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Readers Write: How One ACO Used Analytics to Promote Health Equity: Lessons for the ACO REACH Model

June 20, 2022 Readers Write 1 Comment

How One ACO Used Analytics to Promote Health Equity: Lessons for the ACO REACH Model
By Michael Meucci

Michael Meucci is chief operating officer of Arcadia of Boston, MA.

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A greater focus on promoting health equity is at the heart of changes CMS recently made to its direct contract model, now labeled as the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model.

While an emphasis on health equity is long overdue, this shift creates challenges for ACOs in measuring, monitoring, and improving health equity – something that can’t happen without leveraging advanced analytics to account for those factors impacting a patient’s ability to effectively manage their health, otherwise known as social determinants of health (SDoH).

A CMS Direct Contracting Entity, Massachusetts-based Community Care Cooperative (C3) incorporated advanced analytics and tight partnership with community agencies into its health equity program under the MassHealth Medicaid ACO program, driving significant improvement in the health of its diabetes patient population, in addition to a reduction in its total cost of care, positioning C3 for eventual success under the new model.

The US Centers for Medicare and Medicaid Services (CMS) launched the ACO REACH model in February, highlighting the organization’s commitment to “promoting value-based care that improves the healthcare experience of people with Medicare, Medicaid, and Marketplace coverage.” To that end, CMS requires all model participants to develop and implement “robust” health equity plans to identify underserved communities, in addition to implementing initiatives that “measurably” reduce health disparities within their patient populations.

Next, CMS placed a high priority on ensuring that medical providers play a prominent role in ACO REACH participating organizations, requiring that at least 75% control of each ACO’s governing body must be held by participating providers or their designated representatives. That number is a significant jump from the 25% requirement held by the ACO REACH model’s predecessor, which was known as the Global and Professional Direct Contracting Model.

Additionally, the new ACO REACH model is designed to deliver better protection to patients through more ACO participant vetting, monitoring, and greater transparency. CMS will look to accomplish that by asking for more information on applicants’ ownership, leadership, and governing boards to gain better visibility into ownership interests to ensure participants’ interests align with CMS’ vision.

The new model’s first performance year begins on January 1, 2023, with the model planned to run for four performance years through 2026. Applications to participate in the first year were due near the end of April 2022.

For patients, the promise of the model is better care, but with a greater focus on addressing SDoH, such as barriers to transportation, nutrition, and healthcare. For providers, the ACO REACH model offers the potential of a more predictable revenue stream and the ability to use those funds more flexibly to meet their patients’ needs.

Community Care Cooperative is an ACO that formed when the state of Massachusetts launched the MassHealth ACO program. MassHealth, which combines the state’s Medicaid and the Children’s Health Insurance programs, has emphasized engaging with community partners to help treat the whole patient, including addressing social needs that are barriers to care. C3 was created by a network of Federally Qualified Health Centers (FQHCs) to better serve their communities by providing more opportunities for individuals to receive coordinated, holistic, and culturally appropriate care in the communities where they live and work.

Incorporated in 2016, C3 serves over 170,000 MassHealth members with a total cost-of-care budget of $1 billion at 18 statewide health centers. In early 2020, inspired by the national conversation around equity, C3 launched a health equity program aimed at addressing physical and behavioral health needs, in addition to SDoH such as nutrition and housing. Earlier this year, C3 submitted its application to CMS to become a REACH ACO.

C3 started its health equity initiative in 2020 by collecting self-reported SDoH data from members, including race, ethnicity, and language information. While self-reported data may not be perfect, it is a good starting point to begin understanding the challenges facing a population of patients.

Next, C3 formed a diversity, equity, and racial justice committee to examine its patient data to investigate areas for improvement, in addition to thinking about ways to most effectively use the data in its possession. For example, the committee investigated whether the racial and ethnic makeup of patients referred to outside social services agencies was representative of the group’s overall patient population, in addition to the racial breakdown of immunization rates for two-year-olds.

To promote greater transparency, C3 has established a scorecard of key metrics pertaining to not just the usual operational numbers such as cost and utilization, but also data pertaining to health equity, such as comparisons of hypertension control by patients’ race and ethnicity. At each leadership meeting, these scorecards are posted for each of C3’s 18 health centers, prompting discussions of how to improve the metrics.

Perhaps most importantly, the attention to detail around data has led C3 to establish several experimental “flex” programs under Medicaid that are also known as “Section 1115 Demonstrations,” in which C3 partners with various social-services organizations (SSOs) that specialize in addressing SDoH, such as helping patients obtain housing or groceries.

For example, in one demonstration, C3 partnered with an SSO that delivered nutritious meals to patients’ homes. The program yielded impressive results: 68% of members with diabetes who received home-delivered meals had lower HbA1c scores in their post-enrollment tests compared with their pre-enrollment tests. Similarly, the percentage of diabetes patients with HbA1c scores that indicate their diseases are well-controlled grew significantly as a result of the home-delivery program, from 38% prior to the program to 71% after.

Additionally, the home-meal delivery program led to a substantial drop in the cost of care. In the six months after enrollment, total healthcare costs for the 456 patients enrolled in the program dropped by an average of more than 30%, from $17,902 to $12,349, compared to the six months prior.

C3’s experience with using analytics to improve health equity offers an example that ACO REACH participants can emulate. In the future, C3 looks to leverage the cost savings its programs generate to launch expanded initiatives that promote greater health equity.

Christina Severin, president and CEO of Community Care Cooperative, contributed to this article.

Curbside Consult with Dr. Jayne 6/20/22

June 20, 2022 Dr. Jayne 1 Comment

I get my news from HIStalk just like everyone else, so I was very interested to read about US hospitals sending patient information to Facebook. Involved websites include a third of those listed as Newsweek’s “Top 100 US Hospitals.” Using the Meta Pixel tracker, Facebook is receiving the IP address of patients who scheduled appointments online, as well as the physician’s name and the search-term used to locate them. Investigative reporters also found that multiple high-profile hospitals have installed the tracker on their respective patient portals.

Of course, the major concern is that these organizations may have violated HIPAA by sharing patient health information with a third party without obtaining appropriate consent. During the investigation, one of the scenarios used was as follows. On the website of University Hospitals Cleveland Medical Center, for example, clicking the “Schedule Online” button on a doctor’s page prompted the Meta Pixel to send Facebook the text of the button, the doctor’s name, and the search term used to find her: “pregnancy termination.”

The data being sent from within hospital patient portals is even more concerning. The Pixel Hunt project is a crowd-sourced effort to locate places where the Meta Pixel tracker is installed. Five real patient participants in the project had sensitive data sent, including names of medications, allergic reactions, and details about pending medical visits. The hospitals in question denied having contracts in place that would have permitted the release of this data, and investigators found no evidence that the hospitals were appropriately obtaining patient consent. Multiple organizations have since removed the tracker from their websites and patient portals, but the fact that it was there in the first place is highly concerning.

It’s unclear what Facebook has been doing with the data, and whether it’s using it for marketing or other for-profit purposes. As a patient, I find it horrifying that a health system would willingly put this kind of tracker on a patient-facing site and would want to understand why they would do that. The short answer is that those who do install it have access to analytics about ads they may have placed on Facebook and Instagram as well as access to additional marketing tools. In my opinion, neither of those reasons is enough to justify why my personal information should be sent outside of the healthcare organization. Even worse, the article notes that “if a patient is logged into Facebook when they visit a hospital’s website where a Meta Pixel is installed, some browsers will attach third-party cookies – another tracking mechanism – that allow Meta to link pixel data to specific Facebook accounts.”

