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Morning Headlines 2/28/23

February 27, 2023 Headlines No Comments

Cerebral to Cut 15% of Staff in Fresh Round of Layoffs

Cerebral lays off 15% of its staff, part of the direct-to-consumer telemedicine company’s year-long plan to reorganize and streamline its services.

CodaMetrix Closes $55M Series A to Autonomously Power Medical Coding, Boost Health System Revenue Cycles

Automated coding technology vendor CodaMetrix raises $55 million in a Series A funding round led by SignalFire.

Top-Rated Practice Management Systems Align Tech to Transitioning Medical Office Operations, Black Book Annual Physician Survey

Practice management software end users give EClinicalWorks, ModMed, NextGen, and Veradigm top customer satisfaction marks in Black Book’s latest annual survey.

HHS Announces New Divisions Within the Office for Civil Rights to Better Address Growing Need of Enforcement in Recent Years

HHS OCR renames its Health Information Privacy Division to the Health Information Privacy, Data, and Cybersecurity Division as part of a reorganization that will better enable the office to more effectively respond to complaints.

Curbside Consult with Dr. Jayne 2/27/23

February 27, 2023 Dr. Jayne No Comments

I’m headed to several conferences over the next two months. I spent some time this weekend going through the agendas and looking at the details to identify specific sessions I’d like to attend.

Smaller conferences tend to have smaller agendas, so it was fairly easy to determine what I planned to attend at the first of the series, which is the American Telemedicine Association Annual Conference & Expo in San Antonio. Given the frigid weather across most of the US, I have to say I’m looking forward to the San Antonio weather as much as I’m looking forward to any of the sessions. The topics I’m excited about most include remote monitoring, legal issues, and health equity.

Regarding the latter, telehealth holds huge promise, but there is still significant concern that large groups of patients are being left behind due to technology and connectivity issues. My focus is more on health literacy and the barriers it creates as far as care delivery, so it will be interesting to see what the speakers have to say.

The agenda for the CHIME/ViVE mashup was a little more complicated to navigate since it has a lot of sessions that run concurrently across a half dozen different tracks, along with a number of CHIME-only sessions and events. I found a fair amount of overlap in the concepts behind the ViVE tracks and ended up having to really look at the session descriptions versus being able to use the tracks or titles to help thin out the options. I also looked at the speakers and will be making sure to hit sessions with speakers from organizations that are constantly in the news, such as Amazon Clinic and Teladoc.

I didn’t attend ViVE last year, but the way it’s set up seems similar to HLTH. Many of the sessions are focused around experts discussing their opinions. Although those can be interesting, for those of us who have been heavily into evidence-based medicine, we know that when assessing the strength of a recommendation based on a body of evidence, expert opinion is the weakest. When attending those kinds of sessions, I often find myself thinking, “that’s great, but the proof will be in the proverbial pudding,” so I anticipate having that feeling often during the conference.

If you’re going for talks that hit higher up the evidence-based scale, HIMSS is the place to be, at least as far as its concurrent education sessions are concerned. I’ve made fun of HIMSS in the past because the submission timeline for sessions is so far ahead of the conference that material can become stale. However, that significant lead time is useful when you’re performing an advance review of what is going to be presented and assessing it for things like level of evidence and commercial bias. For those sessions where continuing medical education or other credits will be offered, they must include designated learning objectives, along with disclosures of any financial relationships that might be related to the content of the presentations.

Although some of the HIMSS sessions I’ve been to have been dry, they’re usually well put together and the presenters are happy to correspond with you afterwards if you want to dig into their topics. Of course, several of the sessions I’d like to attend are on top of each other, which is a shame. In the past, I’ve found the recorded sessions to be variable in quality, and if I remember correctly, the lower-cost pass I bought for this year doesn’t include access to the recordings. 

Some of the presentations I’m looking forward to at HIMSS cover health equity, standards and interoperability, using automated care programs to improve clinical outcomes, and integrating virtual care with other healthcare delivery options. I’m doing some volunteer work with underserved populations, so I’m particularly interested in one of the sessions on street medicine and delivering care to the homeless. I’ve worked previously with one of the organizations that is presenting and I’m excited to see how their program has grown in the intervening years. It sounds like they’ve added a lot of technology tools to their approach while they still manage to maintain the focus on whole-person care.

It’s always fun to see where people have ended up in this industry, It feels like we were so green trying to do some of these technology initiatives back in the pre-Meaningful Use days. Some of my favorite clinical informaticists have crossed the 20-year mark in the business, so I’m looking forward to catching up with them in any downtime we can find.

Of course, one of the most fun parts of conference season for the HIStalk team is making the rounds at vendor events and reporting on the overall buzz. In the post-COVID era, those vendor events have been fewer in number and lower in key than when healthcare IT was in its more glamorous phases. That’s to be expected given the economy and the fact that marketing folks know that throwing a big bash with a lot of random attendees who don’t even have decision-making authority isn’t likely the best way to spend their cash. Still, if you’re throwing a blowout event where general attendees can register, feel free to send invites our way and we’ll consider anonymously dropping by.

As long as the weather holds, Chicago is one of my favorite cities for HIMSS because it’s easy to get around and has plenty of non-conference activities going on, unlike Orlando, where everything is mostly concentrated in that one section of International Drive. Unlike Las Vegas, you don’t have to walk through a smoky casino to get to where the action is, so that’s a plus.

Several people have told me that Nashville has turned into a fun conference location, although I haven’t been there since one meeting in 2008 that was held entirely at the Gaylord Opryland Resort. I’m looking forward to seeing what it has to offer and will be happy to have the opportunity to catch up with one of my favorite people in her hometown. It’s always good to have a friend who knows where the real fun is to be had and how to avoid the tourist traps and overhyped restaurants and bars.

If you’re taking part in upcoming conferences, what are you looking forward to the most? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Steve House, Managing Director, Baker Tilly US

February 27, 2023 Interviews No Comments

Steve House is managing director of Baker Tilly US of Chicago, IL.


Tell me about yourself and the company.

I realized the other day that I have entered my 40th year in healthcare. I started back in the early 1980s as a biomedical engineer for Phillips Medical for a decade, and then GE for a decade. I did work for Aetna building ACOs and then Kaiser as a senior director of data. I’ve been around in different spaces around the healthcare environment for a while.

I joined Baker Tilly a year ago. I am a subject matter expert in healthcare. My official title is managing director. I go out and do a lot of strategic work for hospitals, doctors, insurance companies, things like that.

Baker Tilly is fundamentally a tax and audit firm that was started back in the 1930s. It has expanded into all kinds of areas. We have a digital division that does ERP implementation. We have a robust Oracle team. We have an EHR team that was an acquisition of Orchestrate Healthcare. We do strategy service line analysis. We do all types of financial, technical, and clinical sustainability type programs. It’s 6,600 people, almost a billion and a half dollars in revenue, so it is pretty good sized, I think about #9 on the overall consulting size list.

How has health system C-suite leadership changed its thinking about health IT?

It has been a pretty big change and it’s going to be bigger going forward. We have a big labor problem. You have technology like the EHR and work that augments it. That technology is great to have, but it can’t slow doctors down significantly. We have big shortages in primary care, internal medicine, and obviously mass shortages in nursing, so the technology needs to be enabling.

We went through a phase of nearly 20 years where we were getting a handle on the data and making sure that we made it interoperable. It’s not all the way there, but certainly all those things were factors. Now we have to put doctors and nurses in a cockpit of a jet fighter-like concept, where they get the data they need and can make quick, accurate decisions and move them forward. We are in the midst of that transition, and I think it’s absolutely necessary.

Will technology-enabled telehealth and virtual monitoring allow healthcare to become more scalable and then more affordable or more accessible?

Yes. I’m in charge of our hospital-at-home programs. Plenty of people are looking at programs like that, where you are distributing healthcare services differently, in which patients and caregivers become more engaged. You have tools, technologies, social determinants, and an ability to look at it in simplified media formats, like a mobile phone. Suddenly, some of the labor that you need for delivering healthcare services is going to come on behalf of patients and their caregivers themselves as they invest and get engaged in the process. That has the potential to give us the greatest improvement and maybe put us on a path where we can actually succeed in this.

How will patient perceptions of the healthcare system change as more and more physicians become employees of entities whose primary objective is profit?

It’s always going to come down to access first for patients. When you need the system, is it available to you? We have significant access problems because of labor issues. Physicians being employed is, on the face of it, OK as long as you don’t lose productivity and therefore reduce patient access to the system.

But there’s also the other factor, which is that around the world, cost and outcomes — outcomes being lifespan and quality of life — have significant patient incentives. If you’re going to employ doctors and you’re going to have an issue with access because of labor pool problems, the most important next thing you can do is to make sure patients are incentivized to help themselves. You’ve got to make it comfortable and possible for them to manage their own healthcare at some level, and they must be incentivized to do it. Otherwise, it will just become a growing burden cause of aging.

