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From HIMSS 4/17/23

April 17, 2023 News 9 Comments

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I arrived in Chicago in mid-afternoon Monday to lingering snow flurries, whipping wind, temperature in the high 30s, and near chaos in the O’Hare rideshare pickup area that made me glad to have a coat for the wait (unlike several guys wearing shorts and tee shirts featuring understandable but definitely undesirable nipplage). The warm-up starts Tuesday, however, with Thursday topping out in the low 70s, which is likely where weather comparisons to RSNA’s post-Thanksgiving weekend diverge. The view outside looked like six weeks ago in warmer Southern climes, with budding and flowering trees that are surely confused given that Chicago hit a record high of 82 just a couple of days ago.

Many folks on my flight were also headed to HIMSS23, and unlike me, were bubbly and loud in talking shop with their fellow conference travelers. They were all exhibitor people, so maybe they were getting warmed up for glad-handing. I’m staying in a quite nice, and nicely located, River North hotel at excellent HIMSS rates. Dinner was my first time having chicken Vesuvio, which was so fantastic despite its simplicity that I’ll try making it at home. I’m indifferent to Chicago hot dogs compared to Southern chili dogs, I’m not a fan of the underbaked dough lasagna called deep dish pizza, and I’ve yet to try Italian beef although I suspect I would like it a lot. I enjoy Garrett’s and Nuts on Clark popcorn, but not enough to pay the asking price. I also like the Walnut Room and Frango mints from the former Marshall Fields before Macy’s dragged them down a bit, at least from past visits, but I doubt I’ll head down to State Street this time around.

I haven’t even looked at the agenda, but my HIMSS23 plan for the week is simple: get my badge early Tuesday in hoping for shorter lines than last year, wander about the exhibit hall Tuesday and Wednesday, and try to overhear conversations that aren’t intended for me since those are more interesting. I’ll decide Wednesday evening whether it’s worth going again Thursday and then just walk around Chicago if not, heading home Friday.

I need eyes and ears out there because of my slothfulness while all the eager beavers are racing madly from one spot to another and stacking up social events with higher confidence levels than mine that something interesting awaits, so let me know if you hear or see anything important. I’ve been to enough HIMSS conferences to know that other than a few pre-timed announcements early in the week, nothing all that newsworthy happens there, and sites that try to cover it like real news usually end up trying to make lame press releases sound relevant.

I can’t decide: is the HIMSS23 slogan of “Health that Connects + Tech that Cares” calculatedly clever or does it try a bit too hard to deny being a boat show and fall short?


News

Microsoft and Epic announce that they will work together to bring generative AI into Epic’s applications via Azure OpenAI Service. UC San Diego Health, UW Health, and Stanford Health Care are already using an initial solution that automatically drafts message responses. Another solution will add natural language queries and interactive data analysis to Epic’s SlicerDicer self-service reporting tool.

In Japan, investigation of a hospital ransomware attack finds that NEC used the same username and password for thousands of user devices and EHR servers, assuming that front-ending the login process with a user’s smart card would secure the system by hiding the password in what it incorrectly thought was a system that wasn’t connected to the outside world. More than half of the 280 hospitals that are users of that EHR were found to have the same username and password.


Announcements

Medhost announces a Rural Emergency Hospital package.

Intelligent Medical Objects announces IMO Studio, a cloud-based platform for clinical terminologies, code sets, and data quality whose rollout will start with in July Epic customers.

EClinicalWorks will integrate its EHR/PM solutions with ChatGPT, cognitive services, and machine learning models from Azure OpenAI Service.


People

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Ellkay promotes Ajay Kapare, MBA to president and chief strategy officer. He replaces co-founder Lior Hod, who will transition to chief culture officer.

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Health Data Movers hires Darin Ryder (Continuum Health IT) as VP of client services.

From HIMSS with Dr. Jayne 4/17/23

April 17, 2023 Dr. Jayne No Comments

I’m on my way to HIMSS after an eventful weekend. Saturday evening was to be a gala in celebration of the 50th anniversary of the program where I completed my residency training. The planning committee has been working for months to make it a bit of a reunion, a bit of a commemoration, and a celebration, not only of the past, but of what is yet to come. It was time to dust off the little black dress, slip into some heels that were a little more comfortable than what I wore when I was a young resident, and dance the night away.

Unfortunately, the weather was less than cooperative, with severe thunderstorm warnings giving way to a tornado watch and finally a tornado warning. We were in the middle of cocktail hour in the special events annex of a local museum when the sirens went off and they asked everyone to move to the designated storm shelter areas. Being asked to choose between the kitchen area and the ladies’ room, I opted for the latter since I knew it would be less hot and humid than the kitchen.

It was a time to experience a whole new level of networking, as we leaned on the cool porcelain tile and talked about how we were affiliated with the residency program. Several attendees were current program staffers and enjoyed hearing the stories my date and I told about our time as residents. Back in the day, the hospital had on-campus housing ,which created an environment that was significantly different than programs where everyone lived away from the hospital. The more recent graduates were interested to learn what it was like before work hours limits and mandatory vacation days.

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Our “shelter in place” time also led to my spotting the best shoes of the night, which were a pair of glittering Tretorn sneakers. Knowing I was headed for HIMSS in the morning, they made me seriously question my footwear choices. I hadn’t packed anything quite as memorable as those, so I’m definitely going to have to start upping my game.

After nearly an hour, the weather was downgraded to a severe thunderstorm, and we were allowed to finally make our way to the cocktails and appetizers. We ended up at a table with two members of the class of 1985, who had even wilder campus housing stories than we did, including an episode where one of them rented a hot tub and had it delivered to the hospital’s parking lot for an evening of debauchery. One of them is in a private practice locally and the other is at an academic medical center on the West Coast, but they were both eager to learn about clinical informatics.

After dinner, it was time for some speeches and recognition. My class was recognized due to its distinction as the first all-woman class in the program’s history, which has not been repeated until recently when the class of 2025 entered training. We learned that the 300-plus graduates of our program are actively practicing in more than half the states in the US, and that since its inception, our residency program clinic has treated over one million patients. It was a good night to see old friends and to remind ourselves that we’re part of a legacy of people who went into medicine for all the right reasons, and to recommit ourselves to doing the best for our patients each and every day.

By the time the dancing wound down, and a couple of younger physicians learned from us “seasoned’ ladies that it’s perfectly acceptable to bring your dancing slippers in a tote bag for the later parts of the evening, the rain had stopped. The organizers had thoughtfully commandeered some golf carts to take us back to the parking lot, so we were able to avoid the puddles. I headed home, eager to get a good night’s rest before heading to chilly Chicago. The weather for this week’s HIMSS conference certainly isn’t the lovely Chicago spring that many of us had expected, and I swapped out my cute spring jacket for the more practical ski-ready puffer.

My flight was a bit of a roller coaster, so I was glad to make it to the city in one piece. It was followed by a baggage jam at Midway that led to an hour’s delay in getting my luggage. Normally I wouldn’t check a bag, but I had a special situation this time which required it. Delays always leave me questioning my life choices, but everyone in the baggage area was friendly and there was a sense of camaraderie since we truly were all in it together.

My taxi driver spent most of the trip cautioning me about my personal safety given some recent violence that occurred downtown. While I appreciated his caution, I didn’t appreciate his bait-and-switch at the end of my trip by trying to have me swipe my credit card through his personal Square reader.

Upon arriving at my hotel, I discovered that it still has limited food service and no room service options, so knowing that I have some back-to-back calls in the morning, I made a quick Target run. It’s always entertaining to see people who have never seen a store that has a cart escalator. They are amazed watching the shopping carts go up and down. Fully stocked with Diet Dr. Pepper and snacks, it was back to the room to do some work before an evening out with friends.

The weather in the morning is supposed to be dicey and I haven’t figured out the HIMSS shuttle schedule yet, so it should be an adventure. At check-in, my hotel didn’t seem to recognize that my reservation was part of the HIMSS block, and the agent said they didn’t have any information on the shuttle schedule. I was able to find one on the HIMSS website, but it looks like it was part of a welcome packet from January, so who knows. My original plan was to walk to McCormick place since the mileage to and from my hotel is similar to what I walk at home on a daily basis, but the forecast has changed that. We’ll just have to see what things look like in the morning. HIMSS has been characteristically quiet on the forecast attendee counts, so there’s no way to know what the morning migration will look like.

Are you at HIMSS, and if so, are you looking forward to it? What’s your goal for the meeting? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/17/23

April 16, 2023 Headlines No Comments

VA Pauses Rollout of $16 Billion Health Record System

The VA pauses its $16 billion roll out of Oracle’s Cerner EHR software as it renegotiates its contract with Oracle.

