Monday Morning Update 9/25/23

Top News

Nasdaq sends Veradigm a delisting notice for failing to file financial reports, which the company says it expected and will appeal.

Veradigm expects to file the overdue reports by the end of Q4. It blames its failure to file its annual report for 2022 and the two following quarterly reports on accounting software problems. 

Reader Comments

From Former Employee: “Re: ModMed. Acquired Klara last year for $135 million and has laid off 80% of the sales team. It’s an interesting story that unfolds on GlassDoor reviews.” Unverified. Specialty EHR vendor ModMed – formerly known as Modernizing Medicine – acquired the patient outreach messaging vendor Klara in February 2022. Privately held ModMed has raised a reported $400 million, none of it recently, and paid $45 million in November 2022 to resolve federal kickback charges related to referring business to a clinical lab partner.

From Interopguy: “Re: Oracle Health. Mysterious message on the end of code Developer program at Cerner, and uncertain path forward. What does this mean for app developers and for interop with Oracle Health?” The Open Developer Experience was created to help developers build apps for Millennium and HealthIntent that improve interoperability capabilities. Oracle Health developer Aaron McGinn, who appears to have had led the company’s presence with the developer community, has tagged his LinkedIn with “open to work.” Oracle moved its discussion forms to an Oracle site and users report lack of company response along with errors in the developer sandbox.

From Laminar Flow: “Re: Oracle Health. One of their recruiters says on LinkedIn that Adventist Health will end its Cerner ITWorks contract with Oracle in January 2024 and bring the IT function back in house.” The post seeks to hire people for Oracle now who will receive matching offer letters from Adventist Health. Adventist Health signed a big deal with Cerner in January 2018 to take over revenue cycle management and clinical applications, but terminated the RCM contract the following year and brought the 1,700 employees back in house, after which Cerner sold that business to R1 RCM.

HIStalk Announcements and Requests

A few poll respondents know or suspect that AI was used in a recent medical encounter.

New poll to your right or here: How will technology significantly improve US healthcare in the next five years? (multiple answers OK)

I greatly enjoyed reading Brian Too’s cynically relevant comments about VC folk in general and Epic-bashing Bill Gurley specifically:

You want investor capital and lots of it. There is a pathway to this that involves self promotion, a dynamic speaking style, outrageous theories that are unconventional and controversial, and chutzpah. Above all the chutzpah! When challenged on the facts, you just say something like, “It’s only a theory,” or you cite one fact that supports your story but doesn’t actually prove it. Then you get your skeptic to do all the lengthy, boring investigation. You drive off in your fully expensed Ferrari, confident you can stay ahead of any questions. These folks are fun at parties, but they will never come within a million miles of my money. 

Webinars

October 25 (Wednesday) 2 ET. “AMA: The Power of Data Completeness.” Sponsor: Particle Health. Presenters: Jason Prestinario, MSME, CEO, Particle Health; Carolyn Ward, MD, director of clinical strategy, Particle Health. Is your healthcare organization looking to drive profitability and scale quickly? Our experts will explore how comprehensive clinical data can revolutionize the health tech landscape. This engaging discussion will cover trending topics such as leveraging AI and data innovation to enhance patient care and outcomes, real-world examples of organizations leading the charge in data-driven healthcare, overcoming challenges in data completeness and interoperability, and visionary perspectives on the future of care delivery.

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

Acquisitions, Funding, Business, and Stock

The Federal Trade Commission sues US Anesthesia Partners and its private equity minority share owner, claiming that the companies executed an anti-competitive scheme to consolidate anesthesiology practices in Texas to drive up prices and profits. Legal experts say the action is notable because FTC included the private equity investor and not just the company itself in its lawsuit, potentially signaling a new type of federal scrutiny of healthcare.

People

Arrowhead Regional Medical Center (CA) hires CMIO consultant John Brill, MD as chief medical officer.

Announcements and Implementations

AMIA announces the winners of its 2023 Signature Awards:

• Donald A.B. Lindberg Award for Innovation in Informatics — Noémie Elhadad, PhD, associate professor and chair of biomedical informatics, Columbia University.
• Don Eugene Detmer Award for Health Policy Contributions in Informatics — Dean Sittig, PhD, professor, UTHealth Health Science Center at Houston.
• William W. Stead Award for Thought Leadership in Informatics — Atul Butte, MD, PhD, director of the Bakar Computational Health Sciences Institute and distinguished professor, University of California, San Francisco.
• Virginia K. Saba Informatics Award — Susan Newbold, PhD, RN, director, Nursing Informatics Boot Camp.
• AMIA New Investigator Award — Yifan Peng, PhD, assistant professor of department of population health sciences, Weill Cornell Medicine.

A Health Affairs article calls for healthcare ownership transparency so that patients will know if their physician practice is owned by – and perhaps likely to have their clinical judgment influence by — a private equity firm, insurer, health system, Amazon, or a conglomerate such as CVS Health or UnitedHealth. They also call for location transparency to support site-neutral payments, ending the practice of hospitals buying practices or ambulatory centers and then billing higher hospital prices using the parent facility’s provider number and thus preventing the payer from determining where services were provided.

CHIME offers a webinar to prepare potential ViVE 2024 speakers for submitting applications. The call for track speakers closes at the end of October.

Other

The Federal Trade Commission cracks down on the deceptive marketing claims of health influencers, one of them “The Liver King,” who claimed $100 million in annual sales of supplements to accompany his raw meat diet, which generated a net worth of $310 million. He later admitted that his ripped appearance was actually due to taking $11,000 worth of steroids each month, which is not exactly shocking since he sounds a lot like ‘roid rager Danny Bonaduce.

Marginally healthcare relevant, but interesting for a slow news day. Wired covers the “obituary pirates” who scrape death details from funeral home websites, create low-quality videos of themselves reading the deceased’s write-up, then use search engine optimization on the person’s name to draw in people who then hear about their death in the cheesiest possible way while being served ads. As has been noted, death is the ultimate total addressable market.

Sponsor Updates

• EClinicalWorks releases a new podcast, “Unlocking Reporting Capabilities in EBO.”
• NeuroFlow publishes a new case study, “Magellan Healthcare Expands Real-World Impact of DCBT, While Improving Member Access & Engagement.”
• Nordic releases a new Designing for Health Podcast, “Interview with Tricia Baird, MD.”
• Waystar will exhibit at the NJ & Metro Philadelphia HFMA Annual Institute September 27-29
• Wolters Kluwer nominates NextGen Healthcare President and CEO David Sides to its supervisory board.

Blog Posts

• Meditech’s Traverse Exchange Canada network advances health information sharing (Meditech)
• Conversational AI for healthcare is a significant step beyond the chatbot, here’s why (Notable)
• 10 Questions to Ask Autonomous Medical Coding Vendors (Nym Health)
• Fighting Opioid Addiction – One Life at a Time (Netsmart)
• Want to improve patient safety? Up your EHR’s usability (Nordic)
• Three Ways to Prove ServiceNow ROI (Optimum Healthcare IT)
• PLD Is Not Enough: Next-Best-Action HCP Engagement Needs the Patient (OptimizeRx)
• Solving the Top Healthcare Transfer Center Challenges (PerfectServe)
• 4 best practices for boosting your HCAHPS scores (Spok)
• Is Your Provider Data Getting Lost in Your Master Data Management? (Symplr)
• Your complete guide to Meditech Expanse (Tegria)

Contacts

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

Morning Headlines 9/22/23

AMA Future of Health issue brief: Commercial Payer Coverage for Digital Medicine Codes

The American Medical Association says that lack of alignment and adoption of CPT codes for digital medicine limits their use.

Value-based payments are making it harder to see your primary care doctor on short notice

Jeffrey Millstein, MD says that value-based care has made it hard to get short-notice appointment with PCPs who are refocusing on managing populations and meeting payer metrics.

Diligent Robotics Closes $25 Million to Advance Systemwide Expansions of Socially-Intelligent Service Robots, Empower Healthcare Professionals

The company expects to triple its Moxi healthcare robot market footprint of 22 health systems using $25 million in new funding. 

News 9/22/23

Top News

Digital-first care management and virtual care infrastructure vendor UpHealth files Chapter 11 bankruptcy after a court rules that it owes an investment bank $31 million for arranging a SPAC merger to take the company public.

UPH shares that peaked at $28 in late 2021 are now worth $1, valuing the company at $17 million.

Reader Comments

From Nasty Parts: “Re: Verinovum and Robin Healthcare. Both are being shut down by their primary funding entities. First time I’ve seen that.” Unverified, although several Verinovum employees recently added “open to work” to their LinkedIn profiles and Robin is no longer listed as a Khosla Ventures portfolio company. Verinovum offers healthcare data curation, while Robin Healthcare sells a smart assistant that creates clinical documentation for orthopedics.

HIStalk Announcements and Requests

Last call: sponsors who are participating in the HLTH conference can be included in my guide by completing a short form with their details.

