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News 2/8/23

February 7, 2023 News 3 Comments

Top News

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A blog post by Oracle EVP and lobbyist Ken Glueck fires back at members of Congress with unusually aggressive criticism of two recent bills that would postpone or cancel the VA’s Oracle Cerner implementation. Some points:

  • 1980s-era VistA can’t meet the health challenges of veterans, can’t communicate with DoD systems, and has always been nearly impossible to maintain and modernize, so reverting to it at live sites would be a disaster.
  • There’s no magic wand for modernization, but moving to commercial off-the-shelf system workflows is always worth doing.
  • It was a mistake to schedule the first VA go-live in the pandemic’s peak days of October 2020 when caregivers were overwhelmed.
  • With the Oracle acquisition of Cerner, “VA now has essentially two vendors for the price of one” in providing both clinical and engineering expertise.
  • DoD and public hospitals around the world have successfully rolled out Cerner as the VA struggles, suggesting that the VA’s issues aren’t related to product capabilities.
  • A particular VA challenge is that it runs 130 instances of VistA, which Cerner attempted to fix by combining them into a single workflow that turned out to be too cumbersome, such as dozens of options for ordering a liver enzyme test when commercial instances of Millennium might offer four or five.
  • Glueck reiterated Oracle’s commitment to have the first beta test of a rewritten Millennium EHR available in 2023 at no extra cost to the VA or DoD. The cloud-based application will include a modern, Web-based, mobile-friendly user interface and will support voice recognition and AI-based clinical decision support.

Reader Comments

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From Krill Feeder: “Re: more slide decks from the J.P. Morgan Healthcare Conference. Are health IT vendors increasingly using the ‘land and expand’ investor pitch for growth prospects as is common in other industries? Get the customer using a low-cost initial sale, then cross-sell and upsell to create annuity-like profits. Do readers think this still works in a stock market downturn?” Incumbent vendors, unless they are inept, always have the upper hand in making add-on sales by gaining access to health system decision-makers and removing the uncertainty and effort that is required to onboard a new vendor. I like the concept since it encourages vendors to perform well after the sale, which is a win-win, but whether investors should believe such claims is a different issue. A variant is when one company acquires another purely to sell into its customer base, which is often traumatic for those customers whose carefully researched product and vendor assumptions are rendered uncertain by new ownership bearing ulterior motives.

From Pete Drucker: “Re: [vendor name omitted]. To exit the market. Last day for employees is Friday.” Unverified, so I didn’t include the company name. I could not find a press contact or employee email address anywhere, so I’ve sent a Twitter direct message to the CEO and will update with any response.


Webinars

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

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


Acquisitions, Funding, Business, and Stock

CVS Health is reportedly close to acquiring primary care operator Oak Street Health for $10.5 billion.


Sales

  • WellSpan Health (PA) selects Epic-based KeyCare as its virtual care partner for its on-demand care service. The health system was part of the startup’s Series A investment round.
  • VirtualHealth adds automated prior authorization capabilities from Edifecs to its Helios utilization and complex care management technology.
  • Virtua Health (NJ) will implement Memora Health’s automated clinical intelligence software as a part of its care programs for congestive heart failure, specialty pharmacy, and colonoscopies.

People

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April Saathoff, DNP, MS, RN (Harris Health System) joins Johns Hopkins as VP/CNIO.

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ChartSpan names Dan PIessens, MS (RevealRx) CTO.

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Emids names Sean Narayanan, MS (Apexon) as CEO. He replaces founder and CEO Saurabh Sinha, who will transition to board chair.

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Medsphere promotes Jeri Judkins to CEO, replacing Irv Lichtenwald.

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Mass General Brigham promotes Fran Hinckley to VP of digital solutions delivery of its community division.


Announcements and Implementations

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Grocery store operator Albertsons Companies launches Sincerely Health, a digital health and wellness app that offers a questionnaire-calculated health score, linking to activity trackers such as Apple Health and Fitbit, and pharmacy management. The company’s merger with Kroger is pending approval.

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OSF St. Francis Hospital (IL) launches a tele-NICU program using technology from Teladoc Health.

Alpine Health develops AI-powered predictive analytics to help hospital case managers ensure that at-risk patients transition to the right care settings with appropriate social services upon discharge. The startup is the product of a partnership between OSF Healthcare (IL), its innovation center, and consulting firm High Alpha Innovation.

Virginia Mason Franciscan Health (WA) uses hospital-at-home services and technology from Contessa to launch its Home Recovery Care program at St. Joseph Medical Center in Tacoma.

Microsoft launches previews of Bing and Edge that are enhanced with the big brother of AI chat tool ChatGPT. Meanwhile, Google rushes chatbot AI tool Bard to testers in reaction to ChatGPT’s threat to Google’s search.

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


Government and Politics

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The Defense Health Agency’s National Capital Region — which includes Walter Reed National Military Medical Center and several other facilities — will go live on MHS Genesis next month.


Privacy and Security

Federal officials attribute last December’s 988 mental health helpline outage to a cyberattack on Intrado, the emergency communications software company that has managed the service since it launched last summer.


Other

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Moffitt Cancer Center (FL) researchers determine that 25,500 virtual visits conducted through its Department of Virtual Medicine during the pandemic saved patients 3.4 million miles and between $147 and $186 per visit. The center plans to expand its telemedicine capabilities to include clinical trials.

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Sentara Healthcare creates a remote patient monitoring department to oversee the installation and management of 108 remote cameras in rooms across its hospitals in Virginia and North Carolina. The $1.7 million project follows a four-year period of product evaluations, pilot projects, data compilation, and establishment of policies and procedures. Trained technicians at two control centers are responsible for monitoring patients at a dozen facilities.

Did you see this in person as I did? A 3,875-foot scanned document that was created at HIMSS08 in Orlando holds the Guinness World Record as the longest ever. Attendance that year was 28,000 and keynote speakers included former AOL CEO Steve Case, “Freakonomics” author Steven D. Levitt, PhD, and former Google CEO Eric Schmidt.


Sponsor Updates

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  • Availity presents scholarships to students from Jean Ribault High School as part of its Beyond School Walls program with Big Brothers Big Sisters of Northeast Florida.
  • Diameter Health, now Availity, earns Certified Data Partner designation in NCQA’s Data Aggregator Validation Program.
  • King’s College Hospital London – Dubai will implement Oracle Cerner, utilizing Oracle Cloud Infrastructure.
  • AdvancedMD publishes “The Top 6 Healthcare Trends Making an Impact on Medical Practices in 2023.”
  • Nordic publishes a podcast featuring UCHealth CMIO C.T. Lin, MD.
  • Agfa HealthCare announces the successful go live of its breast imaging AI solution at Dubai Academic Health Corp.’s Dubai Hospital.
  • Artera expands its multilanguage support to 109 languages.
  • Baker Tilly releases a new Healthy Outcomes Podcast, “Creating an effective corporate compliance program for healthcare providers.”
  • Bamboo Health names Missi Ledbetter senior program manager, Courtney Forrest onboarding specialist, and Omer Khalil software engineer intern.
  • Emirates Health Services implements Care.ai’s ambient healthcare intelligence platform to enable its smart facility initiative.
  • ChartLogic integrates FlexScanMD’s inventory management and tracking system into its ambulatory practice management solution.
  • Clearwater publishes a new whitepaper, “Understanding Cloud Security Basics: How to Ensure HIPAA Security and Compliance in a Cloud Environment.”
  • CloudWave will exhibit at the North Carolina Healthcare Association Winter Meeting February 15-17 in Cary, NC.
  • WellSky announces that its CarePort Care Management and CarePort Discharge care transition solutions can now coordinate with Dialyze Direct service sites.
  • Azara Healthcare adds cost and utilization analytics and visualizations to its DRVS population health management platform.

Blog Posts


Contacts

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

Morning Headlines 2/7/23

February 6, 2023 Headlines 3 Comments

Feds say cyberattack caused suicide helpline’s outage

Federal officials attribute last December’s 988 mental health helpline outage to a cyberattack on Intrado, the company that has managed it since its launch in July.

Veterans Deserve Better than VistA

Oracle EVP Ken Glueck pushes back against recent Congressional efforts to potentially scrap or overhaul the VA’s Oracle Cerner-powered EHR modernization project, pointing out that the software is being successfully rolled out across the DoD, and has been installed at thousands of hospitals around the world.

Simple HealthKit Raises $8M to Transform Health Diagnostics and Follow-Up Care; Expands Portfolio to Include Solutions for Sexual Health, Tripledemic

Simple HealthKit, which offers a digital health platform encompassing diagnostics and follow-up care, raises $8 million in a Series A funding round led by Initialized Capital.

CVS Nearing $10.5 Billion Deal for Primary-Care Provider Oak Street Health

Sources say CVS Health’s plan to acquire Medicare-focused primary care provider Oak Street Health may come to fruition as soon as this week, with the deal valued at $10.5 billion.

