Morning Headlines 12/30/21

Billing software error leaks info of 1,600 Advocate Aurora patients

The health system says that a billing software error sent the billing statements of 1,600 patients to a single patient’s address, but the mail did not arrive at its destination.

Healthcare IT vet Paramore retiring from OptimizeRx

Miriam Paramore, who has been in health IT for 37 years, retires as president and chief strategy officer of OptimizeRx.

Information on the current situation — Update December 29, 2021 02:30pm CET

CompuGroup Medical says the “vast majority” of its customer systems are up and running as the company implemented its backup infrastructure.

Health IT Turnover Survey Results

This is a recap of the responses received over the past couple of weeks.

Vendor executive

• Significant turnover expected. Have lost 25% of staff, with marketing and sales most affected.
• Considering leaving because of an impending merger.
• Service levels have decreased at times.

Consulting contractor assigned to a single client for several years

• Significant turnover due to retirement, vaccine mandates, and junior staff who leave for better pay and less work.
• No special employer consideration except bonuses for clinical staff referrals.
• Long waits for implementation and some projects have been cancelled.

Software vendor

• Technical turnover, maybe 1%.
• Considering retiring in 2022.

Independent family practice office

• Saw 40% turnover in 2021, mostly MAs and front office. Were able to stabilize and hope turnover will decline in 2022.
• Salaries are up for existing and new employees.
• Patients haven’t been affected since staff pulled together.

Software vendor

• Turnover of 15-20%, heavier in developer roles.
• Have raised wages to closer match inflation, added monthly and annual incentive, boosted health insurance and 401K contributions.
• No impact on customers, but global sniping of roles creates musical chairs with insane pay jumps.

Academic medical center physician

• Lost 15% of faculty and added only 1-2 full-time replacements. Had to close some beds for months due to loss of nursing staff. One person left due to vaccination requirements, but the others left because they were disrespected by administrators, given inadequate protection against COVID, and were being subjected to an increased amount of physical violence and injury from patients. The IT people who left did so to retire – most could have kept working, but their pension had vested and they didn’t want to return to in-person work.
• I will probably stay where I am or retire.
• The hospital claims they are trying to enhance salaries and recruit nurses internationally. We’ve never been good at recruiting in my specialty, which has a shortage, so we’re just begging our residents to stay on July without real success. The bleak recruitment picture is fueling more departures from being forced to cover more patients.
• We aren’t able to see as many patients. Outpatient appointment waits can be 4-6 months. Inpatients get less attentive care even though we try our best.

Clinically integrated network plus insurance plan plus ACO

• Large loss of analytics headcount, not turnover, due to outsourcing. Outsourced staff left the new companies. Turnover among retained employees because of the mess.
• Would consider leaving due to leadership and management instability, lack of strategy, growing workload, and lack of morale. Seeking happy workers, remote option, sense of purpose, peer-to-peer support, professional development, and interesting not-rote work where I can think and be more than a cog in the machine.
• Employer is paying big dollars for some clinical positions such as CRNA. Bonuses in others, such as RN. Some retention bonuses around outsourcing, but not life-changing.
• Analytics and IT are seeing a loss of institutional knowledge and the good people are leaving. Service levels and response time are getting worse. We struggle to deliver analytics as other teams we rely on suffer.

Vendor executive

• We saw very high turnover in entry-level positions in Q3 2021, but this seems to have leveled out. These were mostly onsite support IT technician roles.
• Divisions have been given flexibility to offer work from home for suitable positions. HR and exec teams formed a committee that meets bi-weekly to analyze turnover data, most of which is collected in exit interviews, to develop strategy. I budgeted above-normal salary increases for 2022, anticipating that employees facing inflation will need more than the typical 3% increase to remain satisfied.
• No customer impact so far.

Consulting firm

• Turnover was 25-40%.
• Would consider leaving because of leadership response to COVID, pay discrepancies, and company culture. Will look for a more honest culture with a mission that more closely aligns with my personality. Executives with honor.
• Customers have seen slow work delivery, decrease work quality, lack of integrity.

Clinical analyst in a multi-state health system

• Heavy analyst and desktop support turnover. Long-term employees have been rebadged to contractors over the last 18 months and all of desktop are contractors now. Contracted analysts are offshore, are trained by a rebadged employee, and then the rebadged person disappears.
• I dislike physician training and that is being dumped on me, so I will look aroundfor a challenging and diverse role in a company that values loyal employees who work hard.
• The health system offers free lunch once a week, mostly for clinical and hospital staff retention, but I am remote, so nothing. We strongly feel that leaving or staying makes no difference to upper management.
• We have work not being done. One program broke and none of the replacements knows about it, so doctors just don’t get that information any more and no one cares. Tickets sit around for months because nobody knows what the product is or who handles it. Poor customer service from the help desk, especially Level 1.

Vendor technology director

• Engineering was the most affected turnover area, but it leveled off recently. I expect normal attrition next year, maybe 10-15%.
• Changed jobs for work-life balance, an opportunity to work for a more technically sound team and manager, a deeper focus on more complex clinical integrations, mission around the product, and a 65% pay raise for an equivalent role.
• We are using external recruiters and more focused sourcing. We do quarterly surveys for retention adjustments. We will start reviewing market level salaries quarterly and make adjustments.
• No impact on customers. We have grown, even with periods of significant turnover this summer. Our company is small but has strong processes and good release and monitoring capabilities, so new folks can ramp up quickly.

Health system VP/CIO

• Nursing has seen large turnover as staff leave to make more money as traveling nurses. It’s an unprecedented number. I’ve had a 20% resignation rate in IS versus a decade averaging 3%. COVID is encouraging people to reconsider their careers and either get out of IS or work remotely for more money.
• Sign-on bonuses have been critical for nursing. For IS, we are regrading all of our positions and evaluating salaries to make sure we are competitive.
• The hospitals have been full and cost is up due to the need to hire travelers and contractors. We are maintaining patient care, but not always able to staff beds, and have had to go on diversion at times. IS customers are seeing long lead times in service delivery and I have a long line of people contacting me with complaints.

Consulting firm

• My firm was acquired and we’ve seen a reduction in “material benefits,” such as FMLA at 60% after four weeks instead of full pay. I expected to see a lot of folks leave after 2021 bonuses are paid and this will likely hit us most at at the senior level.
• We are having to backfill from a contractor pool, which is fraught and limited.

Medical device vendor

• Turnover at all job categories and levels.
• Are offering referral bonuses, signing bonuses, and hiring less experienced staff so they have runway to grow.
• Customers are seeing slow delivery of new value and innovation and slower response times for services.

IT in FQHC of ambulatory clinics

• High turnover in MAs, nurses, and providers.
• Would look at offers with good compensation.
• Employer is offering more prizes in the Christmas raffle, better 401k matching, and one-time bonuses.
• No patient impact except a longer wait for appointments.

Software vendor

• I left my old job due to lack of advancement opportunities.
• Company offers flexible schedules and extensive work-from-home options.
• Customers have seen project timeline delays.

Vendor executive

• Turnover is highest in customer support, then developers.
• I would be looking for an employer with remote work and no vaccine mandates.
• The company updated the employee experience intranet, implement 360 reviews of leadership, increased referral bonus amounts, and made salary market adjustments.
• Customers have seen that we increased hiring, improved automation, upgraded our self-help knowledge base and portal, and adding chat bots for commonly asked questions.

Vendor executive

• We have seen a 15-20% turnover in sales and developers.
• I changed jobs to join a great team that offered better compensation, now hoping to stay put.
• The company pays well and treats people with respect and appreciation.
• I have seen no customer impact.

