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Morning Headlines 10/3/24

October 2, 2024 Headlines Comments Off on Morning Headlines 10/3/24

RXNT Acquires Scalabull, Streamlining Clinical Lab and Facility Interfacing For Providers Nationwide

Ambulatory health IT vendor RXNT acquires diagnostic services interface developer Scalabull.

iCoreConnect Inc. Announces Agreement to Divest MSP Division to T20 in an Asset Sale, Expecting to Deliver Strategic and Financial Advantages for Investors

ICoreConnect sells its managed services division to The 20, an IT service management company based in Texas.

Rippl Raises $23 Million in Fresh Series A Capital to Fund Multi-State Expansion

Virtual dementia care services company Rippl announces $23 million in Series A funding.

TTUHSC gives update on patient impact following IT outage

Texas Tech Physicians and parent organization Texas Tech University Health Sciences Center deal with what appears to be the same ransomware attack that is affecting affiliate UMC Health.

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Healthcare AI News 10/2/24

October 2, 2024 Healthcare AI News Comments Off on Healthcare AI News 10/2/24

News

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Microsoft releases a major enhancement to Copilot that adds conversational capabilities, a virtual news presenter that will read headlines, webpage history recall, and the ability to answer questions about the text and images on a browser page.

FDA will hold the first meeting of its Digital Health Advisory Committee on November 20-21, which will address lifecycle considerations for AI-enabled medical devices. The session will be available via webcast with no registration required.


Business

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Claimable launches an AI-powered appeals platform to provide documentation to help patients protest health insurer medication coverage denials for 60 major treatments. The service costs $39.95 per appeal and the company submits appeals via fax and first class mail. It claims that 80% of its appeals are accepted and most cases are resolved in less than 10 days.

WellSpan Health uses Hippocratic AI to develop an AI-powered conversational agent that contacts patients by telephone to close gaps in care.

GE HealthCare closes its $51 million cash acquisition of the ultrasound AI business of Intelligent Ultrasound Group.


Research

Clinicians compare the usefulness of OpenAI’s o1-preview, which features enhanced reasoning, to ChatGPT GPT-4 for medical AI:

  • The new version can perform advanced, step by step reasoning. The effect on diagnostic accuracy has not yet been studied.
  • o1-preview is slower.
  • GPT-4 is good for patient communication and medical advice, while the new version is better at complex reasoning, genetic analysis, and research. The value of those changes for specific medical specialties has not yet been studied.
  • GPT-4 is more prone to hallucinate.
  • GPT-4 is better at human-like conversation.
  • While transparency is limited with both versions, the new version provides chain of thought for double checking.
  • GPT-4 is trained to provide information that is broad but not deep, while o1-preview applies PhD-level reasoning in physics, chemistry, and biology.

A ChatGPT review of 725 websites of clinics that promote “complementary” and “alternative” medicine finds that 97% contain false or misleading claims, including some that relate to cancer treatment.


Other

A woman is told by the ED doctor who sent her home that her face pain and drooping was not concerning gets a second (and correct) opinion from ChatGPT, which advised her to seek immediate medical attention for what was possible Bell’s palsy. She want back to the ED, where the doctor agreed with the diagnosis and started treatment immediately.

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A study of LinkedIn and Glassdoor job postings that mention AI finds that Mount Sinai Health System is #6.


Contacts

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Comments Off on Healthcare AI News 10/2/24

HIStalk Interviews Clay Ritchey, CEO, Verato

October 2, 2024 Interviews Comments Off on HIStalk Interviews Clay Ritchey, CEO, Verato

Clay Ritchey, MBA is CEO of Verato.

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Tell me about yourself and the company.

I’ve spent the last 20 years in healthcare technology. One of the things that strikes me is that over that 20 years, we as an industry have spent billions of dollars digitizing healthcare and investing in digital transformation with the promise of having liquidity of healthcare data – getting it to the right place at the right time to improve outcomes and efficiency of care — only to realize that one of the biggest blockers of the success of that investment is identity. Being able to trust who the data belongs to and knowing who is who.

I got excited about joining Verato four years ago because we think of ourselves as the identity experts who enable better care everywhere by solving this problem that we believe drives everything else in healthcare, which is knowing who is who. We provide organizations with the tools to have a single source of truth for identity that enables this complete and trusted longitudinal view of the person, that single pane of glass that allows you to take all this data in your enterprise, make sense of it, and be able to trust who it belongs to so that you can get insight from it.

What is the business case for reconciling multiple identities of patients, members, and consumers?

The business case used to be around this idea of clinical interoperability. We had clinical systems, EHRs, that weren’t able to do a very good job of resolving identities, so that you had duplicate medical records, or maybe even overlays. The harm of that was either significant increased cost of things like doing duplicate procedures that you don’t need to do, or even worse, some type of sentinel event because you charted somebody else’s information on a patient record.

But as you think about 2024 and the challenges of the modern healthcare organization, we see that the business case is even more strategic. Most of our customers work with us because they’re trying to figure out how to plot a course for growth. Healthcare is just starting to think about consumer-oriented strategies and how they think of that.

A customer told me recently that they had a strategic offsite, where they decided that it is OK to call their patients consumers. That struck me since it gives us a sense of of how healthcare has had this challenge of thinking about investing in the types of tools and technologies that would enable them to understand the complete consumer experience. Tools that help them engage the consumer better, help them change their behavior, and help them consume the right services that they need for better outcomes. That’s where we see the biggest business case.

We’re in a world in 2024 where only one in four of those in the younger generations have a primary care physician. Primary care physicians historically have navigated patients into our into providers for referrals and high-value services. The emergency room is no longer a significant referral source, as urgent care pop-ups are taking more of that market share. We see more savvy consumers who want to search the internet for options for care and self-diagnosis. In that environment, we’re seeing this need to be better than ever at engaging consumers, and to do that, you have to know who is who and you have to do a better job of connecting the dots between all the engagement that you have with your consumers at all your touch points. That allows you to curate the best experience and the best care for them.

A lot of our customers think about, if I have a goal to double my revenue in five years, what infrastructure do I need to build to do that? That’s where they turn to Verato to help them figure out how to double their volume. If they don’t know who is who, they can’t engage consumers, retain them, and acquire them in a more frictionless way.

How is consumer identity management different from just matching up multiple sets of a patient’s records on internal systems, and how is healthcare different from other industries?

We’ve learned that historically, the problem that we have with consumer data and identity is that it’s often thinner information than you have for your clinical data. What you don’t want to do is pollute your clinical match by using less trustworthy data that you’re getting from marketing or consumer sources.

What we have done at Verato to solve that problem is that we have multi-tiered matching, which allows you to have different tiers of matching based on the trust level of your source. That allows you to associate these identities at a consumer level with maybe a clinical-grade identity that you have in your census, but without impacting  the way that you think about identifying that patient in a clinical way. You get the benefit of being able to associate the consumer data with somebody who you believe it belongs to, but at the same time, it doesn’t impact the quality of that match where you really have to get it right on the clinical side. That technology has allowed us to help organizations do a better job of landing consumer information and associate that consumer engagement with the patient with whom they already have a relationship.

How well are organizations using that type of technology?

We still see the industry as laggards when it comes to embracing and investing in modern technology that solves the modern problem of identity matching and resolution. The problem is no longer just about helping manage clinical identities inside of your clinical system. 

We think about three kinds of systems. One is systems of record, such as the EHR. Others are systems of experience, such as CRM, the marketing automation platform, or patient engagement tools or platforms. The third area is systems of insight that drive clinical and consumer insights around people, so things like cloud data platforms.

When you think about those very different systems, and you think about a modern platform or set of investments that you need to make sure that you’re able to share information across those different types of use cases, that’s where we think the modern investment needs to be made in a cloud-based tool that enables you to have a single pane of glass across all of these disparate sources of data and consumers of data. That’s where we’re seeing the marketplace, where provider health systems, payers, and even state and local governments are making investments based on this complexity of not just managing data internally in clinical systems, but also across these systems of insight and systems of experience. Then meeting the demands of all the folks who want to consume and share data outside of your organization.

There’s a whole different level of innovation required to understand and manage identities across that broader, more complex ecosystem. That’s where you’re seeing organizations start thinking about this next level of investment and data management platforms such as Verato’s.

Is there an opportunity to use AI to improve that process?

We are using AI in our platform today. We believe that AI can absolutely continue to help manage identity and identity attribution. We’re using AI today, for example, to make matches that we couldn’t have made otherwise. We are learning from the humans who are stewarding matches. We’re leveraging our AI to track and understand the behavior of humans and the matches that they are making manually. We have already been able to show 25% to 30% improvement on matches that we couldn’t make without AI based on that type of smart stewardship. That’s one area where we are seeing AI to be really, really helpful.

