News 11/10/23

Top News

Indian Health Service chooses General Dynamics Information Technology and Oracle Health for its new EHR, which will replace its VistA-based RPMS.

The 10-year contract is valued at up to $2.5 billion.

HIStalk Announcements and Requests

Listening: London-based all-female Hawxx, whose chaotic, cathartic punk-tinged alt-metal music addresses themes such as mental health struggles, societal norms regarding appearance and femininity, and why metal needs marginalized voices on stage and in the audience. The music is loud but smart, sometimes resembling Rage Against the Machine and at other times Nightwish. 

Webinars

November 16 (Thursday) 1 ET. “How Scheduling Helped Streamline Memorial Hermann’s Communication.” Sponsor: PerfectServe. Presenter: Amee Amin, MD, hospitalist, Memorial Hermann-Texas Medical Center. Dr. Amin will discuss the challenges she experienced in creating schedules for her team of hospitalists, and how an optimized solution transformed her workflow. Attendees will learn now TMC gleans crucial data and analytics from their scheduling system, the impact of real-time schedules being pushed out to other applications, and how Lightning Bolt’s optimized, auto-generated schedules improve provider satisfaction and work-life balance.

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

Acquisitions, Funding, Business, and Stock

Amazon launches One Medical for Prime, which offers access to its One Medical primary care business for $99 per year, which covers all virtual care visits. It offers little benefit for in-person primary care visits at the 24 One Medical locations since those will continue to be billed to insurance or as out-of-pocket costs. Non-Prime members can continue to sign up for $199 per person for an annual membership, so the Prime offer is really just a $100 annual discount. This would be a good time to remind folks of the difference between direct primary care (you pay your doctor a flat monthly fee that includes most services, easy access, and no use of insurance) versus concierge medicine (you pay to skip the line to see doctors who still bill your insurance or you personally at their usual rates). I have the former and question the value of the latter.

Eleos Health, which offers behavioral healthcare providers AI-powered clinical documentation and insights software, raises $40 million in a Series B funding round.

Former Meta COO Sheryl Sandberg and other high-profile investors launch Cercle, whose platform organizes unstructured medical data into a standard format to help clinicians develop personalized treatment plans for women’s health, especially fertility care.

CPSI announces Q3 results: revenue flat, EPS –$0.24 versus $0.15, beating earnings expectations but falling short on revenue. CPSI shares have lost 52% in the past 12 months versus the Nasdaq’s 29% gain, valuing the company at $164 million.

Sales

• Delaware Department of Health and Social Services chooses Findhelp to help residents find substance use disorder and mental health services.
• Resilience Healthcare will implement Altera Digital Health’s Paragon EHR and its Ventus contract management, compliance, and coding solutions.
• Mass General Brigham chooses Best Buy Health to support its hospital at home program with its Current Health care-at-home platform, coordination services, and personal emergency response solutions. 

People

Jeff Park (WellDyneRx) joins Waltz Health as president.

Announcements and Implementations

Enterprise Health announces the Wellby AI assistant to its occupational and employee health solutions, providing clinicians with a concise medical records summary, preparation of standard referral and return-to-work letters, and a proposed care plan based on encounter details.

Health system owned Truveta announces availability of 57 million clinical observations from 2.7 million ECG reports and 1.7 million de-identified patients

KLAS takes its first look at Epic Payer Platform, which extracts clinical data from providers and sends it to payers, finding that all six interviewed customers are satisfied and would buy the solution again.

Privacy and Security

US Radiology pays $450,000 to settle New York State charges that outdated computer hardware allowed a ransomware attack that exposed the information of 92,000 state residents.

Cook County Health notifies 1.2 million patients that their information was compromised in a data theft incident involving its transcription vendor Perry Johnson & Associates. The health system has terminated its relationship with the company.

Five Ontario hospitals whose IT shared services organization was taken offline in a ransomware attack on October 23 say they won’t have systems fully restored until late December. The hospital declined to pay the ransom demanded by the hackers, who have been publishing their patient data online.

Sponsor Updates

• Fortified Health Security and Nordic sponsor Valley Presbyterian Hospital’s golf tournament.
• Inovalon expands its Schedule Management software to include management of third-party agency staff.
• Ampla Health (CA) optimizes operational workflows using EClinicalWorks V12.
• Everbridge secures a new patient in the field of AI, relevant to technology used in analytics dashboards for critical event management software.
• Medical history platform vendor Hona will use Particle Health’s API for medical record retrieval outside of the provider’s EHR.
• First Databank names Andrew Anderson integration specialist, Sarah Callis technical writer, and Pranav Acharya advanced software engineer.
• Clinical Architecture publishes a new episode of its “The Informonster” podcast titled “Documentation in the OR with AORN.”
• Ushur’s Customer Experience Automation solution is listed on the Five9 CX Marketplace.

Blog Posts

• Understanding Nurse-to-Patient Ratios and How They Affect Quality of Care (SnapCare)
• Visage Soars with CloudPACS at RSNA 2023 (Visage Imaging)
• Embracing Technology for Startup Weight Loss and Medical Spa Clinics (EClinicalWorks)
• Addressing Medicare Bad Debt Reimbursement Issues in Healthcare (FinThrive)
• EHR Essentials: 5 Proven Steps for a Successful Epic Implementation (Healthcare IT Leaders)
• Considering Cashless Check-Ins for Your Front Desk? (Impact Advisors)
• Can Software Testing Deliver ROI? (Keysight Technologies)
• What to Ask When Choosing a Healthcare Interoperability Partner (Medhost)
• Giving nurses a voice in EHR launch at Boone Health (Meditech)

Contacts

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

EPtalk by Dr. Jayne 11/9/23

Several readers messaged me trying to get my thoughts on exactly which companies I think might be “in bad shape” following my recent discussion of the Olive shutdown.

The short answer is that a lady never tells, but readers didn’t even have to wait a day to see a non-healthcare answer, as WeWork filed for bankruptcy. The company had a pre-COVID valuation of $47 billion and has had to cope with the upheaval that the pandemic brought to the office-sharing and remote work space. Now there are questions as to how the company’s bankruptcy will impact the commercial real estate market, since the company had billions of dollars in lease agreements, including those for seven million square feet of office space in New York City alone.

One reader sent me the recent Block (formerly Square) shareholder letter, which mentions that they will cap employment at 12,000 people “until we feel the growth of the business has meaningfully outpaced the growth of the company.” They went on to say, “We know the inverse is true today.” A quick web search indicates that the company has about 1,000 more employees than that cap, so I hope they have the foresight to buff up their resumes.

As a public company, Block is required to release certain information and there’s the potential for shareholders to hold the company’s leadership accountable for performance. Block’s futures are closely tied to the retail economy, so it will be interesting to see what happens over coming months given the current state of things in the US.

Speaking of post-COVID challenges, a couple of my colleagues who are infectious disease specialists brought to my attention that the Centers for Disease Control and Prevention is working on an update to its Isolation Precautions Guidance, last updated in 2007. The newest document isn’t due to be complete for several more months, but a draft was finalized last week. It recommends that masks be worn to reduce respiratory pathogens such as influenza and COVID-19, but the mentioned masks are medical masks or surgical masks that aren’t as good at preventing transmission as N95 and other respirators. There’s great concern among physician and nursing leaders that the relatively weak recommendations will allow hospitals to go for the cheapest option rather than making sure that employees are adequately protected.

There’s a lot of discussion about burnout and turnover among frontline clinicians. I would offer a suggestion that one way to make employees feel more valued and appreciated would be to provide higher-level protection to anyone who wants it, without making them jump through hoops or reuse personal protective equipment which has already been anecdotally reported this respiratory season. I’ll take a giant pack of N95s or KN95s over a pizza party any day.

I had a lot going on at the end of October, so I missed the fact that the Federal Communications Commission (FCC) voted to begin the process of restoring net neutrality regulations that would keep US internet providers from slowing down services on their networks based on content. As expected, broadband providers plan to fight the effort, claiming that it is burdensome and that the effort is a regulatory overreach by the FCC. Public comments on the proposed rule are open and the earliest we’ll see a potential change would be 2024. If you’re looking for some scintillating bedtime reading, the Notice of Proposed Rulemaking and a fact sheet are available for your perusal.

Also in my October mail bag was an overview of a new proposed rule that details “disincentives” for information blocking that was recently published by the US Department of health and Human Services. The proposed penalties include losing “meaningful user” status in a given EHR reporting period, which leads to economic penalties; receiving a zero score for Promoting Interoperability under the Merit-based Incentive Payment System (MIPS); and restrictions on participating in the Medicare Shared Savings Program. The proposed rule also describes the process to occur when an organization is accused of information blocking.

It still baffles me that organizations are struggling to get on board with this, since in the vast majority of situations, having greater access to patient data benefits patients and clinicians. I understand the financial ramifications and the desire for organizations to want to restrict competition, but it just comes off as being anti-patient at this point. Physicians in my area are happy to name and shame when organizations do it, and I’ve seen those revelations steer referral patterns away from uncooperative organizations. More information can be found on the related HealthITbuzz blog.

I recently became aware of a new startup that is working to mitigate how often artificial intelligence systems hallucinate or make up information. Vectara has about 30 employees and has raised $28 million in seed funding. Its founders include former Google AI researchers with deep expertise in the field. The company cites the rate of hallucination by AI platforms as ranging from 3% (OpenAI) to 27% (Google’s Palm chat). Meta’s systems rang in at 5%. The company plan to offer solutions that will mitigate the risks of hallucination, bias, and copyright infringement. Putting on my marketing hat, I like their logo, which feels clean and has forward mobility, and the use of color just kind of grabbed me. Including such a spectrum definitely reduces the need for people to debate which Pantone color is the “right” one.

