Recent Articles:

Morning Headlines 5/9/23

May 8, 2023 Headlines No Comments

NextGen Healthcare says hackers accessed personal data of more than 1 million patients

NextGen notifies over 1 million patients of a data breach in which hackers stole personal information by gaining access to its NextGen Office EHR and practice management software using stolen customer credentials.

Healthcare firm Premier explores strategic alternatives

Premier shares rise on the news that it has formed a special committee to consider strategic alternatives including a sale of part or all of the company, partnership opportunities, or recapitalization.

CareCloud Reports First Quarter 2023 Results

CareCloud attributes a 15% drop in Q1 revenue to a dip in professional services revenue, the absence of COVID-related RCM services, and customer migrations away from Meridian Medical Management, which CareCloud acquired in 2020.

Curbside Consult with Dr. Jayne 5/8/23

May 8, 2023 Dr. Jayne No Comments

I’m back in the air this week with some weekend travel, which I don’t usually do. My flight was nearly all vacation travelers. The boarding process started with someone spilling his coffee all over the exit row, which led to a string of urgent maintenance issues and caused confusion and delay. Since he soaked nearly all of the seat belts in the exit row, those had to be changed out. Additionally, the flotation devices under the seats also had to be checked. Meanwhile, no one was able to board into that row or adjacent rows while the spill was being addressed, causing a lot of grumbling.

I’ve seen so many spills and messes at the airport and on planes due to Starbucks and fast food cups that it’s a miracle there aren’t more delays than they are. I don’t understand how people think they’re going to board with a roller bag, a shoulder bag, and a non-secured beverage and expect everything to turn out OK. I also see a lot of impractical shoes, which isn’t going to help anyone in the case of an emergency. I think most people never think of the fact that they might have to emergently exit a plane, but as someone with an interest in disaster preparedness, I’m always ready to deploy that exit door and head out in my trusty running shoes.

One of my projects for the day involves helping a former client. They reached out to me earlier in the week about a custom application that I installed for them way back in 2011, and I was frankly surprised to learn that it was still chugging along. It was designed to help with routing of laboratory results, and it sounds like its simplicity is what led to it still being in service more than a decade later. Since it was a custom build, the client opted at the time for a no-frills approach with a straightforward user interface. I figured they would have retired it long ago as they transitioned from a dedicated ambulatory EHR to an enterprise application, but apparently they continued to use it for some non-employed private practice clients who had steadfastly refused to migrate to the enterprise platform. The last of those physicians is retiring at the end of June and they were looking for advice on how to wind down his laboratory feeds as he transitions out of practice.

As a consultant, I’ve helped with a number of practice and provider “disengagement” processes over the years, so I was able to dust off some existing documentation and point them in the right direction to manage some of the non-application tasks that need to be addressed before they shut it down. Although they were more worried about what to do about the technical infrastructure, I let them know that the issue will largely resolve itself once the lab vendors stop feeding information. Fortunately, the physician is a subspecialist who orders very few laboratories and has been good at tracking outstanding orders, so the odds of a rogue result needing management in the practice’s final days are slim to none.

I enjoyed catching up with the analyst who was tasked with winding down the practice from the information technology side since I had worked with him when we initially configured the system. It’s rare to see someone continue to support a one-off application like that for the duration that they had with this one, but it was fun to talk about where the industry has gone in the years that have passed since we were both relatively new to the clinical informatics world.

My other project for the day is finishing a sorely overdue library book. I’ve had a lot going on in both my professional and personal lives and the amount of time I’ve had for those kinds of pursuits has been largely non-existent. Fortunately, my library has a no-fine policy, but I feel bad about keeping this book out of circulation, especially since someone has now put a hold request on it.

Since I’m spending the rest of the weekend in a hotel, it’s not like I can work on household projects, putter in the yard, do laundry, switch out the winter clothes in my closet for summer ones, or do any of the dozen other projects that are looming. I’ve got some downtime at my destination later in the week and I hope to see some of the sights and do a little shopping, so it will be a good change from my normal routine. Sometimes it’s good to just change things up, so we’ll see what the rest of the week brings.

I’m also still recovering from the respiratory funk that I picked up at HIMSS. Although it wasn’t COVID, it has put a dent in my activities, and I’m realizing that I don’t bounce back like I used to. Even though I no longer work in person in the emergency department or in a high-acuity, high-volume urgent care situation like I did during the height of the COVID pandemic, I feel like those experiences have taken months if not years off my life. I’ve watched nearly everyone I worked with during that time leave frontline healthcare roles, so I know I’m not alone in feeling like the experience was a turning point.

Some of my former colleagues have moved on to subspecialty positions that have more predictable working hours, but others have left clinical medicine entirely. When COVID started, we all promised to see each other “on the other side,” but several were lost along the way, including one to suicide. Thinking about them reminds me how important it is to savor every day even if you don’t feel well or if it’s particularly stressful. It’s also a good reminder of how we need to look after each other because you never know what’s going on in the parts of someone’s life that you don’t see.

Once the business component of this trip ends, I’ll be zipping home to get ready for some family functions. I’ve also got an upcoming girls’ trip that I need to plan, so hopefully I can knock a big chunk of that out on the flight home as long as wi-fi cooperates and we don’t have any major in-flight issues. After June, I can finally enjoy some long-needed R&R.

How do you spend your travel time? Is it full of catch-up tasks, or do you manage to find time for yourself? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 5/8/23

May 7, 2023 Headlines No Comments

Constellation Software hit by cyber attack, some personal information stolen

The ALPHV group of ransomware hackers say they have breached Constellation Software, whose software groups include healthcare-focused Harris Computer, and are threatening to publicly post 1 TB of its data if it fails to pay the ransom.

Zyter Health and Casenet TruCare Introduce New Brand, Representing the Organization’s Continued Dedication to Value-Based Care

Home health, telehealth, and remote patient monitoring company Zyter Health rebrands to Zyter|TruCare after acquiring Casenet and its TruCare care management software solutions from Centene in 2021.

Mayo Clinic Platform expands its distributed data network to partner to globally transform patient care

Mayo Clinic Platform extends its Connect de-identified clinical data network to University Health Network in Canada, Sheba Medical Center in Israel, and Hospital Israelita Albert Einstein in Brazil.

Monday Morning Update 5/8/23

May 7, 2023 News 1 Comment

Top News

image

UC San Diego Health will use a $22 million donation to create a mission control center for digital medical data.

The health system notes that many systems issue constant streams of potentially useful data, which requires experts and AI to isolate the elements and trends that would be immediately useful to caregivers.

The donation and the plan to develop the center were announced in February 2023. They were explained further in last week’s Innovation in Digital Health symposium.


HIStalk Announcements and Requests

image

I’m relieved that poll results suggest that I’m not the only one who has zero interest in sitting through videos and podcasts that were made at HIMSS23. I’m feigning anticipation of the educational session recordings, but I know from past years that my interest drops off quickly in the weeks it takes for them to be posted.

New poll to your right or here: Has your employer cut back on remote work in the past year? I drew the ire of several readers in July 2022 when I said this:

Economic and industry conditions have put bosses back in charge and they know that they need to manage costs while fretting less that their employees might flee to greener pastures … I bet many executives agree with me that you can’t build and maintain a great company when employees are doing task work in their living rooms … I expect companies to compromise by offering a hybrid model of 1-2 offsite work days per week or maybe going with a permanent four-day workweek.

GLP-1 weight loss drugs such as Wegovy and Ozempic are fascinating, especially as they negatively affect the work of physicians. Insurers don’t want to pay for them, so they are adding bureaucratic measures to impede demand, such as prior authorization and documentation proving that less expensive alternatives were tried and failed. Second, patients who cannot afford to pay $800 to $1,500 per month will pressure their doctors to falsely diagnose them with diabetes so their insurance will pay, which could land the doctors in trouble in the absence of supporting clinical documentation. The US is a weight loss drug dream market of overweight people (two-thirds of the population), lobbyist-friendly politicians, and unregulated drug pricing, and while these drugs might improve an individual’s health, our system of frequent job and insurance changes doesn’t reward employers and insurers who spend money today to save someone else on healthcare expenses years from now. And we like drugs better than behavioral changes, as the now-shuttered Jenny Craig can attest.


Webinars

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


Acquisitions, Funding, Business, and Stock

Shares of the Global X Telemedicine and Digital Health ETF were unchanged over the past month versus the SP& 500’s 1% gain. They are down 25% since inception in July 2020 versus the S&P’s 26% gain. Top holdings are Masimo, Doximity, Alibaba, JD Health, and DexCom. 

Minnesota’s largest employer, Mayo Clinic, threatens to redirect billions of its investment dollars to other states in protest of two bills that would: (a) set a maximum patient-to-nurse staffing ratio; and (b) create a Health Care Affordability Board that would set healthcare spending growth targets, enhance provider transparency, and explore alternative payment programs.


