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Readers Write: Lessons Learned from the COVID-19 Pandemic: How Data Sharing is Improving Chronic Disease Outcomes

November 2, 2022 Readers Write No Comments

Lessons Learned from the COVID-19 Pandemic: How Data Sharing is Improving Chronic Disease Outcomes
By Brett Furst

Brett Furst is president of HHS Technology Group of Fort Lauderdale, FL.

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Although the worst of the COVID-19 pandemic is likely behind us, many Americans living with chronic disease will feel its effects for years to come. That’s because chronic diseases such as heart disease, diabetes, chronic kidney disease, and obesity increase the risk for severe and lasting illness from COVID-19.

According to the Centers for Disease Control and Prevention, this improved risk matters, because chronic diseases represent seven of the top 10 causes of death in the United States and six in 10 Americans live with at least one chronic condition, such as heart disease, stroke, cancer, kidney disease, or diabetes. Chronic diseases also are the leading drivers of the nation’s $3.8 trillion annual healthcare costs.  

Among many lessons learned since its start, COVID-19 highlighted the need for health equity, as some patient populations were affected more severely than others. For example, African Americans, Hispanics, and Native Americans have a disproportionate burden of chronic disease, COVID-19 infection, hospitalization, and mortality, primarily due to challenges associated with social determinants of health. Even among the general population, healthcare utilization dropped during the pandemic, with a decline in screenings and subsequent diagnoses for diseases such as cancer. Delayed screening and treatment for breast and colorectal cancers alone could result in almost 10,000 preventable deaths in the US, according to the CDC.

The lasting impact that COVID-19 has on individuals living with chronic disease, and the entire healthcare system, underscores the many lessons we can learn from the pandemic and the need for improved data sharing across all stakeholders. For example, researchers have yet to know the extent to which COVID-19 exacerbates chronic disease, causes chronic illness, or will be determined to be a chronic disease. Although long-term studies and longitudinal surveillance will help clarify these questions, much research remains.

The COVID-19 Research Database (RDB) is a leading industry example of how collaboration and improved access to patient ecosystems can accelerate innovation and understanding, improving immediate and future cost and quality outcomes. Several organizations were led by RDB to accelerate real-world pandemic research, knowledge of condition identification and treatment, and evidence-based healthcare policy.

With 85 billion HIPAA-compliant, patient-level records, RDB enables public health and policy researchers to access real-world data to understand better and combat the COVID-19 pandemic and future health-related events. The RDB provides a standard data schema that allows researchers to access linkable data sets — including claims, electronic health records, and consumer data — and has powered over 70 publications and presentations addressing the direct and indirect effects of the COVID-19 pandemic on population health.

Among the publications and studies resulting from the RDB is the publication of research in Nature Medicine examining the impact of COVID-19 infection on risk for neurological disorders and a separate study published in the Journal of Alzheimer’s Disease that showed a substantially higher risk for older adults in developing Alzheimer’s disease within a year of contracting COVID-19.

Accurate, comprehensive, real-world data represents the healthcare industry’s straightest path toward developing a deeper understanding of the connection between COVID-19, chronic disease, and population health. Data sharing and collaboration provide researchers, providers, and healthcare organizations with the keys to actionable insights, data-driven decision-making, and accelerated innovation related to critical issues like improving health equity and driving healthcare cost and quality outcomes across populations.

HIStalk Interviews Bill Grana, CEO, HCTec

November 2, 2022 Interviews No Comments

Bill Grana, JD, MBA is CEO of HCTec of Franklin, TN.

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Tell me about yourself and the company.

I started my career as a lawyer with the largest for-profit health system in the country. Since then, I have been a tech entrepreneur since for close to 30 years, mostly in software. HCTec is my first stint in a pure services business, but I have run enterprise software companies that had exposure to healthcare.

HCTec is a 12-year-old, Nashville-based IT services firm that is focused exclusively on the healthcare provider sector of the market, so hospital systems and other providers. Our people have specialized skills in different areas of healthcare software and technology. They provide services according to the needs and circumstances of our clients.

What is the labor dynamic in healthcare today?

It is fascinating on one level and maybe terrifying as well, depending upon your perspective. A lot of what you see in the media centers around clinical labor and staffing challenges, which continue to be significant. But I would say that those challenges also extend into non-clinical areas of healthcare, including IT. The great resignation has changed the workforce of our clients. Certainly in compensation, where there has been significant wage inflation over the last two years. We’ve seen that within our own business and with our clients as well.

The dynamic of remote work certainly has had a big impact. In certain type of roles, remote work is here to stay. For those that require of face-to-face interaction and collaboration, hybrid is the model. For many of us, I don’t necessarily see a full-time return to the office the way that it was before the pandemic. As the leader of a business, I’ve had to adjust my thinking. I’m very much a face-to-face type of person who feels that teams are most effective when they can be face-to-face on a regular basis. But I also recognize that the world has changed, and so leadership thinking has to change as well relative to the work environments of our team members.

How will your business change as your clients increase their use of remote work?

I would have expected more of a transition, or at least an increase in the level of open-mindedness, over the past couple of years to outsourcing certain functions within our clients’ IT organizations.  We are seeing that in certain areas, particularly the help desk and service desk arena. But many others that are necessary but not strategic are ripe for partnering with a firm like ours. Because of our scale and focus, we can typically do those functions at a lower cost and a higher level of quality. 

Application support around the enterprise EHR would be one area. The daily care and feeding and maintenance that is required of an enterprise EHR is a perfect opportunity for outsourcing. PC and desktop support is another arena. Provisioning applications, and system provisioning, is another area. We aren’t seeing that trend develop the way that we would have predicted and continue to predict, so that’s an interesting dynamic.

How much business impact are you seeing from Epic’s move to Hyperdrive?

Hyperdrive is the move to a pure browser-based interface. We have seen some opportunity from that, but not a tremendous amount.

What types of consumer-facing technologies are providers considering?

Obviously telehealth, which the pandemic really catalyzed. Usage is down, but still much higher than what it was pre-pandemic. I think it’s fair to say that telehealth is here to stay, certainly for certain use cases. 

Patient portals are playing an even bigger role in how health systems give the patients what they want in terms of access to their information and scheduling and that sort of thing. We’ve seen a huge demand on the help desk side for patient-facing support, much of it related to supporting patient portal applications. We’re doing some remote patient monitoring support as well. As we look forward five years, we think we will be doing a lot more of that. We all know that technology doesn’t always work as designed, and sometimes users don’t understand how to use it and need channels to reach out to get the support that they need.

How has system training changed?

Training continues to play an important role in the ability of users, whether clinicians or patients, to take advantage of the technology that’s in front of them. Most of the patient-facing technology is fairly simple, but depending upon your demographic and whether you grew up with smartphones and computers, training is critical.

How will support needs change as systems are more widely rolled out to patients and caregivers in homes?

That is happening as we speak. Within our help desk capability, we have a specific offering and specialty geared to patient-facing support, recognizing that there are some nuances and differences to how you support a patient end user versus a doctor or non-clinical provider user. The support experience is always important, but for a patient who is calling in or chatting in, that experience is even more important. These are the customers of the health system and their experience with the clinician and the care they receive is obviously critically important, but the experience that they have with supportive technology is equally important. 

Some health systems understand that very well and deeply. Others are getting there with their thinking. We are huge believers that patient experience is critical for these providers, and that isn’t just about clinical care, that absolutely is about their experience with the technology that is being put in front of them.

Several big health system IT and revenue cycle outsourcing deals were signed in the past couple of years. How will that trend progress?

Financial stress is a driver. We are seeing that play out in real time right now, with half or more of health systems operating in the red, partly because the cost structure and partly because the of the revenue side. I’m not sure that things are ever going to return to normal, at least with respect to the cost structure of both labor and non-labor related items. That will force systems to think differently about how they do labor resourcing in certain areas.

Back to my comment earlier, health systems don’t necessarily have to build large organizations of IT professionals to be effective as an IT organization. There are plenty of opportunities to outsource aspects of IT, those things that are necessary but non-strategic or where it’s hard for individual health systems to build real competency. Part of this is a bias, because it’s a big part of what we do, but I believe that there is going to be a trend to more outsourcing within hospital IT functions. It’s going to be more surgical in nature than if you look back 15 or 20 years ago, where there was wholesale outsourcing of IT functions. It will be limited to certain aspects of a hospital’s IT organization.

What are health systems doing strategically after putting plans on hold for the pandemic?

We have a lot of dialogue occurring around help desks and service desks, and much of that around patient-facing support. The pandemic also spurred the notion of patient-centered thinking and the related technology investments that support that. The shift out of inpatient settings and their heavy fixed assets and into light asset settings — with the home being the lightest that you can imagine — is a big trend. That is creating opportunities for us, both on the staffing side as well as the outsourcing side.

What will the company’s strategy focus on in the near term?