A reader also asked me what I thought about the recent news that Cigna is considering an option to jettison its Medicare Advantage business. Perhaps Cigna has figured out, as have others, that it’s becoming harder to make a buck in the Medicare Advantage space while keeping patients happy and avoiding pressure on physicians and providers to overstate patients’ complexity. Medicare Advantage only comprises 4% of the company’s external revenue, so it makes sense for leaders to consider bringing in some cash so the company can focus its efforts elsewhere. There’s also the tidbit where Cigna is paying over $170 million to settle claims about its previous track record of trying to make patients seem sicker than they really are. As I re-enroll with insurance plans, I’m avoiding Medicare Advantage because the rewards don’t seem to be worth the administrative headaches.

Is your organization doubling down on Medicare Advantage or have they decided to pursue other interests? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 11/9/23

Behavioral Health AI Leader Eleos Health Raises $40M Series B Round to Expand CareOps Automation Footprint

Eleos Health, which offers behavioral healthcare providers AI-powered clinical documentation and insights software, raises $40 million in a Series B funding round.

Health AI startup Cercle debuts with backing from Sheryl Sandberg

Former Meta COO Sheryl Sandberg and other high-profile investors launch Cercle, which uses AI to support women’s health and organizes unstructured medical data into a standard format to help clinicians develop personalized treatment plans.

Sauk Prairie Healthcare is the latest company hit with cyber attack

Sauk Prairie Healthcare (WI) restores its computer systems after a cyberattack last week forced it to initiate downtime procedures and reschedule appointments.

Therapy iQ Secures $1.5 Million in Seed Funding to Revolutionize Mental Health Practice Management

Mental health practice management startup Therapy IQ raises $1.5 million in seed funding.

Healthcare AI News 11/8/23

News

OpenAI announces significant new ChatGPT features at its first developer conference, most significantly the ability for users to create a tailored version of ChatGPT – called, somewhat confusingly, a GPT – to perform specific tasks. User-created GPTs can be shared or sold via a GPT Store that OpenAI will launch later this month.

Samsung introduces Gauss, its generative AI model.

Business

Smart stethoscope maker Eko Health earns UK regulatory approval for its AI-enabled tool for the evaluation of heart failure, valve disease, and atrial fibrillation, which Imperial College London will deploy to 100 GPs who will use it in conjunction with the company’s digital stethoscope. The system is sold in the US under the name Sensora.

Agamon Health  will work with Mayo Clinic to extend its offering into cardiology, where it will enhance patient adherence to follow-up.

Former Meta COO Sheryl Sandberg and other high-profile investors launch Cercle. The company uses AI to support women’s health, especially within fertility care, and organizes unstructured medical data into a standard format to help clinicians develop personalized treatment plans.

Israel-based Eleos Health, whose automated scribing solution turns behavioral health conversations into documentation and clinical insights, raises $40 million in a Series B funding round.

Research

Researchers find that ChatGPT does a reasonably good job in answering consumer questions about lifestyle-related conditions, making it appropriate for patients who are waiting on a doctor’s appointment.

Other

Experts in India write that integrating AI into India’s healthcare ecosystem could significantly enhance service delivery and patient care, though it requires overcoming challenges related to data, policy, and infrastructure.

Adweek reports that a hospital shut down its marketing team over compliance problems after it tested ChatGPT.

A Washington Post opinion piece by Leana Wen, MD, MSc describes Kaiser Permanente’s use of AI to flag patients whose condition is deteriorating using near real-time data whose patterns might otherwise be overlooked. She says that KP’s key difference is that it sends the alerts to an offsite team of nurses to decide whether the hospital’s rapid response time should be deployed. The original study she references was published in November 2020.

CNN says that MSN.com and Microsoft Start are featuring bizarre, inaccurate stories that are generated by AI instead of the editors it has fired. The company published an article about a woman’s death that it lifted from The Guardian, then added a “pathetic, disgusting” poll that invited readers to speculate on whether she died by murder, accident, or suicide. One of the laid off editors says the company features stories from small, unreliable sources that provide little information about their ownership or editorial standards. The story above that called a deceased NBA player “useless” was speculated to have resulted from AI that translated the original source’s article from English to another language and back again to hide plagiarism.

Contacts

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

Morning Headlines 11/8/23

Bain to Buy Guidehouse in $5 Billion Deal

Bain Capital will acquire healthcare consulting firm Guidehouse from Veritas Capital for $5.3 billion.

Kythera Labs Announces $20 Million Funding to Accelerate Growth of its Wayfinder Data Technology Platform

Healthcare data insights company Kythera Labs raises $20 million in a Series A funding round.

23andMe data theft prompts DNA testing companies to switch on 2FA by default

The recent theft of 23andMe customer data prompts the company and several competitors to begin requiring customers to use two-factor authentication when signing into accounts.

News 11/8/23

Top News

Surescripts acquires ActiveRadar, a prescription drug benefits data company that identifies therapeutic alternatives.

ActiveRadar’s original iteration was launched by Safeway Food Stores to help its union employees save money on prescription drugs. It was later sold to a private equity firm and rebranded as RxTE, ultimately becoming a standalone company ActiveRadar in 2017.

Reader Comments

From Poindexter: “Re: Amazon Clinic. I received this email. It’s a big step for Amazon.” The service, which recently expended to cover all 50 states, is not all that innovative since it’s just a virtual marketplace for Amazon’s telehealth partners. Still, Amazon’s reach and experience standardization should boost the business of those participating companies and make telehealth a more widely known option. Amazon sells $50 billion worth of ads each year with high margins, renting online space to feature “sponsored products,” company stores, and display ads within its store pages that steer Amazon customers to bigger-spending vendors, so this aligns with their strategy. Amazon says that 60% of its sales come from independent sellers, and some experts think its ad business will even surpass its cloud revenue.

From Chief Pixel Herder: “Re: chief digital officer. I read that the health system job title is being phased out just about as fast as it was phased in.” It’s probably not a good time to hold a newly created C-level position in money-challenged health systems whose primary expense is labor. I wouldn’t expect them to revert back to old titles for chief digital officers and chief innovation officers, but I can see eliminating those folks who occupy newly created positions. Health systems love chasing trends like making everybody and their brother a VP and now a C-leveler, but at some point the suit proliferation becomes embarrassing when pleading poverty from atop extravagant buildings.

From Sveltese: “Re: Olive. A friend worked for them, his job being to automate the denial of prior authorization requests.” That wouldn’t surprise me, in the vein of the brightest minds of a generation spending their days getting people to click on ads. Put your money on insurers versus patients and doctors in choosing a prior authorization winner.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor QGenda. The Atlanta-based company revolutionizes healthcare workforce management everywhere that care is delivered. QGenda ProviderCloud, a purpose-built healthcare platform that empowers customers to effectively deploy workforce resources, includes solutions for scheduling, credentialing, on-call scheduling, room and capacity management, time tracking, compensation management, and workforce analytics. In 2022 and 2023, QGenda won Best in KLAS for Physician Scheduling, as well as Nurse and Staff Scheduling. More than 4,500 organizations, including leading physician groups, hospitals, academic medical centers, and enterprise health systems, use QGenda to advance workforce scheduling, optimize capacity, and improve access to care. Thanks to QGenda for supporting HIStalk.

Lorre’s email has been on the fritz for a few weeks, we belatedly discovered, as emails to her histalk.com address were being delivered to the server but failed to complete the final leg of their journey to her Gmail account. I checked the server to find those that were stuck and set up an auto-forwarder as a backup, but email her again if she didn’t respond since she doesn’t just ignore emails. Email problems are never-ending and reliability has gone way down with the proliferation of complex setups, spam filters, and black lists.

Was Olive a scam, and if so, who are the victims?

The abrupt shutdown of one-time unicorn Olive have led to declarations that the company was an obvious scam all along. I agree that expectations were inflated with the encouragement of the company’s executives, but I don’t think it meets the definition of “scam” given that savvy customers and private investors voluntarily gave the company money without complaint.

Olive has sold off the remaining pieces of its business for an unreported and likely unimpressive price. Waystar has acquired most of it, but the buyer of  its prior authorization business is Humata Health, which was founded in February 2023, presumably with the specific purpose of buying that business. Humata’s company’s founder is  Jeremy Friese, MD, MBA, who was co-founder and CEO of Verata Health, which Olive acquired in December 2020 to form the business that he is now buying back.

Olive reported annual revenue of $49 million. It had raised $856 million, most recently a July 2021 Series H round with investors Vista Equity Partners, Tiger Global Management, and Base10 Partners that valued the company at $4 billion.

An Axios article quoted former employees and other sources who said that despite calling itself Olive AI, the company was actually using primitive screen-scraping and bot tools that frequently broke when vendors of the EHR and claims software they communicated with changed their systems.

The Axios article questioned the company’s cost savings projections, which rarely materialized. Olive’s sales executives knew that overpromises would still get its foot in the door, where health systems would then reassign employees and make it hard for them to change course and kick Olive out. Olive claimed to have 200 enterprise customers, although Axios reviewed internal documents that showed only 80.

