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News 2/24/23

February 23, 2023 News 1 Comment

Top News

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Teladoc Health reports Q4 results: revenue up 15%, EPS –$0.23 versus –$0.07, beating revenue expectations but falling short on earnings.

The company reported a staggering $13.7 billion loss for FY 2022, much of that attributed to goodwill write-downs related to its $18.5 billion acquisition of Livongo in August 2020.

TDOC shares have lost 56% in the past year versus the Dow’s 2% loss, valuing the company at $4.8 billion, having lost about 90% off its value since early 2021.

From the earnings call:

  • CEO Jason Gorevic called Q4 results a strong finish to a “challenging year” in a “more challenging macro environment” that he expects will persist.
  • The company will cut costs, including layoffs and restructuring.
  • Teladoc’s BetterHelp online behavioral health business, which it acquired in early 2015 for $4.5 million, performed well. Teladoc says it has become a billion-dollar business. The company will start reporting performance in two segments, integrated care and BetterHelp.
  • The company expects its employed physicians to eventually conduct more than 50% of visits versus its use of independent contractors, which it says will increase physician productivity and patient satisfaction.

Meanwhile, an outstanding article in MedCity News asks former Livongo CEO Zane Burke directly, “Did you sell a lemon to Teladoc or did they mess up?” Burke says Livongo was a “freaking good business” and that Teladoc was the pursuer of the transaction, but Teladoc’s executives “really liked themselves a lot” and thought they were “clever” in operating a roll-up business versus Livongo’s organic growth and intellectual property. He says Teladoc’s timing was terrible in hindsight and questions why Teladoc’s offer didn’t require Livongo’s executives to stay on board when the acquisition closed, after which 11 of 12 members of Livongo’s leadership team departed.


Reader Comments

From Another NY SR IT Leader: “Re: Sunrise. In addition to Northwell moving to Epic, Altera has Memorial Sloan Kettering, St. Barnabas Bronx, and Brooklyn Hospital all implementing Epic. NYC was once a stronghold for the former Eclipsys Sunrise.”

From Humeris: “Re: HIMSS. Sebastian Krolop, MD, PhD, global COO and strategy officer at HIMSS, has left. Cultural differences with Hal were cited. Another sore spot was his failure to get any traction with Accelerate, the networking platform that he engaged McKinsey to plan and develop.” Verified that he has left after four years, per his LinkedIn post of three weeks ago. As for Accelerate, even HIMSS CEO Hal Wolf hasn’t posted anything, and its LinkedIn page’s last updates were from HIMSS22.


Webinars

February 28 (Tuesday) 1 ET. “Words Matter: Simplifying Clinical Terms for Patients.” Sponsor: Intelligent Medical Objects. Presenters: Whitney Mannion, RN, MSN, senior terminologist, IMO; David Bocanegra, RN, nurse informaticist, IMO. The language of medicine can be confusing and contradictory to patients, challenging their ability to prepare for a procedure or pay their bills. This webinar will explore how the words that are used to communicate – online, in print, and in person – must be chosen carefully to allow patients to comprehend their diagnoses, treatments, and care plans. The presenters will also describe how the ONC Final Rule for the 21st Century Cures Act will make clinical and technical language more directly accessible through patient portals.

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

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Amazon closes its $3.9 billion acquisition of primary care provider One Medical as the Federal Trade Commission fails to challenge the deal by the deadline. FTC has warned the companies that closing the acquisition before its approval is at their own risk, as FTC is still reviewing the transaction. Amazon has already launched a $144 first-year membership in One Medical, which offers 24/7 virtual care via messaging or video, online appointment scheduling, and prescription management. One Medical also runs  physical offices in 22 metro areas that offer on-site lab services. One Medical is a concierge medical practice rather than direct primary care — it bills services to the patient and their insurance like any other non-DPC practice, promising only a more satisfying patient experience.

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Independent primary care network operator Aledade acquires Curia.ai, which offers AI-based value-based care analytics for optimizing patient care and engagement.

Premier Inc. acquires the “Top 100 Hospitals” program from Merative, formerly IBM Watson Health, which it will integrate with its PINC AI technology and services brand.

Chartis acquires DES Health Consulting, whose workforce assessment tool will be offered as the Chartis Center for Burnout Solutions.

Axios reports that healthcare automation startup Olive AI will sell its payer prior authorization business, one of the company’s two remaining business lines. Olive’s headcount has been reduced by more than half via previous asset sales and layoffs.


Sales

  • Memorial Healthcare System implements a virtual care service that is powered by KeyCare’s Epic-based platform.
  • Augusta University Health chooses the turnkey virtual health solution of Biofourmis to expand its Virtual Care at Home program.
  • Silverado will implement hospital and palliative care software and analytics from WellSky.
  • Mount Graham Regional Medical Center (AZ) will implement BridgeHead Software’s HealthStore as a clinical data repository for retired applications.

People

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Benefits administration technology vendor Bridgeway Benefit Technologies hires Todd Plesko, MBA (GHX) as CEO. He replaces Jenny Morgan, MS, who will retire and serve as board chair.

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Deborah Norton, MBA, who retired as CIO/SVP for operations from Harvard Pilgrim Health Care in  mid-2021,  died Saturday at 69.


Announcements and Implementations

A new KLAS report on long-term care EHRs finds that PointClickCare has the highest market share and customer satisfaction, while Epic performs well for health system-owned LTCs.

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Ambience Healthcare launches an AI-powered, human-free medical scribe that embeds in EHR workflow to allow providers to review, edit, and sign off on their notes nearly immediately. The company has raised $30 million through a Series A round.


Government and Politics

A VA official warns that the problem that forced a delay in the planned Oracle Cerner go-live at its Ann Arbor operation, which it announced last week, is likely to affect any VA hospital that conducts clinical research and needs integration with research-based systems.

Companies may no longer require laid-off employees to sign confidentiality agreements or non-disparagement clauses as a condition of receiving severance benefits, per a National Labor Relations Board ruling that takes effect immediately.

The American Hospital Association writes a letter of opposition to the FTC’s proposed rule that would prohibit employee non-compete agreements. AHA says that FTC doesn’t have the authority to enforce the rule, it would affect only new agreements since FTC doesn’t have retroactive authority, the rule should not apply to highly paid hospital executives and physicians, and FTC does not have legal authority over non-profit entities and therefore a non-compete ban would place for-profit hospitals at a disadvantage.


Other

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Folks who tamp ear wax into their skulls by using Q-tips like Civil War cannon rammers might want to swap out for Smart Visual Ear Cleaner, a $30 smartphone-paired tool that features an in-ear camera and a series of silicone scrapers. Although I might spring an extra $5 for the Bebird version that Best Buy sells (pictured above). Some people are addicted to shoving swabs into their ears with the regularity of brushing teeth, sometimes puncturing their ear drum and surely knowing from a basic anatomical standpoint that it’s a bad idea. The third, non-technical hygiene option is perhaps best – use an ear wax removal kit that contains a peroxide solution that fizzes wax right out, which offers comfort of knowing it is working by the sounds of percolation that seem to emanate from deep inside your head and the trickle of the resulting output running down your cheek.


Sponsor Updates

  • Ellkay will exhibit at Rise National March 6-8 in Colorado Springs.
  • GHX has been named a Notable Vendor in the 2022 Gartner Vertical Industry Context: ‘Magic Quadrant for Multienterprise Supply Chain Business Networks.’
  • InterSystems announces that its HealthShare Unified Care Record has earned a Certified Data Partner designation from NCQA’s Data Aggregator Validation Program.
  • Clearsense posts a new case study, “Accelerating Research and Delivering Enhanced Patient Insights with Population Health.”
  • VA names NeuroFlow one of the winners of its Mission Daybreak Grand Challenge, designed to discover new solutions to reduce veteran suicides.

Blog Posts


Contacts

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

EPtalk by Dr. Jayne 2/23/23

February 23, 2023 Dr. Jayne 4 Comments

In the “not a major surprise, but it’s nice to see some data” category, a recent study published in the Journal Healthcare finds that scribes are linked to a 27% reduction in primary care burnout rates. The authors looked at using remote scribes to assist primary care physicians in an effort to boost physician wellness.

The research was performed at University of Wisconsin Health and included approximately 200 physicians in the specialties of family medicine, general internal medicine, general pediatrics, and adolescent medicine. Individual scribes were paired one-to-one with physicians. The intervention group included 37 physicians and the control group numbered 160. The scribes used an audio-only cellphone connection to listen to visits and create documentation in real time. Orders were entered and held in a pending status for physicians to execute. The final notes also underwent review, editing, and signature by the physicians.

Prior to the intervention, more than 70% of physicians reported burnout. Post-intervention, that number was down to 51%. Although that change is dramatic, it is accentuated by the fact that for those physicians who didn’t work with a scribe, their burnout rates rose from 50% to 60%. Additionally, those working with scribes were more likely to describe their workplace as “joyful” and “supportive.” Measures of EHR-related stress were lower than those clinicians who didn’t have scribes. Working with a scribe slashed up to 66 minutes of EHR time out of an eight-hour physician day, with half of that being outside the scheduled workday.

