EPtalk by Dr. Jayne 3/28/24

I attended a recent online forum focused on a telehealth topic. I was surprised to find that some of the participants really didn’t understand the idea of a virtual-first practice. The only way they could conceptualize it was as part of a brick and mortar organization. When I started talking about ordering labs from services that would come to the patient’s home or using patient-provided data from connected devices, I got some blank stares.

The participants were from large health systems and other well-established organizations. I wonder if they’re outliers in their organizations or whether there is really a lack of interest in trying to deliver care outside of traditional office-based settings. Being able to offer services like that isn’t just about convenience. It’s also about serving patients in remote areas and helping those who have other reasons they can’t leave their homes. I hope they take the ideas back to their organizations for discussion.

I receive a ton of marketing emails and spammy-sounding connection requests on LinkedIn. It’s guaranteed that I won’t accept your request if you use made-up words to try to sound cutesy about the serious problems facing physicians today. Case in point: one vendor positioned their product as “the cure for documentitis and physician burnout.” It went on to further define “documentitis” as “inflammation caused by burdensome documentation requirements imposed by EMRs, billing systems, etc.” I’m sure their marketing folks thought it was amusing, but it shows a complete lack of regard for the true causes of documentation fatigue, including out of control regulatory requirements, expanding quality measurement, and lack of regard for the professionals in the system. As someone making purchasing decisions, this kind of messaging takes a company to the bottom of my round file.

Another one of my pet peeves seemed to be everywhere this week — the presence of large microphones in front of the participants on conference calls. I sympathize with the need to have clear audio and to want to use nice equipment, but when you’re a healthcare professional communicating with other healthcare professionals, it’s important to remember that you’re not a DJ and this is not a podcast. The majority of people I take calls with use integrated laptop microphones, earbuds, or something higher tech but unobtrusive, and they sound just fine. I’m hoping this was just a freak occurrence this week and it’s not a new trend. However, as a licensed amateur radio operator, I’ve got some solid options to put into play if it does become the hot new thing.

One of my favorite readers sent me an article about AI nurses, referring to the idea as “cray-cray.” The phrase has been added to the Oxford Dictionary, so I’m not afraid to quote it. The premise on AI nurses is that they’re designed to deliver non-diagnostic nursing care, such as education, which would help mitigate the ongoing nationwide nursing shortage. The idea was dissected recently in The Hustle, which offered some interesting commentary, including the fact that the hardware needed to run such an offering isn’t cheap.

I would add to that the fact that nursing is regulated by the states and licensure is required, so it’s going to be a hard sell that this is actually nursing care versus something else. Organizations will have to look closely at quality metrics that have been shown to be improved through effective nursing education, such as readmission rates, and understand whether AI-delivered education will meet the mark or cause other downstream consequences.

Speaking of potential unintended consequences, I was glad to see a recent article that looked at whether the hospital at home movement could be a double-edged sword. Although positive outcomes have been reported in the literature, such as reduced costs and improved patient experience, some areas haven’t been fully researched. I’ve talked about some of these in the past, including equity and the fact that patients with lower socioeconomic status might not have a caregiver in the home or a safe home environment compared to those in higher socioeconomic categories. The article brings up the idea of safe storage of medications, availability of food particularly in areas that are food deserts, and the ability to safely store meals that may be delivered in advance. Reliable and cost-effective utilities may also be an issue in some situations, as is the presence of broadband for communications and device connectivity.

The comments section on the article brings up additional points. One commenter who used RN in her name described it as “just a fancy earlier discharge scenario. We already have post-ops shoved out the door half awake, unable to dress themselves and throwing up the whole way home. What a crazy, cruel system we have created.” Another referred to the concept as “quite the pipe dream given today’s realities and limited resources.” Another commenter with experience as a home health RN noted, “I have been in extremely low income homes that were kept in immaculate condition and were exceptionally clean and have been in other homes that were in extremely well to do neighborhoods that were so dirty on the inside that I had concerns with even placing my bag on the floor.” That’s an interesting point and creates an additional burden on organizations to ensure suitability of the environment regardless of its ZIP code or other identifiers. I’d be interested to hear from organizations who are already managing hospital at home to understand how they assess potential care environments and what percentage of candidates are deemed suitable once there is a deeper dive.

I’ve always been interested in public health, so I was glad to see the US Food and Drug Administration publish information on egg safety for those who celebrate spring religious holidays such as Easter and Passover. Salmonella is always a concern where eggs are involved, and the press release offers tips on safe handling, cooking, and storage. Deviled eggs are a staple for family gatherings in our family, but I do enjoy the holiday clearance aisle at Target for all my post-Easter cravings.

What’s your favorite springtime food? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 3/28/24

Goodbill raises $2M and expands customer base to unearth and challenge medical billing errors

Goodbill, a Seattle-based startup that has developed software that detects medical billing errors, raises $2 million.

InStride Health Raises Oversubscribed $30 Million Series B to Expand Access to Best-In-Class Specialty Treatment for Pediatric Anxiety and OCD

Tech-enabled pediatric mental healthcare provider InStride Health announces a $30 million Series B funding round.

New Federal Health IT Strategy Sets Sights on a Heathier, More Innovative, and More Equitable Health Care Experience

ONC seeks public comment on the draft “2024-2030 Federal Health IT Strategic Plan” so that federal agencies can better align their health IT policies, programs, and investments.

Healthcare AI News 3/27/24

News

OpenAI files a trademark application for a voice engine and digital voice assistants, possibly signaling that the ChatGPT developer plans to complete with Apple’s Siri and Amazon’s Alexa voice assistants.

An official with the Congressional Budget Office says that AI could reduce healthcare costs by identifying patients who could benefit from early treatment, but it could also increase costs by spurring the development of beneficial but expensive technologies or identifying more patients who need treatment.

Business

Amazon will invest another $2.75 billion in generative AI startup Anthropic, which it had already backed with $1.25 billion, valuing the maker of the Claude chatbot at $18 billion.

Healthcare business process technology vendor Sagility acquires BirchAI, which offers AI-powered call center technology.

Tennr, which use AI to extract and route data from faxes, raises $18 million in Series A funding.

The London-based non-profit Institute for Public Policy Research makes a worst-case prediction that AI could eliminate 8 million jobs with no gain in gross domestic product. The authors predict that a Phase 2 of AI implementation in which AI is allowed to execute tasks could affect financial workers, shop owners, and IT managers, while advancing to Phase 3 – where processes are built around AI and people accept interacting with avatars – could transform the work of teachers, doctors, and hospitality workers. They recommends creating policies that protect tasks where human involvement is valued, consider imposing wealth taxes or social security assistance, and raising taxes companies that replace people with AI.

Research

NIH provides funding for Treatment.ai to develop a culturally sensitive AI approach for collecting family medical history. The company says that approaches for collecting medical histories for African-American families are biased because they do not adequately capture information about blended families, non-traditional relationships, and the lack of patient information about the health of relatives.

Researchers find that AI can successfully design new drugs to overcome bacterial resistance.

ChatGPT generates discharge documents for orthopedics case that are comparable in quality to those that are created by junior orthopedic surgeons and orthopedics residents, but 10 times faster. Interestingly, while reviewers found hallucinations in four documents that ChatGPT created, that was fewer than the six that were found in the physician-generated notes.

A West Virginia University School of Pharmacy study will look at using AI to collect patient medication information from clinical and billing systems, including clinician notes, to help with medication reconciliation and to determine the risk of readmission.

Other

The National Bureau of Economics Research publishes a grant-supported book titled “The Economics of Artificial Intelligence: Health Care Challenges” that analyzes barriers – incentives, management, data availability, and regulation – that will impact the efficiency and cost disruptions that are possible in the 20% of the US economy that involves healthcare.

Contacts

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

HIStalk Interviews Kelly Boyd, SVP/GM, Sonifi Health

Kelly Boyd, MBA is SVP and general manager of Sonifi Health, the healthcare division of Sonifi Solutions of Sioux Falls, SD.

Tell me about yourself and the company.

I’ve been working in healthcare technology for about 20 years. The bulk of that time has been in product development and operations. I have spent time with the customer success and sales aspects.

Sonifi Health is a wholly owned subsidiary of Sonifi Solutions. Our parent company serves hospitality and other commercial markets. Sonifi Health focuses exclusively on the healthcare market. Within Sonifi, both the parent company and our subsidiaries, we have an underlying theme that our goal is to simplify the delivery and operation of technology so that our customers can accomplish all that’s possible when technology works. Technology is great, but it needs to complement the organization where it’s being deployed. Our role and our goal is to simplify that process, make it seamless, and make it valuable to the organizations that deploy it.

We still fundamentally align ourselves with the Triple Aim initiative that was launched by IHI back maybe 2007 and later modified to the Quadruple Aim. We want to enhance the patient experience, improve health outcomes, and drive operational efficiencies. That translates to both cost reductions and staff satisfaction. That is where we live. All of our technologies — smart room technology, staff technologies — are built fundamentally to go after those initiatives. 

You emphasize that healthcare is hospitality. Do you think that most hospitals see it that way and invest accordingly?

I do. We’ve doubled down on this, because in technology and healthcare tech, we can get so caught up in technology itself. The hospital’s mission is patient care, and at the root of that is compassion, comfort, and health outcomes. That essentially is the real meaning of hospitality.

We have launched with that messaging, both to remind ourselves internally and also message to our clients that we get that technology doesn’t exist for technology’s sake. At the end of the day, everything that we are doing is about the human experience. Creating an environment that is comfortable to the patient and that reduces anxiety has a direct impact on outcomes.

Patients aren’t necessarily capable of judging the clinical aspects of the care that they receive. Does the hospitality aspect of their stay carry an outsized importance in their perceived satisfaction?

It’s interesting, because patients aren’t able to perceive different levels of true clinical care. They can attribute that “I survived that surgery, therefore it was good,” but they can’t really assess where that surgery ranked on the spectrum. What they can definitively create is the perception about how they felt were treated and the hospitality side of the care that they received. People can articulate those things more than they can the true clinical aspects of healthcare.

Patients sometimes complain that technology, such as a physician charting in the EHR, is distracting. How do they see in-room technology and smart rooms?

There is no downside to the technology from the patient perception side. We have seen bumps in hospital patient experience scores simply from bringing in smart room technology. Patients translate high tech, cutting edge, state-of-the-art automation technology to better care. Whether that is a fair translation or not, it happens.

People are human, and investments on the hospitality side impact our perception of the quality of care that we are going to receive. Is my room nice? Is the furniture nice? Is the TV nice? Anything that a hospital does to to move to a smart room to enhance the environment impacts the patient’s perception of their quality of care, and to some extent, how they will perceive their outcomes.

Your website cites a study that found that patients who use an interactive, in-room system are more likely to also use it to follow education recommendations. How can hospitals use that finding?

