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Morning Headlines 9/13/22

September 12, 2022 Headlines No Comments

Technology Company Akido Labs Launches New Medical Network Focused on Preventive Care for Chronic Disease

Akido Labs acquires Chaparral Medical Group to create a medical network that will leverage Akido’s predictive analytics-focused Care Delivery Platform.

PurpleLab, Inc. Raises $40M in Funding from Primus Capital

Healthcare analytics company PurpleLab raises $40 million in a Series B funding round.

St. Elizabeth launching Innovation Center

St. Elizabeth Healthcare (KY) launches an innovation center with a $25 million venture fund that it will use to invest in new healthcare companies and technology.

HIStalk Interviews Luke Bonney, CEO, Redox

September 12, 2022 Interviews 2 Comments

Luke Bonney is co-founder and CEO of Redox of Madison, WI.


Tell me about yourself and the company.

I’ve been working at Redox, on Redox, for just about seven years. That’s a long time and a lot more gray hair. Redox is the platform to make healthcare data useful for healthcare’s builders, the people building and scaling healthcare technology.

What have been the most significant interoperability advancements of the past few years?

Our world at Redox is all about how to make healthcare data useful for builders, who to us are the people building and scaling technology and healthcare. We obsess about these people, because through enabling the people who are building technology, everybody will benefit. Patients will benefit, providers will benefit, and you and I will benefit. Great builders build great technology that drives incredible experiences. Those experiences are what drive outcomes. That’s where we need to see meaningful change in healthcare. How do we drive and inspire outcomes?

At Redox, we are constantly obsessing about imagining a world where people can build and scale healthcare technology and be completely unencumbered by the nastiness and complexity of healthcare data, which I know sounds crazy because it is nasty and complex. But we think about a world where with a couple of clicks, people could compose experiences for their users. That’s what we obsess about.

Over the last couple of years, we have continued to focus on healthcare data access and integration. Today, working with Redox means that you have access to existing connections to over 2,500 healthcare organizations across the US and now in Canada. We have integrations with dozens of major payer organizations. We have expanded to not just be focused on clinical data, but financial and payer data, connections into existing clinical networks like Carequality, CommonWell, and a whole bunch of HIEs. We are now connected to 50 out of 50 state public health departments.

We have a lot to be proud of that we’ve focused on in the last couple of years. When we talk to our customers, they say they work with us because we help them focus their engineering efforts and their product efforts on building a truly differentiated product by taking all this nastiness off their plate. We also help them accelerate their sales cycle. We help them get live and implemented faster at all these different locations.

Today, it’s all about data access and integration. As we look to the future of Redox, we will focus on additional problems where we can make healthcare data useful and valuable for builders.

Looking at the industry, I would go to the pretty exciting impact of regulation. I know that might sound weird since regulation is almost always a nasty word, but when it comes to 21st Century Cures, I am definitely in the camp that 21st Century Cures is a game changer, and in a good way. It is definitely not perfect, like any regulation that runs 700 or 800 pages, but it absolutely redrew some of the major goalposts and expectations around healthcare data. The requirements around info blocking and enabling FHIR are good. I think they are incremental. Access is only one component. Standardization and normalization of data are equally if not more important when we think about downstream use cases. We have seen a huge amount of positive change in the impact in the payer world and the payer landscape.

The saying we use at Redox is that what Meaningful Use was for providers, 21st Century Cures, and specifically the CMS patient access rule, is for payers. It has been a major forcing function for payers to modernize their technology. 21st Century Cures is fundamentally making healthcare a friendlier place for builders and innovators by curbing a lot of the power of major incumbents. From where I sit, that is fundamentally a very good thing.

Explain TEFCA and how it changes your business and the industry.

Where I’m super excited about 21st Century Cures, I think TEFCA is a different situation. Had TEFCA been regulated in a way similar to 21st Century Cures, with clear incentives and/or penalties,  we would be a huge fan, because we are fundamentally aligned with the world that TEFCA imagines.

To just state what that is, TEFCA has two core components. It’s a technical framework and a legal framework that allows networks to communicate with one another. It imagines what they think of as a network-of-networks environment. We love that. We think that that would fundamentally change the landscape.

However, as it stands right now — and this is where I think there is huge opportunity — TEFCA completely optional. It provides the framework. In an industry where large change is so typically aligned to hefty incentives, reimbursements, and penalties, TEFCA doesn’t have any of that. Maybe the long story short there is that we believe in TEFCA, we believe in the future it imagines, but we don’t have strong confidence that it’s going to meaningfully shift the industry because of how it is structured.

Having said all that, there’s a number of products we support, connectivity to Carequality, CommonWell, and other networks that we support. But we’re just not convinced it’s the game changer.

ONC is reluctant to apply a heavy hand and instead wants to clear the way for market forces to drive advancement. Where would that market pressure come from to make TEFCA universal?

TEFCA has the framework around what’s called a Qualified Health Information Network, a QHIN. Without going into the tactical details of what qualifies as a QHIN, a couple of networks fit that mold at a high level. CommonWell and Carequality would be classic examples. They support a use case, which is the treatment of care or the transition of care use case, where data is exchanged. The classic example is that your primary care doctor is in New York, you’re in Florida, and you get in a bike accident. CommonWell and Carequality allow that record to get pulled from New York to Florida so that the doctors treating you there have your medical history. That’s a clear use case with appropriate incentives for hospitals and clinics to participate.

It’s harder to imagine future use cases where those alignment of incentives occur, where people would meaningfully come to the date table and agree to share data. There’s some compelling stuff around payments and patient payments where there could be meaningful market pressure.

Your question is a really interesting one because while the painted future is interesting and exciting, it’s hard to imagine a path to get there simply through pressure from market conditions. This is where we need to think about the actual incentives of these organizations, their willingness to share data, and whether they see it as the right thing given the specific use case.

Has the original interoperability idea of paying those who contribute data and then charging for its use gone by the wayside?

I don’t think that model is off the table. I just don’t think it has seen a ton of traction. Where there is traction involves life sciences companies that want to pay for large, de-identified data sets for R&D purposes. But beyond that, there just hasn’t been a ton of traction. That is not at all me saying that we should disqualify that or put it to the side. If there was, I think that would be super exciting. Those are the questions that will be interesting to track. Is it going to enable that world or not? Do we see the early signals that something like that could emerge?

Technology vendors, startups, and health systems themselves are finding it profitable to broker a data connection between providers and life sciences companies. Will additional use cases emerge?

I think we are early days. There’s a ton of opportunity. Costs are high to administer clinical trials. The match rate, how easy is it or hard is it to identify patients to enroll in the clinical trials, is still super high and inconsistent. The data itself is part of it. Another huge part of it is decentralized clinical trials, where there’s a ton of innovation. 

We are early days. That’s a fun and interesting spot to look for for innovation. Drug companies have lots of money that they are willing to put to work.

Do we have now, or will we have in the future, a healthcare technology ecosystem?

There has always been an ecosystem. It’s the question of how big and how impactful that ecosystem is.

Going back to the conversation around 21st Century Cures, you can look at a lot of interesting data. Look at the total amount of funding over the past five years that has gone into digital health. It has been one of the fastest growing categories compared to any other technology sector over the past five years. That’s an incredible sign that people everywhere see healthcare as not just a place where innovation is needed, but for anybody who has been a patient or provider, that innovation is needed and possible.

We’ve been saying for a long time and with a straight face that there is an ecosystem. Now it is probably more apparent to a growing audience. But we also think that it’s necessary. Like many other industries, there isn’t a single person or a single company that will meaningfully move the needle. It needs to be many people working on many problems.

That is one of the fundamental viewpoints we carry. It’s about empowering this entire class of builders. It hasn’t happened overnight, but it’s much more significant than it was yesterday, and I think three years from now, it will be twice as big. It is super exciting.

Now that cloud has finally found its healthcare footing, including technology companies like Oracle and Microsoft acquiring big health IT vendors, where does it go from here?

I’m glad you asked this question. Big tech is making serious moves in healthcare. For those of us who have been in this space for a while, we’ve seen different moments where bets were getting placed. I now have conviction — and not just me, but others — that fundamentally, healthcare delivery in the US is going to look different three to five years from now because of the impact of Amazon, Microsoft, and Google.

The other thing I would say is that it’s not just big tech, but also groups like CVS, Walmart, and others that are making big moves, such as Amazon buying One Medical and CVS’s purchase of Signify. An interesting detail that stuck out to me when Amazon purchased One Medical is that alongside that, they announced that they are winding down what they had previously been calling Amazon Care, which was their initiative around a nationwide telemedicine offering. That tells me that that Amazon, in this case, is moving out of testing different hypotheses, having multiple bets, and solving for optionality and they are moving into a more unified, aligned approach now that they have been in market for a little while. This is a trend that I see across big tech. They have spent some time studying healthcare and now they are making their big bets.

