Curbside Consult with Dr. Jayne 3/4/24

A number of my physician friends still work for independent medical practices, which is a bit surprising given recent market forces that have been challenging even for the most well run of them. Now that the Change Healthcare ransomware attack is approaching the two-week point, many are concerned that they are going to be in financial straits.

The first quarter of the year can be difficult for medical practices, especially if they have a large percentage of patients that are covered by high-deductible health plans. Those patients often avoid care until they reach their deductibles, which means volumes can be down in the practice. This tends to pick up towards the end of the calendar year, when patients have met those deductibles and are trying to squeeze in visits before the new year rolls around. 

Several of my friends were chatting about the inability to send claims to insurance companies and are worried about cash flow. I asked whether their business continuity insurance policies would cover the disruption and was surprised that more than half of them didn’t know if their practices even have that kind of insurance coverage. One would think that after coming out of a pandemic that significantly disrupted practices’ ability to function, groups would have looked into that if they didn’t already have coverage. Maybe the reliance on federal pandemic funds made them think they didn’t need to worry about it, but they are now wishing they did.

For those that outsource their revenue cycle management functions, they have been surprised by the lack of communication about the situation and what the third parties are doing to try to switch to other vendors. Some are wondering how they’re going to be able to make payroll and are trying to get short term loans to cover practice expenses. I’ve heard that a couple of local banks are stepping up to help out, but it sounds like national banks are less excited to be doing so. For lack of a better description, everyone is just scrambling at this point.

My current clinical practice pays me on a per-visit basis, regardless of a patient’s ability to pay or what insurance they might or might not have. That provides me a bit of a buffer from the Change Healthcare situation, although I know that the organization I work with is nervous about the situation. They’re committed to caring for patients and have a decent financial reserve, however, and I feel reassured that I’m unlikely to be benched like I was during the pandemic.

I’m exclusively seeing patients via telehealth these days, partly due to volume demands and partly due to my computer skills. I think my employers enjoy having someone who can power through visits, understands the need to set up their own favorites and defaults, and doesn’t complain about the EHR.

Patients have grown to rely on telehealth. The fact that we don’t know for sure what will happen with telehealth reimbursement is making a lot of organizations nervous. A little more than a week ago, 200 organizations signed on to a letter that asked the US Congress to take action to ensure that virtual care payments that were modified during the pandemic remain favorable. A couple dozen of these organizations were health systems, but among the rest were professional societies, patient advocacy organizations, virtual care companies, and tech giants such as Amazon. Big names signing on included Ascension, Intermountain Health, Johns Hopkins Medicine, Mass General Brigham, Michigan Medicine, Trinity Health, and UPMC.

The signers encourage Congress to take action now so that patients and care delivery organizations can plan and budget, rather than leaving them hanging until the eleventh hour as Congress tends to do. Organizations can be confident when they make investments in virtual and hybrid care models, which will be essential in managing workforce challenges. They also note the need for employers to be able to plan ahead for their health plan offerings for the coming year, which they can’t do if decisions aren’t made well before the traditional open enrollment periods that most employers have in November. Additional points made in the letter include:

• Patients have come to rely on telehealth, and ending payments will be detrimental to established care relationships.
• Safety net organizations have used telehealth to extend care, including community health centers and rural health clinics.
• Continued provision of mental health services via virtual care is essential.

I’m now in my seventh year as a practicing telehealth clinician, which is hard to believe when you think about it like that. It’s a skill that physicians of my training generation certainly weren’t trained to do, but we adapted quickly to it when our organizations decided to roll out programs. Those of us who were already seasoned definitely had an easier time during the pandemic. I was fortunate to be able to use a mature platform that hadn’t been cobbled together with Zoom, duct tape, and leftover Cat 5 cable.

I still chafe having to wear a white coat to perform telehealth visits, as required by my organization, but the annoyance of the scratchy polyester is outweighed by the fact that patients genuinely appreciate the flexibility of care even when I’m just providing advice and not sending out prescriptions.

I can’t think of any physicians I know who still perform house calls, but in many ways telehealth visits have become the house calls of the future. Especially when you can add technology like connected blood pressure cuffs, scales, and imaging devices, it goes along way towards what you could say was almost like being there. Now we just need to break down the payment barriers, and while we’re at it, I’d love to see our federal government find a way to break down the patchwork licensing restrictions in the US that keep me from seeing patients who live a couple dozen miles away from me but who are figuratively in a different world as far as me being able to care for them. My standard of care isn’t going to be different just because of where the patients live, but state medical boards sure try to convince people that it’s a real risk. It’s time for licensure reciprocity or a federal license.

I’m realistic enough to know that probably won’t happen before I retire, but a girl can dream.

What are the biggest priorities that our legislators should be tackling where healthcare is concerned? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 3/4/24

Change Healthcare cyberattack outage could persist for weeks, UnitedHealth Group executive suggests

Change Healthcare executives hint that the company’s ransomware-crippled data exchange systems could remain down for weeks, as the financial and operational impact on provides ripples throughout the industry.

WebMD Health Corp. Acquires Healthwise, Incorporated’s Operating Assets, Building on Leadership in Member and Patient Engagement Solutions

WebMD acquires the assets of Healthwise, the non-profit provider of patient educational resources.

State is taking an ‘important step’ for planned EHR, as key lawmaker moves to speed it up

The State Department’s Bureau of Medical Services is, after a 10-year delay, finally working towards digitizing its paper-based medical record-keeping system.

Larry Ellison’s Cancer Software Startup Project Ronin Is Closing

Project Ronin – which offered oncologists and their patients a platform to plan, personalize, and manage their care journey – shuts down after running out of money due to sales challenges.

Monday Morning Update 3/4/24

Top News

Change Healthcare executives hint that the company’s ransomware-crippled data exchange systems could remain down for weeks, as the financial and operational impact on provides ripples throughout the industry.

Parent company UnitedHealth Group has announced a loan program for providers who are unable to receive payments, although some of those providers say the available funding is too low to be useful to help their high-expense, low-margin businesses that are quickly running out of cash.

The company announced Friday that it has brought an alternate e-prescribing solution online.

Meanwhile, Aledade founder and CEO Farzad Mostashari, MD, ScM observes that had Change not been acquired by UnitedHealth for $13 billion in October 2022, Change would likely have already been forced into bankruptcy by the event, which started nearly two weeks ago.

When its systems are running, Change processes 15 billion healthcare transactions each year, impacting one out of three patient records.

Reader Comments

From MrCernerPizzaDriver: “Re: Children’s Minnesota. Announced internally that they are moving from Cerner to Epic, with go-live planned for fall 2026.” Unverified.

From Where Peeps At: “Re: HIMSS conference. What attendance do you predict?” I stopped doing that years ago because the way HIMSS counts heads is not transparent. It’s like a half-empty baseball ballpark that is claimed to be a sellout by the team, which has every incentive and counting method at its disposal to make itself look more popular than butts in seats would suggest. I wandered in the vast Nevada sunbake that was the COVID-delayed HIMSS21 in a futile search for my supposed 20,000 fellow attendees.

HIStalk Announcements and Requests

Two-thirds of poll respondents say that they or their employers have been affected by downtimes at AT&T or Change Healthcare.

New poll to your right or here: Does Epic operate as a monopoly in the health system market? Cheat sheet for what constitutes a monopoly: the only available producer, high market share, high barrier to entry, and can name their price since no close substitutes exist. That’s not the same as merely dominating the market, which means that my poll question is loaded, but I’m still curious who chooses the monopoly option.

Hello to former HIStalk sponsors who understandably had to tighten their belts over the past couple of years. Spring seems to have sprung, so bring your brand out of hibernation with my Welcome Back package for Platinum-level returning sponsors, which offers special recognition, a CEO interview, and bonus months for the first year. Contact Lorre.