Weight-Loss Telehealth Startup Calibrate Health Cuts 18% of Jobs

Calibrate Health lays off 18% of its workforce as it pivots from a direct-to-consumer online obesity drug prescriber to a telemedicine company that offers its weight-loss services to employers.

Froedtert, ThedaCare plan to merge, hope to launch combined health system by end of 2023

Wisconsin’s Froedtert and ThedaCare, both Epic customers, will merge by the end of 2023 to create an 18-hospital system with $4 billion in revenue.

Monday Morning Update 4/17/23

April 16, 2023 News 2 Comments

Top News

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Arcadia raises $125 million in financing to accelerate its work in aggregating and analyzing healthcare data.  


HIStalk Announcements and Requests

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Poll respondents, whether attending HIMSS23 or not, expect to be working harder this week.

I expect to be working harder this week because I will be unexpectedly lugging some kind of coat around airports thanks to HIMSS choosing to stay home in Chicago (Monday: gale warning, snow, high of 39) in abandoning the usual rotation of Las Vegas (sunny and 81) or Orlando (sunny and 82). The conference is in Orlando next year, then two consecutive years in Las Vegas afterward. Some conference folks put Las Vegas, Orlando, and Chicago as within the top five US conference locations, with former HIMSS cities San Diego (sunny and 64) and Atlanta (sunny and 70) rounding out the list.

New poll to your right or here: Are you using ChatGPT or other AI tools at least daily for work-related tasks?

Ramadan and its month of fasting will end Thursday evening as HIMSS23 is winding down. Muslims aren’t allowed to take anything by mouth – food, water, or medicine – from dawn to sunset, so they usually have a significant pre-dawn breakfast (with lots of water since none is allowed for the following 13 hours) and late-evening meal. It must be challenging to travel to a conference during Ramadan in accommodating prayer times and finding halal food, but at least attendees will be home for Eid al-Fitr.


Webinars

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


Acquisitions, Funding, Business, and Stock

Wisconsin’s Froedtert and ThedaCare will merge by the end of 2023 to create an 18-hospital system with $4 billion in revenue.

Tenet reports that EVP/CIO Paola Arbour’s total compensation in 2022 was $1.7 million, a big drop from the $2.9 million she was paid in 2021.


Sales

  • Alaska’s Department of Health awards a new contract to HealthConnect Alaska, the state HIE, to expand its services.

People

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Taylor Bockweg (MuleSoft) joins CarePayment as VP of national accounts.


Announcements and Implementations

Amazon announces new tools for building with generative AI on AWS. Amazon Bedrock offers foundation models from Amazon and other companies that address use cases such as text generation, chatbots, search, text summarization, image generation, and personalization.


Other

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Industry long-timer Stuart Miller (Craneware) has had his HIMSS23 plans waylaid by an emergency double lung transplant two weeks ago. HIs daughter, Bethany Miller-Urroz (Rhapsody), invites everyone to visit Rhapsody’s Booth 7110 at 4:30 p.m. on Wednesday to send their encouragement via a group photo.

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Also missing a planned trip to HIMSS23 will be Chilmark Research founder and CEO John Moore, who wrote his moving “Bidding Adieu” from hospice care. 


Sponsor Updates

  • Netsmart will exhibit at NATCon23 May 1-3 in Los Angeles.
  • Cone Health exceeds quality goals for its sepsis initiative using Premier’s Pinc AI quality enterprise.
  • Redox releases a new podcast, “Navigating rapid cardiology practice acquisition with US Heart and Vascular’s Cheryl Rodenfels.”
  • Sectra publishes a new case study, “Digital pathology transforms collaboration among pathologists in Greater Manchester.”

Blog Posts


Contacts

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

Morning Headlines 4/14/23

April 13, 2023 Headlines No Comments

Arcadia Raises $125 Million in New Financing from Vista Credit Partners

Health data analytics firm Arcadia announces $125 million in financing from Vista Credit Partners.

Verisma and ScanSTAT Announce Merger, Providing the Strength and Know-How that HIM Departments Need for the Path Ahead

Release of information vendor Verisma acquires competitor ScanStat.

Celebrating a New Season at Spring Health

Digital mental healthcare company Spring Health, which markets its platform to employers and payers, raises $71 million, bringing its total funding to $366.5 million.

News 4/14/23

April 13, 2023 News No Comments

Top News

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Carlyle Group abandons its interest in acquiring a 50% stake in payments integrity technology vendor Cotiviti from Veritas Capital.

Veritas reportedly rejected Carlyle’s offer that had been lowered due to market conditions.

Reuters reported in February that Carlyle was interested in acquiring part of Cotiviti at a $15 billion valuation.

Veritas took Cotiviti private in 2018 for around $5 billion and merged it into its Verscend Technologies payer analytics business.


HIStalk Announcements and Requests

HIMSS23 weather goes from near-record high in the upper 70s through Saturday – which only early-arriving exhibitor personnel will get to see – with a big cool-off with 50-ish highs and the possibility of snow showers on Monday.

I’ve noticed that Oracle seems to be retiring the Oracle Cerner name that was used interchangeably with Oracle Health following the acquisition. Press releases after mid-February don’t include the Cerner name other than one reference to Cerner Millennium.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Interoperability platform vendor 1upHealth raises $40 million in a Series C funding round, increasing its total to $76 million. The company says it will use the proceeds to develop products to support CMS regulations, enhance its data cloud infrastructure, and expand its customer and services teams.

Release of information vendor Verisma acquires competitor ScanStat.

Verato’s identity management solutions will be offered with the interoperability products of Redox to provide a 360-degree view of patients, members, providers, and communities.


Sales

  • Saint Joseph’s Medical Center will extend its deployment of Oracle Health’s EHR and RevElate patient accounting solution to all locations.
  • The Princess Alexandra NHS Trust will implement Oracle Health’s EHR.

People

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Ashish Sant, MTech (Bracco) joins Merative as general manager of its Merge imaging solutions.

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Aspirion hires Amy Amick, MBA (SPH Analytics) as CEO.


Announcements and Implementations

Google will offer limited access to its Med-PaLM 2 medical large language model to a select group of Google Cloud customers for testing and use case development.

Carnegie Mellon researchers develop an Internet-connected OpenAI tool that correctly developed a plan to synthesize ibuprofen, aspirin, and aspartame and to control the lab technology required to manufacture them. They also had the system develop a new cancer drug that was not tested. The authors warn that such a system is promising, but could be used to create illegal drugs or bioweapons. Not surprisingly, they also credit ChatGPT for creating the first draft of the article. 

Google Cloud announces an AI-enabled Claims Acceleration Suite for prior authorization review and claims processing. One module is Claims Data Activator, which allows searching patient records to create FHIR-formatted structured data to speed decision-making. The company is also recommended solutions from Myndshft (real-time prior authorization and benefits) and Pega (expedited manual review of prior authorization requests) that run on Google Cloud.

Walgreens expands its year-old clinical trials business by recruiting participants for an Alzheimer’s drug trial. Walgreens launched the business in June 2022, saying that its nationwide footprint and enterprise-wide data capabilities allow it to make clinical trials more accessible, convenient, and equitable, particularly in the nearly half of its locations that are in socially vulnerable areas.

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Remote diagnostics and telehealth vendor Medaica will provide free, FDA-cleared digital stethoscopes for in-home use by rural and underserved patients who are undergoing telehealth exams.

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Glooko, which offers a home diabetes management system, will integrate Hedia’s bolus insulin dosing advice that can integrate with connected insulin pens.

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Microsoft lists new Teams healthcare capabilities and other products that it will demonstrate at HIMSS23:

  • Launch Teams virtual visits directly from Epic and Cerner via its EHR connector, which also supports joint and group visits.
  • The ability to schedule, brand, and send patient reminders for virtual visits.
  • Track virtual visit no-shows, appointment durations, wait times, and number of appointments.
  • Integration of Teams with Teladoc Health Solo.
  • A new pre-configured home experience for frontline care workers.
  • A Walkie Talkie Teams app.
  • Support for shared use of Android phones.
  • A unified member view and care journey template for payers.
  • Previews of new Azure AI Services for Health that include SDoH and ethnicity support from unstructured data, clinical trials matching, and Health Bot integration.

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Roche announces Navify Algorithm Suite, which allows clinicians to order certified algorithms from Roche and other companies from within their EHR and laboratory systems.

