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Morning Headlines 3/15/23

March 14, 2023 Headlines No Comments

Denied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need

Medicare Advantage plans are using “unregulated predictive algorithms under the guise of scientific rigor” to cut off payment for the treatment of seniors.

Tegria RCM to Adopt Acclara Brand

Tegria rebrands its RCM business as Acclara, naming Tegria RCM managing director Lincoln Popp CEO.

Google introduces Open Health Stack for developers

Google unveils Open Health Stack, an open source program that offers healthcare app developers a FHIR-based Software Developer Kit for Android, design guidelines, and analytics.

VA sprint team outlines 4 key issues leading to EHR rollout problems

The VA publishes an EHRM Sprint Report acknowledging that, while the Oracle Cerner implementation “has not met Veteran or VA expectations,” the VA itself is to blame for failing to standardize processes and fix issues that arose in its initial deployments.

News 3/15/23

March 14, 2023 News 10 Comments

Top News

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Stat reports that Medicare Advantage plans are using “unregulated predictive algorithms under the guise of scientific rigor” to cut off payment for the treatment of seniors.

A palliative care facility official says that “the appeal outlasts the beneficiary” as people who will die within three months are forced into an appeals process that takes up to 2.5 years. A Medicare beneficiary lawyer says that her MA patients start getting payment denials 14 days into their SNF stay even though they are entitled by traditional Medicare to stay up to 100 days.

Former CMS Administrator Tom Scully founded NaviHealth after seeing how nursing homes nearly always keep discharged Medicare Advantage patients for the full number of days of their coverage, sold the company for $410 million to Cardinal Health, who then sold it to a private equity firm that paid $1.3 billion, who then sold it to UnitedHealth for $2.5 billion. The company manages post-acute care for insurers who contract with the company for a share of the savings, with providers saying that the number of denials increased greatly when the company changed hands.

A hospital case manager reports, “NaviHealth will not approve [skilled nursing] if you ambulate at least 50 feet. Never mind that you may live alone or have poor balance. MA plans are a disgrace to the Medicare program, and I encourage anyone signing up to avoid these plans because they do NOT have the patients best interest in mind. They are here to make a profit. Period.”


Reader Comments

From Zoey: “Re: ChatGPT. It’s going to get wild when Open-AI releases the new, much more powerful GPT-4 next week.” I’m paying for access to ChatGPT just for my own education, so the GPT-4 model came live for me midday Tuesday (and is also live in Bing’s AI search preview). “Wild” is probably a good word to describe what will happen when AI goes broader and deeper into even more questionably sourced information. Bigger computing power or broader sources aren’t necessarily better for AI training. Would you want your doctor diagnosing you from a system that was trained on Internet junk content, or would it be better to train a system only on medical literature to accomplish that? We saw that in the early days of Internet search, when the novelty of being able to find anything wore off and the quest for higher-value, higher-relevance information that is tailored to individual searchers became obvious. For example, AI could analyze a patient’s EHR to provide clinicians with critical information that is hidden among the chart bloat, although daily batch training would be necessary to avoid limitations as in ChatGPT’s knowledge cut-off of September 2021. Oracle is in an ideal position to do this with its Cerner EHR.

Speaking of AI, the new version of Google’s Med-PaLM medical domain AI tool – which was the first to “pass” the US medical board test last year with a score of 60%, scores 85% at “expert” doctor level. Apparently that model is trained on valid medical information, which Eric Topol, MD says will soon allow AI to create office notes, manage prescriptions, schedule appointments and labs, obtain pre-authorization, and aggregate and summarize medical records.

From Moneylender: “Re: SVB. VCs created their problem and will benefit from the government’s solution.” Agreed. Some VCs and pundits stirred up Internet mob mentality by urging people to withdraw their deposits from SVB and the banking system isn’t set up to deal with a bunch of me-me-me Internet-fueled toilet paper hoarders. Banks and stock markets require people to believe that they are stable, well regulated, and fair to all participants (the equivalent of the Monty Python sketch about buildings that start to fall once you stop believing that they won’t). Note to CEOs willing to learn from SVB’s former one: never publicly use the phrase “don’t panic” since that acknowledges the fear that people are indeed panicking, which like the aforementioned toilet paper hoarders, doesn’t matter whether it’s justified or not.

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From Desert Frosé: “Re: Larry Ellison. Is he trying to train ChatGPT with misinformation or something by bragging on the ‘one patient, one record’ accomplishments of four Epic clients?” I honestly don’t know why he brought that up in the earnings call, where he seems to take credit for Epic’s interoperability in four of its big customers.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor HealthMark Group. The Dallas-based company is a leading provider of digital health information management solutions for healthcare providers across the country. Guided by over 15 years of experience in healthcare IT, HealthMark helps organizations transform administrative processes into seamless, digital encounters. It provides medical, billing and imaging record release as well as FMLA and audit support. Its technology-driven approach to managing medical record requests improves patient satisfaction and keeps patient data secure and compliant. Thanks to HealthMark Group for supporting HIStalk.

Here’s a HealthMark Group explainer that I found on YouTube.


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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The FDIC transfers all deposits of Silicon Valley Bank to a new bridge bank headed by Tim Mayopoulos, formerly president of mortgage startup Blend and a former Fannie Mae CEO. The government will protect depositors of Silicon Valley Bank and Signature Bank, using a funding program that offers banks loans against securities to avoid emergency asset sales. The FDIC fund, financed by banks rather than taxpayers, will protect depositors but not investors or creditors. However, the majority of SVB’s clients are venture capital firms and their portfolio companies, not small depositors who will benefit from government support. SVB remains open and assures investors that they will have full access to all of their deposits beyond the FDIC’s $250,000 of insurance.

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Bardavon Health Innovations acquires injury prevention company Preventure to expand its worker and health mobility solutions into a complete, end-to-end musculoskeletal solution. Its Safety Intelligence Suite includes customized injury prevention solutions, an AI movement coach, digital and human interventions, and use of engagement data to determine rehabilitation protocols for improved return-to-work times.

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Tegria rebrands its RCM business as Acclara, naming Tegria RCM managing director Lincoln Popp as CEO.


Sales

  • Providence will offer remote physical therapy services from Luna.
  • Prime Healthcare (CA) selects Ceiba Healthcare’s Integrated Virtual Care technology for tele-neurology, tele-stroke, and virtual critical care services.

People

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Ray Gensinger, Jr. MD (Hospital Sisters Health System) joins Tegria as SVP/chief medical officer.

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Broward Health (FL) names Steven Travers (USA Health) CIO.

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Philips hires Julia Strandberg, MBA (Pear Therapeutics) as chief business leader of its Connected Care business.

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Pivot Point Consulting promotes Max Hanner to SVP of business development, Laura Kreofsky to SVP of advisory, Zack Tisch to SVP of innovation and life sciences, and Jillian Wood to SVP of strategy and transformation.

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Carium hires David McCormick, MBA (Innovista Health Solutions) as COO.


Announcements and Implementations

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Ellkay releases LKOpera, an interoperability platform that allows partners to executive a connected digital ecosystem that accelerates go-lives and gives teams full control and transparency.

Children’s Wisconsin integrates Xealth’s patient education software with its EHR.

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Avaneer Health launches a blockchain-based data-sharing network for payers and providers that aims to improve administration workflows. I remain just as skeptical of blockchain-based healthcare solutions as I did back in 2021, when the company launched: “Blockchain is a hammer looking for nails that never seem to get pounded, and while healthcare has a ton of inefficiency and lack of interoperability (weren’t government-subsidized EHRs and HIEs supposed to fix those problems?), the historic safe bet is to be skeptical of companies that pre-profess their technology’s ability make it better.”

UCHealth’s “no-touch estimate” function is serving 36,000 patients per month with no manual work, generating 99% of patient estimates from Epic in which 72% of them estimate the patient’s portion within 5% or $50 of the final billed amount.

PeriGen launches automated quality reports for L&D that review hypertension recognition and response, perinatal core measure 06 (PC-06) unintended harm in the newborn, and persistence of concerning FHR conditions over time.

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A new KLAS report on clinical documentation strategies finds that Nuance’s DAX ambient speech recognition shows initial promise, but front-end speech recognition is becoming the go-forward platform, led by Nuance Dragon Medical One. Computer-assisted physician documentation offers benefits but low physician buy-in, with Nuance CAPD leading the category. Users of Clinical Documentation Integrity solutions, where Iodine Software and Nuance are the top category scorers, believe that development has stagnated with some vendors. Transcription services are on the wane, and while 94% of users of virtual scribes report positive impact, quality is inconsistent, especially when the assigned scribe is replaced.


Government and Politics

The VA publishes an EHRM Sprint Report acknowledges that the Oracle Cerner implementation “has not met Veteran or VA expectations,” but places the blame on the VA itself for failing to standardize processes and fix issues that arose in its initial deployments. The VA will:

  • Analyze the EHR’s safety performance using Leapfrog’s tool.
  • Improve over-the-shoulder support based on best practices from other health systems.
  • Modify PowerPlans to support research.
  • Prioritize new service requests using a patient safety framework.
  • Create a site readiness dashboard for go-lives.
  • Get live sites back to baseline productivity before bringing new sites live.
  • Simulate patient safety risks at the VA National Simulation Center or other locations.

