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Morning Headlines 8/31/23

August 30, 2023 Headlines No Comments

OpenAI releasing version of ChatGPT for large businesses

OpenAI releases an enterprise version of ChatGPT that features enhanced security, privacy, and speed.

Better Life Partners Raises $26.5 Million in Series B Financing

Hybrid substance use disorder treatment company Better Life Partners raises $26.5 million, bringing its total raised to $38 million.

Houston hospital opens tech hub in the Ion

Houston Methodist opens a 1,200 square-foot Tech Hub to showcase innovative solutions it’s implementing in the hospital setting and to promote cross-industry collaboration.

Healthcare AI News 8/30/23



OpenAI releases an enterprise version of ChatGPT that features enhanced security, privacy, and speed. The product overlaps the offerings of the company’s investor Microsoft, which provides a similar offering as part of Azure. The ChatGPT service costs $30 per user per month.

Hackensack Meridian Health will work with Google Cloud on generative AI projects, while HCA Healthcare announces similar plans.


image will commercialize three ECG AI algorithms that were developed by UCSF. The algorithms detect cardiac amyloidosis, pulmonary hypertension, and supraventricular tachycardia.


AI-powered, message-based care provider Curai Health joins Amazon Clinic’s virtual care marketplace.


Drug maker Bayer expands its digital therapeutics business with a partnership with Mahana Therapeutics, which offers an FDA-cleared digital product for irritable bowel syndrome.


A consumer research survey finds that 82% of Americans haven’t used ChatGPT, 81% of them don’t expect it to have a major impact on their jobs, and 85% don’t think it can help them do their work.

A study of EHR data in Israel finds that AI can predict food allergies in newborns, surprising researchers who found a significant correlation in the exposure of pregnant women to antibiotics. They conclude that the antibiotics may have interfered with the babies’ microbiome, which influences allergy development.


ChatGPT successfully improves the readability of patient consent forms, researchers find, creating versions that are shorter and easier to read. The required reading level dropped from college freshman to eighth grader.

ChatGPT-generated cancer treatment plans are full of mistakes, researchers find, where one-third of the tested plans contained incorrect information. ChatGPT also mixed correct and incorrect information together in a way that made it hard for even experts to detect.



KFF News headlines a story about Bamboo Health’s NarxCare as “Artificial Intelligence May Influence Whether You Can Get Pain Medication.” The software predicts the likelihood that a patient will overdose based on their documented use of narcotics, sedatives, and stimulants. CDC has warned providers to make sure use of the algorithm doesn’t harm patients, such as turning them away for visits or denying them medications for documented chronic pain, and has voiced concern about “proprietary algorithms” whose methods are not transparent.


A startup sells Nextflix-type subscriptions to access the AI clones of celebrities who earn recurring earnings for doing little more than providing content from elsewhere and setting the guidelines for how their clones will operate. Experts fear the chatbot will worsen loneliness and encourage replacing human interactions with “parasocial” ones. The founders noted the success of a YouTube influencer whose “virtual girlfriend” earned her $71,000 in its first nine days.


Mr. H, Lorre, Jenn, Dr. Jayne.
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HIStalk Interviews Charlie Harp, CEO, Clinical Architecture

August 30, 2023 Interviews 7 Comments

Charlie Harp is CEO of Clinical Architecture of Carmel, IN.


Tell me about yourself and the company.

I’m a developer by training. I’ve been building systems in healthcare for about 35 years. Back in 2007, after working for a bunch of different companies, I started Clinical Architecture to focus on the plumbing of healthcare, such as semantic normalization, data quality, and gaining insights by looking at patient data.

The industry has more technical pipes available to exchange data, but have we equally advanced terminology and semantic issues?

In the last few years, people have become a little bit more sophisticated in how they share data. USCDI has driven some folks, through the Cures Act, to at least try to share more data. The guidelines we have are still a little fuzzy in terms of being more guidelines than rules. We have made some progress, but we are still dealing with people that might have access to the data through something like data exchange. I think TEFCA  is going to continue this, but I still think there’s a lot of hesitancy to accept that data when you get it.

The last time we talked, you said that providers don’t trust each other’s data, and that one provider doesn’t have much incentive to clean up their own data that they have already used for someone else’s benefit. Has that situation improved?

A little bit. We started doing a data quality survey last February. People generally did not think very much of their own data quality. Most of them — depending upon the domain, whether it’s drugs or labs — had some level of confidence, but they didn’t have high confidence in the quality of that data. The only thing they had less confidence in was the quality of other people’s data, which I thought was interesting.

The problem we have in healthcare today is that we gather information as a byproduct of the process of providing care. Providers rely heavily on their notes to go from one patient encounter to another. They fill in the structured data because they have to.

We have this illusion on the analytics side of healthcare that the structured data is of high quality. When we go to share the data, most of these systems — whether it’s Epic, Cerner, Meditech, or whatever — are still using dictionaries that were developed for that EMR, with code systems that are specific to the EMR. They still have to be normalized on the outbound.

The challenge with people sharing data out, especially if it’s a regulatory requirement, is that it’s a “letter of the law” as opposed to “the spirit of the law” type of engagement. The data is leaving, and people tend not to care as much about the data that’s leaving as they do about the data that’s coming in. The problem with the data coming in is that, to the people who sent it, it was data leaving, so it wasn’t as important to them.

Do those clinicians who don’t trust their own data at least have confidence in the subset that they need to treat patients, or do they create their own notes or records?

It’s a combination of the time famine that providers have. They don’t have a lot of time. A handful are aware and plugged into what’s happening with health informatics and interoperability, but a lot of them in the trenches are just focused on how to provide the best care while complying with the things they are being asked to do by their organization. A lot of them, at least the ones that I talk to, tend to still rely heavily on their unstructured notes to go from encounter to encounter.

A few years ago, we looked at the structured data and did inferencing to find patients who were undocumented diabetics, patients who had no mention of it in the structured medical record. We looked for other indicators, like the fact that they had a hemoglobin A1C that was out of whack, or they were taking something like insulin or metformin. In six months, we found 3,600 undocumented diabetics. When the folks we were working with presented that finding to providers, the feedback was pretty universal — I know those patients are diabetic, that’s why I gave them metformin.

