Readers Write: Healthcare Technology To-Do List: Make Data Valuable for Providers

Healthcare Technology To-Do List: Make Data Valuable for Providers
By Kevin Coloton

Kevin Coloton, MPT, MBA is founder and CEO of Curation Health of Annapolis, MD.

Following my time at HIMSS ’24 and RISE National, I’ve noticed that the healthcare industry considers the maturity of health data exchange as a mission accomplished, when in reality, we are drowning providers in data that’s not usable.

Health plans and other enterprises previously had tons of data that they kept locked away. Now they are touting that they have opened the valve and data is flowing freely to the electronic health record (EHR) for health systems and providers. The problem is that healthcare providers are now drowning in data, making it almost useless. They’ve been given the full clinical encyclopedia when all they need is the CliffsNotes summary of the patient’s priorities.

There’s a huge difference between clinical data exchange and clinical insight delivery. When we step back and look at the problems that we are attempting to solve, it is discerning which data insights are actionable to improve patient care encounters, value-based care (VBC) performance, and health outcomes. The synthesis of the massive data set into actionable priorities is what’s needed. For example, knowing the top three data insights that will be most valuable for each patient during the provider’s 10-minute care encounter.

We need to help healthcare providers contextualize data for each patient. A technology “clinical insight” layer is needed within the EHR to deliver the most relevant and impactful insights from the data set to maximize provider engagement. This efficient use of actionable data can superpower provider workflows by reducing the work load of reviewing a full library of patient data and enhancing the value of time spent with patients.

Managing thousands of patients across an entire calendar year requires an overwhelming amount of data. Other industries, such as retail and ecommerce, have matured faster to accommodate the data than healthcare because we are early on our journey around what’s important for technology integrations. As a healthcare technology industry, we’re still in this era of what is best described as data maximalism, getting so excited about the potential value of a massive data set, which is further complicated by having health plan data being sent to provider EHRs and dumping the data into a giant repositories like data lakes.

From an operational standpoint, healthcare decision makers and information technology leaders are challenged with managing the tsunami of patient data, which is often just pushed directly into provider workflows. However, we must focus our efforts on delivering the highest impact data at the point of care. Those curated data points will be the most important items to focus on during a patient’s care encounter, particularly in a VBC model. When physicians are using great insight and act on it accordingly and compliantly, the patient receives more holistic care, the provider gets an accurate representation of the acuity of their patient, and reimbursement is appropriate based on the clinical risks that are associated with the patient.

To succeed in healthcare’s VBC environment, we must shift gears to a data minimalism approach. This is a strategy with the objective of synthesizing massive amounts of data and ultimately delivering the minimum amount of data required to benefit the frontline healthcare professional in managing a patient’s health. The approach rewards providers with more time for direct patient care, which is the most constrained element of the healthcare equation.

To achieve this result, EHR technology integrations can be deployed that utilize artificial intelligence (AI) and offer relief to clinical and administrative teams for risk-based documentation and coding activities. When looking for the best-fit technology provider, healthcare teams must understand that the goal is not to add more clicks, but to superpower the humans who are already doing their daily jobs.

AI and has made leaps and bounds in healthcare to scale the impact of data analysis. AI-powered technology can transform data into user-friendly formats and then analyze that data against established clinical and quality rules to identify both known and previously undiscovered patient needs. For healthcare provider groups and health insurers that are looking to gain actionable insights from their data sets, they should seek a technology platform that can harmonize patient data into actionable insights so that the information can flow both ways, from a plan to a provider and from a provider to a plan. That way, providers can enhance their partnership with payer organizations to better manage and optimize patient care.

The main takeaway? Using technology to curate data is not intended to replace the human expert in the equation. It should superpower that human expert to achieve scalability and better outcomes. By allowing providers to practice at the top of their license and engage more with the patient because they’re not logging into their records to flip through pages and pages of lab results, medication lists, past visit notes, and specialty referrals, we are succeeding in delivering efficient, effective, and high-quality care. Providers should be able to leverage a curated data set from the EHR to organize information to make it actionable and amplify their true expertise.

Readers Write: Healthcare IT Commercialization Success: Sophisticated Markets Require Sophisticated Strategies

Healthcare IT Commercialization Success: Sophisticated Markets Require Sophisticated Strategies
By Dean Kaufman

Dean Kaufman, MS is founder and CEO of Healthcare Service Consultants of Millburn, NJ.

About 75% of US-based healthcare IT start-up companies fail. That’s a shocking statistic.

Many blame lack of long-term funding. In reality, the failure can often be tied to not providing hard evidence of value and lack of understanding financial drivers. While these companies develop complex, sophisticated products to meet highly specialized needs of healthcare end users, their go-to-market strategy often follows the old “if you build it they will come” approach.

This just doesn’t work. Nor do common B2C and B2B commercialization strategies. Healthcare IT and digital health companies need a well thought out commercialization strategy that is tailored to meet the demands of a complicated and specialized buyer who is risk averse. This becomes even more difficult when a novel solution touches more than one clinical specialty.

The commercialization strategy for a healthcare IT or digital health company must include the following.

Step 1 – set the stage

Before launching the product, many pre-commercial activities need to occur. These activities center around market understanding and developing the proof points that are necessary to establish credibility and interest across clearly defined target audiences. Activities include:

• Establishing pilot sites. Early adopters can provide real use case examples and proof points to support claims. Pilots go beyond clinical trials or validation projects. They exist in live clinical settings that can prove tangible ROI.
• Understanding the sales cycle. In healthcare IT, sales cycles are often longer than expected. It’s important to understand buying cycles and who the decision makers and influencers are.
• Identifying what’s needed to support sales. Healthcare IT often requires a sales support team that can answer complex clinical, workflow or technical questions related to the deployment and use of the product.
• Supporting customers. Ensuring a smooth and timely implementation that results in a delighted customer is critical. but it’s often an underappreciated step in commercialization success. A team with the appropriate skills should be hired as developers typically do not have the people and workflow skills.
• Meeting regulatory requirements. Some healthcare IT solutions need to prove safety and efficacy via a 510(k). In addition, marketing teams need to discern what claims can and cannot be made before and after receiving official clearance.

Step 2 – develop and implement an effective sales strategy

Let’s be honest. No company in this space is selling their products on Amazon or Etsy. With complex healthcare IT products, a direct sales strategy is typically best. It results in complete control over the customer relationship and provides the best opportunity to gain an understanding of customer needs.

In some situations, a channel partnership strategy can be beneficial, especially when the product complements, augments, or can be embedded in another existing system. If pursuing a channel partner strategy, remember that ongoing training and support of the partner sales force is critical.

Step 3 – set realistic sales targets

Sales projections are an important component of a commercialization strategy. Take into account third-party market data as well as soft data such as sales and budget cycles, the prioritization of the challenges addressed by the product, and the complexity of the sale. Many large companies pulled out of the healthcare vertical because they could not realize revenue targets in the projected time frame.

Step 4 – establish a clinically-focused product awareness and demand generation program

A product marketing program that leverages early customer success in the clinical setting is key. These case studies should be leveraged to generate awareness of a solution’s value.

These go-to-market activities should start 12 to 24 months before the planned launch date. This affords enough time to gather proof points, establish a viable sales strategy and forecast, and generate market awareness and demand.

Healthcare IT companies need to have the internal or external talent required to bring these strategies to fruition. When it comes to product marketing in this space, the key to success lies in the ability to authentically connect with target audience. This not only requires content and outbound product marketing strategies that resonate with a sophisticated audience, it also calls for leadership that understands the clinical workflows and problems facing key decision-makers.

To truly connect with a target market, position the company as a thought leader by:

• Keenly focusing on developing messaging and content that reflects the lived experiences of target audiences. Content needs to build the credibility necessary to move prospects beyond awareness and build genuine interest in products and solutions.
• Demonstrating an understanding of clinical and technical challenges  and how the company’s innovation could solve them. Some startups mistakenly prioritize impressive leadership resumes over direct experience to impress potential investors.
• Understanding the unique pain points of healthcare organizations, leaders, and end users. For example, marketing teams need to create campaigns and materials that expressly illustrate how healthcare CIOs are concerned with issues such as cybersecurity, staffing, and systems integration, while radiology directors are fretting over employee burnout, quality of care, collaboration with clinicians across the spectrum, optimal dosing, and patient safety.
• Tapping into clinical knowledge. Such intelligence makes it possible to clearly communicate the value propositions of products and how they fit into clinical workflows or integrate with peripheral systems and devices.

