News 2/17/23

Top News

Unified communications and collaboration services vendor Avaya, whose healthcare offerings include solutions for virtual care, collaboration, and patient access technology, files for Chapter 11 bankruptcy for the second time in six years.

The Durham, NC-based company reported lower than expected revenue and earnings last year, blaming accounting problems with its cloud subscription revenue, after which it replaced its CEO.

AVYA share price has dropped 98% in the past 12 months, valuing the company at $24 million.

Reader Comments

From Baby Payer: “Re: IVF coverage. In an example of our messed up healthcare system, women are taking Amazon jobs and quitting after one day to get fertility benefits.” Women claim that they took a job working in an Amazon warehouse, were covered immediately by its Progyny fertility benefits, and then quit the next day and paid their own COBRA premiums going forward. The women supposedly prefer warehouse jobs because hiring and quitting are automated processes, with no interview required.

From Lou Sassol: “Re: ViVE. Will you be reporting from there?” Probably not. I can’t justify the $2,400 general admission registration and I don’t know of any easy way to attend undercover as a free media attendee. At other conferences, I have either registered at full price under my own name using a phony company name or used someone’s exhibitor pass. 

HIStalk Announcements and Requests

I was searching for something on HIStalk and ran across my old Time Capsule series, which I think is my best work in mixing snark with occasionally insightful observations, fueled by mania that was induced by working several jobs simultaneously with little sleep way back in the mid-2000s. You don’t see a lot of health IT sites running titles like “In a Capitalist Society, Somebody Will Always Sell a Fat Man a Speedo or an Unprepared Hospital a Clinical System.”

Pondering: are hospitals the only businesses that charge customers and employees to park on the lots that they themselves own?

Webinars

February 28 (Tuesday) 1 ET. “Words Matter: Simplifying Clinical Terms for Patients.” Sponsor: Intelligent Medical Objects. Presenters: Whitney Mannion, RN, MSN, senior terminologist, IMO; David Bocanegra, RN, nurse informaticist, IMO. The language of medicine can be confusing and contradictory to patients, challenging their ability to prepare for a procedure or pay their bills. This webinar will explore how the words that are used to communicate – online, in print, and in person – must be chosen carefully to allow patients to comprehend their diagnoses, treatments, and care plans. The presenters will also describe how the ONC Final Rule for the 21st Century Cures Act will make clinical and technical language more directly accessible through patient portals.

March 7 (Tuesday) noon ET.  “Prescribe RPA 2.0 to Treat Healthcare Worker Burnout.” Sponsor: Keysight Technologies. Presenters: Anne Foster, MS, technical consultant manager, Eggplant; Emily Yan, MPA, product marketing manager, Keysight Technologies. Half of US health systems plan to invest in robotic process automation by the end of this year, per Gartner. The concept is evolving to help with staff burnout and physician productivity. The presenters will introduce RPA 2.0, explain how to maximize its value, demonstrate how to quickly start on RPA 2.0 and test automation in one platform, and answer questions about healthcare automation.

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

Acquisitions, Funding, Business, and Stock

Spacelabs Healthcare acquires PeraHealth and its Rothman Index patient deterioration software for undisclosed terms.

Primary care EHR vendor Elation Health acquires Lightning MD, which sells billing and payer connectivity systems.

Centura Health, which is operated as a partnership between CommonSpirit Health and AdventHealth, will dissolve as the partners decide to manage their own respective hospitals. CommonSpirit also announces that it will acquire Steward Health Care’s Utah sites, which includes five hospitals and 35 clinics.

Business Insider runs a first-person report of using Amazon’s new RxPass service that covers dozens of commonly prescribed generic drugs for a flat rate of $5 per month, citing these issues as reasons to not use it again:

• The service isn’t available in eight states and can’t be used by people covered by Medicare and Medicaid. Amazon explains that those programs don’t allow pharmacies to charge cash prices for medications that they cover.
• The display of available meds lists items multiple times – with insurance, without insurance, or with RxPass – and it’s easy to miss the one that is flagged as available under the program.
• Transfer of prescriptions from CVS took a long time.
• One prescription was rejected because it didn’t exactly match Amazon’s inventory, which required starting the process over with the patient’s doctor.

CPSI announces Q4 results: revenue up 12%, EPS $0.61 versus $0.70, beating Wall Street expectations for both. Shares are up 6% in the past 12 months versus the Nasdaq’s 15% drop, valuing the company at $447 million.

R1 RCM announces Q4 results: revenue up 35%, EPS –$0.09 versus $0.11, beating revenue expectations but falling short on earnings. RCM shares are down 46% in the past 12 months versus the Nasdaq’s 15% loss, valuing the company at $6.6 billion.

CommonSpirit Health blames its $474 million quarterly loss on the pandemic, labor shortages, staffing costs, inflation, and its October 2022 ransomware attack. Its financial report says the month-long outage in October has cost $150 million so far.

Sales

• Mosaic Life Care (MO) will start its Epic go-live on March 4, replacing Cerner.
• Care Choice Family Clinic will implement EClinicalWorks.

People

Vanderbilt University Medical Center promotes Dara Mize, MD, MS to CMIO.

Joshua Newman, MD, MSHS, SVP of healthcare and life sciences at Salesforce, will leave the company.

Hongfang Liu, PhD (Mayo Clinic) joins UTHealth Houston as director of the Center for Translational Artificial Intelligence in Medicine and VP for Learning Health Systems.

Lumeon hires Matt Duffy (NextGen Healthcare) as VP of product and Kathy Ruggiero (Commure) as VP of marketing.

Clement Chen, MBA (Leidos Health Group) joins DSFederal as CEO.

Ochsner Health SVP/CIO Laura Wilt, MBA has resigned.

Announcements and Implementations

WebPT enhances its rehab therapy platform with upgraded single sign-on capabilities, enterprise identity management, in-app history reporting, and a Snowflake-powered data warehouse solution.

Purdue-connected HemaChrome wins an NIH challenge for its smartphone app that measures blood hemoglobin non-invasively using phone pictures or screenshots from video calls.

NeuroFlow’s behavioral health platform is named one of the Phase 2 winners of the VA’s Mission Daybreak for suicide prevention solutions. I interviewed co-founder and CEO Molara – a West Point graduate and former Army captain and field artillery officer who served as a platoon leader in Iraq — last year.

Newly spun off GE HealthCare announces plans to develop hospital software to help guide care and assign resources.

Four hospitals in Ontario go live on a centralized patient portal as part of their shared deployment of Meditech Expanse.

Government and Politics

The State Department approves Oracle Cerner’s $250 million contract to implement military health IT systems for Kuwait’s Military Medical Command.

Sponsor Updates

• Healthjump Interoperability Platform is featured in a new KLAS First Look report.
• Elsevier launches the Reproductive Health Hub to support healthcare professionals with trusted information about reproductive health topics.
• Health Data Movers promotes Karla Christopher, Brandon Camp, and Michael Martin.
• Black Book Research surveys of a combined 10,000-plus end users rate Surgical Information Systems the top ambulatory surgical center technology vendor and ModMed the top health IT vendor for integrated practice management, RCM, and EHR solutions.
• CTG publishes a new case study, “CTG Helps Contract Research Organizations Leader Create Business Alignment.”
• Fortified Health Security names Robert Clark (Code42) regional director.
• The HCI Group launches its Epic Center of Excellence in Jacksonville, FL.
• Health Data Movers promotes Michael Martin to senior director of delivery.
• InterSystems releases a new Healthy Data Podcast, “Transitions of Care: Data Integration, Standardization, featuring BJ Evans, Stonerise Healthcare.”
• Kyruus publishes a new whitepaper, “Five Ways to Prioritize Provider Data Management.”
• The Care4 project in Ontario has launched a patient portal shared across four hospitals and ambulatory clinics using Meditech Expanse.
• Net Health will exhibit at APTA CSM 2023 February 23-25 in San Diego.

Blog Posts

• Choice architecture to the rescue (Nordic)
• Healthcare Consumer Behavior – Is Everything Old New Again? Now Quite. (Get Well)
• Epic EHR and Google Cloud Announce Partnership (HealthTech Resources)
• Behind the Scenes: DEI in Health Education Illustrations (Healthwise)
• Disaster Recovery and Business Continuity in Healthcare (Optimum Healthcare IT)
• CMS proposes major changes to Medicare Advantage payment models (Intelligent Medical Objects)
• 3 Healthcare Consumer Engagement Trends for 2023 (Medhost)
• Getting Better Provider Face Time Begins with a Better EHR (Net Health)
• How Array Behavioral Care Addresses Access and Continuity of Care (NeuroFlow)
• Navigating outpatient best practices, part 2: How AI-powered workflows drive appropriate documentation accuracy and reimbursement (Nuance)
• How Automation Fixes the Biggest Issues Facing Healthcare Service Desks Today (NTT Data)

Contacts

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

EPtalk by Dr. Jayne 2/16/23

As we approach the end of the declared emergency surrounding the COVID pandemic, it will be important to assess how shifts in healthcare policies including those involving payment, access, and prescription medications will impact health outcomes.

