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EPtalk by Dr. Jayne 11/10/22

November 10, 2022 Dr. Jayne 1 Comment

I’m glad to see healthcare delivery organizations putting their proverbial feet down when it comes to patients treating staff poorly. Mass General Brigham is one of the more visible examples, as they release their patient code of conduct. The policy has zero tolerance for “words or actions that are disrespectful, racist, discriminatory, hostile, or harassing.” Patients can be asked to seek future non-emergency care elsewhere if they are found to exhibit a list of behaviors, including sexual or vulgar words or actions. Disrupting another patient’s care or experience is also on the list. Patients who violate the code will be asked to explain their point of view prior to decisions being made about future care at the institution.


Next week’s HLTH conference will include the “Patients at HLTH Impact Program,” which has been designed so that patients and patient advocates can be engaged as “equal partners in care design.” The track offers opportunities for health tech leaders to interact with patients. Since nearly every employee of every organization in the US has been a patient at some point in their lives, I’d suggest that execs don’t need to go far or to spend money on conferences to get input. One of the panels being offered is around “What do digitally-savvy, empowered consumers want?” and although that is certainly valuable, we need to not overlook the non-digitally savvy and non-empowered patients who might need our help even more than the other group. I’d like to see health tech execs troll the waiting rooms and cafeterias of any hospital in the US. They would certainly get an earful, and it would be cheaper than a trip to Las Vegas.

Addressing physician burnout is always a hot topic, so I was interested to see this piece from the American Medical Association on helping physicians reduce “pajama time” and have “more great days.” For those who might not have heard the term, pajama time refers to the time that physicians (and sometimes other clinicians) spend working outside of normal working hours. Although a lot of people think this phenomenon started when EHRs became more common, it definitely happened in the paper world. In my early days as a physician, I had a couple of colleagues who were constantly being reprimanded for taking charts home and sometimes forgetting to return them to the office. However, I was disappointed to see the suggestions made in the article. They’re not at all revolutionary:

  • For medication refills, a recommendation was made to renew maintenance medications at the annual visit and to provide the maximum number of refills. This was standard of care in family medicine in the 1990s and appears several times in the literature, yet physicians still can’t incorporate it into their practices. I heard the best description of this workflow at CHIME this week, when UCHealth CMIO CT Lin referred to it as “90 by 4, don’t bother me no more” meaning that patients should receive 90-day prescriptions for their medications with four refills, enough to get them through their next annual appointment. It doesn’t apply to just primary care — anyone performing chronic care can do this and EHR preference lists or favorites make it easy.
  • A physician was frustrated by having to walk to the printer to grab after visit summaries to hand to patients, so they installed printers in each exam room. Why are these not being sent through a patient portal for those who have accounts, so that they can become enduring materials accessible to the patient forever versus a piece of paper that can be lost? If the patient isn’t enrolled in a patient portal, why not have a medical assistant or checkout person print them?

I’ve spent a good portion of my professional life helping organizations address policy and procedure issues. Sometimes it’s a gap and new policies and procedures are needed, while other times there are changes needed to keep up with advances in EHR use, medical group governance, office practices, and more. Policies can be a blessing or a curse depending on what they contain, and the latter is addressed in a recent piece in JAMA Health Forum. The authors address the idea of harmful hospital policies and propose that they should be classified along with other “Never Events” such as wrong-side surgery. The authors list five particularly harmful policies:

  • Aggressively pursuing payment from patients who are unable to afford their medical bills.
  • Spending less on community benefits, such as public health or indigent care, than what is earned through tax breaks due to non-profit status.
  • Noncompliance with federal requirements to be transparent about cost of care,
  • Paying employees less than a living wage.
  • Delivering racially segregated medical care by underserving surrounding communities of color.

They note that other entities, such as insurance companies and medical device makers, are also responsible for harms, but find that given the fact that the majority of hospitals exhibit at least one of the above behaviors, that hospital-associated harms should be addressed in a priority fashion. In addition to calling on hospital leaders to address them directly, they call on the Centers for Medicare and Medicaid Services to deny payments to hospitals engaged in these practices. They also call on state legislatures to require reporting in these areas and state attorneys general to investigate hospitals that are taking advantage of their non-profit status. The article is a quick read and should be mandatory for leaders of healthcare organizations.

Michigan Medicine has fallen victim to a phishing scheme that may have compromised the information of 33,000 patients. The health system learned of the attacks in August, but some patients didn’t receive the breach notification until more than two months later. At least four employees provided credentials that allowed hackers to access their email accounts. I feel for the employees who apparently disregarded their cybersecurity training, for the IT teams that had to investigate and work on the cleanup, and of course for the patients whose information was compromised by individuals who can’t follow the rules.

I feel like I’m fighting a battle on two fronts with email volume right now. At work, I’m getting multiple daily emails from HLTH which don’t always go to their designated folder since I was forced to take a recent Outlook update. In my personal email, I’m inundated with pre-Black Friday emails from retailers. I guess now that the Christmas shopping season actually begins before Halloween, it makes sense for Black Friday to begin November 1. I’d love to see the data on how various retail trends have changed over the years and see what the migration of the start dates for shopping seasons looks like. I’m sure there are big data folks in retail and marketing, so if someone has a connection to the data, maybe you can hook a girl up.

What do you think about the increasingly early start for holiday shopping? Leave a comment or email me.

Email Dr. Jayne.

HIStalk’s Guide to HLTH 2022

November 10, 2022 News No Comments

Bamboo Health


Booth #2030

Contact: Alison Matthiessen, senior communications manager

Billions of dollars are wasted in healthcare services each year due to poorly coordinated care and lack of real-time patient insights. This is fueling the disconnect among physical health, behavioral health, and social care, which has led to an ever-widening gap in health disparity and the rapidly growing behavioral health epidemic. At HLTH, Bamboo Health will unveil several new solutions aimed at better supporting providers and payers to meet their goals for connecting the care continuum and value-based care initiatives. Through its suite of solutions, Bamboo Health delivers distilled and specific insights at the high-value care moments that matter, ushering in a new era of insights and analytics to bridge the gap in health equity, improve both clinical and financial outcomes, and make whole person care a reality. Bamboo Health will also lead discussions on how to reduce the fragmentation and friction that plague healthcare and prevent the desired results of improved outcomes, better experiences and lower costs.

Bamboo Health events at HLTH include an executive fireside chat titled, “988: Opportunity for Equitable Behavioral Health Access?” on Monday, Nov. 14, from 11:50 AM – 12:10 PM PST. Dr. Nishi Rawat, Bamboo’s Chief Clinical Officer will moderate the discussion featuring Madhuri Jha, LCSW, MPH, director at Kennedy-Satcher Center for Mental Health Equity and Morehouse School of Medicine, and Brandon J. Johnson, MHS, MCHES, public health advisor at the Substance Abuse and Mental Health Services Administration (SAMHSA) and Center for Mental Health Services. Together, they will discuss the challenges associated with the 988 Suicide and Crisis Lifeline in terms of an equitable response for all, including varied resources, awareness and stigma. The chat will also explore ways 988 has opened behavioral health access and what remains a challenge for the initiative regarding health equity. Those wishing to continue the conversation are invited to Bamboo Health’s Grove Theatre in booth #2030 from 12:15-12:45 p.m. PST. 

Bamboo Health is a finalist in the Mental and Behavioral Health Best in Class category for the UCSF Digital Health Awards, which recognize the achievements of innovative health technology companies dramatically improving healthcare. Bamboo Health’s executive team will be in attendance at the awards ceremony on the evening of Nov. 14 at 6:00 p.m. PST at the Zouk Nightclub in Resorts World in Las Vegas to see the winners crowned. Find out more at:



Contact: Chris Logan, chief security officer

Censinet’s SVP and Chief Security Officer Chris Logan will be in attendance, and in conjunction with KLAS Research representatives, will be giving out “Cybersecurity Transparent” awards to vendors at HLTH. The “Cybersecurity Transparent” designation represents vendors who have demonstrated meaningful cybersecurity program maturity, cyber preparedness, and an ongoing intention to communicate cyber risk posture to providers and payers looking for Best in KLAS solutions.

Get-to-Market Health


Contact: Steve Shihadeh, CEO and Founder

The continued pace of transformation in healthcare creates enormous pressure on technology companies to adapt and deliver clear value. Get-to-Market Health (GTMH) was formed to address this challenge. Whether a company has taken in a new round of investment and needs to accelerate its top line growth or is bringing new products to market, GTMH helps healthcare technology leaders’ market, sell and create sustainable, long-term relationships with their customers.



Meeting Pod 43

Contact: Nate Smith, Partner Solutions, Digital Health & Emerging Markets

Healthwise has set the standard for health education since 1975. Nonprofit and independent, Healthwise is a trusted resource for health information, technology, and services that help people make better decisions and improve health outcomes. Interactive tools, videos, and content integrate seamlessly into any workflow or application, adding value to your digital health solution while providing consumers the information they need to live healthier lives.



