HHS proposes information-blocking penalties for providers that include loss of Meaningful User status and an inability to participate in ACOs, all of which would result in some impact to a healthcare organization’s bottom line.
Among telehealth physicians, there’s a lot of chatter about an upcoming change in Centers for Medicare and Medicaid Services (CMS) policy that would require physicians and other healthcare providers to report their home addresses when conducting virtual visits from home.
This hasn’t been an issue during the last couple of years because CMS had issued a waiver for the requirement due to the pandemic. However, the agency has indicated that the waiver will end on December 31. Many organizations, including the American Hospital Association, the American Telemedicine Association, and the Alliance for Connected Care have come out in support of healthcare workers, citing privacy and security concerns as well as the rise in violence against healthcare workers.
As someone who has been stalked by a patient, it’s scary to think about patients being able to easily find your home address. Much of the information providers give to CMS (in the form of applications and enrollment documents) winds up on publicly available websites. A simple browser search can provide a surprising amount of information on physicians who haven’t taken steps to protect themselves. Although this is getting a lot of attention right now, it just scratches the surface at highlighting how the patchwork of laws in the US isn’t conducive to helping physicians deliver high-quality care when they want to be 100% virtual.
Problems with governmental agencies are highlighted when physicians apply to deliver telehealth care through national platforms. For example, the major players in the industry require physicians to have a current and unrestricted Drug Enforcement Agency (DEA) number. They use this as a way of screening out “problem” physicians who might have lost their controlled substance prescribing privileges. The companies in question don’t even allow their physicians to prescribe controlled substances and most of the ones that I’ve worked for actively prohibit any controlled substance activity.
Then, there are various states that have their own controlled substance agencies, which typically require the use of an address where controlled substance activities are taking place. This adds to the confusion for those of us who are practicing telehealth but not ever prescribing controlled substances, yet have to attest to the DEA and these state agencies that we have a physical location where they can theoretically come inspect our records.
In my situation, I “see” patients on a handful of telehealth platforms, all of which keep my records electronically. The evidence that I do not indeed prescribe controlled substances is housed on a variety of servers and I have no authority to grant access to any of them. It’s been a decade since I had a prescription pad in my hand. Yet, on the advice of counsel, I keep a locked file cabinet in my basement that houses my controlled substance records. It contains copies of my DEA certificates, state controlled substance authority certificates, various applications and renewal forms, and nothing else.
It’s pretty ridiculous that they expect you to have locked files, since many of us haven’t seen a paper chart for decades. If you ask my state what I should do, they tell me I should surrender my state controlled substance certificate because I’m not prescribing controlled substances. If I do that, I have to surrender my DEA certificate. And if I do that, I can’t work. Every time I have to renew one of these and attest that I’m following the rules, it makes me cringe.
There’s plenty of shared culpability here, from the agencies that haven’t kept their regulations current with how care is being delivered at present to the telehealth organizations that require certifications that don’t make sense for the work they’re hiring us to do. I understand using a variety of strategies to help root out bad apples, but I also take issue with physicians being asked to skirt the truth in order to earn a living.
Not to mention, the cost of maintaining DEA and state controlled substances certificates is not insignificant. There’s also now a continued medical education burden for maintenance of the DEA certificate. Although fortunately there are plenty of free courses out there that will fulfill the requirement, it’s grating to have to spend a minimum of eight hours on coursework that isn’t relevant to a physician’s current practice situation.
It’s also grating to know that some of the big telehealth players are doing some things that could best be described as “sketchy.” One well-known platform where a colleague recently applied to work wanted him to begin a payer enrollment and credentialing process without providing any kind of contractual agreement. I gave him a heads up that their standard non-compete agreement would likely contain a clause that would be a problem with his other employment obligations, but when he asked about it, they went radio silent.
Speaking of credentialing, that’s another problematic element for physicians who want to be 100% virtual since we’re often asked to provide information that’s not relevant (DEA number, anyone?) along with current malpractice insurance policies even if they’re not relevant to the organization where we’re trying to get credentialed.
Although a lot of telehealth physicians have day jobs and are just picking up extra telehealth hours for extra cash, some do it full time. Even though they may have a large organization backing them as far as having a non-home work address they can use, and where they can keep their DEA and state controlled substance numbers registered, in many circumstances they’re still having to fudge the attestations when they sign their renewal forms for those certifications simply because they’re NOT prescribing controlled substances. Now, many of us have to revisit whether we’re going to opt out of Medicare or whether we want to take the risk of having our home addresses made public. Opting out of Medicare brings its own problems, and further narrows the options for positions where we can use our skills.
The DEA and state controlled substance certificate issues don’t impact the majority of physicians who deliver telehealth services, because the vast majority of them have a physical practice location where they might be prescribing controlled substances and the issue becomes moot. However, the Medicare address issue affects many more physicians, including those working for large health systems who might be at home when they engage with their patients via telehealth. I’m hopeful it will get more attention. If we can get this issue resolved, maybe we can get some of the other issues resolved, although I’m not hopeful because it’s way too easy for organizations to simply use a DEA number as a proxy for past good behavior.
What do you think about making physician and healthcare provider addresses publicly available? Leave a comment or email me.
TT Capital Partners acquires a majority share of Cantata Health Solutions, which offers health technology for providers of behavioral health, human services, acute care, and post-acute care.
TT Capital Partners acquires a majority share of Cantata Health Solutions, which offers health technology for providers of behavioral health, human services, acute care, and post-acute care.
Healthcare Growth Partners advised Cantata in the transaction, which is its sixth deal in five months.
Cantata was formerly Keane, then a division of NTT Data.
Reader Comments
From Breathe In and Hold: “Re: Epic. I’m a Epic-experienced physician and would love to get involved in a new customer’s build instead of fixing someone else’s setup. Wondering if you know about any possible Epic signings coming up?” I responded privately with a rumored deal that would be huge while also noting that Epic’s momentum outside the US is growing, but otherwise I’ll ask readers.
From Go Noles: “Re: Tallahassee Memorial Healthcare. Replacing Cerner with Epic, it seems.” Unverified, but they just posted several Epic-related jobs and some are for inpatient.