As a physician who was previously employed by a health system, we know how much health systems profit from the labors of the clinicians that work under their banner. Data from 2016, which is the most recent year I could find, shows that primary care physicians generate $1.4 million in revenue each year. Some specialists, such as cardiologists and orthopedic surgeons, can generate $2.4 to $2.7 million annually. We’ve come to terms with our participation in that equation, but I doubt that physicians think favorably about health systems profiting from confidential patient information that we have worked hard to protect.

Putting on my clinical informaticist hat, the IP address is one of 18 HIPAA Identifiers that are considered personally identifiable information. I remember memorizing these for my last clinical informatics board exam because there were several questions on the topic on practice tests. When you take a piece of personally identifiable information and combine it with clinical data, it is considered Protected Health Information. When investigators were on the Scripps Memorial Hospital physician website, clicking the “Finish Booking” button sent Facebook the physician’s name and specialty as well as the patient’s full name, email address, telephone number, city, and ZIP code. The hospital removed the Meta Pixel from the final stages of the appointment scheduling flow after they were made aware of the investigators’ findings. The article contains a host of other examples of other private information elements that were shared, including patient comments about their medications and information on sexual orientation.

For every patient who has been told they can’t have a copy of their own records, or who has difficult sending records to a consulting physician due to an organization’s misapplication of HIPAA, this is particularly offensive. Glenn Cohen, faculty director of Harvard Law School’s Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics notes, “Almost any patient would be shocked to find out that Facebook is being provided an easy way to associate their prescriptions with their name… Even if perhaps there’s something in the legal architecture that permits this to be lawful, it’s totally outside the expectations of what patients think the health privacy laws are doing for them.” I’ve been privy to dozens of complex legal agreements over the years as well as numerous health systems’ Terms of Use documents for their websites and Conditions of Care documents that they make patients sign. I could see someone nesting language in those documents that might permit a number of things that if spelled out would make patients cringe.

Of course, that assumes that the health system knows what they’re doing and deliberately includes that provision. Maybe we need a law that requires language around data sharing to be in 14-point font at a sixth-grade reading level so that patients can understand, or that requires organizations to present this information in line-item veto format for patients to better identify their wishes. I don’t think the majority of patients would answer “Do you want us to share your medical information with Facebook?” in the affirmative, but then again, you never know. However, from the health system responses cited in the article, it seems that perhaps some of them didn’t fully understand the ramifications of installing the Meta Pixel tracker or what it was actually doing. Others indicated that they have confidence in Facebook’s ability to filter out patient information, and I think the majority of us would suggest that confidence is misplaced.

Since healthcare is going to an increasingly online, patient self-service model, this issue isn’t going to go away. However, I don’t see legislators or regulators dealing with it proactively since they can’t deal with other high-profile issues that dramatically impact our population. I’d love to see a flurry of complaints filed for HIPAA violations and watch Facebook burn money trying to defend itself. Needless to say, it will be a while before we see how this plays out.

If there’s anything that shows how slow the wheels of justice grind, it’s the marking of the Juneteenth holiday, which commemorates the day in 1865 when Major General Gordon Granger delivered the Emancipation Proclamation to enslaved people in Texas – more than two years after it was issued. This is the first year I’m working for an organization that observes the day and it’s a good opportunity to reflect on ways that we can do better as we work to care for all people.

What do you think about the Meta Pixel tracker and its use by healthcare organizations? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Todd Cozzens, Managing Partner, Transformation Capital

June 20, 2022 Interviews No Comments

Todd Cozzens is co-founder and managing partner of Transformation Capital of Boston, MA.

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Tell me about yourself and what you do.

I built two companies in what we now call the digital health space, which we called healthcare IT back then. Marquette Medical offered cardiology software and the first vestiges of patient monitoring, the first vestiges of the electronic medical record. We bootstrapped that company since we didn’t know any better in those days, built it up, and I took the company public with the founder. We had a great run as a public company, then sold it to GE in the late 1990s, where it became GE’s cardiology software division and remains so to this day. I just went to the founder’s funeral a couple weeks ago, Mike Cudahy out of Milwaukee. He was an incredible inspiration and mentor to me.

Picis was the electronic medical record for high-acuity care — operating room, intensive care unit, and emergency room. We started Picis after the Marquette Medical exit and built it up over the years. We had 2,000 hospitals in 23 countries. We were going to take it public in 2010. Then the Affordable Care Act hit and UnitedHealth Group, at that time, was looking at the ACA with a lot of trepidation, thinking about things like medical loss ratio that could challenge their managed care business. As we all know, United made more money than ever in the ensuing years, but at the time, they were worried about that.

United was basically a rollup of 108 health plans. Every time they acquired a health plan, they got a technology piece, like a claims engine or analytics, and they used to roll that up into the division called Health Services. With the Affordable Care Act, they decided to monetize that group of assets and do a string of pearls in acquisitions. They acquired Picis under the idea that hospitals would just become high-acuity centers and low-acuity services would move out of the hospital into the ambulatory areas. They didn’t want to buy bricks and mortar hospitals, but they wanted to engage in the enabling technologies to make hospitals run more efficiently.

I stayed on after that acquisition and did a couple of things for United. Basically I was on the founding team of what became Optum, which was very exciting at the time because it was just a canvas to paint the future of healthcare with the company with the largest momentum and asset base to be able to build something big. Strategizing on how that would shake out was a really exciting time for those of us that participated in that founding. I ran the first value-based care division, which was dedicated to helping hospitals take on risk. This was early on in the value-based care spectrum and it was interesting figuring out what would work and what wouldn’t. My last job there was mapping out strategy and M&A and helping figure out what their next $3 billion of acquisitions would be.

I left there not long after that and joined Sequoia Capital, which was probably the most successful investment firm in the history of the planet. I was really excited to join them and help them with their emerging healthcare focus. They had not done a lot of healthcare in the past, so they needed someone that knew payer, provider, et cetera. I came on to help co-lead the healthcare investing with a guy named Mike Dixon, a young guy that they had hired who, at the age of 26, got them into MedExpress, the urgent care company, Health Catalyst, et cetera. I went on a couple of those boards. ZirMed, which is now Waystar. Little known fact — we were the first institutional investor in Epic, which is a long story, but interesting.

We had a great run there. My only issue with Sequoia was that healthcare was destined to be about 10 to 15% of what they did. I had the chance to start my own fund in 2016 with Leerink, the largest healthcare-focused investment bank. Leerink wanted to get into more on the tech side, and like many investment banks, wanted to start an asset management principle investing wing of the firm. The first fund that they wanted to do was growth equity digital health, so that fit with me.

I’ve known Jeff Leerink for 10 years and I was able to pull Jared Kesselheim, who’s a doc and MBA from the Harvard Mass General system, but more importantly, eight years very successful digital health investing with Bain Capital Ventures. I was able to pull him out of there. He was leading their healthcare investing at the time. Digital health was just starting to boom and the electronic medical record with the HITECH Act was proliferating, generating a whole bunch of data that caused thousands and thousands of companies to be formed. We were at the beginning of the digital health boom and off and running with a $350 million fund, invested in 15 companies across payer, provider, self-insured employer, and pharma, from a tech perspective. We don’t do therapeutics or diagnostics, but pharma is increasingly using this data to bring products to market quicker, et cetera. Virtual clinical trials, what have you. Self-insured employers were starting to directly try to manage conditions of their employees, not getting what they wanted from their brokers and their third-party administrators. The fifth area was the consumer. When I joined the workforce, there were no co-pays, no deductibles, and now families can be spending $6-7,000 on a deductible before they even touch the insurance, so people are going directly online to take control of their healthcare.