Viosk/Booth #V-3359

Contact: Todd Fane

Lumeon believes that care better coordinated is care better delivered. Lumeon is a digital health company that provides a cloud-based care orchestration platform that automates the tasks, workflow, activities, and events that occur during the process of coordinating care. With real-time, bi-directional data/system integration and the dynamic application of clinical intelligence and automation, Lumeon ensures that each patient receives the right care at the right time –every time. By automating care coordination, care teams deliver care faster, more efficiently, effectively, and consistently across the continuum of care, while also empowering clinicians and staff to work at the tops of their licenses and spend time with patients that need it most.



Booth #2609

Contact: Drew Ivan, chief strategy officer

Lyniate delivers secure, proven, and flexible interoperability solutions. As your trusted partner, Lyniate powers the applications and workflows that improve clinical, operational, and financial outcomes today while helping you understand, prepare for, and influence changes on the horizon. Foundational offerings, Lyniate Rhapsody and Lyniate Corepoint, are in use by healthcare teams around the world.



Booth #1418; Meeting Rooms 364 and 366

Contact: Lisa Esch, SVP strategy and industry solutions

NTT DATA is a title sponsor for HLTH 2022. Visit booth #1418 to learn how we’re humanizing the digital healthcare experience with a data-driven approach.

Join our sessions:

  • Health Equity Impact Session: Going Digital: Technology Is Only One Piece of the Puzzle 11:40 a.m. Tuesday, Nov. 15 on the Impact Stage Lisa Esch (NTT DATA) and Kelly Nye (HCA Healthcare)
  • Tech Talk Session: Business-Led Innovation: NTT DATA and Snowflake’s Health Plan Price Transparency Tool 10:35 a.m. Monday, Nov. 14 on the Tech Talk Stage Tamara Villalon (NTT DATA) and Patrick Kovalik (Snowflake)
  • Tech Talk Session: How to Beat Ransomware 10:50 a.m. Tuesday, Nov. 15 on the Tech Talk Stage Jack Buxbaum (NTT DATA)

Watch our demonstrations:

Each day of the event you’ll find informative demos in the NTT DATA booth, including: Hospital at Home, Sepsis Workflow Management, Advocate AI, Patient Experience, Medical Cost Manager (Payment Integrity), AI for Chronic Disease Prediction, Health Data Bank powered by Snowflake, Giving Back.

A healthy planet is fundamental to a healthy society, and we’re partnering with One Tree Planted to plant 2,000 trees on behalf of HLTH attendees! Stop by our booth (#1418) and choose where to plant your tree to support reforestation efforts around the globe.



Booth #V-4845

Contact: Maria Cipicchio, SVP of marketing

OptimizeRx helps people start and stay on life-impacting therapies. Our end-to-end technology platform allows life science companies to support the full care journey – from increased brand awareness, to streamlined market access, to ongoing patient adherence – by connecting providers and patients to treatment information and support at the moments it’s needed most. Our network of 300+ EHR partners provides life science brands with access to 700K+ HCPs, representing 60% of US healthcare providers and 90% of hospital systems. Only OptimizeRx uses patent-pending artificial intelligence and real-word data to deliver more relevant, actionable information, while offering true omnichannel reach within the EHR, online and beyond hospital system firewalls, and across social networks. Visit to learn more, or to connect with a member of our team.

Synapse Medicine


Booth # 4651

Contact: Ingrid Graff-Cailleaud, US market contact
+33 6 63 57 36 34

Synapse Medicine is a provider of data-driven clinical decision support that optimizes drug regimens along the entire patient care journey, from prescribing through adherence, for a safer, more effective and efficient path to medication success. At HLTH 2022, Synapse Medicine is hosting a special Boothside Chat—The Future of EHR Integration—with guest, Brendan Keeler, Head of Product, Flexpa. Champagne & Lite Bites will be served. Be sure to sign up to reserve your spot. Tuesday, November 15 at 12:30 p.m.



Booth #452

Contact: Kevin Kutz, vice president of external relations

Tegria provides consulting and technology services to help organizations of all sizes humanize each healthcare experience. We are more than 4,000 colleagues throughout the United States and internationally who help customers maximize technology, transform operations, improve financials and optimize care. We maintain partnerships with a wide range of technology leaders, including Microsoft, 3Cloud and ServiceNow. Learn more at Visit us at Booth 452 and we’ll donate $5 for every badge swipe to the National Diaper Bank Network, up to $5,000. Please help us spend it all and learn more about how meeting basic needs for young families contributes to health equity. Mark your schedules for Monday 11:25 – 11:45 at the Impact Pavilion for Theresa Demeter’s fireside chat with Leon Caldwell, PhD, senior director for health equity strategies and innovation for the American Hospital Association.

Morning Headlines 11/10/22

November 9, 2022 Headlines No Comments

Hackers Are Posting Australian Health Insurance Data on the Dark Web

Hackers begin publishing patient data stolen from Australian company Medibank after the insurance company refused to pay the requested ransom.

CitiusTech Acquires Wilco Source, Expands Specialized Salesforce Capabilities for Healthcare & Life Sciences

Healthcare technology and consulting firm CitiusTech acquires California-based Wilco Source, which offers Salesforce consulting and implementation for healthcare and life sciences companies.

Fathom Secures $46M Series B Financing

Medical coding automation vendor Fathom raises $46 million in a Series B funding round.

HIStalk Interviews Douglas Fridsma, MD, CMIO, Datavant

November 9, 2022 Interviews 4 Comments

Douglas Fridsma, MD, PhD is chief medical informatics officer of Datavant of San Francisco, CA.


Tell me about yourself and the company.

I’m the chief medical informatics officer at Datavant. Before that, I was president and CEO of the American Medical Informatics Association. Before that, I was the chief science officer at the Office of the National Coordinator for Health IT during the Meaningful Use era, as we were trying to get electronic health record adoption.

A lot of the work I did at ONC was to set up the basic infrastructure for collecting data. The goal, for many of us who were working on these projects, was to make sure that once we collected the data, we would get rid of the lazy data. That is data that would  get collected and then just sit there and not be used for population health, a learning healthcare system, or those sorts of things. That’s my history and where I come from — let’s figure out ways to make data useful for patient care and for healthcare delivery.

Describe how tokenization is performed and how the information that it enables is being used in healthcare.

A lot of data out there is fragmented. If you were to try to get your medical record, you’ve got bits of your information that might be in a claims record, some of it might be in a specialty pharmacy, and some of it might be with your primary care doctor or within a hospital in which you were seen in the emergency room. The problem is that when data is distributed like that, it’s hard to bring it all together into a longitudinal view of that particular patient’s experience in the healthcare system.

If you want to link a record from one hospital to another hospital, you have to have some kind of identifiable information. But if you are using the data for research purposes, HIPAA doesn’t allow us to release that kind of information without lots and lots of safeguards, IRB approvals, and things like that.

It is possible to strip out all of the identifiable information from the medical record — eliminating names, genders, changing birth dates from a month and date to just a year, removing addresses, maybe abstracting ZIP codes to a higher level. Datavant strips out that information and replaces it with an irreversible hash that we call a token. It’s like baking a cake — you cannot go back and get back to the original ingredients. This hash is derived from a lot of that personally identifiable information, but that hash has nothing that would point that back to the original person.

Datavant allows people to de-identify their data within each of their organizations. Then we have the ability to link that data back together without ever revealing a person’s name, Social Security number, or phone number. Using these tokens allows data to  move in ways that protect patient privacy and that reduce the risk of re-identification.

How reliably can the process generate a token that correctly matches the same patient across multiple data sets?

We did a lot of work when I was at ONC on trying to make sure that we could optimize patient match. Patient match is determined by three things — the algorithm that you use; the kind of data that you use, whether you’re doing it based on a phone number or a name or something like that; and the quality of the data. Probably the biggest impact is making sure that you have high-quality data that can then go through this process to generate the tokens. We work with organizations to make sure that their addresses, for example, conform to the US Postal Service standards.

With high-quality data and the algorithms that we use to generate these tokens, our metrics can be very high. It can be almost comparable to what you would get if you had a Social Security number, the name, or all of the identifiable information. It’s quite comparable as long as you’ve gone through the process of making sure that you’ve cleaned up the data and made sure that it’s accurate and an accurate reflection of the patient’s record.

Does that raise the same challenges as in interoperability, where matching data from multiple systems then brings up the new issue of semantic interoperability, where systems represent the same data concepts differently?

You raise a really important point. Datavant can link two records together and do it in a reliable way while protecting a patient’s privacy. But suppose you have one record that has all of the diagnoses in an ICD-10 code and another one that has all the diagnoses in a SNOMED code. You’ve linked the records together and you know that it’s the same patient, but now you have semantic incompatibility between a record that was collected in ICD-10 code and another one that was collected in a SNOMED code.

That’s not part of the problem that Datavant solves. We do find, though, that in the work that the NIH has done with the N3C — the National COVID Cohort Collaborative – before they run data from everybody who is contributing data through the tokenization engine, they normalize the data to an information model that consistently represents diagnoses and consistently represents things like vaccination status or other things like that. Often you can normalize the data and make it semantically consistent at each one of those sites, and then when you combine them, that data flows together much more easily.

There are ways to do it after the fact, after you’ve done the linkages, because now you might have two records that are inconsistent. The National Library of Medicine and others have ways that you can transform, say, one code into a different code to make that happen. The issue that you raise around semantic interoperability is a critical one, but it isn’t one that is solved by the process of tokenization.