From Very Peeved: “Re: use of the word ‘very.’ Annoying to me. To you, too?” It is, and is among the words that I excise most often from interviews and reader-submitted articles where everything is “very good” or “really efficient.”
From HIT Sleuth: “Re: [company name omitted.’’] Rumored to be making [industry CEO’s name omitted] to improve the company’s scale and stability.” Unverified, so I felt ethically bound to render this comment nearly useless by anonymizing it. The company is (or once was) valued at billions, while everybody knows the CEO.
HIStalk Announcements and Requests
Health IT folks don’t believe their wares have done much to influence quality, clinician satisfaction, cost, or equality, but instead of made it easier for consumers to engage with our high-cost, low-quality health systems.
New poll to your right or here: Which social media tools are you using more frequently now than two years ago for job-related tasks? I probably lurk more on LinkedIn than before, I have found YouTube to be surprisingly useful although mostly for non-work purposes and mindless entertainment, and Twitter/X to be less important than before.
It feels heretical to say out loud, but I’m contemplating skipping my first HIMSS conference (or is it the Informa conference?) in many years, disrupting my spring migratory pattern. I had already tapered off my HIMSS conference dosage by shortening my stay and my onsite wandering range, with that and my nagging dread leading me to question the value. I’m open to arguments either way. I’m pretty sure that if I break the habit by skipping Orlando, then I’m certainly unlikely to go to Las Vegas the next two years since I don’t like visiting there.
Welcome to new HIStalk Platinum Sponsor Revuud. The Charlotte, NC-based company – its name is pronounced as “reviewed” — is a leading healthcare IT staffing marketplace that helps healthcare organizations connect with top talent. Its mission is to revolutionize the way healthcare organizations hire IT talent by providing a faster, more efficient, and cost-effective solution. Streamline your hiring process by leveraging Revuud to find, hire, onboard, manage, and pay your IT contractors, all in a single platform at a fraction of the cost. Thanks to Revuud for supporting HIStalk.
I’m always happy to find a new sponsor’s explainer video, so here’s the one from Revuud.
Webinars
None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.
Acquisitions, Funding, Business, and Stock
Spok reports Q3 results: revenue up 5%, EPS $0.22 versus $0.15. SPOK shares are up 78% in the past 12 months versus the Nasdaq’s 17% rise, valuing the company at $302 million.
The $1.5 billion acquisition of England-based healthcare software vendor Emis Group by UnitedHealth Group’s Optum Health Systems UK closes.
Sales
VHC Health chooses Vyne Medical’s Refyne Cloud Fax and Trace platforms to automate management of electronic records and images.
NYC Health + Hospitals and Montefiore choose Findhelp to connect community members with social care services.
Announcements and Implementations
A new KLAS report on financial improvement consulting finds that the most common engagement is for financial performance improvement, while the most common outcome is improved efficiency. Impact Advisors, which was 2023 Best in KLAS for financial performance consulting, topped the performance score list, while already high satisfaction with Guidehouse jumped dramatically since 2020.
Sponsor Updates
Pivot Point Consulting sponsors the annual UVA Community Health Friends of the Foundation Golf Classic.
NeuroFlow releases a new Bridging the Gap Podcast, “Making the Financial Case for Digital Health Innovation.”
Nordic releases a new Making Rounds Podcast, “Lab information, at your service.”
Optimum Healthcare IT publishes a new case study, “Sentara: Strategic Portfolio Management with ServiceNow.”
Spok publishes “The 2023 State of Healthcare Communications Report.”
Waystar will exhibit at the HFMA Region 9 Annual Conference in New Orleans October 29-31.
West Monroe will co-sponsor the HIMSS Washington Chapter’s Unleash the Future of Healthcare with Microsoft Technologies event November 2 in Redmond, WA.
Cybersecurity experts recommend that users of NextGen Healthcare’s Mirth Connect interface engine upgrade to the latest version after discovering an unauthenticated remote code execution vulnerability.
Advocate Aurora Health will pay $12 million to settle a lawsuit over its use of user tracking tools from Meta and Google on its website and MyChart patient portal.
Abridge, whose software converts patient-clinician conversations into clinical documentation, raises $30 million in a Series B funding round.
HIStalk Announcements and Requests
Jump on Lorre’s year-end, cherry-on-top deal and you’ll be among several smart new HIStalk sponsors who snagged the rest of 2023 free, shifted the expense to 2024 if they wanted, and will be outshining the competition as HIMSS approaches. In an industry that is rebounding, marketing prowess earns visibility and opportunity. HIStalk’s sponsor roster is second to none in digital health. I admit that my website is primitive and thrice-weekly industry news posts are so necessarily long at times that they send short attention-spanners to flee for time-wasting TikTok videos, but a lot of decision-makers get their news here and 94% of them say that doing so helps them do their job better.
Webinars
None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.
Acquisitions, Funding, Business, and Stock
Sage, which offers technology for caring for older adults, raises $15 million in Series A funding. Its care coordination platform for senior living residents, which allows users to report urgent issues and to communicate with their care team. The company says use of its system reduces resident and family complaints by up to 90%.
Sales
Colorado’s public health department chooses Findhelp to create a Drug User Health Hub to reduce the transmission and consequences of viral hepatitis.
Midwest Surgical Hospital selects the Simplifi 797 and Pharmacy Compliance suites of Wolters Kluwer Health to support sterile compounding.
University Health Network, UVA Health, and Boston Children’s Hospital will implement Fujifilm’s Synapse digital pathology technology.
People
HCTec hires Peter Reynolds (Jeomise) as VP of strategic sales.
Niki Hall (Contentsquare) rejoins Five9 as chief marketing officer.
The Permanente Federation promotes Brian Hoberman, MD, MBA to EVP/CIO and national IT leader. He also services as CIO of The Permanente Medical Group and led Kaiser Permanente’s implementation of Epic in the early 2000s.
