Readers Write: Bracing for the Silver Wave: How to Design a Healthcare Technology Stack Built for the Future

Bracing for the Silver Wave: How to Design a Healthcare Technology Stack Built for the Future
By Amanda Hansen

Amanda Hansen is president of AdvancedMD of South Jordan, UT.

For some time now, the healthcare industry has been focused on preparations for the coming Silver Wave, the first time in our nation’s history that adults over the age of 65 will outnumber children 18 years old and younger. This dramatic shift in age demographics has major implications for healthcare providers and the patients they serve. As patient populations age, physicians and their staff will need to reconsider everything from the services they provide and the ways they deliver care to the technology solutions that underpin their systems.

Private medical practices are especially vulnerable to the coming changes. Without the resources and budgets of large healthcare networks, many private practices will face a number of challenges associated with the Silver Wave, some of which have already taken root. Chief among these challenges is ineffective technology solutions that fail to meet the needs of an aging patient population. Few private practices have a crystal ball to help them plan for the future, but there are definite steps healthcare providers can take now to prepare for transitions ahead.

As we enter the beginning stages of the Silver Wave, EHR systems will be even more critical to the patient experience. The increased demand for healthcare services that come with caring for older patient populations translates to increased EHR use and greater need for truly interoperable systems.

The impending shifts associated with the Silver Wave require technology solutions that can effectively manage multiple components of care, from basic patient demographics and healthcare records to complex healthcare services often related to elderly patients. Private practices will need EHR systems that can accommodate and support patient records with multiple healthcare providers, complex treatment plans for chronic illnesses, and increased prescriptions, all dynamics connected to elderly care.

EHR platforms are a crucial component of every healthcare technology stack, now and even more so in the future. Without the right solution in place, interoperability becomes a major obstacle that can significantly impair patient outcomes, the financial health of the private practice, and the overall patient experience, a challenge that will be more difficult to overcome as we near the massive shift in patient ages.

During the pandemic, telehealth became an essential healthcare delivery model. It also opened the door to all new opportunities for underserved patient populations, giving rural areas access to a broader selection of healthcare services and providers. In the last few years, telehealth adoption rates have continued to skyrocket. Now, as the healthcare industry faces a future with more patients over the age of 65 than under the age of 18, telehealth and other alternative healthcare delivery models will become integral to the healthcare experience.

Fortunately, many private practices have already tapped into the potential of telehealth, offering virtual visits to patients who desire more flexibility and convenience when scheduling doctor appointments. For aging patient populations, telehealth is no longer a “nice to have,” instead, it becomes a critical need for people unable to leave their homes. Telehealth, combined with at-home care services and remote patient monitoring (RPM) devices, enable healthcare providers to deliver comprehensive treatment to those most in need.

Similar to effective EHR platforms, alternative healthcare delivery models demand technology solutions that enable seamless processes. Telehealth platforms that are safe and secure, but also offer intuitive user-interfaces ensure physicians can care for all of their patients. At-home care requires technology that allows healthcare providers to update patient records in real-time outside of their office. Same with RPM devices: physicians need technology platforms that effectively integrate with RPM solutions to monitor things like blood pressure, heart rate data, and other medical details for at-risk patients managing chronic illnesses.

Many of the technology solutions that will help bolster healthcare services for the coming silver wave are primarily implemented and managed by the healthcare provider, but it’s important to acknowledge how they will impact the patient. While some may assume that an elderly patient population may be tech-averse, recent reports have revealed just the opposite.

After surveying more than 21,000 adults over the age of 55, McKinsey Health Institute discovered the smartphone was the preferred technology device for the vast majority of respondents ages 55 to 64. Nearly 50% of this same age group listed a tablet or laptop as their preferred device. In fact, when it came to barriers around embracing technology, survey participants cited cost and lack of knowledge. In other words, cost-effective technology paired with effective training that teaches patients how to use various tech devices and apps could mitigate many of the technological challenges facing older patients.

It’s worth noting that the silver wave will include a segment of Generation X, the first generation to use email, search the internet, and download songs to their iPod. If ever there was a generation primed for digital healthcare services, Gen X is it. In the same way an early diagnosis allows for improved patient outcomes, early investments in highly effective technology will enable private practices to establish a robust foundation that not only delivers immediate gains but will sustain their practice during the coming silver wave and all the challenges it will bring.

Healthcare AI News 11/1/23

News

A White House executive order on responsible use of AI assigns HHS to establish a safety program for receiving reports of AI-caused harm.

The VA launches a competition for developing AI solutions that reduce the time clinicians spend on taking notes or looking up patient medical records during appointments.

A new Microsoft Windows 11 update adds Windows Copilot, an AI chatbot that can help users open apps, summarize web pages from the Edge browser, and customize the Windows display. The company also started business sales today of Microsoft 365 Copilot, which offers Open AI-powered productivity enhancements to the former Microsoft Office 365 for $30 per user per month.

In England, Addenbrooke’s Hospital uses AI for the first time to interpret images of liver cancer patients to guide radiologists who are performing thermal ablation of a tumor.

Business

China-based technology giant Alibaba releases a healthcare-specific version of its Tongyi Qianwen AI model, which is one of the most powerful available.

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

Thomas Jefferson University Hospital expands its use of software from BigBear.ai for running operational planning scenarios related to resource and bed management, nurse staffing, and transfer center.

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

Other

A Stoltenberg Consulting survey of CHIME members finds that interest in AI has grown fivefold since last year’s survey, taking the top spot in industry focus.

University of Iowa Health Care reminds employees that using AI to draft patient letters, or using AI-powered transcription services, involves sharing PHI that could trigger HIPAA violations.

William Hersh, MD, informatics professor at Oregon Health & Science University, recently delivered a presentation titled “Artificial Intelligence: Implications for Health Professions Education,” for which he shared the session recording.

Contacts

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

Morning Headlines 11/1/23

Olive announces sale to Waystar and Humata Health

Healthcare robotic process automation vendor Olive AI shuts down after selling its clearinghouse and patient access assets to Waystar and its prior authorization line to Humata Health.

A Surging Epidemic: Metabolic Disease Rates Soar in Middle America – PreventScripts Secures $1.5 Million Funding to Arm Physicians with New Tools

Automated preventive health software startup PreventScripts raises $1.5 million in funding.

Patient Engagement Pioneer Rx.Health Joins Commure

Commure acquires Mount Sinai spinoff Rx.Health and will integrate the company’s care coordination software with its Commure Engage automated care coordination technology.

IKS Health Purchases AQuity Solutions to Create the Most Comprehensive Provider of Administrative, Clinical and Financial Services for Healthcare Organizations in the U.S.

