Morning Headlines 7/19/23

Greenwood Village-based DocBuddy secures $1.84M to scale its digital health care workflow solution

DocBuddy, which offers an EHR workflow solution, raises $1.8 million in a seed funding round.

NeuroFlow Acquires Parent Company of BHL and BHL Touch

Behavioral health technology vendor NeuroFlow acquires Capital Solution Design, whose measurement-based care solutions are used by the VA.

Request for Health Information Technology Advisory Committee (HITAC) Nominations

The GAO seeks nominations for appointments to the Health Information Technology Advisory Committee.

Researchers Develop AI Model to Better Predict Which Drugs May Cause Birth Defects

Mount Sinai data scientists develop an AI model that may predict which pre-clinical compounds and medicines, particularly those new to market, could cause birth defects.

News 7/19/23

Top News

Chatbot-based virtual care company K Health raises $59 million in a funding round led by Cedars-Sinai, bringing its total raised to $325 million.

The company’s primary care service offers unlimited text-based visits, remote annual wellness visits, chronic condition management, prescription management, and urgent care services for $49 per month for residents of all states except Alaska and Hawaii.

Cedars-Sinai will offer K Health’s AI-powered app to its patients in California by the end of the year, integrated with Epic and using the health system’s clinicians.

K Health also sells its technology to payers through Hydrogen Health, which it launched with Anthem (now Elevance) and investment firm Blackstone in 2021.

Reader Comments

From Frumious Bandersnatch: “Re: data segmentation. How can you program something that allows a patient to decide after the fact that they want something hidden in their medical record? You can’t just uproot a tree whose roots are interlaced with other trees.” Kevin Baumlin, MD says that ONC’s proposal to require clinicians to redact medical records data elements when a patient requests involves “legalizing tampering with the medical record” that could prove harmful in that patient’s future encounters. He cites examples of patients hiding opioid use or a history of depression. I’ll side with a brilliant reader who says the only practical implementation of the well-intentioned rule would be if patients serve as their own data intermediary, obtaining a copy of their summary as a file that they could edit before sharing. I’m rarely in the “blockchain could fix everything” camp, but perhaps some sort of versioning and permissioning could be involved. I’ll make this the topic of this weekend’s poll. It’s an interesting question — the patient can choose to divulge as much or as little of their history as they want during an in-person encounter, so should that control carry over into digital records? Should providers trust data that the patient may have selectively edited? Perhaps as with redaction, deletions could be obscured but noted to alert the clinician that they are not seeing a complete record. Or, you could get really creative and allow the patient to insert their own notes to explain. But the big challenge is probably propagation across multiple provider data copies – I ask my psychiatrist to hide depression details, so should copies in the EHRs of my PCP, surgeon, and hospital reflect that request or would I need to make individual requests? It would be more manageable if everything flowed through a single HIE or service, but the issue is complex, just like trying to correct EHR entries that have propagated all over the place.

From Eric: “Re: transplant dispute. Thought you would find this interesting.” The non-profit United Network for Organ Sharing (UNOS) — which oversees the entire US transplant system — and organ screening firm Buckeye Transplant Services will take their data dispute to arbitration. Buckeye’s automated tool extracts transplant data directly from hospitals, which UNOS says is unauthorized use of information that only UNOS can provide. UNOS has threatened to lock Buckeye out of its DonorNet organ clearinghouse, which would put Buckeye out of business and force its 63 hospital customers to perform their own screening. The federal government announced in March that it would break up the organ transplant monopoly of UNOS, whose most recent financial report indicates $75 million in annual revenue.

From Anon E. Mous: “Re: Legacy Health financial issues. They have shown sound financial management and avoided excessive spending and vanity projects and navigated the COVID years with care and compassion in the shadow of behemoth Providence. This could be a bellwether for similar systems in the Pacific Northwest.” Six-hospital Legacy, which is losing $10 million per month,  will sell its lab operations to LabCorp in hopes of hitting lender-mandated financial metrics.

From IPC: “Re: Walgreens. The recent earnings call suggests why it previously acquired a majority stake in VillageMD. Maybe they should start branding themselves as ‘pharma-centered care.’” The US healthcare division of Walgreens lost $113 million in the quarter, which it blames on the underperformance of VillageMD and CityMD due to a mild flu season and soft market demand. It also notes an 83% drop in COVID vaccinations and a steep slide in COVID test sales. The company will close 450 stores and lay off 10% of its corporate workforce. IPC’s observation comes from an earnings call comment that 50% of patients who are seen in a co-located VillageMD clinic go next door to get their prescriptions filled at Walgreens, and each clinic generates 40 additional prescriptions per day, with associated profit for the drugstore. WBA shares have lost 22% in the past 12 months versus the Nasdaq’s 24% gain.

HIStalk Announcements and Requests

Mr. H here, reporting back refreshed after several days away on vacation and happy that Jenn’s solo coverage rendered my presence optional anyway. I’m catching up, so remind me if I owe you something.

Webinars

July 26 (Wednesday) 1 ET. “Lessons We’ve Learned Since Launching our Cancer Prevention Program.” Sponsor: Volpara Health. Presenter: Albert Bonnema, MD, MPH chief medical information officer, Kettering Health System; Chris Yuppa, product owner for oncology services and cancer prevention, Kettering Health System. Kettering’s IT department has played a critical role in providing an EHR-driven framework to bring cancer risk assessment and individual prevention plans to more than 90,000 patients. Primary care, OB/GYN, oncology, and imaging providers are now able to assess the hereditary, genetic, and lifestyle factors that affect the risk of developing lung, breast, ovarian, colon, and prostate cancer in any patient encounter. Learn how Kettering brings together people, processes, and technology to be more proactive in the fight against cancer and where its cancer prevention program is headed next.

July 27 (Thursday) noon ET. “Why You Shouldn’t Wait to Use Generative AI.” Sponsor: Orbita. Presenter: Bill Rogers, co-founder, president, and chairman, Orbita. The advent of generative AI tools truly represents a paradigm shift. And while some healthcare leaders embrace the transformation, others are hesitant. Invest 20 minutes to learn why you shouldn’t wait. When combined with natural language processing, workflow automation, and conversational dialogs, generative AI can help leaders address a raft of challenges: from over-extended staff, to the rising demand for self-service tools, to delivering secure information to key stakeholders. You will learn where AI delivers the greatest value for providers and life sciences, how it can solve critical challenges faced by healthcare leaders, and how Orbita has integrated generative AI into its conversational platform so healthcare leaders can leverage its full capabilities safely and securely.

July 27 (Thursday) 2 ET. “Denial Prevention 101: How to stop denials from the start.” Sponsor: Waystar. Presenter: Crystal Ewing, director of product management, Waystar. There’s a reason denial prevention is prominent everywhere in healthcare RCM. Denials reduce cash flow, drive down revenue, and negatively impact the patient and staff experience. More than half of front-end denials don’t have to happen, but, once they do, that money is gone. It’s a pretty compelling reason to take some time now to do some preventative care on your revenue cycle. This webinar will help you optimize your front end to stop denials at the start. We’ll explore the importance of not only having the right data, but having it right where staff need it, when they need it.

