HIStalk Interviews Clement Goehrs, MD, CEO, Synapse Medicine

Clement Goehrs, MD, MSc, MPH is co-founder and CEO of Synapse Medicine of Bordeaux, Nouvelle-Aquitaine, France.

Tell me about yourself and the company.

I’m a public health physician. I have been involved in a lot of research. I was a researcher in biomedical informatics, first in France and then at Stanford University. I returned to Europe, where I co-founded Synapse Medicine with another physician. Synapse is improving medication safety and helping clinicians achieve medication success. We help physicians, pharmacists, nurses, and patients with prescribing, deciding what drugs to take, and how to take them. We provide reliable information on drugs.

How does your offering improve on existing technologies such as as point-of-care drug information, clinical decision support, and order checking?

As a physician and in talking with my colleagues, we were aware of clinical decision support inside the EHR and various resources online. But we came to the conclusion that for a good number of people, it was frustrating to use these tools. They aren’t always up to date, sometimes you have to use several different tools to get your answer, and it can be too time-consuming. As a result, it was not really used. If you ask a pharmacist or physician if they love the clinical decision support tools that they have, such as those found in their EHR, most of them will answer that they don’t use them and aren’t even opening them because there are too many alerts and too many things in the EHR.

We want to improve on that in two ways. The first improvement concerns the content itself, by providing information that is always up to date. We do this using algorithms. It’s using a lot of natural language processing that goes through all the guidelines from the FDA continually, every day and every night. The algorithm processes all the documentation regarding how you should use the drugs and builds a huge knowledge base regarding drugs that is always up to date. The content part ensures that you always have the best-in-class information and that it is always up to date.

The second way that we are trying to improve these tools is by displaying this information in a good way, not just a long list. We have developed software and components are used as standalone products or plugged directly inside the EHR to display drug-drug interactions, side effects, and contraindications in a way that is super easy for the physician or the pharmacist to understand.

How does the EHR integration work?

We are Europe based and we have completed a number of integrations with basically every major EHR. We see a similar context for EHR integration in the US and Europe, where a number of leaders say they want to interoperate with startups, but in reality, we see a lot of resistance. You have to find ways to do deals and motivate them to do their part and do the interoperability work.

We are just entering the US market. We are working with Vanderbilt University Medical Center and Brigham and Women’s Hospital in Boston. We are in the process of integrating with Epic, but for the moment, just inside these two hospitals.

The study description says that pharmacists on rounding teams will use the system. What does that look like and what results do the organizations hope to achieve?

The use case is for very complex patients. Let’s take a patient who is on 15 drugs for several comorbidities. You want to do a complex medication reconciliation. It’s complex because this patient has a regimen of 15 drugs and you want to determine what the best possible medication history is. You need to check for side effects, drug-drug interactions, and contraindications. 

As a pharmacist using our tools, you would log into our app on synapse-medicine.com. You are getting all the information on the patient and the medication history from Epic, because there is interoperability. You are going to do first a complex medication reconciliation, where you will have a visual representation of the different sources of information regarding the patient’s current drug regimen.

Let’s say you have one set of information from Surescripts and another set of information from the main caregiver or the nurse. Using the software, you can compare the different sources of truth for this patient’s medication history. As the pharmacist, you’re going to choose which source of truth you want to follow for each drug, and you are going to complete the best possible medication history. Then you are going to go through a complete pharmaceutical analysis. Our tool is going to give you insights regarding drug interactions, managing side effects, and managing contraindications, so that you can write the best possible prescription for this patient at discharge. Lastly, you are going to be able to automatically generate the necessary documentation for the patient and their care team as a record of their treatment, along with any changes that were made and why.

Your website mentions the platform’s use in telehealth. How would those providers use it?

That’s a cool story. Three years ago in Europe, just before COVID-19, there was a growing number of telehealth companies. Basically every single one of them was building their own EHR for their providers. A number of them came to us saying, we want to improve our EHR. We want to have a best-in-class clinical decision support system for prescriptions. We want to improve patient safety inside the EHR.

These were young companies that didn’t have the resources to integrate drug databases and for build the complete system that they needed. We came to the conclusion that we would be able to help them by creating components. It’s not just an API, but rather like an API with a UI on top of that. You write one line of code and you can import them inside your tool.  We created an entire library of components. We have, for example, a drug-drug interaction component, a side effect component, and a number of other front-end prescribing tools.

The value proposition here is for a young telehealth company or a more mature one that wants to improve the EHR for their provider. You can easily integrate this library of components, and in less than one or two days, you can improve the entire clinical decision process for prescribing by adding the components that your prescribers need. That’s how we partner with telehealth companies. In Europe, we are the leader in prescription assistance for telemedicine and telehealth.

Can it support pharmacovigilance and reviewing a patient’s profile for opportunities to de-prescribe?

Our objective is to save as much time as possible for the provider in the case of a 12- or 15-drug regimen. This means also to consider de-prescribing. Our business model is constructed so that we are not incentivized based on the number of prescriptions, because we want to advocate for fewer prescriptions and de-prescribing.

When it comes to pharmacovigilance, we are trying to close the loop . You and I have been talking about prescribing, dispensing drugs, and reconciling medications, so let’s talk about patient information and that last item of pharmacovigilance. In that way, you’re closing the loop for the entire pathway of a drug after commercialization. In terms of pharmacovigilance, we’ve been working with the French FDA on a tool that saves time for the people in charge of assessing side effect reports for their level of severity and classifying the side effects.

This solution is driven by the same technology. It uses natural language processing. It can interpret the side effect reports very efficiently. For example, let’s say a patient says, “I took acetaminophen this morning and then I felt lightheaded.” The tool will understand everything that is reported and will recognize the side effects to make a first assessment of the severity of the case. Subsequently, a pharmacist and a physician can just say, “We think the technology made a good assessment” or they can correct what the system has been doing.

This is already up and running in France nationwide for all declarations of side effects. Every single side effect reported in France goes through our system first, and the initial assessment is made by Synapse.

How are you working with First Databank?

We are just starting our collaboration. We will see how it evolves. There is a lot of movement in this space, and First Databank has been trying to do more and more. We have a long history of partnering with commercial drug databases, which may be surprising, but we help them find new ways to ensure that their content is always up to date. On the Synapse Medicine side, we use this commercial database as a gold standard for our algorithm to think, “This is the truth.”

What opportunities and challenges do you see in increasing your presence in the US market?

The key for the US market will be EHR integration. The strategic path that we have chosen for Synapse is to offer a tool that has already been proven clinically. In Europe, our tools are used to prescribe, to do medication reconciliation, and to manage complex regimens like oral chemotherapy. We are directly inside the workflow, which is super important because in healthcare, nobody wants to add another tool. If you are outside the workflow, you will have low adoption and will probably end up with no adoption and die. Or, you do the hard work needed to be inside the workflow.

To do this, it is necessary to focus on EHR integration, and integration with the systems that are already in place. This is definitely difficult. It takes time, but then once integrated, you are there for the long term. This is exactly what we are working on right now with a number of EHRs that are being used for prescribing.

Curbside Consult with Dr. Jayne 11/7/22

There has been a lot of discussion recently about practices that send patient portal questionnaires for existing patients to enter their medical histories. Certainly as a patient, I don’t want to enter information that already exists in my chart, and as a physician, I don’t want to have to reconcile a bunch of information that might already exist in the chart against patient-provided information that may or may not be accurate. Some patients are great at knowing their histories, others are less so.

Once a year, I have an appointment at a major academic center’s high-risk breast cancer program. This year, I was pleasantly surprised that for the first time, they didn’t ask me to provide information that they already had in my chart. The check-in process was quite streamlined even though three separate appointments were involved, so I was looking forward to a smooth visit.

The visit itself was great, with speedy access to an exam room, an upgraded exam gown (flannel with satin trim, if you can imagine), and a short wait for the physician. From there I went to the imaging center waiting room. Although the technician was apparently looking for me in the wrong waiting room (they have three), they ended up locating me quickly enough to get me to my imaging appointment early.

My technician was personable and efficient, making me feel like a valued patient and not like just another patient in a long line of tasks for the day. From there it was back to a different waiting room, where I received preliminary imaging results and met with another physician.

After discussing the care plan, they mentioned that a final radiology reading would be available to me via patient portal within 24 hours. They also explained that due to their current patient mix, they were asking some patients to schedule with a midlevel provider rather than the physician for their next visits. Knowing what I know about healthcare economics and physician staffing, I understood what they were trying to do in making sure the physicians have capacity to manage the patients who need active management of breast cancer and who are planning surgeries in the near term. As a patient, you put a certain level of trust in a leading academic institution to have appropriate physician oversight when you’re seeing a midlevel provider, and as a physician, I know how to advocate for myself if the need arises.

