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Morning Headlines 8/17/23

August 16, 2023 Headlines No Comments

Abridge Becomes Epic’s First Pal, Bringing Generative AI to More Providers and Patients

Abridge, whose app turns doctor-patient conversations into transcripts and visit summaries, becomes the first member of Epic’s Partners and Pals integration program.

Tausight Announces Additional $6 Million in Financing

Healthcare data security company Tausight raises $6 million, bringing its total funding to $26 million.

Digital Health Company Babylon Files for Bankruptcy In US, Will Liquidate

Babylon Health will liquidate the assets of two of its US subsidiaries as part of Chapter 7 bankruptcy proceedings.

HIStalk Interviews Sean Cassidy, CEO, Lucem Health

August 16, 2023 Interviews No Comments

Sean Cassidy is co-founder and CEO of Lucem Health of Raleigh, NC.

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Tell me about yourself and the company.

I’m an old enterprise software guy, going back to the early 1990s. I’ve been in digital health since about 2004. I’ve worked mostly on big platform type products sold to healthcare providers, such as data integration, data management, and analytics.

The idea for Lucem Health originated within Mayo Clinic a little over three years ago, Mayo Clinic, like a lot of academically oriented healthcare providers that were doing research in AI and machine learning, was struggling to figure out how to deploy AI at scale so that they could deliver real value and impact in the clinical workflow. They went looking for platforms that could be Swiss army knives, for lack of a better term, for the deployment of a broad set of clinical AI type solutions. They didn’t really find anything, so they made the decision to fund the start of a company which later became Lucem Health.

How do health system executives decide when to jump in or experiment with AI among the daily flurry of AI announcements or research results?

It’s important to have a perspective on what the potential value and impact of AI could be to your organization. But primarily, I would orient yourself — as health system leaders are doing these days – to the real problems that are vexing you; for which solutions exist in the market that are novel, unique, and different from what you have seen before; and that can be deployed against those problems and be force multipliers. When you are inquisitive about that, you will  find that there is AI at the center of a lot of those solutions.

However, it’s important to note, and this is our perspective, that AI is not a panacea. An algorithm is not a solution. It may deliver a strong and accurate predictive output, but if it can’t be delivered to stakeholders in the right context, right place, and right time, then it’s all for naught. It can’t deliver any meaningful value and it can’t solve for those problems that a healthcare provider may be facing.

Are health systems looking for a turnkey solution to address one specific problem or do they want tools and assistance that can help them develop their own expertise?

I actually think that they are looking for both. It depends on the context.

There is a certain class of provider, large providers that do a lot of research and development in a variety of areas, who are struggling with the bench-to-bedside problem. Their problem is not necessarily a technology-oriented problem, but it turns out that they need technology to solve for that.

But let’s take a provider organization that doesn’t have a data science team and is not doing research and development. They see, as they are exploring the market, that there is value in opportunity and solutions that may have AI at the center. They are telling us that they would prefer not to invest in point solutions or a fragmented set of underlying technology platforms, but would rather buy or deploy on a consistent and uniform infrastructure.

How hard is it for connect those external AI systems to their underlying data and work around issues with interoperability and terminology?

As your readers know, in healthcare, that’s a pervasive, it’s always an issue that there is heterogeneity in the operating environment, but the data can be represented in different ways and can be semantically different. AI solutions are no different from any other solution that is trying to leverage data that already exists, whether it comes from an EMR or some other modality. There is a curation process that has to occur in order to optimize the data so it can be served to the AI and provide the appropriate context to a broader AI solution so that it can be delivered effectively.

What are the steps involved in talking to a health system that has defined a problem and thinks AI can help solve it?

Leaving aside the business case for deploying it, what we find today is that providers are looking for a clinical and financial yield, an ROI, that is significant. Otherwise, it’s difficult to gin up yet another project to try to optimize data infrastructure that they have already invested in. But in terms of connecting into infrastructure, we deploy what I would define as narrow AI. These are not large language models or generative AI. These are very specific hammers for very specific nails. Their data requirements are not terribly broad. They are fairly narrow. There are, for example, plenty of ECG-based models that are powerful in terms of being able to detect cardiovascular disease. Generally speaking, virtually no optimization and curation is required on that signals data to be able to feed it into most of the models.

There are a number of really interesting models that are using EMR data. Fairly simple stuff, like demographic data plus usually one or two lab values that can identify risk of certain kinds of diseases. Again, there’s a little bit of work that has to be done to do some curation on that data, but because the dataset is relatively narrow, it’s straightforward.

If they have FHIR connectivity available in their  EMR, which they should have, we can get those EMR-based models up and running quickly without a lot of effort. FHIR as a standard is starting to take hold, and it’s incredibly useful. It’s a bigger lift if we have to go into their PACS and pull CT images. It’s a bigger lift if we have to go to Philips or GE to get enterprise class 12-lead ECGs, but it’s doable. We are finding that health system integration teams have sophisticated integration tools and are really good at being able to tap into the data that’s needed to make AI sing and dance in the real world.

A new survey found that health system executives believe that AI is ready to address some of their issues, yet few of them have developed an AI plan. Is that because they are looking at specific solutions rather than AI in general?

There is an impedance mismatch. I’ve seen those surveys too. When you poll forward-thinking CIOs, CMIOs, and clinical leaders, they are familiar with the opportunity for AI. Of course they to say that they believe that there’s value here, but when it comes down to brass tacks to actually investing in deploying these solutions, their mindset shifts away from the notion of AI as a technical capability to finding solutions that they can deploy. The tip of the spear for them is the solution and the value of the solution over the technology. We think a very high percentage of people feel that way.

How do you position an AI company in a constantly changing environment? 

We talk about that a lot. We have to be solution oriented and solution focused. When we package and position what we are taking to market, we are trying to confront real-world problems. The fact that AI is part of the equation is, to a large degree, incidental. We are in conversations with healthcare providers where AI barely comes up. We’re talking about how to identify undiagnosed diabetics, how to get people into the clinic for overdue screening colonoscopies, and how you deal with undiagnosed or undetected breast cancer from mammographies.

The other thing that we talk about a lot is that the solution matters. What we mean by solution is not just the ability to connect with data and to deliver a novel, powerful insight into a clinical workflow. How do you set up infrastructure? How are you capturing telemetry or instrumenting the process so that you can understand whether the thing is delivering the value and impact you expect? Do you have facilities in place to actually make improvements to that over time?

Every provider organization is different. They are different culturally. They are different in terms of the patients they see. They are different in terms of their affinity for technology and their ability to change or not change workflows. All of those things matter. A solution that can be highly optimal at XYZ health system may not be working very well at ABC. Why is that? How do we detect and understand that? How do we make the necessary adjustments to ensure that it does ultimately deliver value? Everything that I just said puts the solution at the front of the conversation and puts the technology in the background.

How are health systems involving physicians as they consider the potential of AI?

I have two thoughts on that. One is that we are trying to frame the conversation in such a way — and this is not a bromide, this is truth — that clinicians feel at the end of it that it’s going to help them practice better medicine. We think it is important that they are left with that impression, and that is their ultimate reality.

The other thing is that we believe that changing clinical workflows, trying to change how clinicians are using EMRs when they are already frustrated by their EMRs, is not the way to go. We are trying to bring solutions into clinical workflows that deliver impact that don’t require any modifications to workflows. They may make those workflows more efficient, but certainly won’t make them inefficient. They won’t pop up more alerts or fill their inboxes with more junk. We help them practice better medicine and practice it the way they have been doing it in the past without requiring radical change.

Your website says that you don’t make algorithms or applications. What technologies to bring to the table?

I want to be clear that our solutions have AI at the center, so we work with AI innovators. The best analogy that I can come up with is that we are car makers, not engine makers. We work with engine makers, and these engines are immensely powerful. They have a lot of horsepower. They can spin really fast. They can deliver a lot of impact. But if they are not dropped into a car, they can’t get very far down the road and actually do any good in the world. We have optimized our assembly line to make it easy for us to build a lot of different kinds of cars. We can build an ECG-based solution, an EMR-based solution, an image-based solution, and everything in between. That’s core to what we do, and it’s like breathing to us.