Second, we spend a lot of time making matches that aren’t intuitive, where it’s hard to see that these two records involve the same person. We are using AI also to explain to our customers how they can count on and trust that this match really is the same person. AI is being helpful of being able to connect the dots and show the breadcrumbs to those end users so that they can trust the match. It’s kind of counterintuitive, but we’re seeing AI as a tool to help provide more trust in these complex matches that we’re making by being able to help explain it.

Lastly, we think that AI more than anything is a great opportunity for us to drive a lot of productivity inside our organization in how we use AI to write better code and document that code.

With respect to identity resolution itself and how it might actually enable AI, that’s the other area we’re excited about. As I’m talking to a lot of our customers across the healthcare continuum, everybody has a strategic initiative around AI, mostly just trying to understand what their strategy should be and how can they thoughtfully and responsibly move forward towards that strategy. 

A lot of those folks are thinking about data fidelity being the starting point, because garbage in is garbage out, especially with AI. We’re all worried about about these hallucinations, and when AI gets it wrong, they really get it wrong and cause harm.  We are seeing an opportunity for organizations to first focus on the foundational elements of how to get high data fidelity so that you can train AI on data that you trust. That comes back to this basic premise of identity resolution, knowing who is who and being able to trust that the data set is longitudinal and accurate across all the touch points of that person.

What is the interest level in applying identity management to consumer-initiated inbound communication, such as calls to a contact center or conversations with a chatbot?

One of my favorite airlines is Delta. They do an amazing job in that when I call them, they know who I am, they know my history, they know my preferences, and they have already put me into a workflow that will most likely help solve my problem. Because they know who I am, they already know that maybe I just missed a flight and I need to have one rescheduled, and they have already started working on rescheduling that. 

How can you take advantage of a modern call center to not only improve outcomes, but also to become a source of revenue for your health system? We are seeing call centers leveraging tools like Verato to not only identify those who are calling or messaging, but to connect them accurately to their record so they can already be prepared to anticipate that customer’s call and help navigate them to help them where they’re going,

That can also address gaps in care. I call in today to deal with an appointment for myself. Wouldn’t it be great if that call center agent knows that I have three children in my home and two of those children have a gap in care? Maybe they missed their annual checkup. I would be able to close those gaps in care in one call while I have them on the phone. We think these are all great opportunities for identity resolution to be incorporated into the call center workflow experience so that we can better anticipate the needs of the caller and also better anticipate the needs of the other people in that caller’s household. That helps us drive revenue and close gaps in care.

Website user tracking allows big companies and social media to target advertising based on the person’s broader identity or persona. Are there techniques or lessons learned that could be used more noble purposes?

I think yes, but we believe and understand that many consumers and patients are giving up privacy for convenience, along the lines of our policies around consent and preferences. How do we as a society do a better job of allowing consumers to give more granular consent and more granular preferences around how their data will be used, consumed, and shared? Then we can all do a better job of leveraging that information in the right way to create a better experience for them.

Second is that 85% of the US population was uniquely identified in Verato’s platform last year. Through those workflows and experiences, we see a lot of demographic information about these patients. We are continuing to look for ways to get more control to not only to our customers, but also the patient on how that information is used. We want to think about granular consent and how we can be a single source of truth and enable more control by people of how their data can be used for convenience measures, but in a way that they are comfortable with from a privacy perspective.

A hot topic is insures or health systems maintaining accurate and current provider directories, which is harder when clinicians work at multiple facilities or hold multiple roles. How are health systems using provider data management technology?

The current state is pretty sad, in the sense that we find this problem to be even more challenging than patient identity and consumer identity. The state of accuracy of provider directories, their affiliations, and their ability to have open census that’s available where they are available to see new patients hasn’t really improved in the last 10 years.

I saw that last week that 57% of patients who are consuming an inaccurate provider directory results in revenue leaving that payer or that provider into outside their network. There’s all these negative consequences that are associated with not only the patient experience, but also revenue capture and revenue leakage for payers and providers. The stakes are pretty high in getting it wrong, but we still see a scenario where there isn’t a good single source of truth for provider identities and provider information.

We are applying our expertise in patient identity resolution to this big provider problem. We are already seeing a lot of opportunity to do so, not only in a sense of being able to be a single source of provider data that sits inside of an organization, but also a lot of the 85% of the population who comes through Verato is coming through large HIEs that we have relationships with. Those HIEs often have accurate, real-time data around providers and their affiliations, where they’re practicing, and what patients they are are seeing. We are looking for ways to tap into that type of data so that we can get more real time, accurate provider data that can hopefully solve this problem that has been elusive historically.

What are the company’s priorities over the next few years?

I mentioned earlier that our mission is enable better care everywhere by solving this problem that drives everything else, which is knowing who is who. Where I see healthcare going in the next three to five years, and where we want to get there ahead of them, is along these lines of interoperability outside of our customer organizations. 

Most of our customers leverage Verato to help them do a better job of managing data as it relates to people inside their organizations so that they can deliver better services to those patients more efficiently. Where we’re starting to invest in is thinking how we can also enable those flows of data outside of the organizations as interoperability across the care continuum becomes more of a reality and more of a must-have with the requirements like 21st Century Cures, information blocking rules, and the requirements for organizations to create better experiences for patients that are having experiences across payers, life sciences, and providers. We see an opportunity for us to invest there. We are working really hard on finding ways to enable that ecosystem to do a better job of being able to share identity information across the care continuum so that consumers and patients want their information to be shared and have better tools to do so with better reliance.

One of our customers recently told me that they have a bridge that connects a children’s hospital that is not affiliated with them to their to their acute care hospital. They often have patients walking across that bridge to consume services in their hospital from the children’s hospital. Both organizations use the same EHR, but even though they are connected with their bridge, the EHRs are not connected in the same way. Even though it’s the same EHR, they can’t share records in a way that they can depend on. They worked with Verato to take that very simple use case, same EHR but in different organizations, and use Verato as the bridge to enable that interoperable connectivity. Now when that patient comes across the bridge, they already know their history, why they are there, and where the referral came from. They are already  running towards delivering services to that patient. That’s a good example of the beginning of what we see, that Verato will be a part of this bigger interoperability play across the healthcare continuum.

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Morning Headlines 10/2/24

October 1, 2024 Headlines Comments Off on Morning Headlines 10/2/24

VisiQuate Joins Forces with Accel-KKR to Propel Growth and Innovation

Private equity firm Accel KKR acquires VisiQuate, which offers revenue cycle analytics and workflow automation.

Autonomous Medical Coding Engine Nym Announces $47 Million Growth Investment Led by PSG 

Autonomous medical coding company Nym secures $47 million in new funding.

Surescripts Announces Strategic Partnership with TPG to Enhance Patient Care and Meet Evolving Healthcare Needs Nationwide

Private equity firm TPG takes a majority position in Surescripts, which hired an investment bank to search for potential buyers in April 2024.

StrataPT Secures $25MM to Help Outpatient Therapy Practices Improve Clinical Efficiency and Realize Highest Reimbursement Rates

Billing and practice management software vendor StrataPT announces $25 million in funding.

Comments Off on Morning Headlines 10/2/24

News 10/2/24

October 1, 2024 News 4 Comments

Top News

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Private equity firm Accel KKR acquires VisiQuate, which offers revenue cycle analytics and workflow automation.


Reader Comments

From Slivovitz: “Re: Particle Health versus Epic. Particle may be unhappy about Epic’s behavior, but it’s a Hail Mary to claim antitrust behavior, which is rarely  successful.” Particle will need to prove not only that Epic holds a monopoly in the payer platform market, but also that it gained it through illegal means and that consumers were harmed as result. Courts often side with the antitrust defendant company’s business justification, and Epic has a strong one in protecting patient privacy. Epic always defends itself vigorously at whatever legal cost is required, making it unlikely that they will pay Particle to settle the lawsuit. Also to Particle’s disadvantage is that the Federal Trade Commission and Department of Justice are not involved, the lawsuit was not structured as a class action, and Particle’s complaint is mostly limited to itself, which doesn’t seem to be a strong antitrust argument. These cases often take years to resolve, so I assume that Particle’s business litigation law firm is working on contingency in hopes of earning a cut of any damages that Epic pays. The lead attorney represented AliveCor in its successful patent violation case against Apple.


