Recent Articles:

Readers Write: The Key Ingredient to Improving Outcomes in Behavioral Health: Measurement-Based Care

October 4, 2021 Readers Write 3 Comments

The Key Ingredient to Improving Outcomes in Behavioral Health: Measurement-Based Care
By Jason Washburn, PhD

Jason Washburn, PhD is a professor at Northwestern University Feinberg School of Medicine in Chicago, IL.

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The burden of mental disorders is well known. Mental disorders are common, resulting in significant disability and contribute to — and complicate — chronic health conditions. Most mental disorders are untreated, and the COVID-19 pandemic has only further highlighted significant disparities in access to treatment. Effective pharmacologic and psychological treatments are available, yet outcomes in routine practice are often weaker than what is found in randomized controlled trials. 

Measurement-based care (MBC) can improve the outcomes of routine mental health practice. MBC involves routinely and systematically evaluating mental health symptoms, ideally before or during a clinical encounter, to both inform and direct mental health treatment. For example, in 2015, a randomized controlled study of MBC in the treatment of depression found a much higher remission rate among the MBC group compared to usual treatment (73.8% vs. 28.8%). 

What accounts for the impact of MBC on outcomes? MBC can help providers track the response of their patients to treatments, alert providers to when patients need to adjust treatment, and aid clinical decision making. For example, MBC can facilitate changes in dosage and medications, improve case conceptualization, identify the need to change treatment modality and targets, or to increase or decrease service frequency and intensity. MBC can also facilitate communication between patients and providers, improving the therapeutic relationship and shared decision making. 

Patients like MBC. Patients accept MBC practices and report that it improves their care. When implemented correctly, providers also like MBC, recognizing its many benefits and utility in treating patients. Although providers often express fears about the burden of MBC, successful implementation of MBC usually results in little to no barriers or burdens for providers. 

Despite the clear benefits of MBC, routine use of MBC remains rare. The available evidence suggests that less than 20% of psychiatrists, psychologists, and master’s level providers use any meaningful level of MBC. Why do so few providers use MBC? 

Concerns with the practicality of implementing MBC is one of the primary barriers to utilization of MBC. Practical concerns can include the time required to complete measures, the administrative burden of administering measures, and disruptions to patient flow and processes. Another barrier is the reliance of providers on clinical judgment. Even when providers recognize that MBC is likely to improve their treatments, providers may fall back on their clinical judgemnt when the infrastructure for MBC is not available. Unfortunately, clinical judgment is not always accurate: One study found that providers were only able to accurately detect deterioration in their patients 21.4% of the time.  

Although adoption of MBC has been slow, technological solutions hold promise for accelerating the integration of MBC into routine mental health care. Many – if not all – of the perceived and actual barriers associated with MBC can be addressed through technology infrastructure that supports fully automated MBC systems. Automated MBC systems can be integrated into existing clinical workflows, including the electronic health record, providing a seamless experience for both the patient and the provider. 

Accelerating the adoption of MBC, especially through automated systems that provide access to outcome data at the individual and organizational level, will not only improve care, but increase access to care. Given that MBC is associated with faster response to treatment (e.g., 4.5 weeks in MBC group vs. 8.1 weeks in usual care), the increased efficiencies gained in using MBC allows for greater throughput of patients and increased access. By monitoring remissions rates, MBC can also help to identify when patients no longer need a specific level of care, facilitating quicker transitions to lower levels of care and termination, thereby increasing access for new patients to enter the system. 

The available evidence is clear: MBC holds promise in improving mental health care. To actualize the potential of MBC, however, providers and the organizations that support them must make MBC a routine expectation in the provision of mental health treatment.

Readers Write: Obesity and Beyond: How Digital Therapeutics Are Shaping the Future of Managing Chronic Diseases

October 4, 2021 Readers Write No Comments

Obesity and Beyond: How Digital Therapeutics Are Shaping the Future of Managing Chronic Diseases
By Joseph Rubinsztain, MD

Joseph Rubinsztain, MD is CEO and founder of ChronWell of Sunrise, FL.

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As the COVID-19 pandemic took a collective toll on patients’ mental and physical health in the United States, our obesity problem only intensified. Even before the pandemic, 42% of Americans were obese, while two in five recently surveyed reported to gaining an average of 29 pounds since the pandemic began.

Despite the risks of serious disease associated with high blood sugar, hypertension, high cholesterol, and excess abdominal body fat, the pandemic’s disruption to daily routine seemed to spark trends of unhealthy eating and inactivity. What’s more, studies show that having a BMI over 30—which defines obesity—increases the risk of being admitted to hospital with COVID-19 by 113%, of being admitted to intensive care by 74%, and of dying by 48%.

Obesity, as it turns out, is the greatest risk factor contributing to the burden of chronic diseases in the US. It is closely linked with metabolic syndrome, a cluster of conditions that increase risk of heart disease, stroke, and diabetes. What’s worse, research suggests that nonalcoholic fatty liver disease (NAFLD), a “hidden” condition that’s strongly associated with obesity, is on the rise. It causes accumulation of liver fat and ultimately inflammation and scarring if left undetected and untreated.

While the burden of chronic diseases in the US has never been heavier, providers are struggling to provide the continuous support patients require to make much-needed lifestyle changes to improve their health. Physicians can suggest interventions like increased exercise and a healthy diet, but patients across the board struggle to maintain lifestyle changes because treatment plans fail to integrate into their lives in any meaningful way. Providers simply don’t have the staff or bandwidth to repeatedly nudge, support, educate, integrate, and encourage new and sustainable habits in such a high percentage of their patients.

There is, however, a solution that can automate and simplify the process with evidence-based outcomes: digital therapeutics (DTx). These technologies deliver interventions driven by high quality software programs to prevent, manage, or treat a range of medical disorders and diseases. Used independently or complementing medications, devices, or other therapies to optimize patient care and health outcomes, DTx is leveraged directly by patients, or, perhaps most optimally, in concert with physician guidance as part of a prescribed care plan.

Using remote monitoring technology and mobile access points, DTx continuously connects patients and their care teams through methods such as text communication / alerts, on-demand education, exercise coaching, diet reminders and advice, digital assistance, general care coordination, and procurement of medical supplies, to name a few. By streamlining these functions and guiding behavioral change, DTx deliver a personalized care plan to fit specific patient needs in between physician visits, encouraging compliance to treatment plans and overcoming hurdles through reliable partnership and continuous motivation.

Quality algorithms process patient information about clinical presentation, medical history, blood biomarkers, diagnostic imaging exams, laboratory tests, and social determinants of health (SDOH), for example, to generate optimal personalized interventions. Built on specific metrics and outreach methods, these evidence-based interventions create tailored goals and guided treatments that drive higher compliance and better outcomes. Through automation and intelligent integration, physicians are alerted to specific concerns and patient needs with minimal friction so the care team can intervene when needed. DTx becomes a digital extender for managing chronic care cases more efficiently and continuously, enhancing the patient-physician relationship.

As we witnessed the increased use of digital health tools over the past 18 months, acceleration of DTx has become prominent, with notable innovation on the certification, reimbursement, and regulation fronts in the US. Digital therapeutics will help build the roadmap to agile, personalized treatment of chronic conditions, presenting opportunities to provide better, smarter care.

HIStalk Interviews Bob Bailey, Founder, Healthcare IT Leaders

October 4, 2021 Interviews 1 Comment

Bob Bailey is principal and founder of Healthcare IT Leaders of Alpharetta, GA.

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Tell me about yourself and the company.

I’ve worked for 25 years in enterprise IT professional services firms that I have owned and operated. Our company is focused on enterprise applications, deployments, clinical information systems, business information systems, and a practice we’ve launched for COVID called Healthy Returns.

How has your business changed during the pandemic?

Our business changed dramatically as work-from-home became a strategy that we all had to get our arms around. Specific to our industry, a lot of our projects went offline by definition. We had to rethink who we are and what we do. Healthy Returns was a nice practice that we were able to establish in finding a way to be helpful to the communities we’ve served for the past 10 years. That has been a lot of fun and it has become a great success, so we are happy with that.

But it was clearly a time where we all had to sit back, reflect, and think about the business we have today and what might it look like tomorrow, then pivot in a number of directions to get it back on track. As the revenue came offline in the systems, a lot of these projects just started to disappear. It was a challenging time.

What changes are you seeing in the kinds of people who want to do consulting work?

I would say that we’re a work-from-home winner, our industry being professional services and software support. It has opened up wonderful opportunities for consultants, by and large, because they have so much more flexibility in their personal and work life. To us, it has been a tremendous uplift to employee morale internally and also externally for those that are working on behalf of our clients.

What services are health systems most commonly seeking?

