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HIStalk Interviews Steve Shihadeh, Founder, Get-to-Market Health

December 13, 2021 Interviews No Comments

Steve Shihadeh is founder of Get-to-Market Health of Malvern, PA.

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Tell me about yourself and the company.

I have spent my whole career at the intersection of healthcare and technology. I worked for SMS, Shared Medical Systems, right out of college. I grew with that company and ended up running sales for them when Siemens took over. I did that for a few years, then went to Microsoft and ran their US healthcare business. I got involved with the Health Solutions Group through Amalga and HealthVault products. I then went to Caradigm and was their chief commercial officer. 

I started to Get-to-Market Health about almost five years ago to help healthcare technology companies improve their go-to-market activities.

Does the number of recent eye-popping funding announcements mean that the old rules have changed, or is it more of a situation where those companies, who may be new to healthcare, need to learn some hard lessons about carving out a niche?

They are eye-popping to everybody. I see good that comes from it and also some challenges. When the right company gets funding, it helps them go faster. We’ve been working with a company in the medical device space that is well funded, on a really solid track, and they are just able go faster than they would be. The investor is betting on a long-term bigger return by letting them go faster now. We have seen examples of telehealth companies that just got incredible valuations. Whether they hold up over time is the question.

Every company we talk to or work with is in the middle of some sort of funding discussions. It’s healthy overall that entrepreneurs can get capital to build a business, but there are some messy spots to it. Think about Practice Fusion, which ended up being worth maybe a fifth of what people thought. Allscripts had to pick up the pieces. Theranos is still in the news every day. So there certainly are some not-pretty pictures, but on balance, equity investors, private equity investors, venture investors, and hospital-backed venture funds are trying to do their due diligence. They are evaluating companies. Saying that it is spawning a renaissance is maybe a little strong, but it is certainly spawning a lot of interesting companies.

The Silicon Valley model involves grabbing market share and chasing growth at all cost. Is the healthcare investment model still valid that assumes that companies need to be able to improve outcomes or reduce cost?

It’s no surprise to anyone that healthcare is slow. Nobody is imagining that they are going to build a real, honest, billion-dollar business in three years. There’s no confusion that healthcare takes time and it’s a complicated business. What is encouraging is that most of the investors we see today are people who only invest in healthcare. They understand it, they get it, and they know the successes and the horror stories.

Providence has a fund. I think Jefferson has a fund near me. Hopkins has a fund and has launched an interesting company. Those folks clearly get healthcare and they are pretty long-cycle investors. They have more patience than some pure private equity company that maybe spend its mornings in manufacturing and its afternoons in healthcare. You have a little smarter investor than you had even a few years ago.

Is it good or bad that the line between investor-funded companies and providers is blurring as providers start funds and companies and companies are opening clinics and telehealth practices?

There are certain things that a for-profit hospital can do a good job on. I’m not sure you or I would want to go get the most complicated surgery ever at a for-profit hospital. They have different niches. For-profit investors have a different horizon in terms of when they want their money back, and their tolerance is low for any hiccups. There will be a fair amount of appeal to the hospital-backed venture and maybe growth equity funds, because the entrepreneur will look at them and say, they get healthcare. They know how hard it is to get things going. I think they will be pretty successful.

They have a lot of work to do to become as capable of investors as the private firms. Whatever you say about the private firms, they know how to crunch the numbers. They know how to value companies. So probably there’s room for both, and I don’t think it’s bad to have them both in the space. If I was an entrepreneur, I would consider both. There’s going to be a better fit depending on what the business is, the model and how much money you need, and how long you’re going to take to build your business.

How will executive job changes affect the plans of companies?

I wonder if what’s behind that is new investment or a need for new investment. Companies that are taking a round of money or have just taken a round have to demonstrate that they are making changes. A lot of times, the investor comes up and says, let’s build a big go-to-market plan, let’s go to three countries instead of one, or let’s go into some new markets. That is probably a big part of the exodus that you see — there’s a financial transaction coming or has happened, and for whatever reason, they decide they want to bring in a new regime to help steer things, or there’s an exit and those folks move on.

We’ve gotten called in several times to help people build go-to-market plans for a new market because they are anticipating some investment and they want to be able to demonstrate to the investment community where they’re going and how they’re going to get there.

Private equity companies are rolling up companies and acquisitions to earn rich returns, with Athenahealth being a recent example. Will that trend continue?

Five years ago, private equity was somewhat of a novel thing in this space. They were able to buy multiple companies, invest in them, and grow them. They are finding out that it’s not so novel. An alternative to buying lots of companies is to buy one and then buy some smaller adjacencies around it to build a bigger, more complete company. HBOC tried to do that, but had trouble integrating all those pieces. I suspect there may be some issues around the corner for those companies. You can buy companies and put a common brand in front of them, but getting them to work together is a big challenge.

Does a successful exit require customers to be satisfied?

It should 100% matter. If I’m an investor and I’m buying a business that has a bunch of unhappy customers, I’m sure not going to pay $17 billion for it. Either there are a bunch of happy customers that the investor found or they didn’t look carefully enough. My thesis is that a company is only worth as much as its customers are willing to stay with them and willing to pay. Happy customers that are renewing, adding on, and buying new things are worth a lot of money. But you look at some of these companies that have disgruntled customers, it’s hard to imagine that the math works. I would think that investors have figured that out and are taking that into account.

Epic would be worth so much money because they have a loyal, happy, renewing, expanding, and growing customers. They are worth more than another EMR company that might not have happy customers and might have lots of negative press. In our experience, the companies that are doing well are worried about taking care of the customers. It’s not all math. They can’t just think that just because they sold 10 systems, they are a valuable company. They have to have happy customers who are going to renew and buy more stuff or else their future value isn’t what they think.

What kind of help do companies need to support their intention to do more than just make short-term sales and instead to position themselves for long-term success?

Getting your product and your company to be viable in the market includes making sure you have a product that customers can understand, value that they can understand, and that you are serious about a happy, successful deployment and an ongoing relationship. We spend a ton of time in that area, because maybe the investor or CEO who doesn’t have a ton of experience in healthcare may not grasp all that. 

If you’ve been around healthcare, you know how important it is to ensure that you have happy customers, that you invest the time and money, and that you have an empathetic viewpoint about what it takes to make customers happy. An unhappy customer is far more important than 10 happy customers. You have to focus on it, and we absolutely get pulled into those discussions all the time.

I had responsibility for our overall customer satisfaction at SMS, Siemens, Microsoft, and Caradigm. I appreciate it. It’s hard. It’s hard to keep them all happy. But if you take care of your customers, even if you have tough times, they reward you for it. They get how hard it is. When Epic or Cerner fixes a rough customer situation, those customers are loyal to them for a long time.

Do you think HIMSS and RSNA exhibitors were as happy as those organizations claimed that professional in-person conference attendance was down two-thirds?

Those conferences are like a stock market that gets overblown and it takes a drop. It’s actually healthy in the long term. RSNA and HIMSS are doing what they have to do, which is putting on as good a face on as possible. But I’ve talked to enough people who were at both shows to know that there was a real lack of potential buyers. If you were interested in meeting with vendor partners, it was helpful, but it was out of balance between what the vendors would have hoped and expected to see in terms of potential buyers and who was there. The shows have gotten too big and too full of themselves and they need to reorient.

I thought the HLTH conference was pretty good. They had a better balance.They didn’t have a ton of buyers there, but it didn’t feel as out of balance as HIMSS and RSNA have felt to me of late.

They are putting a good face on it, but it wasn’t the show that everyone hoped. I talked to some vendors who had a great show at RSNA, generally the newer entrants that had something exciting, innovative, and disruptive. I don’t think the big mainstream players in any of those shows felt good about them.

How have health IT sales and marketing changed as the pandemic approaches the two-year mark?

We have one client that has never had the luxury of a attending HIMSS or a trade show. They have built their business on having connected advisors who can make introductions for them. They built a comprehensive easy way to showcase and demo their product remotely. They figured out a low-cost way to deploy it and even trial it. They never knew the old way since they are pretty new, and they have seen tremendous growth. 

The old model was to get ready for product announcements in the fall, release them in January or February, go to HIMSS, show them, do a couple of events for customers during the year, and then go back to HIMSS. That model was broken and is broken.

We have clients that have done a phenomenal job with social media. They are on every day and they are using customers and third parties to help promote and educate people about their product. We have one client that has done a great job with social, and as we have helped them go to other countries, people in those other countries are already aware of them. They haven’t spent any energy or time yet in those countries because social is global and they’re on their LinkedIn or Instagram pages learning more about them.

When I was at Siemens, I think we had 600 people at RSNA. Clearly HIMSS and RSNA were multi multi-million dollar investments for those big companies. That model is going to change for sure. After RSNA, most of those companies are going to say, OK, next year we’re going to do something different. They will be at at RSNA, but they probably can’t justify as much space.

I did hear from one client at RSNA that there weren’t a lot of middle- and lower-level people at RSNA. The company sent fewer people. They were able to connect with executives who they wanted to see to talk about a product or an issue or something they had. They felt better about that. I don’t think it was all bad, just not a home run.

How will the vendor-CIO dynamic and conference focus change as health systems create more C-level roles that carry IT and digital responsibilities?

