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EPtalk by Dr. Jayne 6/2/22

June 2, 2022 Dr. Jayne 2 Comments

Surprise, surprise: research shows that patients understand their health records better when they are not full of abbreviations. The study, published in JAMA Network Open, showed improved comprehension when certain abbreviations and acronyms were spelled out. Although study subjects had previous exposure to healthcare organizations, their initial understanding of some common abbreviations was below 40%. Looking at a set of 10 common abbreviations, expanding them increased comprehension from 62% to 95%. The authors urge clinicians to consider that patients may not understand abbreviations and medical terminology. Abbreviations aside, it’s important to understand the low level of health literacy across the US and the need for most patient-facing communications to be written at or below the sixth-grade level.

I recently had another trip into the Patient Zone, and even as a healthcare provider, I found some of the things I encountered confusing. I know how to navigate the system and I still have a post-visit issue that remains unresolved three days later. The office was running significantly late, so I got to listen to quite a few inappropriately overheard conversations. One involved a staffer who kept confusing two “sound-alike” medications to the point where I wanted to step out to the clinical station and correct her. Losartan is for blood pressure, Loestrin is an oral contraceptive. I later found out that she wasn’t working in her usual clinical location because they had floated people to the office to cover shortages. Still, I hope that no one was harmed on their watch. I received some wonky directions from people in the office and it makes more sense if they were temporary staff, but the average patient might not know to question it.

I’m also trying to put myself in the shoes of patients who are receiving immediate lab results via their patient portal accounts. The clinician I saw warned me, “you’ll probably see your results before I will” and she wasn’t kidding. Barely six hours after I left the office, I started receiving a flurry of “new result available” alerts. I’m not sure how the labs were ordered, but each component of the blood work was coming back as an individual result with its own notification. It was unnerving to say the least, especially since the ones I was really waiting for weren’t among the first to return. As a physician, I know what the results mean, but as a patient I can imagine it might be very frustrating. My guess is it won’t be until sometime next week before I receive an official interpretation, once all the results have returned. I’ll be interested to see how the rest of the process goes, and if my pharmacy benefit manager will ever sort out the erroneous script that was sent. I tried to resolve it, but they were never able to find the provider’s name in their system (despite me being able to see the erroneous script from the patient-side login) so I’m betting at some point I wind up driving to the office to pick up a paper script and fax it in myself.

Needless to say, there’s a long way to go for some healthcare organizations to really embrace the idea of patient-centered design. There have been a lot of healthcare futurists over the last decade who have said that patients will vote with their feet and drive their healthcare dollars towards organizations that deliver care that is personalized and consumer friendly. Pre-pandemic I still saw the majority of patients choosing their care based on insurance coverage with very little consideration of quality metrics or anything else. Now, with all the staffing shortages and physicians leaving patient care in droves, patients seem to just be getting in wherever they can. In my area, one of the largest health systems has over 4,000 patients on its wait list for a particular specialty, which now refuses to accept any referrals from outside the health system. That doesn’t seem terribly patient-centric to me. The organization blames its inability to recruit for the shortage of clinicians. I guarantee that if they raised their salaries above 25th percentile they’d be able to recruit.

After reflecting on these recent experiences, I wasn’t sure I was in the right frame of mind to read yet another article about a “man on a mission” in healthcare. One of my shoe-loving friends has a huge crush on Glen Tullman though, so I figured I better keep up so she and I have something to chat about. The premise of Tullman’s latest venture, Transcarent, is leveling the playing field for patients as they try to meet their healthcare needs. He calls out the fact that the health insurance industry is one that doesn’t operate in the best interests of its customers. The article calls out the fact that when insurance companies profit, each dollar represents care that patients didn’t receive. Tullman proposes giving those dollars back to large, self-insured employers who are footing the bill for coverage.

It will be interesting to see if Transcarent is able to succeed where other companies have failed. Haven tried to do this a few years ago for employees of Amazon, Berkshire Hathaway, and JPMorgan Chase. So far, more than 100 companies have signed up, eager to see savings on their healthcare spending. Transcarent makes its money by taking a cut of that savings, which is achieved through pre-negotiated pricing for services as well as by directing patients to lower-cost alternatives. Corporate customers are gravitating to the approach as are health systems, some of which are financially backing the endeavor. Walmart is jumping in with a recent agreement to become a preferred provider, offering primary care, mental health, and dental services. The article was enough to hook me, so I’ll be following along as the company expands. They’ve already hired some really smart people, and I’m eager to see if they’ll be able to move the needle.

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Happy 19th Birthday HIStalk! I didn’t have time to do proper pastry therapy, so this option from my neighborhood Costco will have to do. Even though white cake is my favorite, you really can’t go wrong with a cake that is filled with their signature mousse.

What’s your favorite birthday pastry? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 6/2/22

June 1, 2022 Headlines No Comments

Oracle Purchase of Cerner Approved

Oracle has gained the antitrust approvals necessary for its proposed $28.3 billion acquisition of Cerner, now set to take place next week.

SoftBank-Backed Telehealth Firm Cerebral Announces Layoffs

Amidst federal scrutiny and the recent ouster of its founder and CEO, Cerebral announces that it will lay off an undisclosed number of employees by July 1.

Moxe Health Raises $30M Series B to Further Advance Interoperability

Health data exchange vendor Moxe Health raises $30 million in a Series B funding round led by Piper Sandler Merchant Banking and Vensana Capital.

Accrete Health Partners Acquires Nordic Consulting Partners

Accrete Health Partners, a digital health holding company that launched in May, acquires Nordic Consulting for an undisclosed sum.

Readers Write: Answering the Call of Nurses Month: Arming Nursing Schools to Fill the Practice Gap

June 1, 2022 Readers Write No Comments

Answering the Call of Nurses Month: Arming Nursing Schools to Fill the Practice Gap
By Julie Stegman

Julie Stegman is vice president of the nursing segment of health learning, research, and practice business at Wolters Kluwer.

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The theme of Nurses Month this year is “Nurses Make a Difference.” But they can only continue to do so if they are supported in their roles, and that starts with education.

The ongoing nursing shortage has devastated hospitals across the nation, affecting patient care and driving high rates of burnout among those still practicing. And as the population continues to grow and age, demand for healthcare services will only increase. Reports project that 1.2 million new registered nurses (RNs) will be needed by 2030. To address today’s nursing crisis and empower nurses to continue making a difference, we need a collaborative approach that brings practice and academia together to improve new nurses’ confidence and competence, overall nurse retention, and to produce more nurses ready for the field, eager and product to care for patients.

While practice adjustments such as more flexible work schedules, cross training, and alternative care models can help address the current shortage by better supporting and thereby retaining nurses in the field, academia also has a significant role to play. Training new nurses efficiently and effectively is essential to meet the demands of practice today and for years to come. Yet a survey by the Association of Colleges of Nursing found over 80,000 qualified BSN applicants have been turned away from nursing school due to budgetary constraints and a lack of faculty, clinical sites, and classroom space.

During the pandemic, these challenges were exacerbated as hospitals and academic medical centers closed their doors for educational purposes because they did not want students using the limited personal protective equipment they had on hand, or to be exposed to COVID-19. Sites that had previously closed their doors to students are now becoming more available, but the underlying challenge of a lack of clinical sites continues to limit nursing school applicants.

While the adoption of simulation and other virtual technologies was already underway in nurse education before COVID-19 hit, the pandemic accelerated rapid adoption of virtual simulation, virtually overnight, to help fulfill the necessary clinical time requirements for graduation. This shift was a necessary one, as virtual simulation has proven its value as an essential resource for nursing schools to bridge the gap between classroom and clinical practice, including the use of high-fidelity manikin-based simulation, to ensure professional competency for nurses about to enter the field. It also provides an essential training resource for nurses to learn how to personalize and individualize care based on patient needs and clinical cues.