When outsourcing marketing functions, it is important to ensure that potential partners have the needed clinical domain as well as product marketing understanding. For instance, a small company focusing on medical imaging should prioritize hiring a product marketing agency with a deep understanding of this specific clinical domain. This ensures that the messaging is effective and resonates with the target audience.

Healthcare IT marketing leaders and teams need to convey a depth of industry knowledge that resonates with a risk-averse, critical, and educated healthcare audience. This ability is far more important than experience in other industries or jumping on marketing trends that are prevalent in consumer or other commercial circles.

Readers Write: Making the Right Choices for Hospital Virtual Care Technology

Making the Right Choices for Hospital Virtual Care Technology
By Brad Storm

Brad Storm, MS is VP of technology and integrations at Sonifi Health of Sioux Falls, SD.

No healthcare strategy includes adopting a new initiative under duress. But that’s exactly what many hospitals had to do in the face of COVID-19, when clinicians were desperate to communicate safely, quickly, and effectively with patients and their families. Trying to adapt the ideas from at-home telehealth with whatever technology was easy to get — often simply consumer-grade tablets or video monitors — became the hasty foundation for what virtual care in a hospital setting could be.

Those early days of virtual care in inpatient environments brought a lot of good lessons about what’s reliable, what’s scalable, what’s effective, and just as important, what’s not.

In the years since, hospital executives now have a beat to create long-term strategies for virtual care. Here are some critical questions to consider for hospitals to implement the best inpatient telehealth setup.

What do your nurses have to say?

Nurses are frequently the ones tasked with facilitating virtual care calls. Talk with them about how this affects their workflows. Do they feel they’re losing clinical time coordinating calls, or are they being more efficient with their workload?

What kinds of tasks could be shifted to be virtually done from a command center? Examples: admissions interviews, education and medication review, observation rounding, and discharge instructions.

What equipment do they recommend for ease of use and reliability?

Involving your nurses in your virtual care decisions is critical to supporting them and addressing some of the issues that come with staff shortages, burnout, and inefficient processes.

Give them a voice, and listen to their suggestions. They’ll be much more likely to embrace a strategy and adopt initiatives they are part of from the beginning.

What are your patient demographics?

Think about the digital health literacy of the populations you serve, what kinds of technologies they’re familiar with using, and if common physical or mobility issues exist that may affect their ability to interact during a virtual care call.

For many acute care hospitals, more than half of their patients are 60 and older. In children’s hospitals, the pediatric patients’ caregivers tend to be younger and are typically quite tech savvy. Like the staff who will be using your virtual care solution, take the patients who will be using it into consideration, too.

Patient experience professionals will have great insight into the kind of setup that patients, and their families, will be most comfortable with and willing to use.

What equipment and infrastructure are needed?

With input from the people who will be using virtual care, start to narrow down the technology needed to make it successful, sustainable, and within your budget.

If you already have hardware in patient rooms, such as a television, can it be used for your virtual care setup? If you’ve been using tablets, are they working well, or is there a better alternative to think about?

Talk with providers and clinicians about the kind of camera and microphone capabilities they’ll need for the use cases they’ll be part of. Can the camera be controlled to zoom in to specific areas of the room? Is the microphone sensitive enough for ambient listening?

Should there be something permanently mounted in each room, or are mobile carts the best option?

Once the equipment is decided, make sure you have the infrastructure to support it, including access to power and secure network connectivity.

How does the solution integrate with your other systems?

Interoperability is a major part of a successful long-term strategy for virtual care. Like any technology system, virtual care can be most effective if it integrates with workflows your staff already use, especially for EHR, scheduling, education, screenings, and discharge. Integrated systems will make it much easier to scale and standardize enterprise-wide going forward.

For example, if you have an interactive patient engagement system in patient rooms, all the systems can link together on one platform, drastically simplifying where clinicians have to log in for patient care, as well as how patients can access the information, education, and consultations they need.

Virtual care is becoming part of a standard smart hospital room, so creating a cohesive and seamless experience on the user end will vastly improve its value.

How will you track effectiveness and ROI?

Adding technology to a hospital setting is never a small feat. Make sure your virtual care investment is worth it by identifying how you will track its effectiveness, how you plan to roll it out.

Will you have access to data and analytics about virtual care encounters? Professional and anecdotal insights about use cases? Consultations about ongoing optimizations?

Is there a specific unit or use case you will pilot your virtual care technology with first? What’s the go-no go plan for rolling out to other areas? What’s the role of virtual care for both your short-term goals and long-term goals?

Having the right people in the conversations as well as the right technology in the spaces will be key to making sure your virtual care strategy is the most beneficial for your clinicians, patients, and families, both now and in the future.

Morning Headlines 4/29/24

Teladoc Health Inc. (TDOC) Q1 2024 Earnings: Misses on EPS, Surpasses Revenue Expectations

Teladoc Health reports Q1 results: revenue up 3%, EPS –$0.49 versus –$0.42, beating revenue expectations but falling short on earnings.

Federal rule banning noncompete agreements could give Wisconsinites more job mobility

An Epic spokesperson says that the company agrees with FTC’s regulation to end the use of non-compete agreements as long as the agreements weren’t created to protect intellectual property.

OMIS-A Starts New Chapter

The US Army celebrates the replacement of its MC4 battlefield EHR with Operational Medicine Information Systems – Army (OMIS-A).

FTC Finalizes Changes to the Health Breach Notification Rule

The Federal Trade Commission finalizes changes to the Health Breach Notification Rule that requires vendors of health apps and related technologies to notify individuals, the FTC, and the media if personally identifiable health data is exposed.

Monday Morning Update 4/29/24

Top News

Teladoc Health reports Q1 results: revenue up 3%, EPS –$0.49 versus –$0.42, beating revenue expectations but falling short on earnings.

Shares dropped slightly on the news. They are down 53% in the past 12 months versus the S&P 500’s 23% gain, valuing the company at $2.2 billion. From the earnings call:

• The company says AI will help the company engage with members.
• Its BetterHelp online behavioral health business continues to be challenging as both user count and revenue dropped year over year, although Teladoc has replaced its leadership, hopes to see improvement later this year, and will continue selling only via direct-to-consumer.
• Teladoc says interest is growing in its weight management business and the new members that it brings creates cross-selling opportunities.
• The company says that the it has seen no impact in the former Livongo business from Peterson Health Technology Institute’s critical review of the value of digital health solutions, continuing to be believe that Teleadoc’s chronic care programs provide clear ROI.

Reader Comments

From VendorVP: “Re: Steward Health Care. Wonder what Meditech will do when Steward goes bankrupt and stops paying their invoices?” Steward completed its 18-hospital Meditech Expanse implementation in mid-2022.

HIStalk Announcements and Requests

Most poll respondents, including me, believe that the VA will continue their Oracle Health rollouts this year. Straddling two systems is not sustainable and the VA can’t risk giving Congress more reasons to criticize it.

New poll to your right or here: What effect will the elimination of non-compete agreements have on your present job?

Webinars

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

Acquisitions, Funding, Business, and Stock

An unnamed Epic spokesperson says that the company agrees with FTC’s regulation to end the use of non-compete agreements as long as the agreements weren’t created to protect intellectual property. I’m reading between the lines in concluding that Epic thinks its own non-competes are fine but is happy that chain restaurants can’t use them to limit the careers of sandwich assemblers.

People

Paula Cobb, MBA (Blackbaud) joins AvaSure as VP of marketing.

Amy Rettler, MS (TheraManager) joins Evergreen Health Partners as SVP of EHR solutions.

Announcements and Implementations

The US Army celebrates the replacement of its MC4 battlefield EHR with Operational Medicine Information Systems – Army (OMIS-A).

Government and Politics

FTC Chair Lina Khan warns that healthcare price fixing could be accomplished without back-room deals by using AI algorithms to set prices without undercutting each other. FTC is also looking into the possibility that companies could use AI to set prices dynamically for individual consumers.

