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Morning Headlines 7/26/23

July 25, 2023 Headlines No Comments

Combining Human Expertise with Artificial Intelligence: Experimental Evidence from Radiology

A study finds chest x-ray analysis didn’t improve when radiologists were assisted by AI tools that, on their own, outperformed two-thirds of the radiologists involved.

RetinAI and Retina Consultants of America Join Forces to build the Most Comprehensive U.S.-based Real World Evidence Database in Ophthalmology

Imaging analysis vendor RetinAI and retina care provider Retina Consultants of America will partner to develop a real-world evidence database in ophthalmology.

Teladoc Health shares rise 5% following improved outlook

Teladoc Health shares rise in after-market trading after reporting a Q2 revenue increase of 10%.

News 7/26/23

July 25, 2023 News No Comments

Top News

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A study finds chest x-ray analysis didn’t improve when radiologists were assisted by AI tools that, on their own, outperformed two-thirds of the radiologists involved.

The authors say that the radiologists did not correctly use the AI’s information and instead applied their own biases.

Using AI also increased the per-case time of radiologists, which the report speculates is due to radiologists digesting the information it provided.

The report concludes rather startlingly that “the majority of cases are optimally decided by either the radiologists or the AI alone, but not by the radiologists with access to AI.”


Reader Comments

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From HISTalkFan: “Re: Cerner/Oracle Health hospital count gain in the past five years in the KLAS report. Surprising. Are they counting DoD/VA gains?” Yes. I found an old KLAS US hospital market share report that says Cerner added 167 hospitals in 2018 via its VA contract, but it lost 65 hospitals that year. The company had little change from 2019 through 2022, although it lost ground to Epic in the percentage of total hospital beds served (nearly 50% for Epic at the end of 2022 versus less than 30% for Oracle Health). Epic is the only vendor that gained both facilities and beds in 2022.


Webinars

July 26 (Wednesday) 1 ET. “Lessons We’ve Learned Since Launching our Cancer Prevention Program.” Sponsor: Volpara Health. Presenter: Albert Bonnema, MD, MPH chief medical information officer, Kettering Health System, and Chris Yuppa, product owner for oncology services and cancer prevention, Kettering Health System. Kettering’s IT department has played a critical role in providing an EHR-driven framework to bring cancer risk assessment and individual prevention plans to more than 90,000 patients. Primary care, OB/GYN, oncology, and imaging providers are now able to assess the hereditary, genetic, and lifestyle factors that affect the risk of developing lung, breast, ovarian, colon, and prostate cancer in any patient encounter. Learn how Kettering brings together people, processes, and technology to be more proactive in the fight against cancer and where its cancer prevention program is headed next.

July 27 (Thursday) noon ET. “Why You Shouldn’t Wait to Use Generative AI.” Sponsor: Orbita. Presenter: Bill Rogers, co-founder, president, and chairman, Orbita. The advent of generative AI tools truly represents a paradigm shift. And while some healthcare leaders embrace the transformation, others are hesitant. Invest 20 minutes to learn why you shouldn’t wait. When combined with natural language processing, workflow automation and conversational dialogs, generative AI can help leaders address a raft of challenges: from over-extended staff, to the rising demand for self-service tools, to delivering secure information to key stakeholders. You will learn where AI delivers the greatest value for providers and life sciences, how it can solve critical challenges faced by healthcare leaders, and how Orbita has integrated generative AI into its conversational platform so healthcare leaders can leverage its full capabilities safely and securely.

July 27 (Thursday) 2 ET. “Denial Prevention 101: How to stop denials from the start.” Sponsor: Waystar. Presenter: Crystal Ewing, director of product management, Waystar. There’s a reason denial prevention is prominent everywhere in healthcare RCM. Denials reduce cash flow, drive down revenue, and negatively impact the patient and staff experience. More than half of front-end denials don’t have to happen, but, once they do, that money is gone. It’s a pretty compelling reason to take some time now to do some preventative care on your revenue cycle. This webinar will help you optimize your front end to stop denials at the start. We’ll explore the importance of not only having the right data, but having it right where staff need it, when they need it.

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


Acquisitions, Funding, Business, and Stock

The US Air Force awards IncludeHealth a $1.5 million Tactical Funding Increase, which will enable the physical therapy provider to expand its virtual and in-person MSK care services to additional service members.

Imaging analysis vendor RetinAI and retina care provider Retina Consultants of America will partner to develop a real-world evidence database in ophthalmology.

HealthStream announces Q2 results: revenue up 5%, EPS $0.13 versus $0.10, beating expectations for both. HSTM shares have lost 2% in the past 12 months versus the Nasdaq’s 20% gain, valuing the company at $688 million.


Sales

  • Vanderbilt University Medical Center (TN) selects Nference’s federated clinical analytics software.

People

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Amar Desai, MD, MPH (CVS Health) joins Optum Health as CEO.

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Clarify Health names Terry Boch (Diameter Health) chief commercial officer.

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UCI Health promotes Julie Eastman, RN, MBA to CIO.


Government and Politics

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A federal judge sentences Vishal Vasanji, co-founder and CEO of bankrupt telehealth app vendor Relief Telemed, to 28 months in prison for wire fraud involving the embezzlement of $260,000 of investor funds that he used for personal expenses.

The Federal Trade Commission sues to block the acquisition of Propel Media by IQVIA, a Fortune 500 company that sells provider and prescription records databases to drug companies for marketing their drugs to professionals. FTC says that the acquisition would give IQVIA, which has annual revenue of $14 billion, a market-controlling advantage.


Privacy and Security

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Fortified Health Security’s mid-year cybersecurity report finds that the number of breaches that were reported to HHS doubled versus the same period last year, affecting 40 million people. Breaches involving business associates jumped from 22 to 82. Most of the breaches originated from attacks on network servers rather than email. The report notes an uptick in hackers using file transfer tools such as FileZilla and Windows Secure Copy – some of which don’t require administrative privileges to install or to run from flash drives – to move PHI and other information to cloud storage sites such as Dropbox. The report indicates increased health system use of risk-based identity alerting, in which unexpected user activities trigger multi-factor authentication, system lockouts, or IT alerts.


Other

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A new paper by researchers Dean Sittig, PhD and Adam Wright, PhD looks at the use of EHR audit logs in malpractice cases, listing best practices for healthcare organizations to minimize risk. Some of those include monitoring who is looking at VIP records, identifying those EHR elements that will be produced for a plaintiff’s attorney who asks for the “complete medical record,” and reviewing the EHR function to print a patient’s record to a file to make sure it matches the policy of what will be provided in response to a subpoena.

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Don’t try this at home. Cricket fans – many of them from the US — who are finding that hotel rooms are expensive or fully booked for the India-Pakistan World Cup match in India on October 15 are instead scheduling overnight-stay checkups in Ahmedabad hospitals that are near Modi Stadium. A night in the hospital, which includes medical costs and meals, costs as little as $37 versus $900 in some hotels that have raised rates 20-fold for the match.


Sponsor Updates

  • Nordic releases a new Making Rounds Podcast, “The hopes and promises of AI.”
  • Biofourmis marks its one year post-Series D with major milestones and a focused go-forward growth strategy.
  • CHIME releases a new Trailblazers Podcast, “The Future of Data and Applications with Stacey Johnston.”
  • Visage Imaging publishes a new white paper, “Visage 7 CloudPACS Value Realization.”
  • Liverpool Women’s NHS Foundation Trust transitions to Meditech Expanse.

Blog Posts


Contacts

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Get HIStalk updates.
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Contact us.

Morning Headlines 7/25/23

July 24, 2023 Headlines 3 Comments

NextGen Healthcare Reports Fiscal 2024 First Quarter Results

NextGen Healthcare reports a 16% uptick in Q1 revenue as well as an increase in earnings, beating analyst expectations for both.

Cigna Sued Over Algorithm Allegedly Used To Deny Coverage To Hundreds Of Thousands Of Patients

A pair of plaintiffs in California file a class-action lawsuit against Cigna over its alleged practice of wrongfully rejecting claims in mere seconds using an automated system.

Axxess Acquires Complia Health

Home healthcare technology company Axxess acquires competitor Complia Health for an undisclosed sum.

Collectly wants to make paying healthcare bills easier so medical providers don’t lose $200B

Patient billing startup Collectly raises $29 million in a Series A funding round.

