Medical imaging technology company Medmo, which matches patients with partner imaging centers, raises $9 million.
Reed Jobs’ Yosemite makes first digital health bet on Maia Oncology
Maia Oncology, a virtual primary care clinic for cancer patients, raises $4.25 million in seed funding.
AstraZeneca’s new stand-alone Evinova business will develop and market digital products in the areas of clinical trials, remote patient monitoring, and digital therapeutics.
The Centers for Disease Control and Prevention (CDC) has launched an initiative to tackle burnout in healthcare. The Impact Wellbeing initiative falls under the auspices of the National Institute for Occupational Safety and Health (NIOSH). According to the tagline on its website, it’s designed for “building a system where healthcare workers thrive.” It will provide “evidence-informed solutions” and resources to hospital leaders on avoiding burnout and promoting wellbeing for workers.
I was pleased to see that the website encourages hospitals to use materials from the Dr. Lorna Breen Heroes’ Foundation to address how hospitals can help staff address mental health needs without being penalized. Many hospitals and healthcare organizations still have questions on their employment and credentialing applications that stigmatize mental health conditions rather than supporting those that live with them.
As an example, one job for which I applied asked, “Have you ever been treated for a mental health condition?” with boxes to check yes or no, but no way to provide explanatory information. A better way to approach this is to ask whether the applicant has any current impairment that will prevent them from performing the duties of the position. There are plenty of mental health conditions that are episodic, and asking about past conditions that may be resolved hasn’t been shown to do anything but prevent people from honestly answering the questions.
In looking at some of the other materials on the site, as well as interviews with NIOSH staff that appeared in the media at the time of the announcement, it feels like the organization’s leadership understands that talking about resiliency or offering wellness programs doesn’t scratch the surface where employee mistreatment is concerned. Healthcare workers encounter bullying, harassment, and moral injury on a daily basis and those elements need to be addressed as part of an overall solution.
The initiative also encourages the leadership of healthcare delivery organizations to involve those affected in the process of defining the issues and solving them. I don’t know when it became a revolutionary idea to talk to people in order to understand their needs, but I’m happy to see recognition of the idea featuring prominently in the campaign. Organizers can use the NIOSH Worker Well-Bring Questionnaire to better understand where their workers are across domains that include policies, culture, environment, personal health, and home/community factors.
Although I appreciate that the focus of the campaign is on hospitals since they’re such a critical part of our healthcare infrastructure, I’d like to see these elements addressed in other care delivery sites, such as urgent care centers. There are 14,000 urgent care centers in the US, and according to data provided by the Urgent Care Association, more than 25% of adults visited an urgent care center in the last year.
Unfortunately, the level of regulation for those facilities varies from state to state, and in talking to physician colleagues, abuses are becoming more common as private equity companies expand in the industry. For a while, we saw a lot of emergency department physicians leave those environments to go to the relatively slower pace of urgent care. However, as the complexity of patients presenting to urgent care rises, and the number of patients physicians are expected to see each hour increases, we’re seeing physicians leave those environments as well.
Given the reliance by hospitals on nurses to deliver patient care, there’s a lot of push by nursing organizations to improve things. Since urgent cares use many more non-nurse caregivers — such as medical assistants, emergency medical technicians, and unlicensed patient care technicians — to deliver care at a lower cost, there aren’t many advocacy organizations looking out for those workers.
Quite a few urgent care centers are physician owned and operate more under a private practice model than an emergency care model, so that adds another element to the problem. In my area, a local multi-site urgent care center recently closed after the physician owner was arrested, leaving staff and patients in the lurch. Other organizations have struggled to absorb those visit volumes in the face of their own staffing shortages, and it’s been a bit of a mess.
Meanwhile, capable physicians sit on the sidelines because they’re not willing to go back to abusive environments. At my former clinical employer, nearly all the physician employees left when the private equity company that acquired it started tightening the screws to squeeze out more profit. I know at least six of us who would return from our early retirements if the working conditions were less atrocious.
In speaking with colleagues across the country, this experience is in no way unique. One local urgent care chain classifies its physicians as hourly employees, but pays a “shift rate” that requires them to stay until all patients have left without additional pay for the additional time. I’m not sure how that’s legal under state labor laws, but they’ve gotten away with it for a number of years. On the other hand, it might be one explanation for why they have locations that are mothballed because they can’t staff them.
I admit I didn’t read every single word on the CDC website for the program and didn’t follow every link, but I didn’t see any mention of how organizations need to do more to believe workers when they complain or how to take action when issues are reported. There is still a culture at many organizations of just saying “it is what it is” or “suck it up” when employees report exploitive practices. People are suffering from compassion fatigue, which can lead to lack of empathy and may contribute to workplace bullying if left unchecked.
At one local hospital, nurses scheduled for 12-hour overnight shifts routinely have to stay for 14 or 15 hours due to staffing issues. I guarantee that situation is not doing much for morale or burnout prevention. Even among healthcare workers, I hear comments like “you chose healthcare, what did you expect?” which doesn’t help solve the issue. I have a handful of non-medical friends who understand what we go through, but when medical folks can’t even support each other, how can we expect outsiders to understand what we’re going through?
It will be interesting to follow the progress of the initiative over time and to see how many organizations are using the tools and trying to drive positive change vs. just paying lip service to the idea.
If you’re a care delivery organization leader, had you heard of the initiative before today? What steps are you taking to drive change? Leave a comment or email me.
Email Dr. Jayne.
Over 80 St. Louis NextGen Healthcare workers to be laid off
NextGen Healthcare files WARN documents indicating that it will lay off 84 employees in St.Louis in the first months of next year.
Novant Health to acquire three hospitals from Tenet Healthcare
Novant Health (NC) will acquire three South Carolina-based hospitals from Tenet Healthcare in a $2.4 billion deal that includes RCM services from Tenet subsidiary Conifer Health Solutions.
Aya Healthcare Acquires Winnow AI, a Data Science Driven Platform to Recruit Passive Physicians
Digital staffing platform vendor Aya Healthcare acquires Winnow AI, which identifies physicians who are open to new positions and relocation who match open roles.
