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.

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Mr. H, Lorre, Jenn, Dr. Jayne.
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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.

Readers Write: The Importance of Accurate Benefits Data in Healthcare

The Importance of Accurate Benefits Data in Healthcare
By Gary Davis

Gary Davis is national practice leader for Noyo of San Francisco, CA.

In the world of healthcare IT, there is so much to talk about. Digital transformation, automation, and new tech in the US health system is paramount, holding the promise of improved patient experiences, better health outcomes, and reduced costs, not to mention alleviating burden and burnout among healthcare workers. This crucial topic in healthcare today runs the gambit, covering everything from super advanced tech like artificial intelligence and blockchain to wearables, remote patient monitoring, telehealth, and interoperability among EHRs and other data sources like HIEs and more. 

I am here to address a less-sexy but important healthcare data topic – accurate insurance benefits data.

About 46% of Americans have employee-sponsored insurance benefits. The top benefit in the mix is healthcare insurance. Insurance benefits are focal to all our lives. It’s how we maintain health and wellness through healthcare, dental, and vision coverage.

Right now, many people are in the thick of the open enrollment season, making selections and completing enrollment paperwork, with teams of benefits administrators, HR, brokers, and insurance carriers fast at work getting everything complete and ready for the coming new year of coverage.

When I say “paperwork,” I mean it literally. The insurance industry is ripe for a technology upgrade. In 2023, carriers continue to rely on paper, web portal entry, email, phone, and electronic data interchange (EDI) for data exchange to support important functions of enrollment and member changes. The last major tech advancement in the insurance industry was EDI, and that was back in the 1970s.

Why the slow pace? The status quo is often the sector’s biggest hurdle. Paper-based systems and manual data entry dominate industry workflows. Many leaders think that it works, but not really. Manual data entry is fraught with inaccuracies and data sits in silos and is inaccessible. The lagging tech makes it challenging for benefits software, insurance carriers, brokers, and employers to keep key employee information in sync and drive innovation.

Our insurance benefits are confusing and hard to use, which that often means that services and money are left on the table by many. Just 9% of employees understand benefits terms like co-insurance. Meanwhile, choosing the wrong health plan can be a $2,000 mistake.

A 2023 Harris Poll consumer survey of 2,000 employed adults with employer-sponsored insurance benefits revealed that nearly half the respondents cited frustration when using their insurance benefits because they are hard to understand. Meanwhile, two in five indicated they have received inaccurate bills, have been unable to access care, or that their family has been negatively impacted due to delays because of errors in their insurance coverage.

Plus, because they don’t clearly understand what their benefits offer, many people wait to use their healthcare coverage until a health crisis hits, which isn’t good for the individual, population health, or payers.

In 2024, we predict that modern, frictionless benefits will take hold, enabled by API technology. These are benefits that are easy to use and to personalize to match the needs of individuals. Foundational to this new path forward, though, is accurate benefits enrollment data. There is a lot of inaccurate enrollment data out there, due in large part to decades-old technology in place in the insurance benefits ecosystem. The bad data is getting in the way of innovation and of people better who are understanding and using their benefits to their fullest.

API technology will pave the way forward. Payer organizations should have an API strategy and roadmap to guide them. You can build it yourself or team up with a trusted, visionary partner. Either way, 2024 should bring business imperatives to replace the technology status quo in the industry.

Readers Write: Trauma Thoughts

Trauma Thoughts
By Nicole Cook, APRN

Nicole Cook, APRN, MSN is a trauma clinical nurse specialist with WakeMed of Raleigh, NC and a clinical advisor for TraumaCare.AI.

The science and technology of healthcare is relentless in its pursuit of improvement and change. Techniques and practices that were once held as best practice have been improved upon or disproven, moved to the files of antiquity to be remembered fondly or with embarrassment as we realized that the sacred cow really wasn’t quite so golden. The evolution of care for traumatically injured patients is no exception.

Trauma nurses from 20 years ago would be flabbergasted to receive a trauma patient not on a long spine board. Mixing high-dose Solu-Medrol for an acutely injured spinal cord was cutting edge best practice. Peripheral IVs were flushed with heparin every eight hours, and we certainly preferred a good bolus of crystalloids before considering blood products. Yet now, every one of these interventions is no longer best practice. Our understanding of trauma pathology and care of trauma patients has evolved and will ceaselessly continue to do so.

Given the inevitability of change, trauma nurses must anticipate future shifts to our profession and the care and assessment of these critically injured patients. No new technology is poised to revolutionize healthcare more than the integration and incorporation of artificial intelligence and machine learning (AI/ML)-driven decision-making models into patient care and assessment. Never has technological and scientific change been so ripe with questions, apprehension, and seemingly limitless opportunity. 

We would be remiss to pretend that the last several years have not harshly affected healthcare and the field of nursing. Nurses have left the bedside, turnover in most healthcare organizations is at an all-time high, and uncertainty and change are our continual companions. As the future approaches, we look to lose more staff due to retirement as our patient population only continues to age and grow. Increasing the number of nursing educators and bolstering our nursing education pipeline cannot be ignored, but the impact of that would be felt years in the future. Staff need assistance now.

As healthcare moved into the digital age and EHRs became the norm, new challenges presented themselves. A deluge of digital data is filed into the record, often automatically. This is intended to improve decision-making, but the sheer volume often ends up overwhelming staff who may miss trends and changes among the pages and tabs of data. What was intended to make healthcare easier is resulting in information overload.

Imagine this not too unusual scenario. A busy emergency department, bursting at the seams. A nurse with a heavy assignment receives a multi-trauma patient after resuscitation who is now awaiting an ICU bed. Inpatient beds are at a premium, so the patient boards in the emergency department. This nurse has been well trained, but with a 1:5 nurse to patient ratio, it’s all they can do to keep up with basic tasks for their patients.

