Monday Morning Update 3/13/23

Top News

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

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?

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

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

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

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

• Financial Challenges Facing Hospitals & How to Solve Them (Vyne Medical)
• Breaking down the barriers to health equity (Nordic)
• Can Healthcare Technology Beat Burnout? Not On Its Own. (PerfectServe)
• Four Trends Guiding Healthcare Supply Chain Workforce Management (Premier)
• AI in the contact center just expanded (Talkdesk)
• Advancements in PT Technology and Emerging Digital Trends (WebPT)

Contacts

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

Book Review: The Algorithm Will See You Now

“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.

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

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

Top News

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

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.

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

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

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

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

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

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

• Improving Patient Safety in Hospitals (Vyne Medical)
• VBC Doesn’t Happen Overnight. But It’s Happening Now. (Enlace Health)
• Front Desk Checklist PDF for Better Urgent Care Billing (Experity)
• Drug Overdose Deaths Continue to Surge (First Databank)
• How Transition from Web 2.0 to Web 3.0 Revolutionizes the Life Sciences Industry (Healthcare Triangle)
• 2023’s Top 4 AI Use Cases in Healthcare Communications (Five9)
• 5 Factors in a Successful Medical Record Abstraction (HCI Group)
• Is Poor Tech Support Losing You Patients, Revenue, and Reputation? (HCTec)
• Boost Financial Performance by Improving Patient Outcomes (Healthjump)
• Muscle Building for Transformative Change (InterSystems)
• The cost of building a clinical informaticists team (Intelligent Medical Objects)
• Getting Started with Online Scheduling: 5 Key Steps for a Successful Launch (Kyruus)
• From Ribs to Regimens: Your Complete Guide to Medication Reconciliation (Medhost)
• A can’t miss opportunity awaits you at our 2023 Home Care Symposium (Meditech)
• Full Steam Ahead: Regulations Create Momentum for Streamlined Healthcare Data Exchange & Prior Authorization Automation (Myndshft)
• Claims-Based vs. MDS-Based Insights: What’s the Difference? (Net Health)

Contacts

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

EPtalk by Dr. Jayne 3/9/23

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

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

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.

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

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.

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

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

Top News

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

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

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

Waystar promotes Missy Miller to chief marketing officer.

Direct Recruiters promotes Shayla Jastrzebski to partner.

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

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

Announcements and Implementations

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.

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.

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

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.

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

• 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

• Is Hospital Pre-Registration Possible Without Portal Adoption? (Access)
• Understanding the HHS-HCC Risk Adjustment Model (AGS Health)
• Healthcare disrupted: How to keep pace in a rapidly changing world (Arcadia)
• Ascom Workflow Technology Designed for Interoperability to Make 1+1=3 (Ascom)
• 7 Step Roadmap to Developing a Virtual Nursing Program (AvaSure)
• Using Real-Time Insights to Improve Value-Based Care Outcomes (Bamboo Health)
• Why Double Down on Injury Prevention? CEO Matt Condon Talks About Our New Safety Intelligence Suite (Bardavon Health Innovations)
• Epic Go-Live Planning: Keys to Successful HOD Implementation (CereCore)
• What is a Care Manager? (ChartSpan)
• Enabling Value with Interoperability & Analytics Using the 1Clearsense Platform (Clearsense)
• Harnessing Big Data for Suicide Prevention (Dimensional Insight)
• The 21st Century Cures Act and its Impact on Interoperability and Healthcare (HealthTech Resources)
• Long-Term Cost-Saving Opportunities in Healthcare (Divurgent)
• Key Tips for Successfully Managing and Optimizing Your Revenue Cycle (Vyne Medical)
• Beyond the call: How to differentiate your telehealth experience post-visit (Wolters Kluwer Health)
• Using EHRs to Increase Employee Satisfaction and Retention (Netsmart)
• Be the Poison Control (or help desk) operator your colleagues need you to be (Nordic)
• Combatting Burnout and Fatigue in Healthcare (Optimum Healthcare IT)
• So, Food is Medicine, What Does That Mean for Pharmacy? (OmniSys)
• Break the Backlog: 6 Strategies to Reduce Report Queue Backlogs (Pivot Point Consulting)
• How Clinical Communication Helps Critical Access Hospitals Improve Patient Outcomes (PerfectServe)
• Three Ways Premier is Supporting Continuum of Care Providers (Premier)
• How to Succeed in Value-Based Care Without In-House HCC Coders (RCxRules)
• FAQ: How do healthcare organizations define optimal provider-patient communication? (Relatient)
• Why your hospital should be using patient discharge checklists (Sonifi Health)
• 5 hospital contact center trends to watch (Spok)
• Tegria on Techquity (Tegria)
• The Value of One Integrated Clinical Communication Platform (TigerConnect)
• Advancements in PT Technology and Emerging Digital Trends (WebPT)
• How Evidence-Based Care Leads to Value-Based Care (Zynx Health)

