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Morning Headlines 5/3/22

May 2, 2022 Headlines 12 Comments

Virtual care enabler Capable raises $6 million

Capable Health, developer of plug-and-play virtual care software, raises $6 million in seed funding.

Guidewell and Highmark Ventures Lead $35 Million Funding Round in Kidney Health Leader Healthmap Solutions

Kidney care-focused analytics and population health management vendor Healthmap Solutions raises $35 million, bringing its total funding to $135.6 million.

Allscripts Closes Sale of Hospital and Large Physician Practices Business to Constellation Software

Allscripts finalizes the sale of its hospital and large physician practices business to Harris parent company Constellation Software for up to $700 million in cash.

Health startup MyNurse to shut down after data breach exposed health records

Virtual chronic care management and remote patient monitoring startup MyNurse announces it will shut down alongside its notice to users of a March data breach.

Curbside Consult with Dr. Jayne 5/2/22

May 2, 2022 Dr. Jayne 1 Comment

Today is truly a cleanup day. I’m plowing through 2,300 unread emails. Some days you just can’t make things up with the stories that are out there.

The US Department of Justice announces that a Long Island cardiologist has been charged with crimes related to a COVID-19 healthcare fraud enforcement action. He is alleged to have defrauded Medicare and Medicaid of more than $1.3 million in payments related to COVID-19 testing as he submitted claims to those payers for office visits that were not performed in conjunction with COVID-19 testing. The defendant’s practice had mobile testing sites across Long Island, and apparently some of the billed office visits occurred when the defendant wasn’t even in the state. The prosecution is part of a larger effort by the Department of Justice to crack down on those exploiting the ongoing public health emergency. Criminal charges have been filed against at least 21 defendants for COVID-related healthcare fraud and total nearly $150 million in false claims. The overall Medicare Fraud Strike Force, which was formed in 2007, has gone after more than 4,200 defendants who fraudulently billed Medicare for over $19 billion.

Just a little over a month ago, medical students across the US learned where they’d be doing their training as a result of the National Resident Matching Program. This article about a participant who didn’t match caught my eye. Travis Hughes completed both MD and PhD degrees at Harvard and had a lengthy curriculum vitae with numerous publications and four patents, yet still didn’t match into his desired field of dermatology. More than seven percent of fourth-year medical students in the US failed to match, so he wasn’t alone, although his qualifications likely make him unique. Rather than lament his situation, Hughes used the experience as the push he needed to move towards a career in healthcare technology.

I’m often contacted by people in similar situations looking for advice on moving into healthcare technology or clinical informatics. Not only do unmatched graduates reach out, but those who are in their last year of medical school and who have decided that clinical practice is not for them.

I’m supportive of people finding their bliss in medical careers that don’t involve seeing patients, but have some advice for individuals in this situation. First, just because you graduated from medical school doesn’t mean that you understand what it takes to become a board-certified practicing physician. There’s a lot that happens during the three to seven years of residency training and no amount of reading about it or having friends who are in residency is going to help you become equivalent.

Second, if you’re going to try to find solutions for practicing physicians, you need to understand what happens once you are in practice. Learn what a RVU is or how physician compensation is influenced by patient satisfaction scores and clinical quality metrics. Learn how hard it is to keep a medical practice staffed to a level that provides high quality care but runs as cheaply as corporate employers require.

Third, please don’t talk to practicing physicians like you’ve been in their shoes. Over the past two years, I’ve had many patronizing encounters with physicians who have gone the start-up route. I don’t want to hear about how you dropped out of a surgical subspecialty residency the year before graduation, yet you think you understand what it feels like to be a practicing family physician or an emergency physician dealing with COVID. Sure, you can talk about how you understand the market forces and the pressures we’re under, but you certainly haven’t been there or done that. Also don’t talk about patients like they’re numbers or widgets, because those of us who really treasure the patient/physician relationship aren’t likely to warm to that strategy. If you want to impress us, make sure we feel like you understand that those patients are someone’s mother, grandfather, sister, or child.

Finally, if you’ve decided to take a different path in your career, get some training. If you want to go into clinical informatics, maybe you should join the American Medical Informatics Association. Consider taking one of the 10×10 courses that they offer in partnership with Oregon Health & Science University. Do a fellowship in clinical informatics. Don’t post on physician-focused Facebook groups that you’ve just decided to go into informatics and ask how to get jobs with no experience and no training. Definitely don’t demand that people call you and give you career guidance because you’re too lazy to spend some time on the internet figuring out what it takes to be qualified in the field.

I do wish good luck for all those who are contemplating career changes or who did not match. Much work is ahead and it’s a difficult road. Hopefully, this advice might provide a small amount of insight for those walking it.

I’m doing a fair amount of work with various vendors and have been invited to participate in multiple vendor user group meetings for the upcoming season. While some vendors are going back to their tried-and-true pre-COVID meeting plans, others are using the opportunity to make changes to format and desired attendee profiles. There have been a few recent in-person meetings since HIMSS, and by report, the attendance has been less than previous years. Epic kicked off its XGM Expert Group Meetings last week in Wisconsin and they continue through the end of this week. The American Telemedicine Association meeting is also happening this week in Boston. I’d love to hear from attendees as far as their boots on the ground experiences as well from others who have decided not to attend conferences right now. At least one major health system that I interact with has continued to restrict business travel for the remainder of 2022. They’re not saying employees can’t travel, they’re just refusing to pay for any of it, blaming it on COVID.

Although various states, jurisdictions, and businesses have collectively decided that COVID-19 is over, it’s starting to make a return in my area. Several schools are hitting the thresholds for which students and teachers have to resume masking. I’ve got a couple of flights this week, and despite the airlines’ movement to a mask optional arrangement, I’ll be sporting a KN-95. Even though the COVID infections that most people are getting now are relatively mild, we’re starting to see much more long-term data that shows that even people with mild infections are at higher risk for cardiovascular and other complications. I’ve dodged it so far and am hoping my luck holds.

From a patient care perspective, it’s the school and sports physical season as young people get ready to go away to camps or to prepare for fall sports. Our state has instituted a special process for return to play in youth who have had COVID, and we’re finding quite a few athletes who aren’t as healthy as they thought they were before we started asking some very pointed questions.

Is COVID-19 still playing a role in your habits or travel plans? Is your employer still requiring any mitigation strategies or is everyone back to the office as usual? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Carina Edwards, CEO, Quil Health

May 2, 2022 Interviews No Comments

Carina Edwards, MBA is CEO of Quil Health of Philadelphia, PA.


Tell me about yourself and the company.

I have spent more than 25 years in healthcare technology. I have dedicated my focus and career on delivering experiences that delight customers and drive value and success in digital health. It has been fun being the CEO from the inception of Quil.

Quil is a digital health joint venture between Comcast NBCUniversal and Independence Blue Cross. We help people organize and navigate their health lives in partnership with their providers, their health plans, and their loved ones. We have two solutions. Quil Engage is the care engagement platform that delivers intelligently individualized care journeys to support patients during every step of their care, prescribed by providers and sold to provider organizations. We now have Quil Assure, the connected home platform sold direct to consumer, that helps seniors enjoy greater independence with exercising their preference for aging in place and strengthening that support between the family and friends serving as caregivers.

Seniors say they will accept some kinds of caregiver monitoring technology, such as fall detection and movement tracking, but draw the line at being monitored constantly by audio or video. How does that affect the ways in which monitoring can be performed?

In all of our research, we confirmed the same findings. We have 54 million unpaid caregivers in the country. There is a booming silver tsunami of seniors, and all of them want to live in their home as long as possible. When you start thinking about that dynamic, we need more technologies to help them live independently, but we need those technologies to be invisible to them. To support the caregiver, but also support the senior.

In our research, we focused on ambient sensing. We are leveraging some of the foundations that we know very well from the Comcast side of this joint venture, which is that connected home with motion sensors, door detectors, and connected hub. Being able to take machine learning and the bots that we’ve written to detect anomalies in daily patterns of living and notify on those anomalies. Then, also connect into the broader Internet of Things ecosystem that people have adopted across all ages.

With COVID, you are now seeing the 65-plus community being way more technology receptive. Being able to connect to their Apple Watch if they’re tech savvy. Being able to connect to their Alexa ecosystem for their weekly grocery orders. Having that open platform, but the importance being how the caregiver can verify that everything is OK. Did Mom get up on time? Are things going well? Has she been to the kitchen three times a day like normal? What going on that is abnormal? Did she leave the house for an extended period of time? All of those things to support the senior so that if they need help, it’s there.

