Readers Write: The Importance of Well-Managed Patient Identity Queues

The Importance of Well-Managed Patient Identity Queues
By Megan Pruente, RHIA, MPH

Megan Pruente, RHIA, MPH is director of professional services for Harris Data Integrity Solutions of Niagara Falls, NY.

Identity queue management is an important aspect of an effective value-based care strategy. It lays the foundation for establishing an effective person index, minimizing overlays, and facilitating streamlined care coordination. Left unresolved, backlogged work queues can have costly implications for patient care and safety, as well as revenue integrity.

However, many provider organizations are struggling to stay ahead of burgeoning identity error queues, with health system clients reporting that weekly error tasks have more than doubled. At one health system, the volume of potential overlays queue swelled from 2,000 per week to more than 5,000 per week over the course of just a few months, while another organization found itself dealing with a backlog of 100,000 identity interface errors. The health information management (HIM) director at a third health system shared that his team evaluated up to 400,000 potential overlay tasks in the last year to identify just 60 true overlays.

Many HIM departments lack the staff resources and experience that are necessary to address this volume of mismatched data, and the backlog continues to grow. What’s more, many hospitals and health systems may not be catching potential overlays or identity interface errors because their EHR systems lack the functionality or tools that alert end users to such errors.

Blame for this surge in errors can be traced back to several events, starting with the pandemic. The rapid uptick in adoption and use of patient portals, implementation of self-registration processes, and internal workflows to accommodate telemedicine and vaccination appointments led to a sharp increase in overlays, duplicates, and other identity-related errors. Exacerbating this were staffing shortages created by illnesses, caring for sick loved ones, and an exodus of healthcare professionals due to fears of COVID-19 and burnout, an ongoing challenge that has identity management teams stretched to the breaking point.  Another factor involves changes to fields that are used to capture patient identity data, such as expanded options for sexual orientation and gender identity (SO/GI).

Ironically, some of the blame also lies with the EHR workflow tools that were designed to address patient identity management challenges. For example, Epic’s EMR includes a Possible Overlay Queue, a useful workflow tool that identifies and segregates potential overlays until they can be analyzed and either verified or cleared from the queue if it is determined not to be a true overlay. However, its sensitivity to any change to the patient’s demographic information, whether significant (a name change or new Social Security number) or routine (adding a middle initial or completing SO/GI fields) can sometimes lead to an increased backlog volume as every alteration triggers an overlay task to be added to the queue.

Similarly, when data such as order results and documents cannot be filed automatically into a patient’s existing medical record due to a mismatch or fuzzy match on demographic data points, medical record number (MRN), or other patient-level data point, these messages error out and must be manually reviewed and resolved. When left unresolved, these errors can lead to repetitive orders, duplicate tests, and other issues that could result in denied claims.

The challenge for HIM is that some EHRs do not have interface error work queues that streamline resolving such errors. Even when EHRs do offer such functionality, staff often struggle to keep up with the high volume of errors requiring attention.

The reality is that managing identity error backlogs is a time-consuming and resource-intensive task that few HIM departments have the capacity to handle. The intricate nature of these processes requires meticulous attention to detail and often diverts focus from more critical tasks and strategic initiatives. Exacerbating the challenge, new tools and reports being released to HIM designed to help address duplicate, overlays, and interface errors are contributing to the increase in workload with the same or fewer resources to review the errors.

Healthcare organizations can take a number of actions to reduce the volume of identity errors and prevent backlogs from spiraling out of control. These include:

• Invest in staff training. Provide comprehensive training to enhance HIM professionals’ identity management skills. Keep staff updated on changes in patient data capture fields and the use of EHR workflow tools to reduce errors caused by lack of awareness.
• Prioritize staff resources. Allocate adequate staff resources to address identity queue backlogs and ensure that HIM departments have the capacity to handle the volume of tasks. Also, consider hiring additional staff or redistributing existing resources to focus on resolving identity errors and preventing the backlog from growing.
• Collaborate across departments. Foster collaboration between IT, HIM, and other relevant departments to collectively address identity management challenges. Also, establish cross-functional teams to develop and implement solutions that consider the perspectives and requirements of different stakeholders.
• Outsource MPI management. Evaluate the cost-effectiveness and efficiency of outsourcing MPI management to a vendor or partner with experienced staff overseen by credentialed professionals. Short-term MPI management support should also be considered during M&A activities to ensure integration of clean data and quick turnaround times.
• Implement robust data governance. Establish a strong data governance framework to ensure the accuracy and integrity of patient data throughout its lifecycle, including ongoing quality checks to ensure the accuracy of any automation and other patient matching tools, including AHIMA’s Naming Policy Framework and the Project US@ AHIMA Companion Guide.
• Enhance EHR workflow tools. Collaborate with EHR vendors to fine-tune sensitivity of algorithms to reduce false positives in the identification of potential duplicates and overlays and to customize workflow tools that better align with the organization’s specific needs and processes.
• Use third-party data. Use third-party data like historical addresses and phone numbers that are obtained from outside vendors to help prevent and accelerate remediation of overlays.
• Invest in enhanced patient matching tools. Biometrics and other patient matching technologies can prevent the creation of identity errors by improving accurate identification during front-end registration processes.
• Automate data matching processes. Explore, implement, and closely monitor advanced technologies such as machine learning and AI to automate matching and reduce the reliance on manual reviews. Integrate systems that allow for automatic filing of order results and documents into patient records to minimize errors related to mismatched data.
• Use analytics for insights. Use analytics tools to gain insights into patterns and trends that are related to identity errors and to identify root causes.
• Regularly monitor and evaluate processes. Implement a continuous monitoring system to track the performance of identity management processes and identify areas for improvement. Regularly evaluate the effectiveness of implemented solutions and work closely with IT staff or vendors to optimize processes, as even seemingly minor AI errors can have significant and widespread impacts.
• Don’t overlook the patient’s role in maintaining clean patient identity queues. Implement patient education programs to encourage accurate self-reporting of demographic and other relevant information. Also, promote to patients the importance of maintaining up-to-date and accurate information, including creation of talking points to help staff engage in these discussions.

Unresolved identity errors pose a significant threat to a hospital’s financial health. These errors can lead to reimbursement delays, costly repeat studies, and denied claims, creating unnecessary financial strain. A backlog can also impact patient care by creating gaps in medical histories, unnecessary delays in diagnosis and treatments, and risks to patient safety.

To avoid these impacts, patient identity error queues should be part of an overall MPI management strategy. Whether outsourcing to an outside MPI vendor or increasing internal resources to put in place workflow processes for eliminating the backlog and sustaining ongoing management, hospitals and health systems must prioritize patient identity queue management. Doing so empowers healthcare institutions to optimize operations that are being dragged down by unresolved patient identity errors, generating measurable cost savings, mitigating financial setbacks, and creating room for strategic investments in areas that truly matter.

Readers Write: My Crystal Ball for 2024: PR and Marketing Predictions

My Crystal Ball for 2024: PR and Marketing Predictions
By Jodi Amendola

Jodi Amendola is CEO and founder of Amendola Communications of Scottsdale, Ariz.

2023 will be remembered for a lot of things. Unfortunately, one of them was unpredictable decision-making about investments in HIT solutions and longer sales cycles.

Looking at the year ahead, we may see some continued challenges when it comes to market conditions, but here’s hoping my 2024 public relations (PR) and marketing cheat sheet can help you better navigate uncertain waters.

Bet on LinkedIn

In my predictions for 2023, I shared concerns about the uncertain future of what was then Twitter (now X) when it comes to B2B social media programs. Since then, things have gotten increasingly worse. Under Elon Musk, major advertisers have fled, countless users are deleting their profiles, and even the President of the United States felt compelled to condemn Musk for an anti-Semitic tweet and left X in favor of the emerging social media platform Threads. Companies that remain on X should ask themselves whether the shrinking benefits outweigh the mounting negatives. 

Meanwhile, LinkedIn continues to lead the charge as the business marketing platform to embrace. LinkedIn has strategically added business-friendly features such as product pages, post scheduling, and enhanced content analytics. Businesses that have not embraced LinkedIn for marketing and sales are missing a tremendous opportunity.

To maximize LinkedIn, be authentic and provide relevant information on a consistent basis. No more than 20% of your corporate posts should be about your company. The remainder should focus on third-party content that sparks interesting industry conversations. LinkedIn posts should leverage storytelling for engagement, how-to-guides for interest, and thought leadership for conversations.

Maximizing Conferences: Booths, Networking, and Online Events

In 2022, people flocked back to the big healthcare conferences, eager to gather again in person in the wake of COVID-driven isolation. We saw healthy crowds again in 2023, but many companies are re-thinking this strategy in favor of hosting targeted breakfasts or dinners or attending events for networking purposes only. We will likely see that trend continue in 2024, as many businesses may decide that the cost of sponsorship and exhibiting are too high in a tight economy.