Curbside Consult with Dr. Jayne 2/6/23

February 6, 2023 Dr. Jayne 2 Comments

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As a CMIO, there’s a lot of pressure on you to make sure that the healthcare information technology systems that are being implemented provide a solid return on investment. For many years, EHRs were promoted as a way to improve coding and charge capture. This led to physicians billing higher Evaluation & Management codes, which of course raised suspicion with auditors.

It also led to note bloat, as organizations created macros and templates that would ensure that clinical documentation was compliant with even the most rigorous audits. That meant that a certain percentage of notes actually became less useful than before since they were hard to read and full of nonsense that was required to support billing.

Fast forward to the Meaningful Use era and the rise of value-based care, when more organizations began entering into risk-based contracts. That meant that they needed to get a handle on how sick their patients really were to get the most money to care for those patients.

The Hierarchical Condition Category (HCC) coding paradigm had been created in 2004 and started to rise in prominence over the rest of the decade. HCC codes are tied to ICD-10 diagnosis codes. When combined with demographic information such as age or gender, those HCC codes are used to create a Risk Adjustment Factor (RAF) score for each patient. RAF scores can be used to predict costs, which were tied to payments. The higher your RAF scores, the more money you could bring in.

EHRs were also promoted as the solution to playing the RAF game. They were enhanced to remind physicians to document well so that HCC scores could be assigned and to make sure that they were documenting on those conditions at least annually. ICD-10 selection screens were enhanced to more prominently display codes that would lead to creation of a more complex patient picture.

Professional organizations also got into the game. My own organization published a series of “practice hacks” to encourage physicians to use team-based strategies to improve risk adjustment, essentially leveraging staff to massage documentation in the EHR with a goal of achieving higher payments. Sometimes this led to medical assistants or coders assigning additional codes as charts were reviewed following visits. Often these updates were not approved by a physician.

Practices that bet heavily on participation in Medicare Advantage plans became really good at playing these coding games. Technology made it easy to add highly specific billing codes to better capture patient complexity and to add those codes to the chart, even in visits where they might not have been actually managed.

As consulting clinicians, we could tell if organizations were playing these games. You would see a note for a straightforward visit for a self-limited illness and it would end up with six or eight diagnoses for chronic conditions, all with “continue current management” noted in the assessment and plan. As expected, payments to these organizations rose. However, when dealing with governmental payers, there’s always a piper who will get paid.

CMS is starting to play a mournful tune for many physicians and care delivery organizations with the release of a new rule that calls for organizations to pay back what could be billions of dollars in what CMS now considers overpayments. Auditors will be going after providers who may have indicated that patients were sicker than they actually were, or that they required higher levels of care than the charts can actually substantiate.

CMS won’t just be going after the overpayments, though. It will be using a revised Risk Adjustment Data Validation tool that uses the overpayments that are found during actual audits to extrapolate repayments for all the claims that were submitted during a given year for a given diagnostic subgroup or set of codes. The incorporation of extrapolated repayments applies to the 2018 plan year and subsequent payment periods.

CMS predicts that it will recover $479 million for the 2018 payment year alone, with a forecast of $4.7 billion in repayments over the next decade. An accompanying CMS press release quotes HHS Secretary Xavier Becerra as stating, “For years, federal watchdogs and outside experts have identified the Medicare Advantage program as one of the top management and performance challenges facing HHS, and today we are taking long overdue steps to conduct audits and recoup funds. These steps will make Medicare and the Medicare Advantage program stronger.”

CMS plans to focus its audit strategy on Medicare Advantage Organizations that have been “identified as being at the highest risk for improper payments.” I’ve been involved in consulting engagements at organizations that took fairly substantial liberties in their coding, so it will be interesting to see who winds up on the wall of shame first.

For the tech teams that support organizations that are heavily involved in Medicare Advantage, get ready to be on the looking for requests to look at current functionality and compare it to other features that may be available from EHR vendors or might be on the near-term horizon. It’s also an opportunity for startups to try to fill the gaps, making sure that care that is documented actually gets delivered, even if it’s through lower-cost third parties or use of technology.

For historically conservative organizations that might be quaking in their boots over this, it might lead to requests to restrict access to certain functionalities or workflows or to change the approval workflows when a coder or other personnel want to suggest that a visit’s coding should be changed.

This will also be a win for consulting organizations, who will now be out selling services to help organizations understand their audit risk and how to reduce it, as well as to help support them during the inevitable audit and request for repayments. It’s just one more example of how the complexity of the US healthcare system leads to gamesmanship as everyone tries to get a larger share of the money that makes up the healthcare pie.

Speaking of pie, this week’s pastry therapy includes Blueberry Sour Cream Scones, courtesy of King Arthur Baking. I got a little crazy with the powdered sugar drizzle, but they were the perfect addition to a chilly Sunday morning.

What’s your favorite weekend breakfast food? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: I Know You’re Not Thinking About Blocking Patient Data

February 6, 2023 Readers Write 4 Comments

I Know You’re Not Thinking About Blocking Patient Data
By Troy Bannister

Troy Bannister, MS is co-founder and CEO of Particle Health of New York, NY.

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If you’ve worked in healthcare for 10+ years, this is probably the one hundredth time you’ll read an article about patients being unable to access their own medical data. Here’s why I think that trend might be coming to an end soon.

During healthcare’s slow digital transformation, care providers moved from fax machines to 1:1 digital pipelines to manual portal scraping tools, just to get the charts of their patients. In many instances, these processes are occurring in what are negatively referred to as data silos.

Technology solutions for improving healthcare data accessibility have evolved over the years. The legal requirements for complying with data accessibility have followed closely behind. Most clinicians are connected to nationwide interoperability networks through an EHR, theoretically giving them at least some ability to exchange patient records. Now, the US government has made it clear that their patients have the right to access their medical records in those same technically feasible ways.

Enter the Anti-Information Blocking Rule, the culmination of government efforts to legislate clinical data accessibility. Just like it sounds, its goal is to eliminate practices that interfere with the access, exchange, and use of electronic health information.

Whereas HIPAA has long made it clear that individuals can request their own records in paper format, information blocking rules theoretically give patients access to the same advanced Health Information Networks that care providers use to digitally exchange data.

The Office of the National Coordinator for Health IT (ONC), which sets the rules for information blocking, is working particularly hard to prevent cases where an individual is arbitrarily blocked from access to their own personal health information.

Despite ONC’s intentions, repercussions for information blocking were nonexistent. For that reason, healthcare organizations have continued to drag their feet when it comes to allowing patient data exports.

I’m here to spread the news that information blocking is coming to an end. As of October 2022, the HHS Office of the Inspector General began collecting reports of information blocking on its new online portal, with a mandate to issue fines of up to $1 million per violation. It is no longer in question that healthcare organizations will be held accountable unless they improve patients’ access to their own data.

Information blocking regulations don’t have any health IT loopholes. Providers can’t implement patient-only release delays, turn information into an unreadable format, or seek other ways to water down the rule’s provisions. Generally speaking, EHR vendors, Health Information Networks, and provider organizations must release the entire HIPAA-established designated records set of electronic health information (EHI) to a patient upon request.

In other words, if information exchange is doable for doctors, it’s doable for patients too. Information must be in the manner a patient initially requested. That could entail release over the same efficient digital channels, including APIs, that clinicians have access to.

The lack of access to clinical data at scale remains a core problem for US healthcare that can be linked to many of our system’s inefficiencies. These issues have a fundamental impact on healthcare costs, care quality, and ultimately on patient outcomes. Stakeholders cannot continue to wait for healthcare organizations to make their data-sharing preparations. Information blocking is no longer an acceptable policy, and yet we see it every day.

Ahead of the October 2022 information sharing deadline, there were concerted efforts from several healthcare organizations urging HHS to postpone enforcement, and not for the first time. However, regulators felt there was too much at stake to keep patients and digital health pioneers waiting any longer. Information blocking rules have survived multiple presidential administrations, and there’s bipartisan agreement that they are here to stay.

In reality, not every health system is at the same level of readiness when it comes to anti-information blocking compliance. Patient access to EHI has been a complicated task for many healthcare institutions, especially those that are not prepared to share patient data electronically. Many organizations are scrambling to find their own tools to support such efforts.

Fortunately, the technical challenges of anti-information blocking compliance are addressed by the 21st Century Cures Act, the law which led to information blocking rules in the first place.

The Cures Act aims to increase innovation by fostering an ecosystem that supports the development of data-driven applications. The rule also calls on the healthcare industry to adopt standardized APIs, which will help allow individuals access structured EHI using smartphone applications securely and easily. From new health tools to transferring records between providers, information blocking rules will help patients to take greater ownership of their care.

“In 2023, the vast majority of docs and hospitals will have FHIR APIs live,” Steven Posnack, the Deputy National Coordinator of ONC, predicted last month. With the ONC incentivizing this change, digital health organizations should urgently consider a single, comprehensive API that enables a seamless data sharing experience for institutions of all shapes and sizes. Integrating a pre-built API lets providers retrieve medical records in just a few clicks, eliminating reliance on faxes, portals, and other tired forms of data exchange.