It’s not just the cloud. It’s the technology companies that offer the cloud that are super interesting. When it comes to big tech and the ongoing shift to cloud infrastructure, this has been a core part of the Redox thesis from the very beginning. Hospitals, clinics, payer organizations, and life sciences groups are all right now making massive investments in their cloud infrastructure. It’s because what they all have is data, and what they are realizing is that these big tech companies and their cloud infrastructure has the most robust functionality when it comes to driving value from that data.

I see big changes. The dollars being spent will threaten some incumbents in the space, because change is always scary. But I also think if we all take a step back and look at it from the viewpoint as a patient, I’m incredibly excited, because this is what has happened in other industries and the end result is ultimately a more user-friendly, consumer-friendly experience. It’s real. it’s big. We are in the midst of it right now, and three to five years from now, healthcare is going to look different.

How will  today’s financial market activity change the industry?

On the one hand, healthcare is, and will continue to be, relatively resistant to recessions. As we know, the demand for healthcare doesn’t closely associate with the state of the economy. I would say that overall demand hasn’t changed a ton. Where we do see impact is more specifically related to capital markets and the fact that valuations have come down significantly. Companies that need to fundraise in the short term are finding it harder. This is concentrated in some of the startup and SMB folks. This means that a category of customers and builders in the space that are tightening belts to extend runway. There’s some of that in the short term.

In the long term, I don’t see it having major, major impact. Any time we have a cycle like this, in some ways, it’s pretty natural. It will impact some more than others. We are watching it closely, but overall impact to us hasn’t been significant. We have it pretty balanced. We support SMBs all the way up to the Fortune 5.

As we all know, this story is also not done. It will be interesting to see how this unfolds over the next couple of quarters and year because there are tons of investment dollars available. It will be interesting to see when those investment dollars start to come back into the market. History can help us learn from other experiences, such as recessions, 2008, and the dotcom bubble bursting. It’s not totally uncharted, but we are paying attention to it pretty closely.

What will be important to the company over the next couple of years?

Most important for us is to continue to obsess about our customers. You heard me refer to them as builders. We are early days with the impact that builders are going to have in healthcare. It has never been more apparent to me that now is a great time to be a healthcare builder. We will continue to obsess about the people we support and continue to obsess about the use cases that we support. Doing that means we need to continue to power broader and broader sets of data to exchange. 

We’ve broadened from being clinically focused to many types of data. Today, Redox is focused on data access and integration. As we look into 2023 and 2024, the interesting opportunity for us is to start to support more and more of that healthcare data journey on its path to ultimately being useful. We are working on some exciting things that you will start to hear from us later this year and early 2023. It will enable a whole other class of builders.

With all the craziness going on in the world right now, there has never been a better time than right now to be a health tech entrepreneur. Now more than ever, healthcare as an industry is primed for change. My closing statement is to all of the builders out there. Don’t wait on the sidelines. Come on, let’s do it. There’s plenty of work and plenty of opportunity for impact.

Curbside Consult with Dr. Jayne 9/12/22

September 12, 2022 Dr. Jayne 1 Comment

I was glad that Mr. H mentioned Friday’s opinion piece by former VA Secretary David Shulkin MD. With a title like “State lines should no longer be barriers to health care,” I was hooked.

Going through medical school, I had a passing exposure to the idea that one would need a state-specific license when they went into practice. Mostly this exposure came by watching the anguish that your supervising residents went through as they tried to obtain licenses so that they could earn extra money by moonlighting at rural emergency departments or by covering nights or weekends on the medical center’s newly created hospitalist service. The medical center had a variety of services to support the application process, including access to fingerprinting courtesy of campus police and notary services from the medical school office of student affairs.

Once out in practice, that process becomes more difficult. Especially in a post-COVID world, the process may require making various appointments in person and during normal business hours, which isn’t terribly helpful if you’re a busy physician. Although some states are members of the Interstate Medical Licensure Compact which can expedite this process, a significant number of states have yet to opt in. This can mean going through the licensure process from scratch – providing various transcripts, reports of test scores, copies of certificates, and more.

One state where I applied demanded a copy of my high school transcript, which didn’t seem terribly relevant for someone with a medical degree and a couple of decades experience under her belt. I had a very interesting conversation with the registrar at my high school who eventually found it on microfilm. It looked like something that couldn’t possibly be a legitimate document, with each semester’s results being contained on an address label-like sticker that was applied to a single sheet of copier paper that had my name handwritten on the top. But it had the all-important embossed school seal, so I guess that made it official.

Still, and especially since this was a state that bordered my own, I thought it should be easier since the same standards of care that apply on one side of the line apply to the other. They are called “community standards of care,” not “state-specific standards of care.”

I had been practicing telehealth part time when COVID hit, and the relaxation in licensure requirements boosted my volumes. Almost overnight, I could see patients from 17 states, and as more states relaxed their rules, our wait times for on-demand telehealth visits decreased dramatically. As the pandemic eased, however, many states ended these programs, thereby limiting their residents to a smaller pool of clinicians.

One of the reasons that was cited by multiple states was the concern that easier access to telehealth would result in higher healthcare expenditures and the states didn’t want to be on the hook for that. States were also lobbied by their own state medical boards, in the context of the boards wanting to be able to ensure quality care and discipline physicians. Those boards also receive licensing fees from the physicians who want to practice in a given state, so I’m sure that was a factor.

We knew it would take time to see whether patients would return to in-person care or if they’d continue flocking to telehealth visits. Although many of us have witnessed changes in our volumes, the evidence was largely anecdotal. This week also brought us some research, as the journal NPJ Digital Medicine published a study looking at “The impact of expanded telehealth availability on primary care utilization.” The authors looked at 4 million primary care encounters from 939,000 unique patients from three health systems during the period between 2019 and 2021. They found little change in overall primary care utilization as telehealth services became more broadly used. They noted that “our results suggest the availability of telehealth is not resulting in additional primary care visits, rather, telehealth is serving as a substitute for certain in-person encounters resulting in no overall increase in primary care utilization. Further, it seems telehealth was mostly utilized for patients whose medical needs required multiple primary care visits during each year, suggesting that these telehealth encounters enabled follow-up for patients with chronic illness.”

They noted that additional studies are needed to determine the impact of expanded primary care access on other types of visits, such as urgent care or emergency visits. The authors also noted some limitations to the study, including the inability to determine if patients received additional primary care services from other facilities outside the study dataset. They also could not assess the quality of telehealth encounters compared to in-person visits.

I would also note that although the study looks at visit volume, it doesn’t take into account the differences in the costs of different types of visits. I’ve seen lots of institutional data that shows that telehealth urgent care visits are extremely cost effective, with one organization reporting a savings of nearly $150 for each patient encounter that was handled virtually versus at one of their brick-and-mortar urgent care clinics.

Now that states are cracking down on licensure, it makes it difficult for organizations to maintain the flexibility they need to care for patients. I can barely practice telehealth urgent care now because I’m not licensed in enough states. As an independent contractor, I’m not about to shell about big bucks, and a bigger amount of my time, to obtain additional licenses, so I’m effectively a wasted resource in the primary care / urgent care space.

David Shulkin calls for the states to adopt a model that stretches the boundaries of care, much like the Veterans Administration has done. Many organizations continue to lobby state legislatures to allow continued licensure flexibility, and some states have created lower-cost, telehealth-specific licenses that allow continued practice with more acceptable overhead. Shulkin uses motor vehicle driver licensure as an example, with operators being obligated to follow the laws of the state they’re in regardless of where their license was issued. In that kind of model, physicians would agree to abide by the laws of the patient’s state.

Such flexibility would not only help telehealth programs, but would also help in-person care. Organizations that require support from locum tenens physicians would have access to larger pools of physician candidates and would experience fewer delays in a physician arriving onsite. Ultimately patients would win, which should be the goal of 99% of what we do in healthcare. This would be administrative simplification at its finest.

Unfortunately, I know how state medical boards think, and I don’t see them running to jump on this particular bandwagon. Still, a girl can hope. Maybe some day I’ll be able to see more than two patients a day again.

What do you think about cross-state licensure? Will we see improvement in this decade? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 9/12/22

September 11, 2022 Headlines No Comments

State lines should no longer be barriers to health care

Former VA Secretary David Shulkin, MD advocates for the creation of a licensure compact program that would allow states to recognize each other’s medical licensees.

Nearly 400 workers in Washington state will be laid off due to Amazon Care shutdown

The shutdown of Amazon Care will drive 159 Amazon layoffs in Washington, while another 236 will be let go from its medical provider Care Medical, according to company notifications to the state.

Genetic testing service cuts 23 jobs, CEO steps down as patient volume grows

Telegenetics company Genome Medical lays off 23 employees and announces the departure of its founder and CEO Lisa Alderson.

Verily Announces $1 Billion Investment Round to Fund Continued Growth and Shares Changes to Leadership Team

Verily announces $1 billion in funding earmarked for expanded precision health efforts, the replacement of its CEO, and the resignation of its CFO.

