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Morning Headlines 8/14/23

August 13, 2023 Headlines No Comments

CMA provisionally clears UnitedHealth’s proposed £1.2bn purchase of EMIS

The UK’s Competition and Markets Authority provisionally clears UnitedHealth’s $1.5 billion acquisition of healthcare software vendor EMIS after identifying no anti-competitive concerns.

Cegeka to Acquire CTG for $10.50 Per Share, Enhancing Value to Customers Across North America and Europe

European IT company Cegeka will acquire Computer Task Group, a global, multi-vertical digital transformation consultancy, in a take-private deal valued at $170 million.

Feds now investigating release of trans medical records by Vanderbilt

HHS’s Office for Civil Rights launches a federal civil rights investigation of Vanderbilt University Medical Center for providing Tennessee’s attorney general with the fully identified medical records of transgender patients.

Monday Morning Update 8/14/23

August 13, 2023 News No Comments

Top News

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HHS’s Office for Civil Rights launches a federal civil rights investigation of Vanderbilt University Medical Center for providing Tennessee’s attorney general with the fully identified medical records of transgender patients. Patients who were involved have already initiated a class action lawsuit against VUMC for that release, as demanded by the AG.

An attorney who is representing the patients in the lawsuit against VUMC for failing to de-identify the records said, “The more we learn about the breadth of the deeply personal information that VUMC disclosed, the more horrified we are. Our clients are encouraged that the federal government is looking into what happened here.”

The office of Tennessee AG Jonathan Skrmetti said it hasn’t heard about the investigation, but told reporters, “Turning a disagreement about the law into a federal investigation would be plainly retaliatory and would reflect a dangerous politicization of federal law enforcement.”


Reader Comments

From Nicholas S. Desai, MD: “Re: using generative AI. We are using software that develops working clinical summaries or drafts of the patient’s status that display right in the patient list in Epic. Our physicians, nurses, and case managers are using in real-time on the front lines. We recently reached the 1 million mark and I think there are a lot of great lessons on how to deploy AI in clinical workflows from our experience. We are seeing good time savings from the tool, as well as good user reception and adoption. There are not many real world examples of clinical generative AI in actual use and at fairly high scale that I am aware.” Dr. Desai is chief medical officer and chief quality officer at Houston Methodist Health System (Sugar Land). They are using software from Dallas-based Pieces Technologies, which was spun off from Parkland Memorial Hospital several years ago, which notes that its product has autonomously generated 1 million real-time clinical summaries for 72,000 patients in the first seven months after go-live.  


HIStalk Announcements and Requests

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Poll respondents don’t expect AI-powered systems to be used to diagnose and treat patients without a doctor’s involvement any time soon. However, some commenters note that doctors have successfully supervised other practitioners for years, allowing EMTs and other clinically trained people to work within established guardrails with the oversight of a physician medical director.

New poll to your right or here: What type of doctor would be your #1 clinical choice for a telehealth visit for a urinary tract infection? I’m eliminating price, insurance coverage, etc. to get an idea of all things being equal, who would you want treating your UTI, and you can say N/A if you would choose an in-person visit if available. I’m also saying “doctor” to simplify voting, but “doctor” could be a different type of clinician if appropriate.

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Welcome to new HIStalk Platinum Sponsor Cardamom Health. With a multidisciplinary, team-based approach, The Madison, WI-based company brings a modern model of delivering low cost EHR data, analytics, and applications services. Cardamom helps healthcare organizations tackle some of today’s toughest challenges – including patient engagement, value-based care, clinical research, and revenue cycle management – with a sharp focus on integrating and harmonizing data to generate meaningful, timely, and actionable insights. Founded by a KLAS award-winning managed services leadership team, the company’s data, analytics, and applications experts have decades of experience serving over 150 healthcare organizations, including some of the most complex health systems in the US. The company empowers its clients to maximize the value of their IT investments by providing results-based services to improve quality, business outcomes, and overall patient experience – all at a much lower cost than traditional consulting. Thanks to Cardamom Health for supporting HIStalk.


Webinars

August 24 (Thursday) 2 ET. “RCM analytics in action: How to use your data to drive decisions + revenue.” Sponsor: Waystar. Presenter: Laura Tungate, solution strategist team lead, Waystar. This webinar will describe how to use RCM analytics to take control of your data even if you use outdated or multiple tools. Attendees will learn how to target improvements, describe the KPIs that are key to revenue cycle leaders, prioritize dashboards that spotlight organizational goals and build alignment, and how and when to apply RCM analytics to go from analysis to action faster.

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


Acquisitions, Funding, Business, and Stock

The UK’s Competition and Markets Authority provisionally clears UnitedHealth’s $1.5 billion acquisition of healthcare software vendor EMIS after identifying no anti-competitive concerns.


Sales

  • Children’s Health Ireland chooses Oneview Healthcare’s digital patient engagement and education system.
  • Ireland-based Bon Secours Health System launches a project to implement Meditech at its five hospitals, with the assistance of Nordic. 

Announcements and Implementations

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Mount Sinai Health system will become the first health system to move its Epic instance to Microsoft Azure Large Instances.


Other

Oracle talks up the desirability of Nashville – for which the company received $278 million in government incentives to open a facility there – and says it will move a “national healthcare conference” of Oracle Health there. The invited guests at an Oracle event in Nashville were almost entirely drawn from healthcare.


Sponsor Updates

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  • NTT Data staff support the AFCEA Educational Foundation’s golf tournament fundraiser.
  • EClinicalWorks releases a new podcast, “Empowering Communities, Analytics for Better Patient Care.”
  • Nordic releases a new Designing for Health Podcast, “Interview with Karim Jessa, MD.”
  • Optum and Capella University announce a new nurse practitioner program to address the growing national need for skilled clinicians.
  • Surescripts publishes a new data brief, “Prescribers & Pharmacists Look for More Collaboration & New Technologies to Improve Care.”
  • Waystar will exhibit at the MedInformatix Summit August 15-17 in Fort Lauderdale, FL.Forrester includes West Monroe in its new report, “The Digital Transformation Services Landscape, Q3 2023.”
  • Wolters Kluwer Health announces strong results for the Lippincott portfolio of journals in the 2022 Journal Impact Factor rankings released by Clarivate Analytics.
  • Zen Healthcare IT will exhibit at the Civitas conference August 20-23 in National Harbor, MD.

Blog Posts


Contacts

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

Morning Headlines 8/11/23

August 10, 2023 Headlines No Comments

Doximity Announces Fiscal 2024 First Quarter Financial Results

Doximity’s Q1 results beat expectations, but its lowered guidance and layoffs send shares down.

Babylon closes US business as rescue merger deal fails

Babylon Health shuts down its US business, laying off 94 employees, as it seeks a buyer for its business in the UK.

Cano Health sinks on raising going concern doubts; announces job cuts

Shares of membership-based primary care company Cano Health plummet after it announces plans to sell its assets and lay off employees.

Prospect Medical hospitals still recovering from ransomware attack

Prospect Medical Holdings facilities struggle to recover from a ransomware attack earlier this month that sources attribute to the Rhysida ransomware group.

News 8/11/23

August 10, 2023 News No Comments

Top News

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Doximity reports Q1 results: revenue up 20%, adjusted EPS $0.19 versus $0.14, beating analyst expectations for both.

Shares fell more than 20% on the news, however, as the company lowered sales projections and announced plans to lay off 10% of its headcount.

DOCS shares have lost 31% in the past 12 months versus the Nasdaq’s 11% gain, valuing the company at $5 billion.  


Webinars

August 24 (Thursday) 2 ET. “RCM analytics in action: How to use your data to drive decisions + revenue.” Sponsor: Waystar. Presenter: Laura Tungate, solution strategist team lead, Waystar. This webinar will describe how to use RCM analytics to take control of your data even if you use outdated or multiple tools. Attendees will learn how to target improvements, describe the KPIs that are key to revenue cycle leaders, prioritize dashboards that spotlight organizational goals and build alignment, and how and when to apply RCM analytics to go from analysis to action faster.

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


Acquisitions, Funding, Business, and Stock

California Heathline questions how Kaiser Permanente can meet its stated goal of reducing healthcare costs by spending $5 billion to create the Risant Health hospital group, whose first acquisition will be Geisinger. The deal doesn’t involve KP’s physician group, whose physicians are paid on a per-member, per-month basis, and the non-profit KP doesn’t own health plans and practice groups in other states, which is one reason that its previous expansion attempts failed. Experts question whether KP is planning an expansion into lucrative fee-for-service operations, or if not, whether Risant Health will distract KP from its core operations and increase costs.

