Curbside Consult with Dr. Jayne 5/23/22

I’ve been mentoring young physicians for many years. I was recently asked by one of them to speak to a group of physicians who are struggling with burnout and inability to effectively balance work and home life. Some of them are even thinking about leaving medicine altogether. They were looking for tips from someone a bit more “seasoned” (which is just a nice way to say that at least for those still in training, I’m nearly old enough to be their mother). As we got into the conversation and they were talking about the stresses they were facing in their daily work, I realized several things.

First, these young physicians have always used EHRs. They had no frame of reference for the era of paper charts and how outpatient practices used to operate. They had never been confronted by an unreadable chart, much less a chart that was missing entirely, and as such have never had to perform an established patient visit “blind” as many of us have. There is tremendous anxiety at the idea of not having all the information at their fingertips.

Conversely, they have never had the satisfaction of being able to know what is going on with a patient by scanning a brief note that might say, “Strep, Amoxicillin x 10 days” as the assessment and plan. They’ve been surrounded by so-called note bloat for their entire careers and are used to wading through pools of useless information to try to find important nuggets to use as they care for patients.

Additionally, they’ve never had to go through an EHR implementation, so they have not had the experience of carefully evaluating their workflows to determine if they make sense, or if they need to do some streamlining. They’ve not had much experience pushing back on administrators and tend to be much more likely to take things at face value than my colleagues who trained 20 years ago and who have been through various stages of clinical transformation. Because they’ve always had an operational EHR, they haven’t had the opportunity to ask a lot of questions about why the workflow is the way that it is, or if anything can be made better.

For example, one of them was complaining about the sheer volume of inbox messages that she receives from their practice’s patient portal and how none of them require her expertise. She regularly receives appointment requests, billing questions, and other non-medical messages that she then has to forward to others to address. I asked her why her practice has all the patient portal messages routing directly to the physicians rather than to staffers who can filter the messages. She was unaware that you can even do that with an EHR (and having been a user of her particular system I know it can be done) so didn’t think to ask.

I challenged her to think critically about the other processes in her office. Do all the telephone messages come directly to her, or are they worked by the scheduling team, a medical assistant, and others first, with only those that no one else can address coming to the physician? There’s no reason that messages originating from the patient portal should be handled any differently. I could almost see the light bulb going on over her head as she thought about pushing back on the task of being her own receptionist.

Second, I found that there was a large amount of learned helplessness among these physicians. Some of them are doing four or more hours of documentation at home after leaving the office, but they’re not willing to discuss it with their practices for fear of appearing weak or looking like they can’t keep up or aren’t as productive as their partners. I think some of this comes because of their being in training or their recent proximity to training and not wanting to do anything that would raise a red flag about not being a team player or that they’re not good candidates for highly competitive fellowships or job opportunities.

For the most part, they didn’t seem to be aware of resources that are available to them, such as EHR optimization assistance, classes on personalization or creating templates and macros, or being able to book time with a trainer. It made me wonder if this situation is part of their having grown up in an entirely tech-enabled universe where they assume systems are intuitive even when they’re not, and where people are rewarded for problem-solving on their own without any help. I know that during the early stages of the pandemic, a lot of organizations cut out some of these services, but to not even be aware of a super user in your practice that could help you out is concerning. To be afraid to ask for administrative support is even a bigger red flag as practice arrangements go.

Third, I noticed that many of these younger physicians have no business savvy. There are few subspecialties that require practice management education during training (thank goodness mine is one that does) and I was shocked by the general lack of knowledge around navigating workplace situations. Of the group, only one had an attorney review their employment contract, and most of them weren’t even aware with how much notice they would have to give if they decided to leave or if their medical liability insurance “tail” would be covered upon departure. Failing to understand or negotiate these things up front leaves them locked into these positions longer than they might want. And the lack of business savvy wasn’t only in their own employment – due to the challenges in arranging childcare as a physician, nearly all of them have household employees such as nannies or housekeepers and not a single one had a signed employment agreement or contract for services.

With that lack of understanding, it’s unlikely that any of these physicians would be able to have their own practices or succeed in a physician partnership as compared to being an employee. If they’re not able to demand a drug screen and adherence to policies and procedures for the people caring for their children, would they be able to demand those things of their medical assistants or medical office staff? It feels like they would always be at risk for being taken advantage of or committing some kind of regulatory offense simply out of ignorance.

I was glad to be able to spend a couple of hours taking them under my wing and explaining the concept of being an empowered physician. I stressed the need to spend a little time trying to fully understand the healthcare landscape well enough to be able to make good choices. I was glad to be able to share some information about how to push for better EHR usability and improved clinical workflows. I’m not sure how much a difference our time together will make for their progressive burnout, but it felt good to at least try to make things better.

What does your organization offer to better educate early-career physicians on the non-clinical aspects of working in healthcare? Or does the teaching stop after HIPAA or Fraud, Waste, and Abuse modules? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Justin Sims, President, CareMesh

Justin Sims is president and COO of CareMesh of Reston, VA.

Tell me about yourself and the company.

The business of CareMesh is all about helping healthcare organizations break down communication barriers so they can better coordinate patient care. We do this by helping them solve a number of related problems. Firstly, finding the providers that they want to engage with, then exchanging patient information with them, and then coordinating actions and decisions, both within the organization and between organizations. I guess if you wanted to give us a label, I would call it care coordination.

As to me, I’ve been doing this with CareMesh for the past five years since we started the company, but I’ve worked on a number of similar problems in other health tech companies over the last 20 years. Before that, I did about 15 or 20 years in the telecom industry. But I can tell you for a fact this is a lot more fun.

How well do health systems communicate with their local, community-based physicians?

The truth is that the dominant form of unstructured communication in healthcare today is still stuck in 19th century technology. And I meant it when I said 19th century technology. The first fax, if I’ve got my history right, was sent by Alexander Bain in 1843. That technology is still the dominant form of communication in healthcare.

A lot of people incorrectly think that Direct Secure Messaging is the answer to that, but it isn’t, for a couple of pretty big reasons. The first is a practical one. Only about half of physicians in the community have Direct addresses and can technically use that form of communication. But the second reason is more a structural one, and that is that the standards for Direct messaging focused on exchanging CCDAs, structured patient records, and they didn’t focus on unstructured communications, which is where a massive flow of communications actually takes place. That’s why communication with community providers is still pretty challenging.

It is inevitable that healthcare is scorned for being behind other industries, but isn’t part of the reason that it is more limited by HIPAA and privacy concerns that preclude using the usual consumer-grade tools?

I think that’s right. We are not like others, for a couple of reasons. One is the privacy concerns, although I would say a fax is not exactly the most secure form of communication in the world from a HIPAA perspective. It was one of those things grandfathered. But the other thing that I think makes healthcare communications complicated is that a patient record doesn’t fit into a PowerPoint, an Excel spreadsheet, a Word document, or a PDF document, which is how other industries often exchange information and data. A patient record itself is uniquely structured. 

That’s why it’s important to give credit where due. The government’s efforts around interoperability and getting unique forms of patient record exchange established are important. But again, I come back to these unstructured communications, these things that are so important to coordinating patient care. Not everything fits into a CDA. Not everything fits into a patient record when you’re coordinating a referral or a discharge. Sure, you can send structured patient record information, but that’s only a small part of what needs to be done to properly coordinate with an outside provider. That’s where HIPAA and the lack of a common messaging standard for plain old communications make certain types of communication difficult in healthcare.

Unlike hospitals, most community-based practices don’t have big capital budgets, training and technical support teams, and a commonly used brand of EHR. Does that make communication with them harder?

Yes. It also needs to take into account the workflow within a practice, that there are as many different workflows as there are practices. Some community providers are organized centrally, with a coordinator taking care of everything coming in and protecting the doctor from information overload. Others are organized with perhaps a nurse practitioner or a clinical assistant helping the doctor. Others are organized where the doctor really wants to take care of things themselves.

One of the challenges is that hospitals often attempt to impose their solution to clinical communications on the provider in the community without actually taking account of the fact that they are organized differently. They have different information needs, and they certainly have different workflows. All of that needs to be taken into account when designing a communication strategy, for example, with a hospital and its community providers.

What does a hospital user see and do differently when their organization’s Epic or Cerner system is integrated with CareMesh via APIs?

There are a couple of key things that both the hospital and the community providers get out of that integration. From a hospital perspective, we literally take care of all communications from and between community providers. The hospital doesn’t need to worry about maintaining a directory, dealing with message failures, or having gaps in who they can communicate with.