The visit hit a glitch during the checkout process, since there was no one to staff the checkout desk and everyone was being sent to the waiting room. There was quite a line since most patients needed multiple follow-up appointments for imaging, biopsies, or additional clinical appointments. I had plenty of time to read the Patient Bill of Rights they had posted on the wall, which specified that patients might see a physician assistant or a nurse practitioner as part of their visit. It also spelled out that patients have the right to see the physician if they prefer, although that might result in the rescheduling of their appointment. It’s standard stuff, and I didn’t think too much of it until the patient in front of me began to check out.

She handed over her check-out instruction sheet and began asking questions about the providers listed on the board behind the receptionist, as well as their credentials. She was asking which were breast specialists and which were other types of surgeons since it’s a mixed office. The receptionist was describing them, and when she got to the nurse practitioner, she said “Oh, she does everything,” to which the patient responded asking, “Why didn’t she go to medical school then?”

My ears perked up at that and I knew it was going to get interesting. It’s not hard to overhear things when you’re literally three feet apart, and apparently the patient had been given the same information that I had about not seeing the physician at the next visit and wasn’t aligned with the plan. She was shopping for a different surgeon rather than see someone she stated had less education. Having just read the Patient Bill of Rights, I wondered how the office would handle it. The receptionist said she would go and check with the physician.

While she was gone, the patient — with whom I had exchanged pleasantries about my cute tote bag while we were both in the imaging waiting room — turned to me and mentioned that she knew what the answer would be since the doctor had already told her she had to see the nurse practitioner. She went on to say that she was a cancer survivor and that she is scared to not see her surgeon, who knows her the best. I nodded empathetically and waited to see what would happen.

The receptionist came back and announced that she had spoken to the physician and the answer was still no – she would need to schedule as directed. Clearly that didn’t align with the posted Patient Bill of Rights, and honestly if the organization isn’t going to follow it, they need to take a good look at either modifying it or removing it from the office while they reconsider.

I was able to get my follow-ups scheduled and headed home, eager to get my final reports and try not to think about the whole situation for another six months, which is sometimes the best way to approach it as a patient. I buried myself in work the rest of the day, waiting for the familiar notification from the patient portal app that my result was available.

Unfortunately, the notification didn’t come. Nor did it come the next day, or the next, or the following one. I was busy with work and didn’t have a chance to call and wanted to also give a little benefit of the doubt since I know healthcare is in crisis. But now we’re in the weekend, and I’m relegated to wondering where there is a backup in radiology, whether my study was missed, or whether I’m going to get a callback to come back for more images. I know the system’s EHR and how it’s configured to handle release of test results to patients. Once radiology images are final, they release to the patient. The question then becomes whether something is wrong with the EHR and portal systems, or with the test itself.

Since it’s the weekend, I guess I’ll sit and wonder for a few more days, which is never a position a patient wants to be in.

Thinking about the situation as a whole, I think the practice needs to do some introspection around its messaging. In addition to the Patient Bill of Rights issue, they need to provide additional instructions on what to do if imaging results don’t come back. I’m a physician and know to track it down when Monday comes, but a lot of patients might be from the “no news is good news” generations, or don’t have patient portal access, and wouldn’t know to follow up a missing result. In the mean time, I’m off to a conference, so I will rely on my calendar to remind me to make the call.

Does your organization’s patient summary give instructions on what to do when results don’t return? Do you honor your posted Patient Bill of Rights? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 11/7/22

Roche introduces the navify brand for its digital health solutions at HLTH 2022

Roche, the world’s largest biotechnology company, unifies its 30-solution digital health portfolio under the brand Navify.

Smile Digital Health Expands Product Offering With Alphora Acquisition

Health data and integration vendor Smile Digital Health acquires clinical quality language and metrics company Alphora.

Transcarent Selects Prescryptive Health to Power a New, Different and Better Integrated Pharmacy Experience

Transcarent will use Prescryptive’s prescription intelligence platform to power its Pharmacy Care service, giving members access to Prescryptive’s transparent pricing and network of retail, home delivery, and specialty pharmacies.

Monday Morning Update 11/7/22

Top News

Roche, the world’s largest biotechnology company, unifies its 30-solution digital health portfolio under the brand Navify.

The company’s products include oncology decision support, tumor board, mutation profiler, digital pathology, results tracking, and infection management.

Roche acquired oncology software vendor Flatiron Health for $1.9 billion in April 2018.

Reader Comments

From Itsme: “Re: TeleTracking. At least 40 people lost their jobs last week. Most folks were on the client-facing side.” Unverified. I unsuccessfully searched the company’s website and press releases looking for a media contact so that I could inquire.

HIStalk Announcements and Requests

A great number of providers are apparently insulting their patients-slash-customers by shoving a blank form at them that asks for information that they already have on file. I’m repeating myself in saying that I question how intentionally duplicated information is reconciled and by whom, whether the provider will review only the form’s contents instead of the better-vetted information from the EHR, and why providers think that blank forms are better than letting the patient review an EHR-generated document and the noting any corrections. You would order less frequently from Amazon if its website or app required you to manually enter your name, shipping address, and credit card information every single time.

New poll to your right or here: Would you pay a $250 add-on fee to your conference registration to opt out of having the organizer share or sell your contact information? A reader pointed out that the business model of conferences includes selling the contact information of prospects to vendors, so registrants would have to bear more of the cost if they throttle back on the “ladies drink free” model. I conclude that the amount that you are willing to pay to avoid any particular frustration (a toll road, VIP tickets, or a concierge MD) is a better indicator of the issue’s true importance than the number and passion of the complaints about it.

One of my favorite email tricks is sticking a period somewhere before the “@” in my address, which makes that email address look unique even though Gmail treats it like my real one. Example: email addressed to mr.histalk@gmail.com will actually be sent to mrhistalk@gmail.com, giving me an infinite number of seemingly unique addresses for free trials and such. A reader provides a similarly clever way to tell which companies are selling your email information, which takes advantage of the fact that Gmail ignores characters that follow a plus sign entered to the left of the @ sign. Example: sign up for the HIMSS conference using mrhistalk+himss23@gmail.com and any emails sent there will be delivered to mrhistalk@gmail.com, but with the full address listed so you know who shared your information. These tricks could be foiled by sites or bulk emailers that strip off the extra characters, but I doubt that’s common.

For folks who just can’t figure out the EDT versus EST thing, your confusion won’t be obvious again until March 12. Or never, if you instead just use ET.

If your company sponsors HIStalk and is participating in the HLTH conference, complete this form by Wednesday and I’ll list you in my conference guide.

Thanks to the following companies that recently supported HIStalk. Click a logo for more information.

Webinars

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

Acquisitions, Funding, Business, and Stock

The Global X Telemedicine and Digital Health (EDOC) exchange-traded fund has lost 27% of its value since its inception on July 30, 2020, while the Nasdaq is down 4% and the S&P 500 is up 15%. EDOC has also performed worse than both indices in the past 12 months. 

People

Inflo Health hires Angela Adams, RN (Jvion) as CEO.

Government and Politics

In the UK, NHS nurses will likely strike nationally for the first time in the next few weeks over compensation, with patient waiting lists expected to grow even longer.

Other

Forbes profiles Humana’s use of a virtual assistant to reduce the documentation burden of its clinicians. The company says that 80% of clinician time was being spent documenting rather than interacting with patients, and using the tool that it named Allie has freed up 15% of their time. Allie was built using technology from Automation Anywhere.

A Madison, WI-based non-profit news site runs a well-written piece on Epic. Snips:

• Epic walked away gracefully from its $624 million VA patient scheduling pilot programs when the VA chose Cerner in a $16 billion no-bid contract, which may benefit Epic in the long run since Epic has since enhanced its market position instead of bogging down in government work.
• Epic has 12,500 employees and $3.8 billion in annual revenue versus Cerner’s 27,000 employees and $6 billion in revenue, but Cerner continues to lag product-wise, is losing premium customers to Epic while selling mostly to price-sensitive ones, and was laying off employees when Oracle pursued its acquisition.
• Epic has built all of its products and they integrate well, while Oracle Cerner grew by acquiring unrelated products that were bolted together.
• Epic says it’s too early to say if it will collaborate with Oracle Cerner on the national database of patient records that Oracle Chairman Larry Ellison has announced, with Epic saying that connecting to Cosmos can’t happen until Epic gains understanding about the reliability of Oracle Cerner’s data, its method of de-identifying patient data, and its willingness to legally agree not to sell patient data commercially.
• Observers say that Oracle Cerner prospects may be spooked by Cerner’s history and the Oracle acquisition and may buy Epic instead.
• Oracle has a history of making grand promises about developing new products when acquiring companies, but the end result is usually only that Oracle tries to sell more of its existing products to the acquired customers.

Contacts

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

Morning Headlines 11/4/22

Modernizing Medicine Agrees to Pay $45 Million to Resolve Allegations of Accepting and Paying Illegal Kickbacks and Causing False Claims

A whistleblower lawsuit that was joined by the Department of Justice said that the company, which is now known as ModMed, falsely attested that its EHR met Meaningful Use criteria and paid kickbacks for referrals.

Red Cross seeks ‘digital emblem’ to protect against hacking

The organization hopes that a digital version of its cross will protect medical and humanitarian services from digital harm during armed conflicts.