We use the phrase “AI solution ops” to distinguish from MLOps, which is a term that is fairly well established in the industry. What we do is relatively straightforward, and I’ve hinted at it already. So what is the car? The car is the ability to connect to a broad set of data sources, specifically to support the needs of AI. We are not a general purpose integration platform. That’s not what we are trying to build. To provide mechanisms to support the deployment of many kinds of AI, a broad set of capabilities to interpret the output of the AI in a way that’s human interpretable, human readable, and human understandable, and then to provide robust options, including an application framework for delivering AI insights to clinicians, clinical staff, or to supporting staff so they can benefit from those insights. Underneath the covers, all of that measurement of value and impact, continuous improvement stuff that I mentioned. All of that is the car for us. 

What are your goals for the company over the next few years?

Not surprisingly, like a lot of companies at our stage, we are focused on growth. We think that we have established a product-market fit. We think that we have established that what we are offering to the market is something that the market actually wants. We know who our buying personas are and we know what market segments we should be engaging with. We are focused on trying to get more and more customers to hear that story and to sign up with us and to deploy our solutions.

When we look three to four years out, our goal is to have a broad portfolio of powerful, impactful, practical, and responsible AI solutions that are confronting the hard clinical problems that are facing providers. Today we are talking about cancers, chronic diseases, and areas where there are existing solutions that have not necessarily delivered the goods that providers expected when they made original investments.

The other piece to the business is that we want to be working with a significant number of large provider organizations who are trying to do AI research and deliver AI impact to the front lines of care within their organizations and potentially even beyond, but are struggling with the bench-to-bedside problem. That’s where we intend to be.

Healthcare AI News 8/16/23

News

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Abridge, whose app turns doctor-patient conversations into transcripts and visit summaries, becomes the first member of Epic’s Partners and Pals integration program. The company also announced that Emory Healthcare will deploy its solution.

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Piction Health launches a dermatology virtual clinic in Massachusetts in which patients complete an online intake questionnaire, attach at least three pictures of their area of concern, and then receive a dermatologist’s evaluation – supported by AI image analysis and comparison to its own image database — within two days. The company says that two-thirds of patients receive a treatment plan without an in-person visit. The service is available for patients in New Hampshire, Connecticut, Massachusetts, and Florida and is covered by some insurances or costs $80 otherwise.


Business

Morgan Stanley lists four areas in which it expects AI to create significant investment opportunities:

  • Drug discovery, manufacturing, and physician-patient engagement.
  • Earlier detection of disease, more efficient patient access, claims processing, supply chain management, and helping patients use their insurance and prescription benefits effectively.
  • Support for advanced diagnostics that combine EHR, genomic, and imaging data to gain disease insight and to personalize treatment.
  • Enhance monitoring by analyzing data streams from medical devices such as sensor-equipped implants, continuous glucose monitoring, and cardiac monitoring.

Research

Vanderbilt University Medical Center researchers develop an NLP algorithm that analyzes EHR data to identify patients who need lung cancer screening, improving existing methods that look only at EHR smoking flags. The team found that nearly half of the documented smokers are missing discrete EHR data related to pack years and quit dates, but the NLP analysis of clinical notes delivered 96% accuracy.

Taiwan’s National Cheng Kung University creates AI-powered software to detect age-related muscle loss (sarcopenia) from CT scans. The government has approved the software for sale to other hospitals, although the creators suggest that hospitals perform screening of cancer patients for free since they already have their CT images. Sarcopenia, which increase fall and fracture risk in older patients and those undergoing chemotherapy, can be improved through diet and rehabilitation if caught early.

Carnegie Mellon University is using AI, ML, and NLP to analyze YouTube videos that offer patients information on conditions or treatments for accuracy, comprehension level, trustworthiness, and delivery of actionable guidance. They hope to create filters that give doctors a short list of videos that can be reviewed and then prescribed as needed.

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Newly developed, AI-powered “smart socks” will allow people with dementia to live at home, where the wearable tracks heart rate, sweat levels, and motion to determine when the wearer is in distress. The socks look like real socks, are machine washable, and do not require charging.


Other

In Canada, a report warns that successful use of healthcare AI will be limited by the healthcare system’s reliance on fax machines, handwritten notes, scanned files, and paper recordkeeping.

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Veterinary chain Banfield Pet Hospital offers customers a free AI-powered device – developed by Whistle Health, which like Banfield, is owned by candy and dog food maker Mars — that attaches to a dog’s collar to track caloric intake, scratching that could indicate skin problems, and other health data, with an app that allows chatting with a veterinarian. An enhanced version allows tracking the pet’s location.

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An AI expert notes that AI-created influencers – realistic, computer-generated characters – will increase mental health issues and suicides among followers who can’t function in the real, imperfect world. He says that mental health was already threatened by the false perfection of Photoshopping and plastic surgery. An AI-generated influencer who portrays a young woman from Finland has thousands of followers on TikTok and Instagram, while another influencer created an AI-powered “virtual girlfriend” version of herself using ChatGPT that she expects to generate $60 million per year in subscriptions from an audience that is 98% male.


Contacts

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

Morning Headlines 8/16/23

August 15, 2023 Headlines No Comments

HGP Advises Access eForms in Sale to Phreesia

Patient intake software vendor Phreesia acquires Access EForms, which specializes in electronic forms management and automation.

Luna Announces Luna Labs, a New Artificial Intelligence (AI) Division Working on Enhancing Care Delivery

Home-based physical therapy provider Luna creates an AI division to develop new AI-based solutions, including enhancements to its Auto Charting technology and a chatbot designed to help patients with inquiries related to scheduling and billing.

Hospitals are dialing back on venture capital investing

Hospitals are cutting back on their venture capital investing, shutting down or downsizing their splashily announced investment arms.

News 8/16/23

August 15, 2023 News No Comments

Top News

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Urgent care technology vendor Experity acquires cloud-based, teleradiology-focused OnePACS for an undisclosed sum.


HIStalk Announcements and Requests

My five-year-old, 32 GB IPad has been beset with performance problems that are individually quirky and collectively infuriating. I was about to fling it across the room like a Frisbee last night when I noticed that Apple is offering a new 64 GB Generation 9 version from 2021 at just $250 via Amazon. It arrived less than eight hours later, and pairing it up with its older sibling and copying everything over took just a handful of clicks (that ecosystem convenience is why I’m willing to be slightly extorted by Apple). The new one is snappy, with a nice display and a ton of available memory for a non-power user like me. The old one was too, back in its day, when it cost me $329. It feels like I got a decent deal and acceptable annualized cost both times.


Webinars

August 24 (Thursday) 2 ET. “RCM analytics in action: How to use your data to drive decisions + revenue.” Sponsor: Waystar. Presenter: Laura Tungate, solution strategist team lead, Waystar. This webinar will describe how to use RCM analytics to take control of your data even if you use outdated or multiple tools. Attendees will learn how to target improvements, describe the KPIs that are key to revenue cycle leaders, prioritize dashboards that spotlight organizational goals and build alignment, and how and when to apply RCM analytics to go from analysis to action faster.

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


Acquisitions, Funding, Business, and Stock

Italian investment firm Exor becomes the biggest investor in Philips, acquiring a 15% stake in the company for $2.8 billion. Shoe aficionados may be interested to know that Exor, run by the powerful Agnelli family, also has a hefty stake in the French footwear house of Christian Louboutin.

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Healthcare market intelligence firm Definitive Healthcare acquires provider data and analytics startup Populi.

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European IT company Cegeka will acquire Computer Task Group, a global, multi-vertical digital transformation consultancy, in a take-private deal valued at $170 million.

Hospitals are cutting back on their venture capital investing, Stat notes, shutting down or downsizing their splashily announced investment arms.


Sales

  • The Veterans Health Administration will offer veterans access to digital educational medical content from Mediflix.
  • Nashville General Hospital (TN) will implement Oracle Health’s CommunityWorks EHR.
  • SSM Health (MO) selects diagnostic imaging technology and support services from Siemens Healthineers.
  • The Health Plan Alliance chooses 1upHealth as its preferred vendor for interoperability solutions and services.

People

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Cathy Donohue, MBA (Commure) joins CodaMetrix as SVP of product.

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Annexus Health names Sarah Provan (PointClickCare) VP of operations.

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Bridget Bell (Nordic) joins Cardamom Health as VP of business development.

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David Singer (East Tennessee Children’s Hospital) returns to LCMC Health (LA) as CIO.


Announcements and Implementations

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Lakewood Health System (MN) goes live on Epic.

London Northwest University Hospital will go live on Oracle Health later this week.

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Williamson Medical Center (TN) implements interactive patient engagement technologies from Sonifi Health throughout its new postpartum unit and renovated emergency department and lobby areas.


