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EPtalk by Dr. Jayne 4/28/22

April 28, 2022 Dr. Jayne No Comments

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Half a dozen people sent me this article about Teladoc’s stock woes following recent statements on its outlook. Based on the comments of company leaders, it seems their customer acquisition costs are higher than anticipated. They also cited lengthy sales cycles as a barrier to growth.

Having been on both the health system side and the vendor side of the process, everyone underestimates the length of the sales cycle. My former hospital employer locked in budgets in July of the preceding year, and if you wanted to buy anything that wasn’t previously budgeted, you had to figure out how to fund it from your allocated bucket. Even if you were replacing a system with something newer and more efficient, you better not cross the red line with implementation or consulting fees. This ultimately led to a glacial experience for vendors trying to bring new solutions to the organization.

There have been some interesting articles in the telehealth literature of late. One looked at rates of antibiotic prescriptions for acute respiratory infections and compared performance by hospital-employed physicians to that of third-party contractors. There was a higher rate of antibiotic prescriptions by the contractors. Although the conclusions have received a lot of publicity, I think the results demonstrate that additional analysis is needed. The study looked at telehealth visits for health system employees and dependents between March 2018 and July 2019. The study was controlled for patient age, day of the week, and overnight visits. It only looked at 257 telemedicine encounters for acute respiratory infections.

In my experience as a telehealth provider and CMIO, the study didn’t look at some variables that can influence prescribing patterns. Number of years post-training can indicate whether the physician’s formative years occurred in the “less is better” era of antibiotics. There have been a lot of semi-retired physicians in my telehealth groups who might not be as close to current evidence as we’d like. Importance of patient satisfaction scores is another factor, and I’ve seen plenty of prescriptions issued in both the telehealth and in-person arenas by physicians who didn’t feel empowered to say no because of the potential impact on patient satisfaction scores. Method of compensation can also be an influence when physicians are paid on volume – it takes more time to explain why you’re saying no, which means lower wages for those providers versus those who are being paid a shift rate or who are compensated using other variables.

It also didn’t note whether the physicians were practicing on the same EHR system or whether the telehealth vendor had its own platform. I’ve practiced with three national telehealth vendors and none of them had the same level of clinical decision support that I’ve had in a health system or large practice EHR.

Last, it didn’t look at the presence or absence of quality metrics and reporting. In my health system-employed jobs, I’ve received a monthly quarterly metrics package that directly impacted my pocketbook as well as my understanding of my behavior. In my telehealth-only gigs, quality was only addressed robustly by one vendor and two of them didn’t deliver reports packages to me at all. None of the telehealth-only organizations offered bonuses or penalties tied to quality. I suspect that even if you had third-party physicians, if they were practicing on the same EHR and received the same quality measures reporting, compensation structure, etc. that the numbers would be similar.

It would also be interesting to look at data from the post-COVID world, when most organizations made significant leaps forward in their application of telehealth. Systems used in 2018-2019 were fairly rudimentary compared to what we have today, not to mention that physicians’ experience with telehealth visits has grown exponentially. Hopefully someone will do research to look at the impact of the rest of these factors as I suspect there is more to the story than meets the eye.

Telehealth also took a hit in this JAMA Network Open piece looking at follow-up patterns for acute conditions compared to chronic conditions. For acute problems, patients who had an initial telehealth encounter were more likely to have a follow-up encounter, including emergency department encounters and inpatient admissions. For patients with chronic problems, patients who had an initial telehealth encounter were less likely to have a follow up encounter. The authors note that there are some potential problems with uncontrolled confounding bias. They provided the example of the bias in deciding whether to deliver an encounter via telehealth or in person. They also noted the need to look at other clinically important factors, such as frequency of laboratory testing and prescribing or adjusting of medications. The study was limited to commercially insured patients and didn’t include subjects with Medicare, Medicaid, or no insurance. We know those patients often have significantly different care experiences that would be worth examining.

Thank you to all who reached out regarding my recent post on EHR downtime and medical errors. Many of you had gut-wrenching EHR downtime stories to share. I appreciate the stories but am saddened that we are all part of this club we never wanted to be a part of. Several readers noted the need to have ongoing downtime education – not just when people join the company or at the same time of year that everyone has to churn through annual HIPAA, Compliance, and Fraud / Waste / Abuse training. Others suggested practice downtime events to make sure people know when and how to declare a downtime, as well as where materials and supplies are located. Both strategies would certainly help, so thanks for bringing them front and center.

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I’ve been having difficulty sleeping since the recent time change, which was confounded by multiple trips from one coast to another. I’m not into pharmaceuticals and even some popular supplements like melatonin have fallen out of favor. It’s been a rough couple of weeks, so I’m back in pastry therapy. For your consideration, I present a new take on the classic pineapple upside-down cake. With the right amount of brown sugar and butter, you really can’t go wrong.

What’s your favorite stress-relieving pastime? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/28/22

April 27, 2022 Headlines 2 Comments

HHS puts $90M toward improving health center data collection

HHS allocates $90 million to help health centers modernize their data and reporting capabilities, enabling them to gain a better picture of social determinants of health.

Tenet Reports Cybersecurity Incident

Tenet Healthcare confirms that a cybersecurity incident disrupted patient care last week at several acute care facilities, though normal operations are now being resumed.

Implicity Raises $23M to Broaden Use of Its Cardiac Remote Monitoring Platform

Cardiac remote monitoring and data management technology vendor Implicity raises $23 million in a Series A funding round.

Introducing Source: The Infrastructure Layer for Virtual Care

Virtual care tech startup Source Health launches with $3 million in funding.

Readers Write: Public Health Agencies Share the Blame for COVID-19 Misinformation

April 27, 2022 Readers Write No Comments

Public Health Agencies Share the Blame for COVID-19 Misinformation
By Peter Bonis, MD

Peter Bonis, MD is chief medical officer of Wolters Kluwer Health.

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Surgeon General Vivek Murthy, MD, MPH asked big tech companies to provide data related to COVID-19 misinformation and issued an advisory on confronting health misinformation, reflecting the vital importance trustworthy health information plays in public health. The consequences of misinformation can be deadly to individuals and, tragically, to entire populations, as we have witnessed during the pandemic.

The surgeon general’s approach is, however, unlikely to achieve a meaningful impact on online health misinformation even if big tech companies comply with his request. The impact of misinformation is rooted in the trust that people place in it over alternatives.

The public has good reason to be mistrustful of official sources of information, making our nation’s health agencies partially culpable for the misinformation problem we face today. During the pandemic, we received conflicting guidance that changed frequently, didn’t satisfy our information needs, and was politicized. No “official” source of information has earned unalloyed trust, a role the CDC should own.

Well-intentioned spokespeople delivered inconsistent messages and disagreed in public forums, sometimes acrimoniously, leaving us with serious doubts about what to believe. At the same time, we have been terrified by the uncertainty and bewildered that the agencies charged with protecting us did not have the equipment, distribution systems, regulatory processes, and other operational mechanisms that we’d expect.

These factors contributed to making us less than confident in official sources of information and hence receptive to misinformation. Thus, the issue is bigger than addressing misinformation, it is a matter of restoring trust in our public health system and the policies and recommendations it delivers.

