One factor in his getting caught at UCLA was that he wore a white jacket adorned with a silk-screened image of his own face, which he claims other doctors envied. Googling “Saint James School of Medicine” turns up fascinating stories from former students and a published US residency match of 6% to 20% over several years.

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A former Atrium Health paramedic who is awaiting trial for fatally poisoning his wife with eye drops he had added to her glass of water is arrested for intentionally setting fire to an in-flight medical helicopter, which was forced to make an emergency landing. Josh Hunsucker refused to give permission for his wife’s body to be autopsied and quickly cashed out her life insurance, but a blood sample that was taken for her organ donation was found to have high levels of tetrahydrozoline, the decongestant in Visine that apparently triggered his wife’s heart attack due to her previous heart problems. Authorities think he was copying a murder in which a former VA nurse killed her husband with Visine two years after he recovered from an injury sustained when she used a crossbow to shoot an arrow into his head.

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Jacksonville, FL police arrest a man who was injecting people with Chinese-labeled Botox while drinking malt liquor and champagne, posing as an oral surgeon at an advertised a “Botox and Bubbles” event at an aesthetic spa. At least his price was right – he charged $350 versus the typical $1,200 cost. Googling “Botox & bubbles” turns up thousands of similar events at aesthetic practices, although they are focused on marketing the service rather than delivering it on the spot.


In Case You Missed It


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Morning Headlines 4/2/21

April 1, 2021 Headlines No Comments

SCAN Health Transitions to HIMSS

HIMSS acquires SCAN Health, which offers healthcare supply chain traceability events, a supply chain maturity scale, business case competitions, and design competitions.

Revelstoke’s Carrus Acquires Archetype Innovations

Healthcare training software vendor Carrus acquires EHR training program company Archetype Innovations.

Cerner Finalizes Acquisition of Kantar Health

Cerner wraps up its $375 million acquisition of Kantar Health, a data, analytics, and real-world evidence and research consulting subsidiary of New York-based Kantar Group.

News 4/2/21

April 1, 2021 News 6 Comments

Top News

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HIMSS acquires SCAN Health, which offers healthcare supply chain traceability events, a supply chain maturity scale, business case competitions, and design competitions.

The company, which is funded by the Canadian government, is hosted by the University of Windsor’s business school.

SCAN Health was launched in 2017 with a four-year, $1.6 million government grant that ended this year.

HIMSS Analytics was one of SCAN Health’s partners and financial supporters.


HIStalk Announcements and Requests

Today’s best Internet meme — April 1 is the only day on which Americans will question whether something they read on the Internet might be untrue.

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I took advantage of some special Donors Choose matching funds and those of my Anonymous Vendor Executive to fully fund these teacher requests:

  • A financial literacy kit for Ms. P’s fifth grade class in Fayetteville, NC.
  • Mice and headphones for Ms. G’s elementary school class in Sharon, WI.
  • Science and math materials for Ms. H’s elementary school class in Houston, TX.
  • Hands-on math tools for Ms. M’s elementary school class in Houston, TX.

I took a short, solo, family-related trip this week, the first time I’ve been on an airplane in quite a while. Every person I saw was appropriately masked, all flights were full (one was even oversold with a $900 offer to take a flight three hours later), and the airports were jammed with restaurant lines that looked 100 people long. It was like before COVID, which actually felt pretty good. People-watching yielded two instances where teen passengers showed up in pajamas, which reminded me of that years-ago fad where college students would head out to restaurants at 2:00 on a weekend afternoon in their PJs for breakfast. I have a feeling that the pent-up demand for travel, restaurants, and entertainment and sports events is about to explode as more people get vaccinated. Here’s a tip for Southwest passengers with Group C boarding who are doomed to a middle seat – take the seat between two folks who are conversing, or where one of them is a child. It’s almost always two family members, one of whom will move to the middle so they can sit together and leave you with the aisle.


Webinars

April 21 (Wednesday) 1 ET. “Is Gig Work For You?” Sponsor: HIStalk. Presenter: Frank L. Poggio, retired health IT executive and active job search workshop presenter.  This workshop will cover both the advantages and disadvantages of being a gig worker. Attendees will learn how to how to decide if gig work is a good personal fit, find the right company, and protect themselves from unethical ones.

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


Acquisitions, Funding, Business, and Stock

The Center for Health Affairs sells its CHAMPS Oncology business, which helps providers with cancer registry participation, to clinical data solutions vendor Q-Centrix.

Acute telemedicine technology and solutions vendor SOC Telemed completes its $194 million acquisition of competitor Access Physicians. 


Sales

  • University Hospitals of Cleveland will implement Epic, according to a reader-forwarded internal email. It will replace Allscripts Sunrise.
  • Southwest Medical Center (KS) chooses Healthcare Triangle for cloud disaster recovery services.

People

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Matthew Smith (Ensocare) joins Kno2 as VP of sales and strategic partner alignment.

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Sharecare hires David Guthrie (PatientPoint) as CIO/CISO.

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Walmart Chief Medical Officer Tom Van Gilder, MD, JD, MPH will leave the company next month.


Announcements and Implementations

Samsung integrates GetWellNetwork’s solution with its healthcare-grade smart HTVs, eliminating the need for external hardware.

Netsmart is named the highest-satisfaction behavioral health ambulatory EHR vendor by Black Book Research, which also found that only 18% of respondents feel they are technically ready to engage electronically for care coordination, patient record exchange, and population health. 