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

Acquisitions, Funding, Business, and Stock

Medication supply chain technology company Bluesight, which renamed itself from Kit Check in December 2022, will use a strategic growth investment from Thoma Bravo in its acquisition of drug diversion analytics vendor Medacist.

DocBuddy, which offers an EHR workflow solution, raises $1.8 million in a seed funding round.

Behavioral health technology vendor NeuroFlow acquires Capital Solution Design, whose measurement-based care solutions are used by the VA.

UnitedHealth Group reports Q2 results: revenue up 16%, adjusted EPS $6.14 versus $5.99, beating Wall Street expectations for both. Its Optum unit saw revenues increase 25% to $56.3 billion.

Sales

• Northwell Health selects Aidoc’s AI operating system for triage, quantification, and coordination of acute care across 17 of its hospitals in New York.
• Get Well announces eight new smart patient room projects to support construction initiatives in the US, Kuwait, and New Zealand.

People

Medical coding automation vendor Fathom hires Enoch Shih, MS, MBA (Gusto) as COO.

RLDatix hires Frank Manzella, JD, MBA (Availity) as EVP of global corporate development.

Steve Aspling (Millennia) joins CorroHealth as regional VP of business development.

Trove Health hires Anthony Leon (InteropShop) as VP of growth.

Todd Johnson (SomaLogic) joins Abundant Venture Partners as CEO of the venture studio.

Matthew Kull, MBA (Cleveland Clinic) joins Inova Health System as chief information and digital officer.

Announcements and Implementations

Pediatric Cardiology Center of Oregon implements EClinicalWorks and its Prisma health information search tool.

Medhost will offer Availity’s eligibility and claim verification features to its hospital customers.

The Connected Health Initiative and Duke Margolis Center for Health Policy will host “AI and the Future of Digital Healthcare” on September 26 at the National Press Club in Washington, DC. Panel proposals are due August 1.

Teladoc Health will integrate Nuance DAX into its Teladoc Health Solo platform.

Government and Politics

The GAO seeks nominations for appointments to the Health Information Technology Advisory Committee.

Other

A fascinating report titled “How Private Equity Raided Safety Net Hospitals” looks at PE-backed safety net hospital operator Pipeline Health. It notes that similar to what happened with the now-closed Hahnemann University Hospital, PE firms are breaking promises they make to the community and to regulators in favor of maximizing profit (shocking, I know). Their strategies include monetizing the real estate, expanding unwisely, laying off employees, applying bankruptcies strategically, and closing hospitals. All but one of the eight hospitals that Pipeline has owned earned a CMS star rating of two of a possible five, while one earned three stars. It sold Weiss Memorial Hospital’s parking lot to a real estate developer for $10 million to build luxury apartments.

Sponsor Updates

• The results of eight studies involving the use of Linus Health’s digital cognitive assessment solutions will be presented at the 2023 Alzheimer’s Association International Conference.
• Ronin Chief Scientific Officer Christine Swisher, PhD joins the Coalition for Health AI.
• Medhost and Availity partner to offer Medhost partner hospitals a suite of eligibility and claim verification features.
• Meditech joins the KLAS Arch Collaborative.
• Artera publishes a case study, “Altura Participates in Call-to-Text Pilot Program.”
• Fortified Health Security publishes its 2023 Mid-Year Horizon Report on cybersecurity challenges.
• Baker Tilly releases a new Healthy Outcomes Podcast, “Improving healthcare delivery through employee experience and patient engagement.”
• Nordic publishes a video titled “The Download: Cyber strategies to optimize net new technologies.”
• Bamboo Health will exhibit at the NCHA Annual Summer Meeting July 19-21 in Williamsburg, VA.
• Ronin publishes an article in Nature on its Comparative insights model that delivers predictive insights to empower clinicians to reduce ED visits.
• CereCore releases a new podcast, “CIO on Innovation and Mobile Adoption: ‘Keep Your Eye on Operations.’”

Blog Posts

• Key Decision sin Systematic Healthcare Interoperability Change (Access)
• Overcome Staffing Shortages with a Hybrid Approach (AGS Health)
• Challenges to Adopting New Workflow Solutions (Arcadia)
• High-Quality Clinical Data Has the Potential to Transform HEDIS Quality Reporting and Close Care Gaps (Availity)
• Managing and Leveraging Data for the Next Wave of Healthcare Capabilities (CHIME)
• Unlocking the value of IT in healthcare (Nordic)
• Preparing for HITRUST Certification: The How and Why for Healthcare Service Providers (Clearwater)
• Rethinking Digital Ads for Pharma Brands (ConnectiveRx)
• 5 of the Most Common Legacy App Modernization Challenges for Businesses (CTG)
• Key Factors to Consider When Introducing Automation to Your Teams (Vyne Medical)

Contacts

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

Morning Headlines 7/18/23

Thoma Bravo Announces Strategic Growth Investment in Bluesight to Support the Company’s Acquisition of Medacist

Medication supply chain technology company Bluesight will use a strategic growth investment from Thoma Bravo in its acquisition of Medacist, a drug diversion monitoring and medication management software vendor.

Unicorn K Health raises $59 million in down round

Israeli digital primary care startup K Health raises $59 million in a funding round led by Cedars-Sinai.

These Chicago execs want their fraud convictions overturned. Here’s their argument.

Outcome Health co-founders Rishi Shah and Shradha Agarwal want their fraud convictions overturned based on the argument that prosecutors seized more of their assets than was warranted before trial, leaving them unable to employ their first-pick attorneys.

Curbside Consult with Dr. Jayne 7/17/23

Although my friends and family don’t exactly understand what I do at work, they know that I’m generally aware of cutting-edge technology. I can’t count the number of times in the last six months that people have asked me what I think about ChatGPT or artificial intelligence taking over the world. Although I enjoy reading the scholarly articles that people are publishing in informatics literature about the use of large language models, I’ve made it a point to try to keep up with the lay media so that I understand what my friends and family are reading. It’s also a good proxy to understand what my physician colleagues understand about the technology, given the fact that if they’re reading scholarly literature, it’s most likely in their professional specialty or subspecialty fields.

I was intrigued to see this article in the New York Times this week covering the Federal Trade Commission’s investigation into the potential harms of ChatGPT. Regulators sent a letter to OpenAI to inquire about its security policies and procedures, as well as to learn if consumers have suffered damages related to how the chatbot collects data. They’re also interested in the ability of the technology to generate and publish false information on individuals. The NYT reported that the letter was 20 pages long and included pages of questions, including those seeking information on how the company trains its AI models. It also requested documents related to the inquiry. A question is whether the company “engaged in unfair or deceptive privacy or data security practices or engaged in unfair or deceptive practices relating to the risks of harm to consumers.”