The European Parliament approves the European Health Data Space, which will allow cross-border sharing of electronic health data with patient opt-out and give researchers who are issued permits to access to de-identified patient data. Covered data sources include EHRs, disease registries, claims data, prescription dispensing, genomic information, social determinants of health, environmental factors, and the output of medical devices and health apps. Click the graphic above to enlarge.

Privacy and Security

The VA notifies 15 million veterans that the Change Healthcare ransomware attack may have exposed their health information.

The Federal Trade Commission finalizes changes to the Health Breach Notification Rule that requires vendors of health apps and related technologies to notify individuals, the FTC, and the media if personally identifiable health data is exposed.

Kaiser Permanente notifies 13.4 million current and former members of its health plan that website user tracking tools may have sent their personal information to third-party vendors.

Other

California Nurses Association members picket Kaiser Permanente’s San Francisco Medical Center holding signs that said “Patients are not algorithms” and “Trust nurses, not AI.” The union’s president expressed concern that Kaiser is promoting itself as an AI leader in healthcare, but is likely to use the technology to boost profit rather than to improve care.

Sponsor Updates

• EClinicalWorks will host its 2024 Health Center Summit May 8-10 in Boston.
• Netsmart welcomes Vandoit, which offers mobile vehicles for healthcare, to the Netsmart Marketplace.
• Sonifi Health adds Enghouse Video’s video conferencing technology to its interactive TV systems.
• RxLightning celebrates unprecedented growth and achieves meaningful medication access milestones.
• University medical centers in Germany choose Sectra’s radiology solution to streamline workflows and shorten lead times for patients.
• Spok releases a new e-book, “The Six Strategic Advantages of Consolidated Contact Centers.”
• Surescripts publishes a “QHIN Readiness Guide.”
• Health Data Movers publishes a new episode of its “QuickHITs” podcast with guest Shafiq Rab, MD, MPH, CDO/CIO of Tufts Medicine.
• Symplr adds Branch’s workforce payments software to its Contingent Talent Management platform.
• Waystar will exhibit at the OPIE Software: Driving Practice Success customer conference May 2-3 in Oklahoma City.

Blog Posts

• The IDD Summit Part 3: Expert Panel on Workforce Satisfaction (Netsmart)
• 9 insightful quotes on cloud and AI from Stanford Health Care and AWS leaders at Arab Health 2024 (Nordic)
• Bridging the Workday Skills Gap: A Path to Success with Optimum Healthcare IT (Optimum Healthcare IT)
• The “Whats, Whys, and Hows” of Rebuilding a Healthy Nursing Workforce (QGenda)
• The Impact of Time in Nursing (Symplr)
• Trualta Spotlight: Monique Frahm – Care Educator (Trualta)
• Why Communication is Key for Healthcare Organizations (TruBridge)

Contacts

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

Morning Headlines 4/26/24

Epic Systems is starting sixth campus, and it’s from ‘Other Worlds’

Epic breaks ground on its sixth campus called Other Worlds, which draws inspiration from “The Lord of the Rings” and “The Chronicles of Narnia.”

Health insurance giant Kaiser will notify millions of a data breach after sharing patients’ data with advertisers

Kaiser will notify 13.4 million former and current patients of a data breach that occurred when since-removed tracking code on its website and apps shared patient data with third-party advertisers.

Truveta delivers largest and most complete mother and child EHR dataset to advance healthcare

Truveta publishes a mother-child EHR dataset for research, which includes clinician notes and images from 30 health systems that are linked to claims, SDOH, and mortality data.

News 4/26/24

Top News

Optum shuts down its virtual-first urgent and primary care service, three years after it formed Optum Virtual Care during the pandemic’s peak days.

The company had added a discounted prescription-writing and refill service as part of Optum Perks in January 2024.

Reader Comments

From Oracle of Delphi: “Re: Oracle. Larry Ellison seemed to be riffing off-script when he announced that the company would relocate its headquarters to Nashville.” The company has been holding various events in the city and Larry now says it’s important for the company to be located in healthcare-centric Nashville. He made that surprising announcement during a fireside chat at the company’s healthcare conference, which must have driven its unprepared PR people crazy. I’m surprised that the tiny Cerner tail is wagging the massive Oracle dog, especially since the company – other than Larry – mostly complains that the former Cerner business is not profitable enough, while also surely thinking but not saying that Epic is eating its lunch. The headquarters role is somewhat symbolic, given that Oracle has just 4,000 of its 164,000 employees housed in Austin following its 2020 HQ relocation to there from Silicon Valley. My takeaways:

• This is Larry talking, not an official company announcement. What Larry says doesn’t always happen.
• It could be that the company just wants to take a dig at Austin for some reason or is just incentive-milking given the prestige of having Oracle’s HQ in their city.
• While Ellison said in his surprise proclamation that “Nashville is a fabulous place to live” (note: he doesn’t live there), employees may not be happy to be forced to move there, especially since many of them just moved from California to Texas.
• It’s probably not unrelated that both Texas and Tennessee don’t have state income tax and that quite a few companies are bailing on Austin because of cost that has been driven by high growth.
• I’ll be curious how and when Oracle’s PR people spin this and how quickly the company actually seals the deal by buying or building a headquarters campus.

From Panama Hat: “Re: obtaining your own health records. I am an advanced practice nurse and have had significant issues obtaining my own health records. Especially with M&A, outsourcing HIM request to outside companies, and the lack of access to actual humans. I wonder if in-house IT teams created work flows of the antiquated process involved and validated them afterwards, especially after the hospital merged or outsourced some HIM services.” I don’t have recent experience, although I detailed my frustration with the patient-hostile process way back in 2016, which included a compliant to OCR that they closed in saying that they had provided “technical assistance to the hospital.” Perhaps new information blocking provisions will scare foot-dragging hospitals into doing the right thing and eliminating idiotic policies that require patients to explore the hospital basement to find HIM so they can fill out a paper form in person, or Google an online fax service to (ironically) request electronic copies of their own information. Readers, I would be delighted to hear about your recent experience in obtaining copies of your records, especially if you are still mad about it.

From Mailman: “Re: Epic shutting down data exchange with Particle Health customers that are using it for non-treatment purposes. The wildest example was Integritort, where class action lawyers were using Particle to pull down real-time medical records for lawsuits.” Particle founder Troy Bannister posted a self-righteous LinkedIn diatribe against Epic for closing access to some questionable Particle customers who seemed to be using patient data for non-treatment purposes (which isn’t allowed), but I haven’t heard a peep from him since. My takeaways: (a) it’s pretty easy for Epic to compare which entities are downloading data without sending any back to Epic, which would suggest that those users aren’t actually treating patients; and (b) struggling startups will push ethics aside in favor of plausible deniability (“we didn’t know that our clients were doing anything wrong”) if they gain revenue or investment. Bannister said when he left the company as CEO a year ago that its goal was being refocused to “creating as much value as possible from the growing amount of data we have access to,” which says a lot about trusting startups with healthcare data.

From List Sucker: “Re: Newsweek’s list of best digital health companies. Review their methodology.” Most healthcare company lists are pure clickbait, paid company promotion, or some “content writer” trawling the Internet to make up a worthless and often laughable list (anyone who refers to their pitiful intellectual output as “content” is just trying to fill space for cash). Newsweek’s list of “best” companies looked at financial performance (which is obviously not much of a metric for privately held companies that self-report), website and app traffic data (which is clearly irrelevant), and whatever input Holon IQ chose to provide (its own lists seem to use self-nomination in the absence of auditable company-provided numbers). All companies love being named to “best” lists, even when the award comes from someone who is too ashamed of their criteria to list them, and handing over cash to make the list is not uncommon. The good news is that absolutely nobody cares except company marketing people who report their big win like it came from careful analysis.

From Disruptive Behavior: “Re: readers’ list of realistic first steps to improve US healthcare. Unfortunately ‘realistic’ change means that Congress doesn’t have to act, industry incumbents won’t have their revenue or power reduced, jobs aren’t reduced, and nothing runs afoul of capitalism or the Constitution.” I agree, which is why throwing out great but entirely unlikely options like universal health insurance doesn’t get us anywhere. In the US, healthcare is a right for everyone who sells it.