Beth Israel Deaconess Medical Center will use Google’s Care Studio EHR search tool, expanding a pilot project that started at Ascension.

Audacious Inquiry publishes a guide to the new CMS Conditions of Participation requirement for hospitals to send ADT notifications to the community providers of those patients.


COVID-19

Results from the ongoing Phase 3 clinical trial of Pfizer’s COVID-19 vaccine indicate that protection lasts for at least six months and it works against the South African variant. It was also found to be 100% effective in the small number of trial participants that were 12 to 15 years years old. The study has raised no safety concerns, clearing the way for eventual full FDA approval beyond the vaccine’s Emergency Use Authorization.

CDC reports that 21% of US adults have been fully vaccinated, as have 51% of those 65 and over, as 100 million people have received at least one dose.

Nursing homes report that COVID-19 cases are down 98% and deaths down 95% from their peak on December 20. The CMS data does not break out totals by vaccination status.

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FDA issues Emergency Use Authorization two at-home, antigen-based COVID-19 rapid tests that don’t require a prescription, Quidel’s QuickVue At-Home and Abbot BinaxNOW. The tests are intended for serial screening, where an individual who does not have COVID-19 symptoms needs to be tested several times. FDA’s decision took nearly a year, keeping the tests from being sold when they could have had a major impact. Availability and price have not been announced and it’s not clear how self-test results can be used to prove COVID-19 status.

The Washington Post reports that despite dire predictions, some of the country’s richest health systems boosted their incomes in 2020, reporting big surpluses that were increased even more by federal COVID-19 bailouts. Baylor Scott & White Health reported its biggest-ever operating margin as it booked $815 million in profit for 2020, aided by $454 million in taxpayer-funded relief. UPMC tripled its 2019 margin with an $836 million profit that includes $460 million in bailout funds, while Mayo Clinic’s predicted $3 billion revenue loss ended up being increased revenue and a $728 million profit, including $338 million in bailout funds. Big health systems are either lousy at forecasting or good at manipulating politicians.

People who have had COVID-19 need just a single dose of the Pfizer vaccine to reach maximum immunity, researchers find.

A Baltimore company that manufactures both J&J and AstraZeneca vaccines as a subcontractor ruins 15 million doses of the one-shot J&J product when its workers confuse the two products and mix them together. The company, Emergent BioSolutions, was called out last year for selling the federal government $626 million worth of COVID-unrelated national stockpile items, such as anthrax vaccine, that consumed more than half of the stockpile’s budget during high demand for PPE. The most recent US anthrax attack was 20 years ago, when five people died, and the stockpile contains enough doses for 10 million people. The company bought the vaccine patent from the State of Michigan, then raised prices to the federal government six-fold, as that product plus smallpox vaccine increased its revenue to $1.5 billion as it used its clout to halt the development of better and cheaper vaccines by competitors. President Trump had appointed one of the company’s former consultants to run the office that oversees the stockpile. The company’s market value is over $4 billion. 

In England, a study of discharged COVID-19 patients finds that they were admitted four times as often and died eight times more frequently compared to the control group. The rates of respiratory disease, diabetes, and cardiovascular disease were higher and not limited to elderly patients. Nearly 30% of the discharged patients were readmitted and 12% of them died.

Houston Methodist will give its 26,000 employees until mid-April to either get at least one dose of a COVID-19 vaccine have their religious or medical exemption approved. The health system says 83% of employees have been vaccinated and it is mandatory for new employees. The American Hospital Association says it expects most hospitals to hold off from making vaccination mandatory until FDA gives them its full approval instead of Emergency Use Authorization.


Sponsor Updates

  • Vyne Medical launches a podcast series, with the first episode covering “The Future of Healthcare IT in a Post-COVID Era.”
  • Utah Business names Health Catalyst CEO Dan Burton “CEO of the Year 2021.”
  • Wolters Kluwer Health is named publisher of the American College of Medical Quality’s “American Journal of Medical Quality.”
  • InterSystems joins the Vulcan FHIR Accelerator Program to expand interoperability in life sciences.
  • Black Book Research
  • PerfectServe’s Optimized Provider Scheduling powered by Lightning Bolt achieves top customer satisfaction rankings in the latest Enterprise Physician Scheduling report from KLAS.
  • President Bill Clinton will keynote the Everbridge COVID-19: Road to Recovery Executive Summit May 26-27.
  • Azalea Health Innovations integrates its AzaleaONE EHR with PatientPing for event notification.
  • G2 names Halo Health a leader in its “Clinical Communication and Collaboration Grid Report for Spring 2021.”
  • The HCI Group releases a new “DGTL Voices with Ed Marx” podcast, “How IT Saves Lives.”
  • Imprivata and Emerging Global Technologies partner to bring innovative digital identity technology to healthcare providers in the Middle East.
  • Kyruus publishes a new case study, “How Baystate Health Increased Online Accuracy and Access with a Comprehensive Provider Data Foundation.”
  • LexisNexis publishes a new white paper, “Knowledge-Based Authentication Simplifies MyChart Patient Portal Enrollment.”
  • Meditech publishes a new case study, “Princeton Community Hospital improves response time and physician efficiency with Meditech Expanse and Teknicor.”
  • Medicomp Systems releases the first episode of its “Tell Me Where It Hurts” podcast with Jay Anders, MD.