Those are the end user bases that our companies sell to. We were able to raise Fund Two during the pandemic, $500 million. My former partner from Sequoia, Mike Dixon, joined us as our third managing partner, built out the team of people that are just totally focused and experienced in this area with either the clinicians operators or long experience investing in this space. Healthcare is very complex, and to understand the intricacies of the reimbursement system and the labyrinthic payment system, in addition to all the nuances of sales cycles, et cetera, generalist firms generally have a tough time really understanding the space. We felt our focus would be an advantage. We invested in 16 more companies in Fund Two, and then we just raised Fund Three at $800 million and closed that in January of this year. We were heavily oversubscribed and ready to go. I’m glad we raised that when we did. Now we have lots of dry powder as we face this very uncertain future here.

How would you describe, to someone whose memory isn’t long enough to have seen it before, this market in which companies contract, valuations drop, and IPO activity dries up?

We are facing very uncertain times, but all indications are — and they are compiling every day — that we are going to enter into a extended period of inflation. Every time you’ve had full employment and this level of inflation creeping up, the economy has gone into a recession. The likelihood of us going into some sort of recession is high, and geopolitical factors like Ukraine are only adding to that prognosis. In uncertain times, you’ve got to be extremely aware of your circumstances — where your company is in its cycle, where you’re spending, and where you’re going to get revenue. The end result of that is you’re going to need cash runway to be able to survive these uncertain times. This will hit different areas of healthcare in different ways.

I’ve been through four of these in my career. Most of the millennials that we see as founders of companies today from 2010/2011 onward have never seen a down market, have never seen a contraction, have never seen a deep recession. Healthcare can be resilient because people still get sick and still need care, but other factors may not make that as viable as has been in the past. For example, I was on the phone yesterday with the CEO of a pretty large health system. He said, “This is the most challenging time I’ve ever seen in healthcare. We can’t find people to staff our hospitals. We have incredible shortage of caregivers right now. It’s not only the great resignation. The average ICU nurse is something like 48 years old. We already had a shortage of caregivers going into this and now that’s just been exacerbated.” He told me he was $50 million variance to budget on staffing costs already, year to date. Closed 10 ORs in the main hospital, the most revenue-generating part of the hospital.

I don’t think providers are going to escape this. Self-insured employers are going to start analyzing what’s nice to have, what’s got to have. In other words, is this point solution I have for diabetes or hypertension really going to save me money? Musculoskeletal is an area that has huge ROI, if you can help employees avoid surgery and get rehab. Getting into understanding the financial benefit, in terms of return on investment of your product, is going to be absolutely key here. The consumer will have less discretionary money to spend on some of these applications that they’re going directly online to engage in. Payers, maybe with a lower utilization, will continue to be profitable. Maybe they’re the winners in this. Yet to be told. Pharma is investing more and more in analytics to get their products to market quicker. Maybe they keep that spend going, because time-to-market will be essential here for them to keep their revenue streams going.

There will be winners and losers, but overall, we’re cautioning our founder who have not been through this before that if they just avoid all the mistakes I’ve made, they will probably do great. We went through financial downturns, such as when the Clintons first wanted to go to a single payer and healthcare was just frozen for a couple years. Obviously the dot com bubble, that wasn’t really the dot com bubble, and it wasn’t HIPAA or Y2K around the Year 2000. It was the Balanced Budget Act, where hospitals were bleeding money and they would engage these consultants like the Hunter Group that would help them just slash their budgets. Then obviously the 2009 Great Recession was significant because hospitals had put their monies in these mortgage-backed securities and couldn’t get liquidity in the assets that they had.

It’s really a time to hunker down and make sure you’ve got cash runway. I’m telling companies that they have 48 months. You should never be raising money again unless you’ve got 12 months of cash runway, because it will take that long and investors get spooked when you’re running out of cash, and they come in like sharks. Really hunker down on your expenses, watch your spend across the board, and keep your team motivated and focused. Those are some of the things we’re cautioning our companies on right now.

How will the M&A picture look in a situation where companies that either can’t turn quickly from growth to profitability or can’t establish a place in the market find themselves looking for a fire-sale buyer?

M&A will continue to be a big area of focus for some of the bigger companies. Some stuff will be cheap compared to the totally inflated prices over the last couple of years. We were definitely in a bubble. The multiples of forward anticipated revenue were crazy and off the charts, and now it’s time to get back to reality. What’s the real steady state of this business? What’s its gross margin? When does this company get to cash flow break even?

The multiples are already coming way down. They’ve come down on the public companies and we’re starting to see that creep into the later-stage growth companies. That’s going to start to affect all companies. There’s usually a lag there for sure. But still, in order to be acquired, you’re going to have to be a company that has line of sight on cash flow, break even, and profitability because these public companies have to acquire you and have to merge your profitability, or lack of profitability, into theirs and affect their earnings per share. Good businesses will still be acquired for reasonable multiples and there’s probably going to be a ton of fire sales out there, for sure.

Health systems are going beyond spinning companies off into actually creating startups and running their own investment firms. What effect will that have on the market?

It’s a mixed bag on those strategic entities. When I started Picis, there were 6,000 hospitals, and very few of them were in integrated delivery networks. Now there’s basically 500 health systems out there, so the number of customers that you can sell to in the hospital area has gone down to 500 decision makers versus 6,000. They have consolidated, and to their credit, they have strengthened their balance sheets through that consolidation, and that has generated pretty good cash flow for most of them. Many of them went off and set up these strategic venture funds.

Some of them are integrated into the strategy of the health system, where the C-suite and the chief digital officer are completely aligned on what they should be investing in or participating in. Some of them are kind of off on their own, investing in early stage companies that can’t scale for the health system. I think there’s going to be a culling of those. The ones that have been successful over the years and bringing great returns, like Ascension Ventures and Providence, will continue to see funding. The ones that are less integrated, kind of afterthoughts as in, “Hey, this doctor’s really smart and he’s got an MBA – let’s let him go set a venture fund up” are going to go by the wayside. We’ve already seen a few of them not get their next funding round.

How do you see the next few years playing out?

At the end of the day, we still have a incredibly broken health system, which is extremely inefficient. Yes, you may have a staffing issue, you may have fewer nurses than used to have, but you’ve got to make them more efficient and make them spend less time on tedious tasks and more time on automation. I’m still very bullish on the market and I’m happy with reasonable multiples from historic times.

When I sold Picis to United, four times forward revenue was a fantastic number. We did OK for ourselves back then. We don’t have to be 20 times. We don’t need 20X investments to return to our limited partners. We need reasonable exits in great companies.

I’m still very bullish. The need is there, the market is there. We are still in the early innings of this digitization of healthcare. I think it will take 15 years before we’re anywhere near digitized as other industries. We’re definitely more scrutinizing about the spots we pick, the companies we go after, the founders that we want to work with and who get it. We’re not going to be perfect. We’re not going to always pick the outstanding winners. But I think we’ll pick enough of them that hopefully we’ll be successful.

Morning Headlines 6/20/22

June 19, 2022 Headlines No Comments

Watchdog reveals flaw in Cerner computer system caused nearly 150 cases of harm at Spokane VA hospital

The VA’s OIG finds that at least 148 veterans in Inland Northwest were harmed by a Cerner software flaw that the company was aware of, but failed to disclose to the VA.

Talkspace Reportedly Rejected Merger Offer from Amwell

Virtual mental health provider Talkspace reportedly rejects the acquisition overtures of Amwell.

