Morning Headlines 10/14/22

Walgreens Boots Alliance Accelerates Full Acquisition of CareCentrix

Walgreens will buy the remaining shares of care coordination and benefit management platform vendor CareCentrix for $392 million, with the total acquisition cost amounting to $722 million.

CommonSpirit Update

CommonSpirit Health, which operates 142 hospitals in 21 states, confirms that its continued downtime that started October 3 was caused by a ransomware attack.

Data Dimensions Announces Acquisition of Providerflow to Revolutionize Medical Bill Payments for Clearinghouse

Property and casualty EDI vendor Data Dimensions acquires Providerflow, whose platform manages electronic claims attachments and requests from patients and third parties.

VA extends EHR delay to June 2023 after review finds more system problems

The VA announces that it will push back further Oracle Cerner EHR deployments by an additional six months to give the department more time to troubleshoot issues that have impacted patient care and user satisfaction.

NeuroFlow Closes $25M Growth Investment

Behavioral health assessment and triaging platform vendor NeuroFlow secures a $25 million growth investment.

News 10/14/22

Top News

Walgreens will buy the remaining shares of care coordination and benefit management platform vendor CareCentrix for $392 million.

The total acquisition cost, including the previous investment by Walgreens, is $722 million.

CareCentrix CEO John Driscoll, MBA, MPhil will take a Walgreens role as EVP and president of US healthcare. He has previously served as a top leader of Surescripts, Castlight Health, and Waystar.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Synapse Medicine. The France-based company believes in medication success and is dedicated to making it possible for everyone. To achieve this goal, it has built an extensive, global medication knowledge base using algorithms to ensure the most reliable, up-to-date data. On the front end, Synapse Medicine provides a SaaS platform and UI components that are used to prescribe, dispense, and manage medications across the entire patient journey. The company is working with world-leading hospitals and digital health companies in the United States, Europe, and Japan to transform today’s medication regimens into tomorrow’s medication success. The company offers a webinar titled “Optimizing Prescription Safety for Your Health Tech Product.” Thanks to Synapse Medicine for supporting HIStalk.

Mrs. H insisted that I take a COVID-19 test before we went out to dinner with higher-risk friends Wednesday since I had mild nasal congestion, a bit of fatigue, and a scratchy throat after our recent travels. I did a swab test just to humor her and to make sure I wasn’t a risk to our friends and it turns out that her concerns were well founded – I tested positive (it felt odd to tell them, “We can’t come because I have COVID.”) The mild initial symptoms have eased and no new ones have emerged, so I’m hoping my vaxxed-to-the-max immune system is repelling the viral siege and protecting me from long COVID. I can only imagine how I would have felt – literally and figuratively – had I been infected in the pre-vaccine dark ages of 2020. Mrs. H, who tested negative and whom I see only from a masked distance as I isolate, masked up and went to Walgreens to buy a couple of $20 boxes of rapid tests for follow-up, where she learned from the helpful clerk that people with insurance can get four boxes of rapid antigen tests (two tests per box) per family member every 30 days at no charge. I don’t want to know who is ultimately picking up that tab.

Webinars

October 18 (Tuesday) 2 ET. “Patient Payment Trends 2022: Learn All The Secrets.” Sponsor: Mend. Presenter: Matt McBride, MBA, co-founder and CEO, Mend. Many industries offer frictionless payments, but healthcare still sends paper bills to patients who are demanding modern conveniences. This webinar will review consumer sentiment on healthcare payments, recent changes to the Telephone Consumer Protection Act that create opportunities for new patient financial engagement, and new tactics to collect more payments faster from patients.

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

Acquisitions, Funding, Business, and Stock

Well Health will acquire CloudMD’s Cloud Practice Canada-focused business — which includes the Juno EMR, billing software, and three primary care clinic – for just under $6 million.

Specialty EHR/PM vendor Nextech acquires TouchMD, which sells patient visualization and marketing systems to plastic surgery and dermatology practices.

Property and casualty EDI vendor Data Dimensions acquires Providerflow, whose platform manages electronic claims attachments and requests from patients and third parties.

Prescription discount platform GoodRx launches Provider Mode, which allows providers to compare costs, send coupons to patients, and repeat searches via their own dashboard.

Weight loss coaching app vendor Noom lays off another 10% of its employees, mostly from its coaching team, as it attempts to transition into enterprise sales and a broader, more personalized mind-body platform. The company has raised $650 million and was planning a 2022 IPO at a $10 billion valuation. An Insider review found that the company doesn’t offer the personalized support it claims, and instead cranks out canned calorie-counting plans for a high subscription price with little evidence of long-term weight loss success. The company has generated thousands of Better Business Bureau and FTC complaints for billing users without their consent and making it hard for them to cancel subscriptions.

Behavioral health assessment and triaging platform vendor NeuroFlow secures a $25 million growth investment. I interviewed CEO Chris Molaro in March 2022.

The Private Equity Stakeholder Project calls out the former ownership of safety net hospital system Prospect Medical Holdings by private equity firm Leonard Green & Partners. They say that the PE firm reaped $658 million in fees and dividends over its 10-year ownership by burying the hospital chain in debt and slashing costs to the detriment of patient care. The PE firm sold the chain last year, releasing it from responsibility for the chain’s $3.1 billion of debt. LGP’s investment portfolio also includes health IT-related business MultiPlan (cost management), Press Ganey (hospital patient and employee analytics), WCG (clinical trials), and WellSky (post-acute care software).

Investment firm Francisco Partners the BSwift benefits technology business from CVS Health.

KHN reports that private equity firms are creating and running hospital obstetrics emergency departments – often consisting of a single small room — which allows patients who have pregnancy or post-partum medical concerns to be seen quickly and then billed at high ED rates. Few interviewed patients were told that they were about to incur ED services as they entered the unmarked rooms, often the same triage rooms as before. A physician researcher concludes, “To have people get an emergency room charge when they don’t even know they’re in an emergency room — I mean, that doesn’t meet the laugh test,” while UCSF professor Bob Wachter, MD says that hospitals “will always have a rationale for why income maximization is a reasonable and moral strategy.”

Sales

• CDC awards Accenture Federal Services a three-year, $189 million contract to for cloud migration services.
• ConvergeOne chooses Redox for EHR integration.

People

John Hallock (Transarent) joins Quantum Health as chief communications officer.

Diligent Robotics hires Gregg Springan, RN, MSN (Epic) as head of clinical informatics and Nicholas Bloom, MPH (Cedars-Sinai Accelerator) as head of client success.

Christopher Kunney, MSMOT (DSS) joins Divurgent as SVP of digital acceleration.

Announcements and Implementations

Walmart launches the Walmart Healthcare Research Institute and a related app to increase community access to clinical trials. The My Health Journey app helps patients find studies and send their medical and insurance records to investigators. FDA data suggests that studies are not representative of the entire US population because they recruit participants from their own urban locations who have the time and money to participate.

A Relatient poll of provider group executives finds that while most of them believe that online patient scheduling is critical for patient satisfaction, they are still using phone calls or automated phone messages to communicate with patients before their appointment, partly because that’s what patients prefer. The authors conclude that provider groups understand the importance of automation and digital tools and their associated reduction in staffing requirements, but need to choose the services that patients will actually use.

Campbell County Health (WY) kicks off its year-long, $8 million project to replace Meditech with Epic in an affiliation with UCHealth. An HIStalk search finds several references to the health system – it sent employee W-2s to a hacker who impersonated a hospital executive in 2017, lost $200,000 in Medicaid payments due to billing system failures in its acquisition of a private surgery center in 2018, and went on diversion due to a ransomware attack in 2019.

A Dubai health system goes live with a Metaverse-based hospital, which it says will eventually replace traditional telemedicine services and support its medical tourism program.  

Florida-based AdventHealth University and Full Sail University launch a virtual reality research center that will focus on healthcare employee training and patient safety technologies.