GTCR to Acquire Cloudbreak Health
Private equity firm GTCR will acquire telehealth language interpretation services company Cloudbreak Health from UpHealth for $180 million.
NextGen Healthcare files WARN documents indicating that it will lay off 84 employees it St.Louis in the first months of next year.
Meanwhile, executives who are cashing in on the November 10 sale of the company to private equity firm Thoma Bravo by selling shares include President and CEO David Sides ($15 million), CFO James Arnold ($12 million), and board member Srinivas Velamoor ($9 million).
From AnInteropGuy: “Re: Veradigm. Continues to miss their filing deadlines and met with NASDAQ about the delisting situation — no news on how they will rule — but they have not been able to restate any of the questioned quarters. Leadership continues to say ‘very close’ but the remains substantially quiet on what the timeline looks like. Their last claim in September was that they would file by early November ahead of the NASDAQ meeting. That was before the announcement of the delisting notice so they had been made aware that they were facing delisting. They are still trying to gather contracts, payments, etc for the previous quarters and years — now apparently reaching all the way back to 2015.” A final SEC de-listing hearing was held on Thursday, but the decision hasn’t been announced. I don’t know the extent of accounting work that is required, but it seems strange that a publicly traded company whose shares are about to be de-listed can’t muster the resources, as other firms have done, to meet ASC 606 revenue recognition requirements. As a skeptic, I wonder if other motivations may be in play.
From Epson: “Re: Forward Health’s CarePod. I’m interested in predictions.” OK, here’s mine: (a) the company will deploy less than 250 devices versus its 3,200 goal; (b) issues with maintenance, limitations of the clinical model it was developed around, and lack of member loyalty will stall rollouts and raise questions about the viability of that business; and (c) Forward will try yet another pivot and the CarePods will move from malls to landfills given that no other company would have a use for them. I could be wrong, but Forward Health’s core business doesn’t seem to be sound enough to warrant gadgetary distraction, not to mention that as an N-of-one analysis I can’t see myself paying for such a service as described.
Poll respondents report seeing diminished influence across many of the newly established C-level technology roles within healthcare systems. What’s your experience with these positions being eliminated or downgraded? A LinkedIn wizard could probably find examples.
New poll to your right or here: Who is most likely to disrupt the US healthcare system to benefit patients?
Also, for companies that have 2023 marketing funds to spend, we can bill you now and you can send your ad and materials later when you are ready. You get a full 365 days of sponsorship starting when your ad is posted. I’m mentioning this because Lorre has received the question several times this week.
None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.
Digital staffing platform vendor Aya Healthcare acquires Winnow AI, which identifies physicians who are open to new positions and relocation who match open roles.
Mass General Hospital and Brigham and Women’s announce that they cannot accept new primary care patients because their appointment waitlists are months long.
Children’s Hospital of Philadelphia, Stanford Health Care, and Children’s Medical Center of Dallas implement Wolters Kluwer’s Ovid Synthesis for evidence-based practice workflow applications.
Open AI’s board fires high-profile co-founder and CEO Sam Altman for unspecified reasons in a surprise announcement that wasn’t shared in advance with investors such as Microsoft, which owns 49% of the company. The rumored issue was product safety versus profit and Altman’s work to raise funds to create AI hardware companies outside of OpenAI’s non-profit oversight. Greg Brockman, co-founder, president, and board chair, was removed from the company’s board and then resigned. Several senior scientists also quit. The blowback has reportedly convinced the board to negotiate for Altman’s return, although he says he’s not that interested and would require significant governance changes to return. Meanwhile, the action that has likely cost Open AI much of its $80 billion valuation and the confidence of developers who use its products has also resulted in speculation that Altman and the other departed executives will immediately start a competing company, along with speculation that Microsoft should save OpenAI by buying the rest of it.
Lynsi Garvin, MSN, RN (Google Health) joins Intermountain Health as associate chief clinical information officer.
Adrienne Morrell (SCAN Health Plan) joins MRO Corp. as VP of governmental affairs.
Oracle will hold a one-day health summit on February 13 in Nashville, where the company is significantly expanding.
A new report from Center for Connected Medicine at UPMC finds that the patient engagement potential of health system-owned ambulatory pharmacies is being threatened by drug chains and technology firms that offer more convenient and innovative services and digital tools. Top operational challenges are 340B limitations and staffing issues, while the biggest consumer issue is lack of physical accessibility due to location, lack of transportation, and limited hours of operation. Top tools include delivery service and text-based refill reminders, while telepharmacy kiosks and self-pickup lockers have low interest.
Memorial Hermann Health System and Texas Attorney General Ken Paxton settle the AG’s investigation into reports that its patient portal could not be accessed by the parents of patients aged 13 to 17. Texas law gives parents and legal guardians the right to access the medical records of their children except in specific circumstances where the child can indicate that they don’t want their information shared. The health system agreed to provide better instructions for accessing family records on its patient portal and also cited its planned migration to Epic.
Federal Trade Commission Chair Lina Khan, JD says that she has used ChatGPT to contest questionable medical bills. She didn’t say how she used it specifically, but ChatGPT suggests that it can provided detailed breakdown of charges, explain how insurance applies, identify discrepancies, offer negotiation tips, and draft appeal letters.
The Madison paper covers Nurse Disrupted, which offers a virtual nursing platform. The founder and CEO of the eight-employee company is Bre Loughlin, MS, RN, a former bedside nurse and Epic executive.
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VA still has ‘significant concerns’ as Oracle works to get EHR modernization back on track
VA CIO Kurt DelBene tells a House committee that despite improvements, he has “significant concerns” about Oracle Health related to new incidents, failing to meet standards, end user responsiveness, and workflow.
AAPC Expands Its Technology Solutions Portfolio with the Acquisition of Semantic Health
RCM organization AAPC acquires Semantic Health, a Toronto-based startup specializing in AI-powered coding and auditing software.
3M Healthcare Spinoff Gets a Name: Solventum
The healthcare business that 3M will spin off in the first half of 2024 will be named Solventum.
VA CIO Kurt DelBene tells a House committee that despite improvements, he has “significant concerns” about Oracle Health related to new incidents, failing to meet standards, end user responsiveness, and workflow.
On the positive side, the VA has had no complete system outages in six months.