A recap of Oracle Health Summit this week in Nashville from an attendee

• Seema Verma said that Millennium will be at the center of Oracle Health’s offerings. Product roadmaps have been published, although they didn’t provide them to this group.
• Upcoming products: a payment solution, Oracle Clinical Digital Assistant (expected to GA in a couple of months), public APIs of unspecified variety (addition FHIR APIs, polished up versions of Cerner’s existing ones, use cases not specified).
• HealthIntent has been rebranded as Oracle Health Data Intelligence and has new functionality and user interface.
• A new patient portal will be released this year, with the company saying they have pulled ideas from food and beverage and retail industries.
• Larry Ellison let it slip – accidentally or otherwise – that Oracle’s headquarters will “ultimately” be moved to Nashville. He said it will have a community clinic, a concert venue, a lake, and a pedestrian bridge over the river that will connect the campus to downtown Nashville.
• Ellison took shots at AWS, saying that the Change Healthcare breach wouldn’t have happened if they had been on Oracle Cloud and autonomous databases.
• He says that 50% of Cerner customers have moved to Autonomous Cloud in Oracle Cloud infrastructure.
• The company will add gene sequencing technology to PathNet.
• Ellison says that passwords will be eliminated in all Oracle systems by the end of the year, replaced with passcodes and other authentication methods.
• EVP Mike Sicilia says that the company will focus on a constant stream of incremental improvements rather than large releases and upgrades.
• The consistent theme of attendees per this individual is that Oracle has made big promises and delivered little. Compared to Epic UGM, this meeting had few customers placed front and center, it didn’t offer tangible product previews, and attendees found little to take back home as action items. Oracle had some big names on the panels who tried to seem visionary. Big execs like David Feinberg and Mike Sicilia were accessible and mingling, but that might have been because it was only around 500 attendees.

Thoughts on the FTC’s ban on companies forcing employees to sign non-compete agreements

I received more reader feedback on this topic than any in recent memory. I’ll summarize their thoughts and mine:

• FTC says that 45% of US physicians – as opposed to 20% of American employees in general — are working under non-compete agreements and estimates that healthcare costs will be reduced by $194 billion over 10 years by eliminating them.
• The FTC’s decision will certainly be challenged. It wouldn’t surprise me if Epic gets involved.
• The American Hospital Association loathes the idea, declaring it “bad law, bad policy, and clear sign of an agency run amok” that has ample legal precedent to be challenged. They are particularly galled that FTC would dare regulate “certain tax-exempt, non-profit organizations” whose multi-million dollar executives are among the worst offenders of interfering with a free job market for clinicians to expand their regional and national empires by smothering competitors.

Highlights of the rule:

• It takes effect 120 days after being published in the Federal Register, at which time all existing non-competes – except for those of senior executives who make more than $150,000 and are involved in corporate policy-making – are no longer enforceable. Physicians cannot be excluded from the regulation just because they are highly paid, although health systems might argue that they are involved in corporate policy-making through their medical staff policy involvement.
• FTC urges companies to notify current and former employees that their non-compete clauses are no longer valid.
• FTC clarifies that the popular myth that FTC has no jurisdiction over non-profits is incorrect. It notes that a healthcare system can’t simply hide behind its non-profit IRS status, saying that it will go after organizations that were set up specifically to offer benefits to stakeholders or that have partnered with a for-profit company that gains control of the business. It also says IRS has rejected the non-profit claims of non-profits that pay excessively to executives, founders, board members, families, and other insiders.
• FTC cites precedents by some states that have banned non-competes. It estimates that 58% of non-profits and 19% of government-operated hospitals will likely be covered by the final rule. Its research found that non-competes are almost always used specifically as an unfair method of competition.
• Workers who are contracted by non-profit hospitals from a for-profit staffing company or physician group are explicitly covered by the policy. Their employer can’t use non-competes and their assigned work location is irrelevant.
• FTC says that non-profit health systems that manage to escape FTC jurisdiction will still suffer “self-inflicted damage” because while they can continue to trap current employees with non-compete threats, they will have a tough time recruiting.
• The rule takes a direct shot non-profit health systems that “are operating to maximize profits, paying multi-million-dollar salaries to executives, deploying aggressive collection tactics with low-income patients, and spending less on community benefits than they receive in tax exemptions.”

Additional comments about Epic:

• The company, which requires employees to sign some of the industry’s most restrictive non-compete agreements, has no way to wiggle around this policy as it is currently written.
• However, FTC ruling aside, Epic still controls where former employees (both their own and those who work for client hospitals) can take software-related jobs by controlling access to UserWeb, ongoing training, and certification. It would be difficult for an Epic employee to mount a long-expensive legal challenge of these internal company decisions. If Epic doesn’t want you working for an employer that is included on its long length of “competitors,” you will have a tough time getting hired there regardless of FTC’s proclamations, at which time your only legal recourse is to hire your own attorney to face off against Epic’s. Potential hirers don’t want to poke the Epic bear and FTC rulings won’t change that, except possibly in the part of the rule that prohibits any activity that would prevent worker from seeking a new job or starting a new business (which makes it even more likely that Epic will get involved in the legal debate).
• I believe that Epic’s client contracts preclude their hospitals from hiring employees from other Epic sites except under specific conditions or approvals. I don’t know if those terms violate the FTC’s regulation since the agreement is between the two companies, with no involvement and perhaps no knowledge by the employee.

Healthcare impact, assuming that the regulation stands after inevitable challenges:

• A huge chunk of America’s doctors and other clinician can now change jobs freely and will likely do so. Health systems can no longer strong-arm them into staying and instead had better start addressing their clinical and employment issues since a hospital without doctors and nurses is just a massively expensive, poorly run hotel.
• Doctors who are disgruntled at being stuck working for Optum or other companies that bought their employers are free to leave the building.
• The worst outcome would be if lobbyist-heavy “non-profit” health systems manage to evade the rule and for-profit medical practices don’t, which would allow hospitals to continue to kill off private practices. FTC’s estimate that up to 40% of hospitals don’t fall within their jurisdiction is troubling.
• The regulation calls into question the practice of health systems with multi-billions of dollars in revenue, executive offices filled with million-dollar employees, and market control that spans ever-widening geographic areas should be allowed to hide as non-profits under IRS rules and therefore tie their current stable of doctors to existing agreements to prevent them from taking better jobs.
• Vendors and start-ups will be challenged to see their IP walking out the door in the form of free-market employees who move to competitors mostly because of what they know about their former employer. They are also free to start their own competing firm in using that information.
• Companies can continue to use non-disclosure and confidentiality agreements to protect their IP, and the wording and deployment scope of those might be expanded.
• It’s a good time to be a healthcare recruiter, especially of physicians.

Lawyers or policy wonks – what will FTC’s enforcement mechanism be? Does it have to sue the violator, or will the employee have to file their own lawsuit and then have FTC join? Assuming it can address civil contempt and civil penalty actions, how likely is FTC to quickly intervene with and then resolve the large number of employee complaints that it will receive? Hospitals don’t worry too much about most regulatory issues that don’t involve CMS payment threats, especially if the financial benefit of ignoring the requirement is greater than paying the fine.

HIStalk Announcements and Requests

Three companies reached out in the past week to ask about their sponsorship, only to find that it expired long ago because our company contact had left and nobody else returned our reminder emails. Hint: if your company isn’t listed under Sponsor Quick Links on the right side of the desktop version of the web page, you aren’t a sponsor. Fortunately, the fix is simple — contact Lorre.

I focus on reporting industry news instead of creating videos, podcasts, or self-congratulatory social media campaigns. However, I might be overlooking the value of using LinkedIn to stay in touch with HIStalk readers. Question: if you were me, would you hire someone part-time or contract who knows LinkedIn well to more actively use that channel, even if they aren’t health IT experts? I don’t like the idea of just shouting “Hey, I’m here” in hopes of drawing clicks, but perhaps some of what I’m already doing could be made more accessible there.

Webinars

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

Acquisitions, Funding, Business, and Stock

98point6, which previously operated as a virtual primary care provider and then sold that business to Transcarent to focus on selling its software, lays off what appears to be most of its employees who remained after previous headcount reductions. The company bought chat-based telehealth provider Bright.md in January 2024 and had raised $300 million of venture capital investment as of early 2023.

Walgreens launches a $24 billion annual revenue specialty pharmacy that will add gene and cell services to its AllianceRx specialty and home delivery business.

