Curbside Consult with Dr. Jayne 5/6/24

I volunteer as an instructor at an outdoor school every few months, but I ended up missing a full year of sessions due to schedule conflicts. This weekend, I was back at it. It was a welcome detour from my usual days of back-to-back conference calls and endless client-related fire drills.

There was a threat of rain for the weekend, but all of our participants were reminded of the need to be prepared for anything that nature might throw at them. Part of my responsibility for the weekend was monitoring the weather, and when you consider what can happen during spring in the Midwest, that can be its own challenge.

I usually keep my camping gear packed so that I can be ready for adventure at a moment’s notice, but I apparently moved some items from one backpack to another without replacing them. I ended up arriving without a headlamp and had to make use of my backup flashlight, which was truly terrible. Fortunately, the daylight hours are longer and I wasn’t called out of bed in the middle of the night for a medical emergency or a facilities crisis, so I was OK.

I’ll admit that I was also counting on the fact that if someone had to find me for an emergency in the middle of the night, they would likely have a better flashlight than my backup. It’s always nice when you’re surrounded by people that you trust and that you know will have your back if you need help.

I also forgot a key piece of my outdoor school wardrobe. I was pleasantly surprised that no one gave me grief about not having it. The people with whom I serve on staff know that I have my stuff together greater than 95% of the time, so maybe that had something to do with it. I’m grateful to be able to work with people who trust me and know that if I’m not running at my usual level of performance, there’s probably a good reason for it, and I’ll make up for it if I can.

I admit that I was running around crazy on Friday with some work in the morning that took longer than it needed to. I was dealing with a sex discrimination situation and needed to make sure it was escalated as far as I could take it before I left town, trusting that others would pick it up and continue to act on it in my absence.

It’s disheartening to know that this kind of thing continues to happen in 2024. This particular situation is particularly egregious, with various regional teams deliberately violating a nationwide company’s policy in their attempts to keep women from participating in certain activities, citing “safety” as the reason. The roots of this issue go back several years, and those of us who have been working for decades to have women included in technical or other typically male-oriented fields are simply tired of it.

I wasn’t about to stand by while women were bullied because they are new to the organization and others were afraid to advocate for them for fear of retaliation. That’s when it’s nice to be a consultant, because other than my own work, I have nothing to lose in this situation. Fortunately, the individuals who I escalated to were in agreement that what had been going on was inappropriate, so I doubt I’m going to get kicked off the project any time soon.

We’ve all been the new person on a team, and it can be difficult. It’s important that existing members of the team are willing to support new members and make sure that they are treated fairly. I’ve been on teams where leadership does more bullying than leading, and in those situations, it’s tempting to just keep your head down and try not to become a target yourself. Unfortunately, that approach sometimes emboldens the bully, and it certainly doesn’t help the situation go away.

If we look out for each other, it strengthens the team. Eventually we can arrive at that magical place where the team is fully tuned in to each other and can really start to achieve its goals. It’s not always easy to be an upstander, but as we’re working to build workplace culture, it’s a necessity.

I enjoyed working with my assigned teams this weekend, which included a hospital pharmacist, several paramedics, a chaplain, and more than a couple of IT folks. It was interesting to see people leave their typical roles and focus on new challenges, such as lighting cooking fires in the middle of a rainstorm and figuring out how to safely use axes, saws, and other things they aren’t exposed to in their daily lives. I think our students learned a lot about how they react to new situations, how they can better work with people who may not be like them, and how to “embrace the suck” when things don’t remotely go as planned.

As many times as I’ve done this, I even learned a thing or two. One such lesson was that I shouldn’t have bothered to bring my laptop, because despite the work that needed to be done, I wasn’t going to have time to even power it up. The small amount of free time that I did have was taken up by a delightful power nap under a gazebo while the students were with another instructor.

Another lesson was that even though I was executing a plan I had done dozens of times in the past, I probably needed to check my preparations more thoroughly than I did. One could argue that the corollary to that one is “never take anything out of your go-bag,” and I think I learned that one as well. Last, I was reminded of the fact that even in challenging situations, sometimes you just have to make an attempt to do your best and be OK with that.

I have the dates for the next two outdoor school sessions on my calendar, so barring any urgent work travel or family emergencies, I should be able to stay in the groove. My backpack is restocked and my headlamp has fresh batteries. I’m ready for whatever gets thrown at me next. In the mean time, I’ve learned how to make campfire cannoli with crescent rolls, a stick, and pudding – and let me tell you, when it’s 90% humidity and you’re tired and your feet hurt, one of those is a great pick-me-up.

What’s your favorite dessert for camping? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: It’s Time to Rethink Healthcare’s Reliance on Legacy Tech Amid Cyberattacks

It’s Time to Rethink Healthcare’s Reliance on Legacy Tech Amid Cyberattacks
By Tom Furr

Tom Furr is founder and CEO of PatientPay of Durham, NC.

One of the biggest questions surrounding a large-scale cyberattack in healthcare this spring is one that healthcare is hesitant to confront. Why did it take more than a month to get these systems up and running again?

We would never hear of a financial institution being unable to restore operations for such a long period of time, despite the fact that financial data, just like healthcare data, is an attractive target for cyberattack, with losses totaling more than $12 billion over the past 20 years.

But as financial institutions take a hard look at ways to de-risk technologies to bolster their defense against cyberattack — including by investing in cloud and edge computing and implementing zero-trust architecture to protect legacy tools from threats, partnering with technology hosting companies for their security solutions such as AWS’s Cloud Security, Oracle Cloud Security and Azure Cloud Security —healthcare has been slower to make the move to the cloud.

One study found that while 86% of healthcare organizations have experienced data theft of some type, just 47% of sensitive data in healthcare is stored in the public cloud, compared with 61% across industries, according to research by Skyhigh Security. While 56% of healthcare organizations surveyed by Forrester increased cloud spending between 2022 and 2023, most are focusing on moving electronic medical record (EMR) systems to the cloud. While it makes sense to start with the EMR, leaders shouldn’t overlook the need to move other on-premises systems and applications to the cloud, too, including legacy systems.

A few years ago, a HIMSS survey quantified healthcare’s reliance on legacy systems. It found that 73% of organizations still operate legacy systems even though leaders say that these systems also present the third-biggest security risk to organizations. Insiders refer to these systems as “basement tech.” They have been around so long that few members of the IT team know how to operate them, yet they’re expensive to retire, so they keep chugging along, often in the basement of a facility. I guess now that costs from the most recent breach are starting to become public, it appears retiring old systems might not be that expensive after all.

If a system were hosted in the cloud, it would have access to all the latest security protections as they are released. Even better, there would be multiple layers of security surrounding a system in the cloud. If one layer were penetrated during a cyberattack, there would still be security wrapped around the root code for the system. Even if cyberthieves were to penetrate the root area of the system, the nature of the cloud means access to the system is still possible. The vulnerable system could be shut down, with the same functions spun up in another area of the cloud within minutes, limiting downtime.

We never hear someone say, “I couldn’t access my bank account for a month because of that cyberattack.” So why do we accept that this can happen in healthcare?

The truth is, we shouldn’t. Not when providers’ livelihoods are at stake, with many physicians digging into their personal savings to keep their practices afloat. And let’s not forget the patient impact, with the most recent large-scale cyberattack forcing consumers to pay cash for expensive drugs or endure long waits for needed prescriptions, among other impacts.

The impact of the latest healthcare cyberattack will likely be felt for months, going beyond claim processing and payment to impact functions such as real-time eligibility checks and more. As the industry assesses the damage, providers must also double down on prevention.

Now is the time to take a hard look at what’s holding your organization back from cloud investment, the level of expertise needed to chart a path forward, and the types of investments that will best protect your organization from a breach in an era of increased cyber risk. Your organization’s reputation and its ability to maintain continuity in care depend on these actions.

Morning Headlines 5/6/24

Collusion in Health Care Pricing? Regulators Are Asked to Investigate

Senator Amy Klobuchar (D-MN) asks the Department of Justice’s Antitrust Division to investigate the pricing algorithms that are used by MultiPlan to reduce insurer payments to providers for out-of-network claims.