We found that the entertainment side of it draws people into the system. You want to watch that movie, listen to the music, engage with spiritual content, or whatever those entertainment pieces are that bring the patient into the system. The system is then designed to capitalize on the fact that the patient is engaged with the system.

We will strategically prompt the patient to engage in their care as well. That can be learning about their condition, how the recovery will go once they go home, things that they should watch for once they leave the hospital, and what they need to do to plan and prepare for their discharge. We leverage the entertainment side as a way to pull the patient in, but once they’re in the system, you have all kinds of opportunities to put the important information in front of them.

Do you engage family members in that process?

We love involving family members. When you’re a patient, there is a little bit of anxiety. You’re unsettled. Your ability to grasp the information is much different than a family member. We encourage the family members. We know that the the information lands and and sticks a little bit better when the family members are the ones participating, especially when you’re talking about young children or the adult caregivers of their elderly parents. The family members play a big part of it.

As a parent, I’ve been in the hospital with my kids and I was starved for information. What’s next? What should I expect when I take my son or daughter home? We see a lot of engagement with family members with the system.

How will patient engagement technologies be used outside the four walls of hospitals, such as with hospital at home or virtual hospitals?

This is a trend based on initiatives to reduce costs. It’s clear that the more comfortable the patient is, the better healing, recovery, and outcomes that you’re going to see. The challenge for everybody in healthcare — healthcare tech providers, payers, all of that — is educating patients across the board on health literacy, recovery, lifestyle changes, behavior, and all those things. Companies like Sonifi are trying to increase the engagement and activation of patients so that they can be successful in a home care or hospital at home environment.

How widely are hospitals using digital signage and way-finding?

Most hospitals have some type of digital signage in play. There is a need to continue to get information into the hands of patients and visitors. This could be population health content, where you have people sitting in waiting rooms and have an opportunity to get the right controlled messaging content in front of patients and family members. Signage is everywhere. There’s a lot with branding and marketing of the health system’s mission and vision.

With way-finding, you’re talking substantial institutions that exist on campuses and multi-building setups, where they are trying to make it easier for patients to navigate the campus and get where they need to go.

For Sonifi, we have the nationwide field service organization. We are already providing technology, the breadth and depth of our knowledge of infrastructure, and these type of messaging tools. This becomes a complementary solution for us that we can deliver alongside our more clinical applications.

What are your thoughts about having worked for the same company for nearly 30 years?

When it comes to Sonifi and Sonifi Health, I really love the people that I work for. We’re based in the Midwest, so we have an organization of people who are really committed and care. That “Midwest nice” thing really comes through with the group. I have people in my team who have been here 30 years as well. I have people who have been here 15 years and they joke that they’re the newbies. 

The group believes in what we do. They care about the patient. They care about the the nurse and the clinician. They care deeply about the operations person who is trying to run and manage the distribution system. Everybody is behind what we’re doing, which makes it easy to come to work every day and makes it easy to stay and commit with the organization.

What factors will be important for the company over the next few years?

We are tracking the movement away from inpatient new construction dollars to the outpatient side, with more short stay-focused, hospital-led home initiatives. Interoperability, security, data exchange, and seamless experiences across multiple facilities are big on our radar as well.

Morning Headlines 3/27/24

Brightside Health Raises Strategic Series C, Welcomes Trip Hofer to Board of Directors

Virtual mental healthcare company Brightside Health announces a $33 million Series C investment, bringing its total raised to over $107 million.

Sagility Acquires BirchAI, a GenAI Company in the Healthcare Space

RCM and business process engineering company Sagility acquires BirchAI, a startup that offers AI-powered call center automation technology.

Tennr Raises $18M in Series A Funding

Tennr will use $18 million in Series A funding to further develop and market its AI-based document automation software geared towards providers who rely on digital faxing.

News 3/27/24

Top News

Masimo considers spinning off its consumer business, which includes personal health and audio products, while retaining its healthcare and telehealth solutions.

Reader Comments

From Disingenuous: “Re: Judy Faulkner’s giving pledge. It’s shallow since she’s giving her share of Epic to a foundation that will still have majority control, someone who will carry on her legacy and maintain her vision from the grave.” I read that years ago, thinking that the question then becomes who’s on the foundation and how it interacts with a company that has always had one focused leader who is also the majority owner. Epic has always had a board, I hear, although I know nothing about its members and level of control.

From Psych MD: “Re: VA OIG’s report. The report identifies quite a few problems with the patient’s follow-up mental health care, but using root care analysis leads organizations to identify a single failure among several, to recommend corrective actions even when it seems likely that they would not have affected the outcome, and in this case looks to the EHR as a source of blame or a magical fix. I don’t know why root cause analysis has become ascendant over FMEA or other approaches to optimize care and safety.” The full VA OIG report puts a lot of blame for the patient’s death — which was not determined to be a suicide even though the patient had a history of suicidal ideation — on Oracle Health, but these points seem relevant:

• The EHR failed to issue the VA-specified number of staff reminders to schedule new behavioral health appointments for no-shows or cancellations. 
• The patient had changed their phone number and didn’t respond to appointment scheduling messages.
• The VA contacted family members, who told them the patient was doing OK and didn’t provide the new telephone number, at which time the patient’s flag for being at high suicide risk was turned off, which prevented ongoing suicide prevention reach-outs.
• The patient died of cardiac arrhythmia after using inhalants, of which they had a documented history but denied current use, two months after their most recent visit. 
• This  complex case resulted in some EHR changes involving missed appointments, but the patient was not cooperative despite VA employee efforts and no evidence exists that any changes would have improved this patient’s unfortunate outcome.

From AT: “Re: Epic’s succession plan. What’s yours? I’m hoping that you will post an obituary. My career and even my passion for health IT are forever indebted to everything you have provided me and the entire industry.” I appreciate that, but I want no part of limelight, prehumous or posthumous, for doing what I consider an empty-room hobby. You probably won’t even notice my bucket-kicking absence anyway since Jenn can keep the news coming until existing sponsorships expire and the site can go gracefully dark without stiffing anybody (no pun intended).

HIMSS24 Comments Review

Several folks have said it will be hard for HIMSS / Informa to figure out what needs fixing about the annual conference based on the comments that I received. I’ll take the counterpoint in summarizing the list as being mostly minor and personal gripes, with few underlying themes that indicate mass, irreparable dissatisfaction. My thoughts:

• Attendance and exhibitor count are the ultimate benchmark. Those were just fine for HIMSS24. Informa isn’t forced to rescue a conference whose relevance and reach has slipped beyond repair.
• HIMSS20 and the HIMSS23 carpet debacle soured a lot of people on HIMSS, so hopefully Informa’s acquisition cost reflected the value of the tarnished jewel and the company has the vast experience that is needed to improve it. It also means that Hal Wolf has relinquished a lot of power to Informa, which his critics will celebrate.
• HIMSS conference educational presentations and keynotes mostly draw yawns, but HIMSS can improve those now that Informa is managing the exhibit hall logistics.

My suggestions:

1. Steal ViVE’s “refreshments and meals included” idea, although that will be hard to scale up to a HIMSS-sized conference due to physical space limits. Requiring highly paid executives to fight for space to sit on dirty carpeted floor to dribble dressing from their $20 salad on themselves instead of networking with fellow attendees is absurd. If money is the problem, sell $50 daily vouchers for access to a private area near the exhibit hall that offers food (including fresher and healthier options) and coffee for most of the day, an expanded model of the now-dead HIMSS Bistro offering that I have always thought worked really well when I paid for a ticket. The other limitation here is that convention centers impose their monopoly powers on F&B to charge astronomical prices, such as $73 for a gallon of Starbucks coffee and $29 for a boxed sandwich or salad in Orlando, all plus a mandatory 21.5% service charge plus tax. 
2. Dial back the chirpy influencers and HIMSS Media cheerleading unless the target audience is non-decision makers who like that sort of self-aware gushiness. 
3. Limit the conference to three days and keep the exhibit hall open during all show hours. Nobody enjoys the last-day ghost town, and HIMSS could save money on facilities and let people get back to work by declaring that three days is enough. HIMSS25 will do exactly that, although HIMSS26 sees the return of Tumbleweeds Friday.
4. Get better keynote speakers, schedule them early in the week, and announce them before attendance decisions have already been made. Pay one celebrity speaker, if you must, who packs star power while knowing and caring nothing about the work of audience members (hello, Nick Saban), but otherwise get non-vendor insiders on the big stages.
5. Take advantage of ViVE’s weak spot of high registration fees by using HIMSS clout to lower them, attracting more provider-siders. That won’t necessarily stem the C-level migration from HIMSS to ViVE, but could correct the inflated vendor-provider ratio and draw in health system directors, managers, and clinicians who have influence on technology decisions but who have limited travel money. I would argue that HIMSS can do fine without CIOs since they rarely emerged from their HIMSS VIP sequestration to hit the show floor anyway.

Webinars

March 27 (Wednesday) 3 ET. “Houston Methodist: Deploying clinical AI at scale for improved outcomes.” Sponsor: Health Data Analytics Institute. Presenters: Khurram Nasir, MD, MPH, chief of cardiovascular disease prevention and wellness, Houston Methodist DeBakey Heart & Vascular Center; Brenda Campbell, RN, senior consultant, HM Health System Innovations; Nassib Chamoun, MS, founder and CEO, HDAI. The presenters  will share how an interdisciplinary team collaborated to successfully use predictive models and a novel AI-driven approach to address post-discharge mortality. They will also describe how they expanded use of the platform to reduce clinician time spent digging through the EHR with a one-page risk profile, including codes extracted from notes using generative AI, and targeting their highest risk patients for extra attention. They will speak to how they overcame barriers to bringing AI at scale to support clinicians across the care continuum.

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

Sales

• Nebraska Medicine will implement EVideon’s Vide Health smart room technology within its Innovation Design Unit.
• The Medical University of South Carolina will implement Flatiron Health’s Flatiron Assist oncology clinical decision support software at its cancer center.
• Prisma Health will extend its use of Bamboo Health’s Pings, Spotlights, and Discharge Summaries across its organization and InVio Health Network.
• Samaritan Health Services (OR) will provide virtual urgent care services via Epic MyChart from KeyCare.
• Children’s Hospital Los Angeles offers Nabla’s Copilot AI assistant to its pediatric specialists following completion of a pilot project.
• Community Health Network (IN) will use Ferrum Health’s reference AI architecture to deploy radiology algorithms.

People

CompuGroup Medical will promote Benedikt Brueckle to US CEO in January 2025. He will take over from Derek Pickell, who will retire at the end of this year.

Heather Dunn, MBA (Vanderbilt University Medical Center) joins The SSI Group as president.