I was checking something on the HIMSS24 website and noticed that it will offer exhibitors a reverse expo. I don’t recall that HIMSS has done this in the past, but HLTH and ViVE tout their hosted buyer programs and new HIMSS conference operator Informa specializes in that. I’m also reminded that HIMSS is no longer based out of Chicago, at least from a legal standpoint, having followed many corporations that moved their HQ to the tax haven of Netherlands.

A Reader’s Notes from the Nashville Healthcare Sessions

• HCA says its nursing school will have 30,000 students when it reaches capacity by the end of the decade.
• One investor says their firm is interested in behavioral health investments but is considering AI solutions for staffing and recruiting. They are worried that policymakers could pass knee-jerk AI regulations.
• Another investor says they aren’t interested in point solutions and those that are narrowly focused on management of single conditions and will instead look at platforms or something that ties into bigger workflow and tools. They predict AI use in drug discovery, supporting payer-provider services, and radiology image analysis.
• A Humana executive says interoperability will be a $1 billion opportunity by 2025.
• A16Z sees a lot of AI noise that the industry can’t absorb and predicts that many of the ideas will fail or will be merged into something else. They are concerned about ONC’s proposed algorithm transparency rule and the requirement that EHRs implement risk management practices for third-party predictive models.
• Aneesh Chopra thinks providers will be biggest beneficiary of AI, with the best opportunity being to help patients interpret their own data.

Webinars

October 25 (Wednesday) 2 ET. “Live Ask Me Anything Webinar: The Power of Data Completeness.” Sponsor: Particle Health. Presenters: Jason Prestinario, MSME, CEO, Particle Health; Carolyn Ward, MD, director of clinical strategy, Particle Health. Is fragmented data impacting your organization and its ability to scale quickly? Our experts will discuss the advantage of having a 360-degree, real-time view of your patients. Access to analytic-ready data supports proactive care by enabling rapid clinical decision-making, stratifying high-risk patients, developing and using personalized treatment plans, lowering cost, and quickly closing care gaps.

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

Acquisitions, Funding, Business, and Stock

Hospital-at-home technology vendor Inbound Health, which was spun out of Allina Health in late 2022, raises $30 million in a Series B funding round.

Denmark-based Corti, whose AI platform analyzes medically related telephone calls to make recommendations and generate documentation, raises $60 million in a Series B funding round.

Virtual digestive health vendor Vivante Health raises $31 million in Series B funding.

People

Angie Franks (About) joins Kalderos as CEO.

About hires Jonathan Shoemaker, MA (Allina Health) as CEO.

Impact Advisors promotes John Stanley, MBA and hires Roger Weems, MSHA, MBA (Premier) as chief growth officers.

Announcements and Implementations

Symplr adds survey management capabilities to its compliance platform, allowing healthcare organizations to conduct internal surveys to document conflict of interest, safety culture, and vendor compliance.

Biofourmis enhances its Digital Clinical Trials solution with AI-powered data management automations and integration with 40 devices.

The American Medical Association reviews the use of CPT codes for digital medicine, noting a lack of alignment across insurers and limited widespread use. The report finds that while payers are working directly with health tech companies to provide services for specific disease areas – hypertension, behavioral health, and physical therapy – those services are often disconnected from the patient’s PCP or medical home.

Meditech will add the Suki Assistant ambient listening solution to Expanse via a new Suki extension for Chrome.

Scripps Health will pilot the use of generative AI to draft responses to patient messages, saying that message counts have increased by 50% since the onset of COVID-19, with the average doctor receiving 44 per day.

Arcadia announces an AI assistant that creates patient summaries, which it says will save 50% of the case manager time that is required to gather and interpret medical record data.

Texas Tech University Health Sciences Center launches the Institute of Telehealth and Digital Innovation.

The American Academy of Pediatrics warns about the unintended consequences of auto-populating a newborn’s EHR with pertinent data from the charts of the parents. It cites a newborn’s record in which one of the mother’s listed problems was intimate partner violence by the baby’s father, who didn’t have access to the mother’s records, but could have seen the entry via his legal access to the baby’s chart. An employee noticed the entry and removed it. It concludes that EHRs allow clinicians to limit access to potentially harmful information without running afoul of information blocking regulations.

Other

The Madison newspaper describes how Epic’s growth affects the Verona, WI area as the company begins construction on its sixth campus and considers building a seventh. Epic plans to increase its headcount to 13,300 by next year and has bought more farmland to expand its Verona footprint to 1,700 acres, requiring the construction of new roads, interchanges, and widened bridges that officials hope will ease traffic backups for commuters.

Penn Medicine internist Jeffrey Millstein, MD says that value-based care has made it hard to get short-notice appointment with PCPs who are paid to manage populations and meet payer metrics rather than treating infections and acute pain. Patients are turning instead to urgent care centers and EDs, disappointed that the doctor with whom they have developed a rapport is not available. He recommends limiting comprehensive annual visits to highest-risk patients and replacing routine physician visits with support team virtual outreach for low-risk patients.

The Marshall Project covers for-profit prison medical provider Corizon Care, which attorneys say is using the “Texas Two-Step” bankruptcy method to avoid paying malpractice claims and debts. Corizon created a new company, moved its debt to it, then filed bankruptcy for the new company. It offered plaintiffs $5,000 each to settle their lawsuits, advising them they would probably get nothing otherwise. Meanwhile, the now debt-free and malpractice-free part of the business, much of it involving taxpayer-funded contracts, was moved to another newly created company. Several companies have used the Texas-only tactic – including Johnson & Johnson, which was trying to dodge talcum powder lawsuits – but all were either rejected by federal courts or remain in litigation.

Sponsor Updates

• RCxRules adds 11 private equity-backed specialty medical groups to its Revenue Cycle Engine customer base.
• AGS Health publishes a white paper titled “Optimizing HCC Coding for Accurate Reimbursement in Healthcare.”
• Findhelp releases a new report, “Meeting the Moment: Community Organizations Nationwide See Challenging Times Ahead.”
• Lucem Health releases a new episode of the This Week in Clinical AI Podcast.
• Medhost will exhibit at the TORCH 2023 Fall Conference September 26-28 in Round Rock, TX, and at the NRHA Critical Access Hospital Conference September 27-29 in Kansas City, MO.

Blog Posts

• Want to improve patient safety? Up your EHR’s usability (Nordic)
• The Top 4 Things Healthcare Organizations Want in an IT Vendor (Impact Advisors)
• Embracing DE&I in Your Recruitment Strategy (Direct Recruiters)
• Ensuring EMR Data Can Support Strategic Performance Improvement from the Start (Divurgent)
• Leveraging Networking as a Strategic Approach for Patient Acquisition in Weight Loss and Medical Spa Clinics (EClinicalWorks)
• Improve Your Call or Contact Center Experience (Five9)
• Healthcare cybersecurity threats: August 2023 (Fortified Health Security)
• Maximizing Your Investment: EHR/EMR Consulting (HealthTech Resources)
• Defining Change Management for Your Organization (Impact Advisors)
• Thoughts on AI Consciousness (Keysight)

Contacts

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

EPtalk by Dr. Jayne 9/21/23

I was back in the patient trenches this week, having needed an appointment at a practice where I’m only seen every two or three years. This time around it was less than three, which is the cutoff at which most practices consider you to still be an “established” patient, but they treated me as a new patient nevertheless.

Despite having information in the EHR that they could have printed and asked me to either update or confirm accuracy, they handed me the proverbial clipboard, with six pages of information to read and/or complete. I absolutely hate when medical office forms ask me to write in my insurance member number and group number when they’re right there on the card that the front desk staff just scanned.

I felt validated when a patient who came in shortly after me went back up to the desk and asked if they needed to complete that section, since they had already provided it in the form of the scanned card. I felt a little less validated when the staff responded back by saying yes, they needed it as a “backup to the system,” which could also have been accomplished with a photocopy rather than introduce the potential of a transcription error with a patient copying information from the card.

Across the multiple sheets, I was asked for my primary care physician’s name and phone number two times and was asked for my pharmacy address once and phone number twice. As is common in medical office situations, the documents had been photocopied so many times as to be nearly unreadable in places, which made me want to educate them on the virtues of putting the “master copy, do not use” sticky note on the last sheet in the folder to ensure a clean copy is used for future copies. Alas, I wasn’t there in the role of practice management consultant, so I refrained, although I was sorely tempted.

One of the papers I was asked to complete was essentially the SOAP note (Subjective, Objective, Assessment, and Plan for the non-clinical folks) for the office visit, including a request to complete the History of Present Illness, including the prompts that coding specialists look for when assigning billing codes. These prompts hadn’t really been translated to patient-friendly terms, and still read “location, duration, modifying factors, and associated signs/symptoms” much like you’d see in a CMS manual or a medical history-taking textbook.

I gamely played along and admit that I did enjoy the radio station playing in the waiting room, which was FM 106 coming live to us from Dublin, Ireland. I wish they had radio in the exam rooms, because I could hear in great gory detail what was going on in the room adjacent to mine. A medical assistant popped his head in the door (literally halfway in and halfway out) and asked a few more questions, then said the practitioner would be in to see me. She arrived quickly, addressed my problem, and I had no complaints about the clinical care.