UH operating losses again top $200M; but system says big investment in My Chart is starting to pay off

University Hospitals in Ohio attributes its nearly half billion dollars in operating losses over the last two years to inflation, rising employee costs, and expenses associated with its Epic implementation last fall.

FDA Qualifies Apple Atrial Fibrillation History Feature as an MDDT

FDA qualifies the Apple Watch as the first digital health tool to monitor atrial fibrillation during clinical studies.

Monday Morning Update 5/6/24

Top News

Senator Amy Klobuchar (D-MN) asks the Department of Justice’s Antitrust Division to investigate the pricing algorithms that are used by MultiPlan to reduce insurer payments to providers for out-of-network claims.

The senator questions whether the practice constitutes price-fixing.

HIStalk Announcements and Requests

Just under half of poll respondents who are covered by a non-compete agreement say they’ll be more open to changing jobs once those are gone.

New poll to your right or here: What is the single biggest reason that Walmart Health failed? The “all of the above” option is compelling but intentionally absent. Most interesting to me is why the company so quickly about-faced from “we’re expanding to 75 locations by the end of 2024” to “we’re shutting the whole thing down because it’s not profitable.” I would guess that finding and paying staff was harder than Walmart expected. I also questioned from the beginning whether the “doc in the big box” strategy of Walmart and its equally struggling drugstore competitors is sound when most of us are surrounded by the offices of providers who work for health systems, themselves, or giant corporations such as Optum. There’s just not much opportunity for scale and brand recognition for offering primary care, which is financially challenging even without trying to carve out the financial returns that investors in publicly traded companies expect.

Thanks to these companies that recently supported HIStalk. Click a logo to learn more.

HIStalk sponsors that are participating in the MUSE Inspire conference later this month: tell me about it so I can include your information in my conference guide.

Webinars

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

Acquisitions, Funding, Business, and Stock

Spok announces Q1 results: revenue up 5%, EPS $0.21 versus $0.16. SPOK shares are up 11% over the past 12 months, valuing the company at $291 million.

FDA qualifies the Apple Watch as the first digital health tool to monitor atrial fibrillation during clinical studies.

A Wall Street Journal article on AI-created digital twins profiles Unlearn, which uses the health data of a clinical trials participant to forecast how they would progress in the placebo group without denying them the potentially beneficial treatment. The CEO says that a top reason that people don’t participate in clinical trials is that they don’t want to be randomized into the control group that receives placebo rather than the therapy that motivated them to sign up in the first place.

Sales

• Hospice of the Chesapeake implements Netsmart’s MyUnity EHR.
• Intermountain Health will deploy Nuance’s DAX enterprise-wide to automate clinical documentation.

People

John Seguin (PT Solutions Physical Therapy) joins RevSpring as VP of business development, West Coast.

Industry long-timer Peter Witonsky (Arctevity) joins Innovative Consulting Group as chief revenue officer.

Announcements and Implementations

Sectra and Leica Biosystems earn FDA 510(k) clearance to use DICOM images for pathology diagnostics, which allows replacing proprietary formats and technologies.

Bardavon, which offers workers’ compensation and musculoskeletal health technology, launches Recovery+, a health coaching platform for recovery and return-to-work.

Government and Politics

Kentucky becomes the first state to decriminalize medical errors that are due to mistakes rather than gross negligence or intentional misconduct.

Privacy and Security

Atlanta-based staffing company Insight Global will pay $2.7 million to resolve federal False Claims Act charges that it failed to protect the health information of COVID-19 contract tracing subjects under its CDC-funded contract.

Sponsor Updates

• Surescripts launches the third season of its award-winning podcast, “There’s a Better Way.”
• Clearsense earns the Validated Data Stream designation from NCQA’s Data Aggregator Validation Program.
• First Databank will present at the NCPDP Annual Technology & Business Conference May 7 in Scottsdale.
• Optimum Healthcare IT will present at Knowledge 24 May 8 in Las Vegas.
• RxLightning founder and CEO Julia Regan receives the Rising Entrepreneur of the Year Award at TechPoint’s annual Mira Awards gala.

Blog Posts

• Demystifying the digital front door: What works (and doesn’t) in modern patient engagement (Notable Health)
• California CARE Court: Simplifying the Complex. Serving the Most Vulnerable. (Netsmart)
• How can care management programs broaden their outreach to members? (Wolters Kluwer Health)
• The Art of the Possible: A Q&A with Healthcare Policy Wonk Deanne Primozic (Surescripts)
• Top 5 Needs Solved by Working with a CVO (Symplr)

Contacts

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

Morning Headlines 5/3/24

Transcarent Raises $126 Million Series D

Transcarent raises $126 million in a Series D funding round that values the company at $2.2 billion.

Avel eCare Acquires Hospitalist Telemedicine Provider ‘Horizon Virtual’

Telemedicine provider Avel ECare acquires Horizon Virtual, which offers virtual hospitalists.

Pfizer plans direct-to-consumer platform for Covid and migraine treatments

Pfizer will follow the lead of competitor Lilly in rolling out an online platform where patients can order the company’s drugs directly, connecting US customers with independent telehealth consultants who will send prescriptions to a drug dispensing partner.

Contexture and Quality Health Network Announce Affiliation

Contexture, which manages HIEs in Arizona and Colorado, acquires Colorado-based HIE Quality Health Network.

News 5/3/24

Top News

UnitedHealth Group CEO Sir Andrew Witty tells the Senate Finance Committee – which was questioning him about the Change Healthcare cyberattack – that the half-trillion dollar market cap UHG isn’t all that big. He commented that the company doesn’t own hospitals or drug companies and employs just 10,000 physicians, although he acknowledged that another 80,000 doctors choose to work with the company.

He blamed the ransomware attack on the outdated cybersecurity tools of Change Healthcare, which he says UHG was in the process of upgrading following its October 2022 acquisition of the company. He admitted that two-factor authentication was not implemented.

Witty also admits that he personally made the difficult decision to pay the $22 million ransom that the hackers demanded in hopes of keeping patient information private.

Committee Chair Ron Wyden (D-OR) went after Witty hard over lax cybersecurity and monopolistic practices. When Witty touted the company’s offer of credit monitoring to those who were affected by the breach, Wyden chastised him that “credit monitoring is the thoughts and prayers of data breaches.”

Reader Comments

From MizzuPharmD: “Re: Liberty Hospital. Will be acquired by University of Kansas Health System. May drive antitrust scrutiny.” The two organizations have consummated their mating as was originally announced in November. Lawmakers considered blocking the deal in expressing territorial indignation that a Kansas health system would take over a Missouri hospital. The acquirer runs Epic, while the acquiree runs (or at least did at some point) Altera Digital Health / Allscripts Sunrise.

From Oh the Irony: “Re: Epic. Interesting comment considering the company’s usual take on non-competes, ha!” Judy Faulkner says in a “Hey Judy” post that early-days Epic decided not to challenge a competitor’s theft of Epic’s internal information, concluding that, “Even if someone copies everything in our filing cabinets, it won’t make much of a difference. The corporate culture can’t be easily copied.”

From Dr. Bass: “Re: Walmart Health Centers. Wonder what they will do with all the patient records they need to maintain for years?” They will need to export them from Epic into some sort of retrievable archive, I assume, which is probably easy but not common since few Epic customers have replaced the system or closed their doors. Negotiating a contract cancellation with Epic might be harder, especially since they just signed it in 2021.

From Relayer: “Re: Change Healthcare breach. The portal and underlying systems that caused the problem – and that don’t have multifactor authentication – are the original RelayHealth products that McKesson acquired in 2006. McKesson then ‘merged’ the business with Change Healthcare even though McKesson kept a 70% stake and made billions when Change went public in mid-2019. Acquired companies lose intellectual capital and don’t focus on the stepchild products, so it’s not surprising that these products become vulnerable after being sold off and orphaned.” The breach, as well as the government’s unhappy scrutiny over Change’s lack of two-factor authentication, has raised the user access bar for all software vendors, and likely health systems as well. It’s a squirmy position to be in when members of Congress angrily ask you to defend why you didn’t implement two-factor authentication when other organizations have.