Contacts

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

Morning Headlines 3/7/23

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.

Curbside Consult with Dr. Jayne 3/6/23

Jayne Goes to ATA

I have arrived at the American Telemedicine Association meeting in San Antonio, escaping the freezing rain of the Midwest for the blindingly bright sun of Texas.

Since it’s been a number of years since I’ve been to the downtown area, I did my usual walkabout. I’m always stunned by how small the Alamo is and how surreal it is to be in the middle of downtown surrounded by tourist shops and a wax museum. Although the Riverwalk was bustling Friday night, the surface streets were more subdued. I saw police responding to two restaurants, one near the Alamo and the other on the Riverwalk, due to disorderly patrons. By 7 p.m., Alamo Plaza was all but deserted, but the Riverwalk was bustling.

Saturday morning, I got my four miles in along the Riverwalk before many tourists were up and about. Most people don’t realize that the touristy section of the San Antonio River is made possible by a dam, which can control the height of the pool in the Riverwalk section. I grew up along a major river and had many trips to the lock and dam complexes with my dad, so I’m more prone to notice these kinds of things than the average tourist.

San Antonio is definitely doing its part to keep the area clean, with ample service workers out hosing off sidewalks and picking up trash during the early morning hours. It’s a shame that people have to throw trash in the river in the first place, but maintenance workers were fishing it out nonetheless.

On the way to registration, I stumbled upon San Antonio’s own “love locks” bridge near one of the less traveled sections of the Riverwalk.

At the convention center, I found a street artist working on this piece using paint pens. It was fascinating to watch how they controlled the lift with one hand and painted with the other.

Registration was a breeze, and the friendly check-in agent even asked me about the marathon shirt I was wearing. The conference bags were minimalist in nature and I like that. This is the kind of bag I keep in my suitcase for grocery runs when I’m traveling. It contained the usual flyers and postcards, along with a COVID-19 test kit from sponsor EMed, which is a great thing to include in a conference bag since many people have decided COVID is “over” and I suspect that a lot of the allergies people are complaining about might just be COVID.

On the other end of the useful spectrum is this single sock from ProAssurance. Attendees have to go by the booth to get the other one. Although it seems clever, it has the potential to generate a significant amount of waste, and attendees are becoming more attuned to that. Given the pattern on the sock, I’ll probably go by to get the other one for my favorite MD/JD, however. There were a couple of flyers in the bag, along with a couple of white papers, but none of the random junk I’ve gotten at other conferences, which was much appreciated.

After a brief sojourn to my hotel room to catch up on some of the working hours I missed while traveling yesterday, it was time to head back to the conference for a “Deep Dive” session on the business aspects of telehealth. It was a great session with lots of detail and a ton of attendees, resulting in standing room only conditions and people sitting on the floor around the edges of the room. Topics included compliance, professional liability, cyber liability, and the new proposed DEA regulations on controlled substances within telehealth.