Other

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A ProPublica report describes how insurance companies used a CMS staffer turned lobbyist to convince the federal government to allow them to charge providers up to 5% to receive electronic payments, in essence charging doctors and hospitals fees to get paid the money that is owed to them. An MGMA poll found that large medical practices pay up to $1 million per year in fees, while AdventHealth says it pays $1.8 million. The report concludes,

The shift from paper to electronic processing, which began in the early 2000s and accelerated after the Affordable Care Act went into effect, was intended to increase efficiency and save money. The story of how a cost-saving initiative ended up benefiting private insurers reveals a lot about what ails the US medical system and why Americans pay more for health care than people in other developed countries. In this case, it took less than a decade for a new industry of middlemen, owned by private equity funds and giant conglomerates like UnitedHealth Group, to cash in.

Vanderbilt University Medical Center describes how it has reduced physician inbox message volume with changes to Epic MyChart. Some of them are:

  • Clinicians are no longer notified when a patient hasn’t read a message within 48 hours, which was generating 60,000 notifications per month.
  • Patients are told that they can expect a response within two business days and that messages aren’t read on weekends or holidays.
  • The “read receipt” timestamp was removed from patient view since it triggered when anyone looked at the message, not just the physician.
  • The message character limit was reduced from 1,500 to 1,000.
  • Patients are allowed 14 days to reply to an existing message threat instead of the previous 60 days, at which time they must enter a new message.
  • A MyChart information banner suggests that patients add common VUMC phone numbers as contacts so they will know to accept those calls.

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Cooper University Health Care (NJ) will include an area akin to an Apple Genius Bar within its new facility at Moorestown Mall. Dubbed Cooper Connect, the area will have staff on hand to answer anyone’s questions about the health system’s app, as well as any health and wellness app. The renovated Sears department store is slated to open in November.


Sponsor Updates

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  • Clinical Architecture staff sort and label 3,050 cans at Gleaners Food Bank of Indiana.
  • Virginia Eye Institute transitions to EClinicalWorks V12.
  • Dimensional Insight will co-host a community hike August 29 in Concord, MA with HIT Like a Girl to promote women in health IT.
  • Ascom publishes a new report, “Clinical Decision Support Systems (CDSS), a Clinical Safety Net, Drives Tomorrow’s Brighter Healthcare Outlook.”
  • Baker Tilly releases a new Healthy Outcomes Podcast, “Navigating the 340B Drug Pricing Program for healthcare providers.”
  • Clearwater publishes a new case study, “Fortifying At-Home Wellness Screenings: Reperio Health Teams Up with Clearwater to Safeguard Security.”
  • Nordic released a video titled “Craig Joseph, MD, and his journey to Verona.”
  • Current Health releases a new case study, “Care-at-home program keeps high-risk heart failure patients out of the hospital.”
  • Spok announces that 20 of the 22 adult hospitals and seven out of the 10 children’s hospitals named to the latest US News & World Report Best Hospitals Honor Rolls use the company’s secure healthcare communications solutions to facilitate care collaboration and support exceptional patient care.

Blog Posts


Contacts

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

Morning Headlines 8/15/23

August 14, 2023 Headlines No Comments

Experity Acquires OnePACS, the Leader in Teleradiology PACS

Urgent care technology vendor Experity acquires cloud-based, teleradiology-focused OnePACS for an undisclosed sum.

Agnelli family’s Exor buys $2.8 bln stake in Philips

Italian investment firm Exor becomes the biggest investor in Philips, acquiring a 15% stake in the company for $2.8 billion.

Definitive Healthcare acquires Populi

Healthcare market research firm Definitive Healthcare acquires provider data and analytics business Populi.

Curbside Consult with Dr. Jayne 8/14/23

August 14, 2023 Dr. Jayne 1 Comment

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Many physicians enjoy seeing antique medical equipment or visiting care delivery sites that aren’t your standard brick and mortar medical office building, and I’m no exception. One of my favorite museums is the Mütter Museum at The College of Physicians of Philadelphia, whose mission is to help the public “understand the mysteries and beauty of the human body and to appreciate the history of diagnosis and treatment of disease.” Its collections include items such as a surgeon’s kit from the American Civil War, which not only makes me glad to practice medicine in the current era, but also reminded me that some of the tools used during amputation of a limb haven’t changed much since that time.

I recently spent some time visiting friends in Virginia and was amused to see a 17th century ear cleaning tool found during the archeological excavations at Historic Jamestowne. Those who set out to establish the first permanent English settlement in North America may have struggled for survival, but at least they planned to maintain hygiene standards. We also spent a day at Colonial Williamsburg, which illustrates a time period where healthcare had evolved a bit.

I was looking forward to visiting the Apothecary and learning more about the apprenticeship they would go through, the medications that would have been available at the time, and more. Unfortunately, that particular living history exhibit was closed on the day I visited, so I had to settle for an online tour. Some of the treatments haven’t changed in hundreds of years, including calcium carbonate for heartburn and camphor for strained muscles.

The most modern healthcare delivery setting we visited was aboard a battleship museum, where you could see what shipboard dentistry was like. Not only was that part of the ship nicely restored, but it also featured recorded dental drill sound effects, which probably was a bit traumatic for some visitors. It was interesting to think about medical recordkeeping on a battleship, with the need to keep hundreds of sailors healthy and ready to support complex military operations on a moment’s notice. Unfortunately, the ship’s sick bay wasn’t accessible to visitors, so it will remain a bit of a mystery.

The ship I visited served from World War II to the Gulf War, so physicians aboard would likely have completed their documentation using a range of methods, from index cards to paper charts, but since it was decommissioned in the 1990s, I doubt it had much in the way of electronic recordkeeping. I chatted with some military folks at HIMSS and CHIME earlier in the year, and learned a bit about the additional complexity of military clinical informatics beyond what you would expect in a typical care delivery organization. It’s definitely a subspecialty of its own, and I am grateful for those who serve in that capacity.

One of my funniest reads this week was on the NordPass website. The solution is a password manager that I admit I hadn’t heard of until a friend pointed me to the site. Independent researchers who were examining cybersecurity practices used data from the company to look at the password habits of the C-suite, including CEOs, CMOs, CTOs, CFOs, and others. They found that passwords with sequential numbers (the proverbial “123456” that every cybersecurity training warns us about) remain as popular with executives as they do with other classes of users. Names were popular, with Tiffany leading the race.

Looking at some other articles on the site, I found some interesting statistics. In data from breaches, 20% of passwords were the name of the company or some variation thereof; “vacation” is a popular password in the healthcare industry; and “password” remains one of the most popular passwords across all sectors. In digging into the top 50  on the C-suite list, however, I found these gems:

  • Welcome
  • DEFAULT
  • Letmein

For some of those, it’s clear that IT departments need to beef up their rules for password complexity at least a little bit. You can’t blame those entirely on the end users.

My heart goes out to the people of Hawaii given the recent wildfires and devastation. I can only imagine how taxed the healthcare resources are in the affected communities right now. I’ve heard that first responders and other critical workers are being housed at scout camps and it sounds like everyone is simply exhausted.

I was impressed by the speed at which the Department of Health and Human Services declared a Public Health Emergency. The Centers for Medicare & Medicaid Services quickly followed with an announcement of additional resources and flexibilities for hospitals and providers. Some of the supports announced include addressing the availability of dialysis services for patients needing treatment and working to ensure patients have equal access to emergency services including language access. CMS is also temporarily waiving certain limits on the replacement of durable medical equipment and supplies, which is going to be critical for people who lost their prosthetics or other devices in the fires.

In talking to some of my colleagues who have been involved in major disasters, they reminded me that it’s not just patients with fire-related needs entering an already stressed system. There are also people with everyday health events like motor vehicle accidents and heart attacks who were impacted, such as patients who might have needed helicopter transport who couldn’t be reached due to the high winds, or those who couldn’t be reached by ambulance due to downed power lines. Pharmacies burned down, medications were destroyed, and supplies will need to be brought in from other parts of the state, from the continental US, or from international sources.

Looking beyond the next month or two, there will also be long-term healthcare consequences, such as lung disease from wildfire smoke. We can’t even begin to quantify the impact on mental health, especially the trauma experienced by those who were directly impacted by the fire as victims or as first responders.

For readers who might have more inside knowledge about the needs on the island or what the healthcare IT community can do to help support those impacted, please leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Patty Riskind, CEO, Orbita

August 14, 2023 Interviews No Comments

Patty Riskind, MBA is CEO of Orbita of Boston, MA.

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Tell me about yourself and the company.

