Recent Articles:

Morning Headlines 5/31/22

May 30, 2022 Headlines No Comments

VA Ordered to Report Performance of Troubled Health Records System to Congress

Pending President Biden’s signature, new legislation will require the VA to submit quarterly reports to Congress on the performance of its new Cerner EHR software.

Doctor-Founded Cherry Health Closes $1.23 Million to Expand Job-Matching Platform for Physicians

Cherry Health, a Canadian health tech startup that has developed a job-matching app for physicians, has raised $1.23 million CAD in pre-seed financing.

Report rejects Rebekah Jones’ claim that Florida doctored COVID data

A report from the State of Florida’s Inspector General determines that a former department of health data scientist’s claim that the department intentionally falsified COVID-19 data to support opening the state back up cannot be substantiated.

Morning Headlines 5/27/22

May 26, 2022 Headlines No Comments

Chipmaker Broadcom to buy cloud services firm VMware in $61 billion deal

Broadcom will acquire cloud services vendor VMware for $61 billion.

Change Healthcare Inc. Reports Fourth Quarter and Full Year Fiscal 2022 Financial Results

Change Healthcare reports Q4 results: revenue up 8%, adjusted EPS $0.39 versus $0.42, beating revenue expectations but falling short on earnings.

IT Specialist Charged in Cyber Intrusion of Suburban Chicago Health Care Company

A federal court indicts IT contractor Aaron Lockner for allegedly hacking into the server of a clinic operations company, which had denied him full-time employment two months earlier.

News 5/27/22

May 26, 2022 News 2 Comments

Top News

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Healthcare cybersecurity vendor Clearwater signs a definitive agreement to acquire competitor CynergisTek for $17.7 million in cash.

CTEK shares, which were trading at around $0.60 on the NYSE American small-cap market before the announcement, were down 65% in the past 12 months and were 91% off their 2017 all-time high.


Reader Comments

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From Lollygagger: “Re: Arnot Health. Has an ongoing technical issue that is affecting ambulatory offices and the patient portal.” The health system says its downtime, which has persisted for more than a week, is not related to malicious activity.

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From Kermit: “Re: Jamcare Medical. An interesting niche. Wonder how they handle the documentation?” Jamcare Medical, which seems to be a non-profit, provides medical services such as crisis intervention and drug intervention to music festivals and concerts, which it says avoids unnecessary medical transports and legal involvement for their promoters. Basic service includes a team to help management overdoses and behavioral health issues; its middle-tier offering provides the complete first aid response team, a first aid booth, and around-the-clock grounds surveillance to prevent problems such as “dehydration, fights, and slips and falls;” while its premium package adds an onsite or online physician.

From Long-Time Fan: “Re: medication adherence. We are building a solution and seeking beta partners such as payers, manufacturers, and health systems, anyone who has a vested interest in helping people with chronic conditions take their medications regularly. Do you know of specific organizations that are open to new adherence solutions?” I do not, but I’ll invite readers who have that interest, or know who might, to email me and I’ll forward the information (this is a early-stage company that isn’t quite ready to make a public splash).

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From Pajeet Pete: “Re: Ascension. Gerry Lewis is out, replaced by Gagan Singh.” Gerry is still listed on the executive team page and hasn’t changed his LinkedIn, but Gagan’s LinkedIn shows that he was promoted from chief data officer to SVP/CIO this month. A layoff discussion board entry says Lewis left as of May 13. He was also CEO of Ascension Technologies, whose web page now lists Singh as SVP/CIO. They outsourced a lot of IT work offshore, which continues to draw discussion board vitriol.

From Mark: “Re: wearables. A recent panel concluded that a problem is keeping the devices charged.” Experts say that one of the biggest compliance challenges for remote patient monitoring is that the devices needed to be recharged, leading to hopes that someone will figure out how to power them from body heat or kinetic energy.


Webinars

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


Acquisitions, Funding, Business, and Stock

Walmart and CVS will stop accepting controlled drug prescriptions from online ADHD providers Cerebral and Done, which face a federal review of their compliance with controlled substance prescribing. Both ADHD companies also mail out prescriptions directly to their customers, which seems to be a touted feature, so it isn’t clear what percentage of their prescription volume goes through the drug chains. It’s an interesting situation:

  • The business model of the companies was always at risk since pandemic telehealth waivers will eventually expire.
  • A federal probe will likely review the rigor of the process – or lack of it — by which the companies declared after a brief telehealth conversation that a patient had ADHD that required Adderall or Ritalin.
  • Contracted or employed doctors generated every one of those diagnoses and prescriptions, so their licenses are on the line regardless of what the company told them to do.
  • Should observers be correct in their speculation that the company was complicit in selling drugs to people who used fake IDs or duplicate mailing addresses, the crackdown on telehealth patient vetting could be significant.
  • The companies can’t survive without generating prescriptions, so they are certain to strengthen their prescribing guidelines. Cerebral is already phasing out prescribing of controlled substances.The percentage of their resulting drop in business – which will be huge – will signal how much of it was inappropriate.
  • Other services still advertise “anxiety meds from your couch” and easy access to antidepressants, which may be reviewed by states who receive a wake-up call about what Cerebral and Done were doing even though non-controlled substances are involved.

Change Healthcare reports Q4 results: revenue up 8%, adjusted EPS $0.39 versus $0.42, beating revenue expectations but falling short on earnings.

Broadcom will acquire cloud services vendor VMware for $61 billion.

A leaked presentation from Silicon Valley VC firm Sequoia Capital says that the market boom is over, predicts that recovery will not be quick, and warns its portfolio companies that they should review projects, R&D spending, and marketing expenses to prepare for cutting costs to avoid a “death spiral.”

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I’ve written previously about Miami-based MSP Recovery, which recovers inappropriate Medicare payments for which Medicare does not have primary payment responsibility. The company announced last fall that it would go public via a SPAC merger at a valuation of $33 billion, $23 billion of which would have flowed to the pockets of founder and CEO John Ruiz, who also runs a law firm that represents MSP in claims. The money-losing company, which claimed it would generate $5 billion annual profit by 2026, began trading on the Nasdaq Tuesday, then lost 60% of its value in its first few minutes of trading after opening at $10 per share. MSPR shares have continued their journey south, now trading at $2.56. Trial lawyer Ruiz just bought a $25 million house in Coral Gables, FL, owns another estate he bought for $49 million from the founder of Leon Medical Centers, and zips above mere mortals in his personal jet, a Boeing 767.


Sales

  • Health and Social Care Northern Ireland chooses Tegria and Cloud21 – in which Tegria holds an investment — for its decade-long Encompass program in which Northern Ireland will become the first UK country to implement an EHR that spans acute care, mental health, community care, and social services. Tegria invested an unspecified sum in London-based digital health consultancy Cloud21 in March 2022.
  • Wise Health System (TX) will implement a care-at-home program using the Hospital@Home program of Biofourmis.
  • Zing Health selects Availity’s network for answering provider questions about patient health plan coverage and payments.
  • India’s Narayana Health signs a digital technology collaboration agreement with Honeywell that will emphasize sensor-based applications for patient monitoring and fire safety.

People

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SyTrue hires Chad Wege (Apixio) as VP of product.

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Azara Healthcare promotes Matthew Iezzi to VP, national accounts commercial.

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Kalderos hires Jared Crapo as chief of staff.

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Scott Weingarten, MD (Cedars-Sinai) joins Medicare value-based care provider Vytalize Health as chief value officer.


Announcements and Implementations

Drummond Group launches a pediatric health IT certification program.

NCH Healthcare System (FL) will go live on Epic next week in a $65 million project, replacing Cerner.

Lyniate launches a AWS cloud deployment model for its Corepoint integration engine.

NextGen Healthcare launches Health Data Hub Insights, a data warehouse and analytics solution.

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Hoag Hospital (CA) pilots Hoag Compass, an internally developed, IOS-only mobile app for consumers that includes appointment scheduling, provider messaging, health records review, lab results reporting, and prescription refills. Users who pay $50 per month for the premium plan also gain access to personalized care plans, urgent care support, an on-demand care team, and access to an executive lounge at the Hoag On-Demand Care and Innovation Center.

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A new KLAS report finds that health systems and vendors aren’t delivering the patient engagement tools that many patients want. Providers and vendors fall short of expectations for self-scheduling and prescription refill requests, but have overdelivered on technologies in which patients have limited interest, such as pre- and post-visit communication, patient education, and satisfaction surveys. While most patients are satisfied with virtual visits, they would like to gain a better understanding of the kinds of issues that aren’t best managed by telehealth, be sent an email link before the virtual visit, and spend less time waiting for the clinician to join. Few patients use patient portals regularly, and those who do are more interested in scheduling appointments, requesting refills, and messaging providers than using provider-benefiting services such as updating insurance information or paying bills.


Government and Politics

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Australia’s state of Tasmania will spend $106 million to trial a statewide EHR and patient record viewer in a four-year project that will connect all public and private providers. The state’s overall digital health plan calls for spending $336 million over 10 years.

Miruna Sasu, PhD, MBA, president and CEO of real-world oncology data vendor Cota Healthcare, says that FDA could facilitate the use of real-world data by capturing it cleanly in the EHR so that it looks similar to clinical trial data instead of trying to clean it up afterward.

The VA launches Mission Daybreak, a $20 million challenge program to develop suicide prevention solutions, including the use of digital footprint data and technology that improves access to the Veterans Crisis Line.