Providence spinoff DexCare, which offers system capacity and appointment booking software, acquires Womp Inc., which offers digital front door systems and mobile optimization technology.

CHIME appoints three CIO members to its board of trustees – Daniel Barchi, MS (New York Presyterian), Terri Couts, RN, MHA (Guthrie Clinic), and Tressa Springmann, MAS (LifeBridge Health). Named as director of the CHIME Foundation Board is Sean Kelly, MD of Well Health.

Government and Politics

Forbes updates its article on North Carolina’s sole-source choice of Unite Us’s social services integration platform. A recap:

• The state chose Unite Us for a federal Medicaid social services pilot without having its product reviewed by IT teams. Reports suggest that it will require modification to meet federal privacy requirements.
• Former state HHS Secretary Mandy Cohen, MD, MPH, who is now CEO of Aledade Care Solutions, intervened to get Unite Us the business even though state health systems preferred that of competitor Findhelp.
• Unite Us President and Co-Founder Taylor Justice complained to Cohen that UNC Health was about to choose a different vendor. She promised to call UNC Health CEO Wesley Burks, MD to get him to reconsider. Emails obtained under the Freedom of Information Act indicate that Justice told Cohen, “I shouldn’t have let this happen and it will never happen again.”
• State lawmakers met Wednesday to ask the governor’s administration to explain why it used an non-competitive technology selection process and why, after three years and $27 million of federal Healthy Opportunities Pilot money spent, the only tangible result is that 10 families are receiving food deliveries.

Nebraska’s corrections department OIG says that a female inmate who was incarcerated for life died of cervical cancer because its Excel-based chronic care tracking system allowed her to go 10 years without having a Pap smear performed. OIG notes:

• A seven-year-old state statute requires keeping inmate medical records in an EHR, but NDCS still uses only paper charts like the ones above.
• The Nebraska Department of Correctional Services department spent a $150,000 EHR study grant in 2017 to buy an electronic medication administration record system instead.
• NDCS was appropriated $1.4 million to implement a commercial EHR in 2019, but never opened an RFP.
• In 2021, NDCS received another $745,000 to implement a commercial EHR, but then decided to develop a system internally. Nothing has gone live except for a behavioral health module and an intake form.
• Employees say they waste a lot of time phoning and faxing information that could be easily shared via a commercial EHR and that the lack of an EHR hinders the hiring of medical personnel.
• Among OIG’s recommendations is that if the homegrown system isn’t fully live by 2025, NDCS should abandon the effort and again seek the money to buy a commercial EHR.

Privacy and Security

CommonSpirit Health, which operates 142 hospitals in 21 states, confirms that its continued downtime that started October 3 was caused by a ransomware attack.

Other

An interesting post by Cyrus Bahrassa, founder and CEO of healthcare integration consulting firm Ashavan, opines that OAuth rather than FHIR is the most important interoperability standard. He provides a straightforward definition of OAuth, which is how “log in with Google” or “login in with Facebook” works without exposing App 1’s user account information to App 2.

Two NHS trusts move to downtime paper recordkeeping after an apparent database error in Oracle Cerner required most of a day to resolve. During the downtime, Royal Free London, which was ironically in the middle of a “go paperless” campaign, nearly ran out of paper.

In the UK, the doctor of a 12-year-old girl who died by suicide after being bullied online says she was not able to see the girl’s history of self-harm because her practice’s EHR could not access that of the girl’s previous doctor.

Sponsor Updates

• An InterSystems charity walk event on Thursday included music from an all-company band that features industry long-timer and VP Don Woodlock on drums.
• Nordic posts a new episode of its DocTalk video series called “The Impact of Long COVID.”
• Healthcare Growth Partners advises blood and biologics supply chain automation company BloodHub during its sale to InVita Healthcare Technologies.
• Intelligent Medical Objects will exhibit at the OR Manager Conference October 17-19 in Denver.
• Meditech Greenfield expands to include new collaborative environments – Greenfield Alliance and Greenfield Workspace.
• Baker Tilly US and Artisight launch a strategic implementation collaboration for AI-enhanced workflow automation.
• Netsmart will exhibit at LeadingAge October 16-19 in Denver.
• Nordic joins the Microsoft Cloud Partner Program.

Blog Posts

• The Future is Unsure for the COVID-19 PHE (Experity)
• Retail Pharmacists are Called to Embrace an Expanded Role (First Databank)
• Can expertise on-demand Solutions help your cybersecurity staffing challenges? (Fortified Health Security)
• Health Literacy: Patients Who Understand Content, Use Content (Get Well)
• How to Enhance EHR Use Measures to Mitigate Clinician Burnout (HealthTech Resources)
• OptimizeRx Announces Strong Results from its use of Previously Announced AI/RWE Solution (OptimizeRx)
• Five things to know about the 2023 ICD-10-CM updates (Intelligent Medical Objects)
• Don’t be Fooled by Fake Login Pages: How Multi-Factor Authentication Protects Internet-Facing Servers (Medhost)
• 3 Clear Warning Signs That You Need Prior Authorization Software (Myndshft)
• How Occupational Health Executives Can Plan for the Future of Work (Net Health)
• How the US Naval Academy is Making Mental Health a Top Priority (NeuroFlow)
• Harnessing outcomes-focused AI in radiology reporting: It all starts with the data (Nuance)
• EHR consolidation: How to lead with empathy (Nordic)

Black Book Market Research’s latest ranking of health IT and management advisory firms includes the following HIStalk sponsors:

• Allscripts/Altera Implementation – ReMedi Health Solutions
• Blockchain – Healthcare Triangle
• Compliance, HIPAA, Risk Management, Regulatory – Clearwater
• Epic Implementation – Tegria, Bluetree Network
• HIT Staffing – Tegria
• Interoperability & Integration – Zen Healthcare IT
• Value-Based Care Hospitals – Premier

Contacts

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

EPtalk by Dr. Jayne 10/13/22

The HLTH conference team has announced the headliner for its Industry Night celebration. Let’s just say nothing celebrates digital health and transformation quite like Ludracis.

The American Telemedicine Association shifts the dates of its ATA2023 Annual Conference & Expo. The conference moves from a mid-week placement to begin on Saturday, March 4 and will run through Monday, March 6. The organization notes this is to accommodate busy schedules and to ensure that “even more frontline providers and virtual care practitioners” can attend in person. The meeting remains in San Antonio and two of the evening events have “Celebrity Mixologist” in the title, so it looks like it will be entertaining as well as educational.

The National Center for Health Statistics releases provisional life expectancy estimates for 2021. It shows that from 2019 to 2021, US life expectancy dropped by 3 years for men and 2.3 years for women. The new values – 73 years for men and 79 for women – are the lowest since 1996. Approximately 75% of the drop was attributed to COVID-19 deaths, with the remainder including overdose deaths, suicide, chronic liver disease, and homicide for men. Women lost years due to COVID-19 as well as heart disease, stroke, and chronic liver disease. Losses were not as high as they could have been, however, since they were somewhat mitigated by reductions in deaths due to influenza, pneumonia, and other respiratory diseases.

Mr. H recently posted a poll to assess “Which of the following items did you earn after age 35 that has been most valuable in your career.” Although there were some good choices, including master’s degrees, doctorates, professional degrees, and more, the list didn’t include my personal pick: my Clinical Informatics board certification. As a relatively home-grown clinical informaticist, most of my training was of the on-the-job variety and a good chunk of the learnings were through the school of hard knocks. I didn’t have the opportunity to do a fellowship in the discipline, but worked my way through the major texts of the specialty through grim determination and the Interlibrary Loan system.

In second place, I’d put vendor-specific certifications. I don’t know how much they’ve really helped me with my career, but they’ve definitely helped me do the day-to-day aspects of my job better. Even though I’m in a leadership role, having the certifications allows me to speak the same language as my analysts and better understand the different features and functionalities that we’re implementing. It’s also entertaining when people discover that although you’re a physician, you have certifications in the practice management and billing portions of the application. Not to mention that I’m always happy to talk about EDI and Coordination of Benefits over a cocktail or two.