Also from the hearing:
From Chip Ludd: “Re: CarePod. Serious Silicon Valley Kool-Aid is being slurped by anyone who thinks this will work.” The likelihood of success for this clinician-less health app kiosk in malls has two dimensions – whether it’s a viable business (which I doubt) or if it’s a medical breakthrough (which I’m sure isn’t the case). My reactions:
Also interesting is that the company’s clinics have mediocre reviews from their $149-per-month members, with comments like these making you wonder if investors are watching the company’s member retention rate (independent PCPs, especially direct primary care docs, everything you need for your marketing plan is right here):
From Dockside: “Re: BJC. I work there and the CEO aid in a town hall this week that the merger with Saint Luke’s in Kansas City is set to close on January 1, 2024. For now, the systems will operate as BJC HealthCare in eastern Missouri and Saint Luke’s Health System in western Missouri.” Unverified, but previously rumored as planned “by the end of the year” The merger would create a 28-hospital, $10 billion health system. I think they’re both running Epic.
I’m noting with grammarian interest the sudden pervasiveness of the word “lovely,” which I actually kind of like despite (or maybe because of) its time capsule images of grannies sipping tea pinkies-up on lace doilies. I hereby propose the resurrection of the similarly aged “splendid.”
None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.
Primary care chain Forward Health raises $100 million in growth capital to roll out CarePod, which it calls “the world’s first AI doctor’s office” for members who pay $99 per month for access to the app-equipped kiosks that will be installed in retail locations.
The estates of two deceased individuals sue UnitedHealth Group (UHG), alleging its AI algorithms, which came from its acquisition of NaviHealth in 2020, deny necessary care to Medicare Advantage seniors. The complaint highlights a 90% error rate in the AI system when its decisions are challenged, with the plaintiffs alleging that UHG’s Medicare Advantage patients receive substandard care compared to traditional Medicare patients.
The healthcare business that 3M will spin off in the first half of 2024 will be named Solventum.
Elation Health hires Tom Natt (ConnectRN) as chief growth officer.
Greg Tracy. MS joins Wondr Health (ResMed) as CTO.
VCU Health hires Jeffrey Kim, MD (Loma Linda University Health) as CMIO.
Rimidi will provide its remote patient monitoring technology to Atlanta-based non-profit Brighter Day Health Foundation, which will offer RPM and chronic condition management services to underserved communities from local churches. Rimidi CEO Lucienne Ide, MD, PhD founded the company in 2011, and before her medical training, served as a signals analyst for the National Security Agency.
California health and social data-sharing organization Connecting for Better Health restructures as a non-profit and announces its initial board of directors.
Sectra will integrate its enterprise imaging diagnostic application for radiology with GE HealthCare’s AW Family Advanced Visualization applications.
A new KLAS report on patient engagement finds that patient portals, patient surveys, and telehealth are widely adopted and health systems are moving on to implement provider search and patient self-scheduling. Two-thirds of respondents say their plans involve their EHR vendor, either alone or with third-party solutions, with 58% of Epic-using respondents and nearly as many Meditech customers saying that the vendor aligns with their plans, while one-third of Oracle Health’s customers say the same. Technologies most mentioned for consolidation are virtual care and patient communications.
Mail order pharmacy fulfillment vendor Truepill files a breach notice that the information of 2.4 million people was exposed in an August cyberattack.
Snips from the Digital Health Most Wired 2023 survey:
Mark Cuban disagrees with a tweet that says Big Tech won’t disrupt healthcare, offering a detailed response that I’ll summarize:
UCLA sues Mattel for reneging on its 2017 pledge to donate $49 million to its children’s hospital, claiming that the toymaker is instead offering a few million dollars plus a bunch of toys. UCLA wants the full $49 million plus damages, but Mattel says the donation was earmarked for adding a new tower to UCLA Mattel Children’s Hospital that UCLA decided not to build.
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As a frontline physician who has dealt with my share of angry patients, I’m always worried that one of them will follow me home from work or show up at my house. I’m vigilant about my personal information and make sure that it’s difficult to find me through real estate or other public records.
Recently Doximity announced a free service called DocDefender that can help physicians remove their personal information from public websites. I decided to give it a whirl. I initially tried to find it through my Doximity account, but wasn’t successful. A web search took me to the right site, but I had to go through an email authentication process to get started. From there, the system started scanning and found my information on 17 out of 35 targeted websites.
The removal process is supposed to begin automatically with results in two to 60 days. I should be receiving regular updates on the removal process, so I’ll provide updates in the coming weeks. It’s also supposed to provide periodic checks to identify new listings, so we’ll see how that goes.
While I was digging around my Doximity account, I stumbled upon Doximity GPT, which is described as “A medical writing assistant that can compose patient education, recommendation letters, grant proposals, ortho poetry – basically any writing task you can think of.” I found the idea of ortho poetry to be intriguing but not compelling, so I asked it to write a haiku about clinical informatics instead. It did not disappoint:
Data flows like streams,
In clinical realms it gleams,
Healing in light beams.
Telehealth organizations across the US are jumping into the weight loss business, making it easier for patients to obtain prescriptions for costly injectable medications, although their ability to jump through the hoops imposed by payers is highly variable. Employers are starting to try to control costs, and Mayo Clinic’s employee health plan has announced that it will cap weight loss medication expenditures at $20,000 per patient as a lifetime maximum. Since some of the medications run up to $900 per month, for patients who are already in treatment, we’re going to see what is essentially an unregulated, uncontrolled clinical trial where time and financial means will be influencing outcomes. The caps don’t go into effect for patients using the drugs for diabetes, which creates a strange “chicken or the egg” situation where prevention or risk reduction isn’t covered but treatment of disease is.
This is largely the result of our payment system, where everyone is trying to control costs for their attributed patients, but doesn’t have the means to take advantage of long-term savings. For example, let’s look at an obese 55-year-old patient with pre-diabetes. If they can achieve weight loss, they likely reduce their chances of developing diabetes, which saves money down the line. When you look at the costs of diabetes care or the complications of diabetes, those expenses would likely occur in 10 to 15 years, when Medicare might be paying them as opposed to commercial insurers.