The problem is that there’s a disconnect between the provider, who is legitimately just trying to take care of people, and the unintended consequence of not having the structured data in the system. That means that your quality measures are out of whack, your patient management software is not scheduling foot exams. There’s still a disconnect between why you put in the structured data in the first place and all the downstream systems that consume that. Analytics, machine learning, and AI, all these things that we want to embrace and leverage in healthcare, depend on the structured data being there and being correct. We are pretty far off from that, unfortunately.

Does AI offer opportunities to structure that data using free text notes or audio recordings of encounters?

We have done a lot with NLP and also evaluated what’s going on with large language models. The problem in healthcare is that when it comes to data, it always falls back to trust.

If I could wave my magic wand and fix healthcare, I think what I would change is the way that we collect the data, so that we are collecting structured data without turning the provider into a terminologist to make that work. The problem we have is that providers don’t want to go to a list and pick something. They want to be able to articulate something in a way that is natural and organic for them, and then get it back in a way that’s natural or organic. We’ve had two worlds, one where you create a note and the other where you put things into a list.

I think the real answer is finding a way where the provider gets what they want. They say something in a way that’s granular and organic. We capture in a way that preserves the granularity of that information in high resolution, and can leverage that from an analytics perspective. When the provider wants to see the data, we can deliver it in a way that’s organic to them instead of them looking at a list and reconciling things. We’re a little bit off from that.

The problem with what we are doing now is that we are trying to find an easy way out. We’re saying, let’s just take the note and use NLP, a large language model, or something else to read the note and turn the note into something structured. You can do that, and we have had some success when it comes to high-certainty type data like pulling ejection fraction out of a procedure note or looking across a complete patient record and coming back with a sense of the patient’s diabetes because I found all these references that I can correlate to that. But you still run into the problem of, how can I trust that?

When you look at all the things that are happening in the industry now with AI, large language models, and NLP, there’s a lot of talk about transparency. In the past, when people have tried to do things in healthcare with these types of approaches using NLP or AI, it hasn’t been successful. The machine works great 60% of the time, and then 40% of the time it does something horrifically wrong. That comes back to this idea of trust. If you are taking care of somebody and their life is in your hands and the machine just happens to pick that day to follow the wrong probabilistic pathway, that’s challenging in healthcare.

Thinking back to providers not trusting their own data, is that a vague impression or is it measurable? What could they measure to assess or improve data quality?

When I’m working with clients, I sometimes ask them this question, so I’ll ask you. When it comes to healthcare data for an individual patient, who is responsible for the quality, accuracy, and integrity of that one patient’s data, regardless of where it is?

Some would say the patient, although that’s not a reasonable expectation for all types of data.

The problem is that patients aren’t really trusted to do that. You can fill out a form, hand it to somebody, and they’ll type it in, but rarely is a patient trusted to own and articulate, “Here’s my health situation.” It usually has to be vetted by some kind of clinical person.

That’s fine, but it goes back to this root problem that nobody is responsible. There is no data steward for an individual patient’s health record. When you talk about how you trust the data, the fact that I can take one patient and look across multiple venues of care and see different information. They don’t really trust each other and where their data is coming from. They don’t know whether that ICD-10 code was added for billing purposes or added for clinical purposes.

The problem we have in healthcare is that we don’t have a mechanism that allows us to objectively and quantitatively look at the data and say that the quality is good or bad. We are working with other organizations to do this taxonomy for healthcare data quality, because I think that we should be able to look at patient data in an abstract way and say, is the quality of this data good? Is there duplicate stuff? Is there old stuff? Is there stuff that’s clinically impossible? Are there things in the medical record that contradict themselves?

How can we automate the evaluation of that semantic interoperability so that you don’t need a sweatshop full of clinical people looking at 5 million patient records? How do you build something that can objectively, with some type of deterministic AI, evaluate an individual patient and any data that comes in for them to say, yes, this all makes sense. It looks real, and I just noticed that there’s no mention of this patient’s diabetes, whether you’re looking at unstructured notes and pulling it out.

At the very least, you should pull the data, check it against the integrity of the rest of the medical record, and say, yes, the fact that the note says they are diabetic resonates with the fact that they’ve got a funky fasting blood sugar and they’re taking these three medications that are indicated for diabetes. Let’s go ahead and suggest that they add diabetes to their official structured medical record so that we can take advantage of that. All these things that only look at the structured medical record and retain the evidence of where that came from. Those are some things that we could do to improve the level of trust and the reliability of the data.

My big fear is that we start to roll out some of these more sophisticated things that could be beneficial, but because the data quality is bad, we fumble the results early on and these things fail, and because we applied them before the data quality was ready, people don’t have confidence. You only have one opportunity to be credible. You come in with this new technology and say, “This is going to save lives. This is going to do great things.” But because the data that we are feeding it is bad, it is very possible and probable that the results of what it comes up with will be likewise bad. We will flip the bozo bit, as they used to say, on that thing. Then later, when we fix the data quality, we say, “No, we tried that and it didn’t work.” But maybe it would work if we fed good quality data.

What is the oversight structure and mechanism of reviewing the longitudinal patient record from multiple providers and identifying missing or conflicting data? Then, going back to the data source and either asking them to fix their problem or perhaps excluding their data as being unreliable?

The first place is the pipes. Look at what’s happening with TEFCA and QHINs. Let’s say the QHINs turn on their pipes and people start streaming data from Point A to Point B for every patient. The first thing we need to do is, somewhere in that pipe, we need to have something that looks at the message. Is the message right? Does the data look fundamentally correct? Not clinically correct, but is a valid code in the value set? Let’s say it’s an RXNorm code. Does the name match what RxNorm says that code stands for? So the first thing you do is evaluate someone in the network to determine whether they are a good data provider.

If they’re not a good data provider, you can’t really remediate data quality in flight. You have to go back to the source and say, you’re not a good data provider. This is what our taxonomy is focused on. By identifying the nature of the quality failure, you can go back and say, you’re putting the decimal place in the wrong spot on your lab results. You are not using a valid RXNorm code set. Your maps are bad. Whatever the feedback is.