Our delivery rate is pretty astounding. Only in one out of every 300 communications that the hospital gives us to deliver do we have to go back to the hospital and explain that we can’t deliver it for a particular reason. Very often, that’s because the practitioner has retired or moved out of state or something of that nature. The first thing that the CareMesh solution does is solve or address the problem of the administrative side of communication.

But from a community provider perspective, we don’t force any particular solution on the community provider. We give them multiple options. If they want certain communications delivered by fax or by Direct Secure Messaging, or they want to log into a portal to look at information, they can choose that. If they want information sent centrally or to a delegate of the doctor or to the doctor themselves, they can choose that. We have created a system that allows the community providers themselves to say that if you’re sending a referral, don’t send it to me, send it to this person instead, and I’d actually like it delivered by fax. But every now and then, I’d like to go to a portal and download the patient record. We give as much flexibility to the community providers as possible so that the communications are relevant to them.

Direct addresses were never as simple as they seemed given that a provider can have multiple employers, multiple roles within an employer, and may change employers where some messages should remain within the original practice. Is there a better way to manage the use of the Direct address system?

It’s certainly still a challenge. DirectTrust has done a great job at consolidating a directory of Direct addresses, but the information is only as good as the sources. There’s a chain, if you like, to get the information into the DirectTrust directory. It starts with the organization that employs the doctors and other healthcare professionals and then moves to the HISPs, the health information service providers that run the Direct messaging platform. Then it moves to the DirectTrust directory. That chain can and does break, so often Direct addresses are out of date or they’re not complete.

There are about a million doctors in the country, and we’ve been able to match Direct addresses with a little less than 50% of those. Some of those Direct addresses come from DirectTrust, some from hospital systems, and some from NPPES, which is now collecting that information. We get the data from a variety of sources. But there’s still half of the doctors in the country that don’t have a published Direct address. That represents a fairly big challenge when relying on Direct for communication purposes, in particular, CDA exchange.

One benefit of a fax number is that the receiving organization receives everything that is sent, then intelligently routes each message appropriately. Is there an electronic messaging equivalent?

There are certainly tools around Direct to support that within a number of EHRs. EHRs are able to route messages according to particular rules. One of the things that those of us that are close to healthcare communications would advocate for is Direct working a little bit more like POP email. But that’s really dependent upon the EHR vendors adding more sophistication to their messaging platforms.

In the longer term, there is a strategy that the government is advocating for to create what are called FHIR endpoints. These are essentially web addresses that would allow one healthcare organization to post information into the EHR of another healthcare organization. That could be used for structured communications, like exchanging patient records, or unstructured communications as well. So there is a long-term strategy that could over time close some of the gaps, but it really is a pretty long-term strategy. A lot has to happen for that to solve all of the problems that we’ve been talking about.

What are the challenges involved with maintaining a provider directory?

Maintaining a directory of about 5 million people is a labor of love, but it’s also a big data challenge, and it’s a constantly moving feat. Let’s even narrow that down to just a million doctors. If each of those doctors change a piece of information within their profile every two or three years, such as a change in a location or a communication endpoint, you’re dealing with hundreds of updates that need to take place every day. That’s not something that can conceivably be done manually alone. We heavily rely on big data technologies to pull together the most comprehensive and best view we possibly can of that provider, and we use all sorts of specialized techniques. There’s a concept called master data management that we use to make sure that we present the best possible information possible.

We have also realized that it’s important to design a directory for all, not just some, use cases. We have insurance customers. We have state and local health department customers. We have hospital customers. We have HIEs. We feel that ultimately a single resource that can support many, many different use cases is the only way that anyone is ever going to be able to maintain a strong directory. It’s got to be scaled. It’s got to be heavily utilized by many others. It’s through some of the methods that we talked about that you can gradually get to something that is fit for purpose. It will never be perfect. Anything in big data with 5 million records in it, 5 million providers in it, is never going to be perfect. But it should be good enough to meet the basic needs of registering patients, sending communications, and so on.

How do you see the company’s business changing over the next three or four years?

I think our business is going to evolve as the industry addresses and improves generically on some of the challenges that we’ve talked about. But the foundation of what we do is our directory business, which we brand Search. But a directory on its own is going to be quite limiting in terms of what it can do if it’s not integrated with a communications capability. As we discussed, we augment EHRs and other systems and their native communications capabilities by making it possible to communicate with anyone and everyone.

But the area that is perhaps most interesting as it expands and evolves into a new line of business for us is that once people can find each other and can communicate with them, they then need project management tools and workflow tools to help them manage the patient journey through their particular healthcare condition. It’s those project management tools that we’re providing today, we brand them Navigate, that I think stand the greatest chance of developing into scalable solutions to solve these care coordination challenges that we’ve been talking about.

Morning Headlines 5/23/22

Governor Gianforte, DPHHS Announce Major Investment in Montana’s Health Information Exchange

Montana will invest $20 million in the Big Sky Care Connect HIE, which will fund improvements that include a clinical data repository, ADT alerts, a quality measurement program, and image exchange capabilities.

Why So Slow? Legislators Take on Insurers’ Delays in Approving Prescribed Treatments

Lawmakers attempt to speed up prior authorization approvals by imposing insurer time limits, although an electronic PA process may hold the most promise to get patients their meds faster.

How far has the digitization of medical teaching progressed in times of COVID-19? A multinational survey among medical students and lecturers in German-speaking central Europe

Most medical students have experienced digital education, some to the near exclusion of in-person coursework during the pandemic, but they complain about lack of contact with patients, lecturers, and fellow students.

Monday Morning Update 5/23/22

Top News

The state of Montana will invest $20 million in the Big Sky Care Connect HIE, which will fund improvements to the state-designated HIE that include a clinical data repository, ADT alerts, a quality measurement program, and image exchange capabilities.

BSCC’s members include 75 provider organizations and half of the state’s hospital systems.

Reader Comments

From Preferred Investor: “Re: Cerner. Could stock market conditions cause Oracle to reconsider its acquisition?” I don’t know enough to comment beyond restating known facts. ORCL is paying $95 per share in cash, and of course CERN shares haven’t budged from that price in the mean time since everybody knows the eventual payoff. ORCL shares are down 23% since the deal was announced December 20 versus the S&P 500’s 15% drop. Oracle’s tender offer expires on June 6 after being extended a few times. The deal requires Cerner to pay Oracle a $950 million termination fee under certain circumstances, but I don’t know what if anything happens if Oracle reconsiders. I’ll invite experts to weigh in.

From Ballywood Man: “Re: [company name omitted]. Getting out of the North America provider market due to diminishing success, will focus on life sciences, pharma, and payers / insurers. They  ran into issues providing competitive offshore services for Cerner and Epic customers and accounts are managed by people who came through the IT ranks and know nothing about healthcare solutions as required for consultative selling. Senior sales and consulting leadership has been RIFed. “ Unverified, so I’ve left out the name of the publicly traded company. Reports are welcome. The RIF must have been recent since I see no LinkedIn changes for the executives listed.

HIStalk Announcements and Requests

Few poll respondents see Epic as being better without Judy Faulkner. Sam observes that, like Amazon, changing CEOs shouldn’t trigger major changes since Epic’s culture is wide and deep. IIRC differs, providing examples where the departure of larger-than-life leaders has a negative company impact (giving as examples Meditech, Cerner, GE, Microsoft, and Chrysler). Others are confident that Carl Dvorak has been running the company with Judy and can easily take over, especially given the extensive succession planning that Epic has been performing for decades.

New poll to your right or here: What impact will a stock market downturn have on health IT?

Listening: Aeon Station, basically a solo project of the former co-leader of the Wrens, a band I’ve liked for years. Indie rock, especially the melodic and thoughtful kind, has been somewhat lost in a sea of vapid hip hop collaborations and diva-led formulaic hit factories, so this mature, low-tech alternative sounds fine to my ear. The duct tape that holds Kevin Whelan’s bass guitar together deserves a liner note.

Welcome to new HIStalk Platinum Sponsor Juniper Networks of Sunnyvale, CA. Juniper Networks empowers healthcare IT leaders to deliver simplified experiences for those who run networks and the patients, clinicians, and staff who depend on them. Our solutions deliver industry-leading insight, automation, security, and AI for improved IT operations resulting in better experiences and health outcomes. Thanks to Juniper Networks for supporting HIStalk.

I found this Juniper Networks YouTube video that features Northeast Georgia Health System CIO Chris Paravate, MBA talking about the health system’s AI-powered clinician mobility strategy.