There’s no incentive for a commercial payer to absorb the cost today in order to realize the savings down the road, because the patient won’t be on their books then, and might not even be on the books in a year or a month, if they work for a healthcare IT company that includes them in a reduction in force as we’ve seen plenty of recently. The math just doesn’t work, but inability to get treatments that could improve quality of life and reduce disease burden is a reality for so many patients today.
Mayo Clinic is just following the example of other healthcare employers that have dropped coverage, including Hennepin Healthcare, Ascension, and the University of Texas System in Austin. All of those popped up in a web search as being in the same situation. My crystal ball predicts that many more organizations will be changing coverage over the coming months unless the prices of the drug come down or there’s evidence of a way they could save money by covering it.
This week included my regularly scheduled annual visit to Big Medical Center for follow-up imaging and a consultation with my care team. I received the email reminder of my visit and confirmed it by completing the electronic check-in process the same day the reminder came out. The next day, I received a phone call, right in the middle of typical dinner hours, asking me to again confirm the appointment. However, I had to listen to a minute and a half of recordings about parking and arrival times before I could confirm. They should have told us to allow an extra 20 minutes to deal with the parking and construction situation, because it was rough and I barely made it to my appointment on time. Good thing they didn’t check my blood pressure because I’m sure it was up there.
I was seeing a new provider at this visit, since they’ve changed how the department runs. I wasn’t impressed by the fact that she had a bunch of handwritten paper notes about me, or that she didn’t use the EHR at all during our visit. It would have been one thing if her notes were accurate, but they weren’t, as I discovered when she tried to offer me genetic testing that I’ve already had.
We discussed the existing results, which I wonder if she missed because they’re scanned into the EHR as opposed to being discrete data, and she relied on my memory to tell her what testing I had completed. From there it was off to the imaging department, only to be told that they’re not doing real-time results anymore, which is one of the reasons I use this facility. Results will come to me via the patient portal in a few days, which I suppose is adequate, but the availability of real-time results was one of the reasons I tolerated the long drive and the general hassle of using this facility.
As a last bit of frustration, they used to schedule your follow up at the checkout desk, and they don’t do that any more. The new process is a bit bumpy and I had to wait for the clerk to write the appropriate phone number on a sticky note so I can call back and self-schedule. At a minimum, someone needs to make a half-sheet handout they can give patients that includes all the pertinent information. In the time it took her to write it down, she could have scheduled the appointment since it’s for a year out and my calendar is wide open. I wonder how many patients will be lost to follow up this way, as those sticky notes disappear into purses and tote bags.
As a final insult, when I returned to the parking garage, the car next to me had parked over the line to the point where I couldn’t get into my car. Fortunately, I’m spry enough to do the gymnastics needed to climb in the passenger side and crawl over the console, but I’m betting a good portion of those visiting a world-renowned cancer center might not have the ability to do so. Still, I’m glad it happened to me and not someone who just finished a treatment or who just received life-altering news, so I’ll view it as my good turn for the day.
After I got home and decompressed from the experience, I walked to the mailbox and found a fundraising solicitation from the organization. I’m no stranger to the concept of so-called “grateful patient” fundraising, but the timing on the solicitation gave me an idea. What if I challenged them to fix their messed up processes in exchange for a sizable donation? I’m sure I could solicit patients and family members to participate, as well as physician colleagues who don’t want their patients to be frustrated by the care delivery experience. I’d even throw in some complimentary consulting services to sweeten the deal.
What are the simple things that facilities could do to improve the patient experience? Leave a comment or email me.
Email Dr. Jayne.
Forward Raises $100M and Announces Forward CarePod
Primary care provider Forward Health announces CarePod, a self-contained, unstaffed “doctor in a box” that is available to members who pay $99 per month to access AI-powered apps that perform screening and create care plans.
UnitedHealthcare’s broken AI denied seniors’ medical claims, lawsuit alleges
The estates of two deceased men sue UnitedHealth Group, claiming that the company uses an algorithm to override physician assessments in denying care to its Medicare Advantage enrollees.
Aranscia Acquires YouScript from Invitae
Precision diagnostics vendor Aranscia acquires select assets of the YouScript personalized medication management platform from digital medical genetics company Invitae.
Health Disinformation Use Case Highlighting the Urgent Need for Artificial Intelligence Vigilance
Researchers find that ChatGPT can rapidly and effortlessly create medical disinformation blog posts about vaccines and vaping, including impressive but fake patient and clinician testimonials and literature citations.
The estates of two deceased men sue UnitedHealth Group, claiming that the company uses AI algorithms to deny care to seniors who are enrolled in its Medicare Advantage plans. The complaint says that the AI system that UHG gained in its 2020 acquisition of NaviHealth has a 90% error rate and creates generic care recommendations that are used to override physician assessments of medical necessity, placing the Medicare Advantage patients at a disadvantage compared to traditional Medicare. A previous report found that patients who were entitled to up to 100 days in a nursing home following hospital discharge were usually cut off within 14 days by UHG.
Elsevier and OpenEvidence create an early access version of ClinicalKey AI, which allows doctors to enter patient information that is matched against Elsevier’s medical journal data to help them make clinical decisions. OpenEvidence’s original system is available for demonstration.
OpenAI pauses new signups for ChatGPT Plus due to a user surge following the company’s November 6 DevDay. The company also acknowledges that it is working on GPT-5, which will require more public and proprietary data sets.
The CEO of an AI-powered robotics company says that the factors that made ChatGPT successful – training on a vast and diverse dataset and aligning the model’s response with what humans find useful – are being applied to AI robots that can understand their surroundings, make decisions, and adapt to changing circumstances. He predicts widespread deployment of robots that can perform object manipulation in 2024.
University of Miami Health System will use Aidoc’s technology system-wide to identify and triage abnormalities in patient scans. The Israel-based company offers 13 FDA-cleared algorithms. The CEO is a former AI leader in the Israeli Air Force and co-founded the company with military peers one year after discharge.
Montreal-based Pathway, which provides evidence-based responses to clinician queries, raises $5 million in seed funding.