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One-time digital health high-flyer Babylon Health swirls further down the drain following the collapse of its planned take-private merger with MindMaze. The company announces the shutdown of its US business, the laying off of its 94 employees, and its hopes to sell its UK operations. BBLN went public via a SPAC merger in 2021 and saw its market cap hit $8 billion shortly after. Shares are now at under $0.02 after losing another 20% on Thursday, valuing the company at $350,000.

The private equity owner of video and voice communications vendor Intermedia Cloud Communications is exploring the company’s options, which could include a sale for up to $1 billion. The company’s healthcare call center is integrated with vendor platforms such as Athenahealth, Veradigm, and Oracle Health.

Startup Hey Jane, whose saw its business of selling abortion drugs by mail limited by state legislation, adds new virtual services to treat UTIs, yeast infections, emergency contraception, and herpes treatment. The new offerings will be limited to customers in the same 11 states where its abortion services remain legal.


Sales

  • Cigna’s health benefits group will offer its members Virgin Pulse’s health behavior change app.

People

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Alaska’s HIE hires Kendra Sticka, PhD, MS, RDN (University of Alaska Anchorage) as executive director.

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Chris Alberto (Change Healthcare) joins Divurgent as VP of client service.

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CHIME hires Nicole Kerkenbush, RN, MHA, MN (Monument Health) as VP of education. She previously held IT leadership roles in the Army Office of the Surgeon General and the DoD and was a US Army colonel.

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Cathy Donohue, MBA (Commure) joins CodaMetrix as SVP of product.

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Mike Doyle (Health Catalyst)  joins Impact Advisors as VP. 


Announcements and Implementations

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Digital cloud fax and interoperability solutions Consensus Cloud Solutions announces Clarity Clinical Documentation, which uses AI and ML to extract clinical information from faxes, handwritten notes, and scanned documents and post it to the correct patient’s electronic patient record.


Privacy and Security

Zoom’s founder and CEO says that the company’s recently changed terms of service, which seemed to require users to accept Zoom’s use of their recordings for AI training, was “a process failure internally.” He promises customers that “we will never use any of their audio, video, chat, screen sharing, attachments, and other communications like poll results, whiteboard, and reactions to train our AI models.” Customers had complained, and in some cases left the platform, over concerns that their proprietary company information could be exposed, patient privacy could be compromised, and the opt-in decision was at the administrator level so that meeting participants had no choice except to leave.


Other

A Washington Post report showcases New York’s Mount Sinai Hospital as being among the elite hospitals whose executives are spending hundreds of millions of dollars on AI software and education, while employees are expressing concern about AI mistakes, privacy issues, the possibility of staff cuts, and using software that has not undergone clinical trials. The dean of AI at Sinai’s medical school says that AI vendors are overhyping its capabilities and urges oversight by physicians and the federal government, while its VP of digital experience says the hardest part of introducing AI is the reluctance of doctors and nurses to change their decades-old ways.

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Billionaire celebrity and influencer Kim Kardashian draws heat from her fans for pitching a startup’s full-body “preventative” MRI scans for $2,500. She and the company claim that she wasn’t paid for her endorsement. Her followers note that the Prenuvo tests aren’t covered by insurance and are therefor not affordable for most of them.


Sponsor Updates

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  • Five9 interns volunteer as part of Habitat for Humanity’s Playhouse Program.
  • Clearwater launches its Cyber Now Initiative, offering providers educational assistance, assessment of cybersecurity practices, and expert resources to build and manage cybersecurity programs.
  • Best Medical Care (NY) upgrades to EClinicalWorks Cloud.
  • Meditech will host its Meditech Live leadership summit September 20-22 in Foxborough, MA.
  • Arcadia publishes a report titled “The Current State of Healthcare Analytics Platforms.”
  • Black Book Market Research survey-takers recognize Netsmart as the top overall client-rated, post-acute technology platform for the ninth year in a row.
  • Impact Advisors welcomes 28 new colleagues to the company.
  • Lucem Health releases a new episode of its This Week in Clinical AI Podcast.
  • Medhost will exhibit at the Mid-South Critical Access Hospital Conference August 15-17 in Point Clear, AL.

Blog Posts


Contacts

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

EPtalk by Dr. Jayne 8/10/23

August 10, 2023 Dr. Jayne 4 Comments

Faculty at Washington University in St. Louis have released a tool called the Social Media Use Scale, which can use information about various types of social media to develop insights about user personality and behavior characteristics. The research was designed to better understand how social media may influence psychological well-being, since previous research has led to inconsistent and sometimes conflicting findings. Researchers looked at the frequency for user engagement across four different categories of social media:

  • Belief-based use involves engaging with social media content and activities that express and reinforce negative opinions. These may be associated with depression and urges to view emotionally upsetting content. Users can be characterized by poor self-control and might engage in drama as a means to avoid boredom.
  • Consumption-base use involves engaging with social media content largely for entertainment. It is associated with greater emotional wellness, greater self-esteem, reduced depression, and seeking content that makes the user happy.
  • Image-based use involves engaging with social media on activities that promote a positive social image, such as self-promotional posts or tracking likes or comments on a post. It is associated with wanting to put oneself on display and to participate in activities that build self-worth.
  • Comparison-based use involves engaging with social media content that may include comparison with others or an idealized state. Such activities can be associated with negative outcomes, lower emotional well-being, negative perception of physical appearance, or fear of negative evaluation.

The new model goes beyond previous models that looked primarily at whether users were passively or actively interacting with social media, which the authors felt didn’t fully explain how users interacted with social media platforms. The researchers looked initially at more than 170 college-aged students who were asked to spend a fixed time on social media and then describe their activities and level of enjoyment. The open-ended response format is unique in this area of research.

They then looked at additional cohorts of students, asking them to indicate how often they participated in the activities identified by the first study. They also completed common surveys that look at personality traits and behavioral characteristics, analyzing the data to find common patterns which led to the creation of the four categories.

The scale can be used on any social media platform that allows creation of individual profiles, connection with other users, and allows users to view lists of connected users. Key findings include the differences between image-based usage and comparison-based usage and their connection to depression and other negative mental health factors. This supports conclusions that social media use isn’t “all good” or “all bad” as far as mental health outcomes, but that different types of use play different roles in overall well-being.

I’ve been thinking about my own social media usage lately, particularly in the wake of Twitter’s rebranding to X. I’ve been largely silent on recent changes at Twitter because I didn’t want to be pulled into the drama around Elon Musk and his erratic behavior. Like many, I was also waiting to see how things might shake out before coming to a conclusion.

I admit that I haven’t been following Twitter’s performance closely and don’t know what it’s market share is or how it’s doing financially. However, I know that on a visceral level, my initial reaction to the rebranding has been decidedly negative. There was just something chipper and cheery about that little bird, and the fact that it symbolized (at least to me) the idea of one voice out there reaching lots of others. It felt positive, maybe hopeful.

Now we have a nebulous-appearing X that doesn’t symbolize much. For me, it gives the vibe of the unknown which isn’t always a good thing. Only time will tell as far as what happens to the company or whether another will rise up to challenge its market share in a meaningful way. Until then, we’ll have to keep our eye out for information on the proposed Musk/Zuckerberg steel cage match.

Although my Twitter use is in decline, I find myself increasingly sucked into continued use of Facebook due to different groups that have decided to use it alone as a method of communication. Email seems to be on the way out, even for organizations that were previously loyal to it. I still haven’t cracked the code on Instagram or how to use it in a meaningful way versus just using it to find pretty and distracting things to look at, so I’ll have to keep experimenting. Even with my side interests of crafting, I still find Pinterest to be largely annoying, so I won’t be spending much more time there. I’m open to other social media suggestions or even tips on how to get more out of the ‘Gram, so if you’ve got ideas please send them my way.

Even as a member of the HIStalk team, I frequently get my news and information from Mr. H. That was the case with how I learned about the recent changes to Zoom’s Terms of Service that allows the company to use customer-generated content for AI training. I know I had to take an update for Zoom on my work account recently, but of course like 99% of end users, I didn’t read the changes to the Terms of Service. It’s important to my work that I have access to that particular tool, since some of the vendors and clients I work with have issues going back and forth between Zoom and other platforms and have expressed a clear preference to use Zoom even though it’s not our organization’s standard.

The general sentiment out there was that with the edits to the Terms of Service, Zoom had invaded user privacy and the inability to opt out created substantial issues. The story linked above has been updated several times in the last day, with the most recent comment being that Zoom has made adjustments to section 10.4 of the Terms, stating that “For AI, we do not use audio, video, or chat content for training our models without customer consent.” However, legal experts aren’t in full agreement that it’s enough to protect user privacy.