For large organizations that support value-based care models, being able to work with patient health records at scale lets providers proactively address patient needs. This is especially critical when it comes to evaluating patients with chronic disease and comorbidities, leading to reduced readmissions. For example, on an ongoing basis, an API can help kidney care organizations that track glomerular filtration rate (GFR), endocrinologists who chart A1c values, and cancer care institutions that research case histories. In these instances, the ability to easily query patient health records allows healthcare providers to more efficiently and effectively care for their patient populations.

Moving ahead, digital organizations can look forward to obtaining data quickly and easily, powering tools that deliver more effective care. But it’s not just the data itself that matters; it’s how you get it. Leveraging advanced technology like a single API helps healthcare organizations and their patients tap into their health history when they need it.

Morning Headlines 2/6/23

February 5, 2023 Headlines 1 Comment

Tallahassee Memorial Making Progress Managing IT Security Event

Tallahassee Memorial Hospital (FL) continues to operate using downtime procedures following “an IT security event” – reportedly a ransomware attack — that occurred late Thursday.

Duke Health enters deal to share de-identified patient data

Duke Health (NC) will sell de-identified patient data to drug companies via Nference, with which it may also create a for-profit spinoff business.

Athenahealth announces layoffs, possible office move

Athenahealth will lay off 178 employees, re-deploy 100 to more high-priority areas, and consider making changes to its office space in Watertown, MA.

Monday Morning Update 2/6/23

February 5, 2023 News 3 Comments

Top News

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Democrats on the House Committee of Veterans’ Affairs are working on an alternative to last week’s two Republican-sponsored bills that would end the VA’s Oracle Cerner implementation and convert live sites back to VistA.

FedScoop cites sources who say that the proposal may involve changes that would affect all of the VA’s IT projects.


Reader Comments

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From Krill Feeder: “Re: more slide decks from the J.P. Morgan Healthcare Conference. All vendors know, want, and fear the trademarked Gartner Magic Quadrant, which can have a strong impact on sales and corporate fate. Is NextGen Healthcare’s use of a similar graphic in a May 2022 investor deck without mentioning Gartner sketchy, smart marketing communications, both, or neither? And was its absence from the JPM event deck due to brevity constraints, Gartner objections, or evolving corporate spin?”


HIStalk Announcements and Requests

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Nearly three-fourths of poll respondents who attended HIMSS22 will go to HIMSS23, while 80% of those who didn’t go to HIMSS22 will repeat their absence in April.

New poll to your right or here: Which ways have you used in the past year to send medical information to a clinician? I like nearly everything about my direct primary care doctor, but most of all I like being able to text, call, or email her directly without having to pierce the veil of inept, self-important gatekeepers (she practices alone).


Webinars

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


Acquisitions, Funding, Business, and Stock

Constellation Software delays posting its Q4 and annual reports, blaming the complexity of its May 2022 acquisition of the hospital and large physician practice business of Allscripts, which is now known as Altera Digital Health within Constellation’s N. Harris Computer Corporation business.


Announcements and Implementations

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A regional network of OB-GYN practices and hospitals in New Jersey will collaborate to launch a statewide, value-based maternity care initiative that will be powered by the maternal digital tools of Wildflower Health.

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Jefferson Center goes live on Netsmart’s MyHealthPointe consumer engagement platform for remote patient monitoring and engagement for behavioral health services. It has launched a pilot with assessments for medication check-in, patient health questionnaires, and weekly check-ins and developing new technology services for family support, text communication, wearables, and notifications.


Privacy and Security

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Tallahassee Memorial Hospital diverts patients and cancels non-emergency procedures following “an IT security event” – reportedly a ransomware attack — that occurred late Thursday.

Duke Health will sell de-identified patient data to drug companies via Nference, with which it may also create a for-profit spinoff business. Bioethicists contacted by the local newspaper question whether it should be made more clear to patients that their data may be used to generate profit. Duke Health announced its relationship with NFerence on January 4, 2023, where it talked a lot about community health and research breakthroughs without mentioning that it was being paid for providing patient data.


Other

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Colorado counties report being overwhelmed with 911 calls that start coming in every morning when the ski lifts open and skiers start falling, which sets off the fall detector in their Apple Watches. The interim director of Summit County’s emergency service, which responded to 185 false alarm calls from Watch-wearing skiers in a single week, says that “Apple needs to put in their own call center if this is a feature they want.” She also notes that operators rarely receive false 911 calls from Android phones. The Watch gives wearers 10 seconds to suppress the call before it starts dialing, but those who are wearing ski gear often don’t notice the warning and don’t respond to the 911 call-back, which requires responders to be dispatched. One county’s sheriff has instructed 911 operators to ignore all automated calls from ski slopes, reasoning that there’s nearly always someone around who would call 911 in a real emergency.

In Germany, a nurse in a top teaching hospital confesses to killing two elderly patients by overdosing them on sedatives (unintentionally, the nurse says) so they wouldn’t bother him while he suffered from a hangover. He admits that he did as little work as possible in his job, ignored patients, turned their wheelchairs toward the wall so they couldn’t talk to others, and found it easy to obtain sedatives because “in the hospital, they don’t pay much attention to this.” He has been charged with two counts of murder and six counts of attempted murder. Note: the newspaper article says without explanation that the man “pretended to be a nurse,” but they incorrectly translated the original report from a German publication – he really was a nurse, but working in an area where he had minimal qualifications.

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Political anthropologist and medical resident Eric Reinhart, MD, PhD says in a New York Times opinion piece that physicians are getting burned out and leaving the profession not because of working conditions, but rather because they are “witnessing the slow death of American medical ideology” and feel complicit in putting profits over people. He says that the AMA convinced doctors to fight healthcare as a public service because it would threaten their autonomy and income, forcing doctors to lecture patients on personal health responsibility and their duty to avoid health risks that are mostly driven by economic disparity. He urges doctors to unionize, then demand universal healthcare.


Sponsor Updates

  • Nordic releases a new podcast, “Making Rounds: The up and downside of disintermediation.”
  • Everest Group names NTT Data a leader in its Healthcare Provider Digital Services PEAK Matrix Assessment 2023 report.
  • Sectra publishes a new case study featuring St. Maria General Hospital in Belgium, “How to save time on implementation while creating brilliant workflows.”
  • MGMA’s Insights Podcast features Surescripts Clinical Informatics Pharmacist and Manager of Product Performance Bri Palowitch.
  • Talkdesk names Miles Ennis (Aspen Technology) SVP of sales for North America.
  • WebPT wins three awards from TrustRadius in the categories of Best Feature Set, Best Value for the Price, and Best Relationship.

Blog Posts


Contacts

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

Morning Headlines 2/3/23

February 2, 2023 Headlines No Comments

DrFirst Acquires Diagnotes Secure Messaging and Care Coordination Platform

DrFirst acquires the caregiver collaboration tools of Diagnotes.

HHS Office for Civil Rights Settles HIPAA Investigation with Arizona Hospital System Following Cybersecurity Hacking

Banner Health will pay $1.25 million to settle HHS OCR HIPAA charges from a 2016 data breach that involved the records of nearly 3 million patients.

Democrats working on ‘comprehensive’ VA electronic health record reform bill — sources

Congressional sources say Democrats are drafting a bill that would seek to reform the VA’s EHR modernization program, rather than scrapping it as proposed by some of their Republican counterparts.

Machine learning model predicts physician turnover

Yale researchers are using machine learning to predict physician turnover, using de-identified EHR and physician data to review the amount of time they are using EHRs, their patient volumes, and their ages and length of employment.

News 2/3/23

February 2, 2023 News No Comments

Top News

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Prescription discount site GoodRx will pay $1.5 million to settle Federal Trade Commission charges that it shared the health data of users with advertisers using the Meta Pixel website user tracker.

This is significant because GoodRx is not a covered entity under HIPAA, but was charged under FTC’s Health Breach Notification Rule that covers any vendor of personal health records and third-party service providers. This is the first enforcement of the rule, which was created in 2009.

The company also agreed to obtain consent for any use of patient information, notify users whose information was exposed, demand that companies that received the information confirm its deletion in writing, create a privacy program, and commission a third-party privacy assessment.

GoodRx comments on the action:

  • The issue was addressed nearly three years ago, before FTC stared its inquiry.
  • The company admits no wrongdoing, but says the settlement avoids the cost of litigation.
  • The advertising pixel, which GoodRx removed in early 2019, remains in common use, including by hospitals and the federal government.
  • The company disputes the charge that it violated the Health Breach Notification Rule, saying that it believes its use of the advertising pixel was compliant.
  • The only information that was shared was IP address and website URLs of content that the user reviewed, with confidentiality agreements in place.

A follow-up tweet from the author of the GoodRx article linked to above says that despite the permanent ban, GoodRx is still sending health data to advertisers. The company responded to his inquiry by insisting that it isn’t a problem because it is tracking such use as required by its new compliance obligations.