What will happen as ever-larger health systems and insurers encroach on each other’s turf?

A debate has been running in the areas that I travel around the United States about the difference between medical care and healthcare, healthcare being population health, preventative medicine, the things that we do in that category versus, medical care that hospitals and doctors are fundamentally trained to do. If the insurance companies creep into this space in a significant way, the question is, should we think about splitting healthcare and medical care?

In other words, are hospitals and doctors the best places to do preventative medicine, nutrition, counseling, fitness, and weight management? Or did insurance companies find a way to do that part themselves? They try to pay for it, although I don’t think it is always paid for it at a level it should be. But the bottom line is that as they creep in, hopefully they take their biggest incentive — which is reducing variability and outlying costs because people get sick quickly or they’re not maintaining their health — and address that issue directly. If they did that, the system would work better for the patients.

Is it reasonable to expect most people to monitor their own health and use wearables, or is that just a nice idea that will impact only the few people who are willing?

I saw a statistic recently that of all the people who have a gym membership in the United States, somewhere around 4.5% actually use it. I don’t think that’s an indicator that we have got it figured out. Not everybody has to go to the gym, but I was on a task force during COVID and we determined that the average 80-year-old has lost 80% of their lung capacity. That’s obviously a huge danger sign for people with respiratory viruses. The bottom line is no, we have not done a great job of it.

If you take a system like Singapore, they use HSAs, and if you maintain your health and you meet criteria for blood pressure and weight and things like that, many of the dollars that go into your HSA that you’ve saved automatically become your retirement fund, and you don’t pay taxes on it. Those folks over there using that type of system, and they’re not the only ones, do a tremendous job of maintaining their health and staying in shape because they really want to retire. It’s that simple.

What are the technical priorities of health systems?

There’s still a lot of work to be done on the EHR side. Integration work needs to be done to finalize systems. We talk sometimes about a post-EHR implementation world. I don’t think we’re there yet. You have to go from gathering data, stewarding it, and placing governance around it to actually making it more usable. That’s the next phase and hospitals are looking at that.

The other side of healthcare is whether CFOs, CEOs, CMOs, et cetera have enough information to understand how to compete effectively in their own markets. It is still competitive marketing. Competition in healthcare is good for all of us because it drives better and lower costs. We must do a lot better job on financial reporting and cost accounting. We must do better on issues surrounding the data that we provide people so they can make better decisions in their markets.

What parts of health system digital innovation will stick?

Anything that can allow a patient to make a good decision when they need healthcare. If you’re at the mall, start to feel sick, and don’t know what it is, is there’s a kiosk there that gets you good information or provides contact with somebody who can answer your question on whether you should go home and take an NSAID or go to a hospital urgent care? We still haven’t gotten that figured out and we need to. On the patient engagement side, it’s making information available to patients so that they know how to make routine decisions. It’s all online, but not as functionally usable for patients as it needs to be.

As someone who ran for Congress, what do you expect to see from a political standpoint that will make US healthcare different in 10 years?

The one thing that you get when you are in Congress, or are running for Congress, is that there are 10 lobbyists for every member of Congress on the healthcare side. Political will is butting up against the lobbying process that goes on.

There’s a lot of things that should change, including how we manage PBMs, what safe harbor was intended to be back in the 1980s when it was passed, to how we pay for it. Even the fact that Medicare itself is both a payer and a regulator, and when you’re a payer and a regulator, that’s a disconnected process structure and it should change.

Will it change? We’re sitting at 20 or 21% of GDP. A point will come where if it doesn’t change one way or the other, the system is going to break. Some people want single payer, some people want more competition. I’m not a fan of the single-payer idea. I don’t think that’s going to work. But the bottom line is that if something doesn’t change soon, the sheer weight of the cost is going to become a problem that breaks healthcare down.

What factors will be important to the company and the US health system in general over the next few years?

I think it’s process change culture. There’s a lot of cultural issues in healthcare. The first question I ask any healthcare executive these days is, how is your culture? Are you capable of changing? Have you imagined a different environment? Do you have the information and reporting to give you enough decision-making capability?

Some organizations in healthcare have spent a decade or more just training their own leadership on how to make decisions and do it quickly. Healthcare needs to get faster, a lot faster, on the diagnosis side. A lot faster on the change management side. A lot faster on the decision-making side. That’s probably the area where we need to do the most work. Baker Tilly, as a strategic consultant and someone who does operational work, is focused on those areas.

After spending so long in healthcare in my career, I cannot wait to see this next phase, where data use rather than data aggregation and interoperability becomes our priority. What we can do with tools, devices, and modern concepts of how doctors will interact. The average doctor has 16 minutes to spend with their patient, and 11.3 minutes of that is used to input and take data out of an EHR. That’s not an equation that works in the long run. I have confidence that we’re going to see massive quantities of new technology and ideas come up to help solve that problem.

Morning Headlines 2/27/23

February 26, 2023 Headlines No Comments

Biden Proposal Would Ban Online Prescribing of Certain Drugs

The White House proposes a crackdown on telehealth-related prescribing of some medications when the COVID public health emergency ends on May 11.

Gebbs Healthcare Solutions Acquires CPa Medical Billing

Medical billing and coding vendor Gebbs Healthcare Solutions acquires CPa Medical Billing, which offers RCM technologies and services to FQHCs and physician groups.

Vytalize Health Closes $100M to Support Value-Based Care Transformation

Value-based primary care optimization company Vytalize Health secures $100 million in funding, bringing its total raised to $175 million.

Monday Morning Update 2/27/23

February 26, 2023 News No Comments

Top News


The White House proposes a crackdown on telehealth-related prescribing of some medications when the COVID public health emergency ends on May 11.

Providers would be required to conduct at least one in-person visit before prescribing or refilling Schedule II drugs such as Adderall and opioids.

The DEA says the rule change was prompted by online telehealth companies that took advantage of pandemic-relaxed restrictions to overprescribe drugs such as Adderall, OxyContin,  and ketamine.

The proposed rule would allow prescribing a 30-day supply of Schedule II, IV, and V controlled substances after an initial telemedicine visit, but refills would require the patient to be seen in person. Patients who have seen their practitioner in person or were referred by them to a new practitioner can have all of their prescriptions issued via telehealth visits. 

Reader Comments

From Suzette Crepes: “Re: Teladoc Health. Interesting that it is framing its nearly $14 billion FY22 loss as irrelevant to future success. We use their software and it still is missing features that are in Zoom, Teams, and other software. Reliability is erratic – if a patient receives a phone call during a session, it switches the screen’s focus and disconnects Teladoc. I know some behavioral health clinicians who have left the company and are looking for other opportunities, which are ample, and that may be a worrisome sign.” Unverified. If I were investor in TDOC, I would not find it easy to forgive its executives for satiating their lust for diversified growth by wildly overpaying for Livongo and its skimpy six-year track record. Especially when they failed to make executive retention part of the terms, allowing 11 of the 12 Livongo suits to bail (all but the HR VP). The investor saying to “bet on the jockey, not on the horse” works both ways, and this particular TDOC jockey – who wasn’t a founder and had never been a CEO — was occupying the other end of the steed than Zane Burke. Zane was given the best gift of his life by being disliked by Neal Patterson enough to be passed over for the Cerner CEO job in favor of a far less qualified outsider who had also never been a CEO, allowing Teladoc to make Zane a billionaire in return for his big chair occupancy of less than two years. I don’t know what the TDOC board was thinking, although that of LVGO was surely high-fiving and ka-chinging.

From Benny: “Re: re-imposition of rules requiring an initial in-person visit for prescribing. This is unfortunate, since while a few highly publicized startups were engaging in cavalier practices, most clinicians used this flexibility appropriately. It’s already a challenge to get ADHD care, and stimulants if needed, due to limited availability of professionals, many of whom switched their practices away from in-person healthcare to focus on telehealth. In-person visits are challenging for patients because of transportation and time off from work. Evidence is clear that appropriate treatment ADHD with stimulants improves educational or other outcomes, so this imposed constraint will reduce treatment, worsen outcomes, and increase patient hassle. This will be superimposed on the existing adverse effects of stimulant drug shortages due to regularly constraints placed on manufacturing capacity, of which no evidence exists that it will reduce misuse.” I’m still surprised that DEA is blaming companies rather than individual prescribers, the same as it did with opioid mills where drug distributors paid billions to settle charges for having their products dispensed via the prescriptions of ethically challenged prescribers who were mostly left to keep practicing. ChatGPT could probably spit out a list of shady doctors given only the prescription records of Walgreens or CVS.

HIStalk Announcements and Requests


Nearly 80% of poll respondents who park at work do so for free, and of those who pay, it’s a 50-50 split between employer-controlled and public parking.

New poll to your right or here: Should physicians be allowed to open and operate hospitals? They can’t for the most part due to Medicare restrictions that were intended to prevent self-referral.