Webinars

May 25 (Wednesday) 2 ET. “Leveling Up Your Defenses: Health IT Security and Risk Management.” Sponsor: Intelligent Medical Objects. Presenters: Lori Kevin, VP of security and enterprise IT, IMO; Nicole Pearce, JD, associate general counsel, IMO. The presenters will explain how to fortify security and respond to current threats by establishing security frameworks and managing risks introduced by ransomware attacks, breaches, and phishing schemes. They will describe the drivers of IMO’s privacy and security program, objectives for continuous review of risk management, and the framework for implementing an incident response program.

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

Acquisitions, Funding, Business, and Stock

“Venture Valkyrie” Lisa Suennen applies her experience from the dot-com bust and 2008 stock market correction to predict how recent market drops might affect investors and startups:

• A venture capital downturn lags a stock market decline by 3-6 months.
• The lack of a healthy IPO market means private companies can’t go public and can exit only by selling out. VCs take advantage of the situation by making lowball offers.
• Publicly traded potential acquirers pass on deals involving companies that will dilute their earnings per share, which includes most startups.
• Cash-heavy venture funds will hoard the best deals and lead “down rounds” in investing at lower valuations, damaging smaller, capital-poor funds that can’t afford to meet term sheet requirements of making ongoing investments.
• Companies with less funding or less-resourced investors have to keep the company going to avoid a downward spiral of lower valuations, trading “growth at all costs” for cost-reducing survival mode where company fundamentals suddenly matter.
• Capital-rich funds get to buy later-stage companies at lower valuations.
• Angel investors head for the exits “when the drain is working faster than the tap.”

People

Interoperability vendor Health Gorilla hires Derek Plansky, SM (Informatic Ideas) as SVP of product.

The HCI Solution promotes Dan Collins to EVP.

Care New England Health System CIO Phil Kahn, MS, MBA retires this week.

Announcements and Implementations

Integrated healthcare payments and security software vendor Sphere launches a plug-and-play payment solution, which integrates with PAX terminals, for independent software vendors that offer SaaS products.

Other

A survey of medical students in German-speaking countries finds that while most received some form of rapidly implemented digital education during the pandemic, they didn’t like the lack of patient contact, in-person case studies and discussions, and studying PowerPoints and PDFs alone without instructor interaction. The students suggest that medical schools expand their use of online office hours, faculty Q&A sessions, and simulations and virtual reality.

A Michigan law that takes effect next year will require health plans to take action on urgent prior authorization requests within 72 hours, although a Blue Cross Blue Shield Association VP says that electronic prior authorization holds the most promise for reducing delays, citing a pilot project in which decision time was reduced 69% to six hours.

Former Vanderbilt University Medical Center ICU nurse RaDonda Vaught, who killed a patient in 2017 by giving the paralyzing agent vecuronium instead of the ordered sedative Versed, is interviewed by ABC News following her sentencing to probation:

• VUMC settled with the patient’s family without reporting the error to state and federal officials as the law requires.
• Vaught says she performed manual overrides of the drug dispensing system and ignored several warnings because she was training a new nurse and was distracted.
• Her attorneys say VUMC bears some responsibility because it allowed her to override warnings and a CMS investigation noted some deficiencies, although VUMC was not punished.
• Vaught concludes, “There’s a fine line between blame and responsibility, and in healthcare, we don’t blame. I’m responsible for what I failed to do. Vanderbilt is responsible for what they failed to do.”

Sponsor Updates

• ZeOmega integrates Change Healthcare’s clinical guidelines into its new Smart Auth Gateway electronic prior authorization solution.
• Experity’s EHR/PM software has been recognized with a 2022 MedTech Breakthrough Award in the best practice management solution category.
• CarePort releases its “Evolution of Care” report.
• Arcadia wins the KLAS 2022 Points of Light award for its collaboration with Community Health Plan of Washington.
• Olive has invested in Miami University’s College of Engineering and Computing to expand its healthcare research capabilities.
• The HIT Like a Girl Podcast features PeriGen CNO Alana McGolrick.
• The VA’s Cerner-powered Opioid Advisor wins FedHealthIT’s innovation award.
• Drug Store News LexisNexis Risk Solutions, OmniSys, and Surescripts with Retail Excellence Awards in the technology and automation category.
• Wolters Kluwer Health Director of Clinical Sales Support Karen Eckert wins the National Council for Prescription Drug Programs’ Benjamin D. Ward Distinguished Member Award.
• HFMA’s Voices in Healthcare Finance Podcast features VisiQuate EVP of Product Management Anthony Comfort.

Blog Posts

• Your Business is NOT Data Illiterate! (Clearsense)
• 4 Healthcare Transaction Trends to Know (BDO)
• Inefficient Access Pathways Cost More Than Just HCP Time and Effort (OptimizeRx)
• Digital communication tools can break down language barriers in healthcare (Olive)
• Nurses of Note Awards 2022: The Nurse Informatics Team at Mecklenburg County Public Health (PerfectServe)
• Healthcare Supply Chain Software Improves Providers’ Work, Promotes Partnership (Symplr)
• Improving HCC Coding Accuracy with Stanson Health’s PINC AI clinical decision support at Bon Secours Mercy Health (Premier)
• Determined to Deliver (Protenus)
• Straight talk on remote mental healthcare (Redox)
• Now is the Time for Health Tech to Capitalize on Legislation Moves (RxRevu)
• Understanding the impact of objective, automated evaluation of mammograms (Volpara Health)
• 5 Things to Look for in a Modern EMR Platform (WebPT)
• CIO Top Priorities: Embracing Digital Transformation in Healthcare (Well Health)

Contacts

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

Morning Headlines 5/20/22

Doximity Announces Fourth Quarter and Fiscal Year 2022 Financial Results

Physician social network and pharma marketing vendor Doximity reports Q4 results: revenue up 40%, adjusted EPS $0.21 versus $0.09, providing lowered guidance that sent shares to all-time lows in after-hours trading Tuesday.

Harris Expands in California with the Acquisitions of Innovative Medical Management and MedBill IQ

Harris acquires workers’ compensation EHR/PM/RCM vendor Innovative Medical Management and MedBill IQ, which will become part of the company’s Resolve Healthcare revenue cycle business unit.

IU health doctor says he was fired for objecting to visit time limit

An internal medicine physician sues Indiana University Health, which he claims fired him for complaining about a policy that limits doctor visits to 10 minutes as monitored via the EHR.

News 5/20/22

Top News

The board of online mental health provider Cerebral fires co-founder and CEO Kyle Robertson and shakes up the remaining management team. The company is facing a federal probe into whether it took advantage of pandemic-relaxed mental telehealth regulations to issue excessive numbers of Adderall and Xanax prescriptions to drug-seeking customers.

Cerebral says it will stop prescribing most controlled substances, starting with new patients this week and to existing patients by October.

Cerebral was valued by its most recent investment at nearly $5 billion.

HIStalk Announcements and Requests

I sometimes include a click counter on links that I run, for two reasons: (a) It helps me fine-tune the kinds of news items I write about based on reader interest; and (b) I’m curious about which companies readers follow. I took a rare look today at the results over time:

• The top four most-clicked items were the links that I included in a new sponsor announcement, which ranged from 4,100 to 5,800.
• A company’s top-of-page banner got 4,000 clicks, while the one before that drew 3,700.
• The highest-drawing webinar link has received 3,600 clicks.
• My favorite write-up about the Valcom guys and their post-HIMSS18 adventures with the Smokin’ Doc in Las Vegas drew 3,400 clicks to Valcom’s website.

I just started playing around with no-code web builder Bubble, which seems pretty cool. The fully functional demo allows editing a copy of Bubble’s home page, which of course was developed with its own product. An alternative for developers who need to use an existing SQL database (instead of creating a database within Bubble) is WeWeb. Both would be useful for developing prototypes or minimum viable products or quickly creating internal company tools. Stacker is even simpler in using Airtable or Google Sheets as a source database. 

I had personal experience with the hotel equivalent of a digital front door this week when I visited a surgery-recovering relative and spent a single night in a cheap chain hotel I had booked through Expedia, which I allow to send me text messages. I received a reservation reminder with contact information a couple of days ahead of time; received check-in messages containing the wifi password, a link to local restaurants, and inviting me to respond to management with my first-impression room experience and to let them know if I need anything; and got a message at checkout thanking me and wishing me safe travels. My lesson learned – hotels and restaurants always lament that customers should alert management to problems in real time instead of ripping them in online reviews later when it’s too late to address the problem, so the hotel’s texts let them detect improvement opportunities as they occur. Hospitals and practices have ample such opportunities, but I’m not sure they are as eager or incented as a budget hotel to hear what customers think about excessive waits or surly personnel.