VA to delay electronic medical records deployment to additional sites until 2023

As Congressional concerns over previous implementations mount, the VA decides to delay further Cerner rollouts until 2023 to ensure “adequate reliability.”

Monday Morning Update 6/20/22

June 19, 2022 News 1 Comment

Top News

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VA OIG finds that at least 148 veterans in Inland Northwest were harmed by a Cerner software flaw that the company was aware of, but failed to disclose to the VA.

The VA OIG’s draft report concludes that the Cerner system failed to deliver 11,000 orders for specialty care and lab work due to unrecognized locations that sent the mismatched orders to the “unknown queue.” Each order had to be reviewed and re-entered by VA employees.

A statement from Oracle said the company will bring additional resources to the VA’s Cerner program.

VA OIG contacted four Cerner employees for further information. Two of them, including a Cerner VP, did not respond to repeated requests, while the other two offered no reason that the VA wasn’t notified of the problem.

Meanwhile, the VA will delay further Cerner rollouts until 2023 to ensure “adequate reliability.” Puget Sound VA’s go-live that was scheduled for August will now take place in March 2023, while VA Portland will move its implementation from November to April 2023.


HIStalk Announcements and Requests

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Most poll respondents don’t check email and messages obsessively outside of normal working hours.

New poll to your right or here: How will US healthcare cost and quality be affected by Oracle’s acquisition of Cerner?


Webinars

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


Acquisitions, Funding, Business, and Stock

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Optum UK will acquire Leeds-based healthcare software vendor EMIS Group Plc for $1.5 billion in cash.

Virtual mental health provider Talkspace reportedly rejects the acquisition overtures of Amwell. Talkspace turned down a previous offer for $465 million, with its valuation now at $256 million versus its IPO market cap of $1.4 billion.


Sales

  • Visage Imaging extends its agreements with Sutter Health and WellSpan Health.
  • In the UK, Homerton Healthcare chooses Sectra for enterprise imaging.
  • Boston Children’s Hospital will replace Cerner with Epic, as internally announced Friday. Its physician group is already using Epic.

People

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Pivot Point Consulting, a Vaco Company, names Ryan Sousa (Seattle Children’s) as VP of data and analytics.


Announcements and Implementations

Epic will apply to join TEFCA later this year as a Qualified Health Information Network.


Other

Australia’s My Health Record continues to see low participation despite its $1.4 billion cost since 2012. Consumers are finding that their information is incomplete due to lack of provider data submissions, with ED doctors and nurses accessing the records of just 2% of patients.

A reader-forwarded research article notes that an American family of four who is covered by an employer’s PPO plan will spend $30,000 per year on healthcare in 2022, up 20% from 2020. Hospitals took 51% of the total.

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I was fascinated by this look back at telemedicine in the US, which included these milestones:

  • A Lancet article from 1879 noted the benefit of diagnosis by telephone.
  • A Dutch physician won the Nobel Prize for his work in developing an early electrocardiogram, as described in a paper from 1903.
  • A magazine publisher who also invented the first home radio receiver looked at radio’s potential for medical diagnosis in 1925, which predicted use of a “teledactyl” in which doctors would examine patients remotely with robotic arms.
  • An RSNA paper from 1950 described the use of sending X-rays over the telephone in the Philadelphia area, predicting that it would revolutionize care in rural hospitals.
  • Two Nebraska hospitals 112 miles apart established a TV link in 1948 that was used for psychiatric diagnosis, speech therapy, and seminars.
  • NASA funded remote monitoring for astronauts that was later used to support a mobile health unit for Arizona’s Tohono O’odham tribe.
  • An article published in 2000 titled “The Internet versus the telephone: what is telehealth anyway?” concluded that the Internet would become a critical aspect of telecare.

Sponsor Updates

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  • West Monroe staff in Dallas deliver 46 meals to Meals on Wheels clients.
  • OneMedNet appoints Eric Asbury to its board.
  • Pivot Point Consulting promotes Harold Cramer, Jr. to director, managed services service desk.
  • Quil collaborates with AI and IoT company People Power to bring innovative, AI-enabled health tech to seniors aging at home.
  • Juniper Networks publishes a white paper titled “Improve Patient Outcomes and Reduce Costs with AI-Driven Networking.”
  • RCxRules publishes a new e-book, “Simplify Your Revenue Cycle Workflow Through Automation.”
  • TriNetX partners with Finnish Biobanks to increase clinical and biomedical trials in Finland.
  • Vocera publishes a new case study, “UnityPoint Health Allen Hospital – Relieving Nurse Burden and Strengthening Safety.”

Blog Posts


Contacts

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

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Morning Headlines 6/17/22

June 16, 2022 Headlines No Comments

Facebook Is Receiving Sensitive Medical Information from Hospital Websites

An investigative article finds that the websites of 33 of Newsweek’s top 100 US hospitals send Facebook the IP address of people who schedule an appointment online, potentially violating HIPAA in sharing personally identifiable health information with third parties without patient consent.

Epic Announces Plan to Join TEFCA, Champion Next Step in Evolution Toward Universal Interoperability

Epic will apply later this year to join the Trusted Exchange Framework and Common Agreement health information exchange network as an inaugural Qualified Health Information Network.

Digital Health to Acquire VSee Labs and IDoc Telehealth Solutions with New Entity Valued at Approximately $110 Million

SPAC Digital Health Acquisition Corp. will acquire telehealth software vendor VSee Labs and neurocritical and intensive care-focused telemedicine vendor IDoc Telehealth Solutions for $110 million.

Flexpa sows $8.5M seed for health data sharing

Health data-sharing startup Flexpa, which has focused its services on payers, app developers, and patients, raises $8.5 million in seed funding.

News 6/17/22

June 16, 2022 News 6 Comments

Top News

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An investigative article finds that the websites of 33 of Newsweek’s top 100 US hospitals send Facebook the IP address of people who schedule an appointment online. The Meta Pixel tracker also sends Facebook the doctor’s name and the search term that the user entered to find them.

The hospitals include Hopkins, UCLA, New York Presbyterian, Northwestern, and Duke.

Reporters also found that at least seven health systems have installed Meta Pixel on their patient portals, including Community Health Network, Edward-Elmhurst Health, and Novant Health.

The hospitals may have violated HIPAA in sharing personally identifiable health information with third parties without the consent of patients.


Reader Comments

From Cedar: “Re: pre-Oracle attempts to develop a national EHR. I recall one entrepreneur in the 2000s who had no healthcare experience who announced he was developing a national EHR. I believe it was Jim Clark of Netscape. Are you aware of any other famous Silicon Valley heads who made a big splash and then went nowhere?” Jim Clark’s Healtheon was certainly all over healthcare, trading on his success with Netscape to eventually merge with WebMD. Intel co-founder Andy Grove also hatched grand healthcare technology plans in the mid-aughts that went nowhere. Google and Microsoft had their own arrogance-fueled failures with personal health records. Sun Microsystems made some national noise in the mid-2000s, then sold out to Oracle in 2010. IBM had a bunch of now-forgotten projects. I’ll invite readers to help me recall other big tech companies that showed misplaced confidence in planning to show us healthcare folks how it’s done before slinking away shortly thereafter with the newfound knowledge that you can’t fix a dysfunctional, profit-obsessed healthcare system with technology.


Webinars

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


People

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CloudWave promotes Chris Mellyn to VP of marketing.

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Aetna/CVS Health promotes Ron Wampler to executive director of interoperability.