Collette Health names Christine Gall, DrPH, MS, BSN (Gall Consulting) chief nursing officer.

Announcements and Implementations

OhioHealth Van Wert Hospital goes live on Epic as part of a system-wide transition that was first announced in early 2021.

Black Book Research announces winners of its awards for highest hospital user satisfaction and clinician satisfaction, as determined by 14,000 respondents.

Malaysia’s health ministry says that it will rejuvenate Selayang Hospital’s Cerner EHR, which was the country’s first paperless system, that has deteriorated to the point that the hospital went back to paper.

Amazon expands its same-day prescription delivery, which is already offered in five cities, to New York City and Los Angeles. The company also notes that it is using AI behind the scenes to prepare prescriptions for pharmacist review to increase efficiency.

A study by The Clinic by Cleveland Clinic finds that its virtual second opinions save the patient or their payer $8,705. Two-thirds of its second opinions recommend a change in diagnosis or treatment, while 85% of patients who had been told that they needed surgery were instead recommended an alternate treatment. The $1,850 program includes a video call with an RN, concierge collection of medical records, and referral to a Cleveland Clinic expert who provides a written second opinion.

A new KLAS report on clinical communications interoperability concludes that no vendor connects consistently across all use cases — which include communication with outside physicians; integration with staff scheduling; timely alert and alarm routing; integration with EHRs, dietary, and transport systems; and communication of after-hours needs — but deep adopters are starting to unify their communications.

Government and Politics

Senator Mark Warner (D-VA) introduces the “Health Care Cybersecurity Improvement Act of 2024.” If passed, the bill will enable eligible providers to receive advanced and accelerated payments in the wake of a cyberattack, provided they and, if applicable, third-party vendors meet certain cybersecurity standards. Warner launched the Senate Health Care Cybersecurity Working Group last November.

Privacy and Security

Petersen Health Care, one of the country’s largest nursing home operators, files bankruptcy due to a double whammy of cybersecurity incidents — an October 2023 ransomware attack that delayed bills and then the Change Healthcare cyberattack that reduced receivables. The company operates 90 nursing homes in the Midwest and reported $340 million in revenue in 2023.

Other

UK HealthCare’s Chandler Hospital (KY) opens a new ICU floor equipped with remote patient monitoring technologies, including bedside patient engagement software from GetWell and video monitoring from Caregility.

Forbes Hospital (PA), part of the Allegheny Health Network, will equip a 47-bed unit with smart patient room and virtual nursing technology in the coming weeks.

Sponsor Updates

• EClinicalWorks becomes a HRSA-approved EHR vendor for UDS+ submissions.
• Availity and Bamboo Health will exhibit at the State HIT 2024 Connect Summit April 1-4 in Baltimore.
• Divurgent publishes a new success story, “Divurgent Consolidates Over 120 EHR and IS Applications After Hospital Acquisition.”

Blog Posts

• Addressing Epic EHR Support Gaps When Resources are Scarce (CereCore)
• How Happy Are You at Work? (AdvancedMD)
• HIMSS 2024 – Key Takeaways: Let’s Hear from Lenny! (Agfa HealthCare)
• The Win-Back: ApolloMD Learns There’s No Match for AGS Health’s A/R and Coding Services (AGS Health)
• Going on offense: Filling the gaps in healthcare cybersecurity (Altera Digital Health)
• How the zero-copy data lake will advance modern healthcare and data (Arcadia)
• Social Determinants of Health Tools: Context in Communications (Artera)
• Understanding the Change Healthcare Breach and What It Means for Your Healthcare Organization (Clearwater)
• Black Box for the Medical Industry Provides Unprecedented Data (Dimensional Insight)
• Retaining Excellence: Strategies for Keeping Top Talent in the Healthcare Technology Industry (Direct Recruiters)
• Generative AI Integration into the EHR – Welcome to the Healthcare Revolution (EClinicalWorks)

Contacts

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

Morning Headlines 3/26/24

Arches Medical Partners Acquires 11 Primary Care Practices in Rhode Island

Walgreens-owned VillageMD sells its 11 primary care clinics in Rhode Island to Arches Medical Partners, which owns IPA-focused software company New Era Medical Operations.

Responding to Change Healthcare, Warner Introduces Legislation to Protect Providers in the Event of Future Hacks, Requiring Minimum Cybersecurity Standards

Senator Mark Warner (D-VA) introduces the “Health Care Cybersecurity Improvement Act of 2024,” which, if passed, will enable eligible providers to receive advanced and accelerated payments in the wake of a cyberattack.

Masimo plans to spinoff consumer business

Masimo considers spinning off its consumer business, which includes consumer health and audio products, and retaining its healthcare and telehealth solutions.

Curbside Consult with Dr. Jayne 3/25/24

This weekend was targeted on catching up on some journal articles and making a continuing education plan for the next couple of months. I’ve got some new projects I’m working on that are a little bit outside my comfort zone. I know from experience that unless I make a formal plan to dig into the topics and stick to their plan, there’s a high likelihood that I’ll get pulled into firefighting projects for my clients and will never get done with the reading I feel I need.

Part of today’s effort was to read through all the articles that I’ve bookmarked in the last couple of weeks because I find them interesting, clearing them off the digital reading pile. It was a good cross section of topics and I think readers might find it interesting to see what’s on the reading list of a free-range clinical informaticist.

There were several articles from the Journal of the American Medical Informatics Association, with most of the ones I found interesting arriving in the most recent issue. The first addressed “Using artificial intelligence to promote equitable care for inpatients with language barriers and complex medical needs.” This topic resonated with me since I spent a good chunk of my training at an academic medical center in a city that served a particular refugee population that grew dramatically in the span of a few years.

The authors hypothesized that in-person interpreters are “particularly beneficial for these patients” but underused, and set out to use predictive analytics to identify the patients who should be prioritized for interpreter services. They performed semi-structured interviews with stakeholders to understand what those caring for patients thought about the idea.

I’m a big fan of qualitative research. Although one can gather a lot of information from surveys that elicit specific data points, some of the best understanding I’ve gained on complex issues has come from direct conversations with those who are involved in the issue. Stakeholder analysis is frequently overlooked when organizations are scoping large complex projects, and my feeling is that organizations neglect it at their own peril since it’s an excellent way to identify those who will support your project and those who are likely to block it. The key is having interviewers who are neutral and trusted, and making sure that people feel comfortable sharing their perspectives.

The authors conducted 49 stakeholder interviews and identified significant risks that would need to be addressed, including accuracy, privacy, and supply / demand issues. They also identified benefits including the ability to overcome clinician bias and to empower interpreters. Those are sentiments that you can’t always ascertain from a checkbox.

Another article that caught my attention also dealt with machine learning, this time looking at ethical perspectives on algorithm development for healthcare. The study also included qualitative research, interviewing 10 machine learning researchers on the topic. The participants were unanimous in identifying the ethical significance of algorithm development, which is good.

Not surprisingly, they identified areas where ethics may need to play a larger role, including around “standards related to scientific integrity, beneficence, and justice that may be higher in medicine compared to other industries engaged in ML innovation.” I haven’t read a truer sentence in some time, and it resonated with me after being at HIMSS and hearing some of the things that vendors were saying about artificial intelligence and machine learning. It’s amazing that companies still think that solving the healthcare problem can be done in the same ways that they have solved various problems in other industries. The last two decades have been littered with companies that thought that they had all the answers, but ended up exiting the healthcare space quickly.

A third article looked at whether patients who read visit notes have a higher rate of so-called “closing the loop” on recommended testing and referrals. The authors set out to look at “the relationship between patient portal registration with/without note reading and test/referral completion in primary care.”

For those of you who haven’t spent time in the primary care trenches, the primary care physician is essentially on the hook to make sure that patients complete every recommendation and referral that they are given. Even if the patient says “no” and state that they have no intention of completing a recommended action, the fact that they don’t is reflected in various clinical quality measures and also can come back around and bite the physician in the event the patient has a poor outcome.

I’ve been involved in medico-legal cases where the physician clearly recommended a test and the patient clearly refused it, but fast forward to when the patient has a preventable harm and the usual allegation is that the physician should have tried harder to get the patient to comply.

The article looked specifically at colonoscopies, which are of course recommended for early detection of colorectal cancer. They also looked at dermatology referrals for suspicious skin lesions and cardiac stress tests. They looked at whether patients who used the patient portal and who had read at least one visit note had more timely completion of the tests compared to patients who had portal accounts but didn’t read notes and compared to patients without portal access.

The authors found that compared to patients who had no portal access, those who had accounts had 20% higher chance of closing the loop on recommended tests. When patients had accounts and read at least one note, the odds were 40% higher. The authors controlled for various social, demographic, and clinical factors, but concluded that there are still gaps that must be addressed when recommendations are left incomplete. They recommend increasing efforts to promote patients accessing their notes, as well as other patient engagement strategies to ensure that patients complete recommended diagnostic and preventive steps.

Having done a fair amount of work in the space, the latter is certainly a lofty goal. There are so many reasons that patients may not complete recommended testing. These include but are not limited to: perception of the importance of the test; insurance coverage for and/or the cost of the test; time needed to be off of work or to secure childcare; understanding of the preparation needed for the test; difficulties in scheduling; and transportation issues. The list goes on and on.

I’ve worked on campaigns to address the issue through patient portal messages, texting with chatbots, integrated voice response systems, old-school 1:1 phone calls, postcards, letters, community outreach, health fairs, and more. Each little bit drives the needle, but there is still much work to be done.

I still have a stack of articles to read, but I felt like I at least made a little progress today. What’s on your list for continuing education topics? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: The Countdown Begins: When Will Your Health System Say Goodbye to Traditional Faxing?

The Countdown Begins: When Will Your Health System Say Goodbye to Traditional Faxing?
By Tim Hoskins

Tim Hoskins is VP of solution architecture at Vyne Medical of Dunwoody, GA.

For 145 years, copper wire has been essential in facilitating communication across America, providing seamless nationwide connectivity through the telephone network. However, in 2019, the Federal Communications Commission (FCC) prompted the modernization of this infrastructure by discontinuing the mandate for local phone companies to maintain copper wire services and lifting price cap requirements for customers.

This policy shift led to significant changes in America’s communication networks, forcing the transition of traditional plain old telephone services (POTS) to more advanced systems. Despite this change, some essential services and organizations — including healthcare providers and payers — still use on-premise fax systems. These traditional systems are reliant on the aging and soon-to-be-obsolete copper wire infrastructure. 

To continue providing exceptional patient care, hospitals and health systems that still use traditional fax need to revamp operations and replace their outdated systems. Without this essential update, they risk the inability to efficiently exchange crucial patient information, including referrals, prior authorizations, lab results, and prescription orders.