The Medical Group Management Association, in conjunction with Jackson Physician Search, releases a report on physician turnover in the US. The sample size was small at 326 physicians, but the data is recent since it was obtained in August 2022. Among the most interesting findings: 51% of physicians have considered leaving their healthcare employer in the last year, with 41% considering leaving medical practice and 36% contemplating early retirement. I wonder what percentage of those who are considering leaving medicine could be mitigated if care delivery organizations were willing to create more novel practice arrangements.

For example, I have several friends who have left medicine in the last couple of years because they didn’t want to work full time as primary care physicians. There’s a perception that having part time physicians is difficult or creates scheduling or administrative headaches, so they would rather let people leave. My former medical group was unsupportive of job-share arrangements. Although there was one highly successful physician pair who was tolerated due to their seniority, no additional arrangements were allowed. Assuming the right contractual language and appropriately paired physicians, there’s no inherent reason why a physician job-share wouldn’t be successful.

In the last two decades, I’ve been let go by two emergency department staffing groups because they made the determination that they didn’t want to contract part-time physicians. They can’t use administrative burdens as an excuse since both of them allowed part-time nurse practitioners and physician assistants, who are actually harder to schedule than physicians due to supervisory requirements in my state. Those of us who were let go each time concluded that the motivation was largely financial, although staffing groups would never admit to it.

Several of us started doing our own variations of an in-town locum tenens gig, where we provided supplemental coverage for acute ambulatory visits at peak times such as Mondays or Friday afternoons. We would also cover vacations, maternity leaves, and time off due to FMLA. There was good uptake on our services by individual physicians, but we could never quite get the big health systems in town (or their affiliated medical groups) to consider making us part of their teams. I guess they would rather see physicians scramble for coverage on their own, or worse for morale, just not take time off.

I’d love to get back to seeing patients in person and would be happy to work evenings and weekends if someone were looking for a part-time doc. Unfortunately, the only place willing to hire someone for fewer than 12 shifts per month is my former urgent care, which I wouldn’t touch with the proverbial 10-foot pole.

The MGMA report has a whole section on burnout and summarizes the results of a May 2021 look at burnout. At that time, 86% of healthcare leaders said they didn’t have a formal plan or strategy to reduce physician burnout. By August 2022, the number of leaders who admitted not having a plan had dropped to 66%. Although it’s a move in the right direction, every organization should have a plan in place to address burnout not only of physicians, but of all members of the clinical care team.

We’re living in unprecedented times and everyone is stretched to the limit. Case in point: the charge nurse in the emergency department at St. Michael Medical Center in Washington called 911 because the department’s five nurses were overwhelmed with 45 patients in the waiting room. She requested that firefighters come assist and they did, taking vital signs and helping turn over rooms between patients.

What is your organization doing to help with burnout? Or are they just keeping their collective heads in the sand? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 10/13/22

WELL Health to Acquire EMR, Billing and Clinical Assets from CloudMD

Well Health Technologies, a Canadian health IT vendor and clinic operator, acquires medical record and billing software along with three clinics from CloudMD Software & Services.

Nextech Announces Acquisition of TouchMD, Enhancing Specialty Practice Patient Experience

Specialty practice EHR and practice management software company Nextech acquires TouchMD, a visual consultation, marketing, and imaging software vendor.

Noom lays off more employees amid CFO departure

Weight loss coaching app company Noom announces its second round of layoffs this year, several months after raising $540 million.

Morning Headlines 10/12/22

Brave Health Secures $40M in Series C Funding to Expand Access to Mental Health Services for Medicaid Populations

Medicaid virtual mental health provider Brave Health raises $40 million in a Series C funding round.

Milliman IntelliScript® Acquires OneRecord

Insurer risk assessment technology vendor Milliman IntelliScript acquires API-based EHR records retrieval system vendor OneRecord.

Redesign Health lays off 67 employees a month after raising $65 million

Healthcare startup development company Redesign Health lays off 20% of its staff in a restructuring move that affects its engineering, product, marketing, and recruiting departments.

News 10/12/22

Top News

Medicaid virtual mental health provider Brave Health raises $40 million in a Series C funding round.

The round was led by Town Hall Ventures, of which former acting CMS Administrator Andy Slavitt is a general partner.

The company serves patients in 10 states.

Brave Health’s two co-founders came from General Assembly, which offers technology courses to executives. It was acquired by a workforce development company for $413 million in cash in 2018.

Reader Comments

From Salient Point: “Re: Medicare. The Urban Institute says that the Medicare Part A trust fund will be exhausted by 2028. That’s especially interesting because it’s a presidential election year, meaning we will see a lot of political posturing and paralysis.” US debt is at $31 trillion, which was a big enough time bomb even before interest rates started to rise, so Medicare is another problem that will defy resolution with the near-certain lack political compromise and the voting power of seniors who don’t want to pay more or receive less.

HIStalk Announcements and Requests

If your company isn’t an HIStalk sponsor, you have a few weeks to get on board for 2023 at 2022 rates (the same benefit existing sponsors enjoy, in other words). Beat the price increase and maybe use some leftover 2022 marketing money by contacting Lorre ASAP.

Companies or their PR firms have asked / demanded a few times that I remove my summary of a legitimate news source’s unflattering investigative report. They always say they are seeking to have the original article corrected, although I don’t recall that ever actually happening given that journalists and their editors are pretty careful to fact-check before publishing. My policy is this — if the source updates their article, I’ll update my reference to it, but otherwise I won’t bury or sugarcoat a story just because the company doesn’t like it. They are welcome to state their rebuttal in a comment and let the reader decide.

Thanks to Jenn for covering my recent several days off. It’s a testament to her abilities that you probably didn’t even notice my absence. I traveled only with my $99 Chromebook and it worked flawlessly — it was the lack of decent connectivity (and maybe a lack of personal motivation) that kept me mostly offline.

Welcome to new HIStalk Platinum Sponsor KONZA. The Topeka, KS-based company’s next-generation KONZA National Network supports the delivery of unequaled actionable intelligence, including clinical information at the point of care, while supporting value-based payment models, care management, and analytics. As a member of the EHealth Exchange, it allows health systems to share data internally and with their external partners such as the VA, MHS, CVS, and DaVita. The Azure-powered system, which is available to any organization and does not require participation in a local or state HIE, allows health systems to query aggregated data to monitor care gaps, ED use, opioid use, and readmissions. It can also be queried to match patients with rare conditions with clinical trials and to identify health disparities and provides ADT alerts, submission of quality metrics to CMS, payer analytics, and updating the personal health records of patients when new data arrives. Thanks to KONZA for supporting HIStalk.

Webinars

October 12 (Wednesday) 1 ET. “In Praise of the Problem-Oriented Medical Record (POMR).” Sponsor: Intelligent Medical Objects. Presenters: Amanda Heidemann, MD, CMIO, KeyCare; Amber Sieja, MD, senior medical director of informatics, UCHealth and Ambulatory Services; Jim Thompson, MD, physician informaticist, IMO. The problem-oriented medical record – initially developed in the 1960s by Lawrence Weed, MD – brought important structure to paper charting, and in particular, the problem list. Yet, today, the tool that was once the gold standard for organizing and making sense of patient history is often cluttered and unmanageable. Fortunately, tools and strategies exist to help make the problem list more meaningful, helping to synthesize patient data, highlight insights, and support patient care. The expert panel will share their experiences with POMR, including documentation practices and tools to improve workflows and efficiency, the impact of POMR and charting on the overall health of a patient, and the challenges and obstacles clinicians face when practicing POMR and charting and how they can be overcome.