February 28 (Tuesday) 1 ET. “Words Matter: Simplifying Clinical Terms for Patients.” Sponsor: Intelligent Medical Objects. Presenters: Whitney Mannion, RN, MSN, senior terminologist, IMO; David Bocanegra, RN, nurse informaticist, IMO. The language of medicine can be confusing and contradictory to patients, challenging their ability to prepare for a procedure or pay their bills. This webinar will explore how the words that are used to communicate – online, in print, and in person – must be chosen carefully to allow patients to comprehend their diagnoses, treatments, and care plans. The presenters will also describe how the ONC Final Rule for the 21st Century Cures Act will make clinical and technical language more directly accessible through patient portals.

March 7 (Tuesday) noon ET.  “Prescribe RPA 2.0 to Treat Healthcare Worker Burnout.” Sponsor: Keysight Technologies. Presenters: Anne Foster, MS, technical consultant manager, Eggplant; Emily Yan, MPA, product marketing manager, Keysight Technologies. Half of US health systems plan to invest in robotic process automation by the end of this year, per Gartner. The concept is evolving to help with staff burnout and physician productivity. The presenters will introduce RPA 2.0, explain how to maximize its value, demonstrate how to quickly start on RPA 2.0 and test automation in one platform, and answer questions about healthcare automation.

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



Optimum Healthcare IT hires Jennifer Mahoney, MS (AdventHealth IT) as VP of HR.

Announcements and Implementations


NHS is testing the use of AI-powered software from Deep Medical to predict the likelihood that a patient will miss their scheduled appointment so that they can be rescheduled in advance. I was briefly entertained by the original version of the announcement (above).

Wolters Kluwer Health launches Lippincott Medical Procedures, a point-of-care guide for performing core procedures, and a new medical and healthcare learning solution called Lippincott Connect.

Government and Politics

An employee health plan sues its health insurance administrator for refusing to turn over claims data that would allow the employer to verify the accuracy of charges against its self-funded health insurance plan. Medical supply vendor Owens & Minor says Anthem Blue Cross and Blue Shield has refused to provide it with claims data since 2021 as required by federal law. Anthem says its claims data involves proprietary arrangements that it doesn’t want to make public. Several similar lawsuits have been settled out of court, with details hidden behind non-disclosure agreements.



American healthcare in a nutshell: sign-waving protesters demand a change in leadership at struggling Brooklyn hospital Maimonides Medical Center, recruited from Craigslist for $600 per week as part of a $1 million campaign by a group called Save Maimonides that refuses to name its donors. Hospital leaders say the effort is being funded by Eliezer Scheiner, a wealthy operator of a chain of bottom-rated nursing homes who proposed installing 16 new board members of his choosing who would donate $2 million each in holding a majority of the 30 board seats. The hospital says Scheiner wants to gain control over the hospital’s purchasing to steer business to his many supply and services companies. He denies any involvement in the campaign, saying he gave up trying to help the hospital months ago. The money-losing safety net hospital paid its CEO $3.2 million in 2020.


ProPublica reviews the sprawling family empire that was created by the non-profit Liberty HealthShare, whose healthcare sharing ministry heavily markets its medical insurance alternative to people who didn’t like the political ideology or cost involved with Affordable Care Act policies. The ministry took in $300 million in annually, steering much of it to dozens of businesses that were operated by the same Beers family, who bought an airline, a wedding venue, a marijuana farm, a wholesale carpet chain, a hunting lodge in Canada, and a bank that is now selling services to other healthcare sharing ministries. Healthcare ministries pool customer premiums and pay their bills under their own rules, allowing them to avoid regulation as insurers and to claim religious persecution when investigated. ProPublica found that the ministry collected $1.9 billion in revenue in six years while failing to report $1 billion of that to tax authorities, using self-developed software to make it look as though members controlled their own payments to avoid being regulated as an insurer. The company started rejecting claims and lowballing providers in late 2016, causing at least 50 hospitals – including Intermountain Healthcare – to refuse to negotiate with the ministry.

Sponsor Updates

  • Healing Hands Ministries uses the PRISMA health information search tool of EClinicalWorks.

Blog Posts


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

Morning Headlines 2/24/23

February 23, 2023 Headlines 2 Comments

Teladoc (TDOC) Reports Q4 Loss, Tops Revenue Estimates

Teladoc Health reports a $13.7 billion loss for FY 2022, and mixed revenue and earnings results for Q4, prompting the company to consider near-term layoffs and restructuring.

Premier Inc. Acquires 100 Top Hospitals Program

Premier Inc. acquires the “Top 100 Hospitals” program from Merative, formerly IBM Watson Health, which it will integrate with its PINC AI technology and services brand.

Chartis Establishes the Chartis Center for Burnout Solutions

Chartis acquires DES Health Consulting, whose workforce assessment tool will be offered as the Chartis Center for Burnout Solutions.

News 2/24/23

February 23, 2023 News 1 Comment

Top News


Teladoc Health reports Q4 results: revenue up 15%, EPS –$0.23 versus –$0.07, beating revenue expectations but falling short on earnings.

The company reported a staggering $13.7 billion loss for FY 2022, much of that attributed to goodwill write-downs related to its $18.5 billion acquisition of Livongo in August 2020.

TDOC shares have lost 56% in the past year versus the Dow’s 2% loss, valuing the company at $4.8 billion, having lost about 90% off its value since early 2021.

From the earnings call:

  • CEO Jason Gorevic called Q4 results a strong finish to a “challenging year” in a “more challenging macro environment” that he expects will persist.
  • The company will cut costs, including layoffs and restructuring.
  • Teladoc’s BetterHelp online behavioral health business, which it acquired in early 2015 for $4.5 million, performed well. Teladoc says it has become a billion-dollar business. The company will start reporting performance in two segments, integrated care and BetterHelp.
  • The company expects its employed physicians to eventually conduct more than 50% of visits versus its use of independent contractors, which it says will increase physician productivity and patient satisfaction.

Meanwhile, an outstanding article in MedCity News asks former Livongo CEO Zane Burke directly, “Did you sell a lemon to Teladoc or did they mess up?” Burke says Livongo was a “freaking good business” and that Teladoc was the pursuer of the transaction, but Teladoc’s executives “really liked themselves a lot” and thought they were “clever” in operating a roll-up business versus Livongo’s organic growth and intellectual property. He says Teladoc’s timing was terrible in hindsight and questions why Teladoc’s offer didn’t require Livongo’s executives to stay on board when the acquisition closed, after which 11 of 12 members of Livongo’s leadership team departed.

Reader Comments

From Another NY SR IT Leader: “Re: Sunrise. In addition to Northwell moving to Epic, Altera has Memorial Sloan Kettering, St. Barnabas Bronx, and Brooklyn Hospital all implementing Epic. NYC was once a stronghold for the former Eclipsys Sunrise.”

From Humeris: “Re: HIMSS. Sebastian Krolop, MD, PhD, global COO and strategy officer at HIMSS, has left. Cultural differences with Hal were cited. Another sore spot was his failure to get any traction with Accelerate, the networking platform that he engaged McKinsey to plan and develop.” Verified that he has left after four years, per his LinkedIn post of three weeks ago. As for Accelerate, even HIMSS CEO Hal Wolf hasn’t posted anything, and its LinkedIn page’s last updates were from HIMSS22.


February 28 (Tuesday) 1 ET. “Words Matter: Simplifying Clinical Terms for Patients.” Sponsor: Intelligent Medical Objects. Presenters: Whitney Mannion, RN, MSN, senior terminologist, IMO; David Bocanegra, RN, nurse informaticist, IMO. The language of medicine can be confusing and contradictory to patients, challenging their ability to prepare for a procedure or pay their bills. This webinar will explore how the words that are used to communicate – online, in print, and in person – must be chosen carefully to allow patients to comprehend their diagnoses, treatments, and care plans. The presenters will also describe how the ONC Final Rule for the 21st Century Cures Act will make clinical and technical language more directly accessible through patient portals.

March 7 (Tuesday) noon ET.  “Prescribe RPA 2.0 to Treat Healthcare Worker Burnout.” Sponsor: Keysight Technologies. Presenters: Anne Foster, MS, technical consultant manager, Eggplant; Emily Yan, MPA, product marketing manager, Keysight Technologies. Half of US health systems plan to invest in robotic process automation by the end of this year, per Gartner. The concept is evolving to help with staff burnout and physician productivity. The presenters will introduce RPA 2.0, explain how to maximize its value, demonstrate how to quickly start on RPA 2.0 and test automation in one platform, and answer questions about healthcare automation.