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A Deloitte survey of 30 US health system leaders looks at digital health tools:

  • Three-fourths of respondents say their organizations are rethinking their business models from delivering treatments to maintaining health, with most of them supporting the change with digital technologies but conceding that much work remains.
  • Health systems are successfully meeting consumer and care needs within their four walls, but fall short in preventive and continuing care. Adoption remains low for integrating wearables data, care plans, and clinician messaging.
  • The executives say that integrating digital technologies also requires addressing revenue, fragmented ownership of digital projects, changing workflows. and lack of skilled workers.
  • One interviewee noted that technology could help bridge the gap between what consumers do for their own health and wellness versus the entirely separate activities that they do for healthcare

Government and Politics

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HHS OCR issues a Notice of Proposed Rulemaking that would extend HIPAA to prohibit the use of disclosure of PHI for identifying, investigating, suing, or prosecuting someone for seeking, obtaining, providing, or facilitating lawful reproductive healthcare. The unpublished document is here.


Other

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Bay Area Hospital (OR) is threatened with closure after losing $61 million in its most recent fiscal year, which auditors blame on several problems that include a problematic implementation of Epic that resulted in $18 million of lost billings. Auditors also noted that the hospital spent $15 million more in contract labor in 2022 than in 2021, some of that due to Epic go-live support needs, and also spent $3.6 million to help local medical practices with their Epic installation.

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The University of Virginia newspaper profiles 2016 graduate Aajash Shah, who with his ENT surgeon cousin started home allergy treatment company Wyndly in 2021. The company sells a $249 home finger-stick allergy test whose results are reviewed by a doctor to prescribe under-the-tongue tablets as an alternative to allergy shots. The service, which includes unlimited doctor time and treatments, costs $99 per month.

KFF Health News profiles Horizon Therapeutics, which is about to be acquired by Amgen for $27.8 billion even though it has never developed a drug that has reached the market. The Shkreli-like company buys old drugs, raises their prices, markets them aggressively to physicians who sometimes are paid honoraria, offers concierge-like services to patients to whom it markets directly, and makes sure that insurers rather than patients bear the financial burden via its patient assistance programs. It spent $120 million to acquire a last-resort gout drug that has many cheap alternatives, then marketed it aggressively to drive sales to $1 billion annually after increasing its price tenfold. The company, which saved a fortune in US taxes by moving its headquarters to Ireland, paid $93.4 million in 2015 to its CEO, who will reap a reported $135 million from the acquisition.

In India, authorities raid an unlicensed hospital that was being run by a high school dropout who was posing as a doctor, following reports that the illegal 16-bed Mediversal Hospital included a lab, ICU, emergency room, and surgery suite.


Sponsor Updates

  • Women’s Health Associates realizes a 40% increase in revenue cycle payment processing with Healow Payment Services from EClinicalWorks.
  • Surescripts launches the second season of its There’s a Better Way: Smart Talk on Healthcare and Technology Podcast.
  • BayCare Health System expands its use of Oracle Health technologies to include its RevElate patient accounting software.
  • Vyne Medical will sponsor and present at NAHAM’s annual conference May 2-5 in Orlando.
  • Fortified Health Security names Matthew Prater service desk technician.
  • Health Data Movers publishes a new case study, “Data Conversion for a Growing Health System.)
  • Net Health publishes a new e-book, “10 Practical Tips for Taking Your Physical Therapy Clinic Management to the Next Level.”

Blog Posts


Contacts

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

EPtalk by Dr. Jayne 4/13/23

April 13, 2023 Dr. Jayne No Comments

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From the “it’s always good to double check your work” file. A general practitioner’s practice in the UK mistakenly sends text messages related to a diagnosis of aggressive metastatic lung cancer instead of the planned holiday greeting. The practice, or “surgery” in NHS terms, has 8,000 patients who may have received the message. A corrective message was sent about an hour later, but there’s no way to know how much agony the original message caused. As expected, the practice was then slammed with phone calls and patients were unable to get through. In a past life, I was responsible for putting together population health campaigns that were broadcast to large segments of our health system’s population, and you can bet we had a “two sets of eyes” policy on everything that went out to large cohorts of patients.

Earlier this week, I had the opportunity to attend a presentation given by colleagues at the local academic medical center. Unfortunately, the presentation was marred by blatant sexism. It was a panel discussion, and the moderator habitually referred to the male members of the panel as “Dr. Surname” while referring to the female member of the panel by her first name. All three of the panelists were fully introduced, including their credentials as medical doctors and professors at the institution, so it’s not like there was any confusion about her status as a physician.

Even if she had asked to be called by her first name, which she assured me she didn’t, the thing that made it worse was that neither of the male panelists tried to rectify the situation. When referring to their colleague, it would have been easy for them to refer to her as Dr. Jones to make it clear to the moderator that his address was not appropriate, but instead they joined in. There are numerous published studies about the fact that women physicians are more likely to be addressed by their first names rather than being addressed as Doctor. It was sad to see this at what was supposed to be a progressive institution. Had there been a continuing education evaluation form, I would have commented, but unfortunately there wasn’t.

From a travel standpoint, except for the impacts of COVID, I’ve been a road warrior for more than a decade. This week I had one of the worst travel-related days in recent memory, and none of it had anything to do with the airlines, flight delays, or weather. The first issue involved a parent who insisted on lifting her stroller (including the accompanying strapped-in toddler) onto the parking shuttle rather than folding the stroller and carrying on the toddler. She was snapping at the shuttle attendant  — who in my opinion shouldn’t be responsible for loading a human — and demanding help while not even using two hands to load her child because her other hand was tied up with not only her phone, but also a Starbucks cup. She also snapped at other customers who tried to help, so it wasn’t a good opportunity to fulfill the slogan to do a good turn daily. I know that for some people coffee is life, but it felt like there may have been some misplaced priorities. Ultimately the driver was frazzled, which is never good.

Once I made it through the blissfully quick security checkpoint and arrived at the gate, I ended up in the boarding line in front of a woman who was facilitating a video-enabled conference call on her phone. Other passengers were trying to talk to her to figure out boarding positions and she was ignoring them. Of course, when it came time for her to scan her boarding pass, she was still on the call, and plenty of fumbling ensued. Props to the gate agent who sidelined her and let others through while she tried to get her act together. That’s always preferred to letting one person hold up the whole line.

We also had issues on the plane with passengers failing to follow crew member instructions, with infractions ranging to baggage issues to one gent sitting in the exit row who insisted on trying to lay out his jacket in the overhead bin on a full flight, refused to close his laptop, refused to properly stow it, and then became sassy when asked to fasten his seat belt. I was across the aisle from him just hoping it wasn’t going to turn into an incident where they would have to call security onboard to forcibly deplane him. Eventually he got with the program, but not without causing delays. The flight crew did a good job with service recovery, however, and I enjoyed my complimentary premium beverage, but it was just so unnecessary for him to act that way.

Due to an availability issue, I wasn’t able to use my usual rental car agency and ended up going through Costco Travel to book with Budget, so I wasn’t familiar with the processes at my destination. After waiting in line at the rental counter as instructed by the email I received, I was told, “You have Fastbreak and you’re in the wrong place” and was redirected outside. I was assisted there by a lovely agent who was in training, only to have her supervisor stop her in the middle of processing my rental and tell her to give me a different car from Avis, which is also owned by Avis Budget Group. When I got to the Avis lot, the neighboring vehicle was parked so close that I couldn’t get into it, and neither could the rep when I went back to the counter for help. They had to move two cars to liberate my assigned vehicle. Note to the folks parking cars – if it’s so tight that you have to fold the mirrors in so the cars don’t hit, it’s probably too close for a person to get in the car.

The next annoyance was a badly striped and signed parking lot, where following the exit sign and arrows led me to a dead end and a multi-point turn to get back on track. I mentioned it to the agent at the exit gate, who admitted, “Yeah, we changed that a while ago, we should probably change those signs.” Yes, indeed. He then asked me to show my license for the fourth time in 10 minutes, and finally I was on my way. The rest of the trip included wild drivers, erratic speeds, and the usual highway fun.

I finally made it to my hotel, where I was greeted with a digital key that didn’t work. I went to the desk and got a new key, which was handed over just by saying my room number and without providing ID, which is a safety concern. From there, I went back up to my room, only to find someone in it with the door propped open. It turned out to be the housekeeper, who just let me walk in without unlocking the door or proving it was actually my room. Not the safest feeling, but by this point I was in full “it is what it is” mode and just wanted to get settled so I could attend some conference calls. That’s what multiple layers of security locks are for, I guess.

They say travel is broadening, and I generally enjoy it. Still, let’s hope for less eventful transit next week as I head to Chicago for HIMSS.