Webinars

October 24 (Thursday) noon ET. “Preparing for HTI-2 Compliance: What EHR and Health IT Vendors Need to Know.” Sponsor: DrFirst. Presenters: Nick Barger, PharmD, VP of product, DrFirst; Tyler Higgins, senior director of product management, DrFirst. Failure to meet ASTP’s mandatory HTI-2 certification  and compliance standards could impose financial consequences on clients. The presenters will discuss the content and timelines of this key policy update, which includes NCPDP Script upgrades, mandatory support for electronic prior authorization, and real-time prescription benefit. They will offer insight into the impact on “Base EHR” qualifications and provide practical advice on aligning development roadmaps with these changes.

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


Acquisitions, Funding, Business, and Stock

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Autonomous medical coding company Nym announces $47 million in new funding.

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Private equity firm TPG takes a majority position in Surescripts, which hired an investment bank to search for potential buyers in April 2024.

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CVS Health will lay off 2,900 employees and is reportedly considering breaking up the company’s businesses.


Sales

  • Ballad Health (TN) selects oncology treatment and care management software and consulting and professional services from Varian, which Siemens Healthineers acquired in 2021 for $16 billion.
  • Novant Health (NC) will implement data, analytics, and digital services from CitiusTech.
  • Open Mind Health will incorporate NeuroFlow’s behavioral health technology into its virtual health and wellness services.

People

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Ashley Blankette (Highmark Health) joins CAQH as chief product officer.

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Jeff Pearson, MBA, MBL (Solis Mammography) joins Catalyst Health Group as CTO.


Announcements and Implementations

United Regional Health Care (TX) rolls out Care.ai virtual nursing technology in 16 emergency department rooms.

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TidalHealth launches virtual nursing pilot programs at its Peninsula Regional and Nanticoke campuses.

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Clearway Health launches a patient management system for specialty pharmacy programs that are operated by a health system.

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My favorite big-picture healthcare analyst is Sanjula Jain, PhD, chief research officer of Trilliant Health. Her points from my March 2022 interview have aged well. Her new report highlights trends:

  • The US health economy defies the laws of economics because employers have allowed the status quo to persist, have absolved state and federal governments from underpaying for healthcare services for Medicare and Medicaid enrollees, and via EMTALA have allowed the federal government to delegate responsibility for societal ills to hospitals.
  • Value for money will be a defining trend of of the US health economy over the next decade. This is different from value-based care, which does not create value for the ultimate payer, such as the employer or federal government.
  • The physical and mental health of Americans is deteriorating and the prevalence of chronic conditions is growing, even as the US spends more than other countries with worse results with costs growing, especially with Medicare.
  • Healthcare administrative costs increased 40% to $278 billion from 2011 to 2021.
  • HHS has been experimenting with value-based care for more than a decade and has implement other efforts to constrain costs, with limited effect on reducing cost or improving quality. CMS quality  measurement burden remains high and hospital quality reporting is expensive.
  • Competition does not have a clear effect on hospital quality and negotiated rates are often lower in monopoly markets.
  • Life sciences lobbying is 4.5 times that of other industries.
  • The US pays 422% more for the same brand name prescription drugs than 33 other OECD countries.
  • Use of CPT codes for AI indicates that its highest use is in cardiac conditions.
  • Telehealth’s value as a clinical tool is limited. Patients don’t consider it a substitute for in-person care except for behavioral health, which accounts for 70% of telehealth volume.
  • The shortage of primary care physicians could reach 40,000 by 2036.
  • The average American doesn’t understand or use transparency efforts, which have had little impact on outpatient spending.
  • Retailers have learned that delivering primary care is hard and running a specialty pharmacy is profitable.

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A new KLAS report on population health management finds that health system interest has cooled considerably in recent years as they consolidate vendors and focus on value-based care. Arcadia is the most-considered solution. Systems from Lightbeam, Arcadia, Oracle Health, and HealthEC are most often being considered for replacement.


Government and Politics

The DoD’s Defense Health Agency is developing care delivery technology that will connect data and combat environments to MHS Genesis sometime next year, according to EHR optimization updates from the DHA.

The VA Inspector General and federal law enforcement are investigating at least 12 VA employees who violated HIPAA when they snooped into the medical files of veterans and vice-presidential nominees Senator JD Vance (R-OH) and Governor Tim Walz (D-MN) this past summer. Investigators are trying to determine if the records were shared and why the employees accessed the files. VA OIG found that the records are relatively easy to view because the system is set up to give quick access to doctors.


Privacy and Security

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UMC Health (TX) continues to divert patients and utilize downtime procedures as it works to restore systems impacted by a ransomware attack that began last Thursday.


Other

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Epic CEO Judy Faulkner, who at 81 says she isn’t planning to retire, tells Forbes how Epic will be run without her:

  • Epic will remain private and her nearly 50% share of the company — along with all of Epic’s voting shares — will be moved to a trust that is run by her husband, three children, and five senior Epic managers.
  • The rules of the trust prohibit an IPO, sale, or acquisition.
  • Three long-time Epic customers will serve as trust protectors to make sure that the rules are followed.
  • The next CEO will be required to be a long-term Epic employee who has software developer experience.

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Oracle Health EVP Seema Verma disputes KLAS’s numbers on the company’s loss of customers to Epic, saying that Epic can’t solve major healthcare problems because its only offering is an EHR and that “KLAS’s short-sighted research” doesn’t reflect that.

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Prisma Health opens a new convenience store using Amazon’s Just Walk Out technology at its Richland Hospital in South Carolina.


Sponsor Updates

  • CereCore releases a new podcast, “Oklahoma Heart Hospital and Their 11-Month Epic Implementation.”
  • Surescripts recognizes 10 healthcare organizations with its 2024 White Coat Awards for their leadership in performance, innovation, and accuracy.
  • Artera introduces the 2024 Artera Heartie Award Winners.
  • Ascom employees join Team Ascom to participate in the Great Cycle Challenge and raise money to help kids fight cancer.
  • Medicomp Systems re-architects its Quippe solutions to meet W3C web component standards.
  • TrustCommerce, a Sphere company announces that its next-generation Cloud Payments product has been certified on all major payment processing platforms.
  • Capital Rx announces that its enterprise health platform, JUDI, has earned certified status by HITRUST for information security.
  • Health Level Seven elects Clinical Architecture EVP of Client Services Carol Macumber chair-elect of its Board of Directors.
  • CloudWave will exhibit and present at the Central and Southern Ohio HIMSS Chapter Fall Conference October 18 in Dublin, OH.
  • Divurgent will present at the HIMSS Virginia Annual Conference October 15-16 in Williamsburg.

Blog Posts


Contacts

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

Morning Headlines 10/1/24

September 30, 2024 Headlines Comments Off on Morning Headlines 10/1/24

Major CVS shareholder plans activist push, will meet with management, sources say

CVS shares rise on the news that Glenview Capital executives meet with CVS leaders to discuss rescuing the floundering business, which has seen its stock plummet amidst layoffs, store closures, and other efforts to cut $2 billion in expenses.

VieCure Secures $45 Million Financing to Accelerate Adoption of First AI-Enabled Community Oncology Care Platform

VieCure, which offers AI-powered clinical decision support and EHR software for community-based oncology providers, announces $45 million in new funding.

HHS Finalizes Federal Health IT Strategy to Drive Systemic Improvements in Health and Care

HHS publishes the final 2024-2030 Federal Health IT Strategic Plan, which outlines goals around improving experiences and outcomes for health IT users and the policy and technology components needed to support them.

Comments Off on Morning Headlines 10/1/24

Curbside Consult with Dr. Jayne 9/30/24

September 30, 2024 Dr. Jayne 3 Comments

A care delivery organization recently asked me to work on an AI project. They are looking at ways to incorporate generative AI into the clinical process, but didn’t want to use an off-the-shelf solution due to concerns around cost and clinical quality. Instead, they set out to create their own solution, which I suspect was in part a way to justify the recent creation of an innovation team, which hadn’t yet produced anything mind-blowing despite being a significant cost to the organization.

Although I sympathize with their desire to have a system where they can work behind the scenes and ensure the validity of the data being used and the outcomes, I could have told them months ago that they would spend way more money taking the do-it-yourself approach instead of working with someone who already had expertise in this area.

Their solution is pretty far along in the development process. They have had a single physician who is providing input. They are ready for more physicians to be involved, and because they are a care delivery organization, they assumed that physicians would be clamoring to be part of the project, either in providing clinical scenarios or being beta testers.

However, they didn’t budget compensating those physicians for their time, which given the tone in their physician group, was a significant oversight. Physicians who are already feeling burdened and burned out are less likely to give freely of their time to an organization that they feel is not working in their best interests.

I started my work with them by attending an onsite meeting where the team was strategizing on how to convince providers to be more involved. They asked me to go around to offices and try to convince physicians to participate.