Ambulatory-focused health IT vendor IKS Health acquires AQuity, which offers acute care organizations clinical documentation, coding, and RCM software and services, for $200 million.

News 11/1/23

Top News

Healthcare robotic process automation vendor Olive AI shuts down after selling its clearinghouse and patient access assets to Waystar and its prior authorization line to Humata Health.

Olive, which was once valued at $4 billion after raising $856 million from investors, previously sold its payer-facing prior authorization business to Availity and its business intelligence solution to BurstIQ.

Olive renamed itself from CrossChx in 2018 after divesting its legacy patient check-in technology to focus on AI. Co-founder Sean Lane told TechCrunch last year that Olive had pivoted its business model 27 times.

Axios reported in early 2022 that Olive’s automation software wasn’t saving health systems the millions of dollars it promised. Sources said that the sophisticated AI technology that it claimed to deploy was actually powered by 1990s-era screen scraping tools. They also reported that customers who were receiving a fraction of the expected benefits didn’t speak up because they were embarrassed. Epic made Olive stop using its name, which it said was being used to mislead prospects, and KLAS noted that Olive overstated its capabilities and was not proactive in addressing issues.

HIStalk Announcements and Requests

I received my renewal notice for dental insurance, which reminds me that we not only treat the oral cavity as a non-medical part of the body that requires its own specialists, we also buy “insurance” for their services that is really not insurance at all:

• It covers predictable, inexpensive costs fairly well (like cleanings), but pays little for major dental work, whether planned or not.
• Annual maximum benefits in the $1,500 range mean that the insurer rather than the insured is protected against financial catastrophe.
• There’s no risk pooling since anyone can sign up, and most customers know that they will use basic preventive services.
• The only real value of dental insurance is to provide treatment price discounts that dentists illogically don’t offer to cash-paying patients. Any dental practice could easily craft a better package — two cleanings each year plus best-offered price on everything else – and charge patients directly as a membership, cutting out the middleman while also locking their patients into receiving all their care at their particular practice.

Webinars

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

Acquisitions, Funding, Business, and Stock

Kinsa, which offers smart thermometers that feed a tracking and resource prediction system for contagious illnesses, closes its doors. Founder and CEO Inder Singh is hoping to sell the company’s IP. 

Canada-based Kento Health will use $4.1 million in new funding to bring its AI-powered cardiovascular care software to the US market. Its offerings include predictive analytics, remote patient monitoring, and real-time feedback for cardiac rehab and cardiovascular disease support.

Commure acquires Mount Sinai spinoff Rx.Health and will integrate the company’s care coordination software with its Commure Engage automated care coordination technology. Rx.Health CEO Richard Strobridge is now Commure’s VP of sales.

Ambulatory-focused health IT vendor IKS Health acquires AQuity, which offers acute care organizations clinical documentation, coding, and RCM software and services, for $200 million.

Business Insider investigates Spora Health, a $10-per-month virtual-first primary care practice for people of color, after its readers questioned an interview it did with the company’s CEO Dan Miller. Miller claimed that the company had signed several large companies as customers and was seeing thousands of patients, but actually had shut the company down and laid off all employees in 2022 after failing to make payroll. Reporters found that the company allowed its business registrations to lapse in several states and that most of the clinicians that its website lists no longer work there.

GLP-1 prescription issuing startup Calibrate, which is restructuring under a new private equity investor, fires founder and CEO Isabelle Kenyon.

Virtual cardiac telemetry platform vendor InfoBionic will work with Mayo Clinic to enhance the company’s algorithms and analytics for cardiac monitoring from hospital to home. CEO Stuart Long is an industry long-timer with executive stints at imaging vendors, Philips Capsule, and Monarch Medical Technologies.

Sales

• Behavioral health treatment network Zinnia Health (RI) will use social care referral software from Unite Us as a part of its Healing for Heroes program for veterans and first responders.
• Missouri Department of Mental Health will implement Oracle Health’s EHR.

People

Chris Skiffington, MBA (Oracle) joins Annexus Health as chief commercial officer.

Mia Nease, DBA (Komodo Health) joins Trio Health as chief commercial officer.

Imad Nijim, MBA (Virtual Radiologic) joins United Theranostics as chief information and technology officer.

Jack Courtney, who served as an executive CTG for 25 years until his retirement in 1993, died on October 18 at 87. His daughter Kathy Hochul is governor of New York.

Announcements and Implementations

University Hospitals Coventry and Warwickshire NHS Trust in England delays its Oracle Health implementation, reportedly due to problems it unearthed during testing.

Flatiron Health will integrate Guardant’s genomic profiling tests into its OncoEMR oncology EHR.

Cleveland Clinic will use Zipline’s drones to deliver drugs to the homes of patients starting in 2025.

One-fourth of surveyed US medical students are considering dropping out, while more than half of students who are studying medicine and nursing are hoping to get jobs that don’t involve patient care.

Government and Politics

HHS proposes info-blocking penalties for providers that would result in the loss of Meaningful User status under the Medicare Promoting Interoperability Program, result in a score of zero in the Promoting Interoperability performance category of MIPS, and result in the loss of eligibility to participate in the Medicare Shared Savings Program, among other disincentives. Comments are due January 2.

Other

A New York Times article notes — in referencing the White House’s newly issued executive order to set AI standards — that FDA has authority over using AI tools for patient care only if they are commercially sold, leaving health systems and insurers free to build and use AI tools without government oversight or mandatory transparency. The order requires FDA’s parent HHS to establish an AI safety program.

More than half of surveyed CMIOs serve on the executive leadership team of their employers, while 80% say their responsibilities have grown to include digital transformation, AI tools, and analytics. Three-fourths continue to practice clinically to some degree, with most of those indicating that the revenue generated by their patient work helps cover their informatics compensation.

Symplr creates a “Moments that Matter” movie series that honors nurses who have been nominated for Daisy Foundation awards.

Sponsor Updates

• Ascom Americas employees help sort 28,000 pounds of apples at the Food Bank of Central & Eastern NC.
• Inovalon announces that customers using its cloud-based Converged Quality solution for quality measurement, reporting, and improvement outperformed other health plans on the 2024 Medicare Advantage Star Ratings released by CMS.
• AdvancedMD announces that DeepScribe has joined its marketplace as an integration partner.
• Bamboo Health will exhibit at CrisisCon November 13-16 in Charlotte, NC.
• Cardamom Health will sponsor the 365 Leadership Summit November 6-7 in Madison, WI.
• Censinet releases a new “Risk Never Sleeps” podcast titled “Implementing Effective Cybersecurity Measures.”
• Nordic releases an episode of its In Network podcast, “Designing for Health: Interview with Deepti Pandita, MD.”
• Clearsense announces that it is an Amazon Web Services Healthcare Partner.
• ConnectiveRx will sponsor the Access Insights Conference November 6-8 in Orlando.
• CloudWave and Divurgent will sponsor the Bluebird Leaders S.O.A.R. Without Borders Conference November 1-3 in Scottsdale, AZ.
• Symplr announces that its technology has been recognized as the leading workforce management software for staff retention, clinician scheduling, time and attendance, and compliance in a recent series of awards and industry reports.