What are your wildest stories from recent travel? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Jamel Giuma, CEO, JTG Consulting Group

April 13, 2023 Interviews No Comments

Jamel Giuma is president and CEO of JTG Consulting Group of Miami, FL.

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Tell me about yourself and the company.

I studied finance in college, but I was always in IT. I started working for a retail company while I was in high school in their corporate IT department, and did that through my first couple of years of college. I got tired of working for corporate America pretty quickly and started applying to IT jobs in Jacksonville, Florida, where I was raised. The first place to call me back was the University of Florida health system. I started working in their desktop support group, and one of the areas I was responsible for was the laboratory. I was replacing the lab director’s computer and she said, have you ever thought about becoming a systems analyst? I said, what’s that? I fell in love with the lab, and here I am 16 or 17 years later.

I was recruited by the University of Miami to start their lab team and manage that to grow it to what it is today. I worked at Sunquest as director of interoperability in their product strategy group for a number of years. The travel got out of control, especially being in Australia for a over a year and missing family and friends. I left to work for a five-year-old startup, and after nine months, decided that I was smart and hardworking enough to do this on my own. I started JTG five years ago in September.

Lab was always a healthcare technology pioneer, being the first to recognize the benefit of scale, to implement barcoding and tracking systems, to integrate with systems inside and outside the hospital, and to create a market for health IT that included the formation of Meditech and Cerner with lab as their first offering. What are the lab’s biggest issues today?

Historically, lab leaders were not always the best businesspeople to sell their service, either internally to the health system or externally. I’ve definitely seen a change in lab administration, where we’re starting to see more MBAs and MPHs who understand the business side and can take the lab to the next level. Taking advantage of excess capacity, economies of scale automation, and overall delivery of service for providing providers the first point of diagnosis.

Lab has a huge impact in the ecosystem of a patient’s journey. Without the lab, very few decisions can be made. If you have no radiology or no labs, you have no diagnosis in most cases, or it’s harder to make a diagnosis. With the onset of enterprise EHRs becoming the standard, we’ve seen things change from integration projects to workflow and optimization projects in health systems that allow providers to get more rich data and get it more quickly. It has been interesting seeing the evolution from best-of-breed lab systems to enterprise systems that have that best-of-breed technology embedded in them.

What laboratory-related external technology connections add value?

Folks are looking at more genetic data and genomics. That’s a lot more data than they can even handle. It’s more of a concern at times for providers because of the liability of missing something and understanding and interpreting those more complex and lengthy reports. Hospitals want to provide those services to their providers and patients, but they are also taking a close look at the risk of offering those tests, not just the financial risk of being reimbursed, but also how to interpret these results.

How do we ingest these results? Some of these new reports are 50-plus pages long, where historically doctors are used to receiving a metabolic panel or a CBC that has more discrete results with 20 or 30 assays in it as opposed to interpretative results that are more qualitative and quantitative results that impact how they make decisions to place those orders. They want to be able to provide the patient care, but if they can’t interpret the results or don’t have enough time to review and understand what the results are telling them, then are they adding any benefit to the patient’s overall care?

Are health systems changing their policies or technologies to comply with the Cures Act requirement to release electronic results immediately to the patient?

Health systems historically were risk averse to releasing those results. They don’t want patient going to Dr. Google to figure out how to interpret these results, whether it’s right or wrong. But with the onset of things like Meaningful Use and other technologies that have been embedded in these systems, they are having to release these results. If it’s being sent to a reference lab, patients are getting savvy enough to know that they can register with Labcorp, Quest, or Sonic to create a patient account login and get those results before their provider. A lot of EHRs and lab systems now have automatic release of those within certain parameters. Certain tests, such as STIs and other infectious disease results that are more sensitive, might be released within five to seven days if the provider hasn’t reviewed it. But overall, health systems are becoming more open to the fact that they have to do it, and we are starting to see that paradigm shift at larger health systems.

The introduction of artificial intelligence will bring a lot of opportunities to health systems to provide even better economies of scale to their providers, who can interpret the results before they are released and decide whether they need to add comments. We’ve seen Epic talking about utilizing ChatGPT and Cerner is talking with the FDA on some AI tools as well. AI can be powerful and potentially dangerous, but with the right guardrails, it will help providers, patients, and health systems take advantage of the data that’s already there.

Generative AI seems ideally suited to turn medical language into patient-understandable reports or instructions. Will that effort be led by companies like yours, or vendors themselves?

We are going to all have to partner together to take advantage of those new opportunities and tools. With lab, I’ve seen things like CellaVision, who has been doing artificial intelligence before it was called AI in identifying different cell types in a hematology slide. We’re also seeing things like the Copan WASPLab, a microbiology total lab automation tool that can take pictures of Petri dishes, interpret what’s growing, and group them for the tech to review. Their machine learning and algorithms are getting better every day to help the tech skip things that aren’t value-add, like no growth on a micro plate, and also categorizing things for them to review and confirm.

We will see more of that in chemistry and other areas, doing anything we can to avoid having a tech review a result, using a confidence interval set by the lab’s medical director to allow auto-verification. That will reduce turnaround time and hopefully improve patient care by getting a diagnosis sooner.

Telehealth, remote patient monitoring, and other virtual medical services are limited by the last-mile problem of collecting lab specimens and delivering prescriptions. Several companies have attacked the second issue. How are they approaching the lab collection challenge?

Direct-to-consumer labs is a great example of that. Because of the EUA that the FDA approved for COVID testing, we’re starting to see restrictions and legislation change on patients being able to order their own lab tests. It’s only a matter of time before it crosses all of our states. Across our country, providers and health systems are looking at ways to make it more convenient for patients. Going to a hospital, parking in a garage, and finding the right location are going away. We are starting to see Walgreens, Walmart, and Safeway embedding labs in those shopping centers. You park in a parking lot easily, walk in, get your test done, pick up your Starbucks after you are finished fasting, and you’re out.

That’s one step. But direct-to-consumer, where patients can order the test and self-administer the swab or void into a cup, is another example where we will see this evolve. The concerns that people are raising are also valid. Was the test collected correctly? Is it the same patient who ordered it? Who is responsible for that authorizing provider and interpretation of that result for the patient? There’s still a lot of work to do, but health systems know that to compete with Amazon, Walmart, and CVS they are going to have to change. That will also require lobbying work with the government to make that direct-to-consumer testing possible.

Which of your services are in highest demand?

With the great resignation, it’s difficult to get people to go to work for some reason, so staff augmentation is a big part of our business. We embed full-time employees at organizations to augment the needs of positions they can’t fill. A lot of the work we do can be done remotely, and the pandemic was a great representation of what we can do without having to physically be on site. We’ve done big implementations of new lab systems and EHRs with other vendors and consulting firms that were completely remote, and it’s incredible the amount of work that can be done remotely. Those are some of the big things that are being requested. Also, folks are looking to upgrade their systems constantly and they just don’t have enough people or time with all the competing projects.

Integration work is top of mind for health systems, laboratories, and even private reference labs, being able to interop with their clients, vendors, and patients. Those are quick wins. We are starting to see demand for talking about digital pathology and what that could do for the pathologist, automating some of their workflow and providing remote capability for the pathologist who was historically eyes on a microscope. That still has way to go, but we’ve seen some good headway in the last couple of years.

What have you learned in starting a company and setting its strategy?

From the beginning, I knew that we had to remain focused and not try to be everything to everyone. We’re not afraid to turn down business that doesn’t align with our goals, competencies, and strengths. We are laser focused in the laboratory. and there’s enough business in the laboratory space for not just JTG, but for other firms and vendors. We are happy that we’ve been successful in remaining focused and providing that excellent service to our customers.

Morning Headlines 4/13/23

April 12, 2023 Headlines 1 Comment

Recuro Health Closes $47 Million Series B Financing Led By Arch Ventures

Virtual care services company Recuro Health secures $47 million in a Series B investment round.

98point6 nabs $32M to pivot from provider to licensor

Telehealth company 98point6 raises $32 million less than two months after selling its self-insured employer business and physician group to Transcarent.

Health Data Cloud Leader 1upHealth Raises $40 Million Series C led by Sixth Street Growth

FHIR-based health data vendor 1upHealth announces a $40 million Series C funding round, bringing its total raised to $75.5 million.

Scene Health Secures $17.7 Million Series B Financing Led by ABS Capital Partners

Medication adherence vendor Scene Health, formerly known as Emocha, raises $17.7 million in a Series B funding round.

Healthcare AI News 4/12/23

News

Google will add conversational AI to its search engine, although it says that AI chatbots pose little threat its search business.