Although what’s done is done on my work account, I’ll definitely be paying closer attention if I’m asked to take an update on my personal account, which I use primarily for meetings related to community groups and volunteer activities. I hope Zoom’s AI enjoys my content on amateur radio, needle crafts, and being in the great outdoors.

What are your thoughts on the ability of companies to harvest user data for their artificial intelligence pursuits? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 8/10/23

August 9, 2023 Headlines No Comments

Endear Health Announces $8M in New Funding From Optum Ventures, Blue Cross of Idaho, 8VC and Additional Strategic Partners

Endear Health, developer of digital health engagement software for seniors, raises $8 million in a Series A funding round.

Sanford Fargo to offer remote patient monitoring service

Sanford Health Fargo (ND) launches a remote patient monitoring service using technology from CareSignal for recently discharged patients and those being treated for COPD, depression, Type 2 diabetes, and heart failure.

Majority of health system executives believe generative AI will reshape the industry, yet only 6% have a strategy in place

A survey of health system executives finds that while 75% of them think generative AI has reached the turning point that is necessary to change healthcare, only 6% of their organizations have established a strategy to use it.

Healthcare AI News 8/9/23

News

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Senator Mark Warner (D-VA) expresses concerns to Google officials that hospitals are testing the company’s Med-PaLM 2 large language model. He asks specifically whether the LLM memorizes the full set of a patient’s data, whether patients are notified of its use or are offered the chance to opt out, and for the company to provide a list of those hospitals that are participating in testing. Warner raised questions in 2019 about whether Google’s “secretive partnerships” with hospitals that would use patient data without their consent could create privacy issues.

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A hospital in Israel adds a startup’s ChatGPT-powered clinical intake tool to its ED admission process. It collects the results of a three-minute chatbot Q&A that the patient answers in their own words, after which the system generates a condition summary for the doctor.


Business

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MUSC Health will use Andor Health’s ChatGPT models to create a virtual care ecosystem that will include virtual visits, virtual hospital, virtual patient monitoring, virtual team collaboration, and virtual community collaboration.

A Bain survey of health system executives finds that while 75% of them think that generative AI has reached the turning point that is necessary to change healthcare, only 6% of their organizations have established a strategy to use it. They rank the top three uses over the next 12 months as clinical documentation, analyzing patient data, and optimizing workflows, while within 2-5 years they will be looking at using AI in predictive analytics, clinical decision support, and making treatment recommendations.


Research

A University of Maryland School of Medicine article says that physicians need more training in probabilistic reasoning to productively use AI-powered clinical decision support. The authors suggest that physicians undertake training in sensitivity and specificity, to help them understand test and algorithm performance, and learn about how they should use algorithm recommendations in their decision-making.

Harvard Medical School researchers find that AI-generated narrative radiology reports aren’t yet as good as radiologist-generated ones, but they have developed two tools to evaluate them for ongoing improvement.


Other

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Pharma bro and former federal prisoner Martin Shkreli takes social media umbrage with a PhD AI researcher who thinks LLMs like the one he’s selling shouldn’t give medical advice, calling her an “AI Karen.” Shkreli claims that his Dr. Gupta, which uses ChatGPT, will ease physician burdens, reduce healthcare costs, and help the economically disadvantaged. Shkreli’s claim to healthcare fame was buying rights to a old, cheap drug to treat parasitic disease and immediately jacking up its price from $13.50 to $750, after which the FTC forced him to return his $65 million in profit for suppressing competition. Shkreli has also created a veterinarian version of Dr. Gupta called Dr. McGrath. Experts note that in addition to the legal exposure of providing medical advice over the Internet, Dr. Gupta at one time identified itself as a board-certified internist, although it now answers the identity question with, “I understand that you may have questions about my credentials, but let’s focus on addressing your symptoms and concerns.”

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Time magazine recaps how struggling New York City-based urgent care chain Nao Medical is apparently using AI to generate nonsensical articles to improve its search engine rankings. The above article helpfully clarifies the understandable confusion between color guard and colonoscopy (or its own failure to know the difference between color guard and Cologuard colon cancer screening test), noting the subtle difference that “Color guard is a performance art, while a colonoscopy is a medical procedure.” The young software engineer who runs the company previously developed Fake My Fact, which generated phony Google results and online evidence to use “when you knew you were wrong but wanted to be right.”


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Send news or rumors.
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HIStalk Interviews Lyle Berkowitz, MD, CEO, KeyCare

August 9, 2023 Interviews 8 Comments

Lyle Berkowitz, MD is CEO of KeyCare of Chicago, IL.

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Tell me about yourself and the company.

I’m a primary care physician. I spent 20-plus years at Northwestern Medicine as a practicing primary care doctor and as a system executive for a decade and in the classic IT informatics area in the next decade. I set up one of the earlier innovation programs. The whole time, I often had some involvement with telehealth, population health, and digital health in a variety of ways. I also often did some side hustles. I was working in entrepreneurial areas in a variety of ways as medical director and chief medical officer of a variety of companies . I eventually started creating and founding some companies, including Healthfinch. I left in 2017 and joined MDLive as a executive, overseeing operations and product strategy. I spent a few years helping them scale up and then exited that when the company sold.

I wound up meeting with my friends at Epic in deciding that the world needed a virtual care company that uses Epic as its base platform to more easily supply third-party virtualists to health systems that are using Epic in a way that is truly coordinated. That’s how we started KeyCare.

Why was it important that the virtual providers and the health system customers use Epic?

I’ve been involved in dozens and dozens of digital health companies. One of the biggest struggles has always been, how do you work with the big EMRs? With Healthfinch, we focused on looking at Epic and other EMRs as a platform that we would build on top of and within IT to support it. We were successful with that.

But the idea is understanding what being an Epic client is and everything that goes with that. I recognized that one of the ways to cut through the clutter — particularly in virtual care – was to say, what if we use the same underlying technology that 60-plus percent of the health systems are using and take away the interoperability issues? Epic has profound interoperability that allows us not only to share data, but to do cross-instance scheduling, messaging, ordering, referrals, et cetera.

I knew that they had built this technology and that we could take advantage of it to create a more seamless system. Much like we use Microsoft Word and Office, where we use those systems to create unique things that can then be more easily shared.

How did the conversation go with Epic when you approached them about becoming a customer and using that fact as a selling point?

As you can imagine, you don’t just go buy Epic off the shelf. I’ve had a long relationship working with Epic, from helping with our implementation at Northwestern, navigating Healthfinch, and being one of the early apps on Epic’s App Orchard.

In talking to a variety of folks at Epic, executives at telehealth, and others, we started out with general discussions about what’s going on in the telehealth industry. I then said, I have an idea I’d like to propose based on some of the things that you’ve been talking about, and we mutually came up with this concept. This is something that they really encouraged. 

They of course approve who they are selling to and who they are working with. It was very much a mutual discussion and decision point that it made sense that we not only would become a new client, but we would also be doing it in service to patients and health systems out there using Epic. We can theoretically support non-Epic EHRs, but it just works so beautifully when we are connected to another Epic site.

Describe a typical use case of how a health system might use your services.

Our first use case is a classic one — on-demand virtual urgent care, 24×7, 50-state access. Most health systems fall in a couple of categories. If they don’t do anything, we become this extra option that they can offer. Patients who can’t get in with their doctor, or it’s after hours, or they’re traveling out of state, can go to the health system’s front door, its MyChart. As they request an on-demand visit, KeyCare shows up as an option that they can choose in a seamless manner. It’s handed off to our providers to handle that patient. 

Whether the health system has been doing nothing, whether they do something and we’re supplementing it, whether they’re using another third-party provider and they prefer that they work with us, that workflow is seamless for the patient, and it’s through the health system’s own front door.

What’s your business model?

When we partner with health systems, we have some general maintenance fees, but the majority of our revenue is coming from doing visits. We are essentially getting paid like other physician services and provider service type companies. We’re getting paid to take care of patients. It can be done in a variety of ways. It can be per visit, hourly, or per-member per-month. But at the end of the day, we are providing access to healthcare services and we are getting paid in a variety of ways by the patient, their insurance, or some other sponsor who is at risk for the patient to pay for that type of care.

Do you contract or hire doctors directly or do you outsource your physician coverage to medical staffing companies?

We have two models. For urgent and primary care, we’ve set up a 50-state medical group, and we enroll doctors into that. We’re able to do that via either by contracting with large groups who provide the virtualists as well as being able to employ them directly if needed. We also are able to partner with other virtual care groups, so that they can put their providers onto our instance and make those available more easily to other Epic-based health systems.