The pandemic forced companies to become creative in marketing through virtual events. At the time, these tactics were driven by safety concerns, but now it’s budget priorities. HIT marketers are realizing that they don’t need an expensive 10×12 booth on a crowded convention floor to get their message across.

If webinars, podcasts, and virtual roundtables are carefully targeted and well marketed, you can even reach more qualified prospects than you can at a live event. Virtual events are not only less expensive, but they can be held more often than in-person happenings. Content from virtual events also can be repurposed for sharing through social media, blog posts, and bylined thought leadership articles that you can place in high-value media outlets.

AI is Here to Stay, But Regs Are Coming (Hopefully!)

After disrupting so many professions in 2023, OpenAI experienced its own chaos and upheaval at the end of the year.

However, that particular situation is resolved and artificial intelligence — whether it’s from OpenAI or a competitor — is too powerful to be stopped by C-suite struggles. AI will continue to disrupt not only health tech, but also marketing and PR.

In 2024, marketing departments and agencies will get a better handle on what they can and should do with this emerging technology. AI, when used correctly in a PR and marketing setting, can be a valuable tool, but it will never be a substitute for human writers and human intelligence. It can be useful for research, ideation, and facilitating the writing and thought process, but not for creating creative, thoughtful, highly targeted content.

I expect 2024 to see greater efforts, both public and private, to regulate the use of AI and require disclosure when it is employed.

Uptick in Rebranding is Here To Stay

The past year was a big one for companies that are rebranding (or doing a brand refresh) and updating messaging. We will likely see more of these efforts ahead.

Sometimes a rebrand is necessary because a company expands, changes its offerings, or decides to enter a new market. In other cases, it’s because the old look and old messaging have gone stale, which can happen without a business even realizing it. While a top-to-bottom rebrand is not something undertaken lightly, it’s a necessary part of most corporate evolutions and can help a company re-position or re-invent itself when appropriate.

Video, Video, and More Videos

Regardless of the platform, video is an increasingly popular choice to provide a welcome alternative to the written word. People often prefer to watch or listen to a video for entertainment, education, or just a needed break from reading. Video on LinkedIn increases linger times and engagement, so the algorithm pushes it to more users. The best part: video doesn’t have to be incredibly high production or sophisticated to be effective. Expect video to assume a larger share of marketing content in 2024.

Shorter, Digestible Content Is Preferred

The days of writing 30-page whitepapers and e-books and expecting your audience to download and actually read them are largely over.

In most cases, audiences don’t have the time or patience for content that long or complex. They want relevant information delivered in shorter format such as issue briefs, LinkedIn articles, blog posts, infographics, and videos.

Key In on Customer Champions

If 2024 proves to be as tumultuous for healthcare as most expect, companies will need PR and marketing more than ever. Staying on brand and on messaging through chaotic times means having a consistent and ongoing share-of-voice to rise above the noise and cut through the chatter. The key is to leverage your customer champions and unique industry data to be relevant and demonstrate your key differentiators over the competition.

Do you agree or disagree with my predictions? Come back in a year and we’ll see how many I got right.

Regardless of your technology, product or service, I hope the New Year provides endless possibilities for growth and success. Here’s to leveraging lessons learned, flawless execution, and advancing healthcare.

Readers Write: Empowering Nurses Through Interoperable Technology: Revolutionizing Patient Care in the Acute Environment

Empowering Nurses Through Interoperable Technology: Revolutionizing Patient Care in the Acute Environment
By Elizabeth Anderson, RN

Elizabeth Anderson, RN, MSN is director of clinical experience and solutions at Rauland of Mount Prospect, IL.

The acute care environment represents a dynamic hub of activity, with nurses positioned at its epicenter. Nurses spend long hours managing patient care, coordinating resources across interdisciplinary teams, and providing support to patients’ family members.

Although nurses strive to create positive experiences for their patients, a recent report from Leapfrog Group’s hospital ratings have illuminated a concerning decline in nurse communication, doctor communication, and staff responsiveness in hospitals nationwide. The disconcerting results accentuate the urgency for healthcare institutions to assess the resources provided to nurses and not the capabilities of the nurses. Increasing the number of checklists to complete and equipment to track creates barriers for nurses to work at the top of their licenses.

Hospitals should drive towards integrating solutions that allow nurses to spend more time providing direct patient care. Implementing technologies with true interoperability will assist in streamlining workflows and reduce the volume of decisions that need to be made by clinicians every hour. When nurses are equipped with the appropriate tools for their patient care space, the resultant improvements in outcomes can impact all areas of patient and staff satisfaction.

The pursuit of interoperability within healthcare remains an enduring aspiration, often obstructed by the prevalence of disjointed systems that foster isolated data silos. Consequently, nurses are compelled to navigate multiple platforms for a single clinical decision, leading to cognitive burden that can impede response times and patient satisfaction. The proliferation of technology in patient care has resulted in an average of 10-15 connected devices per patient room. However, not all these devices are optimized for clinical workflows or seamlessly integrated into crucial healthcare systems. Non-clinically vetted or non-interoperable technologies add unwarranted complexity and impose a cognitive burden on nurses.

Purpose-built solutions, such as converged platforms that are tailored to automatically access role-specific data and workflows, streamline tasks, and eliminate unnecessary steps are positive solutions that begin to address current state clinical needs. Equipped with a holistic view of the patient’s condition, nurses can administer personalized care, anticipate patient needs, and avoid medical errors.

Interoperability also curtails redundant communication and paperwork, affording nurses more time to operate at the pinnacle of their abilities and spend valuable time at the patient’s bedside. Outcomes of interoperable healthcare solutions establish harmonized data from various devices in patient rooms and offer a unified data repository that can provide the clinical teams with a global awareness of their patients’ needs that reduces decision fatigue and allows nurses to feel in control of their shift.

Interoperability serves as the linchpin in bolstering nurses and realizing the quadruple aim: enhancing patient experience, advancing health outcomes, reducing costs, and refining clinician experience. Empowering nurses with integrated data and analytic tools refocuses their roles from data-entry to proficient patient advocates. The realization of a connected care team through interoperability solutions is instrumental in manifesting the vision of coordinated, value-based care. Recognizing nurses as the lifeblood of healthcare mandates that they are equipped with the insights and technology requisite to fulfill their life-saving responsibilities.

Providing nurses with clinically tested resources and removing technology barriers that obstruct direct patient care can reverse the downward trajectory of reported satisfaction scores for hospitals. A patient-centric approach, characterized by patients feeling heard, cared for, and secure, leads to superior outcomes, fewer preventable events, and a more sustainable healthcare system overall. Patient experience must persist as the cornerstone of any high-caliber healthcare organization. By deploying the right solutions and technology for nurses to focus on bedside care, hospitals can attain commendable success in their endeavors.

Morning Headlines 1/8/24

Cracks Appear In Walgreens Clinic Strategy As Patient Panels Go Unfilled

Walgreens Boots Alliance struggles with the performance of primary care chain VillageMD, in which it is the majority shareholder, having already closed 27 of the 60 underperforming practices.

Credo Health Announces Oversubscribed $5.25 Million Series Seed Funding

Medical record retrieval and analysis software startup Credo Health raises $5.25 million.

Announcing Our $24M Series B Funding Round

France-based GPT clinical note generator Nabla raises $24 million in a Series B funding round that values the company at $180 million.

Attorney General James Secures $740,000 from Online Mental Health Provider for its Burdensome Cancellation Process

Online mental health provider Cerebral will pay $540,000 in refunds to New York patients in a settlement with the state’s attorney general, who says the company intentionally made it hard for patients to cancel their subscriptions and instructed its employees to submit fake positive reviews.

UpDoc Debuts the World’s First AI Assistant That Manages Medication Prescriptions and Chronic Conditions

UpDoc announces a new funding round alongside the launch of its AI assistant that manages chronic conditions and prescriptions.

Monday Morning Update 1/8/24

Top News

Walgreens Boots Alliance is struggling with the performance of primary care chain VillageMD, in which it is the majority shareholder.

Walgreens has closed 27 of the 60 underperforming locations that it previously announced and will focus on marketing the practices in hopes of boosting patient panels that are lower than expected.

Walgreens said in last week’s earnings call that it will take advantage of its strong neighborhood presence “to help payers, providers, and pharma achieve their goals.” The company is freeing up pharmacist time to allow more meaningful patient interaction via health screenings, immunizations, diagnostic testing, and treatment and has contracted with 25 drug companies to recruit clinical trials participants.