Researchers in Australia refer to large language models that have limited guardrails as “weapons of mass disinformation” in a JAMA Internal Medicine article, where they describe using ChatGPT to create 102 disinformation blog posts about vaccines and vaping. Creation of the posts that totaled 17,000 words, which included fake patient and clinician testimonials and scientific-looking references, took just over one hour. Additional OpenAI tools contributed realistic images and a deep-fake video.
AI outperformed tissue biopsies in grading the aggressiveness of retroperitoneal sarcoma, which could potentially spare low-risk patients from unnecessary treatments and tests.
Tech-heavy medical practice operator Forward Health develops a standalone, app-powered medical station it calls the CarePod, which it hopes to place in malls and office buildings where members will pay $99 per month for access. Founder and former Google computer scientist Adrian Aoun, who says “I don’t even believe a doctor’s office should exist,” hopes to turn healthcare into a product rather than a service. CarePods are powered by a large language model that uses medical research data to create care plans. The company just raised a $100 million Series E round and hopes to launch 25 CarePods initially and scale to 3,200 within one year. Aoun says he hopes to enhance the machines to perform open heart surgery within the next 20 years.
AI expert Mark Hinkle builds a GPT into which users can upload PDFs of their health insurance plan options during open enrollment, then ask ChatGPT specific questions and have it compare plans.
A Nebraska oncology research nurse’s lung cancer is detected by Methodist Hospital’s AI-powered LungGPS, a Medtronic system that double checks radiology images and reports for incidental nodules. She was X-rayed for pain in her left side, but LungGPS noted nodules on the other side, with the early detection allowing her stage 1 lung cancer to be cured via surgery. LungGPS caught 26 patients with undetected cancer in 2022 and 15 so far this year.
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Henry Schein Reports Third-Quarter 2023 Financial Results and Updates Full-Year Guidance
The medical supply vendor misses estimates for both revenue and earnings and lowers guidance even though the quarter was over before its October cyberattack.
UnitedHealth pushed employees to follow an algorithm to cut off Medicare patients’ rehab care
The company reportedly threatened to fire employees who failed to hit targets to limit the rehab care of Medicare Advantage patients to an algorithm-predicted appropriate number of days.
The Next WebMD: An LLM as Your Front Door to Healthcare
A16Z predicts that the model of Googling symptoms and then asking a medical friend or relative could be replaced by AI chatbots that could refer people to a marketplace of services offered for sale, giving the LLM company control of revenue streams worth billions.
EConsult and referral management solution provider AristaMD acquires Sitka, which offers a platform for primary care providers to request video consultations from specialists.
New York Governor Kathy Hochul proposes regulations that would require hospitals to establish a cybersecurity program led by a CISO, assess their cybersecurity readiness, and develop and test response plans.
The state budget includes $500 million for healthcare facilities to upgrade their technology.
From Kvetcher: “Re: investigative reporting. I would like to see more of that.” I always appreciate reader ideas for doing more, while simultaneously noting that all the writing you see on HIStalk is done by a two of us part-timers, or about 1 FTE, who have to be careful about overcommitting.
From Spock: “Re: SPACS. Maybe you’ve posted before, but I’m curious on the logic and money flow. Seems like I read every day another whose value has declined tremendously.” My SPAC opinions summarized:
From Bergamoot: “Re: HIMSS. What business are they in selling tech services to Taiwan?” HIMSS sold its annual conference and now seems to harbor ambition for doing global consulting, which doesn’t seem like a core competency of a membership group. They signed a deal with Taiwan’s national insurance organization to provide “subject matter experts, thought leadership, and advice” in cybersecurity, analytics, and national education programs. HIMSS would not come to my mind in thinking of organizations who provide these services regularly and arguably well, although I would likely list the names of companies that support HIMSS financially and now find themselves as its competitors. Maybe HIMSS sees revenue opportunity in offering a marketplace for vendors who pay it for matchmaking them with clients.
From Horse Pistol CIO: “Re: CHIME. Made a pretty big tactical error by running its fall forum from Friday to Sunday. The number of CIOs who exited early was palpable. The final event on Saturday night was basically a vendor fest which is not ideal for anyone. It’s probably not surprising that folks would prefer to not give up an entire weekend for a conference and then have to go to work the very next day. Rumor was that it ran through the weekend due to prior feedback and that they won’t do it again. To me it was a big miss. Lots of heavy hitters were gone by Friday. Bummer.”
It’s funny how much stupider my Alexa devices and Google searches seem now that I’m using ChatGPT to selectively replace them.
November 16 (Thursday) 1 ET. “How Scheduling Helped Streamline Memorial Hermann’s Communication.” Sponsor: PerfectServe. Presenter: Amee Amin, MD, hospitalist, Memorial Hermann-Texas Medical Center. Dr. Amin will discuss the challenges she experienced in creating schedules for her team of hospitalists, and how an optimized solution transformed her workflow. Attendees will learn now TMC gleans crucial data and analytics from their scheduling system, the impact of real-time schedules being pushed out to other applications, and how Lightning Bolt’s optimized, auto-generated schedules improve provider satisfaction and work-life balance.
Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.
A former employee’s LinkedIn post says that Health Catalyst laid off another 120 employees this week, as suggested in last week’s earnings call in which the company said it would lay off 10% of its people in late Q4. The same call touted the company’s high level of employee engagement and winning five “best places to work” awards. HCAT shares are down 19% in the past 12 months versus the S&P 500’s 12% gain, valuing the company at $456 million.
Henry Schein reports Q3 results: revenue up 3.1%, adjusted EPS $1.05 versus $1.09, falling short of estimates for both even though the quarter was impacted by its October cyberattack. The company lowered full-year revenue and earnings estimates. It says it will file a cyber insurance claim, but its policy has a $60 million limit. Schein expects to restore online ordering next week, which represents most of its business, and said on the earnings call that it hopes to regain the 10 to 15% of its sales that were to customers who order exclusively electronically without a sales rep who took their business elsewhere when systems were offline.
Well Health reports Q3 results: revenue up 40%, adjusted EPS $0.05 versus $0.07.