Other

The lab manager of the VA’s Walla Walla, WA medical center says its newly implemented Cerner system saves employees three hours per day by digitally tracking specimens. He says his goal was to ignore the negative narrative about Cerner and instead spend time preparing for the implementation.

A GHX survey of senior healthcare leaders finds that staff shortages and burnout is their top concern, with 80% of them planning to use automation to reduce manual labor.


Sponsor Updates

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  • Baker Tilly awards a $10,000 Wishes Grant to Turner’s Heroes, a nonprofit pediatric cancer patient support and research organization.
  • In the Netherlands, Northwest Clinic expands its enterprise imaging contract with Agfa HealthCare to include the company’s Rubee for AI platform.
  • AGS Health publishes a new white paper, “The Evolution of Coding: Understanding How Technology is Assisting Us.”
  • Ascom Americas adds Forerunner Technologies to its mobility partner network.
  • CereCore wins a Silver Stevie Award for its achievement in customer satisfaction.
  • Cerner VP and CMO Lu de Souza, MD and Lead Physician Executive Mehul Steth, MD are named Fellows of AMIA.
  • CHIME and WEDI launch the “Think Before You Click” campaign to help consumers prevent the loss of health information.
  • Clearwater founder and Executive Chairman Bob Chanut, author of “Stop the Cyber Bleeding,” will deliver three Online MS in Cybersecurity Badge Courses for Quinnipiac University.
  • RCxRules  publishes an infographic titled “Overcoming Staffing Challenges.”
  • TechVibe Radio features ConnectiveRx SVP of Product Development Mary Beth Sirio.
  • Dina names Mary Naylor, PhD, RN (Pennsylvania School of Nursing) to its Board of Directors.
  • Divurgent names Debbie Rieger (Gold Coast Health Plan) payer principal.
  • EClinicalWorks publishes a new customer success story, “Advocate Aurora Health: Helping a Regional Nonprofit with Population Health Solutions.”
  • FDB names Kristina Shausmanov (FIFA) quality management data analyst.
  • Mach7 Technologies will exhibit at SIIM22 June 9-11 in Kissimmee, FL.
  • Meditech congratulates the more than 90 customers that have been recognized with 2022 Healthgrades Patient Safety Excellence Awards.
  • Nordic will present at the EHealth 2022 Virtual Conference + Tradeshow June 1-2.
  • OneMedNet names Robert Golden, CPA (Cohen, Bender & Golden) to its Board of Directors.
  • Magenta Care Continuum joins the Olive Library to revolutionize the risk adjustment process.
  • Symplr partners with Susan G. Komen to raise $1 million in the fight against breast cancer.
  • Premier joins the Biden administration’s Healthcare and Public Health Sector Joint Supply Chain Resilience Working Group to drive greater resiliency in the US healthcare supply chain.
  • ReMedi Health Solutions will present at the Healthcare IT Institute June 12-14 in San Antonio.
  • Talkdesk donates over $25,000 to various charities as part of its annual Digital Showdown: Innovations in CX event.
  • Wolters Kluwer Health will publish the American Association for the Study of Liver Diseases’ four specialty journals.

Blog Posts


Contacts

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EPtalk by Dr. Jayne 5/26/22

May 26, 2022 Dr. Jayne No Comments

Plenty of clinicians and health organizations are less enthusiastic about wearables than you might think. They’re still worried about the sheer volume of data that can be generated by patient-owned devices and how that needs to be managed with respect to electronic health records and who should own the follow up for any abnormal data. As wearable devices begin to identify more physiologic phenomena, this continues to come up in conversations. A recent JAMIA article looks at whether the ability of Apple devices to identify abnormal heart rhythms could potentially prevent strokes. The authors considered how they might identify high-risk patients in whom device data could lead to a diagnosis of atrial fibrillation and whether those patients would benefit from treatment with blood thinners.

The study used data from over 1,800 patients at Cedars-Sinai Medical Center and looked at both EHR and Apple Watch data collected between April 2015 and November 2018. They estimated the number of high-risk patients using three different methods: medical history, Apple Watch wear patterns, and atrial fibrillation risk determined by an existing validated clinical model. The authors concluded that using clinical and demographic data from the EHR might be helpful to identify patients who would benefit from device monitoring. They noted that “a randomized controlled trial to study the benefit of consumer-directed heart rate monitoring devices in preventing strokes would require either a massive sample size or an enriched sample of patients very likely to experience stroke” due to atrial fibrillation. They noted that Apple Watch users tend to skew towards young healthy, which might not be the best demographic for identifying those at high-risk for stroke. I’m sure there’s more to come because clinicians will continue to question how to best use patient-generated data.

Last week, the American College of Obstetricians and Gynecologists dropped New Orleans as the site of its 2023 annual conference, citing concerns about Louisiana’s restrictive stance on abortion. The group’s official statement noted: “Holding the nation’s largest gathering of obstetrician-gynecologists in a location where the provision of evidence-based care is banned or subject to criminal or other penalties is directly at odds with our mission and values.” There’s been quite a bit of discussion whether other groups will move their conferences as well. It’s a difficult decision as contracts and venues are typically negotiated years in advance.

Other groups are at least talking about it, though. The American Medical Informatics Association published a set of “guiding ethical principles” for selecting venues for AMIA events and conferences. The authors specifically note abortion and voting rights as issues that have led members to question where meetings are held. The document was created with input from AMIA’s Ethical, Legal, and Social Issues Working Group as well as its Ethics Committee and was approved by the AMIA Board of Directors in April 2022. Among the principles are commitments to:

  • Right to benefit from science.
  • Right to safety and security.
  • Freedom to travel.
  • Freedom of speech.
  • Right to nondiscrimination and civil discourse.
  • Human rights.
  • Access to professional development.
  • Transparency and veracity.

AMIA notes that it does not have a list of excluded or boycotted locations, but that the document will allow those who hope to host an AMIA meeting to evaluate their eligibility and the likelihood of a successful bid.

Speaking of organizations selecting interesting locations, University of Pittsburgh Medical Center has opened a cancer center in Sicily, with clinicians receiving support from those at the Pittsburgh location. They’ll be offering medical oncology services that build on the hospital’s surgical focus areas including gastrointestinal and cardiothoracic cancers. In addition to this program, UPMC also has cancer center offerings for radiotherapy in Roma and Campania. I’m sure there are a fair number of clinicians who might be looking forward to rotating at the new site, depending on their love of cuisine and beautiful landscapes.

I’ve been doing a fair amount of work in telehealth, and there are still plenty of barriers to audio-only telehealth visits. Recently, the US Department of Health and Human Services held its first National Telehealth Conference and audio-only telehealth was discussed as a key strategy for health equity. Voice visits can be done without a smartphone or internet connection and can be useful for managing chronic conditions as well as many acute problems. In my urgent care telehealth practice, it’s usually the patient’s story that most leads me to the assessment and plan rather than the cues I might get from a video exam. Of course, certain conditions necessitate a video visit or at minimum a photograph, but often the value of the visit lies in the physician’s advice and counsel rather than with the exam.

Many of the telehealth patients I see are just looking for reassurance that they can wait for an in-person appointment in the morning. Others might not have tried any over-the-counter remedies and are looking for advice in that regard. Some have a self-limited problem that really doesn’t need a visit at all, but the patient’s employer is demanding a work note, resulting in unnecessary healthcare expenditures. There are still barriers to audio-only visits, including payer requirements for initial and/or ongoing in-person visits that aren’t an option for physicians like me who don’t have a brick-and-mortar location. If I couldn’t practice telehealth, I’d be out of direct patient care entirely, which doesn’t seem like the right answer for a nation with a primary care physician shortage.

Audio-only visits are important for rural patients who often have less access to telehealth services compared to their urban counterparts. A recent article notes a gap not only in telehealth service offerings, but in marketing them to rural patients. In rural areas, there are approximately 40 primary care physicians per 100,000 population compared to 53 in urban communities, and as rural areas struggle to recruit, this is not likely to improve. Of the patients I’ve seen in the last month or so, I’d estimate that 80% of them are from outside major metropolitan areas. I always find it interesting to see exactly where people are located as I confirm their pharmacy information or ask questions about their exposures as related to outdoor activities. (It’s tick bite season, in case you’re wondering, so please remember to wear long pants, long sleeves, and some insect repellent.) I’m glad that I can be a resource for those patients, but look forward to solutions where they have their own primary physicians who can coordinate care.

Have you had a telehealth visit in the last year? Was it audio, video, or asynchronous? What did you think? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 5/26/22

May 25, 2022 Headlines No Comments

Drummond Group Launches New Program, Pilot Initiative for Pediatric Health IT Certification

Drummond Group launches a pediatric health IT certification and pilot initiative that will help vendors comply with the ONC’s voluntary EHR certification requirements.

Walmart, CVS to halt filling prescriptions for controlled substances by Cerebral, Done

CVS and Walmart will stop filling prescriptions for ADHD medications from Cerebral and Done Health due to internal concerns and increased federal scrutiny faced by the telehealth companies.

CynergisTek Inc. Enters Into A Definitive Agreement To Be Acquired By Clearwater In A $17.7 Million Transaction.

Cybersecurity, compliance, and risk management company Clearwater Compliance will acquire competitor CynergisTek for nearly $18 million.

Readers Write: How Automation Can Transform Healthcare Delivery

May 25, 2022 Readers Write 2 Comments

How Automation Can Transform Healthcare Delivery
By Lisa Weber, MSHA, MEA

Lisa Weber is director in industry solutions practice at UiPath of New York, NY.