Interestingly, looking at the study design, those receiving scribes were self-selected and had to agree to not only participate in program evaluation efforts, but to see one additional patient per half-day clinic session in order to offset the costs of the scribe. Both of those factors may have had an influence on satisfaction.

The authors noted that four of the intervention group dropped out of the project within the first year, and it would be interesting to look at the reasons given. They also noted that the project began just prior to the COVID-19 pandemic, “which dramatically disrupted clinical operations and could have affected the post-intervention wellness and EHR measurements.” Still, they conclude that “the fact that a scribe program can be revenue-neutral with modest increases in productivity makes them an attractive intervention to help organizations improve the wellness of their physician workforce.”

I think that if primary care colleagues fully did the math, many of them would be willing to see one or two more patients per day in order to shave time off their after-hours documentation.

Working with scribes was critical to my survival in the early days of the pandemic, when my urgent care’s volumes spiked. It would have been impossible to see 80+ patients per day without a scribe. A good chunk of those visits were for COVID testing or COVID concerns without any symptoms, and my scribes were able to capture not on the patients’ stories, but all of my counseling and medical advice, before I left the room.

Unfortunately, many of our practice’s best scribes gained admittance to medical school in the summer of 2020, decimating the program. It wasn’t able to recover prior to the subsequent COVID peaks, and the lack of scribes was directly associated with a number of physicians leaving the organization in the first half of 2021. There is definitely some work effort involved in onboarding a scribe program, but if your organization is experiencing clinician burnout, it’s worth considering.

My Approved Portraits

Senator Tammy Baldwin of Wisconsin is going after health system Ascension. In a letter to the health system’s CEO, she calls out the fact that “Ascension is required to provide charitable benefits to the community and operate solely to serve a public, rather than a private interest. Despite these requirements, Ascension has significant for-profit investment activities that dwarf what the system providers in annual charity care.” She goes on to state that “by operating like a private equity fund, Ascension is squeezing staff, closing facilities, and extracting cash from its member hospitals for dubious ‘management fees’ all to advance its investment activities and provide compensation to its executives.”

Baldwin also calls out the fact that at the recent J.P. Morgan Healthcare Conference, Ascension’s CEO talked up its $18 billion in cash and investments, noting “This number raises questions about why Ascension, a mission-driven health system with non-profit status, is not prioritizing reinvestment into serving vulnerable communities and its own operations – which should include increasing pay and improving working conditions for its burned out and overextended health care workforce.”

She cites data that Ascensions investment funds lost the system more than $200 million more than the organization provided toward charity care during the most recent financial quarter. She closes with a demand for data covering fiscal years 2015 through 2022 that describes investments, returns, charity spend, debt collection practices. She also asks for information on management fees charged to hospitals, how monies from the Provider Relief Fund were used to address hospital staffing, details on over $250 million in charitable care during the last three months, and a list of compensation packages for executives and board members.

I’ve worked for several health systems that sat on billions of dollars while the proverbial city burned. I’ve seen essential frontline workers struggle to maintain full-time status while managers are incentivized to turn them into part-time workers so they don’t have to pay benefits. I’ve seen these systems put the squeeze on primary care physicians while they build fancy non-clinical additions on their buildings. And we’ve all seen some of these organizations aggressively pursue patients for their portion of payments, while barely paying heed to their supposed charitable missions.

On my most recent patient-side visit to one of these systems, I experienced understaffing, scheduling issues, and dirty facilities. With cash in the double-digit billions, it feels like they shouldn’t have baseball-sized dust bunnies in the waiting room. They also shouldn’t be shifting patients away from established physician relationships to brand new mid-level providers because the physician panels are full and they “can’t afford to hire” additional physicians.

It will be interesting to see how this plays out with Ascension, and I’m sure other nonprofits will be following closely.

What do you think about so-called non-profit health systems who have billions in the bank? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 2/23/23

February 22, 2023 Headlines No Comments

New Releases: SDOH Toolkit and Learning Forum Sessions for the Health IT Community

ONC publishes the “Social Determinants of Health Information Exchange Toolkit” to serve as a resource for healthcare stakeholders as they consider incorporating social determinants of health into the design of health IT systems.

Scoop: Olive AI plans to divest second major business line

Healthcare automation vendor Olive AI reportedly considers selling its payer-facing prior authorization business.

Amazon closes deal to buy primary care provider One Medical

Amazon closes its $3.9 billion acquisition of membership-based primary care provider One Medical, which has 200 clinics in 26 markets.

Morning Headlines 2/22/23

February 21, 2023 Headlines No Comments

AGS Acquires Offshore Patient Access BPO Unit from Availity

AGS Health acquires the India-based patient access outsourcing business of Availity, which adds 200 team members to AGS Health’s 11,000 RCM experts.

Ventra Health Announces Acquisition of Deras Global

RCM services provider Ventra Health acquires Deras Global Services, a Philippines-based provider of RCM services for hospital-based physician specialties.

Aledade Adds More Than 450 New Practices for 2023, Making It the Largest Network of Independent Primary Care in the Country

Independent primary care practice management company Aledade acquires value-based care analytics vendor Curia for an undisclosed sum.

News 2/22/23

February 21, 2023 News 3 Comments

Top News

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ONC publishes “Social Determinants of Health Information Exchange Toolkit.”


Reader Comments

From NY CIO: “Re: Northwell Health. Word is it will announce its move to Epic and that it will bring a large number of their Allscripts-outsourced employees back in-house.” Unverified. I’ve been watching the Northwell job site, which lists a handful of positions that include Epic implementation.


HIStalk Announcements and Requests

ViVE and HIMSS23 exhibitors: the conferences will have come and gone within a few weeks, but contact Lorre if you want a full year of HIStalk sponsor exposure for little more than you’ll spend on coffee for your booth people.

This seems like an interesting webinar topic with a compelling title that I ran across on LinkedIn: “TEFCA Kills the National Networks: Or Does it?” offered by Zen Healthcare IT.


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Welcome to new HIStalk Platinum Sponsor Mobile Heartbeat. The Waltham, MA-based company offers the health industry’s leading unified clinical communication and collaboration solution. The MH-CURE platform securely engages colleagues across every department and accelerates decision-making, improves care delivery, and increases patient throughput. Its scalability and reliability is evidenced by a robust user base of 260,000 active users and 130,000 deployed iPhones. Open architecture, anchored in standards-based API, supports both innovation and integration with third-party solutions. Adoption-driven pricing model with unlimited users and a bed-based pricing structure encourages widespread adoption. Thanks to Mobile Heartbeat for supporting HIStalk.


Webinars

February 28 (Tuesday) 1 ET. “Words Matter: Simplifying Clinical Terms for Patients.” Sponsor: Intelligent Medical Objects. Presenters: Whitney Mannion, RN, MSN, senior terminologist, IMO; David Bocanegra, RN, nurse informaticist, IMO. The language of medicine can be confusing and contradictory to patients, challenging their ability to prepare for a procedure or pay their bills. This webinar will explore how the words that are used to communicate – online, in print, and in person – must be chosen carefully to allow patients to comprehend their diagnoses, treatments, and care plans. The presenters will also describe how the ONC Final Rule for the 21st Century Cures Act will make clinical and technical language more directly accessible through patient portals.

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

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AGS Health acquires the India-based patient access outsourcing business of Availity, which adds 200 team members to AGS Health’s 11,000 RCM experts.

RCM services provider Ventra Health acquires Deras Global Services, a Philippines-based provider of RCM services for hospital-based physician specialties.

HealthStream announces Q4 results: revenue up 7%, EPS $0.08 versus –$0.01. HSTM shares are up 3% in the past 12 months versus the Nasdaq’s 15% loss, valuing the company at $800 million.

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A new American Hospital Association report covers recent developments involving retail, payer, and technology disruptors of healthcare in the $260 billion primary care market:

  • Amazon. Will acquire primary care provider One Medical for $3.9 billion pending FTC approval. Added the RxPass generic medication program. Offers home lab testing. Uses AWS to drive innovation. Runs a healthcare accelerator and has invested in disease management.
  • CVS Health. Markets its services to health plan customers that were acquired with its purchase of Aetna. Will expand its HealthHUB to 1,500 locations. Will acquire primary care provider Oak Street Health for $10.6 billion pending FTC approval. Acquired home health company Signify Health for $8 billion. Has expanded its virtual mental health services. Will create health subscription models and commercialize its data and analytics. Has high usage of its CarePass program for free medication delivery and its self-serve digital tool for completing pre-appointment forms. Will spend $3 billion to expand its digital offerings and improve the customer experience. Runs a $100 million early-stage digital health venture fund.
  • UnitedHealth Group. Will process transactions for 85 million patients via its merger with Change Healthcare. Has funded multiple virtual behavior health providers. Invested in care coordination companies and a provider credentialing vendor. Has invested in several tech-heavy remote patient monitoring and home care companies along with several virtual care solution vendors.
  • Walgreens Boots Alliance. Acquired two-thirds interest in primary care provider VillageMD and will have 1,000 practices by 2027. Is buying Summit Health, which operates urgent care provider CityMD, for $8.9 billion. Acquired specialty pharmacy Shields Health Solution. Paid $330 million for controlling interest in CareCentrix, which manages patients in their homes.
  • Walmart. Is continuing to open freestanding health centers. Acquired telehealth provider MeMD last year. Is partnering to extend value-based care to Medicare beneficiaries. Works with Epic to enhance communication and information sharing.
  • Apple. Is creating relationships with payers, health systems, and researchers via health-related features for the Watch and IPhone.
  • Google/Alphabet. Collects health information via Google Fit. Is actively working with drug companies to cut drug development costs via AI. Is focusing on, and investing in, the use of AI ii radiology. Has launched three Health Data Engine accelerators.