Most of the people I talk to act like ChatGPT is no big deal and we should be excited about using it. Although I’m optimistic about its ability to provide value in a variety of different industries and situations, it’s a complex technology and there needs to be thoughtful consideration about how we do or do not use it for patient care. I see a lot of people using it to generate patient-facing correspondence without much review. One physician boasted about how she was able to create lab results letters for her patients, sending a full day’s worth of letters in under three minutes. The ability to create and proofread those letters in the cited timeframe is questionable at best. Based on the looks on the faces of some of the colleagues she was speaking to, I wonder if they were questioning her professional judgement.

Many of the large health systems and EHR vendors that some of my colleagues work at are reported to have been on point with messaging to their physicians and other clinicians about not including protected health information in prompts that are used to access the systems, especially when users are considering using publicly available tools rather than institutional or research tools. However, many of my independent physician colleagues haven’t received the same level of education and didn’t understand that information they’re feeding into the prompts can be used in various ways once a technology company has control of it. Some of the physicians I’ve interacted with on social media still aren’t savvy enough to not post protected health information in their posts or images, and someone is always calling out a group member for posting unredacted content. The majority of physician users I interact with also don’t know that systems also might not have been updated with current data, which makes them unreliable when you’re asking for the latest medication or regulatory information. Without receiving education on the technology, they’re also often unaware about the potential of AI-driven systems to hallucinate or create completely inaccurate information based on patterns presented to it in the past.

It’s also important to understand how AI technologies might impact our economy and those that are doing the jobs that people have proposed for it. For example, earlier this year there was a lot of buzz about AI-generated art and particularly AI-generated head shots. I felt like I was one of the only people in my physician social media circles who didn’t join the scores of people getting new headshots. A handful of people voiced privacy concerns, especially about the need to upload a bunch of pictures for the technology to work, and the potential that the company might be collecting facial recognition data for nefarious purposes. But those were in the minority – and most people were going along with it until the algorithm started going sideways, spitting out images that didn’t look remotely like them. The worst examples included pictures of people in superhero costumes or in situations that weren’t remotely appropriate for a professional headshot. One of my family members is a professional photographer, so I brought up the point that crafting a professional portrait is both an art and a skill – and that AI-generated images compete directly with those professional people who are earning a living and contributing to their communities.

Economic factors are certainly concerning, but the risk of technology creating disinformation raises significant concerns. OpenAI leadership has admitted that there needs to be regulation in the industry. Following the announcement of the letter, its leader said that he’s confident that the company is following the law and that they will be cooperative with the investigation. Other countries have already been more critical of the company than US regulators, with Italy banning ChatGPT in March over concerns about inappropriate collection of personal data from users and lack of age verification for minors trying to use the system. The company addressed the issues and access to the technology was restored the following month. Advocacy groups have been pressing the FTC and other regulatory agencies to address the risks of ChatGPT. The article notes one organization, the Center for AI and Digital Policy, which has asked the FTC to block Open AI from releasing new versions to the public. About a week ago, it updated its complaint with additional supporting materials on the ways that chatbots might cause harm.

Federal agencies often move at a snail’s pace, and it’s unlikely that the FTC’s investigation into ChatGPT will proceed swiftly. The article notes that the FTC “may not have the knowledge to fully vet answers from OpenAI and that they don’t have the staff with technical expertise to evaluate the responses they will get and to see how OpenAI may try to shade the truth.”

Even after the investigation concludes, there’s a possibility that no action will be taken. Outcomes of investigations are often not widely distributed and it will be interesting to see if the FTC decides to err on the side of availability or whether it will take Freedom of Information Act requests to find out the results. Only time will tell whether we’ll see increased regulation or a more wait-and-see approach.

What do you think about the need to regulate AI-powered technologies? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 7/17/23

Electronic Health Records Vendor NextGen Healthcare Inc. to Pay $31 Million to Settle False Claims Act Allegations

NextGen Healthcare will pay $31 million to settle allegations that it violated the False Claims Act by misrepresenting the capabilities of select versions of its EHR software, and that it offered kickbacks in the form of credits of up to $10,000 to users whose recommendations led to new sales.

Phreesia Acquires MediFind, Reinforcing its Commitment to Patient-Centered Care and Expanding its Offerings to Consumers

Patient intake and engagement software vendor Phreesia acquires MediFind, which uses AI-powered technology to help patients find best-fit physicians.

Amazon lays off about 80 workers in pharmacy division

Amazon Pharmacy, the online retailer’s standalone prescription delivery service, lays off 80 employees.

Monday Morning Update 7/17/23

Top News

NextGen Healthcare will pay $31 million to settle allegations that it violated the False Claims Act by misrepresenting the capabilities of select versions of its EHR software, and that it offered kickbacks in the form of credits of up to $10,000 to users whose recommendations led to new sales.

HIStalk Announcements and Requests

It’s full steam ahead when it comes to IT projects for the majority of poll-takers. Lacy says she chose ‘Somewhat’ because “our organization has a very large (several year) IT project underway and for some unexplained reason our management team has decided to manage project intake so that we don’t have multiple competing projects for resources. So we have scaled back for the moment, but once our major project is completed, I expect we will be running multiple projects again. So happy to be working in an organization that is planning IT projects instead of just saying yes and throwing everything at the team at the same time!”

New poll to your right or here: Does the DOD’s declaration of mission accomplished make you any more confident that the VA will be able to complete its own systemwide EHR implementation? I asked a similar question just over a month ago. Sixty-one percent of readers at that time did not believe the VA’s Oracle Cerner roll out would ever be finished.

Webinars

July 26 (Wednesday) 1 ET. “Lessons We’ve Learned Since Launching our Cancer Prevention Program.” Sponsor: Volpara Health. Presenter: Albert Bonnema, MD, MPH chief medical information officer, Kettering Health System, and Chris Yuppa, product owner for oncology services and cancer prevention, Kettering Health System. Kettering’s IT department has played a critical role in providing an EHR-driven framework to bring cancer risk assessment and individual prevention plans to more than 90,000 patients. Primary care, OB/GYN, oncology, and imaging providers are now able to assess the hereditary, genetic, and lifestyle factors that affect the risk of developing lung, breast, ovarian, colon, and prostate cancer in any patient encounter. Learn how Kettering brings together people, processes, and technology to be more proactive in the fight against cancer and where its cancer prevention program is headed next.

July 27 (Thursday) noon ET. “Why You Shouldn’t Wait to Use Generative AI.” Sponsor: Orbita. Presenter: Bill Rogers, co-founder, president, and chairman, Orbita. The advent of generative AI tools truly represents a paradigm shift. And while some healthcare leaders embrace the transformation, others are hesitant. Invest 20 minutes to learn why you shouldn’t wait. When combined with natural language processing, workflow automation and conversational dialogs, generative AI can help leaders address a raft of challenges: from over-extended staff, to the rising demand for self-service tools, to delivering secure information to key stakeholders. You will learn where AI delivers the greatest value for providers and life sciences, how it can solve critical challenges faced by healthcare leaders, and how Orbita has integrated generative AI into its conversational platform so healthcare leaders can leverage its full capabilities safely and securely.