The CEO concludes, “We are going to be a major community-based, neighborhood point of engagement for patients with human beings touching human beings, which I believe in the long term is how how healthcare in this country is going to evolve.”

Reader Comments

From Conferencius: “Re: conferences. Is your skipping the HIMSS conference for the first time in years an early indicator of a trend? I find myself being less interested in attending conferences in general.” I’m not sure a trend exists, although the newer, glitzier conferences may spread the attendance and exhibitor wealth around. Attending conferences without employer expectations can be fun, but I question the ROI for the patients who foot the bill for days of socializing, expensive meals, and splashy entertainment under the guise of “networking” that at least in my experience, never paid off for my employer. However, I learned early as a health system IT executive to grudgingly approve the cost of sending high-value employees to conferences without expectation of ROI beyond stroking their egos and leaving them vaguely “inspired.”It’s funny that as an industry, we assure patients that we can deliver life-affecting health services via telehealth and remote patient monitoring, but we can’t do our paper-pushing jobs without expensively traveling with the herd to a publicly traded company’s equivalent of a destination wedding. The COVID-era failure of virtual conferences proves that it was never about education. Your question inspired a poll (below).

From KC Masterpiece: “Re: David Feinberg. Finally found another company who needs a selfie-taker.” Feinberg isn’t leaving Oracle Health as chairman, at least not at the moment. He has taken an additional paying job as an advisor to a VC firm. People still ponder how it came to be that he took over as Cerner president and CEO (but not board chair) on October 1, 2021 and the board agreed to sell the company to Oracle 80 days later, netting him dozens of millions for having done nothing except choose office furniture. We don’t know if the acquisition was sealed by his hiring and if he knew in advance that it would swell his pockets mightily. I’m not clear on what his day job as “chairman” of a company’s single operating division even means since as far as I know, Oracle Health doesn’t have its own board for Feinberg to chair and I’m not sure he even has direct reports.

From Rascule: “Re: HIMSS Accelerate. The HIMSS VP who ran it is now the head of marketing at HLTH.” Verified from LinkedIn. HIMSS launched the Accelerate online discussion platform in mid-2021, the seemingly ideal time to provide an alternative for COVID-halted conferences, but it never caught on. HIMSS also created the similarly timed and named HIMSS Accelerate Health, whose purpose wasn’t clear but seemed to involve conference tracks and a podcast, but that seems defunct as former links go to 404 pages or to HIMSS TV. I sure would like to see a current HIMSS 990 form that tax-exempts are required to post publicly to get a better idea of the business structure, but they haven’t filed one since FY2020.

From Pivoteer: “Re: consulting. You should do a poll on how many readers lost or quit jobs and tried to morph themselves into a consulting firm until finding a job.” I’ll do that poll next time. I try not to be cynical about folks whose career goes from a seat at the table in the board room to one in the dining room, with intentions ranging from lofty “this is my new passion and life’s work” to the more realistic “this will hopefully pay the bills while I try to get someone to hire me.” I’m only critical when corporate-fueled ego spills over into gig work (I’m thinking about my former boss, who fled back to a health system job before the paint on his consulting company shingle had dried) in the form of of prestigious-sounding company names, splashy websites, and a CEO title for their one-person contract work, and then when the contracts don’t materialize, redirect their unplanned free time into social media and podcast punditry. Still, we all have bills to pay and people to support, so if hanging out a consulting shingle for the short or long term does the job, then be proud of taking the shot with humility, which is required since the phone doesn’t ring nearly as often when you’re a seller instead of a buyer.

HIStalk Announcements and Requests

I ran a similar poll to this one nearly a year ago and only the finishing order has changed – the top vote-getters then and now were AI, precision medicine, and remote patient monitoring. Respondents back then showed insight in ranking AI high long before ChatGPTback triggered a now-obvious AI ubiquity.

New poll to your right or here: Provider employees: did your employer see a hard-dollar ROI within a year of funding your attendance at a national conference?

Thanks to these companies for recently supporting HIStalk. Click a logo for more information.

Webinars

January 19 (Friday) 1 ET. “Unlocking Reliable Clinical Data: Real-World Success Stories.” Sponsor: DrFirst. Presenters: Alistair Erskine, MD, MBA, CIO/CDO, Emory Healthcare; Jason Hill, MD, MMM, associate CMIO, Ochsner Health; Colin Banas, MD, MHA, chief medical officer, DrFirst. Health system leaders will describe how they are empowering clinicians with reliable patient data while minimizing workflow friction within Epic. They will offer real-world experience and tips on how to deliver the best possible medication history data to clinicians at the point of care, use clinical-grade AI to infer and normalize prescription instructions in Epic, and encourage patient adherence to medication therapies for optimal outcomes.

January 24 (Wednesday) noon ET. “Medication Management Redefined.” Sponsor: DrFirst. Presenters: Nick Barger, PharmD, VP of product, DrFirst; Caleb Dunn, PharmD, MS, senior product manager, DrFirst. Clinical workflow experts will paint a reimagined vision for e-prescribing that offers enhanced patient adherence, customizable clinical support, intelligent pharmacy logic, and data integrity and safety. Join this first chapter of an ongoing conversation about what medication management should be, how to deliver greater benefits today, and how to prepare for the future. Elevating your solution and customer benefits isn’t as hard, scary, or economically challenging as you may think.

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

Acquisitions, Funding, Business, and Stock

France-based GPT clinical note generator Nabla raises $24 million in a Series B funding round that values the company at $180 million.

Marshfield Clinic and Essentia Health cancel their planned merger.

Doctors express wariness about drug maker Lilly’s announcement that it will sell some of its drugs directly to consumers using third-party providers of telehealth and pharmacy fulfillment services. The CEO says LillyDirect will make it easier for patients to obtain prescriptions without resorting to compounded or counterfeit versions of products such as its $1,000-per-month weight loss drug Zepbound, but an expert says that LillyDirect is the next step in direct-to-consumer advertising where patients may not learn about treatment options that don’t involve Lilly’s products, also predicting that other drug companies will follow Lilly’s lead. The American College of Physicians responded to the announcement on Friday, expressing its concerns about patients ordering drugs directly from their manufacturer and the approach of “primarily oriented around the use of telehealth services to prescribe a drugmaker’s products.”

Sales

• Brant Community Healthcare System signs up as the first Canadian user of Meditech Expanse as a cloud-based subscription.

People

Kidney testing app vendor Health.io hires Geoff Martin, MBA (Olive AI) as CEO. He takes over from founder and former CEO Yonatan Adiri, who will move to president.

Government and Politics

A home health agency pays $10 million to settle Department of Justice charges that it fraudulently billed the federal government for in-home nursing care that actually involved telephone calls. The cost was billed to a Department of Energy compensation program for people and their survivors who were exposed to radiation from the government’s building of nuclear weapons in the 1940s and 1950s, including employees and nearby residents, that caused long-undetected cancers and birth defects. The program, which was created in 2001, has paid out $23 billion to 137,000 people.

NHS England is reviewing the planned use of social media influencers by Palantir, to which it recently awarded a $415 million contract to develop and operate a national NHS data-sharing platform. The US company says it explored but didn’t actually launch a campaign with New Zealand-based digital agency Topham Guerin, which previously ran Conservative Party campaigns. Palantir’s contract prohibits using NHS’s name without approval. The company planned to pay for posting videos and tweets to correct what it thinks is misinformation about the project, with specific instructions to influencers to not mention Palantir by name or hashtag. The legal non-profit Good Law Project says Palantir is “possibly the dodgiest company ever to gain access to our medical records.”

Online mental health provider Cerebral will pay $540,000 in refunds to New York patients in a settlement with the state’s attorney general, who says the company intentionally made it hard for patients to cancel the subscriptions and instructed its employees to submit fake positive reviews. The AG says the company told subscribers they could cancel via email, but required completion of a survey and then put the cancellation on a multi-day hold while sending them retention offers in hopes of changing their mind. The company also charged customers when it had no providers available to treat them.

Other

In England, a nurse’s hospital employer calls her in for emergency floor coverage, then writes her an $89 parking ticket because her car didn’t have a $50-per-month employee parking pass. She had applied for the sticker, but the hospital admits that it is backlogged on sending them and suggests that employees instead take public transportation.

Sponsor Updates

• Netsmart staff volunteer at the Cornerstones of Care gift gallery to help distribute and wrap gifts for children within the organization.
• CereCore releases a new podcast, “Fostering a Culture of Innovation and Growth.”
• Nym achieves excellent customer satisfaction scores for the second consecutive year.
• Nordic releases a new podcast, “Designing for Health: Interview with Kevin Dufendach, MD and Andy Spooner, MD.”
• The “That’s Derm Good!” podcast features RxLightning founder and CEO Julia Regan.
• Symplr expands its golf sponsorship program with the addition of four-time PGA Tour winner Russell Henley.