Minute changes in labs and assessment for the trauma patient indicate an impending worsening of clinical status, which is not readily apparent on the vital sign monitor. As the nurse treads water trying to keep up with their patient assignment, the very real risk exists that the nurse and care team will miss these subtle clues, leading to adverse patient outcomes.

Now consider one small change to this scenario. As the nurse logs into the EHR, they receive a notification of the impending clinical deterioration that was calculated by a decision-making model that is integrated into the record. The nurse notifies the admitting physician, who responds to the bedside. The clinical team reviews the notification and the pertinent data, adjusts the care plan accordingly, and the patient stabilizes. The nurse is also able to use this information to advocate that the patient be moved up in the queue to receive the next available ICU bed.

One of the concerns with any integration of technology into healthcare assessment is the potential for loss of clinical expertise and critical thinking that is secondary to overreliance. This concern is not unwarranted. The more our reliance on technology grows, the more it has the potential to pull staff from the direct bedside, facing away from the patient and toward a computer screen.

Nursing is an art and a science, twisted and entangled into one inseparable form. The anticipation of impending clinical deterioration is often described as a gut feeling, or simply “I am worried about this patient.” Artificial intelligence cannot replace nurse intuition and excellent assessment skills at the bedside. But this added layer of safety could be a constant background presence that is assessing and reassessing minute changes and alterations, as bedside nurses juggle ever-increasing documentation and regulatory requirements and a thousand little tasks that keep them from having the time to comb the data and see all the details.

Patient safety is created in layers. The Swiss Cheese Model is a well-known illustration of risk management and prevention. Layers upon layers of preventative measures and mitigation strategies result in improved safety. The integration of AI/ML can be seen as a robust addition to the Swiss Cheese Model due to its potential for adaption and development. Trauma nurses have a responsibility to investigate its potential in the evolution of our specialty to anticipate potential gaps in safety, equity, and education, and to take an active role in shaping this technology to assist us in caring for some of the most complex patients in all of healthcare.

Healthcare AI News 12/27/23

News

Researchers predict that AI will enhance the longer-term benefits of using wearables data, such as step tracking, either by directly providing health coaching or by analyzing wearables data to give human health coaches a better picture of the user’s health. The Time article observes that Google will add AI insights to users of its Fitbit devices, Google DeepMind is working on “life adviser,” and Apple will reportedly release an AI health coach next year. Experts suggest that while these projects are interesting, evidence that AI-analyzed wearables data has not been proven to improve outcomes or mortality.

AI researchers obtain the email addresses of 30 New York Times employees by feeding ChatGPT some known addresses and then asking for more via its API, which bypasses some of ChatGPT’s privacy restrictions. The article notes that AI companies can’t guarantee that their systems haven’t learned sensitive information, although AI tools are not supposed to recall their training information verbatim. Training on inappropriately disclosed medical records weren’t mentioned in the article, but should be concerning.

Business

OpenAI is reportedly discussing a new funding round that would value the company at or above $100 billion, making it the second-most valuable US startup behind SpaceX.

Research

Researchers say that while AI can help nurses by automating routine tasks and providing decision support, it cannot replace their excellence in critical thinking, adapting to dynamic situations, advocating for patients, and collaborating. The authors note that nurses have hands-on clinical experience in assessing and managing patient conditions; take a holistic approach that considers the physical, emotional, and psychological aspects of patient care; and requires them to make ethical and moral decisions that respect the patient’s values, beliefs, and culture.

A study finds that ChatGPT 3.5 does a good job in simplifying radiology reports for both clinicians and patients while preserving important diagnostic information, but is not suitable for translating those reports into the Hindi language.

Three Stanford graduate students develop a tool that can accurately guess where a photo was taken by using AI that was trained on Google Street View. The system was trained on just 500,000 images of Google Street View’s 220 billion but can guess the country 95% of the time and can usually guess the location of a photo within 25 miles. The system beat a previously undefeated human “geoguessing champion.” Civil liberties advocates worry that such a system, especially if it is ever rolled out widely by Google or other big tech firms, could be used for government surveillance, corporate tracking, or stalking.

Other

An expert panel that was convened by AHRQ and the National Institute on Minority Health and Health Disparities offers guiding principles for preventing AI bias in healthcare:

• Promote health and healthcare equity through the algorithm’s life cycle, beginning with identifying the problem to be solved.
• Ensure that algorithms and their use are transparent and explainable.
• Engage patient and communities throughout the life cycle.
• Explicitly identify fairness issues and tradeoffs.
• Ensure accountability for equity and fairness in AI outcomes.

Clinical geneticist and medical informaticist Nephi Walton, MD, MS warns that AI is convincing even when it is wrong. He asked ChatGPT how to avoid passing a genetic condition to his children and it recommended that he avoid having children. He says AI has improved, but the way that it is trained is a problem because it pushes old evidence and guidelines to the top while neglecting new information.

Contacts

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

Morning Headlines 12/27/23

Constellation Software’s Harris Operating Group Acquires MEDHOST, Inc.

Medhost will be operated as a standalone business within Constellation’s Harris software group.

Mercy medical record transition heats up in bankruptcy court

Mercy Iowa City and Harris-owned Altera Digital Health argue the terms of continued EHR support as the hospital awaits its acquisition by University of Iowa.

Apple files appeal after Biden administration allows U.S. ban on watch imports

Apple stops selling its smart watches that offer pulse oximetry after losing a patent infringement dispute with medical device maker Masimo.

Why do doctors still use pagers?

NPR talks to doctors whose project to replace ED pagers with smart devices failed.

News 12/27/23

Top News

Constellation Software acquires EHR provider Medhost. Terms were not disclosed.