People

image image

Nym promotes Or Peles to CEO. He replaces co-founder Amihai Neiderman, who will remain on the company’s board.


Announcements and Implementations

Redox announces its reimagined product portfolio: Nexus (integration); Nexus Lite (a lightweight, self-service offering); Access (connection to Carequality and DirectTrust); Chroma (a Verato-powered EMPI); and Nova (transform legacy standards to FHIR using existing provider integrations and libraries).

image

Toronto’s Women’s College Hospital incorporates Indigenous healing and wellness practices into Epic.

image

A new KLAS report on hospice software finds that MatrixCare and WellSky are ranked highest for independent hospices, while Epic Comfort is top ranked overall by its hospital-owned hospice users.


Government and Politics

The Senate Finance Committee wants to hold health plans accountable for “ghost networks,” citing a secret shopper study by Senate staffers in which only 18% could get an appointment with a mental health provider that was listed by 12 Medicare Advantage plans. Another audit of MA plans found that 73% of dermatologists who were listed as in-network providers could not be booked for an appointment due to duplicate entries or a change in plans they accept. 

Kell West Regional Hospital, which was one of just four hospitals that CMS fined for failing to comply with its price transparency rule, will appeal the $117,000 fine because it has successfully met CMS requirements after a company it had hired failed to deliver.


Privacy and Security

The ALPHV group of ransomware hackers say they have breached Constellation Software, whose software groups include healthcare-focused Harris Computer, and are threatening to publicly post 1 TB of its data if it fails to pay the ransom. Constellation, which has acquired 500 software companies since 1995, says it has restored its infrastructure and none of the IT systems of its companies was affected. An ALPHV ransomware attack took down the Colonial Pipeline in May 2021, triggering panic buying that caused gasoline shortages in the eastern US even though the company paid the demanded $4.4 million almost immediately. 


Other

Don Detmer, MD, MA and Andrew Gettinger, MD list essential EHR reforms for the this decade in a JAMA viewpoint article in which they also advocate use of technology such as ambient voice recognition, AI, and cloud-based medication and allergy lists.:

  • Develop a national patient identifier as HIPAA originally mandated.
  • Remove administrative and regulatory content from clinical time. CMS should replace check-the-box documentation by deriving quality measures from existing documentation.
  • Include patient-entered information in the EHR.
  • Reinvent the clinical note to become prospective and to encourage less documentation instead of more. Ban copy-paste and copy-forward functions.

Scan Health President and CEO Sachin Jain, MD, MBA says in a Forbes opinion piece that health systems have “an epidemic of inauthenticity and superficial execution” as much-publicized projects are never scaled beyond pilots or limited deployment, broken care processes are hidden, and regression to the mean is presented as evidence of impact. He adds that we have normalized inauthenticity as being good salesmanship, as people are selling their ideas and building their brands despite lack of real impact, which will eventually breed cynicism and burnout. 

image

Danielle Ofri, MD, PhD observes “The Curious Side Effects of Medical Transparency” in a New Yorker essay, where she ponders how her practice has changed due to Cures Act requirements that patients be given access to clinician documentation:

  • She worries that patients will become alarmed if she records her differential diagnosis correctly and they see serious but unlikely possible diagnoses that she is ruling out.
  • She cites experts who question whether transparency should be its own ideal or whether it should be compared with other ways to deliver the same end result.
  • Seniors whose technology is managed by their adult children have asked her to keep some prescriptions private, and having multiple family members accessing the patient’s portal can make it hard to determine whether communications are going to them directly or to detect when patient records are being accessed by people who are harming them.
  • The use of multi-test lab panels almost ensures that every patient will get a slightly out-of-range result that will be highlighted as abnormal, or the results of tests whose result can’t be expressed as a simple yes or no.
  • She spends time every day managing a flood of patient questions about new test results and is forced to try to answer urgent questions quickly without having completed basic legwork.

Sponsor Updates

clip_image001

  • Wolters Kluwer Health staff in Waltham, MA clean up the banks of the Charles River as part of its Green is Green initiative.
  • Drug Store News recognizes OmniSys XiFin Pharmacy Solutions for the second time with its annual Retail Excellence Award – Technology and Automation.
  • An OptimizeRx physician survey finds that they are receiving life sciences product information from a variety of channels, but with gaps, and with a need for more information about treatment eligibility, affordability, and access.
  • Sectra releases a new episode of its Let’s Talk Enterprise Imaging Podcast, “Beyond the technology – how Sectra provides end-to-end SaaS security.”
  • Black Book Research names Andor Health to the top spot in virtual care collaboration solutions based on a survey of nearly 1,000 health system executives.
  • KLAS awards Ellkay its Points of Light award, recognizing the company’s payer-provider collaboration efforts via bi-directional connectivity. 
  • National Medical Care Company in Saudi Arabia selects Wolters Kluwer Health’s UpToDate, UpToDate Advanced, and Medi-Span solutions.
  • First Databank VP of Clinical Network Services Lathe Bigler will present at the NCPDP 2023 Annual Technology & Business Conference May 9 in Scottsdale, AZ.

Blog Posts


Contacts

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

Morning Headlines 5/5/23

May 4, 2023 Headlines No Comments

Pediatric Mental Health Provider Brightline Cuts 20% of Its Workforce for the Second Time in 6 Months

Virtual youth and family mental health provider Brightline lays off 20% of its employees on top of the 20% that it let go in November 2022.

Inbox Health Raises $22.5 Million Series B

RCM vendor Inbox Health raises $22.5 million in a Series B funding round, bringing its total raised to $43 million since launching in 2017.

WA gov invests $100m in electronic medical record rollout

The Western Australian government will allocate $100 million towards the first phase of an enterprise EHR roll out, beginning with Perth Children’s Hospital and Sir Charles Gairdner Hospital.

News 5/5/23

May 4, 2023 News 4 Comments

Top News

image

The Drug Enforcement Administration, reacting to the record 38,000 comments it received about its intention to reinstate pre-COVID telehealth prescribing limitations for controlled drugs with the end of the public health emergency, will leave the flexibilities intact as it reexamines the issue.


HIStalk Announcements and Requests

A reader previously asked me for financial highlights from HIMSS. The organization hasn’t filed a federal Form 990 since May 2021, after which it changed its fiscal year-end to December 31, so records are current only through June 2020. That wasn’t a good year for HIMSS, when it had to cancel its cash cow annual conference. I’ve reported the numbers previously (they are two years old, after all), but here again are the highlights:

  • Total revenue dropped 74% to $29 million.
  • Profit slid from $21 million to a loss of $54 million, which swung net assets from $33 million to negative $24 million.
  • Top-earning executives were President and CEO Hal Wolf ($1.4 million), former EVP Carla Smith ($1.3 million, of which $375,000 was severance), and 11 others who earned from $250,000 to $666,000.
  • HIMSS reported a revenue breakout of $12 million from membership, $10 million from advertising, $1.9 million from conferences, $1.9 million from its maturity model business, and $1.6 million from corporate sponsors. Recall however that this is in a year when the conference was cancelled and revenue dropped by $83 million compared to the year before.

Happy Cinco de Cuatro to my fellow Cornballers (iykyk).


image

Welcome to new HIStalk Gold Sponsor Keysight Technologies. The Santa Rosa, CA-based company’s Keysight Eggplant is recognized by Forrester as a leader in software test automation. Healthcare providers and medical device manufacturers can experience enhanced healthcare software testing in three areas: (1) non-invasive EMR testing at DevOps speed; (2) streamlined medical device software testing; and (3) test automation and RPA in one toolset. Keysight’s Eggplant Test Automation Software helps healthcare providers design, schedule, and execute test cases that improve their user’s experience. Its solutions are tailored to simplify the complexities of continuous integration, deployment, and testing, enabling healthcare providers to analyze high-fidelity models of complex systems and ensure the best possible outcomes for patients. Thanks to Keysight Technologies for supporting HIStalk.


Webinars

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


Acquisitions, Funding, Business, and Stock

image

Centene will sell healthcare analytics vendor Apixio, which it acquired in December 2020, to private equity firm New Mountain Capital. The private equity firm’s active holdings include Datavant, EMIDS, Cloudmed, and Signify Health.

image

Virtual youth and family mental health provider Brightline lays off 20% of its employees on top of the 20% that it let go in November 2022.

image

Home diagnostics vendor Cue Health will lay off 325 employees, or 26% of its workforce. The company, which was best known for its over-the-counter COVID-19 test that was used by the NBA, went public in 2021 at a $3 billion valuation. HLTH shares have since lost 97%, valuing the company at $105 million. CEO Ayub Khattak said in the March earnings call that the company sold $1 billion worth of tests in the last two years and has added a virtual care delivery solution. The company was awarded a $481 million Department of Defense contract in October 2020 for its rapid COVID-19 test, which uses swabs and a cartridge-based reader that delivers results to smartphones.