Sales

  • Lifepoint Health will use virtual care technology from Midi Health to launch a telemedicine service for women experiencing perimenopause and menopause.

People

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Mass General Brigham hires Rebecca Mishuris, MD, MPH, MS (Boston Medical Center) as VP/CMIO.

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Greg Kidd (Glytec) joins Revuud as regional VP.

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Zachary Lipton, PhD (Amazon AI) joins clinical documentation company Abridge as chief scientific officer.

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Nancy Heininger (Athenahealth) joins Koan Health as RVP of sales.

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XiFin, parent company of OmniSys, promotes Scott Warshaw, MPA to chief strategy officer.


Announcements and Implementations

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The Sequoia Project launches a Consumer Voices Workgroup to learn first-hand about the barriers they experience while accessing, using, and sharing their health information. Nearly all of the members serve as caregivers for patient, 80% of whom don’t use technology.

Sunrise Mountain Family Medical Clinic (NV) implements cloud-based EHR technology from EClinicalWorks.

Infor launches a module for its Workforce Management suite that analyzes EHR data to measure workload for each patient to support nurse scheduling and reduce overtime.

Redox will offer its interoperability systems on Google Cloud.


Government and Politics

President Biden upholds an International Trade Commission ruling that could ban importation of the Apple Watch over EKG patent complaints filed by AliveCor. Masimo has also sued Apple over pulse oximetry patents and has won an initial ruling, which could also apply an import ban to some versions of the Watch. Apple has appealed the AliveCor decision, and experts say that even if Apple loses either decision, it will probably just negotiate a licensing fee with the plaintiff.

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HHS OCR reports that large HIPAA breaches jumped 58% between 2017 and 2021, with HIPAA complaints spiking 39% in that same timeframe. The office says that its funding has not kept up with these increases, limiting its HIPAA enforcement capabilities.

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The federal government shuts down Missouri non-profit Medical Cost Sharing Inc., a healthcare cost-sharing ministry that took in $7.5 million in membership fees while paying out only $246,000 to cover the submitted healthcare bills of members. The two founders pocketed at least $4 million for running a minimally regulated ministry whose members pay premiums that are used to cover the medical bills of other members. Medical Cost Sharing, which required members to attend church and abstain from using drugs and alcohol, offered plans starting at $90 per month that included telemedicine and discounts on visits with its in-network providers.


Privacy and Security

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Lehigh Valley Health Network (PA) refuses to pay the ransom that was demanded by hackers who breached a radiation oncology imaging computer at one of its physician practices.

Tallahassee Memorial HealthCare (FL) restores its computer systems and resumes normal operations 13 days after an unspecified security incident. Sources have suggested that the hospital had been waiting on an insurance payout to meet ransomware demands.


Other

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The New York Times looks at the telehealth-powered growth in prescriptions of the psychedelic-like drug ketamine, also known as club drug Special K, whose use has expanded from surgery sedation to treating mental health conditions, frequently for unapproved uses and supplied by compounding pharmacies that operate outside FDA’s oversight. The authors note the narrowing gap between legitimate medical treatment and online shopping. Online seller Joyous charges $129 per month for a telehealth consultation, medication delivered to the customer’s home, and daily text messages for adjusting dose.

Optum Tri-State CEO Kevin Conroy responds to patient complaints about delays in scheduling appointments, requesting refills, and connecting with care team members, pledging to improve its call center operations, add clinicians, and extend hours. Optum’s Medical Care practice, formerly CareMount Medical PC, stationed a security guard outside of one of its urgent care facilities late last year as tensions rose over service issues.

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A study of the low credit scores of residents of Southern states finds that medical debt is a key contributor, driven by the high prevalence of chronic disease and having eight of the 11 states that haven’t expanded Medicaid. A new policy change will eliminate the two-thirds of medical debt collections from credit reports that involve balances under $500, but people in the South are more likely to have debt over that threshold.


Sponsor Updates

  • An Arrive Health analysis of 78 million prescription transactions finds that its Real-Time Prescription Benefit solution surfaces 37 million transactions in which a $0 medication is available.
  • Bamboo Health will exhibit and Diameter Health will present at the State Healthcare IT Connect Summit March 6-8 in Baltimore.
  • Nordic releases a new episode of its “Designing for Health” podcast featuring Memora Health’s Omar Nagji.
  • HealthMark Group CEO Bart Howe, MBA is elected president of the Association of Health Information Outsourcing Services.

Blog Posts


Contacts

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

Morning Headlines 2/21/23

February 20, 2023 Headlines No Comments

LVHN reports cyberattack from suspected Russian ransomware group

Lehigh Valley Health Network (PA) refuses to pay the ransom demanded by the Black Cat group, which launched a cyberattack on an LVHN computer system that supports one of its physician practices.

Winners revealed in VA’s $20M Mission Daybreak Grand Challenge to reduce Veteran suicides

The VA awards a combined $11.5 million to the 10 winners of its Mission Daybreak Grand Challenge, which aims to discover new suicide-prevention solutions including those that incorporate digital health.

Scribes linked to 27% lower burnout rate in primary care

Primary care physicians who use scribes report lower levels of burnout, improved workflow satisfaction, and less time spent documenting in the EHR.

Curbside Consult with Dr. Jayne 2/20/23

February 20, 2023 Dr. Jayne No Comments

ChatGPT and similar tools continue to be some of the hottest topics around the virtual physician lounge. Plenty of clinicians are experimenting with using the tools to help respond to patient messages, and the bravest souls are even looking at using it to create visit documentation.

Although it’s tempting to think that we might be on the cusp of having reliable tools to help us with some of the most time-consuming parts of our jobs, the reality is that the technology is not yet ready for prime time as far as using it in clinical scenarios. Unfortunately, many frontline physicians may not understand the limitations of the system and are wading into some pretty deep water where it comes to patient care.

Some of my non-medical friends have been using it as well and have a lot to say about the fact that its output can sound completely convincing, but is factually incorrect. There are some examples going around, such as where it lists the peregrine falcon as the fastest marine mammal. The computer science folks note that in order for models like ChatGPT to be useful in healthcare, constraints need to be placed on their predictive capabilities.

For example, if you were using the tool to summarize a patient’s chart, you don’t want to allow it to predict procedures or treatments that didn’t happen. My friends seem to think that the easy answer in healthcare is to just have the physician review everything to make sure it’s accurate. However, those of us who practiced back in the days of heavy use of medical transcription know that’s easier said than done. The number of transcriptions that went out the door without proofreading or corrections was staggering, and led to outcomes running the spectrum from laugh-provoking to malpractice.

There’s also the not so small matter of HIPAA and the risks of feeding large quantities of patient information into the dataset used by the tool. Additionally, trying to leverage AI-based technologies for healthcare isn’t cheap. I’ve seen several startups that try to pass their solutions off as “AI-enabled” when all they really have is a bunch of sophisticated decision trees. There’s a certain threshold of money that has to be raised in order to be able to afford the work needed to truly move into the AI space, and understanding whether a company even has the resources to realistically do AI work should be one of the first steps in determining if they’re blowing smoke.

In related topics, some of my colleagues were discussing a recent editorial in JAMA Health Forum titled “Garbage in, Garbage out – Words of Caution on Big Data and Machine Learning in Medical Practice.” The piece opens with a quote from Alan Turing: “A computer would deserve to be called intelligent of it could deceive a human into believing that it was human.” It goes on to talk about machine learning and the use of data to predict clinical outcomes, such as adverse events related to medications. We know all too well the risks of using data sets that aren’t representative of the population in question or that don’t have all the information needed to generate a reliable prediction. The article uses the example of an opioid prediction rule that didn’t included data on cancer diagnoses or enrollment of hospice as a rule that isn’t ready for prime time.

Especially in the primary care trenches, physicians are often so busy just trying to get the daily work done that they may not be digging in to understand exactly how predictive rules are generated or how valid they are. They have to rely on regulatory agencies and the editorial staff of medical journals to vet proposals. Although this can delay the time for new tools to get to the point of care, it can be a valuable step for protecting patient safety. The article notes that it’s also important to reevaluate rules on a periodic basis, since medical knowledge continues to evolve. It gives the evolution of an HIV diagnosis “from a death sentence to a manageable chronic illness” as an example. It’s good food for thought.