HIStalk Announcements and Requests

Attention to the several HIStalk sponsors who will participate in the MUSE Inspire conference in Denver May 28-31: I’ll include you in my conference guide if you provide your information.

The latest chapter in my quest to achieve grammar curmudgeonliness involves leaving in the word “that” to make sentences easier to read. I’ll show, not tell: the second sentenced is easier to read than the first:

• The doctor said I need to schedule an appointment.
• The doctor said that I need to schedule an appointment.

Listening (and watching): 11-year-old Ellen Alaverdyan, aka EllenPlaysBass, whose little fingers have mastered the sheer complexity and energetic fret-hopping of Chris Wolstenholme’s bass line in Muse’s “Hysteria.” Her videos, which usually include her instructor-dad Hovak, are a treasure. Watch her smile break out toward the end when she realizes that she has nailed the piece. She did a fine, grinning version of Rush’s “Tom Sawyer” when just nine years old. Keep in mind that she not only has to play the songs, she must learn every single note and nuance before picking up the bass.

Webinars

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

Acquisitions, Funding, Business, and Stock

CVS Health reports Q1 results: revenue up 4%, adjusted EPS $1.31 versus $2.20, sending shares down 17% on the news as the company also lowered full-year guidance. Shares have lost 24% in the past 12 months. From the earnings call:

• Its Medicare Advantage business saw a 60% drop in operating income due to higher utilization and payments that were reduced because of lower star ratings.
• The company set aside $500 million for claims that wouldn’t be paid as planned due to the Change Healthcare cyberattack.
• It is performing a cost review, looking at outlier claims, membership selection bias, and pharmacy benefit spend.
• Recent changes in Medicare Part D will disrupt benefits, the company says, also noting that its rate notice was not sufficient and that it will need to consider plan-level benefits changes and exiting some counties.
• The Inflation Reduction Act enriched the value of Part D to patients and plans have greater liability in the catastrophic layer. Some companies may exit the business, and higher prices may push some beneficiaries into Medicare Advantage plans.
• Drugstore sales were up 7% and Oak Street added 33 centers in the past 12 months and expects to add up to 60 more. CVS Health hopes to see a boost from its Cordavis biosimilars business.
• The company is using AI to identify members who could benefit from care management.
• Meanwhile, CVS Health has just acquired Hella Health, a direct broker that sells Medicare Advantage and Medicare supplemental plans that are offered by Aetna CVS Health and its competitors.

Transcarent raises $126 million in a Series D funding round that values the company at $2.2 billion.

Telemedicine provider Avel ECare acquires Horizon Virtual, which offers virtual hospitalists.

Wearable cardiac monitoring vendor IRhythm Technologies announces Q1 results: revenue up 18%, adjusted EPS –$1.23 versus –$1.10. IRTC shares have lost 17% in the past 12 months, valuing the company at $3.5 billion.

Financial Times reports that drug maker Pfizer will follow the lead of competitor Lilly in rolling out an online platform where patients can order the company’s drugs directly, connecting US customers with independent telehealth consultants who will send prescriptions to a drug dispensing partner. According to a global health professor, drug companies have realized that “The best way to convert customers is through patient portals where they can act as a consumer in medicine. They can go to the website, they can get the information they need, they can be linked to a prescriber and then a pharmacy, and do all those things independent of a primary care provider.”

Following its acquisition of Cerner in June 2022, Oracle Health has reduced its employee count in Kansas City from a peak of 14,000 to 6,400.

Bloomberg declares that “Austin’s glow is fading,” with the latest blow being Oracle’s planned headquarters relocation to Nashville after just four years in the Texas city. The article says that companies are rethinking their big plans for Austin, 25% of its commercial real estate is vacant, and residential real estate prices have dropped more than in any other US city. It adds, “That Oracle went to archrival Nashville is particularly painful for Austinites. The two cities compete over which has the more vibrant live music scene and who plays the better host to bachelor and bachelorette parties. There are heated debates over where to find the best custom-made cowboy boots.”

Sales

• Three community health centers that are part of the federally funded Pacific Islands Electronic Health Initiative choose EClinicalWorks.

People

Chris Durham (Medhost) joins HCTec as VP of service desk operations.

Announcements and Implementations

OpenAI CEO Sam Altman describes ChatGPT 4 as “incredibly dumb” as he looks to newer versions that will operate beyond the chat interface into deploying AI-driven agents that are capable of performing tasks with a deep understanding of the user’s specific needs.

Truveta expands its 800-hospital research database to include family history, medication details, complex concepts, and de-identified medical images.

Lucem Health announces Reveal for Lung Cancer, which applies an AI model to EHR data to flag patients who meet USPSTF criteria for lung cancer screening. The company says that a provider organization can expect to identify 60% more patients who have early-stage lung cancer.

Other

Healthcare AI deployers, be careful out there. Catholic Answers defrocks its days-old, AI-powered “Father Justin” after it went rogue in telling users that it was a real priest, took confessions and granted penance, and told one user that it was OK to baptize a baby in Gatorade. The organization says the AI chatbot will be retooled as just plain old layperson Justin, noting, “We didn’t anticipate that someone might seek sacramental absolution from a computer graphic.”

Sponsor Updates

• Healthcare IT Leaders sponsors foster care charity A Door of Hope’s golf tournament.
• Inovalon earns Great Place to Work certification for the second consecutive year.
• Nordic will offer sales, consulting, and implementation of the diagnostic and treatment analytic platform of Clinical Healthcare Analytics.
• EVisit will sponsor and exhibit at the California Hospital Association’s 2024 Emergency Services Forum May 6 in Newport Beach.
• Australian vendor Consultmed re-platforms its software on InterSystems Iris for Health, including InterSystems TrakCare.
• Net Health names Arman Samani president of its rehab therapy division.

Blog Posts

• Reaching New Heights in Leapfrog CPOE Evaluation Compliance (First Databank)
• Unveiling the Future of Contract Negotiations in Healthcare: Intelligence-Driven Solutions (FinThrive)
• From Insight to Impact: Using Real-World Data to Drive Above Brand Strategy (Inovalon)
• Regulation as a Catalyst for Innovation: Leveraging the Interoperability and Prior Authorization Mandate (InterSystems)
• How virtual nursing can guide patients and nurses into the next era of healthcare (Meditech)
• Choosing the Right QPP Reporting Method for MSSP ACOs in 2025 (MRO)

Black Book releases its 10th annual “State of the Healthcare Cybersecurity Industry” report. A corresponding ranking of top cybersecurity firms based on customer satisfaction ratings includes the following HIStalk sponsors:

• Clearwater – cybersecurity advisors and consultants / compliance and risk management solution.
• Fortified Health Security – cybersecurity awareness training and education.
• CloudWave – outsourcing and security network managed services.
• PerfectServe – secure communications platforms, physician practices.
• Spok – secure communications platforms, hospitals and health systems.

Contacts

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

EPtalk by Dr. Jayne 5/2/24

The hot topic in the virtual physician lounge this week was that another company has decided that delivering healthcare is more difficult than it thought.

Across the board, members of a primary care discussion group felt vindicated that Walmart plans to close all 51 of its Walmart Health centers as well as its Walmart Health Virtual Care telehealth offering, citing rising costs and “the challenging reimbursement environment.” These are the same struggles that physicians are facing, usually without any kind of corporate subsidy.

The health centers locations by state are Florida (23), Georgia (17), Texas (7), Arkansas (3), and Illinois (1). Non-provider associates are eligible to transfer to other Walmart or Sam’s Club locations, otherwise they’ll be paid for 90 days and then receive severance benefits. Providers will be paid “through their respective employers” for 90 days and then will receive transition payments. Walmart Health is an Epic client, making me curious as to what breaking that contract looks like.

I’m a fanatic about scheduling my next dental appointment before I leave my current appointment, so I was surprised recently when I started receiving reminder text messages that my appointment was due and I needed to schedule. I called the office and they confirmed that my appointment had disappeared from the system, but offered me the “recently opened spot” that was actually my original appointment. It turns out that they migrated their electronic dental record to a different system and apparently some appointments became casualties. I’ve done enough practice management system conversions in my career to know that sometimes things happen, but it sounds like they may not have had as rigorous of a QA plan as they needed since they said other appointments had disappeared as well.