Simulation programs have offered a vital stand-in for real-world clinical sites that have been unable to take on nursing students during the pandemic. By mirroring real clinical practice, virtual simulation teaches nursing students to recognize and analyze cues such as pain, paleness, urticaria — effectively to take action and respond to unfolding visual and audio responses from the patient to improve clinical reasoning skills in a safe virtual environment. Simulated nursing education programs also offer end-to-end practice instruction, including reflective practice and debriefing after the simulated interaction is complete.

While this technology has been in use for nearly a decade, the last two years have accelerated adoption of virtual tools in and out of classrooms. Simulation can offer a sustained impact on nursing by addressing the shortage of clinical sites that has been a limiting factor to nursing school admission.

While our frontline nurses are continuing to provide care throughout this pandemic, healthcare systems are embracing the opportunity to innovate and modernize their practices to better support their nurses. At the same time, academia continues to innovate to ensure the ripple effects of the pandemic don’t impact the critical nursing education system. Effecting change at the education level is crucial and will positively affect the nursing profession as a whole, creating more practice-ready nurses who are equipped to manage the demands of real-world practice. Staring Nurses Month in the face, we need to enact immediate change at both the practice and academic level to create a more resilient nursing workforce and continue delivering the best care possible to patients.

HIStalk Interviews Waqaas Al-Siddiq, CEO, Biotricity

June 1, 2022 Interviews No Comments

Waqaas Al-Siddiq, PhD, MSc is founder and CEO of Biotricity of Redwood City, CA.

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Tell me about yourself and the company.

I’m an engineer by training. I got interested in remote patient monitoring because I did a bunch of work at my grad school in remote monitoring. One of the applications was healthcare. I took a weird road through my career, as I think all entrepreneurs do. But I really felt that the future of healthcare was going to be in remote monitoring. I founded Biotricity and the rest has been history.

How are clinicians using real-time ECG monitoring and how does that compare to old-school Holter monitors?

There’s an application for both areas. We just recently got into the Holter space as well. But our focus has been chronic patients, patients where you have a risk of a heart attack or a stroke and where 87% of patients are asymptomatic. Many of these issues are happening at nighttime while you are sleeping. Traditional solutions are recording your data, but they are not monitoring. It’s called Holter monitoring, but  the “monitoring” name and nomenclature in the industry is misleading. It is recording your data, which you then download later for analysis the week after that report.

If you are sleeping and you have chest pain and wake up in the middle of a heart attack, the real-time monitor is looking at your data continuously and analyzing. It’s a smart monitor. When it detects that you have crossed a threshold, it sends a message with that strip of data to a call center, where we have nurses who know how to read ECGs and who can deal with emergency response. You can solve the problem for high-risk patients where if they are sleeping, you can get them in, you know what’s going on, and and you can treat them.

How do outcomes change with having a clinician on the other end of a real-time monitor versus consumer phone apps, where users have to initiate the reading and then react to vague “call your doctor” warnings when the app sees something resembling atrial fibrillation?

AFib is a good example, because a lot of people have chronic AFib. A clinician on the other side knows if you need to go to the hospital, such as if you’re in heart failure and won’t survive without immediate help. The clinician has enough data and can interrogate the device to get more data. By the time you get into the hospital, they know what’s going on.

Many times with our products, we see the patient’s heart going through pauses, or AFib burden that is increasing. That means that the patient’s heart is going to stop, or they are going to end up having a stroke if the AFib burden is increasing. You get an alert at 2:00 in the morning, the nurse calls the on-call doctor, and they get the patient in. But they already know that the patient is going to stroke out, or they know that patient needs an emergency pacemaker put in. The diagnostic and the treatment has already been concluded before the patient is even there. 

You are saving the patient’s life. But more importantly, you’re avoiding muscle damage. The big part of rehabilitation is that you have a catastrophic event, you survive it, but now you’re debilitated and you have to go through rehabilitation. Or maybe it’s been so catastrophic that you are going to have to live with a worse organ or a worse condition for rest of your life because they treated you, but got there late. This is where smart monitoring can really make a difference.

Patients at home call 911 and wait for first responders to evaluate and transport them. How does the process work when your monitoring center detects a problem?

They patient won’t always even know. We have had cases where patient is taking a nap, something happens and the alert goes in, and the call center looks at it and decides, this patient is going to go into heart failure or have a stroke, so we need to get them in. The doctor is called, looks at the data, and says yes, get the patient in. Usually there’s either an on-call doctor or a prescribing doctor, depending on how they set it up, so some physician is called once the threshold is met. They will say, call the patient’s family and tell them to come to the hospital immediately. Or they will say to call 911, depending on what is happening. The physician is directing it.

Many times you call the family member and tell them to bring the patient in for an emergency intervention and they say, “Oh no, that can’t be. They are taking a nap.” We say that we understand that they are taking a nap, but you need to wake them up and get them to the hospital because they are having an emergency event.

Smart phone atrial fibrillation apps trigger a lot of false alarms and send patients to cardiologists who determine that treatment isn’t necessary. How can that process be improved?

The bare minimum for effective diagnostics in the heart world, in the ECG world, is 24 hours of continuous analysis. Apple Watches and consumer products collect 30 seconds of data. They are not providing a holistic view of the patient, and even 24 hours doesn’t give you a good chance. Holter monitors and mobile telemetry monitors are being used from seven, 21, or 30 days of continuous recording. False positives and warnings about non-issues could just be random occurrences within that 30 seconds, but in the broader spectrum of 20 days of data, it’s a blip. 

We all have these blips, but our core health is solid. Smart monitors can track and watch this, and if the blips hit a threshold, the doctor sees that. Sometimes the doctor will say, this is not an emergency and I’ll see the patient when they come in. The event doesn’t meet the requirement for an emergency intervention, but they are making that call remotely.

That also happens when the device alerts for something, it goes to the call center, and the nurse looks at it and decides that it’s an issue, but not a life-threatening one, so they might not even need to call the doctor. Or they decide that it could be life-threatening, they call the doctor, and the doctor decides that it’s not an emergency and books them an appointment within the next couple of days.

What was the business case for developing the non-prescription Bioheart chest strap monitor that is sold in the competitive consumer market?

What we see is there’s 15 million Americans, maybe 17 million now, who are diagnosed with cardiac issues. We are part of that diagnostic flow. Once they have been diagnosed, it’s a lifelong condition. Whereas diabetics have glucometers, cardiac patients have nothing.

We created Bioheart to take the technology that we use to diagnose patients and provide it in a simplified, non-diagnostic scenario for personal use. It can collect long-term data on that individual so that patients can better manage their lifestyle. It targets individuals who are diagnosed or at risk for cardiovascular issues so that they can get that broader insight, because cardiac issues are intermittent and most patients and individuals are asymptomatic. 

They don’t have any insight. Diabetics can prick a finger, collect their glucose, and now can use continuous glucose monitoring without even doing the prick — it tells you your level and you can make adjustments to your lifestyle to manage that. Cardiac issues are way more complicated because they are intermittent and many patients don’t have symptoms. You have to collect a long amount of data to determine what you should or should not be doing. We introduced the Bioheart because we felt that individuals needed a tool, and in the marketplace, 30-second and one-minute data collections are just not good enough. You really need long-term data, and that’s why we built Bioheart.

Your website mentions pain management, which is fascinating since pain is monitored as subjective patient perception rather than a physiologic measurement, with limitations that can lead to undertreatment or addiction. How do you see your cardiac issue model applying to pain management?

Exactly right, pain is very subjective. One of the reason we started looking at pain and some of those issues is because pain can manifest itself with an elevated heart rate or elevated temperature. It will show up in certain metrics, including how you are moving. With our Bioheart product and how we are moving in terms of remote monitoring, we looked at how can we quantify and align pain.