October 18 (Tuesday) 2 ET. “Patient Payment Trends 2022: Learn All The Secrets.” Sponsor: Mend. Presenter: Matt McBride, MBA, co-founder and CEO, Mend. Many industries offer frictionless payments, but healthcare still sends paper bills to patients who are demanding modern conveniences. This webinar will review consumer sentiment on healthcare payments, recent changes to the Telephone Consumer Protection Act that create opportunities for new patient financial engagement, and new tactics to collect more payments faster from patients.

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

Acquisitions, Funding, Business, and Stock

Insurer risk assessment technology vendor Milliman IntelliScript acquires API-based EHR records retrieval system vendor OneRecord.

The merged Beaumont Health and Spectrum Health system, which is Michigan’s largest employer, names itself Corewell Health.

People

Former Allscripts CEO Paul Black joins Thomas H. Lee Partners as a consultant for its healthcare investment group.

St. Clair Health hires Jim Kohler (Allscripts) as VP/CIO.

Hutchinson Clinic hires its recently retired CMIO Verlin Janzen, MD as interim CEO.

Mark Burgess (NextGen Healthcare) joins Agfa HealthCare as chief revenue officer for North America. 

Announcements and Implementations

Aspen Valley Hospital (CO) goes live on Epic.

Ascom works with Oracle Cerner to give nurses access to a patient’s EHR on Ascom’s Myco 3 VoWiFi smartphone.

In England, County Durham & Darlington NHS Foundation Trust goes live on Cerner.

UCHealth (CO) implements Eon’s patient management software.

The Sequoia Project seeks feedback on its “Draft TEFCA Facilitated FHIR Implementation Guide.”

Government and Politics

A Forbes report says that North Carolina chose Unite Us as its technology contractor for the federal Healthy Opportunities Pilot for Medicaid beneficiaries in a sole-source contract that did not undergo state IT review. Emails suggest that former state HHS Secretary Mandy Cohen, MD, MPH — now CEO of Aledade Care Solutions — intervened to win Unite Us the business over an unnamed competitor (reportedly Findhelp, formerly called Aunt Bertha), which was the preferred choice of the state’s health systems.

Privacy and Security

In New Zealand, hackers notify Pinnacle Midlands Health Network that they’ve uploaded the stolen data of 450,000 patients to the dark web. The cyberattack on one of the primary care network’s IT systems took place September 28 and Pinnacle issued a statement within a week.

Other

Health IT consulting contracts are on the upswing, according to Black Book Market Research’s latest market analysis. Seventy percent of surveyed providers say they’ll seek out consulting help for RCM optimization projects within the next 15 months. Low-priority projects, according to providers, include those related to EHR optimization, support, and training; and physician burnout. The Chartis Group was noted as the top enterprise health IT consulting firm.

Pediatric cardiologist and CMIO C. Becket Mahnke, MD compares paper charts to EHRs based on his annual cardiology volunteer work in Palau:

• Information retrieval isn’t too bad with paper charts, but is incomplete compared to accessing patient information via HIEs and Epic’s Care Everywhere.
• Lack of filters and search means flipping through paper pages.
• Documentation is faster using pen and paper instead of an EHR, allowing visits of 12 minutes per patient, including ECG time. However, legibility issues are a problem.
• Ordering is faster on paper, but again legibility issues cause problems with the receiving department and there’s no way to track ordering patterns over time.
• Lack of in-basket capability saves time with paper charts, but there’s no easy way to send information to colleagues or to receive result notifications.
• Paper charts aren’t readily analyzable for monitoring, quality improvement, and hypothesis generation.

The New York Times profiles Myron Rolle, MD, MSc, a former Florida State University football star, Rhodes Scholar in medical anthropology, and NFL player whose fizzled pro football career led him to a Mass General medical residency as a neurosurgeon, where he is in his sixth year of the seven-year program. Asked for advice for people who feel stuck, he said, “One: It’s never too late. Two: You’re needed. You’re still needed in this life. Your lane can be yours and it’s for you. What God has for you is going to be for you. Perfect it. Hone it. Be a master of it. Love it. Do it well. Impact people when you do it and help bring somebody up with you.”

Sponsor Updates

• Clearsense supports the George Landess Memorial/NEFL Scottish Games Golf Tournament, benefitting Challenges Enterprises.
• Wolters Kluwer Health announces that 10 of its healthcare publications from its Lippincott portfolio have been honored with 13 awards in the 2022 Folio: Eddie and Ozzie Awards.
• Agfa HealthCare supports The Royal College of Radiologists’ first Global Congress in Dubai.
• Tegria and Microsoft Azure services firm 3Cloud partner to offer EHR clients advance their AI/ML capabilities.
• Baker Tilly releases a new Healthy Outcomes Podcast, “New markets tax credits for healthcare providers.”
• Relatient publishes an e-book titled “2022 Patient Engagement Report: Provider Perspectives on Optimizing Patient Scheduling and Communication.”
• Cordea Consulting will exhibit at the Delaware Valley / New Jersey HIMSS Fall Conference October 12-14 in Atlantic City, NJ.
• Tegria will offer its customers a healthcare-optimized ServiceNow solution to deliver ITSM and CSM solutions.

Blog Posts

• Cybersecurity Tips for Healthcare IT Consultants (Optimum Healthcare IT)
• Five Ways to Optimize Practice Resources While Driving Higher Quality Care (AdvancedMD)
• In-House Medical Coding Post-Pandemic: Is It Worth the Effort? (AGS Health)
• Insights from the RCxRules 2022 National User Conference: Staffing Shortages and Remote Work are Still Top of Mind (RCx Rules)
• Five phrases to grow and nourish a care management program (Arcadia)
• Best Practices for Referral Management (CarePort)
• HFMA Poll: CFO and CIO Synergy is Crucial to Successful Initiatives (CereCore)
• Increase Patient Trust and Retention Using EHR Policies and HIPAA Compliance Safeguards (ChartLogic)
• The Exponential Savings Potential for ACO Participants (ChartSpan)
• A Look at Emerging Healthcare Technology & Associated Security Risks (Clearwater)
• How Leaders and Team Members Can Prioritize Mental Health (Divurgent)
• ‘Value Over Volume, Patients Like Family’ (EClinicalWorks)

Oracle Cerner will host its Health Conference October 17-19 in Kansas City, MO. Exhibiting HIStalk Sponsors include:

• Arrive Health
• Ascom
• Ellkay
• First Databank
• Fortified Health Security
• Get Well
• Healthwise
• Intelligent Medical Objects
• Impact Advisors
• Kyruus
• Loyal
• Medicomp Systems
• Net Health
• Nuance
• Relatient
• Surescripts
• Wolters Kluwer Health

Contacts

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

Morning Headlines 10/11/22

Post-pandemic, Telemedicine startups are evolving — this one just raised $6M for its hybrid approach

Specialty health and wellness telemedicine vendor Index Health raises $6 million in a seed funding round.

Patients’ private details published after cyber attackers stole data on up to 450,000 people

In New Zealand, hackers notify Pinnacle Midlands Health Network that they’ve uploaded the stolen data of 450,000 patients to the dark Web.

InStride Health Providing Virtual Pediatric Anxiety/OCD Treatment Launches with Support from McLean Hospital and Leading Healthcare Investors

Pediatric virtual mental healthcare company InStride Health launches with $26 million in funding.

Curbside Consult with Dr. Jayne 10/10/22

I spent the majority of this weekend on staff at my favorite outdoor classroom program, which focuses on teaching a variety of outdoor skills to adults. Fall has definitely arrived, with frost on the tents the first night and ice the second night. Even though I’ve been doing this a long time and have a good routine to make the experience as comfortable as possible, my body seems to be greeting those early mornings with an increasing number of creaks and groans as I depart my nice cozy sleeping bag. It’s worth it, however, to see people learn new skills and become comfortable with spending time in the great outdoors.