On the Saturday morning prior to my appointment, I received a text message to fill out some forms. I was busy doing other things and didn’t do it, only remembering as I was in the car on the way to the appointment. I had some extra time in the parking lot and tried to fill them, out but discovered that the web app wasn’t really configured for a mobile device and the fonts were too small to read. I couldn’t figure out how to make the fonts any bigger, so gave up and went into the office. They tried to send me the text again to have me complete the forms on my phone. I explained the problem with the font size and they had no suggestions other than to hand me an old fashioned clipboard. They mentioned that “none of the information from the old system came into the new one,” which made my informaticist heart shudder.

The paper forms were a sorry lot, with the first page having been printed without all the desired data elements on it, so someone had gone through and written “Emergency Contact Name and Number” blanks by hand. I zoomed through to the medical history form, and only after answering the first question did I realize that the format made no sense at all. I made my best interpretation at what they were wanting and handed back my clipboard as quickly as possible.

It’s embarrassing that professionals think these kinds of forms are OK. I secretly wanted to offer some clinical consulting services. I mentioned my confusion about the form to the dentist, who reassured me that my records had indeed been migrated into the new system, showing my chart on the in-room display. He said that he would follow up with the front desk to find out why they’re making people fill out a full history, so at least that’s something. I’m not sure who the vendor was on the electronic dental record, but if you work for one and are reading this, please check your mobile app to make sure it’s accessible to those of us who are experiencing the visual changes that come with age.

An ”Inside Story” feature in JAMA Internal Medicine tells the story of what resident physicians feel like when the EHR goes down unexpectedly. The resident describes an “unexpected fatal error to the system that the IT department was working to resolve.” There is no mention of a downtime solution, with the author stating that “samples for the morning laboratory tests could not be collected because the phlebotomy team did not know which patient needed which tests.”

The resident arrived at the “simple answer” of asking patients about their conditions and talking to the nurses who had most recently cared for them. They changed to a “minimum laboratory testing approach” after realizing that it was likely that patients had been undergoing tests that weren’t necessary, but rather were ordered simply as a result of order set use.

The author notes that “the EMR downtime made me realize that while the system seems to make our clinical routine convenient, it may not result in increased efficiency or better patient care.” Patients continue to receive daily labs that are part of an admission order set and those caring for them aren’t asking each day whether those orders are necessary or appropriate. They mention that “I look unprepared to my team when I do not know my patients’ latest basic metabolic panel and complete blood count values during rounds, but no one would ask me how much time I spent talking to my patients.” The author also enjoyed actually talking to members of the care team rather than communicating through the EHR, closing by saying that “our patient care on that day was the most patient-centered and most collaborative than ever in my 2 ½ years of residency.” Only one comment has been left on the piece so far, but I’ve got my popcorn and am sticking around.

It’s time to update those health maintenance settings in the EHR, now that the US Preventive Services Task Force (USPSTF) has issued an updated Recommendation Statement on breast cancer screening. Women aged 40 to 74 are recommended to have screening mammography every two years. The previous recommendation that was last updated in 2016 called for women to begin screening mammograms at age 50 and that women aged 40 to 49 should engage in individualized decision-making to determine a screening plan.

In a situation where we don’t have enough physicians who have the time to truly do health-related counseling during their visits, individualized decision-making can be problematic. Patients are reluctant to schedule a dedicated appointment to discuss screening, so it becomes one more thing that has to be crammed into a well woman or other preventive visit. I wonder how quickly people will be updating the recommendations in their EHRs and how organizations plan to educate physicians and care teams.

What is your organization’s plan to roll out the new USPSTF recommendation? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 5/2/24

CVS Health Corporation Reports First Quarter 2024 Results and Revises Full-Year 2024 Guidance

CVS Health shares plunge on the news of disappointing Q1 results and revised full-year 2024 guidance.

Aledade and Medical Advantage Team Up To Expand Value-Based Care in Michigan

Value-based care and physician practice optimization company Aledade acquires Medical Advantage, a subsidiary of The Doctor’s Company that provides value-based healthcare consulting to practices in Michigan.

Tiger Global-backed Innovaccer in talks to raise $250M in new funding, sources say

Health data and analytics company Innovaccer is reportedly in talks to raise $250 million at a valuation of between $2.5 billion and $3 billion.

Healthcare AI News 5/1/24

News

Google highlights the medical capabilities of its unreleased Med-Gemini AI models. The four models can provide text, image, and video outputs and are integrated with web search.

CLEW announces GA of its FDA-cleared, AI-powered system for early detection of patient deterioration. The company introduced its first AI prediction models for virtual ICUs in 2018 and has since expanded to cover all inpatient settings. CLEW’s CEO is industry long-timer Paul Roscoe, who has held leadership roles with Sentillion, The Advisory Board Company, Visionware, and Docent Health.

Several hundred nurses picket Kaiser Permanente San Francisco Medical Center to express their concerns that KP, which promotes itself as a leader in healthcare AI, will use the technology to improve its margins rather than patient care.

HHS OCR and CMS publish a rule that prohibits the use of patient care decision support tools –- their new name for what they previously called “clinical algorithms” – to discriminate based on race, color, national origin, sex, age, or disability. It requires Covered Entities to identify and review their use of any tools that take those factors into account to make sure they do not discriminate. It lists areas such as prior authorization, medical necessity determination, screening, risk prediction, diagnosis, prognosis, clinical decision-making, treatment planning, healthcare operations, and resource allocation in which race or ethnicity inputs might create discrimination.

Business

AI drug developer Xaira Therapeutics launches with $1 billion in capital. The company’s founding CEO is former Stanford University President Marc Tessier-Lavigne, PhD, who left that post in August 2023 when several of the research papers he published while working for Genentech were found to have used manipulated data.

Startup Dionysus Digital Health develops an AI-analyzed genetic test that it says can detect post-partum depression before symptoms appear. DoD has provided a $6 million grant for further study. The company hopes to earn FDA approval for the $250 test and have it covered by health insurance.

Quest Diagnostics will acquire PathAI’s Memphis-based digitized laboratory – the former Poplar Health, which it acquired in July 2021 — and convert it to Quest’s AI and digital R&D and solutions center to support its AmeriPath and Dermpath Diagnostics specialty pathology businesses. PathAI will continue to offer clinical trials services from its biopharma lab, which is a separate business.

Drug maker Moderna launches its own instance of ChatGPT that has been used by 80% of its employees. The company is using advanced analytics, image generation, and a library of 750 self-developed GPTs that help drive automation and productivity.  One of the GPTs evaluates optimal vaccine doses based on standard criteria and principles, supporting its conclusions with rationale, references, and charts that illustrate key findings, all of which are then reviewed by humans. The company identified its top 100 AI users to serve as champions and created an active internal AI forum. Moderna says that 40% of its active users have created GPTs and each user averages 120 ChatGPT Enterprise conversations each week.

Research

Researchers find that using AI to analyze the high-risk ECGs of hospitalized patients was associated with a 31% drop in all-cause mortality, the first randomized clinical trial to show that AI saves lives.

A study finds that ChatGPT-4 performed poorly in evaluating the data of chest pain patients to determine whether they should be admitted. Researchers noted particular concern that the model would give different risk estimates and test ordering recommendations for the same set of patient data that it reviewed more than once.

University of Texas Southwestern Medical Center researchers find that ChatGPT 3.5 can extract pathological classifications from lung cancer pathology reports with 89% accuracy, with most misclassifications being caused by lack of specialized pathology terminology and its faulty interpretation of TNM staging rules (tumor, number of affected nearby lymph nodes, and the presence of metastasis). The test was repeated using ChatGPT 4, which improved the model’s performance by 5% but at a higher cost.

Other

A Colorado attorney is suspended from the bar for one year and is fired by his law firm employer after admitting that he used ChatGPT to create legal documents. He says that he was trying to save his client money by using AI to perform case load research. ChatGPT generated what he says were “seemingly impeccable case law and case citations” that he didn’t double check, and a judge noticed that some of the cases cited were either incorrect or non-existent.