I liked the seating arrangements – large round tables in the front for those who prefer that configuration, and standard rows of chairs in the back. The audience seemed engaged, with few people leaving until the end. I found the event photographers distracting, though. They were constantly in the room and would move around to take a new round of photos every time new panelists took the stage, often blocking the view of the speakers. A couple of them were also using 360-degree flash units even when shooting photos from far away, and although I don’t think they did much to illuminate the subjects they did a great job of blinding the audience momentarily. I wasn’t super keen on them taking long slow video panoramas of the audience, but I guess that’s just the nature of the beast these days.

From there we were off to the opening session which included speakers from the ATA, Optum, Google, and Microsoft. Topics were far ranging and there was a lot of discussion about how telehealth should evolve and expand in the post-COVID era. The presenters were largely industry folk. I overheard some people talking afterwards that it would have been good to hear from some patients whose lives had been touched by telehealth or whose care was made better through the technology. It’s nice to understand how the work we do impacts people at the point of care, whether they are clinicians, patients, or their families. Maybe ATA will consider incorporating something like this next year.

After the opening session, there was a casino night-themed social event with food and beverage service, although based on the attendance, I think a lot of people ventured out for dinner. I’m not much of a gambler, but it was fun to watch people celebrating at the craps table and to catch up with people I don’t normally get to see in person.

I’ve got some sessions picked out for the next couple of days of the conference, including ones on health equity, telehealth reimbursement, policy and advocacy, interoperability, and usability. I’ll also be hitting the exhibit hall and checking out some potential vendors as well as meeting up with a couple of old friends.

Hopefully there will be some time to soak up a little bit of sun in between sessions because the weather is certainly nicer here than it is back home. My step count was off the charts for today, so it’s now time to put my feet up and settle in with a good book to ensure I’m ready for what looks to be a pretty long day.

What kinds of things do you most like to experience at conferences, and what do you like the least? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 3/6/23

Epic Systems to add 1,700 jobs as it expands its Wizards Academy campus in Verona

Epic will add 1,700 employees to its current headcount of 11,600 in the next 12 months, housing them in two new office buildings that it will build within its Harry Potter-themed Wizards Academy complex.

MUSC invested $15M into RMC partnership; CEO says system focused on quality

The Medical University of South Carolina invests $15 million in its management of Regional Medical Center, which will include expanding telemedicine services and switching the hospital over from Cerner to Epic.

#StopRansomware: Royal Ransomware

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

Monday Morning Update 3/6/23

Top News

Epic will add 1,700 employees to its current headcount of 11,600 in the next 12 months, housing them in two new office buildings that it will build within its Harry Potter-themed Wizards Academy complex.

Two-thirds of poll respondents think that restrictions banning physicians from opening or operating hospitals should be lifted.

New poll to your right or here: Have you used telehealth to obtain a prescription for a drug that you wanted knowing that few questions would be asked?

I’ve done nothing to prepare for HIMSS23 except book a hotel, so I fired up the Meta Quest 2 and Wander, which has become my most-used VR app. I searched for my hotel by name and then could take a virtual stroll through Chicago to check out nearby restaurants, points of interest, and the Riverwalk. It brought back memories of previous HIStalkapalooza events that were in Trump Tower and the House of Blues, the latter of which is still my favorite venue of those I’ve used.

I am amused annually by the American Telemedicine Association, which advocates virtual care to those who attend its in-person conference.

A doctor friend received a PET scan report with good numbers last week, but the dictated summary said that he had heart damage and could expect a significantly shortened lifespan. He spent 12 hours researching the test and its interpretation, then messaged the doctor that the report didn’t make sense. He got a quick response saying that the doctor had pressed the wrong keys in Epic, then received a corrected report indicating that he’s fine after all. He raises these points:

• What if he was a layperson?
• Had he been referred, would a specialist had paid attention to the numbers, or would they use the erroneous summary to make medical decisions?
• Will his medical record reflect that the initial report was incorrect or that the doctor didn’t check the report carefully?
• Does this happen often?