Around the administrative / non-clinical physician water cooler, one of hottest topics over the last couple of weeks was that of annual performance reviews. Making the jump from clinical practice to management requires more than just an interest in administrative topics. It also involves understanding how corporations work and some of the tactics that they use to manage their human capital.

A physician who is new to administrative work recently learned that he would have to perform stack ranking when analyzing his team’s performance. For those who may not have run across this, it requires managers to score workers against their peers rather than against goals and objectives. The first time I ran into this was when I worked for a large hospital system, and a management consultant that had been engaged to “trim the fat” forced our department to implement it.

To make matters even worse, annual merit raises were tied to the stack rankings. For managers with exceptionally talented teams who were all working at or beyond their potential and who were achieving great results, it’s agonizing to have to allocate more of a raise to some and less to others when they were all working extremely hard and crushing their goals. As a relatively new physician leader at the time, I hadn’t been exposed to anything like that. It’s not something you learn about in medical school and it certainly wasn’t covered in the couple of physician leadership intensives that I was sent to as the health system prepared me for greater administrative roles. Fortunately, I’ve spent the better part of the last decade working in environments where this methodology isn’t used, and I felt more than a little disbelief at the fact that it seems to be becoming popular again.

I’m a firm believer that if an employee isn’t meeting expectations, that needs to be addressed early and often through individual conversations with their manager and potentially a performance improvement plan if needed. It shouldn’t be left until the annual performance review. On high-performing teams, members should be able to work without fear that they’re going to be unfairly compared to co-workers just because of a methodology. Stack ranking is hard on managers as well as employees, and contributes to an overall toxic workplace culture. The fact that it’s still out there despite the literature about its consequences says a lot about companies that continue to use it.

The last hot topic of the week was a recent study that looked at whether the board members at the nation’s top hospitals have healthcare backgrounds. Published earlier this month in the Journal of General Internal Medicine, it found that less than 15% of board members had a healthcare background versus finance or business services. Other interesting findings: of those with a finance background, 80% had experience with private equity funds, wealth management, or banking. The rest were in real estate or insurance. Of those with healthcare experience, 13% were physicians and less than 1% were nurses. The authors only looked at top hospitals and there were challenges in finding publicly available information about boards. This could be even more challenging when looking at smaller institutions.

These topics are just a sampling of those that are on the collective minds of physicians who are often just trying to put one foot in front of the other as they slog through caring for patients.

What do you hear when you’re working with clinicians? Are there any particularly hot topics? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Sachin Agrawal, CEO, EVisit

February 20, 2023 Interviews No Comments

Sachin Agrawal, MSc is CEO of EVisit of Mesa, AZ.

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Tell me about yourself and the company.

I’ve been in healthcare consulting and software for 20 years, always focused on the enterprise needs of hospitals and health systems in areas such as revenue cycle, physician network alignment, quality and safety, et cetera. I joined this business about six or seven months ago and took the CEO seat on January 1.

We are network-agnostic virtual care operating platform, primarily for large operators of physician networks and all the professionals that surround them. Typically hospitals and health systems and sometimes significant category leaders in other healthcare delivery categories, but mainly focused on the underpinnings of operating virtual care for these big healthcare delivery orgs.

How would you describe the virtual health technology marketplace?

It is asymmetric in terms of how I’ve seen other HCIT markets operating. It was forced upon everybody, but from the perspective of providers, it was forced upon them for obvious reasons. But it  not one that evolved from the critical foundational needs that hospitals and health systems have. 

As a result, a lot of health systems are picking their heads up, now that we are a few years out from the onset of the pandemic, and saying that they were forced to drive a modality that has been disruptive to their core operations rather than additive in all the ways that they need to be, given the economic climate. I was surprised by that as an outsider. I understood the needs of the providers well, but as an outsider from virtual care coming in, I was surprised by how much of the evolution of the market, from an intelligence perspective, has remained at the surface level despite the tremendous utilization that we saw the past few years.

Providers didn’t have a choice about implementing virtual visits as the pandemic started, but some brought in telehealth companies that use their own medical staff. How are heath systems valuing telehealth’s value to their brand or as it relates to their other services?

This is a head-scratcher for me. It’s puzzling to have seen hospitals either promote the utilization of those networks or let those virtual-first networks promulgate and post up in their back yards. That goes everything that I’ve learned about what complex healthcare delivery organizations are trying to do, in terms of raising the bar on quality and safety, balancing fee-for-service reimbursement with value-based reimbursement, looking at network leakage and network integrity, and things like that.

The common denominator across all those topics is that hospitals and health systems have been focused on tightening their networks, clinical integration, physician practice alignment, and increasing M&A to employ clinicians. I look back on that and it’s puzzling, because in a lot of ways, it’s the antithesis of all those things.

Hospitals and health systems are picking their heads up and saying, this is not aligned with the Quadruple Aim. We need to do something about it in the medium to long term, but we also have to figure out how to engage with those networks in an appropriate manner in the short term, because  going cold turkey is challenging in this labor environment and in this cost environment. There’s a tough needle to thread for healthcare delivery organizations. They are talking to us all the time about how to thread that needle.

How has the patient and provider experience changed as telehealth has moved from a quickly implemented solution to a permanent strategy?

The impetus during the pandemic was to take what was inherently meant to be a brick and mortar set of clinical protocols and a brick and mortar operation and just virtualize it. I’m quite explicit about painting the difference between virtual and digital care. Virtualizing care is what we just talked about — what organizations had to do. Now the industry is at its inception of the next chapter, which is to digitize aspects of care that they otherwise didn’t have the time to think about – design, change management, organizational buy-in, and things like that. That impacts how service lines themselves in a world where you can be digital first. It impacts who’s doing what in terms of top-of-license activities versus bottom-of-license activities. It impacts where people fit.

I can’t tell you how many stories I’ve heard about the pandemic when clinicians were still going into their offices, obviously socially distanced, and doing virtual visits out of the office. That’s not what the promise of virtual care was meant to be. Virtual care itself needs to go through this digital evolution while obviously honoring the systems, processes, and workflows that are in place, many of which are focused on clinical satisfaction, safety, and things like that. I don’t think there needs to be a revolution, but a thoughtful evolution that we’re just at the beginning of now that we’re picking our heads up post pandemic.

How do virtual care needs vary by specialty?

Significantly. I’m excited to see the data around providers leveraging their own networks and clinical protocols in a virtual way to drive similar, if not better, quality and safety outcomes et cetera. It’s great to see the early data on that. What’s needed going forward is both the complexity and the opportunity of going from virtual care to a digital evolution as use cases expand. 

As you go from urgent and primary care up the ladder to things with higher acuity and higher complexity, there could be device dependencies. There could be wearable dependencies. There could be group consultation needs and things like that. Importantly, you need to go from just a provider-to-patient relationship to potentially many providers per patient relationships, or many providers to many providers type relationships to drive complex consultations. That ecosystem, in terms of the need to create connectivity and to do that process and service line that I’m talking about, is going to be underpinning unlocking additional value from virtual care efforts.

What are some telehealth best practices that can help physicians work at the top of their license, such as pre-visit chats and triage?

That is part of an important broader question around what we can do to alleviate the burnout issue and the turnover that happens, which then impacts the high cost of recruiting, credentialing, and privileging clinicians to get back on the front lines. I’m reminded of a story of a customer who is the middle of digital reengineering as opposed to just virtualizing brick-and-mortar care. They are one of the more progressive institutions that I know of in the country, a Top 15 health system. They measure very carefully evening pajama time, where clinicians come home after  busy day, spend time with their families, and then most likely after hours after kids are down and settled in, they are logging right back into the EHR and doing complex charting. It’s because they had this backlog as they went about their visits throughout the day.

This is a critical piece when it comes to the top-of-license question. Pulmonologists didn’t go to school for decades to sit at home in their pajamas doing charting. This could be impacted on the front end through the intake process, the virtual triage process, and the asynchronous process where patients can assume more ownership. It should happen throughout the process as well, in terms of removing the barriers to documentation and charting. Then on the back end, the integration into the leviathan health systems,  power health systems like EHRs and revenue cycle. 

I think of it as the underlying need for integration throughout the process — beginning, middle, and end — to drive down things like evening pajama time. This institution would tell you that, as they have seen a drop in that based on digital re-engineering, they can directly tie that to a drop in turnover and therefore in recruitment and backfilling costs. It’s a KPI that they are looking at carefully, which is the promise of digital as opposed to sticking to your brick-and-mortar workflow and hoping for the best.

What do you expect to happen with telehealth when the public health emergency ends on May 11 and rules and payment policies go back to the early 2020 world?

It has significant implications. There’s a reason why pre-pandemic, the system was largely averse to some sort of a national credentialing or privileging approach, or even a cross-state credentialing privileging approach. First and foremost, we’re probably going to go back to life as we knew it before the pandemic from that perspective. That puts a significant accountability right back onto health systems to do credentialing in multiple states and cross-state privileging and things like that, which is a huge lift. They are already dealing with significant resource turnover. Just keeping up with the credentialing and privileging activities in their home state is drowning them. I think we are going to see a consolidation of where providers are able to practice virtual care. The other thing this will highlight is the need for those higher-acuity use cases that you are talking about.