Warner Releases Policy Options Paper Addressing Cybersecurity in the Health Care Sector

Senate Select Committee on Intelligence Chairman Mark R. Warner (D-VA) publishes “Cybersecurity is Patient Safety,” a policy options paper.

News 11/4/22

Top News

Specialty EHR/PM/RCM vendor ModMed pays $45 million to settle a 2017 whistleblower lawsuit claiming that the company – which was formerly known as Modernizing Medicine — falsely attested that its EHR met Meaningful Use criteria, ignored patient-endangering software defects, illegally paid kickbacks, and sold systems to providers who were promised increased revenue through upcoding.

The Department of Justice joined the whistleblower lawsuit filed by former ModMedVP Amanda Long, who will receive $9 million of the settlement. 

Reader Comments

From Sloopy: ‘Re: a list of best jobs in health IT. Check out the source.” The kids who write for Becker’s often fail to filter out click bait stories as they desperately seek headlines to repurpose. Their source for this item is a poorly written, mostly offshore-staffed Internet of Things website whose article looks like a bored freelancer spent 10 minutes stringing together random Google search results, such as “CIOs can keep tabs on how their companies utilize IT to figure out where cyber security can be tightened up” and “you can be sure that your decision to stick to this sector is good because for a stable livelihood, you need a good stable job.” The methodology it used to determine the “best healthcare technology jobs” wasn’t mentioned because there wasn’t one. The bio of the author, who clearly values quantity over quality, says that she has written 40,000 articles. 

HIStalk Announcements and Requests

Welcome to new HIStalk Gold Sponsor Access. The Dallas-based company believes that hospitals and their patients deserve better than paper. The company eliminates paper troubles by providing EHR-integrated eForms and eConsent solutions that save hospitals money, make the lives of clinicians easier, and provide a better patient experience. Access has led the way with purpose built patient electronic solutions for hospitals for 20 years and now launches its next-generation Focus offering — which will be introduced in a November 9 webinar – that breaks the convention of forms in favor of adaptable digital experiences, positioning hospitals to effectively engage with their patients on their own devices, anywhere, any time. Thanks to Access for supporting HIStalk.

Webinars

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

Acquisitions, Funding, Business, and Stock

Allscripts reports Q3 results: revenue up 5%, adjusted EPS $0.23 versus $0.21, beating analyst expectations on earnings but falling short on revenue.  

Clinical data abstraction platform vendor Carta Healthcare raises $20 million in a Series B funding round.

Hint Health, which sells EHR-integrated membership management and billing software, acquires AeroDPC, which offers an EHR/PM system for direct primary care physicians.

CPSI announces several leadership appointments under Chris Fowler, who was promoted to president and CEO in July 2022.

The president of virtual health provider Cerebral admits that the company tried to grow too fast when federal prescribing regulations were relaxed during the pandemic, drawing federal scrutiny over its controlled drug prescriptions and overspending on advertising to the point that it laid off 20% of its employees last week. Cerebral will abandon several of its existing and planned programs to focus on mental health, with the CEO adding that it needs to become self-sustaining instead of relying on uncertain additional investor funding.

Sales

• Palomar Health will implement Get Well’s GetWell Loop digital care management solution, followed by phases for inpatient experience, ED experience, care gap closure, and health equity.

People

KONZA National Network hires Karla Mills, MS, MBA (Health Gorilla) as COO.

Jared Klingeisen (Medable) joins specialty medication prescribing software vendor RxLightning as COO.

CommonSpirit Health hires Daniel Barchi, MEM (New York-Presbyterian) as senior executive VP and CIO.

ChenMed promotes Chase Titensor, MBA to VP of strategic payer partnerships.

Announcements and Implementations

Truveta announces GA of Truveta Studio, which allows researchers to analyze the de-identified, daily-updated data of its 25 health system members that represent 700 hospitals and 20,000 clinics. Truveta, which was launched in February 2021 by 14 large health systems, has raised $195 million.

Nine organizations licensed the cloud-based model of Meditech Expanse in the third quarter, raising the count of Meditech as a Service hospitals to 70. Five of the nine were new to Meditech.

Redesign Health will create pediatrics-focused healthcare technology products and companies in partnership with KidsX, whose 40 children’s hospital participants work with early stage digital health companies.

UK health IT vendor EMIS Group says that its $1.4 billion all-cash acquisition by Optum UK will be completed in early 2023.

Privacy and Security

The International Committee of the Red Cross will create a “digital red cross” that it hopes will work like its physical counterpart to prevent cyber harm to the systems of medical facilities and Red Cross offices during armed conflicts.

The office of Sen. Mark Warner (D-VA) issues a report titled “Cybersecurity is Patient Safety” that provides issue background and describes policies that could be considered, such as:

• What should a healthcare cybersecurity framework look like? Is NIST’s guidance sufficient and being used?
• Should HIPAA be modernized beyond its focus of PHI protection by covered entities?
• How should Congress create minimum cyber hygiene practices? Should they be deployed under a facility’s Medicare Conditions of Participation?
• Should Congress offer a “cash for clunkers” program to incentivize life cycles for medical equipment? Should providers have a right to repair using third parties?
• Should Congress require healthcare software vendors to publish a “software bill of materials” to allow vulnerabilities to be assessed?
• Should providers be required to train all staff members to use alternate systems during downtime?
• Should providers receive FEMA disaster funds after experiencing a cyber event?
• Should Congress regulate cyber insurance or create its own reinsurance program?

A LexisNexis Risk Solutions study finds that half of participating healthcare payers had a data breach in the past five years, averaging 12,000 compromised records and an average incident cost of $5.4 million. Social engineering was the most common payer cyber fraud source, followed by ransomware. Most respondents say that online identity and credential verification is challenging, especially on mobile apps.

Other

Sixteen medical colleges and hospitals in India’s second-largest state have been using paper charts and radiology film since July 5, when a vendor shut down its hospital system over unpaid bills.

Researchers in Australia apply an electronic Frailty Index similar to that used by UK GPs, using a 36-item screening of PCP EHRs to detect patients with age-related decline who could be treated with vitamins, strength training, and chronic disease management.

Police file several charges against a UPMC ED physician who they say was driving his Tesla at 125 miles per hour in a 35 mph zone when he lost control, killing his passenger, a fellow ED doctor who was not wearing a seatbelt. The driver’s blood alcohol level was twice the legal limit.

Contacts

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

EPtalk by Dr. Jayne 11/3/22

I’ve experienced an uptick in email solicitations over the last couple of weeks. It’s been fascinating to see the different content and how marketers are trying to use various strategies to get the reader’s attention.

Quite a few of them are going for the friendly-sounding approach, with short sentences and colloquial language. One of the repeat senders is further trying to build on the familiarity by mentioning the local weather and a nearby restaurant, which is fascinating but a bit odd since it’s in an adjacent town. I wonder what the algorithm looks like that says, “hey, let’s pick something close, but not creepy-stalker close” and throw that into the email. They even go so far to mention “location inferred from your company” regardless of the fact that my “company” is located hundreds of miles from the town they mentioned.

I strongly suspect that the emails are stemming from mailing lists related to the conferences I’m attending in the next couple of weeks. It’s one more way for meeting organizers to increase conference revenue, even though it’s annoying for the attendees. I don’t recall seeing any kind of “don’t sell my information” opt-out checkboxes during the registration processes for either of them, but there’s always a chance that I missed them along the way (although from past experience, it’s more likely that the conference didn’t give attendees the chance to opt out). Much like the weeks following HIMSS, I’m sure I’ll be spending quite a bit of time creating new email filters and wading through various pieces of junk email.

I do have to say that I’m a little nervous about my upcoming conference attendance, especially since flu cases are on the rise. The US has already seen more than 880,000 cases of lab-confirmed influenza, and that number doesn’t include the patients who are tested using in-office test kits at physician offices and urgent care centers or those patients who don’t present for testing. Physicians who care for children are concerned, since more than 75% of pediatric hospital beds are full. The leading viral strain at present is H3N2 influenza, which has in past years been associated with higher severity of illness for older adults and children.

Based on what I’ve seen during recent travels, I’m betting I will be one of the few people wearing a mask in crowded situations. I have to admit that I did enjoy the first HIMSS post-COVID, when a good number of people were masking, because I used to nearly always return from HIMSS with a sore throat, runny nose, and generally feeling of cruddiness consistent with a respiratory virus. Especially if you’re not going to mask, now is a great time to get a flu vaccine if you haven’t already received one. I know that lots of people are tired of thinking about contagion after the last couple of years, but the basic tenets of public health are always a good idea.

Speaking of vaccines, while some organizations have kept their vaccination requirements static, several leading universities are requiring students to receive the new bivalent COVID boosters. Schools requiring the new boosters include Harvard University, Yale University, Tufts University, Fordham University, and Wellesley College. Pushback is expected, and the comments on the article are all over the place. Uptake of the new booster has stalled in my community and my urgent care and emergency department colleagues are still exhausted, so some of us are dreading what might happen over the coming months when people move their activities inside and begin gathering for the holidays.