Announcements and Implementations
Data scientists at Bardavon provide a rare under-the-hood look at the predictive models they developed for optimizing care for physical and occupational therapy patients. Therapy providers, claims examiners, and case managers use the results to manage workers’ compensation cases.
AI-enabled workforce solutions vendor SnapNurse renames itself to SnapCare. The company offers healthcare organizations a less-expensive alternative to traveling and agency clinicians for managing float pools, PRN staffing, and permanent placement recruiting.
Advisory Board warns of “pharmacy deserts” as drug chains close hundreds of unprofitable stores in low-income areas.
A survey of healthcare finance professionals by AGS Health and HFMA finds that those who use or plan to use autonomous coding trust trust it, but 52% don’t know what it is.
Privacy and Security
Advocate Aurora Health will pay $12 million to settle a lawsuit over its use of user tracking tools from Meta and Google on its website and MyChart patient portal,
Other
Baystate Health implements a cashless policy that even covers its retail pharmacies and cafeterias, saying that card-only payment streamlines the payment process and reduces the risk of theft. The hospital says its policy is consistent with Massachusetts law that prohibits retailers from discriminating against a cash buyer. It’s interesting that some business offer customers a discount for paying in cash to avoid card processing fees, while others implement card-only policies.
Not healthcare specific, but pretty funny, is this “Last Week Tonight” skit about McKinsey. I haven’t watched broadcast TV in many years, so I don’t know anything about the show.
Sponsor Updates
EClinicalWorks announces that Integrated Medical Health (PA) has grown its multi-specialty practice using its EHR and Healow patient engagement solutions.
Health Data Movers releases a new episode of its Quick HITs Podcast featuring Ganesh Persad.
Nordic publishes new Healthcare Chronicles video titled “Maximizing your investment in the EHR | Aligning the EHR to enterprise strategy.”
Lumeon announces that its Lumeon Conductor care orchestration platform has earned HITRUST certification.
From Jimmy the Greek: “Re: clickbait healthcare headlines, try this one: ‘Designing Playful Experiences with Imaging Capsules.’” Jimmy kindly shared a link to Exertion Games Lab, and I found the section header of Ingestible Games just as compelling. Capsule endoscopy was first approved by the US Food and Drug Administration in 2001, but its use is limited. The website notes, “We believe that the capsule’s experiential perspective is often overlooked, i.e. we argue that there is also potential for ‘fun.’” The company created a wearable system named InsideOut where users can see a real-time video of their digestive tract as the camera capsule travels through and can interact with a couple of different games that harness the images. There are links to scholarly articles if you’re interested, as well as a video of the concept in action.
Halloween is almost here, and IMO has shared 13 ICD-10 codes appropriate for the occasion. The codes address injuries related to sewing, pumpkin carving, and handcrafts, as well as open bites of the neck which might occur in vampire-rich areas. My favorite is R46.1 Bizarre Personal Appearance, which I hope to see a fair amount of when I’m handing out candy next week. For your further entertainment, they did a winter holiday code update last year.
The CHIME fall forum is coming up, and Genzeon gets my thumbs-down award for silly giveaways. This Arizona-shaped luggage tag was mailed to attendees and is just one more piece of conference swag for many attendees to add to their trash cans. Colorado State University had a blog piece about this earlier in the year, noting that the annual spend on promotional products in the US is in the neighborhood of $20 billion, with estimates that 40% of it ends up in landfills.
I personally prefer when conferences let you pick and choose the promotional items you want rather than handing you a pre-filled swag bag. At last year’s CHIME event, light-up cowboy hats were a popular take-home item. I wonder how many of them are still in use. I won’t be at CHIME this year, so if you are going, feel free to send me your swag report.
Everyone is talking about burnout, but an article I read this week introduced me to the concept of “rusting out.” It’s described as being on the other side of the spectrum from burnout, and is defined as what happens when an employee’s talents are underused. It can lead to disengagement and lowered productivity. I’ve seen this phenomenon first hand. A good manager will be on the lookout for it and discuss ways to better use the skills of workers.
Although the article mentions recommending workers for retraining programs, in some situations, it could be much easier. This might involve removing repetitive lower-level tasks and adding more complex projects that encourage critical thinking or problem solving. This is tricky to do as a manager, especially if you don’t have resources towards which you can shift those repetitive tasks. Depending on the culture of your organization, it can be difficult to make the case for realigning resources, but executives who ignore these kinds of requests do so at their own peril.
A friend sent me a link to a digital tool called Wellspring, which is designed to help clinicians individualize treatment plans for menopausal patients and uses guidelines from the UK’s National Institute for Health and Care Excellence. There have been many shifts in recommendations for treatment of menopausal symptoms over the years. It is challenging for physicians to make time to address them when they’re pressured to deliver quick visits that satisfy all the check-the-box metrics in front of them. It will be interesting to see if there is any movement on this type of tool in the US and whether frazzled physicians would be willing to adopt it.
I’ve written in the past about some of my experiences with my local health system. I had another one this week that makes me wish I could do some consulting work for them.
I’m registered with their high-risk breast cancer program, which means I have imaging studies performed twice as often as people of normal risk. The program handles pre-approvals with the insurance company since most companies won’t pay for additional screening without appropriate supporting documentation. Additionally, the imaging appointments are scheduled in conjunction with clinical appointments, so that the studies are read and results are given to me before I leave the building.
I received a letter from the hospital this week telling me that it was time to schedule my mammogram and I should call for an appointment or visit the mammogram van, along with a schedule of its locations. Since my next imaging is always scheduled before I leave the office, this made me worry that either my appointment had been canceled or something else had happened to it. As a patient, this causes anxiety as well as time spent calling the hospital to confirm or logging into the patient portal to confirm whether there is an appointment or not.
In addition to the inconvenience factor, there’s also the clinical appropriateness factor. Someone who is part of this particular high-risk program shouldn’t be doing a walk-in at the mammogram van. The letter had my medical record number on it, so it’s not like it was a generic letter. Given the capabilities of the health system’s EHR, there’s no reason that they should be sending out letters like this. It’s entirely possible to construct the outreach campaign by filtering out those patients who are already scheduled for imaging so that we don’t send patients on a wild goose chase looking for their appointments.