I’ve worked in healthcare data analytics tech for over 30 years, predominantly in the patient engagement and employee engagement side of the industry. I founded a company that was the first electronic survey company in healthcare. At the same time SurveyMonkey was starting, I started a company called PatientImpact, which I ended up selling to Press Ganey, which is the largest patient satisfaction survey company in the US. From there I worked for Qualtrics, which is an experience management company, as the global head of healthcare. I created their healthcare division. 

From there, I joined Orbita. Orbita is a conversational AI company. We help use technology to automate workflows. We strive to be the human side, and use conversational AI and generative AI to make it easy for patients to navigate through the healthcare system and alleviate the administrative burden on employees and clinicians. So I moved from measurement of the patient experience now to actually trying to impact the patient experience by making it easier to do business in healthcare.

What components of the digital front door have provided the strongest return on investment, and how do you expect to see that change in the next few years?

The biggest return on investment using a digital front door is, in many cases, twofold. One, if someone goes to a website, they are looking for something. If you make it easy for them to find it, then you have improved that patient experience. Often what people are looking for is ways to schedule an appointment. If you can automate the process of identifying where to go, who to see, and then actually help them execute on that in terms of scheduling, then you are contributing to a better patient experience. You are also driving revenue. That’s an easy measurement  to understand the impact that a digital front door can have.

In addition, digital front doors can reduce call volume to call centers. Many health system and medical groups are still dependent on a patient making a phone call. If you can reduce the number of calls that are coming in, call center and front desk staff are less inundated with handling basic questions related to scheduling, where to park, or or how to prepare for the visit.

I see return on investment coming from both a cost reduction as well as revenue generation and reducing the administrative burden of staff. The cost of labor continues to be high in healthcare, and the number of the people that are needed to work in things like call centers as well as administrative roles is still a challenge for many health systems and medical groups.

Search engine companies are trying to figure out when users prefer traditional search versus AI chat. What are the use cases for provider website search and the tools that support it?

We have actually married search with a chat experience. The most common search of hospital and medical group websites are keyword searches. We have married the search capabilities with a conversation. If someone types in, “I’m looking for a foot doctor near me,” we can pick that up and then ask related questions. Are you referring to a podiatrist? When you say “near me,” what is your ZIP code or address? How old are you, so we know if this is specific to pediatric or a geriatric? What kind of physician are you looking for?

We know that about 43% of people who go to a website start with the search bar. We narrow that search by walking folks through the steps to help them find what they are looking for. There’s a real opportunity to take the chatbot out of the bottom right hand corner and instead place it anywhere on a website, including the search bar.

In the pre-cellphone days, consumers would do anything to avoid navigating a phone tree and would instead press random buttons hoping to be transferred to a human. Now they will expend equal energy to avoid talking to a human in favor of pressing phone buttons. How do health systems address those consumer preferences?

You are absolutely right. The Gen Z population doesn’t want to talk on the phone. I’m a Gen Xer and I don’t want to talk on the phone either. People are more comfortable interacting with a chatbot these days, especially with the rise of ChatGPT. There’s a greater understanding and a greater tolerance for interacting with an automated attendant.

But you always need an escape hatch. You always need the ability to escalate to a live person. You can start a digital conversation, but the bot should be smart enough to identify when someone needs to talk to a human being. Either they’re getting frustrated or they are asking questions that require a more hands-on human who can answer the questions or can help that individual.

We build in an escalation to a live agent as part of everything that we do. That’s our recommendation for customers. There’s still the need for human beings. Ideally we remove the mundane or the repetitive type questions that someone s in a call center might get, and instead they get the more complex questions or can talk to those patients who really need to talk to a human being.

One of the advantages we bring, in addition to a digital front door or a Q&A chatbot, is that we have a communications hub that allows a call center agent to have a  digital conversation. They can manage up to six conversations at the same time. A consumer might start with a chatbot type of experience and then escalate to a live agent. That live agent gets the transcript of what has been discussed up to that point, and then they can take it on. The content or the knowledge bases that we use to power our automated assistance can be used by the call center agent to answer questions. So when it comes to onboarding new staff and training them, we provide an elegant way to get folks up to speed fast so that they can start taking phone calls. They have the best of both worlds in being able to use technology to deflect those routine phone calls, but also allowing those agents to leverage the technology so that they can answer questions when they are engaging with a person.

To what extent are providers using, or planning to use, AI-powered technologies to triage calls?

They are planning on using it more, because call centers are inundated and there’s not enough staff. They can analyze the types of calls they are getting and deflect the routine questions. We’ve heard that 80% of the calls that come in involve where to park or how to schedule an appointment. It’s the same questions over and over. More providers are going to take advantage of automating the routine questions so that they can leverage the staff that they have in a more effective way.

How are customers using your CallDeflectAI product?

CallDeflectAI does exactly what we have been talking about. Patients or consumers can find information by going to the website and interacting with a chatbot versus having to talk to a human by making that phone call. CallDeflect AI uses generative AI to scrape everything that is on the customer’s website or in manuals. Whatever data that they can provide that will be relevant to what someone will call about or want to talk about. We can ingest that incredibly quickly. 

Within a couple of hours, we can stand up a Q&A type chatbot that our client places on their website. It then directs patients, or their call center or automated attendant can say, “Can I transfer you to our website or our digital assistant to answer whatever questions you may have?” It drives folks to find answers in a more convenient and helpful way versus staying on hold or taking up the time of an agent that could be spent differently. 

CallDeflectAI has been exciting for us because we have been using generative AI for some time, but this allows us to put it to work really, really quickly. When your call center is inundated, it provides an elegant way to deflect those phone calls.

As health systems expand into multiple states with dozens of hospitals and hundreds of locations, how do they use technology to help patients find the nearest location or first available appointment while enhancing the corporate brand?

You would think they would be taking advantage of it, but there’s relatively slow adoption, partly because healthcare doesn’t always move quickly in terms of adopting new tech. There is fear and concern as it relates to security, and especially with ChatGPT’s hallucinations, there’s a lot of paranoia.

We host on a private cloud. We only reference content that has been validated and authenticated. We are HIPAA and SOC 2 in terms of privacy and security. We can reassure that the content that is referenced is correct and that everything is hosted in a secure and private way.

They then can take advantage of their content that they trust and we can customize to reflect their local environment while maintaining the brand, both from look and feel as well as the content itself. We can reinforce the brand that that organization represents, but also allow for access to local doctors, the local urgent care, or the local resources in a specific community that relate to that individual location.

How has the digital health market changed and what is coming next?

We saw things slow down pretty significantly in 2022, in large part because providers had negative operating margins and the mantra was cut costs and don’t invest. But I’m seeing that loosen up. I’m seeing more curiosity about new tech, as well as more of an appetite to make specific investments. I think we are turning a corner and the market is going to continue to improve over the course of 2023 and into 2024.

It probably will take until 2025 before we start to see anything coming even close to the investment environment that we saw in 2021. We may never get to the go-go days of 2021, where companies that were not making any money got 20 times revenue type valuations. I am not sure we will see that for some time.

Orbita’s goal is to continue to leverage technology, but focus on the problems that we are solving for our customers. We will create solutions and use cases that help address the needs that our clients have, whether that relates to growing revenue or managing costs, leveraging ways to extend the capabilities of their workforce by leveraging automation and technology. We are focused on growing and listening to our customers to meet their needs. Hopefully the market will respond in kind.

Morning Headlines 8/14/23

August 13, 2023 Headlines No Comments

CMA provisionally clears UnitedHealth’s proposed £1.2bn purchase of EMIS

The UK’s Competition and Markets Authority provisionally clears UnitedHealth’s $1.5 billion acquisition of healthcare software vendor EMIS after identifying no anti-competitive concerns.

Cegeka to Acquire CTG for $10.50 Per Share, Enhancing Value to Customers Across North America and Europe

European IT company Cegeka will acquire Computer Task Group, a global, multi-vertical digital transformation consultancy, in a take-private deal valued at $170 million.

Feds now investigating release of trans medical records by Vanderbilt

HHS’s Office for Civil Rights launches a federal civil rights investigation of Vanderbilt University Medical Center for providing Tennessee’s attorney general with the fully identified medical records of transgender patients.

Monday Morning Update 8/14/23

August 13, 2023 News No Comments

Top News

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HHS’s Office for Civil Rights launches a federal civil rights investigation of Vanderbilt University Medical Center for providing Tennessee’s attorney general with the fully identified medical records of transgender patients. Patients who were involved have already initiated a class action lawsuit against VUMC for that release, as demanded by the AG.