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A recent survey found that 90% of clinicians agreed that quality measures, including patient satisfaction, have driven change in healthcare in the last decade. The desire for better quality of care and patient experience is clear, but many healthcare organizations struggle with where to start. Consider automation.

One of the major barriers to providing the best care is the crushing amount of tedious, administrative work tasked to clinical and administrative healthcare workers. It is hard to think about a doctor’s office without hearing the constant click of a computer keyboard by every type of healthcare worker. Whether it is updating patient records, scheduling follow-up appointments, or simply taking notes, it can seem like everyone is spending more time looking at a screen than looking at the patient, which can be frustrating for both the patient and staff.

Integrating automation tools, such as software robots, can help healthcare organizations improve inefficiencies, alleviate healthcare provider workloads, and transform healthcare delivery by reclaiming time for patient engagement. The saved time ultimately leads to better, more personalized patient care. Doctors, nurses, and supporting staff would rather devote more time to patients and less to navigating and maintaining online records.

Software robots—think of them as digital assistants—can take over day-to-day tasks that involve accessing, entering, and updating systems and processes just as a human would. Much of the routine and repetitive work that medical professionals dread doing – such as data entry, revising records, checking records for compliance, and scheduling appointments – are perfectly suited tasks for digital assistants. They not only give healthcare workers ample time back in their day, but also boost productivity and workplace satisfaction, accuracy of data, and improved patient experiences.

Specific capabilities of digital assistants for the medical field include completing tasks like:

  • Preparing charts ensuring that all the relevant clinical data (from multiple sources, including other physicians) is available and current.
  • Making sure all paperwork is completed, signed, and up to date.
  • Verifying insurance coverage and collecting any due amounts.
  • Scheduling follow-up appointments, labs, and other testing.
  • Initiating prior authorizations and physician referrals.

During the height of the pandemic, a hospital’s infection control department was struggling to keep up with the hundreds of people coming in every day for COVID-19 testing. As fast diagnosis and response are crucial in preventing the spread of COVID-19, nurses at the hospital needed digital assistance to not only streamline testing, but also to take the pressure off already overworked staff. Using software robots, COVID-19 test result information was processed in a fraction of the time, disseminating patient results in minutes. Overall, the hospital saved three hours a day by using automation to distribute COVID-19 test results.

Utilizing digital assistants significantly reduces the administrative workload of healthcare providers, meaning they have more time for patient engagement and other tasks that make better use of their talent and expertise. These positive effects start to snowball as less time on tedious administrative work means less burnout and turnover, and greater employee satisfaction and productivity. And all these organizational benefits gained from digital assistants in turn improve the quality of care and the patient experience.

HIStalk Interviews Ed Marx, CEO, Divurgent

May 25, 2022 Interviews No Comments

Ed Marx, MS is CEO of Divurgent of Virginia Beach, VA.

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Tell me about yourself and the company.

We’re a consulting, design, and services firm. I have been in healthcare for 30 plus years in a variety of roles, initially, as a janitor in a healthcare facility, a combat medic, an anesthesia tech, and eventually chief information officer. I led digital strategy for a few global healthcare organizations, and now find myself as CEO of this consulting firm. It has been quite a ride, and I have to give complete thanks to all my teams and organizations that helped shape who I am that allowed me this opportunity.

Divurgent has been around as a virtual company since its inception 15 years ago. It has grown year over year at a quite fantastic pace. We are privately held, which has many, many advantages, and that certainly was one of the reasons that I was interested in taking this position. We have several hundred W-2 consultants, and we purposely have made many of our consultants W-2 because we think it makes it more of a family-type atmosphere. Depending on the projects that we are undertaking, it could grow to a thousand or 1,500, but those are typically 1099 or traditional consulting roles that we add. It’s a fairly sizable, I would say mid-sized, company, but growing. It’s at a sweet spot right now, but we have quite aggressive opportunity to continue our growth.

As a first-time CEO, how do you assess and manage the company’s culture, especially since you are taking over from a founder?

It’s a very humbling opportunity. One of the things that drew me to Divurgent is the fact that they are very strong in their values, and they live them. What I love is that at the beginning of every meeting, we talk about one of the five what we call ELITE values – excellence, learning, innovation, trust, and enthusiasm — and someone volunteers to give an example of how someone on the team demonstrated those values since the last time that team met. It’s great storytelling, so that the culture continues to be embedded in the fabric of the organization.

My task is simple in that I don’t want to be the one to change that culture. I want to help that culture continue to rise to the challenge. There is a strong basis for culture. There’s a lot of storytelling involved in that culture. It’s not like I have to come in and help create or shape culture. The challenging task ahead for me, as well as the entire organization, is how do we maintain that culture as we double in size? Retaining that culture is always a tremendous challenge for organizations that grow. Because of the foundation that has been set, I think we’ll manage it, but it will definitely be a challenge.

As someone who has spent most of their career working for non-profit health systems, does it feel different running a for-profit company that provides services to health systems?

It’s different, for sure. But what I like about it is that I can bring that mindset of the C-suite of the provider side. Divurgent was already pretty much there in terms of the partnership approach that we took with clients and prospects. Given my experience, the one thing that I am bringing to the table is that I know how the C-suites analyze and determine who they want to partner with. Bringing that thinking over to the supplier side or the consulting side can really meld well. Now it’s a matter of bringing that thinking and experience that I have, understanding the provider side, but also leveraging the team I already have that is expert in consulting, creating this unique partnership and unique capability. We are bringing those two strengths together, the experience of having been in the C-suite as well as the consultative experience, and that will be our sweet spot and one of our key differentiators

How did consulting change since the pandemic started and how will it look over the next few years?

The good news for Divurgent is that it actually thrived during the pandemic. One of the reasons is that because of the agile nature of Divurgent, and being that mid-sized company and privately held, enabled Divurgent to continue with these close relationships and be super flexible on everything when it comes to terms, the nuances of contracts, sensitivity to payments, and things of that nature. Some companies that might be more traditional or more beholden to stakeholders have to go by sometimes bureaucratic methodologies that don’t allow them that sort of flexibility. It hurt them a little bit being unable to respond quite as intimately with their customers. With Divurgent, we’re just continuing in that fashion of being agile in terms of understanding the customer and working with them in whatever unique terms they have. There’s no cookie cutter approach.

That comes out in the way that we work as well. We don’t bring best practices. A lot of companies pride themselves on bringing best practices to bear, but we don’t bring best practices. We co-create best practices with those organizations that are as unique to them as the solution itself. Going back to the size and being privately held, we can take this unique, customized approach. I’ve been on this side before, where I would have presentations done for us as a C-suite member, and it was a standard slide deck that you know they used last week with some other health system, and sometimes there would still be the old name of whoever the particular consultants pitched to last time. We just don’t do that.

During the pandemic, those relationships were solidified. Our customers started to recognize the fact that we’re not doing cookie cutter, we’re not bringing other people’s best practices and forcing them on them, but we will truly co-create with them. That’s the feedback I got before I took this position. I did my homework, just like Divurgent did their homework on my myself and checking references. I called some of their references, some of my peers who I knew were Divurgent customers, and some other knowledge bases that would have some information. One of the common themes is that the way Divurgent worked — and I’m not trying to sound like a commercial, I really am not — was unique in that it was customized. That really showed itself during the pandemic and helped the company to grow during the pandemic. That’s one of the attributes or differentiators that we want to continue with.

How would you describe the key elements of digital transformation in healthcare?

It’s one of those terms now that is almost meaningless. What we’ve been talking about is not digital transformation so much as digital acceleration. Everyone is using the term digital transformation, but when you look at what’s been done in the last few years — other than the majority of healthcare organizations moving to electronic health records and some outliers with virtual care and move to the cloud — we haven’t reached the scale of transformation that we might have hoped for five years ago or even 10 years ago. I’m focused, and we are focused as a firm, on digital acceleration.

One of the basic building blocks that’s still missing — and I’ve done personal surveys with CHIME members and I’ve seen other more formal surveys — is that the majority of organizations don’t even have a strategy in place. If not a strategy, certainly not a roadmap. What we saw through the pandemic — and this was happening before the pandemic, but was really exacerbated during the pandemic – is a lot of what I would call pockets of brilliance. There would be an immediate problem, standing up virtual care would be a great example, and then you look at it now and wow, this great thing was done to help patients, help save lives, and help with clinicians. That’s a pocket of brilliance. But what we want to do now with digital acceleration is take these organizations from pockets of brilliance to enterprises of excellence. It’s not just one area that you need to be good at when it comes to digital transformation, but it’s everything, all the different services that we do.

Beginning with a strategy, having a strategy, having a roadmap that basically says, what’s your baseline, and measure it. A lot of times we talk about progress, but no one takes a baseline. It’s like, no, let’s take a snapshot now. Let’s take a baseline. Let’s find out, where do you want to go? It’s pretty simple what I’m describing, but yet less than 10% of organizations have a written, codified, approved strategy. Let’s do this baseline, let’s benchmark so we have a general understanding where you are as an organization, and then where do you want to go? Then you have a natural gap analysis that’s done.

Then you can determine not 100 different things to do, because you know what happens when you do that — nothing gets done, or a bunch of things get done with a bunch of mediocrity. Let’s take 10. The magic number is different for every organization, but let’s just say the average is 10. Let’s do 10 things that help to move the needle on that gap, so that in three years you can say, we did digital acceleration. We were here in 2022, now it’s 2025, and we measure it. And of course you are measuring all along the way so that you can make adjustments and hold the organization and the leadership accountable. It sounds simple, and it actually is, but few organizations have the resource or focus to do it. 