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

Acquisitions, Funding, Business, and Stock


Amazon closes its $3.9 billion acquisition of primary care provider One Medical as the Federal Trade Commission fails to challenge the deal by the deadline. FTC has warned the companies that closing the acquisition before its approval is at their own risk, as FTC is still reviewing the transaction. Amazon has already launched a $144 first-year membership in One Medical, which offers 24/7 virtual care via messaging or video, online appointment scheduling, and prescription management. One Medical also runs  physical offices in 22 metro areas that offer on-site lab services. One Medical is a concierge medical practice rather than direct primary care — it bills services to the patient and their insurance like any other non-DPC practice, promising only a more satisfying patient experience.


Independent primary care network operator Aledade acquires, which offers AI-based value-based care analytics for optimizing patient care and engagement.

Premier Inc. acquires the “Top 100 Hospitals” program from Merative, formerly IBM Watson Health, which it will integrate with its PINC AI technology and services brand.

Chartis acquires DES Health Consulting, whose workforce assessment tool will be offered as the Chartis Center for Burnout Solutions.

Axios reports that healthcare automation startup Olive AI will sell its payer prior authorization business, one of the company’s two remaining business lines. Olive’s headcount has been reduced by more than half via previous asset sales and layoffs.


  • Memorial Healthcare System implements a virtual care service that is powered by KeyCare’s Epic-based platform.
  • Augusta University Health chooses the turnkey virtual health solution of Biofourmis to expand its Virtual Care at Home program.
  • Silverado will implement hospital and palliative care software and analytics from WellSky.
  • Mount Graham Regional Medical Center (AZ) will implement BridgeHead Software’s HealthStore as a clinical data repository for retired applications.



Benefits administration technology vendor Bridgeway Benefit Technologies hires Todd Plesko, MBA (GHX) as CEO. He replaces Jenny Morgan, MS, who will retire and serve as board chair.


Deborah Norton, MBA, who retired as CIO/SVP for operations from Harvard Pilgrim Health Care in  mid-2021,  died Saturday at 69.

Announcements and Implementations

A new KLAS report on long-term care EHRs finds that PointClickCare has the highest market share and customer satisfaction, while Epic performs well for health system-owned LTCs.


Ambience Healthcare launches an AI-powered, human-free medical scribe that embeds in EHR workflow to allow providers to review, edit, and sign off on their notes nearly immediately. The company has raised $30 million through a Series A round.

Government and Politics

A VA official warns that the problem that forced a delay in the planned Oracle Cerner go-live at its Ann Arbor operation, which it announced last week, is likely to affect any VA hospital that conducts clinical research and needs integration with research-based systems.

Companies may no longer require laid-off employees to sign confidentiality agreements or non-disparagement clauses as a condition of receiving severance benefits, per a National Labor Relations Board ruling that takes effect immediately.

The American Hospital Association writes a letter of opposition to the FTC’s proposed rule that would prohibit employee non-compete agreements. AHA says that FTC doesn’t have the authority to enforce the rule, it would affect only new agreements since FTC doesn’t have retroactive authority, the rule should not apply to highly paid hospital executives and physicians, and FTC does not have legal authority over non-profit entities and therefore a non-compete ban would place for-profit hospitals at a disadvantage.



Folks who tamp ear wax into their skulls by using Q-tips like Civil War cannon rammers might want to swap out for Smart Visual Ear Cleaner, a $30 smartphone-paired tool that features an in-ear camera and a series of silicone scrapers. Although I might spring an extra $5 for the Bebird version that Best Buy sells (pictured above). Some people are addicted to shoving swabs into their ears with the regularity of brushing teeth, sometimes puncturing their ear drum and surely knowing from a basic anatomical standpoint that it’s a bad idea. The third, non-technical hygiene option is perhaps best – use an ear wax removal kit that contains a peroxide solution that fizzes wax right out, which offers comfort of knowing it is working by the sounds of percolation that seem to emanate from deep inside your head and the trickle of the resulting output running down your cheek.

Sponsor Updates

  • Ellkay will exhibit at Rise National March 6-8 in Colorado Springs.
  • GHX has been named a Notable Vendor in the 2022 Gartner Vertical Industry Context: ‘Magic Quadrant for Multienterprise Supply Chain Business Networks.’
  • InterSystems announces that its HealthShare Unified Care Record has earned a Certified Data Partner designation from NCQA’s Data Aggregator Validation Program.
  • Clearsense posts a new case study, “Accelerating Research and Delivering Enhanced Patient Insights with Population Health.”
  • VA names NeuroFlow one of the winners of its Mission Daybreak Grand Challenge, designed to discover new solutions to reduce veteran suicides.

Blog Posts


Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
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EPtalk by Dr. Jayne 2/23/23

February 23, 2023 Dr. Jayne 4 Comments

In the “not a major surprise, but it’s nice to see some data” category, a recent study published in the Journal Healthcare finds that scribes are linked to a 27% reduction in primary care burnout rates. The authors looked at using remote scribes to assist primary care physicians in an effort to boost physician wellness.

The research was performed at University of Wisconsin Health and included approximately 200 physicians in the specialties of family medicine, general internal medicine, general pediatrics, and adolescent medicine. Individual scribes were paired one-to-one with physicians. The intervention group included 37 physicians and the control group numbered 160. The scribes used an audio-only cellphone connection to listen to visits and create documentation in real time. Orders were entered and held in a pending status for physicians to execute. The final notes also underwent review, editing, and signature by the physicians.

Prior to the intervention, more than 70% of physicians reported burnout. Post-intervention, that number was down to 51%. Although that change is dramatic, it is accentuated by the fact that for those physicians who didn’t work with a scribe, their burnout rates rose from 50% to 60%. Additionally, those working with scribes were more likely to describe their workplace as “joyful” and “supportive.” Measures of EHR-related stress were lower than those clinicians who didn’t have scribes. Working with a scribe slashed up to 66 minutes of EHR time out of an eight-hour physician day, with half of that being outside the scheduled workday.

Interestingly, looking at the study design, those receiving scribes were self-selected and had to agree to not only participate in program evaluation efforts, but to see one additional patient per half-day clinic session in order to offset the costs of the scribe. Both of those factors may have had an influence on satisfaction.

The authors noted that four of the intervention group dropped out of the project within the first year, and it would be interesting to look at the reasons given. They also noted that the project began just prior to the COVID-19 pandemic, “which dramatically disrupted clinical operations and could have affected the post-intervention wellness and EHR measurements.” Still, they conclude that “the fact that a scribe program can be revenue-neutral with modest increases in productivity makes them an attractive intervention to help organizations improve the wellness of their physician workforce.”

I think that if primary care colleagues fully did the math, many of them would be willing to see one or two more patients per day in order to shave time off their after-hours documentation.

Working with scribes was critical to my survival in the early days of the pandemic, when my urgent care’s volumes spiked. It would have been impossible to see 80+ patients per day without a scribe. A good chunk of those visits were for COVID testing or COVID concerns without any symptoms, and my scribes were able to capture not on the patients’ stories, but all of my counseling and medical advice, before I left the room.

Unfortunately, many of our practice’s best scribes gained admittance to medical school in the summer of 2020, decimating the program. It wasn’t able to recover prior to the subsequent COVID peaks, and the lack of scribes was directly associated with a number of physicians leaving the organization in the first half of 2021. There is definitely some work effort involved in onboarding a scribe program, but if your organization is experiencing clinician burnout, it’s worth considering.

My Approved Portraits

Senator Tammy Baldwin of Wisconsin is going after health system Ascension. In a letter to the health system’s CEO, she calls out the fact that “Ascension is required to provide charitable benefits to the community and operate solely to serve a public, rather than a private interest. Despite these requirements, Ascension has significant for-profit investment activities that dwarf what the system providers in annual charity care.” She goes on to state that “by operating like a private equity fund, Ascension is squeezing staff, closing facilities, and extracting cash from its member hospitals for dubious ‘management fees’ all to advance its investment activities and provide compensation to its executives.”

Baldwin also calls out the fact that at the recent J.P. Morgan Healthcare Conference, Ascension’s CEO talked up its $18 billion in cash and investments, noting “This number raises questions about why Ascension, a mission-driven health system with non-profit status, is not prioritizing reinvestment into serving vulnerable communities and its own operations – which should include increasing pay and improving working conditions for its burned out and overextended health care workforce.”

She cites data that Ascensions investment funds lost the system more than $200 million more than the organization provided toward charity care during the most recent financial quarter. She closes with a demand for data covering fiscal years 2015 through 2022 that describes investments, returns, charity spend, debt collection practices. She also asks for information on management fees charged to hospitals, how monies from the Provider Relief Fund were used to address hospital staffing, details on over $250 million in charitable care during the last three months, and a list of compensation packages for executives and board members.

I’ve worked for several health systems that sat on billions of dollars while the proverbial city burned. I’ve seen essential frontline workers struggle to maintain full-time status while managers are incentivized to turn them into part-time workers so they don’t have to pay benefits. I’ve seen these systems put the squeeze on primary care physicians while they build fancy non-clinical additions on their buildings. And we’ve all seen some of these organizations aggressively pursue patients for their portion of payments, while barely paying heed to their supposed charitable missions.