Hackensack Meridian Health signs a partnership with Amazon’s One Medical primary care service, the latest of a couple of dozen big health systems opening brick-and-mortar locations together, sell One Medical memberships to employers (the same package that Amazon Prime members get for $99 per year), and then the health system gets the referrals for specialty care from all over the state in claiming to offer coordinated care and connected technologies. Amazon doesn’t like low-margin business, so it would be interesting to see contract details to know whether the health systems are paying Amazon for referral exclusivity or a share of the business it generates. Also, this deal seems to be based on signing up employers to pay the membership fee, which would seem to keep the health system from getting referrals of uninsured patients.
MIT spinoff Layer Health comes out of stealth mode with $4 million in funding. Its Distill product uses AI to use unstructured patient data for a variety of chart review tasks.
Availity hires Sean Keneally, MBA (Elevance Health) as COO.
Australian Capital Territory Government notes the one-year anniversary of its Epic go-live, listing statistics about MyDHR use, internal messaging, and turnaround time for diagnostic studies.
Surescripts applies to become a QHIN.
A Stat investigation finds that UnitedHealth group used a computer algorithm to cut off rehabilitation services to Medicare Advantage plan members, threatening to discipline or fire employees who failed to hit a 1% variation target even when Medicare coverage rules warranted more days of service. Ironically, the algorithm that was developed by NaviHealth – a company that UHG acquired in early 2020 – was designed to help patients meet their rehab goals, not to cut off their financial access to it. Algorithm-denied care isn’t exactly the poster child that AI healthcare proponents are seeking.
Marketing and PR firm Amendola Communications wins awards for its work with KeyCare, DrFirst, and Equality Health.
John Muir Health implements Epic integration with Ambience Healthcare’s ambient AI scribing system, which allows clinicians to view their Epic schedule in the Ambience app, record audio of their visits on desktop or mobile, and immediately view and edit AI-generated documentation within Epic.
FDA designates Mednition’s AI early sepsis detection solution as a breakthrough device.
Mercy launches The Chen Chemotherapy Model, which sends a daily text message to outpatient chemotherapy patients and uses their responses about symptoms to proactively manage their care. It was named after former Mercy data scientist Jiajing Chen, PhD, MPH, who developed it before dying of cancer in January 2023 at 42.
The American Medical Association reviews at its interim house of delegates meeting a previously rejected member proposal to ban the corporate practice of medicine. A radiologist member who spoke on behalf of reviewing the measure said,
We are being picked clean by private equity. There are people who don’t know where their next paycheck is even going to come from because their groups have been flipped so often … [This resolution] is protecting both physicians and patients, it is preserving physician autonomy and preventing burnout. Seventy-four percent of physicians [are] employed; just four years ago it was 50 percent. Private equity has spent $1 trillion in the last decade on acquisitions in buying medical practices. We need to have something to talk about with respect to private equity at this meeting.
Andreessen Horowitz predicts that the “Google –> WebMD –> Friend” protocol of patients entering the health system via a doctor friend or relative will be replaced by personalized large language models that will use a few rules to send instructions to third-party software while simulating empathetic guidance. It describes a potential experience in referencing the Baymax healthcare robot from the movie “Big Hero 6,” which it argues could give companies control of revenue streams worth billions of dollars in connecting an LLM to a marketplace of services that consumers can book directly:
One day, you wake up with a hint of a headache and a sniffle. You sneeze. What do you do next? You turn to your Baymax-like app, input your symptoms, and after a few follow up questions, it predicts— given your current location, the weather, your recent sleep scores, your diet, and your personal trends—that you’ve got allergies. It offers you a same-day appointment with a nearby allergist covered by your insurance to confirm the diagnosis. In the meantime, it recommends you try an over-the-counter allergy medication, offering to have it delivered to your house. It orders extra tissues for you, for good measure.
Mr. H, Lorre, Jenn, Dr. Jayne.
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Governor Hochul Announces Proposed Cybersecurity Regulations for Hospitals Throughout New York State
New York State will require hospitals to establish a cybersecurity program, implement protective measures, assign a chief information security officer role, and implement two-factor authentication for external access, with the plan including $500 million in available grants to help fund compliance.
Dutch hospital uses AI to answer patients’ questions
Groningen University’s teaching hospital UMCG rolls out chatbot to help answer patient questions, which scans their records and providers a clinician-reviewed response in what the hospital says is the first such use in Europe.
How Generative AI Could Help Us Predict the Next Pandemic
Harvard researchers develop an AI tool that can predict the emergence of concerning variants of COVID-19 and other viruses.
A majority of Americans are optimistic that AI will improve healthcare in 2024
A survey of randomly sampled Americans find that half expect AI to create major advancements in healthcare next year, especially in diagnosis and access, although few of them would prefer to work with a doctor who uses AI extensively.
Navigating the Telehealth Regulatory Labyrinth
By Sheeza Hussain
Sheeza Hussain is chief growth officer of SteadyMD of St. Louis, MO.
Telehealth has the potential to amplify its impact on healthcare access while further reducing costs, but a web of state regulations is hindering that promise.
Telehealth became a household term for millions of Americans in 2020, emerging as a vital component of healthcare delivery. It helped bridge the gap caused by clinician shortages, tackled certain social determinants of health, and facilitated care for rural patients who otherwise struggle to access it.
However, the rapid expansion of telehealth has exposed a glaring issue – a labyrinth of regulatory and legal obstacles. State licensure variability, reimbursement policies, telehealth parity laws, cross-state regulations, and other hurdles continue to impede adoption.
Licensure is just one complicating factor in the telehealth regulatory maze. Many states have differing regulations on nurse practitioner scope of practice, with variance in whether NPs can operate independently, require physician oversight, or are restricted entirely. This patchwork hinders multi-state advanced practice clinician telehealth.
Additionally, certain modes of virtual care like asynchronous visits face ambiguity, as some states allow reimbursement while others prohibit or fail to address it. Like licensure, these state-by-state discrepancies in nurse practitioner and asynchronous visit policies make scaling telehealth availability and minimizing legal risk complex for providers. Overcoming the regulatory headaches requires close tracking of each state’s evolving rules.
Among the three primary challenges, the perplexing variations in state licensing rules are the most significant.
Healthcare providers are required to be licensed to practice in the state in which their patient resides. In some cases, patients are forced to cross state borders to receive telehealth services from their chosen physicians.