This time around, I was also the designated health officer and was extremely glad that the weekend had zero incidents requiring my professional skills. The only casualty was a box oven that caught fire in a fairly spectacular fashion but was quickly extinguished.

People are always curious when they find out I’m a telehealth physician and wonder how much we can really do without laying hands on a patient. One attendee was shocked that we’re “allowed” to diagnose anything when we’re not seeing someone in person. I explained that a diagnostic process involves a good amount of history-taking and listening, and once you frame it in that fashion, people start to remember that their own physician might not do much more of an examination than listening to their heart and lungs at an office visit. I also was able to explain some of the technologies that are available to assist physicians and patients. People tend to forget that home blood pressure cuffs and scales can provide data for diagnosis and management as well.

Of course, people also tend to ask for medical advice. This weekend’s hot topics included what I think of the new COVID booster along with what I think is the optimal timing of the flu vaccine.

Generally, I tell people that I’ve already had the new COVID vaccine and have no concerns about giving it to loved ones, and there’s not much more discussion. On the flu vaccine, however, it seems like everyone thinks there is some kind of secret to the best timing. Historically, influenza tended to peak somewhere between January and April, so getting a vaccine in early fall was ideal. There have been a lot of changes to the patterns of various viral infections since the COVID pandemic and there’s a chance our predictions for this year’s flu season might not be as accurate as they’ve been in the past, so my strategy is to recommend people get it as soon they are able, particularly if they are high risk, and to take common sense precautions to avoid infection – like washing their hands and staying away from sick people.

We had some staff members who were unable to participate this weekend due to COVID infections, so I am doubling down on the recommendation that if someone has an important event they’d like to attend, it’s a good idea to up their masking and distancing game if they want to improve their odds of making it happen. Many of the members of our instructor team are IT professionals and are now working from home permanently, so there were a couple of good conversations around the new normal of working when you’re sick along with strategies for juggling work commitments when you might have a sick child at home. People reported a wide range of ways they handle this depending on workplace culture. It seems like more organizations are expecting people to work while sick because they’re remote, even if they have designated sick time.

This conversation led into a follow up discussion of “the perils of unlimited PTO,” which seems to be increasing in popularity among tech companies for a variety of reasons. Workplaces definitely vary in how they’ve implemented it. Some still track time off but it’s unlimited, which doesn’t help much with managing administrative overhead. Others leave it up to supervisors to track their teams’ time off and intervene if there are issues. Another strategy is to not track time off at all. The people in the discussion felt that not having any tracking at all made them more likely to not take an appropriate amount of time off, because they didn’t have any kind of visual indicator of what they had taken or any way to judge where they are in comparison to their peers.

I’ve worked in a couple of unlimited PTO organizations. They have also had extremely flexible work hours, which when combined can be a recipe for working way more hours than one might normally do in a traditional time management structure. My advice for those moving into this model for the first time is to track your hours and your work pattern for a period of time and find out how many hours you’re really working and whether you’re doing more than you think. Having been a consultant and needing to quantify my time in various increments – some as small as six minutes – I know with good accuracy how long many tasks take. People who are working flexible hours and tend to answer emails “here and there” after hours often underestimate how long those take and those minutes add up. I recommended a time tracking exercise for one of my mentees recently and he found that his new position with unlimited PTO and a flexible remote schedule actually had him working 25% more hours than he previously worked.

This drifted into a conversation about so-called “quiet quitting.” It was interesting to hear that those in non-healthcare tech positions were seeing similar manifestations of the phenomenon as those of us who are in healthcare IT. I think at times we think that there’s something particularly challenging about being in healthcare or having been impacted by the pandemic, that we think we’re worse off than everyone else. However, it seems that everyone is similarly burned out and looking for solutions to live a more balanced life. I hope that spending a couple of days in the woods provided some food for thought about the need for balance as well as some strategies for getting more enjoyment in the outdoors. If nothing else, the participants should have gone home with a sense of accomplishment after spending the night in a tent in freezing weather.

Does your organization have unlimited PTO? Do you feel like workers take enough time off to recharge? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 10/10/22

Seattle-area patients frustrated by days of system outages at Virginia Mason Franciscan Health facilities

Nearly a week into CommonSpirit Health’s IT incident, patients are growing frustrated by the lack of digital access that has prevented timely care coordination and prescription refills.

VA’s electronic health records system hit with pharmacy module outage

Oracle Cerner engineers resolve an application package coding issue that caused the VA’s EHR pharmacy module to go down for 11 hours last week.

Nebraska Hospital Association, UNMC announce data collaboration

The Nebraska Hospital Association and the University of Nebraska Medical Center prepare to launch an initiative that will give researchers access to the hospital’s de-identified claims data.

Monday Morning Update 10/10/22

Top News

Virginia Mason Franciscan Health (WA), part of the CommonSpirit Health system, updates patients on the ongoing, unspecified IT incident that last week forced many CommonSpirit facilities to revert to downtime procedures, divert ambulances, and reschedule appointments.

CommonSpirit has yet to issue a statement.

Patients, meanwhile, are growing frustrated by the lack of digital access, which has turned online appointment scheduling and record retrieval into processes more laborious than usual. Prescription refills have also been impacted.

HIStalk Announcements and Requests

The majority of poll respondents are in favor of the HHS decision to hold firm on the October 6 deadline for information sharing.

New poll to your right or here: Which of the following items did you earn after age 35 that has been most valuable in your career? If you’ve done something on the list that turned out to be a great career booster in your 30s or after, others would no doubt be interested. I’m sure I didn’t think of every possible item, so add a poll comment if you earned some other credential that paid off big time.

An Olive rep clarified some points from Thursday’s news post regarding the company’s decision to divest its population health and 340b products: Those offerings make up less than 3% of the company’s revenue and no longer align with Olive’s product strategy. Two of its customers gave notice in August and September, in contrast to the number in the original article.

Webinars

October 12 (Wednesday) 1 ET. “In Praise of the Problem-Oriented Medical Record (POMR).” Sponsor: Intelligent Medical Objects. Presenters: Amanda Heidemann, MD, CMIO, KeyCare; Amber Sieja, MD, senior medical director of informatics, UCHealth and Ambulatory Services; Jim Thompson, MD, physician informaticist, IMO. The problem-oriented medical record – initially developed in the 1960s by Lawrence Weed, MD – brought important structure to paper charting, and in particular, the problem list. Yet, today, the tool that was once the gold standard for organizing and making sense of patient history is often cluttered and unmanageable. Fortunately, tools and strategies exist to help make the problem list more meaningful, helping to synthesize patient data, highlight insights, and support patient care. The expert panel will share their experiences with POMR, including documentation practices and tools to improve workflows and efficiency, the impact of POMR and charting on the overall health of a patient, and the challenges and obstacles clinicians face when practicing POMR and charting and how they can be overcome.

October 18 (Tuesday) 2 ET. “Patient Payment Trends 2022: Learn All The Secrets.” Sponsor: Mend. Presenter: Matt McBride, MBA, co-founder and CEO, Mend. Many industries offer frictionless payments, but healthcare still sends paper bills to patients who are demanding modern conveniences. This webinar will review consumer sentiment on healthcare payments, recent changes to the Telephone Consumer Protection Act that create opportunities for new patient financial engagement, and new tactics to collect more payments faster from patients.

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

Sales

• The VA selects Coforma to assist it in developing clinical decision support apps and EHR integrations.
• A Northeastern health system selects VisiQuate’s denials management, revenue management, and reserve analytics.

Announcements and Implementations

Image-sharing vendor Send Mammogram implements ClearData’s CyberHealth cybersecurity technology.

Box Butte General Hospital (NE) postpones its roll out of Meditech Expanse as it takes into account lessons learned from a mock live event held in late September.

EClinicalWorks announces the addition of sign, patient survey, and chatbot capabilities to its family Healow patient engagement apps at its annual user conference, where it also launched the latest version of its EHR. CFO Mark Speyer noted that the company has increased its staff count by 10% in 2022, and will continue to hire in the next year.