I’m always losing subscribers to my email updates because of spam filters and company policies. If you’re not getting my updates, sign up again and be confident that you won’t get duplicate emails no matter what. While you’re at it, connect with me on LinkedIn so I can see your posts and job changes. If you send me news or a job update and I’m not immediately familiar with you or your company, I check if we are connected, how many connections we share, and if you’re in Dann’s HIStalk Fan Club to help decide whether readers will be interested.

Thanks to the following companies that recently supporting HIStalk. Click a logo for more information.

Webinars

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

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

People

Stuart Miller (Infor) joins Craneware as VP of sales.

Jamie Coffin, PhD (Sema4) joins Nature’s Toolbox as CEO.

Evernorth Health Services hires Sean Tuley, MBA (Global Medical Response) as Evernorth utilization management CIO.

Integra Connect promotes Marie Finnegan, RN to VP of product management.

Government and Politics

Teladoc Health-owned virtual mental health company BetterHelp pays $7.8 million to settle FTC charges that it shared the information of website and app users with Facebook and other social media platforms. Teladoc, which acquired the company in 2015 for around $5 million, says it’s a billion-dollar business.

Other

Telehealth-based weight loss startup NextMed is using fake reviews and before-and-after photos to promote its services to prescribe trendy diabetes drugs like Ozempic and Wegovy, often omitting government-mandated warnings. The company, whose founder just graduated college, outsources clinical work to telehealth companies and customer service to offshore firms. It touts as a competitive differentiator its software that quickly process prior authorizations for the expensive drugs. Customers complain that the company is slow to respond to cancellation requests and offers Amazon gift cards for taking down negative reviews.

Contacts

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

Morning Headlines 3/3/23

Joint Statement of Chair Khan, Commissioner Slaughter, Commissioner Wilson, and Commissioner Bedoya Regarding Amazon.com, Inc.’s Acquisition of 1Life Healthcare, Inc.

The FTC warns Amazon that it will be monitoring its use of patient data following its acquisition of primary care provider One Medical, noting that it will judge pre-acquisition privacy promises by the standard of a “reasonable consumer” rather than that of a HIPAA expert.

Bright Health Group Reports Fourth Quarter and Full Year 2022 Results

Health insurer Bright Health – fresh off layoffs, the exiting of most lines of business, an impending delisting of shares on the NYSE, and a $1.4 billion loss in 2022 – warns that it has overdrawn its credit and expresses doubt that the company can continue as a going concern.

Fertility player Kindbody gets $100M at $1.8B valuation

Fertility-focused provider Kindbody will use $100 million in new funding to open 10 additional clinics, and acquire virtual health and fertility companies.

FTC moves to ban BetterHelp from sharing mental health data for ad targeting

Online counseling company BetterHelp will pay $7.8 million back to consumers to settle FTC charges that it shared health data with third parties for advertising purposes.

News 3/3/23

Top News

VA Deputy Secretary Donald Remy, JD, who oversees the VA’s Oracle Cerner implementation and other initiatives as its equivalent to COO, resigns as of April 1.

Remy’s departure follows that of VA EHR Executive Director Terry Admirim, MD, MPH, MBA, who left the agency last week.

The VA will nominate a replacement for Remy for Senate confirmation.

Meanwhile, Rep. Mark Takano (D-CA), ranking member of the House Veterans’ Affairs Committee, warns that the VA’s Oracle Cerner project “is on its fourth director in five years, and continues to burn money and disrupt care.” The head of the GAO told the committee that while the VA has addressed some challenges, its bureaucratic, decentralized structure makes positive change difficult and EHR project requires a more disciplined approach. 

HIStalk Announcements and Requests

I invited HIStalk sponsors who are participating in the ViVE conference to send me details for my online guide (I should call it a “curated” guide since that’s a crutch word for ViVE). I feel the need to repeat that invitation because I received only one response, and that was from a company that isn’t a sponsor, so I’ve curated them out. I’m amused at the intersection of ViVE’s commercial ambitions versus its attempt to come off as breezy and unorthodox, such as its lengthy “brand guide” that includes a section on making “key messaging” resemble casually created graffiti, murals, or doodles. That is some excellent curating.