Medhost will be operated as a standalone business under Constellation’s Harris software group, where it joins Altera Digital Health, Amazing Charts, QuadraMed, Iatric Systems, Picis, and several other acquired health IT companies. 

Reader Comments

From Oracular Degeneration: “Re: Oracle Health. The former Cerner was blamed for missing revenue expectations. Expect license audits to follow.” Oracle is somewhat famous for turning innocent-sounding “license audits” into a sales channel, where the company collects customer usage information (voluntarily or otherwise) in coordination with a sales rep and then demands that the customer buy more licenses to avoid legal action. Palisade Compliance describes how the city of Denver was rushed into paying Oracle $4 million under an Oracle program that Palisade calls ABC audits (audit, bargain, cloud) in which the company forced the city to buy cloud services to avoid legal actions. NASA recently bought $15 million in unneeded Oracle software in fear that the company would find something amiss. Former clients of Cerner may be running under old contracts or those that weren’t prescriptive about M&A, hardware upgrades, virtualization, or moving services to the cloud, so it might be prudent – especially for any contracts that involve processor-based metrics – to assess your situation before Oracle does.

From Adapt or Die: “Re: changes at my primary care practice. They will now require holding a credit card on file, charge a $15 annual cash fee for services that insurance does not cover, and limit annual physicals to health screenings and risk management with no review of specific medical issues.” These changes seem entirely reasonable, although I would be nervous about leaving a credit card number on file given the unpredictable nature of the amounts and timing of physician billing. This practice says that the patient usually receives the EOB first and has time to resolve problems with their insurer. When the practice’s business office receives their copy of the EOB, the patient’s balance will be billed via InstaMed. Leaving a credit card on file is dangerous for the many or most Americans who can’t afford to pay unexpected (or even expected) medical bills, but patients who can’t afford to pay their legitimate healthcare expenses aren’t the practice’s problem. This state of affairs must be puzzling to the rest of the developed world that can’t understand how we allow every profitable aspect of healthcare to be milked financially by publicly traded companies, zillion-dollar health systems, and private equity firms. The status quo remains in place only because we peasants aren’t all sick at once and thus haven’t charged the healthcare castle carrying torches.

From VTViper: “Re: ModMed. Huge layoff last week. The entire podiatry team was let go.” Unverified.

HIStalk Announcements and Requests

Only 10% of poll respondents expect Oracle Health to be the owner of an improved former Cerner business in five years, with more than half expecting the company to sell or close most of it. Commenters note that Oracle will milk the business solely to keep VA/DoD taxpayer dollars flowing and ponder why David Feinberg is still pocketing millions with few signs of serious job responsibilities.

New poll to your right or here: Did you receive a holiday gift from your employer? My theory is that big-employer gifts are rarely more than a check-the-box effort (company-branded merchandise, a low-value gift card, or a box of candy), although individual bosses may go above and beyond to recognize their employees more personally. My experience is almost entirely within health systems, where the number and diversity of employees ensured low-effort corporate swag like a mug or tote bag. I have mixed feelings about the alternative of department pizza parties, which are tacky on the surface but often slightly fun for those whose schedule and location allows them to attend.

Webinars

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

Acquisitions, Funding, Business, and Stock

Harris Healthcare-operated Altera Digital Health petitions the bankruptcy court of Mercy Iowa City over the hospital’s planned transition to a new EHR upon completion of its acquisition by University of Iowa. The hospital, which partly blames the former Allscripts software for its poor financial condition as its AR jumped 40% after implementation, told Altera that it will be cancelling its agreement but requires access to company support through early 2025. Altera wants the court to either force the hospital to honor its existing agreement that runs through 2031 or declare it void. The company says the $8 million “cure amount” of the existing contract is insufficient and wants $12 million plus damages that are accruing at $207,000 per week.

Apple stops selling its Series 9 and Ultra 2 smart watches due a US International Trade Commission decision that the Watch’s pulse oximetry technology infringes on patents held by medical device maker Masimo. Apple has filed an appeal.

People

Baylor Scott & White Health promotes Nathan Winn, MPA to VP of IT.

Announcements and Implementations

NPR addresses the “why do doctors still use pagers” question, with these observations from doctors who led a failed hospital project to replace them in the ED:

• Pagers, as a 1980s relic from the Sir Mix-a-Lot days that even drug dealers have abandoned, should be easy to displace. Doctors don’t like receiving pages that contain only a phone number with no hint as to who they’re calling or what that person wants. Pages also can’t be verified as received. On-call residents are handed a pile of team-specific pagers for their “Rambo belt” and need to track down which one is beeping.
• However, pagers are “the cockroaches of communication” because they are cheap, nearly impossible to damage, run forever on a single AA battery, and are more reliable with fewer dead spots since they don’t use cellular networks.
• Doctors worry that patients will think they are screwing around if they look at their phones during a visit to read a message, but with a pager, “they know you’re doing doctor work.”
• Smart apps make communication among doctors too easy, where the sender doesn’t worry about bothering a colleague or phrasing a request succinctly
• Pagers provide control, or at least the illusion of it, as even junior residents can decide when and how to respond without the sender knowing if they have seen the message.
• A management professor says that technology isn’t just about the tools and instead is a project that involves RHIP (pronounced “rip”) – risk, habit, identity, and power. Doctors were being asked to change their routines, the change made them feel differently about their jobs, and it shifted power.
• The result was that the pager replacement system failed to reduce patient time in the ED, partly because the existing system was already efficient and also because many doctors had stopped using the new devices.

Other

A small, single-hospital study finds that inpatient satisfaction scores increased if their room’s guest chair was placed near the patient’s bed to encourage doctors to sit while visiting, which the authors call a “chair nudge.”