The CIO and IT department  are as critical as they’ve ever been, but I don’t think they are the front line any more. The front line is the ultimate end user of the product. Then you have to persuade and educate the CIO, CISO, and the IT department and make sure your product fits in with their protocol around security and IT tech and that you meet whatever their criteria are. I still think that there is benefit for IT folks, including the CIO, to attend HIMSS, especially if they want to get a quick look at 10 different companies, if that’s really the best part about it.

There was a day not that long ago where you would sell an EMR or a piece of medical equipment to IT. Now the CIO defers and says, who’s the champion within the health system who wants and needs this product? Then, how do you help that end user understand the product? What’s the market fit for it? How’s the price? Then the CIO has to judge it and figure out whether it fits in their environment.

What industry changes will we see in 2022?

I’m impressed by companies that meet three key things that separate them. They have an innovative product and an innovative pricing approach. They are disruptive, in a good way, to what has been done before. They have a compelling story behind them.

Every company that has done well in this business has a compelling story. Think about Judy building Epic from one scheduling app at University of Wisconsin into a giant, successful company. Her attention on customer satisfaction and all that. There’s a compelling story there and in other companies where the entrepreneur has believed in his or her niche and built the business.

Successful companies are thoughtful about the business, have a disruptive product and/or pricing model —  because people just can’t spend unlimited money — and they have a compelling story that people can latch onto. When I was at SMS, the two founders had put together a business that met a key need, people could understand it, and there was a compelling story. That helped people buy it. That’s still very true today.

Morning Headlines 12/13/21

December 12, 2021 Headlines 1 Comment

CVS Health maps out path to steer into primary care delivery

CVS Health will add primary care centers that offer in-person care and telemedicine services to several hundred of its locations.

Weak defenses made cyberattack on Irish hospitals easy, experts find

Analysis finds that Ireland’s national health service was unprepared for a May ransomware attack that crippled its services after an employee clicked a malicious Excel email attachment.

Reveleer Secures $65 Million To Expand Capabilities To Deliver End-To-End Data Analytics Platform To Healthcare Payers

Health plan member and provider analytics vendor Reveleer raises $65 million in a venture funding round.

Monday Morning Update 12/13/21

December 12, 2021 News 2 Comments

Top News

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CVS Health says in its yearly investor meeting that the company will add primary care centers to several hundred of its locations and open more HealthHubs.

The primary care centers will employ doctors, nurses, and pharmacists who will offer both in-person and telehealth services.

CVS says it will expand its nurse practitioner-staffed MinuteClinic model by acquiring physician practices and clinics.

“We are closer to the consumer than anyone else,” the CEO said.

CVS owns the country’s biggest pharmacy benefit manager, Caremark, and Aetna, the country’s third-largest health insurer.


HIStalk Announcements and Requests

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Over 40% of poll respondents either changed employers in 2021 or plan to do so in 2022.

New poll to your right or here, piggybacking on last week’s poll: Which factor would most influence your decision to take a new job? Most or all of them are important to a given person, but few folks would change jobs unless their #1 factor was satisfied.


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Welcome to new HIStalk Platinum Sponsor MedAware. The Avon, CT-based company’s medication safety monitoring platform lives within existing technology systems, EHRs, and devices to identify dangerous medication-related risks throughout the entire patient journey. Built using longitudinal and real-time patient data, advanced machine learning algorithms identify medication errors, opioid dependency risk, evolving adverse drug events, and more. Due to the high clinical relevancy of its medication alerts, providers have been shown to change their prescribing behavior significantly more often than with traditional systems alone. Founded in 2012, MedAware has offices in the United States and Israel. Thanks to MedAware for supporting HIStalk.


Webinars

December 14 (Tuesday) 1 ET.  “Using Cloud to Boost AI and Enterprise Imaging.” Sponsor: CloudWave. Presenters: Larry Sitka, MS, VP/CSIO of enterprise applications, Canon Medical Informatics; Jacob Wheeler, MBA, senior product manager, CloudWave. Enterprise imaging has remained a holdout of data center complexity despite the benefits the cloud offers. The presenters will discuss innovative ways to reduce complexity and lead with disruptive technology using AI, enterprise imaging, and the cloud.

December 15 (Wednesday) 1 ET. “Improve Efficiency, Reduce Burnout: Leveraging Smart Clinical Communications.” Sponsor: Spok. Presenters: Matt Mesnik, MD, chief medical officer, Spok; Kiley Black, MSN, APRN, director of clinical innovation, Spok. The presenters will identify the technologies that most often contribute to clinician burnout, then explain how improving common clinical workflows can help care teams collaborate better and focus on what they do best—taking care of patients. They will describe how a clinical communication and collaboration platform can automate clinical consults and code calls to alleviate burnout.

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


Acquisitions, Funding, Business, and Stock

Health plan member and provider analytics vendor Reveleer raises $65 million in a venture funding round. 

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Patient prescription support and access platform vendor ConnectiveRx acquires Rx Savings Assistant from Medicom Digital, which finds prescriptions savings offers and embeds them into the EHR, including Epic.

Payments vendor Bottomline Technologies hires an investment bank to review strategic options, including a potential sale of some or all of the company. Its healthcare offerings include user surveillance for privacy visibility, signature capture, electronic forms, and print automation.


Sales

Lehigh Valley Health Network implements Sonifi Health’s in-room technology for service recovery, entertainment, and patient education.


Announcements and Implementations

TriNetX adds Diversity Lens to its real-world research platform to improve clinical trials access for underrepresented patient populations.

Petersburg Medical Center goes live with Cerner, with the Cares Act for COVID-19 relief helping cover the $1.3 million cost of CommunityWorks. The hospital vowed to replace its EHR in March 2021 following discovery that an employee had viewed patient records inappropriately.

Baxter International studies the use of MedAware’s AI-powered medication safety monitoring platform for smart infusion pump programming, concluding that the system can help build and maintain smart infusion drug libraries that can issue real-time warning of possible infusion errors to improve patient safety and reduce clinician alert fatigue. Such warnings are traditionally driven by hospital-developed rules that cover drug dose and rate, unusual concentrations, and uncommon patient weights. 

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A new KLAS report looks at how enterprise EHR vendors meet patient access requirements (address verification, cost estimates, coverage discovery, eligibility verification, medical necessity, prior authorizations, propensity to pay, registration QA, and scheduling). Epic customers reported the highest satisfaction, those of Cerner expressed dissatisfaction with use of integrated third-party partner tools, and Meditech’s customers are very satisfied with what they call a workhorse product.


Government and Politics

AHA and AMA sue the federal government over the method that will be used by arbitrators to decide how much insurers will pay for disputed out-of-network bills under the No Surprises Act.


Other

Analysis finds that Ireland’s national health service was unprepared for a May ransomware attack that crippled its services after an employee clicked a malicious Excel email attachment. The HSE was warned about suspicious activity by two of its hospitals and its antivirus software vendor, but did not take action. The report observed that HSE does not have an official in charge of cybersecurity, relies on a team of 15 inexperienced IT employees (two of whom are students), backs up irregularly to offline tape, and hadn’t set up antivirus software correctly on most of its 70,000 devices. The analysis concluded that HSE was lucky that the hackers didn’t target medical devices, didn’t destroy data, didn’t go after HSE’s cloud-based systems, and provided a ransomware decryption key six days after the attack without requiring a ransom to be paid.

A New York Times article says that telehealth has become a widely used lifeline and enables clinicians to observe patients in their normal surroundings, but it has limits to overcome: (a) patients may still need hands-on care or lab work and some prefer in-person visits for that reason; (b) older Americans are less likely to have and/or actively use computers or mobile devices; (c) Medicare beneficiaries who are black, live in rural areas, are less educated, and who live alone use telehealth less often; and (d) telehealth platforms may need to be designed for simpler use and the mandatory use of a provider’s patient portal may limit telehealth uptake.


Sponsor Updates

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  • Vocera staff volunteer with Second Harvest of Silicon Valley.
  • Austin Health in Melbourne will be the first health service in the Asia Pacific region to implement Cerner’s FHIR service.
  • OptimizeRx earns a silver Digital Health Award for its COVID-19 consumer health communications campaign and a merit award for its TelaRep clinical decision support tool.
  • The Digital Workplace Group honors Nordic Consulting Senior Director Dawn Hancock with its Digital Workplace Leader of the Year Award.
  • Premier releases a new episode of its InsideOut Podcast, “The hidden challenge of the pandemic. Managing surging demand and record-setting staffing shortages.”
  • Redox releases a new podcast episode, “Olive’s Journey to AI through Robotic Process Automation.”
  • Spirion publishes a case study featuring AmerisourceBergen, “Fulfilling healthcare privacy mandates and data protection laws.”
  • Business Intelligence Group honors Talkdesk CEO Tiago Paiva with its 2021 Big Awards for Business Entrepreneurship Award.

Blog Posts


Contacts

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

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Weekender 12/10/21

December 10, 2021 Weekender No Comments

weekender 


Weekly News Recap

  • Ambient clinical documentation vendor Robin raises $50 million.
  • Cerebral raises $300 million.
  • Report: Cotiviti is for sale.
  • Claroty uses $400 million in new funding to acquire healthcare IoT vendor Medigate.
  • Amazon’s Comprehend Medical NLP service adds SNOMED-CT support and cuts API usage prices by up to 90%.
  • The Spokane newspaper calls out problems with the VA’s Cerner implementation at Mann-Grandstaff Medical Center.
  • BDO USA acquires Culbert Healthcare Solutions.
  • Fortive will acquire specialty EHR vendor Provation for $1.425 billion.
  • Netsmart acquires Remarkable Health.