In the environment that we are in, it’s important to have a long-term vision. It’s hard to do strategic planning much more than a year or two out given the amount of uncertainty that exists. We are heavily focused on our own team and making sure that we are positioning ourselves as an employer of choice. We have seen some turnover in parts of our business that is higher than we have ever experienced, and we are not alone in that. But we think and talk a lot about how to source new team members for our business more effectively, how to train them to be successful in their jobs, and how we continue to make HCTec in an attractive place for them to stay.

Interestingly, pay is typically not the most important thing. We are finding that the most important thing for keeping people is around is to define clear pathways from a career and professional development perspective. 

We made an acquisition in July 2021 of a company in Winston-Salem, North Carolina called Talon Healthy IT Services. That was a fantastic acquisition for us. It bolstered our capabilities in the help desk arena, but also gave us new capabilities in the ambulatory and smaller provider space, where we have the capability to be the outsourced IT function for those providers. We are continuing to look for other complimentary businesses to expand our service portfolio and to increase our market presence and footprint. That’s a big part of our strategic focus, and where I’ve spent a lot of my time.

We are now back to where we are actually seeing our clients in person after a two-year hiatus where not a lot of that occurred. We are staying close to our clients; looking at their demands, needs, and opportunities within their organizations; and making sure that we are delivering high quality services and staying ahead of those needs.

Morning Headlines 11/2/22

November 1, 2022 Headlines No Comments

Walgreens-Backed VillageMD Said to Explore Deal for Summit

The proposed $10 billion company would operate the 200 primary care offices of Walgreens and the 340 urgent care locations of Summit Health-owned CityMD.

Americans Take Ketamine at Home for Depression With Little Oversight

Psychiatrists express concern that virtual care startups are prescribing ketamine for off-label treatment of serious mental health conditions.

Is the Promise of PROMs Being Realized? Implementation Experience in a Large Orthopedic Practice

Most of a practice’s total knee and total hip patients entered their patient-reported outcomes measures that were then stored in the EHR, but care teams ignored them during visits 99% of the time.

News 11/2/22

November 1, 2022 News 1 Comment

Top News

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Oracle will close the former Cerner world headquarters and its Realization Campus in Kansas City, MO, consolidating employees from those locations to its Innovations campus as it reduces its footprint as the city’s largest private employer.


Reader Comments

From Doctor and Professor: “Re: Teladoc. We moved to its Solo virtual care platform from Teams. Clinicians are constantly frustrated and several have quit because they can’t deliver good care using the platform. It lacks features that Teams, Zoom, etc. have. You can’t set up backgrounds, share documents, or easily add people to the session. Only 10% of my recent sessions were free of major problems, such as dropped connections, erratic video, and being forced to use telephone audio due to drops and lags. The support people use a standard script that tells both clinician and patient download their app (its advantage was supposed to be that no app is needed), they tell you to plug your device into a charger, they recommend using a hardwired Ethernet connection and wired headsets, and they tell you to warn patients not to use the device for anything else and to turn off all messages while waiting for their session to start. Basically anything to avoid admitting that their system has problems.”


HIStalk Announcements and Requests

Attention HIStalk sponsors that are participating in the upcoming HLTH conference: complete this form by next Wednesday (November 9) to be included in my online guide. The company says it has 800 sponsors, which is up there in HIMSS conference territory. It will be interesting to see how its “open show floor,” which apparently dumps education sessions and exhibits together in the same hall, works out for attendees and vendors. 


Webinars

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


Acquisitions, Funding, Business, and Stock

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Health analytics vendor Advata, which Providence formed in June 2022 by merging six companies from its Tegria business, lays off 32 of its 150 employees. The merged companies were Kensci, Colburn Hill Group, Alphalytics, Lumedic, Quiviq, and MultiScale. Advata CEO Julie Rezek was hired from Facebook and has spent her career in advertising.

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Walgreens-controlled primary care provider VillageMD is discussing a merger with private equity-backed Summit Health that would value the combined entity at up to $10 billion. VillageMD operates Village Medical offices at 200 Walgreens pharmacies, while Summit Health and its urgent care practice CityMD have 2,500 providers working from 340 locations.

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Forbes profiles Forward Health, which offers primary and preventive care memberships in 10 states for $149 per month with no insurance accepted. The company, which was formed by two former Google employees and has attained a billion-dollar valuation, says that one-third of its members are uninsured, either because they don’t like the concept of health insurance or can’t afford the premiums. Forward’s technology-heavy approach uses full body biometric scans, wearables, DNA testing, and AI-powered algorithms that it says reduces its need for specialists and allows much of the in-office exam to be conducted by an administrative assistant. Trustpilot has some interesting reviews.  

HelpAround, whose platform connects drug companies with patients, renames itself to RxWare.


Sales

  • Renown Health chooses provider data management and search from Loyal.
  • Meditech will use Health Gorilla’s Health Interoperability Platform for the Traverse Exchange Canada network for sharing data among participating providers.
  • Cherry Health chooses EHR/PM from NextGen Healthcare.

People

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Anna Yakovenko (Advisory Board) joins the American Medical Association as VP of research and insights.

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RevenueWell promotes Katherine Shuman, MHA, MBA to CEO, replacing co-founder Serge Longin.

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Sean Postol (Joerns Healthcare) joins Nuance as SVP of sales.

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Frank Carozzi, MBA (Streamline Health) joins Medlytix as VP of business development.


Announcements and Implementations

Meditech announces Traverse Exchange Canada, a cloud-based interoperability network that supports information flow among participating organizations.

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A study by Elevance Health, formerly Anthem, finds that 94% of people who have used virtual primary care are satisfied with their experience. Non-users believe that doctors need to see them in person or aren’t sure if their visit will be covered by insurance.

The local paper covers the planned Epic go-live of Albany Med Health System (NY) in 2024. I think that Albany Medical Center and maybe others in the group are using Allscripts, while Glen Falls Hospital had big revenue drops and layoffs in 2018 following its “catastrophic” rollout of Cerner, which resulted in a lawsuit that was settled.

Drugmaker Pfizer raises annual sales forecasts for its COVID products – $34 billion for vaccine and $22 billion for Paxlovid – and will increase the price of its vaccine, which will end up priced at double its launch price in December 2020.

Redpoint Summit, whose products provide “EMR personalization at scale,” releases an AI-powered EHR add-on that speeds order entry by suggesting a given provider’s most commonly used medications, which it co-developed with Nebraska Medicine.

An orthopedic group achieved high response rates for EHR-tracked patient-reported outcomes measures following total knee and total hip surgery, but care teams actually looked at their data in fewer than 1% of encounters. The authors conclude that making PROMs available for care team review in the EHR isn’t enough to encourage their clinical use.

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A new KLAS report on EHR/PM for ambulatory practices of 2-10 physicians finds that Elation Health, NextGen Healthcare, Athenahealth, CompuGroup Medical, and Azalea Health deliver best in providing the desired functionality and value. AdvancedMD users report steady improvements in technology, while those of EClinicalWorks express frustration with training and support.


Government and Politics

The VA awards Accenture Federal Services a spot on its five-year, $650 million contract to fast-track innovative healthcare technology solutions that can scale for clinical use.


Privacy and Security

A major hospital in Japan suspends non-emergency services after its EHR is taken offline in a ransomware attack. The hospital’s director admitted that “the quality of surgeries might be lowered.”

The legacy EHR of Ascension St. Vincent’s Coastal Cardiology (GA) is breached in a ransomware attack that did not affect its production systems.


Other

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Psychiatrists express concern that startups are prescribing ketamine – best known as a powerful anesthetic and party drug – for off-label treatment of serious mental health conditions such as depression, anxiety, chronic pain, and OCD with minimal oversight.


Contacts

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

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Morning Headlines 11/1/22

October 31, 2022 Headlines No Comments

Oracle to close North Kansas City World Headquarters Campus, Realization Campus

Oracle will close the former Cerner world headquarters and its Realization Campus, consolidating employees from those locations to its Innovations campus and drastically reducing its Kansas City area footprint.

Moving Standards to Support SDOH Data Capture from the Sandbox to Production

ONC, HL7, and partners launch a group that will pilot the “SDOH Clinical Care FHIR Implementation Guide” as supported by ONC’s USCDI Version 2.

Valera Health Announces $45 Million Growth Equity Financing to Increase Access to Evidence-based Mental Health Services for High Acuity Patients

The virtual high-acuity virtual mental health provider partners with health systems and plans, emphasizing its use of evidence-based treatment plans.

Seattle-area health data analytics company Advata lays off employees

Revenue cycle analytics company Advata, which was formed in June 2022 by Providence in a merger of six companies it owns and operates as a part of Providence-owned Tegria, lays off 32 of its 150 employees.