Blog Posts

• Integrating Clinical Documentation Improvement and Utilization Management (AGS Health)
• EPA Q&A with Christie Callahan: Putting patient-provider relationships first (Arrive Health)
• Navigating the Path to Health Equity Through Effective Patient Communication (Artera)
• Clearsense + AWS Marketplace: The Next Step in Healthcare Innovation (Clearsense)
• Leading versus Lagging in Healthcare AI Adoption (Dimensional Insight)

Contacts

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

Morning Headlines 10/31/23

HHS Proposes Rule to Establish Disincentives for Health Care Providers that have Committed Information Blocking

HHS proposes information-blocking penalties for providers that include loss of Meaningful User status and an inability to participate in ACOs, all of which would result in some impact to a healthcare organization’s bottom line.

Vizient Announces Acquisition of PrefTech OR, a Next-generation Physician Preference Card Management Technology

Healthcare performance improvement company Vizient acquires PrefTech OR, which offers operating room optimization software.

Kento Health Raises $4.1 million CAD to Bring AI to Cardiovascular Care

Canada-based Kento Health will use $4.1 million in new funding to bring its AI-powered cardiovascular care software to the US market.

Curbside Consult with Dr. Jayne 10/30/23

Among telehealth physicians, there’s a lot of chatter about an upcoming change in Centers for Medicare and Medicaid Services (CMS) policy that would require physicians and other healthcare providers to report their home addresses when conducting virtual visits from home.

This hasn’t been an issue during the last couple of years because CMS had issued a waiver for the requirement due to the pandemic. However, the agency has indicated that the waiver will end on December 31. Many organizations, including the American Hospital Association, the American Telemedicine Association, and the Alliance for Connected Care have come out in support of healthcare workers, citing privacy and security concerns as well as the rise in violence against healthcare workers.

As someone who has been stalked by a patient, it’s scary to think about patients being able to easily find your home address. Much of the information providers give to CMS (in the form of applications and enrollment documents) winds up on publicly available websites. A simple browser search can provide a surprising amount of information on physicians who haven’t taken steps to protect themselves. Although this is getting a lot of attention right now, it just scratches the surface at highlighting how the patchwork of laws in the US isn’t conducive to helping physicians deliver high-quality care when they want to be 100% virtual.

Problems with governmental agencies are highlighted when physicians apply to deliver telehealth care through national platforms. For example, the major players in the industry require physicians to have a current and unrestricted Drug Enforcement Agency (DEA) number. They use this as a way of screening out “problem” physicians who might have lost their controlled substance prescribing privileges. The companies in question don’t even allow their physicians to prescribe controlled substances and most of the ones that I’ve worked for actively prohibit any controlled substance activity.

Then, there are various states that have their own controlled substance agencies, which typically require the use of an address where controlled substance activities are taking place. This adds to the confusion for those of us who are practicing telehealth but not ever prescribing controlled substances, yet have to attest to the DEA and these state agencies that we have a physical location where they can theoretically come inspect our records.

In my situation, I “see” patients on a handful of telehealth platforms, all of which keep my records electronically. The evidence that I do not indeed prescribe controlled substances is housed on a variety of servers and I have no authority to grant access to any of them. It’s been a decade since I had a prescription pad in my hand. Yet, on the advice of counsel, I keep a locked file cabinet in my basement that houses my controlled substance records. It contains copies of my DEA certificates, state controlled substance authority certificates, various applications and renewal forms, and nothing else.

It’s pretty ridiculous that they expect you to have locked files, since many of us haven’t seen a paper chart for decades. If you ask my state what I should do, they tell me I should surrender my state controlled substance certificate because I’m not prescribing controlled substances. If I do that, I have to surrender my DEA certificate. And if I do that, I can’t work. Every time I have to renew one of these and attest that I’m following the rules, it makes me cringe.

There’s plenty of shared culpability here, from the agencies that haven’t kept their regulations current with how care is being delivered at present to the telehealth organizations that require certifications that don’t make sense for the work they’re hiring us to do. I understand using a variety of strategies to help root out bad apples, but I also take issue with physicians being asked to skirt the truth in order to earn a living.

Not to mention, the cost of maintaining DEA and state controlled substances certificates is not insignificant. There’s also now a continued medical education burden for maintenance of the DEA certificate. Although fortunately there are plenty of free courses out there that will fulfill the requirement, it’s grating to have to spend a minimum of eight hours on coursework that isn’t relevant to a physician’s current practice situation.

It’s also grating to know that some of the big telehealth players are doing some things that could best be described as “sketchy.” One well-known platform where a colleague recently applied to work wanted him to begin a payer enrollment and credentialing process without providing any kind of contractual agreement. I gave him a heads up that their standard non-compete agreement would likely contain a clause that would be a problem with his other employment obligations, but when he asked about it, they went radio silent.

Speaking of credentialing, that’s another problematic element for physicians who want to be 100% virtual since we’re often asked to provide information that’s not relevant (DEA number, anyone?) along with current malpractice insurance policies even if they’re not relevant to the organization where we’re trying to get credentialed.

Although a lot of telehealth physicians have day jobs and are just picking up extra telehealth hours for extra cash, some do it full time. Even though they may have a large organization backing them as far as having a non-home work address they can use, and where they can keep their DEA and state controlled substance numbers registered, in many circumstances they’re still having to fudge the attestations when they sign their renewal forms for those certifications simply because they’re NOT prescribing controlled substances. Now, many of us have to revisit whether we’re going to opt out of Medicare or whether we want to take the risk of having our home addresses made public. Opting out of Medicare brings its own problems, and further narrows the options for positions where we can use our skills.

The DEA and state controlled substance certificate issues don’t impact the majority of physicians who deliver telehealth services, because the vast majority of them have a physical practice location where they might be prescribing controlled substances and the issue becomes moot. However, the Medicare address issue affects many more physicians, including those working for large health systems who might be at home when they engage with their patients via telehealth. I’m hopeful it will get more attention. If we can get this issue resolved, maybe we can get some of the other issues resolved, although I’m not hopeful because it’s way too easy for organizations to simply use a DEA number as a proxy for past good behavior.