On my most recent patient-side visit to one of these systems, I experienced understaffing, scheduling issues, and dirty facilities. With cash in the double-digit billions, it feels like they shouldn’t have baseball-sized dust bunnies in the waiting room. They also shouldn’t be shifting patients away from established physician relationships to brand new mid-level providers because the physician panels are full and they “can’t afford to hire” additional physicians.

It will be interesting to see how this plays out with Ascension, and I’m sure other nonprofits will be following closely.

What do you think about so-called non-profit health systems who have billions in the bank? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 2/23/23

February 22, 2023 Headlines No Comments

New Releases: SDOH Toolkit and Learning Forum Sessions for the Health IT Community

ONC publishes the “Social Determinants of Health Information Exchange Toolkit” to serve as a resource for healthcare stakeholders as they consider incorporating social determinants of health into the design of health IT systems.

Scoop: Olive AI plans to divest second major business line

Healthcare automation vendor Olive AI reportedly considers selling its payer-facing prior authorization business.

Amazon closes deal to buy primary care provider One Medical

Amazon closes its $3.9 billion acquisition of membership-based primary care provider One Medical, which has 200 clinics in 26 markets.

Morning Headlines 2/22/23

February 21, 2023 Headlines No Comments

AGS Acquires Offshore Patient Access BPO Unit from Availity

AGS Health acquires the India-based patient access outsourcing business of Availity, which adds 200 team members to AGS Health’s 11,000 RCM experts.

Ventra Health Announces Acquisition of Deras Global

RCM services provider Ventra Health acquires Deras Global Services, a Philippines-based provider of RCM services for hospital-based physician specialties.

Aledade Adds More Than 450 New Practices for 2023, Making It the Largest Network of Independent Primary Care in the Country

Independent primary care practice management company Aledade acquires value-based care analytics vendor Curia for an undisclosed sum.

News 2/22/23

February 21, 2023 News 3 Comments

Top News


ONC publishes “Social Determinants of Health Information Exchange Toolkit.”

Reader Comments

From NY CIO: “Re: Northwell Health. Word is it will announce its move to Epic and that it will bring a large number of their Allscripts-outsourced employees back in-house.” Unverified. I’ve been watching the Northwell job site, which lists a handful of positions that include Epic implementation.

HIStalk Announcements and Requests

ViVE and HIMSS23 exhibitors: the conferences will have come and gone within a few weeks, but contact Lorre if you want a full year of HIStalk sponsor exposure for little more than you’ll spend on coffee for your booth people.

This seems like an interesting webinar topic with a compelling title that I ran across on LinkedIn: “TEFCA Kills the National Networks: Or Does it?” offered by Zen Healthcare IT.


Welcome to new HIStalk Platinum Sponsor Mobile Heartbeat. The Waltham, MA-based company offers the health industry’s leading unified clinical communication and collaboration solution. The MH-CURE platform securely engages colleagues across every department and accelerates decision-making, improves care delivery, and increases patient throughput. Its scalability and reliability is evidenced by a robust user base of 260,000 active users and 130,000 deployed iPhones. Open architecture, anchored in standards-based API, supports both innovation and integration with third-party solutions. Adoption-driven pricing model with unlimited users and a bed-based pricing structure encourages widespread adoption. Thanks to Mobile Heartbeat for supporting HIStalk.


February 28 (Tuesday) 1 ET. “Words Matter: Simplifying Clinical Terms for Patients.” Sponsor: Intelligent Medical Objects. Presenters: Whitney Mannion, RN, MSN, senior terminologist, IMO; David Bocanegra, RN, nurse informaticist, IMO. The language of medicine can be confusing and contradictory to patients, challenging their ability to prepare for a procedure or pay their bills. This webinar will explore how the words that are used to communicate – online, in print, and in person – must be chosen carefully to allow patients to comprehend their diagnoses, treatments, and care plans. The presenters will also describe how the ONC Final Rule for the 21st Century Cures Act will make clinical and technical language more directly accessible through patient portals.

March 7 (Tuesday) noon ET.  “Prescribe RPA 2.0 to Treat Healthcare Worker Burnout.” Sponsor: Keysight Technologies. Presenters: Anne Foster, MS, technical consultant manager, Eggplant; Emily Yan, MPA, product marketing manager, Keysight Technologies. Half of US health systems plan to invest in robotic process automation by the end of this year, per Gartner. The concept is evolving to help with staff burnout and physician productivity. The presenters will introduce RPA 2.0, explain how to maximize its value, demonstrate how to quickly start on RPA 2.0 and test automation in one platform, and answer questions about healthcare automation.

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

Acquisitions, Funding, Business, and Stock


AGS Health acquires the India-based patient access outsourcing business of Availity, which adds 200 team members to AGS Health’s 11,000 RCM experts.

RCM services provider Ventra Health acquires Deras Global Services, a Philippines-based provider of RCM services for hospital-based physician specialties.

HealthStream announces Q4 results: revenue up 7%, EPS $0.08 versus –$0.01. HSTM shares are up 3% in the past 12 months versus the Nasdaq’s 15% loss, valuing the company at $800 million.


A new American Hospital Association report covers recent developments involving retail, payer, and technology disruptors of healthcare in the $260 billion primary care market:

  • Amazon. Will acquire primary care provider One Medical for $3.9 billion pending FTC approval. Added the RxPass generic medication program. Offers home lab testing. Uses AWS to drive innovation. Runs a healthcare accelerator and has invested in disease management.
  • CVS Health. Markets its services to health plan customers that were acquired with its purchase of Aetna. Will expand its HealthHUB to 1,500 locations. Will acquire primary care provider Oak Street Health for $10.6 billion pending FTC approval. Acquired home health company Signify Health for $8 billion. Has expanded its virtual mental health services. Will create health subscription models and commercialize its data and analytics. Has high usage of its CarePass program for free medication delivery and its self-serve digital tool for completing pre-appointment forms. Will spend $3 billion to expand its digital offerings and improve the customer experience. Runs a $100 million early-stage digital health venture fund.
  • UnitedHealth Group. Will process transactions for 85 million patients via its merger with Change Healthcare. Has funded multiple virtual behavior health providers. Invested in care coordination companies and a provider credentialing vendor. Has invested in several tech-heavy remote patient monitoring and home care companies along with several virtual care solution vendors.
  • Walgreens Boots Alliance. Acquired two-thirds interest in primary care provider VillageMD and will have 1,000 practices by 2027. Is buying Summit Health, which operates urgent care provider CityMD, for $8.9 billion. Acquired specialty pharmacy Shields Health Solution. Paid $330 million for controlling interest in CareCentrix, which manages patients in their homes.
  • Walmart. Is continuing to open freestanding health centers. Acquired telehealth provider MeMD last year. Is partnering to extend value-based care to Medicare beneficiaries. Works with Epic to enhance communication and information sharing.
  • Apple. Is creating relationships with payers, health systems, and researchers via health-related features for the Watch and IPhone.
  • Google/Alphabet. Collects health information via Google Fit. Is actively working with drug companies to cut drug development costs via AI. Is focusing on, and investing in, the use of AI ii radiology. Has launched three Health Data Engine accelerators.


  • Lifepoint Health will use virtual care technology from Midi Health to launch a telemedicine service for women experiencing perimenopause and menopause.



Mass General Brigham hires Rebecca Mishuris, MD, MPH, MS (Boston Medical Center) as VP/CMIO.


Greg Kidd (Glytec) joins Revuud as regional VP.


Zachary Lipton, PhD (Amazon AI) joins clinical documentation company Abridge as chief scientific officer.


Nancy Heininger (Athenahealth) joins Koan Health as RVP of sales.


XiFin, parent company of OmniSys, promotes Scott Warshaw, MPA to chief strategy officer.

Announcements and Implementations


The Sequoia Project launches a Consumer Voices Workgroup to learn first-hand about the barriers they experience while accessing, using, and sharing their health information. Nearly all of the members serve as caregivers for patient, 80% of whom don’t use technology.

Sunrise Mountain Family Medical Clinic (NV) implements cloud-based EHR technology from EClinicalWorks.

Infor launches a module for its Workforce Management suite that analyzes EHR data to measure workload for each patient to support nurse scheduling and reduce overtime.

Redox will offer its interoperability systems on Google Cloud.

Government and Politics

President Biden upholds an International Trade Commission ruling that could ban importation of the Apple Watch over EKG patent complaints filed by AliveCor. Masimo has also sued Apple over pulse oximetry patents and has won an initial ruling, which could also apply an import ban to some versions of the Watch. Apple has appealed the AliveCor decision, and experts say that even if Apple loses either decision, it will probably just negotiate a licensing fee with the plaintiff.