How can technology address the key concerns of falls, wandering, and accidentally creating dangerous situations with normal household equipment such as stoves and bathtubs?

A lot of it is sleep quality, which is interesting. Are they getting around the house doing activities of daily living? Are they going to the kitchen? Are they not going to the kitchen? Are their bathroom patterns changing? In early trials, we’ve detected UTIs and other things because of just pattern anomalies. Temperature sensing is a huge one. We’ve had some seniors in the trial where they didn’t want to bother the caregiver, so when their heat went out, they just didn’t say anything. But then the system alerts when it’s turning to 55 in the room.

“Set it and forget it” ambient technologies don’t make them feel like they’re being watched. They’re not being actively probed. They don’t want to interact with the technology if they don’t have to. But then when it’s there, leveraging the pattern button, personal emergency response activation, or even if they’re connecting in the IoT ecosystem, “Hey Alexa, call Quil,” we can be there 24/7 to respond to those things. Sensors and triggers let us see certain patterns that would indicate a big abnormality, so we will start calling down the caregiver circle to make sure they’re checking in on Mom.

The old-school technology is to call the person daily to ask how they are doing and listen for anything concerning in their response or their voice. Do any technologies simulate that phone call type of monitoring?

We are doing insights in the app. The caregiver gets push notifications, text messages, and phone calls. They can see that Mom’s up and about and it looks like a great day. Those type of insights are coming back to the caregiver’s phone. The nice thing is if Mom is technically savvy, she also gets that same view. 

The interesting part is what we’ve learned from the caregivers. There’s this relationship that they are trying to form and it gets stressed when, every time you call, it’s about their health. There’s this fine balance between, “I know I’m aging and I know I have challenges, but don’t remind me of it all the time” and the caregivers saying, “I love being there for you, but it’s sometimes a little bit exhausting and I’m really worried that you’re not OK.” Bridging that relationship with insights that keep everybody on the same page — how things are going, any tasks and appointments coming up, medication reminders — and leveraging that technology to set those reminders so that Mom can acknowledge with their voice that they have taken that medication.

How does technology address those folks who are mobile and can run errands or visit a friend and the caregiver wants to make sure they get home when expected?

We detect when they leave the house, because then there’s no motion in the house and we have the door sensor. This is a learning system, so we learn their patterns over time. The caregiver can also set that they are on vacation or doing something abnormal. It isn’t sensing and triggering, but we are learning, “Looks like bridge club on Tuesdays, normal event. No worries, Mom comes back around 5:00 PM.” Those are the things that we are constantly fine tuning to make sure that we’re understanding the value that those insights provide. And respecting so that the senior in all of this knows what’s being shared, why it’s being shared, and how it’s helping with technology on their terms.

Big players like Best Buy and now Amazon, with Alexa Together, are involved in selling monitoring equipment and services directly to consumers. In Amazon’s case, it is powered by the same Echo devices that a competitor might use and is tied into third-party sensors such as fall detectors. How is the market evolving?

It’s the race to the connected home. I’m excited that we have a head start with Comcast. Then on the population basis, it’s that connectivity and receptivity of seniors to technology. As I mentioned earlier, I think that COVID has accelerated that comfort level with technology. I manage, or as I love to say, I love four people over 78 in my life. It’s hysterical that when I talk to them, if I’m not on FaceTime, there’s an issue – “Why aren’t you on FaceTime? I can’t see you.” Before the pandemic, that was never a thing. 

As we’re seeing this change in receptivity and now this race to the home, I’m also excited about the other side of our joint venture with Independence Blue Cross and the Medicare Advantage population. We see the joint venture through two very connected lenses. One being that we have “prescribed by provider” with Quil Engage. We have now the connected home. We are thinking about models of risk, pulling this all together to say, that’s what we mean by convergence with the home and health at home in a new way. 

It’s a really exciting time with lots of great players in this space. The question is, what level of depth in healthcare will each of the organizations go into? We’ve seen some early acquisitions that are indicators, but a lot more to come. I never dismiss Amazon ever, or Best Buy. Everyone is in this market.

Does the business model require running a 24/7 call center, or can companies provide just the technology without that escalation capability?

This goes back to what populations you’re serving for the level of escalation. We are looking at the market where safety protocols and emergency support are critical for a certain segment of the population. We think about this as a connected care circle, not just your daughter or your daughter’s husband, but even a neighbor just to check in. As we’re thinking about this, the setup and the onboarding process is critical to figure out and evolve with the senior and their patterns. Start with them. Call the house, “Hey mom, how’s it going? Everything OK?” I’m noticing some pattern detection. No answer, call the first person on the call tree, and then go down the list.

If we find something critical, we will absolutely send EMS, but we think about that person’s community and how they want to be escalated. We want to give them independence. With technology, we have so many different ways to turn on and off alerts and escalations based on their desire.

I worked at Philips years ago, and when we bought Lifeline, I got it for my grandmother. She was in an apartment building in Florida and had to do her laundry in the basement. She was taking a basket of towels down to the basement and she hit the button accidentally. EMS came and she was mortified, mortified. That button never went around her neck ever again – it sat in the basket by her bed. Unfortunately, she did have a fall in the house. Couldn’t get to the button. Thank goodness that she lives in the apartment building, because her neighbors checked in on her. It was her neighbor that found her three hours later.

We have learned so much about the sensitivity of the community, about what they want. Targeting their wishes. Do you want EMS to be initially protocoled or not?

The Echo devices have an option to connect with other devices in the neighborhood. Is there any movement to use that to create groups who can keep an eye on each other instead of going from zero to 60 in dispatching EMS?

We have that in the care circle pieces, where they can invite anybody they want, friends or family. They can designate who they are, what they can see, what they can’t see. You hit it spot on that there is a range between zero to 60, and the world of personalization matters to this generation. They want it on their terms. As we are fine tuning all of this, giving that control to the senior who could literally just turn off whoever they want, to turn off any time on their own device, because they’re seeing the same things that the care circle is seeing.

How do you contrast selling directly to consumers instead of to insurers or employers?

The fun part about this being a joint venture is that we get those great best practices from both parent organizations. Our direct to consumer approach was heavily influenced by best practices that Xfinity has done quite at scale with Comcast. Same with Independence. We’ve learned about routes to market for different populations and payers and self-insured employers and how they interact with companies. We’ve built models aligned with those best practices, and that’s allowing us the time to start this conversion piece and be different than some of the more traditionally funded companies. There’s always pros and cons for joint ventures, and this is one of the pros.

When you look at the entire market for remote patient monitoring and other work your company is involved with, how do you see the market evolving over the next few years?

The question that is so critical here is, what does convergence to the home actually look like? We keep on calling it the home like it’s a physical thing. I look at the home now in two different pieces, the digital home and the physical home, or homes plural in populations of different segments and demographics. 

As we start blurring these lines and we start seeing risk shift in different ways, this is where the models get really interesting. Whether it’s hospital  at home, in a risk-based sharing agreement with new signals from the home that are extended for this population as a benefit, wow, that’s an interesting model. If it’s, “I just had a health event, now the person that’s recovering is no longer steady and needs extra eyes,” there’s a referral model. Then there’s the direct to consumer model.

I dislike the word consumerism because really it does come down to, where is the risk, who’s the buyer, and what is the value being derived? How do you make sure you stay clear on that ROI to each of the parties? In a way, you start becoming this B2B to C2C connectivity arm that’s converging on the physical and digital home.

Morning Headlines 5/2/22

May 1, 2022 Headlines No Comments

Walmart Health Introduces Telehealth Diabetes Program To Help Businesses Support Employees Through Education and Behavioral Care

Walmart rolls out a diabetes telehealth program for employers that includes diabetes education, behavioral health analysis and counseling, and discounts on insulin, diabetes medications, and test kits.

HST Pathways Announces Acquisition of Simplify ASC

Ambulatory surgery software vendor HST Pathways acquires competitor Simplify ASC.

Configo Health to relocate to Asheville, raises $2M for growth in Western NC

Configo Health, a North Carolina-based startup that has developed benchmarking analytics for pediatric hospitals, raises $2 million.