Vendor sales executive

• We have seen 35% turnover in trainers and customer support.
• My company’s new model is not sustainable and the future looks grim. I would like to work for a larger employer whose products and serves are geared for future technology.
• When we were going in to the office, the company stocked our kitchen with snacks and food for employees and offered five half-day summer Fridays on top of PTO. Now that we are remote, nothing.
• Customer support is suffering as we have lost experienced workers.

Vendor executive

• Turnover is at 15-20% and is in all areas – sales, technology, operations, legal.
• I have uncertainty about the long-term viability of the company and money.
• The company is increasing salaries, offering retention bonuses, and making a concerted effort around culture.
• Things are taking longer to get done and that cascades to our customers.

Vendor analyst

• Turnover is at 35% and I don’t expect those numbers to go down. Mid-level leadership, senior development, senior implementation, and a few VPs.
• I changed jobs because of leadership failings and layoffs that put too many good people out for no good reason. The pandemic layoff and pay cuts were particularly hard. I moved to a company that wanted to grow, needed my skill, and offered a 30% raise.
• If I leave, and I’m only thinking about it, it would be to hang out my own shingle and consult internationally.
• The company just eliminated PTO with the “take whatever you need” concept.
• Customers are struggling not only on the clinical side due to the pandemic, they don’t have the people to keep up with upgrades, new releases, and support. They need to align with a lot of new initiatives that will be available only in future releases.

Software and benchmarking vendor VP

• I anticipate very high turnover in software development, product management, high-aptitude analysts, data science and BI/data visualization, and any high performer who wants to make the jump to management.
• I plan to stay in 2022 as long as they’ll have me. I’m satisfied with my personal comp and the company mission still resonates with me.
• Employer is increasing pay bands, starting salaries, and annual merit raise percentages. However, it is also stressing a return to office and downplaying virtual work, which is hurting both recruiting and retention.
• Customers have seen no impact, but recruiting for 2022 remains a major risk point. We have plenty of revenue to invest in software development and business development, but recruiting challenges mean it’s difficult to execute with those dollars. Resignations haven’t hit us badly, but annual bonuses for 2021 are paid in Q1 2022 and we anticipate a wave of resignations.

Health insurer

• Turnover is higher than normal. We always have high turnover in our bilingual call center and it will probably get worse. Until we converted a number of jobs to full-time remote, we expected high turnover in IT.
• Full-time remote and hybrid jobs is the company’s biggest innovation in recruitment and retention. My employer was old-school about telecommuting despite being in downtown Los Angeles, where almost everyone has a lousy commute. Now that we’ve been getting the work done successfully for 18 months, they have generally accepted that it can work. We lost some staff to a competitor that advertised full-time remote jobs sooner than we did.
• Turnover has slowed a number of enterprise programs to roll out new services many of which are enabled by technology. We are a highly regulated entity and we’ve been struggling to meet all regulatory deadlines, in part because of a lack of people to do the work and make important decisions in these programs.

Health system

• 10-15% turnover in nursing and IT.
• Would consider leaving for flexibility and career advancement opportunities.
• The company is adjusting salaries.

Software vendor sales

• 10% turnover. Lots of engineering folks with a shift to cloud, on-prem resources will go. Lots of GTM changes due to poor company culture.
• Left due to company culture.

Software vendor sales

• Voluntary turnover has been low, but seems like it is ticking up. R&D has seen record turnover and I expect that to continue along with our implementation team.
• I’m concerned about the company direction. New product announcements talk about functionality we should have had years ago. I don’t see full digitization happening in the next 10 years, but shouldn’t we be working towards that assumption? We aren’t able to quickly produce new code and updates. Pay isn’t so great and there’s no indication it will improve.
• The company has had some sort of HR listening session with some teams, but it seems to have focused on soft things like culture rather than pay and product focus.
• Our customers are certainly impacted by loss of experience in the implementation team, which is directly visible to them. The R&D team is not visible to them.

Multi-hospital health system IT senior solutions architect

• We lost some folks earlier due to work-from-home policies, which have since been loosened up.
• Work-from-home is 100% and work in multiple states.

Morning Headlines 12/29/21

Idea of national patient IDs revives privacy fight

Politico reports that even though the Senate has removed its HHS funding ban of a national patient identifier, political roadblocks remain and an ONC report that summaries its risks and benefits is overdue.

CES 2022: Amid COVID surge, AMD and OnePlus drop out, joining Microsoft, Google, Intel

The Las Vegas consumer electronics show faces big-exhibitor pullout, news sites cancelling onsite coverage, and the likelihood of far smaller attendance than the previous 2020 show that drew 170,000.

All 695 hospitals, clinics of railways connected through software

All Indian Railways facilities have been connected to Hospital Management Information System.

News 12/29/21

Top News

Politico notes that even though the Senate has, for the first time, removed the prohibition of spending HHS money on a national patient identifier for 2022, nothing is guaranteed because of the way HHS appropriations work.

Sen. Rand Paul (R-KY) and Rep. Chip Roy (R-TX) have filed bills that oppose the development national patient identifiers.

ONC was supposed to create a report describing how such identification would work and the benefits and risk of implementing it. That report is is overdue and is holding up the process.

Reader Comments

From IANAL: “Re: Cerner. I suspect the voice assistant statement in Oracles press release was aimed at buyers or holders of Oracle stock. Many see Oracle’s main competitor as Microsoft, which acquired Nuance/Dragon. The press releases of big, boring companies are often aimed at shareholders since shareholders are interested enough to read company press releases and usually need calming after big company decisions. I wouldn’t take it as an indication of Oracle’s actual intentions for Cerner.” Excellent point. Companies often say things in acquisition press releases that don’t match their actual intentions, instead using the limelight opportunity to improve their image with investors. The claim that Oracle will make its little-known voice assistant the primary clinician interface for Millennium may well have been smoke-blowing to make Microsoft’s acquisition of Nuance seem less significant. It seems obvious that the biggest benefit to Oracle is buying a company that in essence resells a lot of its high-margin products (like the Oracle database) and to stave off the company’s move to AWS and force customers onto Oracle’s less-competitive offering. I doubt that the worksheet analysis used by Oracle’s acquisition team contained a lot of columns that predict the acquisition’s positive impact on patients and clinicians, healthcare costs, and outcomes.

HIStalk Announcements and Requests

Few poll respondents expect Oracle’s acquisition of Cerner to improve healthcare. Mike thinks a new focus on infrastructure will slow down the rollout of more-important product features, turning Cerner into another McKesson Horizon that will be sold for parts. Multiple commenters say that both companies are focused on sales rather than products, which is tough in healthcare where sales cycles are long and complicated. Khyber Pass makes an eloquent comparison of US healthcare to Afghanistan, where outside powers waltzed unknowingly into the “Graveyard of Empires” and were undone by fractiousness, complexity, and problems that the locals couldn’t solve. IANAL makes several interesting predictions:

• Meditech, once Neil Pappalardo is no longer involved, will sell to Oracle or private equity, will be acquired by a consortium of customers led by HCA, or will become irrelevant due to customer attrition.
• Oracle will wait for Northwell to leave Allscripts and will then buy the Allscripts hospital division on the cheap.
• Epic seems to be growing concerned about anti-trust issues as evidenced by its no longer using slogans involving world domination or market share. Oracle is tighter with the federal government, is a preferred bidder for government work, and is willing to outsource to India. Epic will move its focus outside of hospitals once it has run out of health systems to convert and the profits no longer outweigh the anti-trust risk.
• Hospital software improvement and innovation will stop unless US healthcare undergoes major paradigm changes.