Curbside Consult with Dr. Jayne 10/31/22

October 31, 2022 Dr. Jayne 2 Comments

I spent a good chunk of time this weekend preparing cranky correspondence to send to organizations that can’t seem to figure out that I don’t work for them any more or that I’m no longer a participating provider with a given payer since leaving the practice. Since I resigned from these organizations anywhere from six months to three years ago, I’m tired of dealing with the continued messages and requests for information. The off-boarding processes were variable across the different organizations, so it’s not surprising that there’s still a bit of a mess to tidy up. Still, one would think that with part-time or contractor physician positions, they would have their act more together.

Let’s take my most recent in-person employer for starters. I was a part time W-2 employee and resigned more than one calendar year ago. Apparently I didn’t get terminated properly with a couple of payers, who continue to reach out to me asking me to update my provider file with copies of my license, Drug Enforcement Agency registration, and state control substance documentation. I’ve sent multiple emails informing them of my last date of employment at the practice, and although a couple of them eventually stopped sending me reminders, there are a couple that are persistent. It’s tempting to ignore the communications, but I want to make sure all my provider files are closed out properly in the event that I join a new practice down the road. It’s always good to have definitive closure, but let’s hope it doesn’t take another 12 months to get it.

Then there’s one of my telehealth side gigs, where I only saw patients for a couple of months before determining that not only was the platform horrendous, but they could never seem to figure out how to pay me correctly. Despite having given ample notice that I was leaving and would not be seeing any patients during my notice period, they went ahead and signed me up for multiple insurance plans after I tendered my resignation. It’s likely a case of the right hand not knowing what the left hand is doing, but I’m tired of getting correspondence from various state-specific plans that can’t seem to understand I’m no longer participating in the provider group or planning to submit any claims.

This same platform continues to text me about high patient volumes despite my trying to opt out of the texts by following the included instructions. I’ve also tried sending emails to various individuals within the company with no response, which leads me to think that either those individuals have moved on or they don’t care. Since I no longer have access to the platform, I can’t look up any additional email addresses or contact information than what I have, so I’m sending my correspondence directly to the CEO and CMO of record as well as the head of the physician group, in hopes that they will respond and point me in the right direction.

There’s also another telehealth side gig, where I signed up but never saw a single patient. After watching them exhibit some unseemly behavior with colleagues, I decided not to engage with them. They followed up on my resignation letter by sending me an administrative termination of their own several weeks later, which I thought was somewhat overkill. They’re still sending me regular emails asking me to complete required training and given their track record with others I want to make sure my provider file is entirely closed out.

My favorite target of cranky correspondence is Illinois Medicaid, which is the “undead” of administrative healthcare organizations. I haven’t been a participating provider since 2014, but every now and then, some computer system somewhere goes haywire and decides that I need to update my provider records. The letters come on paper to my home, I always reply on paper because it seems to work, and I don’t hear from them again for a couple of years. I don’t want to wind up published in a directory as someone who is participating because it has the potential to lead to a lot of phone calls and wasted effort for patients who are just looking for a primary care physician and will keep working their way down the list until they find someone whose patient panel isn’t closed.

We’ll see if this batch of letters and emails is successful at tidying up loose ends or if I’ll still be dealing with them in 2023. It seems like there ought to be a better way. I know there are services out there, but the last time I looked at them, they were fairly pricey. Maybe I can find a retired medical practice manager who is looking to make a little cash on the side and enlist their help to get it done. With the number of people fleeing healthcare employment, it’s not a farfetched idea.

I also have a former employer in the tech space that can’t seem to figure out that I don’t work there even though it’s been more than four years. Not only do I get correspondence from the company proper, but also all of their vendors, including health insurance and more. They just sent me notice of the upcoming open enrollment period for health insurance and encouraged me to sign up quickly and not wait until the last minute. I wonder what would happen if I tried to register for a health plan – might be a good project for next weekend assuming an adequate number of cocktails beforehand.

Speaking of cocktails, I’m prepping to attend back-to-back conferences with CHIME and HLTH and the social event invitations have been trickling in. I almost spit my drink when talking to some colleagues about the latter, which they referred to as “the conference with no vowels.” There’s a lot of discussion about the utility of the HLTH conference and whether it’s worth the money. This will be my first year attending, so I’ll have to let you know in a couple of weeks. I’m looking forward to some warmer weather in San Antonio and Las Vegas, respectively. I’m not looking forward to being in crowded indoor spaces and potentially bringing home COVID, influenza, or some other respiratory illness, so we’ll have to see how it goes.

Any recommendations for a first-time attendee at HLTH? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Guillaume de Zwirek, CEO, Artera

October 31, 2022 Interviews No Comments

Guillaume de Zwirek is founder and CEO of Artera of Santa Barbara, CA.

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Tell me about yourself and the company.

I founded Artera seven years ago. We recently rebranded from Well Health. I had never been in healthcare before I founded the company. I was going through a personal experience with cardiac issues and had a really frustrating time interacting with all of my care providers outside of the four walls of the hospital. The question kept coming back to me — why is healthcare not amazing at customer service?

I founded this company with a simple mission, which is to make healthcare the very best industry when it comes to customer service. I came into it with a lot of naiveté and ignorance. We spent seven years thinking about how to build an effective patient communication system for hospitals that is open; that allows every vendor to deliver its interactions through that platform; and that allows health systems to control the flow, rhythm, and prioritization of their communication so they can have an effective and convenient relationship with their patients.

Is it harder in healthcare where health systems have a large volume of customers but see them infrequently and often involuntarily?

Healthcare is complicated for good reason. It’s protected information, and we want to be sensitive to the privacy of patients and their medical records. There are a lot of stakeholders, even within the hospital. You have your primary care doctor, specialists, labs, pharmacies, clinical trials organizations, payers, and employers. Those parties are are all competing at some point in time for the patient’s attention.

There isn’t a library of five care journeys. This isn’t like an airline, where people are only booking one-way flights, return flights, or getting connecting legs. An infinite number of scenarios could happen for a patient, which makes this so challenging,. Then you layer in all of the ecosystem of vendors who are all trying to help make that experience smooth. When you think about streamlining that communication, that’s a lot of people to consider.

Health systems will have different ways of thinking about the priorities. That’s what we’re trying to solve. How do you consider all of those voices; bring that and surface that to the hospital in a way that is easy to manage, control, and manipulate; add and remove players; and then have that experience feel completely seamless to the patient? We are largely SMS, but the dream is that you are on your phone, your doctor is saved as a contact, you have an issue, you send a text, you get a response back. Whether that response is automated, a human being, a PA that reports into a physician, I’m indifferent to that as long as we get the right answer to the patient every time in the medium that is most effective to them.

If I can just share a quick story, this came to life for me last week in a wonderful way. I got a call from one of our customers with a story. This customer, their population, is rather elderly. They skew probably 70-plus. They had a patient who had a fall and they were wearing an Apple watch that had their emergency contact saved as that hospital. When the new Apple Watch detects a fall, it will text your emergency contact. That text hit our system, a staff member saw it right away, and they got in contact with the family and arranged emergency services for that patient. There are so many scenarios like this one that we haven’t considered yet. That’s what makes this complicated, the infinite number of scenarios and players.

Amazon has set up its own personal monitoring program that is linked to Echo devices. Could a user’s preferred health system replace a third-party call center as a local first step for medical issues?

I had never thought of that, and I think that’s a very logical assumption. My wife works at Google and she just got a pamphlet in the mail for a 24/7 urgent care service where you can jump on the phone, and within two minutes, somebody’s on the other end triaging you. That’s actually driven by the payer, circumventing the health system that she would normally go to. The same thing could apply in this Apple example or Amazon with Echo.

It will be interesting to see where they start. If you can be that first point of contact, you have tremendous influence over where the care gets delivered. If that care is acute, if it’s a specialist type of visit, that’s where the money is made. It could be a big threat to hospitals.

My personal opinion is that competition is great and we should all challenge ourselves to do better. At my core, I believe in the physician-patient relationship. I believe that to be thoughtful and proactive about your care, you have to have a relationship with your PCP. You need to feel like you’re disappointing somebody and somebody has your back if you don’t adhere to directions.

I’ve been using the gym more regularly for three months. I went to see my PCP and he said, great news, your cholesterol has dropped 50 points, what changed? I said that I had started going to the gym. Now I’ve kept it going and I think of him every time. Maybe that’s just me, but I believe that when people have a great relationship with their PCP, they never leave, kind of like the dentist. That’s who our energy is going to be focused on serving,

How does a health system define their customer when people move around, change insurers that take them into or out of network, and perhaps don’t want to hear from providers until they have an acute need?

There’s a whole market around that with population health. Many companies are tackling who to reach out to and onboard, how to bring panels into the system. That’s why the relationship outside of that visit is so, so important. I texted my PCP to see if I could get the third booster, for example. There are so many opportunities for the physician to engage with you, or for you to engage with them, outside of the point of care.