Reader Comments

From SeekingEmployment: “Re: Kyruus. Seventy people were let to Wednesday morning.” Unverified, but layoffs were reported by several now-former employees on LinkedIn. A company spokesperson responded to my inquiry by saying that while Kyruus is streamlining operations in integrating three organizations under the Kyruus umbrella, it will not comment on specific changes.

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From Krill Feeder: “Re: more slide decks from the J.P. Morgan Healthcare Conference. Health Catalyst uses a happy-flywheel graphic, albeit without inclusion of the textual ‘virtuous circle’ claim that was used by aggressive e-commerce vendors. Is it persuasive?” The virtuous circle (or cycle), as the opposite of a vicious circle, refers to a recurring series of events in which each positively improves the effect of the next as a never-ending cycle of good news. Whether it is inevitable or aspirational probably depends on who is displaying it and for what reason. Company investor pitches are of the “never is heard a discouraging word” variety except for the 2-point font “forward-looking statements” section that is mostly ignored because it is as entirely negative as the rest of the slide deck is positive. Readers, what say you about virtuous circles and flywheels in particular and the use of descriptive graphics in general?

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From Fry Salter: “Re: hospital websites taken down by Killnet hackers. The hospitals aren’t admitting that they were breached.” Probably because they weren’t. Taking a website offline via a DDoS attack is like spray-painting your name on a hospital’s billboard – the hospital IT folks can bring it back quickly to restore their few mission-important functions (like paying bills or scheduling appointments). It’s the technology equivalent of angry truck drivers clogging up highways to bring attention to their plight, except that most hospitals aren’t going to suffer much from lack of website availability. The pro-Russian Killnet group that is behind the attacks claims that it has exfiltrated data from unnamed hospitals, which would be a much more important development.

From Ibis: “Re: HIMSS Accelerate. It launched 18 months ago. I haven’t heard it mentioned by any colleagues even once.” All I see on the site is endless cross-posts from Healthcare IT News. It looks like it was expensive to develop and payoff seems minimal. I give HIMSS credit for trying something new, especially after the HIMSS20 cancellation brought it to its knees and raised sobering questions about the future of running profitable in-person conferences.


HIStalk Announcements and Requests

You may have had problems reaching us by our HIStalk email addresses over the past week due to two problems (warning: geek talk) that I hadn’t noticed with the server migration: (a) required changes to the SSL certificate and SMTP server name and port changes weren’t made; (b) the webhost didn’t update the email A record to point at the new server. Anyway, all appears to be fixed and working now.


Webinars

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


Acquisitions, Funding, Business, and Stock

DrFirst acquires the caregiver collaboration tools of Diagnotes.

Spotify founder and CEO Daniel Ek launches Neko Health, which will offer 15-minute, full-body diagnostic scans followed by a physician’s consultation for $164. The Sweden-based company was founded in 2018 as HJN Sverige prior to Ek’s investment.

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A newly laid off employee of Seattle-based consulting firm Brightwork Health IT reports on LinkedIn that the company has closed. Several former employees have updated their profiles with a January 2023 job end date. One of those is Tabitha Lieberman, former president of the company’s EHR and healthcare applications business, who was laid off after just eight months on the job after a long career with Providence St. Joseph Health. She says on LinkedIn that “Brightwork will continue, but in a smaller form.”

Business Insider lists the 15 formerly highest-valuation healthcare startups, most of which haven’t raised funds lately and some of which may struggle to find operating cash:

  1. VillageMD – $16 billion valuation (primary care operator).
  2. Devoted Health – $15 billion (health insurance).
  3. Tempus Labs – $10 billion (precision medicine software).
  4. Datavant – $7 billion (health data software).
  5. Ro – $7 billion (prescriptions for erectile dysfunction and hair loss, telehealth for skincare).
  6. Cityblock Health — $6 billion (Medicaid clinics).
  7. Hinge Health – $6 billion (virtual physical therapy and surgical rebab).
  8. Lyra Health – $6 billion (mental health services for employers).
  9. Cerebral – $5 billion (therapy and prescriptions for ADHD and depression).
  10. Color — $5 billion (genetic testing for health risks).
  11. Olive – $4 billion (services automation).
  12. Noom – $4 billion (weight loss).
  13. Commure – $4 billion (healthcare data integration).
  14. Everly Health – $3 billion (home lab testing).
  15. Komodo Health –- $3 billion (healthcare data analysis).

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Health IT investor John Gorman predicts “an impending extinction-level event” for many early and mid-stage health tech companies that will start late this year, as most startups raised two years of cash in 2021 and 2022, cut their burn rate to extend their runway, but still have less than 12 months to try raising again in a difficult market or either selling the company or merging. He advises his own firm’s portfolio companies:

  • Raise money now before the rush later this year.
  • Cut burn rate decisively, although recognizing that R&D and sales are must-haves.
  • Focus on survival rather than valuation.
  • Bring in veteran C-suite operators since launch teams often struggle in difficult environments.
  • Go on offense to gain market share while competitors are struggling.
  • Consider mergers and joint ventures to better compete on RFPs.

Sales

  • Beacon Health System chooses Biofourmis for remote patient monitoring technology for its eight hospitals, initially focusing on congestive heart failure and COPD.
  • In Canada, the Nova Scotia government will implement Oracle Cerner in a 10-year, $275 million project.
  • Floyd County Medical Center (IA) upgrades to Meditech Expanse with assistance from Healthcare Triangle.
  • Atlanta Women’s Health Group chooses EClinicalWorks and Healow.
  • Wellity chooses EClinicalWorks and Healow.
  • Samaritan Health Services will replace its legacy PACS with Visage 7 Enterprise Imaging Platform in an eight-year, $9 million agreement.

People

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Johns Hopkins University and Medicine hires Richard Mendola, PhD, MBA (Emory University) as VP/CIO.

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Bhaskar Sambasivan, MEng, CEO of CitiusTech for 16 months, posts on LinkedIn that he will resign once a replacement is found.

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Scott Frederick, RN, MSHI (RPM Advisory Group) joins newly launched vestibular rehabilitation remote monitoring platform vendor TheraVista Health as CEO.


Announcements and Implementations

Azara Healthcare launches a cost and utilization application for its population health platform.

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Clew Medical launches a program to convert users of Philips EICU software to its virtual ICU platform in 12 weeks, including FDA-cleared predictive models, a workflow platform, and integration with EHR, monitoring devices, and AV equipment. Industry long-timer Paul Roscoe came on as CEO in November 2022.

Yale researchers are using machine learning to predict physician turnover, using de-identified EHR and physician data to review the amount of time they are using EHRs, their patient volumes, and their ages and length of employment. The small study of 319 physicians in a single health system correctly predicted departures 97% of the time. The authors note as an example that the risk of departure was highest for doctors between the ages of 45 to 64. They also noted that higher levels of EHR documentation time was associated with a lower departure risk for doctors who were hired within the past 10 years,  but a higher risk for longer-employed doctors.


Government and Politics

A press update indicates that HHS will recognize the first set of organizations that will be approved as QHINs under TEFCA on Monday, February 13.

Banner Health will pay $1.25 million to settle HHS OCR HIPAA charges from a 2016 data breach that involved the records of nearly 3 million patients.


Other

A woman is billed $14,000 for her newborn’s NICU stay at in-network Northwestern Medicine Prentice Women’s Hospital because that hospital covers using doctors from Lurie Children’s Hospital – which is connected to Prentice Women’s via a walkway – which was not in her insurer’s network. Lurie turned her balance over to collections, but wouldn’t talk to reporter about why, citing HIPAA even though the woman signed a release. Faced with media coverage, Lurie suddenly decided after months that she owned nothing after all. Lurie denied knowledge of a 2011 state law that prohibits billing out-of-network rates for certain types of doctors, including neonatologists, and the state attorney general’s office says it has never enforced it.


Sponsor Updates

  • CTG earns AWS Service Delivery designation for the Amazon Connect cloud-based contact center service.
  • Ellkay publishes a new client success story, “Seattle Children’s: The Value of Choosing the Right Data Management Partner.”
  • Fortified Health Security names George Srour (Critical Insight) regional sales director.
  • Nordic publishes DocTalk Ep. 202, “The Marvel of In-House Business Intelligence.”
  • Juniper Networks expands its global Juniper Partner Advantage Program with a host of new updates in 2023.
  • Healthtech Consultants, a Nordic Global company, earns the top performance score in KLAS’s first report on EMR consulting services in Canada.
  • Pennsylvania’s HAPevolve will offer hospitals the care transition platform of WellSky-owned CarePort.
  • Meditech AVP Cathy Turner, BSN, RN receives the 2023 HIMSS Changemaker in Health Award.

Blog Posts


Contacts

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

EPtalk by Dr. Jayne 2/2/23

February 2, 2023 Dr. Jayne 3 Comments

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I don’t change the clock on my laptop when I travel because it’s just easier for me to continue to operate in my home time zone. I also display multiple time zones on my Outlook calendar even when I’m at home, so it’s not difficult for me to sort out the local time from my usual time.