Other

Scripps Health lays several dozen employees, most of them in IT, according to LinkedIn commenters.

Grady Memorial Hospital in Atlanta sues two apparel companies over their allegedly unauthorized use of the phrase “Grady Baby.”

This could be a public service announcement for choosing both friends and alcohol consumption wisely. Doctors in Nepal remove a vodka bottle that had been inserted in the lowest part of the lower GI tract of a drunk man by his “friends”. A similar incident occurred nearby a few days before, when a group of party-goers decided to see what would happen if they inserted a 3×5 inch steel drinking glass into the nether regions of their drunken bro.


Sponsor Updates

  • WEDI features Arrive Health CEO Kyle Kiser on its latest podcast, “Lucy Up! Improving Patient Access, Affordability, and Outcomes.”
  • Lumeon names Jennifer Bowman (Molina Health), Karen Cox, RN (Chamberlain University), Christy Dempsey, RN (Press Ganey/Missouri University School of Nursing), Jessie Israel, RN (Denver Wellness Associates), and Timothy Zoph (McKinsey) to its new Thought Leadership Council.
  • Baker Tilly publishes a new case study, “Health system realizes cost savings by outsourcing system integration and ad-hoc IT projects.”
  • Sentara Healthcare (VA) and Hollywood Presbyterian Medical Center (CA) use Wolters Kluwer Health’s Ovid Synthesis Clinical Evidence Manager to enhance their clinical research programs.
  • Agfa Healthcare will introduce its Imaging Health Network at HIMSS23.
  • The HLTH Matters Podcast features Biofourmis co-founder and CMO Maulik Majmudar, “Harnessing the Power of Tech and Data to Bring the Right Care to Patients, No Matter Where They Are.”
  • E-prescribing software vendor DAW Systems implements Arrive Health’s real-time prescription benefit technology.
  • Medhost joins the CommonWell Health Alliance.

Blog Posts


Contacts

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

Morning Headlines 3/14/23

March 13, 2023 Headlines 1 Comment

U.S. FDIC shifts SVB deposits to new bridge bank, names CEO

The FDIC transfers all deposits of Silicon Valley Bank to a new bridge bank headed by former Fannie Mae CEO Tim Mayopoulos.

1 big thing: Iron offers a virtual hand to OB-GYNs

Iron Health, which helps women’s healthcare providers connect their patients with primary and specialty care, and virtual services, raises $4.5 million in a seed funding round.

Notice of Florida Medical Clinic System Cyberattack

Florida Medical Clinic announces that an early January ransomware attack compromised 94,000 patient files, though no financial data was breached.

Curbside Consult with Dr. Jayne 3/13/23

March 13, 2023 Dr. Jayne No Comments

A recent article in JAMA Health Forum caught my eye with this title: “Association of Primary Care Visit Length With Potentially Inappropriate Prescribing.” The study’s goal was to answer the question, “Are primary care physicians more likely to prescribe potentially inappropriate medications during shorter visits?” in part as a proxy for seeing whether shorter visits resulted in lower-quality care.

The authors looked at visits from 4.3 million patients, noting that “those who were younger, publicly insured, Hispanic, or non-Hispanic Black had shorter primary care physician visits.” These visits were associated with higher rates of antibiotic use for inappropriate conditions, such as upper respiratory infections. They were also associated with prescriptions for both opioid analgesics and benzodiazepines in patients who presented with painful conditions. The authors concluded that shorter visits were associated with some measures of inappropriate prescribing, but not all.

It’s a difficult study to analyze, especially looking at the demographics included in the study. We know from other research that there can be racially and ethnically associated differences in care quality. We know that black women have higher maternal mortality and less prenatal care compared to white women, and there are plenty of other examples of racial disparities in care. It’s also difficult to understand from the write-up exactly what kind of EHR data was used in the study, which was conducted from March 2022 through January 2023.

The researchers pulled a dataset from multiple states across the US that encompassed both claims and EHR data from users of the Athenahealth platform. EHR timestamp data was used, including flags for check-in, patient intake, the clinician encounter, checkout, and signoff. In some clinics, these stamps can be a poor proxy for patient visit duration, especially when there’s a lot of waiting involved or when physicians don’t appropriately change the status of visits as they move through their schedules. I would be interested to see data on the concordance of those timestamps with actual visit durations as observed in the practice before using them as a proxy.

The visit time was variable between physicians, and although the median visit length was 18.9 minutes, the range was 14.1 minutes to 24.6 minutes. There was some data I didn’t expect when looking at visit length alone. Those visits that were scheduled for 30 minutes rather than 10 received more physician attention, as one would expect. However, the difference in time spent was only four minutes for the longer appointments. That might indicate that triage algorithms or human schedulers aren’t doing a great job predicting the correct appointment slot for a given patient.

Not surprisingly, visits that had five or more diagnoses were 9.1 minutes longer than those with only one recorded diagnosis. New patient visits were 4.1 minutes longer than those with established patients. The data supported previously proven conclusions, such as female patients having longer visits than male patients and older patients having longer visits than younger patients. It also showed that patients with commercial insurance had slightly longer visits than those with Medicaid or other payers.

The researchers found a correlation between longer visits and a decreased likelihood of inappropriate antibiotic use. On the flip side, longer visits had a positive association with potentially inappropriate prescribing among adult adults, which was an interesting finding. The authors note that “many of the prescriptions that we observed may have been refills; thus, it may have taken the physician less time to refill the medication than to engage in a discussion about de-prescribing.”

The authors end by stating that there are opportunities for additional research and operational interventions for visit scheduling and prescribing decisions in primary care. They also note that data showing that non-Hispanic black patients had shorter visits than non-Hispanic white patients seeing the same physician, which could result in accumulation of time disparities that can potentially contribute to racial disparities. They conclude that the data “should motivate organizations and policy makers to detect, interrogate, and address underlying systemic causes such as structural racism.”

It would be interesting to compare data pulled from Athenahealth users and that from users of other EHRs that may have varying levels of clinical decision support or guidelines content within the clinical workflows. In my community, the user base of the Athenahealth EHR tends more towards an independent primary care practice user base. Practices that are owned by or affiliated with the large health systems or academic institutions tend to use a different EHR, as they do across the US. Therefore, using data from one vendor alone might not be representative of primary care practices across the US.

It would also be interesting to control the data for owned versus independent practices, large versus small, and those who are participating in risk-based contracts versus those who aren’t. I’ve found that certain kinds of practices tend to have a more systems-based approach that can make short appointments more efficient than they might be elsewhere.

I work with physicians who practice in a face-to-face environment, those who practice entirely via telehealth, and those who either do a hybrid approach from within their practices or who practice at separate in-person and telehealth jobs. I’ve seen telehealth physicians held to standards that some of their in-person counterparts aren’t monitored for, because there’s a suspicion that somehow telehealth physicians are doing a worse job at following guidelines and standards than their in-person colleagues.

It would also be interesting to compare and contrast the data for telehealth visits done by third-party providers versus those delivered by the patient’s medical home. You would also have to look at hybridized care models such as a primary care office that uses an acute care telehealth pool that’s part of an overall health system, or primary care offices that allow third-party providers to work within their own EHR.

There’s not a tremendous body of literature looking at the length of telehealth visits compared to the outcomes of those visits, and maybe someday I can be part of the research into how telehealth can best be used for what kinds of care and what clinical decision tools work best to provide care in different environments. It’s been a long time since I was involved in research, but I enjoyed it. I’ve just entered a new Maintenance of Certification cycle with my specialty board and a practice improvement project is in order, so one never knows.

What do you think about the association with visit length and care quality? What have your experiences been from the patient side? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews David Lareau, CEO, Medicomp Systems

March 13, 2023 Interviews 1 Comment

David Lareau is CEO of Medicomp Systems of Chantilly, VA.

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Tell me about yourself and the company.

I’ve been with Medicomp about 20 years and CEO for 10. Medicomp’s core business is connecting all of the clinical information and data that is in an EHR, whether as terminology codes or free text, and making diagnostic sense of it, either for the providers at the point of care or for people reviewing the record for diagnostic relevancy, which is important now with Medicare Advantage and value-based care. We’ve been building this for 45 years. It seems that the industry is moving in the direction of not just trying to paid for transactions and coding them, but getting paid for caring for patients effectively and proving that it was done. It’s an exciting time for us.

Doctors say they are burned out from keystroke overload and entering data that doesn’t contribute to patient care. How might that situation improve?

There are a couple of ways to go about it. If you approach the EHR like a burden, as most of them are now, you’re just trying to isolate the clinician from the EHR. Ambient AI is a play in that space, saying that we’ll just listen to what’s going on in the room, and then maybe at the end, we’ll tell you or a reviewer that you have to meet these quality measures and your documentation might not be sufficient to pass a Medicare audit. Capture stuff at the point of care, get it coded as best you can, but don’t really use the EHR as a tool for the clinician. Just try to isolate the clinician from the usability of the system.