The other thing with pain is that everybody’s concept of pain is different. One person’s pain level of seven might be a pain level of two to someone else. How debilitating it is subjective. One way to contextualize that and provide some objectivity to it – it will still have to be individualized — is to look at their biometrics. Someone may have a pain of seven, another a pain level of two, but both of them have elevated heart rates. One person has a natural tendency to deal with a certain kind of pain better than another. Another thing is the types of pain that individuals have. Some people can handle throbbing pain, other people can handle sharp pain. It’s all over the map. 

Our focus is to try to provide objectivity and link it to remote monitoring so that we can use data to support and provide insight to individuals so that they can better manage their conditions.

How do you see pain monitoring evolving into a business?

As we grow and as we continue to make inroads from a business perspective, it’s a service that we are providing to bring in that objectivity. We are not really focused on the nuts and bolts of revenue, rather that we have the technology, it’s helpful, and let’s make it available and we will provide it at free of cost. 

Long term, how it will transform into a business is that a lot of pain docs need a data point that individuals are engaged with. If they can do that, then they can bring that as a part of their way of managing pain for those patients. The commercialization, the business, will align pain specialists and make it a part of their assets and toolkit to help manage individuals’ pain. In that regard, we can create reporting and ink that to reimbursement. If we can achieve the goal and show outcomes that this tool is effective and offers objectivity that makes sense, then that is something that will become commercialized with insurance and we will have a commercialization pathway.

What are the company’s goals over the next three or four years?

One is to build our diagnostic product. We have multiple products coming out with the Bioheart and with the Holter solution. The next year or 18 months is about transforming into a platform company and building the entire cardiac ecosystem so we can track a cardiac patient from diagnostic all the way to disease management and have multiple touch points with them through their cardiac journey. We are with them every step of the way, and so building that brand.

Then 18 months after that, to democratize cardiac care and delivery across the United States. There aren’t many cardiologists — 70 million people at risk, 17 million diagnosed, and 25,000 cardiologists. It’s just too many patients. Many of these individuals have no access. In the smaller suburbs and rural areas, your access to the specialist is limited at best. We create time if we can make cardiologists who use our platform and technology more efficient. It allows them to focus on the patients that matter and the patients that are stable. We enable them with the tools to manage their conditions and we create time. Creating time and efficiency for cardiologists allows us to improve access. We can use digital help and virtual care to do remote diagnostics and deliver care across the spectrum. That’s our goal and our vision.

In three or four years, you will see a very different company. We are laying the groundwork today. I always joke with my team internally and my reps that everybody thinks Biotricity is playing checkers, but we are playing chess. We are releasing components of a broader picture that will create a domino effect three or four years from now, where we provide accessibility to cardiac solutions and cardiologists in an easy way by big technology, as a conduit for not only those individuals who are stable, but also to create efficiencies so that access is improved.

Morning Headlines 6/1/22

May 31, 2022 Headlines No Comments

Lightbeam Acquires Jvion AI and SDOH Solutions

Population health management vendor Lightbeam Health Solutions will acquire Jvion, which specializes in AI-powered predictive analytics and social determinants of health software.

Cerner ticks higher on report Oracle deal targeted for mid-June close

Oracle’s acquisition of Cerner is reported to be on track to close within the next couple of weeks.

By Light Awarded $82M VA Contract

The VA awards By Light Professional IT Services a five-year, $82 million contract for the continued development, security, and operation of its My HealtheVet patient portal.

News 6/1/22

May 31, 2022 News 2 Comments

Top News

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Population health management vendor Lightbeam Health Solutions will acquire Jvion, an Atlanta-based company that specializes in AI-powered predictive analytics and social determinants of health software.

Lightbeam acquired remote patient monitoring startup CareSignal last November.


HIStalk Announcements and Requests

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Poll respondents most commonly expect the stock market downturn to cause companies to cut expenses, employees to keep working for the same employer longer, and for vendors to buy each other.

New poll to your right or here: How much annual paid vacation time / PTO do you get from your employer?

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HIStalk’s 19th birthday is this week. I started putting my thoughts online on June 3, 2003 since I had no hobbies outside my health system IT executive job. That’s a lot of blank screens filled since.


Webinars

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


Acquisitions, Funding, Business, and Stock

Oracle’s acquisition of Cerner is reported to be on track to close within the next couple of weeks.


Sales

  • St. Peter’s Health (MT) selects the Innovaccer Health Cloud Data Activation Platform to unify patient records across its facilities.

People

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Divurgent names Bismoy Beura (Tata Consultancy Services) VP of client services.

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Christine Havlin, RN (Optum) joins MobileSmith as chief marketing officer.

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Medecision promotes Terri Steinberg, MD, MBA to chief strategy officer / chief medical officer.

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Transcarent names Tim Rosa (Fitbit) chief marketing officer.

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Gerry Lewis (Ascension) joins US Radiology Specialists as CIO.

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World Wide Technology hires Erin Jospe, MD (Kyruus) as chief healthcare advisor.

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Provation Medical promotes Craig Moriarty, MS to chief revenue officer.

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Baystate Health hires Kevin Conway (Tegria) as SVP/chief information and digital officer.

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Change Healthcare promotes Archie Mayani, MBA to SVP and chief product officer of decision support.


Announcements and Implementations

Hospital General Menonita and Manati Medical Center in Puerto Rico adopt CloudWave’s OpSus Live cloud hosting service.

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The Connecticut Children’s Neonatal ICU at UConn Health will go live on Epic later this month.

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In Pennsylvania, Butler Health System launches a telemedicine clinic at Rimersburg Medical Center that was developed by Butler surgeon Rod Stevenson, MD.

Pawnee Valley Community Hospital (KS) transitions its family medicine clinic to Meditech.


Government and Politics

The VA awards By Light Professional IT Services a five-year, $82 million contract for the continued development, security, and operation of its My HealtheVet patient portal.


Other

WVU Medicine Children’s has increased its urology telemedicine clinics from three to four, with a fifth in the works, after an internal study found that virtual visits between 2018 and 2020 were clinically effective and saved families an average of nearly five hours in driving time and $175 in fuel.

Bizarre: two male avatars on Meta’s social networking platform invite the avatar of a female human behavior researcher to a private virtual party, then rape her avatar as they make lewd comments and pass a bottle of virtual alcohol between them. The researcher says it was especially creepy because the Oculus VR headset transmitted physical sensations to her controller when the male avatars touched her. Another researcher says that within 60 seconds of joining the same VR platform, a group of male avatars sexually assaulted hers.


Sponsor Updates

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  • CTG staff donate items for the Community Baby Shower hosted by the United Way of Buffalo & Erie County.
  • EClinicalWorks publishes a new customer success story featuring Provida Family Medicine, “How the EClinicalWorks EHR Integrates Data from Other EHRs.”
  • AGS Health publishes a new e-book, “5 Reasons to Select AGS Health as Your Offshore Service Provider.”
  • WellSpan Health profiles the success its physicians have had using Nuance’s Dragon Ambient EXperience AI-powered voice recognition software to automatically transcribe patient visits.
  • Baker Tilly will present at the Healthcare Capital Markets & Innovation Summit June 1 in Columbus.
  • Bamboo Health has co-sponsored the Columbia River Mental Health Services Spring 2022 Gala.
  • Cerner releases a new podcast, “How COVID-19 impacted consumerism and how healthcare organizations can adapt.”
  • Clearwater publishes a new case study, “Owensboro Health on Taking Cyber Risk Management Beyond the EHR.”

Blog Posts


Contacts

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

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Morning Headlines 5/31/22

May 30, 2022 Headlines No Comments

VA Ordered to Report Performance of Troubled Health Records System to Congress

Pending President Biden’s signature, new legislation will require the VA to submit quarterly reports to Congress on the performance of its new Cerner EHR software.

Doctor-Founded Cherry Health Closes $1.23 Million to Expand Job-Matching Platform for Physicians

Cherry Health, a Canadian health tech startup that has developed a job-matching app for physicians, has raised $1.23 million CAD in pre-seed financing.

Report rejects Rebekah Jones’ claim that Florida doctored COVID data

A report from the State of Florida’s Inspector General determines that a former department of health data scientist’s claim that the department intentionally falsified COVID-19 data to support opening the state back up cannot be substantiated.