When you think about the younger generation, if you can create that relationship with the parents, many children will follow in their parents’ footsteps. I hope that there doesn’t have to be an art of engaging this lost population who never got care. COVID may make that necessary for us to catch up. I hope that we can build those types of relationships from birth and it can be a habit that is sustained throughout a patient’s life. I hope that’s the norm that we can get to as a civilization.

We don’t expect to have a telephone conversation with an actual human employee when we need to interact with a big company like Amazon, where most communication is via an online form, email, or other electronic message. How has that expectation affected healthcare?

Access is good. The mode of the day may be messaging, but it will undeniably change. You see this with connected devices. The example you just highlighted presents an interesting opportunity for health systems and providers. These big tech companies are actually going to a further extreme, which is attacking the labor problem. They want to optimize, they want margins to go up, and they have started making everything automated.

I had an issue recently with a ride hailing service. I called the company and couldn’t talk to a human being. It only gave me automated menu options. I went through it five times just to keep saying I was dissatisfied. I wanted them to know five times that I was dissatisfied. There’s an opportunity for health systems to give real human care and not over-rotate the way some of these big tech companies are doing because of pressure from the public markets. It’s an interesting thing to explore. I’m going to bring it back to the team.

Who within a health system defines the messaging to customer personas that include both active patients as well as potential ones?

In the seven years since we started this company, this has changed. Seven years ago, it didn’t exist. There wasn’t anybody making those decisions. People were thinking about how to make sure patients show up to their appointments. It was a very specific point in time with the acute problem of making sure that we don’t have wasted slots. There’s more and more competition for the patient’s time right now, and there are more and more people who want to engage with a patient. 

The role that we have seen come up increasingly is chief digital officer or chief patient experience officer. They may be VPs or SVPs. Maybe the most famous example of this is Aaron Martin when he was at Providence. Right now, he’s at Amazon, going back to one of your earlier points, which should probably make us a little more scared of Amazon. I have seen the role of chief digital officer that focuses on end-to-end patient experience. Cedars-Sinai has a similar role. We’re seeing this more and more, and we are also seeing a lot of folks outside of healthcare being brought into these roles, pulling from places like Disney and AARP and other brands that have done a decent job of building those relationships with their customers. I like the trend and I hope it continues.

Was it a big change for EHR vendors to open their system to third-party applications? Do you expect further EHR integration developments?

There were couple of announcements recently. You wrote about this, with Larry Ellison at Oracle Cerner making a big push around partnering and saying that partners were really important to them. I love to hear things like that. It warms my heart. Epic has done a lot of work with their App Orchard, and they’ve announced a lot of enhancements to that program. That significantly expanded the APIs that are available. We have a close relationship with Oracle Cerner and Meditech as well, and we have seen them be open in terms of data sharing. It certainly is moving in the right direction.

With the interoperability that just went into play, there was some disappointment by a lot of folks in the space that it was pared back a little bit. There’s a lot of hoops that we have to jump through in healthcare. Even when we think about these feeds, APIs may cover 20% or 30% of the use cases for a vendor if you’re lucky. For the remaining 70%, you’re doing custom HL7 or going to FHIR or Interconnect web services.

That stuff is custom, and it rarely translates from customer to customer. That makes it significantly more complicated. It’s not like an app in the App Store, where you deploy it to Apple and anybody can download it. It requires an implementation. There’s a whole industry in healthcare around professional services and consulting firms that do this for a living. So we are definitely going in the right direction, but we are nowhere near where some other industries, like high tech, are.

A lot of technology adoption happened during the pandemic. As we try to find the new normal, how will that experience be applied?

I have this belief that in the universe, everything has to balance out at equilibrium. This is true for politics, relationships, you name it. Everything needs to find its balance. Things went off balance during COVID. What I’m seeing now is that we are going to shift to the other extreme, and eventually, we are going to find the middle ground. There was really quick adoption of lots of different forms of technology, purchasing cycles, and shortened deployment cycles. We solved problems very quickly.

I’m hearing more and more about consolidation. What does my EHR do? How much of this can I bring back to the EHR? I think we will see a significant paring back of the ecosystem of vendors that provider organizations maintain, along with a shift towards bringing things to the EHR that can be brought to the EHR. We will probably go to that extreme a little too much, and it will likely be a year or two before we find that balance again, where the EHR continues for those core investments and the truly additive things get prioritized and integrated and built on top of it.

How does the market for innovation look if EHRs replace some of those third-party applications and health system consolidation creates bigger but fewer prospective customers?

There’s a famous saying in Silicon Valley that down markets are where the best companies are formed. That creates pressure and forces entrepreneurs to the right places. If a health system can get “good enough” from their EHR, they’re going to go with that. Innovation will need to be unique, differentiated, and tough to replicate. It will do a good job of weeding out the possible solutions in the market, which could be good for healthcare IT overall. In the markets, it will look like investment dollars are slowing into healthcare IT. It will look like fewer purchasing decisions and like more consolidation. But the very best companies will form out of that pressure.

It will be net positive, but it will feel rough for a while. It may hurt health systems that adopted a lot of those technologies during COVID. Some of those technologies may disappear because the company goes out of business or is gobbled up by somebody else. It’s more important than ever to provide differentiated value and to understand the problems du jour of our customers, because they are very different than they were during COVID. It’s a totally different set of challenges. Now it’s labor shortages, labor costs, and margins. We see this in the news every day. We see a tremendous number of layoffs despite a really strong jobs market. It’s a confusing time.

What will be the direction of the industry and company over the next three or four years?

We absolutely have to be added to the EHR. We need to work with the big EHR players, understand what they’re going to tackle and what they’re not going to tackle, and fill in those holes. We need to pair that with what our customers are telling us they need, that are must-dos for them to get through this. It will  be a dark period for the next couple of years. 

We believe in creating an open platform. It will be important to create and invest in our infrastructure so that anybody in the healthcare IT space, any vendor, can route communications through us. I’d like them to be able to do it with no friction. Plug in to Artera once and you can send communication to any of our healthcare partners who enable you.  That’s where we need to get to. We need to create that network. That will create a lot of value for healthcare IT and health systems.

Morning Headlines 10/31/22

October 30, 2022 Headlines No Comments

Teladoc Health Reports Third-Quarter 2022 Results

Revenue and earnings beat expectations due to strong performance in its virtual mental health business, sending shares up.

MUSC Health and The MetroHealth System create Ovatient

The non-profit company will provide virtual and in-home care, hoping to match the digitally powered convenience and experience offered by non-traditional providers.

N.L. Crown agency responsible for health care IT flagged ‘extreme’ security risk a year before cyberattack crippled provincial health-care system

Newfoundland and Labrador Centre for Health Information has been requesting a move from its 40-year-old Meditech Magic system to Meditech Expanse for reasons that include security.

Monday Morning Update 10/31/22

October 30, 2022 News 1 Comment

Top News

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Teladoc Health reports Q3 results: revenue up 17%, EPS –$0.45 versus –$0.53, beating Wall Street expectations for both.

TDOC share price moved up on the news, although it remains down by 81% in the past 12 months. The company’s market cap is under $5 billion versus its all-time high of $45 billion in early 2021.

The company reports strong performance of its direct-to-consumer BetterHelp mental health business. It says it lost a former client of Livongo, which Teladoc acquired for $18.5 billion in October 2020.

Teladoc says that it is getting increased interest from organizations who want to use virtual health to manage chronic conditions at a lower cost.


Reader Comments

From Lomond: “Re: Cerner. Which of its missteps led to its sale to Oracle?” Cerner struggled with product issues (such as revenue cycle), dated architecture, and a client base that was being constantly poached by Epic. Multi-billion dollar federal contracts stretching over decades weren’t enough to keep investors excited. However, Cerner’s biggest mistakes were made by its board, who took forever to choose a successor when Neal Patterson died in 2017 despite the claimed existence of a CEO succession plan, which surely didn’t tell board members to, “Hire a low-profile CEO of a division of a foreign medical device manufacturer for his first real CEO job.” But to be fair, a lot of Cerner executives who should have been likely candidates, especially those who Neal didn’t like much, had already successfully moved on. Brent Shafer’s four years were forgettable except for the board’s capitulation to an activist investor, then the board hired as Shafer’s replacement yet another executive who had never run a publicly traded company, although maybe David Feinberg made Cerner look hipper to eventual acquirer Oracle in his fantastically lucrative few weeks as CEO. Looking ahead, I can’t think of many examples where acquired health IT companies got better running as divisions of unrelated companies whose own growth prospects were questionable, but Oracle is saying and doing all the right things so far. Boards have a fiduciary responsibility to investors and I think they chose the best available option in this case. It’s all great news for Epic, which at some point will have its own CEO succession plan tested in the same way.