Epic breaks ground on its sixth campus called Other Worlds, which draws inspiration from “The Lord of the Rings” and “The Chronicles of Narnia.” The company has 13,000 employees, up 40% over the past six years. New buildings will open this year in its Storybook and Wizards Academy campuses. Interesting: 80% of employees work in individual offices, with the remainder sharing two-person offices, and each office has its own thermostats and windows that open. Also interesting: the company calls its whimsical decorating style “cheap and cheerful,” as it doesn’t cost more to choose colorful paint and carpet and its “cozy spaces” are decorated with thrift store furniture.

Sales

• National reference laboratory ARUP Laboratories will implement Ellkay’s LKOrbit to support its clients in ordering, results delivery, and collecting billing information.

People

Clover Health hires Peter Kuipers, MBA (Omnicell) as CFO.

Linda Stotsky (Boston Software Systems) joins ClinicMind as chief marketing officer.

Prominence Advisors hires Mark Ostendorf, MBA (DrFirst) as chief revenue officer.

Announcements and Implementations

Innovar Healthcare announces an OSS Mirth Connect plug-in that adds OpenAI technology for task automation.

Truveta publishes a mother-child EHR dataset for research, which includes clinician notes and images from 30 health systems that are linked to claims, SDOH, and mortality data.

A new KLAS report looks at CRM, finding that Best in Class winner Innovaccer’s clients are highly satisfied even though it’s the newest CRM market entrant and its user base is small. Epic is seeing increased adoption of Cheers, although nickel-and-diming issues have been reported. Salesforce has the largest market share, but respondents question its value and 60% of them gripe about extra fees for training, support, implementation, and new functionality.

Government and Politics

Seattle Children’s Hospital, which sued Texas Attorney General Ken Paxton for demanding what it says is a “sham” investigation into transition gender care provided to Texas residents, says that the AG’s office has withdrawn its demands for patient-level information. Paxton declared the dismissal as a win, saying that his questions led the hospital to forfeit its registration to do business in Texas.

ONC publishes Common Agreement Version 2.0, which provides updates for FHIR APIs.

California has spent $500 million to offer young people free, app-based virtual counseling sessions for behavioral health issues, provided by BrightLife Kids and Soluna. Response has been close to non-existent – only 0.1% of those who are eligible have even signed up and one company has missed its committed date to deliver an Android version. The state has declined to say how many of those 15,000 registrants have actually engaged with the apps and no schools are promoting their use. Some experts are concerned that the companies – one VC backed, the other publicly traded – sometimes use unlicensed coaches who might miss problems that should be referred to clinicians.

A GAO report says that DoD and VA will  not likely reach the integration goal that was set at the jointly operated and newly live Lovell Federal Health Care Center. GAO also finds that DoD user satisfaction is lower with the Oracle Health system than for the legacy systems it replaced as well as private sector systems. GAO also found that years-old problems remain with the Henry Schein Dentrix dental module, to the point that DoD is looking to replace it.  

Other

A NEJM Catalyst case study from NYU Langone Health finds that AI can help improve poor clinical note quality, also noting that the real challenge is that (a) no universal standard exists for measuring note quality, leaving it up to each organization to define their own standards; and (b) peer-to-peer review of notes organizationally doesn’t scale well. The organization developed components of note quality, then trained AI to grade them by the thousands to perform quality reporting, identify physicians who could benefit from peer feedback, evaluate the impact of new templates and educational interventions, and assess individual performance. The organization also provides data review links to minimize note bloat that was caused by text tables. This is good work because instead of just using AI to summarize a chart or facilitate voice-to-text enhancement to create the same note that could have been done manually, it takes a bigger swing in laying out AI-measurable note quality standards.

It’s Y2K all over again: a 101-year old woman must fly commercial as an “unescorted minor” because airline booking systems translate a birth year of 1923 to 2023.

The times in which we live: Vancouver Island Health Authority tells hospital nurses to allow patients to use illicit drugs in their rooms and suggests that they teach patients to inject their personal stash into their IV lines, extending previous requirements for nurses to offer them crack pipes and matches.

Sponsor Updates

• Healthcare IT Leaders staff conduct a used clothing drive for the No Longer Bound Thrift Store in Atlanta.
• KLAS Research highlights Agfa HealthCare in its new “Enterprise Imaging Report 2024: Vendors and Providers Driving Market Progress.”
• First Databank’s Targeted Medication Warnings earns Epic’s Toolbox designation in the Medication Dosing Decision Support Toolbox category.
• DrFirst will combine its prescription fill data with remote monitoring data from PatchRx to equip providers with the data they need to improve patient medication adherence.
• MRO extends its automated retrieval services by automating data exchange between providers for continuity of care purposes.
• Marshfield Clinic Health System honors Findhelp with its 2023 Outstanding Partner in Community Health Award.
• FinThrive publishes “The Complete Guide to Prior Authorizations.”
• HealthMark Group will present at the American Alliance of Orthopaedic Executives Annual Conference April 26 in Chicago.
• Konza National Network welcomes Wichita Surgical Specialists to the Konza QHIN.
• Medhost publishes a new white paper, “A Guide to Finding a Secure EHR Hosting Service.”
• Meditech works with the Massachusetts Association of the Blind and Visually Impaired to test the accessibility of the Expanse Patient and Consumer Health Portal for the blind and visually impaired.
• Net Health will host its inaugural Net Health Next Customer Conference May 9 in Tampa Bay, FL.

Blog Posts

• AI’s Impact on Patient Care, Clinical Coding, and Quality Metrics (Medicomp Systems)
• Can You Trust Generative AI in Your Contact Center? Delivering Responsible AI for Enhanced CX (Five9)
• Congressional Scrutiny of Healthcare Cyber Risks (Fortified Health Security)
• In the Company of Winners (Impact Advisors)
• The Importance of Medicare Advantage Plan Design: Financial Generosity, Coverage Design, and its Impact on Health Equity (Inovalon)
• How Gen AI Helps Us Deliver Value-based Testing (Keysight Technologies)
• Augmenting Population Health Strategies with AI (Lucem Health)
• Delivering Better Care at Scale (Lumeon)
• How Meditech’s approach to cybersecurity ensures safety for patients, providers, and organizations (Meditech)

Contacts

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

EPtalk by Dr. Jayne 4/25/24

The CMS Innovation Center has announced its proposed Transforming Episode Accountability Model (TEAM), which will incentivize coordination during surgical procedures and for the 30 days following the procedure. The model is expected to improve care quality including reducing readmission rates and decreasing recovery time. It is also projected to reduce Medicare expenditures and create more equitable outcomes. The model will initially focus on lower extremity joint replacement, hip and femur fractures, spinal fusions, cardiac bypass procedures, and major bowel surgeries. Participating hospitals will receive a global payment to cover all expenditures during the procedure and follow up period in exchange for requirements that they coordinate with primary care teams to promote long-term health outcomes. The model also includes coordination around therapy and rehabilitative services, home health, medications, and hospice services related to included procedures. The model is included in the FY 2025 Inpatient and Long-Term Care Hospital Prospective Payment Systems Rule for those of you who need some light bedtime reading.

Low tech but cool: Michigan Medicine is incorporating Barbie into virtual visits for pediatric rehabilitation to help patients understand how they should be moving. Physicians can use the doll to illustrate how their joints should move as they complete various portions of a virtual examination. A recent study showed that Barbie-enabled mock visits required less verbal prompting and led to an improved understanding of the physicians’ directions without any increase in the time needed for appointments.

Violence against healthcare workers continues to be on the rise, often in ways you might not expect. The Vermont State Police arrested a 27-year old man after he destroyed property with a chainsaw and assaulted staff at Northeastern Vermont Regional Hospital. At the time of his arrest, troopers noted he was “in the parking lot actively assaulting staff.” Vermont classifies “Assault on a Law Enforcement Officer/Health Care Worker” into a single violation. I’m glad to see crimes against health professionals receiving the same visibility as those against members of law enforcement.

Sometimes the combination of items in my inbox tells a greater story than any of them on their own. Two subject lines fell into that category this week: “AI’s Influence on Provider Verification, Credentialing and Enrollment” followed by “The credentialing game is a joke! It is easier to buy a gun than to get a job.” I have empathy for the physician making the latter statement in a comment on an article about credentialing. I’m now at the six-month mark waiting to be credentialed to work for a care delivery organization, and at least in my current state of residence, I could walk into any sporting goods store and walk out with a firearm. I have a clean clinical record without malpractice claims, reports to the state medical board, or shady resignations. Anyone who works with physicians and wants to understand another way in which we might be frustrated should check out the article and its comments. If AI can help solve the problem, I’m all for it. Unfortunately, the email about that led to registration for a webinar that will happen while I’m on a plane, so I’ll have to wait to see how that solution might pan out.