What do you think about making physician and healthcare provider addresses publicly available? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 10/30/22

TT Capital Partners Announces Investment in Cantata Health Solutions

TT Capital Partners acquires a majority share of Cantata Health Solutions, which offers health technology for providers of behavioral health, human services, acute care, and post-acute care.

Spok Reports Third Quarter 2023 Results

Spok reports Q3 results: revenue up 5%, EPS $0.22 versus $0.15.

Health Catalyst Reports Third Quarter 2023 Preliminary Results

Health Catalyst reports an 8% jump in Q3 revenue to $73.8 million, leading it to expect annual revenue of between $291 million and $296 million.

Monday Morning Update 10/30/23

Top News

TT Capital Partners acquires a majority share of Cantata Health Solutions, which offers health technology for providers of behavioral health, human services, acute care, and post-acute care.

Healthcare Growth Partners advised Cantata in the transaction, which is its sixth deal in five months. 

Cantata was formerly Keane, then a division of NTT Data.

Reader Comments

From Breathe In and Hold: “Re: Epic. I’m a Epic-experienced physician and would love to get involved in a new customer’s build instead of fixing someone else’s setup. Wondering if you know about any possible Epic signings coming up?” I responded privately with a rumored deal that would be huge while also noting that Epic’s momentum outside the US is growing, but otherwise I’ll ask readers.

From Go Noles: “Re: Tallahassee Memorial Healthcare. Replacing Cerner with Epic, it seems.” Unverified, but they just posted several Epic-related jobs and some are for inpatient.

From Very Peeved: “Re: use of the word ‘very.’ Annoying to me. To you, too?” It is, and is among the words that I excise most often from interviews and reader-submitted articles where everything is “very good” or “really efficient.” 

From HIT Sleuth: “Re: [company name omitted.’’] Rumored to be making [industry CEO’s name omitted] to improve the company’s scale and stability.” Unverified, so I felt ethically bound to render this comment nearly useless by anonymizing it. The company is (or once was) valued at billions, while everybody knows the CEO.

HIStalk Announcements and Requests

Health IT folks don’t believe their wares have done much to influence quality, clinician satisfaction, cost, or equality, but instead of made it easier for consumers to engage with our high-cost, low-quality health systems.

New poll to your right or here: Which social media tools are you using more frequently now than two years ago for job-related tasks? I probably lurk more on LinkedIn than before, I have found YouTube to be surprisingly useful although mostly for non-work purposes and mindless entertainment, and Twitter/X to be less important than before.

It feels heretical to say out loud, but I’m contemplating skipping my first HIMSS conference (or is it the Informa conference?) in many years, disrupting my spring migratory pattern. I had already tapered off my HIMSS conference dosage by shortening my stay and my onsite wandering range, with that and my nagging dread leading me to question the value. I’m open to arguments either way. I’m pretty sure that if I break the habit by skipping Orlando, then I’m certainly unlikely to go to Las Vegas the next two years since I don’t like visiting there.

Welcome to new HIStalk Platinum Sponsor Revuud. The Charlotte, NC-based company – its name is pronounced as “reviewed” — is a leading healthcare IT staffing marketplace that helps healthcare organizations connect with top talent. Its mission is to revolutionize the way healthcare organizations hire IT talent by providing a faster, more efficient, and cost-effective solution. Streamline your hiring process by leveraging Revuud to find, hire, onboard, manage, and pay your IT contractors, all in a single platform at a fraction of the cost. Thanks to Revuud for supporting HIStalk.

I’m always happy to find a new sponsor’s explainer video, so here’s the one from Revuud.

Webinars

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

Acquisitions, Funding, Business, and Stock

Spok reports Q3 results: revenue up 5%, EPS $0.22 versus $0.15. SPOK shares are up 78% in the past 12 months versus the Nasdaq’s 17% rise, valuing the company at $302 million.

The $1.5 billion acquisition of England-based healthcare software vendor Emis Group by UnitedHealth Group’s Optum Health Systems UK closes.

Sales

• VHC Health chooses Vyne Medical’s Refyne Cloud Fax and Trace platforms to automate management of electronic records and images.
• NYC Health + Hospitals and Montefiore choose Findhelp to connect community members with social care services.  

Announcements and Implementations

A new KLAS report on financial improvement consulting finds that the most common engagement is for financial performance improvement, while the most common outcome is improved efficiency. Impact Advisors, which was 2023 Best in KLAS for financial performance consulting, topped the performance score list, while already high satisfaction with Guidehouse jumped dramatically since 2020.

Sponsor Updates

• Pivot Point Consulting sponsors the annual UVA Community Health Friends of the Foundation Golf Classic.
• NeuroFlow releases a new Bridging the Gap Podcast, “Making the Financial Case for Digital Health Innovation.”
• Nordic releases a new Making Rounds Podcast, “Lab information, at your service.”
• Optimum Healthcare IT publishes a new case study, “Sentara: Strategic Portfolio Management with ServiceNow.”
• Spok publishes “The 2023 State of Healthcare Communications Report.”
• Waystar will exhibit at the HFMA Region 9 Annual Conference in New Orleans October 29-31.
• West Monroe will co-sponsor the HIMSS Washington Chapter’s Unleash the Future of Healthcare with Microsoft Technologies event November 2 in Redmond, WA.

Blog Posts

• Intelligent patient experiences, part 2: How easily can your patients manage their appointments and prescriptions? (Nuance)
• Securing healthcare data: The critical need for cyber resilience (Nordic)
• Reducing Burden on Your Maxed-Out Healthcare Technology Team (CereCore)
• Hot 7 with Larry King: A Listicle on Future-Forward Pharmacy (Surescripts)
• The Value of Time in Nursing: Maximizing Patient Care and Outcomes (Symplr)
• Sandwich Generation Caregiver Caring for Her Father with Parkinson’s (Trualta)

Contacts

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

Morning Headlines 10/27/23

Abridge raises $30M to Accelerate Adoption of its Proven Generative AI Solution across U.S. Healthcare Systems

Abridge, whose software converts patient-clinician conversations into clinical documentation, raises $30 million in a Series B funding round.

Critical Flaw in NextGen’s Mirth Connect Could Expose Healthcare Data

Cybersecurity experts recommend that users of NextGen Healthcare’s Mirth Connect interface engine upgrade to the latest version after discovering an unauthenticated remote code execution vulnerability.

Advocate Aurora Health agrees to settlement in data breach lawsuit

Advocate Aurora Health will pay $12 million to settle a lawsuit over its use of user tracking tools from Meta and Google on its website and MyChart patient portal.

SnapNurse Becomes SnapCare

AI-enabled workforce solutions vendor SnapNurse renames itself to SnapCare.

News 10/27/23

Top News

Abridge, whose software converts patient-clinician conversations into clinical documentation, raises $30 million in a Series B funding round.