In cities nationwide, the transition away from copper wire has already begun, and given the substantial costs associated with upkeeping and repairing copper wires, it is welcomed by many. “The copper infrastructure is old, expensive to repair and maintain, and can’t support high-speed Internet connections,” shared Fraida Fund, a research assistant professor at NYU Tandon’s Department of Electrical and Computer Engineering. “Fiber is technically a much better medium for communications; you can transfer data faster over fiber than over copper.”

During severe storms or unexpected line outages, many hospitals and health systems have already experienced the dilemma of not being able to rely on their system’s traditional phone and fax systems, presenting a significant communication challenge for both providers and patients. In 2012, Hurricane Sandy damaged copper lines across New York City, and instead of repairing the lines, fiber optics were installed in their place.

“We lost dial tone on my fax line, so I couldn’t receive or send any faxes. Imagine my patients waiting for their CAT scans, X-rays, their reports of blood, all different kinds of things,” explained Ida Messana, MD, a Queens internist who specializes in geriatric medicine.

Despite its high costs and inconsistent reliability, traditional faxing remains prevalent in healthcare systems nationwide. In 2023, it was estimated that:

• 75% of healthcare still depends on fax.
• 47% of small hospitals and 43% of rural hospitals are most likely to mail or fax medical records.
• On average, a 500-bed hospital loses more than $4 million due to communication deficiencies.

“The problem is abandoning customers in rural areas and small towns who have few if any, choices for broadband,” explained Matt Larsen, CEO of Vistabeam.

As rural health systems navigate this transition, these organizations must advocate for their staff and patients by proactively seeking out replacement solutions to overcome the unique challenges they may encounter.

Cloud fax technology provides a convenient digital faxing solution, removing the need for traditional copper wire transmission within health systems. Beyond resolving the reliance on copper wires, cloud fax brings a host of benefits that can optimize operations and enhance patient care.

When selecting the ideal cloud fax vendor, it’s important to acknowledge that not all vendors are equal. While many provide digital faxing services, the benefits they offer vary greatly. Innovative companies that are eager to collaborate and integrate with an organization’s existing technology can not only address the copper wire dilemma, but also generate time and money savings with a healthcare-centric solution that can provide:

• Outbound faxing for the EMR system.
• Real-time and encrypted exchange networks.
• Remote access capability.

As communication methods evolve, both rural and urban health system technology must adapt accordingly. With solutions available that enable seamless bidirectional cloud faxing, the reliance on copper wire for essential operations can be eliminated. Additionally, the need for printing and scanning is minimized, empowering teams to efficiently manage large volumes of sensitive and urgent communications.

The transformative power of cloud technology in healthcare management is evident in its ability to replace traditional faxing and safeguard patient care from unforeseen disruptions. When one medical center that uses cloud fax technology experienced an incident in their server room, the patient access team feared they would lose their missed incoming faxes. However, following the repair of their server, the inbound fax orders became immediately accessible, highlighting the reliability of cloud-based systems in maintaining seamless operations despite unexpected interruptions.

“That would have been 607 patient orders lost if they weren’t in the cloud. Everything lives in the cloud. Thank you for the cloud!” shared the team’s patient access manager.

As healthcare communication continues to evolve, it’s imperative to equip teams with the right tools to maintain exceptional patient care.

Readers Write: The Vulnerability Few Anticipated

The Vulnerability Few Anticipated
By Darcy Corcoran

Darcy Corcoran, MBA is principal consultant for cybersecurity at CereCore of Nashville, TN.

This healthcare IT security organization takes their job seriously. They secure perimeters, restrict IP addresses from their network (even for IPs that falsify their country of origin), multifactor authenticate access, and protect administrative login credentials. Their access controls are mature and have proven reliable. They’ve thought of everything, right?

Then why were hired hackers able to find their way onto this organization’s network in less than four hours?

It started with something so simple, so seemingly innocuous – and so convenient for so many – that no one even questioned it until the day they learned why they should.

Patient Advocate Olivia wants the best for patients and diligently works to do her part to create great patient experiences. That’s why when she realized that patients needed to contact several departments in the hospital to schedule appointments, ask billing questions, and find out where to park for an imaging appointment, she asked to have a link to the employee directory added to the website. Website Manager Liam added the link right away because he, too, is devoted to patients and wants to make their journey easier.

Days later, he was pleased to see site analytics that showed a few uses of the link. An easy mission accomplished.

Soon after, IT Director Mary received findings of her team’s latest cybersecurity external threat assessment, which alerted her to a publicly available website resource that showed first names, last names, departments, and phone numbers for key employees of the hospital – the employee directory. She acted quickly to have the directory restricted from the website, and network monitoring tools verified that there was no related suspicious activity to investigate.

Why did Mary take such swift action? The information in an employee directory, while convenient for some use cases, contains everything a malicious actor needs to begin a small to large-scale attack by doing any of the following:

• Contact the IT helpdesk to reset a user password or redirect the multifactor authentication to the hacker’s phone number, enabling them to reset the account password manually and gain access to the network.
• Contact the IT helpdesk, impersonating a provider to social engineer information with the aim of figuring out the helpdesk authentication techniques and procedures to better defeat the authentication processes in the future.
• Gather employee lists and emails that allow the hacker to continue to harvest credentials to engage in password spraying and brute force attacks that would assist in gaining access to a user level account or privileged user account.
• Contact a patient as though they are a facility employee in need of personal health information for an upcoming appointment.
• Contact a patient as though they are a member of the facility’s billing department in need of credit card or other information to process a payment
• Contact employees in hopes they will divulge additional seemingly innocuous but powerful information when it’s in the wrong hands, such as email format and locations.
• Gain physical access to the facility.

The people and organization in this story are fictitious, but the vulnerability depicted is a common one. Stories like these help us appreciate how cunning malicious actors can be and how little they need to know to learn more and wreak havoc. It also demonstrates how protecting the organization is difficult and getting harder, given all of the potential vulnerabilities and the numerous gaps to address. Organizations where boards and stakeholders understand, support, fund, and do their part to defend have the best chance in an environment where hackers are looking for their next opportunity.

Morning Headlines 3/25/24

Information on the Change Healthcare Cyber Response

UnitedHealth Group posts target dates for restoring Change Healthcare’s systems from its February 21 cyberattack.

Global Payments wants $3 billion for AdvancedMD—but may have to settle for half of that

Global Payments is reportedly seeking a buyer for its AdvancedMD business at an asking price of $3 billion.

Issues with VA’s new EHR have contributed to patient harms and one death, watchdog says

VA OIG issues three reports related to the VA’s implementation of Oracle Health, each of which highlight system shortcomings.

Trinity Hunt Partners Establishes Healthcare Advisory Platform with Investment in Coker

Private equity firm Trinity Hunt acquires a majority stake in Atlanta-based healthcare consulting firm Coker Group.

Monday Morning Update 3/25/24

Top News

UnitedHealth Group posts target dates for restoring Change Healthcare’s systems following its February 21 cyberattack.

UHG says that it restored its electronic payments platform on March 15 and is proceeding with payer implementations, noting that “the actual cash flow timing is dependent on payers.”

The company says that its medical claims backlog is $14 billion. It has advanced $2.5 billion to affected providers.

Reader Comments

From Aging Out: “Re: Epic. What happens when Judy is replaced?” Judy Faulkner turns 81 this year and will have served 45 years as Epic’s only CEO. The company has always assured that it has a solid succession plan, and more recently, has allowed some of its executives to get more visibility. Epic says it won’t sell out or change its ways, but her Giving Pledge says that she will donate 99% of her assets, including all of the proceeds of her Epic shares that will go to a foundation. Meanwhile, Oracle’s Larry Ellison turns 80 this year, so should he exit the company vertically or otherwise, the former Cerner business will lose its only cheerleader, and Oracle’s lackluster loyalty could take a big hit. I commend Meditech for turning the reins over to a younger and more diverse executive team years ago, to which I attribute the remarkable move from the archaic Magic to today’s state-of-the-art Expanse in making the company relevant again.

From Buoyancy: “Re: fixing healthcare. I always like to push people to name the single best first step.” I would say decouple insurance from employment. Give every American at least basic coverage and limit patient-insurer churn as people change plans every year or two based on decisions by themselves, their employer, or their insurer in the antithesis of medical continuity and health maintenance. We all want health for a lifetime, not just for the next year, and everybody’s incentive needs to be longer term.

From Badman: “Re: Healthbox. It seems to have died in the HIMSS portfolio, as did Health 2.0.” I don’t recall HIMSS saying that they shut the Healthbox innovation consulting firm and accelerator down, but its online presence is outdated, and CEO Neil Patel – a former Chartis Group employee, like Hal Wolf — moved on in May 2021. I assume it was abandoned quietly like HIMSS Accelerate, which is an online ghost town. We can’t see much detail on any of this since HIMSS still hasn’t published an IRS 990 form since the end of 2020.

HIStalk Announcements and Requests

Thanks to readers who provided feedback on HIMSS24, which I have posted.

Longtime HIMSS executive Elli Riley, who was moved to Informa Markets with the conference’s acquisition, says that HIMSS25 will be more of a “conference within a conference” that will be personalized to attendee focus. An executive of conference logistics operator Freeman says that HIMSS24 measured attendee sentiment using technology from Zenus, which uses anonymized “ethical facial analysis” and badge reading data from discreetly installed cameras to analyze attendee reaction for exhibitors and conference organizers. Other Informa-driven changes include greater use of digital signage, creating a new conference website, changing email marketing automation, and running new conference social media accounts. The article in Trade Show Executive also notes that while HIMSS creates the member-driven content part of the conference, “Informa is responsible for overseeing all content and programming development,” which makes it sound like Informa has more control over the entire conference than the initial HIMSS “partnership” announcements suggested.

Speaking of HIMSS, I noticed in Informa’s annual report that it paid $106 million in cash to acquire the HIMSS conference outright.

Most of us haven’t had a provider visit in which conversational audio was used to create documentation.

New poll to your right or here: Have you recently asked an AI tool a question about your health or medical care? Going beyond the scope of a poll question, I would appreciate hearing anonymously from anyone who has asked AI health and medical questions and received answers that changed their life significantly – maybe a new or corrected diagnosis, medication use or side effects, advisability of surgery, or a suggestion to seek medical attention that turned out to be fortunate.