July 27 (Thursday) 2 ET. “Denial Prevention 101: How to stop denials from the start.” Sponsor: Waystar. Presenter: Crystal Ewing, director of product management, Waystar. There’s a reason denial prevention is prominent everywhere in healthcare RCM. Denials reduce cash flow, drive down revenue, and negatively impact the patient and staff experience. More than half of front-end denials don’t have to happen, but, once they do, that money is gone. It’s a pretty compelling reason to take some time now to do some preventative care on your revenue cycle. This webinar will help you optimize your front end to stop denials at the start. We’ll explore the importance of not only having the right data, but having it right where staff need it, when they need it.

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

Acquisitions, Funding, Business, and Stock

Patient intake and engagement software vendor Phreesia acquires MediFind, which uses AI-powered technology to help patients find best-fit physicians. MediFind CEO Patrick Howie, a former head of global analytics at Merck, has joined Phreesia as VP of product management.

Amazon Pharmacy, the online retailer’s standalone prescription delivery service, lays off 80 employees. Amazon has laid off nearly 30,000 staff within the last year.

RCM vendor Aspirion acquires Continuum Health Solutions, which offers motor vehicle accident and third-party liability RCM services.

Sales

• Southern Coos Hospital and Health Center (OR), Arbor Health (WA), Southwest Healthcare Services (ND), and South Lincoln Hospital District (WY) select CrossTx’s chronic care management software and services.

Announcements and Implementations

Texas Children’s Hospital implements Oracle’s Fusion Cloud Applications Suite, bringing seven systems onto one platform.

CommonWell Health Alliance surpasses 200 million users on its information-sharing network, equating to health data-sharing for 62% of the US population.

Sponsor Updates

• Availity partners with Quantiphi to deploy Availity Fusion Upcycling Data solution to the Google Cloud Platform.
• Meditech brings its Meditech-as-a-Service subscription model to the Australian market.
• Healthcare Triangle launches a ransomware initiative for healthcare providers aimed at cybersecurity protection and prevention.
• Net Health expands its partnership with Healogics, implementing its Tissue Analytics solution at Healogics sites.
• Netsmart will present at the NAHC Financial Management Conference July 17 in New Orleans.
• Nordic releases a new Designing for Health Podcast featuring Manish Patel, MD.
• OptimizeRx publishes a new case study, “Improving Oncology Outcomes by Using Artificial Intelligence to Help HCPs Identify More Brand-Eligible Patients.”
• ReMedi Health Solutions announces that it has been approved as an official NHS Digital Outcomes supplier.
• Ronin Chief Scientific Officer Christine Swisher joins the Coalition for Health AI to help advance trustworthy AI in healthcare.
• The Live at ViVE Podcast features Tegria SVP and Chief Medical Officer Ray Gensinger, Jr. MD, “The Role of Technology and Consulting in Healthcare Transformation.”

Blog Posts

• CIO on Innovation and Mobile Adoption: “Keep Your Eye on Operations” (CereCore)
• How being an early adopter improved clinicians’ technical confidence at Stillwater Medical Center (Meditech)
• Amplifying Success: How Care Integration Improves Clinical Outcomes (NeuroFlow)
• Where Are We Now? – Part One of the Healthcare Interoperability Blog Series (NTT Data)
• Unlocking the value of IT in healthcare (Nordic)
• EHR: Your Lifetime Journey (Optimum Healthcare IT)
• Healthcare Coding Series: ICD (Pivot Point Consulting)
• Revolutionizing Oncology Care with Artificial Intelligence: Predicting Acute Care Usage in Cancer Patients (Ronin)
• Demystifying Network Integrity: A Q&A with Cybersecurity Chief Judy Hatchett (Surescripts)
• Rapid Cycle Improvement Programs Deliver Speedy Results, Require Significant Effort (Zynx Health)

Contacts

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

Morning Headlines 7/14/23

Department of Defense Stateside Deployment of MHS GENESIS Complete

The Defense Health Agency announces that stateside roll out of MHS Genesis has been completed on time and on budget.

VA opposed to new EHR requirements but open to more major acquisition review 

VA officials say they are opposed to proposed legislation that would impose strict requirements on the department’s EHR Modernization program, but express support for legislation that would increase oversight of future acquisitions projects.

NICU telemedicine now at North Country Hospital

North Country Hospital (VT) establishes a NICU telemedicine program that gives its pediatricians access to real-time video consults with neonatologists at University of Vermont Medical Center.

News 7/14/23

Top News

The Defense Health Agency announces that stateside roll out of MHS Genesis has been completed on time and on budget. The Oracle Health-powered EHR will be implemented at DOD facilities overseas in the coming months.

The DOD and VA will oversee synchronous deployment of MHS Genesis at the James A. Lovell Federal Health Care Center (IL) in March 2024.

Webinars

July 26 (Wednesday) 1 ET. “Lessons We’ve Learned Since Launching our Cancer Prevention Program.” Sponsor: Volpara Health. Presenter: Albert Bonnema, MD, MPH chief medical information officer, Kettering Health System, and Chris Yuppa, product owner for oncology services and cancer prevention, Kettering Health System. Kettering’s IT department has played a critical role in providing an EHR-driven framework to bring cancer risk assessment and individual prevention plans to more than 90,000 patients. Primary care, OB/GYN, oncology, and imaging providers are now able to assess the hereditary, genetic, and lifestyle factors that affect the risk of developing lung, breast, ovarian, colon, and prostate cancer in any patient encounter. Learn how Kettering brings together people, processes, and technology to be more proactive in the fight against cancer and where its cancer prevention program is headed next.

July 27 (Thursday) noon ET. “Why You Shouldn’t Wait to Use Generative AI.” Sponsor: Orbita. Presenter: Bill Rogers, co-founder, president, and chairman, Orbita. The advent of generative AI tools truly represents a paradigm shift. And while some healthcare leaders embrace the transformation, others are hesitant. Invest 20 minutes to learn why you shouldn’t wait. When combined with natural language processing, workflow automation and conversational dialogs, generative AI can help leaders address a raft of challenges: from over-extended staff, to the rising demand for self-service tools, to delivering secure information to key stakeholders. You will learn where AI delivers the greatest value for providers and life sciences, how it can solve critical challenges faced by healthcare leaders, and how Orbita has integrated generative AI into its conversational platform so healthcare leaders can leverage its full capabilities safely and securely.