Curbside Consult with Dr. Jayne 7/24/23

July 24, 2023 Dr. Jayne 3 Comments

I recently attended a gathering of physicians from across the US and was surprised by the overwhelmingly negative tone of most of the informal conversations. It seemed like the majority of attendees were exhibiting at least some level of burnout, ranging from frustration with daily processes to frank exhaustion from lack of organizational support for patient care.

During the pandemic, many of us were asked to do more with less. In many organizations, those work efforts have become part of day-to-day expectations. Just because physicians can work at that level doesn’t mean that they should, and when they have to do so, it should be the exception and not the rule.

I still remember those COVID-driven shifts when I was responsible for seeing over 100 patients. I would be deluding myself if I said they received the same level of care that they would have pre-pandemic, but we were all just doing what we could at the time. Pre-pandemic, a heavy shift would have been 60 patients, and that would have been with the support of a nurse practitioner or physician assistant. Now, my former employer expects providers (whether physician, nurse practitioner, or physician assistant) to all see upwards of 60 patients as part of a “normal” shift, reinforcing it with comments about how “at least it’s not as bad as it was during COVID.” Whether we like it or not, the baseline has shifted for many, and not in a good way.

I was deeply saddened to see so many of my colleagues sharing some fairly strong sentiments that were decidedly not pro-patient. Some were frankly anti-patient. I listened to a fair amount of victim-blaming, as physicians tried to rationalize broken elements of our healthcare system by shifting responsibility to the patients.

One of the strongest discussions was around the immediate release of laboratory and testing results to patients via patient portals. A physician discussed being contacted by one of their family members who wanted help understanding an imaging report. The write-up included a newly detected tumor as well as the possibility of advanced metastatic disease. Unfortunately, the reading of the study was completed at 2 a.m. on a Sunday, resulting in a “you have new results in your chart” text message that greeted the patient as they were getting ready for the day.

So much has changed about how health systems operate in the last few decades that have led us to situations like this. In my early days in practice, non-urgent studies weren’t read on weekends. They were typically read by the radiologists Monday through Friday from 7 a.m. to 4 p.m. The radiology group was often a small private group that was contracted with the hospital. I knew those radiologists at my various hospitals because we went to medical staff meetings together, saw each other at hospital auxiliary events, and communicated regularly about cases.

Hospital policies were in place that radiologists called the ordering physician for critical or unusual results or findings, such as a massive tumor with possible metastases. At that time, radiologists were relatively tethered to the hospital due to the limitations of imaging systems.

Fast forward to improvements in technology, where nearly all imaging is digital and hospitals looked to take advantage of outsourcing agreements and economies of scale in determining who interpreted radiological studies. Now our studies could be read by physicians in other time zones, with a larger window for results to be released. Unfortunately, the anonymity of those distant physicians made it less likely that hospital policies would be followed, and there certainly weren’t relationships in place that encouraged collegial discussion of our patients. The ability to work during non-traditional hours was also attractive to physicians, who might want to work overnight so that they were more available to their families or for other pursuits.

When taken by itself, each of these factors seems like a positive development until you realize that when combined, they have led to the current state where imaging tests are read 24×7, often by physicians who have no relationship with the ordering physicians. Add the 21st Century Cures Act and its information blocking provisions to the mix and it has the potential to become quite messy.

Some of the comments made by my physician peers included these: “Well, the patient didn’t have to look at it. They could have just stayed out of the portal until their physician called them.” I couldn’t believe what I was hearing. It was immediately followed by, “They should have changed their portal settings so they didn’t get a text.” Several people agreed.

I asked how many of them knew how to update those portal settings, if their practices offered educational materials to help patients through that process, and if they discussed that scenario with their patients when ordering high-stakes testing. They looked at me like I was speaking gibberish.

Another physician kept talking about the provisions of the CARES Act, which they had confused with the 21st Century Cures Act. None of them were aware that there are exceptions to the rules on information blocking in the 21st Century Cures Act.

In a nutshell, the Preventing Harm exception allows providers to block access to electronic health information if they believe the information will cause harm to a patient or another person, assuming certain conditions are met. I’ve seen health systems operationalize this in a variety of ways, most often allowing an ordering clinician to flag a diagnostic order so that the results will not be immediately released to the patient. This meets the conditions of the exception in that it can’t be broader than necessary – meaning that a physician can’t flag all of their orders – and it has to be done on an individualized patient basis.

I’ve seen templated phrases deployed to allow clinicians to document conversations with patients about whether to delay releasing test results. For example, “Discussed with patient that results may be available in the patient portal prior to my review. Patients may find this distressing and it may contribute to worsening of health conditions. Patient elects to proceed with immediate results.”

Or, “Discussed with patient that results may be available in the patient portal prior to my review. Patients may find this distressing and it may contribute to worsening of health conditions. Patient would like results held until the physician review and notification process occurs.”

I’ve also seen where ordering physicians can add additional detail on the kinds of harms that might happen, including worsening hypertension, worsening of anxiety or depression symptoms, etc. I don’t know if these are customizations done by individual hospitals or health systems or whether vendors are actually doing this.

Ultimately the results are indeed released to the patient, but they’re released in a way that meets the patient’s needs.

Most of the commentaries I’ve read say that emotional harm isn’t enough to block immediate release, that it has to be life-endangering or a risk of physical harm, but I think tying it in to potential physiologic changes for the patient makes sense. I would hope that federal regulators have enough to do without going after a physician who clearly documents why they delayed the release of a result after discussing it with a patient and clearly documents the conversation. I also suspect that patients who had their wishes honored would be less likely to file a complaint.

When I discussed these approaches with my colleagues, they stated unanimously that they were unaware of any way to block notification to a patient, even temporarily. They were all from different health systems, so I recommended checking with their IT teams to see if there’s functionality that they’re just not aware of.

Moving beyond the problem of patients seeing test results before their care team, the majority of the conversations fell into the theme of “medicine is going to hell in a handbasket.” Nearly all those present were exhibiting symptoms of compassion fatigue, including exhaustion and feelings of helplessness, anger, decreased professional respect, and powerlessness.

Technology seemed to take a lot of the blame, with plenty of focus on inboxes, patient messages, and EHR documentation, including prior authorizations and referrals. It should be noted the many of these existed in the paper world and technology has brought some efficiencies, but making that point didn’t seem to make a difference in the conversation.

Overall, the conference was a bit of a downer, and I left it feeling less than hopeful for the future of medicine. Regardless of how many healthcare resources each of us consumes now, as we age we’re going to need more resources, and I’m not sure we can get this system back on track. It’s tough to counter the forces that are causing people to burn out, and I’m not seeing a lot of organizations moving the needle in the right direction in this regard.

For patients who are on the downstream end of compassion fatigue, I feel for you. I’ve been there myself, and it’s not anywhere we want to find ourselves.

What steps is your organization taking to fight compassion fatigue? Are they allowing physicians to delay patient portal release on certain results? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: From EHRs to EOM: Enhancing Oncology Model Highlights Limitations of Current Clinician-Facing Tech

July 24, 2023 Readers Write No Comments

From EHRs to EOM: Enhancing Oncology Model Highlights Limitations of Current Clinician-Facing Tech
By Kathy Dalton Ford

Kathy Dalton Ford is chief product and strategy officer at Ronin of San Mateo, CA.

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For years, healthcare leaders have prioritized improving patient access and care delivery through value-based care (VBC) initiatives. However, according to a 2022 report, value-based contracts only accounted for 7% of medical revenue among primary care specialties, 6% among surgical specialties, and 15% among non-surgical specialties. These percentages indicate that despite the efforts of healthcare leaders, there is still a long way to go to implement VBC programs fully.

To address this issue, the Centers for Medicare & Medicaid Services (CMS) introduced a range of value-based care models, including the Enhancing Oncology Model (EOM). EOM, a voluntary five-year model that commenced on July 1, 2023, aims to improve the quality of care while reducing costs through payment incentives and required participant redesign activities.

Provider organizations must use certified Electronic Health Record (EHR) technology as part of the required redesign activities. EHRs are ubiquitous, with nearly four in five office-based physicians (78%) and almost all non-federal acute care hospitals (96%) adopting a certified EHR as of 2021. However, EHRs facilitate billing rather than inform care decisions, lacking the all-important ePROs and daily insights into patient conditions to inform effective cancer care. 

While EHRs support billing and reimbursement, they present several challenges for physicians in delivering timely, quality patient care, resulting from time-consuming data entry, interoperability issues, un-optimized user interface design, and lack of standardization. These problems make it challenging to access vital patient information at the point of care, increasing the time required to document patient encounters and potentially leading to errors or missed details.