Government and Politics

Oracle Cerner engineers resolve an application package coding issue that caused the VA’s EHR pharmacy module to go down for 11 hours last week. In a separate incident, certain patients were unable to access the Defense Enrollment Eligibility Reporting System, a database of US military members, family members, veterans, and others eligible for military benefits. That issue resolved without technical intervention.

Other

The Nebraska Hospital Association and the University of Nebraska Medical Center prepare to launch an initiative that will give researchers access to the hospital’s de-identified claims data. The association hopes to partner with additional hospitals willing to give researchers access to similar data sets.

Intermountain Healthcare (UT) begins offering delivery of specialty pharmaceuticals and certain over-the-counter medications by drone to eligible patients in the Salt Lake Valley area. The health system, which first announced its drone delivery plans in 2018, has partnered with San Francisco-based company Zipline to offer the service.

Sponsor Updates

• Clearwater sponsors the Nashville Health Care Council Golf Tournament.
• Meditech and Forward Advantage develop the PxMobile healthcare system-branded app.
• Methodist Health System extends its 25-year relationship with Oracle Cerner with a 10-year contract extension.
• Optimum Healthcare IT names Shane Kuppler (Health Care District of Palm Beach County) Epic revenue cycle analyst.
• Relatient releases a new episode of Dash Talk Podcast, “How Better Access Gives OrthoSC a ‘Leg Up’ on Care Delivery.”
• Talkdesk receives two Frost & Sullivan 2022 Customer Value Leadership Awards for vertical market excellence.
• Tegria will present at the HFMA Region 2 Annual Fall Institute October 13 in Verona, NY.
• Volpara Health receives a 2022 Good Design Award for Volpara Analytics in the digital design category.

Blog Posts

• Key Takeaways: Evolution of Healthcare Systems (Pivot Point Consulting)
• Nurses of Note Awards 2022: The Clinical Practice Specialist (PerfectServe)
• Top 3 Takeaways from the AHIP Consumer Experience & Digital Health Forum (Redox)
• In-house vs. Outsourcing: The Benefits of a Chart Abstraction Service (ReMedi Health Solutions)
• What is call center routing and how does it improve customer experience? (Talkdesk)

Contacts

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

Morning Headlines 10/7/22

Call it data liberation day: Patients can now access all their health records digitally 

Federal rules take effect that will enable patients to obtain all of their medical records in digital format upon request.

CMS Asks for Public Input on Establishing First, National Directory of Health Care Providers and Services

CMS solicits feedback on the idea of developing a national directory of healthcare providers and services.

Alleva Raises $12 Million Series A Led By Ankona Capital

Behavioral health IT vendor Alleva raises $12 million in a Series A funding round.

Nordic Consulting Acquires Healthcare Consulting Company Hygeian

Nordic Consulting acquires Hygeian, a healthcare consulting and staffing firm that serves customers in the UK and Middle East.

News 10/7/22

Top News

Federal rules take effect today that – in theory – will enable patients to obtain all of their medical records in digital format upon request.

A number of provider organizations attempted to get the October 6 deadline extended so that they could have more time to prepare for patient requests, and to better understand the penalties of failing to comply.

CMS has not yet made clear the ways in which providers and health IT vendors will be held accountable for failing to adapt to this new era of liberated patient data.

Webinars

October 12 (Wednesday) 1 ET. “In Praise of the Problem-Oriented Medical Record (POMR).” Sponsor: Intelligent Medical Objects. Presenters: Amanda Heidemann, MD, CMIO, KeyCare; Amber Sieja, MD, senior medical director of informatics, UCHealth and Ambulatory Services; Jim Thompson, MD, physician informaticist, IMO. The problem-oriented medical record – initially developed in the 1960s by Lawrence Weed, MD – brought important structure to paper charting, and in particular, the problem list. Yet, today, the tool that was once the gold standard for organizing and making sense of patient history is often cluttered and unmanageable. Fortunately, tools and strategies exist to help make the problem list more meaningful, helping to synthesize patient data, highlight insights, and support patient care. The expert panel will share their experiences with POMR, including documentation practices and tools to improve workflows and efficiency, the impact of POMR and charting on the overall health of a patient, and the challenges and obstacles clinicians face when practicing POMR and charting and how they can be overcome.

October 18 (Tuesday) 2 ET. “Patient Payment Trends 2022: Learn All The Secrets.” Sponsor: Mend. Presenter: Matt McBride, MBA, co-founder and CEO, Mend. Many industries offer frictionless payments, but healthcare still sends paper bills to patients who are demanding modern conveniences. This webinar will review consumer sentiment on healthcare payments, recent changes to the Telephone Consumer Protection Act that create opportunities for new patient financial engagement, and new tactics to collect more payments faster from patients.

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

Acquisitions, Funding, Business, and Stock

Patient acquisition, engagement, and remote patient monitoring company PatientPoint acquires eye care-focused competitor Rendia for an undisclosed sum. Rendia CEO Smitha Gopal will also take on the new role of PatientPoint EVP of subscription and procedure-based specialties.

Private equity firm TPG acquires Change Healthcare’s ClaimsXten claims-editing business for $2.2 billion as part of the terms of UnitedHealth’s acquisition of Change.

Health information management vendor ScanSTAT Technologies reportedly puts itself up for sale. It acquired competitor Resolve ROI in August.

Nordic Consulting acquires Hygeian, a healthcare consulting and staffing firm that serves customers in the UK and Middle East.

Healthcare automation company Olive will sell its population health management and 340b program assets to Rotera. The move is in keeping with its decision earlier this year to streamline its offerings. Olive launched Rotera, which also offers healthcare automation software, out of its venture studio in 2021.

Sales

• Acute Behavioral Health (TN) will use Owl’s measurement-based care software to help its staff track patient progress and quantify treatment effectiveness.
• Virtual primary care vendor CirrusMD selects NeuroFlow’s behavioral health-focused clinical decision support, intervention services, and patient engagement capabilities.

People

Chesapeake Regional Information System for Our Patients promotes Craig Behm to president and CEO of CRISP and CRISP Shared Services.

Announcements and Implementations

The SSI Group leverages Myndshft’s automated prior authorization software to power its new PA technology.

CommuniCare implements EClinicalWorks across its 22 sites in Texas.

Google Cloud announces GA of its new AI-enabled Medical Imaging Suite.

Birmingham and Solihull Integrated Care System, Coventry and Warwickshire ICS, and Herefordshire and Worcestershire ICS implement InterSystems HealthShare.

Littleton Regional Healthcare (NH) goes live on Oracle Cerner’s Community Works EHR.

WVU Medicine adds Findhelp’s social and human services search tool to its Epic patient portal.

Nym makes its medical coding engine available to radiology departments.

LexisNexis Risk Solutions launches the Gravitas Network, a clinical research data hub incorporating de-identified data sets from PointClickCare, Ovation, Solis Mammography, health systems collective Truveta, and the Institute for Health Metrics.

Software development company Academy Medtech Ventures implements Clearwater’s ClearAdvantage managed cybersecurity and compliance services.

Government and Politics

CMS solicits feedback on the idea of developing a national directory of healthcare providers and services.

Privacy and Security

CommonSpirit Health facilities in Iowa, Nebraska, Tennessee, Virginia, and Washington continue to deal with the effects of Monday’s unspecified IT incident, which impacted several enterprise systems, including its EHR. Local news reports say that many CommonSpirit sites in those states have reverted to paper-based procedures, diverted ambulances, and postponed appointments.