HHS OCR reports that large HIPAA breaches jumped 58% between 2017 and 2021, with HIPAA complaints spiking 39% in that same timeframe. The office says that its funding has not kept up with these increases, limiting its HIPAA enforcement capabilities.


The federal government shuts down Missouri non-profit Medical Cost Sharing Inc., a healthcare cost-sharing ministry that took in $7.5 million in membership fees while paying out only $246,000 to cover the submitted healthcare bills of members. The two founders pocketed at least $4 million for running a minimally regulated ministry whose members pay premiums that are used to cover the medical bills of other members. Medical Cost Sharing, which required members to attend church and abstain from using drugs and alcohol, offered plans starting at $90 per month that included telemedicine and discounts on visits with its in-network providers.

Privacy and Security


Lehigh Valley Health Network (PA) refuses to pay the ransom that was demanded by hackers who breached a radiation oncology imaging computer at one of its physician practices.

Tallahassee Memorial HealthCare (FL) restores its computer systems and resumes normal operations 13 days after an unspecified security incident. Sources have suggested that the hospital had been waiting on an insurance payout to meet ransomware demands.



The New York Times looks at the telehealth-powered growth in prescriptions of the psychedelic-like drug ketamine, also known as club drug Special K, whose use has expanded from surgery sedation to treating mental health conditions, frequently for unapproved uses and supplied by compounding pharmacies that operate outside FDA’s oversight. The authors note the narrowing gap between legitimate medical treatment and online shopping. Online seller Joyous charges $129 per month for a telehealth consultation, medication delivered to the customer’s home, and daily text messages for adjusting dose.

Optum Tri-State CEO Kevin Conroy responds to patient complaints about delays in scheduling appointments, requesting refills, and connecting with care team members, pledging to improve its call center operations, add clinicians, and extend hours. Optum’s Medical Care practice, formerly CareMount Medical PC, stationed a security guard outside of one of its urgent care facilities late last year as tensions rose over service issues.


A study of the low credit scores of residents of Southern states finds that medical debt is a key contributor, driven by the high prevalence of chronic disease and having eight of the 11 states that haven’t expanded Medicaid. A new policy change will eliminate the two-thirds of medical debt collections from credit reports that involve balances under $500, but people in the South are more likely to have debt over that threshold.

Sponsor Updates

  • An Arrive Health analysis of 78 million prescription transactions finds that its Real-Time Prescription Benefit solution surfaces 37 million transactions in which a $0 medication is available.
  • Bamboo Health will exhibit and Diameter Health will present at the State Healthcare IT Connect Summit March 6-8 in Baltimore.
  • Nordic releases a new episode of its “Designing for Health” podcast featuring Memora Health’s Omar Nagji.
  • HealthMark Group CEO Bart Howe, MBA is elected president of the Association of Health Information Outsourcing Services.

Blog Posts


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

Morning Headlines 2/21/23

February 20, 2023 Headlines No Comments

LVHN reports cyberattack from suspected Russian ransomware group

Lehigh Valley Health Network (PA) refuses to pay the ransom demanded by the Black Cat group, which launched a cyberattack on an LVHN computer system that supports one of its physician practices.

Winners revealed in VA’s $20M Mission Daybreak Grand Challenge to reduce Veteran suicides

The VA awards a combined $11.5 million to the 10 winners of its Mission Daybreak Grand Challenge, which aims to discover new suicide-prevention solutions including those that incorporate digital health.

Scribes linked to 27% lower burnout rate in primary care

Primary care physicians who use scribes report lower levels of burnout, improved workflow satisfaction, and less time spent documenting in the EHR.

Curbside Consult with Dr. Jayne 2/20/23

February 20, 2023 Dr. Jayne No Comments

ChatGPT and similar tools continue to be some of the hottest topics around the virtual physician lounge. Plenty of clinicians are experimenting with using the tools to help respond to patient messages, and the bravest souls are even looking at using it to create visit documentation.

Although it’s tempting to think that we might be on the cusp of having reliable tools to help us with some of the most time-consuming parts of our jobs, the reality is that the technology is not yet ready for prime time as far as using it in clinical scenarios. Unfortunately, many frontline physicians may not understand the limitations of the system and are wading into some pretty deep water where it comes to patient care.

Some of my non-medical friends have been using it as well and have a lot to say about the fact that its output can sound completely convincing, but is factually incorrect. There are some examples going around, such as where it lists the peregrine falcon as the fastest marine mammal. The computer science folks note that in order for models like ChatGPT to be useful in healthcare, constraints need to be placed on their predictive capabilities.

For example, if you were using the tool to summarize a patient’s chart, you don’t want to allow it to predict procedures or treatments that didn’t happen. My friends seem to think that the easy answer in healthcare is to just have the physician review everything to make sure it’s accurate. However, those of us who practiced back in the days of heavy use of medical transcription know that’s easier said than done. The number of transcriptions that went out the door without proofreading or corrections was staggering, and led to outcomes running the spectrum from laugh-provoking to malpractice.

There’s also the not so small matter of HIPAA and the risks of feeding large quantities of patient information into the dataset used by the tool. Additionally, trying to leverage AI-based technologies for healthcare isn’t cheap. I’ve seen several startups that try to pass their solutions off as “AI-enabled” when all they really have is a bunch of sophisticated decision trees. There’s a certain threshold of money that has to be raised in order to be able to afford the work needed to truly move into the AI space, and understanding whether a company even has the resources to realistically do AI work should be one of the first steps in determining if they’re blowing smoke.

In related topics, some of my colleagues were discussing a recent editorial in JAMA Health Forum titled “Garbage in, Garbage out – Words of Caution on Big Data and Machine Learning in Medical Practice.” The piece opens with a quote from Alan Turing: “A computer would deserve to be called intelligent of it could deceive a human into believing that it was human.” It goes on to talk about machine learning and the use of data to predict clinical outcomes, such as adverse events related to medications. We know all too well the risks of using data sets that aren’t representative of the population in question or that don’t have all the information needed to generate a reliable prediction. The article uses the example of an opioid prediction rule that didn’t included data on cancer diagnoses or enrollment of hospice as a rule that isn’t ready for prime time.

Especially in the primary care trenches, physicians are often so busy just trying to get the daily work done that they may not be digging in to understand exactly how predictive rules are generated or how valid they are. They have to rely on regulatory agencies and the editorial staff of medical journals to vet proposals. Although this can delay the time for new tools to get to the point of care, it can be a valuable step for protecting patient safety. The article notes that it’s also important to reevaluate rules on a periodic basis, since medical knowledge continues to evolve. It gives the evolution of an HIV diagnosis “from a death sentence to a manageable chronic illness” as an example. It’s good food for thought.

Around the administrative / non-clinical physician water cooler, one of hottest topics over the last couple of weeks was that of annual performance reviews. Making the jump from clinical practice to management requires more than just an interest in administrative topics. It also involves understanding how corporations work and some of the tactics that they use to manage their human capital.

A physician who is new to administrative work recently learned that he would have to perform stack ranking when analyzing his team’s performance. For those who may not have run across this, it requires managers to score workers against their peers rather than against goals and objectives. The first time I ran into this was when I worked for a large hospital system, and a management consultant that had been engaged to “trim the fat” forced our department to implement it.

To make matters even worse, annual merit raises were tied to the stack rankings. For managers with exceptionally talented teams who were all working at or beyond their potential and who were achieving great results, it’s agonizing to have to allocate more of a raise to some and less to others when they were all working extremely hard and crushing their goals. As a relatively new physician leader at the time, I hadn’t been exposed to anything like that. It’s not something you learn about in medical school and it certainly wasn’t covered in the couple of physician leadership intensives that I was sent to as the health system prepared me for greater administrative roles. Fortunately, I’ve spent the better part of the last decade working in environments where this methodology isn’t used, and I felt more than a little disbelief at the fact that it seems to be becoming popular again.

I’m a firm believer that if an employee isn’t meeting expectations, that needs to be addressed early and often through individual conversations with their manager and potentially a performance improvement plan if needed. It shouldn’t be left until the annual performance review. On high-performing teams, members should be able to work without fear that they’re going to be unfairly compared to co-workers just because of a methodology. Stack ranking is hard on managers as well as employees, and contributes to an overall toxic workplace culture. The fact that it’s still out there despite the literature about its consequences says a lot about companies that continue to use it.

The last hot topic of the week was a recent study that looked at whether the board members at the nation’s top hospitals have healthcare backgrounds. Published earlier this month in the Journal of General Internal Medicine, it found that less than 15% of board members had a healthcare background versus finance or business services. Other interesting findings: of those with a finance background, 80% had experience with private equity funds, wealth management, or banking. The rest were in real estate or insurance. Of those with healthcare experience, 13% were physicians and less than 1% were nurses. The authors only looked at top hospitals and there were challenges in finding publicly available information about boards. This could be even more challenging when looking at smaller institutions.