Morning Headlines 5/27/22

May 26, 2022 Headlines No Comments

Chipmaker Broadcom to buy cloud services firm VMware in $61 billion deal

Broadcom will acquire cloud services vendor VMware for $61 billion.

Change Healthcare Inc. Reports Fourth Quarter and Full Year Fiscal 2022 Financial Results

Change Healthcare reports Q4 results: revenue up 8%, adjusted EPS $0.39 versus $0.42, beating revenue expectations but falling short on earnings.

IT Specialist Charged in Cyber Intrusion of Suburban Chicago Health Care Company

A federal court indicts IT contractor Aaron Lockner for allegedly hacking into the server of a clinic operations company, which had denied him full-time employment two months earlier.

News 5/27/22

May 26, 2022 News 2 Comments

Top News

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Healthcare cybersecurity vendor Clearwater signs a definitive agreement to acquire competitor CynergisTek for $17.7 million in cash.

CTEK shares, which were trading at around $0.60 on the NYSE American small-cap market before the announcement, were down 65% in the past 12 months and were 91% off their 2017 all-time high.


Reader Comments

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From Lollygagger: “Re: Arnot Health. Has an ongoing technical issue that is affecting ambulatory offices and the patient portal.” The health system says its downtime, which has persisted for more than a week, is not related to malicious activity.

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From Kermit: “Re: Jamcare Medical. An interesting niche. Wonder how they handle the documentation?” Jamcare Medical, which seems to be a non-profit, provides medical services such as crisis intervention and drug intervention to music festivals and concerts, which it says avoids unnecessary medical transports and legal involvement for their promoters. Basic service includes a team to help management overdoses and behavioral health issues; its middle-tier offering provides the complete first aid response team, a first aid booth, and around-the-clock grounds surveillance to prevent problems such as “dehydration, fights, and slips and falls;” while its premium package adds an onsite or online physician.

From Long-Time Fan: “Re: medication adherence. We are building a solution and seeking beta partners such as payers, manufacturers, and health systems, anyone who has a vested interest in helping people with chronic conditions take their medications regularly. Do you know of specific organizations that are open to new adherence solutions?” I do not, but I’ll invite readers who have that interest, or know who might, to email me and I’ll forward the information (this is a early-stage company that isn’t quite ready to make a public splash).

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From Pajeet Pete: “Re: Ascension. Gerry Lewis is out, replaced by Gagan Singh.” Gerry is still listed on the executive team page and hasn’t changed his LinkedIn, but Gagan’s LinkedIn shows that he was promoted from chief data officer to SVP/CIO this month. A layoff discussion board entry says Lewis left as of May 13. He was also CEO of Ascension Technologies, whose web page now lists Singh as SVP/CIO. They outsourced a lot of IT work offshore, which continues to draw discussion board vitriol.

From Mark: “Re: wearables. A recent panel concluded that a problem is keeping the devices charged.” Experts say that one of the biggest compliance challenges for remote patient monitoring is that the devices needed to be recharged, leading to hopes that someone will figure out how to power them from body heat or kinetic energy.


Webinars

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


Acquisitions, Funding, Business, and Stock

Walmart and CVS will stop accepting controlled drug prescriptions from online ADHD providers Cerebral and Done, which face a federal review of their compliance with controlled substance prescribing. Both ADHD companies also mail out prescriptions directly to their customers, which seems to be a touted feature, so it isn’t clear what percentage of their prescription volume goes through the drug chains. It’s an interesting situation:

  • The business model of the companies was always at risk since pandemic telehealth waivers will eventually expire.
  • A federal probe will likely review the rigor of the process – or lack of it — by which the companies declared after a brief telehealth conversation that a patient had ADHD that required Adderall or Ritalin.
  • Contracted or employed doctors generated every one of those diagnoses and prescriptions, so their licenses are on the line regardless of what the company told them to do.
  • Should observers be correct in their speculation that the company was complicit in selling drugs to people who used fake IDs or duplicate mailing addresses, the crackdown on telehealth patient vetting could be significant.
  • The companies can’t survive without generating prescriptions, so they are certain to strengthen their prescribing guidelines. Cerebral is already phasing out prescribing of controlled substances.The percentage of their resulting drop in business – which will be huge – will signal how much of it was inappropriate.
  • Other services still advertise “anxiety meds from your couch” and easy access to antidepressants, which may be reviewed by states who receive a wake-up call about what Cerebral and Done were doing even though non-controlled substances are involved.

Change Healthcare reports Q4 results: revenue up 8%, adjusted EPS $0.39 versus $0.42, beating revenue expectations but falling short on earnings.

Broadcom will acquire cloud services vendor VMware for $61 billion.

A leaked presentation from Silicon Valley VC firm Sequoia Capital says that the market boom is over, predicts that recovery will not be quick, and warns its portfolio companies that they should review projects, R&D spending, and marketing expenses to prepare for cutting costs to avoid a “death spiral.”

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I’ve written previously about Miami-based MSP Recovery, which recovers inappropriate Medicare payments for which Medicare does not have primary payment responsibility. The company announced last fall that it would go public via a SPAC merger at a valuation of $33 billion, $23 billion of which would have flowed to the pockets of founder and CEO John Ruiz, who also runs a law firm that represents MSP in claims. The money-losing company, which claimed it would generate $5 billion annual profit by 2026, began trading on the Nasdaq Tuesday, then lost 60% of its value in its first few minutes of trading after opening at $10 per share. MSPR shares have continued their journey south, now trading at $2.56. Trial lawyer Ruiz just bought a $25 million house in Coral Gables, FL, owns another estate he bought for $49 million from the founder of Leon Medical Centers, and zips above mere mortals in his personal jet, a Boeing 767.


Sales

  • Health and Social Care Northern Ireland chooses Tegria and Cloud21 – in which Tegria holds an investment — for its decade-long Encompass program in which Northern Ireland will become the first UK country to implement an EHR that spans acute care, mental health, community care, and social services. Tegria invested an unspecified sum in London-based digital health consultancy Cloud21 in March 2022.
  • Wise Health System (TX) will implement a care-at-home program using the Hospital@Home program of Biofourmis.
  • Zing Health selects Availity’s network for answering provider questions about patient health plan coverage and payments.
  • India’s Narayana Health signs a digital technology collaboration agreement with Honeywell that will emphasize sensor-based applications for patient monitoring and fire safety.

People

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SyTrue hires Chad Wege (Apixio) as VP of product.

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Azara Healthcare promotes Matthew Iezzi to VP, national accounts commercial.

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Kalderos hires Jared Crapo as chief of staff.

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Scott Weingarten, MD (Cedars-Sinai) joins Medicare value-based care provider Vytalize Health as chief value officer.


Announcements and Implementations

Drummond Group launches a pediatric health IT certification program.

NCH Healthcare System (FL) will go live on Epic next week in a $65 million project, replacing Cerner.

Lyniate launches a AWS cloud deployment model for its Corepoint integration engine.

NextGen Healthcare launches Health Data Hub Insights, a data warehouse and analytics solution.

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Hoag Hospital (CA) pilots Hoag Compass, an internally developed, IOS-only mobile app for consumers that includes appointment scheduling, provider messaging, health records review, lab results reporting, and prescription refills. Users who pay $50 per month for the premium plan also gain access to personalized care plans, urgent care support, an on-demand care team, and access to an executive lounge at the Hoag On-Demand Care and Innovation Center.

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A new KLAS report finds that health systems and vendors aren’t delivering the patient engagement tools that many patients want. Providers and vendors fall short of expectations for self-scheduling and prescription refill requests, but have overdelivered on technologies in which patients have limited interest, such as pre- and post-visit communication, patient education, and satisfaction surveys. While most patients are satisfied with virtual visits, they would like to gain a better understanding of the kinds of issues that aren’t best managed by telehealth, be sent an email link before the virtual visit, and spend less time waiting for the clinician to join. Few patients use patient portals regularly, and those who do are more interested in scheduling appointments, requesting refills, and messaging providers than using provider-benefiting services such as updating insurance information or paying bills.