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

Webinars

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

Acquisitions, Funding, Business, and Stock

WebMD acquires the assets of Healthwise, the non-profit provider of patient educational resources. WebMD will move Healthwise’s offerings into its Ignite patient engagement solutions business, which will serve 50% of US hospitals post-acquisition. Healthwise will continue as a non-profit whose board will explore new ways the company can help people make better health decisions. Healthwise was formed in Boise, ID in 1975 by Don Kemper to distribute patient handbooks. Kemper, who retired in 2016, told the Idaho Statesman after the acquisition was announced, “We’re trying to look at the good work that we’ve done through the years and the recognition that the world is changing. It’s exceptional for our little independent nonprofit to last for 50 years.”

Project Ronin – which offered oncologists and their patients a platform to plan, personalize, and manage their care journey – shut down without notice on Friday, according to several former employees who said that the company ran out of money due to sales challenges. Oracle’s Larry Ellison was a co-founder and the primary financial backer of the San Mateo, CA-based company. I interviewed CEO Dave Hodgson and Chief Scientific Officer Christine Swisher, PhD last year. Ronin’s now-available 150 former employees include informaticists, data scientists, software engineers, and NLP scientists, providing a target-rich environment for companies who need their high-demand skills.

I was curious about CNBC’s headline that General Catalyst’s planned purchased of Summa Health “has Ohio community on edge,” wondering if they did a mass area survey or covered a protest march to reach the conclusion that the entire community is biting nails over the deal. It’s click bait, of course, the usually all-hat, no-cattle fake journalism in which the entire story was based on the skimpiest of sources:

• A DC-based health plan group says she’s excited to see if the change brings new approaches even though she’s not sure how it will work.
• A Tennessee-based health venture studio CEO says the idea makes people nervous, but he’s excited to see someone taking big swings.
• The article recycled quotes from elsewhere from the city’s mayor and a member of its city council, noting that 450 people have signed a petition to urge the health system to remain non-profit.
• Bottom line: 450 of the area’s 700,000 residents have signed a petition, and CNBC used 65 paragraphs to provide nothing conclusive or useful in mostly just citing old news from elsewhere.

People

Innsena promotes Britteny Matero to SVP and partner.

Optimum Healthcare IT hires Allie Messimer (Abra) as EVP of enterprise application services.

Healthcare IT Leaders hires Steven Cardenas, MBA (DMCA) as SVP of government relations. He spent 23 years in the US Air Force, retiring as colonel.

Ed Roberts, PhD, a former MIT Sloan management professor and co-founder of Meditech, died February 27. He was 88.

Privacy and Security

Lurie Children’s Hospital has been mostly offline for a month from a ransomware attack, and now the hackers who are responsible are offering to sell its data for $3.4 million. The screenshot is from cybercrime expert Alexander Leslie.

Other

Christine Meyer, MD describes how the Change Healthcare cyberattack has impacted her practice:

• They are submitting claims individually via paper and payer portals, but expect cash flow to dry up within two weeks.
• Once that happens, staff and essential services will be cut, leaving phones unanswered and referrals and refill requests unprocessed.
• Practice hours will be cut back, with same-day and walk-in appointments eliminated, sending patients to overloaded EDs.
• She says that Optum’s loan offer is $4,000 per month versus her payroll of $350,000 per month.
• A commenter notes that it’s nice for parent UnitedHealth Group that while patients will get turned away because of the Change downtime, UHG will still be collecting their insurance premiums without paying claims.

An unintended consequence of requiring hospitals to post their prices: Mount Sinai is strong-arming UnitedHealthcare for a 50% rate increase after the health system used the public transparency data to find that competitors are paid more.

Sponsor Updates

• QGenda employees serve breakfast at Children’s Healthcare of Atlanta.
• PerfectServe opens nominations for its 2024 Nurses of Note awards program.

Blog Posts

• Beyond the logo: The healthcare executive’s guide to creating genuine healthcare technology partnerships (Notable)
• Specialty Medication Technology can Empower Providers and Reduce Admin Burden (RxLightning)
• 4 common challenges for hospital contact centers in 2024 (Spok)
• Faster Meds, Enhanced Care: How One Specialty Pharmacy Makes a Difference (Surescripts)
• Valued Communication with Vendor Relationships (Symplr)
• 5 strategies to reduce future cybersecurity threats in the healthcare revenue (Waystar)

Contacts

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

Morning Headlines 3/1/24

AHA Letter to HHS on Implications of Change Healthcare Cyberattack

The American Hospital Association asks HHS for help with the Change Healthcare attack, requesting better communication and transparency from Change, help with payments that will be delayed, pausing of citations related to wait times, enforcement discretion for the lack of ability to create good faith estimates, and added flexibility in e-prescribing regulations.

Trinity Capital Inc. Provides $25 Million Growth Capital to Moxe Health

Healthcare interoperability vendor Moxe Health receives $25 million in growth capital.

Salvo Health raises $5M to expand GI Provider Enablement for Wraparound Care

Virtual gastrointestinal clinic Salvo Health raises $5 million, bringing its total raised to $15.5 million.

The Sequoia Project and HL7 Enter Strategic Collaboration to Advance FHIR Implementations Nationwide

The Sequoia Project and HL7 will collaborate to accelerate the adoption of FHIR standards in the US.

News 3/1/24

Top News

A ransomware group claims that its cyberattack against Change Healthcare yielded 8 terabytes of data from every provider that sends data to Change, including medical records, insurance records, and data from active military service members. The group quickly removed its post, raising speculation that the company might be negotiating a ransom payment.

CommonWell uses Change technology and has disabled its network as a precaution.

Meanwhile, the American Hospital Association asks HHS for help with the Change Healthcare attack, requesting better communication and transparency from Change, help with payments that will be delayed, pausing of citations related to wait times, enforcement discretion for the lack of ability to create good faith estimates, and added flexibility in e-prescribing regulations.

MGMA lists the problems its medical group members are experiencing due to the Change Healthcare disruption:

• Claims cannot be submitted.
• Prior authorization requests cannot be submitted.
• Patient eligibility can’t be checked.
• Health plan payments cannot be received.
• Prescriptions and lab orders cannot be transmitted electronically.
• Medical groups don’t carry reserves year-over-year due to tax consequences, so they are running short on working capital due to their inability to bill and be paid.

Reader Comments

From EHRMusing: “Re: Epic. I’m interested in your thoughts on this article that examines whether it’s a monopoly.” The Forbes article – which was pretty good except for spelling Judy Faulkner’s name wrong – makes these points:

• Epic holds a 36% market share of US hospitals, short of the usual monopoly definition of 50%.
• The company’s aggressive IP protections, such as non-competes and controlling who can work on a client’s Epic team, could be construed as monopolistic behavior.
• Epic increases third-party costs by limiting developer access, and controls access to its ecosystem via its new Showroom third-party marketplace.
• The nature of buying Epic gives more influence to health system CIOs and thus Epic.
• Epic pre-empts competition by announcing products before their release and by publishing a “Products You Can Replace With Epic” guide.
• Epic plays a positive role in filtering “innovation noise” from flaky startups, gives health systems a single point of contact, and has been around for 45 years with no involvement by outside investors.
• The article didn’t mention other important monopoly factors – a high barrier to entry, the ability to set prices above competitive levels, and lack of substitutes, all of which apply to Epic.
• My opinion is that the IP concerns are valid, but otherwise Epic grew because if offers a better product for the academic health systems where it enjoys a high market share. Monopolistic behavior requires intention, and I don’t think Epic intentionally stifles competition in unsavory ways. The market voluntarily accepted its offerings as superior, and if CIOs preferred Epic because of the cool factor and future job prospects, that’s not Epic’s fault.
• Most amazing to me is that the fresh-from-college kids that Epic sends to prestigious health systems earn the full attention of C-level executives who buy into Epic’s way of running health systems, which is either a tribute to Epic or a criticism of those highly paid executives who let a software vendor tell them how to run their business.