Given the paper nature of the office visit thus far, I was surprised to see a link to a patient portal account before I even made it out of the parking lot. I logged on later in the day and was shocked to see the documentation – vital signs were documented including a weight that bore no resemblance to my own, even though no vital signs were taken. Exam elements that weren’t performed were recorded in great detail, alongside the procedure note, which was fortunately accurate as to what actually occurred.

If those exam elements were used to substantiate a higher level of billing, then what we have there is fraud, which is concerning. As a patient, I shouldn’t be placed in the position of having to correct my records, but apparently that’s where I am at the moment. Seems like a call to the office is in order when I get a break in my schedule.

I’m a huge devotee of evidence-based medicine, where we use science and data to help identify the best treatments for our patients. Taking a data-driven approach has also been a big part of my informatics practice, where I look at system utilization and how multiple physicians are using the system before I approve changes that might have only been requested by one user.

In the sprit of evidence-based practice, I was interested to see an announcement by the US Food and Drug Administration (FDA) about the decongestant phenylephrine, which is found in over-the-counter medications including Sudafed PE and some NyQuil products. An FDA advisory panel found unanimously that the ingredient is ineffective, and questions remain whether it will be banned or whether drug companies will be given time to reformulate their products before having to pull drugs containing the ineffective ingredient from the market.

These types of announcements are important for clinical informatics folks, including our colleagues in the pharmacy sphere, as we have to try to find these drugs in order sets and physician favorites lists and send out bulletins to let people know of the announcement if they’re a frequent user of the drug.

The change in this drug’s status is also important for those of us who have followed the methamphetamine crisis in the US, which forced pseudoephedrine behind the counter and led to increased use of phenylephrine as an alternative. It’s the law of unintended consequences, with patients caught in the middle as they try to self-treat minor illnesses. (It should also be noted that the rise in phenylephrine use was also due to another decongestant, phenylpropanolamine, being pulled from the market in part due to an elevated risk of stroke with use.) The reality is that we haven’t seen much action in the development of new drugs like these in recent years and millions of doses of a drug that isn’t much better than placebo have been used by patients generating well over a billion dollars in sales. Here’s to all the informatics folks who will be hunting down this drug in the coming weeks to months.

This week was Telehealth Awareness Week, as decreed by the American Telemedicine Association. There has been a lot of buzz about it online and plenty of people saying how much they think telehealth is improving the healthcare ecosystem, but there are still some downsides to the modality. Healthcare organizations that aren’t embracing it may unwittingly encourage their patients to have more fragmented care as they seek visits with third parties that aren’t considering the patient’s existing records or sharing back to the patient’s medical homes. Other healthcare organizations are frankly encouraging that fragmentation through third-party contracts. A fraction has found a way to make it work, either by building their own telehealth workforce or by using integrated third parties, but they’re in the minority from what I see. On the telehealth platform where I practice as a physician, I have zero access to patients’ records and it makes delivering good care much more difficult than it needs to be.

So many of my colleagues are hyper focused on research in the realm of artificial intelligence that they might be missing out on other interesting topics. I was absolutely blown away by this article in Plos Biology that looked at how music can be reconstructed from brain activity in the auditory cortex. The article’s opening line “Music is core to human experience, yet the precise neural dynamics underlying music perception remain unknown” is a powerful one. In addition to not fully understanding perception, we also don’t understand what makes one person love a particular piece of music and another perceive it like the proverbial nails on a chalkboard. The authors worked with data from 29 patients who listened to a Pink Floyd song, ultimately reconstructing something recognizable out of the neural recordings. Music perception was more dominant in the right brain and researchers localized a particular part of the brain to perceive rhythm.

The authors noted that their findings show the possibility of “paving the way for adding musical elements to brain-computer interface (BCI) applications.” I was talking to a young colleague about this, and he profoundly stated, “Because if you’re going to do trippy mind control research, Pink Floyd is the way to go.” In case you’re wondering, the specific song used in the research was “Another Brick in the Wall, Part 1” which was cited as constituting “a rich and complex auditory stimulus.” Don’t worry about volunteering to be a research subject in this area soon, since the participants all had surgically implanted electrodes due to a diagnosis of drug-resistant epilepsy.

If you could only listen to one album for the rest of your life, what would it be? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 9/21/23

Epic Systems’ growth means new roads, many changes for Verona

Epic begins construction on its sixth campus and considers building a seventh, with its planned 2024 headcount of 13,300 employees nearly matching that of the entire population of its home town of Verona, WI.

UpHealth subsidiary files for bankruptcy after unfavorable court ruling

UpHealth Holdings, which offers digital-first care management services and virtual care infrastructure, files Chapter 11 bankruptcy following a court’s ruling that it must pay an investment bank its $31 million fee for arranging its 2021 SPAC merger.

Musk’s Neuralink to start human trial of brain implant for paralysis patients

Elon Musk says his startup has received approval to begin human trials of its brain-computer interface implant for paralysis, which will take six years to complete.

AI Startup Corti Raises $60 Million to Take on Microsoft in Health Care

The Denmark-based company, whose voice assistant listens to doctor-patient conversations and makes recommendations based on similar conversations, is valued at $260 million.

Healthcare AI News 9/20/23

News

Oracle announces Clinical Digital Assistant, a voice-first mobile app for clinicians that responds to voice commands, uses ambient listening to generate clinical notes from conversations, allows creating notes and clinical documentation from voice narration, and creates notes and chart details.

Ochsner Health is testing the use of Epic’s new feature that creates draft responses to MyChart patient messages that physicians then review.

Drug and medical technology maker Johnson & Johnson describes how it is using AI:

• Applying AI to diagnostic tests and connected medical devices to detect disease earlier.
• Driving drug discovery.
• Analyzing de-identified patient datasets to identify clinical research research sites, to bring trials to patients outside of major medical centers, and to diversify trials.
• Analyzing demand and inventory trends to prioritize drug shipments.
• Creating a “highlight real” of surgical video that allows surgeons to perform post-case analysis that can be used for teaching.

In Japan, commercial insurer Sompo – which is the country’s largest nursing home operator with 301 facilities and 58 day centers — will install TytoCare’s remote medical examination technology in its facilities.

Business

Denmark-based Corti, whose voice assistant system listens to doctor-patient conversations and makes AI-powered suggestions based on millions of other such conversations, raises $60 million in a Series B funding round.

Research

Chan Zuckerberg Initiative will fund and build a 1,000 GPU computing cluster that will allow researchers to study how cells behave in health or disease

Contacts

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

Morning Headlines 9/20/23

Oracle Transforms Care Delivery with Next-Generation Millennium EHR and Generative AI Capabilities

Oracle announces “the new Oracle Health EHR platform” at its annual conference, which it says will use the Oracle Cloud Infrastructure to offer a modern interface and intuitive processes.

Avel eCare Expands Hospitalist and Senior Care Telemedicine Services with Acquisition of Fident Health

Telemedicine services company Avel ECare acquires Fident Health, a virtual hospitalist business based in Texas.

Bright Health Group Continues to Make Significant Progress Towards ACA Insurance Business Wind-Down

Bright Health announces it has paid 80% of its final ACA insurance business risk adjustment obligations, leaving $380 million still owed to CMS as it continues to close out that business.

Bankrupt Digital Health Company Babylon Sells UK Assets for Just $620,000

Forbes reports that now insolvent digital health company Babylon’s sale of its UK assets fetched a paltry $620,000.

Amenities Health Closes Series A, Raising a Total of $10M to Modernize Health System Digital Front Doors

Amenities Health, a patient acquisition and digital front door software startup based in Dallas, raises $6.25 million in a Series A funding round.

News 9/20/23

Top News

Oracle announces “the new Oracle Health EHR platform” at its annual conference, which it says will use the Oracle Cloud Infrastructure to offer a modern interface and intuitive processes.

The company says some of the announced new Millennium capabilities will be released in the next 12 months.

Oracle also announced Clinical Digital Assistant, which allows providers and patients to interact with its EHR solutions via voice commands.

Reader Comments

From Tech Bro: “Re: Bill Gurley’s comments about Epic. I have seen nothing indicating that CEO Judy Faulkner was a big Obama donor or that her donations landed her a spot on the Health IT Policy Committee.” Neither have I. Online contribution records show that she donated a couple of thousand dollars to the Obama campaign in 2008, but the big numbers that Gurley hinted at were the total donations of Epic’s employees and even those amounts were modest. Also notably incorrect in Gurley’s presentation:

• Meaningful Use did not require doctors to buy software to earn payouts – they could “meaningfully use” the EHRs they already owned. Those who bought EHRs to cash in on MU weren’t buying Epic. All hospital EHRs were certified, so no Epic demand was created by federal action.
• His assumption that ONC “took Epic’s feature set and plowed it into this spreadsheet” to create certification criteria is silly in many ways.
• The EHR vendor fines that he listed weren’t levied because their products failed to meet ONC’s certification criteria, but rather for for falsifying EHR certification test results and paying kickbacks (EClinicalWorks and Greenway Health) and taking drug company kickbacks to use the EHR to push opiate prescribing (Practice Fusion).
• President Obama did not say in an interview with Ezra Klein that creating a barrier to entry for EHRs was his biggest Affordable Care Act disappointment. He expressed regret before leaving office in 2017 that paying MU incentives still left a lot of paper records, indecipherable patient bills, and excessive data entry time for clinicians and also created interoperability challenges with the many EHRs that were being used. He also noted that providers are incented to hoard data.
• The groundwork for HITECH was put in place by Republican President Bush, who also created ONC. ARRA and HITECH were signed four weeks after President Obama took office, a full year before ACA was passed, so the suggestion that HITECH was part of ACA is incorrect.