Digital health vendors must be sweating that their sectors might be next up for a deep dive by the non-profit Peterson Health Technology Institute, which just concluded what we all suspected — that lifestyle-modification diabetes apps don’t deliver enough benefits to cover their cost. The organization noted in its year-ago report that digital health investments were ballooning with little proof that they improved outcomes or cost, calling for an independent authority to evaluate the value of digital health tools (note: PHTI reviews available public and private data and evidence, so it’s up to vendors to conduct studies). I checked the backgrounds of the PHTI’s key people and found little to criticize:

• Executive Director Caroline Pearson came from a research background at NORC at the University of Chicago and spent 13 years with Avalere Health in health policy consulting.
• Managing Director of Strategic Operations David Silk, MBA held marketing executive roles with two health tech companies and at Google Cloud’s healthcare and life sciences group.
• Senior Advisor for Strategic Initiatives Prabhjot Singh, MD, PhD held executive roles in provider groups and was a medical school and public affairs professor.
• Managing Director of Engagement and Outreach Meg Barron, MBA was a digital health VP for the American Medical Association.
• Assessment principal Vanessa Juth, PhD, MPH, MA was a digital strategy executive for two drug companies and was chair of CHOC’s biobehavioral oncology program.
• Senior policy advisor Mairin Mancino worked in innovation at NORC at the University of Chicago and VP of Avalere Health, with provider-side experience at Summa Health.

Listening: Boygenius, which I Shazam’ed in a store thinking sure the song I was hearing was new, hook-heavy Nada Surf. I liked it so much that I was sorry to learn that they’re hugely popular since I was hoping it was an obscure find on my part, but now I know it’s a supergroup of Phoebe Bridgers, Julien Baker, and Lucy Dacus, all in their late 20s, playing guitar-heavy, emotional indie.

Pondering: is anyone buying Apple Vision Pros? The photos that have been posted on X of people at conferences and on streets waving their arms like Bradley Cooper in “Maestro” makes me think it’s just a more expensive way to be a Glasshole, especially given the level of social anxiety among its target audience of trend-chasing nerds. Business and private use is the sweet spot, I assume.

Webinars

March 27 (Wednesday) 3 ET. “Houston Methodist: Deploying clinical AI at scale for improved outcomes.” Sponsor: Health Data Analytics Institute. Presenters: Khurram Nasir, MD, MPH, chief of cardiovascular disease prevention and wellness, Houston Methodist DeBakey Heart & Vascular Center; Brenda Campbell, RN, senior consultant, HM Health System Innovations; Nassib Chamoun, MS, founder and CEO, HDAI. The presenters  will share how an interdisciplinary team collaborated to successfully use predictive models and a novel AI-driven approach to address post-discharge mortality. They will also describe how they expanded use of the platform to reduce clinician time spent digging through the EHR with a one-page risk profile, including codes extracted from notes using generative AI, and targeting their highest risk patients for extra attention. They will speak to how they overcame barriers to bringing AI at scale to support clinicians across the care continuum.

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

Acquisitions, Funding, Business, and Stock

Fortune reports that payment processor Global Payments is seeking a buyer for its AdvancedMD business at a reported asking price of $3 billion. Global Payments acquired the company in 2018 for $700 million.

People

Industry long-timer Kevin Soltysiak, whose career included roles at Shared Medical Systems, Healthtek Solutions, and Alora Home Health Software, died March 15. He was 62.

Announcements and Implementations

Montana HHS goes live on Netsmart’s electronic visit verification.

DrFirst launches TrueRx for pharmacies, which uses AI-enabled fingerprint technology and behavior outlier detection to protect against prescriber identity and prescription fraud.

Government and Politics

VA OIG issues three reports related to the VA’s implementation of Oracle Health:

• A patient died from an overdose seven weeks after missing an appointment at the Columbus facility because of EHR scheduling errors. The report notes that a nurse practitioner did not evaluate the patient’s medication refill request and the psychologist failed to thoroughly evaluate their depression and to consider related critical clinical information. The facility did not send “patient caring communications” because a high-risk flag had been inactivated.
• The Columbus facility went live on Oracle Health despite known pharmacy-related patient safety and usability issues, such as problems with sending newly entered allergy and medication information to VA facilities that are still running VistA. The investigators note that pharmacist burnout increased due to the EHR’s operational inefficiencies.
• OIG warns that the smaller VA facilities that have gone live had problems with patient scheduling that will probably be worse in larger centers, which will require higher staffing levels and overtime pay.

Sponsor Updates

• Experity migrates 300 urgent care practice customers to RCM vendor Waystar in the wake of the Change Healthcare cyberattack.
• Wolters Kluwer Health publishes a new book, “A Practical Guide for Nurse Practitioner Faculty Using Simulation in Competency-based Education.”
• AdvancedMD renews its partnership with data automation platform vendor FrontRunnerHC.
• Availity partners with Zelis to streamline the end-to-end process between providers and payers, from administrative workflows through payments.
• Nordic releases a new Designing for Health Podcast, “Interview with Joyce Lee, MD.”
• Consulting Magazine awards Pivot Point Consulting founder and President Rachel Marano its Leaders in Technology award in the Excellence in Leadership category.
• RxLightning now enables prescribers and their care teams the ability to enroll patients in Free-Drug and Patient Assistance Programs managed by KnippeRx.
• Sectra publishes a new whitepaper, “True SaaS or a cloudy promise?”

Blog Posts

• Social Work Month 2024: How AI-powered speech recognition can boost social worker productivity (Nuance)
• AI in Revenue Cycle Management: Three Key Areas Where Healthcare Organizations are Prioritizing AI Integration (Nym)
• How Technology Supports Value-Based Care in Home and Community-based Services (Netsmart)
• Beyond medicine: Envisioning healthcare’s role in fostering community and connection (Nordic)
• Finding Value and AI at HIMSS 2024 (Optimum Healthcare IT)
• 10 must-know perspectives on digital transformation for healthcare IT leaders (Redox)
• Interoperability insights from Digital Health Rewired 2024 (Rhapsody)
• Achieving the right balance of human interaction and technology at your hospital contact center (Spok)
• ViVE 2024: Navigating Healthcare’s Complexities through Collaboration & Innovation (Symplr)

Contacts

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

HIMSS24 Comments

Responses were evenly split between vendor and non-vendor attendees. The average rating of HIMSS24 was 3.4 on a five-star scale.

What did you like best?

• Felt less crowded in a good way. Some education sessions were solid. Good networking with peers from other health systems.
• I didn’t see many double decker booths, which is perhaps a reflection of current fiscal climate.
• HIMSS tried to copy the Hosted Buyer format, but in a very limited way.
• Opening reception was too loud and there was no awards reception / banquet this year.
• Seeing and talking with current customers. That’s hands down the best part of HIMSS. The next best part was the puppy area.
• Always look for the first time exhibitors and visit their booths, to learn about their product offerings, and discern their rationale for paying the exorbitant fee for tiny space, travel, and lodging. Did they feel it provided ROI?
• Volunteered (did not take the gratuity) for focus groups to listen to vendor thoughts and attempts to discern the future. And to hopefully help them to understand my world, and that of my patients.
• The pre-conference workshops were well done and the new best part of my week.
• There seemed to be fewer attendees, which from an attendee standpoint, was good for me. Hotel rooms were more accessible — I heard people were able to book rooms only a few weeks before the conference.
• Better educational sessions.
• Loved the entrance to the floor with the tunnel and many photo ops. Need a photo booth where people or groups could take their photo and post on Instagram etc. The floor was beautiful, unlike Chicago, which had uncarpeted floors in the walkway, which was painful on feet and dirty feeling. It would be nice if there were a HIMSS person taking group photos or a standalone photo. Social media has improved. I liked how people had templates on their LinkedIn that they were going, but I never received instructions on how to do this.
• Better exhibit hall energy than last few conferences.
• The mobile app was helpful in sending reminders for appointments and announcements. Wayfinding also very helpful on the app.
• I really enjoyed the variety of speakers that were on the agenda. I also felt that the venue was better than Chicago, as there were more food options at the convention center, although the prices were outrageous. I also liked the private meeting areas that were available. It’s difficult to hold a meeting when there is so much noise and conversations taking place.
• Having carpet was a big improvement.
• Facilities and amenities. They’re feeling competitive pressure from HLTH and ViVE and it shows in their ice cream socials, puppy parks, and “fun” events.
• I like that the event has shrunken a little – it’s less overwhelming than it was in past years. Lots of food options in the exhibit hall, although expensive.
• I liked that there was a main stage on the exhibit floor like ViVE so people with booth meetings can go between them and educational sessions more readily. It’s also nice to see more clinical /burnout or hot issues addressed rounding out all the AI, cyber, and cloud topics.
• Great energy in the exhibit hall. Traffic was consistent right until Thursday afternoon, which is a first in my experience.
• It seemed smaller, so there were chairs available in sessions. Some years, rooms were so packed there were no seats. It was possible to get through the crowd without literally knocking into people.
• There seemed to maybe be more tracks this year, so the variety of sessions was good.
• Orlando is a better location as well than Chicago as you can walk more easily to and from hotels in Orlando.
• I was particularly impressed by the educational opportunities this year. A bit more practical.
• The app.
• Lobby looked good. Everything else seemed like it went backwards.
• Oddly enough, the government run talks were the most entertaining to me. Well thought out and with a bit of humor.
• Haha – there was edge to edge carpet throughout the exhibit hall, unlike last HIMSS. Seriously, there was good energy in the halls, attendance and interest was up over prior years.
• Still a boat/car show, but a little more manageable this year.
• My first HIMSS since 2019. The networks and meeting opportunities still valuable. Loved the booths that had AI displays.

What would you like to see changed?