After a recent medical visit, I was flipping through my health system’s patient portal to see how various kinds of documents were rendering and whether there were any changes after the recent updates to requirements for release of information to patients. I found a visit from a few months ago that now had a visible visit note when it didn’t previously have one. I’m confident I would have remembered seeing a note previously based on the last line of the document: “This dictation was done with voice recognition software and may contain errors and omissions.” That’s certainly far from a vote of confidence for the treating provider. Maybe I’m old school, but I can’t imagine putting something like that on one of my notes or signing a note without proofreading and correcting it. I know that everyone in healthcare is stressed, but I’d be embarrassed to allow that in any of my patients’ charts. I had already decided to look for a new physician in this specialty and this just confirms my decision.

It’s common for researchers to create catchy names for their studies, so I was excited to see COSMOS, otherwise known as the COcoa Supplement and Multivitamin Outcomes Study. It’s a randomized clinical trial looking at cocoa extract supplement in comparison to a standard multivitamin with respect to cardiovascular risk reduction. A sub-study, COSMOS-Mind, will look at whether the cocoa extract supplement improves cognitive function and reduces the risk of dementia. Of course, I’m a big fan of chocolate (although usually in baked goods rather than in a capsule) so I’ve been keeping an eye out for the study outcomes, which finally came out this week.

The results were exactly opposite of what was expected. The multivitamin, rather than the cocoa supplement, was found to be more closely associated with improved cognitive function in older adults. The benefits were greatest in patients with a history of cardiovascular disease. Since nearly 90% of the study participants were non-Hispanic whites, the authors note that additional work is needed to confirm the findings, in particular with a more diverse patient population. Halloween passed in my neighborhood with only a small number of trick-or-treaters, so I’ve got plenty of cocoa on hand. I’m looking forward to the mood boost even if it’s not going to prevent dementia.

How was the Halloween traffic in your area? Will you be nibbling chocolates for weeks to come? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 11/3/22

CPSI Announces Business Unit and Executive Leadership Changes

The company announces new leaders following the June retirement of President and CEO Boyd Douglas

CommonSpirit Appoints Daniel Barchi as Chief Information Officer

CommonSpirit Health hires Daniel Barchi from New York-Presbyterian as senior executive VP and CIO.

AeroDPC joins the Hint Health Ecosystem

Hint Health, which sells EHR-integrated membership management and billing software, acquires AeroDPC, which offers an EHR/PM system for direct primary care physicians.

Qualifacts Announces Acquisition of OnCall Health

Behavioral health EHR vendor Qualifacts acquires OnCall, a vendor of telehealth, patient portal, and client engagement technology for behavioral health organizations.

Readers Write: Lessons Learned from the COVID-19 Pandemic: How Data Sharing is Improving Chronic Disease Outcomes

Lessons Learned from the COVID-19 Pandemic: How Data Sharing is Improving Chronic Disease Outcomes
By Brett Furst

Brett Furst is president of HHS Technology Group of Fort Lauderdale, FL.

Although the worst of the COVID-19 pandemic is likely behind us, many Americans living with chronic disease will feel its effects for years to come. That’s because chronic diseases such as heart disease, diabetes, chronic kidney disease, and obesity increase the risk for severe and lasting illness from COVID-19.

According to the Centers for Disease Control and Prevention, this improved risk matters, because chronic diseases represent seven of the top 10 causes of death in the United States and six in 10 Americans live with at least one chronic condition, such as heart disease, stroke, cancer, kidney disease, or diabetes. Chronic diseases also are the leading drivers of the nation’s $3.8 trillion annual healthcare costs.  

Among many lessons learned since its start, COVID-19 highlighted the need for health equity, as some patient populations were affected more severely than others. For example, African Americans, Hispanics, and Native Americans have a disproportionate burden of chronic disease, COVID-19 infection, hospitalization, and mortality, primarily due to challenges associated with social determinants of health. Even among the general population, healthcare utilization dropped during the pandemic, with a decline in screenings and subsequent diagnoses for diseases such as cancer. Delayed screening and treatment for breast and colorectal cancers alone could result in almost 10,000 preventable deaths in the US, according to the CDC.

The lasting impact that COVID-19 has on individuals living with chronic disease, and the entire healthcare system, underscores the many lessons we can learn from the pandemic and the need for improved data sharing across all stakeholders. For example, researchers have yet to know the extent to which COVID-19 exacerbates chronic disease, causes chronic illness, or will be determined to be a chronic disease. Although long-term studies and longitudinal surveillance will help clarify these questions, much research remains.

The COVID-19 Research Database (RDB) is a leading industry example of how collaboration and improved access to patient ecosystems can accelerate innovation and understanding, improving immediate and future cost and quality outcomes. Several organizations were led by RDB to accelerate real-world pandemic research, knowledge of condition identification and treatment, and evidence-based healthcare policy.

With 85 billion HIPAA-compliant, patient-level records, RDB enables public health and policy researchers to access real-world data to understand better and combat the COVID-19 pandemic and future health-related events. The RDB provides a standard data schema that allows researchers to access linkable data sets — including claims, electronic health records, and consumer data — and has powered over 70 publications and presentations addressing the direct and indirect effects of the COVID-19 pandemic on population health.

Among the publications and studies resulting from the RDB is the publication of research in Nature Medicine examining the impact of COVID-19 infection on risk for neurological disorders and a separate study published in the Journal of Alzheimer’s Disease that showed a substantially higher risk for older adults in developing Alzheimer’s disease within a year of contracting COVID-19.

Accurate, comprehensive, real-world data represents the healthcare industry’s straightest path toward developing a deeper understanding of the connection between COVID-19, chronic disease, and population health. Data sharing and collaboration provide researchers, providers, and healthcare organizations with the keys to actionable insights, data-driven decision-making, and accelerated innovation related to critical issues like improving health equity and driving healthcare cost and quality outcomes across populations.

HIStalk Interviews Bill Grana, CEO, HCTec

Bill Grana, JD, MBA is CEO of HCTec of Franklin, TN.

Tell me about yourself and the company.

I started my career as a lawyer with the largest for-profit health system in the country. Since then, I have been a tech entrepreneur since for close to 30 years, mostly in software. HCTec is my first stint in a pure services business, but I have run enterprise software companies that had exposure to healthcare.

HCTec is a 12-year-old, Nashville-based IT services firm that is focused exclusively on the healthcare provider sector of the market, so hospital systems and other providers. Our people have specialized skills in different areas of healthcare software and technology. They provide services according to the needs and circumstances of our clients.

What is the labor dynamic in healthcare today?

It is fascinating on one level and maybe terrifying as well, depending upon your perspective. A lot of what you see in the media centers around clinical labor and staffing challenges, which continue to be significant. But I would say that those challenges also extend into non-clinical areas of healthcare, including IT. The great resignation has changed the workforce of our clients. Certainly in compensation, where there has been significant wage inflation over the last two years. We’ve seen that within our own business and with our clients as well.

The dynamic of remote work certainly has had a big impact. In certain type of roles, remote work is here to stay. For those that require of face-to-face interaction and collaboration, hybrid is the model. For many of us, I don’t necessarily see a full-time return to the office the way that it was before the pandemic. As the leader of a business, I’ve had to adjust my thinking. I’m very much a face-to-face type of person who feels that teams are most effective when they can be face-to-face on a regular basis. But I also recognize that the world has changed, and so leadership thinking has to change as well relative to the work environments of our team members.

How will your business change as your clients increase their use of remote work?

I would have expected more of a transition, or at least an increase in the level of open-mindedness, over the past couple of years to outsourcing certain functions within our clients’ IT organizations.  We are seeing that in certain areas, particularly the help desk and service desk arena. But many others that are necessary but not strategic are ripe for partnering with a firm like ours. Because of our scale and focus, we can typically do those functions at a lower cost and a higher level of quality. 

Application support around the enterprise EHR would be one area. The daily care and feeding and maintenance that is required of an enterprise EHR is a perfect opportunity for outsourcing. PC and desktop support is another arena. Provisioning applications, and system provisioning, is another area. We aren’t seeing that trend develop the way that we would have predicted and continue to predict, so that’s an interesting dynamic.

How much business impact are you seeing from Epic’s move to Hyperdrive?

Hyperdrive is the move to a pure browser-based interface. We have seen some opportunity from that, but not a tremendous amount.

What types of consumer-facing technologies are providers considering?

Obviously telehealth, which the pandemic really catalyzed. Usage is down, but still much higher than what it was pre-pandemic. I think it’s fair to say that telehealth is here to stay, certainly for certain use cases. 

Patient portals are playing an even bigger role in how health systems give the patients what they want in terms of access to their information and scheduling and that sort of thing. We’ve seen a huge demand on the help desk side for patient-facing support, much of it related to supporting patient portal applications. We’re doing some remote patient monitoring support as well. As we look forward five years, we think we will be doing a lot more of that. We all know that technology doesn’t always work as designed, and sometimes users don’t understand how to use it and need channels to reach out to get the support that they need.