Best Reader Comments

No Surprises Act – “Seems to place a heavy burden on provider administrative staff.” Well, the existing system has placed a pretty hefty burden on patients who have gotten nasty surprise bills. Maybe this will be the incentive for insurers and administrative staff to figure it out. (Bob)

We do a lot of credentialing for providers and the payer systems do not all update from credentialing in any sort of timely manner. A provider may be credentialed but not showing as such in their EDI database. This will be an administrative challenge [under the No Surprises Act] for sure! (Practice Admin)

The real problem is, nobody is going to pay for the things that help doctors take better care of their patients, unless there is an ROI associated with it .. There are a lot of smart and creative people in healthcare IT with a lot of really good ideas who want to do the right thing, but none of us work for free and that’s what it all comes down to at the end of the day. (HIT Girl)

This quote towards the end: “What Cerner does best is capture billable events via exhaustive questions and back-and-forth as you input things.” Reminds me of a conversation I had with my doc at then Partners Healthcare after they went live with Cerner’s major competitor. My doc echoed the same sentiment in saying to me: “It’s a good system for billing I guess, but does nothing for me in helping to care for my patients.” Sad testament to our massive efforts to digitize health. It’s a slow slog. (John Moore)

“What Cerner does best is capture billable events via exhaustive questions and back-and-forth as you input things .. They’re very meaningful to a commercial organization, because that’s how they get paid, but they’re meaningless to the VA.” Well, they’re not meaningful to the actual healthcare providers in the commercial organization. So the problem, although admittedly large in the VA context, is really universal, namely trying to organize clinical information and reasoning using “billing systems with text editors tacked on.” (Robert David Lafsky)


Watercooler Talk Tidbits

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Do you know who just helped classrooms in need? Bill, that’s who – his generous donation plus matching funds included those provided by my Anonymous Vendor Executive fully paid to fulfill these Donors Choose teacher grant requests:

  • Robotic engineering kits and books for Ms. K’s STEM elementary school class in S. Ozone Park, NY.
  • A digital microscope for Mr. E’s middle school class in Muskegon, MI.
  • STEM reading and match activities for Ms. A’s middle school class in Hawthorne, CA.
  • Headphones for Ms. M’s second grade class in Phoenix, AZ.

ProPublica investigates how billionaires can write off hundreds of millions of dollars in losses from their hobbies, such as purebred horse racing, to reduce their tax bill.The article mentions healthcare billionaire Patrick Soon-Shiong, who hasn’t paid federal taxes in five consecutive years despite having earned nearly $900 million in the past eight years, although his example was more of tax sheltering than hobby losses. 

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The LA Times (owned by Patrick Soon-Shiong, with losses deducted from his taxes per the item above) obtains screen shots of Scripps Memorial Hospital using Epic to mark up supply prices by several hundred percent. Sutures that cost $20 were priced at $150 and $99 surgical blades had a price of $665. The hospital responded to the newspaper’s inquiries by confirming the accuracy of the prices, but characterizing itself as the victim of a system in which insurers decide how much of the list price they will pay. The reporter previously notes that Scripps billed a patient $80,000 for a procedure that Medicare says should cost $6,000, with the inflated price covering Scripps-imposed “technical service charges” for the room, equipment, and staff.

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The University of Texas’s Hogg Foundation for Mental Health provides a $260,000 grant to digitize and preserve the records of the the state’s first mental illness hospital, the State Lunatic Asylum, which was opened in 1861. All its buildings have been torn down except for its main building, which is a Texas Historic Landmark. A new Austin State Hospital, which will open in November 2023, will have the same number of beds (240) at a cost of $305 million. The records will be preserved for families who can review the records with the approval of the state HHS institutional review board. The hospital’s daily occupancy peaked at 3,330 in 1968 before the implementation of Medicare changed views on mental health beyond locking people up. Similar preservation work was done with the records of Virginia’s Central Lunatic Asylum for Colored Insane, which had a large percentage of black Americans as patients who were admitted for not adequately respecting whites or for being in the wrong place at the wrong time.

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The father of University of Montana senior Danny Burton played football there, while his mother graduated from the university’s pharmacy school. Burton is doing both – “Doctor Dan” plays wide receiver for the football team and will complete his pharmacy doctorate in May. 


In Case You Missed It


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Morning Headlines 12/10/21

December 10, 2021 Headlines No Comments

ConnectiveRx Acquires Rx Savings Assistant® from Medicom Digital

Medication access company ConnectiveRx acquires digital prescription savings software vendor Rx Savings Assistant.

Claroty raises $400M to protect ‘cyber-physical’ systems such as IoT and industrial

Industrial IoT security platform vendor Claroty will use $400 million in new Series E funding to acquire healthcare IoT vendor Medigate.

Grand Rounds, now Included Health, is gearing up for an IPO in early 2022

Included Health, formerly Grand Rounds and Doctor on Demand, is reportedly planning an IPO for the first half of 2022.

ChronWell Secures $6m Funding Round

Digital care management company ChronWell raises $6 million, bringing its total funding to just over $13 million.

News 12/10/21

December 9, 2021 News 3 Comments

Top News

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Ambient clinical documentation vendor Robin raises $50 million in a Series B funding round.

The company says its physician users save 90 minutes per day. It guarantees its work in defending any audits that result.

Co-founder Emilio Galan, MD, MS founded healthcare transparency vendor HonestHealth, while co-founder Noah Auerhahn started and sold shopping portal Extrabux.


Reader Comments

From HisTalk Fan: “Re: Cerner. Sharp HealthCare and Shriners are leaving for Epic.” Verified for Sharp, not yet verified for Shriners (but likely), according to my contacts. Sharp is now an Epic enterprise customer for both the health system and its managed care business. It had been a Cerner user since 1995 and extended its Cerner contract in early 2019 for another eight years. 

From Dr. J: “Re: AirStrip and Nant forming Adjuvare. Patrick Soon-Shiong owns AirStrip since recapitalizing it when Sequoia Capital dumped its holdings.” Thanks. The SEC filing is here.


HIStalk Announcements and Requests

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From Patti: “Re: No Surprises Act. Seems to place a heavy burden on provider administrative staff.” CMS hasn’t posted the transcript of Wednesday’s call as I write this, but some of the elements of the act – which takes effect January 1, 2022 – require providers to: (a) not balance-bill for out-of-network emergency services or non-emergency services unless notice and consent is given; (b) provide uninsured or self-pay patients with good-faith cost estimates in advance; (c) accept plan payments for 90 days after a payer-provider contract ends; and (d) submit provider directory information to health plans at the beginning and end of the agreement and when changes are made and reimburse patients who are billed out-of-network rates because of a directory error. The act also establishes an arbitration procedure for provider-plan disputes (taking patients out of the back-and-forth arguing) and authorizes HHS to establish or improve an all-payer claims database. Providers also need to understand their state-specific billing rules and how they overlap with the No Surprises Act. Perhaps someone can elaborate on the practical impact to providers since the act takes effect in just three weeks.


Webinars

December 14 (Tuesday) 1 ET.  “Using Cloud to Boost AI and Enterprise Imaging.” Sponsor: CloudWave. Presenters: Larry Sitka, MS, VP/CSIO of enterprise applications, Canon Medical Informatics; Jacob Wheeler, MBA, senior product manager, CloudWave. Enterprise imaging has remained a holdout of data center complexity despite the benefits the cloud offers. The presenters will discuss innovative ways to reduce complexity and lead with disruptive technology using AI, enterprise imaging, and the cloud.

December 15 (Wednesday) 1 ET. “Improve Efficiency, Reduce Burnout: Leveraging Smart Clinical Communications.” Sponsor: Spok. Presenters: Matt Mesnik, MD, chief medical officer, Spok; Kiley Black, MSN, APRN, director of clinical innovation, Spok. The presenters will identify the technologies that most often contribute to clinician burnout, then explain how improving common clinical workflows can help care teams collaborate better and focus on what they do best—taking care of patients. They will describe how a clinical communication and collaboration platform can automate clinical consults and code calls to alleviate burnout.

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


Acquisitions, Funding, Business, and Stock

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Online mental health services vendor Cerebral raises $300 million in a Series C funding round, increasing its total to $462 million. The company focuses on medications, referring to its providers as “prescribers” and mailing medications to patient homes. Founder Kyle Robertson was an Accenture consultant and founded a college startup website.

Bloomberg reports that the private equity owner of healthcare analytics vendor Cotiviti is considering selling the company for over $15 billion. Veritas Capital acquired the company in a $4.9 billion take-private deal in 2018. The private equity firm also acquired GE Healthcare’s value-based care business and invested in Truven Health Analytics.

Israel will fund a $18 million digital health innovation program that will help providers implement anonymized data-sharing with healthcare startups for research, hoping to develop an international data sharing standard such as the US-based SEER for cancer statistics.