People

image

DataLink hires Eric Hedrick (Advantmed) as VP of clinical transformation.

image

Remote patient monitoring platform vendor Health Recovery Solutions hires Alan Bugos, MS (Medminder) as CTO.

image

Wi-fi sensing solution provider Origin AI hires Joseph Gwin, PhD (Best Buy Health) as chief innovation officer.


Announcements and Implementations

Apree Health, created in September 2022 by the merger of Vera Whole Health and Castlight Health, launches a cloud-based member analytics platform for health plans and large employers. Former Cerner President Don Trigg is CEO.

UCSD Health demonstrates scannable health insurance cards that use the SMART Health Code QR standard.


Government and Politics

The VA chooses four companies to submit task orders under an eight-year, $1 billion contract for home telehealth for remote patient monitoring: Cognosante, DrKumo, Medtronic Care Management Services, and Valor Healthcare.

The Consumer Financial Protection Bureau warns consumers that high-interest medical credit cards and financing – often advertised in the waiting rooms of physicians, dentists, and hospitals that previously offered their patients no-interest payment plans – can inflate medical bills by up to 25%.


Privacy and Security

A lawsuit that was filed by a woman against Lehigh Valley Health Network, in an attempt to force the health system to pay ransomware hackers to remove her nude patient examination photos from the dark web, has been dropped. The federal judge questioned whether the court has the authority to force a party to comply with an illegal act, leading the plaintiff to drop her proposed class action lawsuit. 

image

NationBenefits says that the information of three million of its members was exposed in an April mass ransomware attack that exploited a flaw in cybersecurity vendor Fortra’s file transfer system. The attack involved other healthcare organizations such as hospital operator Community Health Systems, which said in February that the Fortra-vector attack exposed the information of at least one million of its patients. Fortra has determined that a zero-day flaw in its software allowed a ransomware group to steal data from at least 100 companies starting in January 2023.


Sponsor Updates

  • Healthcare Triangle will exhibit at the 2023 MUSE Inspire Conference June 7-10 in Denver.
  • EClinicalWorks kicks off its summit for FQHCs, rural health clinics, Indian health centers, and community health centers.
  • Volpara Health wil donate 5% of sales of its breast density assessment software to educational website DenseBreast-info.org.
  • Health Data Movers will sponsor a breakfast at the UNOS Transplant Management Forum on May 18 in Denver.
  • Meditech congratulates HCA Healthcare for its top ranking in Fortune’s list of 2023 Most Admired Companies in the medical facility category.
  • Five9 publishes a new case study, “Healthcare Technology Provider Delivers Personalized Member Services.”
  • NTT Data announces it has been named a Leader in all four quadrants of the ISG Provider Lens 2022 – Healthcare Digital Services report.

Blog Posts

The following HIStalk Sponsors win 2023 MedTech Breakthrough Awards:

  • Loyal – best patient registration and scheduling solution
  • Kyruus – best online search and scheduling solution
  • Elsevier Clinical Path – best computerized decision support solution
  • Nym Health – best overall health administration software
  • Availity – health administration innovation award
  • Lumeon – best care orchestration platform
  • Bamboo Health – best care management solution provider
  • ConnectiveRx – best overall patient engagement service
  • Experity – best EHR solution
  • Arrive Health – best EHR service

Contacts

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

EPtalk by Dr. Jayne 5/4/23

May 4, 2023 Dr. Jayne 3 Comments

I was back in the patient trenches this week, having my regular trip through the scanner to determine whether the next six months will be smooth sailing or something else entirely.

What I didn’t plan for was a bumpy preregistration and appointment confirmation process that was scheduled to occur while I was supposed to be off the grid enjoying the outdoors. I just happened to be in cell phone range when the first call came, asking if I had time to complete preregistration. All of the questions I was asked to answer or confirm could have been easily served up as part of a patient questionnaire via the patient portal (as they are when I see the surgeon who is part of the same institution) and could have been sent well in advance of the procedure.

About 20 minutes later, a call came in from the radiology department. This one was a recording, and my Google Assistant picked it up without me realizing it. I had pulled out my phone to check the weather forecast and noticed the call already in progress and recognized the hospital prefix and picked it up. I had to listen to the recording loop through and could finally confirm my appointment. Again, this could have been done through email and/or a patient portal message.

Still, I was left wondering what would have happened had I been truly off the grid as planned? Would they have canceled my appointment, which had been painstakingly scheduled six months in advance and for which I had canceled and rescheduled work meetings? Or would they have accommodated me if I rolled in without confirming? We’ll never know.

Even with that pre-confirmation, things were not smooth on arrival. When I reached the registration desk six minutes before my allotted arrival time),I had to stand there for a few minutes while the registrar copied my details (first initial, last name, time of study, type of study) out of the computer and onto a little sticky strip of paper.

She phoned back to a registrar, who came out and picked up the sticky strip, then hustled me back to the registration area where she rushed me through the process saying, “we can’t have you being late to the waiting room.” Mind you, it was just now my arrival time. She then stuck the paper strip to a notebook in her work area, asked me to confirm my name and DOB, and then asked me to sign on an e-signature pad without even telling me what I was signing. According to the text at the top of the pad, it was my consent for treatment, but I was never offered a copy or advised as to what I was signing. As a physician I know what’s in a typical consent, but the average patient doesn’t, and either way, the consent is invalid unless a patient actually reads it.

From there I was led down the hall at a rapid clip to the appropriate radiology sub-waiting room, where I was handed the proverbial clipboard and asked to complete three sheets of questions, none of which were even remotely populated with my information. As a CMIO, I know it’s entirely possible to generate forms that already have key patient information on them, and for the organization to continue to make the patient print their name, date of birth, and Social Security number on each page is just poor patient experience.

After filling out loads of information that was already in the EHR, I turned in the clipboard and proceeded to sit for a full 10 minutes before I was taken to the changing room. I had enough time to notice the trash under the chairs in the waiting room, and since I was one of the first appointments of the day, it was likely from the day before.

In the changing room, in addition to some fantastic gowns, I was greeted with dust bunnies the size of a plum that had probably been there for several days based on the look of them. I know that all organizations are struggling with retaining lower-wage workers such as housekeeping staff, but I had to ask myself if the president/CEO of the hospital or the members of the board would be proud of their facility. For an institution with billions of dollars in the bank, maybe they could loosen the purse strings a little bit to help recruit and retain staff.

Fortunately, the clinical staff was outstanding. It was one of the best IV starts I’ve had in a long time, and a friendly radiologic technologist had the positioning process down to a fine science. She also honored my request to sleep through the procedure. I’ve had it enough times that I don’t need to be warned every time a new sequence starts, and given the early test time, I was grateful to grab some extra shuteye before heading back to work. At least this time they subsidized the first $1.50 of the parking fee. I always find the idea of paid parking at a world-renowned cancer center to be repugnant when the organization is sitting on a Scrooge McDuck level of reserves.

I usually get my results within 24 hours, but this time it took two full days, which was somewhat agonizing. When the patient portal notification finally came through, I discovered that my biometric settings no longer worked, and the hospital wanted me to log in using my password and then re-enable biometric authentication. Having been a biometric user for years, I didn’t have my password saved within my password manager, so that was a race to try to get the results before going to my next meeting. I was surprised to see that the results had been reviewed by a provider prior to release (usually they release directly) so I’ll have to ask my clinical informatics contacts at the institution what the story is with all the changes.

Although the process was frustrating, at least it took my mind off the other frustration of the week, which involved organizations that I spent a substantial amount of time with at ViVE who have yet to follow up. I’ve got money to spend and time to dedicate to these particular projects, but my patience is flagging. I sent a last round of emails, so we’ll see who responds and which project will get to start first. The others may just have to wait.

Have you had any recent patient adventures? Were they positive or negative? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 5/4/23

May 3, 2023 Headlines No Comments

Statement from the DEA Administrator Anne Milgram on COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications

The DEA announces that it will temporarily extend COVID-era emergency telehealth flexibilities, giving telemedicine prescribers of controlled substances the continued ability to prescribe certain medications after an initial virtual visit.

Centene to divest AI platform Apixio

Centene will sell its AI-powered, value-based platform vendor Apixio, which it acquired in December 2020, to New Mountain Capital.

Murfreesboro Medical Clinic & SurgiCenter Faces Critical Infrastructure Attack 

Murfreesboro Medical Clinic & SurgiCenter in Tennessee remains closed as it works to bring systems back online after an April 22 cyberattack.

Healthcare AI News 5/3/23

News

image

Cloud content management vendor Box launches a ChatGPT-powered tool that allows users to find information in their own stored content and to create content from existing information.

Shares in Chegg, which offers a student learning platform that includes homework answers and tutoring, drop 50% as the company warns that its growth has slowed as students instead to turn to ChatGPT.

Boston Children’s Hospital lists a job opening for an AI prompt engineer for its innovation accelerator.