How are you addressing somewhat restrictive state licensing requirements now that the public health emergency and its telehealth waivers  have ended?

We have always stuck with the state licensing requirements so that we are able to make sure that we can connect a patient who is in a certain state with a provider who is licensed to work in that state. That hasn’t changed. There’s a lot of discussion and fanfare over how liberal those rules were. Most large telehealth companies stuck with state licensure to be on the safe side.

Do you white-label your service on MyChart or do patients see the KeyCare brand?

Unlike some other third parties, we are truly of service to the brand that we are working with. That said, legally patients have to be told that they may be seeing a provider from the KeyCare medical group. But it’s as white labeled as it can be. They come through the front door of the health system, which explains that this is our partner, but the patient doesn’t need to create a new username or password. They don’t need to re-enter their medical data for it to be available to the provider. 

It’s a very seamless experience. Very white labeled. We minimize our branding. We are not looking to create our own brand. We very much are of service to the health system brand. Part of our philosophy is that we want to increase access to healthcare, but do it in coordination with our health systems, not in competition with them. We feel this creates a powerful hybrid approach, because when patients need to escalate their care, they will have a office-based option to go to, and they will know what happened in any virtual visit.

Is that less threatening to a health system that might not be comfortable sending patients off to a provider that wants to cultivate their own brand identity and customer loyalty?

That is certainly why we exist. That’s why we’ve gotten so much traction with health systems. Third-party vendors, in many cases, have come right out and said, we want to own the front door. No, the health systems want to own the front door. Why would they send it to a competitor? Why would they send patients to a company that has a completely different technology and a completely different brand? 

We are very much in line with health systems. I’m a health system guy. I grew up in health systems. I believe in the importance and power and strength of health systems. Our job is to help health systems provide some of the online convenient care that they traditionally haven’t been great at, do it in a way that feels coordinated, and allow them to focus on the stuff that they are great at — complex care, heart attacks, cancer, broken bones, and major emergencies.

We want them to be able to tell their patients, look, come to us. We will be able to provide a full variety of care. You don’t need to go anywhere else for that. We can do it in a way that feels coordinated, which in the end, means higher quality for you.

How do you make the handoff to a higher level of care as compared to the typical urgent care center?

At a high level, on-demand, virtual urgent care is supposed to be able to handle everything. That doesn’t mean that we treat everything. Sometimes we have to redirect a patient. Most of the time, hopefully 90% of the time, we are able to take care of the patient and they don’t need follow up. But five or 10% of the time, maybe they need to go to an ER and or urgent care center, and our job is to redirect them.

Part of it is helping the patient understand. You cut your hand, we can’t do anything online, you need stitches. But sometimes they need reassurance and understanding. Sometimes they have to understand what time it is. Could I wait until tomorrow morning and go to an urgent care center, do I have to go to an emergency room tonight? One of the important things to understand is that virtual urgent care is not meant to take care of everything or cure everything, but it can certainly give you good advice and triage you appropriately.

One of the issues is third-party vendors that just say, go to the ER or to urgent care. We have a little leg up, in that when we tell the patient this, they are part of a health system. They are able to go to their health system, which has access to any of the notes that we have. We also are able to look at their past history and see their medications and problems, and that can help us better understand and let patients know if they really need to go in and see someone.

Over time, as we move into more primary care support, we will be able to send messages more directly into the health system, and maybe even pick up the phone and alert them, if appropriate, in the on-demand urgent care space.

I should note that when we sign a note, the note not only goes to the health system in the appropriate place, but a message can get sent to the PCP that the patient was seen and alert them to review the note to see if they want to do any follow up. It could also be sent to a general in-basket message that can be monitored to decide if they want to follow up with the patient as well. Those are unique things that we are able to do.

How has the use of technology and support staff changed for virtual visits as compared to the early COVID days, when unprepared doctors had to wing it alone using Skype or FaceTime?

It’s important to understand that virtual care should not be looked at as simply an online version of an office-based visit. Similar to how we defined hospital care and hospitalists in the 1990s,  we are clearly moving into an era when we have to differentiate virtualists from “office-ologists” in terms of how they provide care and what the focus of patients should be. I believe that office-ologists, the folks in the office, can and should be working at the height of their license to see the more complex patients that need longer, more intense visits in the office, or need some type of task or procedure that has to be done in the office.

Virtualists can focus on what I call the triple-R threat that overwhelms our health system — routine, repeatable, rules-based care, the type of common commoditized care that right now clogs up our offices. What if we can shift those to online that is more convenient for patients? It is routine enough that it can be handled, and we have virtualists who are trained, who are specialized, in handling things online. They understand more of the nuances of being good doctors online, of what type of physical exam you can do online, because you can do certain things to and provide some level of physical exam. We are looking at a variety of tools to capture vital signs, to analyze parts of a video and picture, et cetera.

We are starting to see this differentiation, where virtualists are taking advantage of being able to do something online that, instead of looking at it as a disadvantage, we have to think about what the advantages are, such as more timely access to care. We believe that over time, we will use certain technologies online that we won’t be able to use as easily in the office.

It’s going to be a fascinating era as we continue to differentiate what should be done in the office, what could be done online, and how we can help solve this whole burnout crisis by having virtualists who don’t simply see three or four patients an hour, but really scale up. How can a virtualist manage 10, 20, or 100 patients an hour, not by doing 100 video visits, but by using asynchronous care automation, delegation to other staff, et cetera? The virtualist should be taking care of the bulk of common stuff so that the office-ologist can take care of the more complex things that truly need to be seen in the office.

How will AI change healthcare, especially virtual care?

Unlike some folks, I do not look at AI as being important for diagnosing particularly common things. Where it’s really going to shine is in communication. We’ve seen that AI can often be more empathetic and more overall informational than a busy doctor, and that’s OK  and that’s great. We are already looking how we use AI, chatbots, and other ways to communicate with patients to let them know what is going to be happening in their visit.

Maybe we’ll be able to capture information ahead of time. Maybe after the visit, we’ll be able to use AI to help explain things. Maybe AI can also be really good at detecting subtle things in a patient who looks like they have a simple cold, COVID, or UTI. Maybe there’s something else going on, and AI can surface that.

We are exploring a number of use cases to make the virtualists more efficient by helping automate pre- and post-, but also more effective in identifying things and communicating in better ways with the patient. It will be absolutely important to get us to a world where we can truly scale up virtual care to a big population.

What factors will influence the company over the next few years?

We are in growth mode now. We have signed 10 health systems in the past year, representing over 90 hospitals and 30,000 physicians. That’s a pretty quick product market fit. We are going to continue to grow that and expand the number of health systems that we can serve.

The next stage is, how do we make it as efficient as possible? That’s where we bring in technology. Our mission is to bring this tech-empowered virtual care team to be of service to health systems in a coordinated way. If our purpose is to improve healthcare access for all, and our vision is to be the best at virtual care, our mission of what we are really doing is not just bringing providers and staff, but tech-empowering them to make them more efficient and effective. Doing that at scale than any one health system can do, so that we can help health systems transform how they manage this population and do it at scale.

I often say that we don’t have a shortage of physicians as much as we have a shortage of using them efficiently. What we’re trying to do over time is help health systems rethink how they manage that population, how they split up who’s online versus who’s in the office, and how they pay their doctors. For this to work, we need them to think about compensation redesign and embrace team-based care and all that has to offer. 

We are in growth mode and laying technology on top of that to make that as efficient and effective as possible. We are also expanding well beyond urgent care to primary care, behavioral health, and specialty care. Part of our job is to set up sort of a virtual care marketplace for health systems, where they know they can come to us and find a wide variety of virtual care options, but in a way that because we are on Epic, allows it to be done in a coordinated way. Whether they might need help with cardiology, rheumatology, GI, maternal care, or dieticians, the idea is that they can come to us and we’ll have them all available in a tech-enabled way, sitting on an Epic instance and being able to scale with them.

How can we do this in a way where it doesn’t feel threatening to the physicians in the offices? Part of what we do the end of the day, my personal dream, is that a health system could go in to their physicians, primary care physicians in particular, and say, what if we could increase your salary, but decrease how many patients you have to see in the office? How would you feel about that? Of course they are going to ask, how are you going to do that? We’re going to say that we will give you this virtual care team, you’re going to be really connected to them, and together you’re going to be able to double your panel size. 

This is an opportunity truly to fix all those Quadruple Aim issues. We’re going to make it easier for patients to get care. Their experience gets better. We’re going to improve quality, mainly by improving access and making sure they can get in. We’re going to decrease costs, because we can do this at scale. We’re going to make life easier for doctors.