These topics are just a sampling of those that are on the collective minds of physicians who are often just trying to put one foot in front of the other as they slog through caring for patients.

What do you hear when you’re working with clinicians? Are there any particularly hot topics? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Sachin Agrawal, CEO, EVisit

February 20, 2023 Interviews No Comments

Sachin Agrawal, MSc is CEO of EVisit of Mesa, AZ.


Tell me about yourself and the company.

I’ve been in healthcare consulting and software for 20 years, always focused on the enterprise needs of hospitals and health systems in areas such as revenue cycle, physician network alignment, quality and safety, et cetera. I joined this business about six or seven months ago and took the CEO seat on January 1.

We are network-agnostic virtual care operating platform, primarily for large operators of physician networks and all the professionals that surround them. Typically hospitals and health systems and sometimes significant category leaders in other healthcare delivery categories, but mainly focused on the underpinnings of operating virtual care for these big healthcare delivery orgs.

How would you describe the virtual health technology marketplace?

It is asymmetric in terms of how I’ve seen other HCIT markets operating. It was forced upon everybody, but from the perspective of providers, it was forced upon them for obvious reasons. But it  not one that evolved from the critical foundational needs that hospitals and health systems have. 

As a result, a lot of health systems are picking their heads up, now that we are a few years out from the onset of the pandemic, and saying that they were forced to drive a modality that has been disruptive to their core operations rather than additive in all the ways that they need to be, given the economic climate. I was surprised by that as an outsider. I understood the needs of the providers well, but as an outsider from virtual care coming in, I was surprised by how much of the evolution of the market, from an intelligence perspective, has remained at the surface level despite the tremendous utilization that we saw the past few years.

Providers didn’t have a choice about implementing virtual visits as the pandemic started, but some brought in telehealth companies that use their own medical staff. How are heath systems valuing telehealth’s value to their brand or as it relates to their other services?

This is a head-scratcher for me. It’s puzzling to have seen hospitals either promote the utilization of those networks or let those virtual-first networks promulgate and post up in their back yards. That goes everything that I’ve learned about what complex healthcare delivery organizations are trying to do, in terms of raising the bar on quality and safety, balancing fee-for-service reimbursement with value-based reimbursement, looking at network leakage and network integrity, and things like that.

The common denominator across all those topics is that hospitals and health systems have been focused on tightening their networks, clinical integration, physician practice alignment, and increasing M&A to employ clinicians. I look back on that and it’s puzzling, because in a lot of ways, it’s the antithesis of all those things.

Hospitals and health systems are picking their heads up and saying, this is not aligned with the Quadruple Aim. We need to do something about it in the medium to long term, but we also have to figure out how to engage with those networks in an appropriate manner in the short term, because  going cold turkey is challenging in this labor environment and in this cost environment. There’s a tough needle to thread for healthcare delivery organizations. They are talking to us all the time about how to thread that needle.

How has the patient and provider experience changed as telehealth has moved from a quickly implemented solution to a permanent strategy?

The impetus during the pandemic was to take what was inherently meant to be a brick and mortar set of clinical protocols and a brick and mortar operation and just virtualize it. I’m quite explicit about painting the difference between virtual and digital care. Virtualizing care is what we just talked about — what organizations had to do. Now the industry is at its inception of the next chapter, which is to digitize aspects of care that they otherwise didn’t have the time to think about – design, change management, organizational buy-in, and things like that. That impacts how service lines themselves in a world where you can be digital first. It impacts who’s doing what in terms of top-of-license activities versus bottom-of-license activities. It impacts where people fit.

I can’t tell you how many stories I’ve heard about the pandemic when clinicians were still going into their offices, obviously socially distanced, and doing virtual visits out of the office. That’s not what the promise of virtual care was meant to be. Virtual care itself needs to go through this digital evolution while obviously honoring the systems, processes, and workflows that are in place, many of which are focused on clinical satisfaction, safety, and things like that. I don’t think there needs to be a revolution, but a thoughtful evolution that we’re just at the beginning of now that we’re picking our heads up post pandemic.

How do virtual care needs vary by specialty?

Significantly. I’m excited to see the data around providers leveraging their own networks and clinical protocols in a virtual way to drive similar, if not better, quality and safety outcomes et cetera. It’s great to see the early data on that. What’s needed going forward is both the complexity and the opportunity of going from virtual care to a digital evolution as use cases expand. 

As you go from urgent and primary care up the ladder to things with higher acuity and higher complexity, there could be device dependencies. There could be wearable dependencies. There could be group consultation needs and things like that. Importantly, you need to go from just a provider-to-patient relationship to potentially many providers per patient relationships, or many providers to many providers type relationships to drive complex consultations. That ecosystem, in terms of the need to create connectivity and to do that process and service line that I’m talking about, is going to be underpinning unlocking additional value from virtual care efforts.

What are some telehealth best practices that can help physicians work at the top of their license, such as pre-visit chats and triage?

That is part of an important broader question around what we can do to alleviate the burnout issue and the turnover that happens, which then impacts the high cost of recruiting, credentialing, and privileging clinicians to get back on the front lines. I’m reminded of a story of a customer who is the middle of digital reengineering as opposed to just virtualizing brick-and-mortar care. They are one of the more progressive institutions that I know of in the country, a Top 15 health system. They measure very carefully evening pajama time, where clinicians come home after  busy day, spend time with their families, and then most likely after hours after kids are down and settled in, they are logging right back into the EHR and doing complex charting. It’s because they had this backlog as they went about their visits throughout the day.

This is a critical piece when it comes to the top-of-license question. Pulmonologists didn’t go to school for decades to sit at home in their pajamas doing charting. This could be impacted on the front end through the intake process, the virtual triage process, and the asynchronous process where patients can assume more ownership. It should happen throughout the process as well, in terms of removing the barriers to documentation and charting. Then on the back end, the integration into the leviathan health systems,  power health systems like EHRs and revenue cycle. 

I think of it as the underlying need for integration throughout the process — beginning, middle, and end — to drive down things like evening pajama time. This institution would tell you that, as they have seen a drop in that based on digital re-engineering, they can directly tie that to a drop in turnover and therefore in recruitment and backfilling costs. It’s a KPI that they are looking at carefully, which is the promise of digital as opposed to sticking to your brick-and-mortar workflow and hoping for the best.

What do you expect to happen with telehealth when the public health emergency ends on May 11 and rules and payment policies go back to the early 2020 world?

It has significant implications. There’s a reason why pre-pandemic, the system was largely averse to some sort of a national credentialing or privileging approach, or even a cross-state credentialing privileging approach. First and foremost, we’re probably going to go back to life as we knew it before the pandemic from that perspective. That puts a significant accountability right back onto health systems to do credentialing in multiple states and cross-state privileging and things like that, which is a huge lift. They are already dealing with significant resource turnover. Just keeping up with the credentialing and privileging activities in their home state is drowning them. I think we are going to see a consolidation of where providers are able to practice virtual care. The other thing this will highlight is the need for those higher-acuity use cases that you are talking about.

Even within state borders, we’re going to see a greater separation of access to care. This is all driven by social determinants of health, access to specialists and subspecialists. Health systems will have an accountability. They’re going to have these key resources largely aligned with them, the subspecialists, that they need to find a way to liberate their time to cover a broader swath of a population even within a state. It’s going to beg the critical questions of how to re-engineer our processes to digitize that so that we can have our most important resources go further at the top of their license.

What changes do you expect to see in the next few years that will affect the company and the industry?

We have set up our company’s strategy to align directly with where we think the industry is going. I’ve been around the block in healthcare and I’ve seen platform categories come up over time. Usually these platforms are filling a critical void that exists between the core hospital systems, some of which I’ve mentioned — scheduling, EHR, revenue cycle, and digital front door if that comes into maturity. There’s a gap between what those core systems do and how to re-engineer care or to drive the efficiencies and to drive quality and safety standards up.

For the industry, as the dust settles on a pure outsource model to virtual networks and things like that, and there’s increased focus on how to we assume command and control of this as a health system, the industry will need a platform layer. I’ve talked to many CIOs and CMIOs in the past six months, and two of them from Top 10 health systems have described this as a need for a middleware to integrate in and out of the core systems, to author workflow, and to ensure that those workflows are being set up for the right people to do the jobs at the top of their licenses.

That’s a complex set of needs that needs a dedicated approach. That market will have plenty of room for participants, because the needs that it addresses are going to be significant. Of course we at EVisit are setting up our strategy to be one of the emerging leaders in what we believe is going to be a really exciting category in healthcare delivery.

Morning Headlines 2/20/23

February 19, 2023 Headlines No Comments

Reported HIPAA complaints and breaches shot up from 2017 to 2021: HHS

HHS OCR reports that it does not have the financial resources it needs to investigate mounting HIPAA breaches and complaints, both of which increased between 2017 and 2021.