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Melissa Bell (Intelligent Medical Objects) joins TigerConnect as president.

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Cone Health hires Jeetu Nanda, MD, MS, MBA (Cerner) as CMIO.

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David Kates, MBA, MSEE (Manifest MedEx) joins Unified Patient Network as CTO.

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Opala hires Ken Chandler (Premera Blue Cross) as CEO.

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Krista Hawk (HealthPay24) joins Doctivity Health as VP of sales and business development.


Announcements and Implementations

Providence and Microsoft launch a nine-month clinical innovation fellowship.

Walgreens launches a clinical trial business that includes patient recruitment, a decentralized clinical trial platform, and real-world evidence.


Other

The Washington Post calls out Phreesia for using the patient information it collects from its patient check-in app collects to target drug company ads.

A Kaiser Health News investigation finds that 41% of US adults are saddled with healthcare-related debt, much of it hidden in the form of credit card balances, family loans, or provider payment plans. An expert says that debt is a main product of a health system that is “almost perfectly designed to create debt.” One in seven people who have medical debt say they can’t receive further care because of their unpaid bills. The authors note that the Affordable Care Act caps out-pocket costs, but few Americans can afford the $8,700 annual maximum and high-deductible plans require paying thousands of dollars before coverage even begins. 


Sponsor Updates

  • EClinicalWorks announces its continued partnership with Witham Health Services (IN) to further improve patient communications and achieve overall operational efficiency in more than 30 locations.
  • Diameter Health publishes a new white paper, “Healthcare ROI: How Health Plans Use Diameter Health’s Automated, Scalable Technology to Maximize Value from Clinical Data Investments and Avoid Significant Operational Cost.”
  • Pivot Point Consulting promotes Molly Kalinowski to director of managed services application support.
  • AGS Health opens an office in Jaipur, India.
  • Experian Health releases a new infographic, “The Digital Healthcare Gap: Streamlining the Patient Journey.”
  • Research from Juniper Networks finds AI adoption has expanded tenfold across enterprises while governance lags.

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 6/16/22

June 16, 2022 Dr. Jayne No Comments

The American Medical Association Annual Meeting is happening in Chicago this week, with the group gathering in person for the first time since the beginning of the COVID-19 pandemic. Many physicians feel the AMA has lost relevance and doesn’t speak for the majority of physicians. Regardless, I found the list of issues that the House of Delegates plans to address to be an interesting commentary on the times:

  • Addressing public health disinformation by health professionals.
  • Regulating ghost guns.
  • Declaring climate change a public health crisis.
  • Banning cannabidiol ads in places that children frequent.
  • Preventing loss of insurance coverage after the COVID-19 public health emergency ends.
  • Urging the Food and Drug Administration to swiftly review and approve over-the-counter status for oral contraceptives.
  • Decreasing bias in evaluations of medical student performance.
  • Ensuring accessibility of quality childcare for physicians in training.

Additional special sessions will include talks on the need for ethical guidelines around private equity acquisition of physician practices; Hattiesburg Clinic’s results when it looked at the impact of nurse practitioners and physician assistants; having physicians work at the top level of their licensure and not performing non-physician work; and reducing burnout.

I’m not sure how you miss this on a background check, but Bay Area Hospital in Oregon recently fired its chief operating officer after only four days on the job. It was discovered that in 2015, he had been sentenced to serve half a decade in federal prison for committing wire fraud and false representation of a Social Security number. Additionally, he used company credit cards for personal purchases. The hospital claims that it conducts criminal background checks across multiple jurisdictions, so I’d be interested to understand how this one slipped through the cracks.

In other legal news, a New Hampshire hospital has lost more than seven gallons of the drug fentanyl, which is a synthetic opioid that is 50 times more potent than heroin. Multiple hospital employees have been suspended. Drugs continued to disappear despite precautions that were added after initial losses were identified. A single nurse admitted taking more than half of the missing drugs, but the fate of the rest of the missing drugs continues to be unknown. Board of Pharmacy documents state that the nurse in question stated she took the fentanyl “for her own use as a way of coping with the stress of working during the pandemic” and also gave some to a friend. The nurse died unexpectedly in March. Nursing and pharmacy leaders at the hospital have also been suspended, with decisions on whether the hospital will lose its pharmacy approval expected later this month.

CMS has started levying fines against hospitals for noncompliance with federal price transparency laws. Atlanta-based Northside Hospital was fined more than $1 million due to problems at two facilities. One didn’t have the required consumer-friendly list of standard charges and the other didn’t have the searchable list posted in a prominent manner. CMS has issued a number of warning notices to noncompliant hospitals, but these are the first fines. Of note, neither hospital submitted a plan for corrective action which might have helped them avoid the penalties. One health policy expert cited in the article describes the hospital’s behavior as “contemptuous” in its lack of response or remediation.

A recent report from the Center for Connected Medicine (which is a partnership of Nokia and UPMC) looks at the reasons why patient self-scheduling isn’t advancing. Not surprisingly, lack of physician buy-in is a major factor. The report notes that 88% of respondents plan to prioritize investments in self-scheduling technologies in the coming year.

My primary care physician is part of a large medical group affiliated with a major integrated delivery network, and their efforts towards self-scheduling have been haphazard at best. Each office within the group is allowed to do their own thing, and then within the office, providers can opt in or out. Although I can’t even request an appointment with my physician online (other than sending a message, which I know is annoying to the staff) I can directly book with the nurse practitioners in the office. I’m overdue for calling to schedule my visit since he’s got a six-month wait, but I never seem to find time to make the call. At least I could self-schedule in those precious minutes between Zoom calls while I’m waiting for attendees to arrive at a meeting or while I’m waiting for the next patient to pop into my virtual waiting room. I definitely can’t make a phone call at either of those times.

Being a patient seems to be getting more and more difficult. I waited more than two weeks for some recent results, only to find that the ordering clinician failed to include the clinical history with the order, which might have made a difference in the results. It took four days from when the results posted in the EHR to when my clinician finally messaged me with note that “all is well, have a great summer,” which is a somewhat useless comment when you’re a patient who wants to know what the follow-up plan should be given the clinical history. Additionally, my physician eye detected a comment in the actual result report that called into question the adequacy of the specimen and that doesn’t feel like “all is well” to me.

I was forced to see this clinician because my own physician was out on a medical leave and the wait for new patient visits for other physicians in this specialty can be several months long. The visit itself was less than satisfactory, and after seeing how the results were handled, I’ll be looking to transfer. I’m fortunate to be a physician with plenty of resources, who not only knows how to research clinical guidelines but who could also reach out to friends in this specialty for advice. Both of my favorite “phone-a-friend” docs agreed with my self-created care plan so that’s something, but overall, the situation is just disheartening.

I feel bad for my physician colleague who is out on leave, because I know the backstory and that she not only feels terrible that her sudden illness left the practice in the lurch, but that there’s a good chance that she may not be able to practice medicine again. She’s an employed physician, though, so it falls on the group’s leadership to ensure that patients receive appropriate care in the face of the unexpected. I wonder how many other patients received less than outstanding care in the last few weeks and whether there will be any long-term consequences.

How have physician or other medical staff shortages impacted your own health or your patients’ care? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 6/16/22

June 15, 2022 Headlines 1 Comment

Constellation4 Health closes round with new outside investment

Florida-based startup Constellation4 Health raises pre-seed funding and acquires Vulcan Health, an offshoot of Florida Eye Specialists & Cataract Institute that specializes in digital referral management technology.