• I would love to see floor hours shortened. The last hour is painfully slow while most people are either gathered around the booths with booze, or have already left.
• Coffee, water stations, and a food court, for the love of!
• Organize the floor or use some methodology for grouping solutions together. It is total chaos. People could evaluate and see more solutions quicker and might even learn about someone new. So many small companies (ours is very large) that do not even get seen.
• The Junior Wolf pack. Avoid Hal and his pontificating pals of their accomplishments.
• Have people who know what he hell they are talking about manning the booths. This was the exception vs the rule but I ran into so many CMF’s (clueless mf’ers) standing around playing pocket pool that it boggled the mind.
• Have no talks on Friday. Poor Nick Saban, although I don’t think he cared as long as he got paid.
• The educational sessions always seem to be better in title than they actually are. Not sure how to fix that other than move the submission date closer to the conference.
• Never do in Orlando. Too long and hard on the feet.
• The quality of the presentations. There needs to be more peer review of the content, perhaps fewer sessions with better content.
• Maybe a structured vendor list by hospital size. As my facility is a rural hospital, we are not going to take on new shiny object, but rather looking to optimize what we have an improve our current operations.
• Unlike other years, the lunch at the informatics symposium was disappointing. There was no coffee or refreshments later in the day, and it was very cold inside.
• There are not enough chairs, and we need bigger rooms for presentations and on the floor. Lots of standing.
• I had trouble with the app and loading sessions. Not all sessions were in the book, which was confusing. Because of this, I missed keynotes. Also, the app’s informatics filters were missing, so I could not easily find sessions I wanted to attend or specific vendor products.
• Speakers and panel discussions. Very little diversity in people and perspectives, seems to reflect the current leadership.
• Being bombarded by the same HIMSS “influencers.”
• Healthier food options or built in like VIVE would be nice.
• Stale content in sessions – seems to be the same topics and people reshuffled.
• Never use Orlando again. Ever. Worst location possible for HIMSS or any conference for that matter.
• Is still often difficult to stay focused on a booth presentation when a neighboring booth is using their sound system to reach a larger crowd. Maybe we should offer presentation audio via Bluetooth so we can actually hear the presenter.
• The traffic in Orlando is a nightmare. Taking the buses or Uber resulted in some long delays in reaching the convention center.
• I’d like HIMSS to condense the show floor when it doesn’t sell out. The Federal Government conference area was so far off the show floor it was difficult to get to. Once they didn’t sell the west end of the show floor, they could have moved things closer together.
• Better, healthier, and faster food options.
• More relevant keynote speakers, shorter exhibition hall hours.
• Bring HIMSS into the 21st century. Better formats, better lectures.
• Conference apps and networking lack other shows. It looks like only around 1,600 people opted in for connecting / messaging, while ViVE had almost 4,800, and I assume HIMSS has significantly more attendees.
• More depth and practical applications of AI. The entire conference and showroom were focused on AI,  but there was no real meat to the conversations, mostly that it’s new, we need to take advantage of it, we should be careful, need to use it responsibly – words without meaning. As physicians, we’re used to new tools and new drugs, for example, and I think this mindset helps us to better embrace AI, even accepting what we don’t understand. Additionally, adding salt to the wound, were folks claiming their product used AI, when it was a simple calculation or formula without any ML.
• Nothing. It will be my last after 20+ years.
• More reasonable food options cost-wise. Would like to see this smaller conference consider other venues such as New Orleans or San Diego because I bet it would fit now. I hate Orlando.
• There seemed to be blatant influence (paid) by big vendors doing “educational sessions” that were complete company product promotions, roadmaps with no third party or customer involved. Oracle Health was the worst! Other agenda items had good titles, but turned out invite-only, which drastically cut down options. As a person who has worked hard for years getting speakers on the agenda, something definitely seemed way off and commercially influenced.
• The HIMSS police called us out multiple times for overspill of our very expensive booth, but the anchor vendors did not get the same treatment. Surprise!
• HIMSS has completely lost touch with the provider community.
• More time between educational sessions. All sessions should be the same duration. Maybe after the first day, every session doesn’t need the intro about handout and eval in the app.
• More free food and drinks.
• Even less people.
• I did not like the keynotes. I think we need more healthcare people – yes, we had some, like the CEO of Hackensack Meridian – but I was not interested at all in Nick Saban, and granted it was Friday (so most people left), you might have gotten more to stay if you had a big name healthcare exec speaking then— Judy Faulkner, John Halamka, etc.
• Better process for main stage. Feel like much of core content is in interop showcase and not on main stages
• I ended up in a number of panel discussions. It’s good for different viewpoints, but I’m not sure that the format appeals to all subjects. I felt that some missed the main point/topic.
• Buy sessions too far removed.
• Floor on the far ends was a train wreck.
• Attempt at being cool on social media was cringeworthy. They need to figure out their lane, stay in it, and stop copying VIVE and their other event HLTH. They did it all first — puppy park, massage, stages on floor etc. It was not a good look.
• More subspecialty educational content. We’re an imaging IT company and there’s almost no relevant content to further attract the tribe of imaging IT professionals. This contrasts to the recent past, where there were always a handful of specialty talks to draw attendees.
• Continue the idea of co-locating vendors.
• Better food options and having it in different venue city rather than Orlando, Vegas, or Chicago if possible.
• The infrastructure in Orlando is terrible. Who planned this conference during spring break? It was pretty much impossible to get anywhere or meet anyone in a timely fashion, and the service at restaurant and other locations was slow and terrible. This conference cannot be held in Orlando any more.

For those who attended both HIMSS and ViVE, how would you compare the two?

• There was definitely more enterprise and implementation focus at HIMSS vs. ViVE’s partnerships and BD flavor with startups. More IT crowd at HIMSS vs. predominantly digital and innovation / investment crowd at ViVE. However, while ViVE has started bringing in CHIME crowd into its fold, HIMSS is increasingly becoming distant to innovation community.
• I like that I don’t have to bother about finding food at ViVE.
• ViVE in LA was just awful. Nashville was better. ViVe is trying to hard be too hip and let’s just forget the CHIME attendees actually visiting the floor except to get awards.
• VIVE resembles the HIMSS of years ago, before it decided HIMSS could be everything to every industry and needed a former vendor to be the Leader of the Pack.
• More entertainment.
• ViVE will replace HIMSS in the next three years. HIMSS has lost its appeal to me, I have been attending for 13 years, I am ready for a change, and ViVE is a refreshing change.
• This year’s ViVE in LA sux.
• Both have different value. I do feel that many of the hospital CIOs did not attend HIMSS24.
• Different energy and scale. HIMSS is bigger, ViVE is more personal.
• ViVE had much better vendors.
• ViVE makes the experience better as an attendee by providing food, drinks, and entertainment. However, from a work/business perspective, HIMSS is still the better show, and it’s not particularly close. There are just more people, more buzz, more product debuts, etc. ViVE is just a party.
• ViVE is far friendlier and feels less formal than HIMSS. It’s easier to see various speakers at ViVE with many of them right on the show floor. Included food and drink is also a nice touch that gives ViVE a relaxed atmosphere. HIMSS is the button-down business conference of yesteryear while ViVE tries to market themselves more like a music festival (with mixed results).
• They way they handle meals/food is so different. ViVE: Coffee stands and food spread throughout the exhibit hall, allowing many opportunities for networking. It’s very easy to grab something to eat or drink (which is built into the conference fees). Plenty of tables/spaces to grab a seat and meet others while getting something to eat. HIMSS: Coffee is $5+ and you need to wait in line in the hallway. Food is expensive and poor quality, typically far away from the events. You need to spend a bunch of time in line, then if you’re lucky you get a table but there’s a good chance you’re sitting on the floor in a hallway.
• ViVE is significantly better.
• ViVE is better. CIOs prefer it, so the power is shifting.
• Both are expensive and do not have the patient in mind. They’re both a money grab.
• They are very different conferences. At HIMSS, you have the advantage of having IT directors and clinicians (nurses and docs) talking about projects they did which, if you are CMIO/CNIO, might really help you as you work on your day to day issues. Yes, HIMSS has the tech companies, but it’s not the only group there. Also, the government track/ area at HIMSS had excellent presentations, but it was so far away (Hall F) if you were in another session you had to race, as most of these government presentations were only 30-minute “bursts” (but really good). ViVE was good too, but it’s really more tech people, companies, innovations, less clinicians (IMO). Yes. some government folks at ViVE, but not nearly as many. I think both are good meetings, but ViVE is SO expensive (the registration fee) that many groups, including mine, won’t send people. I only went as I was a speaker and got free registration.
• ViVE is spot on for the relationships I need to foster and HIMSS is where I go to partner with vendors or meet a bigger cross section of a customers.
• ViVE has grown, audience has evolved, and is for C-suite looking to make a difference and do business. HIMSS seemed much more mid-level in terms of the attendees. Different leagues. I will send a few (very few) from my team to HIMSS next year and my leadership team to ViVE.
• ViVE had more investors, HIMSS very very few. ViVE is more of a C-suite crowd.

Comments

• I miss HIStalkapalooza. The after-hours receptions hosted by vendors were a mixed bag.
• I was particularly disappointed to see a heavily inebriated vendor CEO (a serial entrepreneur, no less) behave very badly with a former health system executive at a networking event, berating them publicly for not giving business to the company while being employed. It was such an unfortunate event to witness and unacceptable behavior by any measure. Vendors need to understand that “No” and “Not Now” are perfectly good answers in current fiscal climate and that business decisions aren’t driven by individual event attendance but rather through stakeholder consensus in matrixed organizations.
• Having two shows so close to each other and SO similar is just a waste of limited resources for vendors and providers. Do we need one, let alone two?
• CHIME and its “leadership” have completely lost their way and ruined it. They don’t realize more people are actually laughing at them vs. looking up to them for guidance. Someone said to me they are more like ET (Entertainment Tonight) vs. 60 Minutes or BBC News. John Glaser must be sad to see what they have turned it into. Parties in Russ’s rooms, lavish all expenses paid board off-sites, international travel. Can someone say 503c3? cough cough audit? My company has more oversight on expenses!
• Both events took place while the US suffered arguably its worst cyberattack that directly impacted patient care. What did both organizations do to help educate? Why, they gave away even more trophies to each other, of course. Sad, frustrating, and vendors should demand an accounting of the foolishness taking place
• Based on what I spent to attend, I no longer think it’s worth attending.
• The people pic animes at ViVE are creepy.
• Being in Vegas back to back again, I might sit out next year.
• The overall feedback I heard from other attendees was that HIMSS was still where the “real” conversations were happening and VIVE was still more about the glitz and VC, aside from the CHIME Forum. There seems to be room for both, but it would be better if they weren’t so close together.
• I generally enjoy these conferences, but this year it just didn’t feel right. I think I’m getting too old (LOL).
• Would love to attend both HIMSS and ViVE, but simply cannot afford ViVE. It is above the limits of what my company will allow.
• AI seems to have given HIMSS a new life. Lots of serious and thoughtful discussions on how to find a way forward with this new technology!
• Other than reconnecting with peers from past conferences, HIMSS continues to struggle. Education sessions are stale. It’s more of a vendor conference. After more than 15 years of attending, I’m not sure I will continue attending. And I still miss HISTALKAPALOOZA. 🙂
• When do we move back to patients at the center of innovation, not PE, AI? Meanwhile, huge orgs cannot secure patient data.
• Likely to skip HIMSS because it is in Vegas. That is a negative, I think for many people.
• Conference has outgrown Orlando.
• Whatever opinion is on business model, HIMSS delivers people that want to connect either to see what is really going on vs hype, meetings with prospects, partners, and clients. As humans, we can filter out the BS. Foot traffic and talk tracks show quickly what is real and what isn’t. The AI hype, robot demos, and VR headsets are still more concept than actual real world applications. It seems like HIMSS HIT community is finally getting data quality matters.
• I left after a day and a half. Content was average and floor was much smaller. All in all an OK event, but not what it used to be. Good luck to Informa. They will need it.

Morning Headlines 3/22/24

New Report Finds That Digital Diabetes Management Tools Fail to Deliver Meaningful Health Benefits to Patients While Increasing Spending

Digital diabetes management solutions increase healthcare spending without delivering meaningful clinical benefits, according to a review of evidence by the Peterson Health Technology Institute.