Olive’s KLAS reviews are mostly bad overall, although it scored pretty well in the prior authorization business that it had acquired from Verata. Customers reported some successes, but complained of high executive turnover, lack of focus on customers, and layoffs that caught customers by surprise and reduced the company’s responsiveness. Still, the company featured testimonials from Gundersen, WVU Healthcare, Allegheny Health Network, Renown Health, and others.

I would argue that customers were not scammed. They could have demanded Olive’s full customer list and contacted them before buying. Poor KLAS scores were a lagging indicator, but a big red flag. Customer contracts should have included penalties for failing to hit cost-saving goals.

Public investors weren’t scammed because the company dismantled itself before it could rush an IPO or SPAC merger, which might suggest that the wheels had been coming off for some time. Its reputable, experienced investors had access to internal information that would have revealed warts and all, although the investment environment encouraged big bets of the “greater fool” variety rather than a forensic analysis of whether the company was blowing smoke in claiming to have invented “the Internet of Healthcare” and its ability to “deliver a new healthcare experience for humankind.”

Those who don’t know health IT history and thus are doomed to repeat it should note these lessons:

• Investors, prospects, or a prospective employees need to look beyond the glad-handers and perform due diligence.
• Customers should contractually obligate their vendor to meet whatever results and metric led them to buy in the first place. Cover the items that you need and fear most.
• Companies brag on their use of AI in hopes of commanding a higher valuation as a tech company, as did their late 1990s predecessors in appending .com to their names, but customers shouldn’t care whether a vendor uses AI or an army of offshore workers as long as they receive the expected benefits.
• Sketchy companies generate a lot of hype that is rarely echoed by their actual customers.
• Companies can be wheezing their last even as they pay big money for impressive exhibits and sponsored events at conferences.
• Rapid company expansion, acquisitions that look like an attention-diverting shell game, and a product line that is too confusing to summarize in a single “what does your company do” sentence are reasons for skepticism.
• All companies and investors look smart when the economy is booming.

Webinars

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

Acquisitions, Funding, Business, and Stock

Health Catalyst acquires Electronic Registry Systems, which specializes in cancer registry services and software.

Bain Capital will acquire consulting firm Guidehouse for $5.3 billion from Veritas Capital. Modern Healthcare says that Guidehouse is the second-largest healthcare consulting firm.

Sales

• Accountable Health Partners, a clinically integrated network based in Rochester, NY, selects Health Catalyst’s Data Operating System, enterprise analytics, and professional services.
• NorthShore-Edward-Elmhurst Health (IL) will implement population health software from Lumeris.
• Emory Healthcare (GA) will roll out Andor Health’s ThinkAndor virtual sitter technology, initially piloting it at two hospitals.

People

Direct Recruiters hires Huntsville Magazine owner Christian Byrd, MA (BC Executive Search Firm) as leader of its medical device practice.

Ovation Healthcare names John Mason, MBA (OakHorn Solutions) president of Tempo Technology Services.

Kali Durgampudi, MS (Zelis) joins Apprio as president and CEO of its healthcare automation division.

Announcements and Implementations

Glacial Ridge Health System (MN) will swap out its Healthland EHR for Meditech Expanse on December 1.

Midwestern University Clinics in Illinois and Arizona replace four EHRs with Epic.

A majority of hospitals will turn to outsourcing certain services over the next five years, according to a Black Book poll of management representatives from 1,428 healthcare organizations.

A new KLAS report on data and analytics platforms finds that Dimensional Insight leads the category with an easy-to-use platform that creates digestible metrics that drive outcomes, while Epic and Oracle Health customers struggle with ease of use.

Government and Politics

NSW Health in Australia will spend $640 million to replace nine systems, predominantly Cerner solutions, with Epic over the next 10 years. The decision to make the switch was first announced in 2020 with an initial deployment goal of 2026.

A watchdog agency  reports that the bankrupt Idaho Health Data Exchange spent $92 million in federal funds with little oversight or accountability because the state created it as a private, non-profit corporation.

Privacy and Security

Duke University researchers find that it costs less than $0.50 to buy data about a military service member from a data broker, including their fully identifiable health and financial information. The authors note that the availability of such information could compromise national security and also note that the US lacks privacy regulation that would prohibit the practice elsewhere.

Other

Virginia Mason Franciscan Health launches an enhanced care registered nursing program at St. Anne Hospital (WA), its second this year. The ECRN virtual nursing program was developed to help combat staffing shortages and help prevent burnout. ECRNs joins bedside shift huddles via Zoom and then typically visit patients virtually twice per shift, largely focusing on home medication lists, care plans, and discharge details.

Sponsor Updates

• Consensus Cloud Solutions sponsors Cognosante’s charity golf tournament benefiting Final Salute.
• Southern Endocrinology Associates increases collections by more than 200% using EClinicalWorks and Healow.
• Netsmart showcases advancements driving value-based care success for senior living providers at LeadingAge 2023 through November 8 in Chicago.
• AdvancedMD receives the 2023 ISV Builder Partner of the Year Award from Zoom Video Communications.
• A Geek Leader Podcast features Arrive Health CEO Kyle Kiser.
• Symplr will host a happy hour at the CHIME Fall Forum on Friday, November 10 at the JW Marriott.
• Artera achieves SOC 2 Type 2 compliance for data security, availability, and privacy.
• AvaSure will sponsor the Insights Summit on Virtual Nursing November 15-16 in Washington, DC.
• Baker Tilly releases a new Healthy Outcomes Podcast, “Navigating the healthcare financial landscape in 2024.”
• Bardavon publishes a new injury prevention case study on insurance carriers and brokers, “Reduce Musculoskeletal Claims Volume Using Wearable Technology and Data Analysis.”
• Censinet releases a new Risk Never Sleeps Podcast, “Bridging the Education Gap in War-Torn Ukraine.”
• Current Health will host its US customer summit, This Way Home, November 15-16 in Boston.

Black Book’s top-ranked Q3 2023 managed services vendors include the following HIStalk sponsors:

• Symplr – credentialing and privileging
• Cloudwave – cybersecurity
• Dimensional Insight – data analytics
• Healthcare IT Leaders – ERP support
• Ellkay – integration and interoperability
• Clearwater – privacy, HIPAA, and compliance
• Experity – teleradiology and diagnostic imaging / urgent care
• Tegria – IT outsourcing/partial services

Blog Posts

• Rural Healthcare: Why Advocacy, Community Engagement, and Technology Matter (CereCore)
• Addressing Challenges in Implementing HCC Coding and Risk-Adjusted Coding Programs (AGS Health)
• 3 ways technology has evolved health care (Arcadia)
• Meet the Clinician – Huyen Cam, RRT, RCP (Ascom)
• 10 Questions to Ask When Evaluating Clinical Data Assets (Availity)

Contacts

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

Morning Headlines 11/7/23

Surescripts Acquires ActiveRADAR to Offer Therapeutic Alternatives for Prescriptions

Surescripts acquires ActiveRadar and its Clinical Catalogue of therapeutic alternatives data.

Health Catalyst Acquires ERS, Bolsters Tech-Enabled Managed Services Offering with Data Abstraction and Oncology Registry Management Capabilities

Health Catalyst acquires Electronic Registry Systems, which specializes in cancer registry services and software.

CareCloud Reports Third Quarter 2023 Results

CareCloud expects layoffs, set to wrap up by the end of the year, to help offset a 13% decline in Q3 revenue.

Curbside Consult with Dr. Jayne 11/6/23

Everyone is talking about the recent shutdown of Olive. Looking back over the last several months, HIStalk has been full of mentions of companies that abruptly shut down, declared bankruptcy, or are otherwise in bad shape. Plenty of other healthcare and health-adjacent are companies in those situations, but they don’t always come across our radar or aren’t noteworthy in the healthcare IT realm, so it’s difficult to know what the true number of companies in this situation might be.

In talking with friends who know the industry well, most are in agreement that it’s time for a lot of companies to pay the proverbial piper since they can’t deliver on the promises they made in exchange for startup funding. They forecast that many more companies will be trying to reinvent themselves over the coming months. Those that are successful may live to fight another day, but others may become the stuff of fire sales or ultimately closures.

Taking a look at Olive, some of the problems that they experienced are readily visible at other companies. They promised the use of artificial intelligence and advanced technology, but it was more sizzle than steak as it became apparent that they were using screen scraping tools and less-than-intelligent technologies. In visiting their booth at HIMSS, the team was more excited to talk about their big purple recreational vehicle than it was to talk about their actual solutions. When we did get them to discuss their business, there were plenty of vague ideas, punctuated by delusions of grandiosity. I wasn’t surprised when the company had layoffs in the summer of 2022. CEO Sean Lane explained in an interview, “Our fast-paced growth and lack of focus strained our product and engineering resources and prevented us from executing quickly on key initiatives.”

How many other companies out there are guilty of this? Plenty of startups go after what they perceive is the brightest, shiniest object, throwing their muscle behind initiatives without doing the level of due diligence or project planning that is needed to set themselves up for success. Product and engineering teams often work in a certain degree of chaos, but good people in those disciplines aren’t going to do that indefinitely, especially if other things are going on in the company that make things feel unstable.

I have no knowledge of how those particular teams felt at that particular company, but I’ve consulted for enough startups to have seen some wildly inappropriate leadership behavior that would make anyone vote with their feet. People don’t generally enjoy having projects shelved on a whim, or see funding diverted to initiatives that they know deep down are non-starters. They don’t like CEOS who yell at their teams, micromanage, or have Jekyll and Hyde personality swings. People also tend to be uncomfortable with the idea that their company might be selling vaporware, and are more likely to move on when that starts. One can only pull a rabbit out of the hat so many times before it becomes tiresome.