AI technology platform Excelera to merge with SPAC Future Health ESG

Excelera, a healthcare AI technology vendor focused on helping physicians succeed in value-based care programs, will merge with SPAC Future Health ESG.

Proximie Raises $80 Million in Series C Funding to Accelerate Product Expansion of Full-Service Connected Surgical Platform

Virtual surgery software company Proximie raises $80 million in a Series C funding round, bringing its total funding to $130 million.

Morning Headlines 6/15/22

June 14, 2022 Headlines No Comments

ResMed to Acquire Medifox Dan, a German Leader in Out-of-Hospital Software Solutions

ResMed will acquire Germany-based MediFox Dan, which offers out-of-hospital software solutions, for $1 billion.

Oracle reviewing Cerner products to identify where third-party tech can be removed

Oracle will review Cerner’s product portfolio to find opportunities to move from third-party technologies to those of Oracle, including moving to Oracle’s cloud infrastructure.

FTC launches probe into mental-health startup Cerebral

The Federal Trade Commission launches an investigation into the advertising and marketing of telemedicine startup Cerebral’s mental health services.

Bardavon Health Innovations Acquires PeerWell to Become First Complete Digital Health Solution Focused on Worker Musculoskeletal Health

Bardavon Health Innovations, whose network offers musculoskeletal health services for workers’ compensation cases, acquires PeerWell, which offers a MSK care coordination platform.

News 6/15/22

June 14, 2022 News 4 Comments

Top News

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Oracle says in its earnings call that it will review Cerner’s product portfolio to find opportunities to move from third-party technologies to those of Oracle, including moving to Oracle’s cloud infrastructure.

Larry Ellison added that Oracle’s plan for a national health records database is “clearly going to be our largest business.”


HIStalk Announcements and Requests

I’m mostly recovered from my infection that may or may not have been COVID (all tests were negative, so who knows). The upside of being flat-on-back for a week is that I rediscovered the amazing decades-old hospital drama “St. Elsewhere,” of which the entire 137-episode run is available on Hulu. Also occupying my fuzzy-minded time is the first podcast I’ve ever listened to, the spectacular “Gilbert Gottfried’s Amazing Colossal Podcast!,” which like me obsesses over obscure TV shows and one-hit musical wonders as described by guests who were involved.


Webinars

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


Acquisitions, Funding, Business, and Stock

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ResMed will acquire Germany-based MediFox Dan, which offers out-of-hospital software solutions. ResMed will pay $1 billion for the acquisition, about 12 times net revenue.

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Bardavon Health Innovations, whose network offers musculoskeletal health services for workers’ compensation cases, acquires PeerWell, which offers a MSK care coordination platform.

London-based Proximie, which virtually connects surgeons to ORs and cath labs, raises $80 million in a Series C round.


Sales

  • Digital health company Zyter selects PatientBond’s psychographic segmentation model and patient engagement software to improve risk stratification and care plan adherence.

People

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Cardiovascular Associates of America hires Jack Sunderman, MS (Clearwater Cardiovascular Consultants) as CIO.

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Joe Rostock (AllosLogic) joins Avaneer Health as COO.

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Amino Health hires Greg Born, MBA (MDsave) as chief growth officer.

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CoverMyMeds promotes Clay Courville to chief product officer.


Announcements and Implementations

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The University of Miami Health System’s Sylvester Comprehensive Cancer Center implements an internally-developed bilingual symptom and practical-needs screening and referral tool within its Epic EHR. Patients fill out the electronic survey through their patient portal before an appointment and are then triaged to supportive services and/or medical teams during their visits.

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Gadsden Regional Medical Center (AL) implements PeriGen’s PeriWatch Vigilance AI-based maternal-fetal early warning system within its labor and delivery department.

Premier expands its PINC AI clinical surveillance technology to long-term care facilities, including automated COVID alerts, outbreak group tracking, documentation, and submission of infections to the CDC.

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Startup Rune Labs earns FDA clearance to use its Apple Watch software, combined with a brain signal monitoring implant, to help doctors optimize therapy for Parkinson’s disease.


Government and Politics

HHS issues guidance on using remote communication technologies to provide audio-only telehealth services when OCR’s enforcement discretion is no longer in effect.

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Eisenhower Army Medical Center at Fort Gordon (GA) works through patient portal appointment scheduling issues in its new MHS Genesis system, which went live over the weekend. The go-live marked the half-way point for the DoD’s facility-wide rollout of the Cerner-based system. The department anticipates wrapping up the enterprise deployment by the end of 2023.


Other

Surescripts reports that 620,000 prescribers – half of those in the United States – used its Real-Time Prescription Benefit cost and coverage tool between December 2021 and May 2022, a 7.5% year-over-year increase The company attributes the technology’s growth to increased adoption among EHR vendors including Athenahealth, CompuGroup Medical, and Greenway Health.

A UK doctor apologizes to the family of a 92-year-old woman for incorrectly diagnosing her with terminal liver failure during a virtual visit, after which he recommended initiating end-of-life care. The family took her to the hospital, where she recovered fully after a four-day stay.


Sponsor Updates

  • Meditech is named 2021 Google Cloud Industry Solution Partner of the Year for healthcare.
  • Hamad Medical Corp. and Primary Health Care Corp. adopt Cerner managed technology to deliver better outcomes in Qatar.
  • EClinicalWorks releases a new podcast, “Healow Payment Services: Convenient, Electronic, and Easy to Use.”
  • Baker Tilly publishes a case study, “Rural hospital draws $1.8 million in annual Medicare reimbursements through status change.”
  • WellSky-owned CarePort announces that 2,500 post-acute providers and 13,000 home- and community-based services joints its network in 2021.
  • Premier Inc.’s PINC AI will collaborate with R1 RCM to offer expanded end-to-end revenue cycle solutions.
  • Change Healthcare, Olive, Optum, Surescripts, Bamboo Health, InterSystems, Diameter Health, Neuroflow, RxRevu, Talkdesk, and Wolters Kluwer will exhibit at AHIP 2022 June 21-23 in Las Vegas.
  • CTG will present and host virtual investor meetings at the annual East Coast IDEAS Investor Conference June 23.
  • Ellkay has raised $49,000 for the Alpine Learning Group through its team participation in Go the Distance for Autism.

Blog Posts


Contacts

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

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Morning Headlines 6/14/22

June 13, 2022 Headlines No Comments

Oracle’s Cloud Business Shows Momentum, Sending Shares Higher

Oracle’s Q4 cloud revenue has increased 19% to $2.9 billion, sending its shares up and, coupled with its Cerner acquisition, accelerating its business momentum.

Eisenhower Army Medical Center now live with MHS-Genesis, DHA rollout marks half-way point

The DoD’s facility-wide roll out of MHS Genesis, a Cerner project, reaches the half-way point with go-live at Eisenhower Army Medical Center at Fort Gordon in Georgia.

HHS Issues Guidance on HIPAA and Audio-Only Telehealth

HHS issues guidance on how covered healthcare entities can conduct audio-only telehealth appointments in a HIPAA-compliant manner.

Readers Write: Real-World Data Connects the Patient’s Past, Present, and Future: A Systems-Level Approach to Effective, Holistic Cancer Care

June 13, 2022 Readers Write No Comments

Real-World Data Connects the Patient’s Past, Present, and Future: A Systems-Level Approach to Effective, Holistic Cancer Care
By Miruna Sasu, Ph.D.

Miruna Sasu, PhD, MBA is president and chief executive officer of COTA, Inc. of New York, NY.