How has system training changed?

Training continues to play an important role in the ability of users, whether clinicians or patients, to take advantage of the technology that’s in front of them. Most of the patient-facing technology is fairly simple, but depending upon your demographic and whether you grew up with smartphones and computers, training is critical.

How will support needs change as systems are more widely rolled out to patients and caregivers in homes?

That is happening as we speak. Within our help desk capability, we have a specific offering and specialty geared to patient-facing support, recognizing that there are some nuances and differences to how you support a patient end user versus a doctor or non-clinical provider user. The support experience is always important, but for a patient who is calling in or chatting in, that experience is even more important. These are the customers of the health system and their experience with the clinician and the care they receive is obviously critically important, but the experience that they have with supportive technology is equally important. 

Some health systems understand that very well and deeply. Others are getting there with their thinking. We are huge believers that patient experience is critical for these providers, and that isn’t just about clinical care, that absolutely is about their experience with the technology that is being put in front of them.

Several big health system IT and revenue cycle outsourcing deals were signed in the past couple of years. How will that trend progress?

Financial stress is a driver. We are seeing that play out in real time right now, with half or more of health systems operating in the red, partly because the cost structure and partly because the of the revenue side. I’m not sure that things are ever going to return to normal, at least with respect to the cost structure of both labor and non-labor related items. That will force systems to think differently about how they do labor resourcing in certain areas.

Back to my comment earlier, health systems don’t necessarily have to build large organizations of IT professionals to be effective as an IT organization. There are plenty of opportunities to outsource aspects of IT, those things that are necessary but non-strategic or where it’s hard for individual health systems to build real competency. Part of this is a bias, because it’s a big part of what we do, but I believe that there is going to be a trend to more outsourcing within hospital IT functions. It’s going to be more surgical in nature than if you look back 15 or 20 years ago, where there was wholesale outsourcing of IT functions. It will be limited to certain aspects of a hospital’s IT organization.

What are health systems doing strategically after putting plans on hold for the pandemic?

We have a lot of dialogue occurring around help desks and service desks, and much of that around patient-facing support. The pandemic also spurred the notion of patient-centered thinking and the related technology investments that support that. The shift out of inpatient settings and their heavy fixed assets and into light asset settings — with the home being the lightest that you can imagine — is a big trend. That is creating opportunities for us, both on the staffing side as well as the outsourcing side.

What will the company’s strategy focus on in the near term?

In the environment that we are in, it’s important to have a long-term vision. It’s hard to do strategic planning much more than a year or two out given the amount of uncertainty that exists. We are heavily focused on our own team and making sure that we are positioning ourselves as an employer of choice. We have seen some turnover in parts of our business that is higher than we have ever experienced, and we are not alone in that. But we think and talk a lot about how to source new team members for our business more effectively, how to train them to be successful in their jobs, and how we continue to make HCTec in an attractive place for them to stay.

Interestingly, pay is typically not the most important thing. We are finding that the most important thing for keeping people is around is to define clear pathways from a career and professional development perspective. 

We made an acquisition in July 2021 of a company in Winston-Salem, North Carolina called Talon Healthy IT Services. That was a fantastic acquisition for us. It bolstered our capabilities in the help desk arena, but also gave us new capabilities in the ambulatory and smaller provider space, where we have the capability to be the outsourced IT function for those providers. We are continuing to look for other complimentary businesses to expand our service portfolio and to increase our market presence and footprint. That’s a big part of our strategic focus, and where I’ve spent a lot of my time.

We are now back to where we are actually seeing our clients in person after a two-year hiatus where not a lot of that occurred. We are staying close to our clients; looking at their demands, needs, and opportunities within their organizations; and making sure that we are delivering high quality services and staying ahead of those needs.

Morning Headlines 11/2/22

Walgreens-Backed VillageMD Said to Explore Deal for Summit

The proposed $10 billion company would operate the 200 primary care offices of Walgreens and the 340 urgent care locations of Summit Health-owned CityMD.

Americans Take Ketamine at Home for Depression With Little Oversight

Psychiatrists express concern that virtual care startups are prescribing ketamine for off-label treatment of serious mental health conditions.

Is the Promise of PROMs Being Realized? Implementation Experience in a Large Orthopedic Practice

Most of a practice’s total knee and total hip patients entered their patient-reported outcomes measures that were then stored in the EHR, but care teams ignored them during visits 99% of the time.

News 11/2/22

Top News

Oracle will close the former Cerner world headquarters and its Realization Campus in Kansas City, MO, consolidating employees from those locations to its Innovations campus as it reduces its footprint as the city’s largest private employer.

Reader Comments

From Doctor and Professor: “Re: Teladoc. We moved to its Solo virtual care platform from Teams. Clinicians are constantly frustrated and several have quit because they can’t deliver good care using the platform. It lacks features that Teams, Zoom, etc. have. You can’t set up backgrounds, share documents, or easily add people to the session. Only 10% of my recent sessions were free of major problems, such as dropped connections, erratic video, and being forced to use telephone audio due to drops and lags. The support people use a standard script that tells both clinician and patient download their app (its advantage was supposed to be that no app is needed), they tell you to plug your device into a charger, they recommend using a hardwired Ethernet connection and wired headsets, and they tell you to warn patients not to use the device for anything else and to turn off all messages while waiting for their session to start. Basically anything to avoid admitting that their system has problems.”

HIStalk Announcements and Requests

Attention HIStalk sponsors that are participating in the upcoming HLTH conference: complete this form by next Wednesday (November 9) to be included in my online guide. The company says it has 800 sponsors, which is up there in HIMSS conference territory. It will be interesting to see how its “open show floor,” which apparently dumps education sessions and exhibits together in the same hall, works out for attendees and vendors. 

Webinars

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

Acquisitions, Funding, Business, and Stock

Health analytics vendor Advata, which Providence formed in June 2022 by merging six companies from its Tegria business, lays off 32 of its 150 employees. The merged companies were Kensci, Colburn Hill Group, Alphalytics, Lumedic, Quiviq, and MultiScale. Advata CEO Julie Rezek was hired from Facebook and has spent her career in advertising.

Walgreens-controlled primary care provider VillageMD is discussing a merger with private equity-backed Summit Health that would value the combined entity at up to $10 billion. VillageMD operates Village Medical offices at 200 Walgreens pharmacies, while Summit Health and its urgent care practice CityMD have 2,500 providers working from 340 locations.

Forbes profiles Forward Health, which offers primary and preventive care memberships in 10 states for $149 per month with no insurance accepted. The company, which was formed by two former Google employees and has attained a billion-dollar valuation, says that one-third of its members are uninsured, either because they don’t like the concept of health insurance or can’t afford the premiums. Forward’s technology-heavy approach uses full body biometric scans, wearables, DNA testing, and AI-powered algorithms that it says reduces its need for specialists and allows much of the in-office exam to be conducted by an administrative assistant. Trustpilot has some interesting reviews.  

HelpAround, whose platform connects drug companies with patients, renames itself to RxWare.

Sales

• Renown Health chooses provider data management and search from Loyal.
• Meditech will use Health Gorilla’s Health Interoperability Platform for the Traverse Exchange Canada network for sharing data among participating providers.
• Cherry Health chooses EHR/PM from NextGen Healthcare.

People

Anna Yakovenko (Advisory Board) joins the American Medical Association as VP of research and insights.

RevenueWell promotes Katherine Shuman, MHA, MBA to CEO, replacing co-founder Serge Longin.

Sean Postol (Joerns Healthcare) joins Nuance as SVP of sales.

Frank Carozzi, MBA (Streamline Health) joins Medlytix as VP of business development.

Announcements and Implementations

Meditech announces Traverse Exchange Canada, a cloud-based interoperability network that supports information flow among participating organizations.

A study by Elevance Health, formerly Anthem, finds that 94% of people who have used virtual primary care are satisfied with their experience. Non-users believe that doctors need to see them in person or aren’t sure if their visit will be covered by insurance.

The local paper covers the planned Epic go-live of Albany Med Health System (NY) in 2024. I think that Albany Medical Center and maybe others in the group are using Allscripts, while Glen Falls Hospital had big revenue drops and layoffs in 2018 following its “catastrophic” rollout of Cerner, which resulted in a lawsuit that was settled.

Drugmaker Pfizer raises annual sales forecasts for its COVID products – $34 billion for vaccine and $22 billion for Paxlovid – and will increase the price of its vaccine, which will end up priced at double its launch price in December 2020.

Redpoint Summit, whose products provide “EMR personalization at scale,” releases an AI-powered EHR add-on that speeds order entry by suggesting a given provider’s most commonly used medications, which it co-developed with Nebraska Medicine.

An orthopedic group achieved high response rates for EHR-tracked patient-reported outcomes measures following total knee and total hip surgery, but care teams actually looked at their data in fewer than 1% of encounters. The authors conclude that making PROMs available for care team review in the EHR isn’t enough to encourage their clinical use.