Government and Politics

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Australia’s state of Tasmania will spend $106 million to trial a statewide EHR and patient record viewer in a four-year project that will connect all public and private providers. The state’s overall digital health plan calls for spending $336 million over 10 years.

Miruna Sasu, PhD, MBA, president and CEO of real-world oncology data vendor Cota Healthcare, says that FDA could facilitate the use of real-world data by capturing it cleanly in the EHR so that it looks similar to clinical trial data instead of trying to clean it up afterward.

The VA launches Mission Daybreak, a $20 million challenge program to develop suicide prevention solutions, including the use of digital footprint data and technology that improves access to the Veterans Crisis Line.


Other

The lab manager of the VA’s Walla Walla, WA medical center says its newly implemented Cerner system saves employees three hours per day by digitally tracking specimens. He says his goal was to ignore the negative narrative about Cerner and instead spend time preparing for the implementation.

A GHX survey of senior healthcare leaders finds that staff shortages and burnout is their top concern, with 80% of them planning to use automation to reduce manual labor.


Sponsor Updates

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  • Baker Tilly awards a $10,000 Wishes Grant to Turner’s Heroes, a nonprofit pediatric cancer patient support and research organization.
  • In the Netherlands, Northwest Clinic expands its enterprise imaging contract with Agfa HealthCare to include the company’s Rubee for AI platform.
  • AGS Health publishes a new white paper, “The Evolution of Coding: Understanding How Technology is Assisting Us.”
  • Ascom Americas adds Forerunner Technologies to its mobility partner network.
  • CereCore wins a Silver Stevie Award for its achievement in customer satisfaction.
  • Cerner VP and CMO Lu de Souza, MD and Lead Physician Executive Mehul Steth, MD are named Fellows of AMIA.
  • CHIME and WEDI launch the “Think Before You Click” campaign to help consumers prevent the loss of health information.
  • Clearwater founder and Executive Chairman Bob Chanut, author of “Stop the Cyber Bleeding,” will deliver three Online MS in Cybersecurity Badge Courses for Quinnipiac University.
  • RCxRules  publishes an infographic titled “Overcoming Staffing Challenges.”
  • TechVibe Radio features ConnectiveRx SVP of Product Development Mary Beth Sirio.
  • Dina names Mary Naylor, PhD, RN (Pennsylvania School of Nursing) to its Board of Directors.
  • Divurgent names Debbie Rieger (Gold Coast Health Plan) payer principal.
  • EClinicalWorks publishes a new customer success story, “Advocate Aurora Health: Helping a Regional Nonprofit with Population Health Solutions.”
  • FDB names Kristina Shausmanov (FIFA) quality management data analyst.
  • Mach7 Technologies will exhibit at SIIM22 June 9-11 in Kissimmee, FL.
  • Meditech congratulates the more than 90 customers that have been recognized with 2022 Healthgrades Patient Safety Excellence Awards.
  • Nordic will present at the EHealth 2022 Virtual Conference + Tradeshow June 1-2.
  • OneMedNet names Robert Golden, CPA (Cohen, Bender & Golden) to its Board of Directors.
  • Magenta Care Continuum joins the Olive Library to revolutionize the risk adjustment process.
  • Symplr partners with Susan G. Komen to raise $1 million in the fight against breast cancer.
  • Premier joins the Biden administration’s Healthcare and Public Health Sector Joint Supply Chain Resilience Working Group to drive greater resiliency in the US healthcare supply chain.
  • ReMedi Health Solutions will present at the Healthcare IT Institute June 12-14 in San Antonio.
  • Talkdesk donates over $25,000 to various charities as part of its annual Digital Showdown: Innovations in CX event.
  • Wolters Kluwer Health will publish the American Association for the Study of Liver Diseases’ four specialty journals.

Blog Posts


Contacts

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EPtalk by Dr. Jayne 5/26/22

May 26, 2022 Dr. Jayne No Comments

Plenty of clinicians and health organizations are less enthusiastic about wearables than you might think. They’re still worried about the sheer volume of data that can be generated by patient-owned devices and how that needs to be managed with respect to electronic health records and who should own the follow up for any abnormal data. As wearable devices begin to identify more physiologic phenomena, this continues to come up in conversations. A recent JAMIA article looks at whether the ability of Apple devices to identify abnormal heart rhythms could potentially prevent strokes. The authors considered how they might identify high-risk patients in whom device data could lead to a diagnosis of atrial fibrillation and whether those patients would benefit from treatment with blood thinners.

The study used data from over 1,800 patients at Cedars-Sinai Medical Center and looked at both EHR and Apple Watch data collected between April 2015 and November 2018. They estimated the number of high-risk patients using three different methods: medical history, Apple Watch wear patterns, and atrial fibrillation risk determined by an existing validated clinical model. The authors concluded that using clinical and demographic data from the EHR might be helpful to identify patients who would benefit from device monitoring. They noted that “a randomized controlled trial to study the benefit of consumer-directed heart rate monitoring devices in preventing strokes would require either a massive sample size or an enriched sample of patients very likely to experience stroke” due to atrial fibrillation. They noted that Apple Watch users tend to skew towards young healthy, which might not be the best demographic for identifying those at high-risk for stroke. I’m sure there’s more to come because clinicians will continue to question how to best use patient-generated data.

Last week, the American College of Obstetricians and Gynecologists dropped New Orleans as the site of its 2023 annual conference, citing concerns about Louisiana’s restrictive stance on abortion. The group’s official statement noted: “Holding the nation’s largest gathering of obstetrician-gynecologists in a location where the provision of evidence-based care is banned or subject to criminal or other penalties is directly at odds with our mission and values.” There’s been quite a bit of discussion whether other groups will move their conferences as well. It’s a difficult decision as contracts and venues are typically negotiated years in advance.

Other groups are at least talking about it, though. The American Medical Informatics Association published a set of “guiding ethical principles” for selecting venues for AMIA events and conferences. The authors specifically note abortion and voting rights as issues that have led members to question where meetings are held. The document was created with input from AMIA’s Ethical, Legal, and Social Issues Working Group as well as its Ethics Committee and was approved by the AMIA Board of Directors in April 2022. Among the principles are commitments to:

  • Right to benefit from science.
  • Right to safety and security.
  • Freedom to travel.
  • Freedom of speech.
  • Right to nondiscrimination and civil discourse.
  • Human rights.
  • Access to professional development.
  • Transparency and veracity.

AMIA notes that it does not have a list of excluded or boycotted locations, but that the document will allow those who hope to host an AMIA meeting to evaluate their eligibility and the likelihood of a successful bid.

Speaking of organizations selecting interesting locations, University of Pittsburgh Medical Center has opened a cancer center in Sicily, with clinicians receiving support from those at the Pittsburgh location. They’ll be offering medical oncology services that build on the hospital’s surgical focus areas including gastrointestinal and cardiothoracic cancers. In addition to this program, UPMC also has cancer center offerings for radiotherapy in Roma and Campania. I’m sure there are a fair number of clinicians who might be looking forward to rotating at the new site, depending on their love of cuisine and beautiful landscapes.

I’ve been doing a fair amount of work in telehealth, and there are still plenty of barriers to audio-only telehealth visits. Recently, the US Department of Health and Human Services held its first National Telehealth Conference and audio-only telehealth was discussed as a key strategy for health equity. Voice visits can be done without a smartphone or internet connection and can be useful for managing chronic conditions as well as many acute problems. In my urgent care telehealth practice, it’s usually the patient’s story that most leads me to the assessment and plan rather than the cues I might get from a video exam. Of course, certain conditions necessitate a video visit or at minimum a photograph, but often the value of the visit lies in the physician’s advice and counsel rather than with the exam.