Fortunately, the White House just appointed Ashish Jha, MD, MPH as the new face of the federal coronavirus response. He will be instrumental in coordinating the response across federal agencies. It’s critical that Dr. Jha and Dr. Murthy collaborate, as misinformation and the coordinated federal response are intertwined. 

The Senate Health Education Labor and Pensions (HELP) committee is also addressing the topic. It is working on the PREVENT Pandemics Act, bipartisan legislation aimed at improving coordination between public health agencies. One component of the proposed legislation will require a senate-confirmed CDC director, a recognition that the public has lost faith in the CDC.

Now to a possible solution that Drs. Jha, Murthy and the HELP committee might consider. We can help tackle misinformation, fortify our public health system, restore the CDC’s reputation, and be better prepared for the next pandemic, all with the same set of actions. The best way to reduce the impact of misinformation is to create a preferred and trusted alternative.

The creation, maintenance, and dissemination of reliable health information are complex. I have spent the last 20 years helping to create and oversee UpToDate, one of the most rigorously vetted sources of medical information that millions of healthcare professionals worldwide rely on every day. From my vantage point, it’s clear where and how public health agencies are falling short and what solutions are needed. The CDC needs support to better tackle the curation and dissemination of information for healthcare professionals, policymakers, and the public. 

Curation involves identification of relevant clinical and policy questions, use of relevant data, and expert peer-review with stakeholders. Questions must be addressed directly, even when information is incomplete or evolving. It should include relevant perspectives, incorporate feedback, and be updated continuously. Controversies should be addressed, the evidence should be transparent, and recommendations that reflect the strength of convictions should be explicit.

Dissemination involves having clear communication approaches across multiple reading abilities, languages, and user types; intuitive user experiences tailored for healthcare professionals, policymakers, and the public; and a content platform that is easy for search engines to index. Major public health announcements should be published and disseminated with coordinated efforts across public health agencies, media, and social media. Officials speaking on behalf of public health agencies should confidently refer to the guidance, distinguishing extemporaneous comments and reflections from consensus opinion.

Applying these principles to develop a trustworthy clinical information service will reduce the impact of misinformation. Search engine and social media algorithms (and policies) will point to and prioritize such guidance. The public would still be free to pursue alternative points of view, but they could be compared against a trusted reference standard while fringe, conspiracy and unscientific information could be more easily de-prioritized—or dismissed.

Readers Write: The Scale of Interoperability: Healthcare Data is at Zettabyte Level and Growing

April 27, 2022 Readers Write No Comments

The Scale of Interoperability: Healthcare Data is at Zettabyte Level and Growing
By Jason Brantley

Jason Brantley is president and general manager, provider solutions at Datavant of San Francisco, CA.

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We are swimming in an ocean of healthcare data. It is everywhere, yet it is incredibly hard to get complete health data for an individual.

Data on the health of anyone individual is being collected everywhere we turn, including when visiting our doctors all the way to the wearables we have on our wrists. All of this health data combined amounts to approximately 30% of the world’s data, and that number is steadily increasing year over year. If we were to consolidate all the healthcare data in the world, we would have an estimated 2 zettabytes, which means 2 trillion gigabytes, of data .

The amount of healthcare data generated has reached the zettabyte level and shows no signs of slowing. And that’s just the digitized healthcare data – there is still a lot on paper and on film.

With over 2 zettabytes of data, we should be able to do some really high-powered research studies to understand rare and complex diseases, personalized treatment for each person, preempt onset of debilitating diseases, among many other ways to ensure that every health decision is based on data.

The current reality is starkly different. Although there are many examples of health data being used to understand diseases, the efficacy of treatment, or how we can detect illness earlier, it is estimated that 97% of the data produced in a hospital goes unused.

How do we ensure that more of the data that is already being generated in the healthcare industry can be used to benefit patients? This is not a new problem, and neither is the answer, which is interoperability.

Interoperability in healthcare has been talked about for years, and has not been achieved yet for a number of reasons. Some of these reasons include lack of communication standards between different systems, integration costs that reduce motivation to become interoperable, and apprehension of organizations to sharing data due to security and safety concerns.

Although there are barriers, improving the ease of exchanging and using data in healthcare will mean complete access to patient information at the time of care, improved care coordination, and the ability to study complex diseases in real time. The zettabyte of healthcare data that is already being generated could actually be used to improve patient outcomes, and more importantly, save lives.

The first step to this vision of interoperability is making sure that health data can be connected and can also be exchanged easily while maintaining patient privacy and security. Data in the healthcare ecosystem will remain fragmented across many different systems until we have efficient and easy ways to exchange health data. Once we have solutions to solve the fragmentation of healthcare data, the right data will be in the right hands at the right time.

Digitizing health data exchange is essential to solving fragmentation. It means that the owners of health data, typically healthcare providers, enable digital retrieval and distribution of the data. This is not a trivial problem, but it is solvable with current technologies. The systems to enable digital exchange must offer easy and intuitive controls such that the data privacy, security, and any other protocol set by the providers are enforced for each exchange of data. A digital network with adequate control mechanisms will ease providers’ concerns on data privacy and security, while dramatically improving speed and cost of health data exchange. It is a giant step towards enabling interoperability.

Readers Write: Chief Nursing Officer Checklist for Healthcare Technology Implementations

April 27, 2022 Readers Write No Comments

Chief Nursing Officer Checklist for Healthcare Technology Implementations
By Robert Wittwer

Robert Wittwer is SVP of professional services at Ascom Americas of Morrisville, NC.

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CNOs and CIOs know that patient-centered technology projects perform their best when clinical workflows drive the selection, integration, and adoption of solutions. However, there are several key considerations they should keep in mind before investing in their next technology-driven patient care improvement project:

  1. Bring the right people to the table early. Gather the right set of stakeholders across IT, nursing, finance, etc. to define your needs and be part of the selection team for a technology vendor.
  2. View technology-driven solutions as implementations that require a more complex set of adoption principles than an installation. Begin with the end in mind and not the technologies available.
  3. Define the objectives and strategy the technology should achieve. A CNO can look across the overall landscape and consider bigger patient care questions. Instead of asking, “Can it be done?” ask, “Should it be done?” Avoid the temptation to use all the capabilities or features of a technology if they don’t benefit your objectives. For example, an alert may not need to be sent if it doesn’t require a nurse to respond to it. Alert fatigue is a leading reason for unanswered alerts.
  4. Think long term. Whether it’s future-proofing your investment or ensuring it’s agile enough to respond to unanticipated events like COVID-19, think about your technology solution’s shelf life. Ensure you’re updating software frequently and having regular conversations about using the technology to adjust your workflows so your technology can support how you do nursing today.
  5. Prepare for organizational adoption. While adopting new technologies and workflows requires nurses to change habits, by having clearly defined objectives for its impact and involving stakeholders in the process, you are better prepared to shorten the time it takes to adopt new ways of working.

Morning Headlines 4/27/22

April 26, 2022 Headlines No Comments

3M is said to consider sale of its healthcare IT division

3M is reportedly seeking a buyer for its Health Information Systems revenue cycle and software business.

Biden Administration Increases Access to COVID-⁠19 Treatments and Boosts Patient and Provider Awareness

The White House’s plan for expanding access to COVID-19 treatments such as oral antivirals includes working with EHR vendors, with Cerner and Epic specifically mentioned, to incorporate antiviral treatment content and availability information.