From HisTalk2Fan: “Re: Teladoc results. Any comments? Do you think the company will survive long term?” My thoughts:

• TDOC shares are down 46% since the company’s IPO in mid-2015, and even worse, are down 95% over the past three years. Share price dropped 25% on the most recent earnings report, with the company blaming macroeconomic conditions rather than its own missteps. Shares in competitor Amwell have tanked equally dramatically, suggesting that the problem is that virtual visit demand didn’t stick once the pandemic eased.
• The company has reported just one profitable quarter in 32 earnings reports.
• Everybody knows that the company wildly overpaid for Livongo in October 2020, as experienced investor Glen Tullman hypnotized Teladoc CEO Jason Gorevic – who had no CEO experience prior to Teladoc – into buying Livongo for a staggering $18.5 billion, stoking Gorevic’s ambition to become a mini-Glen level industry player in a swing (and a miss) for the fences. Teladoc announced vague plans to spend the proceeds of temporarily popular COVID virtual visits to expand beyond telehealth, which based on dramatically falling telehealth demand, might have been the right idea, but certainly the wrong execution. 
• Gorevic somehow kept his job and at least provided the overhyped healthcare startup market with a cautionary tale about irrational exuberance. Teladoc filed a $13.7 billion loss from the acquisition just two years later, and the company’s bragging about its $37 billion value has quieted down now that the whole package is worth just $2.5 billion.
• Meanwhile, last week’s earnings report showed a 46% fall in telehealth visits as Gorevic warned of a well-penetrated market and low single-digit growth for US virtual care products. He also announced plans to expand into weight management and pediatrics while characterizing its virtual care business as a “very stable asset” despite obvious evidence to the contrary.
• BetterHelp, which was about the only good news for the company in previous quarters, failed to meet expectations for revenue and margins.
• I assume the company will survive in some form, but its heyday – if it ever had one – is long past, and they are left with rounds of cost-cutting and trying to shoo away the circling vultures.

From Nomenclaturist: “Re: health system mergers. Why do you usually call them acquisitions?” A merger implies that two companies will combine to do business as a newly formed company, which is rarely the case with health systems. If Health System A and Health System B announce that they will merge and will operate under the Health System A name, then I assume that Health System A is the acquirer and the “merger of equals” characterization is to avoid making the acquired system feel inferior (which they obviously are or they wouldn’t be selling out). I also look to see which company provides the CEO and if one of the health systems will assume the liabilities of the other. 

HIStalk Announcements and Requests

I’ve been away and mostly offline for several days, and the fact that you didn’t notice is a tribute to Jenn, who happily follows my doggedly exacting but sometimes quirky writing rules so that the “product” does not vary in my absence. It was fun to enjoy HIStalk as a reader and to find nothing to second guess about the news items she chose or the way she worded them. In fact, Jenn could probably have outdone me today since I’m recovering from a bug.

This is the final call for sponsors to tell me about their HIMSS24 plans for my guide.

Some folks seem surprised that Billy Idol was good at ViVE. Not me, since I saw him years ago when House of Blues Las Vegas comped me a ticket to his show when I was scouting for HIStalkapalooza there. I figured that the spiky, sneering, nearly septuagenarian Billy hadn’t made waves in 40 years and even then in the now-defunct genre of angry Brit punk, but he put on a good show to a self-selected audience who prefer listening to music from their college-aged years.

Webinars

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

Acquisitions, Funding, Business, and Stock

The Washington Post says that since Amazon’s acquisition of One Medical — the parent company of Medicare-focused Iora Health, which operates in nine metro areas – the business now known as One Medical Seniors has shortened appointments, laid off clinicians, pushed virtual visits to reduce in-person ones, and eliminated much of Iora’s legendary personal interaction and care coordination, all under the usual corporate excuse-making as necessary to “position One Medical for long-term, sustainable success.” The report also notes that Amazon will be challenged to scale One Medical by offering Prime members a discount because of the its limited geographic coverage. The company has implemented a call center and AI chatbot triage to manage an increased number of telehealth visits. Business Insider reported a couple of weeks ago that Amazon has talked about spinning off the former Iora Health business to reduce One Medical’s projected loss of $342 million this year.

Columbus-based Redi Health, which offers digital pharma support to patients with chronic conditions, raises $14 million in Series B funding. Co-founder and CEO Luke Buchanan came from CoverMyMeds.

Healthcare interoperability vendor Moxe Health receives $25 million in growth capital. CEO Dan Wilson founded the company in 2012 after several years at Epic.

Northwell Health announces plans to acquire Nuvance Health, which would create a 28-hospital system with $18 billion in annual revenue. 

The federal government launches an antitrust investigation into UnitedHealth Group, with an apparent focus on the relationship between its insurance business and the healthcare services business of its subsidiary Optum, which is the largest employer of physicians in the US. The justice department previously challenged the company’s $13 billion acquisition of Change Healthcare in 2022, but lost. Change Healthcare’s ransomware attack that has brought US healthcare to its knees is making a good case for the feds.

Online vanity drug prescribing company Hims & Hers Health reports Q4 results: revenue up 65%, EPS $0.01 versus –$0.05, becoming on of the first digital health companies (if that’s what you call it) to show a profit. The company says that new services for weight loss, mental health, and dermatology could each deliver $100 million in revenue starting next year. The company seems excited about the launch of its compounded Hard Mints chewable version of erectile dysfunction drugs.

People

Rhapsody hires Jitin Asnaani, MBA (Health Gorilla) as chief product officer.

Beth Gall (Mantra Health) joins Rainfall Health as VP of sales.

Mark Gee (WellSky) joins Medecision as chief revenue officer.

Former Estes Park Health (CO) CIO Gary Hall, who retired in September 2023, is running for town mayor.

Announcements and Implementations

The Sequoia Project and HL7 will collaborate to accelerate the adoption of FHIR standards in the US. Their initial focus will be on:

• Scalable registration, authorization, and authentication.
• Interoperable digital identity and patient matching.
• Hybrid / intermediary exchange.
• Consent at scale.

Highmark Health will use Epic’s Payer Platform running on Google Cloud to glean insights that can be used to inform consumers of the next best actions. The company says that more than half of its 7 million members are attributed to an Epic-using provider, allowing it to close care gaps automatically.

Several health systems and vendors begin beta testing Hippocratic AI’s healthcare-built LLM, with priority areas being chronic care management, post-discharge follow-up, social determinants of health surveys, health risk assessments, and pre-operative outreach. I was amused to see that the company’s dozen unlabeled photos of healthcare professionals are almost certainly generated by AI in the “dogfooding” style, as verified by Is It AI that places the AI-generated odds at 99.27%.

Keysight announces an AI/ML network validation and optimization solution. 

Elsevier Health launches ClinicalKey AI, which provides clinicians with a personalized conversational search interface for medical literature that incorporates patient context and provides linked citations.

A study finds that 58% of the NeuroFlow users who were flagged via NLP as as having possible suicidal ideation would not have been identified otherwise.

A new KLAS report on home health technology finds that Homecare Homebase has a wide lead in market share, but Netsmart, WellSky, and ResMed have good market share among mostly smaller clients. Most often considered are Homecare Homebase, MatrixCare, and Epic.

Privacy and Security

The White House issues an executive order to protect the sensitive personal data of Americans – including personal health and genomic data — from “exploitation by countries of concern.” It focuses on commercial data brokers that can sell information to other countries, potentially raising privacy, counterintelligence, and blackmail concerns.