We are a heavy Epic firm, as a good two-thirds of our revenue comes from the word Epic. There continues to be a dominant stance for that company, and therefore, a lot of work that we do on behalf of Epic-related clients and also due to continuing consolidation within the industry. We have also seen a tremendous uptick over the last two years in the business systems applications such as Workday, ServiceNow, Oracle, and Infor. Our business was built to support both the clinical systems and the business systems that an enterprise would have to implement and support. We are in the mid-innings, in a baseball analogy, of the overall business systems refresh that is going on in the health system.

Your mentioning Epic made me think of the consulting services arm it was launching a few years ago. To what extent do big software vendors support third-party consulting?

Epic and Epic Boost do a very good job inside of their customers, who then become our customers. Oftentimes we’re working side by side. We don’t see that as a threat to our business, but rather as complementary. If you look at Cerner, they traditionally have had a professional services organization on the ground implementing their software and we work very closely with them as well.

The key to working well with those two large vendors is understanding how they like to support their customers, what they want to do in addition to the software license sale itself, and then how we can cohabitate with them. We have found working with both firms to be a pleasure over the last 10 years. It’s a different set of challenges between those two organizations when you’re working with them, but once you understand what they’re looking to do and then how you can work with them, it becomes harmonious. Success for the client is what we’re both interested in. It has been good for us as a business.

What is the future of conferences such as HIMSS and Epic UGM?

In the healthcare enterprise, we talk about digitization. I think digitization of the conference world is a healthy thing, because we can get together more frequently and with less cost. It’s good for the customers. It’s good for the end clients of the software firms. It’s good for the vendors, in our case, the services firms. That’s healthy.

On the other hand, we are humans and we need to see each other and be around each other. The conference of old, let’s say HIMSS using that as the example, will never be as large as it once was. That’s actually a good thing. But we need to have a little bit of both.

How is the CIO role changing?

We were talking with a client recently who brought in a chief technology officer, who works for the CIO, from the retail industry. We have a number of those scenarios across the system now, where it used to be the CIO and his or her staff was always from the healthcare space, because it’s a unique space today. The good news is that we are starting to see that turnover and we’re starting to see a lot of the outside influences. When we talk about consumerism and healthcare, that’s an interesting thing to say. but does the CIO over the last 20 years really understand what to do about that? These outside influences that are coming in at leadership levels is helpful to that.

But clearly the CIO’s role was changing dramatically. The CIO has to think not only about traditional security, which is an incredibly complex topic, but now they have to think about the same thing for their at-home workforce. It’s a huge challenge. How do we secure Tim’s office, Bob’s office, and the devices they are working on? In addition to digitization, it’s the security piece, both inside the four walls and also now with the work-from-home piece of it.

A lot of the CIOs historically are clinically oriented, as they should be. They are driven to satisfy the chief medical officer and the clinicians with the applications that we bring to life. In today’s world, there’s this massive shift going on to large business systems implementations. They require a totally different set of personnel and leadership techniques. That’s the HR line of business or the finance line of business versus the clinical line of business that they are accustomed to supporting. That CIO seat is a challenging one these days.

How do you balance the value of bringing in outside experts in technology or consumerism who suddenly find themselves trying to understand the complexity of healthcare?

I’ll use as an example B.J. Moore, a friend at Providence who I’ve known going back to his Microsoft days, when he ran their finance division and we were helping them at the time with call center software called Siebel about 20 years ago. Since he came to Providence, you see them moving light years ahead of so many other organizations that are in healthcare. They are acting like a large enterprise, a large corporation, as relates to technology. Providence has been a long-time client of ours as well and they have tremendous healthcare domain expertise inside their IT organization. What they were missing was somebody with a vision to say, what do we do in this new world? How do we turn on the consumer? How do we interact with the patient? How do we treat the clinicians in a different way, to engage them and pull them into these systems that are so important for a place that large? How do we look at our EMR and how do we think about running that EMR as a mature client to reduce the cost of ownership? How does cloud impact our budgets and how can it help us scale our business and secure the business in ways that we’ve never thought about? Those influences are terrific and he has done a wonderful job.

My personal background is that I come from corporate business services for many years and started in healthcare when I created Healthcare IT Leaders 10 years ago. We are happily at our 10-year anniversary right now, so I have a perspective that is a little different than others that have been in the industry for 20 or 30 years. I think it’s wonderful. You need more of that kind of thinking, particularly now as we’re trying to get out to the consumer and make your life and my life that much easier before, during, and after our encounter with said health facility.

Providence has gone deep into providing commercial services as an IT vendor under the Tegria umbrella, while Ascension has decided that IT is not its core business and is outsourcing almost all of it. How are health systems defining IT as core competency?

Whatever industry you’re in, you’re going to have people that think about that question differently. You look at back to what Mercy was doing years ago and today, and look at what Providence is doing today. And then to your point, Ascension, with much different philosophies on core competencies. Providence and Rod Hochman and his team there are very much leaders and visionaries in how they are thinking about healthcare and healthcare IT services. They are looking at it as ways to increase revenue, being as important as it is when you’re an organization that large. Ascension is obviously an incredibly large place as well with a totally different viewpoint on this.

I’m not 100% sure what the right or wrong answer is, but I think you will see both of those models persist depending on the leadership in an organization. I like what Providence is doing. On one hand, it is competitive to what we do, but on the other hand, it’s collaborative. We work together to support Providence in partnership with Tegria. In my view, that’s all good.

Going back to Ascension, no question, that’s a great strategy.  We know a lot of the people there and the leadership and they’re doing wonderful things on behalf of all their clinicians and the patients that they serve. That model is working very well for them as well.

What near-term changes do you expect that will affect healthcare and your business?

Our business was created to satisfy the most important element in the IT organization, which is the clinical information system. But then after Meaningful Use came and went, we turned the chapter on clinical systems in 2017. We will always be there to do the good work we do, but we put a lot of focus and investment in business systems because we knew there would be this natural refresh cycle. When I look out three to five years, from our company perspective, we want to be an organization that is understood by the CIOs to be able to handle the clinical systems and the business systems.

More and more, this Healthy Returns practice becomes important with President Biden’s recent mandate on how you test, trace, and maintain the credentials of employees, vendors, and patients. We start to get into consumerism and pulling all this data together to say, it’s safe for Tim to enter a building and it’s safe for Bob to enter a building based on our policies as a health system. That will persist long after COVID comes and goes because we will never, ever allow ourselves to come offline to the extent we have during COVID times.

Over these next three to five years, those three elements and cornerstones of our business will continue to be dominant trends in the eyes of the CIOs, CFOs, and CMOs that we support.

Morning Headlines 10/4/21

October 3, 2021 Headlines No Comments

On CEO’s first day, Kansas City’s Cerner rolls out vaccine mandate for all U.S. workers

Cerner announces that it will require all US employees to be vaccinated by December 8, and has extended its return-to-office date to January 10, 2022.

Ensemble Health Partners Files Registration Statement for Proposed Initial Public Offering

Cincinnati-based hospital RCM vendor Ensemble Health Partners files IPO paperwork with the SEC.

NextGen Healthcare President and CEO David Sides Issues Open Letter to Shareholders

New NextGen Healthcare President and CEO David Sides urges shareholders to disregard founder Sheldon Razin’s disruptive efforts to take over the board by voting for company-approved candidates ahead of its October 13 meeting.

Monday Morning Update 10/4/21

October 3, 2021 News 6 Comments

Top News

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David Feinberg, MD, MBA takes the helm as president and CEO of Cerner.

Predecessor Brent Shafer ends his three years and eight months with CERN shares down 6% versus the Nasdaq’s 101% gain.


Reader Comments

From Hmmm…: “Re: HR, legal, and marketing. Do readers think they aren’t important because women are in those roles? They are major players in our organization and are heard and respected.” It’s not a lack of respect for the person or the position, but those jobs have limited headcount and budget and aren’t usually where CEOs are groomed as compared to sales, product development, and finance. I occasionally look at the executive team composition of big health IT companies, so here’s a few that I randomly chose today. Only two companies didn’t have a female VP of marketing, HR, or legal — one because its sole female executive works in another area, the other because it has no female executives. How does your company stack up?

  • Allscripts – 10 men, five women (including female VPs in HR, legal, and marketing)
  • Athenahealth – nine men, three women (including female VPs in HR and legal)
  • Cerner – nine men, five women (including a female VP of HR)
  • Change Healthcare – 10 men, three women (including female VPs of legal, HR, and compliance)
  • Definitive Healthcare – nine men, one woman
  • Cognizant – 10 men, two women (including a female VP of HR)
  • Greenway Health – seven men, six women (including female VPs of legal, HR, marketing, and compliance)
  • HCI Group – seven men, zero women
  • Health Catalyst – 17 men, 12 women (including female VPs of marketing, HR, diversity, and learning)
  • Infor – 12 men, three women (including a female VP of marketing)
  • McKesson – three men, three women (including female VPs of HR and legal)
  • Nuance – eight men, three women (including female VPs of legal and HR)
  • Olive – eight men, three women (including a female VP of marketing)
  • Premier – eight men, one woman (including a female VP of HR)
  • Teladoc Health – 10 men, four women (including a female VP of marketing)
  • Transcarent – seven men, six women (including female VPs of legal and HR)

HIStalk Announcements and Requests

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A big majority of poll respondents see no value in state-by-state clinician licensing.