Duke Health and SAS will jointly explore using AI to develop analytics solutions for improving health equity and optimizing outcomes.

A Denmark-based startup that has developed a AI-powered nurse assistant raises a $5 million funding round. Its technology provides an overview of unit events, issues care alerts, monitors sleep, issues fall warnings, and monitors in-room cameras that track patient activities.

AI and NLP company John Snow Labs releases NLP Test, an open source Python library that runs 50 out-of-the-box tests that cover accuracy, fairness, bias, representation, and robustness. Customers of its Healthcare NLP include drug companies, CVS Health, Optum, Cincinnati Children’s, and the FDA.

Truveta launches an AI model that turns EHR records into research data for studying patient care and outcomes. The company says that today’s health research is based on claims data, while its new product uses data that is focused on clinical outcomes without commercial bias. It notes that GPT-4 is not trained on actual medical records, so it sometimes “hallucinates” or makes up information.


Research

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Students at Stanford University create a tool that combines AI with augmented reality to display conversational responses on AR glasses to help people who have social anxiety or challenges during presentations or job interviews.

A Hong Kong-based drug discovery company uses generative AI to discover a new cancer drug. The AI-focused company wrote a peer-reviewed journal article in 2016 in which it said that generative AI could be used to develop new drugs. It submitted nine AI-developed drugs for pre-clinical studies in 2022.


Opinion

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Medical authors suggest potential use cases for what they call generalist medical AI:

  • Creating draft radiology reports that describe normal and abnormal findings that take the patient’s history into account.
  • Serve as a surgical team assistant that can review and annotate video streams of procedures, warn verbally when procedure steps are skipped, and find and read out relevant literature.
  • Provide bedside clinical decision support tools that parse EHR sources, summarize a patient’s current state, predict how that state will change, and recommend treatments.
  • Create drafts of electronic notes and discharge reports for clinician review.
  • Provide patients with detailed advice and explanations as a chatbot.
  • Generate protein amino acid sequences and structures from text prompts.

Other

Boston Children’s Hospital posts a job for an AI prompt engineer to work on its Innovation and Digital Health Accelerator. 


Resources and Tools

  • MemoryGPT – allows AI chat users to save chats indefinitely, giving the system a memory.
  • Speechmatics Ursa – claims to be the world’s most accurate speech-to-text system with support for 48 languages.
  • AI Toolbox for Innovators – test, pivot, or generate ideas with free tools.

Contacts

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

Readers Write: Labor Augmentation Technology Solutions Automating Manual Processes

April 12, 2023 Readers Write No Comments

Labor Augmentation Technology Solutions Automating Manual Processes
By Kelly Feist

Kelly Feist, MBA is managing director of Ascom Americas of Morrisville, NC.

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General care floors represent one area of the hospital that has experienced the most change post-COVID, including increased clinical staff pressure resulting from caring for patients with higher acuity levels than in the past. This continues to be the area of care where continuous monitoring is the exception rather than the rule, and the ability for care givers to have patient contextual information at their fingertips is challenging.

As a result, the possibility of patient deterioration over time goes unrecognized until the patient becomes symptomatic, often resulting in unplanned ICU admissions, activation of rapid response teams, and sometimes other adverse events, such as codes.

By using vendor-agnostic medical device integration capabilities solutions, nursing staff can collect inputs from devices such as patient monitors, spot check monitors, laboratory information systems, EHRs, ventilators, CPAP devices, IV pumps, and more. This information is interpreted via pre-defined algorithms to determine a patient score that is regularly updated and trended. Automated alerts are generated and communicated to appropriate recipients — such as rapid response teams, charge nurses, and physicians — when a change in patient score indicates. The outcome is delivering the needed change in care prior to an adverse event occurring.

Automated, non-latent Early Warning Scoring is a vital tool in preventing unrecognized deterioration on the general patient care floors, ensuring improved clinical outcomes for the patient and financial outcomes for the hospital. There is a real and measurable ROI attached to well executed and automated early warning workflows.

Early Warning Scoring is one of several high-value workflow automations these kinds of MDI solutions can bring to bear to improve nursing efficiencies, create nursing practice safety nets, improve patient outcomes, and ultimately contribute to institutional financial goals.

COVID has had an impact on nursing capacity and on staff-to-patient ratios, resulting in the need for technology to become the force multiplier in the clinical space. There’s incredible opportunity through this technology to elevate the quality of care hospitals can provide today.

HIStalk Interviews Tyler Smith, CEO, Health Data Movers

April 12, 2023 Interviews No Comments

Tyler Smith, MBA is CEO of Health Data Movers.

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Tell me about yourself and the company.

I began my career on Capitol Hill during the recession, but most importantly, it was during the passage of the Affordable Care Act. The HITECH act from the stimulus propelled the digital health transformation forward. Being on the Hill during this time, it was an exciting time to get into healthcare. I left after one year and went to work in the consulting space. I got certified in Epic, spent a little bit of time at Cumberland before they were acquired by Tegria, and then started building what became Health Data Movers.

I focused on application work, while one of my two co-founders focused on data migration and the third brought in our first software development. From the beginning, Health Data Movers has had a technologist focus. Today we offer six core services that we break into two categories. Signature services is software development, integration, and data migration, while foundation services is applications, PMO, and advisory. We are a technologist-first firm. While a lot of great firms that came before us have moved into a desire to be a Big Four advisory-type firm, we enjoy getting our hands dirty and doing the work.

How have health system financials changed the demand for consulting services and affected their technology acquisition process?

I realized as a leader during the pandemic that that change is the only constant. When we saw how the scaling back of fee-for-service could affect budgets, it taught me that have to be flexible and shape-shift with the needs of customers. During that time, we saw pauses in projects, but then when the government acted and figured out ways keep health systems solvent, we saw all these paused projects back in high demand. We were scrambling to put together teams to get these projects kicked off.

At the same time, we also saw a lot of interest in digital health that was created by the pandemic. You saw a lot more digital health firms. We saw more interest from biotech firms that needed to integrate data in and out of the system of record, which is the EHR.  

In terms of our investment, it is staying focused on what we do best, but understanding that ultimately our customers — health systems, biotech firms, digital health firms –have their strategic imperatives and we need to be able to support them from a technology perspective. The directions that they choose to go determines a lot of the direction that HDM ultimately goes.

Are health systems and their technologies prepared to integrate real-world data, life sciences research, and FDA marketing surveillance?

Companies are formed based on ideas and also pre-existing alignment. Especially consulting firms, because folks who have worked together in the past and liked it will work together in the future. One of our co-founders came from a company called OTTR, which was a transplant EHR that was acquired by CareDx, which is a massive life sciences biotech company in the transplant space. We always say that if you can move transplant data, you can move any type of data. We have roots with life sciences because of our transplant background. We’ve been working with CareDx for over three years to ensure that the data from their tests makes its way to the EHR and vice versa. 

As this massive influx of information comes about as these biotech firms are maturing, it has been awesome to see the data from tests that are done by the specialty labs that we work make its way into the EHR. Is the real-world, evidence-rich data entering into the EHR? One hundred percent yes. A lot of the work that we have been doing recently with Epic Aura is getting specialty lab data in and out of the system of record. 

I think we are going to see some really cool improvements in patient care because of the integration of this data. It’s exciting to see how the EMR is moving from being a system for charting and ensuring that there’s billable outcomes to a place where we can have true insights from the interface with the patient and physician that will improve care.

What will the healthcare impact be of new tools such as cloud services, ChatGPT, and low-code systems that make it easier to develop applications?

That’s really exciting. We have an internal team of developers and the energy and excitement they have behind ChatGPT is evident in the Slack channels that I’m lucky enough to lurk in. There’s a specialty that is required in healthcare development, which we see as a competitive advantage because we have a line team of developers. But we also have developers who are well versed in the intricacies of healthcare – HL7 v2, FHIR, and HIPAA-compliant cloud. If there’s now a way for developer to speed up execution, then we can get a lot more done with smaller teams and we can scale the projects that we’re able to take on at a greater pace than just simply scaling headcount.

I get asked a lot about this metric – how big is your headcount? That is important in time and materials type work, but if we are able to empower our engineers to be more efficient with their work, then we can talk more about how many projects were we able to execute. The projects are the work that is pushing healthcare forward. If we can leverage the geniuses that we have in house to take on projects with biotech and digital health firms and essentially scale their skillset, we will be about to move our integration and software development portfolio of work faster, which then ultimately we believe will make healthcare more interoperable, user friendly, and efficient.

How are health systems and their new digital-type C-level officers approaching consumer-facing projects as they begin to compete with big technology and consumer companies?