Many organizations don’t have the tools to implement VBC-based programs and payment models, making EOM’s implementation governance and reimbursement support critical in realizing these life-saving initiatives. Meeting EOM requirements cannot solely be fulfilled by care teams and EHRs alone. Health systems must adopt clinical decision-support technologies that consider the patient experience outside the hospital, connect patients to their care team, and integrate safe and ethical artificial intelligence (AI) to fill the gaps in existing capabilities and realize the benefits of value-based care.

Today’s AI technology can pull data from unstructured clinician notes, accelerate time-consuming chart reviews, and improve care by analyzing data to produce actionable predictive insights. By pairing AI with a robust decision support platform and ePROs, cancer centers can provide patients with 24/7 access to care teams, streamline patient-to-care team communications, engage patients, screen for social needs, deliver health education, and identify patients at risk for adverse events.

Health systems must adopt solutions incorporating safe and ethical AI tools that accelerate precise clinical care decisions and rise above the competition to leverage EOM and capture new revenue without the burden of adding more steps to their workflows. By doing so, healthcare leaders can improve patient access and care delivery while reducing clinical and administrative burdens and realizing the full benefits of VBC programs.

Ultimately, the goal of EOM is for patients to feel better supported in their care; have a clearer understanding of their diagnosis, prognosis, and outcomes; and adhere to their treatment plan. However, the tools and data to help clinicians meaningfully facilitate their job have yet to be available.

Hospitals now have an opportunity to leverage technology to help them realize the vision of comprehensive, coordinated cancer care.

Readers Write: Navigating the Future of Clinical Information Post-Public Health Emergency

July 24, 2023 Readers Write No Comments

Navigating the Future of Clinical Information Post-Public Health Emergency
By Greg Samios

Greg Samios, MBA is president and CEO of the clinical effectiveness business of Wolters Kluwer Health.

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The global health community has acknowledged the official end of the COVID-19 public health emergency (PHE). The impact of the PHE had both positives (telehealth) and negatives. Of the latter, there are many, but the rampant flow of inaccurate and misleading information, also known as the infodemic, is a key one because of its direct impact on patients.

This infodemic highlighted the important role clinical decision support (CDS) tools play in distributing a high volume of reliable, trustworthy, and ever-evolving information to clinicians around the world. As the global health community looks to the future, there are a few lessons from COVID-19 to consider about the power of CDS.

The PHE may have ended, but what about the Infodemic?

The end of the PHE offers a moment of reflection about where the industry goes next to ensure that CDS continues to support clinicians through distributing reliable, transparent, and consistent information across care teams. It also opens the possibility for a period of uncertainty and unpredictable increases in the variability of care.

Looking ahead – as healthcare leaders consider both ongoing threats of COVID-19 as well as the inevitable next pandemic – CDS resources could be leveraged to improve speed and transparency and more effectively reach public health goals during an infodemic. The industry needs to focus on how it can be agile in distributing continually emerging and changing information in the next PHE.

But there is another challenge looming to further deepen the entrenchment of the infodemic: the arrival of generative AI, including ChatGPT. While generative AI offers potential for healthcare, it may also present risks if not developed and applied responsibly. This could be particularly critical around its use in clinical care.

CDS everywhere, including virtual

The PHE helped deliver new avenues for patients to interact with healthcare providers, such as virtual visits. It also proved and elevated the important role that local retail pharmacists play as an extension of a patient’s care team – providing COVID tests, vaccines, treatment, and counsel to patients, among other key responsibilities. The challenge for the future will be to ensure that no matter where patients interact with their care team, they receive the most optimal and consistent care as possible.

In tandem with these shifts, it’s crucial that healthcare systems work together and provide smart, consistent, and accurate information. CDS resources offer a standard approach to align the thousands of micro-decisions clinicians make every day, from physicians in the emergency room to primary care doctors at urgent care to virtual care at home and pharmacists at the neighborhood pharmacy.

Closing the care variability gap

There is still a great deal of care variability, depending on which clinician a patient visits, where the patient lives, how much insurance and social support a patient has, and numerous other factors. Regardless of circumstances, clinicians should still have access to the most recent data and treatment recommendations. COVID-19 demonstrated that when information is widely shared, CDS resources can swiftly close the gap whether clinicians are eight or 8,000 miles apart.

More data, more insight

CDS is standard for clinicians to search data to diagnose patients. But the power of those searches can also create new data that can provide a broader set of insights. By analyzing clinician search queries, CDS enables providers to see around corners and proactively observe trends and understand usage patterns, such as which clinical questions are most important.

CDS resources can also share new medical updates with millions of providers and push notifications within the workflow of electronic medical record (EMR) systems to quickly educate clinicians with treatment recommendations that are trustworthy, verified, and improve patient outcomes, which can be incredibly valuable during a public health emergency.

Ultimately, it’s to everyone’s benefit to create an ecosystem where clinical knowledge systems and EMR vendors can work harmoniously to capture and inform point-of-care decisions.

During the PHE, global healthcare leaders learned how to adapt and make changes to everyday healthcare operations to improve patient outcomes. To make progress as an industry towards closing the care variability gap, and to ensure we are prepared for the next PHE, health organizations should seek a CDS partner that can provide both access to trustworthy and timely information, continuity to support patients no matter where they seek care, and provide insights to benefit the entire healthcare system.

Morning Headlines 7/24/23

July 23, 2023 Headlines No Comments

‘Hi, Doc!’ DM’ing the doctor could cost you (or your insurance plan)

University of California San Francisco research finds that charging for patient portal messages hasn’t reduced email volume as hoped for, given that providers typically only charge for about 3% of messages.

CHC Consulting Group: Leading FQHC and Community Healthcare Consulting Firm Launches Two Subsidiaries, Turbo RCM and CHC Tech RX

FQHC-focused CHC Consulting Group launches new subsidiaries focused on RCM and healthcare technology.

MCI Onehealth Technologies Inc. Enters into Agreements with WELL Health Technologies Corp. to Sell Clinical Assets, Raise New Financing and Empower its AI-Focused Digital Healthcare Business

MCI Onehealth Technologies, which manages a Canadian primary care network and develops health IT, will sell its clinical assets to competitor Well Health Technologies, enabling it to focus solely on AI-powered health IT and clinical research.

Monday Morning Update 7/24/23

July 23, 2023 News 7 Comments

Top News

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The Federal Trade Commission and HHS OCR send a joint letter to 130 health systems and telehealth providers, warning them that the use of online tracking technologies such as Meta Pixel and Google Analytics may create privacy and security issues that violate HIPAA, the FTC Act, or the FTC Health Breach Notification Rule.

FTC notes that companies that aren’t covered entities under HIPAA are still responsible for protecting against unauthorized disclosure of PHI, noting FTC’s recent enforcement actions against BetterHelp, GoodRx, and Premom.


HIStalk Announcements and Requests

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Most poll respondents don’t think that DoD’s successful completion of MHS Genesis has predictive value for the VA’s implementation of the same Oracle Health system.

New poll to your right or here: How much control should patients have in the sharing of their EHR information? I’m also interested in what providers think about receiving what seems to be a complete medical record that may have had some information intentionally hidden by the patient.


Webinars

July 26 (Wednesday) 1 ET. “Lessons We’ve Learned Since Launching our Cancer Prevention Program.” Sponsor: Volpara Health. Presenter: Albert Bonnema, MD, MPH chief medical information officer, Kettering Health System, and Chris Yuppa, product owner for oncology services and cancer prevention, Kettering Health System. Kettering’s IT department has played a critical role in providing an EHR-driven framework to bring cancer risk assessment and individual prevention plans to more than 90,000 patients. Primary care, OB/GYN, oncology, and imaging providers are now able to assess the hereditary, genetic, and lifestyle factors that affect the risk of developing lung, breast, ovarian, colon, and prostate cancer in any patient encounter. Learn how Kettering brings together people, processes, and technology to be more proactive in the fight against cancer and where its cancer prevention program is headed next.

July 27 (Thursday) noon ET. “Why You Shouldn’t Wait to Use Generative AI.” Sponsor: Orbita. Presenter: Bill Rogers, co-founder, president, and chairman, Orbita. The advent of generative AI tools truly represents a paradigm shift. And while some healthcare leaders embrace the transformation, others are hesitant. Invest 20 minutes to learn why you shouldn’t wait. When combined with natural language processing, workflow automation and conversational dialogs, generative AI can help leaders address a raft of challenges: from over-extended staff, to the rising demand for self-service tools, to delivering secure information to key stakeholders. You will learn where AI delivers the greatest value for providers and life sciences, how it can solve critical challenges faced by healthcare leaders, and how Orbita has integrated generative AI into its conversational platform so healthcare leaders can leverage its full capabilities safely and securely.