New poll to your right or here: Have you faxed something in the past six months, and if so, what was the most recent example?

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

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It bugs me that Googling my name turns up all kinds of sketchy “people finder” data broker sites that list my age, current and previous addresses, family members, and sometimes email address, phone numbers, and voter registration information. I read about Optery and gave it a try and it has automatically found and removed most of the entries (more than 100 of them). It’s free for finding the sites, for which you then request removal manually without paying anything, or $10 per month to have Optery automatically submit removal requests for the top 80 sites (or up to $25 per month for 150 sites). The privacy benefit is obvious, but scammers also use the information displayed by these data brokers for stealing identities and placing fraudulent orders.


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Welcome to new HIStalk Platinum Sponsor Availity. The Jacksonville, FL-based company is where healthcare finds the answers needed to shift focus back to patient care. It works to solve communication challenges in healthcare by creating a richer, more transparent exchange of information among health plans, providers, and technology partners. As one of the nation’s largest health information networks, Availity facilitates billions of clinical, administrative, and financial transactions annually. Its suite of dynamic products, built on a powerful, intelligent platform, enables real-time collaboration for success in a competitive, value-based care environment. Thanks to Availity for supporting HIStalk.


Webinars

October 6 (Wednesday) 2 ET. “Solving Patient Experience Challenges Through a Strong Digital Front Door.” Sponsor: Avtex. Presenters: Mike Pietig, VP of healthcare experience, Avtex; Jamey Shiels, MBA, VP of consumer experience, Advocate Aurora Health; Chad Thorpe, care ambassador, DispatchHealth. Patients expect healthcare providers to offer them the same digital experience they get when banking, shopping, and traveling. This webinar will describe how two leading healthcare providers created digital front doors that exceed patient expectations, improve patient outcomes, drive loyalty and acquisition, and future-proof their growth strategies in competitive markets.

October 6 (Wednesday) 1 ET. “A New, Streamlined Approach to Documentation and Problem List Management in Cerner Millennium.” Sponsor: Intelligent Medical Objects. Presenters: Deepak Pillai, MD, physician informaticist, IMO; David Arco, product manager, IMO; Nicole Douglas, senior product marketing manager, IMO. The IMO Core CSmart app, which is available for Cerner Millennium in the Cerner code App Gallery, helps providers document with specificity, make problem lists more meaningful, and improve HCC coding. This webinar will review the challenges and bottlenecks of clinical documentation and problem list management and discuss how streamlined workflows within Cerner Millennium can help reduce clinician HIT burden.

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


Acquisitions, Funding, Business, and Stock

Shares in the Global X Telemedicine and Digital Health exchange-traded fund dropped 6% in the past month versus the S&P 500’s 4% loss.

Redox announces that its network grew by 291 new integrations in Q3, with 78 digital health companies going live at 208 provider organizations. It was the first live integration for 22% of those companies.


Sales

  • Novant Health chooses Visage Imaging to replace multiple legacy PACS in a $30 million contract.
  • HNI Healthcare will integrate the RCxRules Revenue Cycle Engine into its VitalsMD mobile charge capture platform.
  • L’Institut de Cancérologie de l’Ouest, a leading provincial cancer center in France, joins the TriNetX global health research network.

People

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Well Health hires Robin Hackney, MBA (FairWarning) as SVP of marketing.

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Ed Stelmakh, MBA (Otsuka Pharmaceutical Companies) joins OptimizeRx as CFO/COO.


COVID-19

Reported US COVID-19 deaths have hit 700,000, as one in 125 Americans aged 65 and older have died of it.

Cerner announces — on new CEO David Feinberg’s first day of work — that it will require all US employees to be vaccinated by December 8, 2021. The company also extended its return-to-office date to January 10, 2022. Cerner had said on August 1 that it would leave vaccination decisions up to individual employees. Meanwhile, Epic reports that less than 0.5% of its headcount – which translates to under 50 employees – left the company instead of being vaccinated by its October 1 deadline.

University of Ottawa Heart Institute researchers withdraw their pre-print article that incorrectly concluded that one in each 1,000 COVID-19 vaccine recipients develops myocarditis. The authors admit that a miscalculation, which was pointed out by readers, overstated the risk by 25-fold. The article was shared widely by anti-vaccine people and groups who, not surprisingly, did not share its retraction.

Merck says its investigational oral antiviral molnupiravir has reduced COVID-19 hospitalizations and deaths by half, to the point that the company and FDA agree to suspend the trial and apply for emergency use authorization. Some worry that availability of a $700, five-day oral treatment will convince people to avoid vaccination or to take the medication unnecessarily, some experts note that similar antivirals haven’t proven to be all the useful for COVID-19 when administered to large numbers of patients, and others note that the 50% improvement reflects the study’s less-dramatic drop in hospitalization and death from 14% to 7% among high-risk people with mild to moderate infection.

Scientists in England conclude that people who are vaccinated against COVID-19 are less likely to spread it even if they are infected.

FDA’s vaccine advisory committee will meet several times this month on significant topics – October 14 (Moderna boosters), October 15 (J&J boosters), October 15 (mixing and matching boosters), and October 26 (Pfizer vaccine for children 5-11).


Sponsor Updates

  • OptimizeRx publishes a new report, “Addressing Unmet Patient and Provider Needs in Diabetes: New Opportunities Through Pharma through Technology.”
  • Netsmart releases a new CareThreads Podcast, “Hospice: It’s Time to Go Back to the Future.”
  • Olive will hire an additional 300 employees by the end of 2021, expanding its workforce by 30%.
  • The “HIT Like a Girl Podcast” features PatientKeeper VP of Strategy & Innovation Sally Buta.
  • Greater Houston Healthconnect uses InterSystems HealthShare to create the largest known COVID-19 outcomes study.
  • Symplr releases a new case study, “Mount Nittany Health Embraces Symplr’s Controls & Checks for Peace of Mind.”
  • Sectra will be recognized with a Spine Technology Award for its implant movement analysis service at the annual meeting of the North American Spine Society in Boston.
  • EClinicalWorks releases a new customer success story, “How Healow Retooled the Front Office During COVID-19.”

Blog Posts


Contacts

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

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Weekender 10/1/21

October 1, 2021 Weekender 2 Comments

weekender 


Weekly News Recap

  • Microsoft invests in Truveta, the health system-owned data-selling company.
  • Walgreens is rumored to be considering the acquisition of Evolent Health.
  • A GAO report says three big donors of President Trump violated federal law by exerting improper influence on VA decisions, including their recommendation that the VA sell patient data.
  • Walmart announces that it will implement Epic across all of its health and wellness business lines.
  • ONC finds that third-party health apps have been slow to adopt the HL7 FHIR standard as mandated by the Cures Act.
  • Clinical research network vendor Elligo Health Research raises $135 million in a Series E funding round, with existing investor Cerner participating.

Best Reader Comments

I have long noticed when you run updates on promotions that the women featured are most often in HR, marketing, maybe legal, or some lesser important department. Rarely are they sales, CEO, or finance. Sorry, but there is still a very rampant Bro Culture out there. Don’t believe me? Ask your female staff! (JT)

I have asked Truveta if they will allow me to be removed from de-identified data sets and I have asked two participating healthcare organizations if they would remove me from their data submissions to Truveta. Only one organization responded, and they did not address the question. (Concerned_Patient)

A $20 billion valuation for Athena seems strange when you look at comparable companies. If I had to pick some companies that are in the same business as Athena, I would pick Allscripts, NextGen and R1 RCM. Adding up the valuations of those companies is maybe $8 or $9 billion. It’s hard to gauge Athena’s growth since they went private and everybody seems to have stopped publishing stats on outpatient EMR vendors. I get the sense their business improved, but more because the company started to be run more efficiently, not that they are blowing the other vendors out of the water on market share. (IANAL)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. S in California, who asked for headphones to support distance learning for her elementary school class. She reported in December, “Your generous donation has made an impact on my students’ lives. Due to distance learning, focusing has become a major challenge, as not all students have equal access to a calm, quiet, and safe learning environment. Access to headphones has made the task of focusing much easier. My students are incredibly thankful to you.”