OneMedNet, An Expert and Leader in Clinical Imaging Innovation and Data Solutions, to Become Publicly Traded Via Combination with Data Knights Acquisition Corp.

Imaging real-world data vendor OneMedNet will go public via a SPAC merger at a valuation of $317 million.

VA electronic health record system hit with further outages at Walla Walla site

VA and Cerner officials are looking into the cause of two EHR system outages at the Jonathan M. Wainwright Memorial VA Medical Center in Walla Walla, WA earlier this week.

News 4/27/22

April 26, 2022 News 2 Comments

Top News

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3M is reportedly seeking a buyer for its Health Information Systems revenue cycle and software business.


HIStalk Announcements and Requests

Let me get this straight. Health systems claim their big-ticket EHR purchase will improve outcomes and patient safety. When those systems go offline for days or weeks, they declare that going back to paper-based downtime procedures is a non-event that doesn’t put patients at risk. This is where the cynical you wants to speak up. I’ll also add for those without hospital IT experience that the real danger is in the recovery phase, where systems are brought back up with old and missing information and all hands are frantically back-entering orders and hoping they don’t get treated as new ones.

Also for your cynical consideration, the American Telemedicine Association is giddy at the prospect of ditching its virtual conference format and meeting in person next week in Boston.

I was reading about an upcoming White House plan to resettle Ukraine refugees in the US using sponsors who would be responsible for much of the logistics and cost to move a family here. One of many unfortunate barriers is a healthcare one – would you risk your family’s financial security to take on the health insurance premiums and medical costs of a family who is relocating for years to the only developed country that doesn’t offer national health insurance?


Webinars

April 28 (Thursday) 2 ET. “Undercoded and Underpaid: Making It Easier to Document to Optimize Reimbursement.” Sponsor: Intelligent Medical Objects. Presenters: Deepak Pillai, MD, physician informaticist, IMO; June Bronnert, MSHI, RHIA, senior director of informatics, IMO; Nicole Douglas, sales engineer, IMO. The presenters will discuss how to simplify precise documentation for clinicians; the effects of imprecise coding on reimbursement; why accurate code capture at the point of care can have positive downstream impact on population health initiatives; and how third-party solutions integrated with the EHR can reduce documentation burdens.

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


Acquisitions, Funding, Business, and Stock

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Biofourmis secures $300 million in Series D funding, increasing its total raised to $445 million and bringing its valuation to over $1 billion. The company, which specializes in predictive analytics-based remote patient monitoring technology, has named former Medtronic and Intel chairman Omar Ishrak chairman of its board.

UnitedHealth will sell Change Healthcare’s ClaimsXten claims payment and editing software business to TPG Capital for $2.2 billion if its acquisition of Change is finalized.

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Imaging real-world data vendor OneMedNet will go public via a SPAC merger at a valuation of $317 million. Paul Casey will remain as CEO.

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AirStrip invests in clinical analytics company Fifth Eye as part of a collaboration that will include integration of Fifth Eye’s AHI System with AirStrip’s real-time clinical data platform for inpatient surveillance.

Specialist TeleMed secures unspecified funding from LifePoint Health (TN).

Healthstream announces Q1 results: revenue up 3%, EPS $0.09 versus $0.07. HSTM shares are down 11% in the past year versus the Nasdaq’s similar drop, valuing the company at $600 million.

Microsoft announces Q3 results: revenue up 18%, EPS $2.22 versus $2.03, beating analyst expectations for both. Microsoft Cloud revenue was up 32% to $23.4 billion. 


Sales

  • Northwell Health (NY) selects virtual care services from Teladoc Health.

People

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Vidya Raman-Tangella, MBBS, MHA (AWS) joins Teladoc Health as chief medical officer.

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WellSky hires Dale Zurbay (Nuance) as chief growth officer.

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OmniLife names Dyan Bymark (Teladoc Health) chief commercial officer.

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Memora Health promotes Omar Nagji to chief commercial officer and names James Colbert, MD (BCBS of Massachusetts) SVP of care delivery.

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Chris Regan (Experian Health) joins Salesforce-owned MuleSoft as RVP of healthcare.


Announcements and Implementations

St. Lawrence Health (NY) will go live on Epic this weekend through its affiliation with Rochester Regional Health.

Clinical Architecture renames its Nomad data normalization and enhancement software to Nomentys.

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University Health Network in Toronto will go live on Epic in June. The health system incorporated guidance from 80 patient partners in its configuration of the new software.

Ochsner Health (LA) has implemented Nym Health’s automated medical coding technology within its emergency departments.

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Monument Health selects CereCore’s ServiceNow consulting services.

Rhodes Group, a laboratory software and consulting business, uses InterSystems Iris for Health to aggregate and normalize hepatitis C data from labs across New Mexico to support sharing with providers through the state’s HIE.

Nicklaus Children’s Health System launches its MyNicklaus app that includes wayfinding from Gozio Health.

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In the Netherlands, Amstelland Hospital becomes the first hospital in Europe to implement Epic under the Epic Connect model.

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KLAS summarizes US hospital EHR market share activity for 2021 (click the graphic to enlarge):

  • Epic gained four new customers representing 28 hospitals and 13,000 beds last year, losing four due to M&A.
  • Meditech Expanse was chosen by 74% of the company’s legacy customers that made a replacement decision in 2021, compared to 38% retention in 2020.
  • Epic has 33% of hospitals and 44% of beds versus Cerner’s 24% and 27%, respectively.
  • Allscripts and CPSI lost ground in 2021.
  • Cerner had the largest net decrease in bed count last year, with half of those hospitals choosing Epic as a replacement and the other half switching to Epic after being acquired.
  • Cerner hasn’t had a net-new large health system sale since 2013.

Government and Politics

The White House’s plan for expanding access to COVID-19 treatments such as oral antivirals includes working with EHR vendors, with Cerner and Epic specifically mentioned, to incorporate or antiviral treatment content and availability information.

VA Secretary Denis McDonough expresses confidence that the agency has the budget needed to complete its projected 10-year, $16 billion rollout of Cerner, despite a new OIG report that estimates it will need an additional $2 billion for every year that implementations runs behind schedule.

New Hampshire regulators say that the board of the non-profit parent company that owned failed Lakes Regional General Hospital and Franklin Hospital should have reined in hospital executives who undertook an aggressive expansion and a $42 million implementation of Cerner as an aging local population increased the Medicare and Medicaid share of the money-losing hospitals.


Other

A study describes how clinical radiologists at NYU’s medical school create videos explaining a patient’s imaging results in plan language with annotations, then post them to the patient portal for both patients and referring providers. The one-minute videos take the radiologist about four minutes to create using a PACS-integrated reporting tool. On the downside, three-fourths of the videos were never opened and 91% of surveyed patients said they preferred both a written and video report. I’ll also add that the sample video report was full of unnecessary jargon (like bone names) delivered in a monotone.