Monday Morning Update 9/12/22

September 11, 2022 News 7 Comments

Top News


Former VA Secretary David Shulkin, MD says in an opinion piece that Congress should create a licensure compact program that would allow states to recognize each other’s medical licensees.

Shulkin says the process should work like the national driver license compact, where drivers obtain one license and can drive in any state as long as they follow that state’s regulations. That is different from telehealth laws, in which the patient’s location rather than the provider’s defines the licensure requirement.

Shulkin touts the VA’s success in relaxing geographic limits so that clinicians can be assigned to locations as needed and can perform home visits.

Jay Sanders, MD of The Global Telemedicine Group, notes in a LinkedIn comment that telemedicine is already a puzzling outlier – doctors can see any patient in person as long as that patient comes to their location, with telehealth being an electronic version of that same interaction. Also noted by other commenters, however, is that the similarly structured Nurse Licensure Compact has not been adopted by 11 states that still require their own specific licensing.

HIStalk Announcements and Requests


Poll respondents who were recently involved in a health IT purchase most often attribute the initial interest to references or company recommendations.

New poll to your right or here: Does your employer require most or all employees to be vaccinated against COVID-19? Reports suggest that some companies have rescinded their mandatory vaccination policies not because of new scientific knowledge, but because they were losing employees to competitors who didn’t make vaccination required.


Mrs. HIStalk’s (now-former) eye doctor practice was unyielding in its refusal to sell her a box of contact lenses to tide her over until their next-available appointment in November even though her prescription has never changed. A couple of minutes of Googling turned up several contact lens companies that let you do a quick-and-dirty (albeit questionably effective) online eye exam. She did a five-minute, $20 exam through 1800contacts standing in front of her computer, received a prescription PDF signed by a state-licensed ophthalmologist shortly afterward, and ordered contacts through, which  was cheaper and faster than her usual supplier Costco (not to mention that their online exam is on sale for $10, I now realize). An online exam isn’t worth much other than for verifying that refraction hasn’t changed, if even that, but I assume it fulfills a market need in which doctors generate short-term prescriptions without the ability to offer short-term appointments.

Thanks to the following companies that recently supported HIStalk. Click a logo for more information.



September 22 (Thursday) 1 ET. “ICD-10-CM 2023 Updates and Regulatory Readiness.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, marketing director, IMO; Julie Glasgow, MD, marketing manager, IMO. The yearly update to ICD-10-CM is almost here. Prepare your organization for a smooth transition, and avoid any negative impacts to your bottom line, with an in-depth look at the upcoming changes. Listen to IMO’s top coding professionals and thought leaders discuss the 2023 ICD-10-CM coding changes. This webinar will review additions, deletions, and other revisions to the ICD-10-CM code set and how to make sure you get properly reimbursed.

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

Acquisitions, Funding, Business, and Stock

A study of private equity-acquired ambulatory surgery centers finds that unplanned hospital visits, cost, and encounter volume were no different afterward compared to ASCs that were not acquired.

The shutdown of Amazon Care will drive 159 Amazon layoffs in Washington, while another 236 will be let go from its medical provider Care Medical, according to company notifications to the state.

Health coaching and wellness app vendor Twill lays off 10% of its headcount, two months after changing its name from Happify Health.

Verily announces a $1 billion funding round led by Alphabet, the replacement of its CEO, and the resignation of its CFO. The company says it will use the funding proceeds to expand its work on precision health, including real-world evidence generation, healthcare data platforms, and research.



CommonSpirit Health promotes Jamie Trigg, MSITM to system VP of healthcare operating systems.


Optimum Healthcare IT hires Cheryl Abbott (Precision Talent Group) as VP of marketing.


John Curin (Burwood Group) joins Impact Advisors as VP.


Ascension hires Kristi Roe (Qualtrics) as VP of patient and consumer experience.


Nicole Bailey, PhD, MPH (Health Catalyst) joins Aetion as VP of real-world data. 


Raintree hires Bill Sillar (Symplr) as VP of business development.

Announcements and Implementations


A UCSF-led survey of digital health companies and their experience with EHR integration finds that:

  • About half rely partially or fully on proprietary APIs, with the remainder using mostly standards-based APIs.
  • Two-thirds of the companies that use non-RESTful APIs or don’t use APIs at all say it’s because RESTful APIs don’t meet their business needs.
  • The level of effort required to establish or maintain integration with EHRs doesn’t vary widely regardless of whether proprietary APIs, standards-based APIs, or third-party APIs are used.
  • Use of FHIR was reported by 84% of the companies.
  • EHR APIs were used for read access by 91% of respondents, 27% for update, 24% for write, and 7% for delete.
  • Top-reported barriers to EHR integration via APIs were high fees, lack of realistic clinical testing data, lack of standards-based APIs, and lack of valuable data elements.
  • Responding companies said that the federal policies that have most influenced integration progress are Cures Act API regulations, Cures Act information blocking regulations, and HL7 FHIR accelerators.
  • UCSF is seeking to expand survey participation beyond the 104 companies that have responded of 704 that were identified as integrating with EHRs or payer systems. The survey is open.
  • The preliminary survey results will be presented at the ONC Tech Forum on September 16.


The Oracle Cerner Health Conference will return as an in-person event October 17-19, also offering a virtual track to those who prefer to attend remotely.

A study finds that expanded use of telehealth during the pandemic did not increase the overall use of primary care services, suggesting that it is serving as an alternative to in-person encounters instead of adding costs.


In England, hospitals of Manchester University NHS Foundation Trust report delays of 12 hours and more along with cancelled appointments as they go live on Epic in a project they have named Hive.

I received a PR pitch from investor-backed, Toronto-based veterinary telehealth service Vetster, which cites a study that found that the US needs 41,000 additional veterinarians by 2030 as existing practices are being overwhelmed by a pandemic-driven increase in pet ownership that has backed up appointments for up to five months and cause some vets to stop taking new patients. The company says its telehealth marketplace for non-urgent services improves access, increases veterinarian income, and frees up clinics and urgent care hospitals to focus on cases that require hands-on treatment. The company also offers prescription delivery in some areas.

Hospitals are sending unprofitable outpatient primary care patients to independent, non-profit “Health Center Program Look-Alikes” that they create themselves, which are paid higher rates by Medicare and Medicaid, are eligible to buy discounted drugs under the 340B program, and can qualify newly hired doctors for federal help with student debt. KHN says that 108 look-alike health centers are in operation, sometimes on hospital campuses and sometimes staffed fully by hospital employees, to make it easy to divert non-urgent cases away from the ED. Lee Health says the program reduced unnecessary ED visits by 20%.

Sponsor Updates

  • Upfront Healthcare adds new features to its patient engagement and access platform related to content and patient experience, interoperability and integration, and provider experience and outcomes measurement.
  • Sectra publishes a new case study, “One for all – native support for automated breast ultrasound in Sectra’s expanded breast imaging PACS.”
  • Surescripts releases a new There’s a Better Way: Smart Talk on Healthcare and Technology Podcast, “Innovation, Please: What’s Next and What’s Needed in Specialty Therapy.”
  • Vocera releases a new Caring Greatly Podcast, “Managing the Polarity of Changing the System Versus Personal Resilience – Cynda Rushton.”
  • Optum is recognized as Best in Class in the Aite Matrix for Payment Integrity, Number 1 in the 2022 HFS Top 10 Report on IT/Business Services for Healthcare Provider, and a leader in Everest Group’s 2022 RCM Operations PEAK Matrix Assessment.
  • Well Health shares a new case study, “UNC Health App Increases Patient Engagement Through Well Health and Gozio Partnership.
  • West Monroe publishes a new healthcare communications client story, “Building a digital customer success platform drives a 75% increase in new customers.”

Blog Posts


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


Morning Headlines 9/9/22

September 8, 2022 Headlines No Comments

Walmart, UnitedHealth to offer preventive healthcare program for seniors

Walmart and UnitedHealth Group sign a 10-year deal to jointly offer preventive care for seniors and virtual healthcare for all age groups.

Morgan Health Announces New Investment in LetsGetChecked, Expanding Access to At-Home Health Care

At-home testing and virtual care company LetsGetChecked secures a $20 million investment from Morgan Health.

Vera Whole Health and Castlight Health Announce Health Tech Leader Donald Trigg as CEO, Rebrand Company Apree Health

Vera Whole Health and Castlight Health rename their combined value-based care and navigation company Apree Health and hire former Cerner President Donald Trigg as CEO.

News 9/9/22

September 8, 2022 News No Comments

Top News


Walmart and UnitedHealth Group sign a 10-year deal to jointly offer preventive care for seniors and virtual healthcare for all age groups.

The deal gives Walmart access to new Medicare Advantage members while offering UnitedHealth a retail audience of potential insurance enrollees.

The venture will kick off in January at 15 Walmart Health locations in Georgia and Florida, with a focus on value-based care.

UHG’s Optum will provide analytics and decision support tools to Walmart Health’s clinicians, the companies will launch a co-branded Medicare Advantage plan in Georgia, and Walmart’s virtual care services will be added as an in-network offering of UnitedHealthcare’s Choice Plus PPO plan.