It’s wasteful to send out scheduling letters for patients who already have appointments on the books. If you insist on sending something, send a reminder letter with the date of the upcoming appointment. Additionally, patients who are flagged as being part of the high-risk program should likely receive a different letter, even if they are overdue for their imaging and don’t have anything scheduled. The program prefers that these patients call the coordinator to set up the appointments since they get linked with clinical appointments, rather than just showing up at a facility.
I talked to a colleague about the situation, looking for suggestions on how to advocate on behalf of patients. She promptly one-upped me by sharing her experiences with a health system that continued to reach out about her mother’s appointments more than a year after they were made aware of her passing. These are just things that shouldn’t happen given the technology we all have in place.
Is your organization maximizing its use of EHR reporting and recall campaigns, or is it traumatizing patients? Leave a comment or email me.
Washington University in St. Louis launches the AI for Health Institute, which will involve a collaboration of its engineering and medical schools.
NPR Shots covers doctors using AI for diagnosis, including a Mass General infectious disease doctor who is using the AI-enhanced version of Wolters Kluwer’s UpToDate — NPR calls it “Google for doctors” — that can conduct a conversation rather than simply looking up keywords in medical references. Other AI uses mentioned are interpreting diagnostic images, summarizing a patient’s medical history in preparation for their appointment, and allowing AI-assisted primary care physicians instead of specialists to care for some patients.
Business
Amazon begins rollout of AI-powered warehouse robots that it predicts will speed up order fulfillment by 25%. The system’s robotic arms and computer vision identify the correct item and send it to workers, which speeds throughput and places items at waist level to reduce worker injuries.
Research
A Stanford medical school study warns that AI chatbots may worsen health disparities for black patients by perpetuating race-based medical ideas that are known to be inaccurate. When asked to describe differences in skin thickness, lung capacity, and kidney function for a black man, the chatbots provided erroneous information instead of accurately stating that no differences exist. Some experts question the usefulness of the study’s conclusions since doctors shouldn’t be using chatbots to make medical decisions.
Researchers create software that uses AI to enhance CT images to produce MRI-quality information, which they say could be used to improve diagnosis in primary care.
Other
A Nature article predicts a rise in “generalist medical AI,” in which models that are trained on large data sets can mimic the broad analysis of a physician instead of performing a single function. It notes these challenges to AI in healthcare:
AI can’t be trusted to make unreviewed decisions.
Early medical imaging AI tools were trained on available imaging data that allowed them to perform tasks for which doctors don’t need help, such as detecting pneumonia.
Individual tools don’t reflect the cognitive work of radiologists, and the plethora of one-trick AI tools could result in “an IT soup.”
ChatGPT-like “Foundation models” that are trained on broad data sets of images, text, and other information can offer more capabilities than supervised learning, in which experts might analyze chest x-rays and label them as “pneumonia” or “not pneumonia” to train the system.
Few institutions recognize that diagnostic AI models have usually been validated against the same data set that they were trained on, which in the absence of external validation makes it impossible to see if they are actually beneficial.
I hadn’t tried Google’s Bard lately, but enhancements that were release a few weeks ago give it some advantages over ChatGPT:
It can access up-to-date information, such as news headlines and stock market information.
It integrates with Gmail, Docs, and Drive to find or summarize content.
Extensions are supported for Google-owned content, such as Maps and YouTube, and can be invoked specifically by using a keyword such as as @YouTube.
Bard’s initial responses can be double-checked via a Google search by clicking a button.
It can include images in its responses.
I also experimented with Pi, which terms itself as a “personal AI assistant” that emphasizes friendly, personal, and supportive responses. It serves as a polite sounding board, more of an AI companion than a brute force data retrieval engine, and it can conduct natural-sounding conversations. Developer Inflection AI recently raised $1.3 billion at a $4 billion valuation.
I’m also experimenting with Summarize.tech, which summarizes a YouTube video given its link. I gave the link for a recent VA EHR hearing and it did a pretty good job, complete with links to jump to individual video sections.
Digital consulting firm Perficient acquires San Diego-based healthcare software development company Smedix.
Webinars
October 25 (Wednesday) 2 ET. “Q&A: What’s new with the NSA? A No Surprises Act update.” Sponsor: Waystar. Presenters: Joseph Mercer, JD, managing director, Marwood Group; Heather Kawamoto, VP of product strategy, Waystar. The No Surprises Act created a lot of change, and those changes are still coming. A panel of revenue cycle experts answer frequently asked questions and offer a concise update on the NSA, including legislative developments, FAQs, and tips for navigating changes.
October 25 (Wednesday) 2 ET. “AMA: The Power of Data Completeness.” Sponsor: Particle Health. Presenters: Jason Prestinario, MSME, CEO, Particle Health; Carolyn Ward, MD, director of clinical strategy, Particle Health. Is your healthcare organization looking to drive profitability and scale quickly? Our experts will explore how comprehensive clinical data can revolutionize the health tech landscape. This engaging discussion will cover trending topics such as leveraging AI and data innovation to enhance patient care and outcomes, real-world examples of organizations leading the charge in data-driven healthcare, overcoming challenges in data completeness and interoperability, and visionary perspectives on the future of care delivery.
Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.
Acquisitions, Funding, Business, and Stock
PicnicHealth, which uses patient-reported data to build datasets for research, acquires rare disease data aggregator and research firm AllStripes.
Akumin, a national outpatient radiology and oncology care services provider, announces a financial restructuring plan that includes filing for Chapter 11 bankruptcy protection and reverting to a privately-held company. Akumin experienced a ransomware attack in late September that is still impacting its ability to see patients at numerous locations.
HealthStream announces Q3 results: revenue up 5%, EPS $0.13 versus $0.12, beating earnings expectations but falling short on revenue.
Sales
Delaware’s Division of Substance Abuse and Mental Health will work with Bamboo Health to develop and implement behavioral healthcare coordination software.
East Suffolk and North Essex NHS Foundation Trust in England will implement Epic.