New poll to your right or here: Which COVID activities will you practice to a greater degree in the first several months of 2022 compared to mid-2021? I’m trying not to fall victim to the “I’ll get it no matter what I do, so I might as well just live my life” symptom of COVID fatigue, but I’ll at least switch from cloth to KN95 masks in some or all situations. Omicron has changed the dynamic to where all of us probably know someone personally who has had it recently. Post-holiday case numbers will be crazy, although only a small percentage of those will likely result in hospitalization (but a small percentage of a huge number is still a big number of occupied beds that will be unavailable for medical needs of all kinds).

Webinars

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

Announcements and Implementations

In India, Indian Railways – the government-owned railway system that is the world’s eighth-largest employer with 1.3 million employees —  goes live on the Hospital Management Information System at its 695 hospitals and healthcare units, linked to the patient identifier of employees, family members, and employees. 

Mid-Columbia Medical Center (OR) and OHSU Health end most aspects of their longstanding collaboration agreement, which will require MCMC to move away from OHSU’s Epic system.

Other

Dr. Jayne is annoyed that the CES show denied her request for a media pass with a curt “insufficient credentials” response, but the January 5-8 conference might wish they had let her come given high-profile pullouts of dozens of companies from the in-person conference due to COVID-19 concerns – Lenovo, Microsoft, Google, Amazon, Intel, Meta (Facebook), and Omron Healthcare. Several tech reporting sites have decided not to send reporters to Las Vegas for live coverage of the conference, which drew 180,000 attendees the last time it was held in person in January 2020. CES declares that it won’t cancel the in-person show, saying that while 10% of exhibit hall space will now feature chairs and potted plants in being repurposed into impromptu lounges, smaller companies rely on the conference to do business. Some people still expect CES to either give up and cancel the show or try to put good spin (a la HIMSS and RSNA) on drawing 75% fewer attendees, many of whom had already decided to participate virtually or not at all even before emergence of the Omicron variant. According to one tech publisher, “You know something’s different on the Central Hall floor when you see the US Postal Service has really great booth position.”

A researcher says that nursing shortages, accelerated by pandemic-related retirements and reduced nursing school enrollment, will shift health system budgets away from expansion and acquisition of new technology. One travel nurse says the hospital she works at is so short staffed that she is paid more than surgeons, but many travel nurses say the money is only a short-term reason to continue practicing in a high-stress setting where hospitals don’t seem to value their mental health.

The coroner of an 80,000-resident county in Missouri – who, like many of his national peers, had no medical training or experience before he was elected to the low-paying job — tells a reporter that his office “doesn’t do COVID deaths,” having recorded COVID-19 as a cause of death zero times in 2021. Wavis Jordan, who is also a lay preacher, says families would need to provide proof of a positive test to have it included on the death certificate, which goes against CDC’s recommendation of taking symptoms and medical history into account. Many death certificates feature “garbage codes” such as “heart failure, unspecified” that are inappropriate as an underlying cause of death. A county coroner in Mississippi, where deaths labeled as “heart attacks” doubled in 2020, says family members often refuse to allow COVID-19 on death certificates until they learn that the federal government pays for the funerals of people who die of COVID-19.

HuffPost covers private equity’s heavy acquisition of hospice chains, with the number of PE-owned hospices tripling from 2012 to 2019 in a quest to cash in on dying baby boomers in a lightly regulated industry for which Medicare pays generously. Their formula involves slashing costs and staffing and pushing marketing teams to sign up people who might not actually need hospice services. One hospice company that says it is one of the fastest-growing companies in the US declines to name its owner, even after its private equity owner paid $200 million to buy a British Formula One racing team (racing reporters believe the owner is a low-key Hong Kong billionaire). Profits are high because Medicare pays the same per-day rate regardless of complexity, so an aide who feeds a patient lunch is billed at the same rate as a nurse who runs an IV. The acquired hospice market heavily to assisted living facilities since servicing patients who live under one roof increases efficiency.

Contacts

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

Curbside Consult with Dr. Jayne 12/27/21

I’ve been working on a project with a new client for the last couple of months, and it’s been interesting to say the least. It’s been a great example for why you need to make sure that you have the right people at the table while you’re proposing the project, while you’re designing the technology, and especially while you’re executing it.

I was brought in initially to be a purely clinical resource, working with an existing clinical team to develop some evidence-based content that would feed an organization’s rules engine. It seemed straightforward until I really got into it.

The existing clinical folks were purely clinical and didn’t have an understanding of what happens when you try to put clinical information into a rules engine and how to think about documenting what needs to happen. They also had an extensive inpatient background, but minimal experience in the outpatient world, which is where the new content was to be used. They were also heavily academic and didn’t have a good understanding of how a busy ambulatory practice runs or how “just in time” the content needed to be in order to make sure the users weren’t overwhelmed. They were willing to learn, though, and once we brought them up to speed with a mini clinical informatics course, they were able to hit the ground running.

We were given some parameters around how we needed to document the content specifications, but since the front-end of the rules engine hadn’t been built yet, we were somewhat at the mercy of the designers to understand how the users would interact with our content. Wireframes were available, but don’t always tell the full story of how a workflow is going to feel or function. As we started presenting our finalized content, it became clear that we had built it to a different level of specificity than the rules engine could support. We had to do some rework to eliminate some of the granularity while maintaining the intent of the clinical rules. Although it was workable, I wasn’t entirely happy with it, but I understand that there often has to be some give and take as software is built.

After several months of development, it was time to do some user acceptance testing and we had our first look at the user interface in action. The physicians really liked the look and feel of how the rules engine connected to the workflow. It was almost seamless, until you got to the point where it was actually running. There were some definite lags in the performance as the application was trying to serve up the content we had built. At this point, the development team asked a question about how it was supposed to work and whether the users were supposed to be documenting by exception or documenting certain elements of the workflow. Since the physicians had been specifically told to build the content to support documentation by exception, this was surprising.

The mismatch in how we expected the content to perform compared to how the developers thought it was going to perform turned out to be the cause of some of the performance issues. This could have been avoided by having more cross-functional discussions earlier in the project, where everyone reviewed the specifications documents together and were able to ask questions directly. I understand the motivation in not bringing everyone together initially, since there were concerns about coordinating schedules, making sure that expensive resources were only used when needed, and that there was an understanding that the project managers were coordinating everything. Ultimately, though, it led to rework, so I’m not sure how much that decision actually supported efficiency or cost savings.

Working together, we found a few things that needed to be adjusted in the content, and they began working on changes to the rules engine. To the team’s credit, they did a quick turn-around, and at our next testing session, the workflows were performing much better. We were all very excited to get it in front of users from one of the organization’s practices and held a very small testing session where everything passed with flying colors. The next step was to release it to a single practice that had agreed to serve as our beta client.

The team had planned to hold a combined testing/training session to accomplish a couple of goals. First, making sure the rules engine performed under stress, then also making sure that the training materials and training strategy met the users’ expectations. We identified a couple of places where the materials could be tweaked for clarity, and the performance lags we had seen in the initial testing environment seemed to be gone. Everything was ready for the move to production a couple of weeks later, but unfortunately the biggest challenge was still yet to come.

The organization likes to roll out new features on a Wednesday since it’s typically calmer for an outpatient practice than a Monday. It also allows users to get used to the content for a couple of days and then have the weekend to recover if the new feature creates a stressful level of change in the workflows. They had asked the physician content creators to be available in case there were questions about the clinical aspects of the rules, so we had all blocked our schedules and were ready for the big day. It’s always exciting to see something become reality after it’s been largely theoretical for so many months.