A recent article in the American Journal of Obstetrics and Gynecology Maternal-Fetal Medicine looked at hos telehealth care impacted racial disparities in visit attendance during the pandemic. As background, the US has a terrible track record for maternal care, with maternal mortality rates that are significantly higher than other high-income countries. Additionally, in the US black woman are more likely to die during pregnancy and childbirth. During my time in the emergency department, the number of women I cared for who had no prenatal care was simply stunning given our time and place in history.

Researchers at Penn Medicine performed a retrospective cohort study looking at the issue by comparing data from 2020 to the same time period in 2019. Self-identified patient demographic breakdown included 63% black, 26% white, and 1% Latinx individuals. Prior to the addition of telehealth, black patients were less likely than others to attend a postpartum visit. They were also less likely to receive a postpartum depression screening or to breastfeed their infants.

After telehealth implementation, postpartum depression screening rates were equivalent, although black patients remained less likely to breastfeed. The authors concluded that “telehealth implementation for postpartum care during the COVID-19 pandemic was associated with decreased racial disparities in postpartum visit attendance” in a way that was statistically significant.

Numerous studies are demonstrating that telehealth can improve patient outcomes in the right situations. Especially for patient populations that may be marginalized, telehealth options can open the door to care that patients might not otherwise receive. Benefit can be derived from both video and audio-only telehealth visits, assuming the right protocols and safeguards are in place. In the short term, there are just some things that can’t be done without a face-to-face interaction, but as technology improves those gaps are narrowing.

I had dinner with some of my favorite smart women tonight and telehealth was a key topic, as were other non-traditional care delivery opportunities including school-based health clinics, mobile care units, and more. There are so many dedicated people in the healthcare arena who want to make sure patients get the care they need. Now it’s just a question of aligning the right priorities and incentives to make it happen. There are more than enough dollars being spent on healthcare, from insurance premiums to facility and provider bills, that we should be able to do better. We should be able to be better. The next few years will be interesting, indeed.

As someone who has been officially classified as a remote worker for more than 12 years, articles that talk about how remote work will be the death of business tend to catch my eye. The most recent one featured investor Marc Andreessen and his warnings that remote work isn’t good for younger people in the workforce. I got a kick out of the quotes where he called the office a “continuation of a college campus experience” and where he hinted that remote work has prevented not only the development of workplace relationships, but has stifled office romances. For any of us who has had to manage a team where romance may be in the air, I think we could do without the latter.

He also alleged that remote workers don’t have a sense of connection to their co-workers and that they don’t even know who their neighbors are. I’ve been with a fully-remote team for more than a year now, and I have to say that my relationships with some of my coworkers are as strong, if not stronger, than those with people who live in the same ZIP code.

In my experience, it’s more about putting the time in to understand who people really are and how they work best than it is about seeing them in person every day. It’s about setting shared goals and supporting each other, whether you’re 10 feet away or a thousand miles away. My co-workers are engaged outside the workplace whether they are younger, older, married, or single; whether they have families nearby, or whether they don’t. They take non-career-related classes to broaden their horizons, volunteer with various organizations, and travel. They find their sense of community through a mix of virtual and in-person interactions.

As someone who is older and I hope wiser in the workplace, I personally think that it’s healthy to shift the culture away from the idea that the workplace should be our social center. Wanting to have a life outside of work is a significant reason why many want to embrace remote work situations, where they can live where they like and have less time commuting and more time for other pursuits whether they be solitary or with others. I think some of us have forgotten the things that happened with in-office work that made people uncomfortable and that were difficult to get away from due to close quarters. We’ve all dealt with generally boorish behavior, people trashing the lunch room, unwanted smells, unwanted noise, and HR-worthy happenings at company parties and functions.

Although bad behavior can still happen in a remote environment, somehow it seems easier to tune out. If it gets to the point of needing to file a formal complaint, it’s more likely to be documented through email, chat logs, recorded meetings, and other media. Those “your word against mine” situations may look entirely different in a distributed workplace. I know I’m significantly more productive not working in an office, and that includes both work and non-work tasks. Given my penchant for throwing a delightful loaf of Three Cheese Semolina bread in the oven and timing it to be done just in time for dinner, I’m not sure I’d ever want to be in an office full time again.

What are your thoughts on remote work? Will it be the death of us, or should we not believe the hype? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 2/16/23

CPSI Announces Fourth Quarter and Full Year 2022 Results

CPSI reports Q4 results: revenue up 12%, adjusted EPS $0.61 versus $0.58, beating analyst expectations for both.

Cyber attack exposes personal data of approximately 1 million Community Health Systems patients

Hospital management company Community Health Systems (TN) begins notifying patients of a cyberattack on its third-party cybersecurity vendor Fortra, which may have exposed patient information.

CommonSpirit Health Releases FY2023 Q2 Financial Results

CommonSpirit Health reports a $474 million Q2 operating loss, some of which it attributes to the October ransomware attack that took its systems offline for nearly a month.

Readers Write: Faster Horses? Let’s Think Different

Faster Horses? Let’s Think Different
By Stuart Hanson

Stuart Hanson, MBA is CEO of Avaneer Health of Chicago, IL.

American industrialist and business magnate Henry Ford is purported to have said, “If I had asked people what they wanted, they would have said faster horses.” The same could be said when it comes to what it’s going to take to transform the US healthcare system, one of the most administratively complex in the world.

When compared to other high-income nations, we spend the most, yet have poorer outcomes. While we have many initiatives in place to fix our current administrative inefficiencies, what we really need is an entirely new way for healthcare stakeholders to connect, collaborate, and conduct business. That requires the industry to put aside “faster horses” thinking and move beyond more API connections, HIEs, or revenue cycle management bolt-on technologies.

Our healthcare system was designed around payer and provider processes. But at its core, healthcare is human. At the center of every procedure, every diagnosis, every transaction is a human being — a real person with expectations of being treated with dignity at a moment when they are most vulnerable. Yet our back-office processes aren’t built around the patient; they are designed around transactions. Those transactions move across disparate data silos, point solutions, aged technology infrastructure, and manual processes. Many of us can share experiences of how we have been personally impacted by our current systems.

It’s time to create a new way of working together that puts the patient first, restoring the humanity of healthcare. That requires a level of data fluidity that we currently lack, fluidity that enables the sharing of data and seamless collaboration for more effective back-end processes and better patient experiences.

While APIs are great at establishing point-to-point connectivity, they aren’t the answer for achieving true, seamless interoperability that puts the patient first. APIs are still focused on the transaction and the transaction type. We need a digital ecosystem built on a highly secure, decentralized peer-to-peer network that leverages common infrastructure, as well as tools that enable collaboration and trust — a data superhighway. This approach puts the patient, patient identity and all needed data at the center.

With the type of interoperability delivered in a decentralized network:

• Participants retain ownership of their data while giving access (with permission) to the data needed.
• Instead of sending files back and forth, there is automatic access to data and the data owner can revoke rights at any time.
• A single person identity (for the patient/member/provider) and intelligent matching creates confidence in the accuracy of the information exchange.
• FHIR standardizes the data.
• Solutions on the network enable participants to interact, transforming administrative and clinical processes.

One of the most significant benefits of a decentralized network is its ability to provide an unprecedented level of transparency and accountability, which supports greater integrity and personal responsibility among participants. With a decentralized network built upon innovative technologies, the data becomes immutable and is always refreshed and current, eliminating the need for third-party validation. This type of data fluidity would enable real-time risk adjustment, simplified quality reviews, and more proactive process improvements.

Another benefit of this type of network is that payers, providers, and solution vendors can connect to any other network participant without having to build or maintain another API. It’s a completely new way of doing business.

From a patient’s perspective, greater data fluidity via a decentralized network can eliminate much of the complexity that inhibits seamless, timely access to care. Prior authorizations can be completed in minutes instead of days or weeks, reducing delays in care. Referrals take seconds, helping to eliminate gaps in care. Accurate patient financial responsibility can be determined in real time so patients know with 100% certainty what they will owe prior to their service. Patient medical records are accessible in real time no matter where the patient has been seen in the past, giving the provider a complete view of the patient’s medical history without having to request, email, fax, or send records through the mail.

Leveraging a peer-to-peer network, developers and innovators could connect on a single platform and use common tools to collaborate with other stakeholders. Connecting innovators and stakeholders across the ecosystem on a single platform would enable co-creation, which would allow much needed innovations to reach the market faster. Payers win, providers win, vendors win, and most importantly, patients win.

Interoperability is a term that invokes thoughts of payer-provider processes. While that’s true, we need to rethink what it means in terms of the patient. We need to take a step outside of the interoperability solutions around us and rethink how the business of healthcare could work. Instead of trying to fix a broken system, we should reimagine a completely new system, one unencumbered by layers of inefficiencies that inhibit patient care and one that reinvents the patient experience for good.

HIStalk Interviews Adam McMullin, CEO, AvaSure

Adam McMullin, MBA is CEO of AvaSure of Belmont, MI.