Sponsor Updates

• CereCore staff volunteer with the Utah Food Bank and Nashville-based Pencil.
• CHIME releases a new Leader to Leader Podcast featuring Clearsense President Kevin Field.
• EVisit ranks among the top three telemedicine vendors for customer satisfaction, according to a JD Power study.
• Net Health integrates Alinea’s workflow automation and patient and family engagement capabilities with its Therapy for Senior Living software.
• Experity encourages urgent care leaders to submit nominations for its annual Industry Limelight Awards through November 14.
• LexisNexis Risk Solutions publishes a new customer success story, “VGM & Associates and Its Members Increase Market Share and Improve Sales Targeting.”
• Lyniate publishes a new case study, “Greater Bristol Connecting Care underpins Exemplar status with Lyniate EMPI by NextGate for identity data management.”
• Medicomp Systems releases a new Tell Me Where It Hurts Podcast featuring CHIME VP of Public Policy Mari Savickis.
• Meditech adds sepsis detection tools to its Sepsis Management Toolkit.

Blog Posts

• Four Easy Ways to Protect Yourself Online (Fortified Health Security)
• Bring Your Own Device: The Evolution of Patient Engagement (Get Well)
• How Can Supply Chain Do More with Less in the Face of Unprecedented Turnover? (GHX)
• Hire a Consultant for IT Changes and Keep Your Hospital Running Smoothly (HealthTech Resources)
• Souped-Up Search Results: How They Save Clinicians Time (Healthwise)
• Path to Patient Empowerment: Why Healthcare Must Break Data Silos (InterSystems)
• A Q&A with IMO: NextGen and EHR workflows (Intelligent Medical Objects)
• Digital Self-Service: A Must Have for Consumers (Kyruus)
• Healthcare Cybersecurity Awareness Resources (LexisNexis Risk Solutions)
• 3 Major Healthcare IT Security Topics for 2023 (Medhost)
• A new era of health IT transformation revealed at Meditech Live (Meditech)
• Productivity: Why This KPI Matters for Skilled Nursing Rehab Therapy Teams (Net Health)
• Ambient clinical intelligence (ACI) – what it is and why you need it (Nuance)
• Telehealth and LTPAC Part 1: Making Virtual Care a Reality Beyond COVID-19 (Netsmart)
• De-implementation: “Just say no” isn’t enough (Nordic)
• Three potential patient safety risks that can be addressed through technology (Wolters Kluwer Health)

Contacts

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

EPtalk by Dr. Jayne 10/6/22

CMS has released a Request for Information on the idea of a national directory of health care providers and services. The announcement notes that such a compilation might “help facilitate care coordination, health information exchange, and data reporting efforts.” They note, “We envision that an NDH [National Directory of Healthcare Providers and Services] could serve as a centralized data hub for providers’ directory and digital contact information, which would contain accurate, up-to-date, and validated data in a publicly accessible index.” On the surface, this seems like a good idea, until one realizes that there have already been efforts to attempt to create a master database.

My current CMS provider records contain a practice address where I haven’t worked since 2011 despite multiple attempts to update it, so I’m not optimistic about efforts to maintain yet another database. It would also be difficult to account for the information for physicians and other providers who work part time at different institutions, which can be common for certain specialties or classifications of physicians. For example, faculty physicians at my academic medical center might have separate practices (complete with separate billing and communications information) at the faculty practice, the residency practice, the hospital service, and the local Veteran’s Affairs clinic. Similarly, many physicians “moonlight” or pick up extra shifts via urgent care or telehealth companies, so that will add to the confusion. The public comment period ends on December 6, so be sure to submit your thoughts.

The concept of patients calling physicians by their first names is always a hot topic in the virtual physician lounge so I was glad to see this research letter published this week in JAMA Network Open. In the introduction, the authors note the sentiments shared by many physicians, that using the title “doctor” helps in “acknowledging the physician-patient relationship, signifying respect for physicians, and following established social norms.” They mention the results of two previous related studies – one that found that almost three out of four physicians were called by their first name, with 61% finding it annoying, and another that found that having “DOCTOR” boldly indicated on ID badges was associated with fewer episodes of misidentification among female physicians and physicians in underrepresented groups. With that background, the authors set about determining the factors associated with use of the physician’s first name in patient portal messages.

The authors performed a retrospective review of patient messages in the Mayo Clinic EHR from October 1, 2018 to September 30, 2021. Natural language processing was used to identify the greeting and/or closing salutation and those phrases were classified according to formality. Patient demographics (age, gender) as well as physician demographics (age, gender, degree, training level, and specialty) were all identified. The authors found that female physicians were twice as likely to be called by their first names after controlling for other factors. Physicians with a DO degree were also more likely to be called by their first name, as were primary care physicians. Interestingly, female patients were less likely to use their physician’s first name. There was no difference based on patient or physician age or physician training level.

The study has a few limitations noted by the authors, including inability to control for physicians who may prefer to be addressed by their first names or for cultural/racial/ethnic nuances in greetings. The dataset was also from a single health system, so might not be applicable to other organizations. It would be interesting to see how these factors play out in different regions across the United States, since there are definitely nuances in how people are addressed regardless of whether they’re physicians or not. I’ve been called everything from “ma’am” to “y’all” to “sweetie” to “hey yo” to things that are not fit to print while practicing my physician trade, so I’m guessing there might be variation on professional titles as well. I’m currently following a thread in a CMIO group about patient portal messages and which state might best exemplify “upper Midwest nice,” so there’s definitely a physician perception of regional variability.

The authors note that “whether being informally addressed by other medical professionals or patients, untitling (not using a person’s proper title) may have a negative impact on physicians, demonstrate lack of respect, and can lead to reduction in formality of the physician-patient relationship or workplace.” They go on to state that organizations need to focus on a supportive culture and that guidelines, practice changes, or patient education may be needed. The idea of lack of respect is a common sentiment around the virtual water cooler, but times are changing and, at least in the US, social norms feel far more casual than they did a decade ago. I’ll be interested to see what kinds of comments might be added to the article since it’s so new. Responses have been mixed on several platforms that have posted articles referencing the study.

Regardless of title, role, or status, it’s always a good idea to ask people what they prefer to be called, and to discuss if you feel the need to call someone something different than what they request. I’ve worked with seasoned nurses who actively struggle with the idea of calling physicians by their first names even when asked to do so, and in those cases I’m not about to force the issue. Similarly, I wouldn’t dream of calling an adult patient by their first name without their permission, and am happy to note individual preferences on the patient chart. Half the time I refer to pediatric patients by formal titles just to make them laugh since they’ve likely never been called “young Master Johnson” or “my dear Miss Jones,” and it’s fun to watch their faces. I rotated in the UK many years ago and did enjoy the certain level of formality at my practice site where everyone referred to each other as “Nurse Thompson” and “Dr. Jones” and “Trainee Jayne,” but I don’t know if that style has remained.

Does your organization have a policy on title use, or is it anything goes? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 10/6/22

PatientPoint Acquires Rendia to Accelerate Expansion into Ophthalmology Specialty

Patient engagement vendor PatientPoint acquires eye care-focused competitor Rendia for an undisclosed sum.

Drummond Group Introduces Pediatric Health IT Certification Program

Drummond Group, the certifying body for ONC’s Health IT Certification Program, launches a Pediatric Health IT Certification program to help health IT vendors advance pediatric EHR capabilities.

TPG seals $2.2B deal for ClaimsXten

Private equity firm TPG acquires Change Healthcare’s ClaimsXten business for $2.2 billion as part of the terms of UnitedHealth’s acquisition of Change.

Readers Write: Taking Clinical Natural Language Processing Mainstream for Effective Care Management

Taking Clinical Natural Language Processing Mainstream for Effective Care Management
By Kevin Agatstein

Kevin Agatstein is CEO of Kaid Health of Boston.

Across healthcare, clinical natural language processing continues to play an ever more influential role. Kreimeyer et al.’s “Natural language processing systems for capturing and standardizing unstructured clinical information” identified over 70 different CNLP systems in the literature, spanning multiple clinical domains. Unfortunately, few of these directly address the applicability of CNLP to care management. This lack of CNLP supporting care managers will and should change. Making this reality will require adapting the technology to the real-world needs of care management programs and the front-line clinicians who staff them. 