This isn’t going to happen overnight. This is a strategic transformation. It’s going to involve a combination of what I call the three Cs. One is having a care team that is connected and coordinated. KeyCare will provide that team to health systems. Second is compensation redesign. We have to rethink how we pay physicians and how might we pay them to manage a population, not simply be on an RVU treadmill, because that is deadly for physicians. Third is cultural and change management, educating and teaching our patients, our providers, and our staff that team-based care is not only effective, but is actually better in many ways to maintain a more consistent approach to monitoring patients in a coordinated way.

We didn’t invent the concept of population health or team-based care, but we believe that we can execute on it in a way that makes sense, is coordinated, is scalable, and makes life easier and better for providers, patients, and the health system as a whole.

Morning Headlines 8/9/23

August 8, 2023 Headlines No Comments

Thoma Bravo and Madison Dearborn Partners Sell Syntellis Performance Solutions to Roper Technologies

Roper Technologies acquires enterprise performance management software vendor Syntellis for $1.4 billion in cash and will combine it with its Strata Decision Technology business.

Framingham Definitive Healthcare Lays Off Staff Ahead Of Earnings Call

Healthcare market intelligence company Definitive Healthcare lays off 40 employees, its second round of layoffs this year.

Senator warns Google over AI use in hospitals

Senator Mark Warner (D-VA) asks Google for specific information about the inner workings of the Med-PaLM 2 medical large language model, expressing concern that Google’s testing of the product in hospitals constitutes “premature deployment of unproven technology.”

News 8/9/23

August 8, 2023 News 2 Comments

Top News

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Roper Technologies acquires enterprise performance management software vendor Syntellis from its private equity owners for $1.4 billion in cash.

Roper will combine the acquired company with its Strata Decision Technology business. 

Syntellis was spun off from Kaufman Hall in 2020.


Reader Comments

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From Locus: “Re: ResMed CPAP and MyAir app. Delayed data updates aren’t a patient safety issue, but CPAP compliance is all about timely feedback to user and physician.” ResMed confirms that an error in its over-the-air firmware update inadvertently caused its AirSense 11 PAP devices to send huge amounts of data to the online service’s cloud server, leading to week-long delays in data updates.

From Easy Feesy: “Re: credit card fees. Curious how many physician practices are passing them on to patients who pay their bills with HSA cards.” A few states prohibit sticking the customer for credit card fees that range from 2% to 4%, although a creative workaround is to post the fee-added price and then offer a cash discount. Mrs. H and I had dinner at a cheap Mexican restaurant recently that did this, and while it’s logical since customers have a choice of how to pay, it doesn’t seem worth surcharging a few percentage points on a per-person average tab of maybe $15 when customers truly hate that practice. At least half of that restaurant’s reviews are bad as keyboard warriors lashed out at the clearly stated policy that cost them maybe 50 cents extra, especially since people keep using food delivery services without complaint even as they pile on fees that can end up doubling the in-restaurant price for the honor of having your Dasher steal  some of your chips.


Webinars

August 24 (Thursday) 2 ET. “RCM analytics in action: How to use your data to drive decisions + revenue.” Sponsor: Waystar. Presenter: Laura Tungate, solution strategist team lead, Waystar. This webinar will describe how to use RCM analytics to take control of your data even if you use outdated or multiple tools. Attendees will learn how to target improvements, describe the KPIs that are key to revenue cycle leaders, prioritize dashboards that spotlight organizational goals and build alignment, and how and when to apply RCM analytics to go from analysis to action faster.

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


Acquisitions, Funding, Business, and Stock

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Bright Health Group secures additional financing while it completes the sale of its California Medicare Advantage business to Molina Healthcare and shores up its remaining provider network. The company has been in free fall for some time, having sold off its Zipnosis telehealth business in May and closed its insurance offerings in a dozen other markets. It raised $1.6 billion in a 2021 IPO.

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London-based digital health company Babylon announces that its take-private merger with brain technology vendor MindMaze will no longer take place. In a somewhat garbled press release, the company says it will explore strategic alternatives so that it can secure additional financing and sell numerous UK- and US-based assets in order to avoid bankruptcy.


Sales

  • Prime Healthcare (CA) selects Steer Health’s Concierge personalized patient communication software.
  • MUSC Health (SC) will use Andor Health’s ThinkAndor Virtual Command Center as a part of its virtual care program.
  • University Hospitals (OH) will use patient data integrity services and software from Harris Data Integrity Solutions to clean up UH Lake Health’s master patient index ahead of its Epic implementation.

People

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Peter Schoch, MD (AdventHealth) joins Kno2 as chief health officer.

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Cleveland Clinic hires Albert Marinez, MBA (Intermountain) as its first chief analytics officer.

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Configo Health names David Bertoch, MHA (Children’s Hospital Association) EVP of pediatric analytics and research programs.

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Truepill promotes Paul Greenall to CEO.

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Steve Shi (Vault Health) joins Pager as CTO.

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Providence hires Ray Chung, MPH (Strategy&) as VP of clinical IT solution delivery.


Announcements and Implementations

Get Well announces GA of its emergency department and inpatient care engagement technology.

Deaconess Health Care (IN) launches a virtual patient flow command center using technology from GE Healthcare.

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In an effort to gain firmer financial footing, Campbell County Health (WY) postpones its 2023 Epic go live and severs ties with its RCM vendor Ensemble Health Partners. CCH, which had begun the implementation process in 2021 through a partnership with UCHealth, will roll Epic out next summer.


Government and Politics

Senator Mark Warner (D-VA) asks Google for specific information about the inner workings of Med-PaLM 2 medical large language model, expressing concern that Google’s testing of the product in hospitals constitutes “premature deployment of unproven technology.” He cites his previously expressed concern that Google’s race for AI market share involved “secret partnerships” with hospitals that may threaten patient privacy.


Privacy and Security

Zoom updates its terms of service to require customers to consent (with no opt-out) to having their meeting content used by Zoom for AI training, raising concerns about proprietary content and healthcare privacy. In unrelated news, Zoom – which became a household word in supporting work-from-home programs during the pandemic – will require employees to return to the office for at least two days per week.


Sponsor Updates

  • NYSE Floor Talk features Arrive Health CEO Kyle Kiser.
  • The Millenium Live Podcast features Ascom Americas Managing Director Kelly Feist, “The Toolbox for Digitizing Clinical Workflows.”
  • AvaSure publishes a new whitepaper, “Behavioral health needs in hospitals are rising, are you prepared to keep your patients safer?”
  • Baker Tilly publishes a new case study, “Sole community hospital reshapes financial outlook through service line analysis.”
  • Bamboo Health publishes a new case study, “How Eagle Physicians & Associates Uses Pings to Improve Its Transitional Care Management Services.”
  • Black Book Market Research publishes a list of top client-rated healthcare supply chain solutions exhibiting at the AHRMM23 Annual Meeting.

Blog Posts


Contacts

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

Morning Headlines 8/8/23

August 7, 2023 Headlines No Comments

Bright Health Group Secures Financing to Support Operations Pending the Expected Close of California Medicare Advantage Business Sale

Bright Health Group secures additional financing while it completes the sale of its insurance business to Molina Healthcare and shores up its remaining provider network operations. 

Babylon In Discussions of New Strategic Alternatives for its Businesses

London-based digital health company Babylon announces that its take-private merger with MindMaze will no longer take place, that it hopes to secure additional financing, and that it plans to sell numerous assets in order to avoid bankruptcy.

Better Life Partners Lands $26.5M for Virtual SUD, Mental Health Platform

Virtual behavioral healthcare company Better Life Partners raises $26.5 million.

Curbside Consult with Dr. Jayne 8/7/23

August 7, 2023 Dr. Jayne 2 Comments

I will never stop being amazed at the stories of physicians and others who believe they can commit healthcare fraud and get away with it. Especially with the use of computerized systems for billing, inventory management, and more, it’s harder to avoid creating a trail than it might have been back in the paper era.

One of my former residency colleagues sent an article this week about a physician who we knew during our time in training. He was arrested after federal healthcare fraud charges were filed against him. The physician and his office manager are accused of conspiring to bill for services that he didn’t perform or supervise, and which sometimes occurred on dates of service when he wasn’t even in town or even in the country.

They also took advantage of physicians who were still going through training, which makes the whole enterprise even more offensive. Attending physicians were lured into signing bogus collaborative practice agreements, saying that they would supervise the physician learners when they didn’t meet the stipulations of the program criteria. Learners were promised a leg up in the process of trying to obtain a residency training position in the US, but received little education or supervision while being expected to deliver clinical care that possibly exceeded their capabilities or provisional licensure.