I get a lot of feedback from teachers whose classes have benefitted from the Donors Choose donations of HIStalk readers, including Ms. S in California, who provided this update after receiving hands-on STEM tools:

My amazing scholars not only use, but enthusiastically ask for, “Fun Friday” every single week in order to explore the STEM materials YOU helped provide for them! They are building worlds using their imagination, and solving problems as they arise while using the engineering design process. They utilize critical thinking skills, and collaborative skills to learn science through creative fun spaces. Never were so many rowdy 5th graders ready to get their hands moving and brains working so late on a Friday afternoon. They always see these items on TikTok and never have gotten the chance to explore it for themselves. Thank you for giving them that that joyful opportunity!

Today I learned about the Dunning-Kruger Effect, which describes the “unconscious incompetence” in which people who lack knowledge or skill also lack the intelligence to realize just how incompetent they are.

Welcome to new HIStalk Platinum Sponsor Five9. The San Ramon, CA-based company is an industry-leading provider of cloud contact center solutions, bringing the power of cloud innovation to more than 2,500 customers worldwide and facilitating billions of customer engagements annually. Five9 provides end-to-end solutions with digital engagement, analytics, workforce optimization, and AI to increase agent productivity and deliver tangible business results. The Five9 platform is reliable, secure, compliant, and scalable. Designed to help customers reimagine their customer experience, the Five9 platform connects the contact center to the business while delivering exceptional customer experiences that build loyalty and trust. Thanks to Five9 for supporting HIStalk.

Here’s an intro video on Five9’s The Intelligent Cloud Contact Center and Workflow Automation.

Webinars

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

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

Acquisitions, Funding, Business, and Stock

Veradigm, formerly Allscripts, delays its Q4 and annual results reports because a software problem caused it to overstate earnings going back to Q3 2021. Veradigm has also lowered its annual  revenue expectations by 2% and adjusted earnings per share by 10%. MDRX shares dropped nearly 13% on the news. They have lost 27% in the past 12 months versus the Nasdaq’s 15% loss, valuing the company at $1.6 billion.

Health Catalyst reports Q4 results: revenue up 7%, adjusted EPS –$0.05 versus –$0.19, beating estimates for both. HCAT shares have lost 46% in the past 12 months versus the Nasdaq’s 16% loss, valuing the company at $780 million.

Walmart will open 28 new Walmart Health locations in 2024, increasing its count to 75 as it expands into Missouri and Arizona. The 5,750-square foot centers, housed in Walmart Supercenters, offer primary care, dental care, behavioral health, labs, X-ray, audiology, and telehealth.

Health insurer Bright Health – fresh off layoffs, the exiting of most lines of business, an impending delisting of shares on the NYSE, and a $1.4 billion loss in 2022 – warns that it has overdrawn its credit and expresses doubt that the company can continue as a going concern. Its valuation is down 97% since its IPO peak of $11 billion in June 2021. Bright Health paid its CEO $181 million in 2022.

UnityPoint Health and Presbyterian Healthcare Services announce their intention to create a parent company for their health systems, which will operate as a 40-hospital, 40,000-employee organization while retaining their existing brands.

Sales

• Genomics England deploys enterprise imaging from Sectra.
• University of Kansas Health System will implement AI-powered medical documentation from Abridge, which was created at the Pittsburgh Health Data Alliance that includes Abridge investor UPMC. 
• Compass Health Network chooses NextGen Behavioral Health Suite.
• Deaconess Health System will implement Health Catalyst’s enterprise analytics and outcomes improvement.
• Bryan Health selects Health Catalyst for population health analytics and value-based care performance improvement.

People

Holly Urban, MD, MBA (Oracle Cerner) joins CliniComp as VP of clinical product design.