We have been working on some digital front door related projects with strategy firms and more payvider-type organizations. Then you look at the One Medical-Amazon combination and see the rise of concierge medicine and advanced primary care. We talk about the retail health side a lot internally. Patient experience is going to be a critical next piece where technology is applied. Our core is with the healthcare organizations. We are seeing a lot more interest in the patient experience. I’m excited about this next wave of technology that supports that and I’m confident that Health Data Movers will be involved in that next transition.

How does your experience as a Stanford MBA student influence how you run the company?

It’s crazy how much Stanford influence there is at Health Data Movers. We have a board member who was my professor at Stanford, another board member who was the associate CIO at Stanford Health Care, and then both of my co-founders were either full-time or consultants at Stanford Health Care. But to the broader question around the Stanford influence, it’s just insane how much innovation has come out of a really tiny piece of US geography. When you are around it, you understand the energy behind creating something new and using technology to change the world. It’s not just something people say, it’s something they believe.

I could give you a laundry list of all the positives that I got from my Stanford experience or from being around Stanford, but I’ll focus on the idea that we are all capable of making the world change no matter what discipline we decide to do that in. Going to business school at the time when we were developing the company made me realize that yes, we are a services firm, but services firms can create massive change. Having lofty goals to actually improve healthcare through the implementation of EHRs, optimization of EHRs, and software around EHRs is something that can be achieved if we work extremely hard and have total dedication to the mission and vision.

Are you encouraged that healthcare has the ability and the incentives to implement technology that will truly make a difference?

I’m encouraged because there’s been massive adoption. Everyone had to get on the grid. I think Paul Kenyon from OTTR sums it up really well. It’s like the land grant colleges, or the land grants in general, in the Midwest. The government had to create a reason for folks to move to a certain part of the country, and then they were able to step away. We had to HITECH to get everybody onto the grid, and then we had the pandemic. The pandemic was awful,  but in a lot of ways, it also brought in more interest into healthcare. 

As much as people like to write off the EHR vendors as being resistant to change, it’s impossible to separate that there’s so much interest now in healthcare and digital health. Even though some tourists have left, a lot of folks have stuck around. We will see innovation that comes from a lot of brains and energy being in this space.

Just look at your MyChart interface over the years. It is always improving. While the rate of change is slower in healthcare, it will continue to evolve. I am fully confident that it is continuing to become better. I am excited about everything that will be possible now that we are on the grid and folks are interested in making healthcare better through technology,

My dad was seen at two health systems with what turned out to be Parkinson’s. It’s crazy that they operated on his rotator cuff even though they could have looked in his record to see that it wasn’t necessary. Here I was five years ago, working at a healthcare technology firm, and I’m literally sitting there helplessly with him knowing that the physician isn’t getting the full record. That’s when it really clicked to me. We all have these personal stories and that’s just one of millions. A lot of what we are working towards is to become non-existent as a company, because at that point, we will have created truly interoperable patient care that will fix so many avoidable errors. This is also the platform where innovation from life sciences and biotech companies will be made available to the providers who are delivering the care.

Morning Headlines 4/12/23

April 11, 2023 Headlines 6 Comments

Former Outcome Health Executives Found Guilty of Fraud

A federal jury convicts three former executives of waiting room advertising company Outcome Health, which was valued at one time at over $5 billion, of several fraud charges involving inflating the number of ad impressions to advertisers and investors from 2011 to 2017.

Oshi Health Raises $30M Series B Funding to Scale Access to Its Virtual Multidisciplinary Digestive Care

Virtual digestive care provider Oshi Health raises $30 million in a Series B funding round, bringing its total raised to $60 million.

Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing (HTI-1) Proposed Rule

HHS and ONC issue a Notice of Proposed Rulemaking  with changes to the Cures Act and ONC’s certification program.

DHA preps for MHS Genesis follow-on contract

The Defense Health Agency begins researching a support contract for MHS Genesis as its original 10-year, $5.5 billion agreement ends.

Veritas, Carlyle End Talks on Cotiviti Stake Sale

Veritas Capital rejects Carlyle Group’s offer to purchase a 50% stake in its Cotiviti healthcare technology business, which Veritas-backed Verscend Technologies acquired in 2018 in a deal valued at $5 billion.

News 4/12/23

April 11, 2023 News 3 Comments

Top News

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A federal jury convicts three former executives of waiting room advertising company Outcome Health, which was valued at one time at over $5 billion, of several fraud charges involving inflating the number of ad impressions to advertisers and investors from 2011 to 2017.

Convicted are former executives Rishi Shah (CEO), Shradha Agarwal (president), and Brad Purdy (CFO), none of whom testified.

SEC charges are pending against the executives, along with Ashik Desai, who testified against his former bosses in the criminal trial.

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Shah and Agarwal stepped down following a Wall Street Journal investigative report in 2017. They were 31 and 32 at the time. Shah owned 80% of the company, giving him a net worth of nearly $4 billion. PatientPoint acquired Outcome Health  in March 2021.

Shah and Agarwal founded JumpStart Ventures in 2011, whose investments include MedCity News, CoverMyMeds, and Medpilot.


Reader Comments

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From Nikki: “Re: Oracle. I bet whoever made this proclamation is regretting it.” Oracle EVP Mike Sicilia told the US Senate Committee on Veterans’ Affairs on July 20, 2022 that the company would move the VA’s Oracle Cerner implementation to the cloud and rewrite its pharmacy module within 6-9 months. We’re at the nine-month mark and I’ve heard nothing. Maybe they’re saving the announcement for HIMSS23.

From Asclepi Us: “Re: health systems. I’ve heard that the term health system may be replaced as they get bigger and offer broader lines of business. One has said the future is ‘health platform.’” The trendy name progression has included hospital, medical center, regional medical center, health system (which patients generally dislike intensely), and health (particularly questionable given how hospitals make money). My prediction is that because the business of health is so broad and brand-obsessed that it will be like Northwell, Providence, Ascension, and others that simply choose a one-word name  — sometimes by making up an eye-rolling word or painfully conjoining two actual words into one — that they hope age well. The names with the shortest shelf lives will be those where two merging entities can’t bear to see either old name disappear and settle on squeezing both names into one. Assuming I am right that one-word names will prevail, ChatGPT suggests DynaCare, Vitalia, MediVista, Zenitha, Nuviva, or Aurelia.


HIStalk Announcements and Requests

I’ve added a couple of HIStalk sponsors to my HIMSS guide.

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Someone on LinkedIn reference this 2017 article, in which two reporters coined the term “broetry” to describe those overly cutesy LinkedIn posts that — with one pithy sentence per paragraph — try to pass off trite personal or business observations as being inspiring or insightful. They say the broems “read like employee handbook haikus or an E.E.  Cummings motivational poster” that always finish with “some closing fortune cookie-esque takeaway.” One user speculates that the widely scorned format caters to an ADD mentality of get-to-the-point writing or perhaps is popular because it can be easily read on mobile devices. ChatGPT has since made the broet’s work easier and even more mindless.


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Welcome to new HIStalk Gold Sponsor CenterX. The Madison, WI-based company delivers reliable, patient-specific pharmacy benefit data and a fully integrated prior authorization solution, allowing providers to start cost-effective therapy faster. It delivers full benefit transparency at the point of care, including up-to-date pricing information and offering alternatives to medications that require prior authorization. Its electronic prior authorization tools are integrated into the EHR and keep users in the same system, regardless of the payer or plan, without faxing, re-entering, or phone calls. More than 120,000 Epic providers have had the CenterX network added alongside their existing network or alone at no additional cost to the health system. Providers who use prescription benefit information from CenterX made changes 25% of the time to either save their patients money or avoid a PA. Also, prior authorizations dropped by 38% after CenterX ePA was implemented. Thanks to CenterX for supporting HIStalk.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Confirming earlier rumors of a sale, healthcare automation vendor Olive AI sells its payer-facing prior authorization business to health information network Availity. The acquisition includes existing Utilization Management customer contracts and an agreement to hire around 100 key Olive personnel. Olive sold off its population health management and 340b solutions in 2021, and has laid off nearly 700 employees within the last year. According to its website, Olive now focuses solely on autonomous revenue cycle services.

Twitter legally ceases to exist under that name as Elon Musk merges it into another of this companies that is called X Corp. Musk has previously tweeted his intention to turn Twitter into the “everything” X app that includes social networking, messaging, and payments. Musk and his co-founders launched the company that eventually became PayPal by merging their security software company with online financial services company X.com in 2000.