Blog Posts

• How to succeed in value-based care without really trying (Nordic)
• Centralizing On-Call: A Q&A with Qgenda’s Chief Medical Officer, Dr. Patrick Hunt (Qgenda)
• RCxRules HCC Coding Engine Updates for the V28 Transition (RCxRules)
• Redox unwraps interoperability in 2024 (Redox)
• 2024 Predictions: Technology and Collaboration Needed to Improve Patient Care (Surescripts)
• Streamlining OPPE and Improving Outliers (Symplr)
• Reflecting on Trualta’s Transformative 2023 (Trualta)
• Revenue cycle 101: What is denial management in healthcare? (Waystar)
• The Future of Healthcare Interoperability: Looking ahead to 2024 (Zen Healthcare IT)

Contacts

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

Morning Headlines 1/5/24

MultiPlan Announces CEO Succession Plan

Oracle Health General Manager Travis Dalton (previously chief client and services officer at Cerner) will leave the company to join MultiPlan as president and CEO on March 1.

Arbital Health Completes Acquisition of Santa Barbara Actuaries and Closes Series A Financing

Newly formed Arbital Health, which offers technology and third-party adjudicator services to assess whether value-based care outcomes were received, acquires Santa Barbara Actuaries and completes a $10 million Series A funding round.

Georgia medical board restores telehealth prescribing flexibility

The Georgia Composite Medical Board backtracks its decision to re-impose in-person visit requirements for prescription of controlled substances after provider and patient outcry.

Lilly Launches End-to-End Digital Healthcare Experience through LillyDirect

Drug maker Lilly launches LillyDirect, which will offer home delivery of its drugs for obesity, migraine, and diabetes directly to patients via the Truepill pharmacy service.

News 1/5/24

Top News

Oracle Health General Manager Travis Dalton will leave the company to join MultiPlan as president and CEO on March 1. Dalton was previously chief client and services officer of Cerner, as well as president of its government business, when Oracle acquired the company for $28 billion in June 2022.

MultiPlan offers payer cost management services that include analytics and revenue integrity.

MPLN shares have risen 26% in the past 12 months, slightly outperforming the S&P 500 and valuing the company at $850 million. They dropped 7% Thursday in a flat market following the announcement that Dalton will replace Dale White, who will move to executive board chair.

Dalton is the fifth of Cerner’s 10-member executive team to leave the company following its acquisition.

SEC filings indicate that Dalton will be paid a signing bonus of $500,000, a starting annual salary of $825,000, an annual bonus of $1 million, shares worth $8 million, and another $5 million in stock options.

Reader Comments

From Dowser: “Re: HIMSS and Informa. The takeover of the annual conference has been quiet. Wonder if the deal didn’t pan out.” HIMSS24 isn’t listed on the events page of Informa Markets and a search for HIMSS on Informa’s website turns up nothing. However, online conference materials now reference Informa, including headers and footers on the conference home page and an Informa copyright notice. The organizations were maddeningly vague about their business arrangement, with HIMSS calling it a partnership, while Informa characterized it as an acquisition. Still, it’s none of my business since my loyalty to HIMSS as a long-time member, chapter officer, and conference attendee has waned with its new leadership, to the point I rarely give the organization a thought. The boat show will likely improve with the addition of Informa and the subtraction of me.

Webinars

January 19 (Friday) 1 ET. “Unlocking Reliable Clinical Data: Real-World Success Stories.” Sponsor: DrFirst. Presenters: Alistair Erskine, MD, MBA, CIO/CDO, Emory Healthcare; Jason Hill, MD, MMM, associate CMIO, Ochsner Health; Colin Banas, MD, MHA, chief medical officer, DrFirst. Health system leaders will describe how they are empowering clinicians with reliable patient data while minimizing workflow friction within Epic. They will offer real-world experience and tips on how to deliver the best possible medication history data to clinicians at the point of care, use clinical-grade AI to infer and normalize prescription instructions in Epic, and encourage patient adherence to medication therapies for optimal outcomes.

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

Acquisitions, Funding, Business, and Stock

Drug maker Lilly launches LillyDirect, which will offer home delivery of its drugs for obesity, migraine, and diabetes directly to patients via the Truepill pharmacy service. The service will offer a provider search tool and access to independent telehealth providers. The website indicates that Lilly will offer cash discounts on high-price drugs to patients whose insurance doesn’t cover them, such as weight loss drug Zepbound for $550 per month, about half its list price. The telehealth providers are 9amHealth (diabetes), Cove (migraine), and FORM (obesity). The interesting aspect is that Lilly is eliminating unrelated middlemen, such as pharmacies and pharmacy benefit managers, by creating its own package of independent virtual providers and a pharmacy and consolidating its patient discount programs under its own roof.

Mercy completes its acquisition of SoutheastHealth (MO), whose CEO says the hospital needed help because of a big jump in spending on outside labor, the loss of several providers in money-making services, and the cost of upgrading its EHR. The hospital will replace Cerner with Epic.

Walgreens announces Q1 results: revenue up 10%, EPS –$0.08 versus –$4.31, beating Wall Street expectations for both. The company will cut its dividend by nearly 50% to increase cash flow.

Newly formed Arbital Health, which offers technology and third-party adjudicator services to assess whether value-based care outcomes were received, acquires Santa Barbara Actuaries and completes a $10 million Series A funding round. The company also offers value assessments to vendors of healthcare point solutions.

Cigna is reportedly negotiating to sell its Medicare Advantage business to Health Care Service Corp, which operates BCBS plans in five states. for up to $4 billion. The move follows Cigna’s failed attempt to acquire Medicare Advantage insurer Humana less than four weeks ago.

At-home remote diagnostics provider Nanowear receives FDA 510(k) clearance for SimpleSense-BP, a non-invasive, cuffless blood pressure monitor. SimpleSense is an AI-enabled wearable that captures 85 data points to monitor heart rate and sounds, respiration rate, lung volume, and physical activity.

People

Patric Cua (HSG Partners) joins Glytec as president and CEO.

Best Buy Health hires Benjamin Zaniello, MD, MPH (PointClickCare) as chief medical officer.

Wisconsin Statewide Health Information Network promotes Steven Rottmann, Jr. to CEO.

Announcements and Implementations

DirectTrust publishes updated criteria for 19 of its accreditation programs.

Government and Politics

National Coordinator Micky Tripathi, PhD, MPP explores the need for a FHIR API to allow patients to electronically request their insurer’s notes about denied claims.

Privacy and Security

23andMe blames its users for a breach of its systems that exposed the genetic and ancestry data of 6.9 million people. The company says that a hacker’s brute force password attack gave them access to 14,000 user accounts, but the breach expanded because users had activated the DNA Relatives feature that allows 23andMe users to share data with others to whom they appear to be related. The company also says the breach wasn’t its fault because users didn’t change their passwords after they were exposed in security incidents involving other sites.

Other

In the UK, the local paper questions why Princess Alexandra Hospital spent $75,000 to send employees to the Oracle Health Conference in Las Vegas. CIO Phil Holland says other NHS also attended using funding from NHS England’s digital strategy program. The hospital is implementing Oracle Health Millennium.

Sponsor Updates

• Optimum Healthcare IT names Matt Divenere (Optum) director of content development.
• Healthwise employees collect toys for 64 children through the Boys & Girls Club of Ada County in Idaho.
• Healthcare IT Leaders releases a new Leader to Leader Podcast, “Innovation Through Simplification: Minimizing IT Complexity to Drive Results.”
• Gartner recognizes InterSystems as a Challenger in its Magic Quadrant for cloud database management systems.
• KONZA National Network reports that 333 KONZA-powered sites have earned and/or maintained validated data stream designation in NCQA’s Data Aggregator Validation program.
• Meditech staff have contributed gifts to 35 local families over the holiday season through its Adopt-A-Family initiative.

Blog Posts

• Looking Back: Five Key Success Stories from 2023 (EClinicalWorks)
• Health Equity Quality Measures: Supporting Accreditations, Regulations, & Policy (Findhelp)
• How to Create a Contact Center Scorecard (Five9)
• Advisory Services for an Educational Partner (Health Data Movers)
• The 3 Most Popular Patient Data Blogs of 2023 (HealthMark Group)
• Putting the “E” Back in ERP: How to Realize True Enterprise-Level Benefits (Impact Advisors)
• Understanding the Critical Connection Between AFib and Stroke (Lucem Health)
• How to Get the Most Out of CMS Price Transparency Rules (Medhost)
• From App to Powerhouse Platform: Wrapping Up 2023 (Mobile Heartbeat)
• 10 Critical Questions to Ask About Wound Care EHR Software (Net Health)

Contacts

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

EPtalk by Dr. Jayne 1/4/24

I didn’t ring in the new year in Auckland, but since I visited there earlier in the year, I could at least visualize more accurately what it must be like to celebrate in one of the first major cities that greeted 2024.