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 4/1/21

April 1, 2021 Dr. Jayne No Comments

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March 30 marked Doctors’ Day in the US. The date was selected in honor of the anniversary of the first use of general anesthesia in the US, when Dr. Crawford Long used ether prior to a tumor surgery. The US formalized the date in 1990, when President Bush signed a joint resolution created by the 101st US Congress. My practice did nothing to celebrate, so I marked it on my own by scrolling through some photos of my physician exploits. By far one of my most challenging (and rewarding) experiences as a physician was staffing the 24th World Scout Jamboree in 2019. I never thought I would be practicing in a tent, but it was an experience I’ll never forget.

This week also included the ONC 2021 Annual Meeting. I initially had high hopes of making a number of the sessions, but was quickly sidelined as I had to put out some fires with my clients. I was able to catch bits and pieces of some of the presentations but will have to use the on-demand recordings to see the rest of the ones that were on my must-see list. From the sessions I made it to, predictable themes included the use of health IT in the COVID-19 response and interoperability. Major pushes for the former include a basic FHIR approach for vaccine scheduling that could make it easier for patients to find vaccine compared to the “Hunger Games” approach that many patients are experiencing as they compete for scarce spots.

National Coordinator Micky Tripathi credited the health IT industry with making progress on interoperability. He also noted that ONC is helping the White House with plans for vaccine passports. There was also discussion of how health information exchanges fit within the context of nationwide health networks such as the CommonWell Health Alliance. The meeting had over 2,000 attendees in an all-virtual environment and I heard mention of several post-meeting happy hours and get-togethers, also virtual.

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I did a little bit of traveling last week. Even though it was a mid-week trip, my overall impression was one of very few business travelers and mostly leisure travelers, despite the CDC’s recommendation against leisure travel. Fewer seasoned business travelers makes for a messier boarding and deplaning experience, for sure. Most passengers were well behaved and kept their masks on and I didn’t see any flight attendants having to give people extra warnings. My work took me to New Orleans, where I spotted this great mini-pharmacy kiosk. Since many of the patients I see in urgent care haven’t tried any home remedies before coming in, maybe we need strategies like this to encourage people to try a Tylenol or a Claritin before running to the doctor.

One of my best friends is a surgeon. We have been having ongoing conversations about the role of telehealth in his practice versus mine. A recent JAMA Surgery article reported on a study that showed a rise in new patient visits being conducted via telehealth in surgical subspecialties, at least during the first wave of the COVID-19 pandemic in April 2020. The study was conducted in Michigan and found that almost 40% of new patient visits were telehealth-based (compared to 1% pre-pandemic) and decreased as the first peak of the pandemic began to subside.

My last visit to a surgeon could definitely have occurred via telehealth since the physical examination performed was cursory at best and added nothing to the case, other than forcing me to sit for 20 minutes waiting in an awful pink gown that was four sizes too big. As a patient just seeking a second opinion about my MRI and ultrasound results, I could have avoided the hour-long round-trip commute, dealing with the parking garage, and taking more time off work than I wanted to.

Speaking of that visit, it also included some genetic testing, and I was a bit surprised at how the process went compared to previous testing I had done in 2017. The practice didn’t give me any kind of anticipatory guidance on what to expect other than to tell me that results would be back in two weeks (which actually took three). A few days after I had my blood drawn, I received a text from the lab vendor offering me a preliminary cost estimate for my labs, which the surgeon had told me verbally would be fully covered by my insurance. When I followed the link, I had to verify some basic demographic information, then was taken to a page that told me it actually couldn’t give me the estimate due to insurance issues.

When the results were available, I received a MyChart message rather than a phone call from the physician, who claimed that they had a wrong number in the chart and therefore couldn’t reach me. After confirming that every single phone field in Epic has my cell number, I wondered if she even tried to redial after reaching someone else. The message let me know my results were “fine” except for a mutation I already knew I had, and she told me to make sure I’m getting colonoscopies, which I already do, and which she should know since we discussed both the mutation and my recent scope at the visit.

All of that data should be in the EHR from previous visits, so I was left with the impression that she wasn’t fully contemplating my case when she sent the results. Since the outside labs can’t be displayed in MyChart, I’m still waiting for a paper copy of them to be sent to my home. After a previous medical misadventure when the ordering provider missed an abnormal result and told me results were “fine,” I’m not closing the book on this one until I have the paper copy in hand. Just when I think healthcare can’t get any more disorganized or that I can’t have yet one more less-than-optimal patient experience, I continue to be surprised.

Also in the journals this week was a paper on “Factors associated with opting out of automated text and telephone messages among adult members of an integrated health care system.” The authors looked specifically at the volume of messages as a predictor of opting out. They found that patients who received 10 or more text messages or two or more interactive voice response messages were more likely to opt out of receiving future messages. As anyone who has ever opted out of a consumer loyalty program knows, text fatigue is real. Healthcare providers should consider message volumes carefully and make sure they’re balancing what they send with the desired outcomes.

Back to telehealth, a recent piece discussed the realities of telehealth contacts and the things physicians observe in that context. Physicians are able to observe clues from the home environment or interact with families in ways they haven’t been able to previously, sometimes leading to more effective care. I’ve certainly seen some eye-opening situations during telehealth interactions, but as part of a nationwide telehealth-only organization, have even less ability to intervene than I might if I was a traditional primary care physician performing telehealth visits with my own patients. My organization doesn’t have the ability to connect patients with social services or home health referrals, so usually we end up referring patients to brick-and-mortar providers in a process that can take months if the patient doesn’t already have a PCP. We’ll see if payers continue to cover telehealth services as the pandemic dynamics change. Everyone is concerned about the potential for fraud, so we’ll just have to see how things go.