Other

The American Prospect describes what happened when Steward Health acquired Rockledge Regional Medical Center (FL):

• The CEO of Wuesthoff Health System, the two-hospital nonprofit that owned Rockledge, sold out to Health Management Associates, which earned his C-suite a $10.6 million golden parachute, after which the hospital was then sold to Community Health Systems and then sold again to Steward, who used money from the medical properties trust that bought Steward’s real estate. 
• Steward immediately sold the hospital’s hospice center and home health business and outsourced entire departments.
• Nurses report that the hospital runs short of medical supplies and has had medical equipment repossessed. The hospital has been sued by dozens of vendors for non-payment.
• Five of the hospital’s nine elevators have been out of service for a year.
• The company balked at paying exterminators $1 million to remove 5,000 bats from the facility whose guano backed up hospital sinks and pipes.
• Steward stopped showing up at legal proceedings after the Boston paper noted that the company was $1.4 billion in the red when founder and CEO Ralph de la Torre bought himself a $40 million yacht and the Globe exposed the flight records of the company-owned jet that showed trips to Corfu, Santorini, and Antigua.
• Despite all of its problems, the hospital passed its Joint Commission survey and earned an A grade from the Leapfrog Group. Former employees said that the only thing Steward is good at is hiding problems from inspectors.
• Negative company news hasn’t been run in Florida, leading some to predict that the chain is trying to morph into a Florida-only system as state legislators look the other way and lean on news outlets to do the same.

Sponsor Updates

• Censinet publishes its “2024 Healthcare Cybersecurity Benchmarking Study.”
• Lucem Health incorporates Ryght’s generative AI capabilities into its AI SolutionOps platform.
• Arcadia releases its next-generation data platform powered by an open lakehouse architecture.
• Odessa General Surgery Robotics (TX) adds Sunoh.ai medical AI scribe capabilities to its EClinicalWorks EHR.
• Symplr releases the results of its “State of Healthcare Supply Chain Survey.”
• HealthMark Group adds Credo Health’s PreDx record retrieval technology to its Request Manager medical records software.
• AvaSure selects Oracle Cloud to power its AI-enabled virtual care platform.
• Black Book Research’s latest analysis recognizes Netsmart as the top-performing provider in geriatric medicine EHR and practice management software.
• Net Health publishes findings from a new study, “What’s Delaying Advanced Analytics Adoption in Healthcare?”
• FinThrive releases a new episode of its Healthcare Rethink Podcast, “Take a Deep Breath … Virtual Healthcare is Here!”
• Healthcare IT Leaders CEO Ben Hilmes will chair the Kansas City Light the Night Corporate Walk in support of the Leukemia & Lymphoma Society.
• Inovalon will exhibit at Rise National March 17-19 in Nashville.
• Konza National Network publishes its 2023 Annual Impact Report.
• Medhost releases a new customer testimonial featuring Freestone Medical Center in Texas.
• Meditech announces that the Rotherham Hospital is at the forefront of patient data-sharing with the integration of GP Connect.
• MRO will exhibit at the Minnesota HFMA’s HLAMN Winter Conference March 5-6 in St. Paul.

Blog Posts

• An untapped opportunity for today’s telehealth developers: Clinical content (Wolters Kluwer Health)
• Change Healthcare (Optum) Outage FAQs (Experity)
• Medicaid Waivers by State: Findhelp and New York (Findhelp)
• Navigating the Healthcare Staffing Shortage with People-First Technology (FinThrive)
• Prioritize Your Contact Center Cybersecurity Methods (Five9)
• We Answered “The Healthcare AI Question No One Wants to Answer” (Lucem Health)
• The push and the pull: an interoperability update (Meditech)
• Extend the Reach of Your Hospital’s EHR with Clinical Communication and Collaboration (Mobile Heartbeat)
• Unlocking Specialty EHRs: Take a User-Centric Approach to Wound Care (Net Health)

Contacts

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

EPtalk by Dr. Jayne 2/29/24

Lots of folks around the virtual water cooler are talking about the ransomware attack that has brought Change Healthcare to its knees. In addition to negatively impacting financial transaction, the trickledown effects are preventing patients from getting needed medication refills at the pharmacy.

The BlackCat gang claims that they took 6 TB of data, including clinical, payment, and claims files as well as patient demographic data. This includes data on active US military personnel. Spokespeople for parent company UnitedHealth Group have stated that 90% of affected pharmacies have switched to new processes to get the prescriptions moving. You can follow along on a dedicated status page.

From Phi Beta: “Re: healthcare financial departments. Are in full battle mode with claims authorizations and eligibility all off line due to Change Healthcare / Optum cyberattack. I’m hearing Duke Medicine cannot send out any claims. The financial costs for US healthcare entities are going to be massive. No one seems to be telling that story.” Now that the outage has gone as long as it has, I think people are starting to have those conversations. The impact of this will be staggering and cause everything from tsunami-size waves to ripples through revenue cycle processes for the next year.

Several people have sent me fun and sassy pics from ViVE, which were much appreciated since I’m hanging out at home in chilly weather rather than partying it up in LA. Roving reporters indicated that the Billy Idol concert was “shockingly good.” I did get annoyed by the repeated emails from ViVE asking if I had “FOMO.” By definition, can you still have “fear of missing out” when you are actually missing out? Inquiring minds want to know.

Even though many of us in the industry have followed the VA and US Department of Defense IT projects closely due to their sheer size and visibility, the fact that I have active duty military personnel in my family makes it even more interesting to me. I was intrigued by the reports that the EHR transition had slowed down recruiting and onboarding and wanted to know exactly why. Having used both systems in the past, it didn’t make sense to me that switching from one system to the other would have made such a huge difference in workflow or click counts that it would delay entry. Additionally, there were reports that after the new system went live, twice as many recruits were disqualified. That didn’t make sense at all, unless the new system had totally different parameters than the old one.

After doing some digging, reading a lot of articles, and confirming with military personnel, I finally understand. Although the EHR is involved, it’s really not the cause. It’s the sheer volume of records that reviewers are now having to address compared to what they had before. In the legacy workflow, reviewers had access self-reported patient histories coupled with a relatively small number of medical records for each recruit. In the new system, health information exchange technology is used to pull much larger volumes of data about individuals. Although some branches of the military have refused to comment on it, an Air Force spokesperson did provide information to National Review, which confirmed that higher numbers of records are revealing more disqualifying conditions, which then need to be investigated and evaluated.

Previously, 81% of all Air Force applicants passed on their initial screening during fiscal year 2021, but after reviewers had greater access to patient data, that number dropped to 69% in 2022 and eventually to 58% in 2023. Increased access to data led to increased time needed for review, and until additional reviewers were added to help catch up, there was a lag. I’m not sure how failure to staff up in the face of a significant increase in workload can be attributed to the EHR rather than to lack of understanding of the time needed to review records coupled with poor capacity management. It’s always easier to blame the technology than it is to hold management accountable, I suppose.

A UK coroner’s classification of a young woman’s death as “preventable” has landed the EHR in trouble. The 31-year-old patient died from a pulmonary embolism after presenting the day before at the hospital. The coroner’s inquest confirmed that staff identified the diagnosis, but there were “errors and delays” in administering the correct treatment on an appropriate timeline. The hospital’s new emergency department EHR was named as a contributor, noting that it lacked clear and color-coded indicators for patients who needed urgent care, which had been present in the legacy system. Instead, the Cerner system has symbols next to patient names that had to be clicked to indicate the acuity of care rather than the acuity being immediately apparent. The coroner noted that there had been clinician complaints that went unresolved after the transition to the new system. The hospital has 56 days to respond to a demand for action. When we implement healthcare technology, we have user acceptance testing for a reason. Let this be a warning to people who don’t listen to the users or overrule their findings.

From Less-than-happy Hybrid: “Re: return to work. I feel like a ping pong ball going back and forth between the annoyances of working in the office and my Zen home office setup. In the office, my entire group was moved to a different floor that is nothing but cubes. I can’t even see if other people are here, and since none of us have actual cube assignments I don’t know where to find people if I wanted to collaborate. There are no lockers or storage cabinets. so I’m stuck hauling my stuff home at the end of every day, which isn’t an employee satisfier. There’s also a cheapo battery-powered clock on the wall whose ticking is making me crazy. It may not survive the morning. I also just heard a very distinctive sound coming from across the aisle and confirmed that some guy was brushing his teeth. At his desk. I’m so glad we’re building all this culture.” Other readers have weighed in with annoyances with remote colleagues, including attendees who are consistently doing school drop-offs or pickups during standing calls, yet will not admit that the call is scheduled at a bad time and should be moved. I’ve worked with people like that and it’s maddening since you know that they are not paying attention and are possibly placing themselves and their children at risk driving while on calls. One reader shared some photos of backgrounds they’ve seen on calls, including messy unmade beds, sinks piled high with dishes, and inappropriate artwork in the background. I use a lot of platforms and every one of them has an option to use digital backgrounds or at least blur the background, so there’s no excuse for appearing to be in an unprofessional environment even if you are indeed in the middle of one.