Or, you try to put the information in front of the clinician, at the time they need it, for the patient and the condition or multiple conditions that they are dealing with. Here are the clinical quality measures that apply. You’ve met the documentation requirements. You have all the information properly done. Then present them what they need, when they need it, so that the EHR becomes a data repository, not a repository of text and other stuff that has to be dealt with after the fact. If you can’t do that, if you just keep popping up stuff that’s not clinically important when they are thinking clinically, they are going to get burned out and they will be frustrated. 

Value-based care, 21st Century Cures, and TEFCA have increased the need for what we think of as diagnostic interoperability. Either diagnostic interoperability between systems or diagnostic interoperability between the clinician and the system itself, saying, I’m dealing with this patient. They have these conditions. Show me what I need. Show me what reflects the way I think and work. Also, let me complete my work here and get on to the next patient.

One of the big things that people contact me about is Medicare Advantage. Medicare Advantage is not saving the government the money that they thought it would. There’s more and more people of the baby boom generation retiring and they are living longer with chronic conditions. We have to bend the cost curve down. How do we do that? One solution they’ve come up with is to take better care of the patients and their chronic conditions. CMS has said, we’re going to come and look at your records, and we want to see evidence that you have managed, evaluated, assessed, and treated every one of these conditions for which you’re claiming risk adjustment and risk adjustment solutions have been on. Make sure we get these things coded so that we get a higher risk adjustment factor for each patient. Fine, but are they really taking care of the patient? Does their documentation prove it?

That’s where we are seeing the most interest in what we do. At HIMSS, we will be promoting whether you have the processes and technology in place to protect yourself against Medicare Advantage fraud audits, because that’s about managing patient conditions, not just getting the diagnosis code right. We’re getting lots of interest on that from people who haven’t talked to us before.

It’s an exciting time to be in our industry. Some people get excited about AI, and other people poo-poo it. There’s a great place for it if you have good, clean, high fidelity data. Then it can empower these learning models and algorithms. The industry is in such a state of flux because of all that. W are just glad we are in the space we’re in.

Microsoft and Oracle are now deep into the healthcare application area via acquisition, and both companies have placed big bets on cloud and speech recognition. What changes do you excpect and how will they affect other companies?

There’s a great place for speech, text, and the technology. Natural language processing, NLP, which a lot of these approaches rely on, provides at best 75% to 85% data fidelity. Most of those systems are trying to find codes in text – SNOMED, ICD, CPT – through language models. They work pretty well, but when you are trying to get a full clinical picture of the patient, you need to turn all of that into computable data that you can filter diagnostically. That’s what enterprises are being asked to do. Manage these patients, especially under Medicare Advantage and value-based care, manage their chronic conditions, and show that you did it. A lot of the models are relying on reviewing that stuff after the fact to make sure we did it.

We were pretty excited a few years ago when we got approached by Emtelligent, which has a natural language processing engine. They wanted to add our concepts that are in our engine to the roster of vocabularies they looked at. I told them that we weren’t really interested in that, but if they could do a version of their engine that targets our vocabularies, then we can filter that stuff diagnostically. We can take the text record and say, show me what in this record applies to chronic renal failure versus diabetes and then pass that to algorithms that say if it looks like it’s documented adequately to pass a Medicare Advantage audit or not. There’s a real exciting mix of voice navigation and voice capture of information, but that still needs to be turned into data that is computable. We sit in the middle of all that.

How does the growth of ChatGPT and other AI tools impact company strategy?

The Gartner Hype Cycle says that it takes a while for hype to build, but I’ve never seen such an upward thrust in the hype cycle when ChatGPT came out from OpenAI. But there are valuable uses for this, because that kind of technology at its core does statistical analysis of data and pattern recognition. If the data is good and the information that you’re trying to process is best processed as data like they’re seeing now — images, MRIs, and mammograms in a consistent format – there’s an opportunity to get high fidelity data out of that and apply AI to it. 

Machine learning is valuable for remote patient monitoring, for patients who are willing to do it at home, for monitoring their hallmark findings for chronic conditions. Trying to support the clinician at the point of care is problematic, unless you just say that we’re going to use this stuff to capture all the information. We’re going to use voice, speech, and sound and turn it into something and then process after the fact to figure out if we have gaps in care. That whole framework for where this stuff is and where it fits now versus in 10 years, we are constantly looking at that.

We’ve decided for now that our place is to make it possible to take in all this information — whether it’s text or codes from these various terminologies and code sets — diagnostically organize it, and present it back to the user. Eventually that kind of information will be valuable for ChatGPT or other AI algorithms that then apply machine learning to detect patterns that would otherwise not be detectable. We are constantly looking at that. 

People used to call our stuff AI back in the 1980s, not the same way that people do now because we built it using physicians who determined what’s appropriate when you’re thinking of one diagnosis versus others. That’s valuable data. Getting data acquisition and being able to diagnostically filter it is important. We do that pretty well. If people can start applying AI and machine learning to the data to our data points, it will be valuable. We’re pretty excited about it.

ChatGPT provides a chatbot-like response to user input as an ongoing conversation. Will that affect the usual software design paradigm of static screens full of data entry fields and submit button at the bottom?

The chat paradigm is an evolving target. As a conversation proceeds, different things seem to become relevant. The challenge is that clinicians, not just doctors, are pretty highly trained users. They’re not like me going out on the internet and typing in a few searches to put together an itinerary for a three-day visit to Phoenix, I don’t know anything about Phoenix, never been there, so it’s a good tool for that.

When you’re dealing with a highly trained clinical user, and when you think about physicians — medical school, internship, residency, their experience – they are already pretty good at clinical pattern recognition. They would like systems to present to them what they know they need to do their work. That’s what we try to do.

ChatGPT does that by searching the internet to find things that the user is not familiar with and and constructs information for presentation. Our engine does that from a diagnostic framework, pulling all this stuff together. But the technology inside things like ChatGPT will be more useful to the clinician when they’re dealing with conditions that they are not familiar with. For example rare diseases. The National Organization of Rare Diseases has a list of 1,100 to 1,500, depending on how you count them. Rare diseases that in some cases, if detected early, will lead to much better outcomes. If missed, there’s not much you can do about it. You can’t really prompt every clinician to consider the symptoms, history, physical exams, and tests that are relevant for every diagnosis the patient might have.

But with artificial intelligence running in the background, you can present the things to the clinician that make it usable for 98 or 99% of all patients. An algorithm runs in the background that says, this patient might have this condition. If you want to see the hallmark findings of it, click here. If not, go about your work. They tell doctors in medical school that if they hear hoof beats, think horses, not zebras. For things like the zebras in medicine, AI and machine learning could be valuable.

Medicomp has made few announcements of executive changes, acquisitions, or funding, which usually dominates the headlines of other companies. How does that position the company in a challenging economic environment?

People have a tendency to chase the latest hot thing. If you guess right, great. But if you guess wrong and you give away equity or control, you can no longer focus on what the core business is or the core value that you bring. We’ve been clear from the beginning that we wanted to focus on providing a tool that presented information to clinicians, the way they were trained and the way they need it. 

To do that, you need patient capital. You can’t chase quarterly results. You have to approach your people as the most powerful, valuable, and non-replaceable resource in the company, because when you’re creating software and intellectual property, turnover kills you. Change of focus changes or ownership kills you. People say, we’re such and such and it’s in our DNA. I always say to them, yes, until you get a new CEO, and then who knows what’s going to happen? 

We’ve been consistent in what we’re trying to do. We’ve never gone into debt. We don’t chase the latest thing. We’ve always thought it was going to be critical at some point in this industry to move away from tracking transactions to get paid to tracking conditions to get better outcomes. Our engine was built to do that. We’ve been able to retain that focus and get enough people interested in using our stuff so that we had the revenue to stay on track and we had the opportunity to continue to our core engine and all the mappings as the industry changed. Then, adapt for what we needed to for our core mission, which is diagnostically connecting data and presenting it and tools for documenting it, if people want to use our documentation tools.

Changes are fine if you really need to change your focus, vision, or mission. Peter Goltra set one out for us a long time ago and we’ve been able to stay with it. We’ve been pretty happy with that. It has also allowed us to keep the people we need to adapt to things like Meaningful Use, 21st Century Cures, ECQMs, quality control measures, and TEFCA interoperability. Figure out what you’re doing, get really good at it, and stay at it until something tells you you’re doing the wrong thing. So far, we’ve been fortunate that we seem to have made the right big choices whenever we needed to.

What elements will be important in the company’s strategy over the next few years?

We think the healthcare IT industry is on a path to realizing that the clinical record of a patient, regardless of where it resides, should be computable data that will power analytics, AI, and machine learning. The challenge is going to be filtering that data and presenting it to the various people who need it and meeting all the requirements that are being forced down on the providers by all kinds of things. Home healthcare has a set. Hospitals have a set. Ambulatory has a set. 

We think that over the next three to four years, we will see an increasing move and realization that the important thing is caring for the patient using AI machine learning, and other techniques for identifying people in a population who are at risk. But you still have to somehow deliver the care for each of those conditions, one patient at a time. The industry is coming to the realization that it would be much better for these health information technology systems if we had data, not just a bunch of stuff electronically stored. We are excited because of the realization in the industry that data is paramount to everything.

Morning Headlines 3/13/23

March 12, 2023 Headlines No Comments

Silicon Valley Bank has collapsed. Here’s what we know.