A new KLAS report on EHR/PM for ambulatory practices of 2-10 physicians finds that Elation Health, NextGen Healthcare, Athenahealth, CompuGroup Medical, and Azalea Health deliver best in providing the desired functionality and value. AdvancedMD users report steady improvements in technology, while those of EClinicalWorks express frustration with training and support.

Government and Politics

The VA awards Accenture Federal Services a spot on its five-year, $650 million contract to fast-track innovative healthcare technology solutions that can scale for clinical use.

Privacy and Security

A major hospital in Japan suspends non-emergency services after its EHR is taken offline in a ransomware attack. The hospital’s director admitted that “the quality of surgeries might be lowered.”

The legacy EHR of Ascension St. Vincent’s Coastal Cardiology (GA) is breached in a ransomware attack that did not affect its production systems.

Other

Psychiatrists express concern that startups are prescribing ketamine – best known as a powerful anesthetic and party drug – for off-label treatment of serious mental health conditions such as depression, anxiety, chronic pain, and OCD with minimal oversight.

Contacts

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

Morning Headlines 11/1/22

Oracle to close North Kansas City World Headquarters Campus, Realization Campus

Oracle will close the former Cerner world headquarters and its Realization Campus, consolidating employees from those locations to its Innovations campus and drastically reducing its Kansas City area footprint.

Moving Standards to Support SDOH Data Capture from the Sandbox to Production

ONC, HL7, and partners launch a group that will pilot the “SDOH Clinical Care FHIR Implementation Guide” as supported by ONC’s USCDI Version 2.

Valera Health Announces $45 Million Growth Equity Financing to Increase Access to Evidence-based Mental Health Services for High Acuity Patients

The virtual high-acuity virtual mental health provider partners with health systems and plans, emphasizing its use of evidence-based treatment plans.

Seattle-area health data analytics company Advata lays off employees

Revenue cycle analytics company Advata, which was formed in June 2022 by Providence in a merger of six companies it owns and operates as a part of Providence-owned Tegria, lays off 32 of its 150 employees.

Curbside Consult with Dr. Jayne 10/31/22

I spent a good chunk of time this weekend preparing cranky correspondence to send to organizations that can’t seem to figure out that I don’t work for them any more or that I’m no longer a participating provider with a given payer since leaving the practice. Since I resigned from these organizations anywhere from six months to three years ago, I’m tired of dealing with the continued messages and requests for information. The off-boarding processes were variable across the different organizations, so it’s not surprising that there’s still a bit of a mess to tidy up. Still, one would think that with part-time or contractor physician positions, they would have their act more together.

Let’s take my most recent in-person employer for starters. I was a part time W-2 employee and resigned more than one calendar year ago. Apparently I didn’t get terminated properly with a couple of payers, who continue to reach out to me asking me to update my provider file with copies of my license, Drug Enforcement Agency registration, and state control substance documentation. I’ve sent multiple emails informing them of my last date of employment at the practice, and although a couple of them eventually stopped sending me reminders, there are a couple that are persistent. It’s tempting to ignore the communications, but I want to make sure all my provider files are closed out properly in the event that I join a new practice down the road. It’s always good to have definitive closure, but let’s hope it doesn’t take another 12 months to get it.

Then there’s one of my telehealth side gigs, where I only saw patients for a couple of months before determining that not only was the platform horrendous, but they could never seem to figure out how to pay me correctly. Despite having given ample notice that I was leaving and would not be seeing any patients during my notice period, they went ahead and signed me up for multiple insurance plans after I tendered my resignation. It’s likely a case of the right hand not knowing what the left hand is doing, but I’m tired of getting correspondence from various state-specific plans that can’t seem to understand I’m no longer participating in the provider group or planning to submit any claims.

This same platform continues to text me about high patient volumes despite my trying to opt out of the texts by following the included instructions. I’ve also tried sending emails to various individuals within the company with no response, which leads me to think that either those individuals have moved on or they don’t care. Since I no longer have access to the platform, I can’t look up any additional email addresses or contact information than what I have, so I’m sending my correspondence directly to the CEO and CMO of record as well as the head of the physician group, in hopes that they will respond and point me in the right direction.

There’s also another telehealth side gig, where I signed up but never saw a single patient. After watching them exhibit some unseemly behavior with colleagues, I decided not to engage with them. They followed up on my resignation letter by sending me an administrative termination of their own several weeks later, which I thought was somewhat overkill. They’re still sending me regular emails asking me to complete required training and given their track record with others I want to make sure my provider file is entirely closed out.

My favorite target of cranky correspondence is Illinois Medicaid, which is the “undead” of administrative healthcare organizations. I haven’t been a participating provider since 2014, but every now and then, some computer system somewhere goes haywire and decides that I need to update my provider records. The letters come on paper to my home, I always reply on paper because it seems to work, and I don’t hear from them again for a couple of years. I don’t want to wind up published in a directory as someone who is participating because it has the potential to lead to a lot of phone calls and wasted effort for patients who are just looking for a primary care physician and will keep working their way down the list until they find someone whose patient panel isn’t closed.

We’ll see if this batch of letters and emails is successful at tidying up loose ends or if I’ll still be dealing with them in 2023. It seems like there ought to be a better way. I know there are services out there, but the last time I looked at them, they were fairly pricey. Maybe I can find a retired medical practice manager who is looking to make a little cash on the side and enlist their help to get it done. With the number of people fleeing healthcare employment, it’s not a farfetched idea.

I also have a former employer in the tech space that can’t seem to figure out that I don’t work there even though it’s been more than four years. Not only do I get correspondence from the company proper, but also all of their vendors, including health insurance and more. They just sent me notice of the upcoming open enrollment period for health insurance and encouraged me to sign up quickly and not wait until the last minute. I wonder what would happen if I tried to register for a health plan – might be a good project for next weekend assuming an adequate number of cocktails beforehand.

Speaking of cocktails, I’m prepping to attend back-to-back conferences with CHIME and HLTH and the social event invitations have been trickling in. I almost spit my drink when talking to some colleagues about the latter, which they referred to as “the conference with no vowels.” There’s a lot of discussion about the utility of the HLTH conference and whether it’s worth the money. This will be my first year attending, so I’ll have to let you know in a couple of weeks. I’m looking forward to some warmer weather in San Antonio and Las Vegas, respectively. I’m not looking forward to being in crowded indoor spaces and potentially bringing home COVID, influenza, or some other respiratory illness, so we’ll have to see how it goes.

Any recommendations for a first-time attendee at HLTH? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Guillaume de Zwirek, CEO, Artera

Guillaume de Zwirek is founder and CEO of Artera of Santa Barbara, CA.

Tell me about yourself and the company.

I founded Artera seven years ago. We recently rebranded from Well Health. I had never been in healthcare before I founded the company. I was going through a personal experience with cardiac issues and had a really frustrating time interacting with all of my care providers outside of the four walls of the hospital. The question kept coming back to me — why is healthcare not amazing at customer service?

I founded this company with a simple mission, which is to make healthcare the very best industry when it comes to customer service. I came into it with a lot of naiveté and ignorance. We spent seven years thinking about how to build an effective patient communication system for hospitals that is open; that allows every vendor to deliver its interactions through that platform; and that allows health systems to control the flow, rhythm, and prioritization of their communication so they can have an effective and convenient relationship with their patients.

Is it harder in healthcare where health systems have a large volume of customers but see them infrequently and often involuntarily?

Healthcare is complicated for good reason. It’s protected information, and we want to be sensitive to the privacy of patients and their medical records. There are a lot of stakeholders, even within the hospital. You have your primary care doctor, specialists, labs, pharmacies, clinical trials organizations, payers, and employers. Those parties are are all competing at some point in time for the patient’s attention.

There isn’t a library of five care journeys. This isn’t like an airline, where people are only booking one-way flights, return flights, or getting connecting legs. An infinite number of scenarios could happen for a patient, which makes this so challenging,. Then you layer in all of the ecosystem of vendors who are all trying to help make that experience smooth. When you think about streamlining that communication, that’s a lot of people to consider.

Health systems will have different ways of thinking about the priorities. That’s what we’re trying to solve. How do you consider all of those voices; bring that and surface that to the hospital in a way that is easy to manage, control, and manipulate; add and remove players; and then have that experience feel completely seamless to the patient? We are largely SMS, but the dream is that you are on your phone, your doctor is saved as a contact, you have an issue, you send a text, you get a response back. Whether that response is automated, a human being, a PA that reports into a physician, I’m indifferent to that as long as we get the right answer to the patient every time in the medium that is most effective to them.

If I can just share a quick story, this came to life for me last week in a wonderful way. I got a call from one of our customers with a story. This customer, their population, is rather elderly. They skew probably 70-plus. They had a patient who had a fall and they were wearing an Apple watch that had their emergency contact saved as that hospital. When the new Apple Watch detects a fall, it will text your emergency contact. That text hit our system, a staff member saw it right away, and they got in contact with the family and arranged emergency services for that patient. There are so many scenarios like this one that we haven’t considered yet. That’s what makes this complicated, the infinite number of scenarios and players.