HIStalk Announcements and Requests

Jump on Lorre’s year-end, cherry-on-top deal and you’ll be among several smart new HIStalk sponsors who snagged the rest of 2023 free, shifted the expense to 2024 if they wanted, and will be outshining the competition as HIMSS approaches. In an industry that is rebounding, marketing prowess earns visibility and opportunity. HIStalk’s sponsor roster is second to none in digital health. I admit that my website is primitive and thrice-weekly industry news posts are so necessarily long at times that they send short attention-spanners to flee for time-wasting TikTok videos, but a lot of decision-makers get their news here and 94% of them say that doing so helps them do their job better.

Webinars

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

Acquisitions, Funding, Business, and Stock

Sage, which offers technology for caring for older adults, raises $15 million in Series A funding. Its care coordination platform for senior living residents, which allows users to report urgent issues and to communicate with their care team. The company says use of its system reduces resident and family complaints by up to 90%.

Sales

• Colorado’s public health department chooses Findhelp to create a Drug User Health Hub to reduce the transmission and consequences of viral hepatitis.
• Midwest Surgical Hospital selects the Simplifi 797 and Pharmacy Compliance suites of Wolters Kluwer Health to support sterile compounding.
• University Health Network, UVA Health, and Boston Children’s Hospital will implement Fujifilm’s Synapse digital pathology technology.

People

HCTec hires Peter Reynolds (Jeomise) as VP of strategic sales.

Niki Hall (Contentsquare) rejoins Five9 as chief marketing officer.

The Permanente Federation promotes Brian Hoberman, MD, MBA to EVP/CIO and national IT leader. He also services as CIO of The Permanente Medical Group and led Kaiser Permanente’s implementation of Epic in the early 2000s.

Announcements and Implementations

Data scientists at Bardavon provide a rare under-the-hood look at the predictive models they developed for optimizing care for physical and occupational therapy patients. Therapy providers, claims examiners, and case managers use the results to manage workers’ compensation cases.

AI-enabled workforce solutions vendor SnapNurse renames itself to SnapCare. The company offers healthcare organizations a less-expensive alternative to traveling and agency clinicians for managing float pools, PRN staffing, and permanent placement recruiting.

Advisory Board warns of “pharmacy deserts” as drug chains close hundreds of unprofitable stores in low-income areas.

A survey of healthcare finance professionals by AGS Health and HFMA finds that those who use or plan to use autonomous coding trust trust it, but 52% don’t know what it is.

Privacy and Security

Advocate Aurora Health will pay $12 million to settle a lawsuit over its use of user tracking tools from Meta and Google on its website and MyChart patient portal,

Other

Baystate Health implements a cashless policy that even covers its retail pharmacies and cafeterias, saying that card-only payment streamlines the payment process and reduces the risk of theft. The hospital says its policy is consistent with Massachusetts law that prohibits retailers from discriminating against a cash buyer. It’s interesting that some business offer customers a discount for paying in cash to avoid card processing fees, while others implement card-only policies.

Not healthcare specific, but pretty funny, is this “Last Week Tonight” skit about McKinsey. I haven’t watched broadcast TV in many years, so I don’t know anything about the show.

Sponsor Updates

• EClinicalWorks announces that Integrated Medical Health (PA) has grown its multi-specialty practice using its EHR and Healow patient engagement solutions.
• Health Data Movers releases a new episode of its Quick HITs Podcast featuring Ganesh Persad.
• Nordic publishes new Healthcare Chronicles video titled “Maximizing your investment in the EHR | Aligning the EHR to enterprise strategy.”
• Lumeon announces that its Lumeon Conductor care orchestration platform has earned HITRUST certification.

Blog Posts

• AI Technology Takes Center Stage (EClinicalWorks)
• 5 Tips for a Successful Workday HR Implementation in Healthcare (Healthcare IT Leaders)
• Human-centered design for Canadian healthcare technology (Nordic)
• Colorectal Cancer Screening Improvement by the Numbers (Lucem Health)
• YourCare Community: Bridging the Gap Between Patients and Providers (Medhost)
• ACOs prepare for ECQM quality reporting (MRO)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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EPtalk by Dr. Jayne 10/26/23

From Jimmy the Greek: “Re: clickbait healthcare headlines, try this one: ‘Designing Playful Experiences with Imaging Capsules.’” Jimmy kindly shared a link to Exertion Games Lab, and I found the section header of Ingestible Games just as compelling. Capsule endoscopy was first approved by the US Food and Drug Administration in 2001, but its use is limited. The website notes, “We believe that the capsule’s experiential perspective is often overlooked, i.e. we argue that there is also potential for  ‘fun.’” The company created a wearable system named InsideOut where users can see a real-time video of their digestive tract as the camera capsule travels through and can interact with a couple of different games that harness the images. There are links to scholarly articles if you’re interested, as well as a video of the concept in action.

Halloween is almost here, and IMO has shared 13 ICD-10 codes appropriate for the occasion. The codes address injuries related to sewing, pumpkin carving, and handcrafts, as well as open bites of the neck which might occur in vampire-rich areas. My favorite is R46.1 Bizarre Personal Appearance, which I hope to see a fair amount of when I’m handing out candy next week. For your further entertainment, they did a winter holiday code update last year.

The CHIME fall forum is coming up, and Genzeon gets my thumbs-down award for silly giveaways. This Arizona-shaped luggage tag was mailed to attendees and is just one more piece of conference swag for many attendees to add to their trash cans. Colorado State University had a blog piece about this earlier in the year, noting that the annual spend on promotional products in the US is in the neighborhood of $20 billion, with estimates that 40% of it ends up in landfills.

I personally prefer when conferences let you pick and choose the promotional items you want rather than handing you a pre-filled swag bag. At last year’s CHIME event, light-up cowboy hats were a popular take-home item. I wonder how many of them are still in use. I won’t be at CHIME this year, so if you are going, feel free to send me your swag report.

Everyone is talking about burnout, but an article I read this week introduced me to the concept of “rusting out.” It’s described as being on the other side of the spectrum from burnout, and is defined as what happens when an employee’s talents are underused. It can lead to disengagement and lowered productivity. I’ve seen this phenomenon first hand. A good manager will be on the lookout for it and discuss ways to better use the skills of workers.

Although the article mentions recommending workers for retraining programs, in some situations, it could be much easier. This might involve removing repetitive lower-level tasks and adding more complex projects that encourage critical thinking or problem solving. This is tricky to do as a manager, especially if you don’t have resources towards which you can shift those repetitive tasks. Depending on the culture of your organization, it can be difficult to make the case for realigning resources, but executives who ignore these kinds of requests do so at their own peril. 