Contacts

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

Morning Headlines 5/1/24

Walmart Health Is Closing

Walmart Health announces that it will close its clinics and virtual care service, noting that it can no longer sustain a business model that is beset by rising costs and declining reimbursements.

VA remains committed to controversial computer system, says Veterans Affairs official in Spokane visit

Deputy VA Secretary Tanya Bradsher says that the department is committed to rolling out Oracle Health during a recent visit to Mann-Grandstaff Medical Center (WA), which went live on the problematic software in 2020.

Trovo Health Announces $15 Million Seed Funding Round Led by Oak HC/FT

Trovo Health, which offers AI-powered assistants for specialty practices, raises $15 million in a seed funding round.

News 5/1/24

Top News

Walmart Health announces that it will close its clinics and virtual care service, noting that it can no longer sustain a business model that is beset by rising costs and declining reimbursements. The company had previously said that it would open 22 additional health centers this year.

Walmart Health grew to 51 locations in five states during its five-year run, implementing Epic across its clinics in 2022. The concept was piloted in Dallas, GA in 2019, where it offered $40 visits and physicals from standalone offices. Walmart simultaneously ran Care Clinics from inside its stores in three states. Walmart acquired multi-specialty telehealth provider MeMD in mid-2021 and renamed the business to Walmart Health Virtual Care a year later.

The retail giant will continue to focus on the development of its pharmacy and vision offerings, of which there are, respectively, 4,600 and 3,000 in-store sites.

The company launched Walmart Health Care Research Institute in October 2022 to pair members of underrepresented communities with clinical trials, which included digital tools for research participants to manage their health records and insurance information. Walmart says that business will continue.

Reader Comments

From Wiggles: “Re: Walmart Health Centers. We’ve been patients since it opened. It was convenient, offered easy access, and was super affordable. I guess it was too good to be true. My only frustration with the numerous times they cancelled appointments because they didn’t have available clinicians.” The upside is that physicians might be realizing that they can (or could) control delivery since giants like Walmart can’t scale with them, much less without them. Healthcare still requires doctors who might be in short supply, who don’t enjoy offering care-by-wire encounters, or who don’t find that wearing a Walmart-logoed white coat carries the prestige they expected. This is the chance for doctors to wrest control back from the suits in a medical form of a rollback special.

From Spindrift: “Re: Walmart Health. They must have spent a fortune implementing Epic for the short time they used it.” Agreed.

HIStalk Announcements and Requests

Today I learned that Larry Ellison’s son David is founder and CEO of Skydance Media, which makes the “Mission: Impossible” and “Star Trek” films and is negotiating a multi-billion dollar merger with Paramount Pictures. David’s wife is Larry’s connection to Nashville – she’s a country singer (who I could find next to nothing about, which I assume that she’s still hoping to break out) who has a house there.

I’m thinking of all the ways that Epic could theoretically limit the career options of its employees even if non-compete agreements are banned. I found the above language in the Epic contract of Ardent Health, which was filed with the SEC and which I think I recall is Epic standard contract boilerplate. Lawyers, is this legal, or just unlikely to be found illegal because affected employees don’t have the time or money to challenge it?

Webinars

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

Acquisitions, Funding, Business, and Stock

Oracle Chairman and CTO Larry Ellison’s headquarters relocation declaration likely won’t impact most of the company’s US employees, given that the majority — including Ellison, who spends most of his time on his Hawaiian island of Lanai — are remote. Seven thousand are still based in the company’s original home state of California, while 6,400 largely former Cerner employees reside in Missouri. Just 2,500 call the company’s current Austin, TX, headquarters home.

HCA reports Q1 results: revenue up 11%, EPS $5.93 versus $4.85, beating analyst expectations for both. HCA shares are up 23% in the past 12 months versus the S&P 500’s 12% gain, valuing the company at $82 billion.

Streamline Health reports Q4 results: revenue down 19%, EPS –$0.02 versus –$0.04. Shares dropped on the news, valuing the company at $17 million, down 82% in the past 12 months.

Sales

• SSM Health St. Mary’s Hospital (MO) will use Inbound Health’s hospital-at-home services, including virtual care, as part of its new Recovery Care at Home program.
• Ochsner Health (LA) selects self-service triage, care navigation, and capacity optimization software from Clearstep.
• Akron Children’s Hospital will implement Health Catalyst’s population health and analytics solutions.
• Houston Methodist will implement EVideon’s Vibe Health smart room technology at its West Hospital and Cypress Hospital, which will open next year.

People

Penn Medicine promotes Mitchell Schnall, MD, PhD, to SVP of data and technology solutions.

Announcements and Implementations

Hackensack University Medical Center (NJ) implements AvaSure’s TeleSitter virtual care technology.

Researchers find that using AI to analyze the high-risk ECGs of hospitalized patients was associated with a 31% drop in all-cause mortality, the first randomized clinical trial to show that AI saves lives.

Government and Politics

Noting that, “There is no Plan B,” Deputy VA Secretary Tanya Bradsher says that the department is committed to rolling out Oracle Health. She made that promise during her second visit to the Mann-Grandstaff Medical Center in Spokane, WA, which went live on the software in 2020. Resuming implementations at VA facilities will depend upon the readiness of the system and each medical center, which will be determined by analysis of a “readiness scorecard,” according to VA EHR Modernization program lead Neil Evans, MD. Restarts will likely begin in 2025 and go-lives a year later.

Privacy and Security

UnitedHealth Group CEO Andrew Witty confirms via written testimony that hackers used stolen credentials to remotely access a Change Healthcare Citrix portal, which did not have multifactor authentication. The criminals spent nine days nosing around Change systems before initiating the ransomware attack. Witty, who will present his testimony to a US House Committee May 1, adds that paying the ransom was “one of the hardest decisions I’ve ever had to make.”

Other

In Ohio, Montgomery County officials will work with the Greater Dayton Area Hospital Association, Montgomery County Behavioral Task Force, and area providers to develop a behavioral health services referral portal. The project will be funded in part with nearly $2 million received by the county as part of an opioid settlement earlier this year.

Notes from Oracle’s Larry Ellison from his healthcare fireside chat last week:

• Ellison says that hospital pathology departments can’t detect mutated bacteria or viruses, so the next version of Millennium’s pathology module will focus on gene sequencing to support global outbreak surveillance.
• He notes that Oracle is “by far the largest provider of automation systems to hospitals and clinics throughout the world,” with virtually every NHS hospital as clients as well as those in the Middle East, Saudi Arabia, UAE, Kenya, Rwanda, Indonesia, and Japan.
• Ellison was surprised that real-world evidence of drug effectiveness isn’t used for quick approval by FDA for specific conditions, so drug companies spend 10 years and millions of dollars to run another clinical trial, concluding that “classical clinical trials [aren’t] the only way you discover things work”  and proposing the idea that “a clinical trial should never end” in reviewing data on the first 5,000 patients and then ignoring data from the next 50 million.
• He adds that Cerner goes beyond the EHR into life sciences.
• Ellison talked up autonomous digital infrastructure for cybersecurity, with Oracle’s first customers for it being the CIA, NSA, and Britain’s MI6.
• Passwords will be eliminated from all Oracle systems by the end of the year.
• Ellison says that buying Cerner wasn’t just about automating hospitals, but also the hospital-payer interface, noting that high healthcare costs threaten democracy in Europe, with half of the UK’s budget being consumed by healthcare.
• He says that Oracle Health needs to get involved with medical devices, FDA oversight, hospital workforce management with emphasis on the “gig economy” where nurses and doctors aren’t hospital employees, and hospital inventory management.
• Ellison blurted out that “we’re moving this campus, which will ultimately be our world headquarters, we’re moving that to Nashville.” He then laughed that “I shouldn’t have said that,” and then said “what might ultimately be our world headquarters.” He added, “This is where I’d love to go to work. This is the center of the industry we’re most concerned about, which is the healthcare industry.”