Sharp, UCSD affected by computer outage that briefly diverted ambulance deliveries

A power outage at an Epic data center in California knocks several hospitals offline for two hours, prompting them to temporarily divert ambulances.

Syllable Corporation Announces Purchase of Actium Health

Process automation vendor Syllable acquires Actium Health, whose system reviews EHR data to identify patients who may need specific medical services.

Use of Online Tracking Technologies by HIPAA Covered Entities and Business Associates

New HHS guidance reiterates that covered entities can’t use web tracking technologies that might result in PHI disclosure, but clarifies that webpages that don’t require users to log in and that don’t have access to PHI don’t fall under HIPAA’s purview even if the user can be tied to an IP address.

News 3/22/24

Top News

Digital diabetes management solutions increase healthcare spending without delivering meaningful clinical benefits, according to a review of evidence by the Peterson Health Technology Institute.

The study found that the tools facilitate small, clinically unimportant and sometimes temporary reductions in HbA1c that have little impact on overall health.

The report concludes that the solutions “increase net healthcare spending for purchasers because the small, estimated savings are less than the cost of the solution.”

The authors also note that the solutions require patients to record their self-management activities, which may not happen regularly.

Their advice for providers: “Because these digital health solutions complement (rather than substitute for) usual care, they represent an additional cost. Furthermore, these solutions can be labor intensive for provider practices to set-up and document for reimbursement, and effort from the provider and patient is required for implementation. As a result, providers should be cautious when considering the patient benefits weighed against the spending impact of these programs”

Click to enlarge the above graphic for a list of products in the categories reviewed.

Teladoc Health probably didn’t need this reminder that paying $18.5 billion for Livongo the fall of 2020 was unwise, especially now that the entire TDOC business is valued at just $2.5 billion.

Reader Comments

From CPAhole: “Re: disruption. What do you see as the next disruption in the delivery of health IT?” This technology CEO wasn’t optimistic about technology-goosed disruption in the rest of his email to me and neither am I. I don’t think you can disrupt technology without disrupting the delivery of health services, and I see little to suggest that the powers that be, including the elected ones, have an appetite to kill the golden goose. People leave HIMSS every year buzzed on their annual Kool-Aid top-off that technology will improve our embarrassing standing among developed nations in health, cost, and lack of insurance coverage. I could have expressed optimism about AI like most uninspired pundits, but I don’t see how whiz-bang diagnoses and point-of-care research findings help people who can’t afford treatments or even get appointments. Those of us who spend our days in the carpeted parts of healthcare are jarred by reality when we, or our family members, become patients who have to deal with the infuriating system that we created and that lines our pockets. Still, technology can make some inefficient and ineffective parts a bit better – just don’t expect technology to fuel consumer-level disruption or to power big moves of our societal health needle. I am now successfully vented like a time-expired Instant Pot, thank you, so it’s your turn to tell me what you think. What technology could disrupt or at least markedly improve health services delivery? 

From No Cap (IYKYK): “Re: the quotes sent to Existential Dreadlocks about attending conferences. They are aren’t wrong. Conferences are a boondoggle, spurred by the FOMO inertia of company brass, salespeople, and marketers who want to be at the cool kids’ party. Thinking that the next $MM deal is there for the taking.” I’m picturing a “Self-Importance Summit,” where those industry gadabouts who are known for public displays of self-affection sit in their own booths, where they interview each other for podcasts, present each other with fake awards, and “network”at a never-ending happy hour by energetically exchanging business cards like jousting medieval knights.

HIStalk Announcements and Requests

Today I learned that you can send documents to Amazon’s Kindle reader app. An author sent me a PDF proof of their book, which I wanted to read on my IPad. I Googled and found Amazon’s Send to Kindle webpage, where you can send PDF and DOC files to your Kindle library and then read them pretty much like a normal Kindle book. You can also send files directly to the Kindle app on IOS and Android, export them to Kindle from Word, or email them directly to your Kindle account’s email address (who knew that it had one?) Amazon also provides a Chrome extension that can send full webpages to a user’s Kindle library. TL;DR – you can read most kinds of documents on your Kindle app or device.

Webinars

March 27 (Wednesday) 3 ET. “Houston Methodist: Deploying clinical AI at scale for improved outcomes.” Sponsor: Health Data Analytics Institute. Presenters: Khurram Nasir, MD, MPH, chief of cardiovascular disease prevention and wellness, Houston Methodist DeBakey Heart & Vascular Center; Brenda Campbell, RN, senior consultant, HM Health System Innovations; Nassib Chamoun, MS, founder and CEO, HDAI. The presenters  will share how an interdisciplinary team collaborated to successfully use predictive models and a novel AI-driven approach to address post-discharge mortality. They will also describe how they expanded use of the platform to reduce clinician time spent digging through the EHR with a one-page risk profile, including codes extracted from notes using generative AI, and targeting their highest risk patients for extra attention. They will speak to how they overcame barriers to bringing AI at scale to support clinicians across the care continuum.

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

Acquisitions, Funding, Business, and Stock

Pocket Health raises $33 million in Series B funding. The company offers a patient-centric, subscription-based image exchange platform that explains medical terms, detects follow-up recommendations, and suggests questions that the patient should ask their doctor.

CareCloud reports Q4 results: revenue down 13%, adjusted EPS $0.30 versus $0.25, beating earnings expectations but falling short on revenue. CCLD shares have lost 63% of their value in the past 12 months versus the S&P 500’s 27% rise, valuing the company at $20 million. The company said in the earnings call that it will implement a cost savings program and will introduce an ambient listening solution for visit documentation. It took a $42 million goodwill impairment charge in Q4 as a result of suspending the payment of dividends, resulting in FY2023 loss of $49 million.

Process automation vendor Syllable acquires Actium Health, whose system reviews EHR data to identify patients who may need specific medical services.

People

Optimum Healthcare IT founders Gene Scheurer and Jason Mabry return as CEO and president, respectively, and the company promotes Brian Symonds, MBA to chief digital officer and head of digital transformation.

Announcements and Implementations

Artera adds a referral service to its Harmony platform that automates outreach, appointment management and self-scheduling, and pre-visit communications.

A study of Stanford Health Care’s use of AI to draft responses to patient message finds that clinician adoption was higher than expected and assessments of burden and burnout were improved, but EHR audit logs showed no time savings even though study participants perceived that the process was faster.

An Optum insider says that executives at its financially underperforming eastern division planned to order nurses to find old medical conditions in patient charts, whether they remained active or not, to support increased billing. The plan was for the nurse to add detail that would bring those issues back into the active problem list, and when the chart was next updated with a new visit, offshore coders would bill Medicare for the nurse-created codes without the physician’s knowledge.

Privacy and Security

A British privacy watchdog is investigating reports that at least one employee of the London Clinic tried to read the medical records of the Princess of Wales during her January stay for abdominal surgery.

New HHS guidance reiterates that covered entities can’t use web tracking technologies that might result in PHI disclosure, but clarifies that webpages that don’t require users to log in and that don’t have access to PHI don’t fall under HIPAA’s purview even if the user can be tied to an IP address.

Other

Someone used AI to generate this graphic that I saw on Linkedin. Which is most bizarre — the missing and deformed fingers, the oddly designed stethoscopes, the faceless watches, or the guy at the top who is either missing his right hand or using it to violate his female colleague?

Boston surgeons transplant a pig’s kidney into a patient. They didn’t mention how the pig is doing.

Sponsor Updates

• Wolters Kluwer Health publishes a new case study, “Cooper University Hospital of New Jersey achieves USP compliance success with Simplifi+.”
• FinThrive releases a new Healthcare Rethink Podcast, “Let’s Give Healthcare Consumers a Clean Slate!”
• Healthcare IT Leaders releases a new Leader to Leader Podcast, “Technology Planning for Future Growth.”
• InterSystems announces that, as part of the 2024 Best in KLAS Awards, its HealthShare Unified Care Record has been named the regional winner in the Shared Care Records/HIE category in Europe.
• Neuroflow releases a new podcast, “Neuroflow NLP Technology Surfaces Suicide Risk That Assessments Alone May Miss.”

Blog Posts

• Medical Billing Best Practices for Optimal Revenue in Urgent Care (Experity)
• Fixing Inefficient and Costly Prior Authorization: A Path to Modernization (FinThrive)
• How Cyber Attacks Impact Patient Trust (Fortified Health Security)
• Themes on the path to revolutionize clinical trials at SCOPE Summit 2024 (Inovalon)
• How EHRs Elevate Rural and Community Nurses (Medhost)
• Connection Fuels Interoperability at HIMSS24 (Meditech)
• Unlock New Telehealth and Remote Therapeutic Monitoring Opportunities in 2024 (Net Health)

Contacts

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

EPtalk by Dr. Jayne 3/21/24

I’ve seen several recent mentions of Vale Health, which promises to be a “national health marketplace that serves communities through trusted health system relationships and leading health and wellness solutions.” That’s certainly a mouthful.

The company was founded by former Froedtert Health executive Mike Anderes and is designed to be a consumer-facing platform. The company lists 15 founding health system members who have membership on platform advisory boards that “set guidelines for choosing quality solutions, ensure careful treatment of consumer privacy, guide our product development priorities, and create the optimal engagement experience for people they serve.”

The majority of the company’s website is still under development, with only “better sleep” having listed products. Optimal weight, healthy pregnancy, healthy skin, mental wellness, and digestive health are all listed as coming soon.

Under the sleep products page, the site promotes a phone app, smartwatch, cooling sleep blanket, and melatonin tablets. Selecting “learn more” about the products linked me out to the app’s website and Amazon for the rest of the items. The site promises to “curate the highest quality, most respected products and services to address the health needs and wellness goals of the tens of millions engaging with their providers each year.”

Given the fact that the site promotes specific branded products with sales links that clearly indicate that the company may earn a commission, this just feels icky. It reminds me of when the American Medical Association entered into an ill-fated relationship with home appliance maker Sunbeam for product promotion.

As a clinician, I’d love to see the guidelines created by the advisory boards. What led them to choose a Fitbit product as opposed to one from Garmin? What about using Nature Made melatonin versus other brands, not to mention that the use of melatonin for sleep is controversial when you read the medical literature – it’s recommended in very specific situations, which of course aren’t mentioned on the site.

If you dig deep into one of the linked pages, it says that products are chosen using product review websites, information from manufacturers, user opinion, and online research into safety certifications, etc. They “do not conduct physical assessments of the products” and apparently they also don’t post information about the relevance of the products to the current standard of care for any diagnosed condition.

I spoke to someone in the know at one of the partner organizations. They voiced concerns that it feels like the company is “the Goop of healthcare” and I don’t disagree. I’m always suspicious when organizations promote the nebulous “wellness” concept and talk about the vague “health” of a body system, which is a pretty key indicator that nothing that’s about to be presented is FDA-approved or proven in high-quality, peer-reviewed literature. It’s not surprising that when you look at the company’s board of directors, there are venture capitalists. Just one more thing that makes this feel like a money grab rather than anything else.