Another interesting inbox item discussed research looking at how to use a smartphone compass to measure things like blood glucose. It leverages the magnetometer properties of the compass in conjunction with magnetic-hydrogel composites that are responsive to different analytes. The authors used glucose-specific hydrogels as part of a proof-of-concept experiment that measured glucose in one of my favorite substances – wine. They compared levels in sangria, pinot grigio, and champagne. For those not inclined to drink wine, they also measured pH levels of coffee, orange juice, and root beer. It’s an interesting way to avoid the additional processes needed when using human subjects. The authors agree that additional work using biological fluids is needed. Having spent some time recently in California wine country, I can suggest a few additional non-biological substances to sample.

A friend of mine whose company is developing a technology solution reached out to me today to make sure his demo script was believable before putting it in front of prospective clients. I gave him a bit of a talking-to about his company’s approach to development, because if you’re doing the process well, you should have examples of customer use cases that were gathered prior to the creation of the solution in the first place. Those can easily be employed for testing purposes as well as the creation of demo scripts. Unfortunately, that wasn’t the situation here, where they built the solution based on an idea and never really obtained the voice of the customer. Sometimes we refer to that as crafting a solution that’s in search of a problem. I’m guessing that having tens of millions of dollars of someone else’s money to spend might have something to do with their approach.

It certainly doesn’t qualify as healthcare technology news, but the ongoing saga of the Voyager 1 spacecraft has captivated me for the last several months. In short, the 46-year old spacecraft, which is 15 billion miles away from Earth, had been steadily sending back data until late last year, when it started sending back nonsense. For those of us who look at things through a clinical diagnostician’s lens, it sounded like the system had the technology equivalent of a stroke. Scientists have been painstakingly working with the craft, sending various messages and commands that take 22 hours to reach it and the same time to return. Fast forward to last week, when NASA announced that it had identified the problem and was working to solve it. Apparently a single chip in the spacecraft’s Flight Data Subsystem had failed, and there wasn’t enough space anywhere else to move the code that resided there. They split the code into four pieces and moved it elsewhere and are in the process of making other code adjustments to help the system route data appropriately to ultimately restore normal communications.

It’s remarkable that the craft is even functioning at all, given its exposure to the hazards of space. The Voyager support teams have performed the ultimate remote surgery to try to get as much life out of it as possible. I probably have more computing power in my wristwatch than Voyager has on board, which is simply amazing to think about. Other notable happenings in 1977 include the release of the original “Star Wars” movie, initial operation of the Trans-Alaska pipeline, and the introduction of Radio Shack’s TRS-80 computer.

What other technology from the 1970s has stood the test of time? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/25/24

Optum is shutting down its virtual care business

Optum will shut down its virtual care business for urgent and primary care after three years in business.

Midi Health, the Fastest-Growing Virtual Clinic for Perimenopause and Menopause, Raises an Additional $60M in Series B Round – $100M Total Funding to Date – to Transform Women’s Healthcare

Midi Health, which offers virtual care for peri- and menopausal women, raises $60 million in a Series B funding round.

98point6 hit by new layoffs in latest change at health tech startup

Virtual care technology company 98point6 conducts another round of layoffs, with some employees noting on LinkedIn that the company is now running with a skeleton crew.

It’s Always Summer Time: Announcing Our Series A Fundraise

Pediatric text messaging-based care startup Summer Health raises $12 million in Series A funding.

Healthcare AI News 4/24/24

News

In-home health screening startup Reperio Health raises $14 million in its latest funding round. The company plans to expand its offerings beyond digital health screening kits and apps to include virtual consults with nurses and AI software that analyzes test results and suggests treatment plans.

Business

Enterprise network security company Prophet Security raises $11 million in seed funding. Launched last fall, the startup uses AI to aggregate, stratify, and summarize the potential cybersecurity threats and alerts that bombard organizations on a daily basis. The company’s large language model can also be added to third-party cybersecurity products.

Karoo Health, a value-based cardiac care company, announces GA of Kohere.ai, an AI-powered platform that offers automated workflows; analytics and risk stratification; and APIs for health data exchange, sorting, and storage.

After piloting the technology at several HCA Healthcare facilities, Augmedix officially launches its AI medical documentation software for emergency departments.

Research

Mount Sinai researchers determine that LLMs are no substitute for human medical coders after giving LLMs from Meta, Google, and ChatGPT the chance to analyze and code 27,000 unique diagnoses. The LLMs showed limited accuracy, assigning the correct codes less than 50% of the time.

A Mass General Brigham study of LLM-generated replies to patient messages finds that physicians feel the technology has value in terms of reducing workload, but that a clinician should be kept in the loop so as to avoid sending replies with incomplete, incorrect, or delayed information.

Contacts

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

Morning Headlines 4/24/24

Change Healthcare attack did not result in harm to veteran care, VA says

The Change Healthcare ransomware attack has not resulted in harm to VA patients, though it did delay the filling of prescriptions, most of them refills, for 40,000 veterans.

Oracle is moving its world headquarters to Nashville to be closer to health-care industry

Oracle Chairman Larry Ellison says the company will move its headquarters from Austin to Nashville to be closer to a major center of healthcare.

Medical Informatics Engineering Secures Growth Investment from Healthcare Technology Investor Serent Capital

Serent Capital invests in occupational health IT company Medical Informatics Engineering.

FTC Announces Rule Banning Noncompetes

The FTC votes to ban noncompetes in a ruling that it predicts will lead to the creation of 8,500 new businesses each year.

News 4/24/24

Top News

Sources say that members of the BlackCat ransomware group broke into Change Healthcare’s systems nine days before initiating the February 21 ransomware attack, using stolen employee credentials to log in to a remote network access application. They also confirm that parent company UnitedHealth made a ransomware payment to the group, a fact that the company has since substantiated, though it hasn’t specified the amount. Reports over the last several weeks have put that payment at $22 million.

UnitedHealth Group, meanwhile, issues its own update on the ransomware attack. The highlights:

• An ongoing data review determines that files containing the PHI or PII of a “substantial proportion” of American consumers were stolen.
• The company expects it will take several more months before it is able to fully identify and begin notifying impacted customers and individuals.
• It has set up a website and call center to begin helping those impacted by the breach.
• Publication of stolen data by bad actors seems to have been limited to 22 screen shots of files that were posted to the dark web for about a week.
• Pharmacy services, medical claims, and payment processing are back to nearly pre-incident processing levels.
• Eighty percent of Change Healthcare’s functionality has been restored, with remaining services expected to come back online in the coming weeks.

Webinars

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

Acquisitions, Funding, Business, and Stock

Lumeris, a tech-enabled population health management company, raises $100 million in a funding round led by Deerfield Management. Lumeris also operates a Medicare Advantage plan through its Essence Healthcare business, which Oracle Health (then Cerner) invested heavily in back in 2018.

Sales

• Community Health Network (IN) selects care-at-home technology from Biofourmis.
• Auxilio Mutuo Hospital in Puerto Rico will implement Oracle Health’s EHR and patient accounting software.

People

Availity names Sean Barrett (R1 RCM) chief product officer.

Laurie McGraw (McGraw Advisory) joins Transcarent as EVP.

Announcements and Implementations

WakeMed (NC) goes live on Agfa HealthCare’s Enterprise Imaging Platform.

PriMale Health (TX) implements EHR and patient engagement technology from EClinicalWorks, and AI medical scribe software from Sunoh.ai.

Government and Politics

The VA reassures the public that the Change Healthcare ransomware attack did not result in harm to its patients, though it did delay the filling of prescriptions, most of them refills, for 40,000 veterans. The department’s IT team did have to develop workarounds to deal with issues related to CommonWell connectivity, access to clearinghouse services for its Community Care Network claims, inbound prescription orders, and configuring medical imaging storage and retrieval systems. 

The HHS Office of Civil Rights launches a web page featuring frequently asked data breach questions about the Change Healthcare ransomware attack.