Monday Morning Update 5/2/22

May 1, 2022 News 6 Comments

Top News


Walmart rolls out a diabetes telehealth program for employers that includes diabetes education, behavioral health analysis and counseling, and discounts on insulin, diabetes medications, and test kits.

The program was developed with the American Diabetes Association.

The service is provided through MeMD, a Phoenix-based multi-specialty telehealth provider that Walmart acquired in May 2021.

Walmart will sell the program as a standalone offering or as part of a comprehensive telehealth program.

Reader Comments


From Enumerator of Beans: “Re: Teladoc’s share price. Stupendously bad, but take a look at Amwell’s enterprise value, which is less-famously awful.” Refresher: enterprise value (EV) looks beyond a publicly traded market capitalization to also include the company’s debt and cash, which is how a potential acquirer would evaluate it. Amwell’s market capitalization is around $900 million as Teladoc’s woes dragged AMWL shares to record lows, but even worse, Amwell’s EV has tanked from $3 billion a year ago to $150 million now, which seemingly provides a buying opportunity for the strong-stomached investor or down-trending competitor. Teladoc’s market cap has shed more than 80% in that same year as EV slid from $29 billion to $6 billion even as management was hyping the company’s business prospects (I can’t imagine that won’t trigger a bunch of lawsuits). The smartest person in the telehealth room turns out to have been invited visitor Glen Tullman, who found a buyer-in-heat in Teladoc who was willing to massively overpay for largely untested Livongo in that brief pandemic moment where telehealth looked unstoppable, insatiable investors were wildly overfunding digital health companies, and companies sought acquisitions that would arouse or confuse investors (or both). No wonder Glenn is ubiquitous as a conference keynoter, with the sometimes comical train wreck that was Allscripts under his watch being long forgotten.

From Curious from Across the Pond: “Re: American healthcare. Has all the money spent my vendors and the federal government actually improved patient care compared to Europe? It seems that most of the money is to make sure that health systems can bill and collect for ‘patient care’ and that it’s all about growing market share and preserving monopolies and patient care is the last thing on their mind.” US healthcare is bureaucracy-powered big business, not a social obligation, but governments love it because it creates high employment, big political donors, the illusion of economic growth, and shiny new buildings where politicians can pose cutting ribbons. Technology and policies that claim to have the power to improve outcomes and cost can only be as effective as the underlying healthcare system they support, and ours is a mess with no political will to change it given that the wealthy like it just fine. As far as health IT claims, vendors and fawning press cheer every announcement but fail to mention the frequent failure that follows or the user missteps that contributed.

HIStalk Announcements and Requests


Poll respondents say that the factors that are most important to AI’s eventual success in healthcare are maturation of the technology, proven outcomes, and building trust. Commenters noted the need for better-quality EHR data and the alignment of economic incentives.

New poll to your right or here: Within the past two years, have you had to pay a medically related bill that created at least a modest degree of financial hardship?

I received a brilliant spam email this week – Bitdefender warned me that the “unsubscribe” link pointed to a phishing page.


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

Acquisitions, Funding, Business, and Stock

Weight loss app vendor Noom lays off 180 coaches and will part ways with 315 more employees in the next few days, according to a Business Insider report. The company is trying to pivot to scheduled video-based coaching instead of immediate text-based engagement that often involved canned messages and lessons. At least the company is loyal to the video-based model – the employees who were laid off were notified in group video calls.

Spok announces Q1 results: revenue down 6%, EPS –$0.37 versus –$0.12. The company says its strategic alternatives review resulted in no options to sell the company, so it will continue to operate as a standalone business.

Ambulatory surgery software vendor HST Pathways acquires competitor Simplify ASC.



Renee Emmer, RN, MS joins VCU Health as associate VP of clinical informatics.


Ann Baty (OmniSys) joins HealthMark Group as VP of marketing.

Announcements and Implementations

Olive releases Care Campaigns, an automated patient communication and outreach solution whose first user is Gundersen Health System.

Canada’s seven-hospital Hamilton Health Sciences will go live on Epic on June 4 in a rare move straight from paper charts that are scanned into CGI Sovera.

Aurora St. Luke’s Medical Center (WI) joins a clinical trial of UltraSight Echocardiographic Guidance, a machine learning app that helps medical professionals who don’t have advanced echocardiography training to position the transducer.

Rochelle Community Hospital (IL) goes live on Epic, replacing Meditech and Athenahealth. 


Oxford University Press launches Oxford Open Digital Health, an open access journal that will focus on digital health interventions in low- and middle-income countries. The editor-in-chief is Alain Labrique, PhD, MHS, MS, professor and founder of the Johns Hopkins University Global MHealth Initiative and chair of the WHO Digital Health Guidelines Development Group. 


In Norway, St. Olav’s Hospital trains volunteers from the local senior center on HelsaMi, its patient portal that is powered by Epic MyChart, so they can help other seniors.

Government and Politics


Interesting from Politico: a historical graph of how many years Medicare’s Part A fund for hospital expenses has left before running out of money. Today’s number is four years, as in 2026 the fund will go broke because the number of enrollees and their expenses has risen faster than funding from payroll taxes, and that doesn’t even account for pandemic-related impact. The long-term fix would be to shift to value-based care, which would require not only a lot of legwork, but rare political unity. The “gimmick fix” would be to shift some Part A services to Part B, which is funded by premiums and other taxes.



Neonatologist Ross Sommers, MD, who recently founded NICU-at-home monitoring software company Firstday Healthcare, posted this on LinkedIn. I found it interesting given the cost and family disruption involved with NICU babies. The company offers continuous vital signs monitoring monitored by board-certified neonatologists, AI-powered deterioration prediction, a parent app that includes medical records, and care coordination.

A small University of Colorado survey of patients who were given online access to their radiology images and reports finds that most said it was helpful in understanding their condition and few reported being worried or confused. One-third of them saved a copy, one-fourth shared them with a doctor, 15% used them to get a second opinion, and 3% posted them on social media.


Sam Johnson, fired last year as CEO of telehealth vendor VisuWell after he was caught on video telling high school senior Dalton Stevens that they “look like an idiot” for wearing a dress on their way to the prom, sues comedian Kathy Griffin for making fun of him. He says the ridicule triggered a backlash against him and his family. Johnson says he is suing “to stand up against the woke social mob that wants to strip of us of our livelihoods and careers.” He says his issue wasn’t the student’s attire, but rather that the group was being obnoxious and profane in one of his favorite restaurants. Johnson says that he will never again sign an employment agreement that doesn’t contain a “slow action cause” that subjects employment actions resulting from a news story, social media post, or boycott demand to a 30-day cooling-off period. Johnson says that VisuWell and “several health systems” made false statements that were published and urges followers to read the coverage on Fox News. Two months ago, he accused the Nashville Business Journal, VisuWell, and LinkedIn of flagging one of his LinkedIn posts as harmful, which he summarizes as “scared pansies.”


The metaverse quickly got creepy. Bored Carnegie Mellon researchers fit haptic sensors into an Oculus Quest 2 headset that transmits kissing sensations to the wearer’s lips, teeth, and tongue. They describe mundane game-playing uses such as brushing teeth, smoking, and drinking coffee, either naively or coyly overlooking more lucrative integration. SecondLife perverts have a new home.

Sponsor Updates

  • KLAS research ranks Meditech among the top two EHR vendors market share growth.
  • EClinicalWorks releases a new podcast, “How EClinicalWorks RCM Service Boosts Efficiency.”
  • OptimizeRx will exhibit at MedDev 2022 June 7-9 in San Diego.
  • Optum donates COVID-10 test kits to increase access to free testing among underserved communities in Chicago.
  • PatientBond will exhibit at the UCA/CUCM 2022 Annual Convention through May 4 in Las Vegas.
  • PerfectServe will present at the Powderkeg Unvalley virtual conference May 11-12.
  • Premier’s S2S Global donates urgently needed medical supplies to Ukraine via United Help Ukraine.
  • The HIT Like a Girl Podcast features Tegria Director of Patient Access and Technology Rodina Bizri-Baryak.

Blog Posts


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


Morning Headlines 4/29/22

April 28, 2022 Headlines No Comments

Teladoc Health Reports First Quarter 2022 Results

Teladoc Health reports Q1 results: revenue up 25%, EPS -$41.58 versus -$1.31, with the loss driven by a somewhat expected $6.6 billion impairment charge from its $18.5 billion acquisition of Livongo in 2020.