Contacts

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

Morning Headlines 12/22/23

Invitae Divests Ciitizen Health Data Platform and Implements Further Cost Cuts

Medical genetics company Invitae divests its Ciitizen patient-controlled health data business, which it acquired for $325 million in September 2021.

Notice of Cybersecurity Incident

First responder software vendor ESO Solutions notifies 2.7 million people that their information was exposed in a ransomware attack.

Measuring the Impact of AI in the Diagnosis of Hospitalized Patients: A Randomized Clinical Vignette Survey Study

Researchers find that clinician diagnostic accuracy in image analysis dropped significantly when guided by a systematically biased AI model, even when the model included the methods that led to its flawed interpretation.

Vital signs vs. dollar signs: At HCA hospitals, the person monitoring your heart may monitor 79 other patients, too

An NBC News investigation finds that HCA’s remote telemetry monitoring has been plagued by understaffing, system downtime, and poor communication between technicians and floor nurses.

News 12/22/23

Top News

Medical genetics company Invitae divests its Ciitizen patient-controlled health data business to that company’s leadership team and a group of investors who will operate it as an independent company. Terms were not disclosed.

The divestiture is part of an Invitae cost-cutting effort, which includes a 15% headcount reduction, following a $1.3 billion loss in the first three quarters of 2023.

Invitae bought Ciitizen in September 2021 for $325 million. NVTA shares have lost 98% of their value in the past three years. They are down 63% in the past 12 months, valuing the company at $192 million.

Reader Comments

From Cernam: “Re: Oracle Health. GM Travis Dalton is leaving the company.” Unverified, but reported by several employees on social media.

From MD L: “Re: primary care training. It might be better for specialists to go straight into specialist training. Does an endocrinologist or cardiologist really need a full internal medicine residency before specializing? The hardest, least-appreciated, and most-important hallmark of a well-trained physician is the ability to think critically, synthesize disparate information, and eliminate the red herrings. You learn it by seeing patients under appropriate supervision. Students who are in abbreviated MD programs have trouble with this since they start clinical rotations without a good knowledge base. The idea that you can look up what you need is bogus – you need to know what you’re looking for and then understand it. Another concern I have about shortened medical training is that mine involved thinking for ourselves much earlier, where as a student I was doing medical and surgical procedures that are done by senior residents now, and by my second week of internship, I was the only ‘psychiatrist’ in the building at night for the unit and ED, where now attendings are in house 24×7 to see patients and sign them out. This is like kind of knowing a foreign language and trying out your skills with a native speaker who takes over the conversation at the first sign of struggle. For these reasons, I would be concerned about shortening training.”

From Data Holmes, PhD: “Re: AI-driven CDS. This JAMA paper disputes the idea that clinical decision support and AI don’t need to be all that accurate since doctors are making the final decision. That makes me nervous because I think people can turn their brains off too easily and place too much trust in the computer.” Researchers found that clinicians who are analyzing medical images get a slight bump in diagnostic accuracy with AI’s help as long as the AI wasn’t confused by the presence of case-irrelevant information. However, their diagnosis accuracy dropped by 11% when they used AI models that are systemically biased (meaning that the model used irrelevant information). The most important finding is that doctors didn’t read the explanation where the model showed its faulty work, so they assumed that the model’s conclusion was sound. An accompanying opinion piece concludes that the use of AI, even when limited to assistive purposes, should be evaluated before rolling it out widely.

From Jabroni: “Re: HIMSS24. Looks like they have removed the exhibitor count after you reported a rather low number.” That appears to be the case. I’m not interested enough to display the exhibitor list and count them manually.

From Glytec Employee: “Re: Glytec. The insulin titration software company is in turmoil with the departure of its CEO, CEO, CMO, and other leaders. The company is being run by investors and two-thirds of the staff have been laid off after the company failed to get funding after a multi-million dollar offer in October 2022.” Unverified, other than the leadership changes. Of the 11 executives who were listed on its webpage in July 2023, five remain. The CEO and CFO started in October 2023.

HIStalk Announcements and Requests

It is December 21 as I write this, the official beginning of winter and the day with the fewest hours of daylight. Happy Yalda Night — which anyone in the Northern Hemisphere can celebrate regardless of religious beliefs or human-drawn borders – or your choice of Christmas, Hanukkah, Three Kings Day, Advent, Kwanzaa, Las Posadas, or a belated Diwali or St. Nicholas Day (I learned about the latter from the Ukraine person I’m helping learn English over Skype). Hopefully the folks in Svalbard, Norway are in a festive mood during their polar night, where it stays dark from mid-November until the end of January (webcam here to prove it). Whatever you celebrate, even if it’s just another day above ground, enjoy.

Webinars

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

Acquisitions, Funding, Business, and Stock

Business Insider reports that Commure laid off staff in November shortly after its owner combined it with another of its holdings to create a $6 billion company. Commure (data exchange) and Athelas (revenue cycle management) said the combined companies would hire aggressively and even bring on health tech people who had been laid off elsewhere. Commure CEO Tanay Tandon, who came from the Athelas side of the combination, says the company will likely go public in the next two or three years.

Arcadia sells its MSO and value-based care service division to Guidehealth, which offers value-based care software.

People

Brian Bircher, MSEd (Tegria) joins DrFirst as VP of enterprise solutions.

Announcements and Implementations

Children’s Hospital of Orange County and Rady Children’s Hospital – San Diego sign an agreement to merge to form Rady Children’s Health. The name suggests the dominant party, although in a show of collegiality and bad business judgment, the CEOs of both hospitals will serve as co-CEOs of the new one, at least for a few months until it becomes clear – as it always does – that the buck (literally) can only stop with one person.