July 27 (Thursday) 2 ET. “Denial Prevention 101: How to stop denials from the start.” Sponsor: Waystar. Presenter: Crystal Ewing, director of product management, Waystar. There’s a reason denial prevention is prominent everywhere in healthcare RCM. Denials reduce cash flow, drive down revenue, and negatively impact the patient and staff experience. More than half of front-end denials don’t have to happen, but, once they do, that money is gone. It’s a pretty compelling reason to take some time now to do some preventative care on your revenue cycle. This webinar will help you optimize your front end to stop denials at the start. We’ll explore the importance of not only having the right data, but having it right where staff need it, when they need it.

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


People

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Tanya Townsend, MSMI (LCMC Health) joins Stanford Medicine Children’s Health as chief information and digital officer.


Announcements and Implementations

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KLAS looks at the key performance grades of several EHRS and the change in their net number of hospital customers over five years:

Altera / Allscripts: D+, net loss of 143 hospitals.
Epic: A-, net gain of 434 hospitals.
Evident: D+, net loss of 91 hospitals.
Meditech: B, net gain of 14 hospitals.
Oracle Health: D+, net gain of 99 hospitals.

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A Wall Street Journal report says that AI-powered medical scribe service DeepScribe employs a team of 200 contractors to fix mistakes made by its AI, noting that the level of inaccuracy is a reflection of AI’s limitations rather than product shortcomings. The contractors listen to the audio recordings, use Google searches to find billing codes, and catch errors. Current and former workers say the rare mistakes that slip through are always caught by the originating doctor. The co-founders say that the company’s software can create 80% of a given medical record without human help, and WSJ notes that they are transparent about that fact and the rigor of their review process in their sales presentations.


Government and Politics

ONC publishes Version 4 of the US Core Data for Interoperability (USCDI), which includes 20 new data elements and a new data class for describing the physical location of services provided.

Ashavan founder and CEO Cyrus Bahrassa urges the White House to add EHR vendor interoperability charges to its list of much-hated fees that most commonly include Ticketmaster, Airbnb, and banks. He cites the high fees associated with HL7v2 interfaces, FHIR API subscription fees, and the costs of listing and distributing apps via EHR vendor app marketplaces as “interoperability’s junk fees.”


Other

A Johns Hopkins study finds that use of hearing aids was associated with a 48% reduction in cognitive decline in high-risk people. The authors speculate that the benefit is created by a reduced need for the brain to interpret audio signals, the possible reduction in brain atrophy, and higher social activity when hearing problems are reduced.

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AMA President Jesse Ehrenfeld, MD, MPH describes his view of using AI in medicine:

  • The probabilistic algorithms, they’re just too narrow. They can’t substitute for the judgment, the nuance, or the thought that a clinician brings. There’s a lot of opportunity to think about these tools as a co-pilot, but not an autopilot, particularly in the diagnostic realm. That’s why the FDA’s forthcoming regulatory framework for AI-enabled devices is proposing to be much more stringent on AI tools that make a diagnosis or recommend a treatment, especially if it’s an algorithm that continues to adapt or learn over time, these so-called continuous learning systems. Algorithms are great for solving a textbook patient or a very narrow clinical question … but patients, they’re not a standardized question stem. They’re humans with thoughts, with emotions, with complex medical, social, psychiatric backgrounds. And I’ll tell you, they rarely follow the textbooks … There is an active current federal proposal that would hold physicians solely liable for the harm resulting from an algorithm if I rely on the algorithm in my clinical decision making. We don’t think that’s the right approach. We think that the liability ought to be placed with the people who are best positioned to mitigate the harm. And that is likely going to be the developer, the implementer, whoever buys these things, often not the end user, the clinician.

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Cancer survivor and Clearsense marketing director Kate-Madonna Hindes declines to serve as the human interoperability engine for Mayo Clinic in transcribing her Epic-stored information onto a clipboard form. Twitter comments suggest that many of us are tired of being asked to restate the same information and worrying how it will be reconciled on the back end, even if few of us have her nerve to just say no (Mayo folks are always bragging on their technology expertise and commercial tie-ins, so maybe they can explain the point of such redundant analog documentation and how they process the completed form):

  • “A good measure of a poorly run organization is how much of the admin work they pass on to the end user.”
  • “When I had PTSD I got so sick of introducing myself & my history for half the session. Like my records are there, please take some time.”
  • “I’ve started doing similar. No, I don’t need to write down each of my 20 meds on 3 tiny single spaced lines. Or my 45 years of surgical history. You have this.”
  • “What it is telling me is the process is broken. Kinda like complaining to your provider about issues and at the end of the day, they want you to fill out a form.”

Sponsor Updates

  • Encore Health Group and Affiliates sees success with its upgrade to EClinicalWorks V12, and Healow patient engagement solutions.
  • Meditech’s Surveillance predictive analytics solution helps Golden Valley Memorial Healthcare (MO) reduce maternal complications.
  • Mobile Heartbeat publishes a new e-book, “The Many Harms of Alarm Fatigue.”
  • The Heidrick & Struggles Leadership Podcast features Nuance EVP and GM Diana Nole.
  • Netsmart will integrate RethinkFirst’s ABA clinical solution with its suite of certified CareRecords software.
  • Nordic Consulting receives 12 of 13 validations in a recent KLAS report on EHR education software and services.
  • Tegria releases a new case study, “Outsourced Business Office Transforms Accounts Receivable, Increases Cash.”

Blog Posts


Contacts

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

Morning Headlines 7/21/23

July 20, 2023 Headlines No Comments

Franciscan Health parent to shift 61 employees to outside firm

Franciscan Alliance will rebadge 61 IT employees of Franciscan Health Indianapolis to managed services provider R4 Solutions.

UpLift gets $11M Series A for insurance-based telemental health

Virtual mental healthcare company UpLift, which markets its services primarily to payers, raises $10.7 million in Series A funding.

HHS Office for Civil Rights and the Federal Trade Commission Warn Hospital Systems and Telehealth Providers about Privacy and Security Risks from Online Tracking Technologies

The HHS Office for Civil Rights and the FTC warn 130 hospitals and telemedicine companies of the security and privacy risks related to the use of online tracking technologies within their websites or apps, which may be sharing the sensitive personal health data of consumers without their permission to third parties.

News 7/21/23

July 20, 2023 News 1 Comment

Top News

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Private equity firm Thomas H. Lee Partners sells specialty EHR/PM vendor Nextech to another PE firm, TPG, for $1.4 billion.

THL bought the company for $500 million in June 2019, after which it acquired TouchMD and MyMedLeads.


Reader Comments

From Jetty: “Re: forgiven federal Paycheck Protection Program loans. The DOJ is investigating those of over $1 million. Big-dollar exhibitors at ViVE and HIMSS are large takers of these forgiven loans that were intended to keep workers employed during COVID-19.” The reader compared ProPublica’s PPP loan database to online sources that estimate the revenue of privately held companies, noting that two health IT companies derived more than 20% of their annual revenue from forgiven PPP loans, 14 health IT vendors had loans of over $2 million that were forgiven, and 27 HIT companies received $1 million or more of loans that they don’t have to repay. My take: while this is mildly interesting, nothing suggests improper activity. The federal government’s loans – which covered up to eight weeks of payroll costs, including benefits — were forgiven if the recipients documented that at least 60% of the money was spent on payroll. The federal government is reviewing the Small Business Administration’s disbursement of $1.2 trillion in COVID-related loans, of which its OIG estimates that $200 billion involves fraud. The real news will be if the feds accuse any of the health IT companies of wrongdoing, which hasn’t happened.


Webinars

July 26 (Wednesday) 1 ET. “Lessons We’ve Learned Since Launching our Cancer Prevention Program.” Sponsor: Volpara Health. Presenter: Albert Bonnema, MD, MPH chief medical information officer, Kettering Health System, and Chris Yuppa, product owner for oncology services and cancer prevention, Kettering Health System. Kettering’s IT department has played a critical role in providing an EHR-driven framework to bring cancer risk assessment and individual prevention plans to more than 90,000 patients. Primary care, OB/GYN, oncology, and imaging providers are now able to assess the hereditary, genetic, and lifestyle factors that affect the risk of developing lung, breast, ovarian, colon, and prostate cancer in any patient encounter. Learn how Kettering brings together people, processes, and technology to be more proactive in the fight against cancer and where its cancer prevention program is headed next.