For those of us who were aware of the business activities of the accused, it’s particularly salacious, because he made inflammatory statements about competing healthcare organizations, talking about his practice’s superiority for caring for large numbers of Medicaid patients and doing a better job supporting the needs of the community than other similar organizations. Looking at the timeline of the alleged charges, he was likely committing Medicaid fraud at the exact same time he was bragging about his participation in the program.

Electronic health records and their associated billing systems store vast amounts of metadata about the documentation created on their systems. You have to be fairly knowledgeable about database structure and the creation of metadata to try to alter the information, and I suspect that the alleged perpetrators of this scheme weren’t that smart. They certainly wouldn’t have had the ability to alter airline reservations, hotel bills, or other travel records that would demonstrate the whereabouts of the physician at times that he was supposed to have been rendering care or supervising learners.

Unfortunately, it’s not only physicians that are behaving badly at times. Earlier this summer, The Kraft Heinz Company and its various employee and retiree benefits organizations sued Aetna over its failure to provide all of the company’s medical claims data for review. Kraft Heinz is a self-funded employer that uses Aetna as its third-party administrator for medical claims. As such, it has the need to ensure benefits are maximized for plan participants and that costs are managed appropriately.

The Consolidated Appropriations Act of 2021 gives employers greater access to claims data for monitoring. Kraft Heinz claims that Aetna is limiting its access to its own claims data, preventing it from ensuring that the plan’s assets are being managed properly. Specifically, Kraft Heinz is looking into data around provider payments, prior authorizations, and coverage dates. The company alleges that the insurer “paid millions of dollars in provider claims that never should have been paid, wrongfully retained millions of dollars in undisclosed fees, and engaged in claims-processing related misconduct to the detriment of Kraft Heinz.”

I’m sure there are plenty of payer and claims data experts who are ready to dig into the matter, which also includes an accusation that Aetna refused to provide the requested data in a standardized format. Other self-funded organizations, including Bricklayers and Allied Craftworkers Local 1 Fund and Sheet Metal Workers Local 40 Fund are also suing their third-party administrators for lack of access to claims data. It will be interesting to see how the proceedings unfold over the coming months and whether other self-funded plans join the effort to force more transparency from their vendors to ensure that employees and retirees are receiving the healthcare services they’re entitled to.

Rounding out the trifecta of entities behaving badly are health systems and contracted provider organizations. Two North Carolina-based physicians sued HCA Healthcare and TeamHealth in 2022, with the documents becoming unsealed earlier this year when federal regulators passed on becoming involved. The physicians were originally employed at Mission Hospital System, which became part of HCA in 2019. TeamHealth took over physician staffing at the facility the following year. The physicians claim that following the transition, employees were encouraged to order duplicative services, including laboratory testing and imaging studies, especially when patients were received in transfer from outside facilities. They claim that management encouraged them to use generic protocols called “powerplans” rather than their clinical judgment, resulting in excess testing and diagnostic services. They further allege that physicians were pressured to see as many patients per shift as possible regardless of potential negative impact on patients.

The physicians attempted to engage the federal government by serving as whistleblowers under the premise that the organizations were committing fraud by overcharging government programs for medical services. In addition to the redundant services, they also allege that staff overused trauma alerts and the practice of calling codes in the emergency department as a way to generate additional billings. One such example was a trauma designation given to a stable injured patient who was received in transfer and who had already received extensive imaging procedures. The plaintiffs also cited language in emergency department administrative documents that treated physicians more like “salesmen” rather than “emergency department medical professionals who are there to provide care for patients.”

Of course, there were also stories in the last month about an EHR vendor accused by the DOJ of gaming the certification process, along with another EHR vendor accused of stealing intellectual property from both a client and a third-party content vendor. It just goes to show that there’s never a dull moment in healthcare, and that regardless of the altruism of many of us in the field, there will always be someone looking for a way to make a profit at the expense of patients, workers, or taxpayers. Stories like these certainly remind us that depending on how long we’ve been in practice or in the healthcare IT universe, this isn’t necessarily the healthcare world that we all signed up for.

What do you think about the state of healthcare fraud, and would you ever serve as a whistleblower? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 8/7/23

August 6, 2023 Headlines No Comments

New Google alert will tell you when you appear in search, help remove personal information

Google rolls out a new dashboard to alert users when their personal information – including medical records – appears in search results links.

Practice of Telemedicine: Listening Sessions

The Drug Enforcement Administration will conduct listening sessions on September 12-13 to gain input about prescribing controlled substances via telemedicine without requiring an in-person evaluation.

August 4, 2023 Notice of Privacy Incident at Brigham and Women’s Hospital (BWH)

Brigham and Women’s Hospital alerts 1,000 research study participants that someone used the free, online Tableau Public visualization tool to create and share graphs, which were later found to have included a publicly accessible link that displayed patient information.

Monday Morning Update 8/7/23

August 6, 2023 News No Comments

Top News

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A ransomware attack on Prospect Medical Holdings disrupts or shuts down its 16 hospitals and 165 outpatient locations across five states.

The company’s hospitals are in Southern California, Connecticut, Pennsylvania, and Rhode Island. They include those of health systems Crozer-Keystone, Eastern Connecticut Health Network, and Waterbury Hospital.

Prospect Medical Holdings, which serves mostly low-income patients who are on Medicare or Medicaid, made headlines in 2020 as investigative reports detailed its operational challenges under private equity owners who made hundreds of millions of dollars by loading the acquired hospitals with debt and selling their real estate. Chairman and CEO Sam Lee made $128 million.

The FBI is investigating the cyberattack.


Reader Comments

From Indecent Explosure: “Re: HIMSS annual conference. I think that not only was the timing right for HIMSS to lighten its load and rebuild its finances, the conference will improve under outside expertise.” I agree. HIMSS did an admirable job, at least through 2019, of running a logistically complex conference that generated most of its revenue. However, it tarnished the HIMSS brand as an out-of-control boat show with few actual buyers as its CIO audience was poached and some attendees shifted to hipper, glitzier conferences that were more fun, held in more interesting cities, and that blurred the line between education and vendor prospecting. Informa, like HIMSS conference competitor HLTH, won’t have to strike a balance between commercialism and thought leadership and can instead focus on attendee and exhibitor satisfaction that is measured purely by attendance, exhibitor count, and event profit. HIMSS will need to figure out its new, somewhat diminished role, especially since the educational components were among the conference’s most obvious weaknesses. What I expect we’ll eventually see:

  • More conference-sponsored social events, lunches, and entertainment.
  • A better conference app that is geared around connecting exhibitors and attendees before, during, and after the conference.
  • Better marketing and lead retrieval tools for exhibitors.
  • Better support for live-streaming.
  • A stronger emphasis on one-on-one vendor meetings in the hosted buyer format to give exhibitors more bang for the buck. Informa’s mission across its many conferences is to connect people to do business.
  • The triumphant return of carpet to the exhibit hall aisles.

From Get ‘er Done: “Re: HIMSS and Informa. Did you notice in the HIMSS video interview that the terms of the conference sale haven’t been finalized?” I did notice that. Ken McAvoy, president of Informa’s South Florida Ventures division that will oversee the HIMSS annual conference, said this about a potential conference name change in a HIMSS interview last week: “Hal said we may tweak the name. We’re not changing any name. That ain’t happenin’ … I probably would normally say that only after the negotiations are over, for a number of different reasons.” Informa’s July 27 financial report lists the HIMSS conference under acquisitions, but refers to it as “exclusivity to acquire.” HIMSS coyly refers to the deal as a “strategic partnership” while providing no specifics. I don’t know why Informa was so anxious to publicly refer to an acquisition that has not been consummated and why HIMSS wasn’t better prepared to spin the news more quickly.

From JD: “Re: Optum and UHC. Massive layoff Thursday.” Unverified, but widely reported on TheLayoff.com by folks who say that more cuts are coming through August 10. Specifically named was OptumRx, which simultaneously brought over Patrick Conway, MD as CEO from Optum Care Solutions. His LinkedIn indicates that the prescription benefit manager has 30,000 employees and generates $110 billion in annual revenue.


HIStalk Announcements and Requests

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Few poll respondents predict an increased HIMSS relevance following the sale of its annual conference. Art Vandelay expressed some slightly contrarian ideas about how getting out of the conference business might end up making HIMSS more relevant and useful:

  • Provide educational sessions that aren’t vendor commercials or that feature minor achievements that can’t scale to the industry as a whole.
  • Use the research community connections of Informa’s Taylor and Francis, which publishes books and academic journals.
  • Create less obtrusive policies.
  • Consider other conference host cities.
  • Provide executive and leadership tracks that would entice decision makers to attend.