The first thing we need to do is to make sure that the people that are sharing data from their systems are good members of society who care about the data they are sending out and are making sure that the quality is good. QHINs are going to be in a great position to evaluate the data in flight at a basic level and say, OK, the data that you are sending looks clean, looks good, and has good intrinsic quality. That’s the first step, because that’s where you stop bad data from getting out.

We also need to do a better job of knowing where data’s coming from originally so that we can stop duplication. We worked with a partner who gave me a bunch of data to evaluate, data that was coming from a bunch of different sources. In a couple of million records, there were about 750,000 duplicates, the exact same lab result done at the exact same time. Because of the way the data was shared in some of these older formats, you had no idea that that was the same data. It just looked like this patient had 64 lab results on the same day at the same time.

That’s the other thing, if we want to trust data, we need to know where it originally came from, especially as we start sharing data across an entire network of participants.

The last thing is you need is a way where we are landing it or looking at the data in our own system, saying, does it look right for every condition that I have? Do I have a treatment for every drug that’s in their profile? Do I know why they are taking that drug? This goes back to what you are talking about when it comes to oversight. Within any repository of patient data, perhaps a large IDN doing analytics or population health on your patients, we need to have mechanisms that can identify issues in the patient. Data can alert a human operator. Let’s call them a data steward. The data steward can inform the systems that they are connected with on how to remediate the data.

There needs to be oversight. The trick is, how do we have enough automation in place so that instead of a human looking at 5 million patients, automation is looking at 5 million patients for things that are a concern, and streamlining the resolution of those things? Because it’s easy for a human to be presented with something and say, “Yeah, that looks right,” as opposed to humans poring over data looking for something. That’s why when we do semantic normalization, our software does like 85% of the work, where it tries to search for the right target and it suggests the target. A human can take two seconds to look at the target and say, “That’s right.” We need to get to the same place when it comes to patient data.

It’s one of those things where the idea of having people whose job it is to review issues that come up with patient data and resolve it at a patient level might seem a little daunting, but the problem is, that’s the only way we can fix it. You have to fix it at the atomic level to have the entire ecosystem be of high quality. There’s no way to do it at a macro level. You have to do it at an individual patient level.

What factors will be important to the company and the industry in the next few years?

For us to use artificial intelligence and some of these other things that we are coming up with in a meaningful way, we are going to have to move away from pre-coordinated terminologies as how we collect data for patients. We’re going to store patient information in a much more granular graph style, so that both software and people can make better use of it. Right now, everything we do with the terminologies and practices that we use today create these big pixels of information that limit our ability to do sophisticated reasoning over that data, whether it’s for research purposes or for decision support purposes. We’re going to have to dial up the resolution to get to where we want to be in terms of software providing meaningful assistance to people that are providing care.

Morning Headlines 8/30/23

August 29, 2023 Headlines No Comments

In project ‘Secret Tiger,’ Nomi Health copied a Texas COVID-19 app, lawsuit claims

A federal judge orders COVID-19 testing firm Nomi Health to pay $7 million to Texas software developer OSGHD, who sued Nomi for licensing its product only long enough to copy its design to create its own system.

HSHS, Prevea get some phones back, but outages continue

Hospital Sisters Health System (IL) and affiliate Prevea Health (WI) revert to downtime procedures after an unidentified outage forces their systems offline.

TPG and Crowe LLP to Establish Crowe Healthcare Consulting as Independent Company

TPG will acquire a majority stake in revenue cycle software and services company Crowe Healthcare Consulting and rebrand it as Kodiak Solutions.

News 8/30/23

August 29, 2023 News No Comments

Top News


ONC renews The Sequoia Project’s TEFCA management contract for another five years.

The non-profit will also continue to oversee the development of Qualified Health Information Networks, with seven of them underway.


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

Acquisitions, Funding, Business, and Stock


Healthcare market intelligence startup Bonfire Analytics raises $1 million in a pre-seed funding round.


  • Zyter|TruCare integrates Findhelp’s care and social services referral software with its Connected Health data-sharing technology.



Chris Betz (Brightside Health) joins Aptihealth as CTO.


Ascom Americas hires Chris LaFratta, MBA (VieCure) as VP and head of strategic service innovation.


Adam Farren, MBA (Osmind) joins Canvas Medical as president and COO.


Virtual care and remote patient monitoring solution provider TimeDoc Health hires Brian Esterly, MBA (Centria Healhcare) as CEO.

Announcements and Implementations

IBM trains a Watson large language model to convert legacy COBOL applications to Java, noting that enterprise systems around the world execute 800 billion lines of COBOL code every day.

Government and Politics

A federal judge orders COVID-19 testing firm Nomi Health to pay $7 million to Texas software developer OSGHD, who sued Nomi for licensing its product only long enough to copy its design to create its own system. The state of Utah has paid $84 million to Nomi for COVID testing and vaccination, which it originally attempted to run on a system from Qualtrics that it claims couldn’t handle the required volume.

Privacy and Security


The Rhysida ransomware group claims responsibility for the cyberattack on Prospect Medical Holdings. The group has put the stolen legal and financial documents of 500,000 Prospect employees up for sale on the dark web. Prospect has been struggling to get networks at its 16 hospitals back up and running since the attack occurred on August 3. Crozer Health, a Prospect hospital in Pennsylvania, announced last Friday that all of its computer systems were again operational.


Hospital Sisters Health System (IL) and affiliate Prevea Health (WI) revert to downtime procedures after an unidentified outage forces their systems offline. All systems are unavailable at 15-hospital HSHS. Pediatric hospitalist Maddie Mier, MD reports on X that she’s not the “Improvise, Adapt, Overcome” kind of doctor and needs Epic for “my chart stalking routines & easy access to things like.. VITAL SIGNS.”



Oracle Health Chairman David Feinberg, MD, MBA purchases The Weeknd’s furnished Los Angeles penthouse for a cool $19 million. Dubbed “The Mogul” by building management, the 8,000 square-foot pad includes four bedrooms, six bathrooms, a gym, wine vault, and views from four balconies.