What’s your prediction for the ongoing availability of telehealth services? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/1/21

March 31, 2021 Headlines No Comments

CirrusMD Announces $20 Million in Series C Funding

Text-based telemedicine company CirrusMD raises $20 million in a Series C funding round led by Blue Venture Fund.

Q-Centrix Introduces the First Enterprise Clinical Data Management Platform

Clinical data management company Q-Centrix acquires Champs Oncology, a Cleveland-based software and services vendor focused on cancer registry programs.

Governor Lamont Announces Funding To Integrate Remaining Electronic Health Records With Prescription Drug Monitoring Program

Connecticut Governor Ned Lamont allocates $1.3 million in CMS funding to help providers connect their EHRs to the state PDMP via Appriss Health’s PMP Gateway interface.

HIStalk Interviews Josh Schoeller, CEO, LexisNexis Healthcare

March 31, 2021 Interviews No Comments

Josh Schoeller is CEO of LexisNexis Healthcare.

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Tell me about yourself and the company.

I’ve been in the data and analytics space for over 25 years, the last 15 in healthcare. At LexisNexis Healthcare, we use data and analytics to help healthcare operate better and to create healthier communities. That’s front and center right now, given that we spend 18% of our GDP — over $11,000 on every man, woman, and child — for healthcare, yet we don’t even rank in the top 10. We have a lot of work to do, and our data and analytics can help us get better.

How are providers using third-party socioeconomic data of patients, either for care improvement or for their own business outcomes?

They are starting to use it more. I would say that we were pioneers in the SDOH space when we launched our product a little over three years ago, so we have spent a lot of time educating the market. We did some work last year with industry leaders across payer, provider, and health tech on defining the ethical uses of social determinants of health. There was a lot of consternation around how this data should be used.

At the end of the day, it is proven that health outcomes are driven just as much by your social factors as they are by any clinical conditions. It’s critical, if we are going to move to a value-based care system, that we treat people holistically. Their health, not just their clinical conditions. That’s what SDOH is for.

On the provider side, they are using it more from an HRA, health risk assessments, perspective. When you are signing in for your appointment, they’re utilizing information that they give you. They’re not using third parties as much. Some of the cutting edge systems are. We are seeing the third-party use more on the health insurance or the payer side, probably because of the scale. They are not as connected to their members, so they use that third party to get broader insights around population health for larger populations.

To what extent are health systems using outside data?

More and more. That is one of the great areas that we impact today. There isn’t a shortage of data, there’s a shortage of usable data. It is disconnected, siloed, and not standardized. That’s a big piece of what our business does, to help do that data standardization, data transformation, and the linking of that data to incremental data assets to help make better decisions in healthcare.

What are the challenges and imperatives around provider data management?

I was one of the founding members of Enclarity, a company that LexisNexis bought in 2013. We started in 2006 to try to solve provider data quality issues for the industry. Everybody is trying to keep that data up to date, and if every organization is trying to do the same thing, it’s terribly operationally inefficient. If we could do it in one place and leverage that across the industry, then we could do it better, faster, and cheaper for the industry.

We have been successful in being able to roll that out. We have large provider data management businesses across healthcare in health systems, hospitals, health insurance companies, life science institutions, and retail pharmacy.

The challenge is that providers move around a lot. US consumers move on average once every seven years, but the rate of provider change that we see in our MD and DO database is more like 24% per year. To keep up with that, you need to have systems that allow you to monitor, because providers are busy and they are not going to self-report in any meaningful way. We need to be able to monitor and use analytics to track and keep key demographics and key credentials up to date, which then allows us to process claims and have accurate directories for people to find their providers.

Provider data management and the resulting directories have turned into a consumer-facing tool that delivers competitive advantage.

Absolutely. You saw a couple of years ago that a lot of the attorney generals started making regulations around the accuracy rates of provider directories. They were saying that almost one out of every two providers listed weren’t accepting new patients, were no longer at that location, were no longer in network, or had a phone number listed that was no longer correct.

People were going on the exchanges to purchase their insurance, and the #1 driver of choosing an insurance plan outside of price is, do I get to stay with my provider? Almost 50% of the time, they were going to see their provider and finding out that they couldn’t. Then they had to choose between paying out-of-network rates or being disrupted by having to choose a new provider. In California, the AG likened it to a cereal company that lists false ingredients on the box. They put these regulations in place for consumers, not only for their access to care, but also for general continuity.

How are health systems using your systems and data in new ways, especially around the pandemic?

All of our solutions revolve around our three core data assets. They are differentiated proprietary data assets.

First is our provider data, which is the most correct current and comprehensive provider profiles in the US.

The second is the largest de-identified medical claims repository, about 2.2 billion medical claims. You can imagine not only being able to understand where a provider is and what their profile looks like, but now understanding what procedures and what diagnoses they’re doing at what location and who they are referring to, with all that transactional detail being linked. 

The third is more on the consumer side. LexisNexis is one of the largest aggregators of public and private data sources. We utilize that to create a large consumer data asset. That’s a highly regulated data set, but we can utilize it for patient safety. Linking data together from different data sites, making sure that we have high precision, and linking consumer health information together. 