Life sciences, public health and particularly COVID research, and real-world evidence would seem to be good use cases. What opportunities and users do you see for tokenization?

Let me break that down into a couple of use cases that you mentioned and give you some examples of that.

One example that you mentioned was around COVID. We as a country were trying to understand COVID and who got vaccinated, and if they were vaccinated, what their outcome was compared to people who were not vaccinated. The challenge that we had is that people had their vaccinations done at the public health agencies, their primary care provider, or CVS and Walgreens. Their hospitalization or their care might be in an outpatient clinic, the emergency room, or in a hospital setting. The problem was this fragmentation issue. The only way to understand who got vaccinated, who got infected, and who got long COVID was to link together all these different data sources. It’s a tremendously complicated thing to do, particularly because you have to have identifiable information to be able to link, say, your pharmacy record with your emergency room record.

We worked with the NIH to create tokens across this ecosystem from pharmacy, public health, and most of the major medical research institutions in the country that were part of a research program at NIH. That allowed us to pull together all the data and then create data sets that basically said, here are the folks who got vaccinated. Here are the folks who got hospitalized. Here are the people who had long-term complications related to that. That has provided a lot of rich research for the folks at the NIH who are doing that.

We see other use cases in life sciences. When pharmaceutical companies want to do a clinical trial, they get consent to collect information as part of participation in a clinical study. They have identifiable information that they use for that study. But it’s important for drug safety to be able to monitor patients after they have left a clinical study to see if they have long-term follow-up or other things that may happen as part of their participation. That can be tremendously expensive. Those are called Phase 4 clinical studies.

We have found that a lot of life sciences companies are getting permission to tokenize the information of those patients and their record. Then they can find that patient at a population level — not at an individual level, but at a population level — to identify cohorts of patients that might, say, have an increase in their cancer risk. O they may find that their five-year follow-up was fine, but their 10-year follow-up might be more challenging. That has been tremendously valuable within real-world evidence and using that for clinical studies in the life sciences. By creating those tokens as part of that process, they are able to do a lot more of the Phase 4 studies, which are expensive and they take a long time, but to do those efficiently by using this real-world data and being able to collect it directly.

As this becomes increasingly relevant, we are finding that a lot of hospitals and providers are starting to see de-identified data as not just a nice-to-have, but part of a strategic approach to how they use data. For example, within a large-scale academic medical center, there are hospitals that will de-identify and tokenize these very large data sets, and they’ll have them within their institution. They provide the ability to link that data together and reduce the risk of breaches, reduce the risk of other problems, because the data has already been de-identified and can then be used for research purposes.

Other hospitals are taking a look and using de-identification to enhance the data that they already have. They might create tokens within their hospital, but use that as a way of drawing in other data, matching it into their population, and being able to do a richer analysis at a population health level because they have augmented the data with mortality data or with social determinants of health data that allows them to get a better picture of their population. Again, not to the individual patient level, but at that population level.

Many of the providers are using this data to participate in some of these clinical studies, to be able to take their data, de-identify it, and then make it accessible to life science companies and to people who are doing research in a way that is respectful of the patient’s privacy and that prevents that lazy data. They are able to have the data that has been collected as part of their provision of care and make it be useful for other purposes that advance our understanding of how to deliver better health and healthcare.

Could tokenization be used by an EHR or other system to de-link a patient’s identity from their detailed information so that if a hacker exfiltrated their entire database, they still couldn’t connect a patient’s identity to their data?

This whole notion of being able to take two data sets potentially that have been tokenized and not be able to link them together is a fundamental part of the Datavant technology. We have probably 100 billion records and 300 million covered lives that have been tokenized using the Datavant technology. Should someone inadvertently get a copy of, say, one hospital’s tokenized data and the records from another hospital’s tokenized data, our system creates different tokens for each of those sites so that it’s impossible, even if someone were to get that information, to be able to link it together and potentially re-identify a particular patient.

If you had a list of everybody’s name, and you tokenize that and then use that to link to other data sources, as soon as you got a link, you’d say, “I know the name of this person.” We don’t allow those kinds of linkages to occur except under strict review. We also do other reviews to make sure that, even after you’ve linked the data, it is no longer re-identifiable. That’s a fundamental piece of the puzzle.

To your second point, how does an organization reduce their liability or risk if somebody were to breach their system and get access to this data? Obviously, if you have lots and lots of research data sets that are lying around that have identifiable information, the more identifiable information you have, the greater the risk. If, however, you have those data sets that have been de-identified, but it’s still possible to link them together even within your own institution, there are organizations that use that as a way of helping mitigate the risk around research data and still make it useful to people, because it’s not as if you’ve de-identified it and now it can only be used for one purpose. You can de-identify it, but by making sure you’ve got those tokens, you can still then reassemble different kinds of data sets for different purposes as long as you’re being very careful that the risk of re-identification remains low.

If FDA receives tokenized data that requires urgent follow-up with individual patients, would it be possible for them to go back to the contributing source?

If it’s your data, if you’re a provider and you have data within your electronic health record, you can maintain a look-up table that will have the patient’s identity, your medical record number perhaps, and the token assigned to that as well. But that would be something that an individual hospital would maintain and it would never become public knowledge. So the short answer to your question is, absolutely, if the FDA said, “There’s a safety concern, and we’ve identified within this population that there are specific patients that we need to reach out to,” you can go back to the contributing hospitals and you can ask them that question – “We have some folks, here are their tokens, can you help us identify who they are?” If that organization has maintained that look-up table, then yes, we can get back to those things for those safety needs that the FDA or others might have. That look-up is not something that Datavant does. That would be something that would be within the purview of the owners of the data.

Is there a consistent de-identification method that is being used by all these companies, EHR vendors, and even providers themselves who are selling de-identified patient data?

We take maintaining the de-identification of the data pretty seriously. We provide the ability to remove the PHI and to add in the tokens. But you can imagine, you might have one dataset that is perfectly de-identified and another dataset that is perfectly de-identified, but when you combine them, you increase the risk of re-identification.

Suppose the first dataset has specific diagnostic information and the second dataset has specific geographic information. You combine those two and you might say, we have a geographic area in which there’s only a single diagnosis of this particular disease. That becomes highly re-identifiable if somebody connects some of the dots. De-identification, in and of itself, doesn’t necessarily mean that it can’t be re-identified when combined.

For folks who have complex data or complex linkages, we always recommend expert determination, which is a statistical approach to analyzing the risk of re-identification. You can run a series of algorithms across the dataset that can tell you that you have too much geographic specificity or diagnostic specificity. Given the kind of study that you’re trying to do, maybe we need to aggregate this at a less granular geographic area so that you can still ask the questions that you want about the details of a particular diagnosis. That expert determination is a way of assuring, even if the data has been de-identified or linked to other data sources, that you remain compliant and that the risk of re-identification remains low with those datasets.

What kind of expert performs the expert determination?

There aren’t a lot of rules out there around this. A provision within HIPAA says that expert determination is the statistical approach that has a low-to-no risk of re-identification. Typically, you have academicians who are doing expert determination. It’s really about controlling the release of information in a way that has statistical controls around it. There are companies that do this.

Within Datavant, we have a firewalled relationship with a company, Mirador Analytics, that does this expert determination. They work essentially independently when it comes to the expert determination effect. But it’s offered as a service so that people who are doing this tokenization and then linking have the ability to then, in an efficient manner, determine whether there is a risk of re-identification. There’s a whole host of folks that are out there, from academicians that have a shingle and they do a good job of this, to an organization like Datavant that provides that as a service to folks who use our tokens.

You’ve seen healthcare grow data-rich going back to your days working on Meaningful Use. What issues remain on the table for using the wealth of data that is suddenly available?

The Institute of Medicine had a series of articles going back 10 or 15 years — I think it predates some of Meaningful Use work I did at ONC and has has continued since then – describing this notion of the learning healthcare system. To me, that is a societal goal that I would love to see, where every interaction that a patient has with our healthcare system becomes an opportunity to learn how to take care of the next patient, and the next patient after that, in a better way.

There’s a whole host of problems that we have to overcome to get there. One of them that Datavant is addressing is that when your data gets fragmented and you want to get that longitudinal record, is there a way you can do that that preserves a patient’s privacy?

We have got lots and lots of regulatory frameworks in which your data is used. If you are a student and download your student healthcare record, combine it with your electronic health record information, download it to your Apple Watch, and then use that information on your Apple Watch to support a clinical trial, you will have traversed five different regulatory frameworks. People tend to think that if it’s health data, it must be covered by HIPAA, and that’s not the case. For the data that is in an app or that is part of a commercial venture, it’s that 80 pages of stuff that you just scroll through and you click OK because you want to be able to use the app that defines what they can do with your data. One of the things that we’re going to have to address is getting a consistent way in which we address privacy.

The last thing I’ll say about that is that because there is this notion and there are some concerns that data that is outside of the healthcare environment may need some additional protections that the FTC or that Common Rule or whatever doesn’t necessarily cover, we are seeing a lot of states that are starting to come up with their own privacy rules about how health data gets managed. We run the risk of having inconsistent definitions of what de-identification and expert determination is, and that’s going to create a tremendous burden on the industry and it’s going to create potential holes in which patients’ privacy could be otherwise compromised.