Sponsor Updates


  • CloudWave sponsors the Firelands Health “Caddyshack” Open Golf Outing.
  • EClinicalWorks releases a new podcast, “Empowering Communities, Analytics for Better Patient Care.”
  • Nordic releases a new Designing for Health Podcast, “Interview with Matt Sakumoto, MD.”
  • CereCore publishes a new case study, “Next Generation EHR Meets Surgery Partners.”
  • Healthcare IT Leaders refreshes its board.
  • Constellation Research names Artera to its Shortlist for top vendors in the healthcare clinical communication category.
  • A new KLAS report recognizes AvaSure as a complete virtual care platform that improves patient safety while reducing costs and staff workloads.
  • Baker Tilly releases a new Healthy Outcomes Podcast, “Exploring home and community-based services: Insights and considerations for healthcare organizations.”
  • CHIME releases a new Leader 2 Leader Podcast, “Workforce Issues in Healthcare Today: Top Challenges and How to Solve Them.”
  • Clearwater enhances its managed security services capabilities, establishing a new partnership, hiring new experts, and signing on new customers.
  • Clinical Architecture publishes a white paper, “Leveraging Artificial Intelligence to Enable Real-time Semantic Interoperability.”

Blog Posts


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

Morning Headlines 8/29/23

August 28, 2023 Headlines No Comments

AI-Powered Bonfire Analytics Raises $1 Million in Pre-Seed Round

Healthcare market intelligence startup Bonfire Analytics raises $1 million in a pre-seed funding round.

ONC Awards The Sequoia Project 5-Year TEFCA RCE Contract

The Sequoia Project will continue to manage the implementation of the Trusted Exchange Framework and Common Agreement and associated establishment of Qualified Health Information Networks.

Healthcare Governance Body Warns Hospitals Face Debilitating Cyberattacks

The Joint Commission issues new cybersecurity guidelines that advise hospitals to be prepared for at least a month of downtime in the event of a cyberattack.

Curbside Consult with Dr. Jayne 8/28/23

August 28, 2023 Dr. Jayne 1 Comment

I enjoy working with residents and students, so I was glad to see this recent article looking at the role of electronic health records in medical residency training programs.

When I was working in the EHR industry, I saw a tremendous variation in how organizations wanted to treat learners with respect to electronic documentation. Some organizations would not allow students to access the EHR in any capacity other than read-only, which almost certainly hampered their abilities to learn how to manage the EHR when conducting patient interviews or when taking a medical history. Others would allow students to have limited interaction with the EHR, but placed their documentation in a separate clinical note, distinct from the attending physician and others on the care team. This approach is problematic because it fails to see the student as a member of the care team, and also creates additional work for the attending physician to perform completely separate documentation rather than being able to update and affirm the student’s documentation.

As far as residency programs, I’ve seen a wide spectrum of access and EHR usage there as well. I’ve seen organizations that have graduated security groups, where interns have less access than lower-level residents who may have less access than the highest level of residents. It can be complicated to advance everyone to different security groups from year to year, especially if an entire class doesn’t advance at the same time due to taking family or medical leave or having to repeat a rotation.

Generally speaking, in the US, a physician who has completed the intern year and who has passed the appropriate licensing exams can get a permanent medical license (as opposed to a training license), which might bring with it their own DEA number and state controlled substance number. This becomes fun when the resident might be rotating on some services as a learner and needs to operate under one set of credentials but also moonlights on a different service at the same hospital under their permanent credentials.

A friend of mine who works in the process improvement department at a major health system has been asked to do a pilot project around these issues at one of the hospitals, which is having challenges getting its residents the right access to do their jobs. It will be interesting to see how that unfolds since they won’t have the opportunity to pilot the new workflows until the next class of interns is selected in March 2024.

Back to the JAMIA article, it looks at the ways in which EHRs impact resident clinical skills and how the systems’ use impacts patient encounters. The authors conducted qualitative interviews with 32 residents and 13 faculty members or clinical staff in an internal medicine residency program affiliated with a US medical school. The latter point is an important differentiator, because not all training programs are affiliated with medical schools. Those that aren’t are referred to as community-based programs, and although some provide the same experience as those programs that are associated with medical schools, there may be some subtle differences in how residents interact with preceptors and other members of the teaching staff. Although that’s a relatively small sample size and only represents the experiences of those in a single medical specialty, the authors had some interesting findings.

For background, the authors note the breadth of EHR use in the US, with 96% of hospitals and 78% of office-based practices using certified EHRs. I visited one of that remaining 22% of medical practices just last week and gazed with nostalgia at their giant rolling racks of patient charts. I didn’t envy the physician scribbling away during my visit, but I felt I received good care in a timely way, so I didn’t miss the presence of an EHR in the visit. Interestingly, I also received an invitation to visit the practice’s patient portal, so I’ll have to see what it actually contains when I get some free time. The authors also note the continued increase in EHR documentation requirements in the US, which has been partially enabled by the presence of EHRs.

I found it interesting that the researchers interviewed residents on days when residents were scheduled to be in an outpatient clinic, although they noted that they selected days where “resident schedules at the clinic were typically less busy.” The authors, who are also faculty members at the residency program, would ask the residents to be interviewed “during a break in their day,” which is interesting as to the other stressors that residents might have been experiencing at the time of the interview. I’ve done plenty of qualitative research in my career, and I think I might have been more inclined to schedule interviews outside of the clinic environment. The approach they took only allowed them to interview 32 of the program’s 54 residents, but the authors noted that “repetition of responses and minimal novel information in later interviews indicated we had reached sufficient saturation in our sample.” The average interview lasted 23 minutes and was recorded. Interestingly, the recordings were initially transcribed using an AI-based web site, then were reviewed by paid assistants, with one of the authors conducting a final verification of the transcripts.

During the interviews, residents noted that the need to address quality measures during patient encounters added some challenges to the use of the EHR and contributed at times to shifting focus away from the primary reason for the patient’s visit. Addressing those measures also took time that some felt could have been spent coming to a diagnosis and creating a treatment plan for the patient’s presenting concern. The study methods indicated that patients were roomed by a medical assistant who took some preliminary information from the patient but who didn’t address quality measures. Based on some of the participant comments, it’s clear that data was in the chart for the provider to update the quality measures, so it’s unclear why the organization wouldn’t use a less-expensive resource, such as the medical assistant, to update the quality measures as opposed to expecting the physician to do it. That seems to violate one of the key tenets of clinical efficiency, which is to have all members of the team working at the top level of their licensure.