Government and Politics

England’s health and secondary care minister says that its newly contracted, Palantir-provided Federated Data Platform of shared patient data will be more secure than any NHS system. He adds that Palantir won’t be allowed to control or use the data and the system will use patient anonymization technology from IQvia, the Durham, NC-based pharma data vendor that was previously known as IMS Health and Quintiles.

Seattle Children’s Hospital sues the Texas attorney general for requesting documents related any gender transition care that it provided to Texas children, in which the AG cited a Texas consumer protection act. The hospital says that the AG lacks jurisdiction for the request, the hospital has no ties to Texas, and that Washington providers are protected by state law from being required to provide information about gender-affirming care from states that restrict or criminalize the practice. The AG’s demand included all prescriptions, diagnoses, lab tests, and protocols that involve Texas children. The hospital also provided affidavits from its IT directors that its email and EHR servers are based in Seattle.

Privacy and Security

First responder software vendor ESO Solutions notifies 2.7 million people that their information – which ESO obtains from the healthcare organizations that use its software — was accessed by ransomware hackers in late September.

Drug chain Rite Aid settles FTC charges that it unfairly used facial recognition surveillance systems to subject shoppers to unreasonable searches and humiliation. FTC says Rite Aid scanned the faces of customers who entered its stores and matched them against a database of confirmed and suspected shoplifters to trigger closer observation. FTC says the system often mismatched images due to low quality CCTV and cell phone originals. Rite Aid says it only used the technology in a limited pilot project that it ended three years ago. Customer theft or “shrink” is starting to kill off self check-out and the displaying high-theft items on unlocked shelves, so maybe our societal dishonesty will lead us back to the days of Service Merchandise and its “pay first, then wait for your order at the conveyor belt” approach.

Liberty Hospital (MO) transfers some patients to other hospitals as it deals with an unspecified IT event that occurred Tuesday. A local TV station obtained a message that was sent to the hospital by an apparent hacker who gave the hospital 72 hours to pay an unspecified ransom.

Other

An NBC News investigation titled “Vital Signs vs. Dollar Signs” looks at HCA’s use of telemetry technicians who remotely monitor the vital signs of hospitalized patients. They found that the techs are assigned up to 80 patients, monitoring systems have gone down for as long as 26 hours, tech communication with nurses on the floor is slow or erratic, and monitoring stations are sometimes unstaffed due to scheduling problems or staff breaks.

A hospital patient is shot in the butt by a pistol that she had smuggled into her MRI exam after denying that she was packing any metal objects that the machine’s magnet would affect. The bullet did little damage, unlike the example from Brazil earlier this year in which a gun advocate who was undergoing an MRI hid a pistol in his waistband that went off during his procedure and killed him.

Sponsor Updates

• EClinicalWorks releases a new set of podcasts focusing on “Transforming Patient Care with EClinicalWorks and Healow.”
• Symplr congratulates nearly 20 customers on achieving the highest status on CHIME’s 2023 Digital Health Most Wired list.
• Meditech announces its commitment to the HHS/ONC Cancer Moonshot initiative.
• Nym achieves excellent customer satisfaction scores for the second consecutive year.
• Verato earns HITRUST certification for information security.

Blog Posts

• Review, Revise, Resolve – A look at the 2024 updates for CPT (Wolters Kluwer Health)
• 5 Truths About AI-Driven Software Testing (Keysight)
• 40 Years of Community: A Retrospective (Medhost)
• Watch Meditech customers share how they are driving transformational change (Meditech)
• Reducing clinicians’ cognitive load to focus on their well-being (Nuance)
• 12 Ways to Keep Your Spirit Merry and Bright This Holiday Season (Netsmart)
• How a Pediatric Health System Leverages Technology to Combat Claim Denials (Vyne Medical)
• 20 years of Medicare Advantage with MA author Tom Scully on Diagnosing Healthtech (Redox)
• The Care Transition: A Crucial Time for Patient Safety (Surescripts)
• Reflecting on Trualta’s Transformative 2023 (Trualta)
• Revenue cycle 101: What is denial management in healthcare? (Waystar)

Contacts

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

EPtalk by Dr. Jayne 12/21/23

I’ve spent the majority of my career helping people use healthcare technology as efficiently as possible. It gets under my skin when clinicians report wildly inefficient workflows and I always want to dig in to see if I can fix them.

The grating example this week occurred in an article featured in a communication from the American Medical Association. In the piece, the AMA’s vice president of professional satisfaction, Christine Sinsky, MD, claims that workflows for immunization ordering had gone from a verbal order to “21 clicks… to order a flu shot for one patient.”

Although I understand the sentiment, I’m wondering if this isn’t a bit of an exaggeration. There are now thousands of clinical informaticists out there who have dedicated their careers to stamping out what can only be considered a horrific workflow if it actually exists. I’m wondering if she’s not referring to the entire immunization documentation process, which is more than simply placing an order and had a significant number of steps in the paper world if practices were doing it properly.

I don’t think examples like this are helpful, especially if they are inaccurate or if people are comparing apples to oranges. If your workflow for ordering (and not administering) an immunization is really 21 clicks, I encourage you to reach out. Let’s name and shame organizations where this is happening.

The AMA was busy this week, also publishing an article about EHR usability and safety challenges. The article cites a 2018 report looking at EHR safety. I’ve seen some significant improvements in the base versions of EHRs in the last few years and I don’t think it’s necessarily fair to regurgitate data from a half decade ago.

I think also when we look at EHR safety and efficiency, it’s important to note that many clients are not using their vendors’ systems out of the box. I’ve watched client after client configure perfectly good EHRs into the stuff of user nightmares. This typically occurs when those responsible for installing and implementing the EHR don’t understand clinical workflow, don’t have adequate clinical governance, and/or don’t have adequate clinical and end user participation. Usually, these deficiencies are directly related to budget, timing, and politics, a sad combination that often sabotages projects before they start.