Unfortunately, on Monday, the execution phase of the project started falling apart. Apparently, the operational leaders that the project manager had been talking to hadn’t mentioned that two of the practice’s busiest physicians had planned to take the week off to attend a conference and wouldn’t be present for the go-live. The team was happy to support whoever was available to go live, but we knew that there would likely be budgetary concerns about having the entire support team, including the physician content team, available for a secondary go-live with the remaining members of the practice. We couldn’t just push the go-live back a week because there were concerns about the physicians being busier than normal coming back from being gone for the conference.

Pushing two weeks into the future would put us in the middle of Thanksgiving week when key staff would be out of office, and then the next week would be a post-holiday week with a potential volume surge due to having been closed. Following that, the schedule was peppered with absences due to pre-holiday vacations, followed by the Christmas holiday, and more planned vacations. Having that failure of operational communications has now caused the go-live to be pushed from early November into late January, which isn’t what anyone expected, and in the mean time the lead developer announced that he had accepted a position elsewhere.

It remains to be seen how the rollout will go if we ever get to it. Failure to have the right people at the table cost us initially with the development process and then on the operational side. Looking at the root causes of the communications failures, I’m not sure the project ever had the right level of executive sponsorship to keep it on track or to ensure people were giving it the focus it deserved. As we all know, there’s no test like production, so everyone is eager to get things moving so it can be rolled to the rest of the organization. I’ve already started another engagement with a different client, but I still want to see this one through, so hopefully the January 2022 date will hold.

How does your organization handle shifting timelines? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/24/21

EU clears Microsoft-Nuance without conditions

The EU’s competition regulator says it has no anti-competitive concerns with the deal.

Digital Health Technologies for Remote Data Acquisition in Clinical Investigations

FDA publishes draft guidance on using digital health technology to acquire data remotely from clinical investigation participants.

FDA’s Policy Changes for COVID-19 At-Home Diagnostics—Implications for Addressing Other Infectious Diseases and Future Pandemics

Former FDA Commissioner Scott Gottlieb, MD says in a JAMA Forum article that at-home diagnostic tests may be the most enduring technological innovation of the pandemic, so it will be critical to connect those tests with telemedicine to reduce office visits and increase access to care.

News 12/24/21

Top News

Medical software vendor CompuGroup Medical was hit by a ransomware attack on Saturday that has affected its network and telephone support systems. The company is setting up emergency telephone numbers and email addresses for customers.

Reader Comments

From Historian: “Re: Oracle acquiring Cerner. Acquisitions like this don’t usually work out well for health IT customers.” Very true, especially if the acquirer is new to healthcare and states upfront that its primary motivation of the acquisition is to increase growth. Extra negative points since Oracle seems to think that what Cerner needs to finisher higher than #2 in a three-horse race is bolted-on, market-lagging technologies such as its voice assistant. Oracle also may underestimate the challenges that lurk underneath its glib statement that it will magically increase non-US sales of Cerner products. The clinking of milkshake toasts must be echoing throughout the Verona cornfields, with the only other delighted parties being Cerner shareholders and the heirs of Neal Patterson, who are stacking their cash with fingers stuck in ears to avoid hearing him rolling over in his grave.

Webinars

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

Acquisitions, Funding, Business, and Stock

The EU’s regulator approves Microsoft’s acquisition of Nuance, which it says raises no anti-competitive concerns.

Sales

• MUSC Health will implement Sectra’s enterprise imaging solution in a subscription model that covers its main campus, several satellite locations, and all affiliated regional hospitals in South Carolina.

Announcements and Implementations

Vyne Dental announces enhancements to its Trellis revenue cycle and communications platform.

Government and Politics

FDA issues draft guidance on using digital health technologies for remote data acquisition in clinical studies.

Other

The co-founder of the COVID Tracking Project says in The Atlantic that the US is about go temporarily blind in the Omicron variant fight because the folks who collect and report testing results take holiday periods off. Cases will appear to be dropping sharply over the next several days due to underreporting, then will skyrocket in the first several weeks of 2022 as the data backlog is cleared (or as infection rages, or both – it won’t be possible to tell). The only data that is likely to be accurate is HHS’s hospitalization figures, which are more of a record of interventions gone wrong than an early warning system. I think hospital admissions and deaths will become the only relevant numbers since case counts and positivity mean little when nearly everybody is going to become infected and the tools that can blunt the infection’s damage become more important.

An interesting aspect of the ransomware downtime of Ultimate Kronos Group’s cloud-based payroll system. Health systems that can’t access hourly pay records are being forced to issue employee paychecks in the same amount as a weeks-ago pay period. That means that not only will they have to claw back any overpayment right after Christmas (assuming the system is restored soon); they have to deal with newly hired employees, people who received bonuses or overtime in the pay period that is used; and W-2s will potentially be affected by paycheck adjustments.

The New York Times says Pediatrix and its parent company Mednax are earning millions of dollars each year by showing up at the bedside of a newborn’s mother and offering to administer expensive hearing tests, which the mother assumes is covered by the hospital stay. Pediatrix – which also offers pediatric intensive care, pediatric surgery, and obstetric services – is administering the hearing tests to nearly 1 million babies per year. Aetna sued the companies three years ago for inflating charges by more than $50 million but eventually settled, although Mednax admitted in court that it destroyed emails in which it pestered its doctors to upcode procedures. Pediatrix sponsored a successful campaign to pass state laws requiring hearing tests for newborns, then started doing a test that costs several hundred dollars instead of the previous $50. Patients have complained about the surprise bills, with at least one hospital warning expectant parents that the company may not be an approved provider under their insurance and that the company balance-bills patients for what insurance doesn’t cover.

Contacts

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

EPtalk by Dr. Jayne 12/23/21

I haven’t been anywhere near the physician water cooler this week, but around the healthcare IT water cooler, the hot news (as expected) is the Oracle acquisition of Cerner.

I haven’t heard any optimism around it. Most of the comments are of the “lots of organizations have tried to succeed in healthcare and they all fail” variety. Many see it simply as a way for Oracle to increase its customer base as well as it being a win for Epic since customers who might have debated between it and Cerner choose the path that isn’t about to undergo changes to leadership and strategy.

I’ve been involved in a couple of EHR replacement evaluations where Cerner was a contender, but failed to win the deal despite being less costly than the alternative. Primary care physicians tend to find it underwhelming for high-volume ambulatory practices. It will be interesting to see if Oracle does any better at winning those hearts and minds with their promises of voice recognition-based workflows and automation of care delivery.

As far as the virtual hospital hallways are concerned, I’ve been in contact with several friends who are nurses, one of whom is currently infected with COVID-19. They’re irate at suggestions that infected healthcare workers should be subject to shorter isolation periods to avoid straining the US healthcare system. Especially with many healthcare organizations continuing to fail at providing adequate personal protective equipment, including N95 masks, asking those who have shouldered the burden of care to put themselves at additional risk working alongside COVID-positive colleagues is something we never imagined would be suggested at this stage of the game.

My COVID-positive friend, who happens to be an ICU nurse, commented on how beneficial it has been for her to actually sleep for as long as her body needs. She has found her isolation to be somewhat restorative even though she is having mild coronavirus-related symptoms. Asking for additional sacrifice from those workers to care for what truly has become a pandemic of the unvaccinated just rubs salt on existing wounds and will not bolster the morale of healthcare workers. I would propose that if anything, it makes them feel that people think they are expendable.