People
Eskenazi Health promotes Randall Grout, MD to chief health informatics officer.
Karen Mellin (DrFirst) joins CTS Connected Technology Solutions as VP of sales and business development.
Announcements and Implementations
Northern Health in Melbourne, Australia, goes live on Agfa HealthCare’s enterprise imaging through its new Northern Imaging Victoria service.
Netsmart develops an AI Data Lab that is built on Amazon Web Services, which will allow the company to develop new technologies for its CareFabric platform. Missouri Behavioral Health Council will contribute predictive analytics for population health and provision of care functions.
Privacy and Security
MultiCare recovers from a service outage that caused it to suspend surgeries and procedures at several facilities within its system. The Washington-based provider has attributed the outage, which affected multiple systems including its EHR, to an interruption in service from one of its vendors.
In Canada, the IT systems of five hospitals that formed their own IT provider organization go offline due to a cyberattack.
Other
Increased enrollment in Medicare Advantage plans has hurt critical access hospitals, which are paid lower, negotiated rates than those of traditional Medicare. Hospital executives say insurers are “slow pay or no pay” with their Medicare Advantage contracts. They also report that patients must drive long distances to find nursing homes and rehabilitation facilities that accept MA plans versus nearly universal acceptance of Medicare.
Sponsor Updates
ConnectiveRx employees assemble several bikes for children in need as part of the company’s Customer Service Week events.
Frost & Sullivan recognizes Wolters Kluwer Health with the 2023 Global Competitive Strategy Leadership Award for its work with conversational AI in healthcare.
EClinicalWorks integrates with Sunoh.ai, an AI-powered ambient listening technology that generates clinical documentation during appointments.
Dimensional Insight and Health Matrix partner to offer an intelligence and data analytics platform to the Middle East healthcare market.
Baker Tilly releases a new Healthy Outcomes Podcast, “Empowering healthcare leaders with data-driven decision-making.”
Nordic publishes a new episode of its In Network podcast, “Making Rounds: Lab information, at your service.”
Black Book Research recognizes vendors exhibiting at MGMA’s Leaders Conference who’ve received its 2023 awards for highest customer experience and user satisfaction in practice management, including HIStalk sponsors Availity, Dimensional Insight, EClinicalWorks, and Nuance.
Bamboo Health will exhibit at the TAHP Conference November 6-8 in Houston.
Censinet releases a new Risk Never Sleeps Podcast, “In the Trenches of Healthcare Cybersecurity.”
Consensus Cloud Solutions sponsors the annual Cognosante Charity Golf Tournament benefiting Final Salute.
Digital consulting firm Perficient acquires San Diego-based Smedix, which offers cloud-based interface solutions for medical equipment and remote device management.
PicnicHealth, which uses patient-reported data to build datasets for research, acquires rare disease data aggregator and research firm AllStripes for an undisclosed sum.
I traveled this weekend to attend a celebration of life, marking the passing of a longstanding healthcare IT colleague. Many of those in attendance had known each other for decades, from the early days when electronic billing systems began to spawn clinical systems.
It was great to hear so many memories and to reminisce about how the industry used to be. Many of the companies that people worked for are no longer in existence, having either become part of another organization or sold for parts after an acquisition. Most of us were in agreement that the industry continues to be topsy-turvy and that it’s unclear how much or how fast new technologies like artificial intelligence will really have an impact. Hopefully, the next time we get together will be for a less solemn occasion.
I also recently had the chance to meet up with another former colleague, who was passing through my city on the way to a consulting engagement. He’s one of the super-techy types who took me under his wing when I was at the beginning of my clinical informatics career. I’ll always be grateful that he was willing to spend the time making sure I really understood the options that were being discussed versus just trying to get me to make a decision so the tech team could move on.
I’m pretty sure our conversation picked up where we left off the last time we saw each other, as if we saw each other every day, and I’m so grateful for those professional relationships that have turned into genuine friendships. In many of the informatics roles I’ve filled since the beginning of the pandemic, it seems like there’s so much understaffing there really isn’t time for those friendships to develop because everyone’s just scrambling to get the work done.
Once in a while, I see a scholarly article with a title that can only be described as clinical informatics clickbait. This time, the article in JAMIA not only caught my attention, but also delivered. As a clinical informaticist who has spent a good chunk of her career in emergency departments, how could I not be drawn to an article looking at how disaster hazards are represented in SNOMED CT? After all, I used to teach a class called “Things that can get you in the great outdoors,” so this was right up my alley.
Electronic health records are well positioned to gather data about the impact of various disasters on populations and sophisticated analytics platforms can help health systems and governmental agencies understand the respective responses to such happenings. In crafting the study, the authors looked to “determine the extent of clinical terminologies available to capture disaster-related events” as well as to map the United Nations Hazard Information Profiles to the SNOMED CT terminology.
I settled down with a nice cup of tea and dug in. Through the mapping process, the authors identified more than 200 disaster hazard concepts that had the potential to negatively impact health. These included not only things like chemical or biological disasters, but also those related to weather, flooding, earthquakes, or extraterrestrial factors. They noted that “geographically unique” hazards such as heat wave, cold wave, smoke, and drought were not found in the SNOMED CT data, coming to the conclusion that such concepts need to be added in order to improve clinical reporting. As someone who dealt with a variety of heat-related and smoke-related complaints during the long summer of 2023, I can attest to the impact that extreme heat can have on a population, especially when they don’t have access to air conditioning, fans, or transportation to cooling centers.
The authors highlighted the frequency of disasters by listing some of the events of 2023 that happened prior to publication. These included major earthquakes in Turkey and Syria; floods in South America, Indonesia, and Australia; multiple cyclones, wildfires, and more. Technological disasters included a coal mine collapse and shipwrecks. Along with other less major disasters, these events impacted 100 million people and cost $190 billion in economic losses. They also made the point that it’s not only the injuries and loss of life, but the impact of these disasters on healthcare facilities, the healthcare workforce, and the greater healthcare delivery system. They call on organizations to create strategies to make healthcare systems more resilient to disasters whether natural or human caused.