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Industrial IoT security platform vendor Claroty will use $400 million in new Series E funding to acquire healthcare IoT vendor Medigate. Medigate co-founder and CEO Jonathan Langer served in the Israel Defense Forces through 2016.

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Included Health, formerly Grand Rounds and Doctor on Demand, is reportedly planning an IPO for the first half of 2022.


Sales

  • Creative Solutions in Healthcare, the largest skill nursing operator in Texas, deploys the CareSafely quality, safety, and compliance software platform in its 91 facilities.

People

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Anne Donovan, MBA (Zelis) joins Wolters Kluwer Health as VP/GM of its Health Language business.

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Verisys hires Joe Alberta (Optum) as chief revenue officer.

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PatientBond hires Jeff Bohmer, MD (Northwestern Medicine Central DuPage Hospital) as chief medical officer and Mark Spranca, PhD (Mathematica) as chief strategy officer.

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Industry long-timer Brian Graves (Optum) joins surgical care team coordination solutions provider RelayOne as chief revenue officer.

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Vu Van, MBA (Livongo) joins Transcarent as VP of health systems.

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Orchestrate Healthcare hires Eric Boone (InfoBionic) as VP of sales, southeast.


Announcements and Implementations

Google is working with WHO to develop an open source software developer kit for developing FHIR-powered mobile solutions for Android. One of the apps is EmCare, a clinical decision support system that is based on WHO SMART Guidelines.

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Amazon’s Comprehend Medical natural language processing service adds support for SNOMED-CT and reduces the charge for using its API by up to 90%.

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Goliath Technologies launches Multi-Cloud Monitoring, which provides a unified view of AWS EC2 and Workspaces, Microsoft Azure, Citrix Cloud, and Google Cloud for troubleshooting performance, availability, and end-user experience.

Asynchronous telehealth platform vendor Bright.md announces Navigate, in which patients enter their primary symptom and the app presents the appropriate next step – on-demand asynchronous visit, appointment scheduling, or urgent care — based on health system configuration.


Government and Politics

CDC says its questionably accurate vaccination rates among US seniors – which at times has showed more people in a given age group vaccinated than exist – overestimates first doses and underestimates follow-up doses because it can’t always identify people who get their shots from different providers or states. CDC says that providers are required to de-identify their data, which limits the organization’s ability to match vaccinations to recipients. 


Other

Memorial Sloan Kettering paid $1.4 million in severance to three former executives in 2020, with the largest payment of $700,000 going to former CIO Pat Skarulis.

A study of Epic-using ambulatory care clinicians finds that EHR clinician time and after-hours work dropped early in the pandemic, but had recovered by July 2020. Patient messages increased 157% of the pre-pandemic average, with each message requiring more than two minutes of additional clinician EHR time. The authors speculate that increased messaging was caused by the increased use of patient portals, leading them to conclude that higher message volume will persist.

Epic CEO Judy Faulkner says in a “Hey Judy” EpicShare story that she decided to build an Epic campus when the company hit 300 employees, estimating that a safe bet was a capacity of 10 times the headcount then (3,000 employees). She and Carl Dvorak visited the Microsoft campus where her son worked and then found a Verona corn field that she thought was about the same size, only to find later that the Microsoft campus was 29 acres and the Verona property was 350 acres because “we had no ability whatsoever to correctly judge land mass.” The campus has since expanded to 1,200 acres for its 10,000 employees.


Sponsor Updates

  • Meditech celebrates 30 years of supporting healthcare in the UK.
  • Healthcare IT Leaders adds multilingual support from Voyce to its COVID-19 contact tracing capabilities.
  • The Meditech Podcast, “How genomics will revolutionize healthcare in the next decade,” features First Databank Director of Product Management Anna Dover.
  • LexisNexis publishes a case study, “Lehigh Valley Health Network Innovates Strategic Planning in Healthcare with LexisNexis MarketView.”
  • Lumeon’s COVID-19 remote home monitoring solution wins a Silver Best in Biz Award in the Best New Product of the Year category.
  • DCH Health System (AL), which recently went live with Meditech Expanse, has been named to CHIME’s Digital Health Most Wired list.

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 12/9/21

December 9, 2021 Dr. Jayne 1 Comment

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Many physicians are closely watching several cases that are working their way through the US court system, especially those being heard by the US Supreme Court. For anyone who has ever seen oral arguments or read the transcripts, you may have noticed that the justices tend to say what they want to say, and often there is some interesting humor involved. The transcript of Becerra v. Empire Health Foundation did not disappoint. The case questions whether the Department of Health and Human Services followed correct procedures as it created a rule that changed the way Medicare reimbursement rates for hospitals are calculated. Justice Kagan pointed out an issue with the public comment portion of the rulemaking process, asking whether it was “unclear what the commenters thought they were being asked to comment on? In other words, a commenter who said I approve of the status quo, it was unclear whether that was the real status quo or the status quo as mis-described by the agency?”

Justice Breyer tried to reframe the issue, stating “I mean, do I understand this correctly? And the changes I understand it correctly are near zero, okay?” ultimately concluding that “people are exhausted, just like me after reading this case.” Justice Thomas referred to the “indecipherable language,” differentiating the concepts of “entitled to” and “eligible for” while pushing the attorney to explain it in “ordinary language.” Justice Kavanaugh jumped on the bandwagon, explaining the perils of trying to use two different meanings of “entitled” in the same sentence as he illustrated five different problems with the rule. Kavanaugh concludes that “we’ve whacked agency rules for much less than that,” which I found pretty amusing, imagining the members of the Supreme Court as hit people. Trench coats, fedoras, and dark sunglasses, anyone?

I always keep an eye out for articles that look at how companies and individuals are faring with the new normal of working from home. Lenovo has an interesting project in the works that will allow employees to work from one of the most remote locations on Earth. The Work for Humankind Initiative will support volunteers willing to work remotely from an island that is 400 miles of the coast of Chile. Lenovo has been upgrading the technology infrastructure on Robinson Crusoe Island and has built a shared workspace that will be come a community hub once the project is over. Project organizers are looking for volunteers with diverse skill sets who can help support the local community and volunteer 20 hours per week while on the island.

Successful applicants will spend four weeks on the island, from March 1, 2022 through April 10, 2022, and the dates include a 10-day quarantine on arrival. They must be fully vaccinated and willing to undergo COVID-19 testing three times weekly if selected. Finalists will undergo health, background, and psychiatric checks. Of course, the project will feature all the latest and greatest technology from Lenovo, so dedicated Apple users might want to think twice about applying. Interested parties can apply prior to December 30. It sounds intriguing – I’ll have to see if my current consulting gig would consider letting me head south.

From Job Hunter: “Re: sex work. It’s not the kind of healthcare technology piece we usually talk about, but did you see this article about healthcare workers who are leaving the industry for online sex work?” The Medscape article talks about healthcare workers who are struggling to make ends meet and turn to sites such as OnlyFans to supplement their income, or who give up their healthcare careers entirely. One featured UK-based worker made the equivalent of his annual healthcare salary in 22 days using OnlyFans. A featured New York-based emergency medical services worker turned to the site to supplement her income during the pandemic, leading to friction when her co-workers found out. The article goes on to point out the potential of encountering medical students who engage in sex work, which reminded me of the fictional Izzy Stevens in the TV hit “Grey’s Anatomy,” who paid for school by working as a lingerie model. The idea seemed vaguely scandalous at the time, but these days nothing is shocking.

Speaking of burnout and stressed clinicians, a new KLAS report finds that electronic health records might not be the top cause of clinician burnout any more. Nearly 20% of burned-out clinicians list COVID-19 as a top reason. Physicians most commonly list chaotic work environment as a central cause, where nurses cite after-hours workloads. I’m not surprised by the latter based on conversations with my nurse friends, who never get out of work on time and almost universally are looking for new jobs. This matches the KLAS data that shows that since the pandemic started, the percentage of nurses who are likely to leave their organizations in the next 24 months has increased.

My close nurse colleagues have grown tired of having to provide float coverage to patient care units where they might not be fully trained or experienced to care for the patients they’re assigned. I’ll never forget the first night my bestie had to float from the mother/baby unit to an assignment of mostly male medical/surgical patients. There were lots of questions coming my way all night long since the nursing pool was so scarce that she barely had colleagues to ask. I’m always happy to be the phone-a-friend, but the float situation went on for months until enough nurses quit over it that the administration had to reconsider. It’s a shame they didn’t make a better decision earlier before they lost a good chunk of their staff and had to pay exorbitant rates for travel nurses to provide coverage.

COVID-19 cases are rising in my community, and I’ve decided to head back into the clinical trenches on a very part-time basis, providing some cross-coverage for a Direct Primary Care physician while she takes some much-needed time off. It’s a different model than I’ve ever practiced in, and I can’t wait to see what the charts look like when a physician gets to write their notes purely for the sake of patient care and not for billing or any other reason. She uses an EHR I hadn’t heard of before now, and I always love to see how other systems work so I’m looking forward to it.

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This weekend was spent doing a lot of administrative tasks, so I figured I’d go ahead and sign up for HIMSS22. The system needs to verify your membership status and I thought the glitch that created this screenshot was pretty funny. I came back later, and the system worked correctly, but it was still worth a chuckle. Will I see you in Orlando in a couple of months? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/9/21

December 8, 2021 Headlines No Comments

Robin Raises $50 Million to Empower Physicians and Remove Barriers to Health

AI-powered medical scribe vendor Robin raises $50 million in a Series B funding round, bringing its total raised to $65 million.