As we begin to solve these technical problems, there becomes other kinds of problems that come up. Keeping consistency across all of the different states, as well as integrating the different frameworks that we have, even at the federal level, becomes important, because if we’re going to use data in this learning healthcare system, we need to have consistent, reliable, and effective means of making sure that patients’ privacy is protected and done in a consistent way.

Readers Write: How CMS Can Build a National Directory of Healthcare Providers

November 9, 2022 Readers Write No Comments

How CMS Can Build a National Directory of Healthcare Providers
By Justin Sims

Justin Sims is president and chief operating officer of CareMesh of Reston, VA.


Four weeks ago, CMS issued a Request For Information (RFI) to collect feedback on whether it should build a national directory of healthcare providers and services. They highlighted the problems the lack of quality provider information causes for consumers and the industry and asked for feedback on solving those problems.

But doesn’t CMS already have a provider directory?

NPPES is the closest thing that CMS has to a directory. It is used to issue ID numbers to healthcare professionals (NPIs) and covers almost all physicians (about a million) and many other healthcare workers (about five million). However, it suffers from infrequent update (the average age of an entry is 6.7 years old) and has gaps in the information it collects (it lists only 200k validated secure email addresses when there are well over a million).

There is also the Medicare Provider Enrollment, Chain, and Ownership System (PECOS). This is routinely updated by physicians every five years, so it is a little more current, but because it focuses on Medicare enrollment, it doesn’t cover all physicians and doesn’t collect the same information as NPPES.

Why hasn’t the problem already been fixed? In the words of Tom Hanks in “A League of Their Own,” if it wasn’t hard, everyone would do it.

There are several reasons that a single national provider directory has eluded us.

First, there’s scale. Maintaining information on a million of anything is hard.

Second, there’s the structure. Physicians often work for multiple organizations and keep a fluid list of physical locations with different contact information at each one.

Third, there’s content. Do you, for example, know your EIN? And how many physicians do you think know their Direct Address? (Not a lot!) Or their EHR end-points? (Even fewer.) Or can readily list the insurance carriers they accept at each organization and location? Not to mention that providers and their staff are busy.

If CMS is going to take this challenge on, and we hope that they do, we see four broad options:

Provider-Supplied Data

There are already regulations to encourage providers to submit information updates to NPPES and PECOS within 30 days. These rules have some teeth. For example, providers can be suspended from the Medicaid program if they don’t comply. As part of their strategy, CMS could certainly make it easier for providers and their staff to make updates and could increase penalties for those who don’t. But asking a million physicians and a further five million healthcare professionals to update their information manually will be a tough strategy to deliver success.

System-Supplied Data

In most cases, basic profile information about providers is maintained in the EHR. Another strategy that CMS might consider is to modify its Certification of Electronic Health Record Technology (CEHRT) standards and establish a process for EHRs to send directory information electronically using HL7 FHIR standards. While this would only cover EHR users, it would account for almost every prescriber in the country, and done right, it could reduce physician burden and result in continuously updated information, at least for some.

Combine Multiple Data Sources

While the EHR concept sounds promising, it would take some years to implement and a few more to iron out the wrinkles. Another approach that CMS might follow is to combine data from many sources. In addition to CMS data sources, there are many others, including state Medicaid agencies, medical licensing boards, Medicare Advantage plans, Medicaid MCOs, Qualified Health Plans, DirectTrust, and health system and provider group websites (many of which follow the standard), to name but a few.

By combining all of these sources and using statistical techniques to validate the data, CMS could create a more accurate picture of the provider than any single source alone. Minimally, it could use these techniques to identify where data quality issues may exist and then follow up with the provider.

Help Industry Solve the Problem

Finally, CMS could do more to help the industry solve the problem. Several companies, ours included, are already doing a combination of the above. But it would be much easier if CMS standardized its data (in NPPES and PECOS) and modified regulations to ensure that health plans, in particular, shared their information in a standardized electronic format.

For a problem as old as the US healthcare industry — states gained the right to regulate health and license doctors in the Bill of Rights in 1791 — we doubt that CMS will solve this overnight. But it is a challenge that most segments of the healthcare industry are cheering for, and one for which the ultimate solution will lie in a combination of the options described above.

Readers Write: Reversing RCM Brain Drain and Creating Revenue Cycle’s Digital Twin

November 9, 2022 Readers Write No Comments

Reversing RCM Brain Drain and Creating Revenue Cycle’s Digital Twin
By Jim Dumond

Jim Dumond, MS is senior product manager at VisiQuate of Santa Rosa, CA,


Across all industries, the need to retain knowledge of key processes and details has gained new emphasis as the labor supply has tightened and grown more expensive. In the revenue cycle space, health systems are competing against not only each other, but other industries to retain talent and ensure that their organizations run smoothly. The loss of seasoned RCM professionals is creating a knowledge gap or “brain drain,” which makes it harder for systems to keep their businesses moving, let alone do so efficiently.

As result, the question these organizations must answer is: how do we guard against this loss of RCM knowledge by having robust, prescriptive workflow systems in place that direct employees what to do, when to do it, and how to do it based on predictive analytics that mine data to suggest actions that successfully have solved the same issues in the past?

Health systems today are primarily reliant on their human “tribes” of users to pass key knowledge about specific payer processes, required details, and thousands of other minutiae. This has created a system where users inefficiently share that knowledge via occasional Zoom calls, PowerPoints or job aids, and often emails or hallway conversations (if they are back in the office) that don’t get recorded except in a single brain at a time. That verbal tradition of the health system is what is creating the impact that sites are seeing today as users leave for other systems or careers.

Why not create a centralized database of knowledge for all the activities that move an account through the revenue cycle from scheduling to a zero balance? We live in a proactive world. Amazon and Netflix use a recommendation engine to identify what we should buy or watch next. Why not utilize that same approach for the revenue cycle? Use all the available data and user history to provide specific next best steps help the user efficiently work the account.

Just like Waze takes real-time data from drivers, the recommendation engine could be further enhanced by crowdsourcing, gathering data from revenue cycle shops across the country and getting smarter every day.

A digital twin is a virtual representation of a machine, system, or other complex organism that exists in real life. Think of it like a simulated wind turbine in a computer program. You can run it through different kinds of environmental or mechanical break downs and make real-time design changes without costly real-world experiments.

In other words, digital twins are complete, virtual representations of all the actions and sequences of actions taken by a human agent performing a job. In the revenue cycle world, this means curating and combing through all the data signals that are created by a human worker, as well as signals that are coming from third-party systems like payer remits, to create a perfect representation of what the human is doing to a given encounter record.

Some might say that creating such system is unnecessary. After all, most systems have some form of bot automation. That should solve the problem just as well, right?

Automation and bots can be great for productivity, as once online they work endlessly and never skip a step. But bots have to be methodically crafted to perform specific sets of tasks in a specific order, and they require continual maintenance. Turnover contributes to the problem, when the employees who depart are the ones who developed the business rules for the bot.

The next step then is to start to combine intelligent process automation with the centralized, ever-learning, ever-adapting recommendation engine. That recommendation engine should continuously breadcrumb what a worker is doing and even allow workers to add new recommendations to a knowledge repository. That knowledge repository should be connected to incoming data signals so the engine can show the right knowledge to the right person at the right time for a given piece of work the staff member is doing.

Using the recommendation engine enables the system to visualize the end-to-end revenue cycle process, allowing organizations to see where those recommendations and changes lead to better performance or not. The digital twin provides the data and analytics to help revenue cycle leaders prioritize the right work for their users, determine process inefficiencies, help define where best to apply bots, and help those bots change over time. More efficient revenue cycle operations benefit the organization overall because its focus can be placed on the core mission of delivering exceptional patient care.

Morning Headlines 11/9/22

November 8, 2022 Headlines No Comments

SCP Health Announces Acquisition of Tech-Enabled Patient Engagement Company PreMedex

Clinical staffing and outsourced practice management company SCP Health acquires PreMedex, which offers patient engagement and communication software.

Talkspace Announces Jon Cohen, M.D. As Next Chief Executive Officer

Mental health app vendor Talkspace promotes Jon Cohen, MD to CEO after announcing disappointing Q3 results.

Censinet Announces Healthcare Cybersecurity Benchmarking Study Co-Sponsored by the American Hospital Association and KLAS Research

Censinet, the American Hospital Association, and KLAS Research launch a healthcare cybersecurity benchmarking study that will allow health systems to compare cybersecurity investments, resources, performance, and maturity versus peers.

News 11/9/22

November 8, 2022 News 1 Comment

Top News


Primary care company VillageMD will acquire provider Summit Health for $9 billion.

Walgreens owns a majority stake in VillageMD, having invested over $5.2 billion in the company to co-locate its clinics with Walgreens retail pharmacies. It said earlier this year that 200 of the co-branded practices would open in 2022.

VillageMD will operate nearly 700 primary, specialty, and urgent care facilities in 26 markets once the deal is done.

Summit Health was formed in 2019 by the merger of multispecialty medical group Summit Medical Group and CityMD, which operated urgent care centers in the New York City metro area.