That’s one thing that we are emphasizing with digital acceleration. Then of course, we can help with those things that might be needed to fill the gap, whether it’s a virtual care implementation or strategy or help with movement to the cloud or helping with robotic process automation, all these different elements that would be included in a digital transformation acceleration, but just aren’t being done. Or like I said, if they’re done, they’re being done in pockets of brilliance, but not enterprises of excellence. Ultimately, to get to what we’re all striving for, this amazing patient and consumer and member experience, as well as the corollary, which would be clinician experience. Oftentimes we just talk about patient experience, which is super important, but I’m a big believer in, patients come second. It’s the clinicians. It’s the staff. We have to make sure that they are not burned out so they can take care of patients, and that way, everyone wins. It’s that whole gamut from the strategy roadmap, all the way to things around virtual care, but ultimately to the consumer, member, patient, and clinician experience.

Health system CIOs commonly rose through the healthcare ranks and then took responsibility for everything that was related to technology. Health systems are now creating new C-level roles, sometimes filled by people from outside of healthcare, that have technology responsibilities. How is that changing the CIO role?

It has been a huge wake-up call in the ranks of the CIOs. To your point, a lot of CIOs were raised exclusively within healthcare. HR job descriptions would insist and reinforce this old way of thinking — you had to have 20 years of healthcare experience to become a director in a healthcare IT organization. CIOs were people within the ranks, and as a result, we got insular and accidentally shielded ourselves from all the great transformation things that were happening in other industries. 

It hurt us. The response by hospital CEOs and hospital boards was, oh my gosh, we do not have the internal talent to take us to transformation and acceleration and execution. We need to go outside. We need to go to Disney. We need to go to Microsoft. We need to go to AWS. We need to go to Walmart, to CVS, to Rent-a-Center, to you name it. These are real examples that I’ve just given you. These chief digital officers who had all this experience in retail, finance, and entertainment came in, and most of them have done an amazing job. In one way, I look at it as a sad thing, because many of my peers have the skills and can reequip themselves to better understand digital in these other sectors and bring that thinking and leadership to bear. But in many cases, they haven’t, and outside influences came in.

Overall for the patient, I think it’s a net win, because at the end of the day, it’s really about the patient care and patient experience, consumer and member experience, and the clinician experience. It’s a good thing to have this external view, external influence into healthcare. I think it makes us stronger. We could have been a little bit more thoughtful about how it all happened, but it happened, and I think it’s good. I always prided myself on having at least one team member who came from outside of healthcare. I had someone from entertainment, military, or finance because it always made us stronger. The argument that they have to be in healthcare because healthcare is unique and special is not true. While we are unique and special, other people can come in from unique and special verticals and learn healthcare. We all had to learn healthcare at one point. 

It’s good to have these outside influences, and like I said, it has been a net-net gain for everyone. We’ve learned so much from these individuals and these leaders that came from other industries. CIOs who are maybe more traditional should take note of this and take steps now to benefit their organization, and to benefit themselves, to make sure that they are not left out in this next wave or the current wave. Hang out with individuals from other industries, study other industries, learn more about what’s being done, and bring that to their organizations.

The pandemic allowed big health systems to get bigger by acquiring weaker community hospitals, and the remaining standalone facilities are also facing publicly traded competitors who are anxious to cherry-pick their profitable services. Can the traditional community hospital survive?

My heart and soul still are with community care. Divurgent wants to help hospitals of all kinds to not only survive, but to thrive in this new digital era. We want to help everyone. It is really important. I call it “survival of the digital-est.” It’s critical that all these hospitals, including smaller critical access hospitals and community hospitals, grab hold of this whole digital revolution that’s taking place and take action.

I’m afraid that some organizations have not moved quickly enough, or think that they might be insulated because of their location. If they are insulated today, it won’t be for very long. In the digital era, you need to embrace digital tools and all the things we already talked about related to consumerism, the clinician experience, and modern technologies to not only to deliver the highest quality of care, but do it in such an efficient way that you can afford to survive. We really want to help these organizations. 

That’s part of the reason that we wrote the book on digital transformation and have another one coming out on patient experience with Mayo Clinic, Cris Ross. It’s all aimed at trying to help these organizations survive and to move from survival to thrive. It’s incumbent upon the boards of these organizations and the leadership of these organizations to understand what’s going on and take demonstrable action.

How will the company change over the next few years?

At Divurgent, we expect to double in size, but our metric is not currency. When you talk to a lot of companies, they talk about growth that they measure it in dollars and cents. Like, we are going to go from $100 million to $200 million. We are measuring our growth in the number of clients served. We want to double the number of clients served. We believe that if we serve clients and we serve them with excellence, the currency and all the other metrics will follow. Not really fixated on that, but fixated on the growth of clients. How we do that is continuing with excellence. When I did my homework and looked at KLAS ratings and talked to Divurgent customers, 100% are referenceable accounts.That’s a meaningful metric that we’re proud of and will continue with.

Another is to look at new services. We already do advisory and services, but incorporating design, and what I mean by that is this human-centric design, in everything we do. In the past, a lot of consulting and a lot of services were process-oriented, which is good, and built on technology. But what we found are shortcomings. You come in there as a consultant or advisory and you leave and you don’t really ever experience and find out later why none of the initiatives had long-lasting impact. Incorporating the sense of human centricity, human-centered design, is another differentiator that we’re bringing to the table that will help drive growth.

Digital acceleration and that whole model includes the governance piece that was never really solved by many organizations, how they prioritize and how they make effective decisions. It never included what I would call value creation and the concept of, we are going to hold not only ourselves accountable, but let’s hold, or help organizations hold, themselves accountable to doing 360-degree, closed loop investment analysis. I serve on the board of Summa Health in Akron just had the same conversation with the CFO about ensuring that with all these projects, initiatives, and use of consultants, we do these 360, closed loop value realization exercises. That basically means that a year after you came here and you said you’re going to do X, Y, Z, what was the actual performance? It doesn’t have to be with a consulting organization, but since we’re talking about Divurgent, that’s just another sense of differentiation, that we are going to hold ourselves accountable to what we partnered with the organization on.

We’re seeing a lot of M&A in the consulting business. You’re seeing some health systems buying consulting consulting firms, and you’re seeing big tech acquiring firms like Tech Mahindra with HCI. You see mid-sized players exiting the market and I think you’ll see a little bit more of that, which will provide more clarity for those who are left in that market. There’s going to be a lot of changes coming in the next several years, in terms of the number of firms that stay in the market and focus on delivering this level of value that I’m speaking about to their clients.

Morning Headlines 5/25/22

May 24, 2022 Headlines No Comments

Oracle to win unconditional EU nod for $28.3 billion Cerner deal

The EU reportedly gives Oracle unconditional antitrust clearance for its proposed $28 billion acquisition of Cerner.

Plano Telehealth Startup Raises $14.1M

Virtual care company VitalTech raises $14.1 million in equity.

KAID Health Announces Series A to Fuel Growth of its AI-Powered Provider/Payer Whole Chart Analysis Platform

Kaid Health, developer of AI-powered Whole Chart Analysis software, raises $4.25 million in Series A funding.

News 5/25/22

May 24, 2022 News 1 Comment

Top News

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The EU reportedly gives Oracle unconditional antitrust clearance for its proposed $28 billion acquisition of Cerner.


Webinars

May 25 (Wednesday) 2 ET. “Leveling Up Your Defenses: Health IT Security and Risk Management.” Sponsor: Intelligent Medical Objects. Presenters: Lori Kevin, VP of security and enterprise IT, IMO; Nicole Pearce, JD, associate general counsel, IMO. The presenters will explain how to fortify security and respond to current threats by establishing security frameworks and managing risks introduced by ransomware attacks, breaches, and phishing schemes. They will describe the drivers of IMO’s privacy and security program, objectives for continuous review of risk management, and the framework for implementing an incident response program.

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


Acquisitions, Funding, Business, and Stock

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Virtual care company VitalTech raises $14.1 million in equity.

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Kaid Health raises $4.25 million in Series A funding. The company has developed AI-powered Whole Chart Analysis software to help providers more quickly identify gaps in care.


Sales

  • Garrett Regional Medical Center (MD) will use $650,000 in federal funding to replace its 20-year-old Meditech EHR with Epic.
  • Marlette Regional Hospital (MI) will implement telemedicine hospitalist and specialty consult services from VeeOne Health.
  • Geisinger (PA) selects AWS as its cloud provider and will migrate all of its 400 applications to AWS.
  • Morris Heights Health Center (NY) selects NextGen Enterprise EHR/PM.

People

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Talkdesk names Jeff Haslem (PluralSight) as its first CIO.

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Ashish Kachru (Altruista Health) joins DataLink as CEO.

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Komodo Health Chief Medical Officer Aswin Chandrakantan, MD takes on the additional role of COO.

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Regional One Health (TN) promotes Daniel Thomas to VP of IT operations.

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Gregg Veltri, former CIO of Denver Health and Charleston Area Medical Center, has died at 64.


Announcements and Implementations

Northwest Health (AR) launches its Care Management at Home program using remote patient monitoring technology and services from Cadence.

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Chase County Community Hospital (NE) implements Avel ECare’s remote hospitalist services, including telehealth care boards.

Lynn County Hospital District in Texas rolls out care coordination software from CrossTx as part of its chronic care management efforts.

TidalHealth Peninsula Hospital (MD) goes live on the Copernicus electronic referral system for organ and tissue donation.