New poll to your right or here: Will AI-powered systems diagnose and treat patients without direct, real-time physician involvement? See Scott Gottlieb, MD’s recent op-ed piece to learn why he thinks that will happen sooner rather than later. I specifically say “physician” since use of such a system might be supervised by PAs, nurse practitioners, or other non-physician clinicians.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Virtual primary care technology vendor TytoCare raises $49 million in growth funding, which it will use to further integrate AI into its Home Smart Clinic for diagnostic support and remote exam assistance for chronic care management.


People

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Glenn Yarbrough, MBA (CommonSpirit Health) joins field care solutions vendor Coordinista as chief information and technology officer. 


Announcements and Implementations

Google rolls out a new dashboard to alert users when their personal information – including medical records – appears in search results links. The enhanced  “results about you” tool also allows clicking a link to remove results that contain an email address, phone number, or home address, although the company notes that the information is only removed from Google searches, not the source website or other search engines.


Government and Politics

The Drug Enforcement Administration will conduct listening sessions on September 12-13 to gain input about prescribing controlled substances via telemedicine without requiring an in-person evaluation.


Privacy and Security

Brigham and Women’s Hospital alerts 1,000 research study participants that someone used the free, online Tableau Public visualization tool to create and share graphs, which were later found to have included a publicly accessible link that displayed patient names, addresses, diagnoses, lab results, medications, and procedures.


Other

Lexington Regional Health Center (NE) decides to review rather than fire its CEO for failing to disclose to its board “a matter of potential litigation, negotiation, and resulting six-figure settlement” involving IT, which was described as “not stable.” The board secretary and treasurer referred to a recently implemented unnamed computer system and cybersecurity issues that have caused outages of computer and telephone systems. LRHC signed a contract with Cerner in October 2019


Sponsor Updates

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  • West Monroe employees volunteer at the Downtown Women’s Center in Los Angeles.
  • Surescripts Chief Marketing and Customer Experience Officer Melanie Marcus joins the Exceptional Women Alliance.
  • NeuroFlow releases a new Bridging the Gap Podcast, “Child Psychologist and Drexel Department Head Dr. Brian Daly Explores the Adolescent Mental Health Crisis.”
  • KLAS Research recognizes Nym Health’s medical coding engine with a 100% customer satisfaction score in its latest Emerging Solutions Spotlight report.
  • Waystar will exhibit at the HFMA Region 8 Mid-Summer America Institute August 7-9 in Minneapolis.

Blog Posts


Contacts

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

HIStalk Interviews Dave Hodgson, CEO, Project Ronin

August 5, 2023 Interviews No Comments

Dave Hodgson is co-founder and CEO of Project Ronin of San Mateo, CA.

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Tell me about yourself and the company.

I’m a molecular biologist by training. I started my first job on the genome project in Cambridge in the UK. From there, I moved to the United States and worked for a small biotech that was selling genome data to pharmaceutical companies. Then I was part of bioinformatics  for several years for Pfizer, and then knowledge management for Pfizer. Then to  Roche, where I ran scientific computing  for a few years before I decided to completely pivot the career out of pharmaceutical executive land and became part of startups in the Bay area. I lived near Palo Alto and I worked as chief technology officer for a diagnostics company and for a telehealth company. Then I was the first chief technology officer at One Medical, which is now part of Amazon.

After all of that — having been in pharma, the genome project, telehealth, and primary care — it was time to become a consultant. I did a lot of healthcare consulting for a while, and during that was introduced to Dr. David Agus and to Larry Ellison, who were enthusiastic about how we might apply data science and thoughtful clinical interface design to something that could be embedded inside the medical record system to assist decision-making in complicated diseases such as cancer. Project Ronin was the founding of that idea. That was several years ago, and we’ve been working on that challenge ever since.

What drives Larry Elllison’s interest in healthcare and how does he see healthcare and technology merging?

A lot of us have seen the devastation that terrible diseases like cancer can do to the individual, to loved ones, to families, and to friends. It’s a truly horrible situation to be in. So many of us have seen that, and him, too. Then you think about how might you really improve the quality of care —  not just in the United States, but everywhere — and the quality of decision making. 

Cancer is complicated. It’s actually multiple different diseases. Patients have different goals. They have different desires. I want to live as long as possible. I want to stay as healthy as possible, I want to optimize my wellness for now, or I want to do whatever it takes to survive. The diversity continues to their genotype, their other clinical situations, and other things that are going on with them.

Patients are very, very individual. When you are thinking about that quality of decision-making, you have to take into all of that into account. But ideally, you could leverage the entire corpus of knowledge that we have about the disease, from everything published to everything that has happened in the past, and also everything that has happened to a patient like this, from their social situation to their clinical history to their genotype. If you were in the horrible situation of having some kind of tumor diagnosis, you would really love it if your doctor had at their fingertips every single piece of information possible. 

Given that desire and that need, you can start to look at the process of clinical decision-making — diagnosis, selection of treatment, management of treatment, management of survivorship — as a data problem. How might we bring all the world’s clinical knowledge into the space between patient and provider for their most optimized decision-making? Larry, the other founders, all of the team at Project Ronin, many of the clinicians that we work with, and the patients that are on the platform are all quite aligned on that desire to have all the world’s data be in a place where clinicians and patients can use it to make the best decisions for them possible.

What psychology is involved with trying to put all of that together using technology?

It’s a complicated problem. You have many different types of variables to consider — the desires and the situation of the patient, the experience of the oncologist, and the clinical biology of the particular disease that the patient has. Treating late-stage lung cancer is extremely different from early-stage prostate cancer, and very different from mid-stage breast cancer. Very, very different situations. You have all these very different variables. 

The assembly of the data and the processing of those data is extremely complex. That is why this has been a personal mission. Let’s do something very difficult that will have such a broad benefit. There is not only a data assembly complexity, but then there is a psychology that you need to present those data to the clinical team in a way that they can use it, digest it, and take action on it.

That means that you have to present it inside the medical record system. No clinician ever, anywhere, wants to step out of their patient record, charting what happened in the encounter with a patient and then logging into another portal to go look up information or anything else. Although they have to do that in certain cases, they don’t want to do it, because it is clumsy and inefficient. They are already seeing many patients, their day is very busy, and it’s complicated. 

The first source of psychology is to serve up data that is relevant to this particular patient in this particular situation inside the medical record system, so that the clinician has an efficient access to very rich information that they can use to assist or validate or even qualify some of the decisions that they are making.

Similarly, the patient is always wanting to know, what can I expect to happen next? Am I on the right treatment for my situation? If I have questions, can I reach my clinical team? We think very carefully about how we surface the answers to those questions, again under the direction of the clinical team and doing things the right way. But there is some human-centric design very much involved in this that is paired up with all of that data assembly and data rendering that we do. 

You’re probably getting a sense that it’s a pretty hard problem. We don’t believe that anyone has really solved it yet. That’s why we’re working very, very hard to show that it can be done.

A cancer patient with means and knowledge will often seek out the best available expert at an organization such as Sloan Kettering or MD Anderson. Can the scale of technology democratize that for for patients who lack connections, the ability to travel, or insurance coverage to seek out a super-specialist?

Very much, and that was one of our founding desires, to take the expertise that is known by the very best, highly specialized oncologists in the very best academic medical centers and make that knowledge available to practicing oncologists. That’s essentially what we are doing.

One of our best and biggest partners is one of the largest academic medical centers. We have published with them and we are developing the platform with that very goal. How do we package the expertise and the data so that a community oncologist can take advantage of it? We are working with a community practice where when they pull up the patient chart, they see the reference data and the data insights that we add to that. It is supercharging their knowledge in a particular specialty.

Typically in academic medical centers or some of the larger cancer centers, you have practice oncologists that specialize in a particular tumor type, kidney cancer or whatever. Then in the community, you tend to have a little bit more generalist oncologists who are seeing a breast cancer case in one appointment and then a prostate cancer in another. You want to be able to equip them to know, what are all my choices in the right way of treating this particular situation? What has historically been done? What do the reference guidelines suggest? What does the literature suggest? That can take a long time if you do it by hand. We automate that and then present that in an integrated way.

Are providers and pharma connecting in new ways around real-world evidence, clinical trials enrollment, and post-marketing surveillance?

We are seeing that, too. There’s definitely a desire for those worlds to be less separate than they were.