Many of the telehealth patients I see are just looking for reassurance that they can wait for an in-person appointment in the morning. Others might not have tried any over-the-counter remedies and are looking for advice in that regard. Some have a self-limited problem that really doesn’t need a visit at all, but the patient’s employer is demanding a work note, resulting in unnecessary healthcare expenditures. There are still barriers to audio-only visits, including payer requirements for initial and/or ongoing in-person visits that aren’t an option for physicians like me who don’t have a brick-and-mortar location. If I couldn’t practice telehealth, I’d be out of direct patient care entirely, which doesn’t seem like the right answer for a nation with a primary care physician shortage.

Audio-only visits are important for rural patients who often have less access to telehealth services compared to their urban counterparts. A recent article notes a gap not only in telehealth service offerings, but in marketing them to rural patients. In rural areas, there are approximately 40 primary care physicians per 100,000 population compared to 53 in urban communities, and as rural areas struggle to recruit, this is not likely to improve. Of the patients I’ve seen in the last month or so, I’d estimate that 80% of them are from outside major metropolitan areas. I always find it interesting to see exactly where people are located as I confirm their pharmacy information or ask questions about their exposures as related to outdoor activities. (It’s tick bite season, in case you’re wondering, so please remember to wear long pants, long sleeves, and some insect repellent.) I’m glad that I can be a resource for those patients, but look forward to solutions where they have their own primary physicians who can coordinate care.

Have you had a telehealth visit in the last year? Was it audio, video, or asynchronous? What did you think? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 5/26/22

May 25, 2022 Headlines No Comments

Drummond Group Launches New Program, Pilot Initiative for Pediatric Health IT Certification

Drummond Group launches a pediatric health IT certification and pilot initiative that will help vendors comply with the ONC’s voluntary EHR certification requirements.

Walmart, CVS to halt filling prescriptions for controlled substances by Cerebral, Done

CVS and Walmart will stop filling prescriptions for ADHD medications from Cerebral and Done Health due to internal concerns and increased federal scrutiny faced by the telehealth companies.

CynergisTek Inc. Enters Into A Definitive Agreement To Be Acquired By Clearwater In A $17.7 Million Transaction.

Cybersecurity, compliance, and risk management company Clearwater Compliance will acquire competitor CynergisTek for nearly $18 million.

Readers Write: How Automation Can Transform Healthcare Delivery

May 25, 2022 Readers Write 2 Comments

How Automation Can Transform Healthcare Delivery
By Lisa Weber, MSHA, MEA

Lisa Weber is director in industry solutions practice at UiPath of New York, NY.

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A recent survey found that 90% of clinicians agreed that quality measures, including patient satisfaction, have driven change in healthcare in the last decade. The desire for better quality of care and patient experience is clear, but many healthcare organizations struggle with where to start. Consider automation.

One of the major barriers to providing the best care is the crushing amount of tedious, administrative work tasked to clinical and administrative healthcare workers. It is hard to think about a doctor’s office without hearing the constant click of a computer keyboard by every type of healthcare worker. Whether it is updating patient records, scheduling follow-up appointments, or simply taking notes, it can seem like everyone is spending more time looking at a screen than looking at the patient, which can be frustrating for both the patient and staff.

Integrating automation tools, such as software robots, can help healthcare organizations improve inefficiencies, alleviate healthcare provider workloads, and transform healthcare delivery by reclaiming time for patient engagement. The saved time ultimately leads to better, more personalized patient care. Doctors, nurses, and supporting staff would rather devote more time to patients and less to navigating and maintaining online records.

Software robots—think of them as digital assistants—can take over day-to-day tasks that involve accessing, entering, and updating systems and processes just as a human would. Much of the routine and repetitive work that medical professionals dread doing – such as data entry, revising records, checking records for compliance, and scheduling appointments – are perfectly suited tasks for digital assistants. They not only give healthcare workers ample time back in their day, but also boost productivity and workplace satisfaction, accuracy of data, and improved patient experiences.

Specific capabilities of digital assistants for the medical field include completing tasks like:

  • Preparing charts ensuring that all the relevant clinical data (from multiple sources, including other physicians) is available and current.
  • Making sure all paperwork is completed, signed, and up to date.
  • Verifying insurance coverage and collecting any due amounts.
  • Scheduling follow-up appointments, labs, and other testing.
  • Initiating prior authorizations and physician referrals.

During the height of the pandemic, a hospital’s infection control department was struggling to keep up with the hundreds of people coming in every day for COVID-19 testing. As fast diagnosis and response are crucial in preventing the spread of COVID-19, nurses at the hospital needed digital assistance to not only streamline testing, but also to take the pressure off already overworked staff. Using software robots, COVID-19 test result information was processed in a fraction of the time, disseminating patient results in minutes. Overall, the hospital saved three hours a day by using automation to distribute COVID-19 test results.

Utilizing digital assistants significantly reduces the administrative workload of healthcare providers, meaning they have more time for patient engagement and other tasks that make better use of their talent and expertise. These positive effects start to snowball as less time on tedious administrative work means less burnout and turnover, and greater employee satisfaction and productivity. And all these organizational benefits gained from digital assistants in turn improve the quality of care and the patient experience.

HIStalk Interviews Ed Marx, CEO, Divurgent

May 25, 2022 Interviews No Comments

Ed Marx, MS is CEO of Divurgent of Virginia Beach, VA.

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Tell me about yourself and the company.

We’re a consulting, design, and services firm. I have been in healthcare for 30 plus years in a variety of roles, initially, as a janitor in a healthcare facility, a combat medic, an anesthesia tech, and eventually chief information officer. I led digital strategy for a few global healthcare organizations, and now find myself as CEO of this consulting firm. It has been quite a ride, and I have to give complete thanks to all my teams and organizations that helped shape who I am that allowed me this opportunity.

Divurgent has been around as a virtual company since its inception 15 years ago. It has grown year over year at a quite fantastic pace. We are privately held, which has many, many advantages, and that certainly was one of the reasons that I was interested in taking this position. We have several hundred W-2 consultants, and we purposely have made many of our consultants W-2 because we think it makes it more of a family-type atmosphere. Depending on the projects that we are undertaking, it could grow to a thousand or 1,500, but those are typically 1099 or traditional consulting roles that we add. It’s a fairly sizable, I would say mid-sized, company, but growing. It’s at a sweet spot right now, but we have quite aggressive opportunity to continue our growth.

As a first-time CEO, how do you assess and manage the company’s culture, especially since you are taking over from a founder?

It’s a very humbling opportunity. One of the things that drew me to Divurgent is the fact that they are very strong in their values, and they live them. What I love is that at the beginning of every meeting, we talk about one of the five what we call ELITE values – excellence, learning, innovation, trust, and enthusiasm — and someone volunteers to give an example of how someone on the team demonstrated those values since the last time that team met. It’s great storytelling, so that the culture continues to be embedded in the fabric of the organization.

My task is simple in that I don’t want to be the one to change that culture. I want to help that culture continue to rise to the challenge. There is a strong basis for culture. There’s a lot of storytelling involved in that culture. It’s not like I have to come in and help create or shape culture. The challenging task ahead for me, as well as the entire organization, is how do we maintain that culture as we double in size? Retaining that culture is always a tremendous challenge for organizations that grow. Because of the foundation that has been set, I think we’ll manage it, but it will definitely be a challenge.

As someone who has spent most of their career working for non-profit health systems, does it feel different running a for-profit company that provides services to health systems?

It’s different, for sure. But what I like about it is that I can bring that mindset of the C-suite of the provider side. Divurgent was already pretty much there in terms of the partnership approach that we took with clients and prospects. Given my experience, the one thing that I am bringing to the table is that I know how the C-suites analyze and determine who they want to partner with. Bringing that thinking over to the supplier side or the consulting side can really meld well. Now it’s a matter of bringing that thinking and experience that I have, understanding the provider side, but also leveraging the team I already have that is expert in consulting, creating this unique partnership and unique capability. We are bringing those two strengths together, the experience of having been in the C-suite as well as the consultative experience, and that will be our sweet spot and one of our key differentiators

How did consulting change since the pandemic started and how will it look over the next few years?