Silicon Valley Bank, a major player in tech company financing, collapses and is taken over by federal regulators in the biggest US bank failure since 2008.

Top House Republican wants to end VA’s Oracle Cerner EHR contract and ‘claw back the money’

Rep. Matt Rosendale (R-MT), chair of the VA’s subcommittee on technology modernization, says he would like to cancel the VA’s Oracle Cerner contract, claw back some of the money that the company has been paid, and focus instead on improving the VA’s legacy VistA system.

Mental health startup exposes the personal data of more than 3 million people

Virtual mental health startup Cerebral notifies HHS that its use of pixel tracking has inadvertently exposed the information of 3.2 million users to third parties.

Gauge Capital Announces Strategic Investment in Streamline Healthcare Solutions

Behavioral health EHR vendor Streamline Healthcare Solutions secures growth capital funding from Gauge Capital.

Monday Morning Update 3/13/23

March 11, 2023 News 12 Comments

Top News

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Silicon Valley Bank, a major player in tech company financing, collapses and is taken over by federal regulators in the biggest US bank failure since 2008.

SVB has business relationships with half of all venture-backed technology and healthcare companies.

SVB failed as higher interest rates devalued its long-term, low-interest bond portfolio even as venture capital deposits dwindled in a down market, with the unrealized losses raising fear in depositors who created a bank run in trying to withdraw their money.

Notes:

  • Deposits are FDIC insured up to $250,000, meaning that 95% of the money held by SVB is uninsured.
  • Tech companies that can’t get their deposits out of SVB are expressing doubt that they can meet payroll and pay bills in the short term.
  • Venture capital firms used their now-frozen SVB lines of credit to make investments quickly. However, they also triggered the SVB bank run by advising their portfolio companies to pull their money out, which created a liquidity event that forced SVB to convert unrealized losses to actual losses in an attempt to cover withdrawals.
  • Some of the VCs issued their SVB warnings on Twitter, which created a panic that one investor summarized as, “If you are in a movie theater and it’s not on fire and you yell fire, and then you congratulate yourself for being out first while other people are laying on the floor, do you sleep well tonight?”
  • SVB supporters note that the bank has been an ally of innovation, didn’t mishandle deposited funds, and instead chose a conservative investment approach involving government-backed funds that was derailed by interest rate hikes. The company held so much startup money deposited from fundraising proceeds that it couldn’t originate enough profitable loans to invest it, so it turned to low-interest but safe investments.
  • FDIC is expected to pressure another bank to buy SVB, which holds enough assets – albeit long-term and discounted — to cover deposits if it can continue operation.
  • Long-term observers question the involvement of the Federal Reserve in first holding interest rates artificially low, then raising them repeatedly. They also worry that fear will drive companies to move their money from banks to other investments, which will cause other banks to fail as depositors withdraw their funds.
  • Private equity investor Bijan Salehizadeh, MD, MPH, MBA worries that portfolio companies whose funds are tied up in SVB can’t count on their VCs to provide an emergency bridge loan since many or most VC funds also bank at SVB and can’t get their money either, and opening new accounts at overwhelmed banking competitors is not a quick process. He also notes that some companies are funded under terms that require banking with SVB, which means other banks may be wary of taking them on. He says that the federal government needs to force a big bank to buy SVB over the weekend or else “we have not just an academic catastrophe, but an actual catastrophe.” He also urges affected companies to stop all accounts payable activity immediately to preserve cash for payroll.

I would welcome opinions from readers who are involved in venture capital or whose company is being affected by SVB’s collapse.


HIStalk Announcements and Requests

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One in five poll respondents have used telehealth to get a prescription they wanted knowing that the evaluation process would likely be superficial.

New poll to your right or here, following up on Dr. Jayne’ s impressions of ATA: what disappointed you most at the most recent in-person conference you attended? Someone told me once that the single most important item for attendees is food and the opportunities to socialize while consuming it, which brings back painful memories of waiting in endless food and coffee lines at HIMSS conferences only to end up sitting alone on the floor with my wildly overpriced purchase because of lack of seats.

Attention clock spring-forwarders, which is everybody in the continental US except those in Arizona. Avoid embarrassing yourself and mothball EST, CST, MST, and PST until November 5 since it’s all EDT, CDT, MDT, and PDT until then. You don’t get to pick which one you like better, but in a rare confluence of decreased effort accompanying increased accuracy, just write ET, CT, MT, and PT year round to always be correct (those of us in those time zones already know what time it is here). Perhaps unfairly, I assume that anyone who has lived their entire life under Daylight Saving Time but still writes it wrong can’t be all that bright or attentive to detail. TL;DR version – always abbreviate Eastern time as ET.

I keep seeing these clickbait articles in the form of “XXX hospital executives to know” whose selection methodology is whatever the fresh grad writer’s Google searches turn up. Does the “to know” encourage people to cold-call those who are named get acquainted? Otherwise, if they are so important that we should know them, wouldn’t we already?

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I don’t often do book reviews, but I found the new, physician-written novel “The Algorithm Will See You Now” to be worth reading and describing.


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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From the Oracle earnings call:

  • CEO Safra Catz says that “cloud is no longer about just renting commodity white boxes” and instead offers velocity and value that supports business transformation.
  • She says that Oracle has improved Cerner’s operating margin by more than five percentage points in its three quarters of ownership.
  • Chairman and CTO Larry Ellison says that Cerner’s healthcare contract base has increased by $5 billion since the acquisition. He called out wins at Ascension Health, Auxilio Mutio, Vandalia Health, Banner Health, VA, DoD, and NHS.
  • Ellison said that MD Anderson has reduced readmissions by 30% by using Project Ronin’s AI model running on Oracle Cloud.
  • Responding to an analyst’s question about “when does it become clear that Oracle is helping improve the quality of care and saving lives,” Ellison cited implementations at DoD, VA, and Nova Scotia, along with an NHS bid in progress.
  • Ellison stated that Oracle has built “one patient, one record in the database” at Stanford, UCLA, Mayo Clinic, and Cleveland Clinic, failing to note that all of those organizations user Oracle Cerner competitor Epic.

OptimizeRx reports Q4 results: revenue down 3%, adjusted EPS $0.25 versus $0.22.


Sales

  • An unnamed drug manufacturer hub services company will use OptimizeRx’s technology to determine patient drug eligibility and affordability.

People

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Laura Wilt, MBA (Ochsner Health) joins Sutter Health as SVP/CDO.

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Washington University in St. Louis hires Greg Hart, PhD (FTI) as its first CTO.


Announcements and Implementations

An AHA-commissioned report by Kaufman Hall finds that 53% of US hospitals expect to lose money this year, driven by high labor and supply costs.


Government and Politics

Rep. Matt Rosendale (R-MT), who was recently appointed chair of the VA’s subcommittee on technology modernization, says that he would like to cancel the VA’s Oracle Cerner contract, claw back some of the money that the company has been paid, and focus instead on improving the VA’s legacy VistA system. He says VistA is a better system for supporting safe, high-quality care, citing high dissatisfaction rates among the VA’s users of Oracle Cerner.

The former CEO of now-bankrupt medical device company Stimwave is indicted for selling a non-functional piece of plastic as a $16,000 implantable medical device for chronic pain patients. Stimwave settled for $10 million in October 2022. Doctors complained that the implantable part of the original nerve stimulator device was too big, and since the company knew that the technology could not be made smaller, created a plastic dummy component that could be cut to fit, enabling the doctor to bill for implanting the fake device.


Privacy and Security

Virtual mental health startup Cerebral notifies HHS that it use of pixel tracking has inadvertently exposed the information of 3.2 million users to third parties. The shared information includes website visitor responses to a mental health questionnaire that includes responses about panic attacks, alcohol abuse, and personality disorder.


Sponsor Updates

  • Wolters Kluwer launches the Outpatient Prospective Payment System Batch Grouper and Calculator Service within its MediRegs coding, reimbursement, and compliance solution.
  • Nordic releases a new In Network Podcast, “Designing for Health: Interview with Dr. Srinath Adusumalli.”
  • OptimizeRx announces a multi-million-dollar, three-year agreement with a leading Hub services company that will leverage its technology to accelerate patient access for its life sciences brands.
  • Pivot Point Consulting announces new appointments to its Managed Services, Data & Analytics, Clinical Systems/EHR, Business Systems, and Advisory Services segments.
  • Premier publishes a new success story, “Premier’s Pinc AI Clinical Intelligence: A Key to Reducing Clinical Variation and Improving Quality at St. Luke’s University Health Network.”
  • Redox releases a new podcast, “Automation’s Impact on the Patient/Provider Relationship with Mytonomy’s Vinay Bhargava.”
  • Spok earns top honors for the sixth consecutive year in a Black Book Market Research survey of healthcare industry clients on top-rated secure communications platforms.
  • Volpara Health highlights studies presented at the 2023 European Congress of Radiology that demonstrate the important role AI plays in objective breast density assessment, cancer risk assessment, and mammography quality evaluation.

Blog Posts


Contacts

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

Book Review: The Algorithm Will See You Now

March 11, 2023 Book Review 1 Comment

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The Algorithm Will See You Now” is the first novel written by JL Lycette. It is a remarkably polished and engaging thriller that delves into the promise and pitfalls of artificial intelligence, corporate medical greed, and the ever-increasing tension between the science and the humanity of medicine.