Even within state borders, we’re going to see a greater separation of access to care. This is all driven by social determinants of health, access to specialists and subspecialists. Health systems will have an accountability. They’re going to have these key resources largely aligned with them, the subspecialists, that they need to find a way to liberate their time to cover a broader swath of a population even within a state. It’s going to beg the critical questions of how to re-engineer our processes to digitize that so that we can have our most important resources go further at the top of their license.

What changes do you expect to see in the next few years that will affect the company and the industry?

We have set up our company’s strategy to align directly with where we think the industry is going. I’ve been around the block in healthcare and I’ve seen platform categories come up over time. Usually these platforms are filling a critical void that exists between the core hospital systems, some of which I’ve mentioned — scheduling, EHR, revenue cycle, and digital front door if that comes into maturity. There’s a gap between what those core systems do and how to re-engineer care or to drive the efficiencies and to drive quality and safety standards up.

For the industry, as the dust settles on a pure outsource model to virtual networks and things like that, and there’s increased focus on how to we assume command and control of this as a health system, the industry will need a platform layer. I’ve talked to many CIOs and CMIOs in the past six months, and two of them from Top 10 health systems have described this as a need for a middleware to integrate in and out of the core systems, to author workflow, and to ensure that those workflows are being set up for the right people to do the jobs at the top of their licenses.

That’s a complex set of needs that needs a dedicated approach. That market will have plenty of room for participants, because the needs that it addresses are going to be significant. Of course we at EVisit are setting up our strategy to be one of the emerging leaders in what we believe is going to be a really exciting category in healthcare delivery.

Morning Headlines 2/20/23

February 19, 2023 Headlines No Comments

Reported HIPAA complaints and breaches shot up from 2017 to 2021: HHS

HHS OCR reports that it does not have the financial resources it needs to investigate mounting HIPAA breaches and complaints, both of which increased between 2017 and 2021.

Tallahassee Memorial HealthCare resumes normal operations, but questions loom

Tallahassee Memorial HealthCare (FL) announces that it has fully restored its computer systems and services 13 days after an unspecified security incident forced it to downtime procedures.

Lightbeam Health Solutions Is Relocating Its HQ from Las Colinas to Cypress Waters in Coppell

Population health management company Lightbeam Health Solutions relocates its headquarters from Las Colinas, TX to nearby Coppell, expanding its office footprint by 50% in anticipation of growth.

Monday Morning Update 2/20/23

February 19, 2023 News 12 Comments

Top News

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The VA postpones its planned July 2023 Oracle Cerner go-live at its Ann Arbor, MI facilities until later this year or early in 2024.

The service region is concerned about “how well EHRM would interact with VA Ann Arbor’s vital medical research mission.”


Reader Comments

From AT: “Re: pet peeves with service industry words and phrases. ‘I appreciate you,’ following my thanking you and leaving you a tip, which suggests that we are like-minded, decent people even though you have no way of knowing that. Second is thanking someone with ‘of course,” implying that I’m either too stupid to know the obvious answer or should not have even said thanks.” I will admit that even my curmudgeonly self has no problem with either of these, especially ‘I appreciate you’ that I first heard among polite Southerners who likely meant it. “No problem” is much worse in my mind – should I feel relieved that my thanking you for doing the job for which you are paid isn’t a bother? Others that bug me at least a little:

  1. “Yeah-no” or “no-yeah.” Why do people think that appending these opposites adds emphasis?
  2. “Curated.” Unless you are observing nature or some random phenomenon, everything you experience was “curated” by someone.
  3. “It is what it is.” This phrase is intended to convey a philosophical acceptance of immutable circumstances, but most people who use it seem more inarticulate than profound.
  4. “I could care less,” said by people who mean that they could not care less.
  5. Marketing emails that contain “hope you are well” (should I tell you if I’m not?) and using the flabby “please don’t hesitate to call me” as though I not only require an invitation to call, but I have to do it quickly.
  6. Starting a sentence with “know,” as in “know that I am here for you.” Just say what you want me to “know” and I’ll know it without being ordered.
  7. “Now,” “presently,” “today,” or “at this point in time.” It’s always now unless you indicate otherwise.
  8. “Build out” as an unnecessarily wordy way to say “build.” Build it out and they will come?
  9. “Simplistic” means a dangerous oversimplification, which is not at all synonymous with “simple” and does not take an adjective such as “too simplistic.”
  10. I won’t even bother with “reimbursement” as a financially appalling and less-forthright euphemism for “payment.”

HIStalk Announcements and Requests

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Most poll respondents felt cared for during their most recent clinician encounter. However, some of them left comments indicating that while the physician did a good job, they are moated off by the bureaucracy of hospitals, insurers, indifferent front desk staff, and a preoccupation with following mandatory workflows.

New poll to your right or here, following up on last week’s musing: Do you have to pay to park at your primary work site? I’ve only ever had to pay at one employer, an academic medical center. Parking lots are assigned by seniority, so new hires get stuck parking far from their work sites and sometimes extend their workdays for free during waits for shuttle buses both ways. You are also buying access to a garage, not a reserved spot, so your day starts by looking at taillights of your co-workers who are fighting for the same first available spots. The university defended its parking policies by saying that students would otherwise be leaving cars all over the place, but of course those students were also customers who were paying many thousands of dollars each year on top of parking fees. Even worse was charging patients and visitors to cruise dark garages looking desperately for a space as they ran late for appointments, often forgetting how to find their car after leaving, and then being stuck in the exit’s pay line while trying not to forget the clinician’s instructions. My personal gripe was that when I drove in to see a doctor on a different campus as a patient, I theoretically could have been issued a ticket because my permanently affixed sticker (they didn’t use hang tags back then) made it appear that I was parking inappropriately in a spot that was reserved for patients, not to mention that they stopped validating. This is a good marketing lesson – no matter how much good patients get from their visit, the first and last thing they encounter is an impersonal, frustrating parking experience, which you don’t see at CVS and suburban medical buildings that share a plaza with Home Depot.


I get frequent emails from teachers whose Donors Choose grant requests were funded by reader donations along with matching money from my Anonymous Vendor Executive. Here’s a new one from Mrs. S in California:

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. Thank you for giving them that that joyful opportunity!


Webinars

February 28 (Tuesday) 1 ET. “Words Matter: Simplifying Clinical Terms for Patients.” Sponsor: Intelligent Medical Objects. Presenters: Whitney Mannion, RN, MSN, senior terminologist, IMO; David Bocanegra, RN, nurse informaticist, IMO. The language of medicine can be confusing and contradictory to patients, challenging their ability to prepare for a procedure or pay their bills. This webinar will explore how the words that are used to communicate – online, in print, and in person – must be chosen carefully to allow patients to comprehend their diagnoses, treatments, and care plans. The presenters will also describe how the ONC Final Rule for the 21st Century Cures Act will make clinical and technical language more directly accessible through patient portals.

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.


Sales

  • University Hospitals (OH) will work with Premier’s PINC AI Applied Services on projects related to real-world data, prospective research, clinical trials, and the use of natural language processing for early disease identification.

Announcements and Implementations

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A Wolters Kluwer Health survey finds that while most patients prefer receiving educational materials from their providers, they often end up looking online because they have left an encounter with unanswered questions.


Government and Politics

Two Idaho state lawmakers co-sponsor a bill that would make it illegal to administer MRNA vaccines.


Other

Romania investigates five doctors who are accused of faking diagnoses, or intentionally inducing cardiac problems with medications, as an excuse to charge for implanting into their patients medical devices that they had removed from dead people.


Sponsor Updates

  • CTG publishes a new case study, “Healthcare System for Children Transforms Their Data Management Strategy with CTG’s Help.”
  • Meditech will present at the 2023 AHA Rural Health Care Leadership Conference February 19-22 in San Antonio.
  • RxLightning’s MedAccess ecosystem solves specialty medication enrollment problems while relieving healthcare burnout.
  • West Monroe announces Strategic Workforce Optimization with Work 4D, which analyzes a company’s work and aligns it to the most appropriate type of talent – employees, contractors, outsourcers, or automation. 
  • Sectra wins four awards for customer satisfaction – 10 consecutive years of winning in the US.

Blog Posts


Contacts

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

Morning Headlines 2/17/23

February 16, 2023 Headlines No Comments

Avaya Files For Chapter 11 Bankruptcy After Cloud Subscription Accounting Woes

Unified communications and collaboration services vendor Avaya, whose healthcare offerings include solutions for virtual care, collaboration, and patient access technology, files for Chapter 11 bankruptcy for the second time in six years.

Elation Health Acquires Medical Billing Company Lightning MD to Accelerate Market’s First Primary Care All-in-One Solution

Primary care EHR vendor Elation Health acquires practice-focused medical billing company Lightning MD.