A Washington Post article says that ChatGPT can help people develop custom meal plans for conditions such as polycystic ovary syndrome, but notes that it cannot take health history into account, can’t see new developments that occurred since its fall 2021 data cutoff, and can provide incorrect information or misunderstand the user’s requests.

Centene will sell its AI-powered value-based platform vendor Apixio, which it acquired in December 2020, to New Mountain Capital.

A law firm notes the legal challenges that are arising from the use of generative AI:

  • Is a license required to train a model on copyrighted material?
  • Is a copyright infringed when AI generates images, music, or other output that is similar to the works it was trained on?
  • Is the Digital Millennium Copyright Act violated when AI is trained on images that contain copyright watermarks that are not replicated into newly created images?
  • Is an artist’s right of publicity violated by generating works by AI that was trained on their style?
  • If AI generates a new image after being trained on an image that contains a trademark watermark, does that confuse the market or cause damage to the copyright holder when the image is of poor quality or taste?
  • How do open source or creative commons licenses apply to material that is used for AI training?

Opinion

An AMA article notes that its House of Delegates uses the term “augmented intelligence” instead of “artificial intelligence”to emphasis its assistive role. AMA says it is working with FDA to regulate AI tools for safety, clinical validation, and lack of bias. AMA’s president-elect says that doctors should ask four questions before using AI tools in their practice: (a) is its efficacy backed by clinical evidence; (b) will doctors be paid for using it; (c) who is accountable in the event of a data breach; and (d) will it improve outcomes, efficiency, or value in the doctor’s own practice.

Medical resident Teva Brender, MD identifies time-sapping tasks that could at some point be performed by ChatGPT in a JAMA Internal Medicine opinion piece:

  • Prepare discharge instructions that review the hospital stay, medication changes, and scheduled appointments in patient-friendly language.
  • Draft a patient message that explains that their lab test indicates diabetes that will be discussed at their next visit.
  • Write a HIPAA-compliant letter for a patient’s necessary time off from work.
  • Fill out prior authorization forms using information extracted from the EHR.
  • Prepare patient documents in languages other than English, or adding definition links to jargon-laden EHR documents.
  • Turning a patient’s history into a narrative.
  • Checking EHR data to update a problem list.
  • Gather information for medication reconciliation.
  • On the negative side, he notes that AI might overpromise and underdeliver on addressing burnout similarly to the use of scribes; “note bloat” could worsen if AI-generated text behaves like copy-and-paste; and that AI could perpetuate health disparities and invite medicolegal risk.

image

In China, a woman beats a hospital robot “receptionist” in its lobby, with observers noting that patients are frustrated by the replacement of nurses with technology.


Resources and Tools

  • The Superhuman newsletter offers hiring-related prompts for ChatGPT, such as, “I am interviewing candidates for the role of [insert role]. Create an interview with 3 rounds that test for the following traits: culture fit, growth mindset, learning ability, and adaptability. Also create one technical assignment to test their technical ability.“

Contacts

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

HIStalk Interviews Patrice Wolfe, CEO, AGS Health

May 3, 2023 Interviews No Comments

Patrice Wolfe, MBA is CEO of AGS Health of Washington, DC.

image

Tell me about yourself and the company.

I am a industry veteran. I’ve been in the healthcare space, particularly the healthcare technology space, for over 35 years, and have worked both on the provider and the payer side. I think I’ve seen every possible permutation of the challenges that we face in this industry in one form or another. I’ve been with AGS for almost four years. I’m so grateful to be in the revenue cycle space because we are at the core of the challenges that health systems are facing. 

AGS is a global provider of revenue cycle products and services, mostly to large health systems, but also we work with a lot of big physician practices and other players in the market.

What is the financial situation of health systems?

It is dire for a lot of health systems. A few dynamics have converged simultaneously. The rise in inflation impacts the cost of goods that hospitals and providers use and the wages they pay. Inflation is impacting margins across the board. Then you add to that the dynamics around clinical staffing and administrative staffing, where we’ve seen huge turnover across the health system space. They are left with fewer people to do the jobs that need to be done. Then when they try to fill these positions, particularly the clinical ones, they can’t find people, so they are using temp staff at triple the cost. You have huge cost pressures from that. 

On top of that, there’s the drop in investment income that some health systems have seen based on the markets. 

The news came out last week that the federal government will be rescinding a lot of the additional Medicaid coverage and other types of protections that were put in place during COVID, so a lot of health systems will be left with even more indigent care. 

The financial pressures are coming from every single angle for providers. We hear it from our customers. We see the anxiety that they have around, how am I going to cut costs? How am I going to increase revenue given all of these headwinds that I’m facing?

How will technology such as robotic process automation, natural language processing, and generative AI contribute to revenue cycle management?

Some of them are a little more near term than others. RPA has probably been around the longest. There are a lot of good use cases for using automation. I see across our customer base plenty of use cases where they’ve brought in automation to do some rote manual activities. We do quite a bit of RPA to drive out some of the  low-value tasks that you don’t need a human to do, so that the humans can focus on the more complex work. The low-hanging fruit has already been plucked in many cases, but there is an endless supply of additional use cases. It’s dependent on the health system’s ability to harness the data from their EHR and other types of systems and have the ability to attach the RPA to whatever the process is that they are focusing on. It’s a lot harder in practice than it sounds when you are planning it out.

There are some fantastic use cases in the HIM or coding area with the greater sophistication that is available in machine learning and natural language processing. You can see 10, 20, even 30% improvement in coding efficiency. With that comes increased revenue, because if you are getting your coding correct, that can then drive more accurate representation of things like case mix index, which then drive higher revenue. 

These types of tools are still in earlier stages of maturity. But with what we are doing in computer-assisted coding, we have some clear examples where customers are generating additional revenue from implementing these types of tools.

A lot of it comes back to data. You have to be able to extract from your EHR all the right information to take advantage of these tools. That is a critical success factor.

We have been playing around with not just ChatGPT, but some of the other OpenAI tools. We’ve implemented a couple of use cases for our internal use. Voice to text is important in the work that we do because we are often calling payers on behalf of our customers. Sometimes we’re on hold for 40 minutes or an hour, and the conversations that are taking place to follow up on claims can be lengthy and complicated. We’ve been able to use some of the OpenAI tools to turn those lengthy voice discussions into text so that we can do better quality assurance on our own folks as they are in these calls. We’ve implemented a few other use cases. There’s a lot of promise here, but I roll my eyes a little bit at some of the statements that are being made about how it’s going to revolutionize healthcare in the near term. I think it’s more of a long-term play.

Assuming that all the important chart information is in digital form, wouldn’t generative AI be ideal for coding and abstracting, perhaps replacing humans in the same way that speech recognition has done? 

Given how long I’ve been in this industry, I have a hard time saying that I think things will be completely eliminated. I can’t believe that we are still using humans to post payments, which should have gone away 15 years ago. 

The promise is there that these tools will be able to take over a good chunk of that work. But we have seen too often that a human is required to do some of the more nuanced review. It may be that AI can eventually code a chart, but the human is most likely going to need to continue to do some of that auditing. There’s a lot of hype around things like autonomous coding in certain discrete specialties like radiology, where the clinical nomenclature is  limited. But at this point, only a subset of those charts are able to make it through the autonomous process. You have to have humans on the back end to take what falls out and to do that auditing. We have the promise to be able to automate far more of this work than we have to date, but as a grizzled industry veteran, I don’t think we will get to that 100% automation level.

Everybody is unhappy with the prior authorization process. Can it be automated or eliminated?

That is probably the single most expensive activity that takes place in the revenue cycle. I’ve seen estimates of $80 for each prior authorization if you add the cost of the payer and provider to adjudicate. That’s a huge pain point, and there will be a lot going on in the industry to address this. My understanding is that Epic has been working on this for a couple of years now and has some payer partners that they are doing some development work with. The EHR is part of the solution, but I don’t think it is going to be able to completely solve that problem. 

Without a doubt, some of these front-end activities are  getting more complex. We hear from our customers that the barrier to prior authorization has only gotten worse since the pandemic. Some of that may be a reflection of staffing and other problems on the payer side. They are having the same kinds of issues providers are with the great resignation and other types of administrative challenges. We are seeing the prior auth space get worse, so any kind of automation that can be done in this area is of enormous importance to providers and to payers. 

It’s a huge pain point to physicians. We are doing patient access work, including prior auth, with one of our customers. Their physicians are unhappy when they get involved in these peer-to-peer conversations with payers, or when they have to re-review the documentation that was submitted. We are doing a lot to try to minimize how much the physician actually has to get involved in these types of interactions, because it takes them away from their core mission, which is to care for patients.

It’s probably not the best example of healthcare consumerism, but how is patient payment processing developing?

This is an area where every single person has a personal opinion. Earlier in my career, when I was running a patient payments business, any time I talked to anyone, they had a story about trying to pay for something or trying to understand what they were supposed to pay for. This is a visceral topic for a lot of people. 