In the past, I have found the Microsoft Viva employee engagement platform to be mildly annoying, but last week it decided to tell me to stop burning the midnight oil based on what it thought was late night laptop usage. For those of you who haven’t experienced Viva, it also tells you things you already knew, like how busy your calendar is and that there isn’t any time between meetings for you to get work done.

According to the website, Microsoft charges extra for these insights. I wonder how many employees actually think they are beneficial. Employers should take note of these add-ons and make sure they are providing benefit. I know a lot of employees that would rather receive a Starbucks gift card every couple of months for the same price as “engagement” communications that make us feel busier than we already feel.

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I have always found public health informatics to be fascinating, but I haven’t had the opportunity work in the field beyond the population health management that is done by CMIOs. I was excited to see this write-up about reorganization at the Centers for Disease Control and Prevention (CDC). Director Rochelle Walensky, MD, MPH has announced the creation of new offices, including an Office of Health Equity and an Office of Public Health Data, Surveillance, and Technology. The latter will be charged with creating the infrastructure needed to solve the mess of federal, state, and local public health data management.

Walensky stated that the 75-year-old organization “did not reliably meet expectations” during the COVID pandemic, necessitating the reorganization. Those of us that worked the front lines at the beginning of the pandemic still feel acutely the fear and disillusionment we felt when the CDC told us we could wear bandanas as masks if our employers couldn’t provide appropriate personal protective equipment. Many providers have lost faith in the CDC and it will take years for it to attempt to recover to the chaos and confusion of the pandemic and the role the agency played in all of it.

Organizations are having to get creative to deal with ongoing nursing shortages, and I was interested to see that Trinity Health will be piloting the use of virtual nurses to care for hospitalized patients. The creation of the virtual roles provides an opportunity for nurses to continue practicing when they are unable or unwilling to continue in demanding bedside care roles. The so-called Virtual Connected Care Program was piloted at Trinity Health Oakland Hospital in Pontiac, MI during January 2022, with an update in June 2022.

Trinity is creating nursing teams with three nurses: one direct care nurse, one virtual nurse, and one licensed practical nurse. Virtual nurses will be used to make sure patients and families understand the daily care plan and manage patient concerns that might otherwise be reported through a call light or call bell system. Virtual nurses may also provide discharge teaching and help coordinate care with other professionals.

Speaking of virtual care, the Centers for Medicare & Medicaid Services (CMS) plans to add a telehealth indicator to clinician profile pages on its Medicare Care Compare and Provider Data Catalog sites. The Telehealth Indicator is designed to help patients and their caregivers identify providers who deliver telehealth services, as indicated by a low-key graphic near the physician’s name in their listing. The indicator will appear for clinicians billing telehealth visits using Point of Service codes 02 and 10 or using modifier -95 on claims. They intend to use a six-month lookback period and refresh the indicator bi-monthly, along with other provider director information. The code will appear only on individual clinician profile pages, not pages for groups.

This announcement comes at the same time as one about a new federal telehealth program designed to treat COVID-19 patients at home. The new Home Test to Treat program from the National Institutes of Health will allow patients in select communities to receive home rapid test kits, telehealth consultations, and antiviral treatments, all from the comfort of their homes. The program will launch in Berks County, PA, which has up to 8,000 eligible residents. Telehealth services will be provided by EMed and UMass Chan Medical School will work with the provider organization to analyze data to determine what kind of impact the program has on patient outcomes.

I’ve been party to several discussions around the virtual water cooler about hospitals and healthcare delivery organizations contacting patients to recruit them to the donor ranks of associated healthcare foundations and endowments. In some reports, physicians have even been asked to approach patients while they are still hospitalized, laying the groundwork for future donations. I haven’t run across this personally (although I did care for a number of patients in my hospital’s VIP wing during medical school) until I started getting solicited after a series of visits at the local academic medical center. The messaging isn’t even remotely subtle. It makes clear suggestions that patients can “express their gratitude” and “inspire a healthier future” by making donations in the name of care team members who participated in their treatments.

The most recent mailing provided tips on how to solicit donations through an obituary, along with instructions for employer matching and estate planning. These were part of an ultra-glossy magazine that I’m sure wasn’t cheap to produce or distribute.

As a physician, I don’t like the idea of someone trying to coerce my patients into making donations in my honor, and I definitely dislike the concept of approaching people when they are vulnerable. Not to mention that these mailings might be arriving at homes where recent treatments weren’t successful, and I’m sure not all family members would appreciate such a delivery. The hospital in question is sitting on billions of dollars that could certainly be released to the community more generously than is currently happening, so they won’t be getting any of my donation dollars right now.

What do you think of hospitals and health systems soliciting patients and families for donations? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 2/2/23

February 1, 2023 Headlines No Comments

GoodRx illegally shared health data with tech giants to target ads, government alleges

Prescription savings company GoodRx will pay $1.5 million to settle FTC allegations that it shared the sensitive, personal health information of its users with third-party sites like Google and Facebook without their knowledge.

Province signs deal to bring electronic health records to Nova Scotia

Oracle Cerner wins a 10-year, $275 million contract to design, build, and roll out an EHR across Nova Scotia.

Iowa telehealth startup OpenLoop plans massive downtown Des Moines expansion

White label telehealth company OpenLoop Health expands its headquarters in Des Moines, IA to accommodate growth from 25 to 175 employees in the last year, as well as plans to hire several hundred more in 2023.

HIStalk Interviews Angie Franks, CEO, About

February 1, 2023 Interviews 2 Comments

Angie Franks is CEO of About of St. Paul, MN.

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Tell me about yourself and the company.

I’ve been in healthcare technology for 33 years, so this is definitely my passion. I have spent the last six years with About Healthcare, formerly Central Logic. We match the demand for acute and post-acute services with the optimal setting of care to get patients to the best place for the care that they need.

How do EHRs fall short in care coordination as health systems expand their range of services and geographic coverage?

EMRs do many things well. But when you move patients across settings of care, or need to optimize the resources inside of your health system by pulling together different silos and different systems, there’s a lot of data that’s not in the EMR that becomes important and instrumental for making decisions around hospital operations and then executing on that. The EMR is more suited for capturing specific data about a patient, ordering tests, getting those results back, and then billing the insurance company.

When you are making decisions about where a patient should go for the care that they need, how to get them there, choosing the best physician, and then executing on those logistics, you are pulling from data that is not in the EMR. You need information that is in a lot of systems. What we see is that hospitals have lots of silos. They don’t work well as a system of care when it comes to the operations and the logistics. That’s where we focus, which involves connecting to, talking with, and interoperating with the EMR as well as a bunch of other systems.

The data inside of an EMR is impressive, especially when you think about the clinical data and all the work that organizations like Epic can do with disease and tracking all of this clinical information. When you look at it from an operational lens and a growth or a strategy lens, none of these EMRs capture and track this data in a way that is useful to strategy and operations. As a result, many health system leaders don’t look at information even though it could change how they operate as a business. That’s a real benefit of looking at your operations differently than how you look at clinical pathways and the billing systems. You get data out of these tools that inform decisions that you make as a health system executive team that have a impact on your bottom line. Data is an important area of focus for us over the long term.

Bed management and bed visibility became important during the pandemic. Will that have a permanent impact on health system operations?

One of the things that the pandemic showed is how silos create bottlenecks in the organization that prevent patients from getting access to the care that they need. Getting somebody out of the acute bed and getting them to a post-acute setting by doing that electronically and in interoperability setting instead of creating a bottleneck for patients who were trying to get in the front door and into a bed of a particular health system. Those bottlenecks exist all over our care delivery system and impact access to care.

We have gained a lot more visibility into the bottlenecks. Health system EDs were overrun during the pandemic and they couldn’t service all those patients, but maybe a hospital down the street had capacity, but nobody knew about it. Even when we put the USS Comfort and 1,100 beds in the harbor inside of New York City, we placed only 107 patients there. It wasn’t because there wasn’t demand for all of the beds. It was because there wasn’t an ability to access them, to communicate and efficiently see what was available, and then match the patient and move them. That speaks to the need for more interoperability in our healthcare IT ecosystem. We have a long way to go.

How well are health systems operating transfer centers and how do they fit into their business strategy?

It is an important front door for health systems. Acute settings have three entry points — the emergency department, scheduled procedures such as the operating room, and patient transfers. Patient transfers are least known and understood. 

A lot of health system leaders and executives may not have spent much time thinking about access points and access channels. They have business development teams and people who are responsible. It’s almost like a sales channel, but putting in place a conscious strategy and an infrastructure to capture more of the demand that is inside of the geographic service area that a health system serves and that net new patient demand for that hospital system. Those are lucrative patients, and every health system wants to capture more market share and then keep those patients inside of their network.