From Code Spewer: “Re: code generators. Most of us long-timers remember the bust of CASE tools in healthcare years ago.” The empty suits who ran the crappy vendor I worked for many years ago latched onto CASE tools as a competitive imperative, as whispered into their ears by bored techies who craved resume-enhancing experience. They eventually realized that you can’t just feed an old application’s code into a generator and have it create readable, technically efficient code that can be maintained and enhanced ongoing. They also eventually figured out that competitive advantage rarely springs from technology (despite what technology bigots claim) but rather functionality that requires subject matter expertise to design.

From Biliary Duck: “Re: cloud. Some of these companies will regret betting their future on the billing benevolence of cloud providers, who are free to increase fees any time their investors need a thrill.” Health IT vendors have historically regretted making third party software and services a key part of their products. You don’t really want outside companies having outsized influence over your pricing, technology strategy, and relationship with your customers. Cloud is great for quickly scaling up and adjusting for required performance with low capital expense, but you’re trusting cloud vendors to avoid turning the financial screws after you let them become critical to your business. The same goes for outsourcing.

HIStalk Announcements and Requests

Lorre thought that maybe one or two companies would take her up on the new-sponsor offer of getting the rest of 2023 free, but since four or five signed up quickly, she has decided to extend the deal beyond my initial limit of three companies. Everybody can get 25% off produced webinars as well, which generate ongoing views on our YouTube webinar channel. Spend little more than the cost of buying coffee for HIMSS booth staffers and you’ll enjoy a year-plus connection with HIStalk’s loyal readership of industry decision-makers plus the bonus of chatting with Lorre, to whom I wisely deflect calls since my single talent is analyzing and writing, not persuasively describing those offerings that make it possible.

Webinars

September 21 (Thursday) 2 ET. “Unlock open enrollment best practices to stop future denials.” Sponsor: Waystar. Presenter: Lauren Tungate, solution strategist team lead, Waystar. Nearly half of insured Americans consider changing their insurance coverage each fall, necessitating provider safeguards to stop increased denials, find hidden coverage, and prevent uncompensated care. This webinar will crack open enrollment best practices, such as using different data sources to get an accurate picture of benefit details; leveraging automation to identify hidden coverage, confirm active insurance, and avoid lost revenue; and simplifying eligibility workflows to reduce the financial burden on patients and strain on staff.

October 25 (Wednesday) 2 ET. “Live Ask Me Anything Webinar: The Power of Data Completeness.” Sponsor: Particle Health. Presenters: Jason Prestinario, MSME, CEO, Particle Health; Carolyn Ward, MD, director of clinical strategy, Particle Health. Is fragmented data impacting your organization and its ability to scale quickly? Our experts will discuss the advantage of having a 360-degree, real-time view of your patients. Access to analytic-ready data supports proactive care by enabling rapid clinical decision-making, stratifying high-risk patients, developing and using personalized treatment plans, lowering cost, and quickly closing care gaps.

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

Acquisitions, Funding, Business, and Stock

Virtual patient observation and analytics company MedSitter rebrands to Collette Health. The company has also added new AI presence-detection capabilities to its virtual care solutions.

Summus, which offers virtual access to specialty consults, raises $19.5 million.

Telemedicine services company Avel ECare acquires Fident Health, a virtual hospitalist business based in Texas.

Veradigm reports that it is taking longer than anticipated to correct accounting errors that have led to de-listing warnings from Nasdaq, and will thus file yearly and quarterly reports later than expected. The company, which plans to ask a Nasdaq Hearings Panel for an extended file request, has revised its 2023 revenue impact from $40 million down to $20 million.

Amazon is reportedly planning a rapid rollout of healthcare-related subscription services and offering discounts on its One Medical primary care services to Prime members

Sales

• HCA Healthcare selects remote patient monitoring services from Nudj Health.
• Bryan Health (NE) will use KeyCare’s  Epic-based network of virtual care providers.
• UAE-based, publicly traded healthcare operator Burjeel Holdings signs a $34 million contract to implement Oracle Health’s EHR running on Oracle Cloud Infrastructure.
• Emirates Health Services will implement Care.ai.

People

Chad Hendricks (Medecision) joins UpHealth as VP of business development.

Deloitte hires Michael Cleary (Workday) as VP/sales executive.

Direct Recruiters promotes healthcare IT and life sciences team members Rebecca Forristall and Ben Shamis to partners.

Drew Narayan, MS, MBA (PeriGen) joins Swift Medical as SVP of sales and marketing.

Announcements and Implementations

Excelsior Springs Hospital (MO) goes live on Oracle Health.

Tampa General Hospital (FL) implements Andor Health’s ThinkAndor Virtual Hospital technology within its ICU.

A new KLAS report on virtual sitting and nursing talks up AvaSure as an established vendor of solutions that are being used by large organizations going back five years, with a total hospital count of 1,100. Customers of the newly renamed Collette Health like the system for virtual sitting, but would like to see higher video resolution and better EHR integration. Care.ai was the only vendor in which all surveyed customers are using the solution for virtual nursing. All respondents say the product they use is part of their long-term plans.

Sponsor Updates

• Total Health Care (MD) significantly reduces its patient no-show rate by implementing the EClinicalWorks Healow no-show prediction AI model.
• Emirates Health Services will implement Care.ai’s virtual nursing and Smart Care Facility solutions.
• AGS Health will exhibit at HFMA 2023 Biennial Tri-State Conference September 20-22 in Florence, IN.
• Availity sponsors the American Heart Association’s 30^th annual First Coast Heart Walk in Jacksonville, FL.
• Biofourmis releases its expanded Digital Clinical Trials solutions with its platform for biopharma and other life sciences companies.
• CHIME releases a new episode of its Leader 2 Leader Podcast, “The Importance of Cybersecurity Policy Changes and Leadership Buy-In.”
• Clearsense publishes a new case study, “Higher Physician Efficiency and Lower Costs to Patients.”
• Clearwater CFO Baxter Lee joins the Tennessee HIMSS Board of Directors.
• HIStalk sponsors participating in Meditech Live, September 20-22 in Foxborough, MA, include Access, CereCore, CloudWave, First Databank, Nuance, and CHIME.

Blog Posts

• How to Stop Revenue Leaks with Meditech Automated Financial Testing (CereCore)
• Why wouldn’t you take on fully delegated risk? (Arcadia)
• 9 Ways to Go Beyond Basic Texting and Deliver Better Conversations (Artera)
• Meet the Clinician – Kenneth Catoe (Ascom)
• Five Risks of Not Improving Clinical Data Quality (Availity)
• Are Wearables Worth the Investment? 3 Critical Areas Where They’re Proving Their Worth (Bardavon)
• Cloud Risk is Different Than Traditional IT Risk – Here’s What to Do About It (Clearwater)
• Understanding How Prescribers Use Their EHR in Administrative Workflow and Patient-Visit Workflow (ConnectiveRx)

Contacts

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

Morning Headlines 9/19/23

MedSitter Announces Rebranding, Changes Name To Collette Health

Virtual patient observation and analytics company MedSitter rebrands to Collette Health.

Veradigm Inc. Provides Audit Update and Updates Financial Guidance for 2023

Veradigm reports that it is taking longer than anticipated to correct accounting errors that have led to de-listing warnings from Nasdaq, and will thus file yearly and quarterly reports later than expected.

Oracle Brings Generative AI Capabilities to Healthcare

Oracle adds new generative AI-powered Clinical Digital Assistant capabilities to its EHR solutions.

Curbside Consult with Dr. Jayne 9/18/23

Over the years, I’ve been on a number of panels and attended several forums to discuss the participation of women in clinical informatics. One of the most memorable ones was last spring as part of the CHIME track during ViVE, when the CHIME League of Women presented “Mentorship in Action.” We had a chance to understand how mentor/mentee pairs have been instrumental in boosting the presence of women in healthcare IT.

Just anecdotally, when I look at the composition of leadership teams in non-healthcare IT organizations, it seems like there are more women than I see in my own field, but I don’t have any data to back up that sentiment.

A recent article in the Journal of the American Medical Informatics Association titled “Accomplished women leaders in informatics: insights about successful careers” looked at some of the challenges faced by women in the field. Although the study had a relatively small sample size of 16, they looked at women in both academia and industry.

I wasn’t at all surprised when I read the findings: “We conducted a thematic analysis revealing: (1) careers in informatics are serendipitous and nurtured by supportive communities, (2) challenges in leadership were profoundly related to gender issues, (3) ‘Big wins’ in informatics careers were about making a difference, and (4) women leaders highlighted resilience, excellence, and personal authenticity as important for future women leaders.”