Tufts Medicine says it is the first health system to transition its digital health ecosystem to the cloud, having moved 40 applications to Amazon Web Services with a goal of 300 at completion. It has also deployed a chatbot powered by Amazon Lex and telehealth and virtual care services using Amazon Connect’s cloud-based contact center.


Government and Politics

The Roseburg VA Health Care System (OR) will launch its new Cerner EHR on June 11.

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US Army Medical Logistics Command at Fort Detrick, Maryland honors the efforts of its healthcare technology management workforce – “from factory to foxhole” – during its annual HTM Workshop.


Other

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ChristianaCare will use a $1.5 million grant from the American Nurses Foundation to deploy five Diligent Robotics Moxi robots, integrated with Cerner to relieve nurses of delivery tasks and to use AI to predict when they will need equipment, supplies, and medications.

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Tennessee’s most expensive home, a $50 million, 20,000-square-foot mansion on 50 acres, is listed for sale by its billionaire owner, HCA Healthcare co-founder Thomas Frist, Jr., MD. 


Sponsor Updates

  • Nordic posts another episode of its monthly “DocTalk” series titled “Soft Interoperability.”
  • Dina appoints Mary Naylor, PhD, RN to its board.
  • Gyant publishes a case study about OSF Healthcare’s use of its Clare virtual assistant on its website as a virtual care navigation assistant, which it says has generated $2.4 million in revenue.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.

Get HIStalk updates.
Send news or rumors.
Contact us.

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Morning Headlines 5/24/22

May 23, 2022 Headlines 1 Comment

Hospital ward where tragic Meltham dad walked out was ‘understaffed with slow computers’

IT problems prevented staff at a hospital in England from seeing that a behavioral health patient was restricted from leaving unsupervised, after which he was killed when he was hit by a train, an inquest hears.

Disclosure of Lab Results

A former health executive in Georgia writes an op-ed piece urging the state to follow Kentucky’s lead in overriding Cures Act requirements that patients be given their lab results immediately, saying that his late wife was stressed by seeing lab results related to her lung cancer that she didn’t understand.

The dangers of digital health monitoring in a post-Roe world

Popular Science advises its readers to use a browser that doesn’t retain a search history, use a VPN, turn off location sharing, use encrypted messaging, avoid asking about potentially illegal topics publicly, and be aware that the US does not protect period tracker users from having their data sold.

NHS doctors urge bosses to let them WFH! Hospital consultants say they can safely assess ward patients by a ‘computer on wheels’

The British Medical Association urges ministers to study the benefits of a hybrid working model for some physicians and at certain times, citing experience gained during the pandemic.

Curbside Consult with Dr. Jayne 5/23/22

May 23, 2022 Dr. Jayne No Comments

I’ve been mentoring young physicians for many years. I was recently asked by one of them to speak to a group of physicians who are struggling with burnout and inability to effectively balance work and home life. Some of them are even thinking about leaving medicine altogether. They were looking for tips from someone a bit more “seasoned” (which is just a nice way to say that at least for those still in training, I’m nearly old enough to be their mother). As we got into the conversation and they were talking about the stresses they were facing in their daily work, I realized several things.

First, these young physicians have always used EHRs. They had no frame of reference for the era of paper charts and how outpatient practices used to operate. They had never been confronted by an unreadable chart, much less a chart that was missing entirely, and as such have never had to perform an established patient visit “blind” as many of us have. There is tremendous anxiety at the idea of not having all the information at their fingertips.

Conversely, they have never had the satisfaction of being able to know what is going on with a patient by scanning a brief note that might say, “Strep, Amoxicillin x 10 days” as the assessment and plan. They’ve been surrounded by so-called note bloat for their entire careers and are used to wading through pools of useless information to try to find important nuggets to use as they care for patients.

Additionally, they’ve never had to go through an EHR implementation, so they have not had the experience of carefully evaluating their workflows to determine if they make sense, or if they need to do some streamlining. They’ve not had much experience pushing back on administrators and tend to be much more likely to take things at face value than my colleagues who trained 20 years ago and who have been through various stages of clinical transformation. Because they’ve always had an operational EHR, they haven’t had the opportunity to ask a lot of questions about why the workflow is the way that it is, or if anything can be made better.

For example, one of them was complaining about the sheer volume of inbox messages that she receives from their practice’s patient portal and how none of them require her expertise. She regularly receives appointment requests, billing questions, and other non-medical messages that she then has to forward to others to address. I asked her why her practice has all the patient portal messages routing directly to the physicians rather than to staffers who can filter the messages. She was unaware that you can even do that with an EHR (and having been a user of her particular system I know it can be done) so didn’t think to ask.

I challenged her to think critically about the other processes in her office. Do all the telephone messages come directly to her, or are they worked by the scheduling team, a medical assistant, and others first, with only those that no one else can address coming to the physician? There’s no reason that messages originating from the patient portal should be handled any differently. I could almost see the light bulb going on over her head as she thought about pushing back on the task of being her own receptionist.

Second, I found that there was a large amount of learned helplessness among these physicians. Some of them are doing four or more hours of documentation at home after leaving the office, but they’re not willing to discuss it with their practices for fear of appearing weak or looking like they can’t keep up or aren’t as productive as their partners. I think some of this comes because of their being in training or their recent proximity to training and not wanting to do anything that would raise a red flag about not being a team player or that they’re not good candidates for highly competitive fellowships or job opportunities.

For the most part, they didn’t seem to be aware of resources that are available to them, such as EHR optimization assistance, classes on personalization or creating templates and macros, or being able to book time with a trainer. It made me wonder if this situation is part of their having grown up in an entirely tech-enabled universe where they assume systems are intuitive even when they’re not, and where people are rewarded for problem-solving on their own without any help. I know that during the early stages of the pandemic, a lot of organizations cut out some of these services, but to not even be aware of a super user in your practice that could help you out is concerning. To be afraid to ask for administrative support is even a bigger red flag as practice arrangements go.

Third, I noticed that many of these younger physicians have no business savvy. There are few subspecialties that require practice management education during training (thank goodness mine is one that does) and I was shocked by the general lack of knowledge around navigating workplace situations. Of the group, only one had an attorney review their employment contract, and most of them weren’t even aware with how much notice they would have to give if they decided to leave or if their medical liability insurance “tail” would be covered upon departure. Failing to understand or negotiate these things up front leaves them locked into these positions longer than they might want. And the lack of business savvy wasn’t only in their own employment – due to the challenges in arranging childcare as a physician, nearly all of them have household employees such as nannies or housekeepers and not a single one had a signed employment agreement or contract for services.

With that lack of understanding, it’s unlikely that any of these physicians would be able to have their own practices or succeed in a physician partnership as compared to being an employee. If they’re not able to demand a drug screen and adherence to policies and procedures for the people caring for their children, would they be able to demand those things of their medical assistants or medical office staff? It feels like they would always be at risk for being taken advantage of or committing some kind of regulatory offense simply out of ignorance.

I was glad to be able to spend a couple of hours taking them under my wing and explaining the concept of being an empowered physician. I stressed the need to spend a little time trying to fully understand the healthcare landscape well enough to be able to make good choices. I was glad to be able to share some information about how to push for better EHR usability and improved clinical workflows. I’m not sure how much a difference our time together will make for their progressive burnout, but it felt good to at least try to make things better.

What does your organization offer to better educate early-career physicians on the non-clinical aspects of working in healthcare? Or does the teaching stop after HIPAA or Fraud, Waste, and Abuse modules? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Justin Sims, President, CareMesh

May 23, 2022 Interviews No Comments

Justin Sims is president and COO of CareMesh of Reston, VA.

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Tell me about yourself and the company.

The business of CareMesh is all about helping healthcare organizations break down communication barriers so they can better coordinate patient care. We do this by helping them solve a number of related problems. Firstly, finding the providers that they want to engage with, then exchanging patient information with them, and then coordinating actions and decisions, both within the organization and between organizations. I guess if you wanted to give us a label, I would call it care coordination.

As to me, I’ve been doing this with CareMesh for the past five years since we started the company, but I’ve worked on a number of similar problems in other health tech companies over the last 20 years. Before that, I did about 15 or 20 years in the telecom industry. But I can tell you for a fact this is a lot more fun.

How well do health systems communicate with their local, community-based physicians?

The truth is that the dominant form of unstructured communication in healthcare today is still stuck in 19th century technology. And I meant it when I said 19th century technology. The first fax, if I’ve got my history right, was sent by Alexander Bain in 1843. That technology is still the dominant form of communication in healthcare.

A lot of people incorrectly think that Direct Secure Messaging is the answer to that, but it isn’t, for a couple of pretty big reasons. The first is a practical one. Only about half of physicians in the community have Direct addresses and can technically use that form of communication. But the second reason is more a structural one, and that is that the standards for Direct messaging focused on exchanging CCDAs, structured patient records, and they didn’t focus on unstructured communications, which is where a massive flow of communications actually takes place. That’s why communication with community providers is still pretty challenging.

It is inevitable that healthcare is scorned for being behind other industries, but isn’t part of the reason that it is more limited by HIPAA and privacy concerns that preclude using the usual consumer-grade tools?

I think that’s right. We are not like others, for a couple of reasons. One is the privacy concerns, although I would say a fax is not exactly the most secure form of communication in the world from a HIPAA perspective. It was one of those things grandfathered. But the other thing that I think makes healthcare communications complicated is that a patient record doesn’t fit into a PowerPoint, an Excel spreadsheet, a Word document, or a PDF document, which is how other industries often exchange information and data. A patient record itself is uniquely structured. 