HIStalk Announcements and Requests

Latest LinkedIn peeve — congratulating someone who announces their new job with the ungrammatical “You got this!” that seems to question competence in the manner of “I like you no matter what anyone says.” I can identify, however, since even though I crank out millions of words per year, I still get writer’s block when Mrs. H slides a greeting card my way and expects me to awkwardly dash off heartfelt thoughts, at least until I pester her to just dictate what I should say.


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

Acquisitions, Funding, Business, and Stock


ChristianaCare (DE) launches a Business Health Solutions unit to offer employers direct virtual primary and behavioral health services, destination surgery programs, and COVID-19 vaccination and symptom-monitoring capabilities.

Legacy data archiving company MediQuant acquires Knowledge Based Systems, which offers data access and retrieval solutions for several industries.

NantHealth announces Q3 results: revenue up 16%, adjusted EPS –$0.12 versus –$0.10. NH shares are down 81% over the past 12 months and have shed 98% of their value since their first-day close in June 2016, valuing Patrick Soon-Shiong’s company at $39 million.


  • Thirty-year Meditech customer HCA Healthcare will upgrade its hospitals to Meditech Expanse as its go-forward EHR.
  • MedStar Health in Washington, DC will implement and train Zephyr AI’s predictive analytics Insights software using its T2D de-identified data sets.
  • PainChek, an Australian pain assessment and monitoring app, will use TrakCare HIS and Iris for Health EHR integration software from InterSystems.



Scott Van Houten (Philips) joins Lyniate as VP of sales.


Matt D’Errico, MBA (Joslin Diabetes Center) joins Lawrence General Hospital as CIO.


Extrico Health hires Kevin Dawson, MS (Howard University Hospital) as CIO.


Hiteks Solutions names Judy Cassetty, RN (Iodine Software) as chief clinical officer.

image image

Direct Recruiters promotes Jordan Freireich and Jaimie Bailey to partner.

image image image

Aetion hires Dorothee Bartels, PhD (UCB) as chief digital officer, Jade Cusick (Cerner Enviza) as chief commercial officer, and Jeremy Brody, MS (Cerner Enviza) as chief strategy officer.


Polly Israni, MBA (Google) joins CoverMyMeds as chief marketing officer.


Paul Roscoe (Trinda Health) joins CLEW as CEO.


Definitive Healthcare hires Jon Maack, MBA (Athenahealth) as president.


HCTec promotes Mike Linville to president.


Kathy Ruggiero (Commure) joins Lumeon as VP of marketing.

image image

Lee Rivas, MBA will become CEO of R1 RCM on January 1, 2023, replacing Joe Flanagan. John Sparby will replace Rivas as president. Rivas is a West Point graduate and former US Army captain.


Chris Baker (Experian Health) joins Doceree as VP of business development for health systems.

Announcements and Implementations

Censinet, the American Hospital Association, and KLAS Research launch a healthcare cybersecurity benchmarking study that will allow health systems to compare cybersecurity investments, resources, performance, and maturity versus peers.


In Alberta, Canada, Foothills Medical Centre and its associated clinics go live on Epic as part of a province-wide Connect Care rollout set to conclude in 2024.

Healthcare AI and voice vendor Care Angel will partner with senior living company Upside to offer insurers a social determinants of health risk assessment and housing intervention solution.

CCS, which offers clinical solutions and home-delivered medical supplies for people with chronic conditions, adds a gestational diabetes management program that includes remote blood glucose monitoring and clinical coaching.

Epic announces that the country’s six largest health plans, along with 250 health systems, are participating in its Payer Platform.


A new KLAS report on PACS finds that 30% of organizations could replace their vendor due to vendor acquisitions and replacement of legacy systems. Sectra continues to lead the market despite a customer-observed slippage in its high support quality, while Fujifilm and Merative are showing signs of overall improvement in bucking the industry trend. Intelerad customers note worsening support as the vendor makes acquisitions, while Change Healthcare’s are unsure of the product’s future following the company’s acquisition by UnitedHealth Group. GE Healthcare has the most vulnerable customer base because of disengaged relationships.

Government and Politics


Clinical and IT staff at Fox Army Health Center (AL) are working through several issues that are associated with the facility’s September rollout of MHS Genesis, including intermittent access to the cloud-based messaging system and eventual online appointment booking and a backlog of medication requests that have put prescription fulfillment at 72-plus hours.

Attendees of ViVE 2023, March 26-29 in Nashville, can save 35% by registering before Friday at midnight. CHIME and HLTH are expecting the conference to draw 7,500 attendees and 450 exhibitors.


In Canada, the Saskatchewan Health Authority takes its Administrative Information Management System offline after numerous complaints from users related to scheduling and leave requests. AIMS went live last week to replace 82 payroll, human resources, scheduling, and finance systems. Deloitte, Kronos, and Oracle have contributed to the decade-long, $138 million project.

A federal judge denies the three motions filed by former Theranos CEO Elizabeth Holmes in which she requested a new trial, ruling that she was offering no new evidence for her fraud conviction and that a new trial was not likely to lead to her acquittal. She is scheduled for sentencing on November 18.



Ninety-eight percent of hospital management leaders say they have ramped up efforts to employ more outsourcing vendors, according to a Black Book survey of 775 provider organizations. Less than 5% of respondents reported extreme dissatisfaction with current third-party companies.

An AMA survey finds that more physicians are using telehealth and most think it provides patient care advantages, but they have four requirements:

  • The technology must work.
  • They have to be paid properly.
  • Liability insurance coverage and assurances of data privacy and security must be provided.
  • The process must work within existing practice workflows.

Sponsor Updates

  • Bamboo Health will exhibit at the National Association of Medicaid Directors conference November 14-17 in Washington, DC.
  • Oracle Cerner publishes a new client achievement, “Henry Community Health delivers a personalized patient experience with HealtheCRM.”
  • ChartSpan names Askia Sultan sales development representative.
  • Nordic posts a video titled “The Download: Optimizing Performance to Address Labor Shortages.”
  • CHIME awards 18 providers with its Digital Health Most Wired Survey level 10 certification.
  • Ellkay will exhibit at ModMed’s Momentum 2022 conference November 18-20 in Orlando.
  • Sphere company Health IPass joins Azalea Health’s API Marketplace.

Blog Posts


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


Morning Headlines 11/8/22

November 7, 2022 Headlines No Comments

VillageMD Acquires Summit Health-CityMD, Creating One of the Largest Independent Provider Groups in the US

Walgreens-backed primary care company VillageMD will acquire provider Summit Health for $9 billion.

Emocha Health Relaunches as Scene Health to Support Medication Adherence for Each Individual at the Scene of Their Health

Medication adherence vendor Emocha Health rebrands to Scene Health and launches Panorama, an enhanced Directly Observed Therapy program.

ChristianaCare Creates Business Health Solutions to Offer Its Award-Winning Health Care Services to Employers Regionally and Nationally

ChristianaCare’s new Business Health Solutions unit will offer employers direct virtual primary and behavioral health services, destination surgery programs, and COVID-19 vaccination and symptom-monitoring capabilities. 

HIStalk Interviews Clement Goehrs, MD, CEO, Synapse Medicine

November 7, 2022 Interviews No Comments

Clement Goehrs, MD, MSc, MPH is co-founder and CEO of Synapse Medicine of Bordeaux, Nouvelle-Aquitaine, France.


Tell me about yourself and the company.

I’m a public health physician. I have been involved in a lot of research. I was a researcher in biomedical informatics, first in France and then at Stanford University. I returned to Europe, where I co-founded Synapse Medicine with another physician. Synapse is improving medication safety and helping clinicians achieve medication success. We help physicians, pharmacists, nurses, and patients with prescribing, deciding what drugs to take, and how to take them. We provide reliable information on drugs.

How does your offering improve on existing technologies such as as point-of-care drug information, clinical decision support, and order checking?

As a physician and in talking with my colleagues, we were aware of clinical decision support inside the EHR and various resources online. But we came to the conclusion that for a good number of people, it was frustrating to use these tools. They aren’t always up to date, sometimes you have to use several different tools to get your answer, and it can be too time-consuming. As a result, it was not really used. If you ask a pharmacist or physician if they love the clinical decision support tools that they have, such as those found in their EHR, most of them will answer that they don’t use them and aren’t even opening them because there are too many alerts and too many things in the EHR.

We want to improve on that in two ways. The first improvement concerns the content itself, by providing information that is always up to date. We do this using algorithms. It’s using a lot of natural language processing that goes through all the guidelines from the FDA continually, every day and every night. The algorithm processes all the documentation regarding how you should use the drugs and builds a huge knowledge base regarding drugs that is always up to date. The content part ensures that you always have the best-in-class information and that it is always up to date.

The second way that we are trying to improve these tools is by displaying this information in a good way, not just a long list. We have developed software and components are used as standalone products or plugged directly inside the EHR to display drug-drug interactions, side effects, and contraindications in a way that is super easy for the physician or the pharmacist to understand.

How does the EHR integration work?

We are Europe based and we have completed a number of integrations with basically every major EHR. We see a similar context for EHR integration in the US and Europe, where a number of leaders say they want to interoperate with startups, but in reality, we see a lot of resistance. You have to find ways to do deals and motivate them to do their part and do the interoperability work.