It quickly became clear to me that many of the people on the innovation team had not worked in healthcare. They thought that it would be great to just show up during office hours and try to get people’s attention. I had to do a little explaining about how physicians are so protective of their time that many of them have eliminated the presence of non-essential people in the office during the day – no drug representatives, no lab representatives, no med students, etc. They were surprised by this, so I got to share how COVID really changed this landscape and how once clinicians realized how nice it was to not be interrupted, they weren’t going back.

It turns out that during the development process, no one had been working with physician leaders to talk about the project and to build consensus around its use. I found that pretty remarkable since most organizations have by now learned the value of buy-in.

I asked to meet with physician leaders so I could build an understanding of the physician group’s culture and whether there were people who would be willing to participate and what kind of compensation or reward might be needed. Everyone is motivated a little differently, and some will respond to non-monetary incentives like being the first practice to use a new tool or being bumped up in the line for enhancement requests that they’ve already entered. Others do want to participate in making things better, so I thought we should learn about any existing physician wellness committees where we might find willing participants.

I also suggested that since there is a corporate IT department, it might be interesting to pull search histories on some of their clinical users to determine what kinds of things they might be asking Dr. Google. There was a lengthy conversation about this being a violation of user privacy, which surprised me. How many annual compliance training sessions have I been through that explained that nothing that is done on a company-owned device or on a company network is private? Had I stumbled into an alternate universe where people had no fear of corporate types seeing what they were doing on their work laptops?

Although they agreed in principle that it would be an interesting approach, they said that they would have to take it through various approval processes. It was a non-starter in the short term.

In the meantime, while we were working through that issue as well as working with physician leaders to find clinical testers and potential beta sites, I agreed to create some testing scenarios across various specialties. I drafted some requests to pull diagnosis data from their EHR to better understand what kinds of conditions were being treated. My thoughts there were twofold. First, I wanted to find out the most common conditions for which there might be a need for generative AI around patient-facing communication, clinical documentation in the EHR, or other use cases. Second, I wanted to understand the least common conditions for which users might be seeking additional information, either about other similar conditions or about treatment of a condition once they had narrowed it down.

I was a bit surprised that their in-house lead clinician hadn’t suggested these things, and it became more clear in some of those conversations why the organization wanted to bring in someone a bit more seasoned to assist.

I decided to start building test scripts around the organization’s genetics clinic since physicians are seeing increasing numbers of patients who are asking for full-panel genetic testing to try to understand their cancer risk. These tests can be expensive and are often not covered by insurance. They also test for genes that the average primary care physician doesn’t necessarily encounter on a daily basis, figuring there would be searches about them. I developed a test plan and got ready to kick the tires.

The first test scenario I did was with a condition that I thought would be an easy one since it’s fairly common and testing has been around for more than a decade. I asked the system what the clinical implications were for a patient who was a homozygous carrier of the condition, since the answer should be straightforward about early screening. The answer was anything but straightforward, with the system taking me on a wild ride that ultimately ended in a recommendation to do nothing. I was stunned.

I tried quite a few more test scenarios and the system performed as expected, but I was left with a bad feeling about how to proceed. The engineers who had been following my testing didn’t think that one miss was a big deal, but to me as a clinician, the miss was a very big deal. I knew I would have another topic for my meetings with clinical leaders as we would need to discuss what the organization’s tolerance was for misses and near-misses, and also whether there were ethics committees that we could bring to the table.

I was starting to feel like this project was one of those “on the back of a napkin” efforts that hadn’t been fully fleshed out and would ultimately need more discussions than I was prepared to lead as part of my engagement.

We’ll have to see how this shakes out over the next few months, but it left me wondering how many other organizations are in positions just like this, taking projects forward when they don’t have the right stakeholders at the table or an understanding of the true clinical implications of the technology they’re trying to add to the mix. I suspect we’ll have a lot of uncomfortable conversations, and some folks won’t be happy that this outsider is poking holes in their project. Alas, that’s all in the fun of being a consultant, so I’ll just keep putting one foot in front of the other and try to navigate them in the right direction.

What is your organization’s process for ensuring clinical stakeholders are involved in clinical technology projects? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: Healthcare Knows Everything About Patients, But Can’t Keep Them Engaged

September 30, 2024 Readers Write Comments Off on Readers Write: Healthcare Knows Everything About Patients, But Can’t Keep Them Engaged

Healthcare Knows Everything About Patients, But Can’t Keep Them Engaged
By Carrie Kozlowski

Carrie Kozlowski, OT, MBA, is co-founder and COO of Upfront Healthcare.

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Part of what I love about leading a growth-stage health tech company is the chance to jump between worlds. From big-picture “how might we” brainstorming with innovators to in-the-trenches problem-solving with the health system leaders responsible for delivering patient care — I get to see healthcare from both sides.

The problem is, they often remain siloed. While there’s no shortage of ideas about how to solve healthcare’s biggest problems, teams on the ground are barely staying afloat in managing the day to day, let alone implementing big fixes. The industry as a whole gets stuck operating the same way it did 20 years ago.

That’s the paradox that has been on my mind since I spoke at South by Southwest earlier this year, when I addressed an audience of innovators about the future of data-driven care. That is an area of healthcare where the disparity between what we could do and what we do is striking. My co-presenter and I explored why 97% of all data produced by hospitals each year goes unused, even at the expense of transforming healthcare for the better.

Think about how much healthcare providers know about us. Our doctors know our kids’ names, when they were born, what we do for a living, when our schedule is usually free for appointments, and the likelihood that we’ll cancel last-minute. With this much information, healthcare should be creating incredibly personalized patient experiences, but is falling behind.

Healthcare leaders have an incredible amount of data at their fingertips. As an industry, it’s uniquely positioned to understand who consumers are, how they behave, and what services they still need.

I use the word “consumer” intentionally. No matter how healthcare is perceived, patients are consumers and healthcare enterprises are competing for their business. Patients are making consumer decisions, and these decisions hinge on factors like marketing, convenience, and personalization.

If healthcare made the most of its data, health systems could be running tailored engagement programs that are capable of predicting patients’ actions, speaking directly to their needs, and driving better outcomes across the entire healthcare industry to deliver on the promise of patient-centered care. That’s what’s at risk when it comes to data-driven care. Not just efficiency, but long-term success for patients and enterprises alike.

The average hospital produces 25 trillion pages of data each year. Healthcare’s data collection is growing at a staggering annual rate of 36%. That’s 11% faster than media and entertainment.

Not only is the data vast, it’s also accessible. Health systems already have patient information, collected safely and stored securely with no new data collection processes needed. They know about patients’ jobs, families, and modes of transportation. They know if they need translation services and if they have a history of canceling appointments at the last minute. In other words, they have the exact kind of consumer data to make healthcare more convenient, accessible, and effective.

While Netflix and TikTok use their consumer insights to engage viewers for hours each day, healthcare has so far failed to capitalize on patient data. The industry is sitting on a treasure trove of consumer insights, but they’re going unused. As a result, only 8% of patients complete all the screenings they need in a given year. Ignoring healthcare data isn’t just inefficient, it’s reckless.

It’s easy to point to the healthcare industry’s resistance to change as the problem, but we can be more specific. Let’s look at the challenges one by one.

  • Privacy concerns. The words “patient data” often carry with them the fear that a health system will somehow violate a patient’s privacy. Patients might worry that their data will be used against them, preventing them from getting insurance, causing issues with their employer, or otherwise introducing bias into their care. The truth is that HIPAA already forbids this kind of unethical data use. When I talk about leveraging patient data, what I mean is taking the information patients have already willingly handed over and using it to improve their experience dynamically and securely.
  • Fear of litigation. We’ve all heard healthcare described as a risk-averse industry. This makes it sound like individual healthcare leaders aren’t open to new ideas. What it really means is that healthcare lives and dies by compliance, sometimes to a fault. It’s worth a conversation about the difference between reasonable precautions and completely overblown fears. The concept of leveraging patient data might feel new, but the data itself is not. It’s already been collected and is being stored securely by health systems. The next step is as simple as using what’s already known about patients to make more practical decisions.
  • Deficient tools. Patient data is available now, but that doesn’t mean that it’s easy to access or interpret. Health systems are burning money and human capital on often redundant or cumbersome software platforms. If these platforms don’t play well together, there’s no guarantee that they will produce useful insights on demand.

In many cases, these tools could be stripped back and replaced by one or two patient engagement solutions that integrate with the rest of a robust software suite. We don’t need a separate platform for every point of data collection. Instead, look to HIPAA-compliant engagement tools that speak directly to market-leading EHRs, which allow a bidirectional flow of patient data to empower truly personalized outreach.