We know from the postmortem of Theranos that some of these high-flying executives may be lying to their board members and to their investors, as well as to their employees and clients. I haven’t seen any salacious tell-all stories yet about Olive, but will be interested to understand whether there was actual fraud involved or just flagrant mismanagement and a lot of excuses. In this situation, I think there is likely to also have been an element of failure to estimate exactly how much it would cost to try to do artificial intelligence work properly. It’s often much more expensive than people think, especially if you want to do the right kind of training and validation with your models. I’ve seen several companies who claim to have “AI-driven” this or that, when what they really have are sophisticated decision trees and a lot of manual intervention and hard work behind the scenes.

It’s particularly grating when I see a company that is operating in what seems to be a somewhat shady fashion, and I look at their list of investors and see only hospitals and health systems represented. These are their possibly spun-off “innovation” arms, or their venture capital funds rather than the care delivery organizations themselves, but the ultimate source of the money being used for investment is the same – payments from patients, insurance carriers, and the US government. These all boil down to being funded by you and me, in the form of our insurance premiums and tax dollars.

It also makes me angry when I see these care delivery organizations throwing major chunks of cash after technology solutions, when they haven’t yet cleaned up messes of inefficiency that could be handled by solutions they have already purchased. They’re not willing to spend the money to hire analysts and trainers to fully implement the EHRs that they’ve spent tens (if not hundreds) of millions of dollars for, or to optimize those systems to actually improve patient care for the physicians and providers or to improve the patient experience. However, they’re willing to buy other solutions that may just make terrible processes run faster and make their patients and caregivers more frustrated than they already are.

Frankly, you can buy a lot of vaccines, deliver a lot of charity care, and discount a lot of procedures for the hundreds of millions of dollars that are spent annually on solutions that fail to deliver value. Looking at some data on the largest organizations in the most recent year I could find (2021), venture funds run by large hospitals laid out more than $2.7 billion in funding rounds. How much prenatal care could that provide, especially since the US now has the highest infant mortality rate among high-income countries?

They can make the argument that the companies in which they invested are going to bring value that lowers the cost of healthcare, improves outcomes, and more, but the proof is ultimately in the pudding as far as what they are actually able to achieve. I can’t think of anyone I’ve talked to in the last several months that thinks the US healthcare system is stronger or better positioned to handle the challenges it is facing despite all this money being spent on technology. All of the practicing clinicians I speak to are on the frazzled edge, constantly being asked to do more with less, being forced to cut staff, or finding that services have been reduced. Maybe it’s time we start spending healthcare dollars on actual bread-and-butter healthcare delivery and ensure that patients are receiving a minimum level of care before we start writing big checks for pie in the sky ideas.

What do you think about the future of tech unicorns in the healthcare space? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Jeff Smith, CEO, Bamboo Health

Jeff Smith, MBA, MIB is CEO of Bamboo Health of Louisville, KY.

Tell me about yourself and the company.

I have successfully led multiple startups to market-leading companies that have served payers, pharmacists, and providers. I have found that with a relentless focus on the customer and their needs, you can exceed expectations. While at Lumeris, I led the value-based care enablement business. We worked with health systems and independent physicians to transform their financial and clinical model towards value-based care. That required strategies and tactics that were data-driven, team alignment, and clinical innovation to get to better outcomes in the communities we serve coast to coast. At CVS Health, I led enterprise strategy acquisition, physician connectivity, and population health. I was responsible for working with leaders across the business to develop innovative strategies and translate those into technology-enabled services at the point of care decision-making with the physician office and the pharmacy. That was focused on a scaled, innovative approach across the US for a Fortune 50 business.

Bamboo Health works across the healthcare ecosystem. We have the ability to share what we call critical information through our Smart Signals network. We do that by connecting with more than a billion patient encounters across the United States annually through 2,500 hospitals, 8,000 post-acute facilities, 25,000 pharmacies, 32 health plans, and 50 state governments. It’s a broad reach of the ecosystem, enabling admit-discharge-transfer alerts, bed capacity and availability, insights around where patients can receive care, and valuable prescription drug information down to the point of care as well as at the pharmacy. We do that across more than a million acute and ambulatory providers as well. It’s a broad reach on which we will build our strategy to help individuals across the country.

What has changed since the early days of the pandemic when it quickly became obvious, particularly from a public health standpoint, that our lack of real-time capacity and patient information hampered decision-making?

That’s part of the reason that I joined Bamboo Health. I saw that they had these hundreds of millions of critical moments that were occurring every year at the physician level, point of care, at the hospital admit or discharge, or in the pharmacy. Bamboo’s network has the capacity to be real time. It presents an opportunity for us to branch out from being just a technology company into a technology-enabled services company to connect those individuals, when those critical moments are occurring, to the care they need.

How will drug chains and other retailers fit into a system that has been based around health systems and physician practices?

The value-based care movement is creating companies, or is challenging companies to rethink their strategies as well, as what the end-to-end delivery of care looks like for these individuals. The CVS organization has created  strong vertical integration of everything from insurance all the way to pharmaceutical dispensing and engagement at the filling of those prescriptions. That will present an opportunity and a challenge for many of the existing players to rethink the overall value chain and how they can participate and drive value going forward. 

What’s most critical here is that we keep the patient and what’s best for them in mind and determine how everybody can contribute to the end result of what value-based care is trying to achieve, which is a better experience, a better financial outcome, and overall quality for that patient.

With all these new players requiring clinicians even as more of them quit their professions, how will we shift the design of the system to address clinician scarcity?

The solution is ensuring that people are operating at top of license and that we are efficiently connecting individuals to the care that they need at the right location for the right value for the patient in the system. That will be central to the Bamboo strategy and is seminal for us going forward to be successful as a country and fighting these high cost trends and quality challenges we have.

How will AI contribute?

It will be about information assist versus artificial intelligence actually taking the action. We have started to see here at Bamboo, and I’ve experienced this in other companies, a leapfrog moment for the healthcare delivery system in the United States. The ability to leverage vast amounts of information and be able to create an information assist environment — whether it be for physicians, pharmacists, or even the patient — presents an incredible opportunity for us all to drive greater quality of information that will be presented to all of those different stakeholders, along with an opportunity to create greater efficiency among the system itself and get to the highest value outcomes more quickly.

How do you set a company direction that involves AI when it changes significantly literally every day?

That’s why information assist is the correct framing for the healthcare community versus artificial intelligence that actually takes the action. As we see the future unfolding over the next several years at Bamboo Health, we have these millions of critical health moments occurring. We need to take all of the information that we have through our network and have those manifest themselves in the best next action for the patient. We can turn these seminal moments into an information assist moment for the healthcare providers to help them take that next best action.

We are focused on whole-person care at Bamboo Health. That means prioritizing the entire patient, including behavioral health, in the hundreds of millions of critical moments that occur each year. For example, an elderly woman is brought to the ED by her family after she has ingested a large number of pills. The ED physician will have certain suspicions around what she’s suffering from, such as depression, lack of sleep, or other life pressures. These individuals with severe to moderate mental health or maybe drug addiction issues show up into these points of care, and unfortunately, hospitals don’t have the infrastructure to help them.

The doctor at that moment could create direct access for that patient through what I would call the Bamboo Bridge or maybe some type of easy button, where they would be able to connect that patient to a caregiver in that moment who can serve up information to help them assess that patient. Then imagine that a Bamboo Health care navigator springs into action based on that easy button from the physician, where they can directly assess the patient with the information that we have and that’s provided to us. They can help determine the level of care that is required and then schedule, for example, this woman into a mental health care moment as a follow-up.

We have now been able to efficiently capture a critical moment and connect that physician so they can make a decision based on the information that we either serve up to them or to a Bamboo care navigator who will be more informed because of the information assist that occurs. Now that patient gets connected to the right next step, right next moment of care, and then the physician can feel like the next best action has occurred and that patient is better teed up for their next step with care that’s going to occur. We are getting to a state where we are able to help that patient navigate the system and providing the level of care at each step that is more complete, more informed, and helps that caregiver in the limited time that they have be able to make better decisions on the next best step for that patient.

Many people, especially younger ones, prefer episodic interventions over having an ongoing relationship with a primary care provider who quarterbacks their health needs. Could that next best action concept serve as a technology substitute for an ongoing provider relationship?

Our healthcare system needs to meet the patient where they are. What I’ve seen is that at least around value-based care, you need a quarterback of that care that the patient is attributed to. What’s critical here is that we think about some of these patients in behavioral health, where there’s not enough infrastructure around that primary care provider who has this patient attributed to them. This is something that I think the government is recognizing, that there hasn’t been sufficient reimbursement for physicians who are treating those with depression. They have made some changes to the reimbursement model and ensuring that there are enough dollars to those who are providing care for some of these complex patients that have comorbidities.

To your question, the technology should be part of that infrastructure and providing that information assist for these patients, so that not only are we identifying and engaging, but also helping nudge the patient towards the right actions as they move through their life and through the care delivery system going forward. I see it as complementary, and it likely will be different based on the type of patient and individual that we’re treating.