July 27 (Thursday) 2 ET. “Denial Prevention 101: How to stop denials from the start.” Sponsor: Waystar. Presenter: Crystal Ewing, director of product management, Waystar. There’s a reason denial prevention is prominent everywhere in healthcare RCM. Denials reduce cash flow, drive down revenue, and negatively impact the patient and staff experience. More than half of front-end denials don’t have to happen, but, once they do, that money is gone. It’s a pretty compelling reason to take some time now to do some preventative care on your revenue cycle. This webinar will help you optimize your front end to stop denials at the start. We’ll explore the importance of not only having the right data, but having it right where staff need it, when they need it.

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

Acquisitions, Funding, Business, and Stock

Wavely Diagnostics raises $1.35 million in seed funding. The company has developed a telemedicine app and companion medical device that can help pediatricians virtually diagnose ear infections.

Parker Health, developer of FHIR-based health management software that aggregates patient data from a variety of sources, raises $25 million.

Sales

• Novant Health will offer NeuroFlow’s digital mental health resources and support to patients suffering from depression, and to its team members as a resource for self-care and burnout prevention.

Announcements and Implementations

North Country Hospital (VT) establishes a NICU telemedicine program that gives its pediatricians access to real-time video consults with neonatologists at University of Vermont Medical Center.

Censinet announces GA of its new HIPAA Security Rule enterprise risk assessment and remediation module.

Get Well announces eight new smart patient room implementations in conjunction with new hospital tower construction projects.

Government and Politics

VA officials say they are opposed to proposed legislation that would impose strict requirements on the department’s EHR Modernization program, but express support for legislation that would increase oversight of future acquisitions projects.

Other

UMass Chan Medical School will use a $17 million federal grant to launch the Center for Accelerating Practices to End Suicide through Technology Translation. The school will work with partnering organizations to establish best practices for implementing new and existing suicide-prevention technologies. CAPES will also focus on patient-centered care, business development, and ethics.

Nearly 60% of surveyed IT decision-makers are looking to adopt or replace patient engagement technologies, according to the latest research from Black Book. Survey-takers gave InteliChart top marks for its patient engagement and consumer outreach capabilities.

Epic is working to develop a sixth campus in its hometown of Verona, WI. Still in the preliminary design phase, the expansion will be preceded by a recently approved underground parking structure that will open in 2025. The company is already planning to add two new buildings to its Wizards Academy campus to accommodate an additional 1,700 employees. Those facilities are expected to open next year.

The State Medical Board of Ohio permanently revokes the license of former plastic surgeon Katharine Roxanne Grawe, also known as Dr. Roxy on TikTok, for neglecting patients as she livestreamed surgical procedures, spoke directly into the camera, and responded to live viewer questions.

Sponsor Updates

• Divurgent releases a new podcast, “Mastering Epic’s Hyperdrive Migration.”
• Primary Care Joliet (IL) enhances its patient experience with EClinicalWorks EHR and Healow patient engagement solutions.
• Ellkay will sponsor CHIME’s CIO Boot Camp July 26-29 in Salt Lake City.
• Fortified Health Security names Carrie Card accounts payable accountant.
• Healthcare Triangle publishes a new whitepaper, “The Future of Healthcare Infrastructure: An In-Depth Look at the Infrastructure as a Code (IaaC) Landscape.”
• Rhapsody publishes a new case study, “BioMerieux reduces deployment time by 66% with Corepoint Integration Engine.”

Blog Posts

• How Analytics Can Solve the Top Challenges in Healthcare IT (Dimensional Insight)
• Communication: A Key Enabler of Change Management (Impact Advisors)
• Improving patient outcomes in healthcare through test automation technology (Keysight)

Contacts

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

EPtalk by Dr. Jayne 7/13/23

I’ve been surprised by how much conversation I’ve heard about this Epic study in the virtual physician lounge. One of the key purposes of the study was to look at trends in documentation over the time period since CMS made updates to the way physicians can code their office visits. I’ve been surprised to learn how few physicians understand that changes happened – and those that understood that something changed are often unable to articulate how those changes have impacted their documentation. The majority of physicians discussing it share the “nobody told me” narrative, which I struggle to believe is as common as people say.

The largest physician specialty organizations ran article after article about these changes when they happened, as did national multispecialty organizations like the American Medical Association. The health system where I was working at the time had a major educational campaign around this, in part because they hypothesized that physicians would be able to bill higher codes under the new paradigm. There was a lot of chatter about it, but of course this conversation was during the height of the COVID pandemic and I’m sure a lot of us failed to fully understand a lot of things that came across our desks and inboxes during that time frame. For those of you who haven’t seen the study, here’s the highlight reel: Although the time to create clinical notes has decreased, the average length of those notes continues to increase.

While it’s great that notes have taken less time to document, the persistence of longer notes continues to contribute to the problem. It still takes time for recipients to read those lengthier notes, and the impact is compounded the larger the size of the care team. Another interesting factor called out in the study’s key findings is the fact that, “while overall average note length increased, around 40% of providers reduced their average note length.” That means that 60% of providers had the same notes, with some of them having longer, so that the math for the average works out. In my clinical work, I still see plenty of bloated communications from other providers and wish they had the personal drive or institutional support to streamline their documentation.

A reader alerted me to this article that falls squarely in the column of “physicians behaving badly.” A North Carolina otolaryngologist was sentenced to 25 years in prison for committing Medicare fraud by reusing single-use surgical devices. Although she performed more than 1,400 sinus surgeries over a seven-year period, she was only able to provide records of having purchased 36 of those devices. She billed Medicare more than $46 million for the procedures, which most certainly would have raised red flags. Patients impacted by the fraud will have 90 days to present claims for damages. This kind of behavior is horrific and egregious and contributes to the rising distrust of patients felt by many physicians these days. I hope she spends the next couple of decades reflecting on the situation.

Last week, I commemorated the passing of July 1, which is the traditional day in the US that medical students start their internships and other medical trainees advance in their residency programs. I asked for people to share their best or worst memories of internship, and our readers did not disappoint. Dr. Nick van Terheyden shared a blog about his first days as a junior doctor. I was surprised to learn that there was little difference between his experiences in the UK during the 1980s and my experiences in the US in the 1990s. He also reminisced about some notes he came across when a hospital in London was being relocated. The notes were written during The Blitz and as much as we found practicing medicine stressful during the COVID pandemic, I can’t imagine trying to practice in the middle of an air raid.

One of my favorite correspondents shared the story of a July 4 night on call at a big city hospital. They were working in the emergency department but weren’t seeing a lot of patient volume, so their attending physician invited them to take a break to watch fireworks. The savvy attending had brought lawn chairs and led them up the secret stairs to the roof, where they had a great view of the city’s fireworks show.