Unfortunately, some of the concerns do still exist a half decade later. Physicians and other clinicians are doing too much non-value-added data entry, they’re encountering too many alerts that don’t improve patient care, and they’re dealing with content, including drug databases, that isn’t updated with the appropriate frequency. Couple that with inadequate training and rising expectations for patient throughput and you have a recipe for unhappiness all around.

There are also rising expectations for care quality. When you looked at physicians in practice 25 years ago, they were tracking health maintenance screenings and chronic care management elements, but they weren’t necessarily being graded (or paid) based on their outcomes. Now, insurance contracts have added bonuses and penalties for performance, and regardless of EHR use, there is simply more expected of physicians and clinicians. It’s easy to blame the EHR and to wax nostalgic about the good old days of paper charts, but there are so many more complicated factors at play. I watched two more of my family medicine colleagues retire this month and miss them already.

From ShowMe: “Re: the go-live of the Missouri Prescription Drug Monitoring Program (PDMP) last week. I was able to log in through my existing credentials with the St. Louis County PDMP, although I did have to accept new state-level terms and conditions. On the previous system, I had requests for midlevel providers to become delegates under my license that had been pending since I left a previous employer in 2017. They were still there on the new system, but I was finally able to figure out how to decline them. As expected, there were two major inconveniences: the absence of information from surrounding states, and the loss of records of past searches. It will take time for the new system to build up a history on some patients and it still feels a little like two steps forward but three steps back.” Missouri is the last to deploy a statewide solution, and I wish all the clinicians the best as they navigate the transition.

From Internet of Things: “Re: the proliferation of web-connected devices. It’s cool until it’s not. Healthcare isn’t the only single-threaded industry in which connectivity issues can bring everything to a screeching halt. The local school district has lost all internet communication and phone lines due to a fiber-optic cable being cut somewhere, although they don’t know where yet. They have learned that literally everything is tied to the internet, including the bell to start and end classes and the automatic motion-detection light switches. For two days (so far), the kids have been sitting in the intermittent dark, with administrators using an air horn to announce the beginning/end and periods at school. It’s so loud I can hear one school’s horn blow every 42 minutes. They can’t assign, grade, or update any work and it’s finals week. Did I mention that even the photocopiers are internet-based, and they can’t print out worksheets or paper tests?” I come from a long line of teachers and I bet the ones who are having to teach in that environment are losing their minds. It’s already a rough time of year, with many students dealing with end-of-semester anxiety, too much holiday excitement, or increasing levels of family dysfunction. Here’s to those courageous souls that need to make it through just a couple of more days before break starts.

The holiday season is also a time when companies occasionally behave badly. One colleague reported that his hybrid employer took all in-town employees out for lunch, but completely ignored the remote team. I guess management has never heard of sending Uber Eats or DoorDash? Holiday gifts abound, often with company logos and questionable usefulness. Among the best I have received during my career: a Total Wine gift card, small picnic cooler, a $100 bill, and jumper cables. Among the worst: a Santa hat with a company logo, a vanity-published book written by the company founder, framed pictures of the CEO, a rock with an inspirational word carved into it, and nothing.

Does your employer give holiday gifts that put them in the hall of fame? Or are they more deserving of admission to the hall of shame? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/21/23

Get Well Announces Expansion Into Health Plans, Brings Health Plan Strategy Expert Christian Bagge to Lead Go-to-Market Efforts

Digital patient engagement vendor Get Well announces plans to expand into the payer space, bringing on former MPulse Mobile VP Christian Bagge to lead the effort.

Knownwell Raises $20M Series A From A16Z to Scale the First Patient-Centered Healthcare Home For Those With Overweight and Obesity

Knownwell, a hybrid primary care and weight management clinic based in Needham, MA, raises $20 million in a Series A funding round.

Amy Abernethy to step down as Verily’s chief medical officer in latest departure from company

Amy Abernethy, MD, PhD, will leave Verily to join an unnamed nonprofit healthcare institute focused on policy and innovation.

Healthcare AI News 12/20/23

News

OpenAI posts a guide to GPT prompt engineering, explaining six strategies with examples:

• Write clear instructions. 
• Provide reference text.
• Split complex tasks into subtasks.
• Give the model time to think.
• Use external tools.
• Test changes systematically.

Dictionary.com names the AI-related usage of “hallucinate” as its word of the year for 2023, the same year it was added to the dictionary.

Business

Healthcare ambient AI company Nabla announces that 10% of its clinician users were taking advantage of its recently released Spanish translation capability within its first four months, with especially high adoption among psychiatrists, psychologists, and psychotherapists. Two of the company’s three co-founders are former Facebook AI research engineers.

Healthcare payment integrity company Trend Health Partners acquires Advent Health Partners, which uses AI to assemble and present medical records for denials management, utilization management, bill reviews, and DRG reviews.

High-profile investor Vinod Khosla tells conference attendees that AI will impact healthcare by nudging patients to perform preventive health activities. He also says that clinicians practice “crude medicine” by using the same medications on every patient despite their unique genetic characteristics, predicting that medicines will be tailored to individual patients.

Healthcare AI vendor John Snow Labs deploys a medical chatbot using its own large language model running Oracle Cloud Infrastructure. The model provides detailed answers with citations to its research sources, serving as a personal research assistant to the latest biomedical literature or personal document repositories.

Research

A small study finds that AI can accurately screen people for autism spectrum disorder, and possibly determine its level of severity, from photos of their eyes.

Other

Eric Topol, MD of Scripps Research Translational Institute says that with cancer screening, “we’ve got this all wrong” because only 12 to 14% of cancers are being diagnosed via mass screening at a cost of tens or hundreds of billions of dollars each year. He adds that false positives create patient anxiety and it’s “so dumb” that the screening is based on age and misses major cancers among younger people. He says that AI can define individual risk by analyzing clinical notes, test results, and polygenic risk scores.