Spacelabs Healthcare Expands Clinical Informatics Capabilities with Acquisition of Predictive Analytics Company PeraHealth

Spacelabs Healthcare acquires PeraHealth and its Rothman Index patient deterioration software for undisclosed terms.

VA delays health record go-live at key Michigan site

The VA delays Ann Arbor Healthcare System’s EHR roll out, citing concerns over how well the Oracle Cerner software will interact with the health system’s “medical research mission.”

GE HealthCare Makes Push Into Artificial Intelligence

Newly spun off GE HealthCare announces plans to develop hospital software to help guide care and assign resources.

News 2/17/23

February 16, 2023 News 3 Comments

Top News

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Unified communications and collaboration services vendor Avaya, whose healthcare offerings include solutions for virtual care, collaboration, and patient access technology, files for Chapter 11 bankruptcy for the second time in six years.

The Durham, NC-based company reported lower than expected revenue and earnings last year, blaming accounting problems with its cloud subscription revenue, after which it replaced its CEO.

AVYA share price has dropped 98% in the past 12 months, valuing the company at $24 million.


Reader Comments

From Baby Payer: “Re: IVF coverage. In an example of our messed up healthcare system, women are taking Amazon jobs and quitting after one day to get fertility benefits.” Women claim that they took a job working in an Amazon warehouse, were covered immediately by its Progyny fertility benefits, and then quit the next day and paid their own COBRA premiums going forward. The women supposedly prefer warehouse jobs because hiring and quitting are automated processes, with no interview required.

From Lou Sassol: “Re: ViVE. Will you be reporting from there?” Probably not. I can’t justify the $2,400 general admission registration and I don’t know of any easy way to attend undercover as a free media attendee. At other conferences, I have either registered at full price under my own name using a phony company name or used someone’s exhibitor pass. 


HIStalk Announcements and Requests

I was searching for something on HIStalk and ran across my old Time Capsule series, which I think is my best work in mixing snark with occasionally insightful observations, fueled by mania that was induced by working several jobs simultaneously with little sleep way back in the mid-2000s. You don’t see a lot of health IT sites running titles like “In a Capitalist Society, Somebody Will Always Sell a Fat Man a Speedo or an Unprepared Hospital a Clinical System.”

Pondering: are hospitals the only businesses that charge customers and employees to park on the lots that they themselves own?


Webinars

February 28 (Tuesday) 1 ET. “Words Matter: Simplifying Clinical Terms for Patients.” Sponsor: Intelligent Medical Objects. Presenters: Whitney Mannion, RN, MSN, senior terminologist, IMO; David Bocanegra, RN, nurse informaticist, IMO. The language of medicine can be confusing and contradictory to patients, challenging their ability to prepare for a procedure or pay their bills. This webinar will explore how the words that are used to communicate – online, in print, and in person – must be chosen carefully to allow patients to comprehend their diagnoses, treatments, and care plans. The presenters will also describe how the ONC Final Rule for the 21st Century Cures Act will make clinical and technical language more directly accessible through patient portals.

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

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Spacelabs Healthcare acquires PeraHealth and its Rothman Index patient deterioration software for undisclosed terms.

Primary care EHR vendor Elation Health acquires Lightning MD, which sells billing and payer connectivity systems.

Centura Health, which is operated as a partnership between CommonSpirit Health and AdventHealth, will dissolve as the partners decide to manage their own respective hospitals. CommonSpirit also announces that it will acquire Steward Health Care’s Utah sites, which includes five hospitals and 35 clinics.

Business Insider runs a first-person report of using Amazon’s new RxPass service that covers dozens of commonly prescribed generic drugs for a flat rate of $5 per month, citing these issues as reasons to not use it again:

  • The service isn’t available in eight states and can’t be used by people covered by Medicare and Medicaid. Amazon explains that those programs don’t allow pharmacies to charge cash prices for medications that they cover.
  • The display of available meds lists items multiple times – with insurance, without insurance, or with RxPass – and it’s easy to miss the one that is flagged as available under the program.
  • Transfer of prescriptions from CVS took a long time.
  • One prescription was rejected because it didn’t exactly match Amazon’s inventory, which required starting the process over with the patient’s doctor.

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CPSI announces Q4 results: revenue up 12%, EPS $0.61 versus $0.70, beating Wall Street expectations for both. Shares are up 6% in the past 12 months versus the Nasdaq’s 15% drop, valuing the company at $447 million.

R1 RCM announces Q4 results: revenue up 35%, EPS –$0.09 versus $0.11, beating revenue expectations but falling short on earnings. RCM shares are down 46% in the past 12 months versus the Nasdaq’s 15% loss, valuing the company at $6.6 billion.

CommonSpirit Health blames its $474 million quarterly loss on the pandemic, labor shortages, staffing costs, inflation, and its October 2022 ransomware attack. Its financial report says the month-long outage in October has cost $150 million so far.


Sales

  • Mosaic Life Care (MO) will start its Epic go-live on March 4, replacing Cerner.
  • Care Choice Family Clinic will implement EClinicalWorks.

People

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Vanderbilt University Medical Center promotes Dara Mize, MD, MS to CMIO.

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Joshua Newman, MD, MSHS, SVP of healthcare and life sciences at Salesforce, will leave the company.

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Hongfang Liu, PhD (Mayo Clinic) joins UTHealth Houston as director of the Center for Translational Artificial Intelligence in Medicine and VP for Learning Health Systems.

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Lumeon hires Matt Duffy (NextGen Healthcare) as VP of product and Kathy Ruggiero (Commure) as VP of marketing.

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Clement Chen, MBA (Leidos Health Group) joins DSFederal as CEO.

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Ochsner Health SVP/CIO Laura Wilt, MBA has resigned.


Announcements and Implementations

WebPT enhances its rehab therapy platform with upgraded single sign-on capabilities, enterprise identity management, in-app history reporting, and a Snowflake-powered data warehouse solution.

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Purdue-connected HemaChrome wins an NIH challenge for its smartphone app that measures blood hemoglobin non-invasively using phone pictures or screenshots from video calls.

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NeuroFlow’s behavioral health platform is named one of the Phase 2 winners of the VA’s Mission Daybreak for suicide prevention solutions. I interviewed co-founder and CEO Molara – a West Point graduate and former Army captain and field artillery officer who served as a platoon leader in Iraq — last year.

Newly spun off GE HealthCare announces plans to develop hospital software to help guide care and assign resources.

Four hospitals in Ontario go live on a centralized patient portal as part of their shared deployment of Meditech Expanse.


Government and Politics

The State Department approves Oracle Cerner’s $250 million contract to implement military health IT systems for Kuwait’s Military Medical Command.


Sponsor Updates

  • Healthjump Interoperability Platform is featured in a new KLAS First Look report.
  • Elsevier launches the Reproductive Health Hub to support healthcare professionals with trusted information about reproductive health topics.
  • Health Data Movers promotes Karla Christopher, Brandon Camp, and Michael Martin.
  • Black Book Research surveys of a combined 10,000-plus end users rate Surgical Information Systems the top ambulatory surgical center technology vendor and ModMed the top health IT vendor for integrated practice management, RCM, and EHR solutions.
  • CTG publishes a new case study, “CTG Helps Contract Research Organizations Leader Create Business Alignment.”
  • Fortified Health Security names Robert Clark (Code42) regional director.
  • The HCI Group launches its Epic Center of Excellence in Jacksonville, FL.
  • Health Data Movers promotes Michael Martin to senior director of delivery.
  • InterSystems releases a new Healthy Data Podcast, “Transitions of Care: Data Integration, Standardization, featuring BJ Evans, Stonerise Healthcare.”
  • Kyruus publishes a new whitepaper, “Five Ways to Prioritize Provider Data Management.”
  • The Care4 project in Ontario has launched a patient portal shared across four hospitals and ambulatory clinics using Meditech Expanse.
  • Net Health will exhibit at APTA CSM 2023 February 23-25 in San Diego.

Blog Posts


Contacts

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

EPtalk by Dr. Jayne 2/16/23

February 16, 2023 Dr. Jayne 3 Comments

As we approach the end of the declared emergency surrounding the COVID pandemic, it will be important to assess how shifts in healthcare policies including those involving payment, access, and prescription medications will impact health outcomes.

A recent article in the American Journal of Obstetrics and Gynecology Maternal-Fetal Medicine looked at hos telehealth care impacted racial disparities in visit attendance during the pandemic. As background, the US has a terrible track record for maternal care, with maternal mortality rates that are significantly higher than other high-income countries. Additionally, in the US black woman are more likely to die during pregnancy and childbirth. During my time in the emergency department, the number of women I cared for who had no prenatal care was simply stunning given our time and place in history.

Researchers at Penn Medicine performed a retrospective cohort study looking at the issue by comparing data from 2020 to the same time period in 2019. Self-identified patient demographic breakdown included 63% black, 26% white, and 1% Latinx individuals. Prior to the addition of telehealth, black patients were less likely than others to attend a postpartum visit. They were also less likely to receive a postpartum depression screening or to breastfeed their infants.