Healthcare already has the ingredients to change how patients access and experience care. The challenge is actually making that happen, with data at the forefront. In an industry that is understandably reluctant to change, healthcare pioneers will be looked toward to lead adoption. Once processes are built around patients instead of bureaucratic restrictions, the foundation will be laid for a whole new era of healthcare, one in which care is personalized, patients are engaged, and data leads the way.

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Readers Write: EHR Due Diligence: Five Questions That Could Save Millions

September 30, 2024 Readers Write Comments Off on Readers Write: EHR Due Diligence: Five Questions That Could Save Millions

EHR Due Diligence: Five Questions That Could Save Millions
By Kem Graham

Kem Graham, MS is VP of sales for CliniComp.

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Electronic health records (EHRs) have become an indispensable tool in healthcare today. As hospitals and health systems navigate the complex process of selecting an EHR vendor, avoiding hidden costs and ensuring transparency are paramount. Here are five key questions to consider when evaluating EHR vendors to maximize ROI, maintain workflow continuity, and achieve overall success.

1. How transparent is the cost breakdown?

With budgetary constraints more challenging than ever, it’s crucial to identify all contract elements comprehensively. Seek a detailed account of software, hardware, and services components, including costs for data migration, staff augmentation, medical device interfaces, and interoperability. Validate the scope of implementation, configuration, and ongoing support services. Determine any third-party costs that are not covered by the EHR vendor and confirm if there are monthly service support limits. Identify whether your organization will be billed by volume or a fixed cost solution and determine the total cost of ownership from contract signing to renewal.

2. Is the system adaptable and interoperable?

Look for an architectural framework that addresses evolving challenges in interoperability, scalability, and real-time performance data. The system should provide a comprehensive longitudinal patient record that can seamlessly cross multiple sites and environments, adapting to changing data needs over time. Seek a solution that can normalize disparate data sources for seamless interoperability, meeting both current and future innovation requirements.

3. How will it impact staffing?

Organizations often underestimate the staff that is required for EHR implementation and ongoing system management. With persistent clinical and IT staffing challenges, it’s important to understand a vendor’s staffing requirements and support services. Consider whether the new system offers a robust, out-of-the-box solution that can be customized, and how it will affect current clinical, administrative, and financial workflows. Look for a reliable and integrated system that is intuitive and user-friendly, built by clinicians for clinicians, with 24/7 end-user support to minimize the burden on staff.

4. Is System and medical device integration included?

Data migration and integration among systems, devices, and other technologies are critical components that can sometimes be costly add-ons. Understand exactly what elements are included, whether there are limitations around the EHR system’s technology, and what additional costs may be incurred to bridge those gaps. Consider future integration costs as well, such as migrating to different medical devices or vendors. Confirm that the EHR vendor does not limit the hospital’s options.

5. How will operational disruptions be mitigated?

Not all EHRs require downtime for scheduled updates, security patches, and upgrades. Seek a solution that delivers 100% uptime for maintenance, upgrades, and unplanned incidents. Investigate the vendor’s history to understand their experience in avoiding clinical dissatisfaction, poor patient care, and financial losses due to system downtime.

 

Choosing an EHR system is a pivotal decision with far-reaching implications on both the clinical and operational fronts. Trust and transparency are essential in fostering a successful relationship between the vendor and the hospital system. Healthcare organizations with a complete understanding of both upfront and long-term investments, including impacts on staff satisfaction, workflows, and patient care, will have the most satisfactory outcomes throughout the EHR acquisition, implementation, and utilization process.

The vendor’s success should be defined by the hospital’s success, reflecting a true partnership where the vendor acts as an extension of and integrates seamlessly into the organizational team. Transparency from the outset, and exploring all options, such as the comprehensive system as a service model, will set the system up for success for years to come.

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Readers Write: AI is Here to Stay, So Don’t Miss Out on the Opportunity

September 30, 2024 Readers Write Comments Off on Readers Write: AI is Here to Stay, So Don’t Miss Out on the Opportunity

AI is Here to Stay, So Don’t Miss Out on the Opportunity
By Greg Miller

Greg Miller is VP of business development at Carta Healthcare.

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AI is going to take all of our jobs. At least that’s the impression one would get today from far too many media outlets. Alas, blatant scare-mongering works and generates advertising revenue.

We’ve talked recently with dozens of health system technology decision-makers who acknowledge that artificial intelligence (AI) can make their organizations more efficient and cost-effective. Yet some worry that AI will replace their employees. This isn’t just another concern; it’s the top concern that we’ve been hearing.

The prospect of losing valued employees to technology is one kind of AI-related anxiety among healthcare professionals. There’s also fear of missing out (FOMO). Healthcare IT pros are under heavy pressure from leadership to do something with AI or risk being left behind. However, these healthcare veterans have heard it all before about why they must implement a certain technology to keep up with competitors or face imminent doom. No wonder many have become immune to marketing hype.

Whether you’re in the fear of AI or FOMO camp, AI is happening with or without you. Provider organizations that fail to implement an effective AI strategy will struggle as their understaffed workforces become deeply buried under a backlog of clinical administrative tasks. As more healthcare data is generated and jobs go unfilled, healthcare organizations that lack AI capabilities won’t be able to keep up with clinical documentation.

But while many provider organization leaders fear that AI will replace humans, healthcare workers are more likely to welcome the assistance that AI can provide. In a survey from earlier this year, 77% of responding healthcare workers said that emerging technologies like AI could be useful in combating the healthcare staffing shortage.

AI implementations can optimize the return on investment for hospitals and health systems while providing a blueprint for future successful AI initiatives. There are pragmatic and safe ways for provider organizations to apply AI today that are affordable and designed to ease the administrative burden for clinicians.

One good example is using ambient listening to perform clinical documentation tasks. Physicians typically spend between 30 and 90 minutes at home completing clinical administrative work that they couldn’t finish during office hours. Ambient listening functionality can perform these essential clinical documentation tasks, improving efficiency and accuracy while vastly reducing clinician workloads and burnout.

Another strong use case for AI in healthcare is abstracting data from electronic health records (EHRs). On average, it takes an abstractor one hour to finish abstraction work for a single case. That’s a lot of costly time. In contrast, the right AI technology can perform abstractions for thousands of cases in minutes. Can a hospital or health system afford to pass up this opportunity?

It’s important to know where AI fits into your provider organization. AI is a tool and part of a process. It’s also familiar since we use AI every day in our regular lives through computers, smartphones, and other connected devices.

AI is going to help clinicians do more with the time they have. It will help physicians, nurses, coders, and clinical data abstractors by automating simple but necessary tasks. It will also help provider organizations improve efficiency, reduce costs, and enhance care quality. What AI will not do is replace medical professionals.

The already disruptive shortage of physicians and nurses in the US is expected to get worse as the nation’s population ages and our need for care services increases. Hospitals and health systems should embrace the opportunity to use AI in ways that enable their clinical staff to optimize their care for patients.

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Morning Headlines 9/30/24

September 29, 2024 Headlines Comments Off on Morning Headlines 9/30/24

Epic calls on Particle Health to approve release of resolution in patient privacy dispute

Epic asks Carequality to publicly release its resolution regarding the dispute between Epic and Particle Health.

Physical therapy startup Hinge Health hires Moran Stanley as it prepares to confidentially files its S-1

Digital musculoskeletal therapy provider Hinge Health, last valued at $6 billion in October 2021, hires investment bankers to take the company public next year.

EQT to exit AGS Health, eyes $750 million valuation

The investment firm owner of US-based, 12,000-employee health IT services firm AGS Health will seek a buyer for its five-year-old investment at a valuation of $780 million.

A US Crackdown Targeted an Adderall ‘Pill Mill.’ Secretly, It Had Already Moved to China.

California-based telehealth startup Done Global, which prosecutors allege has operated as an Adderall pill mill, has reportedly moved its operations to China and shifted management to employees there to continue business as usual despite the arrest of its US executives.

Comments Off on Morning Headlines 9/30/24

Monday Morning Update 9/30/24

September 29, 2024 News 9 Comments

Top News

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Epic asks Carequality to publicly release its resolution regarding the dispute between Epic and Particle Health.

Epic filed a dispute with Carequality against Particle customers, which it says were downloading patient records for non-treatment purposes in violation of Epic’s policies. Epic blocked Particle’s access to its data, naming Particle customers such as Integritort, which it claims used EHR data to assist personal injury law firms in identifying potential class action lawsuits. Also named were Reveleer (risk adjustment) and Novellia (personal health records).

Epic asserts that Particle mischaracterized Carequality’s resolution and is urging Carequality to make those findings public. Particle says that Carequality had originally requested that the resolution remain confidential, but says it has no objection its release.