That’s why it’s important to give credit where due. The government’s efforts around interoperability and getting unique forms of patient record exchange established are important. But again, I come back to these unstructured communications, these things that are so important to coordinating patient care. Not everything fits into a CDA. Not everything fits into a patient record when you’re coordinating a referral or a discharge. Sure, you can send structured patient record information, but that’s only a small part of what needs to be done to properly coordinate with an outside provider. That’s where HIPAA and the lack of a common messaging standard for plain old communications make certain types of communication difficult in healthcare.

Unlike hospitals, most community-based practices don’t have big capital budgets, training and technical support teams, and a commonly used brand of EHR. Does that make communication with them harder?

Yes. It also needs to take into account the workflow within a practice, that there are as many different workflows as there are practices. Some community providers are organized centrally, with a coordinator taking care of everything coming in and protecting the doctor from information overload. Others are organized with perhaps a nurse practitioner or a clinical assistant helping the doctor. Others are organized where the doctor really wants to take care of things themselves.

One of the challenges is that hospitals often attempt to impose their solution to clinical communications on the provider in the community without actually taking account of the fact that they are organized differently. They have different information needs, and they certainly have different workflows. All of that needs to be taken into account when designing a communication strategy, for example, with a hospital and its community providers.

What does a hospital user see and do differently when their organization’s Epic or Cerner system is integrated with CareMesh via APIs?

There are a couple of key things that both the hospital and the community providers get out of that integration. From a hospital perspective, we literally take care of all communications from and between community providers. The hospital doesn’t need to worry about maintaining a directory, dealing with message failures, or having gaps in who they can communicate with.

Our delivery rate is pretty astounding. Only in one out of every 300 communications that the hospital gives us to deliver do we have to go back to the hospital and explain that we can’t deliver it for a particular reason. Very often, that’s because the practitioner has retired or moved out of state or something of that nature. The first thing that the CareMesh solution does is solve or address the problem of the administrative side of communication.

But from a community provider perspective, we don’t force any particular solution on the community provider. We give them multiple options. If they want certain communications delivered by fax or by Direct Secure Messaging, or they want to log into a portal to look at information, they can choose that. If they want information sent centrally or to a delegate of the doctor or to the doctor themselves, they can choose that. We have created a system that allows the community providers themselves to say that if you’re sending a referral, don’t send it to me, send it to this person instead, and I’d actually like it delivered by fax. But every now and then, I’d like to go to a portal and download the patient record. We give as much flexibility to the community providers as possible so that the communications are relevant to them.

Direct addresses were never as simple as they seemed given that a provider can have multiple employers, multiple roles within an employer, and may change employers where some messages should remain within the original practice. Is there a better way to manage the use of the Direct address system?

It’s certainly still a challenge. DirectTrust has done a great job at consolidating a directory of Direct addresses, but the information is only as good as the sources. There’s a chain, if you like, to get the information into the DirectTrust directory. It starts with the organization that employs the doctors and other healthcare professionals and then moves to the HISPs, the health information service providers that run the Direct messaging platform. Then it moves to the DirectTrust directory. That chain can and does break, so often Direct addresses are out of date or they’re not complete.

There are about a million doctors in the country, and we’ve been able to match Direct addresses with a little less than 50% of those. Some of those Direct addresses come from DirectTrust, some from hospital systems, and some from NPPES, which is now collecting that information. We get the data from a variety of sources. But there’s still half of the doctors in the country that don’t have a published Direct address. That represents a fairly big challenge when relying on Direct for communication purposes, in particular, CDA exchange.

One benefit of a fax number is that the receiving organization receives everything that is sent, then intelligently routes each message appropriately. Is there an electronic messaging equivalent?

There are certainly tools around Direct to support that within a number of EHRs. EHRs are able to route messages according to particular rules. One of the things that those of us that are close to healthcare communications would advocate for is Direct working a little bit more like POP email. But that’s really dependent upon the EHR vendors adding more sophistication to their messaging platforms.

In the longer term, there is a strategy that the government is advocating for to create what are called FHIR endpoints. These are essentially web addresses that would allow one healthcare organization to post information into the EHR of another healthcare organization. That could be used for structured communications, like exchanging patient records, or unstructured communications as well. So there is a long-term strategy that could over time close some of the gaps, but it really is a pretty long-term strategy. A lot has to happen for that to solve all of the problems that we’ve been talking about.

What are the challenges involved with maintaining a provider directory?

Maintaining a directory of about 5 million people is a labor of love, but it’s also a big data challenge, and it’s a constantly moving feat. Let’s even narrow that down to just a million doctors. If each of those doctors change a piece of information within their profile every two or three years, such as a change in a location or a communication endpoint, you’re dealing with hundreds of updates that need to take place every day. That’s not something that can conceivably be done manually alone. We heavily rely on big data technologies to pull together the most comprehensive and best view we possibly can of that provider, and we use all sorts of specialized techniques. There’s a concept called master data management that we use to make sure that we present the best possible information possible.

We have also realized that it’s important to design a directory for all, not just some, use cases. We have insurance customers. We have state and local health department customers. We have hospital customers. We have HIEs. We feel that ultimately a single resource that can support many, many different use cases is the only way that anyone is ever going to be able to maintain a strong directory. It’s got to be scaled. It’s got to be heavily utilized by many others. It’s through some of the methods that we talked about that you can gradually get to something that is fit for purpose. It will never be perfect. Anything in big data with 5 million records in it, 5 million providers in it, is never going to be perfect. But it should be good enough to meet the basic needs of registering patients, sending communications, and so on.

How do you see the company’s business changing over the next three or four years?

I think our business is going to evolve as the industry addresses and improves generically on some of the challenges that we’ve talked about. But the foundation of what we do is our directory business, which we brand Search. But a directory on its own is going to be quite limiting in terms of what it can do if it’s not integrated with a communications capability. As we discussed, we augment EHRs and other systems and their native communications capabilities by making it possible to communicate with anyone and everyone.

But the area that is perhaps most interesting as it expands and evolves into a new line of business for us is that once people can find each other and can communicate with them, they then need project management tools and workflow tools to help them manage the patient journey through their particular healthcare condition. It’s those project management tools that we’re providing today, we brand them Navigate, that I think stand the greatest chance of developing into scalable solutions to solve these care coordination challenges that we’ve been talking about.

Morning Headlines 5/23/22

May 22, 2022 Headlines No Comments

Governor Gianforte, DPHHS Announce Major Investment in Montana’s Health Information Exchange

Montana will invest $20 million in the Big Sky Care Connect HIE, which will fund improvements that include a clinical data repository, ADT alerts, a quality measurement program, and image exchange capabilities.

Why So Slow? Legislators Take on Insurers’ Delays in Approving Prescribed Treatments

Lawmakers attempt to speed up prior authorization approvals by imposing insurer time limits, although an electronic PA process may hold the most promise to get patients their meds faster.

How far has the digitization of medical teaching progressed in times of COVID-19? A multinational survey among medical students and lecturers in German-speaking central Europe

Most medical students have experienced digital education, some to the near exclusion of in-person coursework during the pandemic, but they complain about lack of contact with patients, lecturers, and fellow students.

Monday Morning Update 5/23/22

May 22, 2022 News 3 Comments

Top News

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The state of Montana will invest $20 million in the Big Sky Care Connect HIE, which will fund improvements to the state-designated HIE that include a clinical data repository, ADT alerts, a quality measurement program, and image exchange capabilities.

BSCC’s members include 75 provider organizations and half of the state’s hospital systems.


Reader Comments

From Preferred Investor: “Re: Cerner. Could stock market conditions cause Oracle to reconsider its acquisition?” I don’t know enough to comment beyond restating known facts. ORCL is paying $95 per share in cash, and of course CERN shares haven’t budged from that price in the mean time since everybody knows the eventual payoff. ORCL shares are down 23% since the deal was announced December 20 versus the S&P 500’s 15% drop. Oracle’s tender offer expires on June 6 after being extended a few times. The deal requires Cerner to pay Oracle a $950 million termination fee under certain circumstances, but I don’t know what if anything happens if Oracle reconsiders. I’ll invite experts to weigh in.

From Ballywood Man: “Re: [company name omitted]. Getting out of the North America provider market due to diminishing success, will focus on life sciences, pharma, and payers / insurers. They  ran into issues providing competitive offshore services for Cerner and Epic customers and accounts are managed by people who came through the IT ranks and know nothing about healthcare solutions as required for consultative selling. Senior sales and consulting leadership has been RIFed. “ Unverified, so I’ve left out the name of the publicly traded company. Reports are welcome. The RIF must have been recent since I see no LinkedIn changes for the executives listed.


HIStalk Announcements and Requests

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Few poll respondents see Epic as being better without Judy Faulkner. Sam observes that, like Amazon, changing CEOs shouldn’t trigger major changes since Epic’s culture is wide and deep. IIRC differs, providing examples where the departure of larger-than-life leaders has a negative company impact (giving as examples Meditech, Cerner, GE, Microsoft, and Chrysler). Others are confident that Carl Dvorak has been running the company with Judy and can easily take over, especially given the extensive succession planning that Epic has been performing for decades.

New poll to your right or here: What impact will a stock market downturn have on health IT?

Listening: Aeon Station, basically a solo project of the former co-leader of the Wrens, a band I’ve liked for years. Indie rock, especially the melodic and thoughtful kind, has been somewhat lost in a sea of vapid hip hop collaborations and diva-led formulaic hit factories, so this mature, low-tech alternative sounds fine to my ear. The duct tape that holds Kevin Whelan’s bass guitar together deserves a liner note.