Syllable Raises $40 Million Series C Led by TCV to Improve the Patient Experience with Intelligent Voice Solutions for Health System Call Centers and Medical Practices

Syllable, which sells intelligent voice systems for health system call centers and practices, raises $40 million in a Series C funding round.

Cerner ticks higher on report Oracle likely to see smooth European review

A European antitrust review of Oracle’s planned acquisition of Cerner is likely to surface no concerns, according to a recent report.

News 4/29/22

April 28, 2022 News 4 Comments

Top News


Teladoc Health reports Q1 results: revenue up 25%, EPS -$41.58 versus -$1.31. The loss was driven by a $6.6 billion impairment charge from its $18.5 billion acquisition of Livongo in 2020. Teladoc had warned in early March 2022 that it would write down up to $4 billion of the Livongo acquisition.

Teladoc also cut its full-year revenue and earnings outlook.

TDOC shares dropped 40% on Thursday. They are down 82% in the past 12 months versus the Nasdaq’s 9% loss. The company’s market cap is $5 billion, with Teladoc having lost $39 billion of shareholder value in 14 months.

From the earnings call:

  • The company says it remains confident in its whole-person care strategy, which it describes as “the future of digital health.”
  • Performance of its BetterHelp direct-to-consumer mental health service was less than expected, which the company believes is due to smaller competitors going after potential customers and taking advantage of pandemic-relaxed controlled substance prescribing regulations. Three-fourths of the company’s projected revenue reduction is attributed to BetterHelp.
  • Sales to employers slowed as companies focused on COVID and return to offices. Teladoc also blames “noise in the marketplace” from smaller point solutions.
  • Teladoc reports 54 million paying members, with 731,000 of those enrolled in chronic care programs.
  • CEO Jason Gorevic says that increased customer acquisition cost, mostly due the cost to buy advertising in search results and social media,  was caused by smaller private competitors that have been “recently well funded with a rash of venture capital money” that are making “economically irrational decisions.”

Reader Comments

From Down Underware: “Re: Australian Medical Association. Wants hospitals to eliminate fax machines to improve communication and patient safety.” Banning fax machines would most likely cause communication and patient safety to tank in the absence of solid interoperability. The market will gratefully accept a substitute that checks these boxes and is documented to improve cost and outcomes:

  • Faxes are universal. You only need someone’s fax number, not their permission or prearranged terms, to send them something and then walk away.
  • They are cheap, easily maintained, and never go down.
  • They can be used anywhere there’s a copper telephone wire even in the absence of broadband or cell coverage.
  • Issues of sending and reading protocols don’t exist – the piece of paper on one end pops out as piece of paper on the other end that doesn’t need to be printed as an extra step. What is sent is exactly what is received, with no chance of misinterpretation or sender technology changes that render the information unreadable.
  • Delivery is immediate and verifiable.
  • The recipient is more likely to notice a new paper popping out of the fax machine than an on-screen alert.
  • Fax machines don’t host viruses, there’s not much hacking risk, a malicious fax can’t take your network down, and incoming faxes are as secure as the physical location they are sitting in.


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

Acquisitions, Funding, Business, and Stock

A report says that a European antitrust review of Oracle’s planned acquisition of Cerner is likely to surface no concerns.


A former engineering VP of mental telahealth vendor Cerebral sues the company, saying that they fired him after he complained about its plan to prescribe stimulants to 100% of its ADHD patients. Matthew Truebe says he told the company that patients were setting up multiple accounts to buy extra drugs, as evidenced by 2,000 duplicate addresses in the shipping database. He also says the company ignored his concerns about thousands of patient records that were exposed in a breach.


Syllable, which sells intelligent voice systems for health system call centers and practices, raises $40 million in a Series C funding round.

Microsoft chairman and CEO Satya Nadella says in the company’s earnings call that its Nuance acquisition gives it a platform layer for AI-driven applications in healthcare and contact centers. He says the company will aggressively innovate with Nuance and expects to increase its impact on healthcare, specifically with physician burden.


  • Prisma Health (SC) chooses Philips for patient monitoring, enterprising imaging, and analytics.


image image

Intelerad hires A. J. Watson (Doubleclick) as chief product officer and Paul Johnson (Amwell) as chief delivery officer.

image image

Well Health hires Sarah Shillington, MS (TigerConnect) as SVP of customer experience and Ashu Agte, MS (Autodesk) as SVP of engineering.


Susan Worthy (Optum) joins Amwell as chief marketing officer.


Adventist Health promotes Jennifer Stemmler to chief digital officer.


Salesforce hires Maura King, MBA (Workday) as RVP of enterprise healthcare providers.


Bruce “Skip” Lemon joins Impact Advisors as VP.

Announcements and Implementations


A Panda Health survey of 100 C-level health system executives finds that more than half of them get more than 11 calls and emails each week from digital health vendors, leading 95% of them to conclude that it’s hard to decide which products are worth investigating. Half of the health systems don’t have a strong digital health strategy, and three-fourths of those that have bought digital health solutions are not confident that they chose wisely. Two-thirds say that it takes them at least six months to get to contract signing, with most of the time spent vetting integration capabilities and comparing product functionality.

Tenet Healthcare admits that its recent computer downtime was caused by a cybersecurity incident. The for-profit hospital operator scolded a South Florida TV station early this week for interviewing a patient who worried about the possibility of downtime-caused medication errors, calling it “preposterous” to suggest that paper-based downtime procedures are less safe.

1upHealth announces SQL on FHIR, which allows organizations to make decisions using SQL tools such as Microsoft Power BI and Tableau without coding in FHIR.

Privately insured patients who receive a new diagnosis from a telehealth visit are no more likely than their in-house visit counterparts to visit the ED or be hospitalized within 14 days, a study finds. However, three of 21 conditions were exceptions – upper respiratory infections, bronchitis, and pharyngitis, which researchers think is because those patients required COVID-19 evaluation.

A CoverMyMeds survey of 400 nurses identifies these medication-related technology needs:

  1. A centralized location for medication information.
  2. Knowing the medications that a patient’s insurance covers.
  3. A seamless way to provide medication information to prescribers, such as prior authorization requirements, symptoms, allergies, medication history, and plan formulary.
  4. A better way to perform prior authorization requests proactively instead of waiting for pharmacy rejection.
  5. Ways to reduce pharmacy telephone time, ideally with solutions that provide information at the point of prescribing.
  6. Easy access to a patient’s medication history, including the active meds list that less than half of patients remember, as well as a list of medications that have been tried unsuccessfully as needed for prior authorization requests.
  7. Real-time formulary and benefit updates.
  8. Efficient ways to identify covered alternative medications.
  9. Clearer job expectations, with one option being creating a centralized team to manage prior authorization and insurance interactions.
  10. Moving tasks to EHR workflow, as half use non-EHR applications at least once per day and 20% use their smartphones after the patient leaves.

Government and Politics

The federal government’s Cerner system – spanning the DoD, VA, and Coast Guard — goes down twice this week, once because of a system update that was delivered at lunchtime and the second due to load imbalance, VA and Cerner officials explain at a congressional hearing. Cerner executives told lawmakers that it may commission an independent review of its system to make sure it is stable enough to deploy further.

The Texas Medical Association says in a comment to ONC that 42 of the proposed USCDI Version 3 data elements are not backed by a standard, which will create a lot of work, limit data transfer, and require rework once standards are developed. It cites an example of a hospital that is blasting out ADT information to meet CMS requirements, but a small primary care practice had to hire people manage the flood of information that is not human-readable or and often isn’t useful.



A NEJM article questions whether the time and money that is spent on hospital quality improvement is worth it, as entire industries are created as soon as a measure’s score is tied to payments. The definition of quality remains hard to pin down, it says. It notes the irony of CMS suspending quality reporting requirements early in the pandemic so that “the healthcare delivery system can direct its time and resources toward caring for patients.” Experts say that QI is a billing-driven, box-checking exercise that still can’t answer basic questions about preventable deaths or overutilization of services. The article says that Medicare Share Savings Programs have been expensive to operate and have done little to reduce costs or improve quality in their patients. It also notes that profitable hospitals can afford to hire teams to optimize coding (averaging 50 to 100 employees who do nothing but support measurements), while safety-net hospitals and those serving the highest-risk patients bear the brunt of financial penalties. The administrative costs of quality measurement cause community doctors to retire and small practices to be acquired by hospitals.