The good news for Divurgent is that it actually thrived during the pandemic. One of the reasons is that because of the agile nature of Divurgent, and being that mid-sized company and privately held, enabled Divurgent to continue with these close relationships and be super flexible on everything when it comes to terms, the nuances of contracts, sensitivity to payments, and things of that nature. Some companies that might be more traditional or more beholden to stakeholders have to go by sometimes bureaucratic methodologies that don’t allow them that sort of flexibility. It hurt them a little bit being unable to respond quite as intimately with their customers. With Divurgent, we’re just continuing in that fashion of being agile in terms of understanding the customer and working with them in whatever unique terms they have. There’s no cookie cutter approach.

That comes out in the way that we work as well. We don’t bring best practices. A lot of companies pride themselves on bringing best practices to bear, but we don’t bring best practices. We co-create best practices with those organizations that are as unique to them as the solution itself. Going back to the size and being privately held, we can take this unique, customized approach. I’ve been on this side before, where I would have presentations done for us as a C-suite member, and it was a standard slide deck that you know they used last week with some other health system, and sometimes there would still be the old name of whoever the particular consultants pitched to last time. We just don’t do that.

During the pandemic, those relationships were solidified. Our customers started to recognize the fact that we’re not doing cookie cutter, we’re not bringing other people’s best practices and forcing them on them, but we will truly co-create with them. That’s the feedback I got before I took this position. I did my homework, just like Divurgent did their homework on my myself and checking references. I called some of their references, some of my peers who I knew were Divurgent customers, and some other knowledge bases that would have some information. One of the common themes is that the way Divurgent worked — and I’m not trying to sound like a commercial, I really am not — was unique in that it was customized. That really showed itself during the pandemic and helped the company to grow during the pandemic. That’s one of the attributes or differentiators that we want to continue with.

How would you describe the key elements of digital transformation in healthcare?

It’s one of those terms now that is almost meaningless. What we’ve been talking about is not digital transformation so much as digital acceleration. Everyone is using the term digital transformation, but when you look at what’s been done in the last few years — other than the majority of healthcare organizations moving to electronic health records and some outliers with virtual care and move to the cloud — we haven’t reached the scale of transformation that we might have hoped for five years ago or even 10 years ago. I’m focused, and we are focused as a firm, on digital acceleration.

One of the basic building blocks that’s still missing — and I’ve done personal surveys with CHIME members and I’ve seen other more formal surveys — is that the majority of organizations don’t even have a strategy in place. If not a strategy, certainly not a roadmap. What we saw through the pandemic — and this was happening before the pandemic, but was really exacerbated during the pandemic – is a lot of what I would call pockets of brilliance. There would be an immediate problem, standing up virtual care would be a great example, and then you look at it now and wow, this great thing was done to help patients, help save lives, and help with clinicians. That’s a pocket of brilliance. But what we want to do now with digital acceleration is take these organizations from pockets of brilliance to enterprises of excellence. It’s not just one area that you need to be good at when it comes to digital transformation, but it’s everything, all the different services that we do.

Beginning with a strategy, having a strategy, having a roadmap that basically says, what’s your baseline, and measure it. A lot of times we talk about progress, but no one takes a baseline. It’s like, no, let’s take a snapshot now. Let’s take a baseline. Let’s find out, where do you want to go? It’s pretty simple what I’m describing, but yet less than 10% of organizations have a written, codified, approved strategy. Let’s do this baseline, let’s benchmark so we have a general understanding where you are as an organization, and then where do you want to go? Then you have a natural gap analysis that’s done.

Then you can determine not 100 different things to do, because you know what happens when you do that — nothing gets done, or a bunch of things get done with a bunch of mediocrity. Let’s take 10. The magic number is different for every organization, but let’s just say the average is 10. Let’s do 10 things that help to move the needle on that gap, so that in three years you can say, we did digital acceleration. We were here in 2022, now it’s 2025, and we measure it. And of course you are measuring all along the way so that you can make adjustments and hold the organization and the leadership accountable. It sounds simple, and it actually is, but few organizations have the resource or focus to do it. 

That’s one thing that we are emphasizing with digital acceleration. Then of course, we can help with those things that might be needed to fill the gap, whether it’s a virtual care implementation or strategy or help with movement to the cloud or helping with robotic process automation, all these different elements that would be included in a digital transformation acceleration, but just aren’t being done. Or like I said, if they’re done, they’re being done in pockets of brilliance, but not enterprises of excellence. Ultimately, to get to what we’re all striving for, this amazing patient and consumer and member experience, as well as the corollary, which would be clinician experience. Oftentimes we just talk about patient experience, which is super important, but I’m a big believer in, patients come second. It’s the clinicians. It’s the staff. We have to make sure that they are not burned out so they can take care of patients, and that way, everyone wins. It’s that whole gamut from the strategy roadmap, all the way to things around virtual care, but ultimately to the consumer, member, patient, and clinician experience.

Health system CIOs commonly rose through the healthcare ranks and then took responsibility for everything that was related to technology. Health systems are now creating new C-level roles, sometimes filled by people from outside of healthcare, that have technology responsibilities. How is that changing the CIO role?

It has been a huge wake-up call in the ranks of the CIOs. To your point, a lot of CIOs were raised exclusively within healthcare. HR job descriptions would insist and reinforce this old way of thinking — you had to have 20 years of healthcare experience to become a director in a healthcare IT organization. CIOs were people within the ranks, and as a result, we got insular and accidentally shielded ourselves from all the great transformation things that were happening in other industries. 

It hurt us. The response by hospital CEOs and hospital boards was, oh my gosh, we do not have the internal talent to take us to transformation and acceleration and execution. We need to go outside. We need to go to Disney. We need to go to Microsoft. We need to go to AWS. We need to go to Walmart, to CVS, to Rent-a-Center, to you name it. These are real examples that I’ve just given you. These chief digital officers who had all this experience in retail, finance, and entertainment came in, and most of them have done an amazing job. In one way, I look at it as a sad thing, because many of my peers have the skills and can reequip themselves to better understand digital in these other sectors and bring that thinking and leadership to bear. But in many cases, they haven’t, and outside influences came in.

Overall for the patient, I think it’s a net win, because at the end of the day, it’s really about the patient care and patient experience, consumer and member experience, and the clinician experience. It’s a good thing to have this external view, external influence into healthcare. I think it makes us stronger. We could have been a little bit more thoughtful about how it all happened, but it happened, and I think it’s good. I always prided myself on having at least one team member who came from outside of healthcare. I had someone from entertainment, military, or finance because it always made us stronger. The argument that they have to be in healthcare because healthcare is unique and special is not true. While we are unique and special, other people can come in from unique and special verticals and learn healthcare. We all had to learn healthcare at one point. 

It’s good to have these outside influences, and like I said, it has been a net-net gain for everyone. We’ve learned so much from these individuals and these leaders that came from other industries. CIOs who are maybe more traditional should take note of this and take steps now to benefit their organization, and to benefit themselves, to make sure that they are not left out in this next wave or the current wave. Hang out with individuals from other industries, study other industries, learn more about what’s being done, and bring that to their organizations.

The pandemic allowed big health systems to get bigger by acquiring weaker community hospitals, and the remaining standalone facilities are also facing publicly traded competitors who are anxious to cherry-pick their profitable services. Can the traditional community hospital survive?

My heart and soul still are with community care. Divurgent wants to help hospitals of all kinds to not only survive, but to thrive in this new digital era. We want to help everyone. It is really important. I call it “survival of the digital-est.” It’s critical that all these hospitals, including smaller critical access hospitals and community hospitals, grab hold of this whole digital revolution that’s taking place and take action.