A woman sues Springhill Medical Center (AL), claiming that ransomware-caused downtime prevented doctors and nurses from noticing test results that would have told them that her unborn baby’s umbilical cord was wrapped around its neck. The baby was born in July 2017 with brain damage and died in April 2020. She says the hospital should have disclosed its IT problems so she could have gone elsewhere for delivery. The hospital has made 678 objections for 88 document requests from the woman’s attorneys, arguing that its records are protected by Alabama medical liability laws. The woman’s lawyers say the records are needed to prove the hospital’s assertion that the downtime didn’t affect patient care.

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Cox Medical Center (MO) will issue panic buttons to 400 nurses and other employers after assaults by patients tripled to 123 in 2020, causing 78 injuries. The article didn’t mention the product, but I think it is Midmark’s real-time locating system Clearview badge.

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Hedge fund billionaire Leon Cooperman and his wife donate $100 million to Saint Barnabas Medical Center (NJ), for which the 597-bed hospital which will rename itself Cooperman Barnabas Medical Center. Cooperman hopes their donation will “improve the human condition.” The couple donated $25 million to the hospital in 2017 to create a 241,000 square foot expansion that was named after them.

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Federal agents seize 600,000 counterfeit 3M N95 masks from a Detroit storage facility for which an unnamed hospital had paid $3.5 million to a China-based company that has been distributing counterfeit masks all over the US.

An investigative report finds that financially struggling Griffin Health (CT) has earned $51 million in COVID-19 testing fees as part of its $138 million contract with the state as the primary contractor for nursing home testing. The proceeds provided 25% of the hospital’s total revenue for 2019 as it was paid $55 per test, double the amount of five other hospitals that signed similar contracts. The hospital says it paid $80 million of the money to a laboratory because it didn’t have capacity to process the samples.

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Sharp HealthCare ophthalmologist and informaticist Tommy Korn, MD writes on LinkedIn that he is using the macro capabilities of his IPhone 13 Pro Max to document patient care in the EHR, to show patients what he is seeing, and to support telehealth consultations. 

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Staff at Las Palmas Medical Center (TX) celebrate the return of orthopedic surgeon and active-duty Army surgeon Richard Purcell, MD, who spent three months in Afghanistan treating victims of the Kabul airport bombings.

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In rural Australia, the local transportation department denies a doctor’s request to have his NIssan GT-R sports car registered as an ambulance. Michael Livingston, MBBS hoped to install emergency lights and sirens on his car for responding to emergencies that can be 30 or more minutes away, saying that his speedy response makes other drives think he is challenging them to a race. He holds an emergency pass that allows him to exceed the speed limit when responding to a confirmed emergency. The Western Australia Department of Transport expressed concerns that the car lacks bars in the front to protect the occupant from kangaroo or livestock collisions, noting that, “A dead or severely injured doctor is of no benefit to the current emergency, your community, or any future patients.”  


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Morning Headlines 10/1/21

September 30, 2021 Headlines No Comments

Microsoft and Truveta announce strategic partnership to accelerate Truveta’s vision of saving lives with data

Microsoft makes an unspecified investment in Truveta, the data-selling company that is owned by 17 large health systems.

Evolent Health stock jumps after report of possible Walgreens takeover

Walgreens is considering the acquisition of care management technology vendor Evolent Health.

Vital Raises $15M Series A Funding Led by Transformation Capital to Advance Digital Transformation for Emergency Departments Across the Country

ED patient flow and status communications platform vendor Vital raises $15 million in a Series A funding round.

News 10/1/21

September 30, 2021 News 10 Comments

Top News

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Microsoft makes an unspecified investment in Truveta, the data-selling company that is owned by 17 big health systems. Truveta said in the same announcement that it has chosen Microsoft Azure as its cloud platform.

Microsoft says it won’t have access to Truveta’s de-identified data, but will integrate its platform into Microsoft Cloud for Healthcare.  

Truveta’s member health systems have invested $100 million in the company, which launched in October 2020.

Truveta CEO Terry Myerson is a former Microsoft development EVP.


Reader Comments

From LinkedOut: “Re: LinkedIn user articles. Your gripes with LinkedIn should include providing a platform for people whose expertise and abilities don’t deserve one.” The Internet has made it possible for anybody to post an article, publish a book, or create a video or podcast, some of whom do so in the area of health IT. While some creative voices have rightfully emerged as a result, there’s a lot of junk out there that the publishing gatekeepers of old would have turned down immediately for good reason. Some of it finds an audience through persistence, omnipresent familiarity, or self-promoting gimmicks. I will let the market do its job in picking winners.


HIStalk Announcements and Requests

I looked at the leadership pages of three unrelated health IT vendor websites today while getting news information. Vendor A’s executive team had 12 older white guys and one young female VP of human resources. Vendor B’s page showed 10 less-wrinkly but equally white guys (it was a newer company), two female VPs (HR and marketing), and one female operational exec. Vendor C’s team was nine men and three female VPs (legal, HR, and an operational exec). Toss out legal, HR, and marketing VPs –diversity’s lonely outposts in many companies — and these three random companies had just two female operational executives of 34. I draw no conclusions except it struck me since I wasn’t looking for that information and these aren’t companies I actively follow.


Webinars

October 6 (Wednesday) 2 ET. “Solving Patient Experience Challenges Through a Strong Digital Front Door.” Sponsor: Avtex. Presenters: Mike Pietig, VP of healthcare experience, Avtex; Jamey Shiels, MBA, VP of consumer experience, Advocate Aurora Health; Chad Thorpe, care ambassador, DispatchHealth. Patients expect healthcare providers to offer them the same digital experience they get when banking, shopping, and traveling. This webinar will describe how two leading healthcare providers created digital front doors that exceed patient expectations, improve patient outcomes, drive loyalty and acquisition, and future-proof their growth strategies in competitive markets.

October 6 (Wednesday) 1 ET. “A New, Streamlined Approach to Documentation and Problem List Management in Cerner Millennium.” Sponsor: Intelligent Medical Objects. Presenters: Deepak Pillai, MD, physician informaticist, IMO; David Arco, product manager, IMO; Nicole Douglas, senior product marketing manager, IMO. The IMO Core CSmart app, which is available for Cerner Millennium in the Cerner code App Gallery, helps providers document with specificity, make problem lists more meaningful, and improve HCC coding. This webinar will review the challenges and bottlenecks of clinical documentation and problem list management and discuss how streamlined workflows within Cerner Millennium can help reduce clinician HIT burden.

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


Acquisitions, Funding, Business, and Stock

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Bloomberg News reports that Walgreens is considering the acquisition of care management technology vendor Evolent Health. EVH shares, which are up 133% in the past 12 months in valuing the company at $2.5 billion, rose on the rumor.

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Weight loss app and telehealth vendor Found – which boasts that it allows bypassing doctor visits even though “obesity is a disease, not a decision” – raises $32 million in funding. The company offers prescription diet medications as well. I took its online questionnaire and it recommended the “Found Wellness,” no-meds plan at $49, which includes SMS-based coaching, weekly goal reminders, and community participation, adding up to one of the least-compelling offers I’ve seen. A business model that relies on overweight consumers who have failed in other weight loss programs to keep paying monthly fees for motivational text messages might warrant investor caution.

Intermountain Healthcare launches Tellica Imaging, whose standalone outpatient imaging centers will offer MRI and CT at flat-rate prices that are lower than hospital charges.

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Cerner CEO-in-waiting David Feinberg, MD, MBA says he decided to leave Google Health because he wants to disrupt healthcare, improve lives, and affect healthcare quality and accessibility. He didn’t mention the $35 million compensation package that he gets for leaving the dismantled Google Health.  

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ED patient flow and status communications platform vendor Vital raises $15 million in a Series A funding round.


Sales

  • UnityPoint Health’s home health services subsidiary chooses WellSky’s care coordination platform and personal care agency network as part of its SNF-at-home program.
  • Powell Recover Center (MD) will implement Netsmart’s CareFabric platform, Netsmart network, and MyAvatar integrated EHR.

People

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Fresenius Medical Care North America hires Shelly Nash, DO (AdventHealth) as SVP/CMIO.

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I missed this last week: The Joint Commission names Jonathan Perlin, MD, PhD, MSHA (HCA Healthcare) as its next president and CEO. He has a strong background in informatics at the VA, HHS, and Vanderbilt University.

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Release of information platform vendor Moxe hires Adam Dial (Providence) as SVP of partnerships.

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Divurgent promotes Steve Weichhand, MBA to EVP of client service.


Announcements and Implementations

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Lyniate launches Rapid, a healthcare API gateway and manager for developing and safeguarding APIs, including FHIR-based ones.

Augmedix will integrate Google Cloud Speech-to-Tex into its Notebuilder NLP-powered clinical note platform.