Amazon has set up its own personal monitoring program that is linked to Echo devices. Could a user’s preferred health system replace a third-party call center as a local first step for medical issues?

I had never thought of that, and I think that’s a very logical assumption. My wife works at Google and she just got a pamphlet in the mail for a 24/7 urgent care service where you can jump on the phone, and within two minutes, somebody’s on the other end triaging you. That’s actually driven by the payer, circumventing the health system that she would normally go to. The same thing could apply in this Apple example or Amazon with Echo.

It will be interesting to see where they start. If you can be that first point of contact, you have tremendous influence over where the care gets delivered. If that care is acute, if it’s a specialist type of visit, that’s where the money is made. It could be a big threat to hospitals.

My personal opinion is that competition is great and we should all challenge ourselves to do better. At my core, I believe in the physician-patient relationship. I believe that to be thoughtful and proactive about your care, you have to have a relationship with your PCP. You need to feel like you’re disappointing somebody and somebody has your back if you don’t adhere to directions.

I’ve been using the gym more regularly for three months. I went to see my PCP and he said, great news, your cholesterol has dropped 50 points, what changed? I said that I had started going to the gym. Now I’ve kept it going and I think of him every time. Maybe that’s just me, but I believe that when people have a great relationship with their PCP, they never leave, kind of like the dentist. That’s who our energy is going to be focused on serving,

How does a health system define their customer when people move around, change insurers that take them into or out of network, and perhaps don’t want to hear from providers until they have an acute need?

There’s a whole market around that with population health. Many companies are tackling who to reach out to and onboard, how to bring panels into the system. That’s why the relationship outside of that visit is so, so important. I texted my PCP to see if I could get the third booster, for example. There are so many opportunities for the physician to engage with you, or for you to engage with them, outside of the point of care.

When you think about the younger generation, if you can create that relationship with the parents, many children will follow in their parents’ footsteps. I hope that there doesn’t have to be an art of engaging this lost population who never got care. COVID may make that necessary for us to catch up. I hope that we can build those types of relationships from birth and it can be a habit that is sustained throughout a patient’s life. I hope that’s the norm that we can get to as a civilization.

We don’t expect to have a telephone conversation with an actual human employee when we need to interact with a big company like Amazon, where most communication is via an online form, email, or other electronic message. How has that expectation affected healthcare?

Access is good. The mode of the day may be messaging, but it will undeniably change. You see this with connected devices. The example you just highlighted presents an interesting opportunity for health systems and providers. These big tech companies are actually going to a further extreme, which is attacking the labor problem. They want to optimize, they want margins to go up, and they have started making everything automated.

I had an issue recently with a ride hailing service. I called the company and couldn’t talk to a human being. It only gave me automated menu options. I went through it five times just to keep saying I was dissatisfied. I wanted them to know five times that I was dissatisfied. There’s an opportunity for health systems to give real human care and not over-rotate the way some of these big tech companies are doing because of pressure from the public markets. It’s an interesting thing to explore. I’m going to bring it back to the team.

Who within a health system defines the messaging to customer personas that include both active patients as well as potential ones?

In the seven years since we started this company, this has changed. Seven years ago, it didn’t exist. There wasn’t anybody making those decisions. People were thinking about how to make sure patients show up to their appointments. It was a very specific point in time with the acute problem of making sure that we don’t have wasted slots. There’s more and more competition for the patient’s time right now, and there are more and more people who want to engage with a patient. 

The role that we have seen come up increasingly is chief digital officer or chief patient experience officer. They may be VPs or SVPs. Maybe the most famous example of this is Aaron Martin when he was at Providence. Right now, he’s at Amazon, going back to one of your earlier points, which should probably make us a little more scared of Amazon. I have seen the role of chief digital officer that focuses on end-to-end patient experience. Cedars-Sinai has a similar role. We’re seeing this more and more, and we are also seeing a lot of folks outside of healthcare being brought into these roles, pulling from places like Disney and AARP and other brands that have done a decent job of building those relationships with their customers. I like the trend and I hope it continues.

Was it a big change for EHR vendors to open their system to third-party applications? Do you expect further EHR integration developments?

There were couple of announcements recently. You wrote about this, with Larry Ellison at Oracle Cerner making a big push around partnering and saying that partners were really important to them. I love to hear things like that. It warms my heart. Epic has done a lot of work with their App Orchard, and they’ve announced a lot of enhancements to that program. That significantly expanded the APIs that are available. We have a close relationship with Oracle Cerner and Meditech as well, and we have seen them be open in terms of data sharing. It certainly is moving in the right direction.

With the interoperability that just went into play, there was some disappointment by a lot of folks in the space that it was pared back a little bit. There’s a lot of hoops that we have to jump through in healthcare. Even when we think about these feeds, APIs may cover 20% or 30% of the use cases for a vendor if you’re lucky. For the remaining 70%, you’re doing custom HL7 or going to FHIR or Interconnect web services.

That stuff is custom, and it rarely translates from customer to customer. That makes it significantly more complicated. It’s not like an app in the App Store, where you deploy it to Apple and anybody can download it. It requires an implementation. There’s a whole industry in healthcare around professional services and consulting firms that do this for a living. So we are definitely going in the right direction, but we are nowhere near where some other industries, like high tech, are.

A lot of technology adoption happened during the pandemic. As we try to find the new normal, how will that experience be applied?

I have this belief that in the universe, everything has to balance out at equilibrium. This is true for politics, relationships, you name it. Everything needs to find its balance. Things went off balance during COVID. What I’m seeing now is that we are going to shift to the other extreme, and eventually, we are going to find the middle ground. There was really quick adoption of lots of different forms of technology, purchasing cycles, and shortened deployment cycles. We solved problems very quickly.

I’m hearing more and more about consolidation. What does my EHR do? How much of this can I bring back to the EHR? I think we will see a significant paring back of the ecosystem of vendors that provider organizations maintain, along with a shift towards bringing things to the EHR that can be brought to the EHR. We will probably go to that extreme a little too much, and it will likely be a year or two before we find that balance again, where the EHR continues for those core investments and the truly additive things get prioritized and integrated and built on top of it.

How does the market for innovation look if EHRs replace some of those third-party applications and health system consolidation creates bigger but fewer prospective customers?

There’s a famous saying in Silicon Valley that down markets are where the best companies are formed. That creates pressure and forces entrepreneurs to the right places. If a health system can get “good enough” from their EHR, they’re going to go with that. Innovation will need to be unique, differentiated, and tough to replicate. It will do a good job of weeding out the possible solutions in the market, which could be good for healthcare IT overall. In the markets, it will look like investment dollars are slowing into healthcare IT. It will look like fewer purchasing decisions and like more consolidation. But the very best companies will form out of that pressure.

It will be net positive, but it will feel rough for a while. It may hurt health systems that adopted a lot of those technologies during COVID. Some of those technologies may disappear because the company goes out of business or is gobbled up by somebody else. It’s more important than ever to provide differentiated value and to understand the problems du jour of our customers, because they are very different than they were during COVID. It’s a totally different set of challenges. Now it’s labor shortages, labor costs, and margins. We see this in the news every day. We see a tremendous number of layoffs despite a really strong jobs market. It’s a confusing time.

What will be the direction of the industry and company over the next three or four years?

We absolutely have to be added to the EHR. We need to work with the big EHR players, understand what they’re going to tackle and what they’re not going to tackle, and fill in those holes. We need to pair that with what our customers are telling us they need, that are must-dos for them to get through this. It will  be a dark period for the next couple of years. 

We believe in creating an open platform. It will be important to create and invest in our infrastructure so that anybody in the healthcare IT space, any vendor, can route communications through us. I’d like them to be able to do it with no friction. Plug in to Artera once and you can send communication to any of our healthcare partners who enable you.  That’s where we need to get to. We need to create that network. That will create a lot of value for healthcare IT and health systems.

Morning Headlines 10/31/22

Teladoc Health Reports Third-Quarter 2022 Results

Revenue and earnings beat expectations due to strong performance in its virtual mental health business, sending shares up.

MUSC Health and The MetroHealth System create Ovatient

The non-profit company will provide virtual and in-home care, hoping to match the digitally powered convenience and experience offered by non-traditional providers.

N.L. Crown agency responsible for health care IT flagged ‘extreme’ security risk a year before cyberattack crippled provincial health-care system

Newfoundland and Labrador Centre for Health Information has been requesting a move from its 40-year-old Meditech Magic system to Meditech Expanse for reasons that include security.

Monday Morning Update 10/31/22

Top News

Teladoc Health reports Q3 results: revenue up 17%, EPS –$0.45 versus –$0.53, beating Wall Street expectations for both.

TDOC share price moved up on the news, although it remains down by 81% in the past 12 months. The company’s market cap is under $5 billion versus its all-time high of $45 billion in early 2021.