Webinars

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

Acquisitions, Funding, Business, and Stock

Multi-specialty national telehealth provider MeMD, acquired by Walmart in May 2021, changes its name to Walmart Health Virtual Care. The service, which includes a diabetes program, will expand beyond Florida in the next several months.

Physician social network and pharma marketing vendor Doximity reports Q4 results: revenue up 40%, adjusted EPS $0.21 versus $0.09, providing lowered guidance that sent shares to all-time lows in after-hours trading Tuesday. DOXM shares began trading in June 2021 at $26, then closed their first day at $53. They rebounded Thursday to $32.39, down 43% in the past 12 months in valuing the company at $6.2 billion. Doximity is promoting digital-first drug marketing campaigns, noting that drug companies are cutting back on salespeople and moving money to digital advertising. The company said in the earnings call that pharma is recession-resilient and that physician resignations are good for its business because Doximity sells job-seeking doctors 30-day temporary phone numbers that they can give to recruiters who then can’t “keep calling and texting you for years.”

Harris acquires workers’ compensation EHR/PM/RCM vendor Innovative Medical Management and MedBill IQ, which will become part of the company’s Resolve Healthcare revenue cycle business unit.

Amwell launches a behavioral health program that includes virtual therapy, psychiatry, and coaching. The program incorporates the digital behavioral health programs of SilverCloud Health, which Amwell acquired in July 2021 along with virtual care company Conversa Health for $320 million.

Transcarent adds a behavioral care offering that will connect its self-insured employer members with virtual or in-person mental health providers.

Sales

• Charlotte Radiology will implement Volpara Health’s breast density assessment, mammography reporting, and patient communication software, expanding its use of the Volpara Analytics mammography quality assurance system.
• Zing Health selects Availity’s real-time health information network to allow providers to share information to close clinical care gaps.
• The Wyoming Board of Pharmacy chooses Bamboo Health for its prescription drug monitoring program.

People

John Kelly (PatientKeeper) joins Xifin as CIO.

Divurgent promotes Brittany Williams to VP of marketing and communications.

Adam Seyb (West Monroe) joins Janus Health as chief customer officer.

Imaware promotes Angie Inlow to chief growth officer.

Art Nicholas (Sakon) joins Strata Health US as chief commercial officer.

Mark Grasso (Virtustream) joins Holon Solutions as VP of sales.

SyTrue hires Steven Lang (Apixio) as SVP of sales.

Announcements and Implementations

CPSI pilots Medicomp’s Quippe Clinical Lens to enhance the information in its Patient Data Console.

Cerner, Elligo Health Research (in which Cerner is an investor), and Freenome will participate in an early cancer detection clinical trial using Cerner’s Learning Health Network, which sells de-identified patient data from participating health systems.

UTHealth Houston celebrates its March 2021 go-live on Epic that was performed with all members of Epic’s team, its own project team, and many of its end users working remotely. They earned a $550,000 Good Install credit from Epic.

Other

An internal medicine physician sues Indiana University Health, which he claims fired him for complaining about a policy that limits doctor visits to 10 minutes as monitored via the EHR. An IU Health spokesperson responded that the 10-minute EHR time limit doesn’t necessarily include face-to-face time and in fact was intended to encourage more doctor-patient interaction instead of computer work. The doctor, IU School of Medicine Clinical Assistant Professor Brian Leon, MD, was also a medical director and is a pharmacist.

Researchers find that AI can identify a patient’s race from their X-ray images, raising concerns of inadvertent bias. The study authors found that AI can predict a patient’s self-reported race even when image quality is poor and when clinicians cannot.

Cerner will pay an unreported sum to Sweden’s Västra Götaland to settle complaints over Millennium implementation delays that Cerner attributes to the pandemic and to the region itself. Cerner says it is ready to proceed with the project, has 250 employees working in Sweden, and plans to bring up parts of the system this fall. The region was reportedly seeking payment of $50 million to offset its increased costs.

Malaysia’s government-developed COVID-19 app, which has 38 million registered users, sees usage drop 97% as national check-in requirements are dropped and controversy has erupted over the app’s ownership. The government had planned to expand the app’s use beyond COVID and as a key part of public health efforts.

A Tennessee county that was touted as the exception to low vaccination rates among rural, white, and conservative Southern counties drops to mid-pack after a longstanding ZIP code problem is fixed. The state manually corrected cases in which a single ZIP code straddles multiple counties, as incorrectly reported by Arizona-based STChealth, whose immunization information system is used by several states. Meigs County dropped from 65% to 43% vaccinated overnight. The state says STChealth is fixing the problem, but other states avoided the issue in the first place by geocoding the company’s data for correct county attribution.

Sponsor Updates

• First Databank hires Vivian Nguyen (Pine Park Health) as a customer success solution architect.
• GHX has recognized the recipients of its 21st annual GHXcellence Awards during its annual summit.
• Gyant has completed the Service Organization Controls 2 Type II certification.
• Nordic publishes a video titled “Modernizing Healthcare Data Infrastructure with the Cloud.”
• Meditech congratulates DCH Health CIO Billy Helmandollar for receiving the Alabama Chapter ORBIE CIO of the Year Award in the large corporate category.
• RCxRules publishes a free EBook titled “Simplify Your Revenue Cycle Workflow Through Automation.”
• Nuance congratulates Mary Presti, head of Dragon Medical, on her Lillian Sholtis Brunner Alumni Award for Innovation from Penn Nursing.
• Netsmart COO Tom Herzog signs the ESGR Statement of Support to show its dedication to employees who serve in the National Guard and Reserves.
• Nordic transitions the Tasman brand, and its presence in Europe and the Middle East, to the Nordic global brand.

Blog Posts

• Telemedicine for a Post-COVID World (EVisit)
• 4 strategies to find missing insurance coverage as COVID-19 funding ends (Experian Health)
• Behavioral Health Support Drives Whole Health (Get Well)
• Two Ways to Increase Your Patient Engagement (Healthwise)
• Your Business is NOT Data Illiterate! (Clearsense)
• Protect your Healthcare Organization from Third-Party Risks (Optimum Healthcare IT)
• Essential ephemera: The sad, over-too-quickly life of a wearable datum (Nordic)
• Payment models and value-based care (Intelligent Medical Objects)
• Habilitative vs. Rehabilitative Therapy Billing Differences (MWTherapy)
• Get the FAQs About Automated Prior Authorization (Myndshft)
• Measurement-Based Care is Crucial to Behavioral Health, and It Needs an Upgrade (Neuroflow)

Contacts

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

EPtalk by Dr. Jayne 5/19/22

A friend clued me in to an article about the state of patients’ ability to schedule their own healthcare visits. It points out all the industries that have migrated from scheduling via human interaction to scheduling online: airlines, restaurants, and fitness programs are examples. The authors note that some demographic groups want to avoid making phone calls “like the plague” and go further to comment that “there’s no better way to forcibly eject younger generations from your onboarding and acquisition process than by putting them on hold.”

The article provides a great summary of the difficulties in allowing direct scheduling, including pre-visit requirements, insurance requirements, and varying lengths of appointment slots. For some specialties, there’s also the risk of rescheduled or bumped appointments due to emergencies or operating room delays. They dig into issues around physician preferences and control as well.

When I worked on my first EHR implementation, it also involved conversion of the practice management system. We reviewed well over 1,000 different appointment types that physicians had demanded over the years and winnowed them down to about 70. We analyzed past performance and found that the physicians who had the most rigid scheduling rules often had unused appointment slots, while those with more flexible “open access” schedules had more consistent use of their schedules.

It’s difficult to wrest control away from physicians who have little business training and who aren’t encouraged to challenge the status quo. It’s even more challenging when their office staff members have developed a culture of shielding the providers from change.

I’ve found that practices can benefit even if they only allow a small subset of visits to be directly scheduled, such as allowing only well visits, since they tend to have longer time slots, or same-day sick visits, which would be shorter time slots that are sometimes worked in to the schedule. One of my personal physician offices allows only same-day sick visits to be scheduled via the patient portal, and they are usually gone by 9 a.m. As long as the technology lift isn’t too heavy, sometimes even a small benefit can give both staff and patients a bit of a morale boost. If your office hasn’t considered making the change, I would strongly recommend starting to dig into the pros and cons.

Speaking of shaking things up: CNBC has published its 2022 Disruptor 50 list, which includes a number of health technology companies that I’ve followed over the years including Medable (distributed clinical trials), TruePill (virtual pharmacy), Maven Clinic (virtual women’s health), Ro (virtual pharmacy and diagnosics), and Oura (wearable ring for fitness data). My favorite addition to the list is Biobot Analytics which uses wastewater to detect disease. In an era where people can skew population health data by specifically opting out of testing, that might be the best way to go in order to determine where the COVID-19 pandemic is going.