Nurx launches a birth control and sexual health knowledge skill for Alexa, which can provide pill reminders and answer questions.

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A new KLAS report on clinical communications platforms finds that 100% of respondents reported improved communication efficiency, especially with regard to clinician collaboration. Top satisfaction in workflows went to Halo Health (which is being acquired by Symplr) and PerfectServe Telmediq; Hillrom (which is being acquired by Baxter) and Vocera lead in broad adoption; and satisfaction with delivery of new technology is highest with Halo Health and PerfectServe Telmediq. Customers of PerfectServe Telmediq and TigerConnect also note that the companies offer patient communication, while Vocera Edge is the only third-party solution that can support nurse documentation through bi-directional EHR integration.


COVID-19

CDC urges pregnant women to get vaccinated as COVID-related deaths during pregnancy reached 22 in August, the highest monthly total of the pandemic. Only 31% of pregnant women have been vaccinated.

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A man who went to a freestanding ED in Texas for a COVID-19 test and is billed $56,000 in out-of-network fees, which his insurer eventually negotiated down to $17,000 and paid in full. Medicare would have paid just $100. The man’s wife was tested with him, but the ED company billed her just $2,000 and her insurance paid less than $1,000. Federal laws require insurers to cover the full cost without co-pays or other patient cost sharing.

COVID-19 is killing rural Americans at twice the rate of those who live in urban areas, with lower vaccination rates also causing already-limited healthcare services to be cut back as urban hospitals are unable to accept their transfers for higher-level care. Rural providers are also being hit by resignations of employees who refuse to be vaccinated despite mandates and their inability to afford the high hourly rates of nurse staffing companies. The head of the National Rural Health Association says nobody is addressing the issues and that “we’ve turned many rural communities into kill boxes.”

The New York Times reviews the use of at-home COVID-19 rapid tests, concluding that they will detect infections 85% of the time (with higher sensitivity when people are most infectious), optimal test timing is 3-5 days after known exposure or immediately if symptoms are present, and the tests give more accurate results if repeated a day or two after the first one. Challenges include a national shortage of the tests, the cost of $10-40 per test, and the inability of public health officials to track case counts unless someone who tests positive at home reports that fact to their local health authorities. 

Documents obtained by The Intercept show that conservative-focused groups are spreading disinformation about COVID-19, then making millions selling their followers telehealth-powered prescriptions for ineffective treatments such as ivermectin and hydroxychloroquine. A hacked database from telehealth platform vendor Cadence Health shows that 281,000 patients – 90% of them referred from America’s Frontline Doctors and its telehealth partner SpeakWithAnMD.com – paid $6.7 million in just two months for consultations alone. The database of digital pharmacy operator Ravkoo was also hacked and showed that the company filled 340,000 prescriptions in 10 months for $8.5 million, with 76% of the prescriptions specifying hydroxychloroquine, ivermectin, zinc, or azithromycin. Both Cadence Health and Ravkoo have stopped doing business with the groups. At least one prescriber included a disclaimer in their consultation notes forcing patients to acknowledge that government agencies categorize the drugs as “highly not recommended” and that they will not be held personally responsible for adverse reactions and are not subject to criminal charges, malpractice lawsuits, or state medical board disciplinary actions. The hackers said that the websites of the recently created companies were “hilariously easy” to breach and may have violated HIPAA.


Sponsor Updates

  • Frost & Sullivan recognizes Change Healthcare with its 2021 North American Customer Value Leadership Award for clinical decision support.
  • Spok publishes its “2021 Report: The State of Healthcare Communications.”
  • Gyant is among the 10 startups selected to participate in the inaugural AWS Healthcare Accelerator.
  • Medicomp Systems releases a new Tell Me Where it Hurts Podcast with Iram Fatima, MBBS, COO of CareCloud.
  • CareSignal publishes a white paper titled “Transform Your Population Health Strategy with Scalable Deviceless Remote Patient Monitoring.”

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 9/30/21

September 30, 2021 Dr. Jayne 1 Comment

Due to critical shortages of healthcare personnel and ICU beds, several states have declared “crisis standards of care,” including Alaska. As if they don’t need one more thing to worry about, a new virus has been detected in the state. Dubbed “Alaskapox” by the media, the virus was found in two additional patients who sought treatment at a Fairbanks urgent care clinic. The symptoms include skin sores, fever, joint pains, and swollen lymph nodes. Both patients recovered within a few weeks, but it’s worrisome as these cases are similar to an initial case in 2015 and another one five years later. The virus has been identified as one from the same family as smallpox and cowpox. Epidemiologic investigation linked the virus to outdoor cats who may have picked it up from cows or other mammals, including voles. Just goes to show that public health was important before COVID-19 and will continue to be important in the future. Let’s hope governmental entities show up with their pocketbooks to fund the kinds of investigations needed to tackle emerging illnesses.

A new report from AHIMA, AMIA, and EHRA asks for consensus on the definitions of “electronic health information” and “designated record set” to better help organizations operationalize the requirements found in the 21st Century Cures Act. The organizations had formed a task force last year in preparation for key compliance deadlines. The task force will be asking stakeholders for feedback on the report and will continue to refine their work as the 2022 deadlines for compliance to the information blocking portions of the Act approach. The health information export portion of the Act kicks in at the end of 2023.

I’m glad to see that EHRA is participating since its members are the ones that actually need to incorporate the definitions in the systems we use each day to care for patients. Especially given the need for interoperability and portability for patient data, it’s critical that vendors use a common set of definitions. Having worked with dozens of healthcare organizations over the years, there are so many other definitions that are nebulous, including the definition of the legal medical record. I’ve got some clients that think that the final “visit notes” that you can print from the EHR are the legal medical record, completely disregarding the idea that there is a lot of other information in the system that becomes part of the legal medical record. I can’t count how many hours I’ve spent trying to educate clients on this, but until recognition of the concept is required, there will continue to be confusion.

Looking back to 2019, physicians were already exhausted trying to do everything they needed to do to care for patients – managing in-office visits and managing non-visit encounters including telephone messages, patient portal messages, refill requests, pharmacy communications, insurance communications, and more. Throw 18 months of a pandemic on top of that and we’re seeing some serious burnout. A number of my close colleagues have left the clinical trenches, choosing to either retire early or leave medicine altogether. Someone sent me a recent article from the Journal of the American Medical Informatics Association that looked specifically at objective EHR measures (including time, volume of work, and proficiency) and whether they are associated with exhaustion and cynicism. The study was done in 2018 within the primary care clinics of a large academic medical center. It found that over a third of clinicians had high cynicism and more than half had high emotional exhaustion. Those that had the highest amount of after-hours EHR documentation time and those that had the highest volume of messages had greater odds of high exhaustion. No specific measures were associated to high cynicism.

I would think that cynicism is more likely to be associated with factors that can be difficult to quantify, including having to jump through regulatory hoops, having to deal with administrators that don’t have solid experience but are trying to push the latest and greatest thing they heard in their master’s program despite never having worked in healthcare, and having to deal with the moral injury that stems from not being able to deliver the care we were trained to provide.

As far as exhaustion being related to having high volumes of patient messages, I’ve seen it first hand. A while ago, I worked with a large national organization that was looking to optimize its EHR. Whenever I start one of those engagements, I begin with a current state assessment where I observe a variety of users – extremely proficient ones, middle of the road ones, and those that are struggling. I also observe providers at various visit volumes and across various subspecialties.

The first thing I found was that the organization had different policies depending on whether you were part of the “northern” medical group or the “southern” one. One set of clinics allowed their staff members to do preliminary triage of all messages and handle all the back and forth, while the other required the licensed clinicians to handle every single message in the inbox queue. It’s not difficult to figure out which clinicians were less satisfied and felt more overworked. The organization had never looked at whether it made sense to have different policies for the different regions, it had just evolved over time due to lack of overarching governance. I tried to engage them in a discussion of how modifying the policies could be helpful far beyond any optimization we might do with the EHR, but they weren’t interested.

They also weren’t interested in strategies that have been proven to enhance their patients’ ability to adhere with medication regimens – simple things such as providing refills through the next scheduled visit or providing medications for a year in stable patients. They absolutely refused to consider the idea of a delegated refill policy, where nurses or other clinical staff could check various parameters defined by policy then refill accordingly. They were perfectly happy to push the work up to the physicians rather than to embrace change.

After numerous discussions, it was clear that they just wanted to demonize the EHR. I left them with a lengthy report that included some changes they could make in their system that would help micro-level workflow on the screens, but the vast majority of changes that needed to happen were operations and cultural. They weren’t thrilled with my recommendations, but frankly their technology was in pretty good shape, although their people and processes were not.

Email Dr. Jayne.