The companies plan to expand the collaboration across more insurers to include access to food, addressing social determinants of health, offering prescriptions and OTC medications, and providing dental and vision services.

Reader Comments

From EpicHiccup: “Re: Epic’s latest quarterly upgrade. Customers are being told to delay due to response time issues.” Verified. The company is telling customers to hold off until some fixes can be incorporated since the upgrade doesn’t contain any urgent regulatory or functionality updates.


From MN Nice: “Re: CMS No Surprises act. Enjoyed seeing my local provider find a good spot for displaying ‘your rights.’” At least the obscuring plant doesn’t seem fake or dead, which is always a discouraging sight in the office of someone you are trusting to help you stay alive and healthy.

HIStalk Announcements and Requests

Being peevish, I humbly request that work experience not be stated in the form of, “Tom has over 21 years of sales experience.” Just call it 21 with the realization that the world doesn’t care about Tom’s fractional years of employment. Otherwise, every working human would waste space – except on their hiring anniversary — prefacing their years with “over.”


September 22 (Thursday) 1 ET. “ICD-10-CM 2023 Updates and Regulatory Readiness.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, marketing director, IMO; Julie Glasgow, MD, marketing manager, IMO. The yearly update to ICD-10-CM is almost here. Prepare your organization for a smooth transition, and avoid any negative impacts to your bottom line, with an in-depth look at the upcoming changes. Listen to IMO’s top coding professionals and thought leaders discuss the 2023 ICD-10-CM coding changes. This webinar will review additions, deletions, and other revisions to the ICD-10-CM code set and how to make sure you get properly reimbursed.

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

Acquisitions, Funding, Business, and Stock


Vera Whole Health and Castlight Health rename their combined value-based care and navigation company Apree Health and hire former Cerner President Donald Trigg as CEO. Vera acquired Castlight for $370 million in February 2022.

Mental health app and services vendor Headspace Health acquires Shine, which offers a meditation and self-care app.


Investment firm Carlyle forms Atmas Health, which will acquire medical technology and life sciences companies as buy-and-build, carve-out and take-private transactions.

Streamline Health Solutions reports Q1 results: revenue up 109%, EPS –$0.07 versus $0.00. STRM shares are down 6% in the past 12 months versus the Nasdaq’s 23% loss, valuing the company at $81 million.

Premier-owned Contigo Health pays $178 million in cash to acquire contracts with 900,000 providers and cost containment technology from TRPN, from which it will create a new out-of-network health plan administration product for self-funded employer health plans.


  • Michigan Medicine expands its use of Loyal’s digital experience technology by adding chatbot functionality to answer consumer questions about locations, providers, bills, and COVID support.
  • Patient education video company Mytonomy chooses Redox to integrate its video-based patient engagement solution with EHRs.


image image image

Therapy and rehab EHR/PM vendor Raintree hires Nick Hedges, MBA (MomentFeed) as CEO, Darian Hong, MBA (Act) as CFO, and Rob Rust (Wondr Health) as CTO.

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Health Catalyst promotes Kevin Freeman to chief growth officer, Tarah Bryan, MA to chief marketing officer, and Dave Ross to CTO. President Patrick Nelli will transition to advisor.


Cue Health hires David Tsay, MD, PhD (Apple) as chief medical officer.

Announcements and Implementations

CloudWave launches OpSus Cloud Services with seven healthcare clients, bringing its total customer count to 250 in completing the company’s best-ever quarter.


Cipher Skin, which offers a sensor-powered musculoskeletal rehabilitation remote monitoring platform, rolls out biometric extremity sleeves, a chest motion sensor, bill capture for RTM services, and EHR data sharing with Kno2.

Augmedix releases Prep, a service that organizes chart details to allow physicians to quickly prepare for an encounter.

Government and Politics

An HHS OIG report finds that telehealth use by Medicare beneficiaries jumped 88-fold early in the pandemic, which also resulted in flagging 1,714 providers for submitting questionable bills that totaled $128 million. An interesting finding is that more than half of these high-risk providers practice in a medical group that has a least one other high-risk provider, suggesting that certain practices are encouraging questionable billing. OIG also notes that many providers billed questionably but under the threshold of this report, including 18,000 of them who billed the same service to both Medicare and Medicare Advantage and 5,700 who added a facility fee to a telehealth encounter bill.



A new Compliance Today article not only has a fantastic title that references “When A Stranger Calls,” but brings attention to the non-EHR data that providers should consider in preparing for the next round of information blocking requirements that goes into effect on October 6. Examples of what an organization probably needs to be able to provide:

  • Radiology images to outside providers.
  • The ability to bring in records of outside providers to be used for diagnosis and treatment decisions.
  • Data submitted to cancer and tumor registries.
  • Pharmacy, case management, and billing data that is stored outside the EHR.
  • Information in legacy EHRs and billing systems that wasn’t brought into the current one.

Insider asks several VCs which health tech startups are the most promising. Those that are health IT focused and have no financial connection to the recommender:

  • Commure (data exchange tools).
  • Flexpa (allows patients to collect and share their health information).
  • Infinitus (voice-powered provider-insurer insurance verification).
  • Lasso (healthcare marketing).
  • Ribbon Health (automatically collects data about providers, insurers, and care quality).
  • Truepill (telehealth, at-home lab testing, and mail-order prescription delivery).
  • Turquoise Health (consumer healthcare and insurance price comparison).

Sponsor Updates

  • Quippe Clinical Lens from Medicomp Systems is added to the Cerner App Gallery.
  • First Databank names Kim Hart customer success consultant, Chris Buckley inside sales manager, and Kyle Doneth talent acquisition manager.
  • Clearwater will sponsor the AEHiS Healthcare Security Leaders Forum September 26-28 in Lake Buena Vista, FL.
  • HCTec publishes a new case study, “HCTec’s Legacy EHR Support Enables Prisma Health’s Epic Transition.”
  • CHIME releases a new Leader to Leader Podcast, “Rapid Change, Remote Success, and RPA with Andy Smith,” founder and managing partner of Impact Advisors.

Blog Posts


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


EPtalk by Dr. Jayne 9/8/22

September 8, 2022 Dr. Jayne No Comments


I’m one of the few people in my social and work circles who has yet to have COVID, so I was eager to get one of the new bivalent vaccine boosters. There’s already a lot of misinformation going around with this booster and I feel more credible as a physician being able to genuinely say that I trust it enough to get my own dose on the leading edge of the rollout. I also have quite a bit of work travel coming up and am looking forward to the extra protection.

I initially scheduled a booster through my hospital’s patient portal, only to receive a phone call that they aren’t yet offering the bivalent version and aren’t sure when they’ll get it. However, I was able to find a convenient 8 p.m. slot at my local CVS HealthHub, so I decided to check it out.

Online scheduling and registration processes were quick and easy, and I immediately received a confirmation via email and text. About an hour before the appointment, I received a text with a link to check-in when I arrived, although the check-in button was locked out until 15 minutes before the appointment.

I quickly found the vaccination area in the store, although the signage for where patients should check in for vaccines was difficult to see given all the Halloween candy displays that were stealing my attention. Since I had registered online, the check-in process only involved verifying my name and date of birth. The pharmacist mentioned that they had been giving vaccines all day, which was good to hear.

The vaccination cubicle wasn’t soundproof, but it was clean and well organized. Barcode scanning was used to capture information from the vaccine vial prior to administration. I needed a new vaccine card since mine was full and the pharmacist had to hand-write, it which I’m sure becomes tiresome during the day. They may not be at a volume of administration where it makes sense to print labels as some of the high-volume hospital vaccine clinics do. I was in and out before my actual appointment time, making it back through the gauntlet of Halloween candy without a purchase.

I felt fine the rest of the evening, doing a little work and binge-watching the first part of the new season of “Call the Midwife.” I received a patient satisfaction survey from CVS, which I completed. Upon reading the questions, I realized that they didn’t offer me a Vaccine Information Statement like they should have. An interesting part of the questionnaire is where the patient can record a video snippet instead of a typed review. Any submission becomes the property of CVS and they can use it for marketing, so I wondered how many people actually do that. I took a pass on that one.

I slept well, but woke up terribly achy and felt like the joints in my fingers didn’t want to work at all, which is rough for someone who types all day. I also had significant pain in my underarm, which made me remember the issue I had in 2021 where my COVID vaccines caused an abnormal mammogram, sending me down a diagnostic rabbit hole with ultrasounds, extra mammogram views, and more. I was so excited to get the vaccine that I completely forgot about the follow up at the high-risk breast cancer clinic that I had scheduled for later in the month, and immediately cursed my enthusiasm. I mean, how do you forget something like that?