This is not an early draft of Prince’s Love Symbol, but rather parietal art from the scientifically unsound early days of the pandemic, when stores like my local Walgreens above decided that the virus could be stopped dead in its tracks by making aisles one way to prevent masked customers from facing each other for five seconds. The permanently embedded tape marks obviously aren’t the only reason this ratty carpet needs to go. Also featured in this Walgreens is a Pompeii-like abandoned back section whose surviving sign suggests that it was once a health center, now occupied by carelessly parked carts of inventory awaiting displaying or disposal. The pharmacy metal doors were locked down when I dropped by this week, which has happened three times in maybe eight total visits — once because the power was out, once because the employees had locked themselves out of the pharmacy, and this time because the pharmacist had a death in the family and the store couldn’t find coverage. On the other hand, once the garage-like doors were again rolled up, a patron could obtain a COVID shot, frozen White Castle hamburgers, a rectal thermometer, and a Paw Patrol life jacket within a 10-step radius.

Sponsor Updates


  • AdvancedMD employees join Catholic Community Services of Utah to serve 2,000 meals to community members.
  • The Sheffield Teaching Hospitals NHS Foundation Trust adds Agfa HealthCare’s enterprise imaging solution.
  • Healthcare Triangle publishes the results of a new survey, “Acceleration of Blockchain Adoption in Pharma & Life Sciences.”
  • Nordic posts a new monthly episode of its “DocTalk” series titled “Cloud Approaches for Modernization.”
  • Imprivata secures additional funding from Thoma Bravo to finance its acquisition of SecureLink.
  • Wolters Kluwer Health’s Lippincott Nursing Education solutions have been selected as 2022 SIIA CODiE award finalists in seven categories.
  • Medhost celebrates Patient Experience Week.
  • Texas Association of Community Health Centers offers its members remote patient monitoring from CareSignal.
  • Newman Regional Health (KS) uses Meditech to transform sepsis treatment.
  • Nordic Consulting joins the ServiceNow Partner Program.

Blog Posts


Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
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EPtalk by Dr. Jayne 4/28/22

April 28, 2022 Dr. Jayne No Comments


Half a dozen people sent me this article about Teladoc’s stock woes following recent statements on its outlook. Based on the comments of company leaders, it seems their customer acquisition costs are higher than anticipated. They also cited lengthy sales cycles as a barrier to growth.

Having been on both the health system side and the vendor side of the process, everyone underestimates the length of the sales cycle. My former hospital employer locked in budgets in July of the preceding year, and if you wanted to buy anything that wasn’t previously budgeted, you had to figure out how to fund it from your allocated bucket. Even if you were replacing a system with something newer and more efficient, you better not cross the red line with implementation or consulting fees. This ultimately led to a glacial experience for vendors trying to bring new solutions to the organization.

There have been some interesting articles in the telehealth literature of late. One looked at rates of antibiotic prescriptions for acute respiratory infections and compared performance by hospital-employed physicians to that of third-party contractors. There was a higher rate of antibiotic prescriptions by the contractors. Although the conclusions have received a lot of publicity, I think the results demonstrate that additional analysis is needed. The study looked at telehealth visits for health system employees and dependents between March 2018 and July 2019. The study was controlled for patient age, day of the week, and overnight visits. It only looked at 257 telemedicine encounters for acute respiratory infections.

In my experience as a telehealth provider and CMIO, the study didn’t look at some variables that can influence prescribing patterns. Number of years post-training can indicate whether the physician’s formative years occurred in the “less is better” era of antibiotics. There have been a lot of semi-retired physicians in my telehealth groups who might not be as close to current evidence as we’d like. Importance of patient satisfaction scores is another factor, and I’ve seen plenty of prescriptions issued in both the telehealth and in-person arenas by physicians who didn’t feel empowered to say no because of the potential impact on patient satisfaction scores. Method of compensation can also be an influence when physicians are paid on volume – it takes more time to explain why you’re saying no, which means lower wages for those providers versus those who are being paid a shift rate or who are compensated using other variables.

It also didn’t note whether the physicians were practicing on the same EHR system or whether the telehealth vendor had its own platform. I’ve practiced with three national telehealth vendors and none of them had the same level of clinical decision support that I’ve had in a health system or large practice EHR.

Last, it didn’t look at the presence or absence of quality metrics and reporting. In my health system-employed jobs, I’ve received a monthly quarterly metrics package that directly impacted my pocketbook as well as my understanding of my behavior. In my telehealth-only gigs, quality was only addressed robustly by one vendor and two of them didn’t deliver reports packages to me at all. None of the telehealth-only organizations offered bonuses or penalties tied to quality. I suspect that even if you had third-party physicians, if they were practicing on the same EHR and received the same quality measures reporting, compensation structure, etc. that the numbers would be similar.

It would also be interesting to look at data from the post-COVID world, when most organizations made significant leaps forward in their application of telehealth. Systems used in 2018-2019 were fairly rudimentary compared to what we have today, not to mention that physicians’ experience with telehealth visits has grown exponentially. Hopefully someone will do research to look at the impact of the rest of these factors as I suspect there is more to the story than meets the eye.

Telehealth also took a hit in this JAMA Network Open piece looking at follow-up patterns for acute conditions compared to chronic conditions. For acute problems, patients who had an initial telehealth encounter were more likely to have a follow-up encounter, including emergency department encounters and inpatient admissions. For patients with chronic problems, patients who had an initial telehealth encounter were less likely to have a follow up encounter. The authors note that there are some potential problems with uncontrolled confounding bias. They provided the example of the bias in deciding whether to deliver an encounter via telehealth or in person. They also noted the need to look at other clinically important factors, such as frequency of laboratory testing and prescribing or adjusting of medications. The study was limited to commercially insured patients and didn’t include subjects with Medicare, Medicaid, or no insurance. We know those patients often have significantly different care experiences that would be worth examining.

Thank you to all who reached out regarding my recent post on EHR downtime and medical errors. Many of you had gut-wrenching EHR downtime stories to share. I appreciate the stories but am saddened that we are all part of this club we never wanted to be a part of. Several readers noted the need to have ongoing downtime education – not just when people join the company or at the same time of year that everyone has to churn through annual HIPAA, Compliance, and Fraud / Waste / Abuse training. Others suggested practice downtime events to make sure people know when and how to declare a downtime, as well as where materials and supplies are located. Both strategies would certainly help, so thanks for bringing them front and center.


I’ve been having difficulty sleeping since the recent time change, which was confounded by multiple trips from one coast to another. I’m not into pharmaceuticals and even some popular supplements like melatonin have fallen out of favor. It’s been a rough couple of weeks, so I’m back in pastry therapy. For your consideration, I present a new take on the classic pineapple upside-down cake. With the right amount of brown sugar and butter, you really can’t go wrong.

What’s your favorite stress-relieving pastime? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/28/22

April 27, 2022 Headlines 2 Comments

HHS puts $90M toward improving health center data collection

HHS allocates $90 million to help health centers modernize their data and reporting capabilities, enabling them to gain a better picture of social determinants of health.

Tenet Reports Cybersecurity Incident

Tenet Healthcare confirms that a cybersecurity incident disrupted patient care last week at several acute care facilities, though normal operations are now being resumed.

Implicity Raises $23M to Broaden Use of Its Cardiac Remote Monitoring Platform

Cardiac remote monitoring and data management technology vendor Implicity raises $23 million in a Series A funding round.

Introducing Source: The Infrastructure Layer for Virtual Care

Virtual care tech startup Source Health launches with $3 million in funding.

Readers Write: Public Health Agencies Share the Blame for COVID-19 Misinformation

April 27, 2022 Readers Write No Comments

Public Health Agencies Share the Blame for COVID-19 Misinformation
By Peter Bonis, MD

Peter Bonis, MD is chief medical officer of Wolters Kluwer Health.


Surgeon General Vivek Murthy, MD, MPH asked big tech companies to provide data related to COVID-19 misinformation and issued an advisory on confronting health misinformation, reflecting the vital importance trustworthy health information plays in public health. The consequences of misinformation can be deadly to individuals and, tragically, to entire populations, as we have witnessed during the pandemic.

The surgeon general’s approach is, however, unlikely to achieve a meaningful impact on online health misinformation even if big tech companies comply with his request. The impact of misinformation is rooted in the trust that people place in it over alternatives.