It is competitive for those patients. When you have an optimally functioning transfer center, you capture more of that demand. You impact your top line with revenue and your bottom line with improved margins. It is predictable. You can start achieving an ROI quickly if you invest the time. It’s not a technology implementation. Technology is important for enabling consistency and execution of a business process, but it is changing the way a health system operates and changing the way they utilize all of their resources for matching that patient demand with the right setting of care. If you just defer your front door to the ED, you pretty much get whoever walks in the door at whatever facility they show up at.

Do patients and physicians agree with a health system’s definition and approach to what they call “patient leakage?”

There will always be an amount of leakage. There are appropriate times where the patient is in a setting of care and they need to be somewhere else, which results in a transfer. They need a higher level of service or acuity. That could show up on a report as leakage. You had the patient, then you lost them. They leaked and they went to another system. Some amount of leakage will always happen and that is appropriate.

Hospital operators need to focus on when there is leakage that didn’t need to be. A patient comes into your emergency department, you offer those services, you have capacity, but it was hard to get that patient moved out of the ED into the right bed. It was easier for that ED doc to call their buddy, who is a cardiologist down the road, and move that patient into a different health system. That’s a costly leakage problem, and it happens every day.

It is costly to let patients just walk out the door instead of helping coordinate follow-on services or referrals to a specialist as they take that next step in their care journey. When you leave it up to the patient to just figure it out, it’s not a great experience for the patient, but it also results in a lot of leakage for the health system. It is an important metric to look at, calculate, and focus on, because it has implications to revenue and operationally and it can be a bad experience for the patients as well.

How are health systems changing their business model to address new competitors, telehealth, and new generations of consumers who would rather use urgent care?

What I see health systems doing over the last couple of years, and the pandemic was instrumental in this, is talking about operating as one system of care. How they use all of their capabilities to care for the patients in the community, and do that more efficiently and in a more streamlined manner. The conversations that are happening are really good.

I could give you many examples of what health systems are focusing on. We help them think about the acute and the post-acute patients. That is a  small population of their overall patients and the communities that they serve, but hospitals and health systems have an enormous amount of competition for those healthy patients and the outpatient visits, whether it’s CVS, One Medical, or even Dollar General in some smaller communities. The margin erosion and the patient attrition for services that were maybe more easily captured in the past is an issue, and that revenue has to be replaced some other way.

Health systems are figuring out their population health strategies, figuring out their access channels how to deliver service not only to the patients, but to their referring community. Managing those referring networks as an important growth channel is a different way of thinking. I’m seeing more conversations about that today than I have in the past.

What will be important to the company in the next few years?

I see our company continuing to focus on solving this problem and helping health systems operate as one system of care, doing that by connecting their silos and disconnected systems into a streamlined process so that they can operate more effectively. It is a passion of mine. For everybody who works here at our company, this is what we jump out of bed to do every day. As I’ve gotten older, I see my parents needing to access healthcare services in different ways, and it sure gives you a lens on the importance and the mission orientation of the work that we do. We are going to continue focusing on this. It’s a big problem, and we are in the early innings of the game.

Morning Headlines 2/1/23

January 31, 2023 Headlines 3 Comments

House bill would scrap VA’s $20 billion-plus electronic health record program

Rep. Matt Rosendale (R-MT) introduces a bill, co-sponsored by eight other members of Congress, that would scuttle the $20 billion Oracle Cerner overhaul of the VA’s EHR software.

Clearsense Announces Success of $50M Capital Raise

Health data management company Clearsense raises $50 million in a Series D funding round.

Russian cyber gang Killnet brings down websites of 14 top US hospitals and universities – including Stanford and Duke

The Killnet group of Russian hackers attacks 14 hospital websites, forcing them offline for various amounts of time.

Aluna inhales $15M Series B for asthma monitoring

Aluna, which offers asthmatic patients a smart inhaler and companion app also accessible by physicians, raises $15 million in a Series B funding round.

News 2/1/23

January 31, 2023 News 13 Comments

Top News

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Rep. Matt Rosendale (R-MT) introduces a bill, co-sponsored by eight other members of Congress, that would scuttle the $20 billion Oracle Cerner overhaul of the VA’s EHR software. The bill would order the VA to stop the project within 180 days, dissolve its Electronic Health Record Modernization Integration Office, and revert all live Oracle Cerner sites back to VistA/CPRS.

Rosendale was named this week as chair of the House Veterans Affairs Subcommittee on Technology Modernization, which oversees technology within the VA.

House Veterans Affairs Committee chair Rep. Mike Bost (R-IL) had warned in July 2022 that the project might be cancelled “if there isn’t major progress by early next year.”


Reader Comments

From Employees Deserve a Voice: “Re: Findhelp. Employees are trying to unionize.” Axios reports that 150 employees of Austin, TX-based Findhelp — whose platform connects people who are in need with available social services — have filed to hold a union election. The employees say they want management to address pay inequity, return-to-office policies, and the use of workplace monitoring software.

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From Krill Feeder: “Re: investor relations slide decks. Here’s first of several I’ll mention from the J.P. Morgan Healthcare Conference. Veradigm claims 170,000 ‘partners’ that are grouped with paying customers, which seems unusual and/or a sign of desperation to please Wall Street. What do your readers say?” Consider this an invitation to weigh in. Also interesting is that Veradigm notes that it has pushed 20 billion drug company ad impressions on providers since 2011, presumably via its Practice Fusion EHR. More nuggets from other companies to come.

From Public Health Enemy: “Re: public health and COVID-19 emergencies ending on May 11. Has anyone listed the health IT implications?” I’m interested too. I assume it will end the use of consumer technology to conduct virtual visits, reinstitute pre-pandemic licensing requirements for providers who offer services via telehealth or across state lines (including contract nurses), restore previous policy that limits the prescribing of controlled substances without an in-person evaluation, and change payment parity policies. I assume it will also affect payment for remote patient monitoring and for audio-only visits. More broadly, it will mark the end of free COVID-19 testing, home test kits, vaccines, and treatments for many or most people, depending on their insurer. Confounding the unwinding is products that are being sold under FDA’s emergency use authorization and the layers of state-level waivers.

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From Papal Cut: “Re: HIMSS board. What are they doing meeting with the Pope, per this LinkedIn post from board member Amy Compton-Phillips?” I think we can rule out asking him to get the nuns to take US healthcare back over from the profiteers. Maybe they’re pressing him to keynote HIMSS23 to boost attendance. Will the board be meeting with the heads of other religions that have a strong presence in US healthcare?


Webinars

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


Acquisitions, Funding, Business, and Stock

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Health data management company Clearsense raises $50 million in a Series D funding round.

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Philips will cut another 6,000 jobs globally over the next two years as it struggles to recover from market value losses caused by a recall of its respiratory devices in the United States. The company announced it would lay off 4,000 employees last October. I interviewed Philips VP Elad Benjamin in December.

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Health data infrastructure company Smile Digital Health raises $30 million in a Series B funding round, bringing its total raised to $50 million.

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Prescriber marketplace operator PrescriberPoint raises an unspecified growth investment  from two drug companies, Adobe, and Mastercard.

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Tivity Health, which runs the SilverSneakers and other health programs, acquires Burnalong, which offers a health and wellness platform.


Sales

  • PeaceHealth expands its agreement with Loyal for provider data management and physician search.

People

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Rebecca Woods (Bluebird Tech Solutions) joins Divurgent as SVP of delivery.

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Former Oracle SVP Troy Tazbaz joins the FDA as the director of its Digital Health Center of Excellence, which offers regulatory advice and support to the FDA’s regulatory review of digital health technology.


Announcements and Implementations

CitiusTech announces GA of RealSight, a price transparency data analytics tool.


Government and Politics

Fox Army Health Center (AL) reports that since going live on MHS Genesis in September, call center wait times have been reduced from two hours to 15 minutes, and that online appointment booking and pharmacy text alerts will soon be available.


Privacy and Security

Governance software vendor Diligent notifies customer UCHealth of a data breach that involved the unauthorized downloading of some UCHealth files. Diligent provides hosted services for the Colorado-based health system.

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The Killnet group of Russian hackers attacks 14 hospital websites, forcing them offline for various amounts of time. Stanford Healthcare (CA), Duke University Hospital (NC), Cedars-Sinai (CA), Atrium Health (NC), and University of Michigan Health were among those affected by Monday’s breach.


Other

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In the UK, a report finds that last year’s data center downtime Guy’s and St. Thomas’ NHS Foundation Trust — which was caused by data center cooling problems when temperatures in London hit 104 degrees — required running as a “paper hospital” for two months until its 371 legacy systems were restored. The trust had been warned that the cooling systems were old and inadequate and that having two sites in the same area serve as each other’s failover created exposure to environment-related problems. The report also notes that NHS supplier Advanced was hit with a cyberattack during the trust’s downtime, taking down its CareNotes and Adastra medical records systems for four months. The trust will go live with Epic in April 2023, which the report says will reduce risk and make recovery easier, but it warns that the trust will need to work hard to regain user confidence.