I’d like to chalk it up to the fact that I think I’ve blocked most of 2020 and 2021 from my mind as a coping mechanism for what I experienced on the front lines. Current recommendations call for waiting several weeks after a COVID vaccine before having a mammogram, so I hit the patient portal and messaged my surgeon to find out what she recommended. I was pleasantly surprised to receive a reply within the hour giving me a specific recommended time frame, so I called the office to start the rescheduling dance.

Any time you try to reschedule an appointment with a busy surgeon, especially if it has to be linked in time with a diagnostic study, it’s stressful. The staff did their best to find me a slot within a month of my “clearance” date, so I was happy with that. While I was on hold so they could dig through the schedules and try to make something work, it got me thinking – if I’m a professional who should know better, especially from my own previous experiences, and I couldn’t remember how this works, what are the odds that the average patient isn’t going to do the same thing?

It would be useful if the breast center could send a reminder to patients educating them on the need to space their vaccines and their mammograms so that others don’t wind up in the same predicament. Especially for a high-risk individual, that reminder would be most appreciated, and it should be pretty easy to send out a message through the patient portal. Any time spent crafting and managing that outreach would more than recouped by not having to deal with numerous patients calling to reschedule.

A couple of hours later, about 14 hours after the vaccine, my immune system was apparently doing a really good job of reacting to the vaccine because I started feeling terrible. Headache, crushing fatigue, nausea, and shaking chills came first, then hot flashes, followed by dizziness. I literally had to lie down between conference calls. Then came the drenching sweats. I’m sure the people on my afternoon calls got a kick out of my wardrobe changes.

Then, as quickly as the symptoms started, they were gone – no more headache, significantly reduced achiness, and with nausea giving way to feeling hungry. It was like a switch had been flipped. I had some dinner, did a quick Zoom with one of the organizations where I volunteer, and felt back to normal enough that I went out and walked a couple of miles.

All in all, this was similar to the experience I had with the second dose of the original COVID vaccine, with symptoms right at the 12-hour mark that totally resolved within 24 hours of the vaccine. I didn’t have anything like this with the first or third doses, however.

Although I wouldn’t want to repeat the experience, I’d rather have it than some of the debilitating cases of COVID I’ve seen in the last few months. It’s certainly preferable to the ultimate “bad outcome” that is dying, and which we still see (most recently in my world in a 42-year-old, which was truly tragic). The long COVID clinic at our local children’s hospital has a one-year waiting list, so hopefully vaccines will be helpful in preventing the need for those services. Everyone’s mileage varies as far as how they experience this vaccine. I don’t share this to frighten anyone, but as a longstanding early adopter of many technologies, including this one, knowing what to expect or what might happen might allow someone to plan ahead.

Have you received the new bivalent vaccine, and what was your experience? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 9/8/22

September 7, 2022 Headlines No Comments

CertifyOS Closes $14.5 Million Series A Funding Round Led by General Catalyst

Provider credentialing and licensure company CertifyOS raises $14.5 million in a Series A funding round led by General Catalyst.

Regenstrief and IU developing one of first population-based surveillance systems for long COVID to determine prevalence, trends and outcomes

The CDC awards a $9 million, five-year grant to researchers at Regenstrief Institute and Indiana University to enhance surveillance of and detect trends related to symptoms of long COVID using EHR data.

Noble Introduces Mental Health Technology To Reduce Misdiagnosed And Underserved Patients In Primary Care

Mental health app developer Noble develops remote patient monitoring capabilities to help primary care physicians better care for patients experiencing mental health issues.

Readers Write: The Retail Revolution is Changing Modern Medical Care and Healthcare Organizations Need to Act Now

September 7, 2022 Readers Write 1 Comment

The Retail Revolution is Changing Modern Medical Care and Healthcare Organizations Need to Act Now
By Shelley Davis, RN

Shelley Davis, RN, MSN is VP of clinical strategy at Lightbeam Health Solutions of Irving, TX.


As patients and healthcare providers continue to navigate a post-pandemic world, we have begun to see an overlying trend — especially among the younger generation — that favors convenience and transparency in the way healthcare services are obtained. Retail health is defining a generation of patients who are taking healthcare into their own hands and steering away from the relationship-based patient-PCP (primary care physician) system that older generations have followed.

This can come with some benefits, as more convenient healthcare makes treatment accessible for a wider patient population. However, this new healthcare trend also has potential downsides.

To grow and change with the world around us, health systems must be able to answer two questions. Why are these changes are taking place? How can this new mindset be leveraged to make healthcare more accessible and forge a positive, meaningful impact on many lives?

Consumers Can Shop for Anything They Need, Including Healthcare Providers

The retail health phenomenon comes at a time when digital fluency is high. Most Millennial- and Generation Z-aged patients prefer to choose provider offices that offer a better patient-centered experience or with the highest reviews, much like shopping for a new product or home appliance.

In the past, one might have found it odd to receive an eye exam or mammogram at Walmart or to check into a walk-in clinic instead of contacting a PCP when you become sick. Nowadays, a person’s first thought when it comes to their healthcare options is, typically, convenience. This can be due to any number of reasons. Patients may prefer:

  • To be seen at a moment’s notice.
  • To come in late or on weekends.
  • To have financial transparency or listed prices.
  • To see a provider without having insurance.
  • To go to the clinic or office closest or within walking distance to them.
  • To multi-task, such as grocery shopping immediately after receiving a check-up or vaccine.

Many of these scenarios can be tied back to the health inequities that impact a patient’s ability to acquire the medical care they need. It makes sense that patients have to make decisions based on whether they will have finances, transportation, or even shelter. However, while the convenience of retail health does offer benefits, its drawbacks cannot be ignored.

Benefits and Downsides to the Retail Health Model

When taking it at face value, the trend toward retail health might seem appealing. After all, having this level of convenience allows providers to see patients at intervals flexible with many schedules. More benefits include:

  • Retail health pushes organizations to be more transparent with costs to compete with these convenience-based clinics.
  • Retail health overall is more patient-centric. Moving toward a patient-centric approach rather than provider-centric overall prioritizes the needs of patients.
  • Through retail health, many patients can receive basic care who otherwise would not receive medical attention at all, even though that care may not be the highest quality.

But with these positives come some clear drawbacks. When patients are given this degree of autonomy over their own health journey, it puts an enormous responsibility on their shoulders. Patients who adhere to the behaviors of retail health must act as their own medical historian, care manager, and health expert.

From the patient side, these concerns are rooted in an extreme lack of consistency and continuation of care, stemming from little to no engagement or follow-up after an appointment, as well as disjointed health record tracking. When patients go to multiple places for care that do not communicate with each other, an information silo is created, resulting in reduced efficiency, lower quality services, and potential treatment duplication.

Additionally, the use of medications is significantly higher in patients who use retail health. If a patient does not see a physician or care team consistently, many things can be missed or misdiagnosed. Preventive screening recommendations take a back seat to addressing acute needs and new symptomatology. It also puts a provider at a disadvantage to not have all the information they need, such as family history, past illnesses, symptoms, allergies, and drug interferences. This, in turn, increases the consumers risk of medication compatibility issues, treatment gaps, and single symptom management.

How Can Healthcare Organizations Bridge the Gap Between Convenience and Quality?

Retail health is setting some great precedents that can be harnessed to elevate the more traditional healthcare model to one that is more inclusive, accessible, convenient, and transparent. Opening healthcare information while respecting HIPAA guidelines and privacy could solve many of the issues that are associated with data silos while giving providers more access to important patient information and taking the onus off the patient to act as their sole care manager.

Telehealth has the building blocks to be a great alternative for easier access to care while maintaining consistency and quality. Its capabilities include:

  • Remote patient-provider visits that reach wider audiences and encourage patient engagement.
  • Online or virtual classes to encourage medical literacy for chronic conditions that patients may not know how to best manage on their own, such as diabetes and hypertension.
  • Improved coordination of care between multiple providers.
  • Encouraged patient communities that benefit from cohort-learning or developing interpersonal relationships with others in their group

Going beyond the digital environment, larger healthcare organizations can also take actions to forge partnerships with after-hour facilities or clinics within their communities to bring the high-quality care they provide to those who rely on convenience.

Along with telehealth, other solutions that can be leveraged to match the convenience and transparency of retail health are:

  • Deviceless or device-based remote patient monitoring.
  • After-hours hospital clinics to capture patients who need care outside of the traditional 8 a.m. to 6 p.m. window.

The new mindset surrounding healthcare and how medical services are obtained is not going anywhere anytime soon. Larger health organizations should listen to the needs of their communities and extend their capabilities to match those needs as best they can. Ultimately, the key is to meet patients where they are.

Readers Write: Digital Care – The Opportunity and Threat for Metropolitan, Community, and Rural Hospitals

September 7, 2022 Readers Write No Comments

Digital Care – The Opportunity and Threat for Metropolitan, Community, and Rural Hospitals
By Cody Strate

Cody Strate is managing partner of Upward Spiral Group of Boulder, CO.