In reading the article, I thought about the current state of “resilience” in healthcare in the US. Prior to the COVID-19 pandemic, we didn’t have a lot of reserves to draw from at baseline. There was already a nursing shortage, a primary care shortage, and intermittent supply shortages when factories were hit by natural disasters or there were minor supply chain disruptions. Along came the pandemic, which exposed problems with strategic national stockpiles in the US and a rapid outstripping of global production for medical supplies. Those of us who were on the front lines vividly remember telling us we could wear bandanas to work to try to protect us from airborne pathogens and saw the pictures of our colleagues wearing trash bags when they couldn’t source barrier gowns. Although most of us have returned to relatively normal lives, the horror was real and continues to hit some of us, sometimes daily.
It doesn’t feel like healthcare delivery organizations (or policy makers for that matter) have risen to the challenge of addressing these issues for the future. As a nation, we’re not doing a great job of assessing risk, setting health priorities, or building workforce capacity, all of which the authors deem as essential for meeting future health needs. We already have a tremendous amount of data that we’re not acting on, so although I agree with the authors that more data might be better in planning for the future, I’m skeptical that it will be as useful as it might otherwise be. Certainly, there are more progressive nations out there who might actually make use of the data, and then in a decade or two the US will follow along.
I recently visited a country that has embarked on a half-century plan to eliminate certain invasive species and to return the environment to its natural state. If only we could translate that kind of initiative to the US and use it to promote public health and reduce the burden of chronic disease. Especially over a long-haul study horizon, we’ll need good data to evaluate whether interventions are working and whether we’re achieving the desired objectives.
Although the authors state that the risk of natural disasters is higher due to climate change, they acknowledge that “real-time data demonstrating the adverse impact of climate-change related events on populations, healthcare workforce, and healthcare systems, including natural disasters at the point of care, is lacking.” They attribute this in part to the absence of appropriate concepts in the clinical tools used in electronic health record documentation.
I would go further to add that there need to be additional abilities for clinicians to have easy access to this data, including access to patient-generated health information and pulling data from patient histories or linked geographical information. As an example, I spent a number of years living in a community that was directly impacted by chemical contamination. The federal government has identified particular ZIP codes in their efforts to track the downstream impacts of that contamination; if I could provide that in my patient history, which could serve as a proxy to prevent physicians from having to search for the appropriate codes for soil contamination.
The authors also acknowledge that many areas of the world don’t have health information system infrastructures that support the capture of such codes, and those areas are more focused on “the challenges of providing basic care for vulnerable populations in resource-limited settings.” They also note that there are gaps in the contact infrastructure for some countries to participate with SNOMED International in requesting additions or updates to the terminology and expressed concerns that many of the nations at highest risk for natural disasters are not members of SNOMED International. Although some may see this as a bit of a niche area in clinical informatics, I thought it was a thought-provoking article. I’ll have to reach out to my colleagues who are more closely involved in terminology to see what their thoughts might be.
What do you think about the data infrastructure for tracking disaster-related health outcomes? Leave a comment or email me.
The US Defense Health Agency awards Amwell and Leidos a contract valued at up to $180 million to provide a hybrid care platform that will replace MHS Video Connect.
October 22, 2023NewsComments Off on Monday Morning Update 10/23/23
Top News
Medication management company Cureatr shuts down without notice, blaming a lack of financing and a failed acquisition.
The company acquired SinfoniaRx in March.
Reader Comments
From Tolstoy: “Re: startups. The wave of shutdowns and fire sales is just starting as former stars run out of cash.” Agreed. Companies that ran big early-round raises in a go-go market are just now seeing the invisible investor strings that were attached – the moneyed folk are demanding profitability, growth, and proof that the company’s moat exists and is not drying up. Inexperienced operators, especially first-time founders, are new to a market that values being cash-stingy to ride out the storm. Some will attempt to pivot, which rarely works. The lowest-quality startups will shut down, but most will come hat-in-hand to established companies hoping to sell the business, its IP, or its office furniture at a dismal fraction of now-laughable historic valuation. Meanwhile, the valuation premium for startups versus publicly traded companies is narrowing and founders are packing up their rosy pitch decks being forcefully relocated from the CEO chair to the boardroom. The upside is that the cream floats to the top when irrational exuberance meets reality, so winners will emerge stronger.
From Belzer: “Re: Waystar IPO. Good timing?” It’s hard to say given the long IPO drought and SPAC distraction. The PE-owned company’s string of acquisitions has piled up quite a bit of debt, with the S-1 showing interest payments of $149 million in 2022 on $704 million in revenue, resulting in a $66 million pretax loss. The company was valued at around $3 billion in 2019 when a majority stake was sold. Rumors of an $8 billion valuation floated around last summer when the IPO plans leaked.
From Plowboy: “Re: Henry Schein. We are placing orders by phone while the company keeps its site offline.” The medical and dental supply vendor took its systems offline on October 14 due to a cybersecurity incident, although its practice management software was not affected.
HIStalk Announcements and Requests
Poll respondents who quit because of non-job issues cite management ethics by far as their most common issue.
New poll to your right or here: Looking back five years, which aspects of healthcare have been significantly improved by technology? I ran this a few years ago, so let’s see how the responses differ.
Webinars
October 25 (Wednesday) 2 ET. “Q&A: What’s new with the NSA? A No Surprises Act update.” Sponsor: Waystar. Presenters: Joseph Mercer, JD, managing director, Marwood Group; Heather Kawamoto, VP of product strategy, Waystar. The No Surprises Act created a lot of change, and those changes are still coming. A panel of revenue cycle experts answer frequently asked questions and offer a concise update on the NSA, including legislative developments, FAQs, and tips for navigating changes.
October 25 (Wednesday) 2 ET. “AMA: The Power of Data Completeness.” Sponsor: Particle Health. Presenters: Jason Prestinario, MSME, CEO, Particle Health; Carolyn Ward, MD, director of clinical strategy, Particle Health. Is your healthcare organization looking to drive profitability and scale quickly? Our experts will explore how comprehensive clinical data can revolutionize the health tech landscape. This engaging discussion will cover trending topics such as leveraging AI and data innovation to enhance patient care and outcomes, real-world examples of organizations leading the charge in data-driven healthcare, overcoming challenges in data completeness and interoperability, and visionary perspectives on the future of care delivery.
Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.
Acquisitions, Funding, Business, and Stock
EClinicalWorks announces that it expects to generate $900 million in revenue in 2023, up from the previous year’s $800 million. The company will continue to invest in AI, including ChatGPT integration, an AI-based image model for document management, and RCM improvement.
Weight loss drug startup Calibrate will sell itself to a private equity firm and restructure the business, which recently pivoted from selling prescriptions directly to consumers to having employers offer its services as an employee benefit. The company has struggled with refund-demanding customers who couldn’t get their prescriptions filled due to short supplies, as well as those who found that their insurance wouldn’t cover the high cost of GLP-1 drugs.
Nomad, whose app connects travel nurses with hospitals, lays off employees for the second time this year as budget-challenged health systems reduce their use of expensive travel nurses.
Sales
The US Defense Health Agency awards Amwell and Leidos a contract valued at up to $180 million to provide a hybrid care platform that will replace MHS Video Connect.
People
Tony Ambrozie, MBA, MIM (Baptist Health South Florida) joins CVS Health as chief digital and technology officer, pharmacy and consumer wellness.
Net Health hires Ron Books (ECI Software Solutions) as CEO.
Matter Communications promotes Paul Berthiaume to SVP.
Privacy and Security
HealthAlliance Hospital (NY) discharges or transfers all of its inpatients and diverts ambulances following a cyberattack. Owner Westchester Medical Health Network says the incident also affected Margaretville Hospital and Mountainside Residential Care Center.
Other
Cedars-Sinai researchers develop an AI tool that can detect atrial fibrillation in people who don’t have symptoms, including in diverse settings and patient populations.
Sponsor Updates
Inovalon partners with HealthVerity as part of its new Preferred Data Partner Program to advance the use of real-world evidence in research.
NeuroFlow publishes a new case study, “Prudential Helps High-Risk Disability Claimants Access Support Through Population-Wide Suicide Risk Assessment & Prevention.”
Surescripts shares a new podcast, “A Recap of NACDS Total Store Expo 2023.”
Wolters Kluwer announces that its Emmi patient engagement and education solution has received a 2023 Black Book award for highest client/user satisfaction from managed care providers.
InterSystems partners with Indonesian EHR vendor Zi.Care to provide expert services via the InterSystems Iris for Health – Indonesia Edition data platform.
OptumInsight CEO Neil de Crescenzo leaves the company a year after it acquired Change Healthcare in a $13 billion deal, according to a LinkedIn post. He had been CEO of Change since 2013.
OptumInsight’s new CEO is Roger Connor, who will also continue his role as EVP of enterprise operations and services for parent company UnitedHealth Group.
A reader tipped me off to de Crescenzo’s s departure in mid-September, but the company did not respond to my inquiries.
OptumInsight offers transaction processing, technology, analytics, and revenue cycle management. Its annual revenue is nearly $5 billion.
HIStalk Announcements and Requests
Welcome to new HIStalk Platinum Sponsor FinThrive. The Plano, TX-based company helps 3,200 healthcare organizations increase revenue, reduce costs, improve patients financial experience, and ensure regulatory compliance across their entire revenue cycle continuum. Its SaaS-based RCM Platform delivers the industry’s widest breadth of capabilities, including integrated workflows supporting patient access, revenue integrity, claims management, contract management, and collections management teams within a centralized work environment. The company helps its customers bring modern digital experiences to their patients, including self-scheduling, virtual check-in, price estimations, patient payments and payment plans, and ongoing SMS-based secure communications – with no app downloads required. Its platform also leverages machine learning, robotic process automation, end-to-end RCM analytics, and billing and coding education resources to increase efficiency and drive sustained ROI. Thanks to FinThrive for supporting HIStalk.
Here’s a FinThrive explainer that I found on YouTube.
Webinars
October 25 (Wednesday) 2 ET. “Q&A: What’s new with the NSA? A No Surprises Act update.” Sponsor: Waystar. Presenters: Joseph Mercer, JD, managing director, Marwood Group; Heather Kawamoto, VP of product strategy, Waystar. The No Surprises Act created a lot of change, and those changes are still coming. A panel of revenue cycle experts answer frequently asked questions and offer a concise update on the NSA, including legislative developments, FAQs, and tips for navigating changes.
October 25 (Wednesday) 2 ET. “AMA: The Power of Data Completeness.” Sponsor: Particle Health. Presenters: Jason Prestinario, MSME, CEO, Particle Health; Carolyn Ward, MD, director of clinical strategy, Particle Health. Is your healthcare organization looking to drive profitability and scale quickly? Our experts will explore how comprehensive clinical data can revolutionize the health tech landscape. This engaging discussion will cover trending topics such as leveraging AI and data innovation to enhance patient care and outcomes, real-world examples of organizations leading the charge in data-driven healthcare, overcoming challenges in data completeness and interoperability, and visionary perspectives on the future of care delivery.
Previous webinars are on our YouTube channel. Contact Lorre to present or promote your own.
Henry Ford Health and Ascension Michigan form a joint venture to combine their Detroit-area operations, with the combined $10.5 billion business giving them 44% of the Detroit area hospital market by revenue.
Private equity firm Ardian will increase its stake in Europe-focused healthcare software vendor Dedalus to 92%. Board member Albert Calcagno, who has no healthcare or software experience, has been appointed CEO, with Andrea Fiumicelli moved to board chair.
Sales
Medicare Advantage insurer EternalHealth will implement Inovalon’s Converged suite for quality measurement and risk scoring.
USA Health Children’s and Women’s Hospital goes live on AdaptX’s Obstetric Advisor to improve maternal health equity.
Culbertson Memorial Hospital will go live on Oracle Health CommunityWorks next month.