We are just entering the US market. We are working with Vanderbilt University Medical Center and Brigham and Women’s Hospital in Boston. We are in the process of integrating with Epic, but for the moment, just inside these two hospitals.

The study description says that pharmacists on rounding teams will use the system. What does that look like and what results do the organizations hope to achieve?

The use case is for very complex patients. Let’s take a patient who is on 15 drugs for several comorbidities. You want to do a complex medication reconciliation. It’s complex because this patient has a regimen of 15 drugs and you want to determine what the best possible medication history is. You need to check for side effects, drug-drug interactions, and contraindications. 

As a pharmacist using our tools, you would log into our app on You are getting all the information on the patient and the medication history from Epic, because there is interoperability. You are going to do first a complex medication reconciliation, where you will have a visual representation of the different sources of information regarding the patient’s current drug regimen.

Let’s say you have one set of information from Surescripts and another set of information from the main caregiver or the nurse. Using the software, you can compare the different sources of truth for this patient’s medication history. As the pharmacist, you’re going to choose which source of truth you want to follow for each drug, and you are going to complete the best possible medication history. Then you are going to go through a complete pharmaceutical analysis. Our tool is going to give you insights regarding drug interactions, managing side effects, and managing contraindications, so that you can write the best possible prescription for this patient at discharge. Lastly, you are going to be able to automatically generate the necessary documentation for the patient and their care team as a record of their treatment, along with any changes that were made and why.

Your website mentions the platform’s use in telehealth. How would those providers use it?

That’s a cool story. Three years ago in Europe, just before COVID-19, there was a growing number of telehealth companies. Basically every single one of them was building their own EHR for their providers. A number of them came to us saying, we want to improve our EHR. We want to have a best-in-class clinical decision support system for prescriptions. We want to improve patient safety inside the EHR.

These were young companies that didn’t have the resources to integrate drug databases and for build the complete system that they needed. We came to the conclusion that we would be able to help them by creating components. It’s not just an API, but rather like an API with a UI on top of that. You write one line of code and you can import them inside your tool.  We created an entire library of components. We have, for example, a drug-drug interaction component, a side effect component, and a number of other front-end prescribing tools.

The value proposition here is for a young telehealth company or a more mature one that wants to improve the EHR for their provider. You can easily integrate this library of components, and in less than one or two days, you can improve the entire clinical decision process for prescribing by adding the components that your prescribers need. That’s how we partner with telehealth companies. In Europe, we are the leader in prescription assistance for telemedicine and telehealth.

Can it support pharmacovigilance and reviewing a patient’s profile for opportunities to de-prescribe?

Our objective is to save as much time as possible for the provider in the case of a 12- or 15-drug regimen. This means also to consider de-prescribing. Our business model is constructed so that we are not incentivized based on the number of prescriptions, because we want to advocate for fewer prescriptions and de-prescribing.

When it comes to pharmacovigilance, we are trying to close the loop . You and I have been talking about prescribing, dispensing drugs, and reconciling medications, so let’s talk about patient information and that last item of pharmacovigilance. In that way, you’re closing the loop for the entire pathway of a drug after commercialization. In terms of pharmacovigilance, we’ve been working with the French FDA on a tool that saves time for the people in charge of assessing side effect reports for their level of severity and classifying the side effects.

This solution is driven by the same technology. It uses natural language processing. It can interpret the side effect reports very efficiently. For example, let’s say a patient says, “I took acetaminophen this morning and then I felt lightheaded.” The tool will understand everything that is reported and will recognize the side effects to make a first assessment of the severity of the case. Subsequently, a pharmacist and a physician can just say, “We think the technology made a good assessment” or they can correct what the system has been doing.

This is already up and running in France nationwide for all declarations of side effects. Every single side effect reported in France goes through our system first, and the initial assessment is made by Synapse.

How are you working with First Databank?

We are just starting our collaboration. We will see how it evolves. There is a lot of movement in this space, and First Databank has been trying to do more and more. We have a long history of partnering with commercial drug databases, which may be surprising, but we help them find new ways to ensure that their content is always up to date. On the Synapse Medicine side, we use this commercial database as a gold standard for our algorithm to think, “This is the truth.”

What opportunities and challenges do you see in increasing your presence in the US market?

The key for the US market will be EHR integration. The strategic path that we have chosen for Synapse is to offer a tool that has already been proven clinically. In Europe, our tools are used to prescribe, to do medication reconciliation, and to manage complex regimens like oral chemotherapy. We are directly inside the workflow, which is super important because in healthcare, nobody wants to add another tool. If you are outside the workflow, you will have low adoption and will probably end up with no adoption and die. Or, you do the hard work needed to be inside the workflow.

To do this, it is necessary to focus on EHR integration, and integration with the systems that are already in place. This is definitely difficult. It takes time, but then once integrated, you are there for the long term. This is exactly what we are working on right now with a number of EHRs that are being used for prescribing.

Curbside Consult with Dr. Jayne 11/7/22

November 7, 2022 Dr. Jayne 1 Comment

There has been a lot of discussion recently about practices that send patient portal questionnaires for existing patients to enter their medical histories. Certainly as a patient, I don’t want to enter information that already exists in my chart, and as a physician, I don’t want to have to reconcile a bunch of information that might already exist in the chart against patient-provided information that may or may not be accurate. Some patients are great at knowing their histories, others are less so.

Once a year, I have an appointment at a major academic center’s high-risk breast cancer program. This year, I was pleasantly surprised that for the first time, they didn’t ask me to provide information that they already had in my chart. The check-in process was quite streamlined even though three separate appointments were involved, so I was looking forward to a smooth visit.

The visit itself was great, with speedy access to an exam room, an upgraded exam gown (flannel with satin trim, if you can imagine), and a short wait for the physician. From there I went to the imaging center waiting room. Although the technician was apparently looking for me in the wrong waiting room (they have three), they ended up locating me quickly enough to get me to my imaging appointment early.

My technician was personable and efficient, making me feel like a valued patient and not like just another patient in a long line of tasks for the day. From there it was back to a different waiting room, where I received preliminary imaging results and met with another physician.

After discussing the care plan, they mentioned that a final radiology reading would be available to me via patient portal within 24 hours. They also explained that due to their current patient mix, they were asking some patients to schedule with a midlevel provider rather than the physician for their next visits. Knowing what I know about healthcare economics and physician staffing, I understood what they were trying to do in making sure the physicians have capacity to manage the patients who need active management of breast cancer and who are planning surgeries in the near term. As a patient, you put a certain level of trust in a leading academic institution to have appropriate physician oversight when you’re seeing a midlevel provider, and as a physician, I know how to advocate for myself if the need arises.

The visit hit a glitch during the checkout process, since there was no one to staff the checkout desk and everyone was being sent to the waiting room. There was quite a line since most patients needed multiple follow-up appointments for imaging, biopsies, or additional clinical appointments. I had plenty of time to read the Patient Bill of Rights they had posted on the wall, which specified that patients might see a physician assistant or a nurse practitioner as part of their visit. It also spelled out that patients have the right to see the physician if they prefer, although that might result in the rescheduling of their appointment. It’s standard stuff, and I didn’t think too much of it until the patient in front of me began to check out.

She handed over her check-out instruction sheet and began asking questions about the providers listed on the board behind the receptionist, as well as their credentials. She was asking which were breast specialists and which were other types of surgeons since it’s a mixed office. The receptionist was describing them, and when she got to the nurse practitioner, she said “Oh, she does everything,” to which the patient responded asking, “Why didn’t she go to medical school then?”

My ears perked up at that and I knew it was going to get interesting. It’s not hard to overhear things when you’re literally three feet apart, and apparently the patient had been given the same information that I had about not seeing the physician at the next visit and wasn’t aligned with the plan. She was shopping for a different surgeon rather than see someone she stated had less education. Having just read the Patient Bill of Rights, I wondered how the office would handle it. The receptionist said she would go and check with the physician.

While she was gone, the patient — with whom I had exchanged pleasantries about my cute tote bag while we were both in the imaging waiting room — turned to me and mentioned that she knew what the answer would be since the doctor had already told her she had to see the nurse practitioner. She went on to say that she was a cancer survivor and that she is scared to not see her surgeon, who knows her the best. I nodded empathetically and waited to see what would happen.

The receptionist came back and announced that she had spoken to the physician and the answer was still no – she would need to schedule as directed. Clearly that didn’t align with the posted Patient Bill of Rights, and honestly if the organization isn’t going to follow it, they need to take a good look at either modifying it or removing it from the office while they reconsider.

I was able to get my follow-ups scheduled and headed home, eager to get my final reports and try not to think about the whole situation for another six months, which is sometimes the best way to approach it as a patient. I buried myself in work the rest of the day, waiting for the familiar notification from the patient portal app that my result was available.

Unfortunately, the notification didn’t come. Nor did it come the next day, or the next, or the following one. I was busy with work and didn’t have a chance to call and wanted to also give a little benefit of the doubt since I know healthcare is in crisis. But now we’re in the weekend, and I’m relegated to wondering where there is a backup in radiology, whether my study was missed, or whether I’m going to get a callback to come back for more images. I know the system’s EHR and how it’s configured to handle release of test results to patients. Once radiology images are final, they release to the patient. The question then becomes whether something is wrong with the EHR and portal systems, or with the test itself.