The public has good reason to be mistrustful of official sources of information, making our nation’s health agencies partially culpable for the misinformation problem we face today. During the pandemic, we received conflicting guidance that changed frequently, didn’t satisfy our information needs, and was politicized. No “official” source of information has earned unalloyed trust, a role the CDC should own.

Well-intentioned spokespeople delivered inconsistent messages and disagreed in public forums, sometimes acrimoniously, leaving us with serious doubts about what to believe. At the same time, we have been terrified by the uncertainty and bewildered that the agencies charged with protecting us did not have the equipment, distribution systems, regulatory processes, and other operational mechanisms that we’d expect.

These factors contributed to making us less than confident in official sources of information and hence receptive to misinformation. Thus, the issue is bigger than addressing misinformation, it is a matter of restoring trust in our public health system and the policies and recommendations it delivers.

Fortunately, the White House just appointed Ashish Jha, MD, MPH as the new face of the federal coronavirus response. He will be instrumental in coordinating the response across federal agencies. It’s critical that Dr. Jha and Dr. Murthy collaborate, as misinformation and the coordinated federal response are intertwined. 

The Senate Health Education Labor and Pensions (HELP) committee is also addressing the topic. It is working on the PREVENT Pandemics Act, bipartisan legislation aimed at improving coordination between public health agencies. One component of the proposed legislation will require a senate-confirmed CDC director, a recognition that the public has lost faith in the CDC.

Now to a possible solution that Drs. Jha, Murthy and the HELP committee might consider. We can help tackle misinformation, fortify our public health system, restore the CDC’s reputation, and be better prepared for the next pandemic, all with the same set of actions. The best way to reduce the impact of misinformation is to create a preferred and trusted alternative.

The creation, maintenance, and dissemination of reliable health information are complex. I have spent the last 20 years helping to create and oversee UpToDate, one of the most rigorously vetted sources of medical information that millions of healthcare professionals worldwide rely on every day. From my vantage point, it’s clear where and how public health agencies are falling short and what solutions are needed. The CDC needs support to better tackle the curation and dissemination of information for healthcare professionals, policymakers, and the public. 

Curation involves identification of relevant clinical and policy questions, use of relevant data, and expert peer-review with stakeholders. Questions must be addressed directly, even when information is incomplete or evolving. It should include relevant perspectives, incorporate feedback, and be updated continuously. Controversies should be addressed, the evidence should be transparent, and recommendations that reflect the strength of convictions should be explicit.

Dissemination involves having clear communication approaches across multiple reading abilities, languages, and user types; intuitive user experiences tailored for healthcare professionals, policymakers, and the public; and a content platform that is easy for search engines to index. Major public health announcements should be published and disseminated with coordinated efforts across public health agencies, media, and social media. Officials speaking on behalf of public health agencies should confidently refer to the guidance, distinguishing extemporaneous comments and reflections from consensus opinion.

Applying these principles to develop a trustworthy clinical information service will reduce the impact of misinformation. Search engine and social media algorithms (and policies) will point to and prioritize such guidance. The public would still be free to pursue alternative points of view, but they could be compared against a trusted reference standard while fringe, conspiracy and unscientific information could be more easily de-prioritized—or dismissed.

Readers Write: The Scale of Interoperability: Healthcare Data is at Zettabyte Level and Growing

April 27, 2022 Readers Write No Comments

The Scale of Interoperability: Healthcare Data is at Zettabyte Level and Growing
By Jason Brantley

Jason Brantley is president and general manager, provider solutions at Datavant of San Francisco, CA.


We are swimming in an ocean of healthcare data. It is everywhere, yet it is incredibly hard to get complete health data for an individual.

Data on the health of anyone individual is being collected everywhere we turn, including when visiting our doctors all the way to the wearables we have on our wrists. All of this health data combined amounts to approximately 30% of the world’s data, and that number is steadily increasing year over year. If we were to consolidate all the healthcare data in the world, we would have an estimated 2 zettabytes, which means 2 trillion gigabytes, of data .

The amount of healthcare data generated has reached the zettabyte level and shows no signs of slowing. And that’s just the digitized healthcare data – there is still a lot on paper and on film.

With over 2 zettabytes of data, we should be able to do some really high-powered research studies to understand rare and complex diseases, personalized treatment for each person, preempt onset of debilitating diseases, among many other ways to ensure that every health decision is based on data.

The current reality is starkly different. Although there are many examples of health data being used to understand diseases, the efficacy of treatment, or how we can detect illness earlier, it is estimated that 97% of the data produced in a hospital goes unused.

How do we ensure that more of the data that is already being generated in the healthcare industry can be used to benefit patients? This is not a new problem, and neither is the answer, which is interoperability.

Interoperability in healthcare has been talked about for years, and has not been achieved yet for a number of reasons. Some of these reasons include lack of communication standards between different systems, integration costs that reduce motivation to become interoperable, and apprehension of organizations to sharing data due to security and safety concerns.

Although there are barriers, improving the ease of exchanging and using data in healthcare will mean complete access to patient information at the time of care, improved care coordination, and the ability to study complex diseases in real time. The zettabyte of healthcare data that is already being generated could actually be used to improve patient outcomes, and more importantly, save lives.

The first step to this vision of interoperability is making sure that health data can be connected and can also be exchanged easily while maintaining patient privacy and security. Data in the healthcare ecosystem will remain fragmented across many different systems until we have efficient and easy ways to exchange health data. Once we have solutions to solve the fragmentation of healthcare data, the right data will be in the right hands at the right time.

Digitizing health data exchange is essential to solving fragmentation. It means that the owners of health data, typically healthcare providers, enable digital retrieval and distribution of the data. This is not a trivial problem, but it is solvable with current technologies. The systems to enable digital exchange must offer easy and intuitive controls such that the data privacy, security, and any other protocol set by the providers are enforced for each exchange of data. A digital network with adequate control mechanisms will ease providers’ concerns on data privacy and security, while dramatically improving speed and cost of health data exchange. It is a giant step towards enabling interoperability.

Readers Write: Chief Nursing Officer Checklist for Healthcare Technology Implementations

April 27, 2022 Readers Write No Comments

Chief Nursing Officer Checklist for Healthcare Technology Implementations
By Robert Wittwer

Robert Wittwer is SVP of professional services at Ascom Americas of Morrisville, NC.


CNOs and CIOs know that patient-centered technology projects perform their best when clinical workflows drive the selection, integration, and adoption of solutions. However, there are several key considerations they should keep in mind before investing in their next technology-driven patient care improvement project:

  1. Bring the right people to the table early. Gather the right set of stakeholders across IT, nursing, finance, etc. to define your needs and be part of the selection team for a technology vendor.
  2. View technology-driven solutions as implementations that require a more complex set of adoption principles than an installation. Begin with the end in mind and not the technologies available.
  3. Define the objectives and strategy the technology should achieve. A CNO can look across the overall landscape and consider bigger patient care questions. Instead of asking, “Can it be done?” ask, “Should it be done?” Avoid the temptation to use all the capabilities or features of a technology if they don’t benefit your objectives. For example, an alert may not need to be sent if it doesn’t require a nurse to respond to it. Alert fatigue is a leading reason for unanswered alerts.
  4. Think long term. Whether it’s future-proofing your investment or ensuring it’s agile enough to respond to unanticipated events like COVID-19, think about your technology solution’s shelf life. Ensure you’re updating software frequently and having regular conversations about using the technology to adjust your workflows so your technology can support how you do nursing today.
  5. Prepare for organizational adoption. While adopting new technologies and workflows requires nurses to change habits, by having clearly defined objectives for its impact and involving stakeholders in the process, you are better prepared to shorten the time it takes to adopt new ways of working.

Morning Headlines 4/27/22

April 26, 2022 Headlines No Comments

3M is said to consider sale of its healthcare IT division

3M is reportedly seeking a buyer for its Health Information Systems revenue cycle and software business.

Biden Administration Increases Access to COVID-⁠19 Treatments and Boosts Patient and Provider Awareness

The White House’s plan for expanding access to COVID-19 treatments such as oral antivirals includes working with EHR vendors, with Cerner and Epic specifically mentioned, to incorporate antiviral treatment content and availability information.

OneMedNet, An Expert and Leader in Clinical Imaging Innovation and Data Solutions, to Become Publicly Traded Via Combination with Data Knights Acquisition Corp.