A Bloomberg opinion piece says that management consulting firms have nothing to sell once they have lost their integrity to ethical lapses and greed, focusing in McKinsey as an example of a company who thinks highly of itself despite “tawdry episodes” such as leading Enron to ruin, helping drug companies flood the country with inappropriately prescribed opioids, and connecting authoritarian regimes to corrupt middlemen. It concludes:

They are con men because they exploit their victims’ illusions. They play on people’s greed and desperation by pretending that they can enable companies to “transform your business” or “do more with less.” They also routinely offer low-ball deals so that they can get their feet in the door. But once inside, they transform themselves into vampire squids and set about sucking the lifeblood out of their victims. The ideal consulting engagement from the consultants’ point of view is one that leaves the client permanently dependent on the consultant: With its internal capacities diminished, it needs to keep employing outside help; with its appetite for “transformation” whetted, it remains on the lookout for the next big idea, calling in yet more consultants to solve the problems that the previous collection of consultants created in the first place.

IHI’s Don Berwick, MD says in a JAMA opinion piece that financial self-interest holds a grip on the US healthcare system. He notes that drug companies employ monopoly pricing for products that result from taxpayer-funded research;  Medicare Advantage insurers are gaming the system at a cost of hundreds of billions of taxpayer dollars; and hospitals are claiming large losses even as they sit on billions of dollars of assets. He recommends that healthcare professionals speak louder about unchecked greed; insist that their guilds and trade organizations demote the endless pursuit of higher payment; lobby Congress to reform patent laws, change coding and billing rules, and enforce antitrust laws; and demand that hospitals invest in improving the social influences on health.


Sponsor Updates

  • Compass Medical, a 95-provider organization with six locations in Massachusetts, uses EClinicalWorks to excel at value-based care and combat physician burnout.
  • Ascom launches a Center of Excellence to help customers transform their clinical workflows with the Ascom Healthcare Platform using end points like handsets and smart nurse call systems, as well as middleware and services.
  • AvaSure recognizes AvaPrize winners from MaineHealth, ShorePoint Health, Providence Health & Services – Oregon Region, and the VA North Texas Health Care System for excellence in virtual care delivery.
  • The American Medical Association partners with Azara Health to improve blood pressure control across the country.
  • The Digital Healthcare Innovation Summit will recognize Bamboo Health Senior Advisor Jay Desai with its 2023 West Coast Digital Healthcare Innovator Award February 1 in La Jolla, CA.
  • Healthcare risk management solutions vendor Censinet announces record customer growth in 2022, with an 80% year-over-year increase in customers.
  • CereCore releases a new podcast, “Scaling IT for Growth and Why Managed Services Make Sense.”
  • Clearwater publishes a new white paper, “Understanding Azure Cloud Security Basics: How to Ensure HIPAA Security and Compliance in a Cloud Environment.”
  • ConnectiveRx SVP of Market Development Chris Dowd receives a Pinnacle Award from Medical Marketing and Media.
  • Current Health will exhibit at SCOPE February 6-9 in Orlando.

Blog Posts


Contacts

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

Morning Headlines 1/31/23

January 30, 2023 Headlines No Comments

Philips to cut 13% of jobs in safety and profitability drive

Philips will cut another 6,000 jobs globally over the next two years as it struggles to recover from losses caused by a recall of its respiratory devices in the United States.

Matt Rosendale to lead House VA tech modernization subcommittee

Congressman Matt Rosendale (R-MT) will chair the House Veterans Affairs Subcommittee on Technology Modernization, overseeing congressional scrutiny of technology within the VA.

Software vendor shares information about data breach

Governance software vendor Diligent notifies customer UCHealth (CO) of a data breach that involved the unauthorized downloading of some UCHealth files.

FDA names former Oracle executive as new digital health leader

Former Oracle SVP Troy Tazbaz joins the FDA as the director of its Digital Health Center of Excellence.

Curbside Consult with Dr. Jayne 1/30/23

January 30, 2023 Dr. Jayne No Comments

I’m putting my travel schedule together for the next few months, and I’m pretty excited about some upcoming conferences. Although HIMSS is back in Chicago, the other two are in cities that I don’t get to as often as I’d like. I’ll be attending the American Telemedicine Association (ATA) in San Antonio in early March, and then the CHIME/ViVE event in Nashville later in the month.

I typically register for conferences as early as I know I’ll be attending so I can get the early bird discounts – and for ViVE, the discount is just about a necessity. It’s one of the more expensive conferences I’ll be attending and I hope it lives up to the hype (as well as the cost).

Usually, the decision to attend a conference is based on a directive by an employer or a client, rather than me looking at specific sessions or content. Because of that, I don’t always look at the agendas in detail until they get closer. Depending on the conference, some of them don’t even post agendas until shortly before, meaning that many people make the decision to attend without all the information that would help them make a good decision.

Even though I’ve been doing work in the telehealth space for half a decade, I haven’t attended the ATA meeting. I dropped by their website today to think about what I might like to attend, and the first thing that caught my attention was the tagline on the home pages of “Telehealth. Is. Health.” Which is interesting since the organization has seemingly decided to stick with the “telemedicine” moniker.

Organizations rebrand all the time and spend lots of money doing so, as we recently saw with the rebrand of Intermountain Healthcare to Intermountain Health. The substitution of the word “health” where organizations previously used “medicine” or “medical” seems to have happened just about everywhere else, starting with the transition from electronic medical records to electronic health records. The change indicates that an entity is about something more than just medicine or medical practice.

The realm of telehealth has become significantly larger in the last five years and now includes more than just medical practice. Some of the hottest areas for growth aren’t even “telemedicine,” but include all the other ancillaries that patients need for comprehensive care. Some of these include remote monitoring, psychotherapy, counseling, occupational therapy, physical therapy, speech therapy, nutrition consultations, pharmacist visits, dental advice, and more.

In most states, these areas wouldn’t be considered as “medicine” under the state medical practice acts, so the broader term of telehealth makes more sense. It makes me wonder if the ATA is just keeping with tradition or if they think a rebrand isn’t worth it, or if they don’t see value in going with the broader terminology. From a marketing standpoint, they would still be the ATA, so at least that’s easy. Some of the possible domain names they’d need for a rebrand aren’t in use, although it can sometimes be tricky to get a domain you want if someone is already holding it, so that may be a factor. They do use “telehealth” throughout their publications, at least.

ATA shifted the dates of the Annual Conference and Expo this year, moving it from a Sunday through Tuesday format to a Saturday through Monday format in an attempt to reduce the number of days people need to miss from a traditional work week. Depending on where you are traveling from, however, as well as how much of the conference you are planning to attend, many of us will still miss two weekdays due to limited travel options. Flying into San Antonio isn’t as easy as going to Chicago, Las Vegas, or Orlando, so I guess that’s the downside of having it in a smaller metropolitan area.

The full agenda is available and there certainly isn’t a shortage of good sessions to attend. A couple of my medical school colleagues who are now involved full-time in telehealth will be there, so I’m looking forward to it. Not to mention that San Antonio’s climate in early March is a lot more alluring than the Midwest, as is the Tex-Mex scene.

As for CHIME/ViVE, the value of the ViVE side of the equation is a little more difficult to judge. I really enjoyed CHIME in the fall, especially the low-key vibe and the ability to have high-quality conversations with peers. ViVE is only in its second year and they have really been pushing hard for registrations. I was a on a CHIME/ViVE call last week that was advertised as a way for people to understand the value of attending, but ended up being entirely too salesy. If I heard one more person talking about how it was “curated just for people like you” I thought I was going to scream.

We are less than two months out and they don’t have a full agenda published yet, so it’s hard to judge the value on a day-to-day basis. It’s also hard to schedule meetings and times to connect with colleagues, because it’s inevitable that the time I pick will end up being in conflict with a session I’ll ultimately want to attend. The agenda “themes” are published and several are eye-catching for me. One has a tagline of “delivering virtual care with intention,” but I’m not enamored with its actual title, which is “That’s so Meta.” I’m also interested in sessions on: recruiting, retention, and team development; managing chronic care costs; technology cohesiveness and efficiency; and using technology to advance health equity (although I’m not a fan of using the new buzzword “techquity” to encompass it).

I’m looking forward to visiting Nashville for the conference, as I haven’t been there in years and it’s a good excuse to hang out with one of my shoe-loving besties who happens to be a local. The last time I attended a conference there, it ended up being one of the most crazy drunken vendor user groups ever, so I’m hoping for something significantly more tame. I’m sure my friend will give good advice for off-the-beaten-path adventures that will still let me be vertical the next day. It sounds like Nashville has become quite the foodie city since I last visited, so that’s something to look forward to as well.

What are you looking forward to about upcoming conferences? Is it the food, the people, or the content? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Laura McCrary, CEO, KONZA

January 30, 2023 Interviews No Comments

Laura McCrary, EdD is president and CEO of the Kansas Health Information Network and KONZA National Network.

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Tell me about yourself and the company.