Email Dr. Jayne.

Morning Headlines 2/29/24

Redi Health nabs $14M for patient medication support

Medication adherence and patient engagement app startup Redi Health raises $14 million in a Series B funding round.

Ransomware gang claims they stole 6TB of Change Healthcare data

The BlackCat ransomware group says it has stolen 6 terabytes of data from Change Healthcare’s network, including product source code.

CHI RPM Transforms as VitalCare Sync, Revolutionizing Remote Patient Monitoring with Decades of Clinical Expertise

Pennsylvania-based Cognitive Healthcare International RPM rebrands to VitalCare Sync.

Healthcare AI News 2/28/24

News

Hartford HealthCare creates the Center for AI Innovation in Healthcare and launches Holistic Hospital Optimization, a startup company that will help hospitals optimize patient flow and operations.

A survey that was commissioned by Amazon Web Services finds that US healthcare employees and employers expect AI to deliver a 44% improvement in labor productivity, with potential uses in fraud detection, quality assurance, medical imaging review, and improving communication.

Highmark Health will use Epic’s Payer Platform running on Google Cloud to glean insights that can be used to inform consumers of the next best actions. The company says that more than half of its 7 million members are attributed to an Epic-using provider, allowing it to close care gaps automatically.

The VA says that 40 of the 100 AI use cases that it has identified are being used in the field.

Google CEO Sundar Pichai says that the company has taken its Gemini image generation feature offline for further testing after reports that it created offensive and biased results. Critics noted that the tool seemed exhibit liberal bias, such as creating an image of “a founding father of America” as black and Native American men.

Business

AI-powered clinical documentation tools vendor Abridge raises $150 million in a Series C funding round, valuing the six-year-old company at $850 million.

Research

Vanderbilt University Medical Center uses ChatGPT to analyze the medical literature to find existing drugs that could be repurposed for treating Alzheimer’s disease. The results were then applied to VUMC’s patient data and the All of Us Research Program to identify three drugs that may hold promise – losartan, metformin, and simvastatin.

Other

Scientists warn that while it’s possible to recreate a deceased loved one based on their emails and other writings, that could harm mental health, as it would impede the natural grieving process and create dependence on the technology to the exclusion of forming new relationships.

Another lawyer gets in trouble for using ChatGPT, as a law firm partner bills the court for $113,500 at the ChatGPT-recommended rate of $550 per hour. The judge halved the bill, saying that using ChatGPT to calculate the firm’s fee without submitting supporting detail is “utterly and unusually unpersuasive.”  

Contacts

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

Readers Write: Reframing Healthcare at Home

Reframing Healthcare at Home
By Philip Parks, MD, MPH

Philip Parks, MD, MPH is partner and senior advisor at CWH Advisors of Boston, MA.

What is in store for 2024 for healthcare at home? The organizations that will be successful will make progress rethinking healthcare and reframing both the problems we are solving and how we are solving them.

Whether we think about healthcare from the perspective of a patient, caregiver, payer, healthcare provider, or technology provider, it is undeniable that three types of healthcare experiences are here to stay:

1. Facility-based care. In-person care in facilities has an important place for the highest acuity clinical needs and when facility infrastructure is required;
2. Virtual care. Virtual care, ranging from episodic care to primary care to mental health care, may be the best and most effective way to meet patients’ needs and wants.
3. Care in the home. Virtual or in-person care (or a combination of the two) ranging from hospital home, primary care, specialty care, home health, hospice services, to in-home health evaluations for prevention and wellness.

However, the US healthcare system remains largely organized around facilities, even though the mega trends demand otherwise – aging populations with chronic conditions, adoption of technology, rising costs to support facility infrastructure, and healthcare provider staffing challenges. Therefore, many of the challenges that must be solved for moving care to the home are a work in progress. Often adoption and utilization have not been achieved to the extent needed.

While delineating care models by the site of care is practical for reimbursement and delivery of care, we are evolving to a world where patients just need care they need at the right time. The emerging concept and an example of reframing is that care can be thought of as always being on or continuous care being proactively enabled to address prevention, monitoring of treatment or care plans, navigation, and guiding the next best action for patients, caregivers, and providers.

How we accomplish this type of care in the US health system is, shall we say, a wicked hard problem that is being shaped by health and technology policies for standards information sharing (e.g., passing of TEFCA in December 2023), vertical integration (via acquisitions and/or partnerships) of providers, payers, platforms for care beyond facilities’ walls, and continued incremental innovations in care delivery models.

An often-underemphasized discipline is logistics related to healthcare in the home, especially, high acuity care in the home (or hospital-at-home) where nearly 20 types of services, supply, and staffing resources must come together on a daily basis to serve the clinical need of the patient. Factors to consider include timeliness, complexity, safety, quality, and the management and use of clinical and non-clinical data. We need more impactful partnerships between entities that bring together more integrated solutions with more value to impacting total costs of care, better use of data to directly inform evidence-based decisions and actions, and that reduce friction for patients and providers.

Five must- have tenets of a framework for healthcare services in the home should include:

1. Access. Requires making the intending action easier for patients, awareness of services, mechanism for reimbursement, efficient and cost-effective logistics, 24/7 navigation, appropriate staffing, and technology enablement support by data capture and documentation. Some examples to rethink include logistics and processes: waste disposal, reimbursement – attribution to combined service providers, technology – integration with mainstream EHRs, clinician staff that can travel, cancer care in the home, and clinically appropriate 911 diversion.
2. Engagement. A mix of human touch and empathetically designed and implemented technology; very simply, engagement is the trigger for action for human behavior. Engagement must result in activation of motivation and often is a prompt of some type that is educational, motivational, or oriented toward a desired identity of being healthy. Examples of effective marketing campaigns include making the intended action by the patient or member easier by empathetically addressing “what is in it for the patient and or caregiver”. Patient and caregiver voice is critical to getting this right.
3. Actions. These are the evidence-based behaviors by the provider and the behaviors of the patient (and caregiver) to participate in self-care or provided care. An example of options for home care is direct to consumer campaigns for colorectal cancer screening, which provide information based on the member or patient’s preferences and risk for colorectal cancer and in some cases can be done at home.
4. Adherence. Repeated behaviors related to self-care and active participation in provided care. Critical for adherence are literacy, knowledge, motivation, and ability. Making the repeated action as easy and simple as possible is critical. Examples of effective adherence strategies at home include enlisting the caregiver to reinforce self-care, using technology enabled reminders to prompt good habits, and ensuring that resupply of medications and supplies are automated when possible and medically necessary.
5. Health outcomes are a function of proactively creating access to all people and populations, proactively engaging with education and motivation that must lead to action on the part of patients. Adherence or repeatable actions result in outcomes.

Care at home may be the best site to conduct early screenings and pick up on other factors that wouldn’t necessarily happen in traditional settings. Also, with some diseases, the time period of screening and early detection may be much faster when screening can occur at home. For example, for individuals at average risk for colorectal cancer, samples can be collected in the home and mailed in for evaluation.

These tenets are the most important attributes which must be part of patient-centered design of services in the home. Obsessing over the healthcare and lived experiences of patients, caregivers, and their healthcare provider team members is paramount.

Reframing healthcare at home offers immense potential benefits related to quality of care, decreased costs and improved outcomes, elimination of silos across the continuum of care, and high satisfaction for patients, caregivers, and providers. Perhaps one of the most actionable ways for determinants of health to be identified and addressed is through continuous engagement and support to patients via care navigation, coordination, and the provision of clinical and non-clinical services in the home.