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Welcome to new HIStalk Platinum Sponsor Juniper Networks of Sunnyvale, CA. Juniper Networks empowers healthcare IT leaders to deliver simplified experiences for those who run networks and the patients, clinicians, and staff who depend on them. Our solutions deliver industry-leading insight, automation, security, and AI for improved IT operations resulting in better experiences and health outcomes. Thanks to Juniper Networks for supporting HIStalk.

I found this Juniper Networks YouTube video that features Northeast Georgia Health System CIO Chris Paravate, MBA talking about the health system’s AI-powered clinician mobility strategy.


Webinars

May 25 (Wednesday) 2 ET. “Leveling Up Your Defenses: Health IT Security and Risk Management.” Sponsor: Intelligent Medical Objects. Presenters: Lori Kevin, VP of security and enterprise IT, IMO; Nicole Pearce, JD, associate general counsel, IMO. The presenters will explain how to fortify security and respond to current threats by establishing security frameworks and managing risks introduced by ransomware attacks, breaches, and phishing schemes. They will describe the drivers of IMO’s privacy and security program, objectives for continuous review of risk management, and the framework for implementing an incident response program.

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


Acquisitions, Funding, Business, and Stock

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“Venture Valkyrie” Lisa Suennen applies her experience from the dot-com bust and 2008 stock market correction to predict how recent market drops might affect investors and startups:

  • A venture capital downturn lags a stock market decline by 3-6 months.
  • The lack of a healthy IPO market means private companies can’t go public and can exit only by selling out. VCs take advantage of the situation by making lowball offers.
  • Publicly traded potential acquirers pass on deals involving companies that will dilute their earnings per share, which includes most startups.
  • Cash-heavy venture funds will hoard the best deals and lead “down rounds” in investing at lower valuations, damaging smaller, capital-poor funds that can’t afford to meet term sheet requirements of making ongoing investments.
  • Companies with less funding or less-resourced investors have to keep the company going to avoid a downward spiral of lower valuations, trading “growth at all costs” for cost-reducing survival mode where company fundamentals suddenly matter.
  • Capital-rich funds get to buy later-stage companies at lower valuations.
  • Angel investors head for the exits “when the drain is working faster than the tap.”

People

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Interoperability vendor Health Gorilla hires Derek Plansky, SM (Informatic Ideas) as SVP of product.

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The HCI Solution promotes Dan Collins to EVP.

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Care New England Health System CIO Phil Kahn, MS, MBA retires this week.


Announcements and Implementations

Integrated healthcare payments and security software vendor Sphere launches a plug-and-play payment solution, which integrates with PAX terminals, for independent software vendors that offer SaaS products.


Other

A survey of medical students in German-speaking countries finds that while most received some form of rapidly implemented digital education during the pandemic, they didn’t like the lack of patient contact, in-person case studies and discussions, and studying PowerPoints and PDFs alone without instructor interaction. The students suggest that medical schools expand their use of online office hours, faculty Q&A sessions, and simulations and virtual reality.

A Michigan law that takes effect next year will require health plans to take action on urgent prior authorization requests within 72 hours, although a Blue Cross Blue Shield Association VP says that electronic prior authorization holds the most promise for reducing delays, citing a pilot project in which decision time was reduced 69% to six hours.

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Former Vanderbilt University Medical Center ICU nurse RaDonda Vaught, who killed a patient in 2017 by giving the paralyzing agent vecuronium instead of the ordered sedative Versed, is interviewed by ABC News following her sentencing to probation:

  • VUMC settled with the patient’s family without reporting the error to state and federal officials as the law requires.
  • Vaught says she performed manual overrides of the drug dispensing system and ignored several warnings because she was training a new nurse and was distracted.
  • Her attorneys say VUMC bears some responsibility because it allowed her to override warnings and a CMS investigation noted some deficiencies, although VUMC was not punished.
  • Vaught concludes, “There’s a fine line between blame and responsibility, and in healthcare, we don’t blame. I’m responsible for what I failed to do. Vanderbilt is responsible for what they failed to do.”

Sponsor Updates

  • ZeOmega integrates Change Healthcare’s clinical guidelines into its new Smart Auth Gateway electronic prior authorization solution.
  • Experity’s EHR/PM software has been recognized with a 2022 MedTech Breakthrough Award in the best practice management solution category.
  • CarePort releases its “Evolution of Care” report.
  • Arcadia wins the KLAS 2022 Points of Light award for its collaboration with Community Health Plan of Washington.
  • Olive has invested in Miami University’s College of Engineering and Computing to expand its healthcare research capabilities.
  • The HIT Like a Girl Podcast features PeriGen CNO Alana McGolrick.
  • The VA’s Cerner-powered Opioid Advisor wins FedHealthIT’s innovation award.
  • Drug Store News LexisNexis Risk Solutions, OmniSys, and Surescripts with Retail Excellence Awards in the technology and automation category.
  • Wolters Kluwer Health Director of Clinical Sales Support Karen Eckert wins the National Council for Prescription Drug Programs’ Benjamin D. Ward Distinguished Member Award.
  • HFMA’s Voices in Healthcare Finance Podcast features VisiQuate EVP of Product Management Anthony Comfort.

Blog Posts


Contacts

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

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Morning Headlines 5/20/22

May 19, 2022 Headlines No Comments

Doximity Announces Fourth Quarter and Fiscal Year 2022 Financial Results

Physician social network and pharma marketing vendor Doximity reports Q4 results: revenue up 40%, adjusted EPS $0.21 versus $0.09, providing lowered guidance that sent shares to all-time lows in after-hours trading Tuesday.

Harris Expands in California with the Acquisitions of Innovative Medical Management and MedBill IQ

Harris acquires workers’ compensation EHR/PM/RCM vendor Innovative Medical Management and MedBill IQ, which will become part of the company’s Resolve Healthcare revenue cycle business unit.

IU health doctor says he was fired for objecting to visit time limit

An internal medicine physician sues Indiana University Health, which he claims fired him for complaining about a policy that limits doctor visits to 10 minutes as monitored via the EHR.

News 5/20/22

May 19, 2022 News 1 Comment

Top News

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The board of online mental health provider Cerebral fires co-founder and CEO Kyle Robertson and shakes up the remaining management team. The company is facing a federal probe into whether it took advantage of pandemic-relaxed mental telehealth regulations to issue excessive numbers of Adderall and Xanax prescriptions to drug-seeking customers.

Cerebral says it will stop prescribing most controlled substances, starting with new patients this week and to existing patients by October.

Cerebral was valued by its most recent investment at nearly $5 billion.


HIStalk Announcements and Requests

I sometimes include a click counter on links that I run, for two reasons: (a) It helps me fine-tune the kinds of news items I write about based on reader interest; and (b) I’m curious about which companies readers follow. I took a rare look today at the results over time:

  • The top four most-clicked items were the links that I included in a new sponsor announcement, which ranged from 4,100 to 5,800.
  • A company’s top-of-page banner got 4,000 clicks, while the one before that drew 3,700.
  • The highest-drawing webinar link has received 3,600 clicks.
  • My favorite write-up about the Valcom guys and their post-HIMSS18 adventures with the Smokin’ Doc in Las Vegas drew 3,400 clicks to Valcom’s website.

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I just started playing around with no-code web builder Bubble, which seems pretty cool. The fully functional demo allows editing a copy of Bubble’s home page, which of course was developed with its own product. An alternative for developers who need to use an existing SQL database (instead of creating a database within Bubble) is WeWeb. Both would be useful for developing prototypes or minimum viable products or quickly creating internal company tools. Stacker is even simpler in using Airtable or Google Sheets as a source database. 

I had personal experience with the hotel equivalent of a digital front door this week when I visited a surgery-recovering relative and spent a single night in a cheap chain hotel I had booked through Expedia, which I allow to send me text messages. I received a reservation reminder with contact information a couple of days ahead of time; received check-in messages containing the wifi password, a link to local restaurants, and inviting me to respond to management with my first-impression room experience and to let them know if I need anything; and got a message at checkout thanking me and wishing me safe travels. My lesson learned – hotels and restaurants always lament that customers should alert management to problems in real time instead of ripping them in online reviews later when it’s too late to address the problem, so the hotel’s texts let them detect improvement opportunities as they occur. Hospitals and practices have ample such opportunities, but I’m not sure they are as eager or incented as a budget hotel to hear what customers think about excessive waits or surly personnel.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Multi-specialty national telehealth provider MeMD, acquired by Walmart in May 2021, changes its name to Walmart Health Virtual Care. The service, which includes a diabetes program, will expand beyond Florida in the next several months.

Physician social network and pharma marketing vendor Doximity reports Q4 results: revenue up 40%, adjusted EPS $0.21 versus $0.09, providing lowered guidance that sent shares to all-time lows in after-hours trading Tuesday. DOXM shares began trading in June 2021 at $26, then closed their first day at $53. They rebounded Thursday to $32.39, down 43% in the past 12 months in valuing the company at $6.2 billion. Doximity is promoting digital-first drug marketing campaigns, noting that drug companies are cutting back on salespeople and moving money to digital advertising. The company said in the earnings call that pharma is recession-resilient and that physician resignations are good for its business because Doximity sells job-seeking doctors 30-day temporary phone numbers that they can give to recruiters who then can’t “keep calling and texting you for years.”

Harris acquires workers’ compensation EHR/PM/RCM vendor Innovative Medical Management and MedBill IQ, which will become part of the company’s Resolve Healthcare revenue cycle business unit.