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Maybe this is telehealth’s jump-the-shark moment. A group of doctors who are famous on TikTok and Instagram sells memberships – in the form of NFT cartoon icons — in what one founder hopes will become a metaverse-powered virtual clinic. MetaDocs and its providers, such as Dr. Pimple Popper, is taking heat because the company is not licensed as a telemedicine service and its doctors aren’t licensed in all states, meaning the social media stars can’t legally offer paying customers prescriptions or medical advice. Medical toxicologist Ryan Marino, MD comments commendably drily, “If your child is in respiratory distress in the middle of the night, having a surgeon famous for dancing on TikTok text you might not be that useful.” The company is quickly developing a user waiver that its service is for “informational purposes only” and refocusing its virtual clinics on “third-world countries” that presumably have a short supply of both doctors and lawyers. The company’s website says it plans to act as a connection among doctors, Web3, and healthcare, contributing ideas related to blockchain-powered EHRs, tokenizing services and procedures, and the overall digitization of healthcare.   

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One of my favorite booths at the HIMSS conference is always that of the Philippine Delegation, some super-nice folks who describe the advantages of health IT outsourcing to the Philippines and remind us that they provide more US nurses than any other country outside the US. They report a good HIMSS22 exhibit experience, expecting sales of $30-$40 million from 300 leads, 25 deals that have already closed, and four new partnerships.


Sponsor Updates

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  • Quil employees take part in the company’s fourth annual day of service.
  • Agfa HealthCare welcomes four new peregrine falcon chicks at its headquarters in Belgium.
  • Cerner announces that it added 71 new clients in 2021 and extended or expanded relationships with 330 others.
  • Baker Tilly donates $10,000 to Cray Youth and Family Services and the Washington Township Special Olympics.
  • Biofourmis will present at the ATA Telehealth Innovators Challenge during ATA 2022 May 1-3 in Boston.
  • Bravado Health publishes a new executive brief, “The high cost of low task adherence for surgical and non-surgical procedures.”
  • CarePort will exhibit at ACMA National 2022 May 1-4 in Dallas.
  • Cerner releases a new podcast, “How TEFCA impacts the future of healthcare.”
  • Change Healthcare releases a new podcast, “Capitol Connection: Post-Pandemic Healthcare Policy.”
  • Clearsense publishes a new case study, “Archiving Solution Delivers Rapid ROI.”
  • RxRevu announces that three of the top 10 health systems on US News & World Report’s Best Hospitals list for 2021-22 are now part of its prescription cost and coverage network.

Blog Posts


Contacts

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

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Morning Headlines 4/26/22

April 25, 2022 Headlines No Comments

UnitedHealth agrees to sell Change Healthcare’s ClaimsXten business for $2.2bn

UnitedHealth has agreed to sell Change Healthcare’s ClaimsXten claims payment and editing software business to TPG Capital for $2.2 billion, provided its acquisition of Change is finalized.

Ann Arbor’s Fifth Eye Partners with Texas Health Care Analytics Firm

AirStrip invests in clinical analytics company Fifth Eye as part of a collaboration that will include integration of Fifth Eye’s AHI System with AirStrip’s One platform for inpatient surveillance.

LifePoint Health to Lead Investment in Specialist TeleMed

Specialist TeleMed secures an undisclosed amount of funding from LifePoint Health (TN).

Fathom Secures Investment From Vituity’s Inflect Health

Medical coding automation vendor Fathom secures funding from Inflect Health, the innovation arm of Vituity, a provider group based in Emeryville, CA.

Curbside Consult with Dr. Jayne 4/25/22

April 25, 2022 Dr. Jayne 12 Comments

This week’s Monday Morning Update discussed an EHR outage at two of Tenet Health’s hospitals in South Florida. Apparently Tenet didn’t like the media coverage from WPTV and suggested that a story about the downtime be removed. The story covered a patient’s concern about potential medical errors during the outage, with Tenet complaining that suggesting a downtime could result in medical errors is “preposterous.” As a physician who has been in the trenches for more than two decades and who has been through enough EHR downtimes that I couldn’t begin to count, I’m speechless at the thought that downtimes aren’t problematic.

I’ve been up close and personal with a downtime-related medical error in my career, and the situation certainly would have been different had the EHR been online. It was a bit of a perfect storm-type situation. First, I was a relatively new hire still getting used to the processes at a new urgent care employer. Second, due to someone calling out sick, I had been rescheduled from my usual location to a different site, which added a baseline level of stress to the day since I was working with an unfamiliar team. Third, due to a pre-existing diagnosis, the patient I was seeing for a fever was unable to contribute to the history of the presenting problem and was combative during exam, which is tremendously stressful.

After my initial attempts at history-taking with family members and a brief exam during which I detected no emergent problems, I ordered some laboratory studies and moved on to see other patients. When I left the patient, he was pacing around the room and showed no signs of being in distress or in pain.

At some point before the tests were resulted, the EHR went down. As a new employee, I was unfamiliar with the downtime process, but knew there should be one. I asked if there was a downtime binder or how we were supposed to handle it. The clinical team lead was resistant to instituting downtime procedures, giving excuses along the lines of “the EHR usually comes back in a few minutes” and “it really makes a lot of paperwork if we try to go to downtime procedures.” Knowing that creating paperwork is the point of a downtime procedure, I pulled some paper from the printer and began writing my own SOAP notes and documenting what I could.

I remember having probably half a dozen patients on the board that I was seeing. I tried to move them through the process while begging for a paper prescription pad so I could write discharge medications and keeping a clipboard with sticky notes on it as a tracking board to help me remember what patient was in what room. Lab results were being printed from the instruments on little slips of receipt paper rather than flowing through the interface to the EHR. The results were in an unfamiliar format, with the individual tests being out of order within a panel and the reference ranges being difficult to read. Despite the downtime, the staff continued to room new patients and expected us to move forward. I was surprised by that – none of the patients were emergent, and as a walk-in urgent care center it would have been within our rights according to state regulations to stop taking new patients.

I was managing patients the best I could and providing written discharge instructions that I was typing in Microsoft Word and printing two copies so we could scan them later. For my patient who had a fever, there wasn’t anything apparent on the exam or on my review of the labs that could have been causing it, so I recommended close follow-up at home and told them what to look for. This was during the usual season for viral illnesses, and in many patients, the illnesses begin with fever but don’t always declare themselves with other symptoms for a day or more. Since the patient couldn’t describe his symptoms and the exam was difficult, I didn’t suspect anything serious.

Every one of my hand-typed discharge instructions included my best recollection of the practice’s standard disclaimer, which would have been automatically applied by the EHR had it been online. It was something along the lines of “Your examination at XYZ Health today is limited by the capabilities of this urgent care facility, which does not include advanced imaging or moderate complexity laboratory testing. If at any time you feel your condition is worsening, we recommend that you be re-evaluated at the nearest hospital Emergency Department.” I reviewed this instruction with the patient (who could not verbalize understanding) and his adult caregiver, who said she understood.

Two days later, I was called before the practice’s owner and yelled at for “letting someone walk out of here with those abnormal labs,” because by that point, the patient ended up having a significant abdominal infection that required surgical drainage. I explained that at the time I saw the patient they had no features of a serious abdominal process and reviewed the examination that I had documented on my handwritten SOAP note. I was then asked to review the documentation that had been keyed into the EHR after the downtime ended. There it was, in bright red — an abnormal lab value. I had missed it when looking at the receipt-paper printout in an unfamiliar format and with confusing reference ranges. It wasn’t a critical value, but it was abnormal enough that it might have made me think about additional potential diagnoses, even if the physical exam didn’t point me towards an abdominal cause for the fever.