Ellkay releases LKOrbit, an end-to-end, cloud-based connectivity platform that supports laboratory ordering, results, connectivity, and access to billing information.


Sales

  • Contexture, an HIE serving organizations in Arizona and Colorado, will unify its technology platforms into a single system with assistance from Health Catalyst.
  • McLaren Health Care’s Karmanos Cancer Institute (MI) selects Volpara Health’s Risk Pathways risk assessment and patient management software.
  • Pria will implement Health Connect Cloud technology from InterSystems, which is also an investor in the chronic care management company.
  • Dayton Children’s Hospital will implement Bio-key’s PortalGuard IDaaS biometric authentication in its migration from Epic’s Hyperspace to Hyperdrive.

People

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Ben Hilmes, MHA (Adventist Health) joins Healthcare IT Leaders as president.

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Nate Kelly, MBA (Hospital IQ) joins ChartSwap as president.

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Greenway Health hires Don Kleoppel (Cerner) as CISO.


Announcements and Implementations

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WellSky announces GA of WellSky Patient, giving patients the ability to communicate with providers between visits, access virtual care, and take part in condition management programs.

Equifax, Experian, and TransUnion remove medical debt of under $500 from US consumer credit reports, adding to previous actions that removed paid-in-full medical debt immediately and that gave people 12 months instead of six to pay a medical bill before it appears on their credit report.

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Moffitt Cancer Center profiles CIO Joyce Oh, who joined the organization in September 2022.


Government and Politics

HHS and ONC issue a Notice of Proposed Rulemaking  with changes to the Cures Act and ONC’s certification program. Participation in the Electronic Health Record Reporting Program would become a new Condition of Certification for certified health IT developers and several certification criteria would be revised. The unpublished version is here.

HHS OCR issues a reminder that its HIPAA and HITECH enforcement discretion ends with the expiration of the public health emergency on May 11, 2023. A significant change is that providers will no longer be able to use non-compliant technologies to conduct telehealth sessions.

Cerner Enviza and John Snow Labs will work with the FDA as part of its Sentinel drug safety initiative to develop AI solutions that extract relevant data from clinical notes within EHRs so that the agency can better understand the effects of medications on large populations. Cerner launched the Enviza business in 2020, eventually combining its provider network data with that of health data vendor Kantar Health, which it acquired for $375 million in 2021.

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The Defense Health Agency begins researching a support contract for MHS Genesis as its original 10-year, $5.5 billion agreement ends in July 2025. Leidos was the prime contractor for the July 2015 contract, joined by Cerner, Accenture, and Henry Schein.


Privacy and Security

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The Health Sector Cybersecurity Coordination Center within HHS alerts healthcare organizations to a growing number of distributed denial-of-service attacks. HC3 warns that the volume of invalid requests will not only slow servers down, but prevent valid requests from being processed.


Other

Vanderbilt University Medical Center’s Center for Knowledge Management develops MyKnowledgeHub, an online database of curated clinical evidence, drug information, and patient education resources for VUMC providers.

Former Propeller Health executive Chris Hogg — who left the company and started virtual primary care company Marley Medical in 2021 — analyzes the apparent demise of digital therapeutics vendor Pear Therapeutics following its filing of Chapter 11 bankruptcy:

  • The early idea that software could impact clinical outcomes evolved into focusing individual market segments, with companies such as Omada, Ginger, and WellDoc.
  • Implementation and delivery turned out to be the hard part. The underlying technology is only a small part of the solution.
  • The grind of distribution and payment is hard and expensive.
  • Companies were trying to identify their services business as technology businesses with their P&L showed otherwise.
  • Commodity software was being offered a high prices – up to $500 per patient per month in Pear’s case — based on a limited number of studies, with spotty payment and questionable value of a limited service. Care delivery can’t be sold like a consumer product.
  • Studies proving that tech can improve outcomes are necessary but not sufficient. Healthcare innovation usually fails to succeed due to patient acquisition, payment, and distribution.
  • The path forward is to build a new care model around software to deliver end-to-end-care to produce the outcomes that create value.

Another insightful comment about Pear comes from Eric Gastfriend, founder and CEO of competitor DynamiCare Health, who calls out product cost, lack of payer coverage, and this great summary:

Unrealistic expectations. They went public last year via a SPAC at a >$1B valuation, with just $4M in revenue. Raising too much money at too high a valuation forces companies to take big risks, spending the money they’ve raised to try to quickly drive revenue / milestones in order to justify the valuation. In fact, the SPAC was largely driven by previous rounds that raised too much at too high valuations. In total, the company raised >$400M, 25% of which was in the form of debt. Once you’ve taken on debt, leases, regulatory compliance burdens (FDA for being a prescription product; SEC for being a public company), and other unavoidable costs, it makes it harder to turn the company profitable, and therefore a better strategy is to try to grow as quickly as possible to be able to raise more money. That can work until the macroeconomic / fundraising environment dries up, which is what happened for tech in late 2022.


Sponsor Updates

  • AdvancedMD publishes a new e-guide, “Private Practice KPIs: 12 Data Points That Impact Revenue.”
  • Agfa HealthCare publishes a new case study, “Region Midtjylland (Region Midt) celebrates their Agfa HealthCare Enterprise Imaging Go Live.”
  • Nordic publishes a new episode of DocTalk, “Using data wisely: Telling the insight story.”
  • Bamboo Health will exhibit at the ACMA National Conference April 21-24 in Washington, DC.
  • Care.ai makes its AI-driven Smart Care Facility Platform available on Google Marketplace.
  • CarePort Health publishes a new customer success snapshot featuring Legacy Health Services, “Successfully managing patient populations with help from real-time data.”
  • CHIME congratulates members Cook Children’s Health Care System SVP and CIO Theresa Meadows, CHIME VP David Finn, and Intermountain Healthcare VP and CISO Erik Decker upon receiving their respective Leadership Excellence in Cybersecurity Awards from The Baldridge Foundation.
  • Current Health publishes a new study, “Temporal trends in virtual care data may influence program staffing and design.”

Blog Posts


Contacts

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

Morning Headlines 4/11/23

April 10, 2023 Headlines No Comments

Availity to Acquire Utilization Management Solution and Business Unit from Olive

Confirming earlier rumors of a sale, healthcare automation vendor Olive sells its payer-facing prior authorization business to health information network Availity.

Cerner Enviza Collaborates with FDA to Develop Innovative AI Tools for Drug Safety and Real-World Evidence Studies

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Culbertson Memorial Hospital hit by cyber-attack

Culbertson Memorial Hospital (IL) recovers from a cybersecurity incident last week that forced it to take its computer systems offline.

CommonSpirit Health Provides Cyberattack Notification of Data Breach

CommonSpirit Health issues an update on last year’s ransomware attack, which wound up impacting over 100 facilities in 13 states and compromising patient data stolen from two file share servers.

Readers Write: Healthcare Needs to Slow-Roll Fast-Moving ChatGPT

April 10, 2023 Readers Write 2 Comments

Healthcare Needs to Slow-Roll Fast-Moving ChatGPT
By Jay Anders, MD

Jay Anders, MD, MS is chief medical officer of Medicomp Systems of Chantilly, VA.

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Now that the initial hype surrounding the chatbot ChatGPT has peaked or perhaps plateaued, its strengths, weaknesses, and applications are being scrutinized.

Perhaps one of the most visible applications revealed recently was the AI tool correctly answering 60% of the United States Medical License Exam (USMLE) medical board exam questions, a task that many top-tier students fail to achieve. This raised a number of concerns about how the technology could, and should, be used in healthcare.

Granted, as an AI language model, ChatGPT has a number of applications in healthcare today, including administrative tasks, triaging patient inquiries, and performing preliminary analysis of medical data. However, ChatGPT is not a trained, certified medical professional and should never be relied upon for clinical guidance or diagnosis. Just like a Google or Bing search, it can provide limited general health information, but it is certainly not a substitute for professional medical advice or treatment.

As a physician, my primary concern with ChatGPT and other large language AI models is that patients accessing the technology will begin to distrust the advice of medical professionals when a disagreement occurs.

Here’s an example of how such a disagreement can go awry. Years ago, a patient came to our practice and told me she wanted to feel like ‘that guy surfing in a wheat field’ in a popular ad for an allergy medication.

When I inquired about her allergy symptoms, she said she had none. She argued that the drug would help her anyway. So, when I would not write her prescription, she switched doctors to one of my practice colleagues. My colleague asked why she was making the change, and I told her. My colleague then revealed that this same patient argued with her as well and then switched to the clinic down the street.