There has been a lot of progress made, particularly around the patient front door type of growth. I see progress in patient registration and all the things that we try to push to the front of the revenue cycle that can and should get done before the patient shows up. Some of the mobile-based and text-based tools that are out there are pretty good. As always, getting them correctly integrated with the EHR is often a problem for these providers.

So many people are comfortable with mobile-based payment activity that it makes me happy when I go to a doctor’s office personally and have to do a mobile-based registration process. There has been good progress made in this area, and while I don’t think we are done yet, we want to meet people where they want to be, and most people want to do mobile-based banking and other kinds of financial activity. I feel fairly hopeful about that.

How have operational and market conditions influenced the appetite for innovation in health systems?

That’s such an important question. In the course of my conversations with our customers, I see two camps. One is that I see the organizations that are using this as an opportunity to double down on innovation, but I would say innovation with clear ROI expectations. What we are trying to do a better job of at AGS is quantifying the revenue impact we are having for our customers. Our space historically has patted itself on the back in terms of its ability to reduce customer expenses, which is a great thing, but that’s not enough right now. In this environment, it’s about how you will positively impact a health system’s revenue. Organizations that are  a little more risk-taking and forward thinking are willing to double down on innovation, but they want to see those metrics, which is completely reasonable.

On the other end of the spectrum, we are seeing health systems that are sitting around the boardroom, with the CEO and CFO saying, “I need $5 million in expense reduction out of you, I need $10 million out of you, and $2 million out of you. I don’t care how you do it, just go out and do it.” In those organizations, we are seeing more things that are retrenchment, such as cutting IT spend or vendor use. That’s a challenging situation, because they will regret some of those cuts two years from now. I completely understand the pressure they are under, but there are wise ways to make those cuts and maybe not so wise ways to make those cuts. It’s a challenging position for a lot of these health system executives.

What is the company’s strategy over the next few years?

A few things really matter to us. Our mission is to drive great financial health of our customer organizations. A few things are top of mind. There is a continued need to bring technology to bear in what has often been an inefficient and human-intensive process. As technology matures, whether that is AI or other types of technology, we want to be there thoughtfully using it on behalf of our customers.

The other thing is that we we are fairly acute care focused. We work with a lot of large specialty physician practices, but mostly large health systems. Many of these health systems don’t just do hospital-based care for their patients. They offer ancillary service lines such as home care, skilled nursing, ambulatory surgery centers, et cetera. We have to continue to think about and define the revenue cycle more holistically on behalf of these organizations, because there are opportunities for them to gain efficiencies and drive more revenue out of some of these other parts of their organizations. Those other parts might use different EHRs. They might be managed completely outside of the standard revenue cycle. There could be some good efficiency gains in some of these other areas over the next few years, particularly as we continue to see consolidation in the market.

Morning Headlines 5/3/23

May 2, 2023 Headlines No Comments

Apple vs. Masimo court battle ends in mistrial; jury 6-1 in favor of Apple

The trade secrets lawsuit that medical technology vendor Masimo brought against Apple ends in a mistrial, with Masimo reportedly planning to file for a retrial.

Cue Health Implements Cost Reduction Plan, Lays off 326 Employees

App-enabled at-home and point-of-care testing company Cue Health will lay off 326 employees beginning next month as part of a new cost-reduction plan.

Medical College of Georgia expanding its reach to more rural areas

The Medical College of Georgia’s Center for Telehealth will use $1 million in new funding to offer its services and training to more rural hospitals throughout the state.

News 5/3/23

May 2, 2023 News No Comments

Top News

image

The trade secrets lawsuit that medical technology vendor Masimo brought against Apple ends in a mistrial.

Masimo claims that Apple had expressed interest in working with the company on pulse oximeter technology, then instead started poaching Masimo’s employees, including its chief medical officer, to develop competing technology.

Apple later sued Masimo, accusing the company of copying the design of the Apple Watch.

Masimo says that even though six of the seven jurors believe that Apple did not steal its trade secrets, it will file for a retrial.

The US International Trade Commission will rule later this month on Masimo’s demand that Apple Watch imports be banned because they infringe on its patents.


HIStalk Announcements and Requests

image

The JAMA Internal Medicine article that found that reviewers preferred the answers of ChatGPT over those of clinicians in response to patient questions has been widely reported, leading me to offer these points about the methodology:

  • The 195 randomly chosen questions and the clinician answers were extracted from a Reddit forum rather than real-life examples, due to HIPAA concerns.
  • The Subreddit moderators are responsible for verifying the credentials of participants who claim to be healthcare professionals.
  • The longer answers generated by ChatGPT likely provided the illusion of empathy.
  • The authors had no way to determine if the publicly posted messages are similar to real-life patient questions. Most of the example questions that they posted are of the “do I need to see a doctor” variety.
  • The publicly responding physicians did not know the patients they responded to, did not have their medical history, and haven’t treated them. They were voluntarily responding on their own time as strangers, among responses by multiple users, and thus had no incentive to spend more time on message quality and empathy.
  • The reviewers used measures of empathy and quality that had not been tested or validated. They did not assess ChatGPT’s responses for accuracy. The “which response is better” evaluation is subjective.
  • Some of the lower-scoring physician answers from examples provided were more logistical than clinical and were thus less likely to exhibit or require empathy (you are considering an ED visit but that wouldn’t accomplish much, you’ll be fine without intervention, you should contact your PCP or urgent care).
  • Actual patients did not review the responses, obviously including the person who actually asked the question.
  • The five reviewers, all of whom were co-authors, included one nurse practitioner and four MDs who primarily work in research and/or informatics. Three of the five reviewed each response.
  • The influence of perceived message quality or empathy on eventual patient outcomes or satisfaction is not known.

Webinars

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


Acquisitions, Funding, Business, and Stock

CVS Health closes its all-cash, $10.6 billion acquisition of Medicare primary care chain Oak Street Health.

Clubhouse, the live chat social media platform that was wildly popular for about 15 minutes during the pandemic’s early days when people first got bored sitting at home and were still fawning over every word spoken by technology executives in a soaring stock market, lays off half its employees as people tire of the novelty of listening to real-time audio conversations. I could never understand the appeal, so I was not on the waitlist of 10 million people. 


Sales

  • Good Samaritan Hospital (CA) will implement Nest Collaborative’s virtual breastfeeding support services.
  • Virginia Hospital Center will use Unite Us care coordination and social services referral capabilities via the Unite Virginia network.

People

image

Kyruus names Peter Boumenot (B.well) as chief product officer.

image

Das Health promotes Michelle Jaeger to president and CEO.

image

Retired US Navy commander William Walders, MHA (Health First) joins BayCare (FL) as CIO.

image

Brad Wensel, MBA (AWS) joins Iodine Software as chief customer officer.

image

Brian Parrish (Craneware) joins CVS Health’s ActiveHealth and Health Data & Management Solutions as chief marketing officer.

image

Tenet Healthcare promotes Christopher Waldren, RN, MHA to VP of information technology.

image

Jason Aranda, RN, MBA joins Providence as VP of clinical IT solution delivery, south division.

image

Blue Shield of California promotes Krishna Ramachandran, MS, MBA to SVP of health transformation and provider adoption. He spent several years in technical roles at Epic through 2010 and was chief information and transformation officer at Duly Health and Care for three years.


Announcements and Implementations

image

St. Joseph’s Health (NJ) rolls out clinical communications software from CareMesh, including Connect messaging and Search provider directory services.

Litchfield Hills Orthopedic Associates (CT) implements EClinicalWorks across its surgery center and offices.


Government and Politics

NPR’s “All Things Considered” runs a story on the VA’s struggles to implement Oracle Cerner, interviewing veterans who were negatively impacted by the rollout. It concludes that “many in Congress are suggesting the VA should walk away,” although it does not quantify the number, whose those members are, or what they propose as an alternative. It gives a good bit of airtime to Ed Meagher, a former VA IT executive (he left 17 years ago and has been a contractor consultant for most of the time since), who says that patients at the five VA sites that are live on Oracle Cerner are “guinea pigs” and advocates updating the VA’s 45-year-old VistA system.


Privacy and Security

Ottawa’s Queensway Carleton Hospital notifies 100,000 patients that their data was exposed when a test server of Aetonix Systems, the hospital’s cloud-based communication platform vendor, was breached.