HIStalk Announcements and Requests

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Two-thirds of poll respondents had paid their co-pay by the time they left their ambulatory visit. My personal experience is that medical practices and clinics are much worse at upfront collection than dental practices, which always seem to know exactly how much you need to pay after insurance and nicely ask for that payment while you’re taking possession of your free toothbrush kit.

New poll to your right or here: In the past year, has a provider given you a blank paper or electronic form that asks for information they should already have on file? It is aggravating when the front desk people of a provider that you’ve been seeing all along ask for the same information that they have already collected – medical history, allergies, meds list, emergency contact, etc. – instead of populating the form and allowing you to provide any corrections or updates. Will someone actually update your EHR information correctly if your new list of allergies or meds doesn’t match what is on file? If not, are you completing the form just so the provider doesn’t have to look at the EHR?

I watched Netflix’s movie “The Good Nurse” and it was a so-so yarn about nurse Charles Cullen, who killed dozens or hundreds of hospital patients using drugs like digoxin and insulin that he obtained by taking advantage of a quirk in the Pyxis drug dispensing machine. The hospital’s stonewalling of the police investigation was a big part of the movie, but what should have been mentioned was that many hospitals were irresponsibly using Pyxis like candy machines in the early 2000s, allowing nurses to make withdrawals of unordered meds, storing drugs in shared drawers (Cullen punched in Tylenol, then took digoxin from the same shared drawer), and failing to audit what was taken versus what was charted as given. i wrote a daily report ago for my academic medical center employer years ago that identified Pyxis withdrawals of unordered meds (including logic to account for delayed order entry), and it was so lengthy that nobody would review it. Anyway, the movie recalls the 2017 case of VUMC nurse Rhonda Vaught, who overrode a drug dispensing machine safeguard to give a patient the paralyzing drug vecuronium instead of the ordered sedative Versed, after which the patient died. San Diego-based Pyxis went public in 1992, sold to Cardinal Health for $867 million in 1996, was spun off with other products into Carefusion in 2009, and then was acquired by Becton Dickinson in 2014 for $12 billion.

This is the final boarding call for companies that want to sign up as HIStalk sponsors before the spring conference season begins and you realize that your HIMSS booth doesn’t help you for the 362 other days of the year.


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Welcome to new HIStalk Platinum Sponsor Censinet. The Boston-based company’s cloud-based RiskOps platform and collaborative risk network transforms cybersecurity and enterprise risk in healthcare with the fastest assessment results, most coverage, and best overall experience at a fraction of the cost. Its digital catalog includes 9,500 assessed vendors and 34,000 products and services, offering automated risk ratings and corrective action plan generation to streamline identification and remediation of risks with pre-built workflows. An example is generating a list of vendors and products that have access to PHI but aren’t covered with a business associate agreement. The company offers healthcare organizations no-cost access to its RiskOps for HICP, which simplifies the implementation and assessment Health Industry Cybersecurity Practices. Censinet RiskOps enables health systems to create long-term vendor partnerships, resulting in fewer vulnerabilities, reliable patching, and better performance and compliance overall. Thanks to Censinet for supporting HIStalk.

Here’s a video featuring Censinet founder and CEO Ed Gaudet, who describes the company’s philosophy and product.


Webinars

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


Acquisitions, Funding, Business, and Stock

Investor-backed HLTH says it has 9,400 registrants so far for its conference, which will be held November 13-16 in Las Vegas. I was surprised to see HIStalk list as a media attendee since none of us are going.


Sales

  • Three university hospitals in France choose Sectra’s digital pathology solution.

People

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Hearst hires Atti Riazi (Memorial Sloan Kettering Cancer Center) as CIO.


Announcements and Implementations

SNOMED and LOINC will collaborate to standardize health data terminology, distribute their content together, and reduce duplication.

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Fresh Tri, whose app promotes healthy habit formation, updates its system with improved onboarding, new algorithms to match users to behaviors, and new behaviors to support condition and disease management. Walmart licenses the app for free use by its 1.6 million employees.

Spok’s annual healthcare communications survey finds that the top obstacle in hospitals is budget and resources. Smartphone use for clinical communications dropped slightly for the first time, possibly because hospitals are issuing wi-fi phones instead of asking employees to use their own devices.

MUSC Health and MetroHealth launch Ovatient, a non-profit company and care model that will provide virtual and in-home care. The health systems say they hope that Ovatient can match the convenience and experience that non-traditional providers are delivering using digital tools.


Government and Politics

National Oceanic and Atmospheric Administration confirms that it plans to go live on Oracle Cerner next year, although under the Department of Defense’s MHS Genesis project rather than the VA’s as initially reported. NOAA has 24 clinicians.


Privacy and Security

A review finds that Canada’s Newfoundland and Labrador Centre for Health Information was warned that its 40-year-old Meditech Magic system was vulnerable to hackers a year before a fall 2021 ransomware attack exposed patient information and caused treatment delays. NLCHI has been recommending for years that the province issue a tender to replace Magic, with one study projecting that a move to Meditech Expanse would cost $85 million over 10 years, but would more than pay for itself.


Other

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Congratulations to New Jersey health IT consultant Eric Finkelstein, who has broken a Guinness world record for eating at the most Michelin-starred restaurants in 24 hours. He was able to obtain reservations at 18 of New York City’s best restaurants, traveling between them by Citi Bike bicycle and using a body cam to prove his accomplishment in wolfing down each place’s fastest-prep menu items, sometimes in less than two minutes. He spent $500 on his latest Guinness accomplishment, which also includes visiting all Citi Bike docks, making the longest table tennis serve, and building a flag out of 20,000 ping-pong balls.


Sponsor Updates

  • First Databank helps extend adoption of NCPDP’s National Facilitator Model, which will allow pharmacies, prescribers, and government agencies to access real-time information on prescriptions, testing, and immunization.
  • PeriGen CEO Matthew Sappern appears on Alldus International’s AI in Action Podcast.

Blog Posts

The following HIStalk Sponsors will exhibit at and/or sponsor AMIA 2022 November 5-9 in Washington, DC:

  • Clinical Architecture
  • First Databank
  • Intelligent Medical Objects
  • InterSystems
  • Meditech
  • Oracle Cerner
  • Wolters Kluwer Health

Contacts

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

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Morning Headlines 10/28/22

October 27, 2022 Headlines No Comments

NOAA Could Soon Join the VA’s EHRM Program

A VA official says that the 12,000-employee National Oceanic and Atmospheric Administration may join the VA’s Oracle Cerner project.

Navina Raises $22M Series B Round to Advance Its Rapid Transformation of Primary Care With AI

AI-powered, primary care patient insights company Navina raises $22 million in a Series B funding round, bringing its total raised to $44 million.

MHS Genesis Reaches Significant Operational Milestone

Ninety-two military hospitals and clinics are now live on Oracle Cerner-powered MHS Genesis, with half of all DoD providers actively using the system.

News 10/28/22

October 27, 2022 News 5 Comments

Top News

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In England, the British Medical Association’s general practice group warns members of possible unintended consequences of NHS England’s “Data Saves Lives” program that takes effect on November 1. Patients over 16 will be automatically granted access to all of their digital medical records as stored in TPP and EMIS. The same functionality is being developed for practices that use Cegedim.

BMA GPC suggests that practices use a specifically assigned SNOMED code that allows them to protect the information of patients whose relationships put them at risk.

They also note the “poor functionality of current software” that allows redacted records to be automatically activated when the patient changes doctors.

The group says a media campaign is needed to warn the public that their family members can access their records if they know (or can find or guess) their password.


HIStalk Announcements and Requests

The FOMO in me is calling for experimentation with the Meta Quest 2 virtual reality headset, although the cheapskate in me is countering with (a) the strong possibility I wouldn’t achieve ROI because I’ll lose interest; (b) waiting for the follow-up product’s release next year at about the same price; and (c) my reluctance to support Facebook with eyeballs or dollars.


Webinars

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


Acquisitions, Funding, Business, and Stock

Google acquires five-employee Sound Life Sciences, which offers an FDA-cleared respiration app for smartphones and smart speakers.

Walmart Health will open 16 new health centers in its Florida Supercenters next year.


Sales

  • PerfectServe chooses Lyniate Rhapsody as a Service for integration.
  • AtlantiCare chooses Orbita’s healthcare virtual assistant and conversational AI platform for digital front door and outbound communications such as post-discharge follow-up and care reminders..

People

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Everbridge hires Sheila Carpenter (Zix) as CIO.

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Karen Luk (AbleTo) joins Vivante Health as SVP of product.

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InteliChart hires Anthony Carter, MSEE, MBA (CloudFran) as COO.

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Victor Bagwell, MPH, MAS, MBA, MSc (Optimal Analytics) joins FDA as division director, Center for Biologics Evaluation and Research, Office of Regulatory Operations.

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Avicena hires Tesia Folse (Gainwell) as VP of marketing.