Imaging real-world data vendor OneMedNet will go public via a SPAC merger at a valuation of $317 million.

VA electronic health record system hit with further outages at Walla Walla site

VA and Cerner officials are looking into the cause of two EHR system outages at the Jonathan M. Wainwright Memorial VA Medical Center in Walla Walla, WA earlier this week.

News 4/27/22

April 26, 2022 News 2 Comments

Top News


3M is reportedly seeking a buyer for its Health Information Systems revenue cycle and software business.

HIStalk Announcements and Requests

Let me get this straight. Health systems claim their big-ticket EHR purchase will improve outcomes and patient safety. When those systems go offline for days or weeks, they declare that going back to paper-based downtime procedures is a non-event that doesn’t put patients at risk. This is where the cynical you wants to speak up. I’ll also add for those without hospital IT experience that the real danger is in the recovery phase, where systems are brought back up with old and missing information and all hands are frantically back-entering orders and hoping they don’t get treated as new ones.

Also for your cynical consideration, the American Telemedicine Association is giddy at the prospect of ditching its virtual conference format and meeting in person next week in Boston.

I was reading about an upcoming White House plan to resettle Ukraine refugees in the US using sponsors who would be responsible for much of the logistics and cost to move a family here. One of many unfortunate barriers is a healthcare one – would you risk your family’s financial security to take on the health insurance premiums and medical costs of a family who is relocating for years to the only developed country that doesn’t offer national health insurance?


April 28 (Thursday) 2 ET. “Undercoded and Underpaid: Making It Easier to Document to Optimize Reimbursement.” Sponsor: Intelligent Medical Objects. Presenters: Deepak Pillai, MD, physician informaticist, IMO; June Bronnert, MSHI, RHIA, senior director of informatics, IMO; Nicole Douglas, sales engineer, IMO. The presenters will discuss how to simplify precise documentation for clinicians; the effects of imprecise coding on reimbursement; why accurate code capture at the point of care can have positive downstream impact on population health initiatives; and how third-party solutions integrated with the EHR can reduce documentation burdens.

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

Acquisitions, Funding, Business, and Stock


Biofourmis secures $300 million in Series D funding, increasing its total raised to $445 million and bringing its valuation to over $1 billion. The company, which specializes in predictive analytics-based remote patient monitoring technology, has named former Medtronic and Intel chairman Omar Ishrak chairman of its board.

UnitedHealth will sell Change Healthcare’s ClaimsXten claims payment and editing software business to TPG Capital for $2.2 billion if its acquisition of Change is finalized.


Imaging real-world data vendor OneMedNet will go public via a SPAC merger at a valuation of $317 million. Paul Casey will remain as CEO.


AirStrip invests in clinical analytics company Fifth Eye as part of a collaboration that will include integration of Fifth Eye’s AHI System with AirStrip’s real-time clinical data platform for inpatient surveillance.

Specialist TeleMed secures unspecified funding from LifePoint Health (TN).

Healthstream announces Q1 results: revenue up 3%, EPS $0.09 versus $0.07. HSTM shares are down 11% in the past year versus the Nasdaq’s similar drop, valuing the company at $600 million.

Microsoft announces Q3 results: revenue up 18%, EPS $2.22 versus $2.03, beating analyst expectations for both. Microsoft Cloud revenue was up 32% to $23.4 billion. 


  • Northwell Health (NY) selects virtual care services from Teladoc Health.



Vidya Raman-Tangella, MBBS, MHA (AWS) joins Teladoc Health as chief medical officer.


WellSky hires Dale Zurbay (Nuance) as chief growth officer.


OmniLife names Dyan Bymark (Teladoc Health) chief commercial officer.

image image

Memora Health promotes Omar Nagji to chief commercial officer and names James Colbert, MD (BCBS of Massachusetts) SVP of care delivery.


Chris Regan (Experian Health) joins Salesforce-owned MuleSoft as RVP of healthcare.

Announcements and Implementations

St. Lawrence Health (NY) will go live on Epic this weekend through its affiliation with Rochester Regional Health.

Clinical Architecture renames its Nomad data normalization and enhancement software to Nomentys.


University Health Network in Toronto will go live on Epic in June. The health system incorporated guidance from 80 patient partners in its configuration of the new software.

Ochsner Health (LA) has implemented Nym Health’s automated medical coding technology within its emergency departments.


Monument Health selects CereCore’s ServiceNow consulting services.

Rhodes Group, a laboratory software and consulting business, uses InterSystems Iris for Health to aggregate and normalize hepatitis C data from labs across New Mexico to support sharing with providers through the state’s HIE.

Nicklaus Children’s Health System launches its MyNicklaus app that includes wayfinding from Gozio Health.


In the Netherlands, Amstelland Hospital becomes the first hospital in Europe to implement Epic under the Epic Connect model.


KLAS summarizes US hospital EHR market share activity for 2021 (click the graphic to enlarge):

  • Epic gained four new customers representing 28 hospitals and 13,000 beds last year, losing four due to M&A.
  • Meditech Expanse was chosen by 74% of the company’s legacy customers that made a replacement decision in 2021, compared to 38% retention in 2020.
  • Epic has 33% of hospitals and 44% of beds versus Cerner’s 24% and 27%, respectively.
  • Allscripts and CPSI lost ground in 2021.
  • Cerner had the largest net decrease in bed count last year, with half of those hospitals choosing Epic as a replacement and the other half switching to Epic after being acquired.
  • Cerner hasn’t had a net-new large health system sale since 2013.

Government and Politics

The White House’s plan for expanding access to COVID-19 treatments such as oral antivirals includes working with EHR vendors, with Cerner and Epic specifically mentioned, to incorporate or antiviral treatment content and availability information.

VA Secretary Denis McDonough expresses confidence that the agency has the budget needed to complete its projected 10-year, $16 billion rollout of Cerner, despite a new OIG report that estimates it will need an additional $2 billion for every year that implementations runs behind schedule.

New Hampshire regulators say that the board of the non-profit parent company that owned failed Lakes Regional General Hospital and Franklin Hospital should have reined in hospital executives who undertook an aggressive expansion and a $42 million implementation of Cerner as an aging local population increased the Medicare and Medicaid share of the money-losing hospitals.


A study describes how clinical radiologists at NYU’s medical school create videos explaining a patient’s imaging results in plan language with annotations, then post them to the patient portal for both patients and referring providers. The one-minute videos take the radiologist about four minutes to create using a PACS-integrated reporting tool. On the downside, three-fourths of the videos were never opened and 91% of surveyed patients said they preferred both a written and video report. I’ll also add that the sample video report was full of unnecessary jargon (like bone names) delivered in a monotone.


Maybe this is telehealth’s jump-the-shark moment. A group of doctors who are famous on TikTok and Instagram sells memberships – in the form of NFT cartoon icons — in what one founder hopes will become a metaverse-powered virtual clinic. MetaDocs and its providers, such as Dr. Pimple Popper, is taking heat because the company is not licensed as a telemedicine service and its doctors aren’t licensed in all states, meaning the social media stars can’t legally offer paying customers prescriptions or medical advice. Medical toxicologist Ryan Marino, MD comments commendably drily, “If your child is in respiratory distress in the middle of the night, having a surgeon famous for dancing on TikTok text you might not be that useful.” The company is quickly developing a user waiver that its service is for “informational purposes only” and refocusing its virtual clinics on “third-world countries” that presumably have a short supply of both doctors and lawyers. The company’s website says it plans to act as a connection among doctors, Web3, and healthcare, contributing ideas related to blockchain-powered EHRs, tokenizing services and procedures, and the overall digitization of healthcare.   


One of my favorite booths at the HIMSS conference is always that of the Philippine Delegation, some super-nice folks who describe the advantages of health IT outsourcing to the Philippines and remind us that they provide more US nurses than any other country outside the US. They report a good HIMSS22 exhibit experience, expecting sales of $30-$40 million from 300 leads, 25 deals that have already closed, and four new partnerships.