A former Cigna medical director says that her bosses pushed her to speed up her review of cases that nurses had flagged for coverage denial, saying that she wasn’t given enough time to review the literature or review the patient’s medical records. She said that peers simply copied and pasted the company’s denial language, which company insiders called “click and close,” even though the company’s Philippines-based review nurses often make mistakes that would have led to inappropriate denial of coverage.

Sponsor Updates

• TruBridge will host its national client conference through May 2 in Las Vegas.
• Black Book shares findings from its latest user satisfaction survey regarding specialty RCM firms.
• AdvancedMD welcomes new integration partners Jopari Solutions, TriumpHealth, DMEconnected, and EirSystems.
• Aga Khan University Hospital in Pakistan goes live on Agfa HealthCare’s Enterprise Imaging Platform.
• Ascom Americas will exhibit at Avaya Engage May 13 in Denver.
• The DGTL Voices Podcast features AvaSure Chief Clinical Officer Lisbeth Votruba.

Blog Posts

• How to Bridge the Gap Between Epic and Your IT Ecosystem (CereCore)
• Aligning People, Process, and Technology to Improve Healthcare Experiences (Tegria)
• Leveraging technology to humanize healthcare (Altera Digital Health)
• Key strategies to build a data analytics infrastructure (Arcadia)
• Certification of TREs and SDEs – What Comes Next? (Aridhia Informatics)
• Navigating Governance: Review the Current State of Patient Communications (Artera)
• Steps Every Healthcare Organization Can Take to Ensure an OCR-Compliant Risk Analysis (Clearwater)
• Navigating Regulations in Healthcare: Cyberattacks and AI Governance (Consensus Cloud Solutions)
• Analyzing the Challenges of Pharmaceutical Supply Shortages (Dimensional Insight)
• Scaling Your Practice for Success (EClinicalWorks)

Contacts

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

Morning Headlines 4/30/24

GeBBS Healthcare Solutions Acquires CCD Health (Contact Centers Dominicana)

RCM vendor Gebbs Healthcare Solutions acquires CCD Health, a contact center based in the Dominican Republic that specializes in appointment scheduling for outpatient radiology practices.

Turning point: COVID-era hospital reporting set to end

As of May 1, hospitals will no longer have to submit data on admissions and occupancy related to respiratory diseases.

Telemedicine and In-Person Visit Modality Mix and Electronic Health Record Use in Primary Care

A small study featured in JAMA finds that primary care physicians who saw patients both virtually and in person during a single shift perform around 6% more EHR-based work than colleagues who saw patients via a single modality.

Curbside Consult with Dr. Jayne 4/29/24

Following my recent piece on bro culture, a number of people reached out to me to share their opinions about culture changes in healthcare and healthcare IT over the years. One of them, who I’ll call Nurse Elaine, had some commentary that was absolutely spot on. We ended up having a lengthy back-and-forth correspondence, which is always fun when you’re an anonymous blogger and still can’t believe at times that people are willing to pour their hearts out to you.

“For most millennials (or later) growing up, healthcare wasn’t typically viewed as a field ripe for entrepreneurial breakthroughs, where one could establish a privately owned billion-dollar unicorn enterprise. Becoming a clinician was a stable career path, often seen as a gateway to a comfortable life with dinner-table respect. Professionals in the 1990s, especially those deeply entrenched in healthcare, didn’t speak of any foreseen disruption looming over the healthcare landscape. The sixth graders of 1994 (today’s professionals) marveled at their first encounters with computers, explored the groundbreaking wonders of Microsoft Paint, and navigated the Oregon Trail. Innovation seemed far removed from the realm of healthcare. However, technological promises have increasingly become intertwined with care delivery with each passing era. For better or worse, it’s interesting when you consider how we got here, to a healthcare landscape filled with unicorn promises, some fulfilled but most not.”

Elaine had some amazing commentary about how enthusiasm for healthcare grew out of the dot-com bubble and talked about companies such as Theranos, Outcome Health, Amwell, and Teladoc that “emerged as darlings of the venture capital world, armed with ambitious plans to clear their consciences and revolutionize healthcare delivery with visions aimed to simplify care processes, address complexities, alleviate fears, and enhance accessibility.” Her next comment had me doing a combination cry/laugh: “Sound familiar? Twenty years in, and we’re still marketing to the same problems.” She went on to describe some of the players as “a wave of powerful novices … who eagerly entered this domain despite their lack of profound understanding of clinical care delivery, wearing glasses tinted with the allure of returns.”

She noted that while sexy startups were expanding their funding sources and building infrastructure, the founder generation of EHR companies was “patiently laying the groundwork for documentation process disruption,” which as a nurse, she sees as some of the only true disruption the industry has seen. Companies like Epic and Cerner were ready to reap the rewards of economic stimuli such as the American Recovery and Reinvestment Act and HITECH, which led to Meaningful Use and a record $35 billion flowing to incentivize EHR adoption. (Spoiler alert: it worked.) We had some great conversation around the rise of the chief information officer role within care delivery organizations and the fact that the role continues to be held largely by men over the age of 50. Sure, we’ve seen some amazing newcomers and some bold women, but for most health systems the balance of power hasn’t shifted tremendously.

I always love conversing with readers who have spent time in the trenches, especially those who have served in an informatics capacity, and Elaine definitely had the “been there, done that” vibe, recapping some of the negatives that had come out of the HITECH Act and Meaningful Use that we’re still facing today: “poorly designed user interfaces, coding issues, burdensome documentation, disconnected quality reporting, inaccessible vendor roadmaps, data sharing without meaningful context” and more. Although vendor quality issues have improved at some companies, others in the same sector remain plagued by it, and other than a handful of companies who have gotten it right, vendor roadmaps are often no better than a pirate-inspired treasure map that may or may not lead to what you seek.

From there we fast-forwarded to 2014 with the rise of Theranos and all that brought to the industry. Elaine reminded me that Elizabeth Holmes was the world’s youngest self-made billionaire, but we know now that it was all sizzle and no steak. That segued into a conversation about the 2016 US presidential election and the impact it had on healthcare, as well as women in leadership. She made some great points about the role of women in decision-making roles at venture capital firms (17%) and the fact that so-called femtech funds established by women “tend to be small due to the perceptions of women as investors – smaller ventures can only offer smaller check sizes that typically do not secure a board seat or significant decision-making power within portfolio companies, which lessens the impact on care delivery and investment strategy.”

She brought up some great points about there being “abundant evidence indicating that women primarily make healthcare decisions within their households and that nurses, predominantly female, form the backbone of clinical care delivery, but corporate boards are often dominated by men.” She went on to say that “this gender disparity fosters decision-making based on a camaraderie mentality rather than merit” as well as failing to consider what’s best for care delivery. I pointed out that some of the decisions I’ve seen also leave out the people for whom this entire industry is designed to exist – the patients, and that unfortunately some people in the industry still act like patients are somehow pesky or some kind of a nuisance. She closed on that train of thought by noting that “while healthcare may not be intentionally anti-woman, it is unmistakably pro-bro.”

By this time, I had learned that Elaine has been in the startup space for much longer than I have, and I wish I had someone like her to bounce ideas off of when I first began working with startups. She captured the most recent decade of investment in healthcare technology as “a frenzied gold rush” with a focus on disruption for its own sake rather than as a method to improve care delivery. She pointed out that investor funding has surged since 2016, growing from $4 billion that year to more than $29 billion in 2021. She had me spitting Diet Coke on my keyboard when I read her comments about “flashy conferences headlined not by expert clinicians but by D-list celebrities” and the “sea of investors swarming in puffer vests,” and looking back at some pictures and conference write-ups from the time period, she’s not incorrect in her assessment.

We talked about Theranos, and she gave me a summary of the billion-dollar fraud at Outcome Health, which somehow I had put out of my memory (the Department of Justice write-up on the incident reads like a bad soap opera plot if you’re interested). The short version involves things many in the industry have seen, misleading investors by inflating performance metrics and exaggerating market penetration. Oh yeah, there was also the part about overbilling customers.