Adam Terzich (Redox) joins MediQuant as RVP of sales.

Announcements and Implementations

Wolters Kluwer Health launches Coder Workbench, a high-productivity risk adjustment solution based on the Health Language Data Platform.

A small consumer survey commissioned by KeyCare finds that two-thirds of respondents who needed minor but urgent medical services during out-of-state travels chose telehealth visits with their regular clinicians over urgent care and telehealth visits with non-affiliated providers.

Epic will incorporate patient experience functionality from Press Ganey, initially into MyChart and Cheers, and eventually into other modules. Former Cedars-Sinai SVP/CIO Darren Dworkin joined Press Ganey as president and COO in August 2022 .

HealthBook+ launches to offer a care and guidance platform for healthcare workers that aggregates patient data to offer next best health steps.

Louisiana Children’s Medical Center goes live with Sapphire Health’s AWS-based Epic Cloud Read-Only ransomware recovery tool. Sapphire Health’s founder and CEO is Austin Park, who served two stints as interim CTO at LCMC.

Virtual care technology company Biofourmis and Chugai Pharmaceutical Co. will develop digital solutions for objective assessment and management of endometriosis pain, pairing the Biofourmis Biovitals platform with data that has been collected in studies involving Chugai’s investigational drug product for endometriosis pain.

The Australian Digital Health Agency launches My Health, which provides mobile access to My Health Record’s medical history, lab results, vaccination management, allergy tracking, hospital discharge summaries, and prescription information.

Privacy and Security

The government of Ireland fines provider Centric Health $490,000 for GDPR violations following a 2019 ransomware attack. The personal health information of 2,500 patients was permanently deleted from Centric’s Primacare systems, which is was in the process of replacing. Centric paid an unspecified ransom, but was too late to prevent the data loss.

The Federal Trade Commission warns Amazon that it will be monitoring its use of patient data following its acquisition of primary care provider One Medical, noting that it will judge pre-acquisition privacy promises by the standard of a “reasonable consumer” rather than that of a HIPAA expert.

Other

Osama Alswailem, MBBS, MA, an informaticist who is CIO at King Faisal Specialist Hospital & Research Centre in Saudi Arabia, lists technologies that are driving healthcare in the Middle East: virtual health, AI, wearables, blockchain, 3D printing, and personalized medicine. He says the CIOs have been redefined to chief digital officer as healthcare organizations rely more on data-driven decision-making. His hospital is using AI to improve resource management via a unified command center, working with 3D-printed prosthetics, and using virtual reality for staff training and patient education.

A New York Times opinion piece asks the question, “Why are ketamine ads following me around the internet?” as telehealth startups are taking advantage of pandemic-relaxed rules to aggressively tout the drug for questionable uses, underplaying the abuse potential and potentially dangerous side effects (permanent bladder damage, anyone?) The author brings up an interesting point: the US is one of two countries that allow drug companies to pitch their wares directly to consumers – increasingly, via social media – but even those companies, unlike telehealth companies, are required to stick to FDA-approved uses. Unmentioned in the article is a review of why telehealth-paid doctors are willing and able to ignore science to give customers whatever they want.

An orthopedic surgeon whose planned surgery was denied by the patient’s insurer finds that the company’s peer reviewer is a surgeon who was permanently banned from the OR by the state medical board. The surgeon dug up what he believes is an X-ray from the case that triggered the board’s action against the peer reviewer, in which an artificial hip was implanted backward. Stunned Twitter doctor commenters question whether the surgeon was impaired or incompetent, noting that (a) he also performed two follow-up corrective surgeries without fixing the problem, which was finally caught when the patient was seen by a new surgeon; and (b) horrifically botched surgery or not, the doctor kept his medical license and can practice however he likes outside the OR.