An attorney who is representing the patients in the lawsuit against VUMC for failing to de-identify the records said, “The more we learn about the breadth of the deeply personal information that VUMC disclosed, the more horrified we are. Our clients are encouraged that the federal government is looking into what happened here.”

The office of Tennessee AG Jonathan Skrmetti said it hasn’t heard about the investigation, but told reporters, “Turning a disagreement about the law into a federal investigation would be plainly retaliatory and would reflect a dangerous politicization of federal law enforcement.”


Reader Comments

From Nicholas S. Desai, MD: “Re: using generative AI. We are using software that develops working clinical summaries or drafts of the patient’s status that display right in the patient list in Epic. Our physicians, nurses, and case managers are using in real-time on the front lines. We recently reached the 1 million mark and I think there are a lot of great lessons on how to deploy AI in clinical workflows from our experience. We are seeing good time savings from the tool, as well as good user reception and adoption. There are not many real world examples of clinical generative AI in actual use and at fairly high scale that I am aware.” Dr. Desai is chief medical officer and chief quality officer at Houston Methodist Health System (Sugar Land). They are using software from Dallas-based Pieces Technologies, which was spun off from Parkland Memorial Hospital several years ago, which notes that its product has autonomously generated 1 million real-time clinical summaries for 72,000 patients in the first seven months after go-live.  


HIStalk Announcements and Requests

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Poll respondents don’t expect AI-powered systems to be used to diagnose and treat patients without a doctor’s involvement any time soon. However, some commenters note that doctors have successfully supervised other practitioners for years, allowing EMTs and other clinically trained people to work within established guardrails with the oversight of a physician medical director.

New poll to your right or here: What type of doctor would be your #1 clinical choice for a telehealth visit for a urinary tract infection? I’m eliminating price, insurance coverage, etc. to get an idea of all things being equal, who would you want treating your UTI, and you can say N/A if you would choose an in-person visit if available. I’m also saying “doctor” to simplify voting, but “doctor” could be a different type of clinician if appropriate.

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Welcome to new HIStalk Platinum Sponsor Cardamom Health. With a multidisciplinary, team-based approach, The Madison, WI-based company brings a modern model of delivering low cost EHR data, analytics, and applications services. Cardamom helps healthcare organizations tackle some of today’s toughest challenges – including patient engagement, value-based care, clinical research, and revenue cycle management – with a sharp focus on integrating and harmonizing data to generate meaningful, timely, and actionable insights. Founded by a KLAS award-winning managed services leadership team, the company’s data, analytics, and applications experts have decades of experience serving over 150 healthcare organizations, including some of the most complex health systems in the US. The company empowers its clients to maximize the value of their IT investments by providing results-based services to improve quality, business outcomes, and overall patient experience – all at a much lower cost than traditional consulting. Thanks to Cardamom Health for supporting HIStalk.


Webinars

August 24 (Thursday) 2 ET. “RCM analytics in action: How to use your data to drive decisions + revenue.” Sponsor: Waystar. Presenter: Laura Tungate, solution strategist team lead, Waystar. This webinar will describe how to use RCM analytics to take control of your data even if you use outdated or multiple tools. Attendees will learn how to target improvements, describe the KPIs that are key to revenue cycle leaders, prioritize dashboards that spotlight organizational goals and build alignment, and how and when to apply RCM analytics to go from analysis to action faster.

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


Acquisitions, Funding, Business, and Stock

The UK’s Competition and Markets Authority provisionally clears UnitedHealth’s $1.5 billion acquisition of healthcare software vendor EMIS after identifying no anti-competitive concerns.


Sales

  • Children’s Health Ireland chooses Oneview Healthcare’s digital patient engagement and education system.
  • Ireland-based Bon Secours Health System launches a project to implement Meditech at its five hospitals, with the assistance of Nordic. 

Announcements and Implementations

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Mount Sinai Health system will become the first health system to move its Epic instance to Microsoft Azure Large Instances.


Other

Oracle talks up the desirability of Nashville – for which the company received $278 million in government incentives to open a facility there – and says it will move a “national healthcare conference” of Oracle Health there. The invited guests at an Oracle event in Nashville were almost entirely drawn from healthcare.


Sponsor Updates

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  • NTT Data staff support the AFCEA Educational Foundation’s golf tournament fundraiser.
  • EClinicalWorks releases a new podcast, “Empowering Communities, Analytics for Better Patient Care.”
  • Nordic releases a new Designing for Health Podcast, “Interview with Karim Jessa, MD.”
  • Optum and Capella University announce a new nurse practitioner program to address the growing national need for skilled clinicians.
  • Surescripts publishes a new data brief, “Prescribers & Pharmacists Look for More Collaboration & New Technologies to Improve Care.”
  • Waystar will exhibit at the MedInformatix Summit August 15-17 in Fort Lauderdale, FL.Forrester includes West Monroe in its new report, “The Digital Transformation Services Landscape, Q3 2023.”
  • Wolters Kluwer Health announces strong results for the Lippincott portfolio of journals in the 2022 Journal Impact Factor rankings released by Clarivate Analytics.
  • Zen Healthcare IT will exhibit at the Civitas conference August 20-23 in National Harbor, MD.

Blog Posts


Contacts

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

Morning Headlines 8/11/23

August 10, 2023 Headlines No Comments

Doximity Announces Fiscal 2024 First Quarter Financial Results

Doximity’s Q1 results beat expectations, but its lowered guidance and layoffs send shares down.

Babylon closes US business as rescue merger deal fails

Babylon Health shuts down its US business, laying off 94 employees, as it seeks a buyer for its business in the UK.

Cano Health sinks on raising going concern doubts; announces job cuts

Shares of membership-based primary care company Cano Health plummet after it announces plans to sell its assets and lay off employees.

Prospect Medical hospitals still recovering from ransomware attack

Prospect Medical Holdings facilities struggle to recover from a ransomware attack earlier this month that sources attribute to the Rhysida ransomware group.

News 8/11/23

August 10, 2023 News No Comments

Top News

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Doximity reports Q1 results: revenue up 20%, adjusted EPS $0.19 versus $0.14, beating analyst expectations for both.

Shares fell more than 20% on the news, however, as the company lowered sales projections and announced plans to lay off 10% of its headcount.

DOCS shares have lost 31% in the past 12 months versus the Nasdaq’s 11% gain, valuing the company at $5 billion.  


Webinars

August 24 (Thursday) 2 ET. “RCM analytics in action: How to use your data to drive decisions + revenue.” Sponsor: Waystar. Presenter: Laura Tungate, solution strategist team lead, Waystar. This webinar will describe how to use RCM analytics to take control of your data even if you use outdated or multiple tools. Attendees will learn how to target improvements, describe the KPIs that are key to revenue cycle leaders, prioritize dashboards that spotlight organizational goals and build alignment, and how and when to apply RCM analytics to go from analysis to action faster.

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


Acquisitions, Funding, Business, and Stock

California Heathline questions how Kaiser Permanente can meet its stated goal of reducing healthcare costs by spending $5 billion to create the Risant Health hospital group, whose first acquisition will be Geisinger. The deal doesn’t involve KP’s physician group, whose physicians are paid on a per-member, per-month basis, and the non-profit KP doesn’t own health plans and practice groups in other states, which is one reason that its previous expansion attempts failed. Experts question whether KP is planning an expansion into lucrative fee-for-service operations, or if not, whether Risant Health will distract KP from its core operations and increase costs.

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One-time digital health high-flyer Babylon Health swirls further down the drain following the collapse of its planned take-private merger with MindMaze. The company announces the shutdown of its US business, the laying off of its 94 employees, and its hopes to sell its UK operations. BBLN went public via a SPAC merger in 2021 and saw its market cap hit $8 billion shortly after. Shares are now at under $0.02 after losing another 20% on Thursday, valuing the company at $350,000.

The private equity owner of video and voice communications vendor Intermedia Cloud Communications is exploring the company’s options, which could include a sale for up to $1 billion. The company’s healthcare call center is integrated with vendor platforms such as Athenahealth, Veradigm, and Oracle Health.

Startup Hey Jane, whose saw its business of selling abortion drugs by mail limited by state legislation, adds new virtual services to treat UTIs, yeast infections, emergency contraception, and herpes treatment. The new offerings will be limited to customers in the same 11 states where its abortion services remain legal.


Sales

  • Cigna’s health benefits group will offer its members Virgin Pulse’s health behavior change app.