Still, nothing beats the story of “interoperability” as it occurred in a hospital where the interns figured out how to liberate patient charts from the dialysis clinic when patients needed to be admitted to the hospital. Apparently the clinic had a divided “Dutch door” entrance and an enterprising intern figured out how to get the top half open without a key so they could consult the patient charts, write their notes, and return them before morning. It’s a good reminder of what life was like before electronic health records. I never had to climb into an office to grab a chart but I did spend a lot of hours in the medical records area digging through month-old, half-documented charts to try to make sense of them while I was in the process of readmitting recently discharged patients.

I’m a big fan of celebrating milestones, and today marks the 1,300^th post I’ve written for HIStalk. It’s been a bit of a long, strange, trip. I started writing during the incentive-hungry boom created by the Meaningful Use program. Since then, the world of healthcare information technology has been through numerous ups and downs, including periods of wild growth and unbelievable scarcity. Still, I’m impressed every day by the physicians that continue to put their scrubs on one leg at a time and care for patients despite the frustration and hardships found in the practice of medicine today. I’m continually grateful for the IT professionals that support them and make sure the servers are humming, the desktops are cooperative, and that they have the access they need to take care of people. And to all the others who support patient care – be it housekeeping, nutrition, engineering, or the dozens of other departments – we salute you.

How do you like to celebrate milestones? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 7/13/23

Fold Health streamlines admin work for primary care providers

Primary care-focused administrative software developer Fold Health raises $6 million.

Parker Health Secures $25 Million in Series A Funding to Transform American Healthcare

Parker Health, developer of FHIR-based health management software that aggregates patient data from a variety of sources, raises $25 million.

Gradia Health Secures $4.2M in Seed Funding to Improve Ongoing Care for Patients With Chronic Conditions

Virtual concierge care startup Gradia Health announces $4.2 million in seed funding.

Healthcare AI News 7/12/23

News

Lovelace Health System in New Mexico implements CareHarmony’s AI-powered care coordination software to help patients with two or more chronic conditions better manage their treatment, including medications.

Lehigh Valley Health Network (PA) will integrate Aidoc’s enterprise AI implementation and integration platform and imaging AI algorithms with its radiology department workflows. LVHN will also leverage Rad AI’s Omni and Continuity solutions, which, respectively, will automatically generate study impressions from a radiologist’s dictation and automatically send follow-up recommendations to patients and providers when incidental findings are reported.

Productive Edge announces GA of Generative AI-enhanced solutions for prior authorization, patient engagement and marketing, and health plan member engagement.

Mayo Clinic pilots Google’s Med-PaLM 2 AI tool in several hospitals. Built on the language model powering Google’s Bard chatbot, the tool is designed to answer questions about healthcare information.

Research

Researchers at the University of Pittsburgh and University of Pittsburgh Medical Center develop an easy-to-use, high-risk patient identification model using an algorithm that learns from the digital medical records of 1.25 million surgical patients. Deployed at 20 UPMC hospitals, researchers have found that the model does a better job of identifying high-risk patients than the standard – and manual – American College of Surgeon’s National Surgical Quality Improvement Program.

Children’s National Hospital and Virginia Tech will use new seed funding to expand the work of a collaboration that has sprung up between the hospital’s Research & Innovation team and the university’s Sanghani Center for Artificial Intelligence and Data Analytics. Research will focus on how AI can help to treat specific diseases, enhance smart surgery for pediatric health, and improve hospital management.

A majority of clinicians believe AI isn’t ready for medical use, according to a GE HealthCare survey of 7,500 clinicians in eight countries. Less than half of respondents – 26% in the US – are ready to trust AI.

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Readers Write: Leveraging a Digital Ecosystem to Simplify Specialty Medication Onboarding

Leveraging a Digital Ecosystem to Simplify Specialty Medication Onboarding
By Julia Regan

Julia Regan, MBA is founder and CEO of RxLightning of New Albany, IN.

Specialty medication onboarding has historically been a manual and frustrating process, riddled with complexities, administrative hurdles, and delays. However, the convergence of technology, interoperability, and a robust ecosystem of partners can revolutionize this experience, offering a glimmer of hope and path to a smoother, more efficient onboarding journey for patients.

The Complexities of Specialty Medication Onboarding

Getting a patient started on a specialty medication goes well beyond the enrollment forms. In most cases, onboarding a patient requires enrollment paperwork, benefit verification, prior authorization, financial assistance, and ongoing communication between multiple parties. The trouble is that each of these steps has typically occurred in a standalone manner, without any connection to the other steps in the process. This creates an opaque and disjointed journey for patients and providers, slowing time-to-therapy and causing avoidable administrative burden.

In addition to the process being fragmented and unclear, some parts of the journey are still completed using paper, phone, and fax – hindering transparency from the start! Whether completing the initial enrollment, approving a PA, or submitting Patient Financial Assistance forms, we are living in a world in which the system we’ve created impedes patient outcomes – instead of improving them. We must do better.

The Power of Technology and Collaborative Ecosystems

Thankfully, the advent of interoperable technology and collaborative ecosystems are beginning to bring about significant improvements to the specialty medication onboarding experience.

The first step in creating a better onboarding journey is eliminating the need for paper-based forms and communication. By leveraging fully digital portals for documentation submission and collection, we can provide immediate feedback to users about missing information, statuses, and next steps. And once digital becomes the norm, providing transparency to key stakeholders is no longer an impossibility.

The next – and arguably most important – step is developing an open ecosystem, where each participant plays a vital role in the medication onboarding journey. Each interconnected partner must be aligned in achieving a shared vision, and each plays a critical role in the final delivery and adherence of the medication. Providers and pharmacies can review and confirm coverage information, care teams can find and submit financial assistance applications, and patients can be more effectively supported by manufacturer and hub support teams.

Stakeholders should not need to log into multiple systems to manage one patient journey; instead, they should have access to one platform with all the data and integrations they need. With a truly connected ecosystem, each stakeholder can make informed decisions based on accurate and up-to-date information, ensuring the timely initiation of therapy without unnecessary hurdles.

What’s Next for Specialty Medication?

While today’s specialty medication landscape is already complex, tomorrow’s is set to become even more convoluted. At the 2023 Academy of Managed Care Pharmacy meeting, IPD Analytics shared that nearly 80% of the drugs the FDA is expected to approve in 2023 are specialty drugs, up from 68% in 2020.

How the industry navigates this wave of specialty drug approvals could significantly influence patient care. From my perspective, a transparent, interoperable system could address many of the previously mentioned challenges by streamlining communication and providing real-time access to critical information that can be used to support patient engagement, affordability, and adherence.

As specialty pharmacy continues to expand and evolve, the need for a unified, comprehensive medication onboarding ecosystem becomes increasingly important. By harnessing the power of technology, interoperability, and a collaborative ecosystem, we have the opportunity to revolutionize this space. Together, we can build a world in which every stakeholder, from the provider to the patient, is empowered to navigate the intricacies of the specialty onboarding experience.

Morning Headlines 7/12/23

Hello Pediatrics Completes Series B Funding Round Supporting Product Development Including Behavioral Health Services

After-hours pediatric telemedicine company Hello Pediatrics raises $3 million in a Series B funding round.