Virtua Health will allow its doctors to prescribe Woebot Health’s mental health support app to people who are waiting for behavioral health provider appointments.
People
Bamboo Health hires Jeff Smith, MBA (Lumeris) as CEO. He replaces interim CEO Jay Desai, MBA, who will continue as executive board chair. Former CEO Rob Cohen, MBA left the company in July 2023 to join Livara as CEO.
Adrian Agostini (Booster) joins Experity as chief revenue officer.
Industry long-timer Rob Titemore, most recently with Sonifi Health, died August 13 in a motorcycle accident. He was 52. Visitation will be November 18 in Burlington, MA.
Announcements and Implementations
Insurer Oscar Health describes in an excellent “Continuous Hackathon” website how it is using large language models in pursuit of three goals: creating better client experiences, impacting behavior to generate better outcomes, and automating processes to reduce cost. Some of its ideas for using AI to move care delivery outside of the medical office:
Assign members to virtual primary care doctors.
Use AI to interpret EHR lab results as an initial draft for the virtual care provider. Co-founder and CTO Mario Schlosser says in an X post that the response of providers is binary – either they delete the summary immediately or they accept it with minimal changes.
Automate the creation of care summaries. Schlosser says that providers modify the AI-written summary often, adding their own personal style or adding context.
Collect patient information before starting a virtual patient visit.
In Japan, Fujitsu and Toppan Holdings will collaborate to create research databases from de-identified EHR data and apply analytics to improve the efficiency of drug development and care delivery.
Ronin and MD Anderson experts describe the development of an AI-powered digital tool that identifies cancer patients who are likely to require an unscheduled ED visit within 30 days due to treatment side effects, concluding that 50% of those visits as well as 19% of hospitalizations are avoidable.
Prudential’s implementation of NeuroFlow’s technology for conducting remote clinical assessments of disability claimants triggered 4,200 self-harm or suicide alerts from 24% of the monitored population, enabling the insurer to promptly connect them with mental wellness resources and resulting in a 34% reduction in their symptoms of depression.
Government and Politics
HHS OCR publishes a checklist covering “Telehealth Privacy and Security Tips for Patients.”
Other
A survey of employers finds that health insurance premiums increased 7% in 2023, outpacing worker wage increases and inflation as family coverage averaged $23,968 per year. Employers paid an average of 71% of the cost, although 65% of workers were enrolled in self-funded plans in which the employer pays for health services directly. Employers say that the key health benefits concerns of their employees involve the high cost-sharing that they bear, their ability to schedule timely appointments, and the complexity of prior authorization. More than half of employers think that telemedicine will be important or very important for providing access to behavioral health services and primary care.
An interesting series of tweets from Science.io co-founder and CEO Will Manidis makes these observations in predicting healthcare’s “top deck of the Titanic” moment as consumers abandon the existing system and create their own:
The status quo is that costs have increased constantly and clinic waitlists remained full because: (a) clinicians are in limited supply; (b) insurers pay rather than patients; (c) demand is inelastic and trust is high; and (d) regulatory capture.
He says that all four factors are shifting as (a) LLM-assisted doctors will gain technology leverage; (b) the payer-PCP model will shift to online services that treat individual conditions; (c) patients who are disillusioned by the opioid epidemic and by poor treatment at physician offices will exit the system instead of calling for it to be improved; and (d) FDA’s healthcare regulation doesn’t reflect patient desires and instead rewards incumbents.
Technology will allow new companies to be more efficient than incumbents as vendor overpromising fades.
Amazon, Walmart, and CVS are building a cash-pay, free-market parallel care system.
Margins on low-acuity care will increase due to telemedicine and consumerization, which will also offer cross-selling opportunities for high-margin lifestyle management plans.
A fascinating and potentially HIT-adjacent article in The Atlantic ponders the “failed experiment” of retail self-checkout, which mentions but does not primarily blame customer dishonesty as its main challenge. The initial promise of quick checkout and the ability to deploy freed-up cashiers to offer more customer assistance never materialized, as finicky technology, purchases such as alcohol that require employee review, and assigning a single staff member to oversee the enter kiosk area have diminished the technology’s potential. Snips:
Self-checkout allows cutting back on low-wage cashiers, but the problem-prone technology requires a lot of expensive IT resources to keep running.
It hasn’t been proven to be faster or more convenient, but customers are fooled because instead of just waiting in line, they fumble through the scanning and bagging process in doing the cashier’s job with a small fraction of their efficiency.
Retail store owners used self-checkout as a reason to cut staff in general, resulting in messier stores, poorly stocked shelves, and lack of employees to assist customers.
Retailers aren’t likely to abandon the concept because they spent fortunes installing the technology, but they will likely need to provide more human assistance.
The article concludes, “A familiar limitation of many grand tech-industry promises endures: At the bottom of all the supposed convenience, you do actually just need a lot of people to operate a store.”
Sponsor Updates
Divurgent releases a new The Vurge Podcast, “From Operations to IT: An Inside Look.”
Ellkay will present at the CommonWell Health Alliance 2023 Annual Meeting and Fall Summit November 6-8 in Kansas City, MO.
HealthMark Group employees volunteer at Operation Kindness.
Optimum Healthcare IT posts a case study titled “Sentara: Strategic Portfolio Management with ServiceNow.”
Censinet and First Health Advisory will partner to offer cybersecurity risk assurance solutions, including the Censinet RiskOps platform for managing and mitigating third-party and enterprise risk.
Nordic releases a video titled “The Download | Restart, refuel, or hang tight: The EHR dilemma.”
Inovalon collaborates with Amazon Web Services to develop software to support better healthcare outcomes and economics.
MRO will exhibit at the NCQA Health Innovation Summit October 23-25 in Orlando.
Heart of Florida Health Center realizes a 21% increase in payment collections with EHR and Healow Payment Services software from EClinicalWorks.
Redox partners with healthcare-focused digital transformation consultancy Productive Edge to offer the Healthcare Data Strategy Accelerator and Healthcare Data Integration Accelerator programs.
Going to ask again about HealWell - they are on an acquisition tear and seem to be very AI-focused. Has…