July 27 (Thursday) noon ET. “Why You Shouldn’t Wait to Use Generative AI.” Sponsor: Orbita. Presenter: Bill Rogers, co-founder, president, and chairman, Orbita. The advent of generative AI tools truly represents a paradigm shift. And while some healthcare leaders embrace the transformation, others are hesitant. Invest 20 minutes to learn why you shouldn’t wait. When combined with natural language processing, workflow automation and conversational dialogs, generative AI can help leaders address a raft of challenges: from over-extended staff, to the rising demand for self-service tools, to delivering secure information to key stakeholders. You will learn where AI delivers the greatest value for providers and life sciences, how it can solve critical challenges faced by healthcare leaders, and how Orbita has integrated generative AI into its conversational platform so healthcare leaders can leverage its full capabilities safely and securely.

July 27 (Thursday) 2 ET. “Denial Prevention 101: How to stop denials from the start.” Sponsor: Waystar. Presenter: Crystal Ewing, director of product management, Waystar. There’s a reason denial prevention is prominent everywhere in healthcare RCM. Denials reduce cash flow, drive down revenue, and negatively impact the patient and staff experience. More than half of front-end denials don’t have to happen, but, once they do, that money is gone. It’s a pretty compelling reason to take some time now to do some preventative care on your revenue cycle. This webinar will help you optimize your front end to stop denials at the start. We’ll explore the importance of not only having the right data, but having it right where staff need it, when they need it.

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


Acquisitions, Funding, Business, and Stock

Open access publisher JMIR Publications acquires the Online Journal of Public Health Informatics.


Sales

  • Universal Health Services will expand its Oracle Health acute care EHR implementation to its 200 behavioral health facilities.
  • Thomas Jefferson University Hospital will pilot the use of AliveCor’s personal ECG monitoring technology to monitor its methadone maintenance therapy patients for QT prolongation.
  • Online behavioral health provider WellQor chooses the Arize EHR of Cantata Health Solutions. 
  • Prisma Health will expand its implementation of HealthSnap’s virtual care management platform to all of its ambulatory primary care sites.

People

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Weight loss and health coaching platform vendor Noom hires Geoff Cook (The Meet Group) as CEO as the company transitions into the obesity drugs business. He replaces co-founder Saeju Jeong, who will continue as executive board chair.

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Prescription benefits technology vendor Capital Rx hires Sunil Budhrani, MD, MPH, MBA (Innovation Health) as chief medical and innovation officer.

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Scott Maratea (Motivo Health) joins Curve Health as chief revenue officer.

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WellSky promotes Mitchell Morgan, MBA to VP of sales.

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Brian Briscoe, MD, who pioneered the implementation of digital radiology in his work at the Baltimore VA in the early 1990s and demonstrated workstation-based image reading at RSNA 2000, died July 2. He was 91.

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Industry long-timer Glenn Gross, whose sales roles over the years included time with Tempus Software / QuadraMed and The SSI Group, died last week at 64.


Announcements and Implementations

MemorialCare and Pacific Dental Services will open the first of several planned co-located medical and dental offices, where dentists will use the same Epic system as the center’s family medicine, OB/GYN, and pediatrics physicians. PDS completed its Epic implementation in August 2022, converting the records of 9.7 million patients at its 885 practices in 25 states, training 14,000 employees. The company says using Epic allows its clinicians to create better treatment plans based on oral health’s impact on systemic conditions, identify systemic diseases earlier based on oral health changes, build more trust with patients, and communicate with patients via MyChart.

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KU Medical Center interviews Diego Mazzotti, PhD, assistant professor of medical informatics, about his sleep disorder research. He is connecting data from EHRs, CPAP machines, and sleep studies to determine the types of sleep apnea patients who are most at risk for heart disease and to determine the effectiveness of CPAP in preventing it.

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South Georgia Medical Center recognizes six members of the IT department’s network team as Health System Heroes for their work in protecting patient privacy and health system security.

Franciscan Alliance will rebadge 61 IT employees of Franciscan Health Indianapolis to managed services provider R4 Solutions.

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UCSD nanoengineering researchers say that digital technologies can help mitigate health system burden as life expectancy grows, specifically wearables that allow older adults to monitor their health and maintain independence at home. They predict the rise of smart homes whose body-worn and surveillance tools are connected to telehealth platforms and a cloud analytics platform to provide remote monitoring. They expect to see foot-worn sensors; smart mirrors that can identify appearance changes, detect falls, and serve as a visual display; the use of digital personal assistants to provide reminders and cognitive stimulation; and deployment of robots to support care and to provide stimulation.


Privacy and Security

Froedtert Hospital will pay $2 million to settle a class action lawsuit over its use of Meta’s Pixel web user tracking tool on its MyChart portal and public websites.


Other

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Debbie Sukin, MHA, PhD, EVP/CEO of Houston Methodist The Woodlands Hospital, describes present and future use cases of ambient intelligence:

  • Using inpatient room technology to prevent falls, create clinical documentation, and monitor hand hygiene while anonymizing the people who are present.
  • Tracking OR procedures – start time, turnover time, and instruments used – using AI and machine learning that updates schedules every 60 seconds.
  • Assessing patient pain.
  • Detecting incontinence.
  • Detecting elopement.

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Internist Michael Stillman, MD’s “Death by Patient Portal” JAMA opinion piece describes his struggle to management patient portal messages and his decision to send a message to all of his patients laying out his guidelines. He was surprised to find that many of them told him that they, too are fatigued by hundreds of messages each day and an expectation of constant accessibility. He laid out these expectations, which immediately generated 50 responses from patients expressing their support:

  • He was spending two hours per day responding to 50 portal messages, some of which would have been directed to other employees before the portal was implemented.
  • Despite their convenience, portal messages are not as good as appointments.
  • He will respond to messages within three days, but won’t check them after hours and on weekends, suggesting calling the office for more urgent issues.
  • Referral and refill messages will be managed by medical assistants.
  • Matters related to an upcoming appointment should be saved until then.

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Technology entrepreneur and investor David Heinemeier Hansson – who is also a fine business tech writer whose style reminds me of “Joel on Software” — proudly proclaims that “We have left the cloud,” explaining why software vendor 37signals moved six legacy applications, including one that was developed as a cloud application, from AWS back to its own hardware. Points:

  • The move will save $1.5 million per year, IT team size didn’t change since the promised productivity gains were never realized anyway, and user response time has improved.
  • Total hardware investment was a one-time $500,000, which is amortizable as a capital expense over five years, versus the company’s annual cloud budget of $3.2 million.
  • The company rolls out hardware similarly to rental clouds. It buys hardware from Dell, has it shipped to its two data centers, and uses a third-party service to rack the new machines. Each of its two data centers received 20 servers, which he notes from the delivery photo above is “a staggering amount of computing power in a shockingly small footprint” (4,000 vCPUs, 7,680 GB of RAM, and 384 TB of solid-state storage).
  • The only negative is that the time between needing new servers and seeing them online is obviously increased, but the author notes that while it’s incredible to see 100 powerful machines spin up on the cloud in just a few minutes, you pay dearly for that privilege. He notes that the load variance in many companies doesn’t justify renting.
  • He concludes that the cloud is great for early-stage companies that are either flush with cash or are likely to go broke within two years, but warns that it’s hard to change your mind later when costs increase and the expected reduction in complication doesn’t materialize.

Sponsor Updates

  • Hunt Scanlon offers insights from Direct Recruiters in its latest Private Equity Recruiting Report.
  • Elsevier publishes a new study in the American Journal of Preventive Medicine, “The Health and Economic Impact of Expanding Home Blood Pressure Monitoring.”
  • Universal Health Services expands its Oracle Health EHR across its network of behavioral health facilities.
  • Healthcare Triangle expands its contract with an existing biopharmaceutical customer to extend the customer’s suite of cloud DevOps, data engineering, and data platform management solutions.
  • Fortified Health Security releases its 2023 Mid-Year Horizon Report.
  • Medicomp Systems releases a new Tell Me Where It Hurts Podcast featuring Greenway Health CMO Michael Blackman, MD.
  • Nordic posts a new podcast, “Designing for Health: Interview with Dr. Manish Patel”.
  • Medhost will exhibit at the Texas Healthcare Governance Conference through July 22 in Austin.