Data Usability Takes Root Nationwide Through a Joint Project Between The Sequoia Project and AHIMA

The Sequoia Project and AHIMA launch the Data Usability Taking Root initiative, which will bring together stakeholders committed to implementing data usability guidance developed by The Sequoia Project’s Interoperability Matters Data Usability Workgroup.

Indian health agency must improve review of patient harm data, watchdog says

A Government Accountability Office report finds that the Indian Health Service needs to review patient safety event data by location in order to improve its oversight of adverse events.

News 7/12/23

Top News

HCA Healthcare announces that hackers have stolen patient data from an external storage site used to automate email message formatting and posted it for sale on an online forum.

According to DataBreaches.net, the dataset includes 27.7 million rows, personal patient details, and information related to appointment reminders. The hackers made contact with HCA around July 4, and gave the company until July 10 to meet their unspecified demands.

Based in Nashville, HCA Healthcare manages the operations of 180 hospitals and 2,300 outpatient facilities in the US and UK.

HIStalk Announcements and Requests

The pessimists slightly outweigh the optimists when it comes to health IT business conditions over the next year. IT/OPs_ProjectManager’s experience with recent IT staffing budgets certainly gives credence to the former: “The institution I work with has reduced budget for contracted IT staff and is purposefully throttling the IT project pipeline due to resource ($$ and people) constraints coming out of the pandemic. Knowing this plan makes me think the ‘non-core’ IT projects will be under much more scrutiny.”

New poll to your right or here: Has your organization recently pressed pause on or significantly scaled back IT projects? Feel free to share observations as to why project priorities are changing, and what types of projects are still getting the green light.

Webinars

July 12 (Wednesday) 2 ET. “101: National Network Data Exchanges.” Sponsor: Particle Health. Presenter: Troy Bannister, founder and CEO, Particle Health. It’s highly likely that your most recent medical records were indexed by a national Health Information Network (HIN). Network participants can submit basic demographic information into an API and receive full, longitudinal medical records sourced from HINs. Records come in a parsed, standardized format, on demand, with a success rate above 90%. There’s so much more to learn and discover, which is why Troy Bannister is going to provide a 101 on all things HIN. You will learn what HINs are, see how the major HINS compare, and learn how networks will evolve due to TEFCA.

July 26 (Wednesday) 1 ET. “Lessons We’ve Learned Since Launching our Cancer Prevention Program.” Sponsor: Volpara Health. Presenter: Albert Bonnema, MD, MPH chief medical information officer, Kettering Health System, and Chris Yuppa, product owner for oncology services and cancer prevention, Kettering Health System. Kettering’s IT department has played a critical role in providing an EHR-driven framework to bring cancer risk assessment and individual prevention plans to more than 90,000 patients. Primary care, OB/GYN, oncology, and imaging providers are now able to assess the hereditary, genetic, and lifestyle factors that affect the risk of developing lung, breast, ovarian, colon, and prostate cancer in any patient encounter. Learn how Kettering brings together people, processes, and technology to be more proactive in the fight against cancer and where its cancer prevention program is headed next.

July 27 (Thursday) noon ET. “Why You Shouldn’t Wait to Use Generative AI.” Sponsor: Orbita. Presenter: Bill Rogers, co-founder, president, and chairman, Orbita. The advent of generative AI tools truly represents a paradigm shift. And while some healthcare leaders embrace the transformation, others are hesitant. Invest 20 minutes to learn why you shouldn’t wait. When combined with natural language processing, workflow automation and conversational dialogs, generative AI can help leaders address a raft of challenges: from over-extended staff, to the rising demand for self-service tools, to delivering secure information to key stakeholders. You will learn where AI delivers the greatest value for providers and life sciences, how it can solve critical challenges faced by healthcare leaders, and how Orbita has integrated generative AI into its conversational platform so healthcare leaders can leverage its full capabilities safely and securely.

July 27 (Thursday) 2 ET. “Denial Prevention 101: How to stop denials from the start.” Sponsor: Waystar. Presenter: Crystal Ewing, director of product management, Waystar. There’s a reason denial prevention is prominent everywhere in healthcare RCM. Denials reduce cash flow, drive down revenue, and negatively impact the patient and staff experience. More than half of front-end denials don’t have to happen, but, once they do, that money is gone. It’s a pretty compelling reason to take some time now to do some preventative care on your revenue cycle. This webinar will help you optimize your front end to stop denials at the start. We’ll explore the importance of not only having the right data, but having it right where staff need it, when they need it.

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

Acquisitions, Funding, Business, and Stock

Automated provider credentialing and compliance software vendor Verifiable raises $27 million in a Series B funding round, bringing its total raised to $47 million since launching three years ago.

Sales

• Vandalia Health (WV) will implement Oracle Health across its system. Mon Health and Charleston Area Medical Center, both of which seem to have been Cerner customers, merged to create Vandalia last year. 
• Adventist Health selects WinWire’s cloud-based data analytics and management software.

People

Aaron Neinstein, MD (UCSF) joins Notable as chief medical officer.

Announcements and Implementations

Consulting firm Healthcare IT Leaders forms an Elite Advisor group to offer peer-to-peer advisory services to healthcare executives.

Montage Health leverages Xealth’s digital health integration and digital prescription referral platform as a part of its digital health support programs for behavioral health, consumer wellness, orthopedics, and patient education.

Los Angeles Network of Enhanced Services adopts Google Cloud’s Healthcare API and BigQuery enterprise data warehouse.

Garrett Regional Medical Center (MD), part of the WVU Medicine health system, goes live on Epic.

Privacy and Security

Barts Health NHS Trust, the UK’s largest, reports a ransomware attack in which BlackCat hackers stole 70 terabytes of data. The group claims it is the largest healthcare data breach in UK history.

Other

Regenstrief Institute and Indiana University researchers develop natural language processing algorithms that can extract text data related to social determinants of health from within EHRs. The researchers say that their algorithms are easier to implement and use than more sophisticated risk models.

Sponsor Updates

• Meditech releases a new podcast, “Making transformative care attainable with genomic medicine and informatics.”
• Ethisphere recognizes Availity with its Compliance Leader Verification.
• Bamboo Health will exhibit at the AHA Leadership Summit July 16-18 in Seattle.
• CTG publishes a new case study, “CTG Helps Regional Healthcare System with Microsoft 365 Migration.”

Blog Posts

• Protect Yourself from Outside Competition with Patient Experience Enhancements (Access)
• We Surveyed Our Customers on Mental Health Issues. Here’s What We Learned. (AdvancedMD)
• Webinar Insights: Coding Electrophysiological Study (EPS) (AGS Health)
• Streamlined ECQM submissions with expert support (Arcadia)
• MedTech company revises messaging of existing product to gain additional payer coverage (BakerTilly)
• When Fourth Party Risk Becomes a First Party Nightmare (Censinet)
• Mergers & Acquisitions: Don’t Forget the Data Assets (Clearsense)
• Four Frequently Asked Questions About SOC 2 (Clearwater)

Contacts

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

Morning Headlines 7/11/23

Verifiable validates its healthcare credentialing software with another $27M

Automated provider credentialing and compliance software vendor Verifiable raises $27 million in a Series B funding round.