By this point, Elaine and I had been emailing back and forth a couple of times a day, and we had finally reached 2020 and the arrival of the COVID-19 pandemic. This is where I really enjoyed hearing her impressions as a nurse, because it’s always good to commiserate with someone who knows what it feels like when your job decides that you’re expendable and not worth the $5 a day in personal protective equipment that might literally save your life. She talked about some companies that she was exposed to in her work that “emphasized flashy growth rather than gaining a profound understanding of clinical care delivery” and what it felt like to see outsiders showing up at her institution via Zoom call to offer solutions where “the well-established best practices and protocols in healthcare, developed over hears of research and learned from the challenging experiences of malpractice suits and undesirable patient outcomes clashed with the breakneck speed of ventures trying to meet their inflated valuations.”

Clinical leaders had to figure out how to cope with what she describes as “aggressive marketing tactics” and “massive ROI promises” and solutions that had the risk of worsening the pressure on clinicians. Some of these vendors in turn delivered lackluster solutions and shared some information about vendor employees she had gotten to know through her role that reported toxic work environments where teams were tasked with keeping customers quiet about defects so that the company could achieve a unicorn valuation – resembling “the cutthroat world of investment banking more than a mission-driven service sector focused on building sustainable, effective businesses.” She went on to say that “somewhere in this whirlwind, the essence of care delivery to patients and the dedication of clinicians who invested their education, finances, and daily lives into their work became lost amid the pursuit of profit.”

From there, we segued into the bursting bubble that was health tech in 2022 and 2023, with the inability of companies to raise funds among “rising inflation rates, unfulfilled growth, and frivolous spending” and the collapse of Silicon Valley Bank following a classing bank run by frightened companies. Of course, US taxpayers funded yet another bailout. She had me laughing with her advice to the industry: “Going forward, lessons must be well understood to collect $200 and move past go.” She pointed out the need for solution consolidation, the abundance of competitors, and market saturation in certain healthcare technology areas. She had some great stories about vendors who failed to understand the difficulty of selling into large health systems, including lengthy sales cycles and the need to be able to trust your vendors when you’re focused on clinical care and human health. Many healthcare leaders find the traditional tech mantra of “move fast and break things” to be not only ineffective, but at times frightening, and plenty of vendors fail to understand that.

We both shared excitement for the increase in the number of clinician innovators moving into the space. Some of these are coming from innovation groups at established care delivery organizations. In contrast to the disruptor generation, these individuals have personal knowledge of healthcare delivery and operations and understand the highly regulated industry that they’re working in. However, they’re going to have to work hard to compete with the flash and sizzle that’s out there. In my career, some of my biggest wins have been with solutions that aren’t sexy, but they get the job done and don’t increase burden to patients or their care teams. Elaine hopes that venture capital firms, which will continue to be an essential part of the industry, start taking a more sophisticated approach to innovation with attention to experts in the field and clinicians who understand the industry and its end users, including patients.

Ultimately all of us need healthcare and its associated technology to not only work, but to work well. Most of us will end up in a hospital at least once in our lifetime, whether it’s in childbirth, following an accident, for surgery, or for management of a serious illness. When we get there, we’re not going to care about the sizzle. We’re going to want the care delivery equivalent of a four-course meal and we’re going to want it done safely, respectfully, and ethically.

What do you think about the state of healthcare information technology, how we got here, and where we need to go? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: Healthcare Technology To-Do List: Make Data Valuable for Providers

Healthcare Technology To-Do List: Make Data Valuable for Providers
By Kevin Coloton

Kevin Coloton, MPT, MBA is founder and CEO of Curation Health of Annapolis, MD.

Following my time at HIMSS ’24 and RISE National, I’ve noticed that the healthcare industry considers the maturity of health data exchange as a mission accomplished, when in reality, we are drowning providers in data that’s not usable.

Health plans and other enterprises previously had tons of data that they kept locked away. Now they are touting that they have opened the valve and data is flowing freely to the electronic health record (EHR) for health systems and providers. The problem is that healthcare providers are now drowning in data, making it almost useless. They’ve been given the full clinical encyclopedia when all they need is the CliffsNotes summary of the patient’s priorities.

There’s a huge difference between clinical data exchange and clinical insight delivery. When we step back and look at the problems that we are attempting to solve, it is discerning which data insights are actionable to improve patient care encounters, value-based care (VBC) performance, and health outcomes. The synthesis of the massive data set into actionable priorities is what’s needed. For example, knowing the top three data insights that will be most valuable for each patient during the provider’s 10-minute care encounter.

We need to help healthcare providers contextualize data for each patient. A technology “clinical insight” layer is needed within the EHR to deliver the most relevant and impactful insights from the data set to maximize provider engagement. This efficient use of actionable data can superpower provider workflows by reducing the work load of reviewing a full library of patient data and enhancing the value of time spent with patients.

Managing thousands of patients across an entire calendar year requires an overwhelming amount of data. Other industries, such as retail and ecommerce, have matured faster to accommodate the data than healthcare because we are early on our journey around what’s important for technology integrations. As a healthcare technology industry, we’re still in this era of what is best described as data maximalism, getting so excited about the potential value of a massive data set, which is further complicated by having health plan data being sent to provider EHRs and dumping the data into a giant repositories like data lakes.

From an operational standpoint, healthcare decision makers and information technology leaders are challenged with managing the tsunami of patient data, which is often just pushed directly into provider workflows. However, we must focus our efforts on delivering the highest impact data at the point of care. Those curated data points will be the most important items to focus on during a patient’s care encounter, particularly in a VBC model. When physicians are using great insight and act on it accordingly and compliantly, the patient receives more holistic care, the provider gets an accurate representation of the acuity of their patient, and reimbursement is appropriate based on the clinical risks that are associated with the patient.

To succeed in healthcare’s VBC environment, we must shift gears to a data minimalism approach. This is a strategy with the objective of synthesizing massive amounts of data and ultimately delivering the minimum amount of data required to benefit the frontline healthcare professional in managing a patient’s health. The approach rewards providers with more time for direct patient care, which is the most constrained element of the healthcare equation.

To achieve this result, EHR technology integrations can be deployed that utilize artificial intelligence (AI) and offer relief to clinical and administrative teams for risk-based documentation and coding activities. When looking for the best-fit technology provider, healthcare teams must understand that the goal is not to add more clicks, but to superpower the humans who are already doing their daily jobs.

AI and has made leaps and bounds in healthcare to scale the impact of data analysis. AI-powered technology can transform data into user-friendly formats and then analyze that data against established clinical and quality rules to identify both known and previously undiscovered patient needs. For healthcare provider groups and health insurers that are looking to gain actionable insights from their data sets, they should seek a technology platform that can harmonize patient data into actionable insights so that the information can flow both ways, from a plan to a provider and from a provider to a plan. That way, providers can enhance their partnership with payer organizations to better manage and optimize patient care.

The main takeaway? Using technology to curate data is not intended to replace the human expert in the equation. It should superpower that human expert to achieve scalability and better outcomes. By allowing providers to practice at the top of their license and engage more with the patient because they’re not logging into their records to flip through pages and pages of lab results, medication lists, past visit notes, and specialty referrals, we are succeeding in delivering efficient, effective, and high-quality care. Providers should be able to leverage a curated data set from the EHR to organize information to make it actionable and amplify their true expertise.

Readers Write: Healthcare IT Commercialization Success: Sophisticated Markets Require Sophisticated Strategies

Healthcare IT Commercialization Success: Sophisticated Markets Require Sophisticated Strategies
By Dean Kaufman

Dean Kaufman, MS is founder and CEO of Healthcare Service Consultants of Millburn, NJ.

About 75% of US-based healthcare IT start-up companies fail. That’s a shocking statistic.

Many blame lack of long-term funding. In reality, the failure can often be tied to not providing hard evidence of value and lack of understanding financial drivers. While these companies develop complex, sophisticated products to meet highly specialized needs of healthcare end users, their go-to-market strategy often follows the old “if you build it they will come” approach.

This just doesn’t work. Nor do common B2C and B2B commercialization strategies. Healthcare IT and digital health companies need a well thought out commercialization strategy that is tailored to meet the demands of a complicated and specialized buyer who is risk averse. This becomes even more difficult when a novel solution touches more than one clinical specialty.

The commercialization strategy for a healthcare IT or digital health company must include the following.