Most of the residents said they spent more than half of their clinic time working in the EHR and often had to access it at home. Although some residents felt that use of the EHR became easier as they worked through the training program, multiple senior residents felt they were still struggling with the EHR. Additionally, residents often had to ask questions about EHR use on the fly. Although that’s a great way to develop lifelong learning skills, it can be frustrating when you’re early on in your training and trying to learn the nuts and bolts of seeing patients. The authors found that due to these sentiments, some residents actively tried to avoid or at least minimize EHR use during patient visits.

Some of the raw resident comments were included. I found this one very telling as far as whether a good clinical informaticist was involved in the system build: “They just have these yellow boxes and some administrators told our attendings that we absolutely have to click these yellow boxes. But it’s basically just redundant because I’m already doing it. But if I don’t do it their way, then it doesn’t give them a little green light in their system.” It makes me sad to know that there are still systems out there that lack intelligent design and configuration.

The authors note that while it’s important to develop a culture where residents ask questions about EHR use, it’s also important to note that not everyone enters residency with the same experience with EHRs, the same computer skills, or the same motivation to learn. One faculty member described the EHR training that residents and faculty received as “frankly terrible and doesn’t really prepare you for the actual application or use of this software.” Residents reported learning from each other and from medical assistants as well as from the faculty, but I didn’t see any mentions of them reaching out to dedicated EHR trainers for additional support beyond their initial orientation training.

It definitely seems like a missed opportunity for education, especially since best practices for EHR implementation involve regular follow-up training to solidify skills and teach new content. This would also help counter any inhibitions that residents have about asking for help, if follow-up training is just part of the program for everyone.

The authors conclude by calling on residency programs to “find ways to effectively support their residents’ learning to incorporate EHRs into their work and streamline documentation requirements to maximize the development of residents’ clinical skills.” Since the authors are faculty at the residency program where this study was conducted, it would be interesting to see some follow-up on whether they were successful in changing some of the roles and responsibilities distribution found in team-based care in order to meet this objective. For example, did they hire additional medical assistants to better support the residents? Did they arrange for additional training to ensure mastery of the EHR? If anyone is connected with the University of Nevada Reno, I’d be interested to hear any updates.

What are your thoughts about EHR use by residents and other trainees? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 8/28/23

August 27, 2023 Headlines No Comments

Quebec chooses American firm Epic to create new digital health system

In Canada, Quebec chooses Epic for its $2.2 billion USD digital health record project.

Truepill to slash share price by 90 percent

Truepill, a pharmacy fulfillment business that has expanded into diagnostic testing and telehealth, will seek additional funding at up to a 90% reduction in valuation as it struggles with executive departures and a federal investigation.

Ransomware gang claims it stole Social Security numbers, passport data in recent hospital attack

The Rhysida ransomware group claims it is behind the cyberattack on Prospect Medical Holdings earlier this month, having stolen legal and financial documents of 500,000 Prospect employees.

Veterans Affairs CIO ‘cautiously optimistic’ Oracle Cerner can turn around EHR modernization under new contract

VA CIO Kurt DelBene is “cautiously optimistic” about its Oracle Cerner implementation, as the VA has learned from its first five go-lives and has tightened service level agreements in a recent contract renegotiation with Oracle.

Monday Morning Update 8/28/23

August 27, 2023 News No Comments

Top News


In Canada, Quebec chooses Epic for its $2.2 billion USD digital health record project.

The contract, which is in the final stages of negotiation, comes less than three years after Epic completed its first French language deployment in Belgium.

Six suppliers submitted bids, with Cerner Canada finishing second.

The government expects the first two sites to be live in 2024 and the rollout to be completed within five years.

Quebec has spent a reported $1.5 billion USD over the past 30 years unsuccessfully attempting to computerize its hospitals. 

HIStalk Announcements and Requests


Most poll respondents, especially those responding in their role as a consumer, aren’t fans of hospital consolidation.

New poll to your right or here: Would you walk out of a medical practice without being seen if you saw a fax machine sitting at the check-in desk? I ask because I suspect that even philosophically passionate anti-faxxers don’t choose or exclude doctors based on their technologies.


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

Acquisitions, Funding, Business, and Stock

Truepill, whose pharmacy fulfillment business led it to a multi-billion dollar valuation as it expanded into diagnostic testing and telehealth, will seek additional funding at up to a 90% reduction in valuation as it struggles with the departure of its co-founders and a DEA investigation into its Adderall dispensing related to its mental health partner Cerebral.

Per diem nurse staffing platform vendor Nursa raises $80 million in a Series B funding round.



Colusa Medical Center (CA) names Steve Stark, MS, MSHA as CEO. He previously worked his way up through it IT ranks at other hospitals, from IT director to CIO.


Niall Brennan (Clarify Health Solutions) joins the CDC as senior advisor for its data modernization plan.

Announcements and Implementations

A Baltimore TV station profiles Bowie State University’s new program in public health informatics and technology. The program, funded by a $10 million HHS grant, will offer boot camps, a bachelor’s degree, and a graduate certificate.


Trilliant Health offers developers free API access to its national directory of 2.7 million providers.

Government and Politics

VA CIO Kurt DelBene says that he is “cautiously optimistic” about its Oracle Cerner implementation, as the VA has learned from its first five go-lives and has tightened service level agreements in a recent contract renegotiation with Oracle.

Sponsor Updates

  • AGS Health adds AI-powered Intelligent Authorization to its AI Platform.
  • EClinicalWorks releases a new customer success story, “How Healow Self-Scheduling Helped a New Practice Fill 400 Appointment Slots.”
  • OptimizeRx signs multi-year partnerships with two EHR vendors and one telehealth vendor.
  • NTT Data announces that Everest Group has named the company as a Leader in its 2023 Healthcare Data and Analytics Services Peak Matrix Assessment.
  • PMD unveils new branding to improve transparency and value for customers.
  • Nordic adds enterprise cloud applications for finance and human resources from Workday to its portfolio of ERP Services.
  • PerfectServe is positioned highest in ability to execute in the first Gartner Magic Quadrant for clinical communication and collaboration.
  • Verato will exhibit at E-Solutions Exchange August 27-30 in in Coeur D’Alene, Idaho.
  • Waystar will exhibit at the Texas Association for Home Care & Hospice Annual Meeting August 30-31 in San Antonio.
  • Wolters Kluwer Health will exhibit at Rise West August 28-30 in Dallas.