The KONZA National Network was started in 2010 as part of the HITECH and the American Recovery and Reinvestment Act funding that was made available to each of the states. KONZA is a 501(c)(3) not-for-profit organization that is incorporated in Kansas under the name of the Kansas Health Information Network — KONZA is actually a DBA. The organization provides services not only in Kansas, but across the nation. The KONZA National Network provides health information exchange services as well as analytics services.

Kansas managed the process of establishing a health information exchange a little bit different from other states. That is relevant to the way that the KONZA National Network has developed. For example, Kansas didn’t stand up its own state-sponsored health information exchange like most other states did. Instead, Kansas established a process to certify the exchanges that did business in the state. Kansas didn’t give an allocation of state or federal funds to the health information exchanges. Instead, those funds went to the provider community to purchase interfaces and connect to the health information exchange. That was a key component of the development of KONZA and the health information exchange framework in Kansas. 

The state then established specific criteria that all of the exchanges that did business in Kansas had to meet. You had to run a viable business that had providers and payers paying for the services that you provided. It was a subscription model, and everybody paid.

Also, you had to participate in supporting public health. You had to be involved in building the public health infrastructure. It was a partnership. The HIEs all agreed to send data for electronic lab reporting, syndromic surveillance, and immunizations. Kansas was well prepared for the pandemic because we had been working on that for 10 years.

The other thing that was interesting is that Kansas said that all data that was brought into the exchange also needed to be provided to the patients through a personal health record. Early on, all of the health information exchange data was provided to patients at no cost. That allowed us to be one of the early participants in the Harvard Open Notes model, where all of the data that we had available in the exchange was provided to patients.

It was a very different and unique model of certifying exchanges. One piece that was important was that all the exchanges that did business in Kansas had to connect to each other. While we may have been competitive, we also had to cooperate. That was a basis for how we were able to spread this exchange across the country. We had a commitment to all of the things that I just mentioned because of the way the initial Kansas HIE infrastructure was set up.

What are the implications of creating a national network?

Most of your readers will be familiar with the QHIN model under TEFCA that is beginning to come into fruition. The QHIN model is the Qualified Health Information Network model, sponsored by ONC and The Sequoia Project. KONZA has applied to be a QHIN and is working through that process now with ONC and the RCE. That will be an important development in interoperability across our nation, because we will see a number of QHINs that will have responsibilities to connect to each other and share data to establish that nationwide context.

The fact that KONZA already does business with exchanges in 11 states gives us an opportunity to be at the forefront of that. We run exchanges in Connecticut, New Jersey, Georgia, South Carolina, Mississippi, Louisiana, the Dallas-Fort Worth area, and obviously Kansas and Missouri. We also support an exchange in Northern California. That gives us a pretty broad national scope in terms of leveraging the QHIN model. We are excited about the possibilities of what the future looks like for health information exchange as we move forward into the later part of 2023 and 2024 and we have the QHIN model operational.

What challenges remain to giving patients the full benefit of interoperability?

There will continue to be issues with interoperability until we resolve the issues around standards in data sharing, the actual semantic interoperability of using a variety of different code sets. For example, it is still difficult to make sure that labs are being mapped properly to the LOINC codes and that SNOMED codes are being used properly. We often find that there’s still a lot of challenges in being able to do all of the proper coding and mapping.

We work hard at KONZA on data quality. We are part of the NCQA Data Aggregator Validation, or DAV project, where we take all of our practices and hospitals through DAV accreditation with NCQA to ensure that they have the highest quality of data that can be delivered. We check those things, like has the hospital mapped their labs properly to the LOINC codes? And are we seeing the proper procedure codes coming through? Are we seeing duplicates in data?

All of these things are still challenges for us. The data is still messy, so it’s important for us to focus on data quality. We have a couple of key vendors that are instrumental in helping us do that. But it is a core focus for us on data quality. 

If you can’t get the data quality in the place that you need it to be, you are not going to be able to provide a complete and correct longitudinal record at the point of care for a patient. If a patient shows up in an emergency room and the doctor doesn’t know who he or she is, the doctor is dependent upon getting a longitudinal medical record from the health information exchanged to make sure that the physician knows all of the information about the patient before they begin providing care.

We are getting closer. Let me say that I feel enthusiastic about the future of health information exchange, particularly with the QHIN model that is coming into place. I think that we will see continued improvements in the data quality and the data completeness. But it’s still a work in progress.

The early days of RHIOs involved creating centrally administered platforms that left providers to figure out how to connect. How has that transitioned into a more services-oriented approach?

Health information exchanges flew under the radar from about 2010, when they were funded, up until about 2019 and early 2020 when the pandemic hit. Then it became clear to the entire nation that the health information exchanges had been developing products and services using the data that they were receiving through the health information exchange and aggregating that data and being able to turn it into meaningful information that could help to inform public health and others regarding the progress of the pandemic as well as the vaccination status of the population. Health information exchange quietly built that capacity over the years. 

KONZA has 4,500 organizations that contribute data into the KONZA enterprise data warehouse. When we need to aggregate data across the nation and be able to track disease surveillance, the health information exchanges were well prepared to serve as that public health data utility to step into that space and provide information. For example, they provided COVID registries to the state of Kansas before they had the ability to get a registry set up. We set one up quickly for the state of Kansas in about 30 days, because we were already tracking the data and had it coming in for health information exchange purposes.

KONZA also has the ability to aggregate data across practices and across states to be able to look at quality measures. One of the things that KONZA does is calculate and compute quality measures, not only for physicians and hospitals, but across populations, whether it’s an independent physician association, an accountable care organization, or a Medicaid health plan that needs to be able to look at how they’re doing across their Medicaid population.

The health information exchanges have built that capacity and have been certified as having the highest quality data that’s available. It can be counted upon by payers, providers, and others as it relates to quality metrics. We see imminently on the  horizon that quality measures will not just be calculated out of an individual EHR system. They will be calculated across all of the locations where the patient received care. That way, you have a holistic view of how a hospital or a physician practice is actually doing in providing quality care to a patient across the patient’s entire care team, as opposed to just looking at what happened at their facility.

How will you participate in clinical research?

We regularly get requests for de-identified data to be able to be used for clinical research. When KONZA, executes agreements with our participants, we have a secondary data use agreements that allows the data to be able to be used for purposes that advance medicine. Now, it can’t be used for purposes that would be used for marketing or for financial gain. But for clinical research that actually improves the practice of medicine, we have a team of doctors that meets to review each request that comes in to us. 

In the past years, we have focused on delivering data individually as each request came in. But we are building a product, which is being tested with a children’s hospital, that will provide de-identified data to the researchers at a hospital so that they can look into being able to use the data themselves, configure the data, and manage the actual research without us having to be involved. We are excited about our pilot project. I’m hesitant to name the children’s hospital, but it’s around how chemotherapy has affected children’s cardiovascular systems over time. Because we gather longitudinal records over time, we can often look across an individual’s life. We have, in many cases, 15 or 20 years worth of data that we can look at. Researchers are going to be able to take the data, model it themselves, and start using it for some amazing research that we haven’t been able to do before.

What strategies or tactics do you think will be important for the organization over the next three or four years?

Our work with the payer community is becoming more important. Many of your readers are all too familiar with payers having to send individuals out to pull records or asking practices or hospitals to send medical records so they can do their quality reporting around HEDIS and risk adjustment. That business is starting to become less and less because these records are all digitized. There is no reason to go out and make a copy of a medical record on the copy machine, ask someone to fax a medical record in, or have individuals spend time and precious resources doing things that are no longer going to be necessary as all of these records have become digitized. 

More and more, we find that our business is moving towards providing data to the payers so that they can meet their quality goals around HEDIS and risk adjustment, which is one of the reasons that we are so focused on having the highest quality of data. We want to make sure that the data that we provide to providers is correct and complete, and to our payer customers is correct and complete. That is becoming an increased focus for us, to spend time working with payers, understanding the data that they need, the timeframes that they need it in, the format that they need it in, and to be able to deliver that payers. Our goal ultimately is that we can provide the products and services to the provider community in return for the data that we receive from them. We can provide that to the payers and eventually be able to reduce the overall cost to providers in our community to be involved in a health information exchange to a minimal amount. The providers are contributing their data, and we see that as being extremely valuable and we want to continue to build upon that perspective.

Morning Headlines 1/30/23

January 29, 2023 Headlines No Comments

Start-Up Raises $200 Million to Speed Up Drug Trials

Clinical trials data and patient-matching platform startup Paradigm launches with $200 million in Series A funding.

Smile Digital Health Closes $30 Million in Series B Funding to Progress Innovation as World-Leading Health Data Fabric

Health data infrastructure company Smile Digital Health raises $30 million in a Series B funding round, bringing its total raised to $50 million.

Engage Technologies Group and APX Platform Announce Merger to Form Full-Service, Medical Practice Management, Business Insights, and Patient Engagement Solution

Patient engagement software vendor Engage Technologies Group acquires practice employee optimization company APX Platform.

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