Announcements and Implementations

UCLA Center for SMART Health and Hearst Health announce the finalists for their $100,000 prize for using data science to manage or improve health:

  • Constant Therapy Health (at-home speech, language, and cognitive therapy).
  • Geisinger (linking people with chronic diseases to clinical services).
  • Prenosis (assessing hospital inpatients for sepsis risk).

A Black Book poll of hospitals and physician practices names AQuity Solutions as highest ranked in virtual scribes, medical transcription, and document capture.

The Massachusetts Medical Society opens submissions for its IT in Medicine awards program for MA-based medical students and residents.

Healthcare Triangle launches a service to help healthcare and life sciences organizations implement Metaverse environments.

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GetWell will enhance its inpatient offering as a consumer-forward solution, including a new user experience, mobile-first solutions, automated caregiver workflow and communications, and further EHR integration.

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Net Health integrates its wound EHR with PointClickCare to support clinical documentation exchange with post-acute healthcare facilities.

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A new KLAS report on home health technology finds that Homecare Homebase is vendor of choice for large, independent organizations even though its user satisfaction is average and innovation lags, largely because it offers broad, well-integrated functionality. Independent agencies rate MatrixCare tops, while health system-owned agencies rank Epic and Meditech highest.


Government and Politics

A VA official says that the 12,000-employee National Oceanic and Atmospheric Administration may join the VA’s Oracle Cerner project.

Politico notes that many state Medicaid programs are declining to pay for remote patient monitoring, either because they question its effectiveness in managing chronic conditions or because they are unwilling to spend the money.


Privacy and Security

Australia’s MediBank says that its October 12 breach was worse than the insurer originally reported, now acknowledging that the hacker had access to all of the personal data of its 4 million customers and significant amounts of their health claims data.

A Meta spokesperson says that use of its pixel user tracking tool to send sensitive information to advertisers, as several leading health systems appear to have done, violates its policies.


Other

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Vanderbilt University Medical Center informatics professor Allison McCoy, PhD questions why practices ask long-term patients to input the information that is already documented in their EHR. I’ll join that bandwagon in observing that providers have always shoved the same literal or virtual clipboard full of poorly designed forms at every patient, long-term or otherwise. Beyond making the patient enter information that’s already on file, that raises the question – how are the two sets of information being reconciled, and by whom? Electronic questionnaires, or more specifically their improper use by practices who fail to tailor their messages, may have made the practice even more annoying. Healthcare interactions are among the most important and most expensive for many of us, so to greet loyal customers with blank faces and blank forms is inexcusable, especially when pharmacies, dental offices, accounting and law practices, banks, and even veterinary offices always make customers feel known and valued.

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An entertainment publication profiles retired ICU nurse Amy Loughren, who helped convict friend and colleague Charles Cullen for killing hospitalized patients by adding lethal drugs that he obtained from Pyxis drug dispensing cabinets to their IVs. The story is dramatized in the new Netflix true crime film “The Good Nurse.” Loughren became suspicious in 2002 about several mysterious patient deaths at Somerset Medical Center (NJ). She looked at Cullen’s activity log in Cerner, which showed that Cullen was monitoring patients who weren’t under his care and some of those patients died unexpectedly. Cullen eventually confessed to murdering dozens of patients, having moved from one job to another at hospitals that declined to notify authorities about their suspicions or to give him a bad employment reference because they were afraid of being sued. In another health IT angle, investigators were initially told that the hospital’s Pyxis system retained records for only two months, but a detective found that information was actually stored indefinitely, which convinced Cullen to confess to the 40 murders that he could remember (the actual number of patient deaths was speculated to be as high as 400).


Sponsor Updates

  • Intelligent Medical Objects will exhibit at NextGen UGM November 6-9 in Nashville.
  • Loyal Health will exhibit at the Healthcare Internet Conference November 7-9 in Miami.

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 10/27/22

October 27, 2022 Dr. Jayne 3 Comments

Hospitals and health systems are often sponsors and supporters of various sports teams. Although I understand the reasons and how marketing works, I’m always annoyed since deep down all that spending is fueled by patients.

One of our local surgeons, who is frankly embarrassed at his organization’s sports sponsorships and luxury suites at the local ballpark, shared this piece about a shakeup in stadium naming rights for one of the newest Major League Soccer teams. Health insurer Centene has backed out of a deal to be the naming sponsor for the newly constructed stadium in St. Louis, where the aptly named St. Louis City SC is set to play. The stadium will now be called Citypark while the team hunts for a new naming sponsor. Centene had previously inked a 15-year deal for the naming rights, but a recent statement to local media said it would be realigning partnerships to create “long-term, tangible value for local communities.”

Millions of taxpayer dollars flow through Centene every year via government programs such as Medicaid, so I’m glad they’re reassessing the use of their funds. Not to mention that recent reports indicate that their Medicare Advantage quality scores have been worse than expected, which places its 2024 revenues at risk. The organization recently announced it plans to hire a chief quality officer. I’d much rather see money spent on that role than to name a sports facility. At the same time, Centene noted that quality improvement will be “a compensation metric by which all employees’ performance will be measured this year.” I hope they set things up to truly incentivize the employees as opposed to making it a way to squeak out more cash for the shareholders.

I admit that I’m suckered in by clickbait headlines as much as the next person, so I felt compelled to click on the recent Medscape feature on “Physicians Behaving Badly: US vs. UK.” I had literally just come off a call with a colleague where we discussed various patient misadventures, including misdiagnosis, failure to receive informed consent prior to a procedure, fraudulent patient care documentation, and more. The survey looked at 2,800 physicians in the US and UK. In case anyone is curious, the US ranked higher in several unseemly behaviors, including being verbally or physically aggressive; disparaging others; using racist language; and bullying and harassment. UK physicians ranked higher in public intoxication. “Making unwanted advances” was a choice in the US survey but not in the UK version, and conversely sexist behavior was a choice in the UK but not in the US, so it was hard to compare the two.

When faced with physician misbehavior, US physicians were more likely to complain anonymously to the employer or human resources, where UK physicians were slightly more likely to do nothing. For both groups, the leading demographic for misbehavior was age 40-49, with men outnumbering women twofold. As far as how those surveyed think physicians should behave, data was almost identical for both the US and UK, with two-thirds thinking that physicians should be held to higher standards than the general public due to their role. I dislike seeing healthcare professionals behaving badly, regardless of their title, role, or geographic location. I’ve seen more training programs addressing professionalism in their curricula, so let’s hope things improve.

If primary care physicians spend more time in the EHR, does that lead to improved clinical outcomes? A study published this week in JAMA Network Open looked at this question. Researchers performed a cross-sectional study of 300 primary care providers at two large academic health centers. They found that each additional 15 minutes of daily use of EHR messaging led to improvements in glucose control for diabetic patients, improved management of hypertension, and higher breast cancer screening rates. Of course, that amount of time sounds small, but over the course of a year, 15 minutes a day adds up to an additional week and a half of work for a clinician who is more likely than not to already be burned out and stressed.

The authors noted that “these results underscore the need to create team structures, examine PCP and office workflows, and enhance EHR-based technologies and decision support tools in ways that enable high quality of care, while optimizing time spent on the EHR.” Since so much of EHR messaging work is not part of a clinician’s visit-based, revenue-generating work, they also note that “the associations we have identified between increased in-basket time and enhanced ambulatory quality of care highlight the importance of continuing to develop and expand value-based reimbursement systems that adequately reward outside-of-visit care delivery.”

They note that both academic health systems in the study have dedicated population health teams that support primary care physicians in tracking quality performance. They’re also both located in the same geographic area that has a relatively heterogeneous patient population, and as such, they may not represent the majority of primary care physicians in the US.

My favorite quote from the piece is this: “Our findings suggest that although increased EHR time, particularly after hours, has been associated with increased emotional exhaustion and burnout, it may represent a level of thoroughness, attention to detail, or patient and team communication that ultimately enhances certain outcomes. This finding is consistent with recent research reporting a trend toward better outcomes for measures of health care use for family physicians who reported some level of burnout, suggesting that the extra attention given to clinical problems and extra communication that may occur during additional time spent by PCPs may be valuable for patient outcomes.”

Primary care physicians are living in a way that most are counseled against. Time and again, we have seen their willingness disregard the phrase about “not setting yourself on fire to keep others warm.” In the US, they’re among the most hard-working of physicians with the best opportunity to intervene in chronic conditions and lifestyle issues, yet they’re at the bottom of the pay scale and often with the least support staff. The failure of policymakers to align payments in a way that will best serve patients and reduce overall costs will continue to haunt us for decades.

Do you have a primary care physician, and can you actually get a timely appointment? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 10/27/22

October 26, 2022 Headlines No Comments

National Medical Billing Services Announces Acquisition of MedTek

National Medical Billing Services acquires MedTek, which offers RCM software and services to ambulatory surgery centers and other healthcare providers.

Shadowbox closes Series A Funding round with Baleon Capital

Healthcare workflow automation startup Shadowbox raises $6 million in a Series A funding round.