In reviewing the patient’s course, he hadn’t been taken to the emergency department for more than 12 hours after I had seen him, which wasn’t a guarantee that the process requiring surgery was yet present when I evaluated him. Usually if patients have a significant infection in their abdomen, they’re not likely to be pacing around the room – they are completely still on the exam table, and you can hardly touch them. Still, I couldn’t help but second guess the factors that went into my care of the patient – the unfamiliar staff, the new location, the downtime, and the patient’s individual characteristics and presentation.

I explained to the now shouting and red-faced CEO that this wasn’t a normal visit under normal circumstances and that I didn’t have the luxury of having the abnormal lab highlighted in red in the EHR during the visit because there wasn’t an EHR during the visit. He seemed surprised to hear that. Even after he admitted that the EHR downtime was an issue and there’s to way to know if my care contributed to the problem, I agonized over the situation. Several peers reviewed the chart and had no additional suggestions, but that certainly didn’t make me feel any better.

The bottom line here is that EHR outages are difficult. They raise the potential for medical errors in a number of ways. They add stress to already overwhelmed staff. They remove safety checks that we’ve come to rely on. They increase cognitive load as clinicians look at data in unfamiliar formats. They reintroduce illegible handwriting to the environment. They also create time pressures when they end and staff is forced to key in data while they proceed forward with their usual assigned tasks.

I’m fortunate that the patient in this scenario had an uncomplicated hospital stay and there were no long-term consequences of the event, either for him or for those who cared for him. However, the long-term psychological impact on me as a physician makes me never want to encounter another EHR downtime again.

What do you think about Tenet’s comments regarding EHR downtimes? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/25/22

April 24, 2022 Headlines No Comments

Tenet Health says systems are coming back, calls patient worries ‘preposterous’

A TV station’s report on downtime at two of Tenet Healthcare’s South Florida hospitals prompt the company to complain that it is “preposterous” to suggest that charting on paper during EHR downtime could cause medication errors.

Veteran hospitalized at Spokane VA after missing heart medication, highlighting health record system’s prescription problems

Spokane VA officials confirm that a veteran was hospitalized with heart failure in March after his heart medication prescription – ordered before Mann-Grandstaff VA Medical Center’s conversion to Cerner  – disappeared off his Cerner active medication list.

Newfoundland and Labrador healthcare information system ‘fragmented, outdated’: report

Canada’s Newfoundland and Labrador hasn’t followed through on recommendations that it upgrade to a new version of Meditech in a $92 million project that auditors say would more than pay for itself.

Monday Morning Update 4/25/22

April 24, 2022 News 1 Comment

Top News

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Tenet Health complains to a South Florida TV station that it is “preposterous” to suggest that charting on paper during EHR downtime could cause medication errors.

The TV station’s report on downtime at two of Tenet’s South Florida hospitals included comments from a patient who was being treated at the time. He expressed concern about errors when he noticed that WiFi was down, staff had to go outside to use their phones, nurses were charting on paper, and one nurse dropped a big stack of manual records.

Tenet asked WPTV to remove the story and to “maintain a higher level of integrity when reporting on this topic moving forward.” WPTV told Tenet to take a hike.

St. Mary’s Medical Center and Good Samaritan Medical Center have been down since Wednesday for reasons that Tenet has declined to share.


HIStalk Announcements and Requests

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Few poll respondents are interested in revisiting HIMSS22 electronically, so I feel vindicated that I’m not the only one to choose the “none of these” option. You would have thought in Orlando that the whole world was breathlessly awaiting the release of conference-related podcasts and videos given the phalanx of A/V warriors armed with microphones and cameras who were pontificating theatrically to each other all over the convention center.

New poll to your right or here: Which factor will most influence whether AI has a significant healthcare influence in five years? I didn’t include every possible factor, so feel free to click the poll’s “comments” link to argue for something I omitted.


Webinars

April 22 (Friday) 1 ET. “CMIO 3.0: What’s Next for the CMIO?” Sponsor: Intelligent Medical Objects. Presenters: Becket Mahnke, MD, CMIO and pediatric cardiologist, Confluence Health; Dale Sanders, chief strategy officer, IMO. The relatively short history of the CMIO role includes Version 1.0 (EHR implementation, Meaningful Use, and regulatory compliance) and Version 2.0 (quality and efficiency). Version 3.0 is at the forefront of predictive analytics, population health initiatives, and optimization of data-driven tools. The presenters will discuss the digital revolution’s impact on CMIO responsibilities; the connection between clinical informatics, analytics, population health and the CMIO; and how CMIO 3.0 will be involved in the adoption of advanced technologies.

April 28 (Thursday) 2 ET. “Undercoded and Underpaid: Making It Easier to Document to Optimize Reimbursement.” Sponsor: Intelligent Medical Objects. Presenters: Deepak Pillai, MD, physician informaticist, IMO; June Bronnert, MSHI, RHIA, senior director of informatics, IMO; Nicole Douglas, sales engineer, IMO. The presenters will discuss how to simplify precise documentation for clinicians; the effects of imprecise coding on reimbursement


Sales

  • Allied Anesthesia Associates and Clínica Hamburguesa de Anestesiologia will implement PerfectServe’s AnesthesiaGo OR case scheduling solution.

People

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Tara Nooteboom, MS (Rush University Medical Center) joins UCI Health as head of consumer digital strategy.

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Michael Fenlon (Change Healthcare) joins Relatient as VP of client support.

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TigerConnect promotes John Montealegre, MBA to CFO, Harish Panchal to chief sales officer, and Allie Vu to chief people officer.


Government and Politics

Spokane VA officials confirm that a veteran was hospitalized with heart failure in March after his heart medication prescription – which was ordered a year previously, before Mann-Grandstaff VA Medical Center’s conversion to Cerner  – disappeared off his Cerner active medication list and was not renewed. The incident has been classified as a sentinel event that had the potential to cause significant patient harm, although in this case the veteran was discharged, apparently well, after a five-day inpatient stay. The VA expires all prescriptions after one year and suspects that the heart drug was already discontinued before Cerner was went live, adding that it remained visible on Cerner’s “historical medications” screen. Five Mann-Grandstaff clinicians say they have seen the problem of prescriptions expiring and disappearing from the meds list, but weren’t adequately trained on the process. The VA’s VistA system that Cerner replaced also expired prescriptions after one year, but left them on the active medication list to prompt providers to renew them when appropriate instead of dumping them onto a historical list of inactive meds that could go back years.


Other

Canada’s Newfoundland and Labrador — which is running a 1980s-era Meditech Magic system that is no longer enhanced — hasn’t followed through on recommendations that it upgrade to a new version of Meditech in a $92 million project that auditors say would more than pay for itself.

Quebec’s health ministry apologizes for tweeting a link to COVID-19 statistics that actually pointed to a foot fetish video site. One might reasonably speculate that the government’s social media person had the site open while tweeting and copied the wrong URL, which should raise some interesting internal discussions. 