Sponsor Updates

• Revuud adds its new AI Matching Algorithm to its IT talent acquisition technology.
• Bamboo Health will exhibit at the California Medical Association HIT Summit May 7-8 in San Francisco.
• The Alliance of Women in Workers’ Compensation names Bardavon SVP of Client Experience and Network Expansion Saray Meyer an ambassador of its Northeast Florida chapter.
• AvaSure, Care.ai, EVisit will exhibit at ATA Nexus 2024 May 5-7 in Phoenix.
• Clinical Architecture releases a new episode of The Informonster Podcast, “Data Quality in Healthcare: Inside the Patient Information Quality Improvement (PIQI) Framework.”
• CloudWave will present at the HealthTech Community Hospital Leadership Conference May 5-8 in Nashville.
• Canyonville Health and Urgent Care (OR) expands to chronic care management services using EHR technology from EClinicalWorks and AI medical scribe software from Sunoh.ai.

Blog Posts

• Live Event Day 1: Agfa HealthCare demonstrates steadfast commitment and engagement to industry at the KLAS Summit in Utah. (Agfa HealthCare)
• 5 Trends in Healthcare Delivery and Revenue Cycle Management (AGS Health)
• What do we need from technology to improve patient flow? A frontline clinician’s perspective (Altera Digital Health)
• How interoperability streamlines CMS reporting (Arcadia)
• SATRE: Standardised Architecture for Trusted Research Environments – Supporting Capabilities (Aridhia)
• Navigating Governance in Healthcare Communications: Identifying Existing – or Future – Challenges (Artera)
• 5 Digital Surgical Scheduling Breakthroughs for Better Patient Care (CereCore)
• The Rise of Employer Branding: Building a Talent Magnet in Today’s Competitive Job Market (Direct Recruiters)
• Achieving Digital Maturity with Divurgent’s Assessment Guidance (Divurgent)
• Data Dysfunction: Is Patient Burnout the Next Public Health Crisis? (DrFirst)
• Support Value-based Care with Sunoh.ai (EClinicalWorks)
• Women in Health IT – Lisa Rawlins (Ellkay)

Contacts

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

Morning Headlines 4/23/24

Lumeris Completes $100M Equity Growth Capital Investment Round

Lumeris, a tech-enabled population health services and insurance company, raises $100 million in a funding round led by Deerfield Management.

Hackers Broke Into Change Healthcare’s Systems Days Before Cyberattack

Sources say that members of the BlackCat ransomware group broke into Change Healthcare’s system nine days before initiating the February 21 ransomware attack, using stolen employee credentials to log in to a remote network access application.

Clarity Pediatrics raises $10M for treating ADHD and other chronic childhood conditions

Clarity Pediatrics, a provider of online pediatric ADHD care, raises $10 million in a seed funding round.

Readers Write: Reducing Friction in the Healthcare Ecosystem: Why Convenience, Access, and Patient Experience are Key

Reducing Friction in the Healthcare Ecosystem: Why Convenience, Access, and Patient Experience are Key
By Vytas Kisielius

Vytas Kisielius is CEO of ReferWell.

The future of healthcare relies on our ability to adapt and improve how we meet the needs of patients. Despite recent advances in technology, scheduling difficulties, low appointment show rates, siloed information, and obscure reporting continue to hinder access to care, health outcomes, and care quality. To overcome this friction related to getting people to the doctor, it is essential to prioritize convenience, access, and patient experience. Many other industries have made this shift, but healthcare has been a laggard in addressing this friction. Overcoming it is the key to closing care gaps, decreasing visit no-shows, and fostering patient engagement and retention.

Defining Friction and Its Impact on Patient Care

“Friction” in healthcare significantly impacts patient care and satisfaction, manifesting through:

1. Patient expectations versus reality: The gap between high patient expectations and the reality of poor care experiences, scheduling errors, and missed appointments leads to dissatisfaction and revenue losses. In study after study, consumers report that one negative experience trumps several positive ones in their decision-making regarding repeat business (patient retention) and satisfaction with their experience (which affects CAHPS). At the same time, providers complain about patients who no-show for appointments, so rather than risk losing the revenue associated with those visits, many will routinely double-book their schedules and assume it’s okay to make the patients wait if both show up at the appointed time. Lack of understanding and empathy on both sides increases the friction.

2. Access and operational hurdles: Patients often struggle to find providers, schedule appointments, and navigate insurance complexities, leading to a preference for more accessible healthcare options. All too often, once a patient calls three or four offices selected randomly from their health plan’s portal and finds none of them have availability, they declare, “There’s no access from my plan,” when, in fact, there is available capacity spread throughout the provider network. More friction and frustration on the part of both parties – the patient thought there was no availability and the providers with available slots saw the time go to waste. Like an airline seat, once the flight takes off, an unused seat represents revenue that is forever lost.

3. Perception and trust issues: Many patients feel their health history is not fully understood by their providers. This, combined with negative perceptions of support staff (who in most cases don’t view their jobs as providing customer service but rather as providing support to their doctor employer), long wait times, and billing issues, erodes trust and confidence in the healthcare system. For all too many providers who entered medicine “to heal the sick,” the requisite training in bedside manner took a back seat to the study of symptoms and diagnoses and procedures. Another opportunity to create friction.

4. Data hurdles: When a patient is referred to a specialist following a visit to a primary care provider, the onus to find the right provider and schedule the appointment is often on the patient. Simple questions like, “What GI specialists near me take my insurance and have open appointments?” become research projects. And when they finally do find a participating specialist with availability, many a patient’s last thought is to provide a copy of their relevant medical history, including the notes of the PCP visit, in order to aid the specialist in providing the right treatment.

5. Scheduling issues: During an appointment, whether in a provider’s office or a virtual visit, or in a follow-up care call, the patient is commonly ready and willing to schedule their next appointment. Unfortunately, all too often the provider or their staff does not have the necessary information at their fingertips at that critical moment to help. In fact, in many cases the provider doesn’t think it’s their job to get the next appointment (with someone else) scheduled since, historically, the information about who takes what insurance, who performs which specialties/subspecialties/procedures at what locations and who of them has availability hasn’t been easily obtained – hence, the onus is left on the patient.

The Impact of Friction on Patients

As evidenced by these examples, when patients encounter friction, their access to care is impeded, leading to negative consequences for their health, well-being, and satisfaction with the entire process. Remember also that we typically seek care when we’re not feeling our best, shortening patience and empathy further. Have you ever taken an airplane flight when you didn’t feel 100% healthy? Normally acceptable minor inconveniences or delays can become positively irritating.

One of the primary impacts of friction is increased patient dissatisfaction. When patients face long wait times, encounter administrative hurdles, or experience difficulties navigating the healthcare system, their satisfaction levels plummet. This dissatisfaction can result in patients seeking alternative healthcare options or avoiding necessary care altogether, leading to potentially adverse health outcomes.

Friction also affects patient engagement. When patients face obstacles in accessing their healthcare information or participating in their health management, their engagement levels decrease. This lack of engagement hampers the effectiveness of future healthcare interventions and compromises patient outcomes. It’s a vicious cycle.

These challenges underscore the need for payers and providers to streamline processes, improve experiences and foster a more patient-centered approach to care.

Investing in Patient Experience as a Pathway to Improved Healthcare

Investing in the patient experience is not just a moral imperative but a strategic one, which can offer improved healthcare outcomes for patients and financial success for providers. In fact, healthcare organizations that focus on the patient experience as a critical factor in driving economic success can dramatically increase their recurring revenue. With every dollar invested in enhancing patient experience, a significant ROI, ranging from seven to 10 times the initial expenditure, is observed. This dramatic ROI is attributed to repeat visits and retention, positive word of mouth and referrals, better online reviews, and a better reputation and brand loyalty.

As we look ahead, it is important to acknowledge that we are all healthcare consumers who can relate to the struggle of finding and scheduling the care we need at a time and a place that is convenient for us. While it is easy for patients, providers, and healthcare leaders alike to name the usual obstacles – who takes what insurance, overly complicated appointment scheduling processes, and the question of who’s responsible for sharing the information back with the primary care provider – these obstacles are not insurmountable.

To truly deliver on the promise of better healthcare, we must work together to make the process of finding, scheduling, and following through with care appointments as seamless as possible for the patient. That will, in turn, improve provider experience and reimbursement rates while helping to close care gaps – reducing friction for patients and positively impacting HEDIS and CAHPS scores for providers and health plans.