Readers Write: HTI-1: A Step Towards Demystifying AI in Healthcare

HTI-1: A Step Towards Demystifying AI in Healthcare
By Ryan Parker

Ryan Parker is a consultant and healthcare informatics graduate student. 

The integration of artificial intelligence (AI) in healthcare has been a double-edged sword, offering the potential for revolutionary advancements in patient care while simultaneously posing significant challenges related to data transparency, algorithmic bias, and the elusive nature of AI decision-making processes. The Office of the National Coordinator for Health Information Technology (ONC)’s latest regulatory effort, the Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing (HTI-1), attempts to address these challenges head on. However, the question remains: Is it enough to solve AI’s most pressing issues in healthcare?

The challenges of implementing AI in healthcare extend beyond the technical sphere, often rooted in what I call “the human problem with artificial intelligence.” This encompasses issues like incomplete or biased datasets, unconscious biases leading to unintended outcomes, and the notorious “black box” problem where the reasoning behind AI decisions remains opaque. While the HTI-1 final rule aims to tackle these issues, its scope and impact merit a closer examination.

A significant hurdle in AI implementation is the siloed nature of patient data across the US healthcare system. This fragmentation hampers the development of AI models by limiting access to comprehensive datasets necessary for training. Although HTI-1 does not directly address data silos, you can see how this final rule aligns with ONC initiatives like the Trusted Exchange Framework and Common Agreement (TEFCA), aiming to foster a more interconnected health information landscape.

The problem of algorithmic bias and unintended outcomes—referred to as the “alignment problem” —is acknowledged tangentially in HTI-1. While the rule doesn’t mandate specific measures to eradicate biases, it underscores the importance of transparency and accountability in AI development and deployment. This approach suggests a recognition of the systemic nature of biases within AI algorithms but leaves the responsibility for addressing these issues largely in the hands of developers and implementers.

Perhaps the most significant contribution of HTI-1 is its attempt to illuminate the black box of AI decision-making. By identifying 31 source attributes that must be accessible to end-users—ranging from input variables and the purpose of the intervention to external validation processes—the ONC aims to increase transparency. This initiative is crucial, as studies have shown that healthcare providers are often reluctant to trust AI systems that lack explainability, regardless of the potential benefits.

The emphasis on transparency aligns with the sentiment expressed by Christian (2020), who noted that “the most powerful models on the whole are the least intelligible,” and Ehsani (2022), who highlighted the significant risk perceived by healthcare providers when faced with unexplainable systems.

It’s important to note that HTI-1 does not create a requirement for health systems to implement any specific technology related to decision support interventions (DSIs). Instead, it sets a framework for how AI should be integrated and evaluated within certified healthcare solutions. This approach allows for flexibility and innovation but also places the onus on health systems and developers to navigate the complexities of AI integration responsibly.

As Borgstadt et al. (2022) aptly put, the implementation of machine learning algorithms supporting clinician workflow can enhance the quality of care and provider experience, ultimately leading to improved patient outcomes. However, the journey toward fully harnessing AI’s potential in healthcare is fraught with challenges that require ongoing attention, intention, and effort. At the end of the day, HTI-1 is offering a new tool to healthcare providers, the real impact of which can only be determined by themselves.

Readers Write: Transforming Nursing Education: Seizing the Opportunity for AI and Technology Advancements

Transforming Nursing Education: Seizing the Opportunity for AI and Technology Advancements
By Julie Stegman

Julie Stegman is vice president of the Health Learning and Practice business at Wolters Kluwer Health of Waltham, MA.

In the ever-evolving landscape of healthcare, the nursing profession stands at a critical juncture. The nursing shortage is a pressing concern, and nursing education faces the challenge of preparing students for the day-to-day demands of clinical practice. The intersection of these challenges presents unique opportunities for the integration of artificial intelligence (AI) and other cutting-edge technologies, like virtual reality (VR), in nursing education to usher in a new era of learning and proficiency.

Nursing students find themselves navigating a learning environment that is vastly different from their earlier educational experiences. The transition from K-12 to nursing school is marked by an overwhelming amount of reading from textbooks, a lack of hands-on clinical practice, and the pressure to perform in a high-acuity clinical setting. Consequently, a staggering 37% of nurses who are under 25 said they were planning to leave their current role in the next six months, contributing to the broader nursing shortage.

Nursing schools are grappling with a lot right now, from how to best train practice-ready graduates and fill faculty openings while also reassessing their teaching methodologies. The goal is clear: combat unsafe practices, graduate clinically confident and competent nurses, and enhance retention rates. The need for innovation in nursing education is more critical than ever.

2024 is poised to witness a paradigm shift in nursing education, driven by the integration of AI. Embedded thoughtfully, AI holds the promise of streamlining educational workflows, alleviating the burden on faculty, and enhancing the learning experience for students.

AI offers a solution to the demanding workload faced by educators. By using AI algorithms, faculty members can efficiently assess student knowledge, allowing educators to focus on refining the delivery of content, fostering critical thinking, and providing personalized guidance.

For students, AI provides access to trusted learning materials in a conversational format, making information more accessible and digestible. Educational companies, recognizing the time constraints and expectations of modern students, are early adopters of AI to engage learners and provide personalized study resources.

The convergence of the nursing shortage and the evolving landscape of education creates a unique opportunity for the integration of AI in nursing education. The transformative potential of AI, coupled with innovations like VR and multimedia, can reshape the way nurses are trained and prepared for clinical practice.

At this critical juncture, nursing schools must seize the opportunity to embrace technology and ensure the next generation of nurses is not only clinically competent, but also well equipped to navigate the complexities of modern healthcare. The integration of AI in nursing education is not merely a technological advancement; it is a crucial step towards building a resilient and proficient nursing workforce for the future.

The nursing profession is witnessing a significant exodus of younger nurses, with approximately 15% of those with fewer than 10 years of experience expected to leave the workforce in the next five years. To combat this trend, nursing schools must adapt and incorporate technology to meet the needs of the current generation of learners. Doing so will allow students to be exposed to more lifelike scenarios, helping ease the transition to patient care.

Innovations like VR and virtual simulation can offer a bridge between theoretical learning and real-life clinical practice. Traditional simulation labs often limit students due to the need to share learning experiences. VR technology, on the other hand, enables multiple students to engage in realistic training simultaneously, enhancing the quality of the learning experience.

Combined with AI, these advanced virtual tools can better prepare students for real-world clinical scenarios without risking real patient harm. A startling statistic reveals that only 9% of new graduates are considered within an acceptable range of providing safe patient care, emphasizing the urgency for better clinical preparation. Bringing together VR simulation and testing leveraging AI for personalized learning can play a pivotal role in bridging this gap. This way of teaching and learning allows nursing students to gain practical experience, ensuring they enter the workforce with the skills and confidence needed for safe and effective patient care.

Morning Headlines 2/28/24

Veradigm to Acquire ScienceIO

Veradigm will acquire healthcare AI company ScienceIO for $140 million.

Military health records system Genesis out of action ‘intermittently,’ agency says

Several Defense Health Agency hospitals in Japan and Alaska have reported intermittent MHS Genesis outages lasting for several hours on Tuesday.

Outages from cyberattack at UnitedHealth’s Change Healthcare extend to seventh day as pharmacies deploy workarounds

Change Healthcare parent company UnitedHealth Group says 90% of the nation’s pharmacies have set up electronic workarounds to handle prescription processing while they wait for Change’s systems to come back online.

Ransomware gang seeks $3.4 million after attacking children’s hospital

The Rhysida ransomware group attempts to sell data stolen from Lurie Children’s Hospital (IL) on the dark web for a total of $3.4 million.

News 2/28/24

Top News

Veradigm will acquire healthcare AI company ScienceIO for $140 million.

Additionally, Veradigm reports that it will not be able to meet Nasdaq compliance deadlines for filing annual and quarterly reports from 2022 and 2023. It expects to receive a delisting notice and to be subsequently dropped from Nasdaq trading. Veradigm’s Board of Directors has put together a stockholder rights plan as it prepares for the possibility of acquisition offers.