The authors also noted that “Sexism is undeniably present, although not all participants reported overt gender barriers” and that “women are underrepresented in scientific dissemination, substantially less likely to be in leadership positions, and have not achieved salary parity with men.”

I also wasn’t surprised at some of the statistics, namely that the majority of academic programs and clinical subspecialty fellowships in biomedical informatics are led by men, at 75% and 83%, respectively. The authors also note that men have also held the majority of leadership roles within the American Medical Informatics Association and have received nearly two-thirds of the awards. The article goes on to say that although the National Institutes of Health has recommended conscious effort to promote gender equality, women continue to cite gender imbalances in leadership hierarchies as barriers to advancement.

The article cites specific examples of the themes, some of which really resonated with me. Regarding the idea that careers in informatics are serendipitous, that’s exactly how I wound up in this field. I was looking for a clinical job close to home, and the one that seemed the best fit also had been identified to be a pilot for the “paperless practice” concept for a large health system. The idea that careers are nurtured by supportive communities rings true for me as well, as women made up the entire leadership team of that project, and we supported each other throughout the project’s lifecycle.

One of the major differences of that team compared to others that I’ve been on is that we understood how each other operated and how each other’s efforts supported the team’s overall goals. There wasn’t any competition, and when one of us achieved a milestone or was recognized for something we did, there wasn’t any sense of someone getting ahead or outshining the rest of the team. We shared in each other’s accomplishments as much as we commiserated when things didn’t go well. We stood up for each other when things weren’t quite right.

That concept wasn’t unique to us, as noted by one respondent who explained her strategy to address subtle sexism in meetings: “A colleague who is male will say more or less the same thing [the female said], and that’s what gets picked up on. I call it out. I say ‘Oh, it’s so great that you’ve taken her idea, and now we have it in front of us.’”

Other respondents specifically called out the lack of female participation on boards, as well as differences in how male and female colleagues were treated by leadership. I’ve certainly seen the latter over the last two decades. Sometimes it’s more subtle, such as male leaders inviting male subordinates to sporting events but not their female counterparts.

But in the most egregious situations, I’ve seen male leaders refuse to meet alone with a female subordinate because of concern for potential accusations of impropriety. Male leaders who follow the latter policy actually create an exclusion zone that prevents females from advancing. I would suggest that if they aren’t comfortable meeting with their teams privately, then maybe they’re not the right person for the leadership role.

Women cited specific situations that continue to occur, including differences between recognition of men and women, financial disparities, and women being “spoken over” in meetings. When I see the latter occur in a meeting and don’t see anyone call it out, it’s hard not to think negatively of the leader who allows such behavior to occur on their watch.

Respondents also noted the importance of “being authentic and genuine, not pretending to know something you do not know or being someone you are not, and being true to oneself” as key to being a successful leader. As far as those characteristics, the idea of not pretending to know something you don’t actually know comes up often in leadership books, specifically with references to the idea that men are more likely to project knowledge they don’t possess versus women who are more likely to admit that they need to research or investigate, with the latter being perceived in some circles as a sign of weakness.

It’s like when I was a young physician in that paperless practice. I mentioned in a media interview that having computers in the rooms was great when I needed to look something up. I thought that idea made me sound progressive and that I was seeking the best information for my patient, but in reality, I was chastised by the sponsoring hospital’s vice president for giving the idea that as a physician I wasn’t all-knowing.

The article arrived in my inbox while I had been reading “The Great Stewardess Rebellion: How Women Launched a Workplace Revolution at 30,000 Feet” by Nell McShane Wulfhart. Although the book is about the unequal treatment of female flight attendants in the early days of commercial air travel, there are still a lot of parallels with what women are experiencing today.

Women are often still expected to behave a certain way and have certain appearance standards that aren’t equally applied to their male counterparts. I’ve seen plenty of examples where a woman’s appearance or hair style are called out in a virtual meeting, where no one ever calls out the man with obvious bed head or the one who just slaps on a ball cap to remedy the situation. I’ve heard comments that women look “tired” and “stressed” on days that they don’t wear makeup, which is just a sad commentary on the state of things.

Even though some of the things I read in the article were disheartening, I’m glad that the ideas it brings up are receiving attention in academic circles. Only when we study an issue can we hope to find solutions.

How does your organization handle gender equity? Does it tolerate obvious imbalances or does it engage when people speak up? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 9/18/23

Summus Raises $19.5 Million to Expand Solutions Solving the Access Problem in Specialty Care

Summus, which offers virtual access to specialty consults, raises $19.5 million.

VA wraps first-wave EHR fixes, but employees ‘strongly disagree’ it’s ready to move forward

Though the VA has completed its first round of EHR fixes, at least one facility already live on the software is still experiencing frequent outages that force it to revert to downtime procedures.

No ransom to hackers, says Claxton-Hepburn, Carthage Area Hospital CEO

Claxton-Hepburn Medical Center (NY) and Carthage Area Hospital (NY) resume nearly normal operations while they determine if hackers were able to obtain any significant data during a ransomware attack several weeks ago.

Monday Morning Update 9/18/23

Top News

Two senators ask the Department of Defense to explain how its MHS Genesis (Oracle Cerner) system has affected the time needed to get new military recruits into basic training.

The DoD says that medically clearing new recruits takes three days longer than it did before MHS Genesis went live. However, Senators Elizabeth Warren (D-MA) and Richard Blumenthal (D-CT), both of whom serve on the Senate Armed Services Committee, note that the Navy’s recruit processing time has doubled to 60 days after Genesis was implemented.

The senators say that Genesis retrieves historic patient records comprehensively, to the point that applicants are required to obtain medical waivers for old, healed injuries. A recruiter says that one enlistee had to wait an extra two months because she had sprained her wrist as a child.

HIStalk Announcements and Requests

Doctors seeing new patients transferred their existing records into their systems electronically about one-third of time, poll respondents say, falling short of the 40% of practices that transferred nothing by any means and instead just handed patients a stack of blank forms to fill out.

New poll to your right or here: Do you know or suspect that a provider used AI in a recent encounter with you?

HIStalk sponsors who are participating in the HLTH conference – send me your details by October 2 and I’ll include them in my conference guide.

A Reader’s Notes from AHIP’s Consumer Experience and Digital Health Conference – Day 2

• Horizon Blue Cross Blue Shield says that virtual care went from 1% of behavior health claims before the pandemic to 60% and that high level of virtual care continues.
• Payers won’t covered digital therapeutics just because they are FDA cleared. They want to see positive outcomes over a meaningful population size. Value-based care may be a way to cover more behavioral health interventions.
• AI advancement may taper due to the huge amount of energy and electricity infrastructure it requires.
• Digital therapeutics fall into two categories – cleared by FDA as a medical device, and software that powers humans. FDA’s bar seems to be set lower for the first category since randomized clinical trials aren’t required to prove that the tool works.
• Peterson Health Technology Institute aims to be an independent assessor of digital health tools and has committed $50 million to the effort. Their assessment will include equity factors such as whether the tool reduces cost, if it is rolled out to Medicaid populations, and if it supports multiple languages.
• Rural areas suffer from a low provider-to-patient ratio, low access to transportation, limited broadband access, and provider volumes that are too low to support fee-for-service.
• National Coordinator Micky Tripathi, PhD, MPP says QHINs will go live in November or December, initially for provider-to-provider treatment purposes, with FHIR-based exchanged to follow in Q1.
• Former National Coordinator Don Rucker, MD, MS, MBA expressed concerns about the approach and director of TEFCA, saying that it relies too much on old standards and data formats.
• Two panelists would like to see prior authorization and payer-to-payer data exchange as future TEFCA use cases.
• Even though the conference was touted as representing consumer experience, little attention was paid to how payers will fix the consumer experience issues that we all hate, such as prior authorization and understanding your policy and benefits.

Webinars

September 21 (Thursday) 2 ET. “Unlock open enrollment best practices to stop future denials.” Sponsor: Waystar. Presenter: Lauren Tungate, solution strategist team lead, Waystar. Nearly half of insured Americans consider changing their insurance coverage each fall, necessitating provider safeguards to stop increased denials, find hidden coverage, and prevent uncompensated care. This webinar will crack open enrollment best practices, such as using different data sources to get an accurate picture of benefit details; leveraging automation to identify hidden coverage, confirm active insurance, and avoid lost revenue; and simplifying eligibility workflows to reduce the financial burden on patients and strain on staff.

October 25 (Wednesday) 2 ET. “Live Ask Me Anything Webinar: The Power of Data Completeness.” Sponsor: Particle Health. Presenters: Jason Prestinario, MSME, CEO, Particle Health; Carolyn Ward, MD, director of clinical strategy, Particle Health. Is fragmented data impacting your organization and its ability to scale quickly? Our experts will discuss the advantage of having a 360-degree, real-time view of your patients. Access to analytic-ready data supports proactive care by enabling rapid clinical decision-making, stratifying high-risk patients, developing and using personalized treatment plans, lowering cost, and quickly closing care gaps.