HHS’s use of AI ranks it #4 among federal government agencies, with projects that include:

• Generating clinical study reports using Phase I and II study data.
• Providing first responders with an app that tell them how many Medicare beneficiaries in a given area use electricity-dependent medical devices.
• NIH’s use of an AI tool to rank incoming grant applications to highlight those that address high-priority topics.
• CDC’s use of AI for surveillance testing.
• According to a GAO report, HHS is using an AI chatbot to provide automated email responses for physical security questions.

Bill Gates recaps 2023 by saying that it was the first time he used AI for serious work and “not just to mess around and create parody song lyrics for my friends,” predicting that AI will be used by a significant part of the US population within 24 months. He expects that in healthcare, AI will accelerate discovery of new drugs, predict antibiotic resistance and recommend optimal therapy, serve as a co-pilot for managing high-risk pregnancies, assess risk for HIV, and creating a voice-powered standardized patient record in Pakistan.

Mass General Brigham asks its experts for their 2024 predictions, many of which involved AI:

• Personalizing treatment plans, surgical precision, and post-operative monitoring in neurosurgery.
• Integrating AI into radiology practices.
• Using AI Improvements that allow efficient updating for safety and effectiveness.
• Using AI chatbots for initial patient triage.
• Microsoft, Amazon, and Alphabet acquiring key health AI players as the overall market consolidates.
• Deploying AI-inspired robots to support home caregivers for people with spinal cord injury.
• Using digital twins.

Contacts

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

Readers Write: 2024 Regulatory Changes and their Impact

2024 Regulatory Changes and their Impact
By Vatsala Kapur

Vatsala Kapur, MA, MPAff is VP of external affairs for Bamboo Health of Louisville, KY.

Change is on the horizon. This adage has always been true for the ever-evolving healthcare landscape, especially with the introduction of new federal and state policy and regulations.

As we step into the 2024 election cycle, we expect to see additional changes across the behavioral health realm in particular. Policymakers are implementing various financial penalties and incentives to increase accountability in expanding behavioral health access. These changes open a window of opportunity for organizations that are ready and willing to rise to the challenge of addressing our country’s behavioral health crisis.

Let’s delve into just a few of the dozens of changes that are aimed at improving healthcare delivery for our most vulnerable populations that may impact your organization in the new year.

• DHHS establishes disincentives for healthcare providers that engage in information blocking. The Department of Health and Human Services (DHHS) established disincentives for healthcare providers that are involved in information blocking. These disincentives include penalties of up to $394,000 for hospitals and $686 for individual clinicians who fail to share patient data upon request, underscoring the importance of data transparency. For organizations that are hindered by outdated systems, adopting real-time data systems integrated into daily workflows becomes a regulatory necessity and a pathway to improved patient outcomes.
• Introduction of the Rehabilitation and Recovery During Incarceration Act. If enacted, the Rehabilitation and Recovery During Incarceration Act represents a pivotal shift, allowing Medicaid to finance behavioral health treatment for eligible individuals in criminal justice settings. Effectively addressing the needs of justice-involved populations is crucial for hospitals and clinicians aiming to provide comprehensive treatment at all points of care.
• SAMSHA releases $74.4 million in funding opportunities. The Substance Abuse and Mental Health Services Administration (SAMSHA) plans to inject $74.4 million into the healthcare ecosystem through grants that target behavioral health challenges. These diverse grants aim to prevent substance use initiation, reduce the progression of substance use, and address other concerns along the health continuum. Notably, partnerships that focus on reducing substance use disorder prevalence through collaboration, each valued at $15.5 million, hold the potential to not only address behavioral health issues, but also expand access in rural areas.
• CMS shares notice of funding opportunity with the All-Payer Health Equity Approaches and Development (AHEAD) model. The Centers for Medicare & Medicaid Services (CMS) is set to collaborate with states through the AHEAD model, which is designed to curb healthcare cost growth, improve population health, and advance health equity. Increased investment in primary care is a critical element of this initiative, aiming to reduce emergency department burdens and better integrate behavioral and physical health. With a focus on value-based care, the CMS model plans to bolster primary care physicians as the first point of contact for behavioral health issues, thereby reducing the downstream effects of overburdened hospitals.

As federal and state governments focus on the significant behavioral health issues that are facing communities across the country, regulatory changes and evolving funding opportunities will continue to strengthen the ability of clinicians and health systems to address the needs of their patients and communities. By fostering a resilient and responsive healthcare ecosystem, we can collectively rise to the challenges ahead.

Morning Headlines 12/20/23

Justice Department Disrupts Prolific ALPHV/Blackcat Ransomware Variant

The Department of Justice announces it has taken down digital infrastructure used by the ALPH/Blackcat ransomware group and has offered a decryption key to over 500 victims.

Apple to halt Apple Watch Series 9 and Apple Watch Ultra 2 sales in the US this week

Apple will stop selling its Ultra 2 and Series 9 Watches at least temporarily due to an International Trade Commission ruling related to a blood oxygen sensor technology patent dispute with medical device manufacturer Masimo.

Adventist Health rehiring IT staff previously outsourced to Oracle

Adventist Health ends its ITWorks contract with Oracle Health, which will lay off 65 employees at Adventist’s Roseville, CA headquarters as the health system brings the services back in-house.

MPulse is Combining with HealthTrio and Decision Point Healthcare Solutions

Digital healthcare engagement company MPulse acquires HealthTrip and Decision Point Healthcare Solutions, both of which also offer patient and member engagement solutions.

Liberty Hospital ER diverting patients to other facilities due to IT issue

Liberty Hospital (MO) diverts ER patients and reverts to downtime procedures while it attempts to recover from an unspecified IT event that began Tuesday morning.