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The author’s day job persona is hematologist-oncologist Jennifer Lycette, MD (UCSF undergrad, UW medical school), so the book’s medical and hospital details are accurate.

I admit that I bought this book purely because it sounded kind of interesting and the Kindle version was on sale for just $0.99. Cheap Kindle books are usually amateurishly self-published junk, but not this one — it’s a gem.

The story is set in 2035. Surgery resident Hope Kestrel, MD works for Seattle-based health system Prognostic Intelligent Medical Algorithms, where she has earned the official title of high resident, which PRIMA uses instead of chief resident, in its OASIS unit (Oncologic and Surgical Intervention Success.)

Medical technology has come a long way by 2035, as diagnosis and treatment is performed at PRIMA entirely with AI and a voice-powered chart assistant called Osler. The PRIMA health system’s AI determines upfront whether a patron (its word for “patient”) will benefit from a particular treatment or is instead likely to be a “non-responder.” The goal is to “optimize.” Or as Hope describes, “The AI frees both patients and doctors from the fallacy of choice. The algorithms are more trustworthy than people.”

An anonymous podcaster is critical of PRIMA, however. The algorithm is a mysterious black box. Patrons don’t pay deductibles or co-pays at PRIMA, but aren’t eligible for services for which AI predicts they will be non-responders, and rumor is that PRIMA licenses the technology to insurers who use it to deny coverage. The podcaster summarizes, “The most dangerous lies are the ones that use the truth to sell themselves.”

Hope is fully behind the AI system, declaring that any doctor who won’t embrace algorithm-directed care is as dangerous as surgeons in the 1800s who mocked sterile technique because they didn’t believe in germ theory.

The story continues with each key player, including the most vocal AI proponents, struggling with the health issues of loved ones and themselves, for which AI seems heartless and even wrong based on accidentally or intentionally flawed data training. They don’t face the patrons who are non-responders, but they can’t avoid seeing how the system works for those they love.

There’s also the business angle, as power-hungry PRIMA executives are working on the acquisition of Seattle’s biggest medical group, with plans to go regional, national, and then to be positioned to run a privatized Medicare system.

PRIMA’s medical residents are constantly scored, reassigned, and threatened for various transgressions, one of which is having non-responder patients for which blame must be assigned since nobody will admit that the algorithm could be wrong.

A recurring theme is the accuracy of the AI. Is it wrong one time out of 10,000, as PRIMA touts, or is only 95% accurate as behind-the-scenes data seems to suggest, leaving one patient in 20 to go untreated or to receive treatment unnecessarily that presents side effects and risks? And what are the clinical implications of overfitting, where the computer thinks it sees a pattern that doesn’t exist in the real world?

An uncomfortable moment ensues in a medical staff meeting of the practice that PRIMA hopes to acquire. A skeptical doctor expresses doubt about the AI’s accuracy, then when pressed to state his own accuracy rate, responds instead with a quote from Sir William Osler: “Medicine is a science of uncertainty and an art of probability.” It’s a valid point — doctors really don’t know their own accuracy, so to criticize that of the machine is a tenuous position.

The book is a compelling read that ricochets off the dangers of big data, corporate ambition, and what doctors are supposed to do when told that AI will be taking over their decision-making. It is really written like a movie screenplay, mostly “show don’t tell” scenes rather than exposition, playing for me like an episode of “Black Mirror.” I bail out early on most novels, including those of big-name authors, when I run out of patience for irritating writing style, sloppy editing, and inconsistent character behavior, but this one was remarkably well crafted and hard to put down.

The author wrote most of this book in the pre-2020 dark ages before COVID-19, ChatGPT, and health systems that are fueled by acquisitions racing each other to become national providers to compete with corporate giants such as Amazon and CVS Health. It is not preachy or prescriptive about any of the touchy healthcare topics that its characters are living through 10+ years in the future, which requires the reader to decide whether the tale it tells is entertaining or cautionary.

The author says the idea for the novel came when she saw IBM Watson touted for oncology before it fizzled. She practices as a rural community oncologist, and while she hopes to see the day when precision medicine’s abilities expand enough to cover more than a few patients, she worries about under-resourced systems and disparities in care. Her second book, due in November 2023, is a prequel to “The Algorithm Will See You Now.”

Morning Headlines 3/10/23

March 9, 2023 Headlines No Comments

Oracle Announces Fiscal 2023 Third Quarter Financial Results

Oracle reports Q3 results: revenue up 18%, adjusted EPS $0.68 versus $0.84, beating earnings expectations but falling just short on revenue.

Biden 2024 budget calls for IT spending boosts at VA, Social Security, GSA and CISA

President Biden’s proposed $6.8 trillion 2024 budget includes $1.9 billion for the continued roll out of the VA’s Oracle Cerner EHR.

The founder of Elemy raised more than $200 million to provide better autism therapy for kids. Now he’s ditching patient care to chase billions selling healthcare software.

Elemy, which raised over $300 million to open clinics to treat children with autism, has pulled out of 11 of the 14 states it covered and conducted layoffs as it transitions to selling software to clinicians to command a higher investor valuation.

News 3/10/23

March 9, 2023 News No Comments

Top News

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Oracle reports Q3 results: revenue up 18%, adjusted EPS $0.68 versus $0.84, beating earnings expectations but falling just short on revenue.

The company’s much-watched cloud revenue jumped 45%.

ORCL shares dropped 5% in after-hours trading following the announcement as investors reacted to revenue of $12.4 billion versus the average analyst expectation of $12.41 billion.

Chairman and CTO Larry Ellison highlighted the contributions of its June 2022 Cerner acquisition, saying that its healthcare contract base has increased by $5 billion. He says Oracle is pleased with those results, but expects new healthcare contract signings to accelerate further over the next few quarters.

The Cerner business contributed $1.5 billion in revenue for the quarter, 12% of Oracle’s total revenue.


Reader Comments

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From Marmaduke: “Re: WW. Didn’t they have problems with data privacy issues in the past?” The former Weight Watchers — which changed its name to WW in 2018 to emphasize holistic wellness instead of counting calories – acquired children’s diet app vendor Kurbo Health in 2018 for $3 million. FTC accused the companies of violating COPPA by encouraging users under 13 to falsely state their age to avoid seeking parental consent, then illegally collecting their personal information. WW settled with FTC in 2022 by paying $1.5 million and shutting down Kurbo. WW cautions in its latest SEC filing that it has limited experience in telehealth and drug marketing laws, so success in its planned acquisition of weight loss telehealth vendor Sequence will likely require retaining that company’s management team.

From Dingo with Ears: “Re: wax. While I love your regular news updates and have to come to depend on them, your highlighting the smart visual ear cleaner as an alternative to the trusty ear pickers I’ve been using for years is life changing. Wax on/ wax off!” I have seen roving ear cleaners in Chengdu, China whose patients sit among gaping onlookers in public parks to have their ears probed for many minutes by professionals who are armed with a variety of disturbing-looking tools that supposedly elicit pleasurable sensations (but the faces they make suggest that it isn’t always comfortable). I’ll take the app-powered self-cleaner any time.


HIStalk Announcements and Requests

The increasing trend of prescribing pricey and fashionable weight loss medications via telehealth prompts me once again question the value of making a drug prescription-only. The widespread availability of telehealth services that will sell patients what they want with minimal medical scrutiny – superficially reviewing their checkbox form entries –suggests that neither doctors nor patients see value in traditional exams and responsible prescribing. The telehealth companies make money like a club bouncer who waves a patron around the velvet rope after pocketing a $50 bill. I expect the pendulum to eventually swing back, either because prescribing requirements will tighten or some kid’s telehealth startup will find itself on the wrong end of a huge-dollar medical malpractice lawsuit when it turns out that the checkbox wasn’t a good replacement for actual medical care.

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The single top-of-page banner on HIStalk is almost always booked long term and thus is rarely available, but it is now. Contact Lorre.


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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Business Insider reports that Elemy, which raised over $300 million to open clinics to treat children with autism, has pulled out of 11 of the 14 states it covered and conducted five rounds of layoffs as it hopes to transition from delivering care to selling software to clinicians to command a higher investor valuation. A former employee likened its strategy to “darts being thrown at a dart board.” A leaked recording of a company meeting suggests that it hopes to a scheduling app and an EHR to behavioral analysts, but its 31-year-old founder admits that its early efforts at developing technology were not successful.