To fuel effective care management, actionable data is required across the entire workflow. Examples of actionable data include information that: 

• Identifies which patients require help.
• Stratifies patients for intervention.
• Summarizes the patient for the care manager.
• Determines the specific actions the patient needs.
• Uncovers the barriers to effective care.
• Measures intervention outcomes.

Claims data, lab data, health risk assessments, and motivational interviewing all meaningfully contribute to the above. While all of these are necessary, alas, they are not sufficient. For the care manager to meaningfully coordinate patient care, to accomplish the six steps listed above, they must have access to actual clinical data. They need the medical record. More precisely, they needs the nuggets of actionable insights buried in the massive EHR data set. Finally, they need it to be quickly digestible. Thus, CNLP can not only help, it is all but required.

This actionable data is almost all in the EHR; however, it can be hard to find. A patient’s medical record is often hundreds of pages of text, alongside hundreds of discrete data points (labs, medications, allergies, etc.) Within this morass of usually loosely organized data is the patient’s health history. While claims and labs can give some sense of the patient’s clinical experience, the chart has the diagnosed but not coded conditions, the written but not filled prescriptions, and more. It also has a plethora of exam findings, laboratory reports, radiologic data, and pathology findings that never get put into “structured” EHR fields.

Kharrazi et al., in “The Value of Unstructured Electronic Health Record Data in Geriatric Syndrome Case Identification,” found that the EHR text resulted in finding 1.5 times more patients with dementia than just reviewing the structured EHR data. That same ratio was 1.7 with decubitus ulcers, 2.9 for weight loss, and 3.2 for a history of falling.

Beyond traditional clinical data, the chart often contains insights into the patient’s family health history. It also has data on psychosocial barriers to care, limitations on activities of daily living, and other elements impacting the patient’s care journey. Just as crucial for care managers, the chart typically has data on the patient’s social determinants of health. While SDOH are almost never coded in claims, (and yes, there are ICD-10 SDOH codes), they are noted in charts. AI-powered healthcare data analysis and provider engagement platforms have found hundreds of SDOH in primary care, specialists, ED, and behavioral health charts. Kharrazi found similar results. For example, they found that it is 456 times more likely to find a patient with a “lack of social support” in the free text of the medical note than in the structured data.

For a care manager to do their job well, this data cannot be ignored.

More than just summarizing the patient’s health, the medical record can help translate the EHR text into a structured, actionable, trackable ambulatory care plan by summarizing the physician’s treatment plan noted for each encounter. Specifically, NLP can create a patient to-do list such as follow-up visits, getting testing or labs, addressing unhealthy behaviors, and more. These identified tasks can become the basis of a care management care plan or added to existing plans. As new data enters the chart, either as structured information or new medical notes, the to-do list can be updated. Tasks can be marked as completed, new tasks added, existing tasks amended, and more.

It’s important to remember that NLP algorithms do not digest a medical note the way a human does. Rather, they predict how a trained human would interpret the presented text. This is much more than finding key words. CNLP solutions also need to account for:

• Negation (“does not have cancer”).
• Family history (“the patient’s mother had an MI before age 55”).
• Uncertainty, (e.g., “initial lab findings mean early-stage chronic kidney disease possible, but additional testing is needed”).
• And more.

Making such determinations isn’t perfect, but making useful interpretations of clinical text has been proven possible. Moreover, CNLP does not fatigue as humans do. For example, Suh, et. al. found in “Identification of Preanesthetic History Elements by a Natural Language Processing Engine” that CNLP frequently identified salient clinical facts that a physician reviewer missed. 

Now, new data standards, notably FHIR, and regulatory mandates to share data combine to markedly simplify a CNLP deployment process. This, plus cloud and other emerging data exchange standards, mean CNLP go-lives can be measured in days, not months. By working with partners with rigid technological and workflow controls, extensive security training, and a culture of data security, the data can be processed safely as well.

For a real-world deployment, a care management CNLP solution should be intuitive to clinicians. It should be focused on the needs of care managers to anticipate the workflow. Care managers today deal with several different medical record and care management documentation systems. Effectively managing these variations, and the vagaries of existing workflows, comes only with experience. Most importantly, CNLP needs to add value for the user practically out of the box. They can, and they will.

Readers Write: Diagnostically Connected Data – The Key to EHR Clinical Usability

Diagnostically Connected Data: The Key to EHR Clinical Usability
By Dave Lareau

Dave Lareau is CEO of Medicomp Systems of Chantilly, VA.

Clinicians are among the most highly trained knowledge workers in any industry, yet the systems they use to care for patients often actually hinder their ability to deliver care. We hear anecdotes from patients about clinicians spending inordinate amounts of time trying to find information in their EHRs – only to often give up rather than search through other sections of the chart to find a lab result, view past encounter notes, or try to correlate medications with problems or the course of a condition.

EHRs require users to spend too much time searching for clinically relevant information for the patient they are treating and, once that information is located, to go through a series of disconnected processes to complete their work.

This situation will only get worse once the floodgates of healthcare data interoperability are opened. Then, it will be even more challenging for clinical users to find what they need.

Consider the bright side of this data-driven conundrum: The effects of the 21^st Century Cures Act and TEFCA will make it easier for HIT systems to send and receive information. Plus, emerging terminology standards and the use of common codes such as ICD-10, SNOMED, LOINC, RxNorm, CPT, DSM5, CTCAE, UNII, CVX, and others will provide a basis for what is often called “semantic interoperability.” And today, the performance of natural language processing is getting more consistent and reliable, providing a means to convert free-text notes that use those same terminologies and codes.

So, does that mean that more coded data is a good thing?

Not necessarily – that is, unless clinicians can readily locate the information they need to assess, evaluate, treat, and manage a given patient and their clinical problems. With the widespread adoption of risk-based reimbursement through Medicare Advantage and similar programs sharpening the focus on chronic condition management, it will be increasingly crucial for clinicians to see a diagnostically focused view for each patient along with their medical problems. They need instant access to this view, without searching through disparate sections of the EHR.

Semantic interoperability facilitated by standard terminologies and code sets is a great start – and is necessary for sharing clinical information between systems. It will also drive better analytics and population health insights. But it will not make it easier for clinicians to find the data they need for the patient at the point of care (whether that patient is in-office or on a screen.)

Most existing EHRs, and the terminologies and codes for semantic interoperability, are structured in distinct “domains.” In an EHR, this typically shows up as separate sections or tabs – problem list, medication list, laboratory orders and results, procedures, encounter notes, discharge summaries, etc. Problems, meanwhile, have ICD-10 and SNOMED codes, labs have CPT and LOINC codes, medications have RxNorm or NDC codes, and other domains use other code sets. These codes were designed for their specific domain. They were not designed to work together for the clinical user.

The key to usability is to link these to the problem list, so that the user can click on a problem and immediately view the related medications, labs, procedures, therapies, co-morbidities, and findings from encounter notes that all are related to the problem. This diagnostically filtered presentation could be viewed longitudinally and supported by millions of mappings from standard terminologies and code sets.

Such a unique diagnostic relevancy engine would provide both the semantic – and diagnostic – interoperability that enables clinicians to not only see what they need at the point of care, but also to harness the flood of interoperability-driven data that will soon complicate their work.

Morning Headlines 10/5/22

Paper charts, canceled appointments at VMFH clinics, hospitals as network outage drags on

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Epic overhauls popular sepsis algorithm criticized for faulty alarms

STAT reports that Epic now recommends that its sepsis prediction model be trained on a hospital’s own data before clinical use, and that the company has changed its definition of sepsis onset to a more commonly accepted standard.

Smile CDR Rebrands to Smile Digital Health

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The Way Forward for Mental Healthcare: A Message from Dr. David Mou, CEO, Cerebral

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