In 2002, I began my career on the vendor side, helping hospitals move away from NCR forms and embosser cards towards centralized e-forms that could be printed on demand, which was some serious eyebrow-raising stuff back in the day. For the next 18 years, I had the pleasure of working with some wonderful people to institute digital solutions to vexing paper-based processes at over 1,000 hospitals spanning more than a dozen countries.

I stepped outside the acute care space in 2019, gaining exposure into how leaders in other industries fundamentally think about the market they serve, the importance of value, proactive versus reactive mindsets, and intent towards consumer experience.

After dancing with technology solutions and problem solving in other industries, I can clearly see that there are some threats not too far afield for hospitals that the all-too-pervasive status quo thinking approach to operation, mindset, and leadership is ill suited to handle. I wanted to write this article to call attention to a few things in hope that it opens a few eyes and facilitates some fresh thinking.

Specifically, I’m going to focus this piece around one single theme, which is the opportunity and threat brought about by the ability to extend care across great distances thanks to advancements in technology, a large and reliable communication network infrastructure, and the prevalent adoption of smartphones.

Caveat alert: given the massive institution that is the hospital and health system ecosystem, there are exceptions to every situation and rule. In other words, this is a generalist view derived from the aggregate of my experience of thousands of interactions with healthcare leaders.

The Stakes: Revenue

Just so we’re clear upfront, the cold hard calculus of the following is that pretty much everything comes down to revenue opportunity versus revenue threat. Revenue is the lifeblood of any company in any industry, and hospitals are not immune to this fact. I could elaborate on this, but I don’t think readers need any Finance 101 lessons from me, so let’s just leave it at: (a) lots of revenue = good, versus (b) little revenue = bad.

The Digital Attack on Proximity-Convenient Care

This situation cuts a couple of different ways that we’ll get into, but before that, let’s get straight on what’s happening. It’s a basic principle and rather self-evident that as technology progresses, it consistently renders “impossible” into “possible.” Case in point — the vast geographic distances that kept people isolated from each other, education, services, and so on, are now being bridged through technology.

Proximity Based Care: The Way It’s Always Been

Community hospitals generally exist in an orbit around a metropolitan center, where total beds decrease as distance from the metro area increases. This geographic distance has set the stage for the conventional model we see today, where care is largely accessed and delivered based upon these geographic constraints. In other words, if you live in a rural area, your choice of care is largely dictated by geographic proximity to care. This was my situation as I grew up in rural northeast Texas, where driving into Dallas for big-city healthcare was out of the question. Simply put, geographic proximity to care correlates to convenience of care, which up to this point has served as the primary basis for choice of care.

Potential Winners: Metropolitan Hospitals

Thanks to the combination of (a) 85% of the US population has a smartphone in hand, 84% in suburban areas versus 80% in rural areas; and (b) the emergence of digital capabilities to offer care through these devices, metropolitan hospitals can extend their reach out into suburban and rural areas. If I’m a metropolitan hospital, I would be creating targeted ads regarding specific services to even more specific personas and deploying them through the Facebook ad network, Google display ads, YouTube, TikTok, and the like.

The siren’s song of getting big-city care in palm of your hand can be tempting to people who traditionally are separated from the big-name healthcare due to physical distance. Marketing access to big-brand name healthcare that’s convenient and digitally accessible to these populations can be a lucrative practice for metropolitan hospital systems looking to add more revenue and/or recuperate revenue lost to specialty care service organizations.

Potential Losers: Community and Rural Hospitals

Whereas metropolitan hospitals have the potential to go on the offensive to bring in more revenue, suburban and rural hospitals are a greater risk of having the patients within their community, along with all accompanying revenue, effectively poached. Convenient access to quality care through one’s smartphone is here, and it will only continue to become more mainstream. This places leadership at community and rural hospitals in a precarious situation. The question is how these smaller facilities will strategically position themselves going forward.

The Mindset Problem: BWADITW Thinking versus Proactive Thinking

After stepping away from the acute care industry for a few years and seeing how other industries operate, there’s one thing that’s clear. Generally speaking, the mindset of hospital leadership is largely one set on BWADITW (“because we’ve always done it this way”) versus opportunity and/or threat-based agility found in many other industries.

This should not be a surprise given that most hospitals have the two things required for BWADITW thinking to flourish: (a) size, since these are very large organizations; and (b) time, since many hospitals are long established serving many generations of their community. However, BWADITW thinking stands as a tremendous threat to community and rural hospitals as it offers an alluring false appeal of safety. Building a fixed strategy based upon what’s worked in the past is folly given technology’s acute ability to alter the landscape of the future. If you want to apply lessons from history, consider a more Darwinian lesson of “adapt or die.”

A more vile and derivative threat born from BWADITW is thinking your patient in your area owes your community or rural hospital unwavering fealty. This is complacent leadership at its worst, thinking that your patients owe you something rather than you owing your patients something. Your organization may have been the only game in town for decades, but that is no longer the case. This begs the question — are you working to earn your patients’ business, or are you resting on laurels expecting your patients’ business?

Move Quick and Focus on Earning Your Patients’ Business Rather Expecting It

In industries that are rife with aggressive competition, there is an understanding born from survival. If you want to earn the business of your consumers, you have to offer more value than the other guys. Value is the key here, and it comes in many forms ranging from quality, convenience, cost, convenience, customer experience, and so on. My fear is that certain hospitals may have grown complacent due to a lack of competition, which does not bode well for protecting future strategic interests.

Metropolitan hospitals, it’s a smart move for you to pursue and seize revenue opportunity by leveraging technology to extend the service boundaries of your organization. If you can offer a service that tangibly has more value for the end consumer, then fair game.

Community and rural hospitals, you should act fast to get in front of this threat and seize the opportunity to leverage technology to offer your longtime customer base the best possible consumer experience before they explore any lures from the big-city hospitals. Your goal should be to proactively provide better service, offer more value to your patients, and lock in new consumer behavior patterns. Be proactive in exploring ways to expose your customer base to a new and more convenient way to access the care offered by your facility as a first line of defense, while still having them come to your facility to access face-to-face level care. Do this and you will develop new behavioral patterns in your consumers / patients that any outside competition will find difficult to break.

Simply put, by focusing on providing a quality consumer experience, you will concurrently better serve your patients, continue to fulfill your hospital’s mission statement (often built around how you exist to serve your community), and protect your financial interests from outside invaders looking poach your you patients and revenue.

Morning Headlines 9/7/22

September 6, 2022 Headlines No Comments

Amazon is secretly testing another virtual-care venture that aims to treat common conditions online

Amazon is reportedly internally testing a direct-to-consumer telemedicine and online prescription drug service that will compete with the likes of Hims and Ro.

‘Critical’ network failure at all 3 campuses of The Ottawa Hospital resolved

The Ottawa Hospital in Canada recovers from an unspecified hardware issue that took its Epic, Cerner, PACs, Rhapsody, and Spok systems offline over the weekend.

Upfront Raises $10.5 Million in Oversubscribed Series C

Less than a month after its acquisition of PatientBond, patient engagement and access software vendor Upfront Healthcare raises $10.5 million as part of a Series C funding round.

News 9/7/22

September 6, 2022 News No Comments

Top News


CVS Health will acquire home-based care company Signify Health for $30.50 per share in a deal valued at $8 billion.

Amazon and UnitedHealth had also expressed interest in the company.

Signify Health CEO Kyle Armbrester, MBA, who came to the company in 2018 after seven years with Athenahealth, will continue to lead the business as a part of CVS Health.

The deal is CVS Health’s second largest in recent years, having acquired Aetna in 2018 for $70 billion.

Modern Healthcare notes that the three largest Medicare Advantage insurers will now control the three largest homecare providers.

HIStalk Announcements and Requests


Poll respondents are mixed on why Amazon is closing Amazon Care, with the most common speculation being that its pending acquisition of One Medical is more important to the company or that the company is realizing that healthcare is too complicated to disrupt. IANAL says One Medical is a disruptor that has a better business model than Amazon Care’s selling telehealth and low-acuity home to employers, Fail fast ponders just how poorly things were going with Amazon Care if Amazon didn’t even attempt to combine its work with One Medical, and DD says anything short of creating a national, vertically comprehensive solution won’t appeal to big employers.

New poll to your right or here: In the most recent health IT purchase or sale with which you were involved, what initially triggered the buyer’s interest? It’s probably not easy to say with certainty and I couldn’t list every possible answer, but I’m curious what got the buyer’s initial attention.


September 22 (Thursday) 1 ET. “ICD-10-CM 2023 Updates and Regulatory Readiness.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, marketing director, IMO; Julie Glasgow, MD, marketing manager, IMO. The yearly update to ICD-10-CM is almost here. Prepare your organization for a smooth transition, and avoid any negative impacts to your bottom line, with an in-depth look at the upcoming changes. Listen to IMO’s top coding professionals and thought leaders discuss the 2023 ICD-10-CM coding changes. This webinar will review additions, deletions, and other revisions to the ICD-10-CM code set and how to make sure you get properly reimbursed.