The disparities in telehealth policy between states are glaring. For instance, North and South Dakota, as well as Virginia and West Virginia, don’t see eye to eye on telehealth regulations. This patchwork of policies is emblematic of the broader problem – 50 states, each with its own set of laws, medical communities, and stakeholders, all contributing to the complexity of telehealth regulation.
The existing state-by-state licensure processes are antiquated, leaving telehealth companies that operate in multiple states grappling with a complex and ever-changing regulatory landscape. A common requirement is that telehealth providers must hold licenses in the state where their patients are located. However, this doesn’t simplify telehealth; it complicates it further. Most providers are licensed only in one or two states, limiting their usefulness to telehealth companies operating across several states.
Obtaining licenses in additional states is a costly and time-consuming endeavor for telehealth companies. They must build a roster of multi-state providers, carefully manage supply and demand, and ensure compliance with the laws of each state they serve.
Calls for modernizing licensure portability have gained momentum, with some advocating for a standardized federal system akin to driver’s licenses. However, this transformation won’t occur overnight. As telehealth becomes increasingly integrated into healthcare, state regulations may eventually become more uniform, but this change is unlikely to happen soon. The healthcare industry can advocate for greater licensure portability, such as the implementation of a standardized federal licensing system, but providers need relief now.
In the meantime, telehealth providers are seeking alternative solutions. Many are opting to partner with telehealth infrastructure providers that guarantee compliance with state laws, recruit and manage providers, and stay current with shifting regulations. By entrusting an external partner to navigate the intricate regulatory landscape, telehealth providers can focus on what truly matters – providing the best care to their patients.
One of my professional organizations has a forum for members to help us stay connected about hot topics. I got my chuckle of the day when one member referred to scope creep on federal information blocking rules by saying the content “has now metastasized” to a document that’s nearly 80 pages.
I’ve been in the consulting world for so long that I assume that scope creep will be part of nearly every project. However, when you think of scope creep in terms of being a cancerous growth, it reminds you just how insidious it can be. For those of us who have been around the informatics block for a while and have some implementations under our belt, we understand the phenomenon.
Sometimes scope creep happens because the initial project scoping wasn’t done properly. The “creep” represents efforts to try to get features or requirements added to the project that should have been there in the first place.
How did they get missed, you ask? In my experience, it tends to be combination of factors. Sometimes the right shareholders aren’t at the table when the project is being defined. I’ve seen that happen plenty of times when IT folks are tapped to run what are essentially clinical or operational projects. I think that organizations are getting better at this, however, forming dyads or triads of leaders to ensure that projects have the right people at the helm to deliver results.
You have to be careful with this approach, though, since the old adage of “too many cooks in the kitchen” can easily happen in healthcare technology projects. Having unclear leadership can also lead to problems with prioritization of work efforts and challenges when there are identified barriers that need to be addressed. I’m personally a big fan of formal project management documents that spell out the who, what, when, where, why, and how of a project. It’s essential to capture the goals of the project, expected outcomes, and the change control process if you want to avoid messes later. When you don’t have that kind of documentation, it’s easier for people to claim something was in scope when it wasn’t, or to claim that the project team didn’t deliver when the expectations weren’t well documented.
One of my favorite ways to combat scope creep is to make sure that project deliverables are tied to specific budget items, and that all of those items roll up into the master budget so that everyone can have clarity on how much a project is costing and where the money is coming from. This requires that the project includes people who have solid skills at estimating work accurately and who have a good understanding of their teams’ productivity. I’ve worked with managers who claim a project will be an 80-hour build when it really takes less than 10, which does the project a disservice. Conversely, people who underestimate the complexity of a task or who underestimate their teams’ ability to deliver can create havoc on a massive scale.
Even when a project is properly scoped and estimated, having strong documentation of these estimates and costs makes things easier to manage later when people ask for additions to the project. I’ve been known to ask them to estimate the work effort for their proposed addition, then hand them the budget and timeline documentation and ask them what they propose to alter in order to make their request a reality. Does your department want to pony up the money for us to hire contractors to build the additional content you didn’t mention during the original scoping meetings? Or do you want to give up some other content in exchange for what you now realize is a must-have? Those aren’t fun conversations by any means, but people tend to take them less personally when there’s data in front of them than when it’s just the CMIO telling them no.
There is always going to be a certain amount of scope creep on a project, and usually I see that when the team uncovers an element that they weren’t expecting, or a key element of the project doesn’t work as planned. For example, on a big EHR project I was brought into when there was a lot of leadership infighting, we discovered that laboratory interfaces had been deliberately excluded from the scope due to budget constraints. It’s ridiculous to try to do an inpatient EHR project without laboratories, so we had to add them in, of course after educating the steering committee why they shouldn’t have allowed them to be excluded in the first place. That’s a bigger miss than you typically see on a project like that, but a good example of why at least some percentage of contingency overhead should be included in every project.
When there’s an excessive amount of scope creep, or when organizational politics become too big of a distraction for the project team, I’ve been known to suggest that the project be put on hold while it is re-scoped. Sometimes that approach is the proverbial shot across the bow that people need to get their attention, or to get them to understand how big of a concern it is to handle requests for changes to a project that’s already in flight. Especially in organizations where there are dozens of projects running in parallel, it’s understandable that people might be having trouble keeping track of which elements are part of a given project and which might be included as a separate but parallel effort.
That illustrates why communication plans are so important, so that it’s easier for people to understand what is in our out of scope or to find the information if they generally don’t know. Making sure people understand project timelines and budgets is a key part of this. I’ve found it’s harder for people to ask that new requirements be added to the scope when they can clearly see that the project calendar is running in a yellow/orange status, or that the budget is squarely in the red zone. Sometimes the people who ask for additions aren’t in the weeds with a project, and being able to quickly show them where things stand is key.
I’m working with some relatively new clinical informaticists who are honestly some of the smartest people I’ve ever met. However, most of them don’t have a tremendous amount of experience in project management or the sausage-making that happens when you try to bring a new project live with actual healthcare organizations. I’m trying to teach them as much as I can about the behind-the-scenes work that makes the difference between a project that feels like a slog and one that just flows. Some of that you just have to learn through experience, though, and I don’t envy them the knocks that they’ll undoubtedly take as they move forward in their careers. There’s a certain level of “been there, done that” that we all have to reach, but I’m glad I can help them when the going gets tough.