Since it’s the weekend, I guess I’ll sit and wonder for a few more days, which is never a position a patient wants to be in.

Thinking about the situation as a whole, I think the practice needs to do some introspection around its messaging. In addition to the Patient Bill of Rights issue, they need to provide additional instructions on what to do if imaging results don’t come back. I’m a physician and know to track it down when Monday comes, but a lot of patients might be from the “no news is good news” generations, or don’t have patient portal access, and wouldn’t know to follow up a missing result. In the mean time, I’m off to a conference, so I will rely on my calendar to remind me to make the call.

Does your organization’s patient summary give instructions on what to do when results don’t return? Do you honor your posted Patient Bill of Rights? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 11/7/22

November 6, 2022 Headlines No Comments

Roche introduces the navify brand for its digital health solutions at HLTH 2022

Roche, the world’s largest biotechnology company, unifies its 30-solution digital health portfolio under the brand Navify.

Smile Digital Health Expands Product Offering With Alphora Acquisition

Health data and integration vendor Smile Digital Health acquires clinical quality language and metrics company Alphora.

Transcarent Selects Prescryptive Health to Power a New, Different and Better Integrated Pharmacy Experience

Transcarent will use Prescryptive’s prescription intelligence platform to power its Pharmacy Care service, giving members access to Prescryptive’s transparent pricing and network of retail, home delivery, and specialty pharmacies.

Monday Morning Update 11/7/22

November 6, 2022 News 4 Comments

Top News


Roche, the world’s largest biotechnology company, unifies its 30-solution digital health portfolio under the brand Navify.

The company’s products include oncology decision support, tumor board, mutation profiler, digital pathology, results tracking, and infection management.

Roche acquired oncology software vendor Flatiron Health for $1.9 billion in April 2018.

Reader Comments

From Itsme: “Re: TeleTracking. At least 40 people lost their jobs last week. Most folks were on the client-facing side.” Unverified. I unsuccessfully searched the company’s website and press releases looking for a media contact so that I could inquire.

HIStalk Announcements and Requests


A great number of providers are apparently insulting their patients-slash-customers by shoving a blank form at them that asks for information that they already have on file. I’m repeating myself in saying that I question how intentionally duplicated information is reconciled and by whom, whether the provider will review only the form’s contents instead of the better-vetted information from the EHR, and why providers think that blank forms are better than letting the patient review an EHR-generated document and the noting any corrections. You would order less frequently from Amazon if its website or app required you to manually enter your name, shipping address, and credit card information every single time.

New poll to your right or here: Would you pay a $250 add-on fee to your conference registration to opt out of having the organizer share or sell your contact information? A reader pointed out that the business model of conferences includes selling the contact information of prospects to vendors, so registrants would have to bear more of the cost if they throttle back on the “ladies drink free” model. I conclude that the amount that you are willing to pay to avoid any particular frustration (a toll road, VIP tickets, or a concierge MD) is a better indicator of the issue’s true importance than the number and passion of the complaints about it.

One of my favorite email tricks is sticking a period somewhere before the “@” in my address, which makes that email address look unique even though Gmail treats it like my real one. Example: email addressed to will actually be sent to, giving me an infinite number of seemingly unique addresses for free trials and such. A reader provides a similarly clever way to tell which companies are selling your email information, which takes advantage of the fact that Gmail ignores characters that follow a plus sign entered to the left of the @ sign. Example: sign up for the HIMSS conference using and any emails sent there will be delivered to, but with the full address listed so you know who shared your information. These tricks could be foiled by sites or bulk emailers that strip off the extra characters, but I doubt that’s common.

For folks who just can’t figure out the EDT versus EST thing, your confusion won’t be obvious again until March 12. Or never, if you instead just use ET.

If your company sponsors HIStalk and is participating in the HLTH conference, complete this form by Wednesday and I’ll list you in my conference guide.

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



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

Acquisitions, Funding, Business, and Stock

The Global X Telemedicine and Digital Health (EDOC) exchange-traded fund has lost 27% of its value since its inception on July 30, 2020, while the Nasdaq is down 4% and the S&P 500 is up 15%. EDOC has also performed worse than both indices in the past 12 months. 



Inflo Health hires Angela Adams, RN (Jvion) as CEO.

Government and Politics

In the UK, NHS nurses will likely strike nationally for the first time in the next few weeks over compensation, with patient waiting lists expected to grow even longer.


Forbes profiles Humana’s use of a virtual assistant to reduce the documentation burden of its clinicians. The company says that 80% of clinician time was being spent documenting rather than interacting with patients, and using the tool that it named Allie has freed up 15% of their time. Allie was built using technology from Automation Anywhere.

A Madison, WI-based non-profit news site runs a well-written piece on Epic. Snips:

  • Epic walked away gracefully from its $624 million VA patient scheduling pilot programs when the VA chose Cerner in a $16 billion no-bid contract, which may benefit Epic in the long run since Epic has since enhanced its market position instead of bogging down in government work.
  • Epic has 12,500 employees and $3.8 billion in annual revenue versus Cerner’s 27,000 employees and $6 billion in revenue, but Cerner continues to lag product-wise, is losing premium customers to Epic while selling mostly to price-sensitive ones, and was laying off employees when Oracle pursued its acquisition.
  • Epic has built all of its products and they integrate well, while Oracle Cerner grew by acquiring unrelated products that were bolted together.
  • Epic says it’s too early to say if it will collaborate with Oracle Cerner on the national database of patient records that Oracle Chairman Larry Ellison has announced, with Epic saying that connecting to Cosmos can’t happen until Epic gains understanding about the reliability of Oracle Cerner’s data, its method of de-identifying patient data, and its willingness to legally agree not to sell patient data commercially.
  • Observers say that Oracle Cerner prospects may be spooked by Cerner’s history and the Oracle acquisition and may buy Epic instead.
  • Oracle has a history of making grand promises about developing new products when acquiring companies, but the end result is usually only that Oracle tries to sell more of its existing products to the acquired customers.


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


Morning Headlines 11/4/22

November 3, 2022 Headlines No Comments

Modernizing Medicine Agrees to Pay $45 Million to Resolve Allegations of Accepting and Paying Illegal Kickbacks and Causing False Claims

A whistleblower lawsuit that was joined by the Department of Justice said that the company, which is now known as ModMed, falsely attested that its EHR met Meaningful Use criteria and paid kickbacks for referrals.

Red Cross seeks ‘digital emblem’ to protect against hacking

The organization hopes that a digital version of its cross will protect medical and humanitarian services from digital harm during armed conflicts.

Warner Releases Policy Options Paper Addressing Cybersecurity in the Health Care Sector

Senate Select Committee on Intelligence Chairman Mark R. Warner (D-VA) publishes “Cybersecurity is Patient Safety,” a policy options paper.

News 11/4/22

November 3, 2022 News 4 Comments

Top News


Specialty EHR/PM/RCM vendor ModMed pays $45 million to settle a 2017 whistleblower lawsuit claiming that the company – which was formerly known as Modernizing Medicine — falsely attested that its EHR met Meaningful Use criteria, ignored patient-endangering software defects, illegally paid kickbacks, and sold systems to providers who were promised increased revenue through upcoding.

The Department of Justice joined the whistleblower lawsuit filed by former ModMedVP Amanda Long, who will receive $9 million of the settlement. 

Reader Comments

From Sloopy: ‘Re: a list of best jobs in health IT. Check out the source.” The kids who write for Becker’s often fail to filter out click bait stories as they desperately seek headlines to repurpose. Their source for this item is a poorly written, mostly offshore-staffed Internet of Things website whose article looks like a bored freelancer spent 10 minutes stringing together random Google search results, such as “CIOs can keep tabs on how their companies utilize IT to figure out where cyber security can be tightened up” and “you can be sure that your decision to stick to this sector is good because for a stable livelihood, you need a good stable job.” The methodology it used to determine the “best healthcare technology jobs” wasn’t mentioned because there wasn’t one. The bio of the author, who clearly values quantity over quality, says that she has written 40,000 articles. 

HIStalk Announcements and Requests


Welcome to new HIStalk Gold Sponsor Access. The Dallas-based company believes that hospitals and their patients deserve better than paper. The company eliminates paper troubles by providing EHR-integrated eForms and eConsent solutions that save hospitals money, make the lives of clinicians easier, and provide a better patient experience. Access has led the way with purpose built patient electronic solutions for hospitals for 20 years and now launches its next-generation Focus offering — which will be introduced in a November 9 webinar – that breaks the convention of forms in favor of adaptable digital experiences, positioning hospitals to effectively engage with their patients on their own devices, anywhere, any time. Thanks to Access for supporting HIStalk.


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

Acquisitions, Funding, Business, and Stock

Allscripts reports Q3 results: revenue up 5%, adjusted EPS $0.23 versus $0.21, beating analyst expectations on earnings but falling short on revenue.  


Clinical data abstraction platform vendor Carta Healthcare raises $20 million in a Series B funding round.

Hint Health, which sells EHR-integrated membership management and billing software, acquires AeroDPC, which offers an EHR/PM system for direct primary care physicians.