Step 1 – set the stage

Before launching the product, many pre-commercial activities need to occur. These activities center around market understanding and developing the proof points that are necessary to establish credibility and interest across clearly defined target audiences. Activities include:

• Establishing pilot sites. Early adopters can provide real use case examples and proof points to support claims. Pilots go beyond clinical trials or validation projects. They exist in live clinical settings that can prove tangible ROI.
• Understanding the sales cycle. In healthcare IT, sales cycles are often longer than expected. It’s important to understand buying cycles and who the decision makers and influencers are.
• Identifying what’s needed to support sales. Healthcare IT often requires a sales support team that can answer complex clinical, workflow or technical questions related to the deployment and use of the product.
• Supporting customers. Ensuring a smooth and timely implementation that results in a delighted customer is critical. but it’s often an underappreciated step in commercialization success. A team with the appropriate skills should be hired as developers typically do not have the people and workflow skills.
• Meeting regulatory requirements. Some healthcare IT solutions need to prove safety and efficacy via a 510(k). In addition, marketing teams need to discern what claims can and cannot be made before and after receiving official clearance.

Step 2 – develop and implement an effective sales strategy

Let’s be honest. No company in this space is selling their products on Amazon or Etsy. With complex healthcare IT products, a direct sales strategy is typically best. It results in complete control over the customer relationship and provides the best opportunity to gain an understanding of customer needs.

In some situations, a channel partnership strategy can be beneficial, especially when the product complements, augments, or can be embedded in another existing system. If pursuing a channel partner strategy, remember that ongoing training and support of the partner sales force is critical.

Step 3 – set realistic sales targets

Sales projections are an important component of a commercialization strategy. Take into account third-party market data as well as soft data such as sales and budget cycles, the prioritization of the challenges addressed by the product, and the complexity of the sale. Many large companies pulled out of the healthcare vertical because they could not realize revenue targets in the projected time frame.

Step 4 – establish a clinically-focused product awareness and demand generation program

A product marketing program that leverages early customer success in the clinical setting is key. These case studies should be leveraged to generate awareness of a solution’s value.

These go-to-market activities should start 12 to 24 months before the planned launch date. This affords enough time to gather proof points, establish a viable sales strategy and forecast, and generate market awareness and demand.

Healthcare IT companies need to have the internal or external talent required to bring these strategies to fruition. When it comes to product marketing in this space, the key to success lies in the ability to authentically connect with target audience. This not only requires content and outbound product marketing strategies that resonate with a sophisticated audience, it also calls for leadership that understands the clinical workflows and problems facing key decision-makers.

To truly connect with a target market, position the company as a thought leader by:

• Keenly focusing on developing messaging and content that reflects the lived experiences of target audiences. Content needs to build the credibility necessary to move prospects beyond awareness and build genuine interest in products and solutions.
• Demonstrating an understanding of clinical and technical challenges  and how the company’s innovation could solve them. Some startups mistakenly prioritize impressive leadership resumes over direct experience to impress potential investors.
• Understanding the unique pain points of healthcare organizations, leaders, and end users. For example, marketing teams need to create campaigns and materials that expressly illustrate how healthcare CIOs are concerned with issues such as cybersecurity, staffing, and systems integration, while radiology directors are fretting over employee burnout, quality of care, collaboration with clinicians across the spectrum, optimal dosing, and patient safety.
• Tapping into clinical knowledge. Such intelligence makes it possible to clearly communicate the value propositions of products and how they fit into clinical workflows or integrate with peripheral systems and devices.

When outsourcing marketing functions, it is important to ensure that potential partners have the needed clinical domain as well as product marketing understanding. For instance, a small company focusing on medical imaging should prioritize hiring a product marketing agency with a deep understanding of this specific clinical domain. This ensures that the messaging is effective and resonates with the target audience.

Healthcare IT marketing leaders and teams need to convey a depth of industry knowledge that resonates with a risk-averse, critical, and educated healthcare audience. This ability is far more important than experience in other industries or jumping on marketing trends that are prevalent in consumer or other commercial circles.

Readers Write: Making the Right Choices for Hospital Virtual Care Technology

Making the Right Choices for Hospital Virtual Care Technology
By Brad Storm

Brad Storm, MS is VP of technology and integrations at Sonifi Health of Sioux Falls, SD.

No healthcare strategy includes adopting a new initiative under duress. But that’s exactly what many hospitals had to do in the face of COVID-19, when clinicians were desperate to communicate safely, quickly, and effectively with patients and their families. Trying to adapt the ideas from at-home telehealth with whatever technology was easy to get — often simply consumer-grade tablets or video monitors — became the hasty foundation for what virtual care in a hospital setting could be.

Those early days of virtual care in inpatient environments brought a lot of good lessons about what’s reliable, what’s scalable, what’s effective, and just as important, what’s not.

In the years since, hospital executives now have a beat to create long-term strategies for virtual care. Here are some critical questions to consider for hospitals to implement the best inpatient telehealth setup.

What do your nurses have to say?

Nurses are frequently the ones tasked with facilitating virtual care calls. Talk with them about how this affects their workflows. Do they feel they’re losing clinical time coordinating calls, or are they being more efficient with their workload?

What kinds of tasks could be shifted to be virtually done from a command center? Examples: admissions interviews, education and medication review, observation rounding, and discharge instructions.

What equipment do they recommend for ease of use and reliability?

Involving your nurses in your virtual care decisions is critical to supporting them and addressing some of the issues that come with staff shortages, burnout, and inefficient processes.

Give them a voice, and listen to their suggestions. They’ll be much more likely to embrace a strategy and adopt initiatives they are part of from the beginning.

What are your patient demographics?

Think about the digital health literacy of the populations you serve, what kinds of technologies they’re familiar with using, and if common physical or mobility issues exist that may affect their ability to interact during a virtual care call.

For many acute care hospitals, more than half of their patients are 60 and older. In children’s hospitals, the pediatric patients’ caregivers tend to be younger and are typically quite tech savvy. Like the staff who will be using your virtual care solution, take the patients who will be using it into consideration, too.

Patient experience professionals will have great insight into the kind of setup that patients, and their families, will be most comfortable with and willing to use.

What equipment and infrastructure are needed?

With input from the people who will be using virtual care, start to narrow down the technology needed to make it successful, sustainable, and within your budget.

If you already have hardware in patient rooms, such as a television, can it be used for your virtual care setup? If you’ve been using tablets, are they working well, or is there a better alternative to think about?

Talk with providers and clinicians about the kind of camera and microphone capabilities they’ll need for the use cases they’ll be part of. Can the camera be controlled to zoom in to specific areas of the room? Is the microphone sensitive enough for ambient listening?

Should there be something permanently mounted in each room, or are mobile carts the best option?

Once the equipment is decided, make sure you have the infrastructure to support it, including access to power and secure network connectivity.

How does the solution integrate with your other systems?

Interoperability is a major part of a successful long-term strategy for virtual care. Like any technology system, virtual care can be most effective if it integrates with workflows your staff already use, especially for EHR, scheduling, education, screenings, and discharge. Integrated systems will make it much easier to scale and standardize enterprise-wide going forward.

For example, if you have an interactive patient engagement system in patient rooms, all the systems can link together on one platform, drastically simplifying where clinicians have to log in for patient care, as well as how patients can access the information, education, and consultations they need.

Virtual care is becoming part of a standard smart hospital room, so creating a cohesive and seamless experience on the user end will vastly improve its value.

How will you track effectiveness and ROI?

Adding technology to a hospital setting is never a small feat. Make sure your virtual care investment is worth it by identifying how you will track its effectiveness, how you plan to roll it out.

Will you have access to data and analytics about virtual care encounters? Professional and anecdotal insights about use cases? Consultations about ongoing optimizations?

Is there a specific unit or use case you will pilot your virtual care technology with first? What’s the go-no go plan for rolling out to other areas? What’s the role of virtual care for both your short-term goals and long-term goals?

Having the right people in the conversations as well as the right technology in the spaces will be key to making sure your virtual care strategy is the most beneficial for your clinicians, patients, and families, both now and in the future.

Morning Headlines 4/29/24

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