What’s the worst scope creep you’ve ever seen in a project? Leave a comment or email me.
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Thoma Bravo Completes Acquisition of NextGen Healthcare
The private equity firm takes NextGen Healthcare private in closing its $1.8 billion acquisition.
Doximity Announces Fiscal 2024 Second Quarter Financial Results
The medical professional network beats expectations for revenue and earnings.
MUHC clinical platform crashes, patient appointments cancelled
A software update takes down the Oacis clinical platform of McGill University Health Centre.
Cano Health Announces Financial Results for the Third Quarter 2023
A $92 per share loss by the value-based primary care company raises questions about its ability to remain in business.
Doximity reports Q2 results: revenue up 11%, adjusted EPS $0.22 versus $0.17, beating Wall Street expectations for both and sending shares sharply up.
DOCS shares are down 32% in the past 12 months versus the SP& 500’s 12% gain, valuing the company at $4.4 billion.
The company laid off 10% of its employees and reduced revenue guidance in August 2023.
From Quite the Tenses: “Re: NextGen Healthcare. Thoma Bravo closed on its acquisition and immediately announced a 20% RIF in a town hall meeting. Details to be shared next week.” Unverified, but reported by multiple readers. TB paid $1.8 billion to take NextGen private. The company’s Mirth integration product line didn’t get a lot of airtime in the announcements even though it launched a cloud-based version a few months ago, so I’m wondering how that fits into the new owner’s expectations.
From Big Night: “Re: Amazon One Medical. Why do you call it concierge medicine?” Your $99 per year gets you no medical services except for telehealth visits, and should you show up in one of the company’s limited number of physical locations, either you or your insurance will be paying full price. One Medical’s annual fee was $199, so the only thing new is the $100 discount through Prime. The price is low for concierge medicine, but greater than the $0 memberships that most primary care practices charge. The company also offers Amazon Clinic, which is a marketplace for the telehealth services of paying advertisers. Everybody’s getting overly excited about Amazon’s monetizing of its $4 billion acquisition of One Medical early this year, but it could be a minimally seismic event like when it bought Whole Foods.
Poll respondents confirm that it is common for health systems to shut down community-needed services that aren’t profitable.
New poll to your right or here: Which position seems to be losing popularity or influence the most in health systems?
I appreciate the comments of Kat McDavitt and Lisa Bari of the Health Tech Talk Show, who recapped my Olive implosion summary and described HIStalk as “still the reigning number 1 health tech hotsheet. Despite the 1998 UI.” That appearance-shaming assessment is accurate and I am pleased in an “all cattle, no hat” sort of way. I like to think of HIStalk’s quirks as being the velvet rope that industry leaders happily sidestep to join their peers in consuming what’s inside, while others flee for prettier, shorter content with all the abbreviations spelled out.
My polls are mostly for entertainment and to generate timely reaction, but vendors who wrap advertising around a poll they have conducted should include this information to support validity and thus newsworthiness:
November 16 (Thursday) 1 ET. “How Scheduling Helped Streamline Memorial Hermann’s Communication.” Sponsor: PerfectServe. Presenter: Amee Amin, MD, hospitalist, Memorial Hermann-Texas Medical Center. Dr. Amin will discuss the challenges she experienced in creating schedules for her team of hospitalists, and how an optimized solution transformed her workflow. Attendees will learn now TMC gleans crucial data and analytics from their scheduling system, the impact of real-time schedules being pushed out to other applications, and how Lightning Bolt’s optimized, auto-generated schedules improve provider satisfaction and work-life balance.
Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.
Value-based care and population health management company Cano Health reports Q3 results: revenue up 19%, EPS –$91.87 versus $0.23, sending shares sharply down as investors question its ability to stay in business. The company’s market cap is down to $32 million. It went public via a SPAC merger in November 2020 at a $4.4 billion valuation.
Elucid, whose AI-powered imaging analysis system assess cardiovascular diseases, raises $80 million in a Series C funding round.
Flatiron Health promotes Nathan Hubbard, MBA to chief business officer.
Courney Starnes, MBA (Saint Luke’s Health System) joins Kaleida Health as SVP/CIO.
CommonSpirit Health promotes Jamie Trigg, MSITM to system VP of primary EHR systems.
CHIME names Shafiq Rab, MD of Tufts Medicine as its 2024 John E. Gall, Jr. CIO of the Year.
A Healthcare IT Leaders survey of CHIME members finds that while AI adoption is in its early stages, two-thirds plan to implement or pilot projects with 12 to 24 months. Half expect AI to help alleviate worker shortages, while nearly all involve clinicians in their AI decisions.
In Canada, McGill University Health Centre goes back to paper and cancels appointments as its Telus Health Oacis clinical system crashes following a software update.
An AI system is used for the first time to autonomously negotiate a non-disclosure agreement between to companies with no human involvement, which took just a few minutes.
A new KLAS report finds that digital pathology is used in only 5% of US cases, but early users anticipate benefits such as better patient care, increased efficiency for pathologists, faster image access, reduced storage and delivery costs, and new opportunities for reference labs to attract hospital clients. They also foresee digital pathology paving the way for AI-assisted diagnostics, case screening, and improved quality assurance. The majority of these early adopters, typically having 30 or more pathologists, are progressively implementing digital pathology, initially focusing on applications that simplify pathologists’ tasks.
Tri-City Medical Center (CA) diverts ambulances following an unspecified cyberattack that is rumored to involve ransomware.
The Verona paper summarizes its annual update from Epic:
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IHS Selects New Enterprise Electronic Health Record System
Indian Health Service chooses General Dynamics Information Technology and Oracle Health for its new EHR, which will replace its VistA-based RPMS.
US Radiology pays $450,000 to settle New York State charges that outdated computer hardware allowed a ransomware attack that exposed the information of 92,000 state residents.
Elucid Raises $80 Million in Series C Round Led by Elevage Medical Technologies
AI-powered imaging analysis software company Elucid announces $80 million in Series C funding, bringing its total raised to $121 million.
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Well now if you know that Epic is paying KLAS, do tell, and give evidence! Or is this another Oracle…