Investor Jacob Effron posts a fascinating interview with Naomi Allen, whose worked at Castlight Health and Livongo before starting investor-backed mental health startup Brightline. Snips:

  • Service layer vendors that can connect the digital health ecosystem to get solutions online faster are driving innovation.
  • Most US counties have no pediatrics-trained mental health providers, leaving virtual and hybrid care as the only option.
  • Castlight struggled because nobody had sold digital health solutions to employers and it was tough to prove value to companies and their users.
  • She believes consumers can be incented to shop responsibly for healthcare services via specialty tiers, value-based networks, and incentives for seeing high-quality providers and getting second opinions.
  • She wonders if the down market, with its reduced competition for employees, will require companies that sell solutions that are perceived as an employee benefit will need to find new sales approaches.
  • Livongo figured out member delight early on, identifying pain points such as the cost and effort required to get blood glucose strip refills. It also identified data signals that would allow it to take action immediately instead of having insurer case managers calling randomly.
  • It’s hard to convince patients to cut cords with their child’s behavioral therapist, which creates clinician shortages. Few therapists use measurement to determine when the child can exit care or be well served by other modalities, insurers don’t pay for mental health screening, and evidence doesn’t exist to connect level of care to acuity. 
  • She thinks the Teladoc acquisition of Livongo made sense because Livongo’s impact was limited by two of its acquisitions that used only coaches rather than clinicians. However, Teladoc didn’t invest in keeping Livongo’s executives and its culture clashed with that of Livongo.

Revenue cycle management solutions vendor AGS Health opens an office in Manila, Philippines. The company has 11,000 employees.


Sales

  • The new “smart” hospital of Valley Health System (NJ) will use Meditech Expanse, along with in-room monitors, RTLS patient locating for energy efficiency, and AI-powered video surveillance systems to prevent falls.
  • Shaare Zedek Medical Center implements Juniper Networks Astra software to automate data center network operations.

People

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Alistair Erskine, MD, MBA (Mass General Brigham) joins Emory Healthcare as chief information and digital officer.

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Medhost hires Michael Yzermanm, MS (Avelead) as SVP of customer success and support.

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David Wellons (Windy Hill Group) joins Penon Partners as VP and practice leader of sales operations and CRM process optimization.

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Tegria promotes Brian Cahill, MBA to CEO.


Announcements and Implementations

Healthcare interoperability vendor Health Gorilla and CLEAR, which offers a secure identity verification platform, launch a service that allows consumers to access their health information securely. The program will start in Puerto Rico via the PRHIE.

An NTT Data survey finds that only half of the consumer respondents are aware of at-home care options, while three-fourths would prefer a telehealth visit or house call over making a trip to a provider.

Nuance adds GPT-powered chatbot capability to its Nuance Mix self-service contact center solutions.


Other

An investigative report finds that mental health non-profit Koko searched the social media posts of people 18 to 25 to find crisis-related mental health language so it could direct them to chatbot questionnaires on its website. Experts question why the organization didn’t set up the experiments as human subject research that would have protected the safety and privacy of users. The company previously raised flags by experimenting with AI to allow users to advise each other on mental health issues. A bioethicist concludes, “If this is the way entrepreneurs think they can establish AI for mental diseases and conditions, they had best plan for a launch filled with backlash, lawsuits, condemnation, and criticism, all of which are entirely earned and deserved. I have not in recent years seen a study so callously asleep at the ethical wheel. Dealing with suicidal persons in this way is inexcusable.” The company’s co-founders came from Airbnb.

An NHS scientist wins a racism lawsuit after her complaints about co-workers resulted one of them changing her name in a shared worksheet to “paininarse.”


Sponsor Updates

  • EClinicalWorks releases a new podcast, “Keeping Patients Safe and Compliant.”
  • Intelligent Medical Objects publishes a new case study, “Improving patient cohorts with comprehensive code mapping.”
  • Nordic releases a new episode of DocTalk.
  • Meditech’s Expanse Patient Care helps Major Health Partners realize a 30% time-savings for home medication verification in the emergency department.
  • Nuance publishes a case study, “University of Rochester Medical Center enables effortless image sharing.”

Blog Posts


Contacts

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

EPtalk by Dr. Jayne 3/9/23

March 9, 2023 Dr. Jayne 1 Comment

I survived my trip to the ATA conference, but I can’t say I’m glad to be home. Leaving beautiful the warm and sunny environment of San Antonio for the rainy chill at home was definitely an adjustment. I’m glad I left my heavier coat in the car so I would have it when I got back.

Overall, it was an interesting conference, in that I met some great people and learned about some novel use cases for telehealth. From a logistics standpoint, though, I heard a fair amount of grumbling from attendees and exhibitors alike. The themes:

  • Meal service hours were tightly controlled. Although beverages were laid out 25 minutes before lunch was to be served, the catering staff literally had guards in place blocking anyone from even getting water from the lunch service tables. On the other hand, meals were served throughout the show floor, so that made it easier to pop out and get something. There was no break service upstairs where the majority of sessions were held, however.
  • Breakout rooms weren’t ideally sized for the attendees. Some were standing room only, where others seemed like vast caverns with presenters speaking into a dark void. I don’t recall having the option of indicating interest in a session in advance, which would have helped with room sizing if that’s something the event planners are interested in for the future.
  • The Saturday through Monday scheduled really seemed to mess with people’s sense of time and date. Although they enjoyed being able to focus on sessions on Sunday without dealing with work email, most people still missed three days of work with Friday and Tuesday travel, plus lost their weekend.
  • Exhibitors felt the event wasn’t as well attended as they expected. Exhibit hall hours were long, running from 10:40 a.m. to 6 p.m. On opening day, they let attendees in before it opened, which ruffled some feathers since people weren’t in their booths yet. On Sunday at 5 p.m., the aisles were a ghost town, and on Monday by 4:15, attendance was slim.

On Monday I attended a great Executive Deep Dive session and really enjoyed the first panel, which included veteran healthcare IT guru John Glaser. He’s been a voice of reason over the years and has good advice on how to run projects in a mindset that increases the changes of them being successful. I enjoyed his comments on the different ways that projects tend to turn out: 30% successful, with the rest being divided among options such as “trainwrecks” which are the spectacular failures, or “the great disappointments” which are ultimately worse.

His solid advice of keeping the transformation aspect at the forefront, as well as making sure everyone understands that transformation never ends, still rings true. Other advice such as making sure you have candor and openness on a project and making sure you aren’t trying to do too many things at once are sometimes overlooked but critical to successful initiatives. I also appreciated his advice to know how to pull the plug on an initiative when you see it’s not going to work out or drive value. One of my favorite takeaways from the panel was Glaser’s description of political support for transformation projects: “it’s like a slowly leaking balloon…. You have to re-inflate it every day.”

Monday night was the ATA social event, held at the Hard Rock Café as well as next door at the Howl at the Moon dueling piano bar. The Hard Rock scene was a little more chill, with people sitting and chatting while enjoying hors d’oeuvres and drinks. It was considerably less tame at the piano bar, where some of us retreated to the outdoor balcony in order to be able to have a conversation. I couldn’t help but wonder whether the apartments on the other side of the Riverwalk had soundproofed windows or how the residents otherwise coped with such noisy neighbors.

Still, it was a fun event to meet other attendees, learn what they’re doing in the industry, and to catch up with old friends. I’m at the point in my life where I can’t hang with the party crowd as well as I used to, so I headed back to the hotel while things were still in full swing in order to be ready for my early morning flight.

Wednesday was catch-up day. I’m privileged to have a great team who always has my back while I’m away, which is a big change from when I was doing interim CMIO work. The email volume was manageable and I caught up on some clinical reporting and other projects. The bright spot in my day was talking to one of my favorite graduating college students who is on the receiving end of some career recruiting by an EHR vendor. It was interesting to hear how the company portrays itself to potential applicants who are in non-healthcare fields and what they think of the recruiting pitch compared to other companies who are trying to catch their attention.

Since his major is highly specific and he’s got a very specific career in mind, he plans to look elsewhere, but it was an interesting conversation nonetheless. One of his close friends was also recruited and plans to pursue the opportunity, so I’m looking forward to hearing more about their journey.

I reached out to a couple of friends to ask about their HIMSS plans as I plan my Chicago travel. It sounds like even some of my die-hard attendee friends have opted not to attend this year. It’s a combination of working for companies that still have travel restrictions in place, not wanting to be away from family events given the later spring dates this year, and having limited conference budgets.

I’m not sure if large conferences will ever be what they once were in the pre-COVID era. From a HIMSS perspective, healthcare organizations are still recovering from the financial impacts of the pandemic, and if they have technology dollars to spend, they tend to be looking in focused areas. I’m not sure the large-format boat show of old is relevant to today’s buyers, but would be interested to hear from others with spending authority.

What’s the primary way you engage vendors for technology purposes? Are conferences and trade shows on their way out? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 3/9/23

March 8, 2023 Headlines No Comments

Melinda French Gates’s Pivotal Ventures backs women’s health clinic Tia

Women’s care company Tia, which operates virtual and in-person clinics in three states, secures an undisclosed amount of funding from Pivotal Ventures.

Wave Life Secures $6M Investment to Increase Mental Health Access For Gen Z

App-based mental health and wellbeing startup Wave Life raises $6 million in a seed funding round.

Fifth Third Announces Acquisition of Big Data Healthcare, a Payments Company Serving National Health Systems, Physicians

Fifth Third Bank acquires Madison, Wisconsin-based healthcare payments technology vendor Big Data Healthcare.

Readers Write: The Cost of Doing Nothing: Five Learnings from the Build versus Buy Debate

March 8, 2023 Readers Write 6 Comments

The Cost of Doing Nothing: Five Learnings from the Build versus Buy Debate
By Kimberly Hartsfield

Kimberly Hartsfield, MPA is EVP of growth enablement at VisiQuate of Santa Rosa, CA.