Sponsor Updates

• EClinicalWorks achieves Google’s Chrome Enterprise Recommended designation.
• Experity recognizes three urgent care leaders with Limelight Awards at its Urgent Care Connect Conference in Miami.
• Vyne Medical publishes a new case study, “How to Save Time and Increase Profitability with Auto-Indexing.”
• CloudWave’s OpSus Live cloud hosting for healthcare infrastructure as a service achieves a ‘Best Practice’ rating after completing the Meditech Infrastructure and Supporting IT Process audit.
• The Health Plan Innovation Roundtable honors Enlace Health with the Fall 2022 Innovator Traction Award.
• Nordic publishes a podcast titled “Making Rounds: The Big Squeeze in Healthcare.”
• Fortified Health Security names Dylan Storm (Optiv) renewals specialist, Benjie Graham (Corpay) client success manager, and Jason McKellips (Allied Universal) regional director.
• Get Well honors Product Manager Andrew Todtenkopf with its Heart Award for his extraordinary contribution to company performance and culture.
• Kyruus publishes a new guide, “Successful Online Scheduling in 5 Steps.”

Blot Posts

• Where Does the Fax Machine Fit in 2023? (Vyne Medical)
• Enabling Value with Interoperability & Analytics Using the !Clearsense Platform (Clearsense)
• Equity, Environment, Resiliency, and Risk: Future Considerations for Healthcare Value Analysis (GHX)
• 5 Reasons You Could Benefit from Out-of-Pocket’s Healthcare 101 Course (Healthjump)
• NeuroFlow Helps Organizations Address the Youth Mental Health Crisis with Innovative Solutions for Adolescent and Pediatric Populations (NeuroFlow)
• EHR Advancements for 2023 and Beyond (HealthTech Resources)
• Combatting Burnout and Fatigue in Healthcare (Optimum Healthcare IT)
• The push for patient-friendly terminology (Intelligent Medical Objects)
• Advancing Interoperability in the Age of TEFCA: An Interview with CommonWell’s Executive Director, Paul Wilder: Part 1 (Medhost)
• Confronting maternal mortality with Phoebe Putney Memorial Hospital (Meditech)
• The future of ambulatory care documentation, part 1: It’s time to challenge the status quo (Nuance)

Contacts

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

EPtalk by Dr. Jayne 3/2/23

The hot topic around the virtual water cooler this week was the National Labor Relations Board (NLRB) decision this week that employers can no longer use two specific strategies to silence laid-off employees. Employers are not permitted to include overly-broad confidentiality clauses as terms of a severance agreement. Additionally, they are not permitted to include broadly written non-disparagement clauses that prohibit discussion of previous employment with third parties.

The case involved hospital employees in Michigan who were furloughed when non-essential services were halted during the early days of the COVID-19 pandemic. The decision applies to all US employers with the exception of railroads and airlines. There’s always the chance of an appeal, but for now, the decision is in force. It’s 23 pages of dense reading if you are looking for a sleep aid at the end of a long day.

I’ve mentioned that I’m on the teaching staff for a leadership seminar for one of my volunteer organizations. The participants will be spending five days with us and we’ll be covering a variety of topics around project planning, team development, managing diverse people, and effective communication. I’ve been prepping for some of my sessions and have three presentations on communication, so I was excited to see the Grammarly State of Business Communication report hit my inbox. It was conducted by Harris Poll on behalf of Grammarly Business and surveyed 1,000 knowledge workers and 250 business leaders. The respondents were full-time workers at corporations with 150 employees or more and were across a mix of industries and job functions. Business leaders were at the director level or higher with decision-making authority over strategy, development, customer experience, budgeting, or hiring.