We utilize it for protecting access to data. We do consumer authentication. Health data is yours. As a consumer, you own it. The hospital system doesn’t and the health payers don’t. But for you to get access to it, the covered entities need to make sure you are who you say you are. We have a sophisticated technology to be able to do that identity authentication.

Third is the profile enhancement, like you mentioned before, which is social determinants of health. I’ll give you one use case. During the pandemic, everybody needed to get tested, and now everybody is getting vaccines. We are at the front lines of that, doing the identity authentication. When you log in to check your test results, we’re authenticating that you are who you say you are. When you log in to make an appointment to get your vaccine, we’re doing instant identification of you to make sure that you are a real person so you can then log in to make that appointment.

You mentioned de-identified claims data. The trend is toward drug companies using real-world evidence and performing virtual clinical studies using provider EHR data sold them by third parties, which brings up challenges of data quality and ownership. What challenges do you see in the sudden rush to create a business of selling research data to drug companies?

You nailed the two challenges with it. They call it tokenization of the data. The de-identification of the data needs to meet statistical standards so that it cannot be re-identified. Certainly the SMART on FHIR HL7 standards will help create a better standardization of that data to make it more usable, but we are on the cusp of getting into that with the interoperability rulings coming into play.

Once it is de-identified, you don’t have the consent issue because it is no longer identifiable. But if the entity that is utilizing the data has identified information and they’re trying to link it to it, that can create some concerns as well.

From a hospital system perspective, there’s the new revenue stream of creating real-world evidence, real-world data assets, and leveraging them for life science companies. But I think that the next evolution is even greater, which is not de-identifying it, but  instead the hospital system, as a covered entity, is using it for real-time clinical decision support and clinical health pathways. We need a broader learning and research capability around how we are treating our patients. De-identification allows us to use data for clinical trials, but it’s even more valuable to be able to use it in interacting with our patients on the hospital and health system side.

Are providers using the “patients like this one” model to tap into broad evidence similarly how Amazon recommends an additional item because other customers like you bought it?

Absolutely. The cohort management of the like, I guess I’ll call it, is not only important for providers, but you are starting to see consumers want to be a part of that community and to understand that data.

I run the LexisNexis Healthcare business. Our sister company is Elsevier Health, one of the largest health content companies in the world. We have been doing a lot of work with them to  look within hospitals and health systems to see how they are using content related to those clinical pathways that you described for treatment, as well as for patient engagement. Upon discharge, how are we enabling those patients to understand more about their current health condition, how they should be treating it, and motivating and engaging them to be more in tune with their own health?

How widely are health systems using multi-factor authentication for security and applying technology to positively identify patients?

It’s going to be more and more of a concern. As interoperability enables the rate of health data exchange to go up, up, up, we are going to see the need for tighter data security and identity authentication go up, up, up as well. Some of the regulations have the NIST IAL criteria for authentication. Some of that requires biometrics, which we call TrueID on our side. It uses a driver’s license or a passport photo to verify.

There’s always a fine balance between compliance and enablement of the consumer. You don’t want to put them through such a security gauntlet where 50% of them give up and don’t end up logging in and getting access to the health information that they access. It’s that fine line. As a technology company, we want to enable it to be less abrasive to the consumer, but at the same time, enhancing the overall risk detection on the identity side.

You have seen that we’ve acquired several companies over the last few years, ThreatMetrix being the largest. ThreatMetrix is the largest digital identity network contributory database in the world that understands the IP address of your laptop and your phone. As you are logging in, we can say, “that phone belongs to Josh Schoeller” versus seeing that it’s routing through Eastern Europe. Doing bot detection, checking that the keystrokes are at the speed of someone typing instead of the same individual doing 136,000 transmissions in the last 30 minutes trying different access codes. All those things need to happen behind the scenes and in real time to help with security and to enable consumer access to their health.

How will vaccination passports work?

Every state has their vaccine registries. We work with several partners that interact with them and help them in various ways. All vaccine locations are required to submit to the federal registry.

The question is, will that become a consumer asset? We are seeing apps and companies pop up, saying that you can have your vaccines documented on your phone and pull it up when you want to go to a concert, get on an airplane, or send your kids back to school. There is definitely value in that utility, but the question is, what’s the commercial model? Will people actually pay for that access? If not, what’s the commercial viability of that space? Certainly this pandemic gave us all new kind of understanding. It changed the game as far as the importance of vaccinations and people’s access to them.

How has the pandemic changed the company’s business?

When the pandemic hit, we got together to say, what are the risks and what are the opportunities? We are a health business, and this is a health pandemic, so it’s going to be more impactful to us than other industries or other areas of the broader business.

We were able to look at how we could pivot into the needs that the pandemic created. Within three weeks of the offices shutting down last, almost a year ago this week, we created the LexisNexis COVID data resource. We put that out on the internet for free. That tracked every day all of the people who got COVID, using the Johns Hopkins data. We overlaid that with our claims data to understand hotbeds of comorbidities. We then overlaid that with our social determinants of health to understand other impacts to those communities. Finally, we overlaid it with our provider information. Where are the pharmacies, where are the hospitals that need to treat all these people? You could start to see hotspots of where we needed more resources. That was put out there to help the research community. Out of that, we interacted a lot with our customers around how they could utilize their data during COVID.