I spent the evening in my Midwest neighborhood, where the fireworks started at 6:35 p.m. courtesy of some folks who I suppose either wanted to get a head start or were celebrating with small children before they sent them off to bed. The random gunfire held off until midnight. at least, and fortunately was short lived. Maybe I’ll plan a trip to greet 2025 in a more spectacular locale.

I always like reading various year-end review articles and Google shared the top 10 health-related searches of 2023. The list was wide ranging and showed that even post-pandemic, infectious diseases are still top of mind for many:

1. How long is strep contagious
2. How contagious is strep
3. How to lower cholesterol
4. What helps with bloating
5. What causes low blood pressure
6. What causes warts
7. Why do I feel nauseous
8. What causes preeclampsia
9. How to stop snoring
10. How long does food poisoning last

I have to admit I was a little surprised by #8, which is a pregnancy-related complication. However, a quick Google search of my own revealed that the condition affects over 200,000 pregnant patients in the US each year and the rate of the condition in the US has increased 25% in the last two decades. It’s good to know that people are seeking additional education about the condition, which is a leading cause of maternal and infant morbidity and mortality.

I also got a chuckle out of #7, since it’s decidedly first-person in comparison with the other queries. I doubt Google knows whether the person asking the question recently consumed Flamin’ Hot Cheetos and a Mountain Dew or whether they just returned home from a wild night at the local dance club, so maybe a more refined search is in order.

I spent a few hours on New Years Day catching up on my inbox, which has been overrun the last couple of weeks. One message advertised an upcoming webinar for automated fax processing, which made me chuckle. I’ve had a situation for over a year where a particular pharmacy chain is sending refill requests to my practice fax line for patients (and providers) who have no affiliation with my clinical practice. I thought it had been resolved, but it started up again, leading me to believe that the pharmacy chain somehow downloaded an outdated prescriber database.

I sent a formal notification to their corporate entity, but it hasn’t been corrected yet and they haven’t even responded to my message. If you work for a pharmacy company, please make sure you have updated provider profiles, because this kind of thing keeps patients from receiving their refills in a timely manner.

Also on New Year’s Day, I spotted this ad for Amazon’s clinical care options. I appreciate the sentiment that they are trying to express, namely that they are available for various clinical situations, but nasal foreign body removal isn’t listed as in scope for their in-person offices and it’s definitely not a problem that can be resolved during a virtual visit.

I’ve fished plenty of items out of kids’ noses and ears in my career, and while it might be helpful to talk to a medical professional for advice on whether to go to an urgent care (older kids with certain foreign bodies) or whether to go to the emergency department (pointed objects, young children who might need sedation), waiting for a consultation might lead to a delay before a child gets appropriate care, which can make extraction more difficult due to swelling. Here’s to all the parents who have survived the trauma and drama of this happening and the process that is needed to reverse it.

The US Government Accountability Office has appointed five new members to serve on the Health Information Technology Advisory Committee (HITAC). The group advises the federal government on implementing healthcare IT and has been around since 2016. Four of the new appointees are physicians and one is a nurse. Their experience includes quality standards, innovation, health plans, applied clinical informatics, AI models, and having personally been a caregiver for someone with a serious health condition. Personally, I think the latter element is one of the most important. If we had more healthcare consumers making decisions about healthcare strategy, we might see a different health system than we have today. Each will serve a three-year term with the potential for reappointment.

I’m continually amazed by the number of physicians that don’t understand some of the basics of clinical informatics. This wasn’t such a big deal a decade ago, but now that nearly everyone is using EHRs, there is a minimum level of knowledge that one needs for survival. The first thing to understand is that most EHR installs have significant differences, even if they’re from the same vendor.

I lurk in some unofficial user forums, and people working at different hospitals seem baffled that there aren’t magical pixies that move their favorites and defaults from hospital A to hospital B even though “it’s all Epic.” They’re also confused about the governance of IT systems, that one hospital might tightly lock down their EHR against customizations where another is permissive, and that the EHR vendor isn’t responsible for hospitals that make bad decisions about EHR configuration.

I was glad to see a recent article in the Applied Clinical Informatics journal that calls for the support of informatics curricula in US-based residency training programs. Graduate medical education bodies are focusing on telehealth competencies, clinical quality, and documentation, but I’m not seeing education that helps physicians understand why their systems are the way they are and what they can do to help.

I’d be happy to go back to my medical school or residency program and deliver the same governance lecture that I delivered to countless healthcare executives and physician leaders during my time as a field consultant. I’ve found that helping people manage expectations can lead to happier end users, especially when users are educated on which pieces of the EHR can be customized or configured, which ones can’t, and who makes the decisions. One physician colleague who was recently griping about his EHR was shocked to learn that his practice partner sits on the EHR steering committee. The look on his face when I explained it to him was priceless.

Do your physicians and end users understand that your organization has made the majority of decisions around how your EHR is structured, or do they just assume the vendor is responsible for the things they don’t like? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 1/4/24

Mercy leaders promise upgrades as they close deal for southeast Missouri health system

SoutheastHealth officially becomes a part of Mercy, citing a need to modernize its EHR as a factor in its decision to accept the health system’s acquisition offer.

Robbins Geller Rudman & Dowd LLP Files Class Action Lawsuit Against Veradigm Inc. and Announces Opportunity for Investors with Substantial Losses to Lead Class Action Lawsuit

A San Diego-based law firm spearheads a class action lawsuit against Veradigm, charging the company and certain executives with overstating revenues by $20 million, artificially inflating revenue over a two-year period, misrepresenting demand for products and services, and failing to adhere to appropriate accounting practices.

Medical Device Cybersecurity: Agencies Need to Update Agreement to Ensure Effective Coordination

The Government Accountability Office calls for the FDA and the Cybersecurity and Infrastructure Security Agency to update their medical device cybersecurity agreement so that their efforts are more coordinated and reflect organizational and procedural changes made over the last several years.

Healthcare AI News 1/3/24

News

Microsoft rolls out the Copilot app, which was formerly known as Bing Chat, for Android and IOS. It provides subscription-free access to OpenAI’s GPT-4 and the DALL-E3 image generator.

Humetrix announces a cloud-based international health communicator platform that presents clinicians with a patient’s medical records that it has translated into the clinician’s own language.

VideaHealth receives FDA 510(k) clearance for an AI-powered diagnostic tool for dental diseases, which will also be distributed by Henry Schein One to its dental software users.

In the Netherlands, the CMIO of University Medical Centre Groningen urges the EU to avoid overregulating AI since “it might be the only chance to have some level of healthcare shortly for older people.” The hospital is using AI tools to create draft responses to patient emails and to summarize the information in Epic for rounding,

Business

Bain & Company believes that investment in healthcare-related generative AI is just starting and expects the technology to drive productivity gains, offer a better provider and patient experience, and improve outcomes. It says that companies that were built around AI are raising significant investments, but also that the private equity owners of mature companies are adding AI to improve their products or businesses, which may pose a disruptive threat to some portfolio companies. The highest-risk business are those that provide services for content generation, administrative processes, call centers, and text writing and summarization.

Health insurance brokers are using AI to simplify the process of shopping for ACA marketplace and Medicare Advantage plans. The tools collect an individual’s information, make predictions about their health needs, and then score available plans based on income, prescriptions, and preferred doctors. They can also benefit users by eliminating the incentive for brokers to push the highest-commission plan.

WellSpan Health touts the use of AI in its six hospitals, which includes Artisight virtual sitting and nursing technology, Aidoc for image review, and DAX for ambient documentation.

Research

Dartmouth medical educators develop AI Patient Actor, a ChatGPT virtual patient that medical students can interview while reviewing their vital signs and lab results. The app provides individualized feedback that the student can use to try again. The researchers expect the tool to provide a stress-free environment for students to practice their clinical interaction before moving on to clinical settings or working with actors who pose as standardized patients.

Other

A Toronto newspaper profiles ChartWatch, an AI-driven early warning system for patient deterioration that was developed by St. Michael’s Hospital. The hospital says that use of the risk scores, which are calculated hourly, was associated with a 26% mortality reduction among non-palliative patients in its general medicine unit. The hospital is spending $4 million annually to test AI solutions, about 50 so far. It has also developed solutions to help assign nurses to ED roles, display wait times in the ED, and summarize the medical records of patients with multiple sclerosis that span years. The reports note that Health Canada has approved only AI-powered software in which the algorithms are locked, which requires applying for a license amendment if the algorithms can learn or can be changed.