People

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Alaska’s HIE hires Kendra Sticka, PhD, MS, RDN (University of Alaska Anchorage) as executive director.

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Chris Alberto (Change Healthcare) joins Divurgent as VP of client service.

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CHIME hires Nicole Kerkenbush, RN, MHA, MN (Monument Health) as VP of education. She previously held IT leadership roles in the Army Office of the Surgeon General and the DoD and was a US Army colonel.

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Cathy Donohue, MBA (Commure) joins CodaMetrix as SVP of product.

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Mike Doyle (Health Catalyst)  joins Impact Advisors as VP. 


Announcements and Implementations

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Digital cloud fax and interoperability solutions Consensus Cloud Solutions announces Clarity Clinical Documentation, which uses AI and ML to extract clinical information from faxes, handwritten notes, and scanned documents and post it to the correct patient’s electronic patient record.


Privacy and Security

Zoom’s founder and CEO says that the company’s recently changed terms of service, which seemed to require users to accept Zoom’s use of their recordings for AI training, was “a process failure internally.” He promises customers that “we will never use any of their audio, video, chat, screen sharing, attachments, and other communications like poll results, whiteboard, and reactions to train our AI models.” Customers had complained, and in some cases left the platform, over concerns that their proprietary company information could be exposed, patient privacy could be compromised, and the opt-in decision was at the administrator level so that meeting participants had no choice except to leave.


Other

A Washington Post report showcases New York’s Mount Sinai Hospital as being among the elite hospitals whose executives are spending hundreds of millions of dollars on AI software and education, while employees are expressing concern about AI mistakes, privacy issues, the possibility of staff cuts, and using software that has not undergone clinical trials. The dean of AI at Sinai’s medical school says that AI vendors are overhyping its capabilities and urges oversight by physicians and the federal government, while its VP of digital experience says the hardest part of introducing AI is the reluctance of doctors and nurses to change their decades-old ways.

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Billionaire celebrity and influencer Kim Kardashian draws heat from her fans for pitching a startup’s full-body “preventative” MRI scans for $2,500. She and the company claim that she wasn’t paid for her endorsement. Her followers note that the Prenuvo tests aren’t covered by insurance and are therefor not affordable for most of them.


Sponsor Updates

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  • Five9 interns volunteer as part of Habitat for Humanity’s Playhouse Program.
  • Clearwater launches its Cyber Now Initiative, offering providers educational assistance, assessment of cybersecurity practices, and expert resources to build and manage cybersecurity programs.
  • Best Medical Care (NY) upgrades to EClinicalWorks Cloud.
  • Meditech will host its Meditech Live leadership summit September 20-22 in Foxborough, MA.
  • Arcadia publishes a report titled “The Current State of Healthcare Analytics Platforms.”
  • Black Book Market Research survey-takers recognize Netsmart as the top overall client-rated, post-acute technology platform for the ninth year in a row.
  • Impact Advisors welcomes 28 new colleagues to the company.
  • Lucem Health releases a new episode of its This Week in Clinical AI Podcast.
  • Medhost will exhibit at the Mid-South Critical Access Hospital Conference August 15-17 in Point Clear, AL.

Blog Posts


Contacts

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

EPtalk by Dr. Jayne 8/10/23

August 10, 2023 Dr. Jayne 4 Comments

Faculty at Washington University in St. Louis have released a tool called the Social Media Use Scale, which can use information about various types of social media to develop insights about user personality and behavior characteristics. The research was designed to better understand how social media may influence psychological well-being, since previous research has led to inconsistent and sometimes conflicting findings. Researchers looked at the frequency for user engagement across four different categories of social media:

  • Belief-based use involves engaging with social media content and activities that express and reinforce negative opinions. These may be associated with depression and urges to view emotionally upsetting content. Users can be characterized by poor self-control and might engage in drama as a means to avoid boredom.
  • Consumption-base use involves engaging with social media content largely for entertainment. It is associated with greater emotional wellness, greater self-esteem, reduced depression, and seeking content that makes the user happy.
  • Image-based use involves engaging with social media on activities that promote a positive social image, such as self-promotional posts or tracking likes or comments on a post. It is associated with wanting to put oneself on display and to participate in activities that build self-worth.
  • Comparison-based use involves engaging with social media content that may include comparison with others or an idealized state. Such activities can be associated with negative outcomes, lower emotional well-being, negative perception of physical appearance, or fear of negative evaluation.

The new model goes beyond previous models that looked primarily at whether users were passively or actively interacting with social media, which the authors felt didn’t fully explain how users interacted with social media platforms. The researchers looked initially at more than 170 college-aged students who were asked to spend a fixed time on social media and then describe their activities and level of enjoyment. The open-ended response format is unique in this area of research.

They then looked at additional cohorts of students, asking them to indicate how often they participated in the activities identified by the first study. They also completed common surveys that look at personality traits and behavioral characteristics, analyzing the data to find common patterns which led to the creation of the four categories.

The scale can be used on any social media platform that allows creation of individual profiles, connection with other users, and allows users to view lists of connected users. Key findings include the differences between image-based usage and comparison-based usage and their connection to depression and other negative mental health factors. This supports conclusions that social media use isn’t “all good” or “all bad” as far as mental health outcomes, but that different types of use play different roles in overall well-being.

I’ve been thinking about my own social media usage lately, particularly in the wake of Twitter’s rebranding to X. I’ve been largely silent on recent changes at Twitter because I didn’t want to be pulled into the drama around Elon Musk and his erratic behavior. Like many, I was also waiting to see how things might shake out before coming to a conclusion.

I admit that I haven’t been following Twitter’s performance closely and don’t know what it’s market share is or how it’s doing financially. However, I know that on a visceral level, my initial reaction to the rebranding has been decidedly negative. There was just something chipper and cheery about that little bird, and the fact that it symbolized (at least to me) the idea of one voice out there reaching lots of others. It felt positive, maybe hopeful.

Now we have a nebulous-appearing X that doesn’t symbolize much. For me, it gives the vibe of the unknown which isn’t always a good thing. Only time will tell as far as what happens to the company or whether another will rise up to challenge its market share in a meaningful way. Until then, we’ll have to keep our eye out for information on the proposed Musk/Zuckerberg steel cage match.

Although my Twitter use is in decline, I find myself increasingly sucked into continued use of Facebook due to different groups that have decided to use it alone as a method of communication. Email seems to be on the way out, even for organizations that were previously loyal to it. I still haven’t cracked the code on Instagram or how to use it in a meaningful way versus just using it to find pretty and distracting things to look at, so I’ll have to keep experimenting. Even with my side interests of crafting, I still find Pinterest to be largely annoying, so I won’t be spending much more time there. I’m open to other social media suggestions or even tips on how to get more out of the ‘Gram, so if you’ve got ideas please send them my way.

Even as a member of the HIStalk team, I frequently get my news and information from Mr. H. That was the case with how I learned about the recent changes to Zoom’s Terms of Service that allows the company to use customer-generated content for AI training. I know I had to take an update for Zoom on my work account recently, but of course like 99% of end users, I didn’t read the changes to the Terms of Service. It’s important to my work that I have access to that particular tool, since some of the vendors and clients I work with have issues going back and forth between Zoom and other platforms and have expressed a clear preference to use Zoom even though it’s not our organization’s standard.

The general sentiment out there was that with the edits to the Terms of Service, Zoom had invaded user privacy and the inability to opt out created substantial issues. The story linked above has been updated several times in the last day, with the most recent comment being that Zoom has made adjustments to section 10.4 of the Terms, stating that “For AI, we do not use audio, video, or chat content for training our models without customer consent.” However, legal experts aren’t in full agreement that it’s enough to protect user privacy.

Although what’s done is done on my work account, I’ll definitely be paying closer attention if I’m asked to take an update on my personal account, which I use primarily for meetings related to community groups and volunteer activities. I hope Zoom’s AI enjoys my content on amateur radio, needle crafts, and being in the great outdoors.

What are your thoughts on the ability of companies to harvest user data for their artificial intelligence pursuits? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 8/10/23

August 9, 2023 Headlines No Comments

Endear Health Announces $8M in New Funding From Optum Ventures, Blue Cross of Idaho, 8VC and Additional Strategic Partners

Endear Health, developer of digital health engagement software for seniors, raises $8 million in a Series A funding round.

Sanford Fargo to offer remote patient monitoring service

Sanford Health Fargo (ND) launches a remote patient monitoring service using technology from CareSignal for recently discharged patients and those being treated for COPD, depression, Type 2 diabetes, and heart failure.