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

Acquisitions, Funding, Business, and Stock

A BMJ survey finds that three-fourths of UK hospital trusts still relay on paper-based charts and patient notes, concluding that the UK government failed to meet its target of eliminated paper ordering by 2024. Most of the trusts have electronic systems, but still use paper to some degree. Experts say the NHS data set is widely admired, but is less useful than it seems because it is often stored in systems whose proprietary formats do not support interoperability.

People

Jeff Cutler (Ada Health) joins Validic as chief commercial officer.

Announcements and Implementations

Google announces that Chromebooks that were released after 2020 will automatically receive updates for 10 years, while older devices can be set to receive those updates by the user or IT administrator. An individual device’s Auto Update Expiration date can be displayed from the Settings menu or looked up in an online list.

Government and Politics

Indiana’s attorney general Todd Rokita sues Indiana University Health, alleging that it failed to enforce privacy standards when OB-GYN Caitlin Bernard, MD talked publicly about an abortion she had performed on a 10-year-old. Rokita had previously filed an action against the doctor, who was reprimanded by the state medical licensing board for violating state and patient federal privacy laws, and was unhappy that IU Health publicly disagreed with the decision. Rokita says that IU Health failed to protect the child’s privacy, thus violating HIPAA. The doctor had previously sued the Republican AG in an attempt to prevent hum from obtaining the medical records of her patients for damaging her reputation, which the judge dismissed but with an opinion that Rokita’s public comments about the doctor on Fox News violated state attorney confidentiality laws.

Other

Venture capitalist Bill Gurley rails against Epic in a swaggering presentation this week, which is so full of errors and unproven assumptions that I won’t bother wasting time correcting them (example: he says ONC was formed to oversee ARRA when in fact it predated it by five years; not to mention that his summary of why EClinicalWorks, Greenway, and Practice Fusion paid millions to settle federal charges is way off base.)

[Epic] is the largest player in medical or EHR software medical records. This is their CEO, Judith Faulkner. Now in 2009, Obama put her on his health IT council. She was the only corporate representative. It should not surprise you that she’s a major donor to Obama. Obama passed the American Recovery Act that was his big piece of stimulus, kind of like Biden’s inflation act that happened recently. Tucked underneath and easy to hide in this big bill is the acronym HITECH. It’s this health information technology thing. Then they created an agency called ONC that oversaw it. Now this is the part you’re not going to believe. They came up with a brilliant idea that I have to assume she helped encourage, that doctors would receive $44,000 each if they bought software, 38 billion dollars .. You may be thinking are doctors needy, but here’s the catch. This happened because of the mortgage meltdown. Doctors own multiple homes, so they have multiple mortgages, so they probably needed the assistance … ONC decided the threshold of features you would need for your software to comply with this mandate, and I’m assuming they kind of took Epic’s feature set and plowed it into this spreadsheet. They got the Department of Justice to enforce people that didn’t have the feature set that were getting the payments, and you had three record fines – $155 million, $57 million, $145 million — against the lesser competitors of Epic. Unreal. If you’ve studied “The Innovator’s Dilemma,” the way startups disrupt is they come in with lower feature products, but a feature that really matters to the customer in a simpler product. They move up they put a brick wall there so you couldn’t come up. It’s just amazing. Obama, in an interview with Ezra Klein, said this was the most disappointing part of Obamacare … You may ask, am I am I unhappy with Judith? I’m disgusted with it, but if I were a judge in the Olympic regulatory capture competition, I’m giving her a 10.

The Metropolitan Water Reclamation District of Greater Chicago finds out from a press announcement that its CIO, John Sudduth, had been hired months before as CIO of the American Board of Medical Specialties. He held both jobs as a full-time, Monday through Friday employee without his bosses finding out for 2 1/2 months because of COVID work-from-home policies.

Not healthcare related except as an AI cautionary tale. OpenAI investor Microsoft apparently uses AI to produce crappy articles on MSN, whose content has suffered after it fired many of its human editors and started relying on wildly inconsistent syndicated articles. A now-removed article’s headline about the death of NBA player Brandon Hunter called him “useless,” strung together bizarre and incorrect details in its “story” about his career, and changed words here and there to hide its poorly executed plagiarism from other sites (it listed Hunter’s position as “ahead” instead of “forward” as originally stated in the TMZ piece it stole). The site earned unwanted attention last month after running an AI-generated travel guide to Ottawa, Canada that recommend that tourists visit the local food bank.

Sponsor Updates

• Care.ai launches a podcast series titled “Smart from the Start,” hosted by former HIMSS CEO Steve Lieber.
• Seashore MD streamlines patient booking and patient acquisition with EClinicalWorks EHR and Healow solutions.
• The “HIT Like a Girl” podcast features Nuance EVP and GM of Healthcare Diana Nole.
• Nordic releases a new “Making Rounds” podcast, “Emerging opportunities with cloud-based EHRs.”
• Ronin will present at the virtual NLP Summit October 4.
• Simnova in Italy will integrate Sectra’s medical education platform, the Sectra Education Portal, into their simulation training program.
• SmartSense by Digi names Ed Marx to its healthcare advisory board.
• Sphere publishes a new whitepaper, “Patient Payments: How Providers Can Improve the Last Mile of the Care Journey.”
• Symplr announces that its Symplr Spend Management solution has been named number one according to Black Book’s 2023 top client-rated supply chain solutions rankings.
• Verato will present at the Innovations in Value-based Care Conference September 27 in New York City.
• Wolters Kluwer Health publishes “The State of Drug Diversion 2023 Report.”

Blog Posts

• Leveraging data analytics to achieve positive outcomes (Meditech)
• Diagnosing, optimizing, and funding your next EHR implementation to combat provider burnout (Nordic)
• Avoid These Two Common EHR Implementation Pitfalls (Optimum Healthcare IT)
• The data healthtech needs to deliver to clinicians – Dr. Rob Bart (Redox)
• How Better Health Data Sharing Can Optimize Care for 4 Million Sjögren’s Patients – and My Family (Surescripts)
• Best Practices in Conflict of Interest Disclosure for Hospitals (Symplr)
• Eight Steps for Successfully Moving to Meditech Expanse (Tegria)
• Research on denial management in healthcare: 3 key takeaways from Waystar + HFMA (Waystar)

Contacts

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

Morning Headlines 9/15/23

Senators call on DOD to explain whether its medical records system is causing recruiting delays

Several senators question whether or not the DoD’s new MHS Genesis EHR has caused delays in processing new military recruits.

NHS still reliant on paper notes and drug charts despite electronic upgrades

Seventy-five percent of NHS trusts report they still rely on paper patient notes and drug charts, despite government initiatives to eliminate paper prescribing by 2024 and to implement digital health records at 90% of trusts by the end of 2023.

Apple introduces the advanced new Apple Watch Series 9

The newly announced Apple Watch Series 9 adds the ability to use Siri to request on-device health and fitness information, such as data from connected monitors, and to log health data such as weight and meds.

News 9/15/23

Top News

The VA tells the House Appropriations Committee that it hopes to resume its Oracle Health implementations in the summer of 2024.

Go-live at the joint VA-DoD facility Captain James A. Lovell Federal Health Care Center remains on track for March 2024.

The VA says that restarting the rollout will require VA success metrics to improve at its live sites and for go-live at the Lovell facility be completed successfully.

In the committee hearing, Oracle EVP Mike Sicilia blamed previous VA problems on Cerner technical issues. He added that the VA’s lack of repeatable process has hampered the implementation as compared to the DoD, although he believes the VA is on track.

In a related item, Rep. Greg Murphy, MD (R-NC) said in a House Veterans’ Affairs Committee hearing that it is “inexcusable” to be rebuilding the VA’s Oracle Cerner system five years into the project, adding, “There are other systems out there that are much better.” Murphy is a practicing urologic and renal transplant surgeon at ECU Health (formerly Vidant Health), which uses Epic.

Reader Comments

From HisTalk2Fan: “Re: Larry Ellison’s comments about the Cerner Millennium rewrite made in the earnings call this week. What is your thought?” My reaction to the call in general:

• Blaming the former Cerner’s revenue recognition practices for Oracle’s quarterly financial disappointment seems to throwing the acquired company under the bus, which Oracle has also done in attributing the VA’s implementation problems to Oracle-discovered Cerner technology deficiencies.
• The oft-repeated goal to “drive Cerner profitability to Oracle standards” sounds good to stock analysts, but perhaps less so to customers or prospects who aren’t looking forward to higher bills or reduced service due to cost-cutting layoffs.
• Oracle talks about rewriting Millennium using code generators, but has said nothing about product roadmaps or the layoff-caused lack of clinical resources that would be needed to design, test, implement, and support a rewritten Cerner product. They have stopped talking about Millennium’s weak areas – like not offering a competitive RCM system — and instead talk only about moving the product to the cloud.
• Oracle talked up the development of a hands-free voice interface and increased availability of AI/ML in the December 2021 acquisition announcement, where it also pledged that Oracle would “maintain and grow Cerner’s community presence” in Kansas City.
• The company says it will announce two new contracts worth a combined $1 billion this quarter. My bet is that these are outside the US, where Oracle has said it will expand Cerner sales to create “a huge additional revenue growth engine.”
• I know little about code generators, but the idea that old code or new specs can be fed into a tool that will effortlessly spit out perfect code has never worked. And while customers might (or might not) benefit from a move to Oracle’s cloud, technology changes alone don’t often excite the market. I doubt that the decision of UPMC and Intermountain to move to Epic was driven by Millennium’s infrastructure.
• Oracle has failed to deliver (and now doesn’t mention) the promised rewrite of Millennium Pharmacy for the VA as the first step in Millennium’s transition, which it assured the Senate Committee on Veterans’ Affairs would be finished by April 2023.
• My big-picture takeaway is that the Cerner acquisition was Larry Ellison’s pet project, but now the bean counters are charged with making the healthcare cash register ring, which has been tried by big companies many times with a success rate of 0.0. Meanwhile, Oracle Cerner headlines mostly involve flagship customer attrition and Mike Sicilia slathering corporate concealer to cover its VA black eye.