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

Acquisitions, Funding, Business, and Stock

BJC HealthCare and Washington University School of Medicine will collaborate with CuriMeta, which will provide de-identified, real-world data for research. The organizations also led the company’s $6 million Series A funding round. Founder Davis Walp, MBA previously provided real-world data brokerage services to pharma.


Virtual primary care company 98point6 secures $20 million in new funding, which it will use to scale the licensing of its services to health systems. MultiCare Health System (WA) has implemented 98point6’s technology as part of its Indigo Health ambulatory division, which operates hybrid primary and urgent care clinics.

AESOP Technology, which offers AI-powered medication management and clinical decision support software, raises $3 million. The company, a spinoff of Taipei Medical University in Taiwan, opened an office in San Francisco in 2020.

Business Insider reports that Amazon is internally testing a direct-to-consumer telemedicine and online prescription drug service that will compete with the likes of Hims and Ro.

A New York Times opinion piece says that while Amazon is a Goliath in product sales, its money, technology, and logistics can’t fix the mess that is American healthcare:

Any company claiming its innovation will revolutionize American healthcare by itself is selling a fantasy. There is no technological miracle waiting around the corner that will solve problems caused by decades of neglectful policy decisions and rampant fraud. And a fix aimed at just the upper crust of employer-sponsored health coverage has no hope of making healthcare more accessible to those who are truly being left behind. Amazon Care and One Medical saw the same market opportunity within the crisis-ridden American healthcare system: a paid escape hatch for the better-off … But part of why Amazon Care had difficulties is that not all aspects of primary care are so simple that they can be performed in your home or through a video consultation (which is nevertheless a valuable service that is no doubt here to stay). For anything more complicated, patients would still have to visit a traditional clinic, meaning they would have to contend with all the things that are most tiresome about American healthcare: insurance, phone calls, and drug prices — if they can get the time off to visit the doctor at all.



Eric Brill (Hillrom) joins AirStrip as SVP of advanced clinical alarm communications and care coordination.


WellSky promotes Lauren Witlen to VP of marketing, connected networks.


UConn Health names Rick McCarthy, MS (White Plains Hospital) CIO.


George “Buddy” Hickman, MS (Harris Health System) joins First Health Advisory as chief strategy officer.

Announcements and Implementations


Bonita Community Health Center (FL) will transition to Epic as part of its acquisition by Lee Health.

Biotech company Freenome launches a study of cancer risk factors using Oracle Cerner’s Learning Health Network and study enrollment technology from Elligo Health Research, in which Oracle Cerner is an investor.

Government and Politics

The Federal Trade Commission launches an anti-trust investigation into Amazon’s plan to acquire One Medical as part of the deal’s regulatory approval process.


Moncrief Army Health Clinic at Fort Jackson (SC) will go live on MHS Genesis later this month.

Privacy and Security


The Ottawa Hospital in Canada recovers from an unspecified hardware issue that took its Epic, Cerner, PACs, Rhapsody, and Spok systems offline over the weekend.


The Verona paper reports that 5,500 Epic customers attended UGM, double the number that came to last year’s COVID-compromised conference.

Regional Medical Center (SC) is working with its auditors to adjust its financial reporting model following its year-ago conversion to Cerner CommunityWorks, which it says “is still not functioning as originally expected” as gross accounts receivable increased by 70% and bill submission slowed.

A study of 175,000 Medicare beneficiaries with opioid use disorders finds that those who were offered expanded access to telehealth services remained in treatment longer and experienced reduced risk of overdose.


In Finland, 619 doctors file a complaint with the National Supervisory Authority for Health and Welfare about Epic’s patient record software that was installed at Helsinki University Hospital District last year. The doctors say the system has caused problems with patient data exchange and medication management, has lost information, and offers poor user experience.

Sponsor Updates

  • PMD launches a new website reflecting its shift to end-to-end healthcare solutions.
  • Microsoft publishes a case study featuring EClinicalWorks, “EClinicalWorks thrives in the cloud with Azure Virtual Machines and Azure Disk Storage.”
  • Premier’s Pinc AI Applied Sciences division will use Datavant Switchboard and Privacy Hub to connect, certify, and license or provide research services on linked tokenized datasets for life sciences and health system partners.
  • Nuance reports that customers like RWJBarnabas Health, University of Michigan Health-West, and others average 47% cost savings with 40% call containment and 30% patient self-service rates with its patient engagement solutions.
  • Surescripts reports that providers used its Record Locator & Exchange service to access the health records of more than 62 million patients and exchange more than 622 million clinical documents in the first half of 2022.
  • Clearwater completes its acquisition of CynergisTek, bringing together cybersecurity, privacy, and compliance leaders.
  • Bamboo Health and CarePort will exhibit at the National Association of ACOs Fall 2022 Conference September 8-9 in Washington, DC.
  • Biofourmis will present at the Mobile Tech in Clinical Trials Conference September 12 in Boston.
  • Oracle Cerner publishes a new client achievement, “HHSC Kauai Region implements a clinically driven revenue cycle for a healthier bottom line.”
  • CloudWave will exhibit at the TORCH Fall Conference September 12-15 in Round Rock, TX.

Blog Posts


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


Morning Headlines 9/6/22

September 5, 2022 Headlines No Comments

CVS Health to Acquire Signify Health

CVS Health will acquire Signify Health in a deal valued at $8 billion.

98point6 Announces New Strategic Direction To License Primary Care Platform

98point6 will use $20 million in new funding to help scale the licensing of its virtual primary care service to health systems.

U.S. FTC asks Amazon, One Medical for more information on $3.49-bln deal

The Federal Trade Commission launches an anti-trust investigation into Amazon’s plan to acquire One Medical as part of the deal’s regulatory approval process.

Morning Headlines 9/2/22

September 1, 2022 Headlines No Comments

ESO Acquires Occam Technologies, Leading Provider of Enterprise Master Patient Index (EMPI) Solution

Emergency medical services technology vendor ESO acquires Occam Technologies, which offers an EMPI platform.

Sectra extends medical diagnostics business to include genomics IT

Sectra creates a genomics IT business unit and will work with University of Pennsylvania Health System to develop a precision medicine solution.

Tiger Global-Backed Healthtech Unicorn Innovaccer Lays Off 120 Employees

Innovaccer reportedly lays off 120 employees, about 8% of its workforce, nine months after it ran a $150 million Series E funding round that valued the company at $3 billion.

SOC Telemed Expands Behavioral Health Offering with Acquisition of Forefront Telecare

Specialty acute care telemedicine vendor SOC Telemed acquires Forefront Telecare, which offers virtual behavioral health services.

News 9/2/22

September 1, 2022 News 2 Comments

Top News


Emergency medical services technology vendor ESO acquires Occam Technologies, which offers an EMPI platform.


September 22 (Thursday) 1 ET. “ICD-10-CM 2023 Updates and Regulatory Readiness.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, marketing director, IMO; Julie Glasgow, MD, marketing manager, IMO. The yearly update to ICD-10-CM is almost here. Prepare your organization for a smooth transition, and avoid any negative impacts to your bottom line, with an in-depth look at the upcoming changes. Listen to IMO’s top coding professionals and thought leaders discuss the 2023 ICD-10-CM coding changes. This webinar will review additions, deletions, and other revisions to the ICD-10-CM code set and how to make sure you get properly reimbursed.

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

Acquisitions, Funding, Business, and Stock


Wheel, which offers virtual health infrastructure and clinical services, lays off 35 employees, representing 17% of its headcount. The company says the workforce reduction will allow it change focus from building a marketplace to developing an enterprise platform.

Sectra creates a genomics IT business unit and will work with University of Pennsylvania Health System to develop a precision medicine solution.

Insurer Oscar Health announces in an SEC filing that a Florida health plan is cancelling its contract to use Oscar’s technology platform. Health First Health Plans, which previously announced that it was pausing its implementation of the +Oscar system due to integration challenges, was generating $60 million in annual revenue for Oscar.

Walgreens Boots Alliance completes its acquisition of a majority stake in CareCentrix, which sells predictive analytics and homecare technology.

Innovaccer reportedly lays off 120 employees, about 8% of its workforce, nine months after it ran a $150 million Series E funding round that valued the company at $3 billion.

Specialty acute care telemedicine vendor SOC Telemed acquires Forefront Telecare, which offers virtual behavioral health services.


  • Visage Imaging signs contracts with Montage Health, Children’s Hospital of Philadelphia, and Bay Imaging Consultants.



Katherine Virkstis, ND (Advisory Board) joins Get Well as VP of clinical advisory services.

Announcements and Implementations

The Sequoia Project publishes QHIN standard operating procedures and an application for designation, which it will begin accepting on October 3.

The CommonWell Health Alliance will apply to become a QHIN.

Ochsner Health incorporates oncology precision medicine information from Tempus in its Epic system.

Southern Ohio Medical Center reports a 30% reduction in hospital-acquired C. difficile infections following work with Meditech Professional Services and implementation of Expanse tools.