After telehealth implementation, postpartum depression screening rates were equivalent, although black patients remained less likely to breastfeed. The authors concluded that “telehealth implementation for postpartum care during the COVID-19 pandemic was associated with decreased racial disparities in postpartum visit attendance” in a way that was statistically significant.

Numerous studies are demonstrating that telehealth can improve patient outcomes in the right situations. Especially for patient populations that may be marginalized, telehealth options can open the door to care that patients might not otherwise receive. Benefit can be derived from both video and audio-only telehealth visits, assuming the right protocols and safeguards are in place. In the short term, there are just some things that can’t be done without a face-to-face interaction, but as technology improves those gaps are narrowing.

I had dinner with some of my favorite smart women tonight and telehealth was a key topic, as were other non-traditional care delivery opportunities including school-based health clinics, mobile care units, and more. There are so many dedicated people in the healthcare arena who want to make sure patients get the care they need. Now it’s just a question of aligning the right priorities and incentives to make it happen. There are more than enough dollars being spent on healthcare, from insurance premiums to facility and provider bills, that we should be able to do better. We should be able to be better. The next few years will be interesting, indeed.

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As someone who has been officially classified as a remote worker for more than 12 years, articles that talk about how remote work will be the death of business tend to catch my eye. The most recent one featured investor Marc Andreessen and his warnings that remote work isn’t good for younger people in the workforce. I got a kick out of the quotes where he called the office a “continuation of a college campus experience” and where he hinted that remote work has prevented not only the development of workplace relationships, but has stifled office romances. For any of us who has had to manage a team where romance may be in the air, I think we could do without the latter.

He also alleged that remote workers don’t have a sense of connection to their co-workers and that they don’t even know who their neighbors are. I’ve been with a fully-remote team for more than a year now, and I have to say that my relationships with some of my coworkers are as strong, if not stronger, than those with people who live in the same ZIP code.

In my experience, it’s more about putting the time in to understand who people really are and how they work best than it is about seeing them in person every day. It’s about setting shared goals and supporting each other, whether you’re 10 feet away or a thousand miles away. My co-workers are engaged outside the workplace whether they are younger, older, married, or single; whether they have families nearby, or whether they don’t. They take non-career-related classes to broaden their horizons, volunteer with various organizations, and travel. They find their sense of community through a mix of virtual and in-person interactions.

As someone who is older and I hope wiser in the workplace, I personally think that it’s healthy to shift the culture away from the idea that the workplace should be our social center. Wanting to have a life outside of work is a significant reason why many want to embrace remote work situations, where they can live where they like and have less time commuting and more time for other pursuits whether they be solitary or with others. I think some of us have forgotten the things that happened with in-office work that made people uncomfortable and that were difficult to get away from due to close quarters. We’ve all dealt with generally boorish behavior, people trashing the lunch room, unwanted smells, unwanted noise, and HR-worthy happenings at company parties and functions.

Although bad behavior can still happen in a remote environment, somehow it seems easier to tune out. If it gets to the point of needing to file a formal complaint, it’s more likely to be documented through email, chat logs, recorded meetings, and other media. Those “your word against mine” situations may look entirely different in a distributed workplace. I know I’m significantly more productive not working in an office, and that includes both work and non-work tasks. Given my penchant for throwing a delightful loaf of Three Cheese Semolina bread in the oven and timing it to be done just in time for dinner, I’m not sure I’d ever want to be in an office full time again.

What are your thoughts on remote work? Will it be the death of us, or should we not believe the hype? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 2/16/23

February 15, 2023 Headlines No Comments

CPSI Announces Fourth Quarter and Full Year 2022 Results

CPSI reports Q4 results: revenue up 12%, adjusted EPS $0.61 versus $0.58, beating analyst expectations for both.

Cyber attack exposes personal data of approximately 1 million Community Health Systems patients

Hospital management company Community Health Systems (TN) begins notifying patients of a cyberattack on its third-party cybersecurity vendor Fortra, which may have exposed patient information.

CommonSpirit Health Releases FY2023 Q2 Financial Results

CommonSpirit Health reports a $474 million Q2 operating loss, some of which it attributes to the October ransomware attack that took its systems offline for nearly a month.

Readers Write: Faster Horses? Let’s Think Different

February 15, 2023 News 4 Comments

Faster Horses? Let’s Think Different
By Stuart Hanson

Stuart Hanson, MBA is CEO of Avaneer Health of Chicago, IL.

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American industrialist and business magnate Henry Ford is purported to have said, “If I had asked people what they wanted, they would have said faster horses.” The same could be said when it comes to what it’s going to take to transform the US healthcare system, one of the most administratively complex in the world.

When compared to other high-income nations, we spend the most, yet have poorer outcomes. While we have many initiatives in place to fix our current administrative inefficiencies, what we really need is an entirely new way for healthcare stakeholders to connect, collaborate, and conduct business. That requires the industry to put aside “faster horses” thinking and move beyond more API connections, HIEs, or revenue cycle management bolt-on technologies.

Our healthcare system was designed around payer and provider processes. But at its core, healthcare is human. At the center of every procedure, every diagnosis, every transaction is a human being — a real person with expectations of being treated with dignity at a moment when they are most vulnerable. Yet our back-office processes aren’t built around the patient; they are designed around transactions. Those transactions move across disparate data silos, point solutions, aged technology infrastructure, and manual processes. Many of us can share experiences of how we have been personally impacted by our current systems.

It’s time to create a new way of working together that puts the patient first, restoring the humanity of healthcare. That requires a level of data fluidity that we currently lack, fluidity that enables the sharing of data and seamless collaboration for more effective back-end processes and better patient experiences.

While APIs are great at establishing point-to-point connectivity, they aren’t the answer for achieving true, seamless interoperability that puts the patient first. APIs are still focused on the transaction and the transaction type. We need a digital ecosystem built on a highly secure, decentralized peer-to-peer network that leverages common infrastructure, as well as tools that enable collaboration and trust — a data superhighway. This approach puts the patient, patient identity and all needed data at the center.

With the type of interoperability delivered in a decentralized network:

  • Participants retain ownership of their data while giving access (with permission) to the data needed.
  • Instead of sending files back and forth, there is automatic access to data and the data owner can revoke rights at any time.
  • A single person identity (for the patient/member/provider) and intelligent matching creates confidence in the accuracy of the information exchange.
  • FHIR standardizes the data.
  • Solutions on the network enable participants to interact, transforming administrative and clinical processes.

One of the most significant benefits of a decentralized network is its ability to provide an unprecedented level of transparency and accountability, which supports greater integrity and personal responsibility among participants. With a decentralized network built upon innovative technologies, the data becomes immutable and is always refreshed and current, eliminating the need for third-party validation. This type of data fluidity would enable real-time risk adjustment, simplified quality reviews, and more proactive process improvements.

Another benefit of this type of network is that payers, providers, and solution vendors can connect to any other network participant without having to build or maintain another API. It’s a completely new way of doing business.

From a patient’s perspective, greater data fluidity via a decentralized network can eliminate much of the complexity that inhibits seamless, timely access to care. Prior authorizations can be completed in minutes instead of days or weeks, reducing delays in care. Referrals take seconds, helping to eliminate gaps in care. Accurate patient financial responsibility can be determined in real time so patients know with 100% certainty what they will owe prior to their service. Patient medical records are accessible in real time no matter where the patient has been seen in the past, giving the provider a complete view of the patient’s medical history without having to request, email, fax, or send records through the mail.

Leveraging a peer-to-peer network, developers and innovators could connect on a single platform and use common tools to collaborate with other stakeholders. Connecting innovators and stakeholders across the ecosystem on a single platform would enable co-creation, which would allow much needed innovations to reach the market faster. Payers win, providers win, vendors win, and most importantly, patients win.

Interoperability is a term that invokes thoughts of payer-provider processes. While that’s true, we need to rethink what it means in terms of the patient. We need to take a step outside of the interoperability solutions around us and rethink how the business of healthcare could work. Instead of trying to fix a broken system, we should reimagine a completely new system, one unencumbered by layers of inefficiencies that inhibit patient care and one that reinvents the patient experience for good.

HIStalk Interviews Adam McMullin, CEO, AvaSure

February 15, 2023 Interviews No Comments

Adam McMullin, MBA is CEO of AvaSure of Belmont, MI.

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Tell me about yourself and the company.

I’m thankful that I found my way into healthcare in 2006. I had worked around the US and the globe helping companies operate more efficiently by adopting technology. That was intellectually interesting. Getting into healthcare changed my life. That connection to the mission and how you can impact and help care teams and patients helped me find a sixth gear.

Before I got into healthcare, all I knew about healthcare was that a nurse agreed to marry me. It’s an odd coincidence that many of the businesses and teams that I have been involved in a focused around serving nurses with clinically-led and technology-enabled solutions.

AvaSure is the leader in acute virtual care. We are in about 1,000 hospitals, including all of the Top 10 US health systems, one-third of the magnet hospitals, and 70 academic medical centers. We help our customers adopt virtual care to get better outcomes at a lower cost.