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Too often, fragmentation across the care continuum prevents the delivery of timely, tailored cancer therapies. By leveraging real-world data to inform our decision-making at the systems level, we can ensure that cancer patients have access to personalized, effective treatments.

For the typical cancer patient, the road to remission is anything but a straight line. From getting the right diagnosis to accessing the most effective therapies, patients face a fragmented and disjointed journey that can be filled with roadblocks and detours.

Part of the problem is the nature of cancer itself. It adapts and evolves to evade treatment, driving oncologists and life sciences companies to continually develop innovative therapies and update their standards of care.

But equally problematic is the way we direct patients along their journey. In too many cases, we cannot access the data-driven insights that we need to make timely decisions with our patients. We struggle to overcome systemic barriers, such as competing incentives and overly narrow methods of care delivery. And we don’t have the shared infrastructure in place to continuously learn from our patients and enhance future decision-making based on the lessons of the past.

Fortunately, we can change the status quo if we adjust our notions of what it means to work together at a systems level  and if we leverage emerging assets, such as real-world data (RWD), to create a more comprehensive, predictive, and personalized pathway to better cancer care for all patients.

Healthcare is an industry of extreme specialization, which brings both benefits and challenges to patient care.

Naturally, it’s crucial to have experts with deep experience in very specific fields to ensure that people with complex conditions get the care they need. But specialization can make it more difficult for patients to get the right care at the right time.

For example, if a patient goes to a podiatrist for pain in their foot, the podiatrist will do everything she can to examine the relevant structures.

If they finds nothing remarkable, however, they likely won’t suspect that the problem might actually be referred pain from ovarian cancer. And chances are, they won’t have access to information about the patient’s mother’s BRCA-1 mutation, which potentially raises the risk of that cancer in the person they are treating. The patient will go home with a recommendation to rest and ice their foot, not a referral to an oncologist, and it may be weeks or months before they get the correct diagnosis.

Both the patient and the podiatrist did everything “right” in this situation, yet the outcome is still suboptimal for everyone involved.

That’s because both our care practices and our patient data are viewed through an overly narrow lens, causing us to miss the big picture and make connections that may fall outside of the traditional site-specific approach to medical care.

In cases like these, what we need is a generalist: a holistic, comprehensive view of the patient, their history, their clinical and non-clinical risks, and all of the other factors that may point to the correct diagnosis or a favorable response to a certain therapy.

Data can be that generalist. By combining RWD from electronic health records; claims; medical devices; patient reports; and other sources with clinical trial information, registry data, and additional inputs, we can begin to develop the systems-level thinking we need to effectively diagnose and treat patients with cancer.

To maximize the value of our data to inform care decisions, we need to reexamine the fundamental architecture of our operating environment.

Life sciences companies, clinical providers, payers, and regulators struggle with trust issues and conflicting incentives that inhibit collaboration and prevent us from working together efficiently as a coordinated system.

If patient data is to be the generalist that unlocks silos in care, we need to stop treating it as proprietary, competitive leverage and start viewing it as a shared resource that can actively save patient lives.

In order to successfully make this shift, we must transcend our individual motivations and more effectively share precise and applicable data-driven insights across the divide so that everyone can benefit from what RWD can tell us about the right patient care.

With this approach, we can begin to take that holistic, bird’s-eye view of patient care that is crucial for identifying and treating cancer as quickly as possible. We can start to build cohorts of similar patients based on rich and comprehensive information about their treatment paths and outcomes. Then, we can predict the experiences of future patients and get them on therapy sooner, make the next correct treatment decision, or enroll them in promising clinical trials.

The result will be better experiences and outcomes for patients and more fuel for innovation for life sciences companies and providers, including a more robust and targeted pipeline for filling clinical trials.

If used correctly, RWD can be the bridge that connects the isolated corners of the care environment and leads us along a smoother, faster, more personalized pathway to high-value cancer care.

RWD will be crucial for understanding how to efficiently pivot for the patient as their story evolves. As we integrate RWD into our decision-making processes, we will need to work together to make certain that it is created, collected, and curated correctly while paying the utmost attention to patient privacy and data security.

We know this won’t be an easy task, especially if we let historical divisions influence our relationships with one another. We know that we have a great deal of work ahead of us to realign incentives, develop our real-world data assets, and set appropriate guardrails for a newly collaborative industry.

However, it can be done. If we can put aside our personal viewpoints and look at the cancer journey through the eyes of a frustrated, frightened patient, we will be able to successfully focus on our shared mission to find new treatments for cancer, improve patient experiences, and ultimately save lives.

Curbside Consult with Dr. Jayne 6/13/22

June 13, 2022 Dr. Jayne 2 Comments

I was sorry to read of Mr. H’s COVID-like symptoms, which as of his last post hadn’t yet resulted in a positive test. Especially in vaccinated patients, we’re seeing a pattern where antigen testing doesn’t become positive until five days or more after symptoms have started. Although vaccinations are still very good for preventing hospitalizations and death, I’m seeing a fair number of people with some pretty debilitating symptoms as well as a large number of patients with long-COVID symptoms. Best wishes for a speedy recovery for Mr. H.

As a physician who has spent thousands of hours staffing emergency departments and urgent care facilities, I fully support the idea of having interoperable systems to better understand patients’ medication histories. My first informatics employer stood up a private health information exchange (HIE) to help its employed physicians better share data with community physicians who also used the same EHR. It was an exciting time to learn how the connectivity needed to work and to navigate through decisions such as whether we would be an opt-in or opt-out platform in the face of changing privacy laws and state requirements that weren’t keeping up with the times. As the first HIE in the state, if was something to be proud of, but we knew it could be done better and were ready to support broader statewide efforts when they came along.

One of the major benefits of even our limited regional system was being able to see prescription histories and to identify patients who were visiting multiple physicians for controlled substances, or who were trying to refill their medications sooner than they should. Having the data made it easier to have those uncomfortable conversations with patients so that we could try to arrange appropriate follow up. From those experiences, it was natural to be a champion for Physician Drug Monitoring Programs (PDMPs) when they were first proposed. Some states were faster in creating these programs than others, and at least one state still doesn’t have a true statewide platform. As soon as one became available to me, I signed up, and before long I was using it nearly every day.

My last urgent care employer had a large number of midlevel providers seeing patients – nurse practitioners and physician assistants outnumbered the physicians nearly three to one. In my location, those providers weren’t allowed to sign up for the PDMP on their own, but required a sponsoring physician to allow them to be a delegate on their account. I thought that was unusual since those providers can prescribe controlled substances in my state as long as they have the name of their collaborating physician on the prescription, but I’m not the one who makes the rules. Several of the nurse practitioners asked me to sponsor them even though I wasn’t their collaborating physician. Apparently, the physician owners (who were the collaborating physicians for many of the midlevels) refused to sponsor them for the PDMP because they didn’t want it to create inefficiency in the workflow.

I found that approach to be short-sighted as well as non-collegial, so I agreed to sponsor a few of them who I had worked with for years and knew very well. They continued to use the system under my sponsorship until I left the practice and terminated the linkage between our accounts. It looks like their collaborating physicians still won’t sponsor them, because every two weeks I get an email from the PDMP noting that I still have open requests for sponsorship. In thinking about the fears of inefficiency, it’s likely more complex than that since the practice dispensed medications on a cash basis (including controlled substances) and was well known for making sure providers were “treating the heck out of symptoms.” Patient satisfaction was also a big push and of course it takes more time to counsel a patient about something you might find in the PDMP versus just prescribing medication. The practice also refused to install technology that would allow e-prescribing of controlled substances, so you get the picture. Attitudes like that are part of why I no longer work there, but one does still have to think about the impact of any new systems on efficiency.