Blog Posts


Mr. H, Lorre, Jenn, Dr. Jayne.
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Morning Headlines 8/25/23

August 24, 2023 Headlines No Comments

Healthcare payments tech firm Waystar confidentially files for US IPO

Reuters reports that Waystar has confidentially filed for an IPO that could value the company at $8 billion.

Ovation Healthcare Expands Technology Services with 3D Technology Merger

Hospital shared services vendor Ovation Healthcare acquires 3D Technology, which offers professional and managed services.

Keona Health hauls in $7 million

Patient engagement and relationship management software startup Keona Health raises $7 million.

News 8/25/23

August 24, 2023 News No Comments

Top News


NextGen Healthcare is reportedly exploring options that could include selling the company.

NXGN shares lost 6% in the past 12 months versus the Nasdaq’s 11% gain, valuing the company at $1.2 billion.

Reader Comments

From UGM Attendee: “Re: Epic. Moving into the documentation management systems area with the announcement of Gallery at UGM.” Unverified.


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

Acquisitions, Funding, Business, and Stock


The assets of AireHealth, which offers a platform-connected nebulizer for monitoring chronic respiratory conditions, will be liquidated in an online auction.

WellSky acquires Experience Care, which offers an EHR and other software for post-acute and long-term care providers.

Hospital shared services vendor Ovation Healthcare acquires 3D Technology, which offers professional and managed services.


  • Ireland’s Bon Secours Health System will implement Meditech Expanse.



Kurt Hammond, MBA (EMed Digital Healthcare) joins Exo as chief commercial officer.

Announcements and Implementations

Delta Air Lines is upgrading its onboard medical technologies to include app-powered direct access to doctors on the ground and enhanced diagnostic equipment, such as an automatic blood pressure cuff and pulse oximeter. Delta says it will be adding telemedicine and remote monitoring technologies.

Australia’s Queensland Health creates a clinical staff credentialing and training system using SAP, which will support the movement of clinicians among its 16 hospitals and health services.


A new KLAS report looks at Epic’s initiatives to improve EHR efficiency and satisfaction. Providers report increased satisfaction after participating in the company’s Physician Power User and Physician Builders programs. Features that are correlated with improved clinician efficiency are Rover (mobile documentation and notification), Brain (inpatient nurse planning), Secure Chat (staff collaboration), and Hey Epic! (voice assistant and reminders).

Privacy and Security

Hackers who breached a hospital in Israel are contacting its high-profile patients to demand that they pay a ransom to avoid having their medical records published. Among those messaged was Health Minister Moshe Arbel, who released his own medical information rather than be extorted.



I seldom retweet (or re-X), but this is good. Will Manidis is founder and CEO of, which offers an AI-powered patient cohorting solution for patient screening and research.

Sponsor Updates

  • KeyCare caps a successful year of fundraising, health system collaborations, and high-quality telehealth delivery.
  • Fast Company names Linus Health’s DCTclock a winner in its 2023 Innovation by Design Awards.
  • Lucem Health releases a new episode of the This Week in Clinical AI Podcast.
  • Wolters Kluwer Health announces that 15 of its Lippincott healthcare titles received 28 wins in the 35th annual Awards for Publication Excellence competition.
  • Healthcare Growth Partners advises Experience Care in its acquisition by WellSky.
  • CereCore wins ClearlyRated’s 2023 Best of Staffing Client and Talent Awards for service excellence.

Blog Posts

Sponsor Spotlight

Dimensional Insight is a leading provider of analytics, data management, and performance management solutions, offering a complete portfolio of capabilities ranging from data integration and modeling to sophisticated reporting, analytics, and dashboards. Founded in 1989, Dimensional Insight has thousands of customer organizations worldwide and consistently ranks as a top-performing analytics organization. The company is an eight-time Best in KLAS winner in healthcare business intelligence and analytics between 2010 and 2021. (Sponsor Spotlight is free for HIStalk Platinum sponsors).


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EPtalk by Dr. Jayne 8/24/23

August 24, 2023 Dr. Jayne 2 Comments

As a clinical informaticist, a lot of my time is spent thinking about how technology impacts physicians and other users of the systems that care delivery organizations implement. Patient experience is sometimes an afterthought, with organizations doing a variable job taking that into consideration.

However, I’m seeing more and more discussions in the clinical informatics world about how technology is impacting patients. Predictably, there’s a lot of attention on artificial intelligence right now, but I’m starting to see more attention given to the basics – namely screen time among children and adolescents. An article recently published in JAMA Pediatrics looks at the amount of screen time that children are exposed to at one year of age and how it might impact communication and problem solving skills at age 2 and 4.

The study was conducted in Japan and used questionnaires about screen time that were completed by parents of nearly 8,000 pediatric patients. Data showed that children of first-time mothers who were younger, those whose mothers had postpartum depression, and those with lower income and educational levels tended to have higher levels of screen time. The authors concluded that children who were exposed to more than four hours of screen time daily were more likely to have developmental delays. Both areas were delayed at age 2 and 4, and additionally, it was noted that fine motor and personal/social skills were delayed at age 2 but resolved by age 4.

Most of the major EHRs I’ve used have prompts for pediatric providers to deliver anticipatory guidance around screen time when they are conducting well-child visits, but I wonder if we’ll see action from professional organizations that change these recommendations.