Tell me about yourself and the company.

I’m thankful that I found my way into healthcare in 2006. I had worked around the US and the globe helping companies operate more efficiently by adopting technology. That was intellectually interesting. Getting into healthcare changed my life. That connection to the mission and how you can impact and help care teams and patients helped me find a sixth gear.

Before I got into healthcare, all I knew about healthcare was that a nurse agreed to marry me. It’s an odd coincidence that many of the businesses and teams that I have been involved in a focused around serving nurses with clinically-led and technology-enabled solutions.

AvaSure is the leader in acute virtual care. We are in about 1,000 hospitals, including all of the Top 10 US health systems, one-third of the magnet hospitals, and 70 academic medical centers. We help our customers adopt virtual care to get better outcomes at a lower cost.

What are the clinical and business benefits?

That strong ROI was one of the things that attracted me to AvaSure. The ability to both operate demonstrably more efficiently while having proven clinical outcomes was to a level I hadn’t seen. AvaSure pioneered the tele-sitter market. About 20% of patients have a clinical need for observation, but only 10% or less actually get an observer, which is a person physically sitting in the room with the patient. The data on the performance of the in-room observers is not very strong.

We can take 16 of those observers and monitor them in a virtual care center. We have over 120 studies as to why that improves results, such as reducing falls or harm. That is an ROI around using your team more efficiently during a labor crisis and getting better outcomes. Once you have adopted that, you have also put in the fundamentals of your virtual care infrastructure. That allows you to move into other areas such as virtual nursing, which is seeing a lot of interest.

What is a typical profile of an observer and what is their job like?

In a virtual care center, we have the virtual observers, and increasingly, virtual nurses. The virtual observers usually have a clinical background, where they were providing a significant amount of documentation around the types of patients being observed and what they are seeing in the room. If you look at sitting, there was virtually no documentation. The great catches that we get daily are around preventing falls, because they have clinical insight and can often determine that a step was missed. We have unfortunately found situations where visitors or family members are giving substances to a patient that they shouldn’t be getting, or that they are concealing a weapon. They are doing a lot of things by observing those patients. We are 15% nurses and growing. We work to ensure that those virtual sitters, and increasingly virtual nurses, are integrated well into the rest of the care team.

How are hospitals using the system to improve employee safety?

We unfortunately have had a significant increase across the nation in behavioral health issues. Patients often first present in the ED, where you don’t have the history. We are seeing all sorts of things, whether that’s aggression against a caregiver or elopement, where patients or just take off when they’re not supposed to. By having a virtual observer, we’re able to notify the care team so that they can intervene, call for help, or call for security if necessary.

Are the cameras recording at all times?

That’s a really important point. None of the video is recorded. Otherwise, you would have to have patient consent. The video is being observed in real time and trained observers are doing the job to make sure that they are appropriately monitoring the patients.

Are observers screened or trained to manage the psychology of seeing patients in their most intimate and sometimes unfortunate moments?

That brings to mind a couple of things. We guide hospitals as they are hiring observers to look for people who have clinical experience. It’s a great role where you can have a outsized clinical impact, especially if you’re at a point in your career where you don’t want to be on the floor as much.

Gay Landstrom, the chief nurse of Trinity Health –which credits tele-sitting with saving $22 million per year – told a story at our company meeting about a patient who was nearing end of life. This was during COVID, when there was no additional nurse to be in there to be with that patient. The observer worked it out with their supervisor so they could be one-on-one with that patient. They talked to them at this incredibly intimate moment and then ended up singing to them as they unfortunately and sadly passed. That story really connected what we are doing to the mission.

I’ve heard story after story. I was recently at the VA in North Dallas and there was a virtual sitter who got very attached to the patients she was observing, because you have clear two-way audio. It got to the point that she was bringing treats and brownies. There’s a pretty deep connection because these virtual sitting sessions can go on for days. You need to make sure that you have a high quality connection.

Do observers and patients have a lot of verbal interaction, or is it mostly observers asking patients how they are doing or giving instructions?

Oftentimes there are also redirects. One of the reasons that patients fall is that they need to go to the bathroom and don’t want to call someone to help them. If the observer sees someone with high fall risk who is about to get out of bed, they can redirect them. They can summon the care team, let the nurse know, and let the patient know that help is on the way. Other times the patient might need help with something that is non-clinical, and they can take that need off the care team, which cuts down on the number of times the patient has to engage their clinical team.

As you move into virtual nursing, which is focused on either continuous observation — for example, things like avoiding patient demise and keeping patients out of the ICU — or episodic admissions and discharges. If you’re doing a discharge, the unit is right next to the bed and you’re doing a lot of that discharge documentation and training. That’s a deep engagement between the virtual clinical team member and the patient.

Do observers have access to any of the hospital’s clinical systems for observation or data entry?

Our solution is a purpose-built, high quality, highly reliable, high level of quality of service, audio, video, either mobile or mounted device, plus a very scalable backend technology. For example, we monitor 80 hospitals for Trinity out of two centers. When we talk about integrating with other devices, we integrate with the EMR. You can get into your EMR and you can launch the setting, so you can see both documentation and have the audio-video connection. We integrate out to the clinical communication and collaboration space so that you can appropriately route information to the right caregiver. The cameras are high enough fidelity that you can actually read the monitors in the room, and if there are other key alerts, we can bring those into the system as well.

Once the technology is in place and services have started, who is involved on the hospital side?

You want to make sure that the change management is done with the care team that is actually on the units. We have some best practices to make sure that there is great connectivity and that we facilitate building trust between the virtual care center and those who are caring for the patients. Those in the virtual care center are obviously there ongoing.

We as a company provide 24×7 support for the solution so that we can make sure that you have the quality of service when you are delivering care or observing these patients with a critical need. We think a lot, from the technology side, about Day 2. After you go live, how do you make sure that this is well supported and that we are monitoring the health of the devices and the technology?

Does virtual nursing offer a way for nurses to continue their clinical careers without the punishing physical demands?

I was with a customer last week and we were talking about this. They call them their wisdom workers. In nursing, there’s something called the complexity experience gap. The complexity or acuity of patients has gone up, and as nurses have left the workforce, they are disproportionately the most experienced nurses. You are backfilling them with newer nurses who may have had less clinical training during the pandemic. Using your more experienced nurses in a virtual care center is of extremely high interest. It creates a second set of eyes as a way to better support your new nurses, travel nurses, and foreign nurses.

We’ve even had situations where nurses have suffered a physical disability, but they still want to contribute. Getting them engaged in a virtual care center, where they can be working with patients, supporting patients, and working with care teams, is a phenomenal way to make sure that their wisdom isn’t lost to our healthcare system

Are you seeing creative uses of your system that you didn’t anticipate?

We are seeing a tremendous amount of experimentation with virtual nursing, whereas virtual sitting is a well established use of virtual care in hospitals. People are running new pilots around virtual nursing to test wound care, respiratory therapy, and monitoring patients to keep them out of the ICU. They have put our devices in the hallways to have an extra set of eyes where there’s elopement risk. We do see a fair amount of creativity once you have high fidelity audio and video system with mobile units and units that are wired fully into the room.

What is the company’s strategy going forward?

We are finding a tremendous amount of interest in virtual care, so we are continuing to invest significantly there. As we do that, we are focused on a few things. First, that we continue to make sure that our technology integrates really well with the rest of the technology environment. We’ve unfortunately seen care teams underserved with systems are standalone or not well integrated, and we’ve bulked up in that area.

Second, and this is a bit of an overused term, is artificial intelligence. What that means in our market is computer vision and noticing more about what’s happening in the room. We don’t want to take a care team member out of the chain. We want to augment care team members. But with computer vision, we are seeing success and noticing more about what’s happening in the environment. We know if the patient is in the room or if they are about to leave the room. As we continue to invest in that technology, you can imagine that there are myriad things that we will be understanding, such as an IV bag that is about to be empty or that a tube has been pulled.

We will continue to augment the data layer. As you look in care environments, they are manually run. There’s a lack of data to understand how are we performing, what’s working, and how can we do better. Being able to provide real-time data and visibility into the performance of care units has been highly valued by our customers and we will continue to do more there.

We started with sitting, and now there’s a tremendous focus on nursing, We’ve also seen pharmacists and physicians using the technology. I’ll give you an example. We are working with a micro hospital that wants virtual nursing. They also want a centralized way to bring the specialists into the care team. It allows you to get the right talent to the right place at the right time, improve financials, and get better outcomes.

This is the most energized I’ve ever been in a role. That is because of the opportunity to help hospitals with the staffing crisis, the financial challenges they face, in such a meaningful way. The VA in North Dallas freed up 51 FTEs, so they are able to serve more of our nation’s vets. Being on the forefront of virtual care and acute care has been incredibly exciting. We are making a significant investment into the clinical research that goes along with this so that we can partner with our customers as we work together to pioneer how virtual care can play a role in helping health systems operate effectively going forward.