Another hot topic among healthcare policy friends is the jump in US health spending. The number topped $4.1 trillion for 2020 as we attempted to fight COVID-19 in our dysfunctional and misaligned way. Case in point: COVID testing. My county testing with no direct cost to patients through multiple drive-through clinics. Results are generally delivered same day via email. Appointments are readily available on its website, with dozens of unclaimed appointments each day. Despite this, I see dozens of posts every week in various community-focused Facebook groups and other forums where patients are looking for open slots at CVS, Walgreens, and other pharmacies because they are booked solid.

My former clinical employer is running four testing sites that do several hundred visits each day, but with a twist – they require each patient to be seen by a licensed provider (MD, DO, NP, PA), which results in a full visit billed to the insurance company. Since patients don’t incur that cost up front, they don’t understand that what could have been a relatively cost-effective testing visit has been inflated by a factor of 10. Even if they don’t pay the cost out of pocket, they’re going to pay it down the road through increased insurance premiums and shifts to cost sharing.

These processes are why spending has jumped nearly 10%, double its usual rate, with no corresponding improvement in outcomes. I don’t think people realize that $1 of every $5 in the economy is going to healthcare. Even if people did, I’m not sure it would have much meaning to them.

Other interesting tidbits in the report, since it’s hiding behind a paywall:

• Health spending works out to approximately $12,500 per person.
• The count of uninsured individuals held steady, although there was a shift in those covered from workplace-based policies to Medicaid and Affordable Care Act marketplaces.
• Medicare beneficiary counts grew more slowly due to significant numbers of deaths in those aged 65 and older.
• Individual out-of-pocket spending decreased due to deferred care, such as postponed surgeries and screening procedures.

The latter two are certainly negatives in my book. Where senior citizens accounted for roughly 15% of all COVID-19 cases, they represented 80% of the deaths. The loss of so many family members and loved ones is tragic. I’m fortunate that the elders in our family are extremely healthy and their living situations allowed them to be protected thus far, but plenty of my friends and colleagues have lost an entire generation to the virus.

I’m hearing a lot more this year about people planning to test prior to family gatherings. Hopefully that will help prevent at least a small amount of transmission and reduce the strain on our overwhelmed healthcare workers. I’ve been generally pre-quarantining just to be on the safe side, but not everyone has the luxury of working from home.

I enjoyed attending the Consumer Electronics Show last year, even though it was virtual. There were plenty of products to check out and many of the companies did a great job trying to engage the virtual audience. Obtaining a media registration last year was easy, but they made things trickier this year for me since a photo is required even for digital attendees. My credentials are still pending approval, so there’s no guarantee I’ll be on prowl in the virtual exhibit hall this year. I’ve lived a full year without the $16,000 bathtub I was eyeing last year, so I guess if I can’t attend, I will survive. One of my colleagues is attending in person and I’m a bit jealous, but I’ll be holding down the fort while he’s gone and will have to rely on him for the in-person buzz.

What conferences are you looking forward to attending this year, or do you think COVID-19 will keep us all close to home again? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/23/21

Technical failure — Update December 22, 2021 08:30pm CET

CompuGroup Medical reports that it was been hit by “a so-called ransomware attack” on Tuesday morning whose effects have continued.

HFRI Changes Name to ParaRev; Move Reflects Expanded Revenue Cycle Capabilities

Healthcare accounts receivable recovery and resolution management company Healthcare Financial Resources changes its name to ParaRev.

Transition Plan for Medical Devices Issued Emergency Use Authorizations (EUAs) During the Coronavirus Disease 2019 (COVID-19) Public Health Emergency

FDA issues draft guidance for medical device manufacturers that are selling products approved under EUAs on how to transition to normal approvals once EUAs are discontinued.

Morning Headlines 12/22/21

Oracle’s Cerner Purchase Prompts a Trio of Debt-Downgrade Warnings

Several investment firms and bond ratings organizations downgrade Oracle’s shares and debt due to the cash requirements and possible lack of strategic value in acquiring Cerner for $28 billion in cash.

Oracle’s $30 billion Cerner deal is about more than health care records. It’s about AI.

A privacy advocate worries how Oracle, which runs the world’s largest third-party data marketplace, will use Cerner’s EHR data after the acquisition.

AccessOne Acquires CueSquared

Patient financial solutions vendor AccessOne acquires patient payments platform vendor CueSquared.

News 12/22/21

Top News

Several investment firms and bond raters downgraded Oracle’s shares and debt Tuesday following its announced intention to acquire Cerner. They worry that the cash payout is large and Cerner’s offerings aren’t strategic to those areas where Oracle should focus.

Oracle has $23 billion in cash and will likely need financing to complete the Cerner acquisition for its offer of $28 billion in cash.

ORCL shares dropped 5% on the announcement Monday and were flat Tuesday.

Oracle’s biggest previous acquisition was PeopleSoft, which it acquired for $10 billion in 2004.

Reader Comments

From Change of Control: “Re: Cerner. Could CEO David Feinberg really have been key to the Oracle acquisition given that he’s been on the job for less than three months?” That was my immediate question as some seemed to give him credit for the deal. Either way, he’s even more fabulously wealthy than when he started on October 1 – shares in his $35 million compensation package have jumped in price. He is also protected by a change-of-control employment clause if Oracle fires him within 12 months of closing the deal (two years of base salary, 24 months of benefits, immediate vesting of shares, and his initial $1.35 million cash bonus). It seems from the cheap seats that Oracle would have pursued its long-rumored acquisition regardless of who was sitting in the CEO chair, and the fact that it was the new guy Feinberg is very good for him. I doubt Oracle based its plans on his ongoing involvement or found Cerner to be a more attractive target because the CEO spent less than three years working for Google. It may well be that 77-year-old Larry Ellison’s testosterone kicked in (a common tech punch line: “God doesn’t think he’s Larry Ellison”) at the chance to steal an AWS client and to match Microsoft’s acquisition of Nuance by rather wildly claiming that Oracle will make its voice assistant the primary clinician interface to Millennium.

From On-Demand: “Re: Cerner. Oracle is buying into healthcare, not buying into a sexy acquisition.” I agree. CERN revenue and shares haven’t budged much in years, the company lost a lot of its executive talent (to the benefit of other health IT vendors) while Brent Shafer kept the CEO chair warm for his short and generally forgettable three years, and Cerner is #2 and losing ground in its primary business. Oracle’s history involves milking database customers hard while missing trends such as cloud, AI, and voice assistants, but revenue from the former lets them belatedly buy their way in. Tech analysts raised interesting questions: are more Oracle acquisitions imminent since the company historically plays aggressive catch-up, and will Salesforce be pushed into broadening its modest healthcare presence?

From Bob Loblaw Law Blog: “Re: Cerner. Oracle triggers more customer complaints than any software vendor I’ve seen.” A class action suit that was filed in early 2020 claims that Oracle’s shares were tanking because it failed to predict cloud-based competitive threats, so the company boosted its numbers by forcing customers to buy its flawed cloud offerings by using a strategy called “Audit, Bargain, and Close.” The lawsuit claims that Oracle intentionally installed on-premises software that boosted the customer’s license usage without their knowledge, then threatened to impose large license agreement penalties unless the customer accepted a cloud subscription that they didn’t want and wouldn’t use. The lawsuit quotes a company executive who said that up to 95% of the company’s cloud sales involved these “financially engineered deals” that were designed to mislead investors into thinking that Oracle’s cloud strategy was working.