Morning Headlines 9/30/21

September 29, 2021 Headlines No Comments

Kipu Acquires Avea, Combining the Best Clinical and Revenue Cycle Solutions for Behavioral Health

Addiction treatment-focused EHR vendor Kipu acquires Avea, which offers RCM software for treatment centers.

Biden-Harris Administration Provides Nearly $1 Billion in American Rescue Plan Funds to Modernize Health Centers and Support Underserved Communities

HRSA awards $1 billion to 1,292 health centers across the country for capital improvements and equipment purchases including telemedicine technology.

Telacare Health Solutions, LLC Acquires ViewMyID Health Assets

TelaCare Health Solutions acquires the assets of ViewMyID Health, a membership-based health data management company.

Morning Headlines 9/29/21

September 28, 2021 Headlines 1 Comment

Healthcare Triangle slated to go public this week

Cloud, security, advisory, and implementation services company Healthcare Triangle will likely go public later this week in an anticipated $40 million IPO.

Stellar Health Raises Over $60 Million in Series B Funding Round Led by General Atlantic

Value-based care company Stellar Health raises $60 million in a Series B funding round, bringing its total raised to $75 million.

EqualizeRCM Strengthens Physician Billing Expertise With Acquisition of Practice Resource Network, Inc. – Expanding in Tennessee

EqualizeRCM in Texas acquires competitor Practice Resource Network for an undisclosed sum.

News 9/29/21

September 28, 2021 News 6 Comments

Top News

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A Government Accountability Office investigation into the activities of President Trump’s trio of Mar-a-Lago associates finds they were involved in decision-making for no fewer than five VA programs, including its contract with Cerner, despite having no official ties to the agency.

A review of 223 email exchanges between the three men and VA officials found they also weighed in on personnel decisions, budgeting, and ideas around monetizing VA patient data.

One of the three, Bruce Moskowitz, MD, shopped the data-selling idea to Johnson & Johnson, Apple, and CVS after a consultant he employed said that “it can be leveraged into hundreds of millions in revenue.” No personal gain was implied in the proposal. Documents suggest that VA Secretary David Shulkin, MD liked the idea.

Another member of the group, former Marvel Entertainment chairman and CEO Ike Perlmutter, scolded Haley Van Dyck, then deputy administrator and co-founder of the White House’s US Digital Service, for communicating with Apple while excluding “our broader team of subject matter experts.” He accused her of exhibiting “clear disrespect for everyone involved” and “hijacking of this effort,” adding, “I will not allow this to happen while I am involved.”


Reader Comments

From Academic Doc: “Re: Teladoc. I found your commentary about its stock performance interesting. Our hospital started using Microsoft Teams for telehealth early in the pandemic. There were a number of glitches and problems with people downloading the app, but in general it has been pretty usable. We piloted Teladoc and it was horrible in performance and features, although a newer version helped. The main advantages seem to be that you don’t need an extra app installed and Teladoc has their own support to help patients (although we don’t yet know how responsive they really are). It allows patients to complete rating scales, consents, and other forms, which was a weakness with Teams and our patient portal, but it apparently won’t integrate with the EHR except as a PDF. It also doesn’t seem to accessibility features such as closed captioning and doesn’t support group sessions. It integrates with the EHR’s patient schedules but not Outlook, so you have to switch back and forth to see scheduled patients versus other meetings.”


HIStalk Announcements and Requests

I analyzed the first 100 items in my LinkedIn feed this morning, excluding promoted items, which yielded just 13 possibly relevant and interesting items (13%) as LinkedIn becomes more like Facebook every day:

  • Annoyingly flowery inspirational story written or liked: 20
  • Company or product pitch: 14
  • Interesting article link: 11
  • Personal article (deaths, new puppy, new school): 8
  • Congratulations to a company or person: 8
  • Recruiter or job available pitch: 8
  • Unrelated local event or link to unrelated article: 6
  • Social issue, company complaint, or COVID arguing: 6
  • Proud of employer or team: 6
  • Preachy how-to business instruction: 3
  • Excitement at attending a conference: 3
  • Self-promotion: 3
  • Need a job: 2
  • Mildly interesting company update: 2
  • Job update: 2
  • Relevant poll: 1
  • Irrelevant poll (what is the best chain chicken sandwich?): 1

Webinars

October 6 (Wednesday) 2 ET. “Solving Patient Experience Challenges Through a Strong Digital Front Door.” Sponsor: Avtex. Presenters: Mike Pietig, VP of healthcare experience, Avtex; Jamey Shiels, MBA, VP of consumer experience, Advocate Aurora Health; Chad Thorpe, care ambassador, DispatchHealth. Patients expect healthcare providers to offer them the same digital experience they get when banking, shopping, and traveling. This webinar will describe how two leading healthcare providers created digital front doors that exceed patient expectations, improve patient outcomes, drive loyalty and acquisition, and future-proof their growth strategies in competitive markets.

October 6 (Wednesday) 1 ET. “A New, Streamlined Approach to Documentation and Problem List Management in Cerner Millennium.” Sponsor: Intelligent Medical Objects. Presenters: Deepak Pillai, MD, physician informaticist, IMO; David Arco, product manager, IMO; Nicole Douglas, senior product marketing manager, IMO. The IMO Core CSmart app, which is available for Cerner Millennium in the Cerner code App Gallery, helps providers document with specificity, make problem lists more meaningful, and improve HCC coding. This webinar will review the challenges and bottlenecks of clinical documentation and problem list management and discuss how streamlined workflows within Cerner Millennium can help reduce clinician HIT burden.

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


Acquisitions, Funding, Business, and Stock

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Healthcare Triangle will likely go public later this week in an anticipated $40 million IPO. The cloud, security, advisory, and implementation services company was formed in June 2020 through the merger of health IT firm Cornerstone Advisors and software company 8K Miles, now known as SecureKloud.

Former HHS Deputy Secretary Eric Hargan launches a healthcare consulting firm offering advisory services, investor guidance, and legislative and policy expertise.


Sales

  • Walmart will implement Epic across all of its health and wellness business lines, beginning early next year with four new Health Centers in Florida. Some, if not all, of its clinics were using Athenahealth when they opened in 2019.
  • IHealthHome will add VitalTech’s remote patient monitoring technology to its senior-focused care management software.
  • The Marion County Health Department will implement Epic through a software sharing agreement with West Virginia University Medicine.
  • Unity Health (AR) will implement Meditech Expanse across its three hospitals and long-term acute care facility.

People

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MedeAnalytics names Steve Grieco (ConnectYourCare) CEO.

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Chris Powell (Aspenti Health) joins clinical assessment and triage software vendor ThinkMD as CEO.

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Lumeon hires Breht Feigh, MSc (Press Ganey) as CFO.


Announcements and Implementations

Southwestern Health Resources (TX) implements analytics and predictive modeling from ClosedLoop.

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Carolina Pines Regional Medical Center (SC) rolls out Vocera’s Ease app, enabling care teams to securely send messages to a patient’s family members.

Mile Bluff Medical Center (WI) will convert from NextGen to Meditech Expanse on October 1.

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A new KLAS segment insights report looks at how 27 health systems define the term “digital front door.” Click the graphic above to enlarge. Epic customers turn to Epic first for digital front door tools, while Cerner customers more likely look elsewhere to companies like Amwell, Kyruus, R1, and Well Health. Companies that have successfully carved out niches include Kyruus (provider search and match and self-scheduling), Krames (patient education delivered via existing platforms), and Zoom (video visits). Those health systems reported that a wide variety of their C-level executives oversee their digital front door programs, ranging from CEO, CIO, CMIO, chief digital officer, and chief experience officer. Only one-third of respondents sought outside help to create their program.


Sponsor Updates

  • Imprivata has celebrated the achievements of customers from the UK and Ireland at its annual HealthCon user group meeting.
  • Arcadia announces that its MSSP ACO customers generated $386 million in shared savings in 2020, averaging $10.7 million each.
  • Azara Healthcare completes the NCQA HEDIS Health Plan Measure Certification Program for 35 measure year 2021 HEDIS measures.
  • Central Logic congratulates Clinical Operations Regional Lead & Solutions Architect Charles Larson on being elected to the American Organization for Nursing Leadership Board of Directors.
  • CHIME releases a new Digital Health Leaders Podcast, “A Conversation with Aaron Miri, CHCIO, FCHIME, SVP, CDIO, Baptist Health.”
  • Dina will exhibit at the NAACOS Fall Conference September 29-October 1 in Washington, DC.

Blog Posts


Contacts

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

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Morning Headlines 9/28/21

September 27, 2021 Headlines 7 Comments

Walmart Selects Epic To Help Customers Simplify Their Health Care

Walmart will implement Epic across all of its health and wellness business lines, beginning early next year with four new Health centers in Florida.