CPSI announces several leadership appointments under Chris Fowler, who was promoted to president and CEO in July 2022.


The president of virtual health provider Cerebral admits that the company tried to grow too fast when federal prescribing regulations were relaxed during the pandemic, drawing federal scrutiny over its controlled drug prescriptions and overspending on advertising to the point that it laid off 20% of its employees last week. Cerebral will abandon several of its existing and planned programs to focus on mental health, with the CEO adding that it needs to become self-sustaining instead of relying on uncertain additional investor funding.


  • Palomar Health will implement Get Well’s GetWell Loop digital care management solution, followed by phases for inpatient experience, ED experience, care gap closure, and health equity.



KONZA National Network hires Karla Mills, MS, MBA (Health Gorilla) as COO.


Jared Klingeisen (Medable) joins specialty medication prescribing software vendor RxLightning as COO.


CommonSpirit Health hires Daniel Barchi, MEM (New York-Presbyterian) as senior executive VP and CIO.


ChenMed promotes Chase Titensor, MBA to VP of strategic payer partnerships.

Announcements and Implementations


Truveta announces GA of Truveta Studio, which allows researchers to analyze the de-identified, daily-updated data of its 25 health system members that represent 700 hospitals and 20,000 clinics. Truveta, which was launched in February 2021 by 14 large health systems, has raised $195 million.

Nine organizations licensed the cloud-based model of Meditech Expanse in the third quarter, raising the count of Meditech as a Service hospitals to 70. Five of the nine were new to Meditech.

Redesign Health will create pediatrics-focused healthcare technology products and companies in partnership with KidsX, whose 40 children’s hospital participants work with early stage digital health companies.

UK health IT vendor EMIS Group says that its $1.4 billion all-cash acquisition by Optum UK will be completed in early 2023.

Privacy and Security

The International Committee of the Red Cross will create a “digital red cross” that it hopes will work like its physical counterpart to prevent cyber harm to the systems of medical facilities and Red Cross offices during armed conflicts.


The office of Sen. Mark Warner (D-VA) issues a report titled “Cybersecurity is Patient Safety” that provides issue background and describes policies that could be considered, such as:

  • What should a healthcare cybersecurity framework look like? Is NIST’s guidance sufficient and being used?
  • Should HIPAA be modernized beyond its focus of PHI protection by covered entities?
  • How should Congress create minimum cyber hygiene practices? Should they be deployed under a facility’s Medicare Conditions of Participation?
  • Should Congress offer a “cash for clunkers” program to incentivize life cycles for medical equipment? Should providers have a right to repair using third parties?
  • Should Congress require healthcare software vendors to publish a “software bill of materials” to allow vulnerabilities to be assessed?
  • Should providers be required to train all staff members to use alternate systems during downtime?
  • Should providers receive FEMA disaster funds after experiencing a cyber event?
  • Should Congress regulate cyber insurance or create its own reinsurance program?

A LexisNexis Risk Solutions study finds that half of participating healthcare payers had a data breach in the past five years, averaging 12,000 compromised records and an average incident cost of $5.4 million. Social engineering was the most common payer cyber fraud source, followed by ransomware. Most respondents say that online identity and credential verification is challenging, especially on mobile apps.


Sixteen medical colleges and hospitals in India’s second-largest state have been using paper charts and radiology film since July 5, when a vendor shut down its hospital system over unpaid bills.

Researchers in Australia apply an electronic Frailty Index similar to that used by UK GPs, using a 36-item screening of PCP EHRs to detect patients with age-related decline who could be treated with vitamins, strength training, and chronic disease management.

Police file several charges against a UPMC ED physician who they say was driving his Tesla at 125 miles per hour in a 35 mph zone when he lost control, killing his passenger, a fellow ED doctor who was not wearing a seatbelt. The driver’s blood alcohol level was twice the legal limit.


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


EPtalk by Dr. Jayne 11/3/22

November 3, 2022 Dr. Jayne 2 Comments

I’ve experienced an uptick in email solicitations over the last couple of weeks. It’s been fascinating to see the different content and how marketers are trying to use various strategies to get the reader’s attention.

Quite a few of them are going for the friendly-sounding approach, with short sentences and colloquial language. One of the repeat senders is further trying to build on the familiarity by mentioning the local weather and a nearby restaurant, which is fascinating but a bit odd since it’s in an adjacent town. I wonder what the algorithm looks like that says, “hey, let’s pick something close, but not creepy-stalker close” and throw that into the email. They even go so far to mention “location inferred from your company” regardless of the fact that my “company” is located hundreds of miles from the town they mentioned.

I strongly suspect that the emails are stemming from mailing lists related to the conferences I’m attending in the next couple of weeks. It’s one more way for meeting organizers to increase conference revenue, even though it’s annoying for the attendees. I don’t recall seeing any kind of “don’t sell my information” opt-out checkboxes during the registration processes for either of them, but there’s always a chance that I missed them along the way (although from past experience, it’s more likely that the conference didn’t give attendees the chance to opt out). Much like the weeks following HIMSS, I’m sure I’ll be spending quite a bit of time creating new email filters and wading through various pieces of junk email.

I do have to say that I’m a little nervous about my upcoming conference attendance, especially since flu cases are on the rise. The US has already seen more than 880,000 cases of lab-confirmed influenza, and that number doesn’t include the patients who are tested using in-office test kits at physician offices and urgent care centers or those patients who don’t present for testing. Physicians who care for children are concerned, since more than 75% of pediatric hospital beds are full. The leading viral strain at present is H3N2 influenza, which has in past years been associated with higher severity of illness for older adults and children.

Based on what I’ve seen during recent travels, I’m betting I will be one of the few people wearing a mask in crowded situations. I have to admit that I did enjoy the first HIMSS post-COVID, when a good number of people were masking, because I used to nearly always return from HIMSS with a sore throat, runny nose, and generally feeling of cruddiness consistent with a respiratory virus. Especially if you’re not going to mask, now is a great time to get a flu vaccine if you haven’t already received one. I know that lots of people are tired of thinking about contagion after the last couple of years, but the basic tenets of public health are always a good idea.

Speaking of vaccines, while some organizations have kept their vaccination requirements static, several leading universities are requiring students to receive the new bivalent COVID boosters. Schools requiring the new boosters include Harvard University, Yale University, Tufts University, Fordham University, and Wellesley College. Pushback is expected, and the comments on the article are all over the place. Uptake of the new booster has stalled in my community and my urgent care and emergency department colleagues are still exhausted, so some of us are dreading what might happen over the coming months when people move their activities inside and begin gathering for the holidays.

After a recent medical visit, I was flipping through my health system’s patient portal to see how various kinds of documents were rendering and whether there were any changes after the recent updates to requirements for release of information to patients. I found a visit from a few months ago that now had a visible visit note when it didn’t previously have one. I’m confident I would have remembered seeing a note previously based on the last line of the document: “This dictation was done with voice recognition software and may contain errors and omissions.” That’s certainly far from a vote of confidence for the treating provider. Maybe I’m old school, but I can’t imagine putting something like that on one of my notes or signing a note without proofreading and correcting it. I know that everyone in healthcare is stressed, but I’d be embarrassed to allow that in any of my patients’ charts. I had already decided to look for a new physician in this specialty and this just confirms my decision.

It’s common for researchers to create catchy names for their studies, so I was excited to see COSMOS, otherwise known as the COcoa Supplement and Multivitamin Outcomes Study. It’s a randomized clinical trial looking at cocoa extract supplement in comparison to a standard multivitamin with respect to cardiovascular risk reduction. A sub-study, COSMOS-Mind, will look at whether the cocoa extract supplement improves cognitive function and reduces the risk of dementia. Of course, I’m a big fan of chocolate (although usually in baked goods rather than in a capsule) so I’ve been keeping an eye out for the study outcomes, which finally came out this week.

The results were exactly opposite of what was expected. The multivitamin, rather than the cocoa supplement, was found to be more closely associated with improved cognitive function in older adults. The benefits were greatest in patients with a history of cardiovascular disease. Since nearly 90% of the study participants were non-Hispanic whites, the authors note that additional work is needed to confirm the findings, in particular with a more diverse patient population. Halloween passed in my neighborhood with only a small number of trick-or-treaters, so I’ve got plenty of cocoa on hand. I’m looking forward to the mood boost even if it’s not going to prevent dementia.

How was the Halloween traffic in your area? Will you be nibbling chocolates for weeks to come? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 11/3/22

November 3, 2022 Headlines No Comments

CPSI Announces Business Unit and Executive Leadership Changes

The company announces new leaders following the June retirement of President and CEO Boyd Douglas

CommonSpirit Appoints Daniel Barchi as Chief Information Officer

CommonSpirit Health hires Daniel Barchi from New York-Presbyterian as senior executive VP and CIO.

AeroDPC joins the Hint Health Ecosystem

Hint Health, which sells EHR-integrated membership management and billing software, acquires AeroDPC, which offers an EHR/PM system for direct primary care physicians.

Qualifacts Announces Acquisition of OnCall Health

Behavioral health EHR vendor Qualifacts acquires OnCall, a vendor of telehealth, patient portal, and client engagement technology for behavioral health organizations.

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