Sponsor Updates


  • Quil employees take part in the company’s fourth annual day of service.
  • Agfa HealthCare welcomes four new peregrine falcon chicks at its headquarters in Belgium.
  • Cerner announces that it added 71 new clients in 2021 and extended or expanded relationships with 330 others.
  • Baker Tilly donates $10,000 to Cray Youth and Family Services and the Washington Township Special Olympics.
  • Biofourmis will present at the ATA Telehealth Innovators Challenge during ATA 2022 May 1-3 in Boston.
  • Bravado Health publishes a new executive brief, “The high cost of low task adherence for surgical and non-surgical procedures.”
  • CarePort will exhibit at ACMA National 2022 May 1-4 in Dallas.
  • Cerner releases a new podcast, “How TEFCA impacts the future of healthcare.”
  • Change Healthcare releases a new podcast, “Capitol Connection: Post-Pandemic Healthcare Policy.”
  • Clearsense publishes a new case study, “Archiving Solution Delivers Rapid ROI.”
  • RxRevu announces that three of the top 10 health systems on US News & World Report’s Best Hospitals list for 2021-22 are now part of its prescription cost and coverage network.

Blog Posts


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


Morning Headlines 4/26/22

April 25, 2022 Headlines No Comments

UnitedHealth agrees to sell Change Healthcare’s ClaimsXten business for $2.2bn

UnitedHealth has agreed to sell Change Healthcare’s ClaimsXten claims payment and editing software business to TPG Capital for $2.2 billion, provided its acquisition of Change is finalized.

Ann Arbor’s Fifth Eye Partners with Texas Health Care Analytics Firm

AirStrip invests in clinical analytics company Fifth Eye as part of a collaboration that will include integration of Fifth Eye’s AHI System with AirStrip’s One platform for inpatient surveillance.

LifePoint Health to Lead Investment in Specialist TeleMed

Specialist TeleMed secures an undisclosed amount of funding from LifePoint Health (TN).

Fathom Secures Investment From Vituity’s Inflect Health

Medical coding automation vendor Fathom secures funding from Inflect Health, the innovation arm of Vituity, a provider group based in Emeryville, CA.

Curbside Consult with Dr. Jayne 4/25/22

April 25, 2022 Dr. Jayne 12 Comments

This week’s Monday Morning Update discussed an EHR outage at two of Tenet Health’s hospitals in South Florida. Apparently Tenet didn’t like the media coverage from WPTV and suggested that a story about the downtime be removed. The story covered a patient’s concern about potential medical errors during the outage, with Tenet complaining that suggesting a downtime could result in medical errors is “preposterous.” As a physician who has been in the trenches for more than two decades and who has been through enough EHR downtimes that I couldn’t begin to count, I’m speechless at the thought that downtimes aren’t problematic.

I’ve been up close and personal with a downtime-related medical error in my career, and the situation certainly would have been different had the EHR been online. It was a bit of a perfect storm-type situation. First, I was a relatively new hire still getting used to the processes at a new urgent care employer. Second, due to someone calling out sick, I had been rescheduled from my usual location to a different site, which added a baseline level of stress to the day since I was working with an unfamiliar team. Third, due to a pre-existing diagnosis, the patient I was seeing for a fever was unable to contribute to the history of the presenting problem and was combative during exam, which is tremendously stressful.

After my initial attempts at history-taking with family members and a brief exam during which I detected no emergent problems, I ordered some laboratory studies and moved on to see other patients. When I left the patient, he was pacing around the room and showed no signs of being in distress or in pain.

At some point before the tests were resulted, the EHR went down. As a new employee, I was unfamiliar with the downtime process, but knew there should be one. I asked if there was a downtime binder or how we were supposed to handle it. The clinical team lead was resistant to instituting downtime procedures, giving excuses along the lines of “the EHR usually comes back in a few minutes” and “it really makes a lot of paperwork if we try to go to downtime procedures.” Knowing that creating paperwork is the point of a downtime procedure, I pulled some paper from the printer and began writing my own SOAP notes and documenting what I could.

I remember having probably half a dozen patients on the board that I was seeing. I tried to move them through the process while begging for a paper prescription pad so I could write discharge medications and keeping a clipboard with sticky notes on it as a tracking board to help me remember what patient was in what room. Lab results were being printed from the instruments on little slips of receipt paper rather than flowing through the interface to the EHR. The results were in an unfamiliar format, with the individual tests being out of order within a panel and the reference ranges being difficult to read. Despite the downtime, the staff continued to room new patients and expected us to move forward. I was surprised by that – none of the patients were emergent, and as a walk-in urgent care center it would have been within our rights according to state regulations to stop taking new patients.

I was managing patients the best I could and providing written discharge instructions that I was typing in Microsoft Word and printing two copies so we could scan them later. For my patient who had a fever, there wasn’t anything apparent on the exam or on my review of the labs that could have been causing it, so I recommended close follow-up at home and told them what to look for. This was during the usual season for viral illnesses, and in many patients, the illnesses begin with fever but don’t always declare themselves with other symptoms for a day or more. Since the patient couldn’t describe his symptoms and the exam was difficult, I didn’t suspect anything serious.

Every one of my hand-typed discharge instructions included my best recollection of the practice’s standard disclaimer, which would have been automatically applied by the EHR had it been online. It was something along the lines of “Your examination at XYZ Health today is limited by the capabilities of this urgent care facility, which does not include advanced imaging or moderate complexity laboratory testing. If at any time you feel your condition is worsening, we recommend that you be re-evaluated at the nearest hospital Emergency Department.” I reviewed this instruction with the patient (who could not verbalize understanding) and his adult caregiver, who said she understood.

Two days later, I was called before the practice’s owner and yelled at for “letting someone walk out of here with those abnormal labs,” because by that point, the patient ended up having a significant abdominal infection that required surgical drainage. I explained that at the time I saw the patient they had no features of a serious abdominal process and reviewed the examination that I had documented on my handwritten SOAP note. I was then asked to review the documentation that had been keyed into the EHR after the downtime ended. There it was, in bright red — an abnormal lab value. I had missed it when looking at the receipt-paper printout in an unfamiliar format and with confusing reference ranges. It wasn’t a critical value, but it was abnormal enough that it might have made me think about additional potential diagnoses, even if the physical exam didn’t point me towards an abdominal cause for the fever.

In reviewing the patient’s course, he hadn’t been taken to the emergency department for more than 12 hours after I had seen him, which wasn’t a guarantee that the process requiring surgery was yet present when I evaluated him. Usually if patients have a significant infection in their abdomen, they’re not likely to be pacing around the room – they are completely still on the exam table, and you can hardly touch them. Still, I couldn’t help but second guess the factors that went into my care of the patient – the unfamiliar staff, the new location, the downtime, and the patient’s individual characteristics and presentation.

I explained to the now shouting and red-faced CEO that this wasn’t a normal visit under normal circumstances and that I didn’t have the luxury of having the abnormal lab highlighted in red in the EHR during the visit because there wasn’t an EHR during the visit. He seemed surprised to hear that. Even after he admitted that the EHR downtime was an issue and there’s to way to know if my care contributed to the problem, I agonized over the situation. Several peers reviewed the chart and had no additional suggestions, but that certainly didn’t make me feel any better.

The bottom line here is that EHR outages are difficult. They raise the potential for medical errors in a number of ways. They add stress to already overwhelmed staff. They remove safety checks that we’ve come to rely on. They increase cognitive load as clinicians look at data in unfamiliar formats. They reintroduce illegible handwriting to the environment. They also create time pressures when they end and staff is forced to key in data while they proceed forward with their usual assigned tasks.

I’m fortunate that the patient in this scenario had an uncomplicated hospital stay and there were no long-term consequences of the event, either for him or for those who cared for him. However, the long-term psychological impact on me as a physician makes me never want to encounter another EHR downtime again.

What do you think about Tenet’s comments regarding EHR downtimes? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/25/22

April 24, 2022 Headlines No Comments

Tenet Health says systems are coming back, calls patient worries ‘preposterous’

A TV station’s report on downtime at two of Tenet Healthcare’s South Florida hospitals prompt the company to complain that it is “preposterous” to suggest that charting on paper during EHR downtime could cause medication errors.

Veteran hospitalized at Spokane VA after missing heart medication, highlighting health record system’s prescription problems

Spokane VA officials confirm that a veteran was hospitalized with heart failure in March after his heart medication prescription – ordered before Mann-Grandstaff VA Medical Center’s conversion to Cerner  – disappeared off his Cerner active medication list.

Newfoundland and Labrador healthcare information system ‘fragmented, outdated’: report

Canada’s Newfoundland and Labrador hasn’t followed through on recommendations that it upgrade to a new version of Meditech in a $92 million project that auditors say would more than pay for itself.

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