A healthy individual will have different needs than somebody with behavioral health and the complexities associated with that. The top 5% of patients drive about 50% of healthcare costs. Those patients in that 5%, as we see based on primary and secondary data, have behavioral health issues. These individuals will require more infrastructure and more care, particularly given the comorbidities they have. A patient that has substance use abuse may also have chronic kidney disease. Of those that have chronic kidney disease, one study found that almost 50% have symptoms of depression and anxiety. They also likely have heightened hypertension and diabetes. How are we creating an infrastructure and a care around that patient to engage them based on the different points that they engage in the healthcare community?

Part of our mission at Bamboo is that we want to work with these individuals who have these needs and then take advantage of all these seminal moments, working with our care partners — physicians, pharmacists, the care teams — to best engage that patient along each step of the way. I hope that if we can do that, that technology can nudge them into that next best action. Where I’m particularly excited about is that given the opportunity to engage some of these patients earlier in their disease or as we start to see certain habits emerge, we can more rapidly connect them upstream to these care providers to get them the care that they need. That will help the patient and the families that are trying to get them to a better state down the road.

As a company with private equity backing and an acquisitive history, what are the challenges for younger companies that might be running out of financial runway and opportunities for companies like Bamboo? 

Bamboo is very strong in terms of the current state of the company and our future growth prospects. I feel confident with the involvement of our backers Clearlake Capital and Insight Partners, with $100 billion of capital. Healthcare providers are looking for a turnkey solution to their problems. Bamboo is well positioned, given our customer base and the solution we already have in place, to find partners to supplement what we’re able to do today to create a better turnkey solution for our customers and the patients that we look to serve and exceed their expectations every day.

I came here because of the personal calling that I saw observing the healthcare system and where it is today. We have an opportunity to reduce the suffering that people are experiencing today, like many of us who have had family members and close friends who have struggled with behavioral health. We can make a real difference with the platform we have.

Morning Headlines 11/6/23

Cyber gang threatens to release Henry Schein data in ransomware attack

Ransomware hackers claim to have taken Henry Schein down again, two weeks after the medical supply distributor’s systems went offline from a similar attack that it reported on October 15.

Avail Medsystems abruptly shuts down

Avail Medsystems, which offers technology that virtually connects medical device reps with operating rooms, shuts down after reportedly failing to secure a needed funding round.

Blackbird invests in Carepatron’s ‘radically accessible’ healthcare management platform

Healthcare operating system startup Carepatron raises $4 million in seed funding, which it will use to develop AI and automation features.

Monday Morning Update 11/6/23

Top News

Ransomware hackers claim to have taken Henry Schein down again, two weeks after the medical supply distributor’s systems went offline from a similar attack that it reported on October 15. The company is again directing customers to place orders by telephone.

The BlackCat ransomware group says it has re-encrypted 35 terabytes of the company’s just-restored data. It posted company data publicly but later deleted it, hinting that Schein is either actively negotiating with the hacker group or has already paid its demanded ransom.

New SEC rules require publicly traded companies to disclose cyberattacks that could have a material impact, which the company has not done. However, it has asked the SEC for more time in filing its quarterly report due to the malware-caused shutdown of some operations.

The same ransomware group was behind the May 2021 shutdown of the Colonial Pipeline that caused gas shortages until the company paid a $5 million ransom. It claims that its actions have already cost Schein $150 million, adding that its other attacks cost Clorox $500 million and Dole $200 million.

Reader Comments

From Enigmass: “Re: mission versus money. Anyone else hearing that this is a hotter and hotter topic at hospitals? Hearing lots of stories about hospital / systems closing money losing birthing centers, satellite offices, mobile health vans, etc. to help the bottom line. Also hearing when local residents find out about it the public backlash is extreme.” This seems to be a daily occurrence, except possibly for the “public backlash” part since the facilities or services that are being shut down are nearly always located in areas that have low political clout. I’ll run a poll below. I suppose one could argue that businesses in general have the right to close unprofitable locations, but hospitals get huge tax breaks for the limited charity care they provide and are seemingly becoming less worried about public reaction to pruning their portfolio, just as they are no longer shamed to be paying their executives multi-million dollar salaries.

From Kvetcher: “Re: anonymous comments about companies. I’d like to see an example.” Here’s a recent one from “Don Draper” that I have heavily redacted. I’ll explain below why it is problematic to run it unedited even though I appreciate receiving it:

Next up [after Olive] is [company name] and their sponsored [events] while they’re laying off people left and right. CEO [x] is out, CRO [x] is out, supposed data genius [x] is now a “consultant,” and they’re laying off many more. They’re no longer selling a platform that never existed, they’re just doing data archival. Word is they lost their biggest account due to issues similar to what Olive’s clients experienced. No delivery. Then they pump out an announcement that they landed [big health system] which is just a data archiving project. Big secret is, the CIO at [big health system] has a son that sells for [the company]. How do these hospitals not see that they’re getting fleeced by their own people making decisions that enrich themselves and not the hospitals. But no news about this stuff. Everybody just keeps it under wraps because nobody wants to be outed as the fool.

Notes:

• LinkedIn and the company’s executive page do not show any job changes for the three people named. 
• It shows that someone with the CIO’s last name sells for the company, so I’m sure that’s true, but not necessarily indicative of misconduct.
• No layoffs have been announced, but since just about every company has laid people off, that is almost certainly true to unknown degree.
• The company still markets a platform, so I’m not sure if the comment means that they retired it or that customers are buying services instead.
• My takeaway is that this comment is probably mostly or completely accurate, at least from the unstated vantage point of the commenter. I haven’t heard customer complaints, but those are usually communicated via reference site inquiries.
• Bottom line: companies nearly always overstate their capabilities and successes – which isn’t necessarily a scam — and it’s the prospect’s job to perform due diligence by contacting existing customers, which is easily done without waiting for breaking news.
• It’s my job to look for and responsibly report red flags in hopes of generating non-anonymous verification. The Axios report on Olive was paywalled, so my recap may have been news to many.
• Olive claimed to have 900 hospital customers, so now that the company is defunct, I would appreciate hearing performance details and/or seeing what their signed agreements promised. I would also like to see what KLAS had to say about the company after talking to its customers. 
• One last point. Sometimes reference sites are compensated for touting a vendor’s product. Talk to the people who actually work with it or who should benefit from its results, not C-level folks whose next job could hinge on not burning vendor bridges.

HIStalk Announcements and Requests

LinkedIn is the only social media tool that poll respondents are using significantly more for work-related purposes than two years ago.

New poll to your right or here: has a local hospital or health system closed money-losing businesses or locations in the past year to the community’s detriment?

I hoped to like the new tune that is attributed to the Beatles, but George Harrison was right: it’s a sweet but “rubbish” poor-quality John Lennon demo that he rightfully discarded, reworked by AI into a fake Beatles reunion. About the only positive I can muster is that Yoko didn’t insist on shrieking along and it came with new nostalgia-inducing video showing Paul and Ringo recording their parts. Don’t let “Now and Then” be your final Beatles memory – re-watch “A Hard Day’s Night” or the video of their farewell rooftop concert or listen to “In My Life” or “Here, There and Everywhere” when they actually played together. The Fab Four’s jobs are safe from AI.

Happy end of Daylight Saving Time, with the falling back meaning that (a) driving home from work involves headlights; and (b) the time-challenged among us who incorrectly express times as EST for the full year can enjoy being right for the next four months.

Thanks to the following companies that recently supported HIStalk. Click a logo to learn more about them.

Webinars

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

Acquisitions, Funding, Business, and Stock

The Wall Street Journal reports that chain drugstore understaffing – exacerbated by reduced front-of-store sales as customers shop online and by investor focus on the newly acquired medical practices of drug chains – has cratered their customer satisfaction, caused medication errors, and created prescription filling delays.

People

Shahzad Safar, MBA (Rx Savings Solutions) joins Trualta as CTO.

Announcements and Implementations

AMIA recognizes Susan Newbold, PhD, RN of Nursing Informatics Boot Camp with its Virginia K. Saba Informatics Award.

Other

A Washington Post review describes how hospitals hastily discharge elderly patients who lack immediate relatives by petitioning to have them assigned to court-appointed guardians. The guardians, who in Florida are required only to complete a 40-hour course, immediately gain control over the patient’s finances and assets. The article recounts a former pilot who was assigned a guardian through a hospital-retained attorney – who also served as the guardian’s counsel at $300 per hour – despite having living relatives. The guardian moved the patient to a nursing home, sold his house at a lowball price with help of a phony valuation report to a buyer who flipped it as-is for a 50% profit, and liquidated his belongings in a cash-only estate sale. The guardian claims that she never saw all the cards and gifts that were mailed to the patient’s home from family members. The state declined to pursue a criminal investigation, but the guardian was reprimanded for filing late reports and ordered to take eight more hours of training.

Sponsor Updates

• Symplr staff raise money for breast cancer research by participating in the Susan G. Komen More Than Pink Walk.
• NeuroFlow will present at Behavioral Health Tech 2023 November 15-17 in Phoenix, AZ.
• Notable announces the 2023 recipients of the Notable Impact Awards, which recognize health systems and executive champions who are driving tech-led transformation.
• Netsmart will incorporate ReThink Behavioral Health’s practice management software for applied behavioral analysis and pediatric therapy into its CareRecords software.
• Optimum Healthcare IT publishes a new case study, “UHealth: Supporting the unique ITSM needs of an Academic Medical Center.”
• PerfectServe’s Lightning Bolt achieves top marks for overall performance, ease of use, quality of support, and proactive service in the 2023 KLAS Physician Scheduling Report.
• Redox releases a new Diagnosing Healthtech Podcast, “Treating veterans and interoperability with former Secretary of the VA, Dr. David Shulkin.”
• Waystar will present at the HFMA Hawaii Chapter 2023 Revenue Cycle Seminar November 9 in Honolulu.
• West Monroe launches Nigel, a generative AI-powered internal chat platform designed to enhance employee productivity and efficiency.