Findings that caught my attention:

• The time spent on written communication is up 18% from 2022, but the quality of written communication is waning. This aggregate of 21.4 hours per worker includes writing and responding to written communications, creating materials to be shared, reviewing and editing the work of others, revising materials, and other writing tasks.
• Effectiveness of written communication has declined 10% over the past year.
• Miscommunication is frequent, with 100% of respondents reporting miscommunication at least once per week, 66% reporting it once per day, and 48% reporting multiple instances per day. Miscommunication costs US businesses $12,506 per employee per year and comes with decreased productivity and increased worker-reported stress.
• One in five business leaders feel that inadequate communication has eroded brand reputation, with 19% reporting lost deals due to poor communication. Conversely, one in three leaders feel that effective communication has helped them gain new business.
• Confident writers are more likely feel confident in their work and engaged in their roles than non-confident writers. They also report higher mental well-being at work.
• Increases in asynchronous work creates greater urgency for projects aimed at improving the quality of written communication.
• More than one in five workers report that they have considered finding a new job due to poor communication.

There’s such a great push for many industries to bring workers back to the office that I think people sometimes lose sight of the benefits of asynchronous work. The majority of respondents felt asynchronous communication made their jobs more flexible. Additionally, a good percentage of workers in key demographics felt asynchronous work made them feel more included: 40% each for millennial and Latinx workers, and 39% for neurodivergent workers.

I was particularly interested in learning the details of people’s specific struggles with written communication. The majority of respondents (71%) struggle to choose words that don’t offend others and with finding the balance between formal and casual written speech. Additionally, 63% say they spend too much time trying to convey their message in the right way. There are additional challenges for workers with English as their second or less familiar language, who report higher levels of uncertainty than their primarily English-using colleagues on things like tone, word selection, communication length, jargon, and idioms.

The long and short of it is that communication is key, and I’m looking forward to being part of a leadership development experience that puts some useful skills and well-accepted methodologies in front of people who might not otherwise receive formal communication training. As a side bonus, this is an outdoor leadership program so I get to do all of my teaching in front of a picnic table rather than in front of a Zoom screen. There will also be some sleeping in a tent, which is fine by me, although I’m crossing my fingers for beautiful spring weather rather than the rain and hail I’ve had teaching previous outdoor leadership courses.

From Bianca Biller: “Re: March is Colorectal Cancer Awareness Month. Look what greeted me on a practice visit. Hopefully the patients will identify with it and get their tests scheduled. The practice had a whole ‘Patient Communication’ wall with at least 10 signs taped to it.” Bianca included a picture of that wall that I can’t run due to the practice letterhead being all over the documents. Some of them are laminated, and based on the photo, they range from knee height (diabetes) to about seven feet from the ground (Affordable Care Act and preventive visits). The fonts were pretty small and I can’t imagine anyone being able to actually read it all. Hopefully they are using other methods to communicate with patients such as their website, patient portal, email outreach, and chatbot campaigns.

The practice also uses a super fancy inventory management system for the exam rooms, placing the burden of managing inventory on the people who are in direct contact with patients and using the supplies in the rooms. I guess the days of having the staff clean and restock rooms at the end of each day have passed. I understand the “just in time” approach here, but I guess the idea of working at the top of your license might not be top of mind in this practice. Compared to regular checks by support staff, this also increases the risk that you could run out of something if you inadvertently let supplies get lower than the time it takes for someone to notice that the magnets have moved and to find the time to get an item and restock it.

At my last clinical location, there was a designated support staff member that started going through the office with a supply cart in the final hour before closing. Despite seeing up to 20 patients in each exam room each day, we never ran out of anything, we always had what we needed for patient care, and delays were nonexistent. It’s a brave new world, I guess.

As I get ready to head to the American Telemedicine Association’s 2023 Annual Conference & Expo in San Antonio for the first time, I have to reflect on the fact that it is the spammiest conference I’ve ever attended. There are only 220 exhibitors on the list and it feels like I’m getting emails from all of them. Some have a tone of increasing urgency, asking if I missed their previous email and pushing for a response. I understand the sales strategy here, but it’s annoying and actually makes me less likely to consider you as a vendor when you do this. I also loathe emails that address me as “Hey Jayne.” An email isn’t a formal letter and personally I don’t think it needs a salutation. I’d rather receive one with no salutation than one with the “Hey” at the top.

What’s your greatest pet peeve when it comes to email? Leave a comment or email me.

Email Dr. Jayne.