Telehealth startup Cerebral has lost its CEO with the departure of Kyle Robertson. The company has been under scrutiny for some time, but experienced increased criticism around its prescribing processes in recent weeks. Cerebral is accused of excessively prescribing stimulant medications such as Adderall. It has received a grand jury subpoena from the US Attorney’s Office for the Eastern District of New York as it investigates possible violations of the Controlled Substances Act. Cerebral has stated it would largely stop prescribing controlled substances, which is likely to create some interesting care-seeking patterns in the brick and mortar world as patients have their refills curtailed.

The changes occurred following a board meeting which included other leadership changes. President and Chief Medical Officer David Mou will take over, COO Jessica Muse will become president, and clinical advisor Thomas Insel will join the board. Cerebral has tried to recruit me as a provider several times, and the way they conduct their recruiting gave me the heebie jeebies as it felt like they were basically trying to rent my license so that they could generate as many prescriptions as possible.

I always enjoy hearing about different EHR vendors and their client conferences. A regular reader clued me in that CPSI is holding its National Client Conference in St. Louis this week. The conference schedule has a number of interesting offerings and wrapped early enough in the evenings for attendees to take advantage of the city’s food scene, including Italian, Vietnamese, and Bosnian offerings. The customer appreciation event featured the Anheuser-Busch Brewery Experience, complete with brewery tours, a biergarten, and of course the Budweiser Clydesdales. Sounds to me like a great way to cap off a conference.

Other things I enjoy hearing about: the intersection of science with one of my favorite treats. The American Institute of Physics journal Physics of Fluids recently explored Oreology, which it defined as “the fracture and flow of milk’s favorite cookie.” Researchers looked at the failure mechanics involved in twisting an Oreo apart, including the variables of filling amount, rotation rate, and flavor. They assessed a stress-strain curve as well as “postmortem crème distribution” that was typically unequal. Researchers went as far as creating an “open-source, three-dimensionally printed Oreometer powered by rubber bands and coins” in order to encourage “higher precision home studies to contribute to new discoveries.”

Little did I know that Oreo filling could be characterized as having “complex or non-Newtonian viscosity” or the many ways in which science impacts the processing of different foods – from using fractional calculus models to evaluate cheese structure to using physics to improve chocolate quality. Although sections of the paper seemed to be bordering on sarcasm, I thoroughly enjoyed reading it and look forward to discussing it with my favorite physics students when I see them over their summer break. The authors note the need for further research on other varieties of sandwich cookies, custard creams, macarons, and ice cream sandwiches, although I’m particularly intrigued by their mention of the physics of Nutter Butters since they were a special childhood treat.

What’s your favorite variety of Oreo? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 5/19/22

Cerebral just replaced CEO Kyle Robertson as the mental-health startup faces increased scrutiny

The board of mental health telemedicine startup Cerebral votes to oust CEO Kyle Robertson amidst federal scrutiny of its controlled substances prescribing practices.

HealthStream Acquires CloudCME

Healthcare continuing education company HealthStream fully acquires CE application vendor CloudCME for an additional $4 million.

Futura Healthcare Announces Acquisition of Leading Healthcare IT Solutions Provider

IT consulting and staffing firm Futura Healthcare acquires competitor Winola Lake Health IT for an undisclosed sum.

Morning Headlines 5/18/22

ThoroughCare Announces $3 Million Capital Raise to Advance Care Coordination for Value-Based Care

Care coordination software company ThoroughCare secures a $3 million investment from Cypress Growth Capital.

Chillicothe VA reviewed after allegations of failing to follow a consultation process

A VA Office of Inspector General report determines that lack of prompt EHR documentation and care coordination between a VA provider and private chiropractic clinic contributed to the spinal and rib fractures of an 87 year-old patient.

National Medical Billing Services Announces Acquisition of Medi-Corp, Inc.

National Medical Billing Services, an RCM vendor focused on the surgical market, acquires Medi-Corp, which offers RCM services for anesthesia, ASCs, and pain management providers.

News 5/18/22

Top News

A Venezuelan cardiologist and self-taught programmer is charged with the development, use, and sale of plug-and-play ransomware and creating profit-sharing arrangements with his customers, whom he often persuaded to leave positive online reviews.

The criminal complaint, brought against him by US authorities, claims that “the multi-tasking doctor treated patients, created and named his cyber tool after death, profited from a global ransomware ecosystem in which he sold the tools for conducting ransomware attacks, trained the attackers about how to extort victims, and then boasted about successful attacks.”

The cardiologist’s preferred pseudonyms included “Aesculapius” and “Nosophoros,” Greek words referring to the ancient Greek god of medicine and disease, respectively.

Webinars

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

Acquisitions, Funding, Business, and Stock

PatientIQ, an outcomes data and insights vendor, raises $20 million in a Series B funding round. The company gathers its data from 1.4 million patients across more than 200 healthcare organizations.

Sales

• Bon Secours Mercy Health will use Strive Health’s CareMultiplier technology and clinical care teams to improve its care for chronic kidney disease and end stage kidney disease patients across Ohio.

People

CTG names Scott Clark (Ensono) VP of North American sales.

Mikael Öhman (TransformativeMed) joins KMS Healthcare as CEO.

Bakul Patel, former chief digital health officer at the FDA, joins Google as senior director of global digital health strategy.

University Hospital hires Paul Contino, MA (Guthrie) as CIO.

Thynk Health hires Jim Farmer (FYNS) as SVP of sales.

CPSI President and CEO Boyd Douglas will retire from that position and the company’s board on June 30 after 34 years. Replacing him is COO Chris Fowler.

Announcements and Implementations

Novant Health (NC) works with Health Recovery Solutions to launch a remote patient monitoring pilot program for bariatric patients.

In England, The Queen Elizabeth Hospital King’s Lynn NHS Trust implements enterprise imaging software from Agfa HealthCare.

In Norway, Helseplattformen brings Trondheim kommune live on Epic. Epic’s Rachel Kantosky reports on LinkedIn,

On top of the complexities of a ‘typical’ Epic install, the team added enterprise applications into a system live solely on Beaker lab, translated over 4 million system terms into Norwegian, and completed several significant development projects, including SFM ePrescribing integration, eMessaging, and digitizing the Norwegian pregnancy card. Go-live is just the beginning and we are looking forward to further rollouts and optimization! I’m also incredibly proud of the 32 American expats who moved their lives to Norway to support this important work.

Government and Politics

A VA Office of Inspector General report determines that lack of prompt EHR documentation and care coordination between a VA provider and private chiropractic clinic contributed to the spinal and rib fractures of an 87 year-old patient. The nearly century-old Ohio facility is one of 35 that the VA is considering closing within the next several years.

DoD facilities including Naval Branch Health Clinic and the 3rd Combat Aviation Brigade, Hunter Army Airfield, both in Georgia, will transition to MHS Genesis next month.

Other

A lawyer and veteran advocate writes a satirical article on using the VA’s MyHealtheVet to “micro-manage your VA doctor from your sofa.” A snip:

I swear, sometimes, I feel like some VA personnel intentionally dupe us into keeping a request verbal. When the floor falls out on whatever issue you were trying to resolve, when the time comes to “prove it,” the conversation never happened. It will be your word against theirs, and you will lose. Remember, if it’s not written down, it did not happen. This is why tools like My HealtheVet are so great. It can allow you direct access to your care team. It allows you direct access to at least some (but not all) of your health records. It gives you the power to put it in writing even after the appointment, just to be sure everyone is on the same page. What an empowering tool, no? Should your physician refuse a procedure but not write it down, you can send a note about it later that should be added to your records. If you need to appeal the refusal in a clinical appeal, healthcare appeal, or if it comes up in a malpractice matter, the request will be documented.

A nurse and former cardiovascular director sues MercyOne, alleging that she was fired in retaliation after she reported that a cardiothoracic surgeon was not obtaining proper patient consent, was performing too many add-on procedures, lied to patients about likely outcomes, and put patients with poor post-surgical outcomes on ventilators for 30 days so their deaths would not be reported to the Society of Thoracic Surgeons database as being due to surgical complications. She also claims the surgeon screamed at her in a meeting about the issues and referred to her as “this little girl.”