Webinars

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

Acquisitions, Funding, Business, and Stock

B.well Connected Health raises $40 million in a Series C funding round, bringing the consumer-focused health data aggregator’s total raised to $88 million since launching in 2015.

R1 RCM shares spike on the news that majority shareholder New Mountain Capital has offered to acquire it in a deal valued at $5.8 billion. Meanwhile, the company reports break-even Q4 earnings per share and a 7.8% increase in Q4 revenue, falling short of analyst expectations for both.

Providence Health plans to more than double its workforce in India to increase capacity for its own off-shore management operations and to expand its technology services to other hospitals. Providence seems to have gotten out of the RCM business with the sale late last year of its Acclara RCM business to R1 RCM for $675 million.

People

Former Concord Hospital CIO Aaron Wootton joins Huntzinger Management Group as chief digital officer.

Announcements and Implementations

Censinet announces GA of new Risk Register software, designed to help healthcare organizations identify cyber risk exposures in real time across the enterprise; and Connect Copilot software, which automates cybersecurity risk assessment questionnaires.

OSF HealthCare (IL) implements Curbside Health’s clinical decision support software.

VerifiNow develops PatientVerifi to help virtual healthcare providers securely and accurately confirm patient identities.

Somerset Hospital (PA) will implement Epic through its affiliation with UPMC Health. The hospital expects to go live in late 2025 or 2026.

Imprivata announces GA of its Biometric Patient Identity technology.

Government and Politics

Several Defense Health Agency hospitals in Japan and Alaska have reported intermittent MHS Genesis outages lasting for several hours on Tuesday. Military pharmacies have also been affected by the cyberattack on Change Healthcare, causing them to notify patients that prescriptions will be triaged and filled using manual procedures until the disruption is resolved.

Privacy and Security

The Health-Information Sharing and Analysis Center publishes a Threat Bulletin on the Change Healthcare cyberattack that includes details on its possible connection to recent ConnectWise ScreenConnect vulnerabilities and suggested mitigation steps. The BlackCat ransomware group has claimed responsibility for the February 21 attack.

Change Healthcare parent company UnitedHealth Group says 90% of the nation’s pharmacies have set up electronic workarounds to handle prescription processing while they wait for Change’s systems to come back online.

Sponsor Updates

• Consensus Cloud Solutions celebrates two years of being listed on the Nasdaq.
• Agfa HealthCare enterprise imaging goes live at Policlinico Umberto I in Rome.
• Altera Digital Health upgrades the Singapore Ministry of Defence’s Sunrise EHR system while also implementing Altera Opal document management software.
• Bamboo Health will exhibit at Behavioral Health Business Value March 11-13 in Miami.
• Biofourmis partners with GE HealthCare to scale and deliver innovative care-at-home solutions.
• Care.ai partners with CHIME to launch an industry advisory panel that will help to develop the Smart Hospital Maturity Model.
• Censinet announces the winners of its Cybersecurity Transparent Awards, which include HIStalk sponsors Divurgent, Ellkay, and Fortified Health Security.
• DrFirst announces that nominations are now open for its 2024 Healthiverse Heroes Award.
• AvaSure adds episodic care capabilities to its Intelligent Virtual Care Platform.

Blog Posts

• The New Year Ushers in Sweeping Changes to OPPS (AGS Health)
• Going on offense: Barriers to implementing offensive cybersecurity programs (Altera Digital Health)
• The Pre-competitive Space for Drug or Vaccine Development: What Does it Look Like Now and What Could it Look Like in the Future? (Aridhia Informatics)
• Come on Barbie, Let’s Go Party: Artera iO Hosts its Second Annual Hackathon Demo Day (Artera)
• How Predictive Editing Can Boost Revenue Cycle Performance (Availity)
• The Hospital Room of the Future: Episodic Care Powered by AvaSure’s Intelligent Virtual Care Platform (AvaSure)
• How Commitment to ROI can Improve a Health System’s Bottom Line (CereCore)
• Build a Business Case for Data Governance (Divurgent)
• With an AI-Powered EHR, Sunoh.ai, and Healow Patient Engagement, ECW is a One-Stop Solution for Small and Independent Practices (EClinicalWorks)

Contacts

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

Morning Headlines 2/27/24

B.well Connected Health Secures $40M to Power The Connected Health Ecosystem

B.well Connected Health raises $40 million in a Series C funding round, more than doubling the consumer-focused health data aggregator’s total raised since launching in 2015.

Reveleer Secures $65 Million in Financing to Drive Strategic Expansion and Enhance Product Offerings

Payer and provider data and analytics company Reveleer announces $65 million in new funding.

R1 RCM majority shareholders consider taking company private

R1 RCM shares jump on the news that majority shareholder New Mountain Capital has offered to acquire it in a deal valued at $5.8 billion.

Change Healthcare / Optum Network Connectivity and Additional Recommendations

The Health-Information Sharing and Analysis Center publishes a Threat Bulletin on the Change Healthcare cyberattack that includes details on its possible connection to recent ConnectWise ScreenConnect vulnerabilities and suggested mitigation steps.

Curbside Consult with Dr. Jayne 2/26/24

In the US, our love of technology often overtakes our trust of people’s knowledge and expertise. I encountered this on a regular basis in the urgent care setting, where patients demanded testing for conditions that were well-suited to the use of clinical decision support rules. In other countries, clinical decision support rules are accepted – and even expected – as a way of helping patients avoid unnecessary testing and healthcare costs. Some of the most useful and validated CDS rules are those around probability of strep throat, ankle fractures, and pediatric head injuries. However, testing has become a proxy for caring, and if physicians don’t order tests for patients with applicable conditions, those physicians are likely to wind up on the receiving end of low patient satisfaction scores or even hostile online reviews.

I had been thinking about this when I stumbled across a recent article in the Journal of the American Medical Informatics Association that looked at whether explainable artificial intelligence (XAI) could be used to optimize CDS. The authors looked at alerts generated in the EHR at Vanderbilt University Medical Center from January 2019 to December 2020. The goal was to develop machine learning models that could be applied to predict user behavior when those alerts surfaced. AI was used to generate both global and local explanations, and the authors compared those explanations to historical data for alert management. When suggestions were aligned with clinically correct responses, they were marked as helpful. Ultimately, they found that 9% of the alerts could have been eliminated.

In this case, the results of using XAI to generate suggestions to improve alert criteria was two-fold. The process could be used to identify improvements that might be missed or that might take too long to find in a manual review. The study also showed that using AI could improve quality through identification of situations where CDS was not accepted due to issues with workflow, training, and staffing. In digging deeper into the paper, the authors make some very important points. First, that despite the focus of federal requirements on CDS, the alerts that are live in the field have low acceptance rates (in the neighborhood of 10%), which causes so-called “alert fatigue” and makes users more likely to ignore alerts even if they’re of higher importance. Alerts are also often found in the wrong place on the care continuum – they cite the examples of a weight-loss alert firing during a resuscitation event and a cholesterol screening alert on a hospice patient.

They note that alerts are often built on limited facts – such as screening patients of a certain age who haven’t had a given test in a certain amount of time. While helpful in some situations, these need to include additional facts in order to be truly useful; for example, excluding hospice patients from cholesterol screenings. I’d personally note that expanding criteria that underlie alerts would not only make them more useful but would avoid hurtful alerts – for example, sending boilerplate mammogram reminders to patients who have had mastectomies and the like. I’ve written about this before, having personally received reminders that were not only unhelpful but led to additional work on my part to ensure that my scheduled screenings had not been lost somewhere in the registration system. There’s also the element of emotional distress when patients receive unhelpful (and possibly hurtful) care reminders. Can you imagine how the family of a hospice patient feels when they receive a cholesterol screening message? They feel like their care team has no idea what is going on and isn’t communicating with each other.