HIStalk Announcements and Requests

I’m curious about what you think about Oracle’s planned acquisition of Cerner. Let me know. I’m thinking of these themes:

• How does Oracle perform as a health system vendor (database, HR, ERP, EMPI, etc.)
• How well does Oracle’s Voice Digital Assistant work? Could it really be suitable as Millennium’s primary user interface for clinicians?
• What is the customer impact of Cerner moving from AWS, which is already complete for some systems and in process for others, to do an about-face move to Oracle’s Gen2 cloud services?
• How will Cerner’s VA and DoD business be affected?
• How many on-the-fence Cerner customers and prospects will be spooked by uncertainty and will instead make a quick Epic decision?
• What will Oracle’s strategy be given that much of healthcare, including Epic, uses InterSystems Cache’ rather than relational databases like Oracle’s?

Speaking of the acquisition, let’s give credit to some HIStalk readers who called it early (July 25, 2021). Eddie T. Head stated confidently that Oracle will be the top general technology firm in healthcare “after they buy Cerner,” which he expected because Cerner is a heavy Oracle user (databases and Java), Oracle is desperately late to the cloud, and Cerner seemed primed for sale. IANAL added that Oracle has acquired other sector-specific application vendors such as NetSuite and predicted accurately that it would be a $30 billion acquisition.

I’m always happy to see December 21 even though it’s the first day of winter (and another COVID one at that) because at least daylight hours start increasing.

An Anonymous Health System CIO’s Initial Thoughts About Oracle Acquiring Cerner

We’ve been a Cerner customer on the acute EHR side for quite a while and have further implemented both ambulatory and rev cycle. On the acute side, we’ve been generally pleased with the product, services, and support. However, we saw Cerner challenges with the ambulatory and rev cycle implementations. From my viewpoint, Cerner’s biggest problems today are:

• Revenue cycle functionality. Millennium still has challenges to get it to work well. I’m hoping the RevElate strategy pans out.
• Ambulatory functionality. We’re seeing improvements made, but they lack the product maturity other vendors have. Generally, we are able to make it work.
• People and process. This is actually their biggest problem. Cerner has struggled to maintain competent staff that understand healthcare and individual customer workflows. Throughout our implementations, we had major challenges with project management, availability of experienced staff, and the ability to help us make informed decisions.

Here are my thoughts on Oracle acquiring them:

• If Oracle is going to help reduce the cost of healthcare, they also need to help find savings for their customers.
• One of the things mentioned in their announcement was the use of Oracle’s voice assistant product. Our Physicians use Dragon and are very pleased with it. I don’t believe Oracle understands how difficult it is going to be to get physicians to give up something they like and benefit from.
• Oracle should be able to bring more technical resources to bear to help with Cerner’s products. However, I hope Oracle isn’t going to distract Cerner to move from their AWS strategy to an Oracle cloud strategy immediately. While this would be favorable to Oracle, I fail to find any immediate value to customers.
• Oracle is not going to be able to help bring additional healthcare resources initially.
• I hope Oracle can help improve Cerner’s service delivery through more mature processes. However, not knowing the healthcare space or Cerner products, I’m not sure what they can do initially to bring value for customers.

Webinars

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

Acquisitions, Funding, Business, and Stock

Bloomberg reports that activist investor Elliott Investment Management and Vista Equity Partners are considering making a joint bid for Citrix Systems, whose shares are down 36% this year and the company has been exploring its options.

Huron will acquire healthcare analytics vendor Perception Health.

Patient financial solutions vendor AccessOne acquires CueSquared, which offers a mobile payment platform for patient self-pay balances.

The executive director of the World Privacy Forum is concerned that the acquisition of Cerner will give Oracle – which runs the world’s largest third-party data marketplace – access to Cerner-stored patient data. She says that business associate rules might allow Oracle to use Cerner’s EHR patient data to train AI systems.

People

ZeOmega hires Andy Arends, MBA, MSc (NTT Data) as chief growth officer.

Other

KHN finds that small-town pharmacists are opening independent drugstores to replace big-box chains that pull out and leave those areas without pharmacy services. The article notes that the number of pharmacists employed by big-box stores peaked at 31,800 in 2012, but online and mail-order sales dropped that number to 18,000 by 2019. Experts say that people do less “roaming shopping” now, meaning that running a loss-leading pharmacy in the back of a retail or grocery store is not necessarily the most profitable use of the square footage. Rite Aid announced Tuesday that it will close another 63 stories, which follows CVS Health’s announcement that it will close 900 stores in the next three years.

The BMJ complains to Facebook that its peer-reviewed COVID-19 articles are being flagged as “false information” by Facebook’s fact-checking contractor Lead Stories. Lead Stories responds by saying that BMJ’s article “COVID-19: Researcher blows the whistle on data integrity issues in Pfizer’s vaccine trial” and its “scare headline” were adopted by anti-vaxxers to prove that the clinical trial was fraudulent. Lead Stories says the allegation actually involves just three of 153 research sites, the whistleblower Brook Jackson is an EHR auditor rather than a scientist and had worked in the lab for just two weeks, and her Twitter account shows her support for misinformation spreader Robert F. Kennedy, Jr. It also notes that it flagged the article only as being potentially misleading without additional context. Jackson filed an FDA complaint about the clinical trial and was fired by her research contractor employer the same day.

HIMSS announces featured HIMSS22 speakers, none of whom I’ve heard of other than former Olympic swimmer Michael Phelps — the CEO of a children’s education organization, the guy who ran Disney’s ABC Television group for a short time, a couple of former Air Force pilots turned consultants (they sound pretty interesting), an audit firm’s economist, the CEO of the Society for Human Resource Management, and a “60 Minutes” correspondent (those last three are co-presenting a single session on workforce). Exhibitor count is at 550 and Oracle isn’t among them.

Oracle says it will expand non-US sales of Cerner software. The above from KLAS’s “Global (Non-US) EMR Market Share 2021” report shows where Cerner stands.

Weird News Andy, this is my holiday gift for you. In England, the bomb squad is called to a hospital ED when a patient presents with “munition in his rectum.” The patient showed little originality in claiming that he fell on the World War II-era armor-piercing projectile.

Contacts

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

Morning Headlines 12/21/21

Oracle Buys Cerner

Oracle will acquire Cerner for $28 billion in an all-cash deal, describing the company as a “revenue growth engine” whose business it will expand globally.

GAO Makes Appointments to the Health Information Technology Advisory Committee

GAO appoints seven new members to HITAC, established by the Cures Act to provide recommendations to ONC.

AliveCor Lists its Industry-leading KardiaMobile 6L in Epic’s App Orchard Marketplace

AliveCor integrates its six-lead personal ECG device with Epic.

Oracle Acquires Cerner

Oracle will acquire Cerner for $28.3 billion in equity value in an all-cash deal, the companies announced this morning.

Oracle chairman and CTO Larry Ellison said in a statement, “Working together, Cerner and Oracle have the capacity to transform healthcare delivery by providing medical professionals with better information—enabling them to make better treatment decisions resulting in better patient outcomes. With this acquisition, Oracle’s corporate mission expands to assume the responsibility to provide our overworked medical professionals with a new generation of easier-to-use digital tools that enable access to information via a hands-free voice interface to secure cloud applications. This new generation of medical information systems promises to lower the administrative workload burdening our medical professionals, improve patient privacy and outcomes, and lower overall healthcare costs.”

Oracle vertical industries EVP Mike Sicilia said that Oracle will make Cerner’s systems easier to learn by making Oracle’s hands-free Voice Digital Assistant the primary interface to Millennium.

The transaction is expected to close in 2022. Cerner will operate as an industry business unit within Oracle.

The acquisition, at $95 per Cerner share, represents Oracle’s largest acquisition. Oracle says Cerner will be “a huge additional revenue growth engine for years to come” as Oracle expands its business to additional countries.