Sponsor Updates

image

  • Ascom Americas Senior Product Quality Technician Ronald Bullock rappels down 17 floors of the 21C Museum Hotel in Durham, NC as part of a fundraiser to support Duke Children’s Hospital.
  • Agfa HealthCare earns Frost & Sullivan’s 2023 Customer Value Leadership Award for its customer-first approach and innovative leadership.
  • Baker Tilly releases a new Healthy Outcomes Podcast, “The senior housing and care sector – challenges and opportunities.”
  • WellSky adds new predictive analytics capabilities to its CarePort Connect solution to help providers reduce SNF readmissions and optimize end-of-life care transitions.
  • Essentia Health launches a medical financial assistance enrollment program using CenterX’s EHR-integrated system.
  • Consensus Cloud Solutions joins the AWS ISV Accelerate Program.
  • Nordic releases a new episode of its In Network podcast, “Making Rounds: Leveraging analytics to create efficiencies.”
  • Divurgent releases a new episode of it’s The Vurge Podcast, “Translating Business Needs Into Software Solutions, featuring Simple Interact founder and CEO Ravi Kalidindi.
  • EClinicalWorks releases a new podcast episode, “Enhanced Telehealth Experience with Healow Solutions.”
  • Surescripts publishes a new data brief, “How Are Care Teams Evolving to Fill Primary Care Gaps?”

Blog Posts


Contacts

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

Morning Headlines 5/2/23

May 1, 2023 Headlines No Comments

VMG Health Acquires BSM Consulting, a Healthcare Consulting Firm

Healthcare strategy and advisory firm VMG Health acquires BSM Consulting, which offers practice management consulting and compliance services to ambulatory surgery centers and ophthalmology and medical aesthetic practices.

Morgan Health Announces $25 Million Investment in Kindbody, Expanding Access to Fertility and Family-Building Care

Tech-enabled fertility care provider Kindbody raises $25 million in a funding round led by Morgan Health, bringing its total raised to $306 million.

Medical Consulting Group and Corcoran Consulting Group Announce Merger

Ophthalmology-focused Medical Consulting Group acquires Corcoran Consulting Group, which specializes in revenue cycle services for eye care professionals.

Curbside Consult with Dr. Jayne 5/1/23

May 1, 2023 Dr. Jayne 4 Comments

Over the last couple of years, I’ve been trying to learn more about marketing. It’s a critical part of what we do, whether it’s trying to promote a company, advertise a hospital, or convince patients to adopt healthier behaviors or take advantage of cancer screening tests.

When I was training to become a physician, I thought that it would be about learning all the science and figuring out how to apply that to examining patients and identifying a diagnosis and treatment. Over time, I learned that identifying the diagnosis and making a treatment plan was only half the battle. Convincing the patient to get on board with the proposed plan was a tremendous lift. I learned more about persuasive speech and sales techniques than I ever expected to know, except I was using them to try to convince patients that taking a cheap generic medication to treat their conditions would actually be a better option than the flashy drugs that they had seen advertised on television.

Working for a large health system, I also learned a lot about the ways that organizations market themselves. Sometimes this was productive, trying to increase community awareness about available services. For example, when we launched a mobile diabetes screening unit, there were multiple marketing campaigns to drive awareness and create buzz about the importance of diagnosing diabetes early. Things became more challenging when those patients were actually diagnosed but ran into insurance issues or inability to get the care they needed. I wish that the campaign to launch the mobile unit had included training for primary care offices on how to best handle the influx of patients we were seeing, especially in a startup office like mine.

I also saw plenty of counterproductive marketing efforts, such as when two hospitals that were part of the same health system launched competing orthopedic surgery marketing campaigns, both aimed at the same patient population in the geographic area where I also lived. It seemed like every time I opened the mailbox, I had a competing flyer from one of the programs. Since the flyers had the health system branding as well as the individual hospitals’ branding, I’m sure it was confusing for patients. As a physician who was on staff at both hospitals, it created plenty of confusing conversations with patients and without the requisite talking points that would  have been good for staff physicians to have at their fingertips.

This article about Mercy’s personalized healthcare marketing strategy caught my eye. I originally thought I was going to learn something about how precision marketing can help patients, but unfortunately, the first quote in the story left me somewhat baffled. The health system’s chief marketing office, Kristina Dover, stated, “One of the examples I really like to use is that a 55-year-old male OB-GYN should never see our mother-baby advertising if we’re doing our job right.” Actually, I think the midlife, male OB-GYN is exactly who should understand the health system’s mother-baby marketing strategy, because it’s his patient base that is the target of that advertising. Who better to understand a hospital’s advertising tactics than those who are expected to deliver on its promises? Expectation mismatch is a key factor contributing to patient dissatisfaction so that the care delivery team is well-served by understanding those expectations.

Other comments that Ms. Dover made were confusing. She mentioned trying to balance supply and demand through personalized advertisement, by pointing patients to service lines with openings at the time. She is quoted as saying, “We are honestly having conversations every day to say, ‘We have the access for inpatient primary care visits today, let’s increase our marketing or let’s dial back a little bit,’” which makes no sense. I wonder if she can even define what an “inpatient primary care visit” is or whether she understands that you can’t just go out trolling for inpatients as a way to increase your census. As a former emergency department physician, there were plenty of patients that I would like to have been able to admit, but factors like insurance, acuity requirements, and more were always standing in the way. How wonderful that a marketing team has found a way around all of that.

Of course, I’m being facetious, and for Ms. Dover’s sake, I’m hoping this was some kind of misquote or misunderstanding on the part of the reporter. Helping patients understand their healthcare choices is complex, and I struggle to understand how it can be reduced to an Amazon-like shopping experience regardless, given all the drivers such as insurance coverage, acuity, provider experience, accreditations, and more. It’s not exactly a retail commodity, and trying to reduce it to that level might not be the best thing for solidifying a medical home or providing continuity of care that drives outcomes. It’s been a decade since the two marketing examples I discussed at the beginning of this piece happened, but it seems like there is still plenty of dysfunctional marketing out there.

I’d like to get a better understanding of how health systems might take a more informed approach to marketing. Do they consider the opinions of patients, caregivers, providers, and employees as they create their campaigns, or are they created in corporate lock-ins or Madison Avenue-style conference rooms? Do health systems consider previewing their campaigns to their internal constituents so they are prepared for any patient questions, and if so, do they ever make changes based on feedback they receive? Maybe I’ve just been in health systems that didn’t give us a sneak peek, but I’m eager to learn what’s going on in the greater healthcare marketing universe.

I’d also like to learn other opinions on personalized marketing strategies. Are other organizations using different tactics than what the article described is happening at Mercy? Have you found that new strategies have made a difference in how patients and potential patients receive marketing messages? What do you think about hospitals moving towards consumer-focused marketing as a way to drive volumes? Are we all eventually going to be a commodity? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Christine Swisher, PhD, Chief Scientific Officer, Project Ronin

May 1, 2023 Interviews No Comments

Christine Swisher, PhD is chief scientific officer of Project Ronin of San Mateo, CA.

image

Tell me about yourself and the company.

My background is in healthcare, mostly in oncology, but also in building predictive models and AI as software and as a medical device. I’ve worked at Philips Healthcare, which is in the Fortune 500, as well as several startups. I’ve led from idea to FDA clearance and expansion in the US and in Europe.

I am passionate about responsible AI and what that means, to deliver AI that is impactful in healthcare and that improves the lives of patients at scale.

At Ronin, we are fortunate to have a wonderful network and partners such that we are set up to achieve our mission of improving the life of cancer patients at scale and impacting all four of the Quadruple Aim verticals. We build technology such that an oncologist and the clinical care team that cares for cancer patients can see at a glance, and understand, their patient’s journey. We look through all of the structured data, clinical notes, and documents and bring that forward, so there isn’t that 30 minutes of clicking to prepare for a visit, but help them understand their patient at a glance. We also bring in the patient’s voice to understand what’s happening to the patient outside of the hospital and render that in their clinical workflow.

We have a mobile application that engages patients, not just for having a better understanding of the patient, but to empower clinicians with predictive information so they can take actions earlier and prevent adverse events and avoidable hospitalizations or emergency department visits and also better manage symptoms so that patients can stay on treatment longer.

What is the extent of genetics and genomics data that can be used to make clinical decisions?

A lot of that is about contextualizing that information. There’s a big jump from what scientists have discovered and where we are in this, especially in the genetics field. How do we deliver that to have meaningful outcomes in clinical care? How can we contextualize that information alongside their patient record of what’s happening, their entire patient record such as comorbidities, social determinants of health, and patient-reported outcomes? What’s happening to them at home? How can we bring all that together to have a total patient understanding, including their patient preferences?

With that total patient understanding, we can make the best choice for that particular patient. It’s a critical piece of information, especially things like EGFR mutations that are so impactful for treatment decisions that they can be lifesaving. We need to bring them into care decision making.

ChatGPT feels like an overnight success, but probably isn’t to experts in the field like yourself. How will your work be changed by its capabilities and popularity?

It definitely impacts the work that we do it. In fact, I think it enables the next level of technology if we are thoughtful in how we deliver that.

It didn’t happen overnight from my perspective. In 2012, we witnessed a similar event in AI, where there was a technological breakthrough with convolutional neural networks, rectified linear units, and dropout that allowed us to have computer vision perform as well as humans for general domain tasks in classification. That particular event sparked the deep learning revolution.