Speaking of money grabs, the White House is launching new efforts to address healthcare costs. A task force is being formed and will include representatives from the Justice Department, the Federal Trade Commission, and the Department of Health and Human Services. Drug and provider costs will be at the top of the list of items to address.

I’ll be interested to follow the formation of this task force and would love to see the inclusion of other types of representatives. Let’s add some patient advocates, some “average” primary care physicians struggling to keep their doors open, and while we’re at it, let’s also include real-life patients who are fighting the system daily and struggling to pay their bills. I’ve long said there’s more than enough money spent on healthcare in the US that every one of us should have high quality care at a reasonable cost. Unfortunately, a good chunk of it goes to profits and also to fraud, waste, and abuse. This is why we can’t have nice things.

The best medical article I read this week was one in JAMA Network Open that looked at the effects of tai chi versus aerobic exercise on the systolic blood pressure readings of prehypertensive patients. It summarizes a randomized clinical trial that was performed in China. Although the study was small at 342 participants, it showed that blood pressure reductions at the 12-month point were greater in the tai chi group than with group that performed aerobic exercise. A little more than half of the study participants were women, and the mean age was 49.3 years in a range of 18 to 65. The participants had to either be untreated (no western or traditional Chinese medicine treatments) or to have been off of treatment for at least two weeks. Patients were excluded if they had diabetes, coronary artery disease, chronic kidney disease, current pregnancy, or breastfeeding.

Each intervention included supervised sessions, both in person and via video, that were conducted four times per week. They involved a 10-minute warmup, 40 minutes of core training, and a 10-minute cooldown. The tai chi component included 24 standard movements of Yang-style tai chi, where the aerobic component included stair climbing, jogging, brisk walking, and cycling. The sessions were conducted between July 2019 and January 2022, which is interesting given the span across the start of the COVID-19 pandemic. Blood pressures were measured at baseline, six months, and 12 months. Researchers also looked at lipid profile, fasting glucose, kidney function, weight, body mass index, and adverse events occurring during the study, although there were no differences in the parameters between those two groups. More than 82% of participants completed the study.

I’ve been working to keep myself out of the hypertension range since having episodes of mind-blowingly high blood pressures during the COVID pandemic. It turns out that when I’m exposed to the stress of a busy emergency department or urgent care, I’ll hang out with a systolic blood pressure in the 180s. If I’m at my primary care office or any other healthcare facility, 150 isn’t unheard of. I’ve come to accept that as part of the traumatic anxiety of caring for thousands of COVID patients. At home, I’m occasionally in the prehypertension range, but that has become better in the last couple of years as I avoid salt and exercise more. I’ve never tried tai chi given the limited options where I live, but maybe I’ll have to find some online resources and see if that brings it down any further.

What’s your ideal exercise? Do you like trail running, beach walking, swimming, or something more exotic? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Gene Scheurer, CEO, Optimum Healthcare IT

Gene Scheurer is co-founder and CEO of Optimum Healthcare IT of Jacksonville, FL.

Tell me about yourself and the company.

Jason Mabry and I started Optimum Healthcare IT in 2012. I had started CSI Tech, which we sold to Recruit in 2010, so we put the band back together in 2012. We were primarily focused on EHR implementations and rode that wave. We were #1 in KLAS in multiple overall services for a couple of years. We grew the business exponentially during that time.

We spun off Clearsense in 2016. That’s a data aggregation, data platform play. I went over to Clearsense in 2018 on a full-time basis to be the CEO. I promoted Jason Mabry and then Jason Jarrett into the CEO role at Optimum. I’ve been at Clearsense since. We signed some of the largest healthcare systems in the country as a data platform company. UPMC is a client and investor, Cleveland Clinic, Trinity, CommonSpirit, et cetera. We grew that business and started getting into the payer market as well.

As we made the transition to more of a product company and going into the payer market, I came to the realization that that isn’t really my strength. I went to the board nine months ago and told them that it was time for me to pass the baton and for them to find a CEO who has a product and technical background and payer experience.  We did that in January of this year and now I’m back at Optimum as CEO on a full -time basis. I was always executive chairman at Optimum, so I had kept close to the business.

In 2020, we sold a majority interest to Achieve, which is an educational fund out of New York. We weren’t necessarily looking to sell, but their business model is to tap into their network of university partners. We created CareerPath, where we take kids out of college or with one or two years of operational experience and put them through a six-week healthcare IT curriculum and certification that is operated by CHIME and is exclusive to Optimum. They get a healthcare IT certificate through CHIME and then we put them on a track to get certified in Epic, ServiceNow, or Workday. We also do project management and BI.

It was a good opportunity to add talent into the marketplace from a supply and demand perspective and to lower costs to our customers by offering up-and-coming resources. We can reduce those pay rates to those individuals and ultimately pass that along to our customers.

After we did that transaction in 2020, we did an acquisition of Trustpoint Solutions, which focused on cybersecurity advisory. Then we added ServiceNow and cloud migration services and earned Workday certification.

How do you deploy both experienced resources as well as those you have developed through CareerPath?

We still do Epic implementations and we have 600 employees, so we still are providing opportunities to those consultants who have been in the ecosystem and have experience for 10-plus years. The CareerPath model, with more junior resources, was an option to offer a hybrid. We can marry highly experienced team leads with junior-level resources from an analyst perspective, and they can do some mentorship. It’s a way to drive down implementation or optimization costs for our customers while creating a new talent pool for ServiceNow and Workday.

What areas do health systems need help with?

We have new clients that are doing new Epic installs and there’s a lot of Cerner to Epic migrations happening. We also have some Meditech to Cerner customers that are doing new implementations. We have opportunities for new installs, training, go-lives on new-new implementations, and optimization.

A lot of healthcare systems have financial headwinds. They have made a large investment in the EHRs of their choice. They are optimizing those to make them as efficient as possible. We are asked to do a lot of workflow redesign and revenue cycle projects.

On the ServiceNow side, we have become the only Elite partner in healthcare. They are looking more from a vertical perspective right now. Healthcare is so nuanced in terms of understanding the landscape and workflows and everything that goes into healthcare. It’s probably one of the most dynamic and involved of all the verticals that they have, so they love the fact that we are healthcare focused. We bring to bear a lot of advisory around the healthcare landscape in conjunction with the ServiceNow and Workday implementation.

Where are we in the always-swinging pendulum between healthcare outsourcing and insourcing of IT and revenue cycle?

We are seeing a lot more insourcing, as opposed to outsourcing. Those cycles always change, but within our customer base, we are seeing a lot of insourcing, coming back into the revenue cycle space. That is good for us because we can partner with our customers to help them bring in consultants to stand up those revenue cycle initiatives as they get operationalized and then get to a steady state.

Are you seeing any impact from AI?

The software partners that we’re working with – Epic, Workday, and ServiceNow – have incorporated AI into their software and technologies. Everybody is using AI to some degree, and it’s typically use case specific. It’s a lot of buzz, but as it matures, you’ll start seeing AI’s true ability to demonstrate real results. A lot of it is embedded into the software, behind the curtain in a lot of ways, and people are using it one way or another even if they don’t realize it.

AI will drive efficiencies to your customers where they are becoming reliant upon whatever technology is within their ecosystem. Companies are learning how AI can make their software products more valuable to their customers.

Going back to your comment about preferring to run a services business rather than a product business, how do the required skills and abilities differ?

The services business is more transactional in nature. It’s more volume. You can create value through a different lens on the services side, because any services business is in professional services and it’s providing human capital. You need policies, procedures, and enablement for your consultants to thrive within a given customer. They need to feel supported, so there’s a high touch, high customer service aspect to it. You’re working with human capital, so you want to make those people feel valued.

That also drives how your customers and clients view Optimum and our competitors. It’s how you handle situations when things don’t go exactly according to plan with a particular consultant, They have lives. Things happen. They have families. A particular consultant might be going through something that doesn’t allow them to perform at their best, or they have issues where they can’t be on site.

While you are dealing with employee or consultant issues, you have to offer white glove service to clients. You make sure that the client understands that we will do everything we can to backfill someone who doesn’t work out. The onus is on a professional services company to have a system in place that supports your consultant so they can do the best job. They shouldn’t have to be worried about whether their expenses are going to get paid or payroll will be on time. Then, do they have a support system and mentors internally?

In comparison, on the software side, you are selling a multi-year, enterprise-wide data platform product. That sales cycle can take eight to 12 months. It’s very much a consensus-driven sale because you are touching multiple stakeholders within the healthcare system. You need to get the buy-in from the CIO, CFO, CMIO, and sometimes the CEO. There are multiple sales points.

The other side of it is delivery. Once you sell the deal, the difference is on the delivery of professional services. You are reliant on the human capital and their knowledge base.

On the technology or SaaS data platform side, you are reliant on the technology. That incorporates a wholly different set of challenges and people that you are working with. I’m not technical even though I started the business. I still have a great team over at Clearsense. When technical issues hit my desk, I don’t have an answer, and that’s a humbling experience. Whereas on the professional services side, I’ve been doing this so long that even if I don’t have all the right answers, I have a good idea of how we should overcome certain challenges within the business.

What factors will impact the company’s strategy and performance over the next few years?

Growing those emerging service lines. We have a history of great delivery on the EHR side of the house and we are proud of that. With Jason and me coming back, we are infusing a culture of celebrating our wins, us against the world, and driving the type of growth that Optimum had in the early days. We are demonstrating that through high quality work, great relationships, and accountability.

We are proud to have become an Elite ServiceNow partner in a short period of time, and we are excited about the growth of that business.

We earned Workday certified partnership late last year and we are in the infancy stage of kicking off that practice. We hired our first practice director. Workday’s presence in healthcare is similar to Epic’s back in the day, with great software. They are starting to verticalize their offerings, having specific healthcare-focused salespeople and enablement, and looking at healthcare differently than their financial services customers.

On the cloud side, we are an AWS certified partner and a Microsoft partner. We are building that capability, whether it’s moving your DR to the cloud or moving an Epic instance to the cloud. We did the first one with Baptist last year, and we’re touting that as a use case.

We will be able to cross-sell into a healthcare system with these multiple offerings, essentially becoming more of a digital transformation professional services organization than an EHR implementation company as we have historically been.

It’s important for us to make that transition and stay relevant in today’s ecosystem with the technologies that our customers are using. We want to be able to help them through the process of being successful with their implementation of those products. We need to give our message concisely, understand how each type of software impacts the other, and make ourselves a vendor of choice for our provider clients, a trusted partner, whether it’s Epic, Cerner, Workday, ServiceNow or cloud migration.