HCA Healthcare Reports Data Security Incident

HCA Healthcare announces that an unauthorized and unknown entity stole patient data from an external storage site used to automate the formatting of email messages and posted it for sale on an online forum.

VA medical center in NC notifies veterans of email breach

The Charles George VA Medical Center in North Carolina notifies patients of a data breach involving an email containing the PHI of 1,541 patients that was mistakenly sent to the wrong veterans.

Curbside Consult with Dr. Jayne 7/10/23

In my past life, I did a fair amount of medicolegal consulting. Although I don’t regularly work in that space anymore, I’m mentoring a young clinical informaticist that finds himself thrown into that space without much warning. When you’re a front-line physician, you know that there is always a chance that a patient complication or a poor outcome could lead to a legal claim. Even when you’re not primarily responsible for the situation, if you’ve participated in the care of a patient, you might be contacted to serve as a fact witness. Regardless of the situation, depositions can be nerve wracking. No matter the industry you work in, generally people don’t really look forward to being dragged into a legal situation. Most informaticists don’t expect to be drawn into legal issues, but when complex systems are involved in documenting the care that was rendered, it’s becoming increasingly more common.

In the past, fulfilling legal requests meant that the health information management department would pull hundreds of pages of paper records and photocopy them to send to the requesting attorney. When we started transitioning to EHRs, sometimes the records requests were fulfilled in a hybrid manner depending on where the hospital was in its EHR journey. There might have been a mix of documents, with some being photocopied and others being printed from the EHR. When I first started seeing these kinds of records, it amazed me how different the EHR output was from different hospitals. Some had better formatted notes than others; others were sometimes downright confusing. The transition of electronic flowsheets to paper output is particularly problematic at times, and when I used to work legal cases regularly, I’d sometimes have to put all the paper representations of formerly electronic flowsheets across the living room floor to try to make sense of them.

Now that the majority of care delivery sites are fully documented using electronic records, the size of documentation on a per-note basis has grown dramatically. Hospital daily progress notes that typically would have been a page or a page and a half in the paper world are now three to five pages long. Despite efforts to the contrary, they often exemplify the concept of “note bloat” with lots of copy and paste and more carry-forward documentation than most of us want. Even a short hospital stay, when converted from an EHR chart to a paper record, can generate thousands of pages of records. Wading through them can be challenging, even when you’re experienced in looking at EHR output. Lately, I’ve seen some notes from hospitals that are exposing metadata within the notes themselves. For example, tagging every sentence with its author in a superscript, or tagging sentences to identify whether the content was generated from a template or through manual entry.

My young colleague has been working in clinical informatics for a couple of years, but mostly spending his time as a super user and helping support his specialty colleagues at the point of care. He only recently started getting into more strategic areas of EHR management. He served on a couple of EHR committees, one of which was depicted last year in a glowing article in the health system’s public-facing newsletter. That particular article was about work that the informatics team had been doing to revisit procedure documentation in a particular specialty area as part of a preventable harms project. It was intended as a feel-good piece, describing how the hospital was using information systems to promote patient safety. Various people were quoted in the article, including my friend, who talked about how the committee was reviewing procedure note templates and order sets to ensure they were being kept up with current evidence and represented the highest standards of care.

Unfortunately, the quotation in the article also ended up tagging my colleague as a potential expert in how the hospital decided to redo its clinical content. Apparently, there was a potential legal claim after a procedure that resulted in a poor outcome, and there’s a hypothesis that an outdated order set contributed to the situation. Since the article appeared on the hospital’s website, it’s easily found in an Internet search, leading to a request for deposition from some enterprising attorneys. He’s now second-guessing the EHR Quality Committee’s strategy in deciding which documentation pathways to review now versus those that were marked for later analysis. Like all of us, his organization was struggling with the idea of having so much to do and so little time, so hard decisions had to be made.

In learning more about the case, it’s not clear how much influence the EHR really had on the situation, even if its documentation was outdated. Ultimately the clinician at the bedside is responsible for placing the right orders for the right patient and for ensuring that they meet the standard of care. Unfortunately, many of us have become so dependent on the EHR as our mechanism for ensuring we’re ordering what we should be ordering. I’ve seen plenty of physicians who have let their critical thinking skills slide and who don’t question what they’re seeing even when they know it’s not right. They’ve come to rely on the prompts and reminders given by the EHR, sometimes to the detriment of the patient when the EHR either doesn’t have any care pathways for a particular situation or when there’s a technology outage.

Plenty of us are speculating as to how artificial intelligence can help us be better doctors – whether it be through helping us write notes that make more sense than what humans are currently generating or whether we’re using it to suggest alternative diagnoses or treatments that might not be top of mind. However, such technology is only going to take us further down the proverbial rabbit hole of reliance on tech. Some of the most harrowing moments I’ve had in clinical practice have been during an EHR downtime and I don’t wish that experience on anyone. Particularly, I feel for those clinicians who work at hospitals that have been hit by ransomware and who have to resort to downtime procedures for extended periods of time. Technology may be making us dumber, in a way.

In the meantime, I’m helping my colleague through the legal process as much as I can, recommending additional training about how his system presents data and educating him on what it will be like to be deposed. He’s incredibly nervous and he never dreamed that EHR governance was going to be on his mind as much as it is now. No one ever said being a clinical informaticist was dull, but I hope for his sake that the next couple of weeks are fairly boring, including the deposition. Being in his position is certainly something they didn’t teach us about in medical school or residency, and definitely not in clinical informatics training. Fortunately, though, in those educational environments they do teach us critical thinking skills, logic, and the need for ongoing learning, so I hope my friend can use those skills to weather the current storm.

Has your IT department ever been cited as party to a legal action? Was it juicy enough to be the subject of a courtroom drama? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 7/10/23

Two Years After Coding Changes Sought to Decrease Documentation, Notes Remain ‘Bloated’

An Epic analysis of 1.7 billion clinical notes written by 166,318 outpatient providers during a nearly three-year period finds that average note length increased just over 8%, while the average time spent on documentation decreased 11%.

Intermountain Pediatric Telehealth Connects Local ERs with Primary Children’s Hospital

Intermountain Health expands its Pediatric Telehealth program to give its ER doctors access to virtual consults with pediatric specialists at Primary Children’s Hospital in Utah.

Lovelace hospital using AI to improve care for patients with chronic illnesses

Lovelace Health System (NM) implements CareHarmony’s AI-powered care coordination software to help patients with two or more chronic conditions better manage their treatment, including medications.