Sponsor Updates

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  • Orbita raises $3,000 for charitable causes by sponsoring a 5k in Boston during its first in-person meeting of the year.
  • Healthcare Triangle achieves HITRUST risk-based certification to manage risk, improve security posture, and meet compliance requirements.
  • CEO Monthly has recognized PatientBond CEO Justin Dearborn as “The Most Influential CEO 2022 – the USA.”
  • Clearsense publishes a new case study, “Archiving Solution Delivers Rapid ROI.”
  • The HIT Like a Girl Podcast features Pivot Point Consulting CEO Rachel Marano.
  • Protenus names Daniel Thompson junior engineer, Nick Strand infrastructure engineer, and Sean Richwine staff infrastructure engineer.
  • Netsmart promotes Natalie Caruso to senior communications specialist.
  • Redox and Well Health will exhibit at AAOE April 29-May 2 in Chicago.
  • RxRevu adds new functionalities to its real-time prescription benefit solution to improve transaction success rates and display additional plan cost data.

Blog Posts


Contacts

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

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Morning Headlines 4/22/22

April 21, 2022 Headlines No Comments

Netsmart Expands the CareFabric Platform to Support Physical Therapy, Rehabilitation and Wellness Providers

Netsmart acquires TheraOffice, an EHR/PM for physical therapy and rehabilitation practices that will be incorporated into Netsmart’s CareFabric platform.

Mendel Raises $40 Million Series B Round to Expand its Team and Grow Product Offering

Mendel, which uses natural-language processing and AI to transform unstructured clinical data into analytics-ready information, raises $40 million in a Series B funding round.

Reify Health Raises $220M Series D to Bridge the Diversity Gap in Clinical Trials

Clinical trials solutions vendor Reify Health raises $220 million in a Series D funding round that values the company at nearly $5 billion.

NexHealth Raises $125M Series C at $1B Valuation

Healthcare API developer NexHealth raises $125 million in a Series C funding round, bringing its total raised to $177 million.

News 4/22/22

April 21, 2022 News 8 Comments

Top News

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Clinical trials solutions vendor Reify Health raises $220 million in a Series D funding round that values the company at nearly $5 billion.

The co-founders, who attended the Johns Hopkins University School of Medicine and served a three-month stint as Rock Health fellows, are Ralph Passarella, MD, PhD and Michael Lin.


Webinars

April 22 (Friday) 1 ET. “CMIO 3.0: What’s Next for the CMIO?” Sponsor: Intelligent Medical Objects. Presenters: Becket Mahnke, MD, CMIO and pediatric cardiologist, Confluence Health; Dale Sanders, chief strategy officer, IMO. The relatively short history of the CMIO role includes Version 1.0 (EHR implementation, Meaningful Use, and regulatory compliance) and Version 2.0 (quality and efficiency). Version 3.0 is at the forefront of predictive analytics, population health initiatives, and optimization of data-driven tools. The presenters will discuss the digital revolution’s impact on CMIO responsibilities; the connection between clinical informatics, analytics, population health and the CMIO; and how CMIO 3.0 will be involved in the adoption of advanced technologies.

April 28 (Thursday) 2 ET. “Undercoded and Underpaid: Making It Easier to Document to Optimize Reimbursement.” Sponsor: Intelligent Medical Objects. Presenters: Deepak Pillai, MD, physician informaticist, IMO; June Bronnert, MSHI, RHIA, senior director of informatics, IMO; Nicole Douglas, sales engineer, IMO. The presenters will discuss how to simplify precise documentation for clinicians; the effects of imprecise coding on reimbursement; why accurate code capture at the point of care can have positive downstream impact on population health initiatives; and how third-party solutions integrated with the EHR can reduce documentation burdens.

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


Acquisitions, Funding, Business, and Stock

Amwell expands its virtual services to include musculoskeletal and dermatology.

Remote patient temperature monitoring technology vendor Blue Spark Technologies raises $40 million in growth funding. I interviewed President and CEO John Gannon last May.

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Netsmart acquires TheraOffice, an EHR/PM for physical therapy and rehabilitation practices that will be incorporated into Netsmart’s CareFabric platform.

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Venture capitalist Aike Ho explains why she doesn’t invest in healthcare AI companies:

  • AI doesn’t really exist in healthcare. It is really just machine learning (“glorified big data”) with no deep learning or neural networks.
  • It takes months or years, at startup burn rates, to get agreements from health systems and universities to provide data for training models.
  • The data is often low quality or in need of cleaning.
  • The total addressable market for most AI applications is small because it involves ancillary services such as diagnostic help and workflow automation and most US healthcare revenue involves services.
  • Gaining adoption is hard unless you are also delivering care. That’s her preferred model for AI/ML – digital health companies that use AI/ML to improve their own care delivery. No AI/ML company that sells to provider groups has had a breakout so far.
  • It’s hard to get risk-averse providers to use a solution without documenting superior clinical outcomes.
  • Insurance rarely pays, so that leaves patients and providers to foot the bill. That’s harder if the value proposition is saving money rather than boosting revenue.
  • Workflow friction and training costs must be minimal.
  • Charging for usage is great, but only if you can figure out adoption, while a flat cost is harder to sell.

People

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New Zealand-based breast imaging screening AI vendor Volpara Health promotes advisor Teri Thomas, RN, MSN — who spent 21 years through 2016 as an Epic executive — to CEO. She replaces founder Ralph Highnam, PhD, MSc, who will transition to chief science and innovation officer.

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Health system-owned interoperability vendor Graphite Health hires Ted Gaubert, PhD, MBA (Dunn & Bradstreet) as CTO.

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Ed Marx resigns as Tech Mahindra’s chief digital officer for health and life sciences.


Announcements and Implementations

A study performed by the Australian New South Wales Health Service finds that use of Net Health’s wound imaging and analysis platform resulted in better documentation, more engaged patients, and improved wound measurement and management.

Golden Valley Memorial Healthcare (MO) goes live as the first site running Meditech Expanse Genomics.

Kyruus and Upfront partner to offer provider search, match, and scheduling with continued personalized and omnichannel engagement.

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A new KLAS report looks at health system compliance with CMS’s requirement to post prices for common services, as revenue cycle leaders express doubt that the regulation – which they say was poorly executed, is confusing, and requires extensive labor for compliance — will improve financial outcomes. Respondents say that posting a master list of prices may benefit payer and provider organizations more than patients. Epic was the most-often used vendor to comply with the requirement, while Experian Health, Vitalware, and NThrive/FinThrive led the third-party solutions list. 


Government and Politics

Healthcare waste management company Stericycle – which also owns patient engagement technology vendor Stericycle Communication Solutions — pays $84 million to settle DOJ charges that it bribed officials in Brazil, Mexico, and Argentina to earn waste management contracts.

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The VA congratulates Hardeep Singh, MD, MBA of the Houston VA for earning Joint Commission’s patient safety and quality award for safety related to diagnostics and health IT.


Other

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Adventist Health Mendocino Coast Chief of Staff William Miller, MD outlines lessons learned from its implementation of Cerner in its clinics in a local newspaper opinion piece:

  • Timelines were extended due to COVID-caused staff resignations and shortages.
  • System bugs prevented the prescription refill function from communicating with local pharmacies and impeded referrals to specialists.
  • The problems increased phone call abandonment and hold time.
  • Moving data to Cerner required more time than expected, extending appointment scheduling time from weeks to two months.
  • The hospital didn’t do a good job of communicating the transition to patients and the community.