UCSD Health’s newly named chief AI officer Karandeep Singh, MD, MMSc says that the best near-term use of AI in healthcare involves “keyboard liberation” in drafting patient message replies, summarizing chart documentation, and creating document from ambient conversations. He predicts that AI-powered decision-making “is very far away.”

Contacts

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

Morning Headlines 1/3/24

Veradigm Strengthens Award-Winning Revenue Cycle Services Portfolio with Acquisition of Full-Service RCM Company

Veradigm acquires Koha Health, a full-service revenue cycle management company for orthopedic practices and ambulatory surgery centers.

Cano Health Receives NYSE Notice of Non-Compliance with Market Capitalization Criteria

Primary care company Cano Health receives a second de-listing warning from the NYSE, this time pertaining to its inability to sustain a $50 million total market capitalization over a 30-day trading period.

Liberty Hospital staff worries patients are in ‘jeopardy’ if ‘cyber security incident’ drags on

Liberty Hospital (MO) continues to rely on paper charts as it works to get IT systems up and running after a December 19 cyberattack.

News 1/3/24

Top News

Veradigm acquires Koha Health, a full-service revenue cycle management company for orthopedic practices and ambulatory surgery centers.

Koha Health, which was known until mid-2022 as Physicians Resources Ltd, is a 40-year-old family business with headquarters in Merrimack, NH.

Reader Comments

From Ipanema: “Re: AI-powered chatbots and online tools. Will organizations gain strategic advantage by not using them?” They might. Oligopolies such as utility providers, banks, streamers, and Amazon can get away with barricading their knowledgeable and helpful employees behind walls of technology and offshore workers that add little except to prevent their “valued customer” from receiving valued service. Chasing scale unfortunately means removing humans from the process wherever possible, no different than companies of yore that programmed their phone trees to ignore desperate customers who pressed “0” or “#” trying to get out of endless loops and poorly designed options. The high-cost, low-service, tech-heavy business model doesn’t always work when you have competitors and low switching costs. I can call my direct primary care doctor directly on her cell, but otherwise I find the typical medical practice’s telephone and online options frustrating because they are often designed by the same cranky front desk people who post scolding signs about turning off cell phones, filling out forms, and not leaning on their precious glass.

From Todd Castor: “Re: podcasts. It has become so common among self appointed experts that they’re now interviewing each other.” I’ve seen a few recent examples among podcast pontificators who must believe that they’re smarter than the people doing actual frontlines work.

HIStalk Announcements and Requests

Half of poll respondents received a holiday gift from their employer, although 40% of those say that it wasn’t memorable.

New poll to your right or here: Which technology will have the greatest impact on health outcomes and costs over the next five years?

You can support HIStalk by:

• Signing up for email updates when I post something new.
• Connecting and following on LinkedIn and joining Dann’s HIStalk Fan Club.
• Mentioning HIStalk to your colleagues and vendors.
• Sharing news, rumors, and intriguing insights.

Webinars

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

Acquisitions, Funding, Business, and Stock

Cano Health receives a second de-listing warning from the NYSE, this time pertaining to its inability to sustain a $50 million total market capitalization over a 30-day trading period. The primary care company is in the midst of an overhaul, with plans to sell certain assets and lay off employees in an effort to cut costs by $290 million over the next 12 months.

CIOs say that they will control IT costs in 2024 to find room in flat budgets to work on new technologies such as generative AI. Tactics include reducing cloud usage, consolidating vendors, and negotiating discounts. Projects with high ROI will take priority, and global companies will cut back in their investment in startups unless they are likely to provide immediate benefit.

Sales

• North Memorial Health (MN) will replace 14 business systems with Oracle’s Fusion Cloud Applications Suite.
• RCM vendor Advantum Health selects AI-powered medical coding and billing software from Aidéo Technologies.
• The VA awards Iron Bow Technologies a $1.4 billion contract for connected care technologies and support.

People

Verily Chief Medical Officer and VP of product development Amy Abernethy, MD, PhD says in a LinkedIn post that she will leave the company to start a non-profit that will focus on the collection of health data.

James Crawford, PhD, MA (AMI Expeditionary Healthcare) joins Nordic Consulting as president of Nordic Federal.

Propeller Health co-founder Greg Tracy, MS (ResMed) joins Wondr Health as CTO.

David Stewart (Gerent) joins Divurgent as VP of client services.

Announcements and Implementations

UCHealth’s Sterling Ranch Medical Center (CO) implements Epic.

Trinity Health Grand Rapids (MI) launches virtual nursing care at its Lacks Cancer Center using technology from Teladoc Health. The health system has implemented Virtual Connected Care in 19 hospitals since launching the program in 2022.

An Artera Health survey finds that nearly half of patients experience communications issues with their providers, leading to unpaid bills, the inability to schedule appointments, and the willingness of 60% of them to switch providers because of poor communication. Eighty percent want to be able to initiate text-based conversations with providers on any topic, not just to reply to text messages with “Y” or “N.

Privacy and Security

Anna Jaques Hospital, part of Beth Israel Lahey Health (MA), recovers from a Christmas Day cyberattack that forced it to divert ambulances and revert to downtime procedures.

Liberty Hospital continues to rely on paper charts as it works to get IT systems up and running after a December 19 cyberattack.

Other

BayCare SVP/CIO William Walders, MHA – whose healthcare experience includes a 22-year stint in the US Navy through 2018 – posts an insightful comment on LinkedIn:

The soundbite is that the old CIO role is dead. The role of SOLELY keeping the network secure and resilient, applications available and up to date, and support functions consumer centric is dead. However, the responsibility persists and is understood by your peers to be the bulk of the CIO’s role. While it varies by organization, the “new role of the CIO” is now, more than ever, a strategic business leader aiding in decision making on ALL healthcare decisions, many of which aren’t glamorous, innovative, or require digital evangelism. Looking back at 2023, my year was 70% being brilliant at the IT basics, 20% healthcare strategist and thought partner with the C-suite on non-IT specific topics, and 10% innovative.

A USA Today opinion piece by Harvard’s Marie Plaisime, PhD, MPH describes her disappointment at receiving an Apple Watch for Christmas that, like many medical wearables, don’t work for people whose skin is dark. The author notes that soap dispensers, pulse oximeters, and forehead thermometers can’t register darker skin tones. She also bristles that the Apple Watch leaves the consumer to figure out how to use blood oxygen readings since the company has not earned FDA clearance to market the Watch for medical uses.

Mayo Clinic’s new hospital in La Crosse, WI, which will open in September, will feature wireless remote patient monitoring technology across all of its 94 beds. Patient rooms will also feature infotainment systems that offer access to medical records and virtual consultations.

Sponsor Updates

• Skin Solutions Dermatology (TN) reports a significant increase in monthly online appointments after implementing the Healow Open Access online appointment booking solution from EClinicalWorks.
• Wolters Kluwer Health predicts the top four impact-drivers for generative AI in 2024.
• Amenities Health announces that its digital front door platform is now available in the Panda Health Marketplace.
• CereCore releases a new podcast, “Fostering a Culture of Innovation and Growth.”
• Arrive Health sponsors holiday gifts for residents of one of WellPower’s resident treatment locations.
• Clearwater releases a new podcast, “Navigating Information Blocking Regulations in Healthcare Transactions.”

Blog Posts

• How Technology Can Reshape Communication and Efficiency in Healthcare (Vyne Medical)
• Recapping the Best Blog Posts and Resources of 2023 (CereCore)
• The Future of Medical Coding and the Vital Role of Autonomous Coding Technology (AGS Health)
• Tips for success post go-live: Strategic approaches for healthcare data analytics platforms (Arcadia)
• Southern Ohio Medical Center Reduces Unnecessary Urine Culture Orders by 29% With MEDITECH’s Clinical Decision Support (Meditech)
• Back to Basics: Healthcare Revenue Cycle Management 101 (Availity)
• Industry Experts Share Insights on Improving Behavioral Health and Physical Health Integration (Bamboo Health)
• Reflecting on Progress: A Review of the Healthcare Technology Industry in 2023 (Direct Recruiters)

Contacts

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

Morning Headlines 12/29/23

Apple will sell latest Apple Watch models again after import ban temporarily stopped by U.S. appeals court

The company also says it has submitted redesigned Apple Watch models for customs approval.

Walgreens’s Ambitions Lean on Its Technology. First, It Has to Build Up Its IT Department.

The Wall Street Journal says that the company is on its third CIO in a year, has low IT employee satisfaction, and has cut back on use of contractors, all of which place its business turnaround in jeopardy.

Another Corewell Health data breach impacts more than 1 million patients

The Michigan hospital has patient information exposed for the second time in a month after breaches involving its vendors HCTec and Welltok.