News 12/20/23

Top News

Apple will stop selling its Ultra 2 and Series 9 Watches at least temporarily due to an International Trade Commission ruling related to a blood oxygen sensor technology patent dispute with medical device manufacturer Masimo.

Masimo accuses Apple of meeting for partnership talks with the intention of obtaining competitive information for developing its own technology, after which it paid huge money to poach several Masimo inventors and executives.

Masimo’s pulse oximetry technology earned FDA clearance, but Apple was able to bring its sensor to market without it by claiming that it provides information but doesn’t diagnose.

Reader Comments

From Sunny Daylight: “Re: healthcare AI experts. Who are the thinkers and researchers who are doing the best work? If you wanted to build the world’s greatest network of healthcare AI experts, who would be on that list?” I don’t usually think in terms of individual experts, with the exception of Eric Topol, MD, but I’ll open it up to readers. It likely depends on the area in which the person works – as a clinician with AI interest, an AI researcher who focuses on healthcare, or armchair experts who speak and write confidently on the topic without a relevant work history.

Webinars

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

Acquisitions, Funding, Business, and Stock

Remote patient monitoring and virtual care company CoachCare acquires RPM vendor Verustat, its fourth RPM acquisition within the last 12 months.

Molina Healthcare will acquire Bright Health Group’s California Medicare Advantage business for $500 million, rather than the originally proposed $600 million, in a previously announced deal expected to close January 1.

Lehigh Valley Health Network and Jefferson Health announce plans to merge to create a 30-hospital, 62,000-employee health system with annual revenue of $14 billion.

Sales

• In England, Birmingham and Women’s and Children’s NHS Foundation Trust will implement Epic in 2024, with expected go-live in 2025.
• CoxHealth (MO) will implement Epic, replacing Oracle Health.
• Wilbarger General Hospital (TX) selects operational and financial analytics from Sixth Sense Intelligence.

People

Methodist Le Bonheur Healthcare (TN) hires interim SVP/CIO Tina Smith, MBA (Seattle Children’s) to the full-time position.

Physician compensation and contract management software vendor Ludi promotes Danielle O’Rourke to CEO.

Lisa Morella, MBA (Mass General Brigham) joins CodaMetrix as VP of data and analytics.

Amino Health promotes John Asalone, MS to CEO. He takes over from David Vivero, who has taken on the role of chairman.

Announcements and Implementations

Avera launches virtual nursing pilot programs at McKennan Hospital & University Center and St. Mary’s Hospital in South Dakota.

Multi-state Mercy health system launches a patient-facing chatbot dubbed Toni in memory of Mercy’s first CEO, a Sister of Mercy for 65 years who died in 2022.

A Wolters Kluwer Health study finds that nearly nine out of 10 Americans worry that generative AI is not transparent about where it gets the information that it presents or that it uses unvetted Internet data.

Adventist Health ends its ITWorks contract with Oracle Health, which will lay off 65 employees at Adventist’s Roseville, CA headquarters as the health system brings the services back in-house.

Other

The “Bill of the Month” of KFF Health News involves a patient of Mount Sinai (NY), which booked her a telehealth visit when she called in asking about sinus symptoms. Her five-minute visit yielded prescriptions for a nasal spray and an antibiotic along with a bill for $660, which her insurance declined to cover because the doctor – whose name and employer she could not determine – was out of network despite being affiliated with Mount Sinai, which had provided a pre-visit estimate of $60. She was billed for a moderate-level visit. The doctor’s office would not respond to her inquiries and the hospital told her they could send her a copy of the consent form that she had signed only by fax. Payment for the September 2022 visit remains unresolved.

The correct Jeopardy answer: “What company’s far-from-reality marketing claims made the term Watson synonymous with healthcare AI failure?”

Sponsor Updates

• Ascom Americas helps to raise $7,500 for Duke Children’s Hospital during a local radiothon.
• EClinicalWorks releases a new customer success story, “Healow Enables Seamless Interoperability for Foster Children’s Medical Records.”
• Wolters Kluwer Health and The American College of Obstetricians and Gynecologists launch the O&G Open journal.
• AvaSure publishes a new case spotlight, “A proven approach to reducing patient falls while driving staffing efficiencies.”
• Censinet releases a new Risk Never Sleeps Podcast, “The Vital Partnership Between CISA and Healthcare.”
• Cegeka successfully completes its tender offer for CTG.
• HIMSS New England honors Divurgent VP Dana Locke with its Volunteer of the Year award, and Divurgent SVP Rebecca Woods with its Heyman Lifetime HIT Achievement award.
• FinThrive publishes a new guide, “How to Maximize Medicare and Medicaid Reimbursements.”
• Fortified Health Security names Jeff Brown regional director.

Blog Posts

• 2024 Healthcare Technology Industry Trends: Top Challenges for CIOs (CereCore)
• Underpayments in Healthcare: Causes and Implications (AGS Health)
• Leverage technology to reshape healthcare economics: A path to improved patient outcomes (Arcadia)
• Healthcare Communication Trends: Nearly 70% of Patients Prefer Conversational Messaging Over Basic Texting (Artera)
• Information Management: Digital Empathy, Bad Data, and More (Clinical Architecture)
• Urgent Care Conference 2024: How to Make the Most of Urgent Care Connect (Experity)
• Welcome Home: Helping Immigrant and Refugee Families Thrive (Findhelp)
• 5 Key Questions When Choosing a Digital Health Education Vendor (Healthwise)
• Buy or build? 4 crucial considerations for risk adjustment software decisions (Inovalon)
• The Year Ahead: Costs of Prescriptions, Treating Obesity, and AI in Healthcare (DrFirst)

Contacts

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