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Economist and sociology professor Juliet Schor discusses four-day work weeks at the TED2022 conference, citing her consulting work with non-profit Healthwise last year. She says Healthwise employees are happier and the company is enjoying higher revenue and outstanding customer satisfaction scores after the change. Healthwise CEO Adam Husney says employees picked up the pace to complete a week’s worth of work in four days, shifting personal tasks to their off days and using more time-efficient messaging so they can enjoy their downtime as a whole day off instead of occasional breaks.

The New York Times looks at the use of robots in nursing homes and the development of “virtual assisted living” in which technology – medication reminders, social engagement, fall prevention and response, food delivery, and toilet-powered health analysis – gives seniors an alternative to cash-strapped, understaffed nursing homes. The director of MIT’s AgeLab says Best Buy and Amazon are offering senior-friendly mobile phones that detect falls, connect to hospital systems, access electronic medical records, and give one-touch access to call centers that are prepared to contact doctors, arrange transportation, and notify caregivers.

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Redesign Health provides yet another unwanted glimpse into the marketing sausage-making in being “thrilled to share our rebrand, which embodies both our aspirations for the future and the urgency that this moment in healthcare demands.” New logo, new color scheme, got it … but those responsible can’t resist pontificating in violating the “show, don’t tell” principle in mandating an eye-rolling journey through a self-congratulatory backstory (imagine if they had painted the Mona Lisa):

The symbol tells us where we want to go and what we want to be, beyond where we are now. And as the omnipresent fixture in our branding and the world we create, it will be something we use to tell our story forever … Ultimately, we hope our brand becomes a symbol in the world of health. We hope it influences not only how we continue to approach our work, but also the type of people that want to join us and the way our industry tackles big challenges — namely, with more ambition, urgency, and perspectives.

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Is this how editors role?


Sponsor Updates

  • Healthcare Triangle will present at NobleCon18 April 21 in Hollywood, FL.
  • LexisNexis Risk Solutions announces that it has been named a leader in the “IDC MarketScape: US Provider Data Management for Payers 2022 Vendor Assessment.”
  • InterSystems offers prizes for applications that use its FHIR services as part of MIT Hacking Medicine’s Grand Hack 2022.
  • OSIS, which provides NextGen Healthcare technology services to Community Health Centers, chooses Well Health as a preferred vendor of digital patient communications.
  • Clearsense publishes a case study of a data archiving project that saved a 93-hospital IDN $23 million in annual cost savings.
  • Steve Shihadeh of Get-to-Market Health posts the second part of his conversation with digital health investor Lee Shapiro of 7wireVentures, which includes tips for co-existing with Epic, Cerner, and Meditech.
  • Medicomp Systems releases a new episode of its Tell Me Where It Hurts Podcast featuring Greenway Health CMO Michael Blackman, MD.
  • Meditech President and CEO Michelle O’Connor and EVP/COO Helen Waters will offer a May 17 keynote at the MUSE conference in Dallas titled “Looking to the Future of Digital Healthcare and MEDITECH.”

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 4/21/22

April 21, 2022 Dr. Jayne 1 Comment

Telehealth company Amwell adds two new clinical programs to its platform. Payers can brand the offerings as part of their digital engagement strategies. The dermatology program offers sessions with board-certified dermatologists in an effort to alleviate delays in dermatologic consultations which can be several months in many parts of the country. The press release notes that it offers “most diagnoses returned in just 24 hours,” which makes me wonder if it’s an asynchronous offering versus a virtual visit with a dermatologist. The musculoskeletal program will help payers address challenges with physical therapy access, disrupted productivity, and downstream costs. It will provide patients with a personalized physical therapy plan, telehealth visits, digital sensors for guided exercise sessions, behavioral health support, and patient engagement services.

This article about non-fungible tokens (NFTs) caught my eye since it’s not often that you see them mentioned in the same sentence as “medical ethicists.” It raises important points about the fact that EHR data is being sold without patients being fully aware of it. How many of us actually read the documents given to us at medical appointments such as the Consent to Treat, Assignment of Benefits, and HIPAA Notice of Privacy Practices? The numbers are likely low because we just want to be treated and aren’t going to walk away regardless of what’s in there, for the most part. The last time I was at my local academic medical center, I was asked to sign a signature pad saying I had received the documents despite not having been actually offered the documents.

The premise is that a patient could own an NFT of their medical information, which could be stored in a secure database that would track access requests and approvals. The piece also points out that patients could maintain ownership of their biological specimens, from blood to tissue and even down to the cellular level. When you learn about the cell lines used in research and where they came from, there’s been tremendous injustice. (“The Immortal Life of Henrietta Lacks” is a great read if you’re curious.) Some ethics professionals disagree, saying that ownership of such data is shared between patients and the physicians and health systems who are involved in their care. The article notes that there needs to be a balance between privacy and public health along with greater understanding of why patients might not want to share their data.

There are also sustainability concerns around the creation of NFTs and maintaining the blockchains used to track them, as well as the risks of data making it outside of the public ledger or it moving to the black market. One researcher points out that “you can’t de-identify something with a genome,” reminding us of the uniqueness of each and every one of us. I would settle for greater attention to how patients are informed of the ways in which their information is used, and protections for those who want to opt-out of having their data become part of anonymized data sets that lead to profits for others. I’m not sure what the other potential answers are here, but will be interested to see how things evolve over the coming years.

With as much time as I’ve spent recently with marketing and branding exercises, I was surprised to learn that “debranding” is also a thing. Upon further review, it’s an extension of branding, but with a focus on simplicity and cleaner design. Examples include removing complicated color gradients or shadows in order to make logos cleaner. Increased use of mobile devices is a driving factor, as is a drive towards a more professional appearance. It’s fun to look at certain brands and see how their presentation has changed over time, especially in the consumer space.

A recent KLAS publication looked at the causes of clinician turnover. Although nurses are most likely to leave in the next year, other types of clinicians are close behind. EHR and IT tools are cited as a major cause, along with burnout, chaotic work environment, lack of personal control over workload, and more. I recently joined an online physician forum for EHR issues and have been shocked that the majority of questions are actually operational and management questions rather than technology issues, but physicians are turning to technology hacks to try to fix deeper issues.

I feel like I’m yelling into the void every time I say something along the lines of, “This is an operational issue requiring a policy and procedure to keep your practice staff from dumping on you, not something that needs another macro or preference or configuration in your EHR.” One physician confided in me that her two partners have left because the practice, owned by a large health system, is so chaotic and mismanaged. Rather than hiring a locum tenens physician until they can fix the problem and find permanent hires, the employer expects her to manage a panel of over 10,000 patients by herself with only a front desk staffer and two medical assistants. This is in a semi-rural area, and I’ve seen the complexity of her case mix. She’s to the point where she’s ready to resign if she doesn’t get some help, and the health system doesn’t seem to care. From a couple of decades in practice management and healthcare operations, I’d bet on the fact that better EHR templates and macros to respond to patient portal messages are not the answer. Shame on the health system for letting it get to this point and especially for thinking this is an acceptable solution.