Particle filed an anti-trust lawsuit against Epic last week, accusing the company of leveraging its market dominance to block Particle’s entry into the payer platform market. Particle also lodged an information blocking complaint against Epic with HHS OIG.


HIStalk Announcements and Requests

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The US is the only wealthy, industrialized nation that does not provide universal health insurance / healthcare, and poll respondents say that implementing that would be the best way to improve our collective health. That wouldn’t fix our issues with industrial-manipulated food and our general appetite for unhealthy behaviors, but at least it would start with fixing the symptoms and then moving upstream to the problems. Which will never happen, of course, because someone’s pocketing profit with every one of these.

New poll to your right or here: Which party seems to have a stronger case in the Particle Health vs. Epic lawsuit? This is a first reaction kind of poll since we’ve only seen Particle’s complaint and Epic’s brief response.


Webinars

October 24 (Thursday) noon ET. “Preparing for HTI-2 Compliance: What EHR and Health IT Vendors Need to Know.” Sponsor: DrFirst. Presenters: Nick Barger, PharmD, VP of product, DrFirst; Tyler Higgins, senior director of product management, DrFirst. Failure to meet ASTP’s mandatory HTI-2 certification  and compliance standards could impose financial consequences on clients. The presenters will discuss the content and timelines of this key policy update, which includes NCPDP Script upgrades, mandatory support for electronic prior authorization, and real-time prescription benefit. They will offer insight into the impact on “Base EHR” qualifications and provide practical advice on aligning development roadmaps with these changes.

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


Acquisitions, Funding, Business, and Stock

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Digital musculoskeletal therapy provider Hinge Health hires investment bankers to take the company public next year. It was last valued at $6 billion in October 2021.

California-based telehealth startup Done Global, which prosecutors allege has operated as an Adderall pill mill, has reportedly moved its operations to China and shifted management to employees there to continue business as usual despite the arrest of its US executives. US-based clinicians are still issuing prescriptions, with some of them reporting minimal review of patient records. One nurse practitioner earned $43,000 in May 2024 alone by prescribing for 3,000 patients. Team members claim that the company instructed its Philippines-based customer care staff to sit in on patient appointments and shared patient information internally via WeChat, which raises concerns about potential US privacy violations. The company’s founders were arrested in June 2024 for illegal distribution of 40 million pills of Adderall, which earned them $100 million.

The investment firm owner of US-based, 12,000-employee health IT services firm AGS Health will seek a buyer for its five-year-old investment at a valuation of $780 million.

WW International (WeightWatchers) fires its CEO, who pivoted the company into digital health and GLP-1 prescribing with the $132 million acquisition of weight management telehealth provider Sequence in March 2023. Tech executive Sima Sistani took the CEO job in early 2022. 

Steward Health Care CEO Ralph de la Torre, MD – who was held in contempt of Congress last week for refusing to comply with a Senate subpoena to answer questions about corporate greed and the financial struggle of Steward’s hospitals – will resign this week.


Sales

  • Sectra will implement its Sectra One Cloud enterprise imaging solution in all of Quebec’s public hospitals.

Announcements and Implementations

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ChristianaCare President and CEO Janice Nevin, MD, MPH confirms its Cerner-to-Epic switch via a video announcement. Go-live is planned for 2026.


Government and Politics

US Rep. Matt Rosendale (R-MT) tells the technology modernization committee of the House Committee on Veterans’ Affairs that the VA should not have shut down its $624 million, Epic-powered MASS appointment scheduling system project in 2019 (which it later downgraded to a pilot project) in a “disastrous” decision to move to Cerner. He also wants the VA to explain its decision to turn off the its $278 million WellHive external provider scheduling system due to budget problems.

The VA expands its tele-emergency care pilot nationwide after finding that it avoided an ED trip for 59% of callers.

Ireland’s competition regulator opens an investigation into 1,000-employee global healthcare software vendor Clanwilliam to review the company’s EHR, referral, and text messaging business. Clanwilliam launched as Medicom in 1996 and renamed itself in 2014 after making several acquisitions.


Privacy and Security

The Atlantic warns that 23andMe’s rapid company decline should concern “anyone who has spit into one of the company’s test tubes” since the only asset it has left to sell is the genetic information of 15 million customers. The company is not bound by HIPAA and its privacy policies state clearly that it can sell customer data if merged or acquired. 23andMe’s market cap, which was nearly $5 billion three years ago, is down to $150 million and its entire board quit last week, leaving CEO Anne Wojcicki as the only remaining member. 

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The New York Times reports that behavioral health patients are feeling “stunned, ambushed, and traumatized” after learning that their progress notes are available to other clinicians on the patient portals of hospitals that have adopted OpenNotes data sharing.


Other

A San Francisco software engineering manager is convicted of tax evasion for offsetting his three-year income of $1.2 million with a claimed $1.1 million in medical expenses for a 2010 appendectomy that actually cost him just a few hundred dollars. DOJ didn’t say where he works, but a LinkedIn search suggests Apple.


Sponsor Updates

  • EClinicalWorks works with HealthEfficient to complete Hyndman Area Health Center’s (PA) UDS+ submissions to HRSA.
  • Availity publishes a new whitepaper, “From Complexity to Connectivity: The Journey of Availity’s Payer-to-Payer Data Exchange Cohort.”
  • Rhapsody announces that it has been recognized as Sample Vendor in Gartner’s Hype Cycle for Real-Time Health System Technologies report in the Next-Generation EMPI category.
  • Redox publishes a new report, “DIY or Outsource: EHR Integration Costs for Providers.”
  • Verato will present at the Reuters Total Health Conference October 8-9 in Chicago.
  • Waystar will exhibit at ACEP24 September 29-October 2 in Las Vegas.

Blog Posts


Contacts

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

Morning Headlines 9/27/24

September 26, 2024 Headlines Comments Off on Morning Headlines 9/27/24

Graybill to separate from Palomar Medical group, citing cyber attack

Graybill, a California-based primary care group, will split from Palomar Health Medical Group, citing that organization’s inadequate support following an April 2024 cyberattack that took systems offline for months.

Dimer Health raises $2.95M to cut down hospital readmissions

Dimer Health, a startup that specializes in healthcare facility discharge and post-acute care coordination, raises $3 million in a seed funding round.

VA makes tele-emergency care available nationwide, offering Veterans more virtual care options

After a successful pilot, the VA expands its tele-emergency virtual triage service to veterans nationwide through its VA Health Connect program.

Wyden and Warner Introduce Bill to Set Strong Cybersecurity Standards for American Health Care System

Senators Ron Wyden (D-OR) and Mark Warner (D-VA) introduce cybersecurity legislation that, if passed, would mandate the development and enforcement of tougher minimum cybersecurity standards for healthcare organizations, remove the current cap on HIPAA fines, and provide cybersecurity funding for select hospitals.

Lubbock UMC experiences ransomware attack, diverts patients to other hospitals

University Medical Center (TX) diverts patients and enacts downtime procedures as it deals with a ransomware attack.

Comments Off on Morning Headlines 9/27/24

News 9/27/24

September 26, 2024 News 4 Comments

Top News

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Graybill, a California-based primary care group, will split from Palomar Health Medical Group, citing that organization’s inadequate support following an April 2024 cyberattack that took systems offline for months.

Palomar disputes Graybill’s claim that some of its systems are not yet fully recovered. It also suggests that Graybill shares responsibility, noting that a Graybill physician serves as Palomar Health Medical Group CMIO.

San Diego-based Arch Health Medical Group and Graybill Medical Group joined Palomar Health to create the 170-physician Palomar Health Medical Group in November 2020.


Reader Comments

From A Frustrated Vet: “Re: VA. Happening as I write this on the House VA Technology Modernization Subcommittee: ‘Our veterans would have been much better served if the VA had not abandoned the Medical Appointment Scheduling System (MASS) in 2019. This project had implemented Epic’s scheduling system and patient portal in Columbus, Ohio, and they were working well. But the VA leaders at the time made a special effort to eliminate it, paving the way for Cerner to duplicate the work and install an inferior system. This was a disastrous decision that we are all still paying for.’ – Chairman Rosendale (R-Mont.)” Thanks. I will recap more fully in the weekend’s news once the hearing is finished.


HIStalk Announcements and Requests

Conference season is the ideal time to become an HIStalk sponsor and get year-round exposure to decision-makers instead of betting the farm on a booth rental. Lorre is likely offering incentives for new sponsors, startups, and former sponsors who return to my little fold, although she will also ensure that current sponsors, some of whom have supported me for more than a decade, don’t get shortchanged. Also for sponsors, if your company is attending HLTH 2024 in any capacity, send me your info soon to be featured in my online guide.