HIStalk Announcements and Requests

Listening: Living Colour, whose 40-year history I had missed until a social media mention sent me to Spotify to learn more. The New York City funk metal band has remarkably kept the same lineup since 1984 other than swapping bass players in 1992. They were boxed out of entire genres that should have made them famous due to ever-changing musical tastes, record label pigeonholing, and lack of support for most black artists, but they just keep doing what they do.

A Reader’s Notes from AHIP’s Consumer Experience and Digital Health Conference

• Looks like about 300 attendees, with key themes of AI, member engagement, health equity, bringing digital solutions to the customer experience, and some discussion about analytics and interoperability.
• It’s about as low-key as healthcare conferences get (HLTH will be a shock after this). Quality is good, speakers are specific with evidence and examples, and panelists who are pressed to predict the future seem to have anxiety that no one knows what the payer world will look like in a few years.
• John Halamka says that Mayo is focused on low-risk use cases of generative AI, such as drafting appeals letters and replying to patient messages. They are thinking about use in prior authorization, but haven’t done anything. He says B2C AI tools are too risky because of hallucinations and the risk of giving patients incorrect information. He concludes that when working with AI startups, it is critical to separate fact from fiction.
• A panel says that AI-powered ambient listening and documentation is a big opportunity, but adds that the onslaught of AI tools has been hard to triage.
• California-based Manifest MedEx is using data on 36 million Californians – from EHRs, immunization registries, EMS EHRs, and claims – to promote health equity, although data normalization and consistency across data sources are challenges.
• Oscar has a platform that creates patient interventions and messages based on knowledge about that person, such as recommending that a care manager arrange a specialist referral in response to a chatbot question, while Cambia has an initiative to lower the out-of-pocket medication cost of members. They say the message must be matched to the patient, such as tailoring to the local Spanish dialect used, and sent via the patient’s preferred communication method.
• One presenter expressed concern about trends such as fewer providers accepting Medicaid, wondering if low-income patients will eventually be limited to virtual care only.

Webinars

September 21 (Thursday) 2 ET. “Unlock open enrollment best practices to stop future denials.” Sponsor: Waystar. Presenter: Lauren Tungate, solution strategist team lead, Waystar. Nearly half of insured Americans consider changing their insurance coverage each fall, necessitating provider safeguards to stop increased denials, find hidden coverage, and prevent uncompensated care. This webinar will crack open enrollment best practices, such as using different data sources to get an accurate picture of benefit details; leveraging automation to identify hidden coverage, confirm active insurance, and avoid lost revenue; and simplifying eligibility workflows to reduce the financial burden on patients and strain on staff.

October 25 (Wednesday) 2 ET. “Live Ask Me Anything Webinar: The Power of Data Completeness.” Sponsor: Particle Health. Presenters: Jason Prestinario, MSME, CEO, Particle Health; Carolyn Ward, MD, director of clinical strategy, Particle Health. Is fragmented data impacting your organization and its ability to scale quickly? Our experts will discuss the advantage of having a 360-degree, real-time view of your patients. Access to analytic-ready data supports proactive care by enabling rapid clinical decision-making, stratifying high-risk patients, developing and using personalized treatment plans, lowering cost, and quickly closing care gaps.

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

Acquisitions, Funding, Business, and Stock

RCM technology vendor Aspirion acquires AI-powered intelligent document processing platform vendor Infinia ML.

Digital therapeutics vendor Akili, which sells a videogame that is an FDA-approved treatment for ADHD, will lay off 40% of its headcount and abandon its business model that involves prescriptions and payers. The company will sell directly to consumers with no prescription required, saying that payers were standing in the way of patients receiving treatment. The company went public via SPAC merger in August 2022, with shares opening at $36 but falling to $4 within a week as another spectacular but highly profitable failure from SPAC king Chamath Palihapitiya. AKLI shares are now at 90 cents, valuing the former unicorn at $70 million. 

Politico reports that private equity acquisition of hospitals and nursing homes, financed with low-interest loans, are at risk for layoffs and bankruptcies as higher interest rates eat into their profits. Federal agencies such as CMS and the SEC are alarmed over the undisclosed debt and the involvement of PE firms like The Blackstone Group – which holds $1 trillion in assets and controls businesses that employ 12 million Americans – that walk away from acquired companies after milking quick profits and management fees.

Sales

• CommonWell Health Alliance names Ellkay as its technical service provider, where it will provide the interoperability infrastructure to support current requirements and CommonWell’s goal of becoming a QHIN under TEFCA.
• Central California Alliance for Health will implement ZeOmega’s care management solution.

People

Rhapsody hires Sagnik Bhattacharya, MS (HealthEdge) as CEO.

Thirty Madison names Gil Shklarski, PhD (Flatiron Health) as CTO.

TeleTracking hires Nigel Ohrenstein, MA (Kaia Health) as president.

Julia Bernstein, MBA (Thirty Madison) joins behavioral telehealth provider Brightside Health as COO.

Bruce Gray, MBA (HIMSS) joins WPS Health Solutions as chief information and digital officer.

Announcements and Implementations

Blue Ridge Medical Center earns Rural Emergency Hospital designation with the assistance of Medhost and its REH package.

UT Health San Antonio and UTSA launch a five-year MD/Master of Science in Artificial Intelligence degree program.

Geisinger goes live on Exo Works, which integrates ultrasound documentation with its EHR and PACS.

The newly announced Apple Watch Series 9 adds the ability to use Siri to request on-device health and fitness information, such as data from connected monitors, and to log health data such as weight and meds.

Aridhia Informatics and Replica Analytics will collaborate to offer an end-to-end research data-sharing platform for research hospitals, pharma, and global consortia.

Other

The government of China cracks down on doctors who accept illegal commissions from drug companies for selling their products to patients, supplementing their “very small” salaries with “red envelope” money that can make up a significant part of their income. A previous study also found that one-third of patients had bribed their own doctor to get better treatment.

The Philadelphia newspaper notes that Children’s Hospital of Philadelphia paid its CEO $7.7 million in 2021, exceeding the amount of charity care the hospital provided in the three previous years combined.

Sponsor Updates

• EClinicalWorks publishes a new customer success story, “Unlock Healthcare Benefits with Healow.”
• CereCore releases a new podcast, “Liverpool Women’s CIO on the EPR Implementation Journey.”
• Arcadia announces that ACO using Arcadia Analytics outperformed the market in Medicare Shared Savings Program bonuses by nearly 20% on average in 2022.
• Elsevier Health publishes its Clinician of the Future 2023 report, highlighting the new ways in which technology will provide relief for healthcare workers.
• InterSystems will sponsor HackMIT September 16-17 at MIT in Cambridge, MA.

Blog Posts

• How to Reach the CMDB Summit (Optimum Healthcare IT)
• The Secret to Exceptional Customer Support: A Look into Dimensional Insight (Dimensional Insight)
• Connecting Californians: Supporting Medicaid Members via CalAIM (Findhelp)
• What’s the Difference Between a Call Center and a Contact Center? (Five9)
• Stretching your cybersecurity budget: 6 ways to do more with less (Fortified Health Security)
• Why am I going to attend HLTH next month? (Get-to-Market Health)
• The Value of Using the Right Health Education Videos for Patients (Healthwise)
• Three Keys to Unlocking Provider Productivity (Impact Advisors)
• Unleashing the Cure: RPA 2.0’s Impact on Healthcare and Aerospace & Defense (Keysight Technologies)
• Master Denial Management: 4 Essential Techniques for Healthcare Providers (Medhost)

Contacts

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

EPtalk by Dr. Jayne 9/14/23

Updated COVID-19 vaccines should be available soon, following approvals by the US Food and Drug Administration and the Centers for Disease Control and Prevention. They’re recommended for everyone age six months and older, so I anticipate that quite a few IT folks will be scurrying around to add the vaccine to EHRs near and far.

Although many healthcare folks seem to have stopped following the data, hospitalizations have been increasing recently, but might be leveling off. I’ve been traveling and have definitely seen an uptick in masking, with the most recent trip revealing about 5% of passengers and 20% of service workers being masked. The latter are less likely to have paid time off than other categories of workers and are likely to have negative impacts from illness, so it makes sense. Of the people who are masking, most seem to be wearing higher-filtration masks rather than basic surgical masks, and I didn’t see any cloth masks. Of note, two of my recent flights have been less than half full, so it appears the summer travel season is indeed winding down.