A friend sent me a link to a digital tool called Wellspring, which is designed to help clinicians individualize treatment plans for menopausal patients and uses guidelines from the UK’s National Institute for Health and Care Excellence. There have been many shifts in recommendations for treatment of menopausal symptoms over the years. It is challenging for physicians to make time to address them when they’re pressured to deliver quick visits that satisfy all the check-the-box metrics in front of them. It will be interesting to see if there is any movement on this type of tool in the US and whether frazzled physicians would be willing to adopt it.

I’ve written in the past about some of my experiences with my local health system. I had another one this week that makes me wish I could do some consulting work for them.

I’m registered with their high-risk breast cancer program, which means I have imaging studies performed twice as often as people of normal risk. The program handles pre-approvals with the insurance company since most companies won’t pay for additional screening without appropriate supporting documentation. Additionally, the imaging appointments are scheduled in conjunction with clinical appointments, so that the studies are read and results are given to me before I leave the building.

I received a letter from the hospital this week telling me that it was time to schedule my mammogram and I should call for an appointment or visit the mammogram van, along with a schedule of its locations. Since my next imaging is always scheduled before I leave the office, this made me worry that either my appointment had been canceled or something else had happened to it. As a patient, this causes anxiety as well as time spent calling the hospital to confirm or logging into the patient portal to confirm whether there is an appointment or not.

In addition to the inconvenience factor, there’s also the clinical appropriateness factor. Someone who is part of this particular high-risk program shouldn’t be doing a walk-in at the mammogram van. The letter had my medical record number on it, so it’s not like it was a generic letter. Given the capabilities of the health system’s EHR, there’s no reason that they should be sending out letters like this. It’s entirely possible to construct the outreach campaign by filtering out those patients who are already scheduled for imaging so that we don’t send patients on a wild goose chase looking for their appointments.

It’s wasteful to send out scheduling letters for patients who already have appointments on the books. If you insist on sending something, send a reminder letter with the date of the upcoming appointment. Additionally, patients who are flagged as being part of the high-risk program should likely receive a different letter, even if they are overdue for their imaging and don’t have anything scheduled. The program prefers that these patients call the coordinator to set up the appointments since they get linked with clinical appointments, rather than just showing up at a facility.

I talked to a colleague about the situation, looking for suggestions on how to advocate on behalf of patients. She promptly one-upped me by sharing her experiences with a health system that continued to reach out about her mother’s appointments more than a year after they were made aware of her passing. These are just things that shouldn’t happen given the technology we all have in place.

Is your organization maximizing its use of EHR reporting and recall campaigns, or is it traumatizing patients? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 10/26/23

MIDAS Healthcare Solutions Extends Series A Round With New Investment by MCPC Healthcare Fund

Medication security technology vendor MIDAS Healthcare Solutions announces a $2 million investment from MCPC Healthcare Investment.

CISA, HHS Release Collaborative Cybersecurity Healthcare Toolkit

HHS and the Cybersecurity and Infrastructure Security Agency publish a new cybersecurity toolkit for healthcare and public health.

Greater Good gets $20M for value-based senior clinics

Senior-focused primary care company Greater Good Health raises $20 million in a Series A funding round, bringing its total raised to $33 million.

Healthcare AI News 10/25/23

News

Washington University in St. Louis launches the AI for Health Institute, which will involve a collaboration of its engineering and medical schools.

NPR Shots covers doctors using AI for diagnosis, including a Mass General infectious disease doctor who is using the AI-enhanced version of Wolters Kluwer’s UpToDate — NPR calls it “Google for doctors” — that can conduct a conversation rather than simply looking up keywords in medical references. Other AI uses mentioned are interpreting diagnostic images, summarizing a patient’s medical history in preparation for their appointment, and allowing AI-assisted primary care physicians instead of specialists to care for some patients.

Business

Amazon begins rollout of AI-powered warehouse robots that it predicts will speed up order fulfillment by 25%. The system’s robotic arms and computer vision identify the correct item and send it to workers, which speeds throughput and places items at waist level to reduce worker injuries.

Research

A Stanford medical school study warns that AI chatbots may worsen health disparities for black patients by perpetuating race-based medical ideas that are known to be inaccurate. When asked to describe differences in skin thickness, lung capacity, and kidney function for a black man, the chatbots provided erroneous information instead of accurately stating that no differences exist. Some experts question the usefulness of the study’s conclusions since doctors shouldn’t be using chatbots to make medical decisions.

Researchers create software that uses AI to enhance CT images to produce MRI-quality information, which they say could be used to improve diagnosis in primary care.

Other

A Nature article predicts a rise in “generalist medical AI,” in which models that are trained on large data sets can mimic the broad analysis of a physician instead of performing a single function. It notes these challenges to AI in healthcare:

• AI can’t be trusted to make unreviewed decisions.
• Early medical imaging AI tools were trained on available imaging data that allowed them to perform tasks for which doctors don’t need help, such as detecting pneumonia.
• Individual tools don’t reflect the cognitive work of radiologists, and the plethora of one-trick AI tools could result in “an IT soup.”
• ChatGPT-like “Foundation models” that are trained on broad data sets of images, text, and other information can offer more capabilities than supervised learning, in which experts might analyze chest x-rays and label them as “pneumonia” or “not pneumonia” to train the system.
• Few institutions recognize that diagnostic AI models have usually been validated against the same data set that they were trained on, which in the absence of external validation makes it impossible to see if they are actually beneficial.

I hadn’t tried Google’s Bard lately, but enhancements that were release a few weeks ago give it some advantages over ChatGPT:

• It can access up-to-date information, such as news headlines and stock market information.
• It integrates with Gmail, Docs, and Drive to find or summarize content.
• Extensions are supported for Google-owned content, such as Maps and YouTube, and can be invoked specifically by using a keyword such as as @YouTube.
• Bard’s initial responses can be double-checked via a Google search by clicking a button.
• It can include images in its responses.

I also experimented with Pi, which terms itself as a “personal AI assistant” that emphasizes friendly, personal, and supportive responses. It serves as a polite sounding board, more of an AI companion than a brute force data retrieval engine, and it can conduct natural-sounding conversations. Developer Inflection AI recently raised $1.3 billion at a $4 billion valuation.

I’m also experimenting with Summarize.tech, which summarizes a YouTube video given its link. I gave the link for a recent VA EHR hearing and it did a pretty good job, complete with links to jump to individual video sections. 

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Morning Headlines 10/25/23

Network issue resolved after MultiCare temporarily suspends surgeries, procedures at some facilities

MultiCare recovers from a service outage that caused it to suspend surgeries and procedures at several facilities.