Cerebral Raises $300 Million in Series C Funding to Democratize Mental Health

Online mental healthcare company Cerebral raises $300 million in a Series C funding round, bringing its total raised to $462 million.

Pair Team Secures $7.3 Million in Funding to Build Primary Care Infrastructure for Medicaid and Underserved Populations

Pair Team, which offers community health centers tech-enabled care teams and digital assistants, raises $7.3 million.

Quartet Health Acquires InnovaTel Telepsychiatry, Making Shared Vision of Speed to Quality Mental Health Care for All a Reality

Mental healthcare company Quartet Health acquires InnovaTel Telepsychiatry following a $60 million investment led by Independence Health Group.

Morning Headlines 12/8/21

December 7, 2021 Headlines No Comments

‘Veterans here are tired of being guinea pigs’: After more than a year, new health record system still causing problems at Spokane VA hospital

Providers and patients recount numerous issues with the VA’s implementation of Cerner at Mann-Grandstaff Medical Center in Spokane, WA.

BDO USA, LLP Expands Management Advisory Services in Healthcare with the Addition of Culbert Healthcare Solutions, Inc.

Accounting and advisory firm BDO USA acquires 90-employee Culbert Healthcare Solutions.

Suki Announces $55 Million Series C Funding Round

Healthcare voice AI vendor Suki raises $55 million in a Series C funding round that values the business at $400 million.

Veritas Explores Sale of Health IT Firm Cotiviti

Private equity firm Veritas, which sold Athenahealth last month for $17 billion, is reportedly considering selling payer-focused health IT vendor Cotiviti instead of taking it public.

News 12/8/21

December 7, 2021 News 14 Comments

Top News

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The Spokane, WA newspaper talks to local patients and employees about the VA’s implementation of Cerner at the city’s Mann-Grandstaff Medical Center, reporting these issues:

  • Two former senior VA officials who were involved in the project say it was misguided and is unlikely to improve on the existing VistA system.
  • One hour after VA Deputy Secretary Donald Remy assured a House subcommittee that “The Cerner system works,” the system went down for 80 minutes and had at least some downtime 10 times in September and October. The system has gone fully down four times since it went live in October 2020.
  • Former VA deputy CIO and CTO Ed Meagher said it is “absolute malpractice” that the VA did not anticipate performance problems by modeling workload against infrastructure, adding that otherwise, “you’re working off of Cerner marketing material.”
  • Several veterans said they were unable to navigate the patient portal and it sometimes locks up and fails to deliver messages.
  • Prescriptions were not transferred to Cerner, requiring mistake-prone manual re-entry that left some veterans without psychiatric and other chronic care medications.
  • Employees sometimes have to fax medication lists when patients are sent to other facilities for emergency treatment that isn’t offered 24×7 at Mann-Grandstaff..
  • The VA, which was the subject of a national wait-time scandal in 2014, has removed Mann-Grandstaff from the wait time web page because it hasn’t figured out how to measure wait times on Cerner.
  • The VA’s training did not include the referral management module and one veteran whose urology referral was lost was found to have an untreated, aggressive form of prostate cancer when finally seen nine months later.
  • A chief of anesthesiology said EHRs are billing systems with text editors tacked on while VistA was written by clinicians whose goal was to provide the best care possible. He says that Cerner told him that one online form requires 90 minutes to complete, and when doctors told the company that the nurse had under five minutes to examine the patient and document the visit, Cerner said they should hire more people.
  • Meagher concluded, “What Cerner does best is capture billable events via exhaustive questions and back-and-forth as you input things. That’s what ties them up. They’re answering questions that are meaningless to them. They’re very meaningful to a commercial organization, because that’s how they get paid, but they’re meaningless to the VA.”

Webinars

December 8 (Wednesday) 1 ET. “What Lies Ahead for the EHR’s Problem List.” Sponsor: Intelligent Medical Objects. Presenters: James Thompson, MD, physician informaticist, IMO; Deepak Pillai, MD, MBA, physician informaticist, IMO; Jonathan Gold, MD, MHA, MSc, physician informaticist, IMO. The EHR problem list can be cluttered with redundant, missing, and outdated diagnoses, and displays don’t always help clinicians process the available data correctly. The presenters will discuss how improvements in creating, maintaining, and displaying problems could reduce errors and decrease the cognitive load of clinicians while continuing to optimize reimbursement.

December 9 (Thursday) 1:30 ET. “Cone Health: Creating Extreme Efficiencies in Surgical Services.” Sponsor: RelayOne. Presenters: Wayne McFatter, RN, MSN and Sharon McCarter, RN co-directors of perioperative services, Cone Health. The presenters will discuss how they have empowered the entire surgical care team, including vendor representatives, to get real-time access to surgery schedules and case requirements in the palms of their hand. RelayOne CEO Cam Sexton will also present the findings of a recent study of 100 hospital leaders regarding their operating room optimization plans for 2022.

December 14 (Tuesday) 1 ET.  “Using Cloud to Boost AI and Enterprise Imaging.” Sponsor: CloudWave. Presenters: Larry Sitka, MS, VP/CSIO of enterprise applications, Canon Medical Informatics; Jacob Wheeler, MBA, senior product manager, CloudWave. Enterprise imaging has remained a holdout of data center complexity despite the benefits the cloud offers. The presenters will discuss innovative ways to reduce complexity and lead with disruptive technology using AI, enterprise imaging, and the cloud.

December 15 (Wednesday) 1 ET. “Improve Efficiency, Reduce Burnout: Leveraging Smart Clinical Communications.” Sponsor: Spok. Presenters: Matt Mesnik, MD, chief medical officer, Spok; Kiley Black, MSN, APRN, director of clinical innovation, Spok. The presenters will identify the technologies that most often contribute to clinician burnout, then explain how improving common clinical workflows can help care teams collaborate better and focus on what they do best—taking care of patients. They will describe how a clinical communication and collaboration platform can automate clinical consults and code calls to alleviate burnout.

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


Acquisitions, Funding, Business, and Stock

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Accounting and advisory firm BDO USA acquires 90-employee Culbert Healthcare Solutions.

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Healthcare voice AI vendor Suki raises $55 million in a Series C funding round that values the business at $400 million.

Change Healthcare will permanently lay off 170 employees in Pittsburgh in February.


Sales

  • The Christ Hospital Health Network in Ohio will offer IncludeHealth’s virtual physical therapy service to its pre- and post-operative patients.
  • Kidney care company Strive Health selects Bamboo Health’s Pings real-time admission, discharge, and transfer (ADT) e-notifications; and interactive, real-time Spotlights performance metrics dashboards.

People

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Valerie Simon (Rise Consulting) joins Lumeris as SVP and chief of marketing and communications.

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Lee Taylor, MBA (Relatient) joins Health Catalyst as VP of sales. 

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Geoff Gibson (Teladoc Health) joins Mend as VP of sales.

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Wolters Kluwer Health promotes Greg Samios, MSE, MBA to president and CEO of the clinical effectiveness business unit.

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Zach Wood, MBA (Surescripts) joins Well Health as head of corporate development.


Announcements and Implementations

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Ochsner Health (LA) has implemented provider data management and API technologies from Kyruus to improve patient-provider matching on its website and apps.

Mach7 Technologies incorporates ImageMover’s EHR-integrated medical imaging capture technology into its vendor neutral archive and enterprise diagnostic viewer.

Surescripts leverages Diameter Health’s data optimization capabilities to ensure specialty pharmacies can easily access accurate patient data through the Surescripts Specialty Medications Gateway.

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Holy Cross Health (FL) implements online patient appointment scheduling capabilities from DocASAP.

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HCA Healthcare will go live on Meditech Expanse at three hospitals in New Hampshire by the end of 2022, with the assistance of CereCore.

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A survey performed by the Center for Connected Medicine and KLAS finds that health system executives expect patient access to be the top area that will be improved by digital health. Respondents name telehealth as the greatest area of technology-driven improvement in the past two years, while 38% expect AI to be the most exciting emerging technology in the next two years but acknowledge that it hasn’t yet met expectations for improving patient outcomes. Nearly all of the respondents say their health systems are placing a high priority on improving access and most of those say they will invest in technology accordingly (most commonly used are telehealth, patient reminders, an online provider directory, and online bill pay). Just over half of responding health systems are using some form of a digital front door, but expect to continue improving and optimizing it while recognizing that not all patients want to connect digitally. Only 17% of respondents are using patient financial financial experience vendors such as Flywire, Patientco, and RevSpring. Health systems  like the idea of price transparency, but recognize that it’s hard to show a given patient their actual cost.


Other

A study using Epic Health Research Network finds that 91% of sore throat patients whose encounter was via telehealth are prescribed antibiotics without having a strep test performed (down from 98% pre-pandemic), while the test was done before prescribing (per AAFP recommendations) for in-office visits about half the time, raising concerns about future antimicrobial resistance.