An article in JAMA Health Forum addressed the topic this week, with findings that having a PDMP that’s integrated with the EHR led to increased use of prescribing recommendations by primary care clinicians. It shouldn’t be surprising to anyone that if you have a solution that makes it easy to do the right thing, people will be more likely to actually do the right thing. The researchers looked at 43 clinics and how they used the Minnesota PDMP. There were 21 clinics that had the PDMP integrated with the EHR, which reduced the need for a separate login to the outside system while also lowering the need to intentionally think about using the PDMP.

Monthly query rates for the non-integrated sites were 6.6 per clinician before the intervention versus 6.9 after. Monthly query rates for the integrated sites were 8.8 before the intervention and 14.8 after. Additionally, the findings showed a greater impact of the EHR integration on less-experienced clinicians, which they noted “may reflect a less inflexible practice style and/or faster uptake of new features in the EHR.” While the study was underway, Minnesota initiated a mandate that clinicians query the PDMP before prescribing opioid drugs, which led to an uptick in query counts in both groups, although that increase was more significant for prescribers in the intervention group.

There are several potential limitations to the study, including the fact that it didn’t directly assess opioid prescribing. The study was also limited to a single health system and its affiliated prescribers within a limited geographic range, although there was inclusion of urban, suburban, and rural areas. The study also could not identify whether queries were clinically appropriate or not or whether the PDMP queries led to providers deciding to not prescribe controlled substances when they otherwise might have. The authors do plan to look at this in a further analysis using information from the EHR.

I do hope that those who are trying to increase the adoption of EHR-integrated solutions use information like this to show that they can have a positive impact on provider workflow. They can also have a significant impact on patient outcomes when it comes to identifying patients who might benefit from an intervention with regard to controlled substances. I’m interested to see what results other organizations may have had with EHR integration and how their clinicians responded to it.

Have you integrated your state’s PDMP with your EHR? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 6/13/22

June 12, 2022 Headlines No Comments

Boulder Care raises $36M to grow telehealth platform to treat opioid addiction

Substance use disorder telemedicine startup Boulder Care raises $36 million in a Series B round that brings its total funding to $50 million.

Cognosante Awarded Contract to Modernize Pennsylvania Patient and Provider Network

The Pennsylvania Department of Human Services awards Cognosante a $16 million contract to migrate the state’s Patient and Provider Network and Public Health Gateway to a new HIE platform.

IBM CEO explains why he offloaded Watson Health: Not enough domain expertise

IBM Chairman and CEO Arvind Krishna says the company sold Watson Health to Francisco Partners for $1 billion in January because IBM just didn’t have the domain expertise to keep the product viable in healthcare.

Monday Morning Update 6/13/22

June 12, 2022 News 5 Comments

Top News

Oracle Executive Chairman and CTO Larry Ellison says in a Cerner acquisition update that hospital EHRs – he names Cerner, Epic, and Allscripts – fragment records across providers because each hospital buys and operates its own, preventing providers from accessing a patient’s records in an emergency and limiting the value to public health researchers.

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Ellison says Oracle will create a national EHR database that is continuously updated via updates from provider EHRs. Providers will be able to access identifiable information if authorized by the patient, while public health researchers would be limited to a de-identified view.

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Ellison says Millennium will be significantly enhanced with voice UI, AI models, and automated clinical management. He mentioned the oncology decision support work of Project Ronin, of which Ellison is a co-founder.

Much of the presentation touted Oracle’s other healthcare offerings, such as ERP, workforce management, clinical trials, and cloud services.

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Cerner will operate under the name Oracle Cerner, according to several references in the presentation.


HIStalk Announcements and Requests

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Poll respondents are evenly split about feeling welcome and appreciated when contacting their preferred hospital. One commenter says the hospital person always reads the appropriate script even though it’s clear their main job is as a goalie to keep people from talking to someone who could answer questions. ServiceWithaSnarl says that the academic medical center where they work as a physician faculty member at least gives everyone equally horrible service, physician or not.

New poll to your right or here: How often do you read or send work-related email and messages on evenings and weekends?


Webinars

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


Acquisitions, Funding, Business, and Stock

IBM Chairman and CEO Arvind Krishna tells attendees at a stock market analyst conference that the company sold Watson Health to Francisco Partners for $1 billion in January because IBM just didn’t have the domain expertise to keep the product viable in healthcare. The company is now focused on developing Watson’s AI capabilities for automated order-taking at fast-food chains and IT operational efficiencies.


Sales

  • The Pennsylvania Department of Human Services awards Cognosante a $16 million contract to migrate the state’s Patient and Provider Network and Public Health Gateway to a new HIE platform the company will also help to develop.

People

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First Databank hires Any Comeau (Greensea Systems) as SVP of sales and marketing.

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Mobile Heartbeat names Annabaker Garber, RN, PhD chief clinical officer.

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Matthew Grose (Optum) joins Ōmcare as CTO.

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Thomas Bartiromo (Children’s Hospital of Philadelphia) joins Tower Health (PA) as VP/CTO.

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Doctivity promotes Cathryn Connolley-Kluck to president and Haili Coombe to VP of client engagement and software product innovation.


Announcements and Implementations

Carilion Clinic (VA) integrates TytoCare’s telemedicine software and devices into its virtual care program.


Other

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In Canada, Hamilton Health Sciences employees celebrate the seven-hospital system’s Epic go-live.

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A recent study from Net Health company Focus on Therapeutic Outcomes finds that 82% of physical therapy patients with low back pain who received rehabilitation via telemedicine during the pandemic were very satisfied with their treatment results. Outcomes were found to be equally effective and visits as efficient as in-office appointments.


Sponsor Updates

  • EVisit wins a silver Digital Health Award in the connected digital health: telehealth/RPM category.
  • Black Book Research announces that Netsmart has earned the 2022 award for highest customer satisfaction in its annual client experience performance ratings for enterprise behavioral health EHR vendors.
  • Everbridge joins the AWS Independent Software Vendor Accelerate program.
  • FDB names Patrick Mulry customer success manager.
  • Nordic posts a video titled “The Impact of Cloud on Patient Care.”
  • Healthwise wins a merit Digital Health Award in the digital health media/publications: video category.
  • Imprivata wins three awards from Cyber Defense Magazine in the categories of most comprehensive identity and access management, next gen identity security, and market leader privileged access management.
  • The Empowered Patient Podcast features Medicomp Systems CEO Dave Lareau.
  • NTT Data publishes a new case study showcasing how its solutions have improved Independent Health’s IT experience for employees and transforms its infrastructure services.
  • Symplr partners with human resources analytics company Visier to develop healthcare workforce analytics to help organizations more effectively recruit, hire, and retain staff.

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Morning Headlines 6/10/22

June 9, 2022 Headlines No Comments

Oracle’s Ellison Pitches US Health Database With Power of Cerner

Oracle board chairman and CTO Larry Ellison shares the company’s plans for newly-acquired Cerner including developing a national system of anonymized digital health records and updating Millenium with voice interface, more telehealth features, and disease-based AI models.

Northside Hospital fined more than $1 million for failing to publish medical prices

CMS issues the first civil money penalties against hospitals that failed to comply with federal price transparency laws, with Georgia’s Northside Hospital system fined more than $1 million.

H1 secures an extension on its Series C to further its mission of creating a healthier future through the use of connected and accessible healthcare data

Clinical, scientific, and research data company H1 adds funding to its Series C investment, bringing the round’s total to $123 million.

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