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It’s a conundrum that health system executives regularly face. Build a much-needed software solution in-house or buy it from a vendor?

Once hospital leaders identify the need for a solution that requires new functionality, the debate is on. Revenue cycle management (RCM) solutions are no different.  While many hospital IT departments are no doubt capable of designing, constructing, and implementing new RCM solutions, leadership must decide whether taking this route is likely to yield the best business results.

Often, it starts with hospital leaders surveying vendors, seeing the price tag, and deciding to embark on the journey to complete the project internally, with the premise that it will be at a much lower cost. The decision frequently backfires. Rather than making the investment and having the technology that hospitals need to support their RCM operations efficiently, do-it-yourself health IT projects often end up taking years to fail and costing hospitals far more than if they would have signed with a vendor in the first place.

Health IT leaders see a pretty Tableau or Qlik dashboard and think, “We can do this ourselves.” When it comes to data visualization, they probably can. What they don’t consider is that the data aggregation, normalization, and transformation work that happens under the hood is actually the challenging part of RCM transformation.

The following are factors to consider when considering whether to build or buy a new RCM solution.

Complex health IT projects require more than health IT

IT departments sometimes believe that because they have their own developers and analysts, they can design, build, and implement complex health IT systems on their own. However, complex health IT projects require far more than technical skills. There must be business knowledge and experience married to that technical skill. Frequently that is where the projects break down because the people with the business knowledge already have full time jobs in the organization that are not related to building a platform.

Indeed, the reality of large IT projects is that they frequently exceed timelines, go over budget, or sacrifice important functionality. For example, one in six large IT projects have an average cost overrun of 200% and a schedule overrun of almost 70%, according to Harvard Business Review. Similarly, 56% of IT projects fall short of the original vision, according to a study by McKinsey.

It’s all about speed to value

Leading RCM vendors have been waking up every day for years thinking about how they can work to evolve revenue cycle analytics and deliver value and ROI to clients. Vendors have the benefit of having seen and evaluated RCM systems from healthcare organizations of many different shapes and sizes across the country. They understand best practices, having implemented RCM solutions alongside numerous electronic health records systems. This experience enables the ability to identify idiosyncrasies that hide within data and frequently uncover gaps that clients didn’t know existed.

While hospital do-it-yourself RCM projects may take years to complete, leading vendors can perform an installation in 90 days, delivering immediate insights and ROI.

RCM processes are broken and technology is the fix

It’s an unprecedented time for healthcare. There is no model for the circumstances the industry is undergoing, given labor shortages, supply chain constraints, and the financial after-effects of the COVID-19 pandemic. Across the nation, hospitals are pushing for more automation to augment staffing issues, letting their staff focus on tasks that require decision making, not repetition.

In many cases, RCM processes are broken, and technology is the only route hospitals can take to do more with less. Hospitals must lean into technology and automation, leveraging data to build predictive models and using artificial intelligence and machine learning to boost efficiency.

Unless hospitals are large, mature, and complex, they typically don’t have the resources to handle a large RCM project internally. Smaller hospitals often lack resources like a database administrator, a data warehouse, and data scientists who can build predictive analytics models, for example.

RCM processes continually evolve

It’s easy to forget that RCM projects typically are not “build it and you’re done” solutions. In addition to building RCM solutions, hospital IT departments must provide ongoing support and maintenance. These projects continually evolve, with new requests for additional reports or functionality upgrades. This often requires analysts, engineers, and other highly paid technical resources that are difficult to find and are only growing more expensive.

Further, it’s an open question as to whether build-it-yourself solutions deliver enough value and differentiation to be worth the time, expense, and effort. For example, if all an organization’s competitors can simply build their own systems to accomplish a certain objective, then that system is hardly a source of competitive advantage.

Move from descriptive to predictive

RCM employees cannot manage by spreadsheets. The industry is moving beyond rows and columns. RCM employees need to be able to visualize data to detect patterns to quickly identify outliers and manage by exception. Additionally, hospitals must move their RCM processes beyond descriptive analytics to predictive and prescriptive analytics.

It is no longer acceptable for hospital leadership to simply understand what happened yesterday. Hospital leaders must look to the future with the ability to anticipate and predict what will happen tomorrow, next month, or even in six months. Through automation and advanced data analytics, leading RCM solutions drive those insights.

Readers Write: Making a Case for Digitizing HICS Protocols and Emergency Notification Processes

March 8, 2023 Readers Write No Comments

Making a Case for Digitizing  HICS Protocols and Emergency Notification Processes
By Dave Sinkinson

Dave Sinkinson, MBA is VP of mobile at Rave Mobile Safety of Framingham, MA.

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Patient safety is and always will be at the forefront for healthcare systems. While planned events such as a move or community open house warrant and receive pre-planning by hospital officials, emergency situations can and do arise in the healthcare setting at a moment’s notice. Whether it is a global pandemic, natural disaster, system malfunction, or a violent incident, hospitals must plan for and respond quickly to adverse events, not only for the sake of their patients, but also because they have a duty of care to safeguard employees and visitors to their facilities.

That’s where the Hospital Incident Command system (HICS) comes in. HICS offers hospitals and other healthcare organizations a standardized framework for managing complex emergencies and helps health systems prioritize safety. But meeting the various HICS requirements in the midst of an already busy role can be arduous for health system emergency managers and those they rely on during crisis events. Healthcare safety practitioners are ditching outdated tools and technologies — such as printed manuals, paper phone tree lists, or legacy communication systems — in favor of digital solutions that streamline work, automate compliance, meet quorum requirements, and improve notification capabilities.

Digital transformation is certainly not new in the healthcare sector. Healthcare safety leaders have been using technology to improve patient care processes and outcomes for years, and to help with emergency notification. However, healthcare safety practitioners are realizing the benefits of using these same tools to digitize incident command protocols and to enhance operational efficiencies.

The Mayo Clinic is using technology to tackle the manual, time-consuming tasks on their HICS to-do list. Their automated approach to industry compliance is not only ensuring that all HICS team members are on the same page, in real time, it is ticking the box on staff accountability, notification, and reporting. Emergency management professionals at the world’s top hospital recognized how unrealistic it was for key personnel to access hard copies of crisis plans with detailed responsibilities or to search for materials in times when seconds matter. They digitized safety protocols, resources, and benchmarks in a handy, one-stop app that not only helps them to accomplish necessary HICS steps, but allows them to do even more, for example, further leveraging the Common Alerting Protocol (CAP) for a more integrated approach to safety.

By automating HICS activations, healthcare safety professionals can lay out emergency response plans in the order they need to be carried out, manage permissions, reassign responsibilities if they are not undertaken swiftly, and notify certain audiences about an event unfolding and steps that need to be taken. Technology also captures important data including when an emergency alert was sent, who received important messages, and which HICS team members performed emergency response actions.

Health systems are also tapping into these tools for non-emergencies. They are being used to communicate about staffing shortages and to share severe weather updates that may impact employees coming to work or leaving their shift. They are also being used more often as digital resource centers. In the past, it may have been sensible to house emergency preparedness and response materials on a hospital website or intranet portal, but when you consider how many of us are tethered to our phones these days, it just makes sense to prioritize safety apps.

As with anything worthwhile, it is not simply a matter of building it and they will come. Hospitals must consistently communicate about safety tech solutions via signage, during meetings, and as part of staff onboarding to raise awareness and encourage usage during crisis situations and as part of the health system’s engagement culture. They must commit to training staff at different intervals throughout the year so that personnel can take an active role in their own personal safety by using anonymous tip-to-text technology and two-way communication components, or simply just so they know where to go for important hospital updates. Reviewing page visits and other digital data can also help hospitals to better understand what is resonating with employees and what may need tweaking or highlighting.

Communication and collaboration are the foundation for any HICS plan. With the push of a button, safety apps can effectively connect hospital leaders with people in the trenches while simultaneously informing first responders of an emergency situation.

Morning Headlines 3/8/23

March 7, 2023 Headlines No Comments

Gang leaks Lehigh Valley Health Network cancer patient photos as part of data hack

BlackCat hackers post pictures of Lehigh Valley Health Network (PA) cancer patients on the dark web after the health system refused to meet the group’s ransomware demands last month.

Virtual Education Center Provides Health Information to Patients

The Defense Health Agency launches a six-month pilot of its Virtual Education Center, a tool offering validated health information to patients and providers that will eventually be integrated with the MHS Genesis EHR.

Best Buy will set up in-home hospital care through a new deal with Atrium Health

Best Buy will set up in-home virtual care systems for Atrium Health in a three-year deal that will enable the health system to remotely monitor up to 100 patients.

VA expects its legacy EHR to be ‘around for a long time’ as it troubleshoots replacement

VA officials tell members of the House Committee on Veterans’ Affairs, Subcommittee on Technology Modernization that its legacy VistA system will be utilized for at least another five to 10 years while the new Oracle Cerner EHR is implemented across the department’s remaining facilities.

News 3/8/23

March 7, 2023 News No Comments

Top News

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Transcarent will acquire virtual primary care company 98point6’s care delivery division — which includes an AI-powered chatbot, physician group, and self-insured employer business — for $100 million.