Blog Posts

• The new dawn of senior care: Digital health’s role in aging in place (Nordic)
• Don’t Get Spooked by Cloud Call Center Solutions (PerfectServe)
• The Role of Medical Necessity in Healthcare (RCxRules)
• Through the Lens of Lynne Nowak, MD, Our New Chief Data and Analytics Officer (Surescripts)
• No Surprises Reboot (VisiQuate)

Contacts

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

Morning Headlines 11/3/23

Lawsuit Challenges Federal Rule That Ties Providers Hands in Efforts to Reach Their Communities

The American Hospital Association, Texas Hospital Association, Texas Health Resources, and United Regional Health Care System sue the federal government over an HHS rule that prohibits health systems from using web user tracking tools such as Meta Pixel and Google Analytics.

Covera Health Announces Up to $50M in Additional Series C Funding to Redefine the Role of Radiology Nationwide

AI-enabled radiology performance measurement software vendor Covera Health raises up to $50 million in a Series C funding round and finalizes its acquisition of CoRead, a hospital AI quality assurance company.

Patient data published following cyberattack against southwestern Ontario hospitals

Five hospitals in Ontario confirm that patient data that was stolen in a recent ransomware attack against their self-created shared services organization has been published online.

News 11/3/23

Top News

The American Hospital Association, Texas Hospital Association, Texas Health Resources, and United Regional Health Care System sue the federal government over an HHS rule that prohibits health system from using web user tracking tools such as Meta Pixel and Google Analytics.

The plaintiffs note that the federal government, including HHS, uses those same technologies. They also claim that the new rule oversteps HHS’s HIPAA statutory authority.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor DrFirst of Rockville, MD. Since 2000, the healthcare IT pioneer has empowered providers and patients to achieve better health through intelligent medication management. It improves healthcare efficiency and effectiveness by enhancing e-prescribing workflows, improving medication history, optimizing clinical data usability, and helping patients start and stay on therapy. In the last few years, DrFirst has won over 25 awards for excellence and innovation, recognizing its game-changing use of clinical-grade AI to streamline time-consuming healthcare workflows and prevent medication errors. The company’s solutions are used by more than 350,000 prescribers, 71,000 pharmacies, 300 EHRs and health information systems, and 2,000 hospitals in the US and Canada. Visit their website and follow @DrFirst. Thanks to DrFirst for supporting HIStalk.

I’m thrilled when readers comment on HIStalk articles, but I should explain a ground rule. It wouldn’t be fair for me to approve anonymous comments that make specific legal or moral allegations about people or companies who are named specifically. Comments such as “Company X is all smoke and mirrors and knowingly sells a product that doesn’t work” or “CEO John Smith has had affairs with three consecutive assistants” may well be true, but I have no way of knowing (and comfortably publishing) that.

Webinars

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

Acquisitions, Funding, Business, and Stock

Bloomberg highlights Apple’s unfulfilled health ambitions even as the company uses health-centric selling points for its Watch and the company’s 2024 roadmap that includes hypertension and sleep apnea detection, turning AirPods into hearing aids, adding health capabilities to its Vision Pro headset, and launching an AI-driven paid health coaching service. Apple’s core market remains the “worried well,” and venturing into medical domains and patient care could embroil it in global regulatory complexities. Insider accounts reveal that Apple has shelved various health projects in fearing that a subpar consumer experience would tarnish its reputation. Apple even flirted with running in-store clinics staffed by employed doctors and engaged in acquisition talks with Crossover Health and One Medical for staffing them, but abandoned the idea because the cost was competitive only for young, healthy customers.

Meditech announces a return to office plan that requires employees to spend 40% of each pay period in the office — spread among Tuesday, Wednesday, and Thursday as full-time days — beginning in March 2024. That seems entirely reasonable to me, although an employee tells me that it’s a big jump from today’s twice-per-month requirement.

AdaptX, which offers AI-powered EHR analytics tools, raises $10 million in funding. CEO Warren Ratliff, JD was a co-founder and COO of Caradigm.

AI-enabled radiology performance measurement software vendor Covera Health raises up to $50 million in a Series C funding round and finalizes its acquisition of CoRead, a hospital AI quality assurance company.

Ambulatory practice technology vendor IKS Health acquires coding and documentation outsourcer AQuity Solutions for $200 million, increasing its headcount to 14,000 and its annual revenue to $330 million.

Doximity launches DocDefender, a free service for physicians that removes their personal contact information from public websites.

Waystar will delay its IPO due to market conditions, pushing the offering back to December at the earliest but more likely into next year.

Sales

• Inland Empire Health Plan and Molina Healthcare of California will offer 72,000 teens in two counties access to BeMe’s behavioral health platform.

People

Walgreens Boots Alliance hires Neal Sample, PhD (Northwestern Mutual) as EVP/CIO.

Luke Bonney steps down from the CEO position at Redox, naming Trip Hofer, MBA (Optum Behavioral Health Solutions) as his replacement.

Matt Cardoso, MS, MBA (Quest Diagnostics) joins WellStack as VP of product management.

Announcements and Implementations

DrFirst launches Fuzion, an enterprise-wide, AI-powered, Epic-integrated platform to streamline medication reconciliation, prescription price transparency, and prescription reminders. Baptist Health says it saved 19,000 hours of clinician work by using DrFirst solutions to convert nine million medication instructions in multiple EHRs to standard sigs during its conversion to Epic.

Government and Politics

In Australia, Victoria’s health department reports dozens of doctors to the country’s practitioner regulator for failing to perform a mandatory check its SafeScript prescription drug monitoring program to detect doctor-shoppers.

Privacy and Security

A Massachusetts medical management company pays $100,000 to settle HIPAA charges that it failed to protect patient information from a December 2018 ransomware attack that came 20 months after the malware was installed. The breach affected the information of 207,000 patients of covered entities with which Doctors’ Management Services is a business associate. The settlement is HHS OCR’s first that involves ransomware.

In Canada, five Ontario hospitals confirm that patient data that was stolen in a recent ransomware attack against their self-created shared services organization has been published online.

Other

A UCSF Health study finds that physicians who conducted visits by telemedicine due to the pandemic spent one additional hour per day working in the EHR, both during and outside of normal hours, despite not receiving an increased number of patient messages.

The Miami paper delves into the thriving business of cosmetic surgery in South Florida, which has created an underground network of illicit post-op recovery centers for medical tourists that are nestled within suburban homes, some of them rented. A recent raid of one such home found 17 recuperating patients who were each paying at least $250 per night. Some centers employ registered nurses, but others opt for untrained, underpaid staff. Despite the modest risk of being arrested due to a thinly spread four-person investigative unit that also investigates Medicare fraud, the recovery center operations can generate up to $90,000 monthly from a single inexpensive house. A review of emergency calls that were linked to terms “lipo,” “plastic surgery,” and “BBL” (Brazilian butt lift) over six years yielded 2,220 records, of which 1,500 patients required a hospital trip, 200 were bleeding, 19 had experienced a heart attack, and five were already dead by the time an ambulance arrived.

Sponsor Updates

• Availity’s “Big Brothers” and “Big Sisters” meet their new “Littles” at Big Brothers Big Sisters of Northeast Florida.
• Elsevier Health’s first “Clinician of the Future 2023: Education Edition” finds that most medical and nursing students are planning careers outside of patient care.
• Findhelp announces that Navigate has incorporated its social care referral capabilities into Navigate’s wellness platform.
• Nordic publishes a new episode of its Healthcare Chronicles series, “Maximizing your investment in the EHR | Solving tomorrow’s problems today.”
• Netsmart integrates RethinkFirst’s practice management software that was designed for Applied Behavior Analysis and pediatric therapy into human services workflows into Netsmart CareRecords.
• FinThrive will present at the Florida Association of Health Plans 2023 Conference November 8.
• Zoom recognizes AdvancedMD as an ISV Partner of the Year for innovative use of its videoconferencing platform.
• Optimum Healthcare IT publishes a case study titled “UHealth: Supporting the unique ITSM needs of an Academic Medical Center.”
• HCTec will host a CHIME Fall Forum cocktail hour November 10 in Phoenix, AZ.
• New research from Inovalon and Harvard University finds that Medicare Advantage beneficiaries have superior quality outcomes relative to traditional Medicare.
• InterSystems partners with analytics company BritHealth in Indonesia.
• JTG Consulting Group names Henry Ford Health System veteran Lisa Dwyer project manager.

Blog Posts

• Hospital-at-Home Programs Present New Opportunities & Risks (First Databank)
• How AI is Changing Contact Centers & How to Benefit (Five9)
• How to Successfully Navigate HIPAA Cybersecurity Requirements (Fortified Health Security)
• Your Guide to HIPAA Rules for Transferring Medical Records (HealthMark Group)
• Overcoming 5 Healthcare Marketing Challenges (Healthwise)
• Job Haunting: 5 Ways Candidates Scare Hiring Managers (Healthcare IT Leaders)
• Rely on Workday Releases to Advance Your Spend Management Capabilities (Impact Advisors)
• HBMA 2023 wrap-up: Top challenges and opportunities for billing companies (Inovalon)
• 8 Ways Your EHR Can Transform Healthcare Efficiency (Medhost)
• Deeper Connections: Reflections on the KLAS Interoperability Summit (Meditech)
• From Inpatient to Outpatient: 5 Ways to Enhance Your Hospital Therapy Operations (Net Health)

Contacts

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

EPtalk by Dr. Jayne 11/2/23

The state of public health in the US continues to decline, and I’m worried about the potential lack of available data for COVID surveillance. Now that many people with COVID are either testing at home or just not testing at all, it’s more important than ever that we use wastewater surveillance to help predict rising cases.