There are a few dimensions where that makes a lot of sense in the priorities of both parties, and that is to enroll the right patients for all clinical trials. There’s a lot of new medicines in the pipelines of pharmaceutical companies that are oncology drugs. There is, and has been for several years, a desire to find the right qualified patients to be enrolled in a trial and the patient’s attributes that would qualify them in or out of any particular trial. A lot of that data is in the patient chart, sitting in the medical record system. There’s an obvious place there to look for eligibility and enrollment by integrating those two systems. 

Then the other part that you mentioned of real-world evidence. There’s clearly a desire to have some kind of companion for the patient through parts of their journey, such as managing their wellness and managing their general interaction with their primary care doc. If they are in a situation where they are diagnosed with cancer, that there would be some companion that would take them through that, including if they found themselves as part of a clinical trial. You would want that companion app, let’s call it, to be with them through that, where it’s collecting the appropriate data of how they are experiencing treatment. 

Then not only have that be an input into how the treatment is performing, but also help the patient manage their side effects and symptoms, which is part of the Ronin platform as well. We do that symptom monitoring and capture of patient-reported outcomes and patient experience.

How much data is needed to make the “patients like me” concept clinically useful, especially for uncommon conditions?

We have done a lot of work in how to acquire the right patient records and then structure them, because clinical data is very much dominated by clinical notes, encounter notes that are all text. They are written in a certain clinical language that is a little bit difficult to manage. There’s a lot of work to do with the data, cleaning up and mapping to a central model. We do a lot of that.

The good news is that over time, we have become pretty good at not requiring an enormous data set or enormously high quality data set. Over our experience in the last few years, we are getting better at doing not only the cleanup, but also requiring less voluminous amounts of data. With a few hundred records, we can do quite a lot of trending and analytics on those data sets to be in a position to serve up insights in a qualified, thoughtful, and high-integrity way. We have a lot of standards around data quality. Our QA and QC processes are robust and strict, so that anything that we put before a clinician or a patient is rigorously tested and validated first.

The early days of precision medicine had limited applicability since few correlations existed between genomic data and condition management options. Will advances make precision or personalized medicine more of a standard?

Very much so. We see that certainly every day. In that data view that we have built with our collaborators that we serve up inside the medical record in the patient’s chart, we show all of the known genomic biomarkers that the patient has been tested for, and then the literature that shows any particular consideration of those. If the patient has lung cancer and is their EGFR is positive, there’s good literature around which treatments may or may not be effective because of the presence or absence of that biomarker. 

In oncology, we spend most of our time in those correlations between biomarker presence or absence and which treatments that information suggests that you should use. Those are becoming quite well published, and therefore, we want to be able to have those reference data be available to the clinician. We are seeing that progress as the science progresses and as the the clinical evidence progresses. We are serving that up when it has been published and validated in all the right ways.

What will the company’s next few years look like?

I want two things to happen, and I would have to speculate greatly on whether they will happen. Obviously there’s a lot of hullabaloo about what will AI in medicine will really look like. We are obviously very invested in that, and we have developed some pretty effective large language models for in the generative AI space. We have some really exciting prototypes that we are taking through some validation, some research processes. In the next couple of years, we are going to begin to identify the most appropriate, safe, and effective uses of AI algorithms, machine learning, and deep learning, including large language models, to the practice of medicine. I hope that we will see the safe and effective demonstrations of those, and the company is heavily invested in that.

The second, which is my dream, honestly, is a greater ubiquity of value-based care reimbursement, where the incentives for practicing medicine in the US are driven by getting paid when the quality outcome for the patient is met rather than getting paid on the volume of procedures that are performed. Value-based care has been conceptually around for decades and has made slow progress, but my dream is that that progress would go faster and that there would be more and more reimbursement using value-based care structures. Technology has a role to play in enabling that. That brings the aligned incentives that we really crave that will really drive a lot better outcomes and a lot better economics.

Morning Headlines 8/4/23

August 3, 2023 Headlines No Comments

TytoCare raises $49 million to build out AI-enhanced chronic care

Home Smart Clinic company TytoCare raises $49 million in a Series D extension round, bringing its total raised to $206 million.

SimplePractice Announces Strategic Purchase of Assets of Luminello

SimplePractice, a health and wellness technology company owned by EngageSmart, acquires psychiatry-focused EHR and practice management vendor Luminello.

FBI investigating ransomware attack affecting Eastern Connecticut Health Network, Waterbury Health

A ransomware attack on Prospect Medical Holdings, which operates 17 hospitals in five states, causes facilities to experience network outages, diversions, and closures.

Waystar Acquires HealthPay24, Accelerating Mission to Simplify Healthcare Payments

Waystar acquires patient payments company HealthPay24 from EngageSmart.

News 8/4/23

August 3, 2023 News 1 Comment

Top News

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HIMSS announces that it has sold the exhibit portion of its Global Health Conference & Exhibition to London-based B2B events and publishing company Informa. HIMSS will continue to manage the educational aspects of the annual conference. Terms of the acquisition were not disclosed.

The organizations say that the 2024 conference in Orlando will offer improved digital features, enhanced registration, and better marketing and product discovery tools. Informa’s conference approach is to connect buyers to sellers in specialist markets. Informa said in a joint interview that it will not change the name of the conference.

The conference will be managed by Informa’s South Florida Ventures, which runs Florida luxury lifestyle shows in art, beauty, boating, and yachting. The organizations did not say how that oversight might affect the HIMSS 2025 and 2026 conferences, which are set for Las Vegas, or if the conference’s Orlando and Las Vegas rotation will change.

HIMSS President and CEO Hal Wolf said that HIMSS had been looking for a partner to take over the logistics of running the conference for about a year, allowing HIMSS to focus on membership activities and programming. It will continue to run its media operation, certification programs, and several smaller conferences. Wolf says 30 HIMSS employees will move to Informa.

HIMSS announced the news to members Wednesday in an email from Wolf, who framed the deal as a “landmark partnership” without mentioning the word “acquisition” as Informa did in its financial report last week. He assured members that they will continue to receive Global Conference registration discounts, noted the “unparalleled thought leadership” of HIMSS, and referred to the conference as “the esteemed industry-leading event that members, attendees, exhibitors, and sponsors know and love.”


Webinars

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


Acquisitions, Funding, Business, and Stock

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Reed Jobs, the 31-year-old son of Apple co-founder Steve Jobs, launches a venture capital firm that will focus on cancer treatments. The firm, named Yosemite, has raised $200 million from investors that include Memorial Sloan Kettering Cancer Center. It will run a for-profit business, but will also operate a foundation that will provide grants to scientists. Jobs majored in pre-med at Stanford, but ended up earning bachelor’s and master’s degrees in history after his father died in 2011.


Sales

  • WVU Medicine chooses QGenda Provider Cloud for physician and nurse scheduling, time tracking, and compensation management across its 23 hospitals.
  • Imprivata and its regional partner will provide Ireland’s Health Service Executive with Imprivata’s OneSign enterprise access management solution.
  • The Richmond Behavioral Health Authority chooses Netsmart CareFabric and MyAvatar for its services and treatment programs.

Government and Politics

New SEC rules will require publicly traded companies to disclose material cybersecurity incidents within four business days.


Other

Former FDA Commissioner Scott Gottlieb, MD says in a CNBC op-ed piece that it won’t be long before autonomous AI systems will diagnosis and treat patients without physician involvement, assuming that federal regulators approve such use. He adds that AI can’t reduce healthcare costs unless it replaces doctors since in healthcare since “the labor itself is the product.”

In Thailand, a hospital that turned away patients when its hospital information system crashed blames a hospital employee for sabotaging the system to convince the hospital to buy backup software. Meanwhile, several procurement employees at three hospitals in Taiwan are fired and indicted for accepting a computer supplier’s bribes of cash, cell phones, and “drinks with female escorts” to win business.


Sponsor Updates

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  • Clinical Architecture sponsors the 11th Annual Bob Kravitz Golf Outing to Defeat ALS.
  • Symplr Chief Nursing Officer Karlene Kerfoot, RN, PhD receives the DAISY Foundation’s Lifetime Achievement Award for excellence and compassion in her 40-year nursing career.
  • CereCore International announces that it is a certified hardware integrator for Meditech in the UK and Ireland.
  • Ellkay will host its virtual user group meeting August 8-10.
  • Get Well will integrate Care.ai’s Smart Care Facility Platform with its in-room interactive TV solution.
  • Dresner Advisory Services recognizes Dimensional Insight as an overall leader in business intelligence for the eighth consecutive year.
  • Fortified Health Security names Yakov Leonov security compliance advisor.
  • Lucem Health releases a new episode of its This Week in Clinical AI Podcast.

Blog Posts


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