Sponsor Updates

• About releases a new podcast, “US Healthcare: Understanding Challenging Trends for Hospitals and Health Systems with David Burik.”
• Availity makes its Enhanced Claims Status, a multi-payer RESTful API, available to its trading partner network.
• BDO expands its alliance with Microsoft to deliver solutions that create value for its global clients.
• TechVibe radio features ConnectiveRX VP of Product Development Mary Beth Sirio.
• Get-to-Market Health celebrates its five-year anniversary.
• Experity earns 2022 Great Place to Work Certification.
• Sonifi Health integrates the HealthTouch food service system from MCR Technologies into its interactive patient engagement platform.
• Imaging data vendor OneMedNet announces a joint referral partnership agreement with data management company Flywheel for biomedical research and collaboration.

Blog Posts

• RCD: What You Need to Know (Ability Network)
• Stop Making Patients Work So Hard (Orbita)
• Healthcare Claim Denials: How to avoid common medical coding errors (AGS Health)
• It’s a Small World in Clinical Communication and Collaboration (Ascom)
• Peer-Reviewed Study Validates NarxCare as Effective Patient Screening Solution for Opioid Risk (Bamboo Health)
• Pros and cons of centralized vs. decentralized staffing models for value-based care success (Bravado Health)
• Healthcare M&A: Why Clinical Operational Readiness Matters (CereCore)
• A Look at Risk Analysis – 9 Steps to Getting It Right (Clearwater)
• Asembia 2022: Specialty Patient Access, Centricity and Adherence (CoverMyMeds)
• The Benefits of Partnering with the Right Healthcare IT Managed Services Provider (Divurgent)
• HEDIS: Completing the Picture of Patients’ Health (EClinicalWorks)
• 5 Essential Qualities of Front Office Staff (Experity)
• Hiring an Epic Team? Start with a plan. (Healthcare IT Leaders)

Contacts

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

Morning Headlines 5/17/22

Skylight Health Group Reports First Quarter 2022 Financial Results

Skylight Health Group, a multi-state practice management company, attributes its 18% dip in revenue from the previous quarter to implementation of Athenahealth’s EHR across its practices, and a reduction in COVID-19-related urgent care visits.

Hacker and Ransomware Designer Charged for Use and Sale of Ransomware, and Profit Sharing Arrangements with Cybercriminals

A practicing Venezuelan cardiologist has been charged with the use and sale of ransomware, and profit-sharing arrangements with his customers.

Change Healthcare brings lawsuit against former employee

Change Healthcare sues a former employee, now working at Olive, for violating his contract’s non-compete clause by going to work for a direct competitor.

Curbside Consult with Dr. Jayne 5/16/22

With the rise of telehealth, there’s a lot of discussion about “web side manner” and the strategies that physicians and other clinicians should use when evaluating and treating patients via telehealth.

I’ve worked for a variety of telehealth employers, some which require their clinicians to wear a white coat and others who are fine with what they discuss as a “professional” dress code. For many years in the hospital culture, white coats were considered a symbol of being a physician or physician in training. Typically, medical students wore short coats and those with their degrees wore longer coats. However, over time, many other clinicians began to wear white coats both short and long, including pharmacists, nurse practitioners, physician assistants, and more.

The use of the white coat also evolved at the department level. At the hospital where I primarily trained, medical students wore short coats and residents, fellows, and attendings wore long coats. Except, that is, for the surgery department, where interns and first-year residents were further hazed by being required to continue to wear short coats.

However, the policy in the operating suites was that if you were wearing surgical scrubs and needed to leave the area, you were required to put on a long white coat or a “cover gown” to protect the surgical scrubs from non-OR contacts. However, the surgery interns knew they’d get in trouble if they were caught in long coats, so if they left the OR and there were no cover gowns available, they’d have to change back into street clothes and then don new scrubs when they returned. They detested the fact that students could wear the long coats in that situation, but they couldn’t.

The surgery interns were further hazed by being required to wear ties if male, and not being allowed to eat or drink anywhere but the hospital cafeteria or a break room. Where the rest of us could scurry away from the cafeteria holding a to-go cup and finish it in the elevator on the way back to our duty assignment, the surgical residents had to either chug it in the cafeteria or remove the straw to make it look like they weren’t drinking it until they got to their destination. There were a lot of other elements of hazing in those programs, and needless to say, they were a turn-off for a lot of students rotating on the service. This was also long before COVID, when masks changed how we handle food and drink in hospitals.

Since the white coat is no longer a definitive indicator, quite a few of the hospitals that I’ve worked at have taken to other methods to make sure patients know the credentials of different members of their care teams, including oversized name badge frames or backings that contain prominent credentials such as MD or DO or RN written in bold font that is nearly an inch tall. Still, there’s often confusion about who is caring for the patient, as noted in this recent Medscape article.

Despite all our advances in patient engagement and consent, the use of whiteboards, bedside technologies to track the care team, and more, patients are still confused about who they’re talking to. Some of that can have situational influences since hospitals are strange and unfamiliar places with routines that don’t often make sense. Patients may be less perceptive than usual due to illness or being overtired, since we know that hospitals aren’t great places to get rest.

Following the emergence of COVID-19, those bold credential nametags became even more necessary as many of us ditched white coats (which were largely used for their pockets anyway) in favor of scrubs that we could change before going home. Neckties all but disappeared as we tried to understand the nature of this novel pathogen. Other countries had previously moved away from white coats and neckties due to the infection risk, but the US has been a holdout. When I spent some time in a healthcare institution in the UK many years ago, no one wore sleeves of any kind below mid-forearm to allow for better hand hygiene, and neckties had also been voted off the healthcare island.

Still, there’s the question of how clinicians should dress for telehealth visits. The reality is that our world has become much more casual since the start of the pandemic. Plus, there’s no need for those white coat pockets when you’re sitting at a desk and can use a laptop, PC, or phone to access references rather than having to tote around a “Washington Manual” and a “Pocket Pharmacopeia.” However, there’s still that association of the white coat with professionalism.

The article cites research done at Johns Hopkins to look at patient preferences. Nearly 500 adults were surveyed in the spring of 2020. They were asked about various types of dress, including white coats, scrubs, and fleece or softshell jackets with the institution’s logo. They were also asked to rank photos of models in various attire to identify their level of experience, professionalism, and friendliness. Those models in white coats were seen as experienced and professional, while those in softshell jackets were seen as friendlier. Responses varied by age of those surveyed as well as their geographical location. The white coat seemed to be favored by older respondents as a mark of professionalism.

Another study conducted at NYU Grossman School of Medicine in 2018 surveyed over 4,000 patients at 10 academic medical centers. Those patients preferred formal dress and a white coat, but it would be interesting to see what a study of that size would show in the pandemic-era and whether the results would hold across different encounter settings including inpatient, outpatient, and telehealth visits. At least for the majority of patients receiving telehealth services, they’re not being seen by a whole team of people, so I would hypothesize that the white coat is not necessarily helpful to avoid confusion on what type of provider is present.

Personally, I prefer not to wear the white coat while conducting telehealth visits. I wore it only intermittently in my solo practice, mostly because I had no need for the pockets and everyone knew I was the doctor. In the emergency department, I wore it for the pockets, but ditched it when I went to urgent care. I did bring it back for COVID, partly because my employer couldn’t provide adequate gowns and it was one more layer of protection, not to mention I didn’t want a stethoscope around my neck given our initial lack of understanding about COVID transmission – pockets made much more sense.

Still, I wear it on certain telehealth visits when a particular employer requires it, even though I don’t like it and I don’t think the patients really care. It will be interesting to see how telehealth culture evolves over the next few years and whether the white coat becomes more or less of a requirement.

What does your institution think about white coats and telehealth? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 5/16/22

PatientIQ Raises $20M to Transform Patient Outcomes Data into Actionable Intelligence that Advances Clinical Care

PatientIQ, a patient outcomes data and insights vendor, raises $20 million in a Series B funding round.

Amwell Announces Results for First Quarter 2022

Amwell announces Q1 results: revenue up 11%, EPS –$0.26 versus –$0.16, missing analyst expectations for both.

Remote Monitoring and Behavioral Economics in Managing Heart Failure in Patients Discharged From the Hospital: A Randomized Clinical Trial

A randomized clinical trial finds that remote monitoring and financial incentives had no impact on readmissions or deaths among discharged heart failure patients.

Monday Morning Update 5/16/22

Top News

Remote monitoring and financial incentives had no impact on readmissions or deaths among discharged heart failure patients, a randomized clinical trial finds.

Participants were given a digital scale, a monitored pill bottle for diuretics, and daily “regret lottery” incentives for providing medication and weight measures from the previous day.

The authors conclude that success may require earlier or deeper patient engagement and might need to include unrelated issues that cause HF readmissions.