Morning Headlines 2/15/23

UnityPoint ‘MyChart’ app to start charging for messages to doctors

UnityPoint Health (IA) begins charging patients between $36 and $70 for messaging their physicians via its MyChart patient portal, citing the “tremendous increase” in messaging seen since the beginning of the pandemic.

Progress on IT Security Event Tuesday, Feb. 14, 2023

Tallahassee Memorial Healthcare (FL) continues to recover from a February 2 cyberattack, bringing its physician practices and urgent care centers back online and slowly transitioning back to digital documentation.

Oracle Cerner signs contract with Accenture to provide extra electronic health record training for VA clinicians

Oracle enlists Accenture to provide additional Oracle Cerner EHR training to VA clinicians ahead of implementations scheduled to resume this summer.

News 2/15/23

Top News

HHS, ONC, and The Sequoia Project announce that CommonWell Health Alliance, EHealth Exchange, Epic Trusted Exchange Framework and Common Agreement Interoperability Services, Health Gorilla, Kno2, and Konza have been approved to implement TEFCA as prospective Qualified Health Information Networks.

Webinars

February 28 (Tuesday) 1 ET. “Words Matter: Simplifying Clinical Terms for Patients.” Sponsor: Intelligent Medical Objects. Presenters: Whitney Mannion, RN, MSN, senior terminologist, IMO; David Bocanegra, RN, nurse informaticist, IMO. The language of medicine can be confusing and contradictory to patients, challenging their ability to prepare for a procedure or pay their bills. This webinar will explore how the words that are used to communicate – online, in print, and in person – must be chosen carefully to allow patients to comprehend their diagnoses, treatments, and care plans. The presenters will also describe how the ONC Final Rule for the 21st Century Cures Act will make clinical and technical language more directly accessible through patient portals.

March 7 (Tuesday) noon ET.  “Prescribe RPA 2.0 to Treat Healthcare Worker Burnout.” Sponsor: Keysight Technologies. Presenters: Anne Foster, MS, technical consultant manager, Eggplant; Emily Yan, MPA, product marketing manager, Keysight Technologies. Half of US health systems plan to invest in robotic process automation by the end of this year, per Gartner. The concept is evolving to help with staff burnout and physician productivity. The presenters will introduce RPA 2.0, explain how to maximize its value, demonstrate how to quickly start on RPA 2.0 and test automation in one platform, and answer questions about healthcare automation.

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

Acquisitions, Funding, Business, and Stock

Doximity launches a beta version of DocsGPT, which allows providers to submit prior authorization documentation to insurers using the AI chatbot technology of ChatGPT. In an “only in healthcare” convergence of cutting edge and ancient technologies, Doximity will also integrate ChatGPT with its fax solution. DocsGPT errored out every time I tried to use it, which I assume is because ChatGPT was overloaded.

In the UK, hospital software vendor System C acquires Clevermed, which offers the BadgerNet system for pregnancy and newborns.

Sales

• Emirates Health Services will deploy Care.ai’s smart care facility platform throughout the UAE, with a focus on redesigning clinical and operational workflows through ambient monitoring and virtual inpatient care.
• Mary Washington Healthcare (VA) will launch an inpatient virtual nursing program using technology from Caregility.
• Montana’s Big Sky Care HIE selects Lyniate’s Rhapsody Interoperability Suite.

People

Joe Sedlak, RN, MBA (Xealth) joins Vital as VP of client success.

Regenstrief Institute names Rachel Patzer, PhD, MPH (Emory University School of Medicine) president and CEO.

Alan Portela (AirStrip) joins Masimo as SVP of strategic business and hospital automation.

Government and Politics

Senate Veterans’ Affairs Committee Chairman Jon Tester (D-MT) says the VA’s EHR Modernization Program must move forward, pointing out that issues with the new Oracle Cerner system do not outweigh those with the department’s legacy VistA system. Tester co-authored the VA Electronic Health Record Transparency Act, which was signed into law last summer, that requires VA Secretary Denis McDonough to update Congress on the software’s costs, performance, and outcomes.

Oracle Cerner, meanwhile, continues to push back on recent legislative efforts to shut down or overhaul the VA’s EHR program. Oracle EVP Ken Glueck has followed up his February 3 criticism of those bills with a new blog post that outlines the benefits to veterans and end users and points out the folly of the “improvements” act, which places “the go/no go decision to migrate to the new EHR to …171 different medical centers.”

ONC announces that 95% of certified health IT developers met the December 31 deadline to update and provide their customers with technology that, among other things, enables access to information through FHIR-based APIs “without special effort.”

Other

Malaysia’s Selayang Hospital, one of the first hospitals in the world to go paperless in 1999, struggles technically after shutting down its Cerner system, switching to a Notepad-like text editor called BHIS that it had developed for barebones data entry during downtime, and then overloading that system 18 months later in forcing a switch to yet another homegrown system that was designed for COVID-19 quarantine centers. The hospital has also shut down its IT department after outsourcing to a vendor whose contract was terminated. The radiologist who developed BHIS in just four hours says he was limited in that most hospital computers were running Windows XP with Internet Explorer 6.0, the hospital’s network speed was limited, and the virtual server the hospital gave him had only 1 GB of memory. The hospital’s website still declares that its now-mothballed Total Hospital Information System makes it “a showcase to the rest of the world.”

UnityPoint Health (IA) begins charging patients between $36 and $70 for messaging their physicians via its MyChart patient portal. UnityPoint Clinic President and CEO Patricia Newland, MD says the organization decided to start charging due to the “tremendous increase” in messaging seen since the beginning of the pandemic. Patients will not be billed for messages that are related to appointment scheduling or prescription refills.

Duke University researchers discover that acquiring mental health data from data brokers is fairly easy, inexpensive, and typically comes with few strings attached. Researchers approached 37 data brokers for bulk mental health data and received offers from 11, that said they could provide potentially identifiable data on people with depression, anxiety, and bipolar disorder sorted by demographic information including credit scores. Some brokers offered information on 5,000 people for as little as $275.

Sponsor Updates

• Availity CEO Russ Thomas joins the Florida Chamber of Commerce Board of Directors.
• Azara Healthcare publishes a new customer success story, “Alaska Health Centers Improve Diabetes Care Through Data-Driven Healthcare Model.”
• Baker Tilly publishes a new case study, “State health department captures more complete and timely data on highly transmissible diseases through ECR implementation.”
• Censinet debuts its new Risk Never Sleeps Podcast, focusing on the people protecting patient safety across healthcare.
• Thirty-two community, critical access, and specialty hospitals select Oracle Cerner’s CommunityWorks technology.
• Clearsense publishes a new whitepaper, “How AI and Governance Can Transform Healthcare.”
• Clinical Architecture releases a new episode of The Informonster Podcast, “The CDC Shares the Success of Collaboration During a Crisis.”
• Direct Recruiters celebrates 40 years in business.

Blog Posts

• From Transactions to Transformations: Putting a Premium on Human Connection in Registration (Access)
• 5 Key Performance Indicators to Monitor for a Healthy Revenue Cycle (AGS Health)
• Futureproofing care: New models in care delivery (Arcadia)
• Health Systems’ Untapped Growth Opportunity: Pharmacy (Arrive Health)
• Taking the temperature of health systems (Nordic)
• How to Create a Continuous Healthcare Experience (Artera)
• Health IT Innovation: Opportunities to Protect Your Health System in a Volatile Economy (CereCore)
• Social Determinants of Health (ChartSpan)
• Epic EHR and Google Cloud Announce Partnership (HealthTech Resources)
• How Vulnerabilities Hide in Plain Sight (& How to Mitigate Them) (Clearwater)
• Helping Physicians Overcome Barriers in Risk-based Documentation and Coding (Curation Health)

Contacts

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

Morning Headlines 2/14/23

Building TEFCA

HHS, ONC, and The Sequoia Project recognize CommonWell Health Alliance, EHealth Exchange, Epic Trusted Exchange Framework and Common Agreement Interoperability Services, Health Gorilla, Kno2, and Konza as the first set of networks to be approved to implement TEFCA as prospective Qualified Health Information Networks.

Top Senator Says Modernizing VA’s EHR ‘Is Not Optional’

Senate Veterans’ Affairs Committee Chairman Jon Tester (D-MT) says the VA’s EHR Modernization Program must move forward, pointing out that issues with the new Oracle Cerner system do not outweigh the fact that the department’s legacy VistA system needs to be updated.

Johns Hopkins Winds Down Pioneering Pandemic Data Tracking

Three years after launching, Johns Hopkins University & Medicine’s Coronavirus Resource Center announces it will stop collecting and reporting COVID-19 data on March 10.

Curbside Consult with Dr. Jayne 2/13/23

I went to a birthday party Sunday night, which of course overlapped with the Super Bowl, turning it into an impromptu Super Bowl party. It has been years since I’ve actually seen the game played since usually I volunteered to work Super Bowl Sunday because it’s a historically mellow day in the emergency department and urgent care arenas. People would typically only come in if they were truly sick, which meant a fair amount of downtime, the deployment of numerous Crock Pots, food that you could cook in a microwave or toaster oven, and plenty of camaraderie.