From Madison Maiden: “Re: Epic UGM. Judy opened the executive address with her ‘family photo album,’ including pictures of her adventures in Minnesota and Oregon as a young person along with tales of her time swimming, canoeing, and otherwise being outdoors. This year’s theme is ‘Castaway’ and she described the healthcare environment as ‘tumultuous’ and listed hospital closures and reduced access to services as critical issues facing patients. She said that Epic’s headcount is up to 14,000 employees who are in the office full time. Another speaker said that more than 38,000 people were watching the session either in person or via live stream.” That background helps explain some of the décor adjacent to the Deep Space auditorium, where an entire level is devoted to overwhelming woodsiness with the inclusion of camping gear reminiscent of the late 1970s and early 1980s. Other readers chimed in to mention that the “Castaway” theme included homage to “Gilligan’s Island” as well as the Tom Hanks movie of the same title.

CMS is launching a new Electronic Prescribing of Controlled Substances (EPCS) Program Prescriber User Group, tasked with giving input on educational content and the usability of the CMS EPCS Program prescriber portal. The application process is open through August 30 at 8 p.m. ET and those interested should plan to commit approximately 10 hours to the group over the coming year. CMS hopes to have various specialties, practice locations, and prescribing patterns represented, so if you’re interested or know someone who is, please submit.

I’m mentoring some alumni from my medical school who have decided that clinical medicine isn’t for them. One wants to dip their toes into clinical informatics and asked if I would take a look at their LinkedIn profile and provide some feedback. Although their work history and education sections looked great, I advised that they replace the photo with a head shot that wasn’t obviously cropped out of a group pictures. Generally, by the time you reach age 30, especially in the era of the Google Photos Magic Eraser and similar features on the iPhone, one should have a passable head shot that doesn’t have other people’s hands or shoulders in it. I also recommended that they update their headline to remove their realtor credentials if they want to be taken more seriously when applying for informatics positions.

Illinois-based Advocate Aurora Health has settled claims about its use of the Meta Pixel and other web trackers for $12.25 million. The settlement covers multiple claims filed after the health system disclosed a breach affecting more than 3 million patients. The attorneys in the case will receive $4.3 million plus expenses and the class representatives will receive $3,500 each. Patients who join the class and file a claim form will receive a payment from the remaining settlement fund.

Blue Shield of California has partnered with Mark Cuban Cost Plus Drug Company, Amazon Pharmacy, and others in a new model to attempt to transform prescription drug management in the US. The plan hopes to achieve a $500 million annual savings on medications for its 4.8 million members. The initiative, titled Pharmacy Care Reimagined, is supposed to improve transparency as well as lowering costs. Prescription drugs are big business, with large numbers of the population taking multiple prescriptions at any given time. US spending on prescription medications is in the $600 billion range, with an average of $1,500 per patient per year. When I was in a traditional family medicine practice, it was a constant battle to try to convince patients that low-cost generic medications were as good if not better than flashy newer drugs with equally flashy price tags.

This particular effort hopes to remove some of the non-value-added links found in the typical pharmacy supply chain, where more than a dozen entities can be part of the process. It looks to reduce the players to five, including pharmacy, specialty pharmacy, benefits management, payer, and complex care management entities. I’ve only tangentially followed Mark Cuban’s entry into the pharmacy world, but I did enjoy a recent Fireside conversation between him and negotiation expert Chris Voss. When asked what he sees that kills time and brain power, Cuban said, “Meetings, meetings, meetings, meetings, meetings, meetings, meetings, meetings.” He went on to say, “People over-meet and over-call … You kill so much time. I try to only do meetings if I have to come to a conclusion or there’s no other way. Same with phone calls. Every meeting is, ‘Who got the donuts? What do you got going on? How are the kids?’ If it were up to me, if I had to have a meeting – and I tried this early on in my career, and I wasn’t established enough to get away with it – I’d take away all the chairs from the meeting room. It’s amazing how quickly meetings get over with if no one has a chair or some place to sit.”

I once worked for a development organization that did some amazing standup meetings and produced quality products at a breakneck pace, so I’m on board with that philosophy. They also brought in a dedicated management consultant to do a quick hit project to simplify their meeting structure, so maybe they were more forwarding thinking than I might have thought at the time.

What are your thoughts about reducing drug costs in the US? Can Blue Shield of California and Mark Cuban get it done? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 8/24/23

August 23, 2023 Headlines, News No Comments

Healthcare software vendor NextGen explores sale

NextGen Healthcare shares rise on the news that the company is considering putting itself up for sale.

Fisher Auction Company will handle the Sale of the Assets of AireHealth, Inc., a Remote Patient Respiratory Care Platform

AireHealth will liquidate its respiratory remote patient monitoring assets including patents, software, hardware, and intellectual property in an online auction September 13.

WellSky Acquires Experience Care to Enhance Long-term Care Providers’ Ability to Operate Efficiently, Advance Resident Care

WellSky acquires Experience Care, which offers health IT for post-acute and long-term care.

U of U server outage brings down hospital, campus, UTA systems

A University of Utah heat-related server outage forces its affiliated health system to revert to downtime procedures and divert emergency patients.

Book Review: “The AI Revolution in Medicine: GPT-4 and Beyond”

August 23, 2023 News 3 Comments

Review by Tyler Smith, CEO, Health Data Movers.


Reading a paperback in the age of AI feels (and is) anachronistic. But until Neuralink pumps the information into our brains, such combinations of societal shattering technology breakthroughs and pre-AI workflows remain. In reading “The AI Revolution in Medicine: GPT-4 and Beyond,” it becomes evident that a combination of new technology and old processes will prevail in medicine over the next phase of technological advancement.

Given an early glimpse of GPT-4, authors Peter Lee, PhD, Carey Goldberg, and Isaac Kohane, MD penned distinctive chapters focused on their areas of expertise and the potential they have experienced or can imagine with the application of GPT-4 to medicine. They explain the basics of the incoming technology — including the fundamentals of LLM and machine learning, along with platforms like Nuance DAX — and contemplate the potential ethical pitfalls and opportunities of AI, including non-medical capabilities such as writing poetry.

Although presented as an academic text, the co-authors’ diverse backgrounds: computer scientist (Lee), physician (Kohane), and journalist / patient advocate (Goldberg) bring variety and thus life to case studies. Endowed with an introduction by the present king of AI, Sam Altman, and closed with a piece by Microsoft’s CTO, Kevin Scott, the work has all the makings of AI thought leadership star power.