Elion Raises $3.3M in Seed Funding for Digital Health Technology Marketplace

Elion raises $3.3 million to further scale its digital health technology marketplace, which offers buyers evaluations of software and services.

HIStalk Interviews Mike Alkire, CEO, Premier

October 26, 2022 Interviews No Comments

Mike Alkire, MBA is president and CEO of Premier of Charlotte, NC.

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Tell me about yourself and the company.

I’ve been in my role as CEO for the better part of a year and a half. Premier is an evolving business and has been an evolving business in the 18 years I’ve been here. We started as an organization that was focused on supply chain cost reduction and healthcare system quality improvement. We’ve morphed into doing those two elements plus many other capabilities, including standardizing the way that clinicians practice and pharma and med device looking at utilizing our capabilities to help them in real-world evidence studies and in identifying patients for trials.

We created a couple of subsidiary companies in the last few years. They are focused on helping our healthcare systems as they think through new revenue models and are working more closely with the employers in their market. That’s our Contigo Health initiative. We also have an initiative called Remitra, which is all about e-invoicing and e-payables.

Everything we do and contemplate doing is about helping healthcare systems become more efficient, using technology to reduce labor usage and to help them generate more revenue and more profitability.

How can technology make the health system supply chain more efficient?

During COVID, we stood up a coalition of all of the suppliers and distributors of PPE, personal protective equipment. Then we melded that with HHS , FEMA, CDC, and FDA. Because what became painfully apparent in March 2020 was that the federal government didn’t have a real good idea of the location of products to protect caregivers. We quickly stood up that coalition and started getting some traction on getting access to product and getting that supply chain up and running. We understood the utilization patterns of PPE in New York. We used some AI and machine learning capability to forecast from our data as well as the Hopkins data on the progression of COVID. Then we layered our utilization patterns on top our models so that we could help health systems determine the amount of product they needed.

That was important, because everybody was in the market at the exact same time looking for product. That was driving up the cost. Everybody was trying to stockpile against those that actually needed the product. We needed to bring some sanity to that madness. We developed that technology. Some federal agencies are looking at it today as something that they might want to continue to use going forward.

Another element is labor extenders. It’s amazing that 75% of healthcare invoices are still paper. Or focus is to use technology to automate that or digitize those invoices. We have some pretty cool advanced optical character recognition capability and some machine learning capability to make that more effective. But the point is that this invoicing and payment function is still fairly antiquated, and our goal is to bring that up into the 2020s as opposed to being something that has existed for 25 or 30 years.

We are also looking at products and drugs and the outcomes associated with those. We’re so much better at that with our acquisition of Stanson Health. Writing standards of care in Epic, Cerner and Athenahealth that are based on data, how the patient presents themselves, and lab values and other screens is critical. That will evolutionize healthcare. We want to continue to proliferate technology like that all throughout the healthcare system.

You launched Contigo Health three years ago and it recently made a big acquisition of contracts and technology. How is that business doing?

It’s going incredibly well. Thank you for asking. It is meeting its growth profile. Health systems are obviously under a great deal of stress and pain, struggling with high labor costs and supply cost inflation. We are creating new models for them to get access to revenue that maybe they hadn’t had access to in the past. 

Contigo is just one of those ways to do that, to help build plans and capabilities so that health systems can go directly to employers, both in their market and at a national level. That program is doing really, really well. We continue to build the high-value network of health systems that provide care to a significant number of large national and international companies. We bought a third-party administrator a few years back for the centers of excellence programs that most advanced employers or innovative employers use, so that when folks need a knee or a hip done, they can be sent to a national center of excellence. The TPA supports that function.

As you said, we recently ran an acquisition of an organization that has access to a 900,000-provider contract. Our healthcare systems that have health plans can leverage a wrapper that is very economical and has a number of providers who can fill the needs of those health plans outside of the region of where that care is being delivered by that provider. We are excited about the direction that Contigo is going.

Will health system consolidation continue to the point that we have just a dozen or two regional and national health systems?

It’s tough to tell. They are battling against the sheer scale of health plans. Optum and UnitedHealth Group have $500 billion in market cap. You have Anthem, Aetna, and Cigna with market caps of tens or hundreds of billions of dollars. Then you look at the health system, HCA being the largest at $60 billion. It’s a huge issue in access to capital. Do you want our health system being innovated by the providers, or do you want it being innovated by the payers? These health systems are trying to create enough scale to bring a bit more balance against the payers on this.

I don’t necessarily have a prediction in terms of what large health systems will look like. I think you’ll have a lot of regional health systems and then still have local health systems, because those communities have specific needs to the point that they will probably need to remain independent, especially as healthcare continues to move outside the four walls of the hospital.

The way that we will look at health systems in 20 years will be much different than today. We have these big acute settings, non-acute settings, clinics, physician practices, rehab, labs, and all those kinds of things. But health systems are trying to move as much into the community as possible. That means trying to figure out ways to lower overall variable cost and fixed cost. The way that care will be provided in the future is going to be dramatically different, and advanced technology will be needed to help drive that transformation.

Optum is hiring a lot of physicians and buying practices, and at the same time, big retailers could be planning to cherry-pick the most profitable parts of the health system business. How are health systems responding?

When you have well-capitalized companies getting into any space, you’re always going to keep an eye towards that. Our interest, and that of many of our health systems, is to figure out ways to partner with those entities and help them meet the needs of what they’re trying to accomplish. That’s one of the reasons that Contigo got started. It was driven by Walmart trying to figure out ways to get more value for their healthcare dollar. I don’t think this is going to go away. With the rising cost of health insurance, you will see employers continue to look at unique models. We want to be there with capabilities, services, and technology to help them as they transform their healthcare costs.

How is the data connectivity between health systems and life sciences companies changing?

The most important aspect is data security and data protection, making sure of de-identification capabilities and using things like avatars to represent people. Those will be essential in research going forward. That scale will be important. That pharma or med device doesn’t have the ability to reach out to 5,000 hospitals, so scaling all that data and technology is going to be important.

How you consume the data and serve it up will be important in the future as well. Everybody will have different needs in terms of what they’re trying to consume from a data standpoint. You’ve got people in the middle of trials, you’ve got real-world evidence studies, you’ve got off-label utilization of products, you’ve got identification of patients just because of the need for more heterogeneity in these studies and those kinds of things. It depends on the prevailing needs. But the most exciting thing is that technology is coming to a place where we can meet all those challenges just because of a lot of the work that has been done over the last 10 years.

How do you see the business environment playing out over the next two or three years, especially for smaller companies?

It is incredibly important to have strong ROIC, return on invested capital. We want to have nice return for our shareholders and to drive our EBITDA and our cash flow and those kinds of things. Those are the most important parts of a business. When you launch new businesses and you’re making investments in those kinds of things, you have to make sure that you have the right plan in place and that you are getting the right level of returns. Organizations that have great ideas, a strong history of delivering ROIC, and a strong history of delivering performance will generally do well going forward.

The other side of that, as you were talking about it from an investor standpoint, is that it is even more important that we are creating offerings that can show short-term, mid-term, and long-term returns for our customers. It is no longer the day that you’re implementing something that will provide a a return in a year. Health systems are under such duress. You have to be able to walk in with options, services and technology that will help you drive results very quickly. Then, as much as possible, get a lot of that information and insights embedded into the electronic medical record so that you have long-term sustainable improvement as well.

What will be important for the company over the next three or four years?

A couple of things will be critical for us. Even with market’s labor factors being the way they are, this is all about getting great talent into the organization. Recruiting great talent is so interesting. I had a conversation with a student in an MBA program that is top five in the world. I was impressed with her and asked, “Where are you thinking about doing your internship, Google, Apple, or Amazon?” She said, “Yes, I’m considering those because I’m really interested in what they’re doing in healthcare.” I said, “One of the things that we think is unique about Premier is that we truly understand healthcare and have been building incredible technology capability over the years, as opposed to a great technology company that is trying to understand healthcare.” Getting access to great talent is going to be really important.

I constantly challenge my team. Are we continually pragmatically innovating? How are we taking the platforms that we’ve created and creating those next layers of innovation? We’re doing some amazing things using a artificial intelligence, machine learning, and natural language processing.

The sky is the limit for us. Now it’s a matter of getting the right use cases built and getting the right products developed to support our health systems along their journey to transforming the way they are providing care to their patients.

Morning Headlines 10/26/22

October 25, 2022 Headlines No Comments

Telehealth unicorn Cerebral lays off 20% of staff for ‘operational efficiencies’

Virtual mental health provider Cerebral lays off 20% of its staff, reportedly affecting 400 employees in primarily clinical and care counselor roles.

Electronic Caregiver Announces the closing of an additional $42.5 Million in Funding to Accelerate Expansion

Electronic Caregiver, which offers remote patient monitoring, virtual care, and chronic care management services, raises $42.5 million.