The worst place I ever worked on Super Bowl Sunday was labor and delivery. That is primarily because no one came in during the pre-game or the game itself, but waited at home as long as humanly possible before coming in. Once the final scores were tallied, people started arriving in droves and every bed was full, with babies arriving quickly. One year we even had to deploy a team to the parking lot to assist a patient who didn’t quite make it.

It was nice to be able to hang out with family and friends, although I did have to manage a patient callback in the middle of it due to some pharmacy-related shenanigans. The after-hours exchange was flustered and I wasn’t sure about waiting for the usual process to work, but I was happy to give them a ring. My family hasn’t seen me on call in years, so they were wondering what could possibly be going on.

The planned menu was all about the birthday person. By halftime, I was wishing that I had some taco dip, smoked queso, or Buffalo chicken wings. Certain foods just go with football, at least from my past, so maybe I’ll have to make up for it with this week’s meal planning.

I haven’t seen some of my extended family in some time, and it’s always interesting to try to explain to them what exactly it is that I do as a CMIO and how I can still be a physician if I’m no longer working in the emergency department. Usually I explain that I help manage all the clinical systems behind the scenes, including the patient portal and the software that the physicians use when they write their notes, order labs and tests, or send medications to the pharmacy.

Even with advanced age, many family members are used to communicating with their physicians through a patient portal or following their lab results on their phones. It has been fun to watch some of them become more active participants in their healthcare, although there is always the one relative that takes everything they hear from their doctor as gospel and refuses to question anything, even when the only doctor in the family says they might want to ask some questions based on some concerning prescribing patterns.

Some days are more difficult than others, such as when you have to explain to clinicians that although they have great ideas about workflows, they are not always possible. Especially when you are using a certified EHR, certain things, including workflows that are deeply connected to coding, billing, and other regulatory requirements, just can’t be changed. I’m a fan of giving my users choices, though. If you’re not happy with your current state, here are two potential future states that we can actually accommodate based on the EHR and regulatory guidance, so  which do you prefer? Often they end up preferring the current state, especially when it has been designed by board-certified clinical informaticists who have observed thousands of patient care encounters and who have worked in numerous EHR and documentation systems. 

Other difficult days happen when end users are raging against third-party requirements, but blaming it on the EHR. Sometimes these third parties have created the requirements because they are good for patient safety, and I’m not likely to budge on those. For example, when a physician doesn’t believe that they should have to associated a diagnosis with a prescription. I can certainly empathize with those two extra clicks, but as a primary care physician, I think it’s important that patients know what condition they are taking a medication to treat.

Additionally, when you work for a healthcare organization that has decided that this is a good thing and has created a policy and procedure around it, there’s not much I can do for you as an informaticist other than teach you the most efficient workflows and show you how you can use your clinical support staff to help you make some of these associations as they prep patients for their visits.

I’m always shocked by physicians who don’t know where their grievances should be directed. For example, if they don’t like the clinical policy and procedure, they need to take that up with their department chair or the chief medical officer, not the CMIO or a member of the clinical informatics team. I think sometimes we wind up at the tip of the proverbial spear because we are actually in the clinics interacting with people on a regular basis, which might not be the case with a CMO or a department chair, especially in a geographically diverse organization.

The best days are when someone proactively reaches out to you to let you know that they think a feature that you have recently deployed is cool. I remember vividly the technology that I deployed that generated the first non-hate email from a physician. That was more than a decade ago, and those emails are few and far between.

At my current institution, we were recently early adopters of a solution that I think is pretty darned revolutionary, and most of my physicians don’t have any idea how cool it really is compared to other commercially available options. It’s leaps and bounds better for our patients, has multilingual support, and uses data already in the EHR to drive a better user experience. However, because it has a purpose that some of our providers don’t think is necessary, it’s not getting the love it deserves. We’ll see if more users start to engage with it as they develop a greater understanding of what it can do, and I’ll still hold out at least a little hope that some clinician eventually says thank you.

Valentine’s Day is coming up on Tuesday, so consider showing a little love to your favorite clinical informaticist. If you don’t want to impress them with a witty card, conversation hearts, or an edible treat, consider thanking them for trying to make your user experience the best that their budget and staffing allows.

Email Dr. Jayne.

HIStalk Interviews Eric Ly, CEO, KarmaCheck

Eric Ly,  PhD, MS is co-founder and CEO of KarmaCheck of San Francisco, CA. He was a co-founder and the founding CTO of LinkedIn.

Tell me about yourself and the company.

I am a technology entrepreneur. I have worked on B2B software for multiple decades. I was one of the co-founders of LinkedIn. What got me interested in background screenings and verifications was that I was interested in something like a blue checkmark that would verify the information contained on LinkedIn profiles. That led me to the background screening industry, where I saw an opportunity to bring efficiencies and transform the way that background screenings and verifications get done.

You’ve mentioned the possibility of allowing people to store verified credentials in a digital wallet. How do you see the company being involved in that?

That’s a vision that we are working towards. If we are able to provide a wallet of credentials to professionals in the future, those credentials that are verified can essentially be persistent. When they go for new opportunities, that information is mostly there already. That speeds up the process of applying and getting job opportunities, both for candidates themselves as well as for employers. They don’t have to go and check many of those facts again.

Certainly there is information that needs to be updated with recent changes, but that opens up a world where the onboarding process can be more efficient for both sides. As we are moving towards the world where there is a more flexible and contingent workforce, the need and the value that provides is going to be become even greater.

It would make sense that LinkedIn user identities would require verification, especially now that we are seeing LinkedIn scammers pretending to be both employees and employers. Do you think that will happen?

That’s an interesting scenario. LinkedIn has been successful in amassing the professional information and histories of professionals all across the world. There can be a layer on top of that that provides verification of the  information that has been entered by those individuals. We are creating value by bringing truth so that the information that is associated with those profiles — whether they are on LinkedIn or elsewhere, let’s say on a job site — can be trusted so that when employers are looking at candidates, they will know that the information about the backgrounds of those candidates is confirmed.

The Department of Justice recently announced that thousands of people purchased phony nursing educational credentials, and some number of those folks presumably ended up obtaining licenses and caring for patients. We’ve also seen examples of nurses who harmed patients intentionally in hospitals that declined to prosecute or publicize them, allowing them to take jobs with new hospitals and continue their crimes. What kind of analysis or AI review could detect these issues?

Those are some interesting cases. In healthcare, here’s an example of where verifying someone’s credentials and their background is especially important, because we are talking about life and death for patients that healthcare providers affect. It’s especially important that the backgrounds of clinicians are verified. Beyond verifying current credentials, which is a complicated and complex stack already, skill competency tests could be run to ensure that the individuals have the expertise and knowledge that they need to do their job.

Something we have seen recently becoming more of a problem is verifying the identity of a particular candidate. If it’s possible to hire someone in the place of a clinician without ever meeting them in person, there is also an increased chance of the identity of that individual being falsified as well. ID verification technologies that can be used not only to confirm someone’s background, but to confirm that that background actually belongs to the individual that is being placed on an assignment.

The US has low unemployment and a significant percentage of citizens who have been convicted of a felony, suggesting that employers are either unaware or unconcerned about their criminal history. How would hiring decisions change if finding criminal records at local, state, and federal levels became easy and inexpensive?

Numerous surveys have found that at any given time, 25% to 40% of people have falsified their backgrounds. That’s pretty consistent across the board, whether it’s on an online platform or from a resume. Knowing where the falsification happened becomes an important point.

In this historically low unemployment situation, there might be the temptation to bypass some of these checks in the name of bringing more people on board, placing them, and so forth. That puts the employer or the staffing company at risk, because if something goes wrong, that carries a pretty heavy liability. In a field like healthcare, we are talking about life and death situations, so it’s not a light topic.

Because of the complexities that are involved in doing credentialing and meet compliance, this is an area and opportunity where technology can help. If those processes, as complex as they are, can be made more efficient and perhaps more cost effective, the reason to skip, overlook, or miss some of the infractions or violations that happen don’t have to happen as much. Companies and employers can still protect themselves while going through these compliance processes just as much as they should in more normal times.

How much inefficiency in provider credentialing could be eliminated by technology?

We are entering into a new world in healthcare and the staffing of healthcare. The general trend is that the scale and the velocity at which placements are occurring is speeding up. Hospitals and staffing companies have had to manage their staff at a faster pace than they ever had to before. Based on this backdrop of complicated credentialing needs, it becomes an unmanageable situation. The challenge is even greater when you have costs going up.

Technology generally helps to deliver scale and to deliver efficiency, so there are certainly opportunities for technology to be applied in these kinds of situations to help increase efficiency. That translates into is operating efficiencies and lower costs for the facilities.

That scalability might provide the opportunity to assemble a deep candidate profile that includes social media posts, credit reports, driving, records, online photos or reviews, and any number of information items that aren’t directly related to being hired. Will we see a tension between what is possible versus what is fair or reasonable?