On the broader industry side, we were already moving rapidly towards digital healthcare, the digitalization and consumer-driven healthcare. COVID probably moved us five years ahead in that area. We saw a 400% increase in the use of telemedicine. That’s not going to go away. Consumers, because of all the news and all the information that was out there, generally got more engaged, and they did that in a digital way. That’s not going to change.

Our business needed to pivot to help both the consumer-patient-member as well as our customers, who are payers, pharmacies, and hospital systems. How we can help that digital experience — from a data security, compliance, and operational efficiencies perspective — improve health and healthcare delivery in the United States?

Do you have any final thoughts?

We are on the cusp, and we are seeing it every day, of healthcare transforming. It is consumer driven and digitally driven, but at its roots, it will be driven by the use of data and analytics to help drive better health care outcomes.

LexisNexis and other companies are in a unique position to help both public and private sector healthcare improve healthcare outcomes. That’s our mission and goal over the next several years. I’m bullish on us being able to improve healthcare delivery, as well as health outcomes, to create healthier communities across the US and being able to have the data and metrics to track that from an ROI perspective for our customers.

Morning Headlines 3/31/21

March 30, 2021 Headlines No Comments

SteadyMD Raises $25 Million to Power Telehealth Infrastructure for Digital Health Companies and Employers in All 50 States

Telehealth provider SteadyMD raises $25 million in a Series B funding round, increasing its total to $35 million.

Optimum Healthcare IT Acquires TrustPoint Solutions

Optimum Healthcare IT acquires TrustPoint Solutions, which offers technology planning and implementation solutions.

VA secretary worried by productivity issues, rising costs of $16 billion EHR rollout

VA Secretary Denis McDonough is concerned about user productivity at its first live Cerner site, raising the issue that the project’s cost could exceed its $16 billion budget.

SOC Telemed Completes Acquisition of Access Physicians To Form Largest Acute Care Telemedicine Company in the US

Acute care telemedicine company SOC Telemed acquires competitor Access Physicians for $194 million.

News 3/31/21

March 30, 2021 News 1 Comment

Top News

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Specialty-focused software and analytics vendor Net Health acquires Casamba, an EHR developer that focuses on home health, hospice, and outpatient therapy providers.


HIStalk Announcements and Requests

Listening, and continuing my 1960s psychedelia fascination: Vanilla Fudge, in a bizarre, grainy TV appearance that captures the era perfectly. The tuxedo-wearing, white-bread TV host gamely turns it over to the annoyingly trippy and somewhat pretentious Fudge, who having enrobed themselves in trendy Nehru jackets, dashikis, and scarves, employ the wildest flourishes imaginable while go-go dancers in tunics and knee-high white boots gyrate freeform to the band’s cover of “You Keep Me Hanging On.” The Fudge could have lip-synced like most bands did in these crappy TV variety shows that catered to senior citizen viewers downing shots of Geritol, but they instead laid down a museum piece of their divisive talent in which every member achieved maximal punchability but sounded great doing it. The over-the-top yet consummately skilled bass player is Tim Bogert, who died in January at 76. The go-go dancers are now great-grandmas with wild memories.


Webinars

April 21 (Wednesday) 1 ET. “Is Gig Work For You?” Sponsor: HIStalk. Presenter: Frank L. Poggio, retired health IT executive and active job search workshop presenter.  This workshop will cover both the advantages and disadvantages of being a gig worker. Attendees will learn how to how to decide if gig work is a good personal fit, find the right company, and protect themselves from unethical ones.

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


Acquisitions, Funding, Business, and Stock

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Crossover Health, an online and in-person primary care company that serves payers and employers, raises $162 million in a Series D funding round, bringing its total raised to $282 million. Earlier this month, the company expanded its territory for Amazon employees from its pilot site of Dallas to four more states. The founder and CEO is Scott Shreeve, MD, who founded Medsphere with his brother Steve in 2002.

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Cardiac remote patient monitoring and data management company PaceMate raises $8 million.

Telehealth provider SteadyMD raises $25 million in a Series B funding round, increasing its total to $35 million.

Optimum Healthcare IT acquires TrustPoint Solutions, which offers technology planning and implementation solutions. 


Sales

  • Carilion Clinic (VA) will work with MetiStream to develop AI-enabled Surgical Clinical Review software to improve case reviews and decision-making.
  • Tampa General Hospital (FL) will add TytoCare’s home medical exam kit to its virtual TGH Urgent Care services.
  • Millennium Physicians (TX) goes live with RCxRules to automate charge review and charge correction, integrated with their NextGen PM/EHR.

People

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Kristen Hagerman, MS, RN-BC (Connected Care Consulting) joins Kaleida Health (NY) as CNIO and VP of clinical informatics.

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Censinet hires Cormac Miller (Optum) as president and chief commercial officer.

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Divurgent names Stephanie Evans (Accenture) security and privacy principal.

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Flatiron Health promotes Carolyn Starrett to CEO. She succeeds Nat Turner, who will remain chairman of the board.


Announcements and Implementations

In West Virginia, Cabell-Huntington Health Department will implement Epic through a partnership with Mountain Health Network.

Sharp HealthCare (CA) implements patient review and feedback capabilities from Podium.

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Healthcare Triangle develops Readabl.ai, automated document capture, processing, and data-routing software.