An imaging magazine says that even though the just-concluded RSNA 2021 conference had two-thirds fewer professional attendees compared to pre-pandemic numbers, vendors were happier because the interactions they had were more serious in the absence of “tire-kickers.” It says that HIMSS21 similarly delighted exhibitors with one-third the usual attendance because only non-buyers stayed home (color me skeptical in a “make lemons into lemonade” sort of way now that brag-worthy record attendee numbers aren’t happening).


Sponsor Updates

  • Availity rebrands its suite of provider products to Availity Essentials, and will soon give its customers the ability to gain access to additional payers throughout its network.
  • The State of Delaware’s Treatment and Referral Network, built on Bamboo Health’s OpenBeds software, has in its first year seen a 45% increase in treatment referral requests and a 25% increase in the rapid acknowledgment of referrals.
  • CHIME names University of Missouri Health Care CEO Jonathan Curtright and CIO Bryan Bliven winners of the 2021 CHIME-AHA Transformational Leadership Award.
  • CloudWave congratulates 14 of its hospital partners for being recognized as part of CHIME’s Digital Health Most Wired program.
  • Gartner includes Dimensional Insight in its 2021 “Hype Cycle for Healthcare Providers” report as a sample vendor in the Digital Analytics Architecture category.

Blog Posts


Contacts

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

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Morning Headlines 12/7/21

December 6, 2021 Headlines No Comments

Well Health Provides Update on the Organic Growth of its Virtual Services Business, and announces Tuck-in Acquisition of CognisantMD’s Ocean Platform, Canada’s Leader in Patient Engagement Technology and eReferral Software

Well Health Technologies acquires CognisantMD, a Canadian developer of patient engagement and referral software, for nearly $14 million.

HealthStream Acquires Rievent Technologies

Healthcare learning management and performance software vendor HealthStream has acquired Rievent Technologies and its CME/CE management applications for $4 million in cash.

Lyn Health Emerges from Stealth to Pioneer New Care Model for Polychronic Patients

Lyn Health launches with funding from Summer VC to offer patients with chronic conditions access to virtual care and support services.

Curbside Consult with Dr. Jayne 12/6/21

December 6, 2021 Dr. Jayne 1 Comment

One of the best parts of being a HIStalk sidekick is hearing from readers. I’ve got a handful of folks who correspond regularly, sometimes with comments on recent pieces, but other times giving me a heads-up on happenings that I otherwise would have missed. I’ve been way behind on my email due to the amount of work I’ve been doing for one of my new projects and was glad to see something from one of my regular correspondents as I reached deep into the abyss that is my inbox.

Most of us in clinical informatics tend to subspecialize, depending on where we work and how many other clinical informatics professionals are on a project. When I was starting out as a relatively new CMIO, I was a generalist as far as having to work with a lot of different clinical specialties, but was relatively specialized in that 90% of my work was in the ambulatory space. I only had to know about inpatient as much as was needed to address interoperability and the flow of data from health information exchanges and clinical repositories.

From there, I moved to the health system side and had to know a lot more about hospital-based medicine, but still worked with a broad swath of specialties. I became an expert in things like Meaningful Use and clinical quality reporting more out of necessity than anything else.

As a consultant, I run into all kinds of different informatics situations and have to think on my feet. Most of the time I’m fairly well-versed in the topics that get thrown at me, but occasionally I run into something I know very little about. This particular email illustrated one of those situations and was a good lesson on how essential change control really is, along with understanding the downstream impacts of systems changes. My reader was happy to provide some background to get me up to speed.

Over the last 15 years, the US Food and Drug Administration (FDA) has been implementing Risk Evaluation and Mitigation Strategies (REMS) for various medications with serious safety concerns. The goal is to reinforce appropriate use and to help reduce the risks of those medications. One of the most well-known REMS is the program for Accutane, which can cause serious fetal anomalies. As a precursor to REMS, one antipsychotic medication, clozapine, has had FDA-imposed monitoring requirements since its approval in the late 1980s. Clozapine is an antipsychotic drug that can sometimes cause low white blood cell counts, leading to a patient being unable to fight infections. In rare instances, those cell counts can get dangerously low. These effects were seen in the initial clinical trials and frequent laboratory testing was needed before patients could pick up their prescriptions from the pharmacy.

Initially, this was managed using a paper process to submit data to the registry, but for some time, the FDA has had a website where prescribers could enter laboratory results and pharmacists could query whether patients were current. My reader states it worked pretty well, including notifications to providers when a patient was late in having a lab result entered.

However, this changed during the initial months of the COVID-19 pandemic. They note, “FDA left the monitoring up to clinical judgment as patients who were stable on the drug for years really didn’t need monthly labs. But before the pandemic and currently, the rules have been quite clear – no lab test recorded, no dispensing of drug.” This made sense in the context of an emerging healthcare crisis when there may have been barriers to patients obtaining blood work, since having people miss medication doses aren’t good for patients, particularly when missed doses could cause relapse of a serious mental health condition. Additionally, when patients are off this particular medication more than 48 hours, they have to be brought slowly back up to their steady-state dose, which creates a window of suboptimal treatment.

Fast forward to the present, where FDA had an issue with the REMS website vendor that resulted in vendor and process changes. It wasn’t clear to the reader which process changes were supposed to be beneficial as opposed to which ones were caused by limitations of the new website contractor. Regardless, the transition has been described as “an unmitigated disaster.” They note that “the new process is hard to understand, even after taking the mandatory training to register for the new website.” There are PDF forms for submission as well as an electronic process, but the new process is more cumbersome with additional fields, poor layout, and suboptimal usability. Additionally, physicians had to re-enter the results for the most recent blood draw in the new system even though they were in the old system.

To cap it off, the website locked out users even though they had pre-enrolled for the new site, and the help line was overwhelmed, leaving many clinicians, pharmacists, and patients worried that patients wouldn’t be able to get their clozapine. Ultimately, following urgent meetings with stakeholders, the FDA temporarily suspended the documentation requirements. In FDA parlance, “Tthe FDA does not intend to object if pharmacists dispense clozapine without a REMS dispense authorization (RDA).” My reader closes out with this thought — even though the FDA has been focused on pandemic-related matters, they could have handled this transition better.

Putting on my “after-action” reporter hat, it sounds like some key steps were missed, things like stakeholder alignment on business requirements, clinical usability review and sign-off on development requirements, user acceptance testing, go-live support planning, and a contingency plan for reversion or emergent intervention if things were not going well. These are all things that many of us deal with on a daily basis and it’s always baffling how these big projects miss the mark. (Case in point: the VA and Cerner, but that’s a much longer topic and I don’t have enough wine in the house to start tackling that one.)

I hope FDA is able to work swiftly with its vendors to get this sorted out so that patient care can take precedence, and that the learnings from this one will allow them to do better in the future. It’s a good reminder for all of us that work with systems that directly impact patients – we need to be vigilant and make sure that corners aren’t cut so that patient’s aren’t harmed.

What’s the most egregious example of poor change management that you’ve seen in your healthcare IT career? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: Improvements in Content Quality, Regulations Highlight 2021 Interoperability Trends

December 6, 2021 Readers Write 1 Comment

Improvements in Content Quality, Regulations Highlight 2021 Interoperability Trends
By Jay Nakashima

Jay Nakashima, MBA is executive director of EHealth Exchange of Vienna, VA.

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Once again, the COVID-19 pandemic grabbed many health IT headlines in 2021. But interoperability was a major topic in 2021 as it truly turned a corner during the last 12 months. More providers are connecting into data sharing networks, and this is good for everyone. This momentum should continue in 2022, but definite challenges will arise.

As someone who heads the oldest and largest nationwide health information network in the United States, I continually monitor trends in healthcare technology. While the past 12 months have been packed with major developments, the following are what I deem are the most significant interoperability trends in 2021.

Public health emphasis. The COVID-19 pandemic spotlights the digital disconnect between healthcare systems and public health agencies. Much work remains in this area, but now it is recognized as a major issue and helped to drive the conversation around health IT this year. The EHealth Exchange partnered with the Association of Public Health Laboratories (APHL) to enable automated generation and transmission of case reports from electronic health records (EHR) to the necessary public health agencies, increasing accuracy while reducing reporting burdens of providers. This electronic case reporting (eCR) service is available to EHealth Exchange network participants, as well as those outside the network but connected via Carequality. The EHealth Exchange – APHL connections can be used for any reportable disease or condition, not just COVID-19.

Regulations. The information blocking rule clearly expanded access to patient data requested for treatment purposes. Anticipation of the final rule alone propelled EHealth Exchange’s transaction volume to 12 billion transactions annually. The industry continues to anticipate and plan for the Office of the National Coordinator for Health Information Technology’s (ONC’s) new Trusted Exchange Framework and Common Agreement (TEFCA) exchange paradigm.

Content quality. The industry as a whole saw great improvements in content quality in 2021. For example, 98% of EHealth Exchange participants were able to successfully pass rigorous content quality testing. Because of the vast number of participants and their influences in healthcare, there is now a new, universal floor of interoperability inside and outside the network. This means that the network isn’t just moving data; it is moving standards-based, computable data, which is human readable and machine consumable, the gold standard for interoperability.

Adoption of new technology such as FHIR. While exchanging Fast Healthcare Interoperability Resources (FHIR) at scale still requires final new standards, particularly related to security, the industry as a whole worked to implement FHIR in production after successful proof of concept initiatives. In partnership with public health, we expect to see finally see the promise of FHIR in broad, real-world connectivity in 2022.