There has been a lot of recent talk about AI and the application of AI. It enables any user to sift through more and more information to catch information that might help enlighten the background of a clinician, for example. The ability to look at more information, to learn more about the candidate, ensures that a qualified candidate gets placed, such that problems and liabilities are reduced. There is ever more information out there, and technology is a tool to help look through that ever-increasing amount of information.

What healthcare opportunities will the company explore in the next few years?

For an industry like healthcare that has maybe traditionally been slower to adopt technology, there are some great opportunities to take a look at making operations more efficient and cost effective. The main reason for doing any of this is to deliver better patient care, which everybody wants. In doing that and evaluating technologies, my recommendation is to not necessarily take a look at point solutions, but instead to have a holistic sense of the technologies that will deliver value to an organization, how it fits into processes and workflows, and how existing workflows can be changed a little to create significant improvements in operational efficiency. To take a higher-level strategic look at how technology can be deployed within an organization would be helpful for the healthcare industry.

Innovation is definitely happening within technology to specifically serve the healthcare sector. From a standpoint of cost savings and delivering better patient care, some good answers are starting to emerge.

Morning Headlines 2/13/23

VA electronic health record modernization program director Terry Adirim to depart

Terry Admirim, MD, MPH, MBA, program executive director of the VA’s EHR Modernization Integration Office, will leave the VA to pursue other, unstated opportunities.

Healthtech firm Nomad Health lays off 17% of workforce

Healthcare staffing company Nomad Health reduces its headcount from 691 employees to 572, nearly eight months after securing an investment of $105 million.

NJ hospital admits data breach involving thousands of patients

CentraState Medical Center (NJ) announces that the December cybersecurity incident that impacted new admissions was a ransomware attack involving the data of 617,000 patients.

Monday Morning Update 2/13/23

Top News

Terry Admirim, MD, MPH, MBA, program executive director of the VA’s EHR Modernization Integration Office, will leave the VA to pursue unstated other opportunities.

Serving as interim after her February 25 departure will be Neil Evans, MD, senior advisor to the assistant secretary for information and technology and CIO and head of the VA’s Connected Care program.

Reader Comments

From Tempus Fugit: “Re: Olive. I heard endlessly about their unicorn status and huge customer count, which sounded like BS and probably means they are counting some rando clinic that is using a tiny solution as a customer. I know a sales guy there and he said the company paid them a ton to sell consulting engagements, but with nothing meaningful deployed, they went back to selling small patient access solutions. He said customers were unhappy that they were promised a 5x ROI that hasn’t happened anywhere.” Unverified. Axios reviewed LinkedIn records in May 2022 to determine that among the 20 Olive employee departures in the previous month were its EVP/GM, senior director of partner programs. director of data engineering, chief marketing officer, and VP of product. Axios also reported in April 2022 that Olive overpromises, under-delivers, and doesn’t actually use AI/ML. The company told the reporter at that time that it had 1,000 hospitals in 200 enterprise customers using its products and services, although an Axios review of internal documents shows 80 customers. The company has raised $856 million in funding through a Series H round, with its last investment being in July 2021.

From Domainatrix: “Re: company layoffs. A positive aspect is that young workers will now know that their employer isn’t their friend, co-workers aren’t their families, and employers as well as employers are free to end their bargain for any reason.” Long-timers who have been negatively affected at some point by company decisions rolled eyes at the unquestioning willingness of fresh go-getters to work ridiculous hours or grind away at crappy jobs, convinced that they would be rewarded by their benevolent bosses. Fast-forward to the end of boom times that has put employers back in control with little fear of mass resignations. The result is a scaling back of work-from home programs and an insistence that “valued associates” work harder or longer because the company has found itself in a jam, often of its own making. Bosses aren’t friends, the job of the chief people officer is mostly to work against the interest of employees, and you would be replaced and turned into a break room trivia question within three months of your departure.

From Purported Victim: “Re: hospitals ending some services or closing in poor areas. So much for being a charitable non-profit.” You will always be disappointed if you expect any person or organization to take any action that isn’t the one that is most beneficial to them.

HIStalk Announcements and Requests

Patient portal, telephone, and online forms are the most common ways poll respondents have recently sent medical information to a clinician.

New poll to your right or here: Did your most recent clinician encounter, in whatever form, make you feel “cared for?”I voted yes because when I recently texted my direct primary care doctor about refill, she asked me how I was doing and mentioned that I hadn’t seen her for a while and might want to drop by for routine lab work and a health review, none of which increase her income.

Webinars

February 28 (Tuesday) 1 ET. “Words Matter: Simplifying Clinical Terms for Patients.” Sponsor: Intelligent Medical Objects. Presenters: Whitney Mannion, RN, MSN, senior terminologist, IMO; David Bocanegra, RN, nurse informaticist, IMO. The language of medicine can be confusing and contradictory to patients, challenging their ability to prepare for a procedure or pay their bills. This webinar will explore how the words that are used to communicate – online, in print, and in person – must be chosen carefully to allow patients to comprehend their diagnoses, treatments, and care plans. The presenters will also describe how the ONC Final Rule for the 21st Century Cures Act will make clinical and technical language more directly accessible through patient portals.

March 7 (Tuesday) noon ET.  “Prescribe RPA 2.0 to Treat Healthcare Worker Burnout.” Sponsor: Keysight Technologies. Presenters: Anne Foster, MS, technical consultant manager, Eggplant; Emily Yan, MPA, product marketing manager, Keysight Technologies. Half of US health systems plan to invest in robotic process automation by the end of this year, per Gartner. The concept is evolving to help with staff burnout and physician productivity. The presenters will introduce RPA 2.0, explain how to maximize its value, demonstrate how to quickly start on RPA 2.0 and test automation in one platform, and answer questions about healthcare automation.

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

Acquisitions, Funding, Business, and Stock

Business Insider looks at the “fleet of secret workers” who aren’t visible to customers but who perform much of the work that is attributed to sexy technology or who are required to keep that technology running. The author concludes that robots, automation technology, and AI chatbots won’t replace employees, but they may allow companies to shift less-visible offshore to lower their costs. I would say that we are in the early days of companies overstating their use of AI and other tools in failing to mention that behind-the-scenes humans are doing a lot of the actual work, the “10,000 diligent Indians” concept a vendor CEO once told me about. It’s kind of a sad state when companies brag on their tools rather than their humans, but investors love employee-lite scalability and companies yearn to be viewed as a technology high-flyer instead of a low-tech sweatshop.

NPR notes that hospitals are outsourcing their EDs to staffing companies that are owned by private equity investors, with a result being that doctors are being replaced by nurse practitioners and physician assistants to boost margins. The change is motivating some ED doctors to change their work setting because they went into medicine to see patients, not supervise lesser-trained employees.

Sales

• Norman Regional Health System selects VisiQuate Denials Management Analytics, Revenue Management Analytics, and PayFlo.
• Onsite Women’s Health will use Volpara Health’s analytics software to improve mammography quality by assessing positioning, compression, and radiation dose.
• Complete Care implements the EClinicalWorks EHR.

People

Health Catalyst promotes Cathy Menkiena, RN, MBA to GM/SVP Northeast.

Industry long-timer and former CHIME VP Tim Stettheimer, PhD died February 9 of ALS (Lou Gehrig’s disease). He was 56.

Announcements and Implementations

Stick around until the Friday morning keynote of HIMSS23 (which is asking a lot) and you can hear just-announced speaker and NFL player Damar Hamlin, who was saved by CPR and AED after suffering cardiac arrest in a game on January 2. He will speak on “Winning the Game of Life.”

A new KLAS report covers IT advisory services.

Sponsor Updates

• CloudWave launches its Cybersecurity Insider Program to offer members access to information about the latest cybersecurity trends and threats, as well as ongoing education.
• Nordic releases a new Designing for Health Podcast featuring UCHealth CMIO Dr. CT Lin.
• PeriGen partners with Baylor College of Medicine, Texas Children’s Hospital, and the Malawi Ministry of Health to assist with successful newborn in Malawi using PeriGen’s AI-augmented continuous electronic fetal monitoring.
• PerfectServe publishes a new case study, “How Savannah Neurology Specialists Reinvented Their Medical Answering Service Workflows.”
• Sphere releases a new e-book, “Unaffordable Medical Bills: A New Social Determinant of Health.”
• Spok receives ISO 13485:2016 certification from Dekra Certification.
• Talkdesk has been recognized as a Customers’ Choice in the 2023 Gartner Peer Insights “Voice of the Customer” for contact center as a service.

Blog Posts

• OpenAI and ChatGPT: A Primer for Healthcare Leaders (Orbita)
• The PINC AI Applied Sciences Team Partners with NWCF to Advance Health Equity and Expand Education (Premier)
• ChatGPT is coming to your contact center (Talkdesk)
• MIPS Extreme and Uncontrollable Circumstances Policy Update (WebPT)
• As Emergency Department Clinicians Struggle with Burnout, Clinical Decision Support Emerges as a Potential Lifeline (Zynx Health)

Contacts

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

Morning Headlines 2/10/23

Scoop: Olive AI lays off 215 employees

Robotic process automation vendor Olive lays off a reported 215 employees, about one-third of the company.