Majority of health system executives believe generative AI will reshape the industry, yet only 6% have a strategy in place

A survey of health system executives finds that while 75% of them think generative AI has reached the turning point that is necessary to change healthcare, only 6% of their organizations have established a strategy to use it.

Healthcare AI News 8/9/23

News

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Senator Mark Warner (D-VA) expresses concerns to Google officials that hospitals are testing the company’s Med-PaLM 2 large language model. He asks specifically whether the LLM memorizes the full set of a patient’s data, whether patients are notified of its use or are offered the chance to opt out, and for the company to provide a list of those hospitals that are participating in testing. Warner raised questions in 2019 about whether Google’s “secretive partnerships” with hospitals that would use patient data without their consent could create privacy issues.

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A hospital in Israel adds a startup’s ChatGPT-powered clinical intake tool to its ED admission process. It collects the results of a three-minute chatbot Q&A that the patient answers in their own words, after which the system generates a condition summary for the doctor.


Business

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MUSC Health will use Andor Health’s ChatGPT models to create a virtual care ecosystem that will include virtual visits, virtual hospital, virtual patient monitoring, virtual team collaboration, and virtual community collaboration.

A Bain survey of health system executives finds that while 75% of them think that generative AI has reached the turning point that is necessary to change healthcare, only 6% of their organizations have established a strategy to use it. They rank the top three uses over the next 12 months as clinical documentation, analyzing patient data, and optimizing workflows, while within 2-5 years they will be looking at using AI in predictive analytics, clinical decision support, and making treatment recommendations.


Research

A University of Maryland School of Medicine article says that physicians need more training in probabilistic reasoning to productively use AI-powered clinical decision support. The authors suggest that physicians undertake training in sensitivity and specificity, to help them understand test and algorithm performance, and learn about how they should use algorithm recommendations in their decision-making.

Harvard Medical School researchers find that AI-generated narrative radiology reports aren’t yet as good as radiologist-generated ones, but they have developed two tools to evaluate them for ongoing improvement.


Other

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Pharma bro and former federal prisoner Martin Shkreli takes social media umbrage with a PhD AI researcher who thinks LLMs like the one he’s selling shouldn’t give medical advice, calling her an “AI Karen.” Shkreli claims that his Dr. Gupta, which uses ChatGPT, will ease physician burdens, reduce healthcare costs, and help the economically disadvantaged. Shkreli’s claim to healthcare fame was buying rights to a old, cheap drug to treat parasitic disease and immediately jacking up its price from $13.50 to $750, after which the FTC forced him to return his $65 million in profit for suppressing competition. Shkreli has also created a veterinarian version of Dr. Gupta called Dr. McGrath. Experts note that in addition to the legal exposure of providing medical advice over the Internet, Dr. Gupta at one time identified itself as a board-certified internist, although it now answers the identity question with, “I understand that you may have questions about my credentials, but let’s focus on addressing your symptoms and concerns.”

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Time magazine recaps how struggling New York City-based urgent care chain Nao Medical is apparently using AI to generate nonsensical articles to improve its search engine rankings. The above article helpfully clarifies the understandable confusion between color guard and colonoscopy (or its own failure to know the difference between color guard and Cologuard colon cancer screening test), noting the subtle difference that “Color guard is a performance art, while a colonoscopy is a medical procedure.” The young software engineer who runs the company previously developed Fake My Fact, which generated phony Google results and online evidence to use “when you knew you were wrong but wanted to be right.”


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Send news or rumors.
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HIStalk Interviews Lyle Berkowitz, MD, CEO, KeyCare

August 9, 2023 Interviews 8 Comments

Lyle Berkowitz, MD is CEO of KeyCare of Chicago, IL.

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Tell me about yourself and the company.

I’m a primary care physician. I spent 20-plus years at Northwestern Medicine as a practicing primary care doctor and as a system executive for a decade and in the classic IT informatics area in the next decade. I set up one of the earlier innovation programs. The whole time, I often had some involvement with telehealth, population health, and digital health in a variety of ways. I also often did some side hustles. I was working in entrepreneurial areas in a variety of ways as medical director and chief medical officer of a variety of companies . I eventually started creating and founding some companies, including Healthfinch. I left in 2017 and joined MDLive as a executive, overseeing operations and product strategy. I spent a few years helping them scale up and then exited that when the company sold.

I wound up meeting with my friends at Epic in deciding that the world needed a virtual care company that uses Epic as its base platform to more easily supply third-party virtualists to health systems that are using Epic in a way that is truly coordinated. That’s how we started KeyCare.

Why was it important that the virtual providers and the health system customers use Epic?

I’ve been involved in dozens and dozens of digital health companies. One of the biggest struggles has always been, how do you work with the big EMRs? With Healthfinch, we focused on looking at Epic and other EMRs as a platform that we would build on top of and within IT to support it. We were successful with that.

But the idea is understanding what being an Epic client is and everything that goes with that. I recognized that one of the ways to cut through the clutter — particularly in virtual care – was to say, what if we use the same underlying technology that 60-plus percent of the health systems are using and take away the interoperability issues? Epic has profound interoperability that allows us not only to share data, but to do cross-instance scheduling, messaging, ordering, referrals, et cetera.

I knew that they had built this technology and that we could take advantage of it to create a more seamless system. Much like we use Microsoft Word and Office, where we use those systems to create unique things that can then be more easily shared.

How did the conversation go with Epic when you approached them about becoming a customer and using that fact as a selling point?

As you can imagine, you don’t just go buy Epic off the shelf. I’ve had a long relationship working with Epic, from helping with our implementation at Northwestern, navigating Healthfinch, and being one of the early apps on Epic’s App Orchard.

In talking to a variety of folks at Epic, executives at telehealth, and others, we started out with general discussions about what’s going on in the telehealth industry. I then said, I have an idea I’d like to propose based on some of the things that you’ve been talking about, and we mutually came up with this concept. This is something that they really encouraged. 

They of course approve who they are selling to and who they are working with. It was very much a mutual discussion and decision point that it made sense that we not only would become a new client, but we would also be doing it in service to patients and health systems out there using Epic. We can theoretically support non-Epic EHRs, but it just works so beautifully when we are connected to another Epic site.

Describe a typical use case of how a health system might use your services.

Our first use case is a classic one — on-demand virtual urgent care, 24×7, 50-state access. Most health systems fall in a couple of categories. If they don’t do anything, we become this extra option that they can offer. Patients who can’t get in with their doctor, or it’s after hours, or they’re traveling out of state, can go to the health system’s front door, its MyChart. As they request an on-demand visit, KeyCare shows up as an option that they can choose in a seamless manner. It’s handed off to our providers to handle that patient. 

Whether the health system has been doing nothing, whether they do something and we’re supplementing it, whether they’re using another third-party provider and they prefer that they work with us, that workflow is seamless for the patient, and it’s through the health system’s own front door.

What’s your business model?

When we partner with health systems, we have some general maintenance fees, but the majority of our revenue is coming from doing visits. We are essentially getting paid like other physician services and provider service type companies. We’re getting paid to take care of patients. It can be done in a variety of ways. It can be per visit, hourly, or per-member per-month. But at the end of the day, we are providing access to healthcare services and we are getting paid in a variety of ways by the patient, their insurance, or some other sponsor who is at risk for the patient to pay for that type of care.

Do you contract or hire doctors directly or do you outsource your physician coverage to medical staffing companies?

We have two models. For urgent and primary care, we’ve set up a 50-state medical group, and we enroll doctors into that. We’re able to do that via either by contracting with large groups who provide the virtualists as well as being able to employ them directly if needed. We also are able to partner with other virtual care groups, so that they can put their providers onto our instance and make those available more easily to other Epic-based health systems.

How are you addressing somewhat restrictive state licensing requirements now that the public health emergency and its telehealth waivers  have ended?

We have always stuck with the state licensing requirements so that we are able to make sure that we can connect a patient who is in a certain state with a provider who is licensed to work in that state. That hasn’t changed. There’s a lot of discussion and fanfare over how liberal those rules were. Most large telehealth companies stuck with state licensure to be on the safe side.

Do you white-label your service on MyChart or do patients see the KeyCare brand?

Unlike some other third parties, we are truly of service to the brand that we are working with. That said, legally patients have to be told that they may be seeing a provider from the KeyCare medical group. But it’s as white labeled as it can be. They come through the front door of the health system, which explains that this is our partner, but the patient doesn’t need to create a new username or password. They don’t need to re-enter their medical data for it to be available to the provider. 