The authors also summarized previous research about how users respond to alerts, which can differ based on users’ training, experience, role, complexity of the work they’re doing, and the presence of repetitive alerts. Bringing AI into play to help process the vast trove of EHR data around alerts and user behavior should theoretically be helpful, if it can successfully create recommendations for which alerts should be targeted. The authors prescreened alerts by excluding those that fired less than 100 times, as well as those that were accepted less than 10 times during the study period. They then categorized the remaining alerts depending on whether they were accepted or not, then going further to look at features of alerts that were not accepted including patient age, diagnoses, lab results, and more before beginning the XAI magic.

Once suggestions were generated, they were evaluated against change logs that showed whether the alerts in question had been modified during the study period. They also interviewed stakeholders to understand whether proposed alert changes were helpful. The authors found that 76 of the suggestions matched (at least to some degree) changes that had already been made to the system, which is great for showing that the suggestions were valid. The stakeholder process yielded an additional 20 helpful suggestions. Together, those 96 suggestions were tied to 18 alerts; doing the math revealed that 9% could have been eliminated by incorporating the suggestions. For those interested in the specific alerts and suggestions made, they’re included in a table within the article.

In the Discussion part of the article, the authors address the idea of whether their work can be applied at other institutions. From a clinical standpoint, they address conditions and findings that are seen across the board. However, if an organization hasn’t yet built an alert around a given condition, there might not be anything to try to refine. They do note that the institution where the study was performed has a robust alert review process that has been in place for a number of years – a factor that might actually underestimate the effectiveness of the XAI approach. For institutions that aren’t looking closely at alerts, there might be many more found that could be eliminated. The institution also has strong governance of its CDS technology, which isn’t the case everywhere. The authors also note that due to the nature of the study, its impact on patient outcomes and user behavior isn’t defined.

As is with most studies, the authors conclude that more research is needed. In particular, findings need to be explored at a number of organizations or by using a multi-center setup. It would also be helpful to those responsible for maintaining CDS to have a user-friendly way to visualize the suggestions coming out of the model as they’re rendered. It will be interesting to see if the EHR vendors that already have alert management tools will embrace the idea of incorporating AI to make those tools better or whether they’ll choose to leverage AI in other more predictable ways.

Is your organization looking closely at alerts, and trying to minimize fatigue? Have users noticed a difference in their daily work? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 2/26/24

Abridge scores $150M Series C as race to save doctor’s appointment heats up

AI clinical documentation company Abridge raises $150 million in a Series C funding round.

UnitedHealth subsidiary Change Healthcare down for a fourth day following cyberattack

Change Healthcare continues efforts to recover from a cyberattack that parent company UnitedHealth Group suspects is the brainchild of a “nation-state,” according to its Thursday filing with the SEC.

Tuned Secures $3.2M Seed Extension to Scale Hearing Health Benefits for Modern Workforce

Employer-focused digital hearing health company Tuned raises $3.2 million in an investment round led by Unum Group.

Monday Morning Update 2/26/24

Top News

AI clinical documentation company Abridge raises $150 million in a Series C funding round co-led by Lightspeed Venture Partners. Lightspeed Advisor Paul Ricci is a former chairman and CEO of Nuance, one of Abridge’s biggest competitors. I interviewed Abridge founder and CEO Shivdev Rao, MD nearly one year ago.

HIStalk Announcements and Requests

A majority of readers, whether on their own dime or their employer’s, plan to attend conferences like ViVE and HIMSS for the networking opportunities. Scoring new customers and/or prospecting comes in at a close second. The results seem pretty intuitive, but Ex Epic makes a good point by reminding readers that these events offer folks being pulled back into office settings after working remotely for the last several years “a good opportunity for teambuilding and seeing coworkers in person.”

New poll to your right or here: Has the AT&T or Change Healthcare outage affected you or your organization? I’m wondering if a majority of readers felt the pinch of non-existent wireless service or have had trouble processing prescriptions, either as a patient or provider. Share your experience by leaving a comment.

ViVE kicks off today in Los Angeles, though social media chatter indicates an influx of health IT folks flew in on Saturday. I have to wonder if the Clearsense-sponsored Billy Idol concert Tuesday night will get as many people out on the dance floor as Party on the Moon did at past HIStalkapaloozas. Feel free to email me your conference observations, anecdotes, and pix so that HIStalk readers who’ve stayed at home can live vicariously through your (anonymous if you so choose) experiences.

Check out HIStalk’s Guide to ViVE.

Webinars

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

Acquisitions, Funding, Business, and Stock

DarioHealth, which offers digital solutions for the management of chronic conditions, will acquire mental health and wellness app company Twill.

Sales

• Yale New Haven Health (CT) selects Abridge’s AI clinical documentation software.

People

Mednition promotes Deena Brecher, RN to chief nursing officer.

Announcements and Implementations

Vyne Medical adds automation capabilities to its Trace clinical communication management software.

25m Health will work with Clearwater to develop custom cybersecurity and compliance programs for companies within its portfolio of startups.

CenTrak announces GA of its cloud-based Connect RTLS management software.

NorthBay Health Urgent Care (CA) will take over management of its facilities, which had been operated by primary and urgent care company Carbon Health since 2017. The clinics will transition to NorthBay’s Oracle Health EHR when they re-open March 4. Meanwhile, Carbon Health, which operates clinics in 13 states, announced a fourth round of layoffs last week.

Privacy and Security

Change Healthcare continues efforts to recover from a cyberattack that parent company UnitedHealth Group suspects is the brainchild of a “nation-state,” according to its Thursday filing with the SEC. Change, which processes 15 billion healthcare payment transactions annually and is one of the country’s largest prescription processors, says it’s taking multiple approaches to restore its systems.

Other

A coroner warns that ill-configured software likely contributed to the death of an emergency department patient, according to findings presented at the inquest of an NHS dietician who died of a pulmonary embolism in 2022. University Hospital of North Durham in England had implemented new Oracle Health software two months before Emily Harkleroad was admitted to its ED, a period of time during which clinicians complained that the new system didn’t adequately alert users to the sickest patients – a flaw the coroner believes delayed any potentially life-saving treatment Harkleroad may have received. The hospital and Oracle Health have been asked to issue a plan of remediation.

It comes to light that an unspecified IT error at an NHS hospital gave physician associates access to e-prescribing privileges that allowed them to illegally prescribe opiates and sedatives 22 times over a seven-month period.

Netsmart achieves top customer satisfaction rankings for behavioral health and post-acute care technology, according to recent Black Book Research surveys.

Sponsor Updates

• Netsmart sponsors The Battle Within’s Heroes Journey event, which helped to raise $350,000 for its cause.
• Healing Hands Ministries (TX) adds Sunoh.ai medical AI scribe capabilities to its EClinicalWorks system.
• Artera welcomes Azara Healthcare, Health IPass, Memora Health, Feedtrail, and more to the Artera Marketplace.
• Nordic releases a new Designing for Health Podcast featuring Mark Townsend, MD.
• Sectra publishes a new case study, “Paving the way with AI at innovative Dutch hospital.”

Blog Posts

• Optimizing Medical Coding with Technology: Comparing Encoders, Computer-Assisted Coding, and Autonomous Coding Solutions (Nym Health)
• Bedroom blunders: The hidden usability issues of hospital-at-home devices (Nordic)
• Optimum Healthcare IT is Headed Out West for ViVE 2024 (Optimum Healthcare IT)
• CMS Update: Texting Patient Orders in Healthcare (PerfectServe)
• Six critical data security questions you should ask every healthcare technology vendor (Redox)
• Bridging the Gap: Medical Data Standardization and Data Quality (Rhapsody)
• Leveraging a hosted solution to enhance hospital operations (Spok)
• 5 Ways Clinical Direct Messaging Can Help Close Gaps in Care (Surescripts)
• Tackling 2024’s Biggest Healthcare Operations Hurdles (Symplr)
• How digital transformation can help address clinician burnout (Wolters Kluwer Health)

Contacts

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