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A Brigham and Women’s study finds that Epic-using medication prescribers would receive 94% fewer alerts by using Seegnal, a commercial clinical decision support product that was developed by Israel-based Seegnal EHealth. Seegnal’s platform uses patient EHR data, algorithms, drug interaction references, and pharmacokinetic and pharmacogenetic databases to present only relevant alerts and then suggest alternatives. The company says its system offers 98% accuracy versus the 6% provided by commercial EHRs, then allows clinicians to detect, prioritize, and resolve problems in 5-10 seconds.

Health plan support company NeuGen implements real-time care alerts from PatientPing.

Pivot Point Consulting expands its virtual care services practice to include telehealth selection and implementation, integration, revenue cycle, patient experience, and app development.

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A new KLAS report looks at social determinants of health referral networks, with Aunt Bertha leading the small pack. Unite Us – which just announced a funding round that values the company at nearly $2 billion — scored well, though with fewer healthcare customers.


Government and Politics

VA Secretary Denis McDonough says in a House hearing that he is concerned about user productivity at its first live Cerner site, Mann-Grandstaff Medical Center (WA), raising the issue that the project’s cost could run over its $16 billion budget.

Tulsa-based MyHealth Access Network withdraws its protest of the state’s selection of Orion Health to provide a statewide HIE platform for $49.8 million, which is nearly $30 million more than its own bid. MyHealth founder and CEO David Kendrick, MD says it’s time now to focus on partnering with the new HIE to improve care for patients across the state.


COVID-19

Federal health researchers report that the Moderna and Pfizer COVID-19 vaccines prevent 80% of infections two weeks after the first injection, then 90% two weeks after the second shot. The CDC study also found that the vaccines seem to offer protection against coronavirus variants. It also noted that while more than 50% of people weren’t having symptoms when they were diagnosed, 90% eventually developed them.

CDC reports that 50% of all US seniors have been fully vaccinated.

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The White House assigns HHS to standardize the development and management of vaccine passports to support business reopening and travel, encouraging solutions that are free, open source, secure, and able to create both electronic and paper documentation similar to an airline boarding pass. The government has identified at least 17 initiatives that are underway. An unnamed official says such credentialing will take time because “this has a high likelihood of either being built wrong, used wrong, or a bureaucratic mess” since developers need to consider how to address variants, track booster shots, and account for yet-unknown immunity duration.

Meanwhile, the Wall Street Journal suggests that people keep their vaccine card because it is often their only record of being vaccinated, although the card design is not consistent and would not be hard to fake.

HHS will investigate a three-location, surgeon-owned California outpatient clinic that has been paid $146 million from the federal government’s COVID-19 patient assistance program. The practices are owned by Anthony Dinh, DO, an ENT and plastic surgeon.

The New York Times examines COVID-19 testing bills from Lenox Hill Hospital (NY), which advertises its testing services on a banner outside its ED but doesn’t mention that the hospital charges $3,000 per test, multiples of the typical cost. One family needed 12 tests last year to return to work and school and was billed $39,000. The paper also found that owner Northwell Health has charged similarly high prices for drive-through tests by tacking on ED fees. Federal law requires insurers to fully pay for COVID-19 testing with no cost to patients, so patients don’t actually have to pay, but as a medical billing expert told the paper, “This is such a gold mine for hospitals because now they can charge emergency fees for completely healthy people that just want to be tested. This is what you’d expect from a market-oriented approach to health care. It’s the behavior our laws have incentivized.” Northwell says patients who present a doctor’s order are sent to a service center that does not charge ED fees, but those who just show up – many from seeing the banner urging them to do so — are evaluated in the ED with the facility fee added on. Lenox Hill has also been criticized for opening a freestanding ED and charging patients, who sometimes confuse it with an urgent care center, many multiples of the usual cost, such as $3,000 to treat a sprained ankle. Northwell’s closest urgent care center down the street performs the same COVID-19 test with a doctor visit for just $350, so choosing the wrong of two doors will cost an extra 700%.

Pfizer will begin US studies in April of a version of its COVID-19 vaccine that can be stored under normal refrigeration.


Other

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Wisconsin’s UW Health OB-GYN department requires patients to sign surgical consent forms the day of surgery instead the day before, as noted in a newly issued medical board order against Jay Lick, DO. A patient told Lick in an office visit that she did not want her ovaries removed as part of a hysterectomy, then called his office back later to say that she had changed her mind. The nurse added an EHR note that Lick didn’t see, so the ovaries weren’t removed and she had to undergo a second surgery later the same day. The state’s review noted that the clinic’s EHR does not share information with the hospital’s EHR, so the information that the surgery team reviewed during surgery timeouts did not indicate ovary removal. The board also found that the OR team used medical procedure terminology that the patient would not have understood, so she didn’t catch their mistake. The clinic’s consent forms wasn’t scanned into the hospital EHR until after the patient had been discharged.


Sponsor Updates

  • King Abdulla Medical City in Saudi Arabia goes live on Agfa HealthCare’s enterprise imaging.
  • The Chartis Group names Mike Brown (MD Anderson) director.
  • HST Pathways will incorporate RCM software from Waystar with its software for outpatient surgical centers.
  • Frost & Sullivan recognizes Wolters Kluwer Health with a 2021 New Product Innovation Award for its suite of clinical surveillance solutions.
  • Glytec releases the newest version of its EGlycemic Management System, including enhancements and new integrations to improve workflow and patient safety.
  • Hills Health Solutions incorporates GetWellNetwork’s patient engagement solutions with its technologies already in use in hospitals Australia and New Zealand.