I’m afraid that some organizations have not moved quickly enough, or think that they might be insulated because of their location. If they are insulated today, it won’t be for very long. In the digital era, you need to embrace digital tools and all the things we already talked about related to consumerism, the clinician experience, and modern technologies to not only to deliver the highest quality of care, but do it in such an efficient way that you can afford to survive. We really want to help these organizations. 

That’s part of the reason that we wrote the book on digital transformation and have another one coming out on patient experience with Mayo Clinic, Cris Ross. It’s all aimed at trying to help these organizations survive and to move from survival to thrive. It’s incumbent upon the boards of these organizations and the leadership of these organizations to understand what’s going on and take demonstrable action.

How will the company change over the next few years?

At Divurgent, we expect to double in size, but our metric is not currency. When you talk to a lot of companies, they talk about growth that they measure it in dollars and cents. Like, we are going to go from $100 million to $200 million. We are measuring our growth in the number of clients served. We want to double the number of clients served. We believe that if we serve clients and we serve them with excellence, the currency and all the other metrics will follow. Not really fixated on that, but fixated on the growth of clients. How we do that is continuing with excellence. When I did my homework and looked at KLAS ratings and talked to Divurgent customers, 100% are referenceable accounts.That’s a meaningful metric that we’re proud of and will continue with.

Another is to look at new services. We already do advisory and services, but incorporating design, and what I mean by that is this human-centric design, in everything we do. In the past, a lot of consulting and a lot of services were process-oriented, which is good, and built on technology. But what we found are shortcomings. You come in there as a consultant or advisory and you leave and you don’t really ever experience and find out later why none of the initiatives had long-lasting impact. Incorporating the sense of human centricity, human-centered design, is another differentiator that we’re bringing to the table that will help drive growth.

Digital acceleration and that whole model includes the governance piece that was never really solved by many organizations, how they prioritize and how they make effective decisions. It never included what I would call value creation and the concept of, we are going to hold not only ourselves accountable, but let’s hold, or help organizations hold, themselves accountable to doing 360-degree, closed loop investment analysis. I serve on the board of Summa Health in Akron just had the same conversation with the CFO about ensuring that with all these projects, initiatives, and use of consultants, we do these 360, closed loop value realization exercises. That basically means that a year after you came here and you said you’re going to do X, Y, Z, what was the actual performance? It doesn’t have to be with a consulting organization, but since we’re talking about Divurgent, that’s just another sense of differentiation, that we are going to hold ourselves accountable to what we partnered with the organization on.

We’re seeing a lot of M&A in the consulting business. You’re seeing some health systems buying consulting consulting firms, and you’re seeing big tech acquiring firms like Tech Mahindra with HCI. You see mid-sized players exiting the market and I think you’ll see a little bit more of that, which will provide more clarity for those who are left in that market. There’s going to be a lot of changes coming in the next several years, in terms of the number of firms that stay in the market and focus on delivering this level of value that I’m speaking about to their clients.

Morning Headlines 5/25/22

May 24, 2022 Headlines No Comments

Oracle to win unconditional EU nod for $28.3 billion Cerner deal

The EU reportedly gives Oracle unconditional antitrust clearance for its proposed $28 billion acquisition of Cerner.

Plano Telehealth Startup Raises $14.1M

Virtual care company VitalTech raises $14.1 million in equity.

KAID Health Announces Series A to Fuel Growth of its AI-Powered Provider/Payer Whole Chart Analysis Platform

Kaid Health, developer of AI-powered Whole Chart Analysis software, raises $4.25 million in Series A funding.

News 5/25/22

May 24, 2022 News 1 Comment

Top News

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The EU reportedly gives Oracle unconditional antitrust clearance for its proposed $28 billion acquisition of Cerner.


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

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Virtual care company VitalTech raises $14.1 million in equity.

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Kaid Health raises $4.25 million in Series A funding. The company has developed AI-powered Whole Chart Analysis software to help providers more quickly identify gaps in care.


Sales

  • Garrett Regional Medical Center (MD) will use $650,000 in federal funding to replace its 20-year-old Meditech EHR with Epic.
  • Marlette Regional Hospital (MI) will implement telemedicine hospitalist and specialty consult services from VeeOne Health.
  • Geisinger (PA) selects AWS as its cloud provider and will migrate all of its 400 applications to AWS.
  • Morris Heights Health Center (NY) selects NextGen Enterprise EHR/PM.

People

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Talkdesk names Jeff Haslem (PluralSight) as its first CIO.

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Ashish Kachru (Altruista Health) joins DataLink as CEO.

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Komodo Health Chief Medical Officer Aswin Chandrakantan, MD takes on the additional role of COO.

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Regional One Health (TN) promotes Daniel Thomas to VP of IT operations.

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Gregg Veltri, former CIO of Denver Health and Charleston Area Medical Center, has died at 64.


Announcements and Implementations

Northwest Health (AR) launches its Care Management at Home program using remote patient monitoring technology and services from Cadence.

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Chase County Community Hospital (NE) implements Avel ECare’s remote hospitalist services, including telehealth care boards.

Lynn County Hospital District in Texas rolls out care coordination software from CrossTx as part of its chronic care management efforts.

TidalHealth Peninsula Hospital (MD) goes live on the Copernicus electronic referral system for organ and tissue donation.

Tufts Medicine says it is the first health system to transition its digital health ecosystem to the cloud, having moved 40 applications to Amazon Web Services with a goal of 300 at completion. It has also deployed a chatbot powered by Amazon Lex and telehealth and virtual care services using Amazon Connect’s cloud-based contact center.


Government and Politics

The Roseburg VA Health Care System (OR) will launch its new Cerner EHR on June 11.

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US Army Medical Logistics Command at Fort Detrick, Maryland honors the efforts of its healthcare technology management workforce – “from factory to foxhole” – during its annual HTM Workshop.


Other

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ChristianaCare will use a $1.5 million grant from the American Nurses Foundation to deploy five Diligent Robotics Moxi robots, integrated with Cerner to relieve nurses of delivery tasks and to use AI to predict when they will need equipment, supplies, and medications.

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Tennessee’s most expensive home, a $50 million, 20,000-square-foot mansion on 50 acres, is listed for sale by its billionaire owner, HCA Healthcare co-founder Thomas Frist, Jr., MD. 


Sponsor Updates

  • Nordic posts another episode of its monthly “DocTalk” series titled “Soft Interoperability.”
  • Dina appoints Mary Naylor, PhD, RN to its board.
  • Gyant publishes a case study about OSF Healthcare’s use of its Clare virtual assistant on its website as a virtual care navigation assistant, which it says has generated $2.4 million in revenue.

Blog Posts


Contacts

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

Get HIStalk updates.
Send news or rumors.
Contact us.

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Morning Headlines 5/24/22

May 23, 2022 Headlines 1 Comment

Hospital ward where tragic Meltham dad walked out was ‘understaffed with slow computers’

IT problems prevented staff at a hospital in England from seeing that a behavioral health patient was restricted from leaving unsupervised, after which he was killed when he was hit by a train, an inquest hears.

Disclosure of Lab Results

A former health executive in Georgia writes an op-ed piece urging the state to follow Kentucky’s lead in overriding Cures Act requirements that patients be given their lab results immediately, saying that his late wife was stressed by seeing lab results related to her lung cancer that she didn’t understand.

The dangers of digital health monitoring in a post-Roe world

Popular Science advises its readers to use a browser that doesn’t retain a search history, use a VPN, turn off location sharing, use encrypted messaging, avoid asking about potentially illegal topics publicly, and be aware that the US does not protect period tracker users from having their data sold.

NHS doctors urge bosses to let them WFH! Hospital consultants say they can safely assess ward patients by a ‘computer on wheels’

The British Medical Association urges ministers to study the benefits of a hybrid working model for some physicians and at certain times, citing experience gained during the pandemic.

Curbside Consult with Dr. Jayne 5/23/22

May 23, 2022 Dr. Jayne No Comments

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.

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