Hospital for Special Surgery (HSS), The Global Leader in Orthopedics, Launches Newco Targeting $380B National Musculoskeletal Health Burden

Hospital for Special Surgery announces plans to launch for-profit virtual musculoskeletal physical therapy provider RightMove, which is backed by a $21 million Series A funding round.

VA Awards Oracle Cerner $956M in EHR Modernization Task Orders

The VA awards Oracle Cerner $956 million worth of task orders to continue its rollout.

News 10/26/22

October 25, 2022 News 2 Comments

Top News

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Philips reports lower revenue and a loss of $1.28 billion in Q3 due to supply chain issues and the recall of several million of its CPAP devices.

Newly appointed CEO Roy Jakobs says the company will immediately lay off 4,000 employees.

Philips hopes that remediation of 4 million CPAP and ventilator devices – which were found to contain foam whose degradation can cause serious injury or death — will be completed for 90% of users by the end of the year.


HIStalk Announcements and Requests

Lorre and Jenn are looking for fun ways to celebrate HIStalk’s 20th birthday in June 2023, should you have ideas.


Webinars

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


Acquisitions, Funding, Business, and Stock

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HealthStream announces Q3 results: revenue up 5%, EPS $0.12 versus $0.05. HSTM shares are down 23% in the past 12 months versus the Nasdaq’s 27% loss, valuing the company at $666 million.

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Point-of-care digital patient education company CheckedUp acquires competitor Health Media Network.

Virtual mental health provider Cerebral lays off 20% of its staff, reportedly affecting 400 employees in primarily clinical and care counselor roles. A round of layoffs earlier this year impacted support and operations teams. The news comes less than a month after fairly new CEO David Mou, MD renewed the online mental healthcare company’s commitments to clinical safeguards and patient identification verification protocols and software, areas in which it has come under federal and consumer scrutiny. He also vowed to conduct a comprehensive review of internal operations and performance.


Sales

  • Arizona HIE Contexture selects technology from Unite Us to power its CommunityCares social determinants of health referral system.
  • OSF Healthcare (IL) will use CareSignal’s deviceless remote patient monitoring technology as part of its OnCall Connect digital care management service.
  • Sinai Medical Group (IL) will implement physician RCM services from Conifer Health Solutions.

People

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Walmart Health hires Claude Pirtle, MD, MS, MBA (West Tennessee Healthcare) as CMIO.

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Brian Graves (RelayOne) joins Resolv Healthcare as VP of sales and marketing.

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CVS Health hires Amar Desai, MD, MPH (Optum) as president of its newly formed healthcare delivery organization.

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Commure hires Chris Kuhns, MBA (Iris Telehealth) as CFO.

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Jamie Hall (Transcarent) joins virtual primary care vendor CirrusMD as president and CEO.

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Health Recovery Solutions names Jaydeo Kinikar, MBA (Best Buy Health) chief product officer.

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Laizer Kornwasser, MBA (CareCentrix) joins Teladoc Health as president of enterprise growth and global markets.

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RevenueWell promotes Julie Coviello to chief customer officer.

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Medical device data platform vendor Canary Medical hires Lisa Suennen (Manatt, Phelps & Phillips, LLP) as president of digital and data solutions.

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Mark Burgess (NextGen Healthcare) joins Agfa HealthCare as president, North America.

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Health Care District of Palm Beach County hires Daniel Scott (Good Samaritan) as AVP/CIO.

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Denis Tanguay, MSHA (Huntzinger) joins Sturdy Memorial Hospital as VP/CIO.

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Tim Johnson (247/ai) joins Nuance Communications as head of UK sales, healthcare.

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Talon hires Elif Eracar, MS (Redox) as COO.

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Atlas Health hires David Franklin (Ontario Systems) as president; Christopher Parks (Avaneer Health) as chief client officer; Nicole Nye, MBA (Finvi) as VP of product management; Nicole Hess, MBA (Olive) as SVP of marketing; and Todd Helmink (PatientBond) as head of strategic partnerships.


Announcements and Implementations

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Penn State Health’s Milton S. Hershey Medical Center goes live on Oracle Cerner.

ACO MultiCare Connected Care implements prior authorization automation technology developed with MCG Health using the HL7 Da Vinci Project FHIR standard.

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Lake Region Healthcare (MN) will go live on Epic November 1 through a Community Connect partnership with Sanford Health.

Healthcare concierge program Renee adds a flat-fee prescription drug program that covers 500 commonly prescribed generic medications for $25 per month. The company was founded by the husband-and-wife team of Nick Desai, MS and Renee Dua, MD, who founded doctor house call company Heal in 2014.

Hospital for Special Surgery announces plans to launch for-profit virtual musculoskeletal physical therapy provider RightMove, which is backed by a $21 million Series A funding round.

A Harvard study of an academic medical center’s orthopedic surgery patients finds that patient-reported outcomes are completed less often by patients who are black, covered by Medicare, aren’t married, don’t speak English, or who haven’t activated their patient portal account, which could create bias in clinical outcomes research. The authors speculate that patients who activate a portal account are self-selected for technology fluency, access to technology, and willingness to engage and manage their health.

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CHIME’s Fall Forum will be held November 7-10 in San Antonio. The opening keynote speaker is humanoid celebrity Sophia, while the closing keynote will be offered by the US Navy’s first F-14 Tomcat fighter pilot Carey Lohrenz.


Government and Politics

The VA awards Oracle Cerner $956 million worth of task orders to continue its rollout.

North Carolina’s state treasurer says that the non-profit “hospital cartel” always puts profits ahead of patients in providing vague and sometimes conflicting data about the benefit they provide taxpayers in return for billions of dollars worth of tax exemptions. The report cites Atrium Health, which claimed that it lost $640 million in Medicare patients, but whose financial reports show a $120 million profit on those patients. National analysis shows that nearly all health systems spend less on charity care than they receive in tax breaks.


Privacy and Security

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The US Cybersecurity & Infrastructure Security Agency advises the healthcare and public health sector of ransomware attacks and data extortion schemes conducted by the Daixin Team. The group has been especially active over the last five months, with Oakbend Medical Center being one of its more high-profile victims. It stole 3.5 GB of data from the center in September, after which it published a sample of 2,000 OMC patient records on its data leak site.


Other

A fascinating article describes how, in the late 1960s, two pathology residents at Englewood Hospital (NJ) used their hands-on experience with newly developed lab test processing machines to later form what became Quest Diagnostics and LabCorp. The companies used that automation to scale, reducing per-test cost and weeks-long  turnaround times to the point that smaller labs either went out of business or sold out to the companies. One expert says that they are no longer lab companies, but rather “M&A companies in the lab space.” Competitors can’t crack the exclusive contracts that insurers sign with Quest and LabCorp and can’t compete with their armies of salespeople, so their only options are to focus on a low-profit niche like allergy testing, locate in low-density population areas that are unattractive to the big players, or agree to be purchased. The article goes off track a few paragraphs in, ranting off topic on electronic medical records except pointing out that EHRs don’t make it easy for doctors to choose competing labs.


Sponsor Updates

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  • Clearsense sponsors Banner Health’s Pulse of the City Soiree.
  • Kyruus publishes its sixth annual patient access journey report, “The Many Digital Doors of Patient Access and Engagement.”
  • The Who Would Have Thought: Digital Health Innovation Podcast features Arrive Health CEO Kyle Kiser.
  • Azara Healthcare achieves HITRUST risk-based, two-year certification.
  • Baker Tilly releases a new Healthy Outcomes Podcast, “Implementing an effective hospital-at-home care delivery model.”
  • Bamboo Health affixes new signage to the top of its office building.
  • Clearwater announces that the National Association of Corporate Directors has recognized founder and Executive Chairman Bob Chaput as NACD Directorship Certified.
  • Diameter Health will exhibit at the NCQA Health Innovation Summit October 31-November 3 in Washington, DC.
  • EClinicalWorks publishes a new customer success story showcasing how its AI-based Scribe dictation technology has helped Open Door Family Medical Center combat pandemic challenges and reduce physician burnout.

Blog Posts


Contacts

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

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Morning Headlines 10/25/22

October 24, 2022 Headlines No Comments

Healthcare tech giant Philips scraps 4,000 staff worldwide

Philips will lay off 5% of its global workforce in an effort to bounce back from its $1.28 billion Q3 loss, brought on in part by the recall of its potentially defective sleep apnea machines.

CISA Warns of Daixin Team Hackers Targeting Health Organizations With Ransomware

The US Cybersecurity & Infrastructure Security Agency advises the healthcare and public health sector of ransomware attacks and data extortion schemes conducted by the Daixin Team.

Unified Women’s Healthcare acquires Gennev to become the leader in menopause care in the US

Practice management company Unified Women’s Healthcare will acquire Gennev, a digital care company for menopausal women.

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