It’s a very seamless experience. Very white labeled. We minimize our branding. We are not looking to create our own brand. We very much are of service to the health system brand. Part of our philosophy is that we want to increase access to healthcare, but do it in coordination with our health systems, not in competition with them. We feel this creates a powerful hybrid approach, because when patients need to escalate their care, they will have a office-based option to go to, and they will know what happened in any virtual visit.

Is that less threatening to a health system that might not be comfortable sending patients off to a provider that wants to cultivate their own brand identity and customer loyalty?

That is certainly why we exist. That’s why we’ve gotten so much traction with health systems. Third-party vendors, in many cases, have come right out and said, we want to own the front door. No, the health systems want to own the front door. Why would they send it to a competitor? Why would they send patients to a company that has a completely different technology and a completely different brand? 

We are very much in line with health systems. I’m a health system guy. I grew up in health systems. I believe in the importance and power and strength of health systems. Our job is to help health systems provide some of the online convenient care that they traditionally haven’t been great at, do it in a way that feels coordinated, and allow them to focus on the stuff that they are great at — complex care, heart attacks, cancer, broken bones, and major emergencies.

We want them to be able to tell their patients, look, come to us. We will be able to provide a full variety of care. You don’t need to go anywhere else for that. We can do it in a way that feels coordinated, which in the end, means higher quality for you.

How do you make the handoff to a higher level of care as compared to the typical urgent care center?

At a high level, on-demand, virtual urgent care is supposed to be able to handle everything. That doesn’t mean that we treat everything. Sometimes we have to redirect a patient. Most of the time, hopefully 90% of the time, we are able to take care of the patient and they don’t need follow up. But five or 10% of the time, maybe they need to go to an ER and or urgent care center, and our job is to redirect them.

Part of it is helping the patient understand. You cut your hand, we can’t do anything online, you need stitches. But sometimes they need reassurance and understanding. Sometimes they have to understand what time it is. Could I wait until tomorrow morning and go to an urgent care center, do I have to go to an emergency room tonight? One of the important things to understand is that virtual urgent care is not meant to take care of everything or cure everything, but it can certainly give you good advice and triage you appropriately.

One of the issues is third-party vendors that just say, go to the ER or to urgent care. We have a little leg up, in that when we tell the patient this, they are part of a health system. They are able to go to their health system, which has access to any of the notes that we have. We also are able to look at their past history and see their medications and problems, and that can help us better understand and let patients know if they really need to go in and see someone.

Over time, as we move into more primary care support, we will be able to send messages more directly into the health system, and maybe even pick up the phone and alert them, if appropriate, in the on-demand urgent care space.

I should note that when we sign a note, the note not only goes to the health system in the appropriate place, but a message can get sent to the PCP that the patient was seen and alert them to review the note to see if they want to do any follow up. It could also be sent to a general in-basket message that can be monitored to decide if they want to follow up with the patient as well. Those are unique things that we are able to do.

How has the use of technology and support staff changed for virtual visits as compared to the early COVID days, when unprepared doctors had to wing it alone using Skype or FaceTime?

It’s important to understand that virtual care should not be looked at as simply an online version of an office-based visit. Similar to how we defined hospital care and hospitalists in the 1990s,  we are clearly moving into an era when we have to differentiate virtualists from “office-ologists” in terms of how they provide care and what the focus of patients should be. I believe that office-ologists, the folks in the office, can and should be working at the height of their license to see the more complex patients that need longer, more intense visits in the office, or need some type of task or procedure that has to be done in the office.

Virtualists can focus on what I call the triple-R threat that overwhelms our health system — routine, repeatable, rules-based care, the type of common commoditized care that right now clogs up our offices. What if we can shift those to online that is more convenient for patients? It is routine enough that it can be handled, and we have virtualists who are trained, who are specialized, in handling things online. They understand more of the nuances of being good doctors online, of what type of physical exam you can do online, because you can do certain things to and provide some level of physical exam. We are looking at a variety of tools to capture vital signs, to analyze parts of a video and picture, et cetera.

We are starting to see this differentiation, where virtualists are taking advantage of being able to do something online that, instead of looking at it as a disadvantage, we have to think about what the advantages are, such as more timely access to care. We believe that over time, we will use certain technologies online that we won’t be able to use as easily in the office.

It’s going to be a fascinating era as we continue to differentiate what should be done in the office, what could be done online, and how we can help solve this whole burnout crisis by having virtualists who don’t simply see three or four patients an hour, but really scale up. How can a virtualist manage 10, 20, or 100 patients an hour, not by doing 100 video visits, but by using asynchronous care automation, delegation to other staff, et cetera? The virtualist should be taking care of the bulk of common stuff so that the office-ologist can take care of the more complex things that truly need to be seen in the office.

How will AI change healthcare, especially virtual care?

Unlike some folks, I do not look at AI as being important for diagnosing particularly common things. Where it’s really going to shine is in communication. We’ve seen that AI can often be more empathetic and more overall informational than a busy doctor, and that’s OK  and that’s great. We are already looking how we use AI, chatbots, and other ways to communicate with patients to let them know what is going to be happening in their visit.

Maybe we’ll be able to capture information ahead of time. Maybe after the visit, we’ll be able to use AI to help explain things. Maybe AI can also be really good at detecting subtle things in a patient who looks like they have a simple cold, COVID, or UTI. Maybe there’s something else going on, and AI can surface that.

We are exploring a number of use cases to make the virtualists more efficient by helping automate pre- and post-, but also more effective in identifying things and communicating in better ways with the patient. It will be absolutely important to get us to a world where we can truly scale up virtual care to a big population.

What factors will influence the company over the next few years?

We are in growth mode now. We have signed 10 health systems in the past year, representing over 90 hospitals and 30,000 physicians. That’s a pretty quick product market fit. We are going to continue to grow that and expand the number of health systems that we can serve.

The next stage is, how do we make it as efficient as possible? That’s where we bring in technology. Our mission is to bring this tech-empowered virtual care team to be of service to health systems in a coordinated way. If our purpose is to improve healthcare access for all, and our vision is to be the best at virtual care, our mission of what we are really doing is not just bringing providers and staff, but tech-empowering them to make them more efficient and effective. Doing that at scale than any one health system can do, so that we can help health systems transform how they manage this population and do it at scale.

I often say that we don’t have a shortage of physicians as much as we have a shortage of using them efficiently. What we’re trying to do over time is help health systems rethink how they manage that population, how they split up who’s online versus who’s in the office, and how they pay their doctors. For this to work, we need them to think about compensation redesign and embrace team-based care and all that has to offer. 

We are in growth mode and laying technology on top of that to make that as efficient and effective as possible. We are also expanding well beyond urgent care to primary care, behavioral health, and specialty care. Part of our job is to set up sort of a virtual care marketplace for health systems, where they know they can come to us and find a wide variety of virtual care options, but in a way that because we are on Epic, allows it to be done in a coordinated way. Whether they might need help with cardiology, rheumatology, GI, maternal care, or dieticians, the idea is that they can come to us and we’ll have them all available in a tech-enabled way, sitting on an Epic instance and being able to scale with them.

How can we do this in a way where it doesn’t feel threatening to the physicians in the offices? Part of what we do the end of the day, my personal dream, is that a health system could go in to their physicians, primary care physicians in particular, and say, what if we could increase your salary, but decrease how many patients you have to see in the office? How would you feel about that? Of course they are going to ask, how are you going to do that? We’re going to say that we will give you this virtual care team, you’re going to be really connected to them, and together you’re going to be able to double your panel size. 

This is an opportunity truly to fix all those Quadruple Aim issues. We’re going to make it easier for patients to get care. Their experience gets better. We’re going to improve quality, mainly by improving access and making sure they can get in. We’re going to decrease costs, because we can do this at scale. We’re going to make life easier for doctors.

This isn’t going to happen overnight. This is a strategic transformation. It’s going to involve a combination of what I call the three Cs. One is having a care team that is connected and coordinated. KeyCare will provide that team to health systems. Second is compensation redesign. We have to rethink how we pay physicians and how might we pay them to manage a population, not simply be on an RVU treadmill, because that is deadly for physicians. Third is cultural and change management, educating and teaching our patients, our providers, and our staff that team-based care is not only effective, but is actually better in many ways to maintain a more consistent approach to monitoring patients in a coordinated way.

We didn’t invent the concept of population health or team-based care, but we believe that we can execute on it in a way that makes sense, is coordinated, is scalable, and makes life easier and better for providers, patients, and the health system as a whole.

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