Tallahassee Memorial HealthCare resumes normal operations, but questions loom

Tallahassee Memorial HealthCare (FL) announces that it has fully restored its computer systems and services 13 days after an unspecified security incident forced it to downtime procedures.

Lightbeam Health Solutions Is Relocating Its HQ from Las Colinas to Cypress Waters in Coppell

Population health management company Lightbeam Health Solutions relocates its headquarters from Las Colinas, TX to nearby Coppell, expanding its office footprint by 50% in anticipation of growth.

Monday Morning Update 2/20/23

February 19, 2023 News 12 Comments

Top News


The VA postpones its planned July 2023 Oracle Cerner go-live at its Ann Arbor, MI facilities until later this year or early in 2024.

The service region is concerned about “how well EHRM would interact with VA Ann Arbor’s vital medical research mission.”

Reader Comments

From AT: “Re: pet peeves with service industry words and phrases. ‘I appreciate you,’ following my thanking you and leaving you a tip, which suggests that we are like-minded, decent people even though you have no way of knowing that. Second is thanking someone with ‘of course,” implying that I’m either too stupid to know the obvious answer or should not have even said thanks.” I will admit that even my curmudgeonly self has no problem with either of these, especially ‘I appreciate you’ that I first heard among polite Southerners who likely meant it. “No problem” is much worse in my mind – should I feel relieved that my thanking you for doing the job for which you are paid isn’t a bother? Others that bug me at least a little:

  1. “Yeah-no” or “no-yeah.” Why do people think that appending these opposites adds emphasis?
  2. “Curated.” Unless you are observing nature or some random phenomenon, everything you experience was “curated” by someone.
  3. “It is what it is.” This phrase is intended to convey a philosophical acceptance of immutable circumstances, but most people who use it seem more inarticulate than profound.
  4. “I could care less,” said by people who mean that they could not care less.
  5. Marketing emails that contain “hope you are well” (should I tell you if I’m not?) and using the flabby “please don’t hesitate to call me” as though I not only require an invitation to call, but I have to do it quickly.
  6. Starting a sentence with “know,” as in “know that I am here for you.” Just say what you want me to “know” and I’ll know it without being ordered.
  7. “Now,” “presently,” “today,” or “at this point in time.” It’s always now unless you indicate otherwise.
  8. “Build out” as an unnecessarily wordy way to say “build.” Build it out and they will come?
  9. “Simplistic” means a dangerous oversimplification, which is not at all synonymous with “simple” and does not take an adjective such as “too simplistic.”
  10. I won’t even bother with “reimbursement” as a financially appalling and less-forthright euphemism for “payment.”

HIStalk Announcements and Requests


Most poll respondents felt cared for during their most recent clinician encounter. However, some of them left comments indicating that while the physician did a good job, they are moated off by the bureaucracy of hospitals, insurers, indifferent front desk staff, and a preoccupation with following mandatory workflows.

New poll to your right or here, following up on last week’s musing: Do you have to pay to park at your primary work site? I’ve only ever had to pay at one employer, an academic medical center. Parking lots are assigned by seniority, so new hires get stuck parking far from their work sites and sometimes extend their workdays for free during waits for shuttle buses both ways. You are also buying access to a garage, not a reserved spot, so your day starts by looking at taillights of your co-workers who are fighting for the same first available spots. The university defended its parking policies by saying that students would otherwise be leaving cars all over the place, but of course those students were also customers who were paying many thousands of dollars each year on top of parking fees. Even worse was charging patients and visitors to cruise dark garages looking desperately for a space as they ran late for appointments, often forgetting how to find their car after leaving, and then being stuck in the exit’s pay line while trying not to forget the clinician’s instructions. My personal gripe was that when I drove in to see a doctor on a different campus as a patient, I theoretically could have been issued a ticket because my permanently affixed sticker (they didn’t use hang tags back then) made it appear that I was parking inappropriately in a spot that was reserved for patients, not to mention that they stopped validating. This is a good marketing lesson – no matter how much good patients get from their visit, the first and last thing they encounter is an impersonal, frustrating parking experience, which you don’t see at CVS and suburban medical buildings that share a plaza with Home Depot.

I get frequent emails from teachers whose Donors Choose grant requests were funded by reader donations along with matching money from my Anonymous Vendor Executive. Here’s a new one from Mrs. S in California:

My amazing scholars not only use, but enthusiastically ask for “Fun Friday” every single week in order to explore the STEM materials YOU helped provide for them! They are building worlds using their imagination, and solving problems as they arise while using the engineering design process. They utilize critical thinking skills, and collaborative skills to learn science through creative fun spaces. Never were so many rowdy 5th graders ready to get their hands moving and brains working so late on a Friday afternoon. Thank you for giving them that that joyful opportunity!


February 28 (Tuesday) 1 ET. “Words Matter: Simplifying Clinical Terms for Patients.” Sponsor: Intelligent Medical Objects. Presenters: Whitney Mannion, RN, MSN, senior terminologist, IMO; David Bocanegra, RN, nurse informaticist, IMO. The language of medicine can be confusing and contradictory to patients, challenging their ability to prepare for a procedure or pay their bills. This webinar will explore how the words that are used to communicate – online, in print, and in person – must be chosen carefully to allow patients to comprehend their diagnoses, treatments, and care plans. The presenters will also describe how the ONC Final Rule for the 21st Century Cures Act will make clinical and technical language more directly accessible through patient portals.

March 7 (Tuesday) noon ET.  “Prescribe RPA 2.0 to Treat Healthcare Worker Burnout.” Sponsor: Keysight Technologies. Presenters: Anne Foster, MS, technical consultant manager, Eggplant; Emily Yan, MPA, product marketing manager, Keysight Technologies. Half of US health systems plan to invest in robotic process automation by the end of this year, per Gartner. The concept is evolving to help with staff burnout and physician productivity. The presenters will introduce RPA 2.0, explain how to maximize its value, demonstrate how to quickly start on RPA 2.0 and test automation in one platform, and answer questions about healthcare automation.

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


  • University Hospitals (OH) will work with Premier’s PINC AI Applied Services on projects related to real-world data, prospective research, clinical trials, and the use of natural language processing for early disease identification.

Announcements and Implementations


A Wolters Kluwer Health survey finds that while most patients prefer receiving educational materials from their providers, they often end up looking online because they have left an encounter with unanswered questions.

Government and Politics

Two Idaho state lawmakers co-sponsor a bill that would make it illegal to administer MRNA vaccines.


Romania investigates five doctors who are accused of faking diagnoses, or intentionally inducing cardiac problems with medications, as an excuse to charge for implanting into their patients medical devices that they had removed from dead people.

Sponsor Updates

  • CTG publishes a new case study, “Healthcare System for Children Transforms Their Data Management Strategy with CTG’s Help.”
  • Meditech will present at the 2023 AHA Rural Health Care Leadership Conference February 19-22 in San Antonio.
  • RxLightning’s MedAccess ecosystem solves specialty medication enrollment problems while relieving healthcare burnout.
  • West Monroe announces Strategic Workforce Optimization with Work 4D, which analyzes a company’s work and aligns it to the most appropriate type of talent – employees, contractors, outsourcers, or automation. 
  • Sectra wins four awards for customer satisfaction – 10 consecutive years of winning in the US.

Blog Posts


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

Morning Headlines 2/17/23

February 16, 2023 Headlines No Comments

Avaya Files For Chapter 11 Bankruptcy After Cloud Subscription Accounting Woes

Unified communications and collaboration services vendor Avaya, whose healthcare offerings include solutions for virtual care, collaboration, and patient access technology, files for Chapter 11 bankruptcy for the second time in six years.

Elation Health Acquires Medical Billing Company Lightning MD to Accelerate Market’s First Primary Care All-in-One Solution

Primary care EHR vendor Elation Health acquires practice-focused medical billing company Lightning MD.

Spacelabs Healthcare Expands Clinical Informatics Capabilities with Acquisition of Predictive Analytics Company PeraHealth

Spacelabs Healthcare acquires PeraHealth and its Rothman Index patient deterioration software for undisclosed terms.

VA delays health record go-live at key Michigan site

The VA delays Ann Arbor Healthcare System’s EHR roll out, citing concerns over how well the Oracle Cerner software will interact with the health system’s “medical research mission.”

GE HealthCare Makes Push Into Artificial Intelligence

Newly spun off GE HealthCare announces plans to develop hospital software to help guide care and assign resources.

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  1. I think you're referring to this: It's a fascinating example of the swiss cheese effect, and should be required…

  2. Yes, let me be clear about my statements. These things have happened at the VA, and these things have caused…

  3. 21 years working with the Oracle/Cerner system at many organization sites. Never once have I seen an order get placed…

  4. I think you may have never used an EHR, or if you did, you did not like it. I think…

  5. This reminds me of that story a few years ago where a doctor placed an order in mg/kg instead of…


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