As far as masking in healthcare environments, I’ve seen a couple of articles addressing the topic. A recent opinion piece in the Annals of Internal Medicine suggests that healthcare organizations should make decisions that place patient safety first and should consider masking “as part of routine healthcare policies.” They suggest that care delivery sites “should be mindful of continuing areas of uncertainty while integrating the lessons learned into our hospital-based practices to prevent harm to vulnerable patients rather than reverting to suboptimal pre-pandemic behaviors.” I appreciate the fact that they called out the notion that the good old days weren’t necessarily that good in many care locations. In addition to vulnerable patients, there are plenty of vulnerable healthcare workers out there who deserve a safe work environment.

Regardless of the COVID case counts, the reality is that a lot of hospitals and health systems are still stressed. Some of the urgent care centers in my area have been closed for an extended time period due to lack of staffing, and many of my former colleagues have retired or left practice for other pursuits. My hospital colleagues tell me they’re still having staffing issues especially in labor and delivery, and apparently there’s a shortage looming for anesthesia medications, so it might be a bumpy winter.

I visited the local Costco for my flu vaccine this week and it was a seamless process, although I skipped the hot dog and soda combo and instead went for the sample of Kinder Bueno chocolate on the way out the door. There’s also a new vaccine out for Respiratory Syncytial Virus (RSV) intended for pregnant women as a way to protect their newborns, so I anticipate people are updating their EHRs and clinical decision support reminders to promote that one during patient visits as well.

This month’s issue of the Journal of the American Medical Informatics Association features an interesting back and forth about so-called EHR “gag clauses,” in response to a recent article that looked at whether those clauses had negatively impacted the inclusion of screenshots in peer-reviewed literature. Informatics guru Ross Koppel submitted a letter to the editor noting that informatics experts had been pushing for removal of those clauses since 2009. He also mentioned that informaticists may still be living in a climate of fear that vendors will punish them for publishing screenshots, regardless of moves by ONC or anyone else to remove such gag clauses. He concludes by stating, “Ethical vendors should have welcomed feedback about problematic EHR screens, rather than punishing medical informaticists who sought to improve those EHRs by demonstrating their dangers to patient safety.”

The authors of the original article responded to Dr. Koppel, agreeing with his comments but also pointing out that ONC and scientific journals should encourage the inclusion of screenshots in submitted articles and also that such screenshots should be included in safety bulletins and other documents covering EHR issues. They suggest that research needs to be done to understand why screenshots aren’t being included, and one way to do this would be to ask authors whether they’re aware of policy changes that prohibit gag clauses. They conclude by calling out Dr. Koppel’s comment that “…we should all be troubled by EHR vendor actions to prohibit sharing screenshots and that the EHR vendor insistence that the gag clauses are necessary for protecting intellectual property (IP) is meaningless if the IP is protecting poor design.” For those of us who have worked in EHRs that range from suboptimal to downright dangerous, that’s pretty much a mic drop right there.

As medicine has become more complex, the need for patient advocacy has increased. I was surprised to see a recent research letter in JAMA Internal Medicine about the prevalence of industry ties in patient advocacy organizations. The authors looked at the top 50 US patient advocacy organizations (ranked by revenue) and looked at ties between their senior leaders and the pharmaceutical or medical device industries. They found that a whopping 74% had board members or senior leaders with prior or current industry ties, with half of the organizations having conflicts of interest among paid staff or executives.

Although past ties are certainly worrisome, having a current conflict of interest seems particularly concerning. I appreciate the authors’ methodology. They used publicly available data from GuideStar to identify the high-revenue patient advocacy organizations and investigated the LinkedIn profiles of those listed on the organization websites. They also used other readily available sources such as annual reports, public tax documents, personal websites, and publicly posted biographies.

The authors listed some limitations, including “incomplete disclosure of board members, senior paid staff, or executive employment history, as well as the possibility of omissions from website profiles, limited (and likely underestimating) our characterization of industry ties.” Overall, they raise the concern that industry is influencing the advocacy organizations’ positions on patient education, policy making, and treatment guidelines. Definitely something to think about when you’re following the money in the complex web of the healthcare industry.

What do you think about conflicts of interest in patient advocacy organizations? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 9/14/23

Aspirion Acquires Infinia ML, an established leader in AI and Machine Learning

RCM technology vendor Aspirion acquires AI-powered intelligent document processing platform vendor Infinia ML

VA Going ‘Back to the Drawing Board’ for EHRM Deployment Schedule

The VA will develop a new deployment schedule for its EHR Modernization program, likely resuming in the summer of 2024 provided the scheduled March 2024 roll out of the Oracle Health system at the Captain James A. Lovell Federal Health Care Center goes well.

Carenostics helps clinicians prioritize at-risk patients

Carenostics,a clinical decision support software startup initially focused on chronic kidney disease, raises $5 million in seed funding.

Readers Write: Navigating the Early Days of Healthcare AI Integration

Navigating the Early Days of Healthcare AI Integration
By Michael Burke

Michael Burke, MBA is founder and CEO of Copient Health of Atlanta, GA.

Have you tried using any of the AI tools that have taken the world by storm recently? This article will probably be more helpful if you have some knowledge or experience with ChatGPT, Google Bard, Anthropic Claude, or any other LLM/chat model tool.

If you haven’t already, try asking one of these tools a specific question or give it an assignment to produce a specific document and see where it leads. You may be surprised at just how useful the results can be.

If you’ve used these tools to answer questions or generate content (e.g., a legal document, a policy document, an email, or an article like this one), you have some sense of their potential. Imagine what could be done with a tool that leveraged an LLM like ChatGPT on your hospital’s data. The software vendors you use are all either investigating or actively releasing tools powered by LLMs to leverage your data. At Copient Health, we are, too.

It’s my belief that these tools will fundamentally change the way you interact with those vendor systems and ultimately, in both the way that you do your work and the results that you get.

A comprehensive list of all use cases is impossible because we’re so early in the process, but here are a few obvious low-hanging fruit uses that are relevant for software vendors:

• LLMs are already powering chart notes that are built in real time from patient conversations.
• Dashboards and reports will become unnecessary, because you will always have the specific data or chart that you need just a query away. The LLM can even proactively push the appropriate information in the appropriate format for the appropriate context.
• You can forget about manuals, indexed help systems, or frustrating first-generation chat bots that perform poorly. LLM-powered solutions are better at finding what you’re looking for using a similarity search of a vector database.
• You might even abandon memorizing complex commands or menu hierarchies and ask the LLM to accomplish the task instead.

But ChatGPT and other public-facing LLMS were trained on public data. How can they be leveraged for use cases that require knowledge of private data?

The answer to that question used to take a lot of time, money, and a team of data scientists to train your own LLM, or at least fine tune an existing open source model. That has changed dramatically, mostly in the last 6-8 months, based primarily on a term that you may have heard: “prompt engineering,” and one that you probably haven’t: “in-context learning.” Here’s a quick summary:

LLM models are text-in, text-out black boxes. But the text-in doesn’t have to be limited to a simple question. It can include prompts of background information, examples of questions and answers to similar scenarios, chunks of data, or simply directing the LLM to “think step-by-step.”

These are all basic forms of prompt engineering. The LLM temporarily “learns” from this prompt data, at least enough for your current conversation. LLMs can be used as an inwardly-directed service to decide what data or tool to use based on the prompts that it receives. This design pattern has demonstrated better results than the more cumbersome fine-tuning approach for the smaller data sets that we’re talking about.

An entire ecosystem of software tools has emerged to support the use of these pre-trained LLMs on private data. These tools convert the challenge from what was once an arcane AI data science problem to a data engineering problem, primarily built around prompt engineering and in-context learning.

Here’s an illustration of how quickly these tools have evolved and been adopted. One of the most widely used tools in the ecosystem, LangChain, was first introduced in October last year as an open source project from two college students. In a few months, its use expanded globally. The founders incorporated and raised $20 million in venture funding from Sequoia Capital. Since last October, they have garnered 60,000 GitHub stars, which is a measure of its popularity among software developers. For context, Python, the language the LangChain toolset is written in, has fewer stars over a significantly longer time period: 51,500 stars over six years. ChatGPT itself captured one million users in just five days.

This head-spinning rate of change gives an advantage to startups, given their rapid iteration and integration of new tools and ideas. Some large healthcare software vendors that are infamous for relying almost exclusively on internally developed tools find themselves in a challenging situation. It’s impractical for them to build their own LLMs, as they would likely never rival the performance of commercially available options, and it would take forever. And since they are not used to relying on third-party software as part of their solution, they aren’t prepared for the rate of change at which these solutions are evolving.

For instance, just yesterday, LangChain had 18 separate commits (i.e., changes) to their codebase. That’s fast! Adapting to rapid changes and advancements requires a new level of agility.

We’ve recently heard announcements and partnerships from big tech and big healthcare IT. It will be interesting to see if these announcements produce real value in the near term, or if they are just a way to buy time for the vendor to figure out this rapidly evolving space.