From 2012 to 2020, there were about 100 FDA-cleared applications, 88 of which were computer vision or in the radiology space. That happened quickly and the characteristics of these winners that were able to deliver on deep learning at that time. Radiologists, pathologists, and recipients of this technology were skeptical, just as skeptical as they are now.

It’s slightly higher publicity now because so many people are using things like ChatGPT in their work. But it’s a lot of mirroring to what happened in the 2010s, when the AI winners in healthcare did three things. One, they prioritized interpretability and risk mitigation. Two, they focused on super-powering the clinicians versus trying to compete with them, and companies that said they were going to replace a clinician were not successful. Third is that they delivered a complete solution, and those solutions fit seamlessly into the clinical workflow. They delivered on the CDS five rights, which means that it was the right information, the right person, the right format, the right channel, and at the right time. That’s the key to success.

None of those things have really changed about healthcare in the past 10 years. There was a technological breakthrough with the transformer architecture in 2017, and then a new generalizable method, which was GPT- based models. We had a new generation of applications like ChatGPT, Stable Diffusion, Dall-E, and all of these generative AI technologies. It’s very much like what we saw in 2012.

If we can take those learnings about what success looks like, and bring those into how we think about this new innovation or new class of AI-powered applications, we’re going to be a lot more successful. I am really excited about generative AI, but I think that it has to be delivered the right way.

We heard way too much back then about big data, which is rarely mentioned using that name today. Will AI and ML help deliver that promise?

We’ve been doing things that are interesting. AI has helped identify sepsis patients earlier and to identify ischemic strokes so that patients can be treated within the golden hour. It’s been able to better detect breast cancer, lung cancer, and prostate cancer earlier. It’s already impacting people’s lives. That was with big data. It’s already living up to, maybe not at the scale that was predicted, but it is actually improving people’s lives at scale.

Now what we are seeing with this new class is new ways that we can better improve people’s lives. Generative AI can help scientists and researchers better discover new drugs, new treatments, and new therapies for cancer and other diseases.

It’s going to enable a better understanding of the patient’s journey, just like what we are doing at Ronin, being able to dig through the 80% of the EMR that is unstructured data documents, clinical narratives, and notes and have a better understanding of patients at an individual level and at a population level. That means that we are going to be able to better predict things like mortality, progression, adverse events, toxicities from treatment, and acute care utilization like emergency department visits. Then by being able to predict them and see what caused them, we can better inform on actions. I’m really excited about the technology, as long as it’s delivered safely and ethically.

The new book “Redefining the Boundaries of Medicine” notes that medicine is based around huge population studies that may lead to the wrong conclusions when a specific intervention doesn’t appear to be effective collectively, but works on subgroups of patients who share particular circumstances or comorbidities. How would a data scientist look at that issue?

This is very core to our Ronin mission, to deliver care decisions that are personalized to that particular patient versus based on population averages. So many decisions in oncology are based on population averages. By bringing data of what happened to patients like them — what happened in terms of their progression, their quality of life, the toxicities that they experienced — we can look at the patient in a comprehensive way, thinking about their demographics, social determinants of health, their cancer and treatment specific risk factors, their comorbidities, symptoms, active problems, and biomarkers as well.

If we bring that together to then say, what happened to patients like my patient, we can provide more personalized decisions. We can also empower the care team, oncologist, patient, and caregiver with data to make that decision.

Previous technologies were implemented as advisory rather than a closed loop system that would require FDA approval. How prepared is FDA to evaluate AI technologies and are the usual retrospective studies adequate to do so?

I have two answers for that. The first is that regulatory and best practice groups are moving quickly in response to the innovation and excitement around generative AI and AI in general. Three seminal documents were released just in the past few months. The White House delivered a blueprint for an AI bill of rights, NIST delivered their risk management framework, and the Coalition for Health AI delivered their “Blueprint for Trustworthy AI Implementation Guidance and Assurance for Healthcare.”

When you look at these three documents, five themes emerge across them. You need validated, safe, and effective systems. You need protections against bias. You need privacy and security. You need interpretability and explainability. Finally, you need transparency and human factors.

Whether or not it’s FDA-cleared 510 (k) software as a medical device, a CDSS, a CLIA-validated laboratory developed test, or AI for another application that doesn’t fit it under those regulatory guidance, it’s still important that it delivers on those five principles. In fact, those actually expand past healthcare.

Those are the things where we will see guidance from groups like CHAI on how we concretely deliver on those principles. The principles have been defined, and now these groups are working very quickly to define the next steps. I also think that infrastructure cloud vendors and AI tooling vendors will, at some point, start to provide certified tools to companies like Ronin and others to accelerate our ability to deliver AI safely. That’s a huge market opportunity.

AI in healthcare, particularly with our last AI revolution in the 2010s, was most successful when it was partnered with clinicians to make them super-powered clinicians. If you look at other domains, the same thing is true. AI did not replace as many jobs as people thought it would.

You could also look at things like when we went from animators hand drawing to CGI. CGI just expanded the scope of what they could deliver, how productive they could be, and allowed them to work at a higher level with the tedious tasks taken away. It’s the same thing of going from FORTRAN to C++ to Python and how we develop AI.

If we look at how those industries are impacted, there’s as guiding principle that AI empowers people and takes the tedious things off their plate so that they can operate at a higher level and deliver higher quality. That’s true in healthcare as well.

How will the availability of complete, representative, and unbiased training data affect the market for AI technologies?

Protections against bias is a key theme in those three seminal documents that I just talked about, and something that we need to do proactively and continuously. It’s not a one-time event where you look at your patient population, see how it performs in subgroups, and then write it up in a medical journal.

It has to be part of your system, where you are continuously monitoring for bias. Then when you detect a bias incident, you need to have the systems in place to rapidly mitigate that issue. One of solutions is representative data, but we need a three-pronged approach, where the first prong is like the brakes in your car, the second prong is the seatbelt, and the last one is the airbag.

The first prong, our brake, is about preventing any foreseeable bias. So that when you are developing the model, you have representation of the populations that you intend to serve. You have subject matter experts that understand that there isn’t bias built into the actual ground truth data or the data feeding into the model. That the way it is delivered from a user experience will not exacerbate currently existing biases in the system, so that there’s a lot of voice of the customer or human-centric design that has representation of the populations that we intend to serve. That’s the brake.

The seatbelt and the airbag are two pieces. The first is that you need to have proactive and continuous monitoring for bias across important subgroups. Things like social determinants of health. Do they have access to transportation? What about their insurance and demographic groups? We need a comprehensive understanding of the different ways that we could introduce bias that causes harm to different types of groups, then detecting that and being able to diagnose any problem quickly before it causes patient harm.

Then knowing that you have a problem, the next step is to fix the problem, so having the systems in place so you can rapidly retrain a model and you have the technology or ability to mitigate bias quickly. The machine learning operations, MLOps needs both infrastructure and practice to mitigate that and then deliver that fix quickly before there’s patient harm. In addition, there are human factors in how it’s delivered so that you can mitigate risk as well.

IBM Watson Health failed at trying to do years ago what people think is possible now. What has changed?

For those that will be successful, what’s different now is the user experience and real-world validation of the technology. What is the AUC, area under the curve, of a model? All these abstract metrics that AI practitioners tend to focus on … instead of focusing on those, focus on the meaningful measures. Does the AI plus the human better prevent acute unplanned care? Does it keep patients on treatment longer with their symptoms better managed? Does it increase progression-free survival? Going back to what a meaningful measure is and evaluating the performance of your models against that, versus abstract measures, is one of those key pieces.

The other one is thoughtful, human-centric design. With those pieces together, that’s where you have meaningful impact. Companies compete too much on model AUC, accuracy, or F1 score. A 5% difference sounds good on paper, but it’s the execution of that. When you delivered in clinical workload, did you live up the CDS five rights? If that’s true, you’re going to have a bigger impact. Focusing on the meaningful measures versus the abstract measures is key.

Is there a tension between the absolutes of data science versus the frontline practice of medicine that incorporates variables that are personal, local, or perceptual?

Especially for CDSs that rely on predictive models, machine learning, or statistical methods, it’s crucially important. It is written in the FDA’s guidance that you need to share the basis of the prediction and the relevancy of the training of the development data. Both of those things need to be shared.

At Ronin, we show that in a way that is accessible to the clinician. You don’t have to have statistical knowledge or machine learning knowledge to understand that. It’s right there at the point of making the decision, the relevance of the patients that are similar that are giving this insight for this particular patient. The basis of that prediction is right there during clinical decision versus buried in a user manual or peer-reviewed publication that might be behind a paywall.

For things like generative AI and language models, we still need to innovate and develop the methods for transparency in sharing the basis of our prediction. When we look back to things like convolutional neural networks, there was innovation on how we do that. Things like saliency maps were invented and the methodology to do that. Semantic segmentation was another innovation that allowed us to provide that type of insight.