One last housekeeping item: hair-trigger spam filters always inappropriately unsubscribe readers from my spam-free update list. Drop your email here to stay in the loop—you won’t get duplicate emails regardless.

I got the ChatGPT update today with Advanced Voice Mode. It’s cool, though not revolutionary—it allows for natural voice conversations, pauses if interrupted, and adjusts its responses based on what you say. It’s fun that you can choose a voice with a personality that affects tone and word choice. Advanced Voice makes Alexa, Google Assistant, and Siri seem even more primitive, and it’s convenient to interact with ChatGPT via voice. The microphone stays open until you turn it off, so my phone sits beside my keyboard, ready to respond without requiring a wake word or key press.

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I politely declined the interview invitation of Kat McDavitt, Lisa Bari, and Melissa Denino, the boundless energy folks who are behind the “Health Tech Talk Show.” Reasons for no-ing: (a) I avoid the spotlight like a vampire shuns sun; and (b) I say everything I know right here and don’t see the value of repeating myself. Still, I offered to help them feed the content beast by inviting potential interviewees to email them at hello@healthtechtalkshow.com. It’s refreshing not to need to stab the eject button seconds-in on a host who is long on self-importance but short on industry knowledge and a compelling style.


Webinars

October 24 (Thursday) noon ET. “Preparing for HTI-2 Compliance: What EHR and Health IT Vendors Need to Know.” Sponsor: DrFirst. Presenters: Nick Barger, PharmD, VP of product, DrFirst; Tyler Higgins, senior director of product management, DrFirst. Failure to meet ASTP’s mandatory HTI-2 certification  and compliance standards could impose financial consequences on clients. The presenters will discuss the content and timelines of this key policy update, which includes NCPDP Script upgrades, mandatory support for electronic prior authorization, and real-time prescription benefit. They will offer insight into the impact on “Base EHR” qualifications and provide practical advice on aligning development roadmaps with these changes.

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


Acquisitions, Funding, Business, and Stock

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India-based Qure.ai completes a $65 million Series D funding round to expand into the US market and to pursue acquisitions.


Sales

  • UAB Health System will implement Epic as its single EHR in a seven-year, $380 million project, replacing Oracle Health.
  • ChristianaCare will implement Epic, replacing Oracle Health.
  • Children’s Hospital of Orange County will deploy Oneview Healthcare’s Care Experience Platform on patient room TVs.

People

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Susan Worthy (Amwell) joins Gainwell Technologies as chief marketing officer.

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Former Cerner executive Maria Flynn, MBA, MS is named president and CEO of the Patterson Family Foundation, a $1.5 billion asset non-profit that focuses on rural health and was founded by Cerner founder Neal Patterson and his wife Jeanne, both deceased. She was also co-founder of Digital Health KC.


Announcements and Implementations

Cobb County, GA joins the Find Help social network to launch an online resource that connects residents with assistance programs.

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Sonifi Health integrates NESA’s Epic-integrated virtual care system with its patient room TVs.

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Meditech kicks off its annual customer leadership conference in Foxborough, MA.

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A new KLAS report on smart IV pumps finds that BD Alaris recalls and the FDA’s approval of next-generation technology are driving earlier replacement and expansion decisions. EHR integration is the most important factor in purchasing, usage, and satisfaction, followed by cost and ease of use.

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KLAS also takes an initial look at Epic’s Hello World integrated SMS messaging system. All interviewed organizations are satisfied, would recommend it, and would buy it again. Customers say it reduces appointment no-shows using reminders, speeds communication with patients, and is deployed via MyChart.


Government and Politics

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HHS OIG finds that the use of remote patient monitoring for Medicare patients has increased dramatically, but needs additional oversight to prevent fraud as patients are not always receiving all required services and Medicare lacks the information to oversee its use. CMS agrees with OIG’s recommendations: (a) require a provider’s order for RPM that is included on claims and encounter data; (b) develop ways to identify the health data that providers say they are monitoring; (c) educate providers about billing for remote patient monitoring; and (d) identify and monitor those companies that are billing for RPM. OIG says that 43% of Medicare enrollees did not receive all three mandatory RPM components: education and device setup, collection of an adequate number of device readings, and use of the data to manage treatment.

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The Senate unanimously votes to hold Steward Health Care CEO Ralph de la Torre, MD in contempt of Congress for ignoring its subpoena to answer questions about his compensation as the bankrupt company’s hospitals struggled to deliver safe, effective care. A spokesperson for de la Torre says that he has the right to not answer questions under the Fifth Amendment and won’t be intimidated by Congress. He faces prison time as the first person to be held in contempt by the Senate since 1971.


Other

Allina physicians report problems that were caused by order entry confusion resulting from the health system’s switch of in-house outpatient lab work to Quest Diagnostics last week.

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I truly enjoy reading the “Hey Judy” posts on Epic Share, where she has written these ruminations for September:

  • She paid her 15-year-old son – who wrote contest-winning computer games from their home basement where Judy was working on Epic — $5 to develop a programmer test after hiring Epic’s first programmer and then realizing that people aren’t always as talented as they think. Epic used that test for 18 years to choose new employees, then expanded the question bank when they leaked out.
  • She describes the origins of Share Everywhere, which Dave Furhmann created (he’s now SVP of R&D) after Judy learned that Cerner hospitals couldn’t exchange information with each other.

Sponsor Updates

  • Black Book Research ranks Inovalon #1 in its 2024 provider enterprise RCM analytics solutions survey, with top ratings across 12 KPIs.\
  • A new KeyCare survey of 400 patients finds that the majority prefer telehealth to office visits for medical issues including urgent care, preventive care, chronic care, and specialty services.
  • Black Book Research publishes the results of its 2024 supply chain customer experience survey, with Dimensional Insight taking the top spot for benchmarking and comparative analytics.
  • Inovalon promotes Sandy Warford to director of product marketing.
  • Five9 and Verint expand their partnership to deliver AI-driven customer experiences.
  • Fortified Health Security will present and Healthcare IT Leaders will sponsor the Georgia HIMSS Conference October 1 in Atlanta.
  • Linus Health unveils new tools for early dementia detection at AAFP’s FMX 2024 conference.
  • Meditech customer Ontario Shores Centre for Mental Health Sciences becomes the first hospital in Canada to implement Expanse Genomics.
  • MRO will exhibit at the Medical Practice Excellence: Leaders Conference October 6-9 in Denver.

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EPtalk by Dr. Jayne 9/26/24

September 26, 2024 Dr. Jayne 2 Comments

The hot topic around the virtual physician lounge this week was an article from the American Medical Association (AMA) that identified “Five physician specialties that spend the most time in the EHR.”

Physicians were whipped into a frenzy by the statistic that ambulatory care physicians spend an average of 5.8 hours in the EHR for every eight hours of scheduled patient care time. Even if you adjust for the time one spends in the EHR while you’re seeing a patient – for example, when you’re reviewing the chart, capturing the patient’s story, and writing prescriptions – that means a lot of clinicians are still doing loads of documentation during non-scheduled working hours.

The article cites a study that was published in the Journal of General Internal Medicine that found the highest EHR times per eight hours of scheduled patient care were: infectious disease (8.4), endocrinology (7.7), nephrology (7.5), internal / family medicine (7.3), and hematology (7.2). The lowest EHR times were: dermatology (4.3), surgery (4), ENT (4), orthopedics (3.3), and anesthesiology (2.5).

The study’s lead author, Christine Sinsky, MD, is vice-president of professional satisfaction at the AMA. She notes that, “These are specialties with complicated patients with multiple medical conditions for whom there’s a lot of visit-note documentation, lots of orders, and require a lot of communication between the patient and the physicians or the team between visits, so the inbox time is highest among those five specialties as well.” That inbox time was noted as 0.8 hours of work per eight hours of patient care, on average, but primary care, infectious disease, and endocrinology were at 1.2 hours per eight hours of patient care.

Since orthopedics spends only 0.4 hours in the inbox per eight hours of patient care, she hypothesizes that, “Many of the procedural specialties have hired staff who assist with some of the tasks of order entry, visit-note documentation and being the first responders to the inbox.” Even the lowest-paid orthopedists in my area make twice what a family physician does, so it’s a little easier for them to afford the staff to help them get through the day.

I dug into the article itself and found that it used data from more than 200,000 physicians at 400 organizations. The source was Epic’s Signal platform, which measures physician activity both within and outside scheduled working hours.