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Amwell launches a behavioral health program that includes virtual therapy, psychiatry, and coaching. The program incorporates the digital behavioral health programs of SilverCloud Health, which Amwell acquired in July 2021 along with virtual care company Conversa Health for $320 million.

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Transcarent adds a behavioral care offering that will connect its self-insured employer members with virtual or in-person mental health providers.


Sales

  • Charlotte Radiology will implement Volpara Health’s breast density assessment, mammography reporting, and patient communication software, expanding its use of the Volpara Analytics mammography quality assurance system.
  • Zing Health selects Availity’s real-time health information network to allow providers to share information to close clinical care gaps.
  • The Wyoming Board of Pharmacy chooses Bamboo Health for its prescription drug monitoring program.

People

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John Kelly (PatientKeeper) joins Xifin as CIO.

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Divurgent promotes Brittany Williams to VP of marketing and communications.

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Adam Seyb (West Monroe) joins Janus Health as chief customer officer.

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Imaware promotes Angie Inlow to chief growth officer.

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Art Nicholas (Sakon) joins Strata Health US as chief commercial officer.

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Mark Grasso (Virtustream) joins Holon Solutions as VP of sales.

SyTrue hires Steven Lang (Apixio) as SVP of sales.


Announcements and Implementations

CPSI pilots Medicomp’s Quippe Clinical Lens to enhance the information in its Patient Data Console.

Cerner, Elligo Health Research (in which Cerner is an investor), and Freenome will participate in an early cancer detection clinical trial using Cerner’s Learning Health Network, which sells de-identified patient data from participating health systems.

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UTHealth Houston celebrates its March 2021 go-live on Epic that was performed with all members of Epic’s team, its own project team, and many of its end users working remotely. They earned a $550,000 Good Install credit from Epic.


Other

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An internal medicine physician sues Indiana University Health, which he claims fired him for complaining about a policy that limits doctor visits to 10 minutes as monitored via the EHR. An IU Health spokesperson responded that the 10-minute EHR time limit doesn’t necessarily include face-to-face time and in fact was intended to encourage more doctor-patient interaction instead of computer work. The doctor, IU School of Medicine Clinical Assistant Professor Brian Leon, MD, was also a medical director and is a pharmacist.

Researchers find that AI can identify a patient’s race from their X-ray images, raising concerns of inadvertent bias. The study authors found that AI can predict a patient’s self-reported race even when image quality is poor and when clinicians cannot.

Cerner will pay an unreported sum to Sweden’s Västra Götaland to settle complaints over Millennium implementation delays that Cerner attributes to the pandemic and to the region itself. Cerner says it is ready to proceed with the project, has 250 employees working in Sweden, and plans to bring up parts of the system this fall. The region was reportedly seeking payment of $50 million to offset its increased costs.

Malaysia’s government-developed COVID-19 app, which has 38 million registered users, sees usage drop 97% as national check-in requirements are dropped and controversy has erupted over the app’s ownership. The government had planned to expand the app’s use beyond COVID and as a key part of public health efforts.

A Tennessee county that was touted as the exception to low vaccination rates among rural, white, and conservative Southern counties drops to mid-pack after a longstanding ZIP code problem is fixed. The state manually corrected cases in which a single ZIP code straddles multiple counties, as incorrectly reported by Arizona-based STChealth, whose immunization information system is used by several states. Meigs County dropped from 65% to 43% vaccinated overnight. The state says STChealth is fixing the problem, but other states avoided the issue in the first place by geocoding the company’s data for correct county attribution.


Sponsor Updates

  • First Databank hires Vivian Nguyen (Pine Park Health) as a customer success solution architect.
  • GHX has recognized the recipients of its 21st annual GHXcellence Awards during its annual summit.
  • Gyant has completed the Service Organization Controls 2 Type II certification.
  • Nordic publishes a video titled “Modernizing Healthcare Data Infrastructure with the Cloud.”
  • Meditech congratulates DCH Health CIO Billy Helmandollar for receiving the Alabama Chapter ORBIE CIO of the Year Award in the large corporate category.
  • RCxRules publishes a free EBook titled “Simplify Your Revenue Cycle Workflow Through Automation.”
  • Nuance congratulates Mary Presti, head of Dragon Medical, on her Lillian Sholtis Brunner Alumni Award for Innovation from Penn Nursing.
  • Netsmart COO Tom Herzog signs the ESGR Statement of Support to show its dedication to employees who serve in the National Guard and Reserves.
  • Nordic transitions the Tasman brand, and its presence in Europe and the Middle East, to the Nordic global brand.

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 5/19/22

May 19, 2022 Dr. Jayne 3 Comments

A friend clued me in to an article about the state of patients’ ability to schedule their own healthcare visits. It points out all the industries that have migrated from scheduling via human interaction to scheduling online: airlines, restaurants, and fitness programs are examples. The authors note that some demographic groups want to avoid making phone calls “like the plague” and go further to comment that “there’s no better way to forcibly eject younger generations from your onboarding and acquisition process than by putting them on hold.”

The article provides a great summary of the difficulties in allowing direct scheduling, including pre-visit requirements, insurance requirements, and varying lengths of appointment slots. For some specialties, there’s also the risk of rescheduled or bumped appointments due to emergencies or operating room delays. They dig into issues around physician preferences and control as well.

When I worked on my first EHR implementation, it also involved conversion of the practice management system. We reviewed well over 1,000 different appointment types that physicians had demanded over the years and winnowed them down to about 70. We analyzed past performance and found that the physicians who had the most rigid scheduling rules often had unused appointment slots, while those with more flexible “open access” schedules had more consistent use of their schedules.

It’s difficult to wrest control away from physicians who have little business training and who aren’t encouraged to challenge the status quo. It’s even more challenging when their office staff members have developed a culture of shielding the providers from change.

I’ve found that practices can benefit even if they only allow a small subset of visits to be directly scheduled, such as allowing only well visits, since they tend to have longer time slots, or same-day sick visits, which would be shorter time slots that are sometimes worked in to the schedule. One of my personal physician offices allows only same-day sick visits to be scheduled via the patient portal, and they are usually gone by 9 a.m. As long as the technology lift isn’t too heavy, sometimes even a small benefit can give both staff and patients a bit of a morale boost. If your office hasn’t considered making the change, I would strongly recommend starting to dig into the pros and cons.

Speaking of shaking things up: CNBC has published its 2022 Disruptor 50 list, which includes a number of health technology companies that I’ve followed over the years including Medable (distributed clinical trials), TruePill (virtual pharmacy), Maven Clinic (virtual women’s health), Ro (virtual pharmacy and diagnosics), and Oura (wearable ring for fitness data). My favorite addition to the list is Biobot Analytics which uses wastewater to detect disease. In an era where people can skew population health data by specifically opting out of testing, that might be the best way to go in order to determine where the COVID-19 pandemic is going.

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Telehealth startup Cerebral has lost its CEO with the departure of Kyle Robertson. The company has been under scrutiny for some time, but experienced increased criticism around its prescribing processes in recent weeks. Cerebral is accused of excessively prescribing stimulant medications such as Adderall. It has received a grand jury subpoena from the US Attorney’s Office for the Eastern District of New York as it investigates possible violations of the Controlled Substances Act. Cerebral has stated it would largely stop prescribing controlled substances, which is likely to create some interesting care-seeking patterns in the brick and mortar world as patients have their refills curtailed.

The changes occurred following a board meeting which included other leadership changes. President and Chief Medical Officer David Mou will take over, COO Jessica Muse will become president, and clinical advisor Thomas Insel will join the board. Cerebral has tried to recruit me as a provider several times, and the way they conduct their recruiting gave me the heebie jeebies as it felt like they were basically trying to rent my license so that they could generate as many prescriptions as possible.

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I always enjoy hearing about different EHR vendors and their client conferences. A regular reader clued me in that CPSI is holding its National Client Conference in St. Louis this week. The conference schedule has a number of interesting offerings and wrapped early enough in the evenings for attendees to take advantage of the city’s food scene, including Italian, Vietnamese, and Bosnian offerings. The customer appreciation event featured the Anheuser-Busch Brewery Experience, complete with brewery tours, a biergarten, and of course the Budweiser Clydesdales. Sounds to me like a great way to cap off a conference.

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Other things I enjoy hearing about: the intersection of science with one of my favorite treats. The American Institute of Physics journal Physics of Fluids recently explored Oreology, which it defined as “the fracture and flow of milk’s favorite cookie.” Researchers looked at the failure mechanics involved in twisting an Oreo apart, including the variables of filling amount, rotation rate, and flavor. They assessed a stress-strain curve as well as “postmortem crème distribution” that was typically unequal. Researchers went as far as creating an “open-source, three-dimensionally printed Oreometer powered by rubber bands and coins” in order to encourage “higher precision home studies to contribute to new discoveries.”

Little did I know that Oreo filling could be characterized as having “complex or non-Newtonian viscosity” or the many ways in which science impacts the processing of different foods – from using fractional calculus models to evaluate cheese structure to using physics to improve chocolate quality. Although sections of the paper seemed to be bordering on sarcasm, I thoroughly enjoyed reading it and look forward to discussing it with my favorite physics students when I see them over their summer break. The authors note the need for further research on other varieties of sandwich cookies, custard creams, macarons, and ice cream sandwiches, although I’m particularly intrigued by their mention of the physics of Nutter Butters since they were a special childhood treat.

What’s your favorite variety of Oreo? Leave a comment or email me.

Email Dr. Jayne.

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