Blog Posts


Contacts

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

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Morning Headlines 3/30/21

March 29, 2021 Headlines No Comments

Crossover Health Secures $168 Million in Series D Financing to Fuel Expansion of National Primary Health Service

Crossover Health, a primary care company serving payers and employers like Amazon, raises $162 million in a Series D funding round, bringing its total raised to $281.5 million.

MTBC is Now CareCloud

Ambulatory health IT company MTBC rebrands to CareCloud, which it acquired in early 2020.

Net Health Acquires Casamba

Specialty-focused software and analytics vendor Net Health acquires Casamba, which has developed EHR software for therapy providers, and home health and hospice organizations.

PaceMate Closes Series A Financing to Accelerate Growth

Cardiac remote patient monitoring and data management company PaceMate secures $8 million in Series A financing from Ballast Point Ventures.

Curbside Consult with Dr. Jayne 3/29/21

March 29, 2021 Dr. Jayne No Comments

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I recently received an email from Doximity, which is kind of like a physician-specific LinkedIn that also offers some services such as being able to call patients using your cell phone but have your office number display in the caller ID. The email invited me to review a personalized report on diagnostic behavior among US clinicians, comparing me to other family physicians using data provided by CMS. It sounded interesting, so of course I clicked the button. It goes without saying that when CMS data is your kind of clickbait, you must be a clinical informaticist.

The actual report was less exciting than the teaser – it only showed five diagnoses for a total of seven claims. Sinusitis was the leader, with pinkeye, wrist sprain, allergic rhinitis, and right lower quadrant pain following. That’s a typical day in urgent care, but I was surprised to see such a small number of claims. Digging deeper into the information that came with the report, the data was drawn from CMS claims files available at Data.CMS.gov. It also reflected the 2019 calendar year. I’m pretty sure I saw more than seven Medicare beneficiaries in 2019, but who knows how the data was parsed.

There was also a set of comparison data, looking at how I fared versus other physicians in my specialty in the same state. I apparently see significantly fewer cases of hip pain, cellulitis, and bronchitis than my peers. I found that funny since I’m an urgent care physician and those kinds of acute conditions make up the bulk of my practice. I’m sure they were pulling the data using the CMS specialty taxonomy codes alone and not stratifying by place of service. I wonder how I would stack up against other urgent care docs in my area. The top diagnoses in my state were not surprising – hypertension, hyperlipidemia, and type 2 diabetes. These were similar to national diagnosis rates.

The one thing I did find surprising was the number of encounters that they said family physicians were billing for “Encounter for screening mammogram for malignant neoplasm of breast.” I don’t know a single family physician who performs or interprets mammograms, so I was surprised that the data said that more than 71,000 of my peers have been documenting it on claims. Based on the coding education I’ve received, it should only be coded by the person reading the mammogram, but maybe something has changed and I missed it because I’ve been deep in the COVID-19 trenches.

I visited the CMS data site and try to find the raw data to see if I could come up with other conclusions, but was never able to find the correct file for 2019. Probably it was there but named something that didn’t click in my brain as being a claims data file, even though I tried various filters and searches including just trying to restrict to outpatient data. I would be curious to see how the diagnosis patterns shifted over the years and whether the usual problems are still the usual problems. I know there have been some shifts in conditions like sinusitis due to the pandemic, since more people are wearing masks.

I’m not sure how useful the data would be if I had it since it’s just Medicare data, and Medicare beneficiaries represent a small percentage of my practice. It would be much more useful as a provider to be able to see a big, aggregated data set that looked at multiple years, irrespective of where I’ve practiced. Sure, you could get your diagnosis mix out of your EHR, but for people like me who have worked in a variety of settings and places, that’s easier said than done.

Data is interesting stuff, but it’s only as powerful as the people who have access to it and the tools they have to manipulate it. If we really want to use it to make change, we need to be able to further stratify it. For example, what does my data look like when compared against other in-person urgent care settings? How does an independently-owned urgent care’s treatment habits compare against one that is owned by a hospital system? Does it make a difference whether physicians are full-time or part-time, or how long it has been since they finished their medical training? It would be fun to have that kind of data at your fingertips, at least if you’re someone who’s into that sort of thing.

Although I’m pretty good at manipulating data, I miss having easy access to dedicated data analysts on a daily basis. As a CMIO, I loved having a team where I could explain a business problem and trust that they knew not only how to find the data in the applications (or who would know, if they didn’t) but also the best ways to render it depending on the intended audience. Working with my health system clients, I tend to be at the mercy of their IT teams and sometimes it can take weeks for a request ticket to make it through the support queues before I hear from someone who will attempt to track down the information I’m looking for. Sometimes it even takes so long that by the time we have an answer to the question, the team has moved forward with a decision without the benefit of data. That can be maddening, but it’s common when there is a mismatch of supply and demand.

I think the more useful type of report looks at not only what you diagnosed, but how you treated it, as well as whether the condition was well controlled if it’s a chronic one. Physicians seem to see some of those reports more often in the post-Meaningful Use era than they used to previously, but I know that some organizations only present their clinicians with data a couple of times a year where others may have monthly or real-time access. If there are any physicians out there who received a similar report from Doximity, I’m curious what you thought of your data and whether it was useful in any way.

What kind of reports would help your clinicians deliver the best care and best outcomes? How often should they be reviewed? Leave a comment or email me.

Email Dr. Jayne.

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Reader Comments

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