When people are under stress, they turn to different diversions – often during the workday. If my Facebook feed is any reflection, there are many people are into playing the New York Times Wordle game. There have been plenty of imitators as well as specialty games. If you’re looking for some brain-stretching timewasters, I offer for your consideration:

Ever gotten the Wordle on the first try? How fast can you transcribe Morse code? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/21/22

April 20, 2022 Headlines No Comments

MetroWest Medical Center Turned Away Ambulances & Patients Earlier Today

MetroWest Medical Center and St. Vincent Hospital – facilities in Massachusetts owned by Tenet Healthcare – divert patients for several hours in response to a likely cyber attack.

CDC Launches New Center for Forecasting and Outbreak Analytics

The CDC has launched the Center for Forecasting and Outbreak Analytics to enhance the federal government’s ability to respond to outbreaks using data, models, and analytics.

CentralReach Leases Space at Bell Works

CentralReach, a behavioral health EHR vendor based in New Jersey, will relocate its headquarters to build out a remote-first hybrid work space for its 400 employees.

HIStalk Interviews Steve McDonald, President, Interbit Data

April 20, 2022 Interviews No Comments

Steve McDonald, MBA is president of Interbit Data of Natick, MA.

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Tell me about yourself and the company.

I’ve enjoyed a rewarding 30-year career in healthcare IT, where I’ve worked with some of the largest EMR vendors and some of the greatest minds, such as Neil Pappalardo and Neal Patterson. I also worked with two leading consulting companies.

A lot of your followers have seen significant progress made in the industry. I’m encouraged by the advancements in digital health and move to the cloud. Even AI is showing some promise. CMS is putting teeth around their policies with bundled payments and value-based care and it looks like commercial payers are following suit. I was naturally attracted to the opportunity to join Interbit because we help hospitals that are dealing with some of those challenges

What are the benefits of having a report delivery system that is driven by rules?

We’re a subscription-based service, we’ve been around 25 years, and we have about 500 clients. We simplify communications by being able to send information out to a variety of people on the care team with value-based care contracts. We’re able to send information based on their preference. If a doctor wants to receive abnormal results via text message, we can send it that way. We can send by Direct message. This is all of the care teams. If a skilled nursing facility wants to receive emails or secure texts via an API, we could send things out via FHIR. The value is broad distribution of information to the care team in whatever format that they want to receive it in.

That’s one of our solutions, but the bulk of our value that we drive is on the care continuity side, in being able to provide information at the point of care for situations where the EMR is not available. Things like your EMAR, labs, radiology, pharmacy, and census open orders. If the EMR is not available, we have a snapshot of that information that can be readily available for care teams to access that information to provide care continuity.

Patient engagement uses the word “omnichannel” in giving people information in whatever form they prefer. When you look at the big picture of interoperability, what is the role of those different channels, where people may have legitimate reasons to prefer information sent by fax or PDF?

Healthcare is individual preference, and one size does not fit all. To the extent that a person or a provider wants to receive their faxes or a secure text message — let’s say for abnormal results, which is a great example — we can send it that way. It’s critical that we’re able to accommodate the wishes of our providers. Care teams are expanding with value-based care and bundled payments. You have physical therapists and skilled nursing facilities. They all want to receive it in different formats.

We allow the hospitals to send it to us and then we’ll take care of the distribution. Obviously if we need to put in HL7 or FHIR, we can send it to CommonWell and Carequality to push it out that way. But what we specialize in is operational communications, where we can pull it out of the EMR and then push it out in whatever format that the care teams want it.

How should a downtime solution work to support the continued provision of safe care while mission-critical applications are offline?

That is our sweet spot. If you have a scheduled or unscheduled downtime, you have the luxury of pre-planning for it and identifying the kinds of reports that should be made available. Your med administration record, labs, NPI, nursing, open orders, forms, even your employee contact list should be available house-wide in your hospital.

We have two varieties. One is a server that, during a planned or unplanned downtime, can still be on your network. We would be able to parse the EMR data and send the EMARs up to 2 West and to the pharmacy to allow for documentation, in the case of the EMR not being down. If it’s a full-blown cyberattack, we have an air gap server off your trusted network that contains that same type of information, but it is secure behind a firewall. It would only be accessed in a break-the-glass situation to allow for care continuity even in a case of a cyberattack.

Do hospitals anticipate these needs, or are prospects people who have had an incident that needs to be prevented in the future?

Cyberattacks doubled last year despite all the great efforts in trying to prevent them. The bad guys still get in. Hospitals request a way to have that critical information available even during an attack. We developed that solution about a year ago, to allow for access to that critical information so that they can at least have some level of care continuity. Ours is not a full-blown disaster backup plan,but is a safety net until the systems get restored. Nurses have visibility into a patient’s latest lab tests, for example.

Do hospitals recognize the clinical problems that are caused by that downtime gap even when it is shortened by good technology planning?

Most hospitals go to a paper-based backup in case of a full-blown cyberattack. That’s manual, and affects patient safety. We also see a lot of lost charges occur in that scenario. We are automating that solution to minimize the amount of effort when you reconcile back and your system’s up and running, to sync up all of that information that occurred during the downtime period.

What factors will be important in the company’s future?

The biggest factor we have is the ability to focus in on the human element of delivering care. People get caught up in all these technologies. Our focus is on simplifying operational communication, pushing that information out to the caregivers in the format that they can digest. Because at the end of the day, this is about the sanctity of the relationship between the doctors and the providers and the patient, that human element. We want to continue to deliver information in a format that they can use to deliver care.

A lot of people will say, “Healthcare IT will solve this.” Healthcare IT is great, but it’s not a substitute for that human intervention. Our operational communications approach is still at the ground level of delivering care. We also support the mobile user. We can push information out so that people who aren’t tethered to the internet have information available to make intelligent decisions in the care delivery process. Then once they are back online, we can help sync up to the major EMR system that they are using. 

I’m excited about the industry. I have a deep passion for it. It has been my entire life’s mission to try to improve healthcare by leveraging technologies, and I’m excited that the industry is getting an incredible amount of external capital as Wall Street is taking notice. We are a privately held, cash flow positive company and we don’t necessarily need any of that outside capital, but it’s great that the industry is progressing to help bend the cost curve and deliver higher quality care.

Morning Headlines 4/20/22

April 19, 2022 Headlines No Comments

The Chartis Group Welcomes National Health Equity Advisory Firm Just Health Collective

The Chartis Group acquires health equity advisory firm Just Health Collective, whose founder and CEO Duane Reynolds, MHA has worked in inclusion and diversity executive roles with UnitedHealth Group and the American Hospital Association.

Protenus Granted New Patent “Methods and Systems for Analyzing Accessing of Drug Dispensing Systems”

The US Patent Office awards patient privacy monitoring company Protenus a patent for “Methods and Systems for Analyzing Accessing of Drug Dispensing Systems.”

RevX upgrades MHS GENESIS at Puget Sound Military Health System

Puget Sound Military Health System, Madigan Army Medical Center, Naval Health Clinic Oak Harbor, the Air Force’s 62nd Medical Squadron, and Naval Hospital Bremerton upgrade their Cerner-powered MHS Genesis EHR software with Revenue Cycle Expansion features.

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