Trump’s Mar-a-Lago Buddies Tried to Get the VA to Sell Access to Veterans’ Medical Records

Congressional investigators determine that President Trump’s trio of Mar-a-Lago business associates attempted to monetize VA patient data.

Former Deputy Secretary of the U.S. Department of Health and Human Services (HHS) Launches a New Healthcare Consulting Firm

Former HHS Deputy Secretary Eric Hargan launches a firm offering healthcare stakeholders advisory services, policy and legislative consulting, and investor guidance.

Med-Metrix Secures Capital Investments From A&M Capital Partners, Hackensack Meridian Health and Existing Management in Support of Growth Initiatives Including a Merger with Miller & Milone

RCM and business intelligence company Med-Metrix secures an undisclosed amount of funding and merges with RCM-focused law firm Miller & Milone.

Curbside Consult with Dr. Jayne 9/27/21

September 27, 2021 Dr. Jayne 1 Comment

Last week’s biggest medical news was the approval of COVID-19 booster shots for certain groups who had previously received the Pfizer immunization. When the announcement was made, one of the first things I thought about was how my clients would handle the need for outreach to populations who are now eligible. Certainly there would need to be some reporting to identify eligible patients, followed by communication, self-scheduling, and all the workflows we mastered earlier in the year. I wondered how long it would be before one of them reached out to me for assistance.

In the meantime, since I plan to be doing some in-person clinical work next month, I decided to schedule a booster dose for myself. Word on the street is that local pharmacies are throwing away doses due to lack of eligible patients, and if they’re going to waste a dose, it might as well go directly into the arm of a frontline physician.

I hopped online to see what my options were. The first place I looked was Costco, since I had a great experience there with my flu shot. Their website walks you through your vaccination history, but doesn’t ask anything about whether you are immunocompromised (which would have made you eligible for a third dose for several weeks) or your age. Instead, it gave me a happy green banner at the bottom of the screen that said, “Congratulations! You have received the recommended number of COVID-19 vaccine doses. You are officially vaccinated and do not need to schedule another appointment.”

The next place I checked was CVS. After a question about current symptoms and exposure status, I was asked whether I need to start the series, schedule a second dose, or whether I need to schedule a booster dose under the new criteria. Kudos to their IT team for updating the system quickly – things were looking promising. They also asked if I wanted to add a flu shot to the appointment (if available), so kudos for co-administration as a way of promoting public health. After keying in my date of last vaccine and that I had received the Pfizer product, it took me to a scheduling screen, where I quickly learned that there were no timely or convenient appointments at any of the three locations closest to my house. There were also no appointments available after 6 p.m. at the 10 closest locations. If we really want people to be vaccinated, we ought to make it convenient.

I also tried Walgreens, just for fairness if I was going to go the retail pharmacy route. Walgreens also had an updated system where I could quickly document my eligibility for a third dose or a booster dose depending on which criteria applied. Walgreens had an excellent assortment of evening appointments, but interestingly, none during the day – 5:45 p.m. was the earliest available slot. The site also offered the opportunity to add multiple other vaccines to the appointment including those for flu, shingles, pneumococcus, and Tdap. It was looking like the best option so far.

Glancing up at the vaccine card that’s stuck on the bulletin board behind my desk, I was reminded to think about the hospital where I received my initial COVID vaccines. There weren’t any opportunities to schedule vaccines of any kind within MyChart, only office visits, video visits, or telephone checkups. Visiting the health system’s website, it did appear that they were offering third dose appointments, but through a completely separate scheduling system depending on your state. After a few quick questions, it was on to the scheduling menu which had dozens of open slots but only on Mondays, Wednesdays, and Fridays, which might make it difficult for some patients depending on their work schedules. At the moment, my schedule is pretty flexible, so I scheduled for later this week. At the point where I needed to confirm the appointment that I selected, it offered me the opportunity to log into MyChart so that the appointment would be put on my record.

In hindsight, that seems like the best option regardless of convenience, because then all three doses will be from the same entity and I can download them all on a single record. Interestingly, the hospital in question hasn’t been very proactive about scheduling booster dose clinics for its employees and staff physicians, so it feels a little strange to be in the first wave of boosters when I’m not as exposed as others at the moment, especially considering how it was last December when the same health system was vaccinating its attorneys and marketing people but wouldn’t share doses with frontline urgent care physicians actively seeing dozens of COVID-positive patients each day. It just goes to illustrate how topsy-turvy and often without direction our healthcare system has become since this all started.

At a hospital where I have a pending application to be on the medical staff, they haven’t even started scheduling influenza vaccine clinics for employees despite typically starting them in September. Even though it’s not contraindicated to receive both vaccines on the same day, many people prefer not to receive two if they don’t absolutely have to. I’m hopeful that we have enough people masking and still modifying their activities that we have a flu season that is as mild as last year’s, but I’m not going to hold my breath.

I’ve got my talking points ready for any clients who reach out asking for assistance with scheduling of booster doses and have started putting some thoughts together on best practices for vaccine clinics in the event that the Pfizer vaccine is approved for children under age 12 next month. Parents in our community are clamoring for it as a way to avoid quarantines for their children as well as it being a way to try to restore some level of normalcy to childhood. I’m hoping that schools offer in-building vaccine clinics to make it easy for parents and caregivers, but given the politics around vaccines in some communities, that might be easier said than done.

How is your institution handling COVID-19 booster shots? Are you running recall campaigns, making a plan, or just trying to figure out how you’re going to address it? Leave a comment or email me.

Email Dr. Jayne.

An HIT Moment With … Ajay Kapare

September 27, 2021 Interviews 4 Comments

An HIT Moment With … is a quick interview with someone we find interesting. Ajay Kapare, MBA is chief strategy and marketing officer of Ellkay of Elmwood Park, NJ.

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How was the HIMSS21 experience for Ellkay and what are your plans for HIMSS22?

The team at Ellkay had a very successful HIMSS21 and our overall experience was just fantastic. And of course we would also like to thank you for the special shout out during HIMSS. This year’s HIMSS was smaller than in years past, for obvious reasons. However our team found a way to make the most of the opportunity and finally meet with industry colleagues in person again. Although we have accomplished a lot through virtual experiences over the past 18 months, nothing beats making personal connections face to face. It was really great and exciting to see how all of our hard work and planning had such a big impact and result.

As for HIMSS22, our planning is very much underway as it just around the corner. At HIMSS21, we had the chance to start new relationships, rekindle old ones, and revisit other facets of previous partnerships. We want to build on this momentum. Our goal now is to ensure we keep our HIMSS presence strong and establish the most effective methods of engagement from our HIMSS21 experience.

How do you go about setting goals for a conference like HIMSS and then developing a plan to achieve them?

Like with any marketing initiative, the first step was to evaluate Ellkay’s purpose of presence at HIMSS. We researched whether our own attendance would increase the chances of achieving strategic objectives, based on who we anticipated attending. Once our executive team determined the HIMSS audience would be an asset, we knew we wanted to make valuable use of our time there.

We take on an integrated and holistic approach with our marketing. Team Ellkay does not take on a project unless we can do it well. It’s like “Moneyball “in healthcare. We believe that many small things, done well, add up to make a big difference. All of those small items from our efforts, whether it’s training or graphics or social media posts, add up to make the event the best that it can be.

To pull this off requires collaboration between all of our contributing teams. The marketing team was essential in planning a dynamite, functional booth and scheduling innovative activities for sales to invite attendees to enjoy. The sales team then collaborated with strategies that attracted customers, colleagues, and of course prospects to our booth. We couldn’t do it without our product and operations teams, which have given us the foundation for compelling conversations and solutions we can be proud to demonstrate.

What advice would you give to to a small health IT company about developing or expanding its marketing efforts?

Ellkay’s event strategy is proactive marketing and sales collaboration. We did not just set up a great booth, then sit and wait for people to show up and ask about our products and services. Instead, we had already taken valuable time to build relationships and a reputation. Our colleagues at HIMSS intentionally sought us out, knowing we were there. The sales team was also in full partnership with our marketing efforts.

Each team member from Ellkay that attended HIMSS knew the type of HIMSS attendees and who they should connect with at the conference. This involves extensive research and pre-work for our sales team to set meetings in advance.

Ellkay is known for its conference giveaway of honey from its own bees. How did that come about?

Our co-founder and president, Lior Hod, had a long-held dream of raising honeybees. In 2015, there was a lot going on in the news about the declining honeybee population, so Lior decided to act. He called his beekeeper friend, who set up the first 36,000 bees on Ellkay’s rooftop. Our honey is harvested right at headquarters for our friends, colleagues, and conference attendees. Today, we have more than 1 million bees on Ellkay’s rooftop from 22 active hives. Every event we attend, we find the honey to be both a great conversation starter that really reflects our culture, as well as a memorable takeaway. Year after year, we have people returning for our honey, and of course good conversation.