Employers Increase Access to Mental Health-Related Chatbots or Apps

Two-thirds of large employers offer access to mental health chatbots or apps as an employee benefit despite concerns about effectiveness and privacy.

News 12/29/23

Top News

Apple restarts sales of the advanced models of its Watch Thursday after an appeals court temporarily pauses an import ban. The halt was related to Apple’s ongoing pulse oximetry patent dispute with Masimo and AliveCor.

Apple also says that it has submitted design changes to the Watch to the US International Trade Commission that could make the ban unnecessary.

Reader Comments

From Upshot: “Re: Harris / Constellation acquisition of Medhost. What is Constellation’s business model and what health technology company will be next?” Company founder and billionaire Mark Leonard is like Warren Buffett, with a simple, steady, and ingenious formula that has worked consistently. Constellation has acquired several hundred companies and has sold only one (Leonard still kicks himself for that one exception). A $10,000 investment in CNSWF five years ago would be worth $40,000 today as the company’s market cap has reached $53 billion. Leonard – who is 6’5” tall and sports a ZZ Top-like gray beard — is either “intensely private” or “bizarrely reclusive,” depending on who you ask. He took a rare step into the public eye with a podcast interview in 2020 that I may transcribe and post here for posterity. The company’s acquisition strategy is based on these ideas:

• Focus on companies that sell mission-critical software to a vertical market whose customers will keep paying recurring fees to avoid replacing the incumbent software. These are often in the public sector.
• Choose from potential acquisitions using the First Chicago Method of valuation: set scenarios for best, worst, and average cases; set a valuation for each scenario using the net present value of future cash flows; and weight the likelihood of each scenario to arrive at a hurdle number.
• Acquire companies that are profitable and that have consistent earnings and growth.
• Acquire 100% of the company rather than a partial share.
• Do not use hostile takeovers or unsolicited bids. Companies will often volunteer to be considered for acquisition for a variety of reasons.
• Look for acquisitions that have a lower growth rate and thus command a modest price, reportedly 1 to 1.5 times revenue.
• Leave the acquired company’s management and employees in place and let them run the business.
• Improve the acquired company through coaching, sharing best practices with Constellation’s other companies, and management training and mentoring.
• Use the cash flow to fund more acquisitions instead of trying to fuel growth.
• Minimize corporate involvement except for data analysis.
• Incent business unit leaders based on return on invested capital and organic revenue growth and treat them as owners.

Aledade CEO and former National Coordinator Farzad Mostashari, MD, MSc observes that Constellation had a rare (and large) misfire in paying $700 million in 2022 for the hospital and large practice business of Allscripts that it renamed Altera, only to have its biggest customer Northwell announce soon afterward that it was moving to Epic. Constellation highlighted Altera’s dramatic revenue slide in its most recent quarterly report. Mostashari adds that healthcare software is a good fit for Constellation and the total addressable market is huge – he notes that the Allscripts business that they didn’t buy, which is ambulatory and Veradigm, is worth just $1.1 billion but will generate $100 million of free cash flow this year – but EHRs require more product development to keep up with regulatory changes.

He also added an insightful HIStalk comment from a reader and Altera customer who expressed disbelief at another reader’s report that Altera declined to renew their health system’s maintenance contract (click the image to enlarge).

Webinars

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

Acquisitions, Funding, Business, and Stock

Stat reports that UnitedHealth Group has denied rehabilitation care for Medicare Advantage patients who live in nursing homes or have cognitive impairment by changing its guidelines for clinicians.

Walgreens needs to rebuild its IT department to support the company’s business plan, The Wall Street Journal reports, following CIO and IT management turnover, cutbacks on the use of contractors, low employee morale, and the company’s plan to make big cuts in operating and capital expense. Walgreens is dealing with legacy systems and technologies used by its acquired companies even as it plans to implement AI and supply chain technology.

Best Buy Health recaps its 2023 accomplishments that include partnering with providers, enhancing its cell phones and alerts for seniors, and launching its sale of continuous glucose monitoring systems.

Sales of over-the-counter hearing aids are lower than expected, given that one in five US adults struggle with hearing and those problems often precede cognitive decline. Possible reasons for the lagging sales include physician inattention to adult hearing issues, lack of insurance coverage, and the stigma of wearing hearing aids. Experts also note that unlike vision problems, people who have hearing deficiencies often aren’t aware of their diminished hearing. FDA approved direct-to-consumer sales of hearing aids last year for mild to moderate hearing loss. Johns Hopkins researchers have developed a standard at-home hearing test for consumers that may spur awareness.

Sales

• HSS Sports Medicine Institute will implement Kemtai’s computer vision exercise guidance technology for home training of athletes to avoid ACL injuries.

Announcements and Implementations

Preventable, serious medical complications increased significantly among Medicare patients after hospitals were acquired by private equity firms, a JAMA-published study finds. Staffing cutbacks, which have been anecdotally blamed for clinical quality issues, were not reviewed in the study.

Government and Politics

A chiropractic clinic wins a lawsuit that it brought against McKesson for faxing unsolicited ads for medical billing software to the practice. The court rejected McKesson’s defense that the clinic consented to receiving ads by listing its fax number on licensing forms, ruling that providing a fax number doesn’t imply consent to receive ads. The court denied class action status, however, citing a precedent that sending faxes through an online fax service falls outside the Telephone Consumer Protection Act.

Privacy and Security

Corewell Health (MI) reports its second patient data breach in a month to patients, both involving its vendors (HealthEC and Welltok).

Poland’s data protection agency fines the health ministry for disclosing a doctor’s medical information on social media. The former health minister looked up the records of a doctor who had publicly criticized new regulations that limit doctors to issuing 300 electronic prescriptions each day, then posted on social media that the doctor had prescribed psychotropic drugs for himself. That health minister resigned in August after his actions came to light.

Contacts

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

EPtalk by Dr. Jayne 12/28/23

As we expected, coming out of the Thanksgiving holiday and moving towards Christmas, emergency department and hospital visits for respiratory viruses were on the rise. According to data from the Centers for Disease Control and Prevention, the most recent numbers show a 21% increase from the previous week, with influenza accounting for the majority of visits.

While seeing patients, I’m hearing a lot of stories about family drama when someone attends a gathering and they’re sick. I’m also hearing a fair number of complaints about people who are staying home when sick, depriving their relatives of the chance to see them. It’s rough for patients who can’t win either way, especially when all they want to do is take a nap and feel better. Kudos to those who stay home when sick and keep their germs to themselves.

Speaking of staying home, Uber is advertising its package service as an option to help with post-holiday gift returns. Customers selecting “Return a package” can send up to five packages to a single postal carrier for $5, with the driver sending a confirmation when the drop off is complete. Packages are limited to less than 30 pounds, need to fit in the trunk of a midsize car, and must not contain any prohibited items. I perused the list of banned items for entertainment value. As expected, you can’t send illegal items, weapons, money, or alcohol. Also making the list: recreational drugs, stolen goods, obscene materials, livestock, or animal parts.

The virtual water cooler is abuzz with a recent private equity-related article that was published in the Journal of the American Medical Association. The findings suggest poorer quality care and clinical outcomes at facilities that are owned by private equity firms. The researchers were associated with heavy-hitting organizations: Massachusetts General Hospital, Harvard Medical School, Beth Israel Deaconess Medical Center, and the University of Chicago. They looked at data on millions of hospitalizations at 300 facilities, focusing on years before and after private equity transitions. They found that private equity-acquired hospitals had higher rates of hospital-acquired conditions such as falls or central line-associated bloodstream infections. Surgical site infections also rose after acquisitions. The other interesting finding was the lower-risk demographic of patients at private equity-associated hospitals, which makes the other findings all the more striking.

As expected, more research is needed, but lots of physicians are jumping on the fact that staffing looks dramatically different at PE-owned hospitals compared to other community hospitals or even academic medical centers.

In other journal publication news, this year’s Christmas edition of the BMJ provides an “Analysis of Barbie medical and science career dolls” as a descriptive quantitative study. Among the highlights: although Barbie can be a doctor, she is usually shown caring for children and rarely meets occupational safety standards. Loose hair, heels, and exposed legs are all considered workplace hazards. Science-related Barbie dolls were also short on personal protective equipment such as gloves or full-coverage lab coats. Competitor dolls were also analyzed and had a more “clinically accurate” appearance. Of note, Dr. Ken was more compliant due to his full-length pants, flat shoes, and short hair.