What are the clinical and business benefits?

That strong ROI was one of the things that attracted me to AvaSure. The ability to both operate demonstrably more efficiently while having proven clinical outcomes was to a level I hadn’t seen. AvaSure pioneered the tele-sitter market. About 20% of patients have a clinical need for observation, but only 10% or less actually get an observer, which is a person physically sitting in the room with the patient. The data on the performance of the in-room observers is not very strong.

We can take 16 of those observers and monitor them in a virtual care center. We have over 120 studies as to why that improves results, such as reducing falls or harm. That is an ROI around using your team more efficiently during a labor crisis and getting better outcomes. Once you have adopted that, you have also put in the fundamentals of your virtual care infrastructure. That allows you to move into other areas such as virtual nursing, which is seeing a lot of interest.

What is a typical profile of an observer and what is their job like?

In a virtual care center, we have the virtual observers, and increasingly, virtual nurses. The virtual observers usually have a clinical background, where they were providing a significant amount of documentation around the types of patients being observed and what they are seeing in the room. If you look at sitting, there was virtually no documentation. The great catches that we get daily are around preventing falls, because they have clinical insight and can often determine that a step was missed. We have unfortunately found situations where visitors or family members are giving substances to a patient that they shouldn’t be getting, or that they are concealing a weapon. They are doing a lot of things by observing those patients. We are 15% nurses and growing. We work to ensure that those virtual sitters, and increasingly virtual nurses, are integrated well into the rest of the care team.

How are hospitals using the system to improve employee safety?

We unfortunately have had a significant increase across the nation in behavioral health issues. Patients often first present in the ED, where you don’t have the history. We are seeing all sorts of things, whether that’s aggression against a caregiver or elopement, where patients or just take off when they’re not supposed to. By having a virtual observer, we’re able to notify the care team so that they can intervene, call for help, or call for security if necessary.

Are the cameras recording at all times?

That’s a really important point. None of the video is recorded. Otherwise, you would have to have patient consent. The video is being observed in real time and trained observers are doing the job to make sure that they are appropriately monitoring the patients.

Are observers screened or trained to manage the psychology of seeing patients in their most intimate and sometimes unfortunate moments?

That brings to mind a couple of things. We guide hospitals as they are hiring observers to look for people who have clinical experience. It’s a great role where you can have a outsized clinical impact, especially if you’re at a point in your career where you don’t want to be on the floor as much.

Gay Landstrom, the chief nurse of Trinity Health –which credits tele-sitting with saving $22 million per year – told a story at our company meeting about a patient who was nearing end of life. This was during COVID, when there was no additional nurse to be in there to be with that patient. The observer worked it out with their supervisor so they could be one-on-one with that patient. They talked to them at this incredibly intimate moment and then ended up singing to them as they unfortunately and sadly passed. That story really connected what we are doing to the mission.

I’ve heard story after story. I was recently at the VA in North Dallas and there was a virtual sitter who got very attached to the patients she was observing, because you have clear two-way audio. It got to the point that she was bringing treats and brownies. There’s a pretty deep connection because these virtual sitting sessions can go on for days. You need to make sure that you have a high quality connection.

Do observers and patients have a lot of verbal interaction, or is it mostly observers asking patients how they are doing or giving instructions?

Oftentimes there are also redirects. One of the reasons that patients fall is that they need to go to the bathroom and don’t want to call someone to help them. If the observer sees someone with high fall risk who is about to get out of bed, they can redirect them. They can summon the care team, let the nurse know, and let the patient know that help is on the way. Other times the patient might need help with something that is non-clinical, and they can take that need off the care team, which cuts down on the number of times the patient has to engage their clinical team.

As you move into virtual nursing, which is focused on either continuous observation — for example, things like avoiding patient demise and keeping patients out of the ICU — or episodic admissions and discharges. If you’re doing a discharge, the unit is right next to the bed and you’re doing a lot of that discharge documentation and training. That’s a deep engagement between the virtual clinical team member and the patient.

Do observers have access to any of the hospital’s clinical systems for observation or data entry?

Our solution is a purpose-built, high quality, highly reliable, high level of quality of service, audio, video, either mobile or mounted device, plus a very scalable backend technology. For example, we monitor 80 hospitals for Trinity out of two centers. When we talk about integrating with other devices, we integrate with the EMR. You can get into your EMR and you can launch the setting, so you can see both documentation and have the audio-video connection. We integrate out to the clinical communication and collaboration space so that you can appropriately route information to the right caregiver. The cameras are high enough fidelity that you can actually read the monitors in the room, and if there are other key alerts, we can bring those into the system as well.

Once the technology is in place and services have started, who is involved on the hospital side?

You want to make sure that the change management is done with the care team that is actually on the units. We have some best practices to make sure that there is great connectivity and that we facilitate building trust between the virtual care center and those who are caring for the patients. Those in the virtual care center are obviously there ongoing.

We as a company provide 24×7 support for the solution so that we can make sure that you have the quality of service when you are delivering care or observing these patients with a critical need. We think a lot, from the technology side, about Day 2. After you go live, how do you make sure that this is well supported and that we are monitoring the health of the devices and the technology?

Does virtual nursing offer a way for nurses to continue their clinical careers without the punishing physical demands?

I was with a customer last week and we were talking about this. They call them their wisdom workers. In nursing, there’s something called the complexity experience gap. The complexity or acuity of patients has gone up, and as nurses have left the workforce, they are disproportionately the most experienced nurses. You are backfilling them with newer nurses who may have had less clinical training during the pandemic. Using your more experienced nurses in a virtual care center is of extremely high interest. It creates a second set of eyes as a way to better support your new nurses, travel nurses, and foreign nurses.

We’ve even had situations where nurses have suffered a physical disability, but they still want to contribute. Getting them engaged in a virtual care center, where they can be working with patients, supporting patients, and working with care teams, is a phenomenal way to make sure that their wisdom isn’t lost to our healthcare system

Are you seeing creative uses of your system that you didn’t anticipate?

We are seeing a tremendous amount of experimentation with virtual nursing, whereas virtual sitting is a well established use of virtual care in hospitals. People are running new pilots around virtual nursing to test wound care, respiratory therapy, and monitoring patients to keep them out of the ICU. They have put our devices in the hallways to have an extra set of eyes where there’s elopement risk. We do see a fair amount of creativity once you have high fidelity audio and video system with mobile units and units that are wired fully into the room.

What is the company’s strategy going forward?

We are finding a tremendous amount of interest in virtual care, so we are continuing to invest significantly there. As we do that, we are focused on a few things. First, that we continue to make sure that our technology integrates really well with the rest of the technology environment. We’ve unfortunately seen care teams underserved with systems are standalone or not well integrated, and we’ve bulked up in that area.

Second, and this is a bit of an overused term, is artificial intelligence. What that means in our market is computer vision and noticing more about what’s happening in the room. We don’t want to take a care team member out of the chain. We want to augment care team members. But with computer vision, we are seeing success and noticing more about what’s happening in the environment. We know if the patient is in the room or if they are about to leave the room. As we continue to invest in that technology, you can imagine that there are myriad things that we will be understanding, such as an IV bag that is about to be empty or that a tube has been pulled.

We will continue to augment the data layer. As you look in care environments, they are manually run. There’s a lack of data to understand how are we performing, what’s working, and how can we do better. Being able to provide real-time data and visibility into the performance of care units has been highly valued by our customers and we will continue to do more there.

We started with sitting, and now there’s a tremendous focus on nursing, We’ve also seen pharmacists and physicians using the technology. I’ll give you an example. We are working with a micro hospital that wants virtual nursing. They also want a centralized way to bring the specialists into the care team. It allows you to get the right talent to the right place at the right time, improve financials, and get better outcomes.

This is the most energized I’ve ever been in a role. That is because of the opportunity to help hospitals with the staffing crisis, the financial challenges they face, in such a meaningful way. The VA in North Dallas freed up 51 FTEs, so they are able to serve more of our nation’s vets. Being on the forefront of virtual care and acute care has been incredibly exciting. We are making a significant investment into the clinical research that goes along with this so that we can partner with our customers as we work together to pioneer how virtual care can play a role in helping health systems operate effectively going forward.

Morning Headlines 2/15/23

February 14, 2023 Headlines No Comments

UnityPoint ‘MyChart’ app to start charging for messages to doctors

UnityPoint Health (IA) begins charging patients between $36 and $70 for messaging their physicians via its MyChart patient portal, citing the “tremendous increase” in messaging seen since the beginning of the pandemic.

Progress on IT Security Event Tuesday, Feb. 14, 2023

Tallahassee Memorial Healthcare (FL) continues to recover from a February 2 cyberattack, bringing its physician practices and urgent care centers back online and slowly transitioning back to digital documentation.

Oracle Cerner signs contract with Accenture to provide extra electronic health record training for VA clinicians

Oracle enlists Accenture to provide additional Oracle Cerner EHR training to VA clinicians ahead of implementations scheduled to resume this summer.

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