Coming fresh off a viewing of “The Terminator,” the ethically positive potential of AI was a pleasant surprise, underscored by the authors’ assertion that GPT-4’s tone is more empathetic and caring than human doctors, a viewpoint reiterated recently in this post by Chris Longhurst, MD.

Quite a plot twist if the robot’s apparent empathy may force clinicians to improve their own written bedside manner. It has been awhile since I watched “Terminator 2,” but that might be a more appropriate cinematic pairing.

But as the authors take us through the modern reality of endless data capture and regulatory compliance processes (the dreaded prior auth!) that plague our healthcare providers, only a reader devoid of empathy would overlook that physicians are drowning in typing. If AI can lift the clerical burden, maybe a softer touch can find time on a physician’s daily calendar.

As an Epic implementation consultant who came of age during the Meaningful Use era, the hope presented in the book validated days and nights spent in Chronicles and Hyperspace. True the burden of typing was a byproduct of the installs performed across the country. But if the data that was gathered by such typing can now be mined and used to generate insights, and if the initial installs are seen as the first step in the shift to integrating technology into workflows (workflows that begin to substitute vocal cords for fingers), maybe it wasn’t all in vain.

A more radical prognostication of the future applications of AI in medicine would have made the book monumentally more thought-provoking. A scene similar to that contained in Lanier’s “Who Owns the Future,” wherein the reader is presented with an image of our lifestyles after physical activity disappears from the human experience (we simply live in pods) would have distinguished the work. Will AI alter our lives in such a way that medicine will change because our injuries and illnesses of the AI era will be symptoms of habits and a life we can’t even begin to imagine?

Since the authors don’t appear to aspire to thread the needle between Huxley and an academic piece, the book achieves stature as the perfect preface to an optimistic future for AI in medicine. As a fellow optimist, I’m hopeful as well, and will take such sentiment into today, where the real chapters of the story are being written.

Readers Write: Tell Me Again Why Fax is Superior?

August 23, 2023 Readers Write 4 Comments

Tell Me Again Why Fax is Superior?
By Dan Wilson

Dan Wilson is founder and CEO of Moxe Health of Madison, WI.


The “inherent security” provider argument in a recent KLAS report on digital fax is unfounded and a remnant of another era. User error is inherently possible when a process involves manual steps, and fax isn’t secure relative to more modern ways to encrypt and transact data between multiple parties. It’s also unlikely that faxing remains analog (using only a phone line), as groups are using Efax or VOIP lines with transactions going over the Internet and the fax isn’t actually encrypted. 

“Ease of use” sounds like the person who used to say that “no one will text, because it’s easier to just pick up the phone and call someone.” Faxing is easy only because finding a directory of where to send files electronically is so hard. If we solve the directory issue, the “ease of faxing” benefit is reduced.

Another way to think about ease of use is that it’s actually a tradeoff for security. Fax is easy because you send a document to a clinic’s single number. That means that the message isn’t specific to a patient or recipient. Anyone who has access to the fax machine can see the information. Rarely do you get both ease of use and security, but there’s a better set of options with digital exchange to select the right tradeoffs based on the sensitivity of the information versus just having a blunt tool.

Fax is hopelessly outdated. It creates enormous manual effort and adds cost on both ends of the transaction. A CAQH study estimates that faxing or mailing instead of using digital transfer costs $25 billion per year.

For the love of God, can we stop making doctors do a ton of work to digitize records and paying people to print them and fax them, taking those records from digital to analog and then to an even worse version of analog (an image)? And then consuming massive resources on the recipient’s end to try to reconstitute a digital copy of what started its life as a digital record? And along the way, losing fidelity of information in addition to people and compute time.

Tell me again why fax is superior?

Healthcare AI News 8/23/23


In China, the Beijing Municipal Health Commission proposes prohibiting the use of AI by online services to generate prescriptions, make diagnoses, and deliver treatment. The commission also plans to take a supervisory role for medical institutions that run online services.


Microsoft lists its AI collaboration efforts with Epic as showcased at UGM:

  • Note summarization for clinicians to speed up documentation.
  • Nuance DAX Express embedded in Hyperdrive and Haiku.
  • Providing medical coding staff with suggestions based on the clinical documentation.
  • Adding NLP queries and interactive analysis to SlicerDicer.


Genesis Therapeutics, which hopes to advance its AI-discovered drug pipeline to clinical development, raises $200 million in a Series B funding round.

Suki integrates its AI-powered clinical documentation assistant with Cerner, adding to its previously announced integration with Epic.


A Mass General Brigham study finds that ChatGPT delivered 72% accuracy in making diagnoses and care management decisions throughout a patient’s complete case, performing equally well in primary care and emergency settings. ChatGPT struggled with differential diagnosis, demonstrating the value of physician expertise at the beginning of the encounter, where a small amount of presenting information is used to consider possible diagnoses.


Three physicians say in a Time opinion piece that healthcare AI could create a “nightmare scenario” where AI tools block patients from talking to humans for reassurance or to offer input in care decisions. Studies have shown that AI is perceived by some as more empathetic and compassionate than doctors, which means it’s time to hit the “reset button” on how doctors approach patient communication and teach those skills to medical students and residents.


Dermatologists describe how ChatGPT could be used to support rural dermatology practices, including creating disease-specific educational patient handouts at appropriate readability levels, generating procedural note templates, and creating drafts of prior authorization requests.


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Morning Headlines 8/23/23

August 22, 2023 Headlines No Comments

Five9 to Acquire Aceyus extending the Five9 platform to streamline the migration of large enterprise customers from on-prem to cloud and leverage contextual data to deliver personalized experiences

Five9 will acquire Aceyus, which offers customer experience analytics.

Thyme Care Secures $60M Series B to Scale Cancer Care Beyond the Clinic

Tech-enabled cancer care support company Thyme Care raises $60 million in a Series B funding round, bringing its total raised to $82 million.

Singing River Health System cyberattack currently under investigation

Singing River Health System’s computer systems remain offline after a cyberattack was detected over the weekend.

Zivian Health lands $3M to expand digital health platform

Healthcare staffing and collaborative care software startup Zivian Health raises $3 million in seed funding.

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