How should a marketing team work effectively with the company’s executive team and its salespeople?

Events represent a significant investment of time and resources for every company. Before committing to an event, the executive team needs to evaluate whether it is a good fit for their strategic objectives. Once they determine if the event’s audience and message are advantageous to the business goals, the marketing team steps in. Marketing develops a strategy to provide the sales team members with the tools they need in order to achieve substantial relationships through the event.

All teams involved should be aware of the purpose in attending the event, the audience, the company messaging which best appeals to the specific audience, and the strategic targets all parties must try to achieve. We spend significant time internally strategizing and communicating to ensure everyone is on the same page and recognizes the significance of the event.

Additionally, no team should enter an event without a plan for evaluation afterwards. All teams must have metrics in order to assess how they performed at the event, and how event attendance helped the company achieve its overall objectives. The evaluation plan should be shared before attending so all teams know how their performance is to be graded.

After attending an event, our team always asks for feedback from all members of participating teams. This allows our colleagues to share their personal perspectives on areas they found that could use improvement, or methods that were particularly successful, for consideration on future event participation.

Readers Write: Curating Information to Reduce Physician Burnout

September 27, 2021 Readers Write No Comments

Curating Information to Reduce Physician Burnout
By Nele Jessel, MD

Nele Jessel, MD is chief medical officer of Athenahealth of Watertown, MA.

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No one in healthcare would dispute that it’s an enormous job to manage and distill all the patient data and clinical notes that are available with modern-day technology. Of course, technology has delivered many innovations and improvements to both the physician and patient experience. Yet sometimes even the most well-intentioned technology tools end up creating more challenges, with the unintended consequence of greater administrative burden, leading to provider dissatisfaction and burnout. I don’t know of any physicians who wanted to devote their career to the practice of medicine and are happy that they instead find themselves spending much of their time on administrative tasks.

A decade ago, my frustration with EHR technology – which made my life harder, not smarter – inspired me to open my own practice with the aim of using technology to automate workflows wherever possible. My goal was to spend more time with my patients and practice old-fashioned medicine in a high-tech setting. Over the past several years, my passion for the use of technology to drive advancements in healthcare and patient access, while facilitating the physician-patient relationship, led me deeper into the technology realm, resulting in my recent transition to Athenahealth, where I was once a client.  

At Athenahealth, we fielded a survey in late 2020 to a broad sampling of physicians about technological challenges and physician wellbeing. More than half of the physicians surveyed agreed or strongly agreed that technology supports their ability to deliver high-quality care to patients. However, the physicians also said the more they feel information overload (i.e., poorly curated information), the more it causes them stress in day-to-day practice, and the more often they feel burned out.

The irony here is obvious. We need technology to address physician burnout that is caused by technology. From the physician responses, it’s clear that the legacy technology to help with this issue has some room to grow.

Additionally, EHR technology has sharpened the focus on provider documentation, and therefore electronic notes can be voluminous compared to paper notes. With nonsensical coding and billing requirements to count the number of bullets in sections of the documentation, a rampant use of copy and paste has resulted in bloated notes. New coding guidelines for 2021 have shifted the focus away from bullet points to managing the illness and/or making medical decisions. It remains to be seen whether this change will translate into shorter and more succinct notes that capture all the relevant clinical information and tell the patient’s story without any extraneous information. 

With so much patient data available, managing the information and distilling it into exactly what is necessary to make decisions is a job unto itself. These burdensome administrative tasks are a serious problem when they take a physician’s focus away from direct patient care.

Practices looking to help with information overload should identify technologies that not only capture and store information, but also curate and translate data back into clinically meaningful terms. The increasing use of artificial intelligence and machine learning has the potential to transform how physicians work and interact with their patients.

For example, voice and ambient solutions integrated into the EHR enable automated messaging and speech-enabled applications that offer human-like interactions designed to help clinicians quickly locate key patient information and execute clinical tasks like navigating the exam and entering orders. Implementing the right technologies can help curate both the quantity and quality of information that a clinician must process, as well as minimize the manual effort required to integrate information from multiple sources.

We can do better for physicians to get the quality information they need for superior patient care.

Readers Write: Achieving Health Equity through Improving Diversity in Nursing

September 27, 2021 Readers Write No Comments

Achieving Health Equity through Improving Diversity in Nursing
By Karen E. Innocent, DNP, RN, CRNP

Karen E. Innocent, DNP, RN, CRNP is executive director of CE-CME for Wolters Kluwer, Health.

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In meetings among nurse leaders, one of them expressed pride in only hiring nurses who have played contact sports, because nurses who were involved in sports were good “team players.” As the group praised that nurse executive’s selection criteria, I thought back to when I was growing up and remembered that my sisters and I didn’t play team sports. It was not by choice, but that my parents emphasized academic study and college preparation.

I jumped into the discussion and said that only hiring athletes could result in lack of diversity because everyone is not able to participate in contact sports. Some families value academic achievement, some may have financial limitations, and others may discourage sports because of gender norms in their cultures. We should all consider that teamwork and leadership skills can be acquired from non-athletic activities including having a part-time job, community service, or scouts.

Diversity is often associated with race, ethnicity, religion, gender, sexual identification, or disability. In addition, diversity could be viewed more broadly as political views, interests, hobbies, or lifestyle. Nurse leaders and other hiring managers in healthcare have the human tendency to hire employees who have similar characteristics as themselves. When there is homogeneity among workers, the employees have similar perspectives, beliefs, and behaviors. While this is not inherently bad, it does present a serious concern in healthcare. Creating a diverse healthcare workforce is an essential strategy for improving the quality of patient care.

Unconscious bias and structural racism have been linked to healthcare disparities. Variability in patient care can result from a lack of representation between those patients and the healthcare organizations serving them. Overwhelming evidence points to the benefits of hiring healthcare workers in proportion to the diversity represented in the communities they serve. 

Since the Institute of Medicine report “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care” was published in 2003, healthcare leaders have recommended increasing the diversity among healthcare professionals. The landmark report synthesized decades of research and concluded that racism, discrimination, and lack of awareness of cultural needs of the patient population resulted in poor health outcomes among various underrepresented ethnicities and sexual orientations. Research in the same report demonstrated that physicians of similar ethnic groups as the population had better patient outcomes.

More recently, a United States study from 1992 to 2015 that controlled for socioeconomic status, age, education, and comorbidities found significantly higher mortality in black infants regardless of maternal risk factors (Greenwood,  Hardeman,  Huang, Sojourner, 2020). The authors recommend increasing diversity among nurses and physicians to reduce health disparities.  Patients experience better outcomes with healthcare professionals of the same race, and experience other benefits such as improved communication, empathy with the needs of the community, and development of appropriate interventions and care plans.

Achieving diversity is a process. In order to effect significant change, healthcare leaders must commit to addressing root causes that result in a lack of diversity, including outdated hiring practices and barriers to admission into schools of nursing.  Diversity experts recommend that employers target their recruitment efforts at networks including Black, Hispanic, and Asian & Pacific Islander nursing organizations, community organizations, and online social networks. They recommend improvements in the hiring process to avoid unconscious bias in the hiring decisions. 

Regarding nursing school admissions, many qualified nursing school applicants – including those of underrepresented groups – are turned away because of inadequate nursing faculty. Other barriers include inability to afford tuition and uninformed high school guidance counselors. According to the American Association of Colleges of Nursing, there are more than 80,000 qualified nursing school applicants turned away annually because of faculty shortages (AACN, 2021). As baby boomers are retiring, there are insufficient faculty to fill open positions. Low faculty salaries, lack of awareness of teaching opportunities, and lack of preparation in nursing education need to be resolved to fill this growing void.

Many students who meet academic requirements come from low-income households. They require scholarships and grants to attend nursing school. However, there is difficulty connecting these disadvantaged students with financial aid. Several research studies indicate that high school counselors are unaware of the demand for nurses, the academic requirements, and financial aid available to students. Lack of awareness and misinformation results in qualified students lacking guidance to pursue nursing as a career (Williams & Dickstein-Fischer, 2019).  More should be done to ensure that there is information and access in underrepresented communities to create a pipeline of diverse high school students to enter the healthcare profession. 

Perhaps the presence of healthcare workers who reflect the diversity of the community will not be enough. Therefore, all employees with patient interaction should have continuing professional development on diversity, equity, and inclusion principles and social determinants of health to facilitate delivery of equitable treatment. To build patient trust, there should be hotlines established to enable reporting of observed or suspected discrimination or inequitable care. Because we can’t fix what we don’t measure, health systems should track quality improvement metrics related to equitable delivery of care and implement action plans to help achieve their goals.

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