The article goes into gory detail on a lot of different features, but is interesting to think about given the sheer number of Barbie dolls out there. Of note, my own childhood Barbie doll had scrubs, and although they came with a pair of white sneakers, she couldn’t wear them due to her heavily molded feet. My Ken doll was a hand-me-down and had one leg that popped out of the socket any time you tried to get him dressed, so in hindsight perhaps my own Barbie should have been an orthopedic surgeon rather than whatever specialty she was.

It was nice to take a bit of a holiday break, but my heart goes out to all the healthcare professionals who are working during the holidays. I’ve spent enough of them in the emergency department to know that it’s hard work, and the pressure just keeps increasing. One of my colleagues mentioned that the new ED mandate is “do more, do it faster, do it friendlier, with less resources, and you can never ever make one mistake.” Hospitals continue to use short staffing as an excuse for everything, and often the buck stops in the ED because they don’t turn patients away and the halls end up filling with patients who are boarding. They don’t yet have rooms elsewhere in the hospital, yet require care that is often different from what the emergency department is equipped to provide. It’s stressful for all involved, especially when there are empty beds in the hospital but not enough people to staff them.

I’m involved in an online physician support group where one of our members shared an editorial that was published this week in the Annals of Emergency Medicine. The title is certainly eye-catching: “My Suicide Blanket.” It begins with a vignette about a hospital giving out blankets to staff as part of a mental health improvement plan. It reminded me of the challenge coins and other tokens given to staff during the height of COVID and which served only to illustrate how disconnected administrators were from those who were actually delivering care on the front lines.

Emergency department physicians are often treated as if we are expendable, expected to operate under a mindset where we don’t dare call in sick because that means we’re not team players. We’re supposed to just take everything thrown at us even when we know we’re working so fast that we aren’t delivering good care. The author of the piece is a member of our group and mentioned that it had to be published anonymously due to fear of retaliation. Students have been seeing this for the last few years, and during the most recent residency program match, they ran away from the specialty of emergency medicine.

Many of your clinician colleagues are not OK. Check on them and let them know that resources are available. They can call or text 988 or visit the 988 Suicide and Crisis Lifeline for help at any time.

Email Dr. Jayne.

Morning Headlines 12/28/23

Attorney General James Secures $300,000 from NewYork-Presbyterian Hospital for Failing to Protect Patient Data

The health system settles state charges that it used pixel tracking to send the information of 54,000 website users to advertisers that sometimes included their search terms and demographic information.

Hackers in an Integris Health data breach are emailing victims. What to do if you receive one.

Hackers are emailing the health system’s patients to demand a $50 payment to keep their information private after Integris declined to pay a ransom.

AliveCor praises ITC for Apple Watch ban in the US as it still disputes with Apple

The smartphone ECG vendor company expresses support for Masimo as both companies are embroiled in legal fights with Apple over claimed patent violations.

Kansas City students brainstorm new life for former Cerner headquarters

Students propose that the vacant former world headquarters of Cerner at 2800 Rockcreek Parkway be turned into either a mini-community that includes expansion of an adjacent hospital or a college campus.

Readers Write: The Evolving Role of a Security Control Assessor

The Evolving Role of a Security Control Assessor
By Angela Fitzpatrick

Angela Fitzpatrick, MSHI is VP of IT risk management for Meditology Services of Atlanta, GA.

As the cybersecurity and regulatory landscapes continue to change and escalate, healthcare organizations find themselves juggling a myriad of priorities within their security strategy. They must ensure they have adequate assurance options while dealing with the increased intertwining of cybersecurity with other functions such as procurement, compliance, and digital transformation.

In response, healthcare organizations are broadening their security operations, highlighting the need for security leaders who strategically understand the use cases for cybersecurity within the business. They are also redefining the role of security control assessors (SCAs), from merely applying standards to also understanding how standards fit into the organization’s larger cybersecurity framework.

The rising value of patient data, including protected health information (PHI) and personally identifiable information (PII), makes healthcare organizations prime targets for cyberattacks. This data is highly sought after, with black market values skyrocketing to 10 to 40 times more than credit card numbers.

According to the 2023 “Cost of a Data Breach Report” by Ponemon Institute and IBM Security, the average cost of a breach for a healthcare organization is close to $10 million, a 53% increase from 2020. This surpasses the average cost for breaches across all industries in 2023, which stands at $4.45 million.

The Health and Human Services (HHS) Office for Civil Rights (OCR) “Wall of Shame” reveals a distressing trend that aligns with these figures. From January to November 2023, nearly 500 breaches affecting 500 or more individuals were reported to the OCR, a sharp increase from the 278 reported breaches during the same period in 2022. The attacks, which affected more than 90 million individuals, were reported across 300 provider organizations, 120 business associates, and 73 health plans. The majority were hacking incidents (407), followed by unauthorized access or disclosure (80) and theft (7).

Although it’s alarming to see the escalating cost and frequency of cyberattacks, perhaps the most unsettling fact is that a mere one-third of these attacks were detected internally by security teams or tools. Even more startling is the revelation that the attackers themselves reported the majority of these breaches, accounting for 67% of the total.

The incessant cyber onslaught aimed at patient data has left healthcare organizations in a frantic search for solutions. Part of the answer lies in escalating investments in incident response (IR) planning and testing, staff training, and technologies for detecting and responding to threats. The Ponemon/IBM report identified these activities as the most efficient ways of reducing the cost impact of an attack, complemented by implementing a DevSecOps approach.

To maximize the efficiency of these investments, it’s crucial for healthcare organizations to scrutinize the pivotal role that SCAs have in pinpointing and alleviating potential vulnerabilities.

The Evolving Role of the SCA

Security control assessors meticulously examine security measures in place within an information system, employing a repertoire of assessment and testing methodologies to gauge the efficacy of administrative, operational, and technical safeguards. Their primary responsibilities include detecting vulnerabilities, proposing remedial measures, and safeguarding system integrity by pinpointing and mitigating potential paths of exploitation.

Additional SCA responsibilities encompass:

• Creating strategies for tracking and evaluating risk, compliance, and assurance operations.
• Constructing specifications to harmonize risk, compliance, and assurance endeavors with security prerequisites.
• Organizing and executing reviews of security authorization.
• Assessing interfaces for potential vulnerabilities.

In addition, SCAs are tasked with validating application software, network, and system security implementations. They meticulously document deviations from the prescribed security standards and, crucially, propose appropriate rectifying measures.

In the current era, the role of an SCA has evolved beyond traditional responsibilities into that of a guide who appreciates the unique complexities and limitations inherent to an organization, and charts an achievable path towards enhanced cybersecurity. This pragmatic approach strikes a balance between stringent security protocols and the practicality of implementation. Assessors deploy a tailored strategy for each organization, aligning with its specific hurdles, assets, and cybersecurity objectives. They assist in evaluating various attestation alternatives and guide organizations in pursuing attestations in an incremental manner, thus strengthening cybersecurity over time.

In the healthcare domain, the significance of the SCA’s role is heightened due to their ability to align assurances with regulatory stipulations such as HIPAA. As the landscape of regulatory requirements shifts, SCAs must stay at the forefront of changes. They must transcend the boundaries of occasional involvement and adopt the mantle of a persistent catalyst for progress, fostering an environment of perpetual learning and advancement.

Moreover, as the domain of cybersecurity expands its interdisciplinary reach, SCAs assume the mantle of navigating the humanistic and cultural facets of the certification and attestation process and its subsequent repercussions on the organization’s everyday operational realities. In the end, proficient SCAs conduct assessments and actively participate in remediation planning and implementation, steering clear of a mere evaluate-and-depart modus operandi.

Impact on Attestation

An SCA has the potential to significantly influence a healthcare organization’s success in attaining attestation by minimizing challenges and resistance. By comprehending the full context and nuances of an organization’s cybersecurity stance, the SCA is best equipped to navigate it along the attestation pathway. This reduces impediments and facilitates a more streamlined and achievable certification process.

In the current cybersecurity landscape, the SCA’s role is to boost the chances of attestation success by adopting a mentorship stance and investing time in gaining a deep understanding of their organization’s specific context. This focused approach equips assessors to offer actionable and customized guidance, thereby enhancing the organization’s prospects of achieving successful attestation.

The metamorphosed role of the SCA underscores the importance of cooperation and participation among all interested parties. Serving as a connecting link, SCAs promote improved dialogue and comprehension, ensuring that everyone is synchronized in their objectives and anticipations. This simplifies the procedure, cultivates confidence, and fortifies alliances, which are essential for enduring cybersecurity partnerships.

Ultimately, SCAs play a pivotal role in fostering sustainable progress and substantial expansion in the realm of cybersecurity.

By establishing an effective alliance, healthcare organizations can utilize the expertise of SCAs to critically evaluate and guide the maturation of in-house programs. With a strategic orientation, this collaboration can instigate enduring change and promote lasting advancements.