Blog Posts


Contacts

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

EPtalk by Dr. Jayne 7/20/23

July 20, 2023 Dr. Jayne No Comments

There’s not a day that goes by that I don’t see an article or hear commentary about how AI is going to somehow cause the end of the world. Earlier this month, it caused plenty of chaos at Gizmodo, when an AI-created story about Star Wars hit the virtual presses.

The author, “Gizmodo Bot,” created a work about the chronological order of various installments in the Star Wars franchise. A deputy editor who performed an initial review found 18 issues with the story, including elements being out of order, missing, or incorrectly formatted. He also took issue with the fact that the story didn’t include a disclaimer that it was AI-generated except for the byline. I found it interesting that the story was written using both ChatGPT and Google Bard.

Gizmodo staff commented: “I have never had to deal with this basic level of incompetence with any of the colleagues that I have ever worked with… If these AI [chatbots] can’t even do something as basic as put a Star Wars movie in order one after the other, I don’t think you can trust it to [report] any kind of accurate information.”

As much as many of us share concerns about using AI in healthcare, using it in news might be even more worrisome. Although this certainly wasn’t a hard-hitting news article, it deals with subject matter about which there are a number of authoritative resources and its chronology is undebated. When you consider other subject matter where things might not be so clear (such as when there are consensus recommendations, expert opinion, and data from clinical research that might not always agree), the stakes are higher.

Still, I got a chuckle out of a description of employee feedback that was delivered in a Gizmodo Slack channel. A company comment about future use of AI received “16 thumbs down emoji, 11 wastebasket emoji, six clown emoji, two face palm emoji, and two poop emoji,” according to screenshots provided to media. Here’s to employees who feel comfortable speaking their mind.

Following a recent change to Utah law which allows pharmacists to prescribe birth control, Intermountain Health has launched a virtual care program to serve the state’s women. After a virtual visit, patients can receive prescriptions for contraceptive pills, patches, or rings. Medications can be mailed directly to patients. The $20 virtual visit fee makes it an economical care option for many. Utah joins 24 other states plus the District of Columbia in allowing pharmacists to have prescriptive authority for birth control.

The hot topic around the virtual water cooler this week was the Freed AI-driven virtual scribe service. They must have done a major marketing push because several people had heard of it and a couple were checking it out. They advertise 20 free visits with no credit card required for signup, and an ongoing price of $99 per month for unlimited visits with no lead time for cancellation. They also offer discounts if you are an “in-debt resident or facing financial challenges.” The solution says it will place all the documentation — including notes, pended orders, and after-visit summaries – into “your favorite EHR” for review and signature.

I’ve seen enough virtual scribe services to be at least a little skeptical, especially given the pricing. If you know more about Freed, or if you’ve given it a test drive, let me know. I’ll be happy to run your anonymous thoughts and impressions.

CMS has opened a call for public comments on MACRO cost measures. The 12 measures have been part of the Merit-based Incentive Payment System since the 2020 performance year and CMS is considering a comprehensive reevaluation. The survey  is open until July 21 at 11:59 p.m. Eastern and is divided into two sections covering cross-cutting questions and measure-specific questions. All questions are optional, which is nice for those of us who might not have the time to go through the entire thing or for those who just want to give specific feedback about a particular measure that applies to their specialty or subspecialty. CMS is using a survey partner to make recommendations on whether there should be changes, although the ultimate decision belongs to CMS.

I was intrigued to learn about the Alcohol Capture app that is designed for patients to capture 14 days of alcohol consumption data for research purposes. It’s been found to be valid and reliable, and includes the drinks and sizes commonly available in its development site of Australia. I enjoyed learning that there’s a drink size called a schooner (425 mL) and also one called a middy (285 mL). Users can report their alcohol intake in real time or by responding to twice-daily notifications. Although users can see a history of their data entry dates and times, they can’t look back at the alcohol data.

Pet peeve of the week: I attend webinars for professional organizations, vendors, and educational companies. There is nothing worse than hustling around to make it to a call on time and to find an idle “welcome” screen that says, “We’ll start in 5 minutes to allow everyone time to join.” That does a disservice to those people who worked hard to be there on time. We should honor the people who are doing the right thing. Those who arrive late can wait until the recording or transcript is distributed and can catch up on their own time.

Severe weather seems increasingly common these days, and on Wednesday a tornado struck a Pfizer pharmaceutical facility in Nash County, North Carolina with reports of “50,000 pallets of medicine that are strewn across the facility.” According to the Pfizer website, the facility is one of the largest in the world for manufacturing sterile injectables, with nearly 25% of all such medications used in US hospitals being manufactured at the site. I’m sure we’ll all be on the lookout for what are likely to be shortages of anesthesia, pain management, and anti-infective medications in the coming months.

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Over the weekend, I had the chance to help teach the Radio Merit Badge at a local scout camp. It’s always good to see young people showing interest in activities where they are not traditionally represented. Watching them learn that radio is the force behind a lot of the technologies they use every day was rewarding. My co-instructors included a computer science expert, an electrical engineer, and an enterprise software architect.

They had lots of questions about what exactly a physician does in the technology space. It was great helping them understand what happens behind the scenes when they seek healthcare. Our students were engaged, and although they were initially nervous about using the radio, they quickly became confident in their skills. It’s always good to help people learn new things and maybe have the chance to inspire them in a career.

What do you do in your spare time that brings you joy or makes you hopeful for the future? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 7/20/23

July 19, 2023 Headlines No Comments

TPG to Acquire Leading Specialty Healthcare IT Platform Nextech

Confirming speculation from several weeks ago, TPG acquires ambulatory healthcare IT vendor Nextech from Thomas H. Lee Partners for $1.4 billion.

GenHealth.AI Accelerates into Healthcare AI Market with New Funding, Advisor Appointments and Use Cases Across Healthcare

Financial and care management-focused generative AI startup GenHealth.AI raises $13 million.

Teladoc Health Expands Collaboration in AI with Microsoft to Address Healthcare Workforce Crisis

Teladoc Health will use Microsoft’s AI services and its Nuance DAX ambient documentation product into its virtual care platform, expecting to automate the creation of clinical documentation during virtual exams.

Healthcare AI News 7/19/23

News

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Meta and Microsoft release Llama 2, a fully open competitor to ChatGPT 3.5 that is free for research and commercial use. Unlike ChatGPT, users can add their own data to Llama 2.

Elon Musk forms XAI, an AI company that he says will seek to “understand reality” and will work with Twitter, Tesla, and other Musk-owned companies.

Teladoc Health will use Microsoft’s AI services and its Nuance DAX ambient documentation product into its virtual care platform, expecting to automate the creation of clinical documentation during virtual exams. The company’s medical group will use Nuance DAX Express for the visits it provides directly.

Engineering consortium MLCommons develops MedPerf, an open benchmarking platform that evaluates the performance of AI models on real-world medical data while preserving patient privacy.


Business

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Causaly, which created an AI platform for drug development, raises $60 million in a Series B funding round.

Nividia invests $50 million in AI drug discovery vendor Recursion Pharmaceuticals, which will train AI models on Nvidia’s cloud platform. RXRX shares jumped 80% on the news, valuing the 10-year-old company at $2.6 billion.


Research

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A Google paper proposes supporting medical imaging predictive AI in a “know when they don’t know” manner, where the extra AI layer can decide via a confidence score whether it should defer to a clinician. The use of such a system reduced false positives by 25% while still identifying all true positives.

A new study finds that ChatGPT’s healthcare-related output is hard to distinguish from that created by healthcare providers, but patient trust decreased as task complexity increased, suggesting that the best use of healthcare chatbots is to assist with patient-provider communication related to administrative tasks and routine management of chronic conditions.

Researchers find that Google’s PaLM large language model generated long-form answers to common medical questions that aligned with scientific consensus just 62% of the time, but system tuning improved performance to equal that of human clinicians, with 93% of its answers found to be scientifically correct. The system generated potentially harmful answers 5.8% of the time, slightly outperforming clinicians.

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A Science perspective piece predicts that pairing AI applications with medical robotics will create a new era of medicine in which autonomous robots could perform diagnostic imaging and surgical procedures as well as create and optimize the use of prosthetics.

Researchers are developing an AI too that can quickly recognize the genetic features of gliomas, the most common form of brain cancer, providing a molecular diagnosis in 15 minutes versus the manual process that takes weeks. Surgeons could use the results to make immediate operating decisions in the OR.


Other

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UMC Health System deploys ZeroEyes, an AI-based platform that identifies guns from live security camera video streams. The company’s monitoring center can verify threats, issue alerts, and dispatch first responders within 3-5 seconds of detection.