Mindstrong’s demise and the future of mental health care

Mindstrong, which has raised $160 million in funding from high-profile investors, will wind down its virtual behavioral healthcare service and lay off 130 employees starting in late March.

Center for Health Innovation Expands with $22 Million in Gifts

UC San Diego Health will use a $22 million donation to launch a patient health and safety monitoring hub that will aggregate data from across its EHR, bedside monitors, wearables, and other enterprise technologies.

NHS tech funding falls to less than £1bn

NHS England’s technology budget has reportedly been cut in half to just over $1 billion, which will likely impact requests for electronic patient records.

News 2/10/23

Top News

CVS Health will acquire primary care company Oak Street Health for $10.6 billion in cash.

Oak Street Health’s 600 primary care providers work from 169 medical centers in 21 states.

Meanwhile, CVS Health reports Q4 results: revenue up 9.5%, adjusted EPS $1.99 versus $1.98, beating Wall Street expectations for both. CVS shares are down 20% in the past 12 months versus the Dow’s 5% loss.

Reader Comments

From Another Company Debacle: “Re: Allscripts / Veradigm. Major layoffs this week in R&D and solutions involving employees in both the US and India. Veradigm (formerly Allscripts) Practice Management took a big hit. Veradigm Interface Engine too.” Unverified.

From Jay Glick: “Re: Oracle Cerner. Fared poorly in Best in KLAS, wouldn’t you say?” Agreed. Oracle Cerner finished last among software suites, 20 points behind Epic and mostly “well below average” scores in every product segment except for attaining “average” in virtual care. In the all-important large hospital market, Epic scored 89.4 versus Oracle Cerner’s 70.0. Oracle Cerner finished first in no categories versus its last-place showing in a bunch of them. In trying to come up with a “glass half full” conclusion, I have two thoughts: (a) at least Oracle Cerner will keep making a lot of money from the federal government unless it gets shown the VA’s door and loses its only prime contractor deal, not to mention that a lot of Oracle’s recent revenue and earnings growth came from the former Cerner; and (b) perhaps the corporate stumbles that followed Neal Patterson’s death, along with high-visibility revenue cycle product problems, made it inevitable that the keys needed to be turned over to a new owner who has the money and objectivity to right the ship. From the “glass half empty” perspective, few health IT examples exist where a big outside company improved a vendor by acquiring it. Another sobering thought for Oracle is that KLAS reports only what customers are saying, and some of the older Cerner sites may re-muster the fortitude and cash that would be needed to move to Epic.

HIStalk Announcements and Requests

I suppressed my HIMSS23 indifference long enough to book my hotel, so the “am I going or not” question has been answered. The exhibit hall will be open full days on Tuesday (April 18), Wednesday, and a slightly shortened day Thursday. The hotel I was considering was nearly $500 per night on Expedia and on the chain’s loyalty club site, which would have kept me home, so kudos to HIMSS for making it available to attendees at barely more than half that price for the same dates. The website shows 764 exhibitors. I don’t think I’ve been to Chicago since HIMSS15. Opening day temperature highs going back from 2022 were 42, 55, 42, 76, and 43 degrees, and of course many remember the HIMSS09 opening reception near-blizzard where the McCormick Place coat check people had actual coats to manage instead of just last-day luggage holds.

I realized that I wasn’t seeing Altera Digital Health Sunrise (the former Allscripts Sunrise that is now owned by N. Harris) on the Best in KLAS report, where for years it topped the list of large-hospital inpatient EHRs. It had too few customers surveyed to be stacked up against Epic and Oracle Cerner (the only two products that were ranked), but its performance score was the lowest of all at 63.8. In the midsize category, it performed even worse at 54.6 (and Altera’s Paragon got a 37.6 score, also with too few responses to compare, and also pegged the lowest score in the small hospital category at 49.0). Also on the KLAS report, I also didn’t see segment categories for ED, anesthesia, laboratory, radiology, and pharmacy management systems, so I guess those products are no longer reported as part of Best in KLAS.

Webinars

March 7 (Tuesday) noon ET.  “Prescribe RPA 2.0 to Treat Healthcare Worker Burnout.” Sponsor: Keysight Technologies. Presenters: Anne Foster, MS, technical consultant manager, Eggplant; Emily Yan, MPA, product marketing manager, Keysight Technologies. Half of US health systems plan to invest in robotic process automation by the end of this year, per Gartner. The concept is evolving to help with staff burnout and physician productivity. The presenters will introduce RPA 2.0, explain how to maximize its value, demonstrate how to quickly start on RPA 2.0 and test automation in one platform, and answer questions about healthcare automation.

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

Acquisitions, Funding, Business, and Stock

Olive lays off a reported 215 employees, about one-third of the company. The company has reduced its headcount from a one-time peak of 1,400. The robotic process automation vendor, which once had a valuation of $4 billion, has been plagued by customer and executive defections along with reports that its promises of hospital savings have rarely materialized. 

A leaked internal email indicates that healthcare will remain a top priority of Oracle and is the primary focus on CTO and executive chair Larry Ellison. The company is also moving its data and AI unit under its cloud business.

Google’s valuation drops by $100 billion the day that its newly announced Bard chatbot was found to have given an inaccurate response in a company promotional video, raising questions about Google’s competitive position against Microsoft, which has already integrated ChatGPT functionality into its Bing search.

Virtual behavioral service company Mindstrong, which has raised $160 million in funding from high-profile investors, will wind down its operation and lay off 130 employees starting in late March.

Healthcare staffing marketplace operator Nomad reportedly lays off 20% of its headcount as pandemic-fueled demand and payment rates cool. The company has raised $200 million, including $105 million seven months ago.

Sales

• McClow, Clark, and Berk, PA Radiology Services (FL) selects Healthcare Administrative Partners for revenue cycle management.
• Southern Illinois Healthcare will implement Xealth to allow clinicians to find and order digital health tools and programs.
• Southern New England Health chooses Koan Health’s Datalyst for population health and medical economics.

Announcements and Implementations

Highlights from KLAS’s Best in KLAS in software and services for 2023:

• Epic, Impact Advisors, Nordic, Medasource, and Chartis were named for notable performances.
• Software suite rankings were topped by Epic and Meditech.
• Most improved software products were Veradigm’s FollowMyHealth and KPMG’s ERP business transformation and implementation leadership services.
• Top physician practice ranking went to Epic, followed by Meditech and Athenahealth.
• The overall IT services category was a tie between Impact Advisors and Nordic.

CareCloud integrates the Quippe Clinical Data Engine of Medicomp Systems into its EHR platforms.

Researchers at University of Missouri School of Medicine find that a small group of EHR testers identified 2.5 usability concerns for each new function, 70% of which were correctable before rollout.

Government and Politics

A KHN investigation finds that HHS has ignored repeated congressional mandates, going back to 2006, to implement a public health network that can detect and address infectious disease outbreaks. Experts say HHS didn’t follow through because the task is complex, funding is inadequate, consensus is lacking on the data that is needed in an emergency, and HHS can’t decide which of its operating divisions should lead the project.

Rep. Mike Bost (R-IL), chair of the House Committee on Veterans’ Affairs — who is involved with two bills that would change or end the VA’s Oracle Cerner implementation – says he will listen to more moderate proposals that are submitted by Democrat lawmakers to hold the company and the VA more accountable, but adds via a spokesperson that “the time for half-measures and tinkering around the edges is over.”

Other

NHS England’s technology budget has reportedly been cut in half to just over $1 billion, which will likely impact requests for electronic patient records. 

A survey of 9,500 consumers in six countries, including the US, finds that far fewer of them feel “cared for” than their primary care doctors believe. Key consumer issues are faster and more accurate diagnosis, convenient access, a focus on long-term health, and making healthcare more affordable. China leads the other countries in use of health portals, digital health apps, and telehealth. Half of consumers think that doctors and hospitals should be leading the charge to connect health information, but US physicians say they don’t do that because they aren’t paid extra, obtaining patient consent is a pain, they are experiencing data overload, they don’t know how to use the data, and technology doesn’t work well. Only 40 to 50% of US consumer respondents say they would share their health information even if the result was improved health, better-tailored services, safer treatments, or lower costs.