Of course, these are not the only trends that drove the healthcare IT sector in 2021. We saw a major emphasis on privacy, cybersecurity, controlling healthcare costs, and efforts to address disparities. Look for these and other trends to continue into the new year as the sector continues to evolve and address new challenges that will surely appear.

Morning Headlines 12/6/21

December 5, 2021 Headlines No Comments

Fortive to Acquire Provation, a Leading Healthcare Workflow Software Provider

Fortive will acquire specialty EHR vendor Provation from its private equity owner for $1.425 billion.

Netsmart Accelerates AI Healthcare Technology Innovations with Acquisition of Remarkable Health

Netsmart acquires Remarkable Health, which offers AI solutions – including an EHR and virtual clinical documentation – for behavioral health, substance use, and human services.

Adjuvare Launches Real-Time Remote Patient Monitoring Combining AI Mobile Technology and Virtual Acute-Care Services

NantWorks forms Adjuvare, which is built on AirStrip’s patient monitoring solution for remote patient monitoring.

U.K. Digital-Health Startup Vinehealth Raises Seed Financing

UK-based Vinehealth, whose app collects oncology patient-reported outcomes, raises $5.5 million in funding for a planned expansion to the US.

Monday Morning Update 12/6/21

December 5, 2021 News No Comments

Top News

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Fortive will acquire specialty EHR vendor Provation from its private equity owner for $1.425 billion.

Seller Clearlake Capital acquired the company from Wolters Kluwer in early 2018 for $180 million. Provation then acquired Pentax Medical’s EndoPro endoscopy platform and documentation procedure vendor IProcedures, both in 2021, and EPreop in 2020.

Provation reports annual revenue of $110 million. It has 5,000 health system customers.


Reader Comments

From Sporacide: “Re: Adjuvare. I didn’t see you mention its formation.” I didn’t see it, but added it below. Patrick Soon-Shiong’s NantHealth is involved with the company, which uses technology from one-time high-flyer AirStrip, whose apex was sharing an Apple stage with Tim Cook way back in 2015 after raising $65 million (and another $22 million in 2019). NantHealth has seen its own struggles, with shares down 95% since its IPO and the company’s valuation down to around $100 million, while NantKwest died quietly in being merged with another Soon-Shiong company, immunotherapy developer ImmunityBio, whose shares have dropped 85% in the past 10 months.

From Roman Board: “Re: Boardsi. I was exploring potential board positions post-retirement. They are a pay-to-play setup like ExecRank and spam me with lots of opportunities that require paying to be considered. Do companies really pay them to recruit board members?” I hadn’t heard of the company, which charges candidates $200 upfront and $195 per month (auto-renewing) and in return guarantees nothing. Anonymous complainers claim the company posts fake LinkedIn board position postings and refuses to answer basic questions about percentage of people placed or its user satisfaction rate, while I would characterize quite a few of the glowing online reviews as questionable (no verifiable user or company names, bot-sounding reviews that refer more to job recruiting than board placement). BBB shows 18 complaints, mostly involving being ignored when requesting cancellation, not having emails and calls returned, and having zero companies make contact. Some observe that the few positions the were offered involve informal advisory boards, which pay nothing and aren’t much of a resume builder. Please share your experience with Boardsi.

From Lindy: “Re: VCU Health. The CIO is leaving abruptly in the middle of an Epic rollout, 10 days post go-live, four years into her first CIO job.” Verified. Susan Steagall, MBA will leave VCU on December 16 after its December 4 go-live on Epic.


HIStalk Announcements and Requests

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Most poll respondents expect their employers to struggle with staffing over the next few years. Commenters brought up good points: (a) senior people are leaving, both because they have more opportunity with competitors but also because they have lost trust in their employers due to layoffs and poor corporate culture; and (b) work-from-home has created endless opportunities that devalue geographic loyalty and break through local compensation practices,

New poll to your right or here, following up on last week’s question: Did you change employers in 2021 or do you expect to do so in 2022?

We offer tiny startups a first-year, one-time sponsorship discount. Lorre says she will make that same deal available for companies of any size that have never sponsored HIStalk through December 31. Contact her.

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

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Webinars

December 8 (Wednesday) 1 ET. “What Lies Ahead for the EHR’s Problem List.” Sponsor: Intelligent Medical Objects. Presenters: James Thompson, MD, physician informaticist, IMO; Deepak Pillai, MD, MBA, physician informaticist, IMO; Jonathan Gold, MD, MHA, MSc, physician informaticist, IMO. The EHR problem list can be cluttered with redundant, missing, and outdated diagnoses, and displays don’t always help clinicians process the available data correctly. The presenters will discuss how improvements in creating, maintaining, and displaying problems could reduce errors and decrease the cognitive load of clinicians while continuing to optimize reimbursement.

December 9 (Thursday) 1:30 ET. “Cone Health: Creating Extreme Efficiencies in Surgical Services.” Sponsor: RelayOne. Presenters: Wayne McFatter, RN, MSN and Sharon McCarter, RN co-directors of perioperative services, Cone Health. The presenters will discuss how they have empowered the entire surgical care team, including vendor representatives, to get real-time access to surgery schedules and case requirements in the palms of their hand. RelayOne CEO Cam Sexton will also present the findings of a recent study of 100 hospital leaders regarding their operating room optimization plans for 2022.

December 14 (Tuesday) 1 ET.  “Using Cloud to Boost AI and Enterprise Imaging.” Sponsor: CloudWave. Presenters: Larry Sitka, MS, VP/CSIO of enterprise applications, Canon Medical Informatics; Jacob Wheeler, MBA, senior product manager, CloudWave. Enterprise imaging has remained a holdout of data center complexity despite the benefits the cloud offers. The presenters will discuss innovative ways to reduce complexity and lead with disruptive technology using AI, enterprise imaging, and the cloud.

December 15 (Wednesday) 1 ET. “Improve Efficiency, Reduce Burnout: Leveraging Smart Clinical Communications.” Sponsor: Spok. Presenters: Matt Mesnik, MD, chief medical officer, Spok; Kiley Black, MSN, APRN, director of clinical innovation, Spok. The presenters will identify the technologies that most often contribute to clinician burnout, then explain how improving common clinical workflows can help care teams collaborate better and focus on what they do best—taking care of patients. They will describe how a clinical communication and collaboration platform can automate clinical consults and code calls to alleviate burnout.

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


Acquisitions, Funding, Business, and Stock

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Netsmart acquires Remarkable Health, which offers AI solutions – including an EHR and virtual clinical documentation — for behavioral health, substance use, and human services.

NantWorks forms Adjuvare, which is built on AirStrip’s patient monitoring solution for remote patient monitoring.

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UK-based Vinehealth, whose app collects oncology patient-reported outcomes, raises $5.5 million in funding for a planned expansion to the US. Co-founder and CEO Rayna Patel, MBBS, MPhil is an NHS England National Innovation Fellow.

Shares in the Global X Telemedicine and Digital Health ETF dropped 16% in the past month versus the Nasdaq’s 4% loss. They’re down 15% in the past 12 months versus the Nasdaq’s 23% gain.


People

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The Wall Street Journal profiles recently named Mass General Brigham CIO/Chief Digital Officer Jane Moran, MBA (Unilever). She says the health system is working to extend its EHR with CRM capabilities and is working on remote patient monitoring.


Announcements and Implementations

United Arab Emirates launches Riayati, a national medical record that will be linked to the Wareed and Nabidh EHRs and Dubai Health Authority’s HIE. UAE intends to create an integrated medical record for every UAE resident.

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Google adds languages spoken to its medical office search results, although of course it’s up to the office staff to update the information by claiming their Google Business Profile (and making sure that the person who speaks the claimed language is working on any given day). Google previously added the insurances accepted by practices, which is almost certainly wildly inaccurate since even insurers can’t keep track of that.

Michigan Health Information Network Shared Services, Velatura Public Benefit Corporation, and Findhelp will establish a national HIE portal that will offer interoperable social services referrals.

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VCU Health (VA) was scheduled to go live with Epic over the weekend, replacing Cerner.


Other

US COVID-19 deaths are at 777,000.

Google will reportedly launch the Pixel Watch smart watch in 2022, which will offer a heart rate monitor and activity tracking. It will not bear the Fitbit name even though Google acquired that company for $2.1 billion in January. Google killed off its first Google-labeled watch before it was scheduled to be announced in 2016, choosing to license its software to other companies instead. Business Insider quotes company sourcea as saying that Google’s offering will be “a pretty direct mirror” of Apple Health.


Sponsor Updates

  • OptimizeRx names Brandon Feldmeier BI engineer.
  • Olive extends its Hack for Health 2021 virtual hackathon submission deadline to December 17.
  • VitalTech integrates Bright.md’s asynchronous telehealth solution with its remote patient monitoring technology.