Contacts

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

Morning Headlines 7/19/23

July 18, 2023 Headlines No Comments

Greenwood Village-based DocBuddy secures $1.84M to scale its digital health care workflow solution

DocBuddy, which offers an EHR workflow solution, raises $1.8 million in a seed funding round.

NeuroFlow Acquires Parent Company of BHL and BHL Touch

Behavioral health technology vendor NeuroFlow acquires Capital Solution Design, whose measurement-based care solutions are used by the VA.

Request for Health Information Technology Advisory Committee (HITAC) Nominations

The GAO seeks nominations for appointments to the Health Information Technology Advisory Committee.

Researchers Develop AI Model to Better Predict Which Drugs May Cause Birth Defects

Mount Sinai data scientists develop an AI model that may predict which pre-clinical compounds and medicines, particularly those new to market, could cause birth defects.

News 7/19/23

July 18, 2023 News 1 Comment

Top News

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Chatbot-based virtual care company K Health raises $59 million in a funding round led by Cedars-Sinai, bringing its total raised to $325 million.

The company’s primary care service offers unlimited text-based visits, remote annual wellness visits, chronic condition management, prescription management, and urgent care services for $49 per month for residents of all states except Alaska and Hawaii.

Cedars-Sinai will offer K Health’s AI-powered app to its patients in California by the end of the year, integrated with Epic and using the health system’s clinicians.

K Health also sells its technology to payers through Hydrogen Health, which it launched with Anthem (now Elevance) and investment firm Blackstone in 2021.


Reader Comments

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From Frumious Bandersnatch: “Re: data segmentation. How can you program something that allows a patient to decide after the fact that they want something hidden in their medical record? You can’t just uproot a tree whose roots are interlaced with other trees.” Kevin Baumlin, MD says that ONC’s proposal to require clinicians to redact medical records data elements when a patient requests involves “legalizing tampering with the medical record” that could prove harmful in that patient’s future encounters. He cites examples of patients hiding opioid use or a history of depression. I’ll side with a brilliant reader who says the only practical implementation of the well-intentioned rule would be if patients serve as their own data intermediary, obtaining a copy of their summary as a file that they could edit before sharing. I’m rarely in the “blockchain could fix everything” camp, but perhaps some sort of versioning and permissioning could be involved. I’ll make this the topic of this weekend’s poll. It’s an interesting question — the patient can choose to divulge as much or as little of their history as they want during an in-person encounter, so should that control carry over into digital records? Should providers trust data that the patient may have selectively edited? Perhaps as with redaction, deletions could be obscured but noted to alert the clinician that they are not seeing a complete record. Or, you could get really creative and allow the patient to insert their own notes to explain. But the big challenge is probably propagation across multiple provider data copies – I ask my psychiatrist to hide depression details, so should copies in the EHRs of my PCP, surgeon, and hospital reflect that request or would I need to make individual requests? It would be more manageable if everything flowed through a single HIE or service, but the issue is complex, just like trying to correct EHR entries that have propagated all over the place.

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From Eric: “Re: transplant dispute. Thought you would find this interesting.” The non-profit United Network for Organ Sharing (UNOS) — which oversees the entire US transplant system — and organ screening firm Buckeye Transplant Services will take their data dispute to arbitration. Buckeye’s automated tool extracts transplant data directly from hospitals, which UNOS says is unauthorized use of information that only UNOS can provide. UNOS has threatened to lock Buckeye out of its DonorNet organ clearinghouse, which would put Buckeye out of business and force its 63 hospital customers to perform their own screening. The federal government announced in March that it would break up the organ transplant monopoly of UNOS, whose most recent financial report indicates $75 million in annual revenue.

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From Anon E. Mous:Re: Legacy Health financial issues. They have shown sound financial management and avoided excessive spending and vanity projects and navigated the COVID years with care and compassion in the shadow of behemoth Providence. This could be a bellwether for similar systems in the Pacific Northwest.” Six-hospital Legacy, which is losing $10 million per month,  will sell its lab operations to LabCorp in hopes of hitting lender-mandated financial metrics.

From IPC: “Re: Walgreens. The recent earnings call suggests why it previously acquired a majority stake in VillageMD. Maybe they should start branding themselves as ‘pharma-centered care.’” The US healthcare division of Walgreens lost $113 million in the quarter, which it blames on the underperformance of VillageMD and CityMD due to a mild flu season and soft market demand. It also notes an 83% drop in COVID vaccinations and a steep slide in COVID test sales. The company will close 450 stores and lay off 10% of its corporate workforce. IPC’s observation comes from an earnings call comment that 50% of patients who are seen in a co-located VillageMD clinic go next door to get their prescriptions filled at Walgreens, and each clinic generates 40 additional prescriptions per day, with associated profit for the drugstore. WBA shares have lost 22% in the past 12 months versus the Nasdaq’s 24% gain.


HIStalk Announcements and Requests

Mr. H here, reporting back refreshed after several days away on vacation and happy that Jenn’s solo coverage rendered my presence optional anyway. I’m catching up, so remind me if I owe you something.


Webinars

July 26 (Wednesday) 1 ET. “Lessons We’ve Learned Since Launching our Cancer Prevention Program.” Sponsor: Volpara Health. Presenter: Albert Bonnema, MD, MPH chief medical information officer, Kettering Health System; Chris Yuppa, product owner for oncology services and cancer prevention, Kettering Health System. Kettering’s IT department has played a critical role in providing an EHR-driven framework to bring cancer risk assessment and individual prevention plans to more than 90,000 patients. Primary care, OB/GYN, oncology, and imaging providers are now able to assess the hereditary, genetic, and lifestyle factors that affect the risk of developing lung, breast, ovarian, colon, and prostate cancer in any patient encounter. Learn how Kettering brings together people, processes, and technology to be more proactive in the fight against cancer and where its cancer prevention program is headed next.

July 27 (Thursday) noon ET. “Why You Shouldn’t Wait to Use Generative AI.” Sponsor: Orbita. Presenter: Bill Rogers, co-founder, president, and chairman, Orbita. The advent of generative AI tools truly represents a paradigm shift. And while some healthcare leaders embrace the transformation, others are hesitant. Invest 20 minutes to learn why you shouldn’t wait. When combined with natural language processing, workflow automation, and conversational dialogs, generative AI can help leaders address a raft of challenges: from over-extended staff, to the rising demand for self-service tools, to delivering secure information to key stakeholders. You will learn where AI delivers the greatest value for providers and life sciences, how it can solve critical challenges faced by healthcare leaders, and how Orbita has integrated generative AI into its conversational platform so healthcare leaders can leverage its full capabilities safely and securely.

July 27 (Thursday) 2 ET. “Denial Prevention 101: How to stop denials from the start.” Sponsor: Waystar. Presenter: Crystal Ewing, director of product management, Waystar. There’s a reason denial prevention is prominent everywhere in healthcare RCM. Denials reduce cash flow, drive down revenue, and negatively impact the patient and staff experience. More than half of front-end denials don’t have to happen, but, once they do, that money is gone. It’s a pretty compelling reason to take some time now to do some preventative care on your revenue cycle. This webinar will help you optimize your front end to stop denials at the start. We’ll explore the importance of not only having the right data, but having it right where staff need it, when they need it.

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


Acquisitions, Funding, Business, and Stock

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Medication supply chain technology company Bluesight, which renamed itself from Kit Check in December 2022, will use a strategic growth investment from Thoma Bravo in its acquisition of drug diversion analytics vendor Medacist.

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DocBuddy, which offers an EHR workflow solution, raises $1.8 million in a seed funding round.

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Behavioral health technology vendor NeuroFlow acquires Capital Solution Design, whose measurement-based care solutions are used by the VA.

UnitedHealth Group reports Q2 results: revenue up 16%, adjusted EPS $6.14 versus $5.99, beating Wall Street expectations for both. Its Optum unit saw revenues increase 25% to $56.3 billion.


Sales

  • Northwell Health selects Aidoc’s AI operating system for triage, quantification, and coordination of acute care across 17 of its hospitals in New York.
  • Get Well announces eight new smart patient room projects to support construction initiatives in the US, Kuwait, and New Zealand.

People

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Medical coding automation vendor Fathom hires Enoch Shih, MS, MBA (Gusto) as COO.

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RLDatix hires Frank Manzella, JD, MBA (Availity) as EVP of global corporate development.

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Steve Aspling (Millennia) joins CorroHealth as regional VP of business development.

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Trove Health hires Anthony Leon (InteropShop) as VP of growth.