Sponsor Updates

• Healthcare consumer platform operator League will offer healthcare cost and quality information from Kyruus-owned HealthSparq.
• Everbridge adds DigitalOps Insights, a new AI-powered situational awareness tool, to its Digital Operations solutions bundle.
• Southern Ohio Medical Center reports a 30% drop in hospital-acquired C. difficile infections following the development of expedited testing tools by Meditech Professional Services.
• First Databank names Joe Bodkin (Franciscan Health) clinical informatics pharmacist specialist, Angela Johnston (Astra Zeneca) regional representative, and Shafer Grytness (Insight Global) software engineer.
• OSF HealthCare releases a new podcast featuring Get Well Supervisor of Clinical Digital Care Kate Johnson and Digital Patient Care Manager Kara Roat.
• InterSystems releases a new Healthy Data Podcast, “FFS vs. Integrated Care.”
• Intelligent Medical Objects secures SOC 2 Type 2+ HIPAA certification.
• Meditech shares the ways in which Valley Health System (NJ) clinicians have used its Surveillance tool to quickly identify patient conditions, provide relevant data, and expedite orders to initiate treatment.
• NeuroFlow completes its SOC 2 audit, reinforcing its commitment to protecting health data.
• Everest Group names NTT Data a Leader in its Provider Digital Services Peak Matrix Assessment 2023 report.

Blog Posts

• Unlocking the Power of Meditech Through a Robust Health IT Infrastructure (Healthcare Triangle)
• EHR Integrations: To Build or Not to Build (Healthjump)
• Most Popular Healthcare Technology Trends of 2023 (HealthTech Resources)
• Optimum CareerPath Spotlight: Meet Pratik Shekade (Optimum Healthcare IT)
• Newly Minted Rural Emergency Hospitals Face Old RCM Challenges (Medhost)
• Celebrating #1 Best in KLAS for image exchange: Innovative ways patients and providers are sharing without boundaries (Nuance)

HIStalk sponsors that were named as Best in KLAS Software and Services 2023 or Best in KLAS Global Software 2023:

• Agfa HealthCare (PACS Middle East / Africa)
• Arcadia (value-based care managed services)
• Azara Healthcare (population health management)
• Findhelp (social determinants of care network)
• Fortified Health Security (security and privacy managed services)
• Impact Advisors (security and privacy consulting services, ERP implementation leadership, financial improvement consulting)
• InterSystems (clinical portals Europe)
• Lyniate (integration engines)
• Meditech (acute care EMR small)
• Nordic (HIT core clinical implementation leadership)
• Nuance (computer-assisted physician documentation, speech recognition front-end EMR, image exchange)
• Oracle Health (acute care EHR Middle East /Africa)
• Pivot Point Consulting, a Vaco Company (managed IT services)
• Premier / PINC AI (value-based care consulting)
• Sectra (PACS large, PACS small, PACS Asia / Oceania, PACS Canada)
• Visage Imaging (universal viewer)
• Wolters Kluwer (infection control and monitoring, patient-driven care management)
• Zynx Health (clinical decision support care plans and order sets)

Contacts

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

EPtalk by Dr. Jayne 2/9/23

Mr. H’s current poll asks about the methods used by patients to send medical information to clinicians in the past year. I wasn’t surprised to see that patient portal messages are leading the way, followed by phone calls and electronic forms. Mailed paper forms and faxes are at the bottom of the list, as expected.

It would be interesting to see a poll around the topic of “In which ways have you had productive communication and/or a positive outcome” when looking at electronic communication and portal messages. I recently tried to use the online scheduling feature offered by my dermatologist, with whom I am well established. There were no spots available until June, so I used the feature located on the online scheduling page called “request an appointment.” I mentioned that the request was to be seen for a suspicious and changing mole that had already been seen by my PCP, who recommended I see dermatology. I listed my preferred days and times, but basically said that due to the nature of the issue, I was willing to take any open appointment.

Four days later, I received a portal message back that “we are not currently offering online appointment requests” and was directed to call the academic medical center’s access center. If you’re not offering online appointment requests, I might recommend disabling that feature so that patients can’t use it. I’ve used the access center before to request an appointment with this dermatologist and it’s a centralized scheduling nightmare. For urgent issues, they take a message and route it to the office who hopefully calls you, and then if you’re like me and tied up on calls and in meetings all day, you play phone tag, which is exactly what the online requests are supposed to prevent.

I mentally said, “forget it” and made an appointment with a new dermatologist who was happy to get me in within 48 hours given the history and PCP referral. Since my clinical issue was resolved, we will see if my original dermatologist ever follows up, who now has a concerning message documented in my chart. We are going on six weeks so I’m not holding my breath, but for a patient who isn’t as persistent in getting care, it could be tragic.

From Jimmy the Greek: “Re: chatter about using ChatGPT in healthcare. It might amount to the scene out of ‘A Charlie Brown Christmas’ where Lucy is listing off phobias and asking Charlie Brown if he has them.” I’ve certainly seen some interesting applications, or should I say attempted applications, of ChatGPT recently. Today brought an email from a colleague that was most likely produced by some sort of bot since the syntax didn’t sound anything like her usual written patterns. I found it pretty annoying since what she sent was a reply to a pretty straightforward question that could have been answered in five words or fewer. It’s fine if you want to play around with it, and since we are both informaticists, it could have been “hey, check out what ChatGPT created as a reply,” but since there had to be a few more back-and-forths to get the original question answered, it wasn’t much of a time saver.

Everyone is trying to figure out how to streamline workflows in ambulatory medical practices. Solutions being implemented for pre-visit flows include patient portal-based check-in that can be completed at home up to a few days prior to the visit; chatbot-based flows that can be completed either at home or upon arrival; and self-check-in kiosks. A recent article in the Annals of Family Medicine looked at a “self-rooming” process implemented in primary care clinics from October through December 2020. Researchers found that most patients preferred self-rooming, although some felt less welcomed, more lost or confused, more frustrated, or more isolated compared to escorted rooming.

Based on the overall positive response, the organization decided to roll out the process to all remaining primary care clinics, and it will become a permanent change for the institution. The process design included some decidedly low-tech features, such a laminated wayfinding card that was used by the patient to reach their exam room. Once the visit was over and the room had been cleaned and prepared for the next patient, the card was returned to the front desk so that another patient could be directed to the newly prepared room.

I recently learned that my residency training program is celebrating its 50th anniversary and will be holding a gala in honor of the milestone. Unfortunately, they didn’t start promoting the event until 60 days out, which isn’t nearly enough lead time when you consider that most of us open our clinic schedules up to a year in advance and on-call schedules are done at least 90 days in advance. I circulated the information to my class and the residents in the years above and below mine, but it looks like only the handful of folks who can travel without taking off work are likely to attend.

I had no idea the program had reached such a major milestone and it really seems like a missed opportunity to bring people together. Other organizations I’m part of that have had similar events have sent cards anywhere from six months to a year in advance telling people to save the date, which is key if you want to try to get a couple hundred physicians together in the same place at the same time.

It’s technology upgrade time at the House of Jayne and I’m very happy about my first purchase, which was a Kindle Paperwhite. I’ve been using the Kindle app to read on a decade-old iPad and decided I wanted something smaller and lighter for travel. Amazon was offering a deal on the high-end version as long as you didn’t mind buying it in Agave Green. I’m thrilled with the purchase and have already burned through two books. I’m still getting to know all the features, but it’s a significant step up from my previous reading situation.

I also had to break down and replace one of my monitors, which started having some issues with static electricity. Every time I touched my keyboard tray after walking on the carpet and accumulating a charge, the monitor would suffer a blue screen of death that required a reboot to bring it back to life. Tomorrow is unboxing and installation day, so wish me luck as I crawl around and under the desk to get things hooked up. Still on the to-do list after that is a new phone, but that’s a much larger project, especially since I want a full featured Android device that’s on the smaller side.

What’s your favorite piece of new technology? What’s the one thing you’d recommend everyone consider getting? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 2/9/23

CVS Health to acquire Oak Street Health

CVS Health will acquire Oak Street Health, a Medicare-focused primary care provider based in Chicago, for $39 per share in a deal valued at $10.6 billion.

Oracle reorganized its data and AI initiatives amid a leadership shake-up, leaked internal memo shows

Oracle moves its AI and data business units within its cloud infrastructure business amidst the departure of Oracle Cloud Infrastructure EVP Don Johnson and the company’s continued focus on healthcare.

NOCD Completes Additional Funding in its Quest to End the OCD Crisis

Digital OCD therapy startup NOCD raises $34 million in a financing round led by Cigna Ventures and 7wireVentures, bringing its total raised to $84 million.

Morning Headlines 2/8/23

Imperative Care Announces Formation of Stroke Recovery Digital Health Company Kandu Health

Medical technology company Imperative Care launches Kandu Health, which offers digital support for recovering stroke patients.

Senators probe telehealth companies for tracking and monetizing sensitive health data

A bipartisan group of senators ask executives at telehealth companies Cerebral, Workit, and Monument for details of their data-sharing policies including a list of all third-party sites they’ve shared data with over the last three years.

Albertsons Companies Launches Sincerely Health™ Digital Health and Wellness Platform

Grocery store operator Albertsons launches Sincerely Health, a digital health and wellness app that offers a questionnaire-calculated health score, linking to activity trackers such as Apple Health and Fitbit, and pharmacy management.

Oracle Unit Wins Fees After Beating Patent Case

A judge rules that CliniComp must pay nearly $1 million in attorney fees after losing a 2017 patient infringement lawsuit against Oracle Cerner.