Curbside Consult with Dr. Jayne 4/22/24

I recently spent some time in Silicon Valley, meeting with both existing and potential new clients. I have to say, this is the greenest landscape I’ve seen in this part of the world in a long time. The area has had a lot of rain in recent months and the vistas look very different when they’re not painted in shades of brown. I’ve worked with a number of startups over the years, some of which are headquartered here and others in other tech-heavy parts of the country including Austin, Atlanta, and Las Vegas. It’s been interesting to see how the places have changed and the nature of the business has evolved in recent years. Some of the players, however, don’t seem to have evolved much.

When I first became involved with healthcare technology, it was definitely male dominated. My health system had one or two women analysts, but none in IT management or executive positions. Our ambulatory EHR project was led and managed entirely by women who had a reputation for taking charge – especially since we were the organization’s first technology project that was run by the customer rather than by IT. We opted to lease IT resources from the organization rather than having them run things, since we had several years’ experience with ambulatory EHRs and practice management systems and they had none. Even though we had a bit of friction due to that project structure, everyone was professional, and we were able to get an amazing amount of work done.

Our vendor had a bit more of a boys’ club vibe, with nearly all executive functions held by men. There were a few women in management positions, mostly in more supportive departments like training and accounting. This was my first exposure to what we now call “bro culture,” but at the time, the bros were more outliers and it seemed like executive leadership humored them because they drove results, but only to a point. The guy who took clients to a strip club disappeared from the company shortly after the incident, and people who made inappropriate comments were quickly sidelined. Fast forward half a decade and I was introduced to my first real “bros” – who espoused not only the culture but who somehow brought leadership under their spell and convinced them to spend millions of dollars on projects with questionable merit and even more questionable management. It was the first time I saw people throwing money around with abandon and marginalizing the people who were actually experts in the field and who were doing the work but who didn’t buy in to the culture.

Over the years, we’ve seen the rise of tech bros and pharma bros, and lots of bros behaving badly. Especially after my recent travels, it’s clear that bro culture is still going strong. There are numerous articles out there about the phenomenon, including in the human resources literature. There are some common features seen as people define the issue – including a culture that places winning (and hustling) above all and that excuses the bad behavior that often happens along the way. Bro culture often includes excessive partying, bullying, and harassment of colleagues who don’t play along. If you’ve been in an environment where coworkers make comments because you’re not drinking alcohol or not drinking as much as everyone else, you might be in a bro culture. If you’re hearing snide comments about parental leave, blocked time for breastfeeding, or colleagues being “no fun,” you might be in a bro culture.

I find the phenomenon interesting, because some of the most hustling, winning people I’ve ever worked with are distinctly not bros. At one company, the teetotaling sales reps who were eager to get home to their families did some of the best work, closing deals all over the place. They won by understanding the voice of the customer, prioritizing customer and prospect needs, and valuing the people who worked with them. When working in those environments, I never experienced the level of malicious gossip, toxic commentary, or foul language that I’ve seen in recent times. Don’t get me wrong, I’m not afraid to drop the F-bomb when it’s warranted, but it’s all about knowing your audience and the situation. But if you’re in a situation where inappropriate comments are the norm and not the exception, you might be in a bro culture.

In some organizations I’ve worked with, investors play a role in supporting the bro culture. The New York Times ran an article about this back in 2017, and there are many things about this that haven’t changed. The piece noted that change will only come “… if the people in charge of Silicon Valley – venture capitalists, who control the money – start to realize that the real problem with tech bros is not just that they’re boorish jerks. It’s that they’re boorish jerks who don’t know how to run companies.” I felt validated when I read other comments in the Times piece. As a physician, I’m often one of the only “licensed” people working with a company – the other area being legal. Physicians working in clinical informatics are highly attuned to regulatory and legal requirements and use that knowledge to keep stakeholders out of trouble. If you’re working with people that push you to ignore regulations, you might be in a bro culture. Recent settlements between the Department of Justice and various tech vendors tell that story.

The Times piece uses Uber circa 2017 to make many of its points, with some of those being that “toxic workplace culture and rotten financial performance often go hand-in-hand” and that “bros do best when they hire seasoned executives to help them out.” The author referred to “adult supervision” and “institutional restraints” as essential to avoid a situation where bro “vices end up infecting the culture of the workplaces they control.” One thing not mentioned in any of the articles I found but that I’ve heard about from a couple of people is what we might call the “girl bro.” She definitely has bro tendencies but also functions as an enabler for bad culture and sometimes as a “fixer” trying to clean up messes as they occur. Most of the girl bros I’ve heard of have been in sales roles, but I’ve also heard of them filling an HR function, and if you identify one of the latter rare creatures in the wild, you’re definitely in a bro culture.

I agree with the Times piece that sometimes it takes the business cratering before you start to see a change. That’s unfortunate for the people who work at those companies and who are just trying to get by. Especially in healthcare technology, it’s important to remember that not only are workers there because they’re trying to support their families, but also because they’re often “true believers” who want to do the right thing for patients and their loved ones. I think for those types of individuals it’s especially difficult to be in a bro culture and they often vote with their feet.

What do you think about bro culture in healthcare, and in healthcare technology in particular? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/22/24

About Healthcare Acquires Edgility, Advancing AI and Decisioning Across the Patient Journey

About Healthcare, which specializes in software for patient flow management across healthcare settings, acquires patient flow predictive analytics vendor Edgility.

DHA looks to contract a ‘digital front door’ to modernize its health system

The Defense Health Agency solicits bids for digital front door technology that will enhance the DoD’s MHS Genesis EHR.

VA Seeks Vendors to Support T&E Work on Modernized Electronic Health Record Platform

The VA issues an RFI for testing support for the department’s Oracle Health-based EHR Modernization program.

Monday Morning Update 4/22/24

Top News

About Healthcare, which specializes in software for patient flow management across healthcare settings, acquires patient flow predictive analytics vendor Edgility.

HIStalk Announcements and Requests

A majority of voters believe high-visibility CEOs make their companies more attractive acquisition targets. Samantha Brown points out that, “Healthcare, like every other industry, gets caught up in the idolatry of the ‘innovators.’”

New poll to your right or here: Do you think the VA will in fact restart Oracle Health EHR roll outs next year?

Webinars

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

Sales

• Health First (FL) will implement Epic as part of its two-year, $160 million Mission Unity project.

People

Michael Reagin, MBA (Sharp Healthcare) will join Banner Health as VP and CTO in June.

Nordic Consulting will promote Don Hodgson to CEO upon the retirement of Jim Costanzo this summer.

Government and Politics

The VA issues an RFI for testing support for the department’s Oracle Health-based EHR Modernization program, which is set to restart go lives at additional facilities sometime next year.

The Defense Health Agency solicits bids for digital front door technology that will enhance the DoD’s MHS Genesis EHR by offering provider search, appointment scheduling, secure messaging, and data management support; as well as integration with wearables and devices. The department also hopes to expand its digital health capabilities to include virtual nursing, remote patient monitoring, and hospital command center features.

Sponsor Updates

• Netsmart launches the Netsmart Marketplace, advancing interoperability and integration offers for community-based providers.
• Nordic releases a new Designing for Health Podcast, “Interview with Josh Liu, MD.”
• Spok publishes a case study, “How North Mississippi Medical Center overcame high call volumes and staffing shortages.”
• Upfront Healthcare co-founder and COO Carrie Kozlowski joins an episode of the HIT Like a Girl Podcast.
• Waystar will exhibit at the MGMA Financial Focus Conference April 24-27 in San Diego.

Blog Posts

• The IDD Summit Part 2: Partnership and Innovation (Netsmart)
• Strengthening healthcare IT infrastructure: A wake-up call for cybersecurity resilience (Nordic)
• Five Key Takeaways from ONC’s Federal Health IT Plan 2024-2030 (Optimum Healthcare IT)
• The Ultimate Guide to Exam Room Management (QGenda)
• Saving Patients Nearly $2 Million on Prescriptions is About Trusted Relationships (Surescripts)
• The 6 People You Need on Your Clinical Communications Improvement Team (Symplr)
• Key Takeaways from IPMI Healthcare Finance Institute (Tegria)

Contacts

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