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Todd Johnson (SomaLogic) joins Abundant Venture Partners as CEO of the venture studio.

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Matthew Kull, MBA (Cleveland Clinic) joins Inova Health System as chief information and digital officer.


Announcements and Implementations

Pediatric Cardiology Center of Oregon implements EClinicalWorks and its Prisma health information search tool.

Medhost will offer Availity’s eligibility and claim verification features to its hospital customers.

The Connected Health Initiative and Duke Margolis Center for Health Policy will host “AI and the Future of Digital Healthcare” on September 26 at the National Press Club in Washington, DC. Panel proposals are due August 1.

Teladoc Health will integrate Nuance DAX into its Teladoc Health Solo platform.


Government and Politics

The GAO seeks nominations for appointments to the Health Information Technology Advisory Committee.


Other

A fascinating report titled “How Private Equity Raided Safety Net Hospitals” looks at PE-backed safety net hospital operator Pipeline Health. It notes that similar to what happened with the now-closed Hahnemann University Hospital, PE firms are breaking promises they make to the community and to regulators in favor of maximizing profit (shocking, I know). Their strategies include monetizing the real estate, expanding unwisely, laying off employees, applying bankruptcies strategically, and closing hospitals. All but one of the eight hospitals that Pipeline has owned earned a CMS star rating of two of a possible five, while one earned three stars. It sold Weiss Memorial Hospital’s parking lot to a real estate developer for $10 million to build luxury apartments.


Sponsor Updates

  • The results of eight studies involving the use of Linus Health’s digital cognitive assessment solutions will be presented at the 2023 Alzheimer’s Association International Conference.
  • Ronin Chief Scientific Officer Christine Swisher, PhD joins the Coalition for Health AI.
  • Medhost and Availity partner to offer Medhost partner hospitals a suite of eligibility and claim verification features.
  • Meditech joins the KLAS Arch Collaborative.
  • Artera publishes a case study, “Altura Participates in Call-to-Text Pilot Program.”
  • Fortified Health Security publishes its 2023 Mid-Year Horizon Report on cybersecurity challenges.
  • Baker Tilly releases a new Healthy Outcomes Podcast, “Improving healthcare delivery through employee experience and patient engagement.”
  • Nordic publishes a video titled “The Download: Cyber strategies to optimize net new technologies.”
  • Bamboo Health will exhibit at the NCHA Annual Summer Meeting July 19-21 in Williamsburg, VA.
  • Ronin publishes an article in Nature on its Comparative insights model that delivers predictive insights to empower clinicians to reduce ED visits.
  • CereCore releases a new podcast, “CIO on Innovation and Mobile Adoption: ‘Keep Your Eye on Operations.’”

Blog Posts


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Morning Headlines 7/18/23

July 17, 2023 Headlines No Comments

Thoma Bravo Announces Strategic Growth Investment in Bluesight to Support the Company’s Acquisition of Medacist

Medication supply chain technology company Bluesight will use a strategic growth investment from Thoma Bravo in its acquisition of Medacist, a drug diversion monitoring and medication management software vendor.

Unicorn K Health raises $59 million in down round

Israeli digital primary care startup K Health raises $59 million in a funding round led by Cedars-Sinai.

These Chicago execs want their fraud convictions overturned. Here’s their argument.

Outcome Health co-founders Rishi Shah and Shradha Agarwal want their fraud convictions overturned based on the argument that prosecutors seized more of their assets than was warranted before trial, leaving them unable to employ their first-pick attorneys.

Curbside Consult with Dr. Jayne 7/17/23

July 17, 2023 Dr. Jayne 3 Comments

Although my friends and family don’t exactly understand what I do at work, they know that I’m generally aware of cutting-edge technology. I can’t count the number of times in the last six months that people have asked me what I think about ChatGPT or artificial intelligence taking over the world. Although I enjoy reading the scholarly articles that people are publishing in informatics literature about the use of large language models, I’ve made it a point to try to keep up with the lay media so that I understand what my friends and family are reading. It’s also a good proxy to understand what my physician colleagues understand about the technology, given the fact that if they’re reading scholarly literature, it’s most likely in their professional specialty or subspecialty fields.

I was intrigued to see this article in the New York Times this week covering the Federal Trade Commission’s investigation into the potential harms of ChatGPT. Regulators sent a letter to OpenAI to inquire about its security policies and procedures, as well as to learn if consumers have suffered damages related to how the chatbot collects data. They’re also interested in the ability of the technology to generate and publish false information on individuals. The NYT reported that the letter was 20 pages long and included pages of questions, including those seeking information on how the company trains its AI models. It also requested documents related to the inquiry. A question is whether the company “engaged in unfair or deceptive privacy or data security practices or engaged in unfair or deceptive practices relating to the risks of harm to consumers.”

Most of the people I talk to act like ChatGPT is no big deal and we should be excited about using it. Although I’m optimistic about its ability to provide value in a variety of different industries and situations, it’s a complex technology and there needs to be thoughtful consideration about how we do or do not use it for patient care. I see a lot of people using it to generate patient-facing correspondence without much review. One physician boasted about how she was able to create lab results letters for her patients, sending a full day’s worth of letters in under three minutes. The ability to create and proofread those letters in the cited timeframe is questionable at best. Based on the looks on the faces of some of the colleagues she was speaking to, I wonder if they were questioning her professional judgement.

Many of the large health systems and EHR vendors that some of my colleagues work at are reported to have been on point with messaging to their physicians and other clinicians about not including protected health information in prompts that are used to access the systems, especially when users are considering using publicly available tools rather than institutional or research tools. However, many of my independent physician colleagues haven’t received the same level of education and didn’t understand that information they’re feeding into the prompts can be used in various ways once a technology company has control of it. Some of the physicians I’ve interacted with on social media still aren’t savvy enough to not post protected health information in their posts or images, and someone is always calling out a group member for posting unredacted content. The majority of physician users I interact with also don’t know that systems also might not have been updated with current data, which makes them unreliable when you’re asking for the latest medication or regulatory information. Without receiving education on the technology, they’re also often unaware about the potential of AI-driven systems to hallucinate or create completely inaccurate information based on patterns presented to it in the past.

It’s also important to understand how AI technologies might impact our economy and those that are doing the jobs that people have proposed for it. For example, earlier this year there was a lot of buzz about AI-generated art and particularly AI-generated head shots. I felt like I was one of the only people in my physician social media circles who didn’t join the scores of people getting new headshots. A handful of people voiced privacy concerns, especially about the need to upload a bunch of pictures for the technology to work, and the potential that the company might be collecting facial recognition data for nefarious purposes. But those were in the minority – and most people were going along with it until the algorithm started going sideways, spitting out images that didn’t look remotely like them. The worst examples included pictures of people in superhero costumes or in situations that weren’t remotely appropriate for a professional headshot. One of my family members is a professional photographer, so I brought up the point that crafting a professional portrait is both an art and a skill – and that AI-generated images compete directly with those professional people who are earning a living and contributing to their communities.

Economic factors are certainly concerning, but the risk of technology creating disinformation raises significant concerns. OpenAI leadership has admitted that there needs to be regulation in the industry. Following the announcement of the letter, its leader said that he’s confident that the company is following the law and that they will be cooperative with the investigation. Other countries have already been more critical of the company than US regulators, with Italy banning ChatGPT in March over concerns about inappropriate collection of personal data from users and lack of age verification for minors trying to use the system. The company addressed the issues and access to the technology was restored the following month. Advocacy groups have been pressing the FTC and other regulatory agencies to address the risks of ChatGPT. The article notes one organization, the Center for AI and Digital Policy, which has asked the FTC to block Open AI from releasing new versions to the public. About a week ago, it updated its complaint with additional supporting materials on the ways that chatbots might cause harm.

Federal agencies often move at a snail’s pace, and it’s unlikely that the FTC’s investigation into ChatGPT will proceed swiftly. The article notes that the FTC “may not have the knowledge to fully vet answers from OpenAI and that they don’t have the staff with technical expertise to evaluate the responses they will get and to see how OpenAI may try to shade the truth.”

Even after the investigation concludes, there’s a possibility that no action will be taken. Outcomes of investigations are often not widely distributed and it will be interesting to see if the FTC decides to err on the side of availability or whether it will take Freedom of Information Act requests to find out the results. Only time will tell whether we’ll see increased regulation or a more wait-and-see approach.

What do you think about the need to regulate AI-powered technologies? Leave a comment or email me.

Email Dr. Jayne.

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