HealthEC Secures Additional Capital to Fuel Ongoing Growth, Names New CEO and New Chairman

Population health management services and technology vendor HealthEC announces a new round of capital and names Chris Caramanico (JJCAL) CEO.

5 southwestern Ontario hospitals hit by cyberattack, patient appointments to be rescheduled

In Canada, the IT systems of five hospitals that formed their own IT provider organization go offline due to a cyberattack.

Paragon Consulting Partners Becomes Paragon Health IT, Reflecting a Commitment to Enabling Evidence-Based Transformation of Digital Healthcare Services

Paragon Consulting Partners, which specializes in consulting and data services for medical imaging, rebrands to Paragon Health IT.

News 10/25/23

Top News

Digital consulting firm Perficient acquires San Diego-based healthcare software development company Smedix.

Webinars

October 25 (Wednesday) 2 ET. “Q&A: What’s new with the NSA? A No Surprises Act update.” Sponsor: Waystar. Presenters: Joseph Mercer, JD, managing director, Marwood Group; Heather Kawamoto, VP of product strategy, Waystar. The No Surprises Act created a lot of change,  and those changes are still coming. A panel of revenue cycle experts answer frequently asked questions and offer a concise update on the NSA, including legislative developments, FAQs, and tips for navigating changes.

October 25 (Wednesday) 2 ET. “AMA: The Power of Data Completeness.” Sponsor: Particle Health. Presenters: Jason Prestinario, MSME, CEO, Particle Health; Carolyn Ward, MD, director of clinical strategy, Particle Health. Is your healthcare organization looking to drive profitability and scale quickly? Our experts will explore how comprehensive clinical data can revolutionize the health tech landscape. This engaging discussion will cover trending topics such as leveraging AI and data innovation to enhance patient care and outcomes, real-world examples of organizations leading the charge in data-driven healthcare, overcoming challenges in data completeness and interoperability, and visionary perspectives on the future of care delivery.

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

Acquisitions, Funding, Business, and Stock

PicnicHealth, which uses patient-reported data to build datasets for research, acquires rare disease data aggregator and research firm AllStripes.

Akumin, a national outpatient radiology and oncology care services provider, announces a financial restructuring plan that includes filing for Chapter 11 bankruptcy protection and reverting to a privately-held company. Akumin experienced a ransomware attack in late September that is still impacting its ability to see patients at numerous locations.

HealthStream announces Q3 results: revenue up 5%, EPS $0.13 versus $0.12, beating earnings expectations but falling short on revenue.

Sales

• Delaware’s Division of Substance Abuse and Mental Health will work with Bamboo Health to develop and implement behavioral healthcare coordination software.
• East Suffolk and North Essex NHS Foundation Trust in England will implement Epic.

People

Eskenazi Health promotes Randall Grout, MD to chief health informatics officer.

HealthEC names Chris Caramanico (JJCAL) CEO.

Karen Mellin (DrFirst) joins CTS Connected Technology Solutions as VP of sales and business development.

Announcements and Implementations

Northern Health in Melbourne, Australia, goes live on Agfa HealthCare’s enterprise imaging through its new Northern Imaging Victoria service.

Netsmart develops an AI Data Lab that is built on Amazon Web Services, which will allow the company to develop new technologies for its CareFabric platform. Missouri Behavioral Health Council will contribute predictive analytics for population health and provision of care functions.

Privacy and Security

MultiCare recovers from a service outage that caused it to suspend surgeries and procedures at several facilities within its system. The Washington-based provider has attributed the outage, which affected multiple systems including its EHR, to an interruption in service from one of its vendors.

In Canada, the IT systems of five hospitals that formed their own IT provider organization go offline due to a cyberattack.

Other

Increased enrollment in Medicare Advantage plans has hurt critical access hospitals, which are paid lower, negotiated rates than those of traditional Medicare. Hospital executives say insurers are “slow pay or no pay” with their Medicare Advantage contracts. They also report that patients must drive long distances to find nursing homes and rehabilitation facilities that accept MA plans versus nearly universal acceptance of Medicare.

Sponsor Updates

• ConnectiveRx employees assemble several bikes for children in need as part of the company’s Customer Service Week events.
• Frost & Sullivan recognizes Wolters Kluwer Health with the 2023 Global Competitive Strategy Leadership Award for its work with conversational AI in healthcare.
• EClinicalWorks integrates with Sunoh.ai, an AI-powered ambient listening technology that generates clinical documentation during appointments.
• Dimensional Insight and Health Matrix partner to offer an intelligence and data analytics platform to the Middle East healthcare market.
• Baker Tilly releases a new Healthy Outcomes Podcast, “Empowering healthcare leaders with data-driven decision-making.”
• Nordic publishes a new episode of its In Network podcast, “Making Rounds: Lab information, at your service.”
• Black Book Research recognizes vendors exhibiting at MGMA’s Leaders Conference who’ve received its 2023 awards for highest customer experience and user satisfaction in practice management, including HIStalk sponsors Availity, Dimensional Insight, EClinicalWorks, and Nuance.
• Bamboo Health will exhibit at the TAHP Conference November 6-8 in Houston.
• Censinet releases a new Risk Never Sleeps Podcast, “In the Trenches of Healthcare Cybersecurity.”
• Consensus Cloud Solutions sponsors the annual Cognosante Charity Golf Tournament benefiting Final Salute.

Blog Posts

• Navigating the Challenges of Transcription: Finding a Solution That is Accurate, Timely & Secure (AdvancedMD)
• How Machine Learning Can Enhance the Healthcare Revenue Cycle (AGS Health)
• Make a good first impression: Keys to achieve long-term success in healthcare data analytics (Arcadia)
• HLTH 2023 Takeaways (Arrive Health)
• Meet Alexandra Ricciardiello – OCP Analyst (Optimum Healthcare IT)
• Unlocking Patient Engagement: The Power of Advanced Communication Approaches (Artera)
• Securing healthcare data: The critical need for cyber resilience. (Nordic)
• Meet the Clinician – Julia Greer, VP, Clinical Strategy, Ascom Americas (Ascom)
• Fuel Your FHIR with Better-Quality Data (Availity)
• The Bardavon Index: How Does it Inform Better Treatment Decisions? (Bardavon)
• What CIOs Want ITSM Providers to Know (Clearsense)
• How Geek Squad Supports Care at Home (Current Health)
• Crafting Effective Job Postings (Direct Recruiters)

Contacts

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

Morning Headlines 10/24/23

Perficient Reaches Definitive Agreement to Acquire SMEDIX, INC.

Digital consulting firm Perficient acquires San Diego-based Smedix, which offers cloud-based interface solutions for medical equipment and remote device management.