HIStalk Announcements and Requests

These are timely poll results since former Vanderbilt nurse RaDonda Vaught was sentenced Friday to three years of probation (no jail time) following her conviction on negligent homicide charges after killing a patient by giving the wrong medication. Most poll respondents favor open investigations and a review of the work setting rather than charging clinicians with a crime or revoking their license. I spent time reviewing technology-related medical errors in a large academic medical center and the “Swiss cheese effect” is real, where errors were rarely caused by one rogue, incompetent clinician but rather by a series of unusually aligned events, such as systems going down, drug shortages that required substituting an unfamiliar alternative, and lack of coordination in workload-necessitated handoffs among clinicians who weren’t accustomed to working together. It’s not like insurance fraud, where someone takes individual illegal action in return for payment. It’s more like a skilled programmer who makes an honest mistake that affects users because they are overworked or undertrained and the programmer’s employer doesn’t run a competent QA function.

New poll to your right or here: What will be the impact on Epic when CEO Judy Faulkner is no longer involved? She will turn 79 this year and the company’s succession plan will eventually take effect. We saw dramatic changes when Cerner CEO and Chairman Neal Patterson died in 2017, leaving the company without its leader and most visible co-founder for the first time in its 38-year history.

I’m getting more of my “People” updates from LinkedIn since organizations don’t always issue formal announcements. Connect with me and I’ll see and possibly mention your job change. Minimal effort is required and there’s no downside.

Webinars

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

Acquisitions, Funding, Business, and Stock

West Monroe will expand its its digital services business in Western Europe, opening new offices and hiring 1,000 employees.

Amwell announces Q1 results: revenue up 11%, EPS –$0.26 versus –$0.16, missing analyst expectations for both. AMWL shares are down 88% in the past 12 months versus the Nasdaq’s 6.6% gain, valuing the company at $855 million. The company spent most of the earnings call talking about Converge, a technology platform that it says will improve patient connectivity and user experience when interacting with providers and payers.

Sales

• The UK’s Kent NHS trusts choose Sectra’s enterprise imaging system.

People

Community Health Systems promotes Paul Novak to CIO.

Announcements and Implementations

TriNetX enhances its real-world research offerings by launching Follow the Patient, which allows researchers to segment, tag, and monitor de-identified patients over months or years.

Hospitals of Community Health Systems that offer OB services implement PeriGen’s PeriWatch Vigilance for maternal-fetal early warning.

HLTH retools its November conference to push attendees into the exhibit hall (or in its own buzzwords, “focus on audience journeys–tailoring pathways through content, programs, and meetings based on a deeper learning about each population and individual that interacts with us.”) Attendees will be required to sit in the exhibit hall for sessions and meals, the conference will emphasize the “hosted buyer” format in which healthcare buyer attendees earn registration discounts for meeting with vendors, and both HLTH and ViVE will offer a digital health innovation track that is co-sponsored with investment company StartUp Health.

Other

South Korea requires hospitals to install video surveillance cameras in operating rooms to record all surgeries involving general anesthesia, as lawmakers address widespread reports of “ghost surgeries” in which doctors turn procedures over to unsupervised assistants. The problem arose in the 2010s as the government started promoted medical tourism and plastic surgeons took advantage of demand by allowing nurses, assistants, and even medical device technicians to perform procedures. The practice then spread to spinal surgery centers that saw a profitable opportunity when faced with high demand and few available doctors to perform relatively uncomplicated surgeries.

I missed this earlier. Netherlands-based Aimedis creates Aimedis Health City, which it calls “the first hospital chain in the metaverse” in which de-identified data will be exchanged and monetized. It plans to offer provider advertising, virtual consultations, patient and clinician interaction, education, and rehab courses. It will offer space for rent or purchase using its own NFT marketplace.

Sponsor Updates

• Tegria partners with the One Roof Foundation and Duwamish River Community Coalition to provide asthma remediation items to local families.
• OptimizeRx will present at the RBC Healthcare Conference May 17-18 in New York City.
• Olive publishes a new analysis, “Long COVID leads to longer hospital stays, time in OR.”
• HLTH releases a new podcast featuring Optum MedExpress CEO Kristi Henderson, NP.
• Community Health Systems will present encouraging results seen after its implementation of PeriGen’s Vigilance early warning and clinical decision support system at the IHI Patient Safety Congress May 16-18 in Dallas.
• Talkdesk has won 2022 Top Rated Awards for contact center, call center workforce optimization, call recording, and VoIP.
• Twistle will exhibit at the OR Business Management Conference May 16-18 in San Antonio.
• Volpara Health will exhibit at the SBI/ACR Breast Imaging Symposium May 16-19 in Savannah.
• Wolters Kluwer Health publishes a new book, “Coping with COVID-19: The Mental, Medical, and Social Consequences of the Pandemic.”
• Zen Healthcare IT achieves HITRUST risk-based, two-year certification to mitigate risk in third-party privacy and security.

Blog Posts

• Connect with Providers When Their Patients Need to Change Therapies (OptimizeRx)
• Navigating the Medication Journey: How Digital Patient Engagement Tools Help (PatientBond)
• Innovating for Tomorrow (Protenus)
• 3 Reasons Why It’s Time to Switch to a Concurrent Risk Adjustment Review (RCxRules)
• The Role of Price Transparency in Improving Patient Access to Care (RxRevu)
• 6 Questions to Ask When Evaluating Clinical Communication & Collaboration (TigerConnect)
• How to Improve Patient Adherence for Physical Therapy (WebPT)

Contacts

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

Morning Headlines 5/13/22

Cerner falls short of contract target for ‘uptime,’ prompting McMorris Rodgers to accuse VA of ‘blatant negligence’ over computer outages

Cerner will issue the VA an unspecified credit for failing to meet the minimum system uptime requirements specified in the $10 billion contract.

Managers of Arizona Telemedicine Company Admit Roles in $64 Million Nationwide Kickback, Health Care Fraud Schemes

Two owners of a “purported” telemedicine company plead guilty to participating in an elaborate scheme of bribes, kickbacks, and fraudulent prescriptions for drugs and medical equipment that netted them $32 million and cost insurers $64 million.

OncoHealth Secures Strategic Investments from Arsenal Capital Partners & McKesson Corporation

Oncology-focused digital health company OncoHealth secures unspecified investments from Arsenal Capital Partners and McKesson.

News 5/13/22

Top News

Bon Secours Mercy Health launches Accrete Health Partners, a digital holding company that will manage its digital health services, investments, and partnerships.

It will be headed up by Chief Digital Officer Jason Szczuka, JD.

HIStalk Announcements and Requests

Welcome to new HIStalk Gold Sponsor Experity.The Machesney Park, IL-based company is the leading software and services company for on-demand healthcare in the US urgent care market, providing an integrated operating system complete with electronic medical record, practice management, patient engagement, billing, teleradiology, business intelligence, and consulting solutions. Nearly 50% of the US urgent care market runs on Experity solutions. With Experity, providers can best meet the demands of the evolving on-demand space and deliver high-quality, high-velocity care by streamlining operations, improving patient experiences, and optimizing revenue. A GTCR portfolio company, Experity’s leadership is comprised of growth-minded urgent care experts and business leaders committed to improving on-demand healthcare for all. Thanks to Experity for supporting HIStalk.

Webinars

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

Acquisitions, Funding, Business, and Stock

Health Catalyst acquires Armus, which provides clinical registry development and data services.

This is an insightful comment from digital health advisor Marc Sluijs.

Sales

• Mount Sinai Medical Center chooses ActX Genomic Decision Support, integrated with Epic.
• American College of Cardiology chooses the care management platform of Biofourmis as the exclusive virtual platform for its TRANSFORM(3) study.

People

Kermit Randa (Syntellis Performance Solutions) joins recruiting software vendor Symphony Talent as CEO.

Ryan McDaniel (Huron Consulting Group) joins Impact Advisors as VP / ERP service line leader.

Announcements and Implementations

Atrium Health and Advocate Aurora Health announce plans to merge, creating a system that will have 67 hospitals, 150,000 employees, and $27 billion in annual revenue with locations in Illinois, Wisconsin, North Carolina, South Carolina, Georgia, and Alabama. The combined organization will be called Advocate Health, with headquarters in Charlotte, NC and with an academic component in Wake Forest University School of Medicine. Both organizations use Epic. The announcement cited several technology issues as contributing to the decision to merge – healthcare becoming more digital, population health management, and analytics. The health systems pledge to create 20,000 new jobs while making healthcare more affordable.