Sinsky calls on EHR vendors to reduce the burden of documentation, including the number of screens and clicks that it takes to perform specific tasks. She cites the click count that is needed to document ordering and administering a single vaccination at 32, which I agree is a tragic level of clicks. My favorite EHR took three to order (launch immunizations, click influenza, click order) and six to administer (open the order, side/site picklist, manufacturer, lot/expiration picklist, checkbox to confirm the Vaccine Information Statement publication date, click save) with an optional click or two if you needed to change the sequence number on a vaccination for a patient who had received previous doses elsewhere. I’d be interested to hear from readers how many clicks it takes in your system, and what they are beyond the basics noted above.

It will be interesting to see what this data looks like in the future, when we can have before-and-after studies that follow the implementation of ambient/AI documentation solutions. We also need to continue to look at payment models that deliver enough revenue to primary care and other specialties with complex patients so that they can hire adequate support staff. I worked for many years with a human scribe in a practice and I can vouch for the difference that it makes in how you spend your day.

I was also fortunate enough to spend a good chunk of my career working for an organization that felt that physicians needed to be seeing patients and not doing other tasks, so it was rare that a phone or inbox message came to me. When it did, it had already been managed by staff as much as possible. Not every organization shares this belief, though, and many rely on the after-hours labor of their physicians to keep the practice running.

One of the physicians in the discussion said, “They know we’ll do it even when they cut our pay, because we care about our patients even when the hospital doesn’t.” That provides more than an inkling of the level of moral injury our physician colleagues are experiencing. Another noted that her practice’s own Signal data showed that primary care physicians are doing an additional 3-4 hours of charting each night at home. She concluded, “Why are they going to pay a scribe $15 per hour when they know we’ll do the work for free?”

From there, the conversation hopped to topics such as overthrowing corporate overlords and whether lottery tickets might be a good investment for the physician on the go, so I stopped following. If you’re from an organization that’s aggressively addressing these concerns, I’d love to hear more about your efforts and what you’ve learned to date.

NCQA has released health plan ratings that might be helpful to individuals as they go through employer open enrollment plans. The ratings include 1,000 health plans, including commercial payers, Medicare, and Medicaid options. Data is from the 2023 calendar year and plans are rated on a five-point scale. The quality measures contributing to the ratings, include those on clinical quality, patient experience, and health plan structure and quality processes.

This year includes expanded quality measures that assess whether health plans capture race and ethnicity data for their members in an effort to provide relevant services. Notable quality improvements were seen in reported control of hypertension and diabetes, as well as appropriate testing for patients with sore throat. One concerning quality indicator was a decline in childhood immunizations, which should be worrisome across the board.

I looked up my own plan and found that they have 3.5 out of 5 overall, with only 2.5 for patient experience. Childhood immunizations were at 4 stars, adolescent immunizations at 3 stars, and there were plenty of 4-star scores for prenatal / postnatal care, breast and cervical cancer screening, diabetes care, and appropriate use of antibiotics.

Those scores are due to the diligence of the providers who are enrolled in the plan rather than the plan itself, so it seems weird to see the plan taking credit for it. I’ve never received any kind of health communication from my plan, and I also know that my physicians participate in plenty of other insurance plans that are also claiming credit for their good work. Only in the US do we see this kind of fuzzy logic, but at least it’s something transparent, I guess.

More stories from the patient-side trenches this week, as I started receiving bills from my healthcare adventures over the summer. I remember back in the early days of EHR/PM implementations where we were piloting real-time claims adjudication. Nearly two decades have passed and I have yet to see an office that does it.

In fact, with one of my current physicians, they didn’t send a statement to the patient until more than 60 days after the insurance posted to the account. Definitely not a revenue cycle best practice. When I received my paper bill, I looked for a way to pay it online. There wasn’t one, nor was there one on the practice’s patient portal. Not even a phone number to pay via that route. I literally had to write a paper check, which gave me a laugh when I looked at the check register and saw how long it’s been since I’ve written one, coupled with the fact that the calendar on the back of the register dates to 2017. Fortunately, the pathology lab associated with the procedure had an online payment portal, and it took me less than 90 seconds to pay up.

How long has it been since you’ve written a paper check? How old is the calendar in your check register? Leave a comment and let’s see who gets the bragging rights.

Email Dr. Jayne.

Morning Headlines 9/26/24

September 25, 2024 Headlines Comments Off on Morning Headlines 9/26/24

Global healthcare AI innovator Qure.ai completes $65 million Series D funding round led by Lightspeed and 360One Asset

Global healthcare AI company Qure.ai raises $65 million in a Series D funding round.

Pomelo Care Acquires The Doula Network, Becoming The Only National Maternity Care Model to Offer Virtual & In-Person Care, Greatly Expanding Access Across the United States

Pomelo Care acquires The Doula Network to add wrap-around doula services to its virtual and now in-person maternity care offerings.

UAB Health System to invest in new EHR platform

UAB Health System will spend $380 million over the next seven years to implement and operate Epic.

Comments Off on Morning Headlines 9/26/24

Healthcare AI News 9/25/24

September 25, 2024 Healthcare AI News Comments Off on Healthcare AI News 9/25/24

News

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The New York Times covers physician use of Epic’s In Basket Art to create draft responses to patient questions that have been submitted using MyChart. Some major health systems decided not to use the technology over concerns that doctors would approve responses without reviewing them, while others thought that patients would recognize the message as AI generated and devalue it. An Epic study found that doctors are sending unedited responses to one-third of messages. Duke Health Chief Health Information Officer Eric Poon, MD, MPH says that Epic’s product creates drafts that are still “moderate in quality,” which keeps doctors vigilant in looking for mistakes, but ponders whether they will let their guard down as the AI gets smarter. A Duke colleague adds that it tried to get Epic’s product to stop giving clinical advice, but “we couldn’t take out its instinct to try to be helpful.”

OpenAI will roll out Advanced Voice to paying subscribers of ChatGPT this week. The enhancement adds speedier conversational responses, the ability to pause when interrupted, and additional voices. However, it reportedly does not support web search, custom GPTs, images, or unlimited use.

Google Cloud releases upgraded versions of its Gemini 1.5 chat-based AI assistant that it says are twice as fast at half the cost, with the capability of handling 1,000-page PDFs and hour-long videos. The company says that its Cloud and DeepMind divisions are developing new AI products and models and that developers are starting to use Gemini to create their own chatbots and voice assistants. Google has added the standalone Gemini app to Google Workspace.

The Association for the Advancement of Medical Instrumentation (AAMI) will work with the Consumer Technology Association to create standards for post-market market surveillance of non-prescription health devices  and for evaluating and assessing AI/ML products.


Business

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London-based Noki.ai announces an ambient AI medical companion that can transcribe visit conversions, automate scheduling, manage forms, verify insurance, display a patient dashboard, and exchange data in FHIR format. Monthly pricing ranges from free to $299 based on functionality and usage limits.

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Ferrum Health, which offers a secure platform for health systems to deploy AI, raises $16 million in a Series A funding round. Co-founder and CEO Pelu Tran founded Augmedix in 2012, which at that time hoped to commercialize the use of Google Glass for medical documentation. He dropped out of Stanford’s medical school weeks before graduating to work on Augmedix full time, then left the company in 2018 and started Ferrum.

Healthcare AI call agent developer Hippocratic AI adds $17 million to its Series A funding round that was led by Nvidia’s venture arm, increasing its total raised to $137 million.


Research

A study finds that real-time screening of medical claims using AI can reduce healthcare fraud, waste, and abuse by allowing questionable charges to be reviewed before payment instead of after. Tests found that such screening reduced claim payments by 1.2%. 

Researchers from Brigham and Women’s Hospital use AI to improve the accuracy of results from the PREVENT cardiac risk calculator by calibrating it to local populations. The authors conclude that the black box nature of AI applications can be tailored while preserving their functionality.


Other

Singapore’s health minister says that general practitioners will use AI for assessing health risks, prescribing drugs, and recommending lifestyle changes, which will eventually be powered by mandatory use of its national EHR program. Ong Ye Kung told conference attendees that, “We have medical records, we have genome data, we have lifestyle data, we have socioeconomic data, and the technology is already available. We can train very sophisticated, high parameters, AI models to identify risk factors and to predictive preventive care.” He says that Singapore’s biggest health challenge is the “buffet syndrome,” where patients are overtreated because their insurance pays.

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AAMC News profiles David Fajgenbaum, MD, MBA, who as a medical student in 2010 was dying of organ failure but was saved by experimental chemotherapy. The Penn Medicine professor created Every Cure, which uses AI to score 3,000 approved drugs for their possible use in treating other conditions, which gets them into the hands of patients quickly and inexpensively. That organization was awarded $48 million in federal funding earlier this year.


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Mr. H, Lorre, Jenn, Dr. Jayne.
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Comments Off on Healthcare AI News 9/25/24

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