I am a staunch advocate of transparent patient information that is accurate and science based. In this case, a little knowledge could be a dangerous thing. At the time of the dispute, the patient was taking a medication that would interact with this antihistamine and cause a severe reaction.

Although ChatGPT and AI weren’t available at the time of this encounter, the danger is clear. There is a genuine risk that some patients, particularly those without access to primary care or those trying to avoid the inconvenience or expense of an office visit, might rely on AI technology like ChatGPT for medical guidance. This could lead to incorrect self-diagnoses, misinterpretation of symptoms, and any number of potentially harmful consequences. It is essential for consumers and patients to understand the limitations of AI in healthcare and always seek professional medical advice for their health concerns.

AI and the role of the clinician

What is the clinician’s role in this learning curve? Healthcare providers (and naturally, developers of AI solutions) should emphasize the importance of using AI as a supplementary tool rather than as a knowledgeable substitute for professional medical care.

The real issue is the lack of reliable, trustworthy information for patients. Patients, especially those with a rare disease community or with complex conditions, can’t advocate for their own health and care if they don’t know anything about the condition they are battling. Reliable academic medical information isn’t as freely or easily available to them, so they often rely on what they find on the internet to supplement what their doctors tell them for peace of mind and, in some cases, survival. The patient advocacy community calls the patient administrative burden associated with this lack of reliable information “information toxicity.”

That said, patients are already using AI to self-triage, so it’s really up to the medical and technology communities to establish parameters to prevent people from using the technology in lieu of trained medical professionals, or educate them on how to do it safely. Ultimately, it would seem that both communities would work to make the AI better able to do it better.

In my experience as a physician, I’ve encountered many patients who consider themselves quasi-medical experts and excellent researchers. Still, some patients don’t particularly care if the information they unearth is accurate. They just don’t want to feel left in the dark about their symptoms. After all, a wrong answer is still an answer.

Overall, patients want and need to be collaborators in their own care, and with the availability of information being what it is, they are moving forward in the best way available (to them). Unfortunately, the burden is on the physician to correct the misinformation, and that will need to be included in the job description of physicians and nurses going forward. With technologies like this on the rise, with questionable, though increasing, accuracy, there is no choice.

The responsibility is on health systems to educate patients on how to use these technologies and other more reliable websites to research and also regularly share population health information with communities to combat disinformation. Additionally, efforts should be made to ensure equitable access to quality healthcare for all, reducing the reliance on AI technologies for primary medical guidance.

Harnessing AI to supplement clinical decision support

Looking back at those USMLE licensing exams, consider this. The exams are written very discreetly. “A patient presents with X, Y, and Z. What is the diagnosis?” It’s based on a set of facts, and is possibly multiple choice. Humans do not operate that way. Consider a 65-year-old with high blood pressure, elevated cholesterol, diabetes, osteoarthritis, and spinal stenosis. That is not a single question, it’s multiple conditions. Physicians are trained to mesh those conditions together because a treatment for any one condition may exacerbate another. An exam would not approach it this way.

Physicians need to learn how to use AI to augment their practice, knowledge, and skill, not the other way around. Harnessing AI as a supplement to clinical decision support is a promising option.

For now, ChatGPT is out there, and it will be used, sometimes for medical advice. That’s all well and good until it makes a mistake or doesn’t surface something of importance. Meanwhile, there are technologies in use that work with clinicians, in their workflow, and present clinically relevant information regarding conditions in a way that mirrors the way they think and work.

The human element is, by necessity, still very much at the center of healthcare. So, for now, let’s slow the roll on ChatGPT. Let it mature. Crosscheck it. See how it evolves as its models are further trained and deepened. The technology holds tremendous promise, but is still in its infancy.

Curbside Consult with Dr. Jayne 4/10/23

April 10, 2023 Dr. Jayne No Comments

I was dismayed to see an announcement over the weekend that Pear Therapeutics has filed for Chapter 11 bankruptcy protection and has drastically scaled back its operations. The part of this story that isn’t obvious to many is that for some patients, prescription digital therapeutics may be a major part of their opioid treatment care plan. The Pear Therapeutics website notes that it is no longer accepting new prescriptions for its three major products, nor will refills be dispensed. They “will attempt to keep our products available for patients who are already using the products for the duration of the current fill of their prescription, but there can be no assurance that we will be able to do so.”

The company is seeking a sale of the business or assets, but who knows how this will unfold? Prescription digital therapeutics has been a promising technology and the ReSET product from Pear Therapeutics was the first approved by the US Food and Drug Administration. I hope this isn’t the beginning of the end for this type of treatment option.

The team at KRIS 6 news in Corpus Christi reports that a Texas teen posed as a physician assistant at two hospitals for nearly a month. The impersonator showed up in Corpus Christi Medical Center’s Bay Area Hospital wearing newly purchased scrubs and asked for a badge, stating that he was a traveling physician assistant. A volunteer coordinator who was covering the human resources office while its staff was out of the office made him a badge. The suspect began to interact with staff, not only at that facility, but also at Doctors Regional Hospital. After he was found loitering in an intensive care unit and talking about topics that seemed unusual, staff became suspicious. He told staff that he was a student at Stevens College in Missouri, which is a women’s college, raising concerns. Nurses found the suspect’s social media accounts, identified him as an impostor, and had him escorted from the facility.

A hospital spokesperson noted that the suspect didn’t interact with patients and that they were assisting in the law enforcement investigation. However, records show that his badge was used to access the emergency department, intensive care unit, operating rooms, cardiac catheterization lab, and the newborn nursery. Badge records show that tried to access several other areas without success, including the operating room’s locker room and the physician parking area. Investigators noted that the suspect also has bank fraud charges against him in Missouri. A search of his room at a local hotel uncovered a homemade firearm, a bulletproof vest, ammunition, firearms-related accessories, and a shirt with “sheriff” printed on it, raising suspicions that he was planning to impersonate a law enforcement officer. He was also found to have been driving a Crown Victoria police interceptor with accessories that are consistent with a law enforcement vehicle. They also determined that he tried to obtain a badge at Driscoll Children’s Hospital, but was unable to do so.

Following arrest, the suspect was released on bond then arrested shortly thereafter, having violated his GPS tracking system limitations nearly 200 times. He entered a guilty plea to multiple third-degree felonies and was sentenced in such a way that his conviction will be removed from his record after six years, as long as he completes requirements such as completing a GED or a high school diploma, maintaining a required curfew, and meeting with a community supervision officer. He immediately violated the terms of his sentencing agreement by leaving the state.

This story definitely falls under the category of “you can’t make this up,” but it’s shocking that he was able to obtain an ID badge in the first place. The volunteer who started the ID process was terminated from the hospital, even after notifying her supervisors of the strange situation the same day it happened. She was quoted as saying that the hospital “basically beat it into our heads that we needed to be all about customer service” and that’s why she started the process. Maybe having this story circulate will motivate facilities to check their processes and make sure their policies are a little tighter than those at the facility in question.

The last thing that caught my attention this weekend (during a major attempt at cleaning up my inbox) was a research article in JAMA that looked at the “Association Between Drug Characteristics and Manufacturer Spending on Direct-to-Consumer Advertising.” My understanding is that the US is one of a few countries that allow drug manufacturers to advertise prescription-only products to patients. (It might be one of two, with New Zealand being the other, but I’m running into some conflicting data.) The authors looked at 150 prescription drugs with the highest US sales in 2020 and found that drugs with lower clinical benefit received a higher portion of promotional spending.

As a practicing physician, I spend entirely too much of my time explaining to patients that although I appreciate the idea of “ask your doctor if this medication is right for you,” either the medication in question isn’t indicated for any of the conditions with which they have been diagnosed or that there are a number of inexpensive generic medications that have been proven to treat a condition just as well or better than the drug being advertised. It’s usually not a quick conversation, and ultimately saying no has a negative effect on patient satisfaction scores, but it’s the right thing to do.

Direct-to-consumer (DTC) advertising of prescription drugs didn’t start in the US until the mid-1980s. In speaking to colleagues, I haven’t yet found anyone who thinks that the practice has been shown to deliver better outcomes for patients. For those of us trying to deliver high-quality care and being faced with EHR alerts telling us to go with better options that are well proven for our patients, it’s one more frustration that contributes to burnout. It’s a major dissatisfier for physicians, but money talks, so I don’t see the practice being changed any time soon. I’d personally love to see all the money that is being dumped into DTC be diverted into health literacy and patient education instead, but that’s definitely a fever dream.

Since we’re in the healthcare IT news doldrums in the run up to HIMSS, what articles or news stories caught your attention this week? Leave a comment or email me.

Email Dr. Jayne.

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