Blog Posts


Contacts

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

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Weekender 12/3/21

December 3, 2021 Weekender 1 Comment

weekender 


Weekly News Recap

  • Nordic acquires S&P Consultants.
  • A private equity firm will acquire CNSI.
  • The VA revises its Cerner implementation timeline to restart the project in early 2022 and complete the rollout in 2024.
  • A new investment values Iodine Software at $1 billion.
  • HHS OCR settles with five providers who failed to give patients timely access to their medical records.
  • Greenway Health promotes President Pratap Sarker to CEO.
  • FDA forces Owlet to stop selling unapproved baby socks that monitor vital signs and sleep patterns.
  • Best Buy discloses that its October acquisition of remote patient monitoring technology vendor Current Health cost $400 million in cash.

Best Reader Comments

Thank you for honoring our dear Dr. Virginia K. Saba. She was a colleague, educator, mentor, and friend to many. Her influence is international. Her work will carry on through the multitude of nurses and others she has mentored. Dr. Saba promoted her Clinical Care Classification to the very end. Her legacy also will continue with two named awards that she endowed administered by Sigma and AMIA. (Susan K. Newbold)

Re: The WSJ Article: I think one of the takeaways from that article is that operations, both clinical and business, needs to take ownership of their role in decision-making, priorities, strategy, etc. In a lot of organizations (including my own), I don’t see this happening well. Many departments are fine with throwing things over the wall as an “IS problem” instead of an organizational problem. That puts IS (or IT) in a bad spot and enforces the image of IS being a barrier. (Ralphie)

Fast Forward 10 years: new WSJ.com Headline – “Decentralized IT Departments are Dead – Centralized IT Could Solve Fragmentation and Interoperability Issues.” (HITPM)

I think getting into healthcare regulatory reporting software would make a ton of sense for InterSsystems. InterSystems has an existing relationship with almost every health system running Epic. InterSystems has an integration product, and the majority of the work in integration projects are related to understanding the organizations data and understanding the organizations process. If you do regulatory software, you also have to do the work to understand data and processes in order to compare that to what the government expects. (IANAL)

If you implemented distributed IT at my employers, the result would be an unsatisfactory mess. Some few departments would be organized and effective. The majority would be rather distracted and neglectful  (IT is neither their interest nor their core competency). A few would do the absolute minimum, which might mean they do nothing at all. Most companies wind up with a central IT department. I don’t think that’s an accident. Truly distributed businesses are a rarity; trying to shoe-horn in IT as distributed, when everything else is centralized? It’s a culture clash and a recipe for big problems. It’s one thing to identify a problem, WSJ. It’s quite another to recommend a solution which will be helpful. (Brian Too)

About that WSJ article. I take EXTREME exception to the author’s assertion about the type of people that work in healthcare IT. I can tell you most, if not all that I have worked with do so because of the greater good and being part of something that matters. (Justa CIO)

Having acknowledged those failures, the wheels didn’t come off [on Athenahealth] until Elliott got rid of Bush, through questionable means, and forced an acquisition. It’s extremely charitable to call Elliot’s involvement merely “applying discipline.” Hundreds of employees were laid off, which Bush and his management team initially refused to do. Benefits were scaled back. Products were cancelled. Market segments were eliminated. Investment in R&D was significantly reduced. Efficiencies and discipline that leads to greater shareholder value could have been achieved without going to those extremes. I’m of the opinion that shareholder interests are important, but they should be balanced by customer and employee interests. Elliot only realized those gains by prioritizing shareholder interests (and primarily their own, at that) over those of customers and employees  (who don’t have a voice in the boardroom, of course). So who won in the end? Certainly not customers. (Ex-Athena)

Elliott did quite a bit better than 3x on its investment [in Athenahealth]. The original deal was funded with about $4.8B of debt and $1B of equity from the hedge fund sponsors. Add in the acquisition cost of Centricity (call it $500M of equity, $500M of debt) and the equity investors are all-in with $1.5B of equity and $5.3B of debt. They sold off some assets for a total of ~$600M in cash, so net equity in play is $900M. They turned that equity into $11.7B (assuming no interim debt pay down), which is a 13x return. 13x feels ridiculous, but if you’d invested that same levered-up $6.8B in the Nasdaq (QQQ) on the same timeline (Elliott began buying ATHN in spring 2017), you could sell today for $18.1B. Absurd as this whole deal sounds, it has actually underperformed the market. This story is more about tech multiple expansion/bubble broadly than it is about improving management or running the business. (Debtor)


Watercooler Talk Tidbits

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Generous “Giving Tuesday” donations from Vicki and Mark (Mark’s was made in honor of the IT professionals of Atlantic Health System), with matching money from several sources along with my Anonymous Vendor Executive, allowed me to fully fund these teacher projects, nearly all of which involve historically underfunded schools:

  • A drawing tablet for Mr. M’s middle school science class in Hemet, CA.
  • A programmable robot for Ms. K’s STEM computer science class in S. Ozone Park, NY.
  • Science books and resources for Ms. H’s middle school class in Hattiesburg, MS.
  • Computer science and robotics materials for Ms. H’s middle school class in Kissimmee, FL.
  • STEM kits for Ms. H’s first grade class in Escondido, CA.
  • A makerspace for Ms. G’s elementary school library in Paterson, NJ.
  • An all-in-one printer, fax, and scanner for school nurse Ms. U in Trenton, NJ.
  • AV presentation technology for Ms. M’s middle school class in New Castle, DE.
  • Learning station supplies for Ms. W’s middle school science class in San Marcos, TX.
  • Programmable robotics kits for Mr. N’s middle school class in San Antonio, TX.
  • Privacy boards and math flash cards for Ms. S’s elementary school class in Kittanning, PA.
  • Hands-on STEM materials for Ms. Z’s elementary school class in New Windsor, NY.
  • Headphones for Ms. H’s middle school class in Manassas, VA.
  • Inclusive STEM books for Ms. K’s middle school class in Las Vegas, NV.
  • Weighted hula hoops for the structured autism class of Ms. D in Laguna Niguel, CA.
  • Magnetic letters for Ms. G’s first grade  class in Philadelphia, PA.
  • Kites and balls for outdoor science learning for Ms. C’s elementary school class in Ryan, OK.
  • Online resources for the International Baccalaureate high school class of Ms. K in McAllen, TX.
  • Instructional resources for Ms. S’s high school class on Los Angeles, CA

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Ms. P checked in with an update on the projector and remote control presenter readers provided to her Baltimore elementary school via Donors Choose donations: “Thank you! The technology has really helped transform family events, classroom experiences, staff professional developments, and more. The projector has allowed me to project presentations that converted our learning. Students were able to see across the classroom the texts we were discussing, videos to supplement the work, and dance it out to ‘brain breaks.’ The projector was also utilized for family and student events. For example, students who had perfect attendance got to watch a movie with snacks and another time, we utilized the projector to share a presentation that discussed health to families. It was great! Instead of being hovered around a tiny computer screen or only having paper copies of the materials, we were able to create a view large enough for all to see! The most exciting part about receiving the items was seeing the students react! They were so grateful that people they never met and some they knew chose to donate to support them. They were appreciative that people cared about their education and making it fun. So thank you again for thinking of my kiddos!”

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Physicians are complaining that physician assistants – who say that their jobs haven’t required hands-on physician oversight for decades – are pushing to change their titles to “physician associates.” The AMA says the new name would confuse patients and is intended to position PA’s for independent practice. Another group pushing for a name change is the former American Association of Nurse Anesthetists (they changed the last word to “anesthesiology” last year), who said “anesthetist” was confusing to the public and hard to pronounce, but they note that the new title still labels them as nurses rather than physicians even though “we’re doing the lion’s share of anesthetics in this country.” Both name changes were chosen carefully to preserve the all-important existing abbreviations.

A South Carolina rehab center’s director of nursing is indicted on federal charges of creating phony COVID-19 vaccination cards, then lying to FBI and HHS. Her lawyer says she only made a couple of fake vaccination cards to “help” an anti-vaxxer family member.

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In Australia, a cosmetic surgeon who has 13 million TikTok followers is ordered to temporarily stop practicing medicine pending an investigation into issues with hygiene, safety, and surgical mistakes. Daniel Aronov, MBBS was also ordered to take down his social media accounts, which included photos of near-nude female patients and explicit lyrics. Australia allows anyone with a basic medical degree and no specific training – such as Dr. Aronov, who is a GP – to call themselves cosmetic surgeons.

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In Italy, a dentist is charged with fraud after a healthcare worker notices that the veinless arm that he bared for his COVID-19 shot was in fact artificial. The man, who was trying to obtain the country’s Green Pass that requires vaccination for most public activities, asked the worker to ignore his failed attempt and said, “Would you have imagined that I’d have such a physique?” The local newspaper speculates that he bought a male chest suit from Amazon since someone commented on that listing in Italian, “If I go with this, will they notice? Maybe beneath the silicone I’ll even put on some extra clothes to avoid the needle reaching my real arm.”


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Morning Headlines 12/3/21

December 2, 2021 Headlines No Comments

Nordic Consulting acquires S&P Consultants, expands Cerner division to meet industry demand

Nordic acquires S&P Consultants, which focuses on providing Cerner-related services.

Carlyle agrees to acquire healthcare tech company CNSI from Alvarez & Marsal Capital

Private equity firm Carlyle Group will acquire government health IT vendor CNSI from its private equity owner.

Omnicell to Acquire ReCept

Omnicell will acquire specialty pharmacy management services vendor ReCept Holdings for $100 million in cash.

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