We probably will have to invent some new methods, and I’m excited and hope that we continue excited about what that will be. We would like to be a part of that, and I am hopeful that our research community will gather around this challenge.

Will we see a trough of disillusionment with generative AI?

There will probably be a realization of the challenges, limitations, and areas of success. We’re going to learn that. We’re still learning about what this technology can do. How do we really understand what’s going on underneath the hood? How do we get it to explain the basis of its predictions?

People who are skeptical now — especially if they start to use it to help with writing, as a second reader, or to write code – may start to see a lot of value in it. On the other hand, we’re going to learn about its limitations. I think we might see the more skeptical folks being more embracing, and the ones that are less skeptical becoming more skeptical, as we learn more about the limitations.

What will the next few years bring to Ronin?

We are realizing that personalized, data-driven, total patient understanding in care decisions for cancer patients empowers clinicians. We can use AI, machine learning, and data science informatics for that and to bring the patient patient’s voice into it as well, where they can say what’s happening to them outside the home and their preferences can be brought in to care decision-making, even in the data that is driving those care decisions. There’s a huge opportunity to deliver on that vision, and we are already doing it.

Morning Headlines 5/1/23

April 30, 2023 Headlines No Comments

Comparing Physician and Artificial Intelligence Chatbot Responses to Patient Questions Posted to a Public Social Media Forum

Researchers find that licensed healthcare professionals preferred ChatGPT 3.5’s responses to patient questions over those that were written by doctors 80% of the time, judging the computer responses to be more empathetic.

VA’s health record ‘reset’ has budget fallout

VA Secretary Denis McDonough tells a Senate Appropriations Subcommittee that the agency will need to tweak its $1.86 billion EHR Modernization program budget request by $400 million due to its suspension of new implementations.

CUSP Citizen Petition to Protect Patients

The Center for US Policy petitions FDA to declare Bamboo Health’s NarxCare software a misbranded medical device that should be recalled, claiming that its opioid risk score for patients is being used inappropriately to prevent pain patients from obtaining appropriate opioids.

Monday Morning Update 5/1/23

April 30, 2023 News 2 Comments

Top News

image

Researchers find that licensed healthcare professionals preferred ChatGPT 3.5’s responses to patient questions over those that were written by doctors 80% of the time, judging the computer responses to be more empathetic.

A study limitation is that the patient question and the physician response came from public Reddit postings rather than from actual patient interactions.

However, I would also note that the Reddit responses presumably came from doctors who had sufficient time and empathy to respond without personal benefit in the first place, which makes me think real-life responses would exhibit significantly less empathy and thoughtful thoroughness in giving ChatGPT an even wider lead.


Reader Comments

From Zingaro: “Re: collaborative software groups. Have you heard of examples where Meditech Magic standalone clients joined a regional Cerner collaborative?” I’ll invite readers to chime in, and if you are willing to share your experience, provide your contact information offline and I’ll forward to Zingaro.

From Joint Pain: “Re: HIMSS23. Thanks for giving a shout-out to our company as one of the small-boothed folks who nonetheless worked hard at the conference.” I know how it feels to stand in near isolation in a 10×10 booth that is off the beaten track in the exhibit hall’s nether regions, not inexpensively, I might add. I’ll also make this offer – if your company exhibited at HIMSS23 in a booth that was 10×20 or smaller, I’ll give you a first-year HIStalk sponsorship discount that will cover 365 days instead of your three on the show floor. Contact Lorre since I’m just blurting this out without thinking in assuming that she will figure out details.


HIStalk Announcements and Requests

image

Poll respondents who attended HIMSS23 gave it decent scores. Some offered constructive criticism to beef up the health equity track, improve food and beverage options, and book more inspiring keynote speakers. I think that other than the carpet gaffe, they did a good job.

New poll to your right or here: Which HIMSS23-related recordings have you consumed for at least two hours? I’m asking as someone who has spent zero minutes and is questioning whether that makes me an outlier, given that it seemed like half the people at the conference were chasing the other half with cameras or microphones. I just don’t have the attention span to watch or hear self-indulgent interviewers and interviewees saying nothing useful when five seconds of skimming a transcription (had they made one) would have sent me fleeing. I will check out the official session recordings when they come out, although my attention span wanders there, too.


Webinars

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


Acquisitions, Funding, Business, and Stock

image

Teladoc Health reports Q1 results: revenue up 11%, EPS –$0.37 versus –$0.47, beating analyst expectations for both. TDOC shares have lost 21% of their value in the past 12 months versus the Dow’s 3% gain, valuing the company at $4.3 billion.


Sales

  • Parkview Health chooses Sectra’s imaging cloud subscription service.
  • North Carolina HHS contracts with Optum for provider enrollment, credentialing, and data management.
  • Horizons Mental Health Center will implement Netsmart’s CareFabric platform, including the MyAvatar behavioral health EHR, as it transitions to a Certified Community Behavioral Health Clinic.

People

image

Kaiser Permanente promotes Nari Gopala, MBA to chief digital officer for its health plan and hospitals.

image

Genevieve Morris, MA, formerly of UnitedHealth-acquired Change Healthcare, joins UnitedHealth Group-owned Optum as VP of interoperability strategy, medical network.

image

Rahul Goyal, MD (Malaffi) joins Elsevier as chief medical officer.

Brian Parrish (Craneware) joins CVS-owned ActiveHealth and HDMS as chief marketing officer.


Announcements and Implementations

Artera launches self-service analytics for creating patient engagement data dashboards.

Centre for Neuro Skills goes live on Meditech Expanse.

A Sphere study finds that two-thirds of providers believe that improving patient payment collections is a top priority, with interests in specific technologies such as text message payments, point-of-service kiosks, card on file processing, and incorporating check-in and payment into digital front doors.


Government and Politics

image

The Center for US Policy petitions FDA to declare Bamboo Health’s NarxCare software a misbranded medical device that should be recalled, claiming that its opioid risk score for patients – which is calculated from state prescription drug monitoring program data using what CUSP says is non-transparent methodology — is being used inappropriately to prevent pain patients from obtaining appropriate opioids.


Other

A New York Times opinion piece says that private equity is ruining the country by taking advantage of loose regulations to bankrupt acquired companies while making their own executives billionaires. A showcase example is Carlyle Group’s acquisition of nursing home chain ManorCare that was funded by piling debt onto to the chain – not to the private equity firm – then flipping its real estate to allow Carlyle to recover its investment while sticking the chain with paying high rents. Then came layoffs, cost-cutting, and poor resident care that ended up bankrupting the nursing home company, after which Carlyle avoided the resulting wrongful death lawsuits by claiming that it was an advisor, not an owner.


Sponsor Updates

  • Nym Health names Hallie Heffington (Summit Medical Billing Solutions) and Chermanda Jackson medical coding and compliance auditors, Omer Bar-Sela (Mobileye) implementation squad lead, Scott Rulkowski (Olive) customer success manager, and Niv Shashoua (HP) junior software engineer.
  • Nordic Consulting rebrands Bails & Associates, which it acquired in 2021, Nordic ERP Services.
  • Eleanor Health reduces its month-end closing time from 15 days to one day using a customized AI workflow solution from RCxRules.
  • Optimum Healthcare IT names Kevin Scahill Epic HIM analyst and Rachel Clemans ServiceNow engagement manager.
  • Methodist Le Bonheur Healthcare (TN) uses PerfectServe to streamline transfer center communications.
  • Specialty medication technology company RxLightning wins a Disruptor of the Year Mira Award.
  • SunStone Consulting will offer VisiQuate’s advanced revenue cycle analytics to its clients.
  • Pivot Point Consulting, a Vaco company, publishes its Q2 healthcare IT market report.
  • South-Eastern Norway Regional Health Authority expands its enterprise imaging contract with Sectra to include its digital pathology module.
  • Surescripts will apply to become a Qualified Health Information Network.
  • Upfront Healthcare’s latest psychographics study shows the pandemic’s impact on consumer health behaviors.
  • West Monroe celebrates its 21st anniversary.Wolters Kluwer Health will exhibit at AONL 2023 May 1-4 in Anaheim, CA.

Blog Posts


Contacts

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

Text Ads


RECENT COMMENTS

  1. Agreed, The VA is using CCDAs today for outbound communication and they started with C32s back in 2012. Looked at…

  2. Part of my attitude relates to an experience I had. And this was within a single HIS. I wanted to…

  3. For what it's worth, the VA currently releases C-CDA (or HITSP C-32...my memory fails me) via eHealth Exchange and has…

  4. Unfortunately, I can't disagree with anything you wrote. It is important that they get this right for so many reasons,…

  5. Going out on a limb here. Wouldn't Oracle's (apparent) interoperability strategy, have a better chance of success, than the VA's?…

Founding Sponsors


 

Platinum Sponsors


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gold Sponsors