Curbside Consult with Dr. Jayne 12/20/21

The news this week has been dominated by surges in COVID-19 cases across the country. Epidemiologists are predicting a January peak and hospitals in many parts of the country are becoming overwhelmed. Staff members at those hospitals, as well as at urgent cares, community health centers, ambulatory offices, etc. are beyond overwhelmed, as they have been fighting this pandemic for nearly two years.

Most of the colleagues who I talk to regularly are beyond stressed as their organizations try to figure out how they’re going to staff another surge. The nursing shortage continues, with some of that work being shifted to physicians, which is increasing their levels of burnout. The thing that bothers them the most is not the hours or the work, but the feeling that they community no longer supports them but instead takes them for granted, or worse, sees them as expendable.

There’s a tremendous push for people to “live their lives,” but the reality is that we would all be better served by dialing it down a notch and sticking close to home for a while. None of us want to be constrained. We’re all tired of it, but it’s a necessity for many families right now as they struggle to protect vulnerable individuals in their households.

Seeing JP Morgan Chase cancel its healthcare conference was bittersweet. Everyone is so desperate for “the old normal,” but cramming people in hotels and restaurants isn’t the right answer. There’s a shortage of home testing kits across the country at the moment and people in some cities are facing long waits for clinic-based testing, so it doesn’t seem right to burden those systems with pre-travel testing. The same goes for people planning to travel out of the country for the holidays, which can generate multiple tests per traveler on their return, depending on workplace and school policies. I’m glad people have the money to travel to the Caribbean, but I feel for the healthcare workers who will grimly trudge through the lines of tanned, happy travelers seeking testing as they wonder when they will be able to take a break. One of my urgent care clients is routinely testing more than 100 patients per day at a single location, which is an unsustainable pace.

Mr. H noted that HIMSS is reviewing its Right of Entry Protocols for HIMSS22 to see how they’ll play in Florida, which has blocked vaccine mandates for workers and won’t allow businesses to require proof of vaccination. I have to say I hadn’t thought of that before registering for the conference, but now it’s giving me pause. We’ll have to see what the case rates look like as the conference is closer. We know that vaccination doesn’t necessarily prevent transmission, but data is good as far as there being less viral shedding and a shorter duration of symptoms. As we get more data about the Omicron variant, that may change, but right now I’m definitely more comfortable being around people who are fully vaccinated as well as masked versus the unmasked people at the supermarket who are talking on the phone as they shop, aerosolizing as they go. Influenza A is starting to rip through our community as well, so if the COVID-19 doesn’t get you, there’s a chance the flu will.

From a healthcare IT standpoint, I’m starting to see hospitals and health systems put projects on hold again as they cite the need to be all hands on deck for patient care issues. Organizations that haven’t already been tuning up their telehealth strategies have probably missed the window of opportunity while utilization was relatively low. Those who have robust telehealth programs are seeing greater demand, and most of the physicians I’ve spoken with are considering retooling their schedules to create dedicated blocks for telehealth visits so that they can minimize disruption to their days. With hospitals canceling elective cases again, patients are left in the lurch, and I feel bad for those who have been waiting for procedures that are again being pushed back.

As we approach the third year of the pandemic, I’m also starting to see physicians look for part-time opportunities due to childcare issues, especially in dual-physician households. As higher wage earners, these couples have historically had greater ability to afford full-time household caregivers such as nannies, but the long hours and unpredictably lengthened days have caused some caregivers to leave their physician employers. There is also some degree of mismatch between COVID-sensitive physician families and caregivers who might not want to be vaccinated or mask at work, just like there is in any other part of the workforce. Parents of young children who were hopeful for a vaccine to be available soon for their children are crushed by the recent Pfizer announcement that they’d be amending the clinical trial for children 6 months to under 5 years of age. This could delay the vaccine by an additional six months as boosters are studied. For those families, it will be a long winter, indeed.

There are so many terrible things that have come with the COVID-19 pandemic that when you come across something good that has come from it, you just have to celebrate it. Partway through the pandemic, I was introduced to what was then called The Covid Cello Project. It started as a group of 17 professional cellists who couldn’t work due to the initial lockdowns and decided to do a virtual collaboration. Since then, it’s grown to over 500 cellists who submit individual recordings that are then compiled and mixed into a group performance. It was rebranded some time ago as The Global Cello Project to reflect its worldwide reach as well as the easing of the pandemic, but now many of us are staying close to home again, so it’s hard not to refer to it by its original name.

The founder challenged us to put our most recent piece together in only nine days (usually we have several weeks) and I spent the first three of those days in the woods, so I’ve really had to work to get my part ready. Tonight was the recording deadline, and with the support of my in-house production crew, I was able to nail it in one take. Now the team gets to work editing all the videos and mixing all the recordings and we all get to be surprised by the finished product. It’s been great to have something to think about and work on that brings people together, even though my fingers have had the most exhausting week of their lives.

What good things have you encountered as a result of the pandemic? Have you taken up a new hobby or found a new passion? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: The EHR is (Still) Dead, But I’m Optimistic

The EHR is (Still) Dead, But I’m Optimistic
By Rob Dreussi

Rob Druessi is chief information officer of HCTec of Brentwood, TN.

In May, HCTec CEO Bill Grana published a company article on the evolution of the EHR entitled, “The EHR Is Dead. Long Live the EHR.” In August, digital health strategy consultant Seth Joseph published a similarly titled article, “Long Live the EHR Platform” on Forbes.com.

The key distinction in the headline encompasses his argument for the future of EHRs. Joseph’s two-part article is both comprehensive and detailed. He provides compelling analysis and research, sourced from industry experts to assert that while the government-backed investment (ARRA, HITECH ACT) into EHR adoption did, in fact, achieve the goal of wider physician and hospital adoption of EHRs based on government Meaningful Use (MU) criteria, EHRs collectively have been a disappointment and have not lived up to the hype.

For the most part, I agree with his points and appreciate his arguments, but drawing on 25 years of healthcare IT leadership as my lens, I politely disagree with a few of them.

To compete in a subsidized marketplace, vendors couldn’t just be best-of-breed for specialized focus areas. They needed robust capabilities to survive. In effect, they grew to be” a mile wide, but an inch short in the most important ways.”

In the short term, EHR vendors certainly focused on becoming certified by the US Department of Health and Human Services (HHS) to be MU-compliant. However, hospitals still had the ability to continue using the best-of-breed approach, as modular certifications allowed systems to be certified using a subset of criteria intended for their specific use. Examples of best-of-breed areas include laboratory, surgical, radiology, pharmacy, decision support, oncology, home health, and revenue cycle.

Many hospitals continue to use specialty systems for all the above. But more frequently, they are looking to decrease the overall complexity of running multiple EHRs. If anything, the MU era accelerated the move from full best-of-breed solutions to a modified hybrid approach, where hospitals use a primary EHR with select departmental solutions as necessary. Then, if and when the EHR vendor can provide a sufficient solution with functionality on par with the independent solution, the supplementary solution is often phased out.

In my experience, best-of-breed systems are difficult to manage and costly to maintain. In instances that my company has seen, many health systems agree with me. To illustrate, a Southeastern-based health system recently migrated one of its markets onto Epic from a combination of Cerner (acute side), a third-party home health system, multiple ambulatory systems, and over 50 related third-party applications. Similarly, we have supported many Epic-based organizations move from their independent departmental solution to Epic’s Beaker module this year.

EHRs went from competing on the value of their product to competing on the breadth of functions they offered. Epic achieved its dominant market share for this reason. It offered hospital CIOs a one-stop shop at a time when the CIO’s job was dependent upon helping the organization achieve Meaningful Use of EHRs, no matter how much physicians detested the actual software.