Microsoft-owned Nuance and The Health Management Academy form The AI Collaborative, which brings together executives of hospitals that are using AI technologies. The big draw for participants is that they get a trip to Microsoft’s headquarters – which always arouses both technical and business geeks – and attend annual summits.

A new KLAS report on go-live support finds that CSI Healthcare IT is busiest, and along with Experis Health, is best at vetting resources.

Government and Politics

Cerner will issue the VA an unspecified credit for failing to meet the minimum system uptime requirements specified in the $10 billion contract.

Two owners of a “purported” telemedicine company plead guilty to participating in an elaborate scheme of bribes, kickbacks, and fraudulent prescriptions for drugs and medical equipment that netted them $32 million and cost insurers $64 million.

Other

The BMJ reports that drug companies and universities that were found in NHS Digital audits to have breached patient data-sharing agreements – repeatedly, in some cases — have not had their access to that data revoked. The article notes that clinical commissioners authorized the release of patient data to Virgin Care without patient permission and the company then refused to allow NHS Digital to audit their compliance while also refusing to delete the information.

US hospitals are rationing the use of contrast media after a GE Healthcare facility in Shanghai, China temporarily closes due to COVID-19 lockdowns. Experts say not only does most of our contrast supply comes from a single country, hospitals sign preferred vendor contracts that give them no alternative source.

A NordPass review of user passwords finds, not surprisingly, that number-formed combinations starting with “12345” represent seven of the top 10 most common. but a common one I hadn’t thought of us “1Q2W3E,” which alternates top and bottom row keys at the left of the keyboard. A similarly digitally lazy choice at #33 is “ZXCVBNM,” which is the first six bottom-row keys left to right. Several of the commonly used passwords include f-bomb variants, which would make an interesting analysis to see if unrestrained anger toward passwords is linked to even more bitter interaction with online humans.

Sponsor Updates

• Bamboo Health announces record company growth and the opening of its office in Boston.
• CereCore joins the ServiceNow Partner Program.
• Get Well will offer medically-endorsed guided imagery and meditation audio programs from Health Journeys to its customers and their veteran patients.
• GHX makes Exchange Advantage, a unified platform that automates end-to-end digital transactions, available to all suppliers in North America.
• Interbit Data publishes a new white paper, “The value of 24/7 access to critical patient data – a nurse’s perspective.”
• InterSystems will relocate its Boston headquarters, taking up the top 14 floors of a new building at One Congress.
• Diameter Health publishes a new brief, “Why Upcycling Data Matters.”

Blog Posts

• Best Practices for Fielding a Project Team (Optimum Healthcare IT)
• Using “SMART” Reference IDs for Workday (ERP) Data Conversion (Impact Advisors)
• 3 Ways to Increase Telehealth ROI (EVisit)
• 4 digital enhancements to improve patient access (Experian Health)
• 5 Elements of a Superior Solution for Health Systems That Need to Grow Margins (Gyant)
• Honoring the Role of Nurses in Empowering Patients (Healthwise)
• Did Your IT Project Fail? Here are 4 Ways Change Management Could Change the Outcome (Healthcare IT Leaders)
• Using “SMART” Reference IDs for Workday (ERP) Data Conversion (Impact Advisors)
• AI in healthcare: A wicked problem and needed solution (Intelligent Medical Objects)
• Why Upcycling Data Matters (Diameter Health)
• Hospital Week 2022: Celebrating Healthcare Systems and Healthcare Workers (Loyal)
• Medhost University: Multiple Options for Optimizing Medhost Product Knowledge (Medhost)
• How to Make Coordination of Benefits More Transparent and Truly Coordinated (Myndshft)
• Avoid Information Overload: Making Business Intelligence Data Actionable for SNF Rehab Therapy (Net Health)
• National Nurses Week: How can we better support the nurses that work so hard to care for us? (Nuance)
• Achieving Interoperability in the Real World (Netsmart)

Contacts

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EPtalk by Dr. Jayne 5/12/22

There is always a lot of buzz around wearables and using them to boost patient engagement. This Bloomberg piece caught my eye with its discussion of the “nocebo” effect. Where a placebo can make patients feel better, a nocebo that’s providing negative data could make patients feel worse. The article points out that not everyone “will truly benefit from 24-7 monitoring, arbitrary goals served up by an algorithm, and regular notifications telling you that you’re stressed, tired, fit, or simply ‘unproductive.’”

I definitely see this with my patients, who are frustrated by what they’re seeing with their bodies because they don’t understand it. For example, the patient starting a new workout plan who is frustrated due to weight gain might not understand that this is because they are building muscle.

During the course of the COVID-19 pandemic, many clinical informaticists have learned more about public health informatics than they ever imagined. The Strengthening the Technical Advancement & Readiness of Public Health via Health Information Exchange Program (STAR HIE Program) provides support for public health agencies who need to exchange health information during times of emergency. Although the program was initially funded by the CARES act in 2020, it was expanded in 2021 to further support efforts to increase vaccine data sharing between local or regional Immunization Information Systems and HIEs. Various projects have involved: improved delivery of COVID-19 test results; improved reporting among providers, hospitals, and public health agencies; providing accurate lists of non-vaccinated patients to improve vaccination rates; improved case reporting; and creation of new connections between HIEs, hospitals, and correctional facilities.

For those who think “COVID is over,” here’s another example that it’s not and we’re all in this together. Due to COVID-19 lockdowns in China, there is a global shortage of contrast dye that is needed for CT scans. This has resulted in some medical centers rationing CT scans. Organizations are used to having to message patients to reschedule appointments due to physician emergencies or illness, but having to cancel imaging procedures due to lack of supplies is a bit new, so I imagine there’s new reports and new outreach campaigns being created by IT teams. Much like the shortage of intravenous fluids that happened after a Hurricane Maria devastated Puerto Rico, the supply chain is weakened by having too few locations for the manufacture of critical supplies. The shortage is expected to last a few more months and hope this leads manufacturers and distributors to rethink their manufacturing strategies.

Quest Diagnostics releases the results of its 2022 Health at Work survey. They queried 800 workers at companies that had at least 100 employees about what kind of health plan benefits would encourage them to stay with their companies. They were also asked to weigh in on at-home healthcare. Although the majority of respondents (nearly 90%) believe health screenings and wellness initiatives are important benefits, they had concerns about privacy and how much their employer might be learning about an individual’s health. More than two-thirds of workers didn’t want their employers to know the results of health screenings, and more than half had concerns about employer involvement in patient healthcare. Employees are enthusiastic about at-home testing including biometrics and felt they would take advantage of more screenings if they could do them at home. A majority said that telehealth was a desirable benefit.

Remote monitoring is an exciting technology, but a recent article in JAMA Internal Medicine questions the outcomes of remote monitoring in managing heart failure patients who have been discharged from the hospital. It should be noted that the study was small – 290 men and 262 women – and the mean patient age was 64.5 years. The participants were randomized either usual care or to remote monitoring of medication use and weight management with financial incentives for adherence. The primary outcomes were time to hospital readmission and death. Researchers found that there was no significant difference in outcome scores over 12 months.

Personally, I’d like to see some slightly different research. For example, what does the data look like for using remote monitoring to prevent hospitalizations in the first place? Is the data different for patients in different parts of the country since this study was done regionally? I’d also be interested to understand how much patient involvement was present in the remote monitoring, and whether outcomes are better if patients have to be more or less involved in the monitoring.

The best article I saw this week was this: “Effect of Genre and amplitude of music during laparoscopic surgery.” Researchers proposed that since music is often present in the operating room, they’d like to examine the effect of different types of music and different volumes on surgical performance. The research subjects were “novice surgeons” who were measured on their performance of laparoscopic surgical techniques. Music was either soft rock by the Beatles or hard rock by AC/DC and was played at medium or high volume. Surgical task performance was measured on speed and accuracy. Those hearing soft rock at medium volume were faster and more accurate than doing those tasks without music. When the soft rock was played at high volume, the improvements were lost. Hard rock at medium volume led to faster precision cutting compared to no music. Hard rock at high volume also led to increased speed. The authors concluded that “our data reveal that the effect of music… might depend on the combination of music genre and amplitude. A generally well-accepted music genre in the right volume could improve the performance of novice surgeons during laparoscopic surgeries.” I discussed with my surgical colleagues and they would like to understand whether outcomes are different for experienced surgeons, but no one is ready to draft a research proposal just yet.

Shoes of the week: This sassy shoe-sock combo was spotted a conference tweet. They look very comfortable and I’m a sucker for sparkles, so if anyone has the details on these, I’d love to know where I can get a pair.

What’s your go-to slip-on shoe? Leave a comment or email me.

Email Dr. Jayne.