The company reports strong performance of its direct-to-consumer BetterHelp mental health business. It says it lost a former client of Livongo, which Teladoc acquired for $18.5 billion in October 2020.

Teladoc says that it is getting increased interest from organizations who want to use virtual health to manage chronic conditions at a lower cost.

Reader Comments

From Lomond: “Re: Cerner. Which of its missteps led to its sale to Oracle?” Cerner struggled with product issues (such as revenue cycle), dated architecture, and a client base that was being constantly poached by Epic. Multi-billion dollar federal contracts stretching over decades weren’t enough to keep investors excited. However, Cerner’s biggest mistakes were made by its board, who took forever to choose a successor when Neal Patterson died in 2017 despite the claimed existence of a CEO succession plan, which surely didn’t tell board members to, “Hire a low-profile CEO of a division of a foreign medical device manufacturer for his first real CEO job.” But to be fair, a lot of Cerner executives who should have been likely candidates, especially those who Neal didn’t like much, had already successfully moved on. Brent Shafer’s four years were forgettable except for the board’s capitulation to an activist investor, then the board hired as Shafer’s replacement yet another executive who had never run a publicly traded company, although maybe David Feinberg made Cerner look hipper to eventual acquirer Oracle in his fantastically lucrative few weeks as CEO. Looking ahead, I can’t think of many examples where acquired health IT companies got better running as divisions of unrelated companies whose own growth prospects were questionable, but Oracle is saying and doing all the right things so far. Boards have a fiduciary responsibility to investors and I think they chose the best available option in this case. It’s all great news for Epic, which at some point will have its own CEO succession plan tested in the same way.

HIStalk Announcements and Requests

Two-thirds of poll respondents had paid their co-pay by the time they left their ambulatory visit. My personal experience is that medical practices and clinics are much worse at upfront collection than dental practices, which always seem to know exactly how much you need to pay after insurance and nicely ask for that payment while you’re taking possession of your free toothbrush kit.

New poll to your right or here: In the past year, has a provider given you a blank paper or electronic form that asks for information they should already have on file? It is aggravating when the front desk people of a provider that you’ve been seeing all along ask for the same information that they have already collected – medical history, allergies, meds list, emergency contact, etc. – instead of populating the form and allowing you to provide any corrections or updates. Will someone actually update your EHR information correctly if your new list of allergies or meds doesn’t match what is on file? If not, are you completing the form just so the provider doesn’t have to look at the EHR?

I watched Netflix’s movie “The Good Nurse” and it was a so-so yarn about nurse Charles Cullen, who killed dozens or hundreds of hospital patients using drugs like digoxin and insulin that he obtained by taking advantage of a quirk in the Pyxis drug dispensing machine. The hospital’s stonewalling of the police investigation was a big part of the movie, but what should have been mentioned was that many hospitals were irresponsibly using Pyxis like candy machines in the early 2000s, allowing nurses to make withdrawals of unordered meds, storing drugs in shared drawers (Cullen punched in Tylenol, then took digoxin from the same shared drawer), and failing to audit what was taken versus what was charted as given. i wrote a daily report ago for my academic medical center employer years ago that identified Pyxis withdrawals of unordered meds (including logic to account for delayed order entry), and it was so lengthy that nobody would review it. Anyway, the movie recalls the 2017 case of VUMC nurse Rhonda Vaught, who overrode a drug dispensing machine safeguard to give a patient the paralyzing drug vecuronium instead of the ordered sedative Versed, after which the patient died. San Diego-based Pyxis went public in 1992, sold to Cardinal Health for $867 million in 1996, was spun off with other products into Carefusion in 2009, and then was acquired by Becton Dickinson in 2014 for $12 billion.

This is the final boarding call for companies that want to sign up as HIStalk sponsors before the spring conference season begins and you realize that your HIMSS booth doesn’t help you for the 362 other days of the year.

Welcome to new HIStalk Platinum Sponsor Censinet. The Boston-based company’s cloud-based RiskOps platform and collaborative risk network transforms cybersecurity and enterprise risk in healthcare with the fastest assessment results, most coverage, and best overall experience at a fraction of the cost. Its digital catalog includes 9,500 assessed vendors and 34,000 products and services, offering automated risk ratings and corrective action plan generation to streamline identification and remediation of risks with pre-built workflows. An example is generating a list of vendors and products that have access to PHI but aren’t covered with a business associate agreement. The company offers healthcare organizations no-cost access to its RiskOps for HICP, which simplifies the implementation and assessment Health Industry Cybersecurity Practices. Censinet RiskOps enables health systems to create long-term vendor partnerships, resulting in fewer vulnerabilities, reliable patching, and better performance and compliance overall. Thanks to Censinet for supporting HIStalk.

Here’s a video featuring Censinet founder and CEO Ed Gaudet, who describes the company’s philosophy and product.

Webinars

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

Acquisitions, Funding, Business, and Stock

Investor-backed HLTH says it has 9,400 registrants so far for its conference, which will be held November 13-16 in Las Vegas. I was surprised to see HIStalk list as a media attendee since none of us are going.

Sales

• Three university hospitals in France choose Sectra’s digital pathology solution.

People

Hearst hires Atti Riazi (Memorial Sloan Kettering Cancer Center) as CIO.

Announcements and Implementations

SNOMED and LOINC will collaborate to standardize health data terminology, distribute their content together, and reduce duplication.

Fresh Tri, whose app promotes healthy habit formation, updates its system with improved onboarding, new algorithms to match users to behaviors, and new behaviors to support condition and disease management. Walmart licenses the app for free use by its 1.6 million employees.

Spok’s annual healthcare communications survey finds that the top obstacle in hospitals is budget and resources. Smartphone use for clinical communications dropped slightly for the first time, possibly because hospitals are issuing wi-fi phones instead of asking employees to use their own devices.

MUSC Health and MetroHealth launch Ovatient, a non-profit company and care model that will provide virtual and in-home care. The health systems say they hope that Ovatient can match the convenience and experience that non-traditional providers are delivering using digital tools.

Government and Politics

National Oceanic and Atmospheric Administration confirms that it plans to go live on Oracle Cerner next year, although under the Department of Defense’s MHS Genesis project rather than the VA’s as initially reported. NOAA has 24 clinicians.

Privacy and Security

A review finds that Canada’s Newfoundland and Labrador Centre for Health Information was warned that its 40-year-old Meditech Magic system was vulnerable to hackers a year before a fall 2021 ransomware attack exposed patient information and caused treatment delays. NLCHI has been recommending for years that the province issue a tender to replace Magic, with one study projecting that a move to Meditech Expanse would cost $85 million over 10 years, but would more than pay for itself.

Other

Congratulations to New Jersey health IT consultant Eric Finkelstein, who has broken a Guinness world record for eating at the most Michelin-starred restaurants in 24 hours. He was able to obtain reservations at 18 of New York City’s best restaurants, traveling between them by Citi Bike bicycle and using a body cam to prove his accomplishment in wolfing down each place’s fastest-prep menu items, sometimes in less than two minutes. He spent $500 on his latest Guinness accomplishment, which also includes visiting all Citi Bike docks, making the longest table tennis serve, and building a flag out of 20,000 ping-pong balls.

Sponsor Updates

• First Databank helps extend adoption of NCPDP’s National Facilitator Model, which will allow pharmacies, prescribers, and government agencies to access real-time information on prescriptions, testing, and immunization.
• PeriGen CEO Matthew Sappern appears on Alldus International’s AI in Action Podcast.

Blog Posts

• Partners in Success: What to Expect from the RCxRules Implementation Process (RCxRules)
• Optimum CareerPath Celebrates Global Health Equity Week (Optimum Healthcare IT)
• 4 Steps to Vulnerability Remediation in Healthcare (Pivot Point Consulting)
• Don’t Get Spooked by Cloud Call Center Solutions (PerfectServe)
• Montefiore Medical Center Maximizes Savings and Drives Efficient Medication Use with Analytics (Premier)
• What’s the Promise of Healthcare Technology for Aging in Place? (Quil)
• Partners in Success: What to Expect from the RCxRules Implementation Process (RCxRules)
• Digital health is ready for its second act. Will it deliver on its promise to empower patients and providers? (Redox)
• New Research: Scheduling and communication technology integral to patient experience (Relatient)
• ‘Standard Bearers’ in E-Prescribing: CancelRx and RxTransfer (Surescripts)
• 8 steps for effectively coaching call center agents (Talkdesk)
• CIO Guide to Security and Patient Privacy (TigerConnect)
• The Rehab Therapist’s Guide to Co-Treatment Under Medicare (WebPT)
• A Change of Heart: Well Health Rebrands to Artera (Artera)
• Achieving Best Outcomes for Surgery in Older Adults (Zynx Health)

The following HIStalk Sponsors will exhibit at and/or sponsor AMIA 2022 November 5-9 in Washington, DC:

• Clinical Architecture
• First Databank
• Intelligent Medical Objects
• InterSystems
• Meditech
• Oracle Cerner
• Wolters Kluwer Health

Contacts

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