Wellstar Health System will close money-losing 460-bed Atlanta Medical Center on November 1, leaving Grady Memorial Hospital as the city’s only level 1 trauma center.


Masimo releases its $499 W1 consumer health watch, which offers continuous monitoring of oxygen saturation, pulse rate, respiration rate, and hydration levels. The medical version, which is available only outside the US, adds spot check ECG, atrial fibrillation detection, and a remote monitoring and telehealth application for clinicians and hospitals.

Privacy and Security

Credit rating agency Fitch Ratings says that the cost of cyber risk mitigation is increasing for non-profit hospitals even as their margins are decreasing, placing them at more risk for cyberattacks.


A physician-authored opinion piece calls the EHR inbox an “after-hours second job for physicians” who are expected to respond to patient messages and manage low-value inbox notices without compensation or adjusted productivity targets. The authors recommend:

  • Measure the volume of inbox messages and the time required to manage them.
  • Turn off low-value messages, such as for tests ordered but not yet resulted and notifying primary care physicians of every test ordered during an inpatient stay.
  • Assign a lower-license team to review new messages, resolve those they can, and then meet with the physician to manage the rest.
  • Pay physicians for providing patient services via email and include that work in productivity measures.
  • Research the non-visit inbox work across specialties, assess the risk and benefits to patient care of that work, and study the effectiveness of interventions that are intended to reduce inbox management demands.

A behavioral health researcher whose bipolar disorder has required numerous medication changes over the years recommends that clinicians use a simple, shareable form to document when a patient’s drugs are started, stopped, or adjusted along with the reason for the change. The document would help patients remember their medication history and avoid having a medication ordered that was previously unsuccessful.

An emergency medicine physician leaves the specialty, citing inappropriate ED use that is fueled by hospital administrators and contracted ED operators who boost profits by encouraging people to visit the ED for sports physicals and other non-emergent issues. Leonard Arnavi, MD also observes that hospitals push HIPAA responsibilities onto doctors even though ED layouts guarantee a lack of privacy, tie compensation to patient satisfaction surveys that force doctors to choose between practicing good medicine versus giving patients what they want, and train resident physicians poorly in their quest to capture GME funds and to create a supply of cheap labor.


Zus Health founder Jonathan Bush provides his always-interesting perspective to Fast Company. Snips:

  • The hospital itself can only serve the people that can drive there. They’re in a local battle for a deep, vertical monopoly … [new market entrants are saying], “I’m going to take one narrow thing—anxiety, prediabetes—and crush it nationally.” These new companies don’t give a shit about vertical monopoly. They have no plans on even having an exam room, let alone a lab, a pharmacy, an operating room, an imaging center.
  • A new class of company that on their most selfish day are happy to share data because that’s not how they make money; they can’t win by controlling your referral patterns beyond what they’re focused on.
  • While Amazon has been able to keep its true North Star ever “closer to the customer,” One Medical has needed to seek payment from one hospital provider over another. This channel conflict with consumer interest will be very tough to iron out as the market heats up.
  • [Health IT startups should] quickly get to the thing that no one else has and spend all your R&D, design, product time on that and rent everything else, at least until you get to break even or get to some sort of operational stability. That may be obvious advice, but during this last orgy of nearly free capital, people forgot it, and many young people started businesses not ever knowing that was a thing, and they’re about to get a massive bucket of water on their head explaining it to them.

Sponsor Updates


  • Tegria supports the Snoqualmie Valley Schools Foundation in Snoqualmie, WA.
  • PerfectServe celebrates its 25th anniversary.
  • Surescripts releases a new episode of its There’s a Better Way: Smart Talk on Healthcare and Technology Podcast, “Healthcare, Tech, and Capitol Hill.”
  • Vocera releases a new Caring Greatly podcast, “Linking Leader and Team Member Well-Being.”
  • Sixteen of Wolters Kluwer Health’s Lippincott healthcare publications earn 24 wins in the annual Awards for Publication Excellence competition.
  • Surescripts announces that use of its Record Locator and Exchange increased by 76% in the first half of 2022 versus 2021, exchanging 622 million clinical documents for 62 million Americans.

Blog Posts


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EPtalk by Dr. Jayne 9/1/22

September 1, 2022 Dr. Jayne 6 Comments

There’s an often-cited study in the primary care literature that looks at the number of hours a physician would need to spend each day to perform the recommended care for a standard panel of patients. The problem was that it hadn’t been updated in years. Earlier this month, a study was published in the Journal of General Internal Medicine that updates the info and confirms that the situation hasn’t gotten any better.

Researchers from the University of Chicago, Johns Hopkins University, and Imperial College London found that primary care physicians would need to spend nearly 27 hours each day in order to provide all the guideline-based care needed for a hypothetical panel of 2,500 patients. The breakdown includes 14.1 hours for prevention, 7.2 hours for chronic diseases, 2.2 hours for acute care, and 3.2 hours for documentation and wrangling the inbox.

The authors used data from the 2017-18 National Health and Nutrition Examination Survey (NHANES) and the 2020 care recommendations to develop the projections. The statistics seem grim, so what’s the answer? Most agree that team-based care needs to be the norm and not the exception. The authors took the same requirements to see how they could be delivered by a team. That approach would reduce the physician component to 9.3 hours per day, with most of the savings occurring in the areas of preventive care and chronic disease care.

In this model, counseling might be delivered by a dietician, nurse, or other member of the support staff. The authors noted, however, that many practices are already using teams to deliver a variety of pre-visit screenings and counseling, so the ability to improve this might be variable. They went further to conclude that even with team-based care, the requirements would be “excessive.”

Another potential solution would be for physicians to have fewer patients on their panels, although this wouldn’t do much to ease the primary care shortage. Overall, fewer patients generate fewer appointment requests and fewer phone calls. The reality is that many of the organizations that employ physicians won’t let them close their panels to new patients without a lot of weeping, wailing, and gnashing of teeth. I once did a consulting engagement with a group that forced physicians to take new patients until their panels were so large that they couldn’t provide any same-day care and the wait for routine care was several weeks. When physicians work like this, they feel like they’re on a perpetual hamster wheel and that they can never catch up.

Yet another solution would be to shift some of the work to the patients themselves  through self-service programs or outreach. It’s fairly easy for organizations that have implemented certified EHRs to generate lists of patients who need a particular service and queue them up for outreach. Even if you can pick off a certain percentage of the patients by delivering asynchronous education through a patient portal, you’re still helping the practice with workflow. Throw some patient self-scheduling on top of it and that’s a winner.

I’m still baffled by the number of practices that won’t allow patients to self-schedule for routine visits. When I press the issue, they’ll argue with me that self-scheduling doesn’t help the provider. I counter that it can when the FTE employee positions that used to schedule are instead redeployed as more clinically relevant roles such as health coaches, care navigators, etc.

Automation can be a big piece of the solution as well. I’ve seen some very cool functionality recently that allows automated rerouting of patient messages based on their content, so that the most appropriate staff member can manage them as opposed to everything having to come through the physician first. It can also be used to send pre-visit questionnaires to patients to help identify whether they’re doing well with their chronic conditions or whether they’re having issues that might merit another team member helping with the visit, such as a pharmacist, social worker, or health coach. Questionnaires can return data that can auto-populate the visit note, reducing documentation time.

Not all patients will be amenable to reading patient education materials via a patient portal, or to interacting with a chatbot or other virtual assistant, but at this point offices are so congested that any number of patients you can divert from the “same old, same old” workflow is a bonus. There’s often an argument that older patients aren’t candidates for digital engagement, but I call baloney on that. Thinking of the retirees with whom I interact the most, they might have some small struggles with technology, but overall they find their time to be valuable and are willing to try solutions that might allow them to spend more time with their grandchildren versus hanging on the phone with a medical office.

Most of the primary care colleagues I reached out to about this updated research said they feel the drain of all that work directly and on a daily basis. One recently decided to give up primary care because she didn’t feel she could deliver the kind of care she wanted to do, or was trained to do, with the constraints her employer had placed on her. She isn’t able to hire additional team members and is expected to run a full family medicine panel with only one medical assistant helping her, which is ludicrous. Several have closed their panels to new patients, and others are limiting office hours. The only ones that sounded even remotely hopeful for the future were the ones who had transitioned to Direct Primary Care models, where they’re only caring for 200-400 patients at a time versus the thousands that physicians are conventionally expected to manage.

One colleague I spoke with said that society needs to double down on public health education everywhere, not just in the physician office. Patients need to make healthier choices and need to be hearing about prevention regularly, not just during an annual visit. Healthier patients make for much quicker and easier office visits than those featuring patients with multiple chronic conditions. However, requirements for health education have been cut in many schools and we’re certainly not flooding the airwaves with evidence-based health education. I’ll keep doing my part with healthcare IT, advocating for patient engagement, outreach, automation, and increased self-service options. I’ll lobby my representatives to support public health efforts.

What do you think is the answer to the ever-expanding burden placed on primary care delivery organizations? Leave a comment or email me.

Email Dr. Jayne.

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