Introduced in 2009, MU can’t take credit for the complete success of EHRs. Epic, for example, was already long thriving as an EHR market leader for hospitals with 400 or more beds by then. Kaiser Permanente became an Epic client in 2003 as part of a $1.8 billion deal, and by 2005, their client base included the likes of Cleveland Clinic Foundation and Sloan-Kettering Cancer Center. This shows that while MU may have accelerated the move to Epic for many health systems, Epic wasn’t just competing on the MU compliance to win deals. They were winning deals due to their ability to not only provide a solution that handled both the inpatient and outpatient areas, but one that was developed 100% in-house, without the need for mergers or acquisitions.

Normally, CIOs selecting Epic were not dealing with physicians who detested the Epic EHR. Epic was even known in the marketplace for “selecting” its clients. Commonly, in my personal experience with many Epic organizations, the deciding factor was Epic’s ability to provide multiple reference sites running their full product suite, whereas competitors struggled to do the same.

“EHRs have been more than a disappointment: they have largely turned into a national nightmare…. Additionally, while EHRs may improve safety in some areas, they also introduce new risks that are systemic in nature.”

There are undoubtedly drawbacks to EHRs, and we certainly have not yet fully realized the potential of these digital systems, but to say they are a sweeping disappointment suggests that they have not offered any societal benefit. Before EHRs, providers struggled to have a clear picture of a patient’s health background, even within the same organization. A patient could go to the ER and later visit a primary care physician, who had no record of that visit or what occurred during it.

Our nation would have had a difficult time shifting to telehealth during the COVID-19 pandemic without the currently deployed EHRs. With EHR systems, we can now better share critical patient data across a healthcare organization and even across other healthcare systems when required. For those populations who spend different seasons in different parts of the country, the ability for their separate health systems to “talk” and share health information is an invaluable component in their health journey. With an EHR, providers can access real-time, up-to-date patient information, regardless of where treatment was provided. This element alone is vital for patient safety and care.

“By virtually every financial and operational metric, the business prospects for EHRs have gone in one direction over the past decade: down.”

Joseph is correct that EHR vendors have seen a downturn in the number of net new EHR implementations. Recent implementations appear to be driven by mergers and acquisitions or the routine replacement life cycle when the current EHR is not meeting organizational needs, with a traditional selection process to identify a new solution. More commonly, smaller, specific modules are being introduced as opposed to the full EHR implementations. While EHR vendors have seen declining revenues post MU, which is not totally unexpected, their futures are ripe with opportunity. They will adapt to the changing environment and will take steps (or have already taken steps) to size their workforce accordingly based on the future demands for maintenance / support and new implementations.

I share Joseph’s curiosity as to the future of EHRs. For now, Meditech is seeing more traction with its Expanse solution, with HCA most recently announcing they are implementing the solution at three HCA hospitals in the New Hampshire market. Meditech will realize tremendous growth with HCA if they are able to move the system’s vast footprint of hospitals running the Meditech Magic EHR onto their Expanse solution. Meditech would also realize a significant loss of business if HCA moved away from Meditech altogether.

Epic has chosen a strategic route in developing a web-based client (Hyperdrive) to generally replace the desktop client (Hyperspace). Hyperdrive clients should experience cost savings from the reduced manpower and related technologies necessary to support a web-based client. These savings could also open the door for new adoption at smaller organizations by finally making the ongoing TCO of running Epic feasible. During the pandemic, Epic was also able to deliver their clients a solution, including the underlying technology, for patient telehealth visits representing an unexpected boost in revenue, which luckily for Epic, is here to stay for the foreseeable future.

Perhaps the next boom for major EHR providers will be international growth as opposed to domestic. Whatever the next big break is, I’m curious to see what Joseph sees in his crystal ball for the future of EHRs.

Readers Write: COVID-19 Drastically Cut Lung Cancer Trial Participation. What Can We Do to Reboot?

COVID-19 Drastically Cut Lung Cancer Trial Participation. What Can We Do to Reboot?
By Miruna Sasu

Miruna Sasu, PhD, MBA is chief strategy officer at COTA, Inc. of Boston, MA.

COVID-19 has had a devastating effect on the nation’s health. In addition to hundreds of thousands of deaths directly caused by the virus, millions more patients have been unable to access crucial healthcare services due to lockdown orders, economic stress, and fear of illness.

During the early days of the pandemic, primary care visits declined by nearly 60% before rebounding later in 2020. Screenings for common cancers, including breast, colon, and cervical cancer, dropped by an average of 91%, prompting fears of a wave of advanced cancers in the coming months. 

A new study from the University of Memphis shows that the clinical trial ecosystem has not been exempt from this trend. The pandemic has prompted a 43% decline in enrollment for lung cancer trials, forcing researchers to delay, postpone, or cancel their initiatives.

Lung cancer leads to a quarter of all cancer deaths: more than colon, breast, and prostate cancers combined. Clinical trials are essential for helping to save and extend the lives of lung cancer patients.

My own life is a perfect illustration of how important clinical trials can be. After immigrating from Romania as a child, my grandfather helped to raise me in America. Soon after, he was diagnosed with advanced metastatic lung cancer and given three months to live. We did not have the resources for conventional treatment, but he enrolled in a clinical trial that offered experimental care we could afford.  

Instead of living for three months, he went into remission and got to spend another 30 years with his family. We were lucky to have access to this life-altering program. We knew that the option existed. We lived close enough to the trial site for regular visits. We were able to provide a strong network of support at home. Not every family is so fortunate.

The care access issues of COVID-19 have compounded existing challenges with clinical trial enrollment, including proximity to centralized trial locations and the ability to completely mold one’s life around the demands of constant clinical visits, treatment side effects, and emotional self-care.

We now have the opportunity to rethink how we approach these problems and restart the momentum that has been lost during COVID-19. I believe that three things could potentially be solutions to care access issues and substantially improve trial recruitment and retention for patients:

• Increasing enrollment. We can start by ensuring that patients from all walks of life are aware that clinical trials may be an option for them. Clinical trials perennially fall short when recruiting diverse and representative populations, excluding far too many underserved individuals from medical research. By using emerging data strategies, such as leveraging multifaceted real-world data to identify new research sites serving representative populations, we can educate more providers and patients about the positive potential of clinical trials. Real-world data from electronic health records, claims, and other sources can also help us match individuals with the most appropriate trials to maximize their odds of better outcomes.
• Maintaining patients on trials. We also need to make sure that patients have the day-to-day resources they need to stick with the program from start to finish. Non-clinical services, including transportation to appointments, childcare, meal delivery options, and other assistance to mitigate social determinants of health are critical for enabling patients to stay adherent to complex trial protocols.
• Patient understanding of trial opportunities. Continued trial interest is important for both healthcare providers and patients. We need to work hard to ensure that everyone within the care ecosystem understands their options for clinical trials. As such, building a community of care around clinical trial participants can improve quality of life while making sure that researchers can keep their enrollment numbers where they need to be. To do this, we have to get very good at things such as being able to showcase trial options and providing educational materials to doctors and patients that are tailored for each of these audiences. We also need ask patients questions about life style and quality of life at the right times and provide a variety of easy ways to not only treat but also connect with clinicians and care teams.

Making the investment in these and other strategies could save untold lives and give lung cancer patients, like my grandfather, many more happy moments with their family and friends. 

As we work through the ongoing challenges of the pandemic and continue to design and implement innovative clinical trials, we must commit to enrolling more diverse and inclusive patient cohorts and supporting them holistically during trials so they live their lives to the fullest for as long as possible.

Morning Headlines 12/20/21

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