Politico reported on a contract dispute between the Centers for Disease Control and Prevention and one of its surveillance contractors, resulting in a quarter of testing sites being shut down. The situation might not be resolved until early 2024, which is concerning local officials across the country. Wastewater can also be used to monitor Mpox and changes in opioid use with only passive public involvement in the process. Let’s hope CDC can get the situation resolved so that communities aren’t going into a potential COVID surge blind.

Yet another company is wading into the telehealth space, and this time it’s GNC, the vitamin and supplement company. Their press release lists three tiers of service, with graduated annual fees relative to the services offered. The offerings include not only physician visits, but also a list of up to 400 prescription medications that are shipped directly to the patient with a $0 copay, along with discounts on other medications at retail pharmacies.

I’m still struggling to figure out how the economics of some of these offerings work. The Basic offering for individuals costs $34.99 per year and provides free virtual urgent care, virtual “lifestyle” care, and a list of 100 free prescriptions. Plenty of physicians are airing their dirty laundry on Facebook these days, reporting that the typical payment for physicians for a virtual urgent care visit is $25 to $30 depending on whether the visit is audio or video. Even if you’re mailing out a dirt cheap generic medication, adding in the postage for that one visit and its associated treatment will break the budget for that $34.99 annual subscription.

How are they making their money, you ask? We can only guess at this point, but I suspect that they are going to push all kinds of nutritional supplements and vitamins. If not during the visit, I’m sure the patient will receive marketing emails and text messages. I would bet that they’re also monetizing the patient information to outside firms as well.

Looking at the other plan options, the Plus option is monthly ($9.99 for individuals and $29.99 for families of up to six people) and gets you the benefits of the Basic tier plus free virtual primary care and zero dollar access to the full 400 medication formulary. The premier option jumps to $39.99 per month for individuals and $59.99 for families, and adds free virtual mental health care and virtual physical therapy. Looking at GNC Health’s website, there’s no mention of how they will coordinate care with your existing care team, or what they will do if you need care beyond what they offer.

I also found a likely untruth in their FAQs, which state that “Only the medical professionals in our provider partner’s network can access your personal identifiable health data.” I suspect personnel in quality assurance, customer service, and others will have access to the data. Most people don’t consider a customer service agent or call center rep to be a medical professional, and since I doubt GNC is going to have medical assistants or nurses fielding patient complaints, they might want to update their verbiage.

I found it interesting that their text refers to “medical doctors,” so I wonder if they are excluding doctors of osteopathy? It’s more likely that they just need a better copy editor.

Digging deeper on their menu of services, they leave the door wide open for urgent care with mention of “other individual medical concerns.” I was pleasantly surprised to see they offer emergency contraception since that’s such a charged area of practice in many states. The medication list for Basic members is pretty decent, too. I didn’t have a lot of time to try to figure out what provider group they’re using, and I doubt they have built their own, so if anyone knows, please share with the rest of us. Good luck to GNC as they wade into this, and I hope they engage the help of a solid physician copy editor soon.

Speaking of copy editing, I’ve been using Grammarly for the last couple of years, mostly because my employer pays for it and I’ve found it to be a handy tool. While I was traveling over the last couple of weeks, I was using a different laptop and didn’t realize that it wasn’t connecting with Grammarly. The service perceived that as inactivity and ended my 110-week streak. Gamification is a big thing for encouraging some people to stay persistent, and I have to say that I enjoyed earning the different badges from time to time. I consulted the internet to see if there was any way to reinstate the streak, and it doesn’t seem there is a remedy. It also sounds like there isn’t a way to pause your participation, which is really a negative for people who want to take an actual vacation and not write for a while. It sounds like there have been a number of requests from users to Grammarly for that kind of feature, but they haven’t created it yet. Come on, folks, let’s help enable some work-life balance here.

Earlier this week, Mr. H made mention of a survey that indicated that 25% of medical students in the US are considering leaving the field or selecting careers that don’t involve treating patients. Globally, students’ main concerns include mental health (60%), clinician shortages (60%), burnout (63%), and income (69%), and 12% of students worldwide are considering stepping away from medicine. This is not a new phenomenon. When I graduated more than two decades ago, fully 10% of my medical school class did not go on to residency training. They chose PhD programs, MBAs, law school, or business careers.

Students in the US often graduate with huge student loan debt, which often leads them to avoid pursuing lower-paying specialties such as pediatrics and family medicine, both of which we need desperately. Over the last three years, students undoubtedly had the chance to see that resident and attending physicians were treated as expendable and were subjected to crushing workloads in many fields, including emergency medicine as well as the two specialties previously mentioned. As in any high-pressure scenario, something has to give. In the face of untenable work expectations, loss of privacy, increasing violence, and economic pressures, the fact that people are opting out is not surprising.

I stumbled upon this chap during my recent travels, and I had no idea what it was until I Googled it. Spokane’s famed Garbage Goat has been helping clean up the city since the World’s Fair was held there in 1974. The goat connects to a vacuum that helps it “eat” pieces of trash and was built by the late Sister Paula Mary Turnbull, famous in the area as “the welding nun.” I love finding wacky things when I travel, so couldn’t resist sharing. It’s just over the hill from a giant Radio Flyer red wagon, so if you’re in the area, be sure to catch them both.

What’s the most interesting piece of public art you’ve seen? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 11/2/23

AdaptX raises $10M to expand its AI-driven medical data analysis for healthcare providers

AdaptX, which offers AI-powered EHR analytics tools, raises $10 million in funding.

Tabula Rasa HealthCare Stockholders Approve Acquisition by Nautic Partners

Private equity firm Nautic Partners acquires pharmacy services and medication management vendor Tabula Rasa HealthCare and will merge it with its ExactCare Pharmacy business.

Waystar delays US IPO to ride out market volatility

Sources report that Waystar will delay its IPO until early next year.

VA to launch artificial intelligence contest to help health care staff

The VA will launch an AI Tech Sprint competition with $1 million in prizes to discover AI-powered solutions for healthcare worker burnout.

Readers Write: Surviving the Blizzard: How Technology Can Ease Specialty Medication Re-Enrollment Season

Surviving the Blizzard: How Technology Can Ease Specialty Medication Re-Enrollment Season
By Julia Regan

Julia Regan, MBA is founder and CEO of RxLightning of New Albany, IN.

One of the most challenging times of the year for providers, medication access staff, biologics coordinators, and other team members who support specialty medication onboarding is re-verification and re-enrollment season, which is aptly known as Blizzard Season.

While insurance selections are finalized and patients are counting down the days until the new year, coverage modifications on the back end can cause significant challenges in medication access. Most common adjustments include updates to a coverage policy and a new prior authorization requirement, reset deductibles, the end of co-pay assistance and patient assistance programs (PAP), or the selection of an entirely new insurance provider.

Some of these changes can wholly prevent the continuation of medication fulfillment, while others – like deductible and financial assistance resets – may surprise patients enough to forego the unexpected costs and immediate adherence to their meds.

Manufacturers, hubs, and patient support groups often hire small armies of workers to meet the influx of benefits verification demands, but this model is inefficient and expensive. While much of the work cannot be started until updated forms and insurance details are finalized, a robust Blizzard Season plan is a necessity.

To accelerate the benefits verification process and reduce the resources and costs required, providers should understand which plans, manufacturers, FRMs, and hubs they may be working with, and proactively collect as much information about coverage changes and patient health changes so that re-submitting paperwork can be more nearly seamless. Additionally, teams should communicate with patients early to understand who may be changing plans, alert them of potential upcoming requests such as signatures required and plan details, and support them through this confusing time.

While many programs transition on January 1, enrollment or PAP forms are often available 1-2 months ahead of time, enabling teams to get a head start on the re-enrollment process. With the right plan of attack, as well as the right technology, Blizzard Season can be more efficient and straightforward.

There will always be a need for real people to manage some of the more complex patient cases, wherein new coverage restrictions, financial assistance, or prior authorization is required to continue a patient’s care regimen. However, a significant portion of re-enrollments and re-verifications can be streamlined by using technology.

In many cases, the first step for re-enrollment is finding the appropriate medication or PAP paperwork and completing the paper form correctly. While this may seem simple, completing thousands of paper forms is a tedious and error-prone task. With new digital enrollment technologies, providers and care teams can be assured that they are completing the most up-to-date form with no missing information, greatly reducing the risk of a downstream issue in the application.

Another important step that can be streamlined with technology is (re)confirming the patient’s insurance and completing an eligibility and benefits check. Instead of manually scrolling through documents on a plan’s website or calling a representative to confirm coverage, real-time connectivity can accurately display a patient’s plan details while providing insight into cost and restrictions required, reducing time spent confirming details and allowing stakeholders to move on to more complex steps of the process.