Ovation Healthcare Expands Portfolio with Launch of Tempo Technology Services

Ovation Healthcare launches Tempo Technology Services, a managed and IT services and procurement firm.

PicnicHealth Acquires AllStripes, Fortifying its Role as the Leader in Patient-Centered Healthcare Evidence Generation

PicnicHealth, which uses patient-reported data to build datasets for research, acquires rare disease data aggregator and research firm AllStripes for an undisclosed sum.

Curbside Consult with Dr. Jayne 10/23/23

I traveled this weekend to attend a celebration of life, marking the passing of a longstanding healthcare IT colleague. Many of those in attendance had known each other for decades, from the early days when electronic billing systems began to spawn clinical systems.

It was great to hear so many memories and to reminisce about how the industry used to be. Many of the companies that people worked for are no longer in existence, having either become part of another organization or sold for parts after an acquisition. Most of us were in agreement that the industry continues to be topsy-turvy and that it’s unclear how much or how fast new technologies like artificial intelligence will really have an impact. Hopefully, the next time we get together will be for a less solemn occasion.

I also recently had the chance to meet up with another former colleague, who was passing through my city on the way to a consulting engagement. He’s one of the super-techy types who took me under his wing when I was at the beginning of my clinical informatics career. I’ll always be grateful that he was willing to spend the time making sure I really understood the options that were being discussed versus just trying to get me to make a decision so the tech team could move on.

I’m pretty sure our conversation picked up where we left off the last time we saw each other, as if we saw each other every day, and I’m so grateful for those professional relationships that have turned into genuine friendships. In many of the informatics roles I’ve filled since the beginning of the pandemic, it seems like there’s so much understaffing there really isn’t time for those friendships to develop because everyone’s just scrambling to get the work done.

Once in a while, I see a scholarly article with a title that can only be described as clinical informatics clickbait. This time, the article in JAMIA not only caught my attention, but also delivered. As a clinical informaticist who has spent a good chunk of her career in emergency departments, how could I not be drawn to an article looking at how disaster hazards are represented in SNOMED CT? After all, I used to teach a class called “Things that can get you in the great outdoors,” so this was right up my alley.

Electronic health records are well positioned to gather data about the impact of various disasters on populations and sophisticated analytics platforms can help health systems and governmental agencies understand the respective responses to such happenings. In crafting the study, the authors looked to “determine the extent of clinical terminologies available to capture disaster-related events” as well as to map the United Nations Hazard Information Profiles to the SNOMED CT terminology.

I settled down with a nice cup of tea and dug in. Through the mapping process, the authors identified more than 200 disaster hazard concepts that had the potential to negatively impact health. These included not only things like chemical or biological disasters, but also those related to weather, flooding, earthquakes, or extraterrestrial factors. They noted that “geographically unique” hazards such as heat wave, cold wave, smoke, and drought were not found in the SNOMED CT data, coming to the conclusion that such concepts need to be added in order to improve clinical reporting. As someone who dealt with a variety of heat-related and smoke-related complaints during the long summer of 2023, I can attest to the impact that extreme heat can have on a population, especially when they don’t have access to air conditioning, fans, or transportation to cooling centers.

The authors highlighted the frequency of disasters by listing some of the events of 2023 that happened prior to publication. These included major earthquakes in Turkey and Syria; floods in South America, Indonesia, and Australia; multiple cyclones, wildfires, and more. Technological disasters included a coal mine collapse and shipwrecks. Along with other less major disasters, these events impacted 100 million people and cost $190 billion in economic losses. They also made the point that it’s not only the injuries and loss of life, but the impact of these disasters on healthcare facilities, the healthcare workforce, and the greater healthcare delivery system. They call on organizations to create strategies to make healthcare systems more resilient to disasters whether natural or human caused.

In reading the article, I thought about the current state of “resilience” in healthcare in the US. Prior to the COVID-19 pandemic, we didn’t have a lot of reserves to draw from at baseline. There was already a nursing shortage, a primary care shortage, and intermittent supply shortages when factories were hit by natural disasters or there were minor supply chain disruptions. Along came the pandemic, which exposed problems with strategic national stockpiles in the US and a rapid outstripping of global production for medical supplies. Those of us who were on the front lines vividly remember telling us we could wear bandanas to work to try to protect us from airborne pathogens and saw the pictures of our colleagues wearing trash bags when they couldn’t source barrier gowns. Although most of us have returned to relatively normal lives, the horror was real and continues to hit some of us, sometimes daily.

It doesn’t feel like healthcare delivery organizations (or policy makers for that matter) have risen to the challenge of addressing these issues for the future. As a nation, we’re not doing a great job of assessing risk, setting health priorities, or building workforce capacity, all of which the authors deem as essential for meeting future health needs. We already have a tremendous amount of data that we’re not acting on, so although I agree with the authors that more data might be better in planning for the future, I’m skeptical that it will be as useful as it might otherwise be. Certainly, there are more progressive nations out there who might actually make use of the data, and then in a decade or two the US will follow along.

I recently visited a country that has embarked on a half-century plan to eliminate certain invasive species and to return the environment to its natural state. If only we could translate that kind of initiative to the US and use it to promote public health and reduce the burden of chronic disease. Especially over a long-haul study horizon, we’ll need good data to evaluate whether interventions are working and whether we’re achieving the desired objectives.

Although the authors state that the risk of natural disasters is higher due to climate change, they acknowledge that “real-time data demonstrating the adverse impact of climate-change related events on populations, healthcare workforce, and healthcare systems, including natural disasters at the point of care, is lacking.” They attribute this in part to the absence of appropriate concepts in the clinical tools used in electronic health record documentation.

I would go further to add that there need to be additional abilities for clinicians to have easy access to this data, including access to patient-generated health information and pulling data from patient histories or linked geographical information. As an example, I spent a number of years living in a community that was directly impacted by chemical contamination. The federal government has identified particular ZIP codes in their efforts to track the downstream impacts of that contamination; if I could provide that in my patient history, which could serve as a proxy to prevent physicians from having to search for the appropriate codes for soil contamination.

The authors also acknowledge that many areas of the world don’t have health information system infrastructures that support the capture of such codes, and those areas are more focused on “the challenges of providing basic care for vulnerable populations in resource-limited settings.” They also note that there are gaps in the contact infrastructure for some countries to participate with SNOMED International in requesting additions or updates to the terminology and expressed concerns that many of the nations at highest risk for natural disasters are not members of SNOMED International. Although some may see this as a bit of a niche area in clinical informatics, I thought it was a thought-provoking article. I’ll have to reach out to my colleagues who are more closely involved in terminology to see what their thoughts might be.

What do you think about the data infrastructure for tracking disaster-related health outcomes? Leave a comment or email me.

Email Dr. Jayne.