Transcarent, which has relied on contracted clinicians, will gain 98point6’s 150 directly-employed doctors and support staff.

98point6 has raised $270 million in funding.

After the acquisition, 98point6 will stop providing patient care and will develop and sell technology to health systems. MultiCare Health System has signed on as its first software customer.


HIStalk Announcements and Requests

Hear ye, HIStalk sponsors participating in ViVE 2023 — send me your details for inclusion in my conference guide. It’s easy, free, and fun (well, maybe “fun” is a stretch) but why not tell reader attendees why they should drop by your expensive booth?


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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WW, known as WeightWatchers until a 2018 name change, will acquire telehealth-based weight management company Sequence for $132 million. Sequence’s $99 per month membership plan provides prescriptions for high-demand weight loss drugs such as Wegovy and Ozempic, a price that does not include the $1,000+ monthly cost of the drugs themselves. Sequence touts its prior authorization technology as a differentiator. WW shares, which have slimmed down 57% in the past 12 months versus the Nasdaq’s 12% loss,  jumped 79% on the news, valuing the company at $489 million.

Best Buy will set up in-home virtual care systems for Atrium Health in a three-year deal. Atrium expects to monitor 100 patients remotely, buying devices from Best Buy and having them installed by its Geek Squad. Best Buy Health’s president is Deborah DiSanzo, MBA, who was formerly GM of IBM Watson Health and CEO of Philips Healthcare.

Newly launched Opkit announces GA of a health insurance verification platform for telehealth companies and virtual clinics.


Sales

  • De Baca Family Clinic (NM) selects EHR and patient engagement software from EClinicalWorks.
  • CareView Communications adds Sonifi Health’s interactive communications technology to its patient video monitoring software, giving patients the ability to communicate with care teams from bedside smart TVs.

People

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Healthcare identity management vendor Verato hires Avi Mukherjee, MBA (Verily Life Sciences) as chief product officer.

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Waystar promotes Missy Miller to chief marketing officer.

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Direct Recruiters promotes Shayla Jastrzebski to partner.

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Cookeville Regional Medical Center (TN) promotes Tim McDermott, MBA to CIO.

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Kyruus promotes Heather Berndt, MA to VP of mid-market and client sales.


Announcements and Implementations

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The Medical University of South Carolina takes over management of Regional Medical Center and will convert it from Cerner to Epic.

Vitalchat announces GA of AI-Enabled E-Sitter, virtual nursing technology that enables clinicians to remotely monitor up to 100 patients from a central hub.

Weill Cornell Medicine (NY) uses AI-powered ProviderIQ technology from Hatchleaf to more effectively match patients with best-fit providers across specialties.

A study of procedure documentation modalities for hand surgery – AI-based virtual scribe, medical scribe, transcription service, and EHR voice recognition –  finds that all four generate acceptable results. The AI scribe required the least amount of surgeon time and was able to identify most of the elements needed, but the plans it generated required clinician review.

An NYU School of Medicine study finds that prescribing rates for mineralocorticoid receptor antagonists doubled when cardiologists were presented with an EHR banner alert reminding them of the appropriateness of the treatment for their heart failure patients. MRAs can greatly improve survival rates but are ordered for only one-third of eligible patients, resulting in an estimated 20,000 preventable deaths in the US each year.

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A new KLAS review of small-hospital patient accounting finds that Meditech Expanse tops the list, with Epic coming in second because service quality varies under the CommunityConnect model in which the host hospital provides services instead of Epic.


Government and Politics

The Defense Health Agency launches a six-month pilot of a tool that offers validated health information to patients and providers.

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The House Committee on Veterans’ Affairs, Subcommittee on Technology Modernization held the first of a series of oversight hearings on the VA EHR program Tuesday afternoon. Notes:

  • Chair Rep. Matt Rosendale (R-MT) said that VA IT systems exist to improve care, not to “turn out cushy contracts to technology companies.” He says that all EHR projects or options will be evaluated on patient safety, reliability, user satisfaction, and cost.
  • Rosendale says that some elements of VistA will be used for at least 10 years, and some parts that aren’t addressed by Oracle Cerner may never go away, so VistA must be maintained.
  • Rosendale said Mann Grandstaff VA Medical Center has become “the most dangerous VA hospital in the country” based on its post-Oracle Cerner patient safety reports of 500 per year versus an average of 55 per year from VistA-using facilities.
  • Former VA CIO Roger Baker says concrete evidence exists that veterans have better outcomes from facilities that use the VA’s legacy VistA system instead of Oracle Cerner.
  • Baker says that lobbyists are falsely claiming that VistA can’t be improved because of age, complexity, and technology. He says that big modernization improvements were made under his tenure even though VA had cut off VistA improvements for 16 of the last 24 years.
  • Baker says that replacement of VistA Laboratory with the cloud version of Cerner’s laboratory system in 2007 was a failure that never expanded beyond the first hospital because of the cost and timelines required to customize it using available parameters.
  • Baker says Oracle Cerner is the VA’s third attempt to replace VistA, following HealtheVet and IEHR, and all have failed because the VA’s culture values local control rather than software standardization.
  • Baker says that studies have shown that only 16% of large US government IT projects succeed, and as the largest federal IT project, “VA has no chance of actually succeeding on this program.”
  • Former VA executive Peter Levin testified that the billions of dollars that have already been spent on Oracle Cerner cannot scale to enterprise-wide clinical services. He said that DoD fared better because they had already transitioned to a centrally administered workflow, they planned better, and predecessor system AHLTA was a mess that made Cerner look like an improvement to users.
  • Asked about Cerner being awarded a no-bid contract, Levin says he doesn’t think the selection was unfair, but there were “political exigencies.”
  • VA IT executive Daniel McCune says that the annual cost of maintaining VistA has ranged from $418 million in 2018 to $891 million in 2022, and the cost will continue to increase until Oracle Cerner is fully implemented.

Privacy and Security

The FBI and Cybersecurity and Infrastructure Security Agency release a Cybersecurity Advisory to help healthcare providers protect their networks from the Royal ransomware variant.


Other

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A Black Book survey of 2,500 health IT leaders finds that 30% plan on investing in health data integration solutions this year. Reducing duplicate and unnecessary procedures, increasing volume of consumer health data, patient demands for nearly immediate health results, and gaps in clinical device connectivity were cited as top reasons for investment. Innovaccer took top marks for its data integration solutions.

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CNBC profiles Denmark-born Ida Tin, whose company launched popular menstrual health app Clue. She coined the term “femtech” to describe the trillion-dollar market to attract investors who would not have been comfortable with “a company that helps women not pee their pants.” She stepped down as CEO of birth control app vendor Clue in 2021, explaining that, “I could see that the things that I would have had to learn to really serve the company were things I’m not that good at, and I was not so interested in a lot of very serious operational stuff and that didn’t excite me as much.” She became interested in business when she got lost at the college where she was studying art and ended wandering by mistake into a business course interview.


Sponsor Updates

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  • Sam Larson, head of marketing for Philips Capsule, and his family will take a team to Jamaica’s Mustard Seed Communities this summer to complete several work projects.
  • AdvancedMD publishes a new e-book, “2023 MIPS Attestation Guide.”
  • Bardavon Health Innovations acquires injury prevention company Preventure and launches a Safety Intelligence Suite for employers and insurers.
  • CarePort publishes an e-book, “5 levers for hospital success under value-based care.”
  • ChartLogic will exhibit at the American Association of Orthopedic Surgeons Annual Meeting March 8-10 in Las Vegas.
  • ConnectiveRx will sponsor the Point-of-Care Marketing Summit March 22 in New York City.
  • AdvancedMD publishes a new e-guide, “2023 CPT/HCPCS Codebook.”
  • Netsmart will integrate the CAMS-care Collaborative Assessment and Management of Suicidality Framework and Suicide Status Form with its CareFabric platform.
  • Nordic releases a new podcast, “Making Rounds: The Big Squeeze in Healthcare.”
  • Optum will exhibit at the Academy of Managed Care Pharmacy Conference March 21-24 in San Antonio.
  • Sectra publishes a new case study, “AI frees up valuable time for radiologists in a Swedish healthcare region.”
  • Spok earns top honors for the sixth consecutive year in a recent Black Book survey for its secure communications platform.
  • Verato publishes a new case study, “Large Texas non-profit health system avoids costs, enhances productivity, and improves scalability.”
  • West Monroe promotes 16 new managing directors.

Blog Posts


Contacts

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

Morning Headlines 3/7/23

March 6, 2023 Headlines No Comments

Transcarent To Acquire Part Of AI-Powered 98point6 In $100 Million Healthtech Deal

Transcarent will acquire virtual primary care company 98point6’s AI-powered chatbot technology, among other assets, in a deal CEO Glen Tullman says could be worth up to $100 million.

Cybersecurity incident impacts Houston Healthcare’s operations

Houston Healthcare (GA) works to restore its computer systems after a cybersecurity incident March 3 forced it to use established back-up processes and downtime procedures to continue caring for patients.

WeightWatchers to Acquire Sequence, a Digital Health Platform for Clinical Weight Management

WeightWatchers will acquire Sequence, a telehealth company specializing in chronic weight management, in a deal valued at $132 million.

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