Next, collecting consent. While patient and provider signatures are necessary to re-enroll for a specialty medication or PAP, with the click of a button, email and SMS notifications can be sent to appropriate stakeholders to securely sign documents from wherever they might be. No waiting until the next in-person visit or stop by the desk to collect a signature. Instead, consent can be collected remotely in a matter of seconds.

As mentioned, with deductibles, co-pay, and PAP all resetting, it is essential for technology to surface affordability options that can support patients, whether through long-term PAP enrollment, foundation or grant support, or short-term, low-cost options that a patient can receive in the interim while their specialty medication enrollment is being finalized. With an interconnected network of coupon and discount providers, care teams can easily identify and communicate with patients about affordable options that are available to them.

One of the most time-consuming tasks of the re-enrollment process is filtering which patients are qualified for PAP or financial assistance programs. Major credit check companies now allow technology vendors to connect into their systems to provide real-time insight into income and credit score, enabling an initial verification of assistance eligibility. Using this technology can greatly fast-track certain patient cases over others.

The unfortunate truth is that manufacturers, hubs, patients, and providers all have work to do to complete a specialty medication re-enrollment successfully. However, from digitized forms to automated eligibility checks, and digital consent collection to real-time notifications, the process to re-enroll a patient is more streamlined, personalized, and error-free than ever before.

With a thoughtful plan, innovative technologies, a robust ecosystem, and proficient staff, Blizzard Season can require less resources and time, enabling what matters most, consistent care with no lapse in medication access.

HIStalk Interviews B.J. Schaknowski, CEO, Symplr

B.J. Schaknowski, MBA is CEO of Symplr of Houston, TX.

Tell me about yourself and the company.

I have been the CEO of Symplr for three years. Over that time, we have tripled the size of the company. We acquired seven companies in that time, but we have seen strong organic growth because we have developed a competency around delivering value for our healthcare system customers. We are in 97 out of 100 US acute care facilities. We are earning the right to add more value as we deliver for these systems and deliver important outcomes during a time where they have financial problems and workforce shortages. Symplr turned into an important partner over that time, and we are just getting started.

How has the company integrated those acquisitions?

It’s a lot of work. It starts with a thesis and a strategy. We say no to infinitely more potential acquisitions than we ever do. For most of them, it’s not for lack of what would be otherwise a creative financial engineering, but it’s that they don’t fit our strategy. We have built a concept of non-clinical or administrative healthcare operations that are divided into four portfolio areas – provider data management; workforce management; contract and supplier management; and compliance, quality, and safety. If a potential acquisition doesn’t round out or add scale to one of those pillars, we say no.

We have a concept of a connected enterprise. We believe that interoperability and a common UI will make a healthcare worker’s day simpler, with better outcomes, less time in front of computer screens, and more time in front of patients. Acquisitions have to fit into one of those portfolio areas.

Once we identify one and get the deal done, it becomes, how do we take the best of that acquisition, incorporate it into the Symplr culture, lexicon, and core processes, or if we have better, more mature processes here at Symplr, how do we apply those to that asset to get the right level of scalable and sustainable competency for our customers going forward? It takes a lot of time. It takes a lot of hard work. Our team puts in long days and long weeks, but our systems are telling us that it’s working.

Financing and competitive challenges may force young companies to be acquired or die. How would you characterize the likely winners and losers?

There are certainly fewer processes in general. There is still access to capital, even for the smaller companies that weren’t running at much of a margin. It is wildly expensive right now, as you might imagine. Some of those companies that might have otherwise tried to stick it out for a few more years, or sell to somebody like me or another strategic, may be looking at taking on new private equity investment or new partners. They will give up more of their companies because they are not at a point where they can realize the full value.

But the good companies, the companies that have run well — which are the ones that we are interested in, that for a sustained period of time, have had good customer referenceabiliy and have thought about both profitability and growth — those are still attractive assets. It’s less about the financial profile for us. It’s more about the value that they bring to a customer. If we have a complementary or tangential solution, we call it one plus one equals three. Those are still the most interesting assets for us. They usually come from companies that have managed their overall operational portfolio and financial portfolio well.

How aggressively are health systems reducing their technology vendor count, and how has that influenced acquisitive, investor-backed companies versus a one-product startup?

It is the dominant theme relative to technology in healthcare today. COVID shone the spotlight on all the inefficiencies. Fifty or 60% of healthcare systems are using 50 to 100 applications. Think about the credentials, data security, and privacy issues on that. Think about the inability to get your data and send it to your healthcare administrator to be able to make intelligent decisions about how to run the system. At the same time, you’re trying to drop a nurse into three or four facilities, and he or she may literally feel like it’s Day 1 on another system facility that he or she walks into.

It is the driving force behind a lot of technology decisions. It is the driving force behind the evolution and escalation of the CIO as a real driving force of healthcare system — productivity, efficiency, financial outcomes, patient safety, and workforce engagement. Technology consolidation is applied to a highly fragmented patchwork quilt of systems that it took to run a healthcare system. You will see that phase in to more centralized decision-making over the next five years, how it relates to the availability of healthcare technology assets.

Companies that look like Symplr are trying to accomplish the same thing that we have. They may not have the same philosophy around integration or UX/UI, but I see a narrowing of the aperture relative to the willingness to consider a lot of small vendors versus partners who can be there at scale and deliver for you in a variety of areas. As the commercial challenges potentially mount for those companies — and there will be good ones, there are always great ideas, true innovation, and real outcomes —  but they will become a little bit more scarce. The larger, the more sustainable, more successful ones that can offer more breadth and depth will continue to become more attractive. It will be interesting to see where that leaves some of the little guys.

OpenAI just killed the valuation and prospects of a few startups by enhancing ChatGPT to read PDF documents, which made those other products instantly obsolete. In digital health, how do companies stay out of Epic’s way while hoping not to be killed off by Epic as an incumbent vendor building a good-enough competing product?

You have to be really careful about where you pick your lanes. With Symplr and some of the other larger operational software companies, there will always be a little bit of coop-etition. But you need to understand where any of the large players are headed and then understand how you can be complementary.

We have our own AI ML strategy, which is a funny thing since AI is not new. The consumability of AI relative to ChatGPT and some of the other formats that have been released recently has been the game-changer. But as you think about their ability to meaningfully come in to do the non-value added workflows, that is super interesting. OCR is 20-plus years old and isn’t new or novel. We would never create a business around that. It’s understanding your swim lanes and having technological innovation and process differentiation that allows you to collaborate and live alongside, hopefully at incremental value, and very rarely overlap.

Health systems are reporting poor financials even though they have near-monopoly markets, charge high prices, and should theoretically be improving efficiency at scale via acquisition. What technology business opportunities does that create?

At the end of the day, if you are a services business and you don’t have enough people to fulfill demand, you are going to have financial troubles. We have a 45% nursing shortage and another 25% saying they will retire in the next five or 10 years. That’s problematic. When you can’t actually get the patient throughput to fulfill the demand you have, even if you are somewhat monopolistic in a market, that’s bad math that doesn’t take an MIT PhD to figure out.

The real question is, how do you leverage technology? This is what Symplr does. Everyone else is oriented around the patient, while we are oriented around the healthcare worker. We’re trying to make them more productive. That means more efficiency, more productivity, and less time in front of a computer screen, yet better outcomes and more time in front of the patient. Seeing more patients, having better patient safety,  having better patient quality visits and engagement when they are actually in the system through leveraging technology. That’s where we see the differentiation. 

There is still extraordinary waste inside healthcare systems, particularly those that have been run in a highly fragmented or decentralized way. We see in our contract and supplier and spend management portfolio the opportunity for hundreds of millions, if not billions, of dollars of improved savings just by leveraging better technology, which obviously that system can then redeploy return to shareholders or whatever it looks to do. Getting back to the fundamentals of what a healthcare worker is supposed to do and how to manage the bottom line through technology are the two obvious areas.

How are health systems addressing clinician labor challenges?

It’s putting the same level of emphasis around healthcare worker processes and workflow that they have had around patient throughput and patient workflows for all these years. 

If you look at the amount of time that a nursing leader, for example, had previously spent in front of a screen scheduling nurses or doing patient safety audits, all of these things could be done in a simpler way, where they are served to served to him or her. Cut that time by two-thirds to 75% and then you get 45 minutes back in an hour to spend on patient care or mentoring younger nurses, which is from what we’ve seen is the key to improving healthcare. It’s all about time. Healthcare is all about giving them more time and then giving them the optimal workflows to get through the day, to see the right patients and give them the right outcomes. 

That’s where more progressive systems are focused. How do we empower rather than constrain our nurses, our physicians, and our respiratory therapists? And down the line, to be in the moment more and less in front of that computer screen being forced  to follow a set of antiquated workflows or processes.

What are the biggest changes you expect to see in digital health over the next handful of years?

It’s not a sexy answer, but a return to basics and doing it at system-wide level. Where you used to have 47 different facilities inside of one system running as 47 different organizations, as you begin to see them consolidate into a standard way, a best practice way, a gold standard way, you’ll see that beginning to improve not only patient outcomes, but healthcare worker outcomes. That’s what this is about. The focus on the healthcare worker — their engagement, minimizing burnout, making sure that they have the right tools to do their job successfully and effectively, and making sure they aren’t wasting their time on red tape administrative workflows. It’s a return to some of those things, leveraging technology, be it workflow technology or a little bit of AI/ML, to augment and make them more productive. If we get back to the basics and leverage technology to do so, you’ll see a step function improvement in the outcomes that healthcare systems deliver, and that will be to the benefit of every constituent in the healthcare ecosystem.