News 5/19/23

Top News

The VA and Oracle Cerner complete their scheduled five-year contract renegotiation.

The VA’s next five-year renewal period will be changed to five, one-year terms.

The revised contract will also include stiffer financial penalties if the Oracle Cerner system fails to meet specific performance metrics.

Reader Comments

From MmSEC Observer: “Re: Veradigm. This is how private equity firms steal shareholder value in taking public companies private. They are pillaging companies that misstep software accounting rules. See Avaya.” Publicly traded digital communications vendor Avaya filed bankruptcy a few weeks ago in a deal that allowed two private equity firm lenders to take control of the company, leaving Avaya’s shareholders with nothing. The company’s problems came to light after executive changes and delays in filing earnings reports that followed a previous bankruptcy filing in 2018. A bondholder class action lawsuit accuses Avaya’s board of “massive fraud” in misleading investors. MDRX shares have lost 34% in the past 12 months versus the Nasdaq’s 4% gain, valuing the company at just over $1 billion.

HIStalk Announcements and Requests

Reminder: if your company sponsors HIStalk and is participating in the MUSE conference, give me details for my conference guide.

Webinars

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

Acquisitions, Funding, Business, and Stock

RCM automation vendor Adonis raises $17 million in a Series A funding round.

Virtual care management platform vendor HealthSnap raises $9 million in a Series A funding round.

CVS Health will close the clinical trials business that it launched in May 2021. The service provided technology-drive patient recruitment, real-world data collection, and clinical trial delivery.

A Business Insider piece says that Oracle is “crushing morale” among former Cerner employees since its $28 billion acquisition of the company by these actions:

• Laying off 3,000 of 28,000 employees.
• Freezing raises and promotions.
• Vacating Cerner’s former buildings in Kansas City.
• Sidelining former Cerner CEO David Feinberg to a “ceremonial” role as chairman of Oracle Health.

Doximity reports Q4 results: revenue up 18%, adjusted EPS $0.20 versus $0.21, beating expectations for both. Shares dropped 6% on the news to their year-ago price, valuing the physician networking company at $6 billion.

NextGen Healthcare reports Q4 results: revenue up 18%, adjusted EPS $0.31 versus $0.19, beating analyst expectations for both but sending shares down on the news. NXGN shares have lost 16% in the past 12 months versus the Nasdaq’s 4% gain, valuing the company at $1 billion.

Sales

• Gundersen Health System will implement cloud-based Visage 7 Enterprise Imaging Platform in its seven hospitals and 65 clinics.
• SUNY Downstate Health Sciences University will implement Memora Health’s care delivery platform.

Announcements and Implementations

Executives for Health Innovation, which was known as EHealth Initiative through 2021, will shut down, 22 years after it was founded.

UF Health will acquire Flagler Health+ (FL), with one of Flagler’s goals being to upgrade its IT systems. Flagler chose Allscripts Sunrise in 2011, while UF Health uses Epic.

UnitedHealthcare takes heat for its decision to require prior authorization for colonoscopies starting June 1, a move that left the American Gastroenterological Association “profoundly alarmed and disappointed.” The insurer says approval will be immediate for procedures that follow evidence-based guidelines and within two days otherwise.

OpenAI launches ChatGPT for the IPhone on the Apple App Store.

Government and Politics

A judge orders Theranos founder Elizabeth Holmes to report to prison to begin serving her 11-year sentence for investor fraud, rejecting her last-minute bid to remain free while she appeals. Holmes and former Theranos COO Sunny Balwani, who is serving a 13-year sentence, were also ordered to pay $452 million in restitution to 12 defrauded investors and former partners Walgreens and Safeway.

An Oklahoma doctor and pharmacist are charged with manslaughter in the death of a 75-year-old rehabilitation center patient from a methotrexate overdose. The physician admitted that he didn’t order correctly, while an investigation found that the pharmacist ignored the computer’s red-letter warning that the prescribed dose of 20 mg of methotrexate daily for seven days – instead of the intended 20 mg every seven days – was excessive.

Privacy and Security

A proposed Federal Trade Commission order would bar ovulation tracking app Premom from sharing user health data in charging the company with making unauthorized disclosures to third parties when its privacy policies claimed it doesn’t. The company will also pay $200,000 in federal and state fines.

Related to the Premom order, FTC seeks comments on its intention to extend the Health Breach Notification Rule to cover health apps.

An Oklahoma allergy clinic shuts down permanently following a cyberattack. The clinic’s physician owner says all of the practice’s technology was impacted when she and her husband downloaded an unspecified IPhone app, locking them out of all of its systems even as patients were receiving appointment reminder text messages. The owner says that the FBI, Department of Justice, and Department of Defense are investigating, but the FBI says it has received no reports about the issue. Social media comments claim that the same doctor abruptly shut down other clinics, including a medical spa, for reasons unrelated to technology.

Sponsor Updates

• Divurgent releases a new episode of The Vurge Podcast, “Digital Mental Health Insights: Breaking the Stigma with Data.”
• Fortified Health Security names Candace Manning (Lifeway) client success manager.
• Loyal wins Best Patient Registration and Scheduling Solution in the MedTech Breakthrough Awards.
• Consensus Cloud Solutions partners with Hyland Software to offer a digital cloud fax solution that integrates with OnBase.
• AvaSure, which offers acute virtual care and remote safety monitoring solutions, establishes a chief nursing executive advisory board with 10 inaugural members.
• CereCore will recruit and train hundreds of EHR and clinical informatics staff over the next one to three years to support HCA Healthcare’s deployment of Meditech Expanse.
• Nordic releases a video titled “The Download: Valuing IT as an Asset to Improve Patient Care.”

Blog Posts

• What does Consensus CTO, Jeffrey Sullivan, have to say about Generative AI? (Consensus Cloud Solutions)
• Can AI Replace Your Doctor? (Dimensional Insight)
• HIPAA: 4 Enforcement Discretions Expire with End of PHE (Experity)
• The key to better, faster innovation: Healthcare data standardization (Intelligent Medical Objects)
• Demystifying Compliance: How Interoperability Solutions Can Simplify Healthcare Regulations (Medhost)
• In Healthcare, an AI Pause Isn’t Feasible. But, an AI Strategy Is. (Lucem Health)

Contacts

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

EPtalk by Dr. Jayne 5/18/23

A colleague clued me in about an article that was published in JAMA Network Open last week, “Perspectives on the Intersection of Electronic Health Records and Health Care Team Communication, Function, and Well-being.” The associated qualitative study looked at the habits of more than 70 attending and resident physicians and found that the EHR dominated most inter-office communication.

Although it can be helpful for management of patient-related tasks, they found that communicating through the EHR limited the “rich communication and social connection required for building relationships and navigating conflict.” The authors suggest that “the technology shifts attention away from the human needs of the care team, and interventions to cultivate interpersonal interactions and team function are necessary to complement the efficiency benefits of health information technology.”

Digging into the study design, I found it interesting that the participants in the qualitative interviews were separated in time, with a significant event in the middle with the emergence of the COVID-19 pandemic. The first of the two cohorts was interviewed from March to October 2017 with the other being interviewed from February to April 2022. The authors called this out as a limitation of the study. They also noted that the first study focused on EHR-related distressing events and their role in physician emotions and actions, where the second study focused on EHR use and “daily EHR irritants.”

I would propose that in a post-pandemic world, even the smallest of daily annoyances is felt much more acutely than it might have been in 2017. This is exacerbated by the staffing and financial pressures that have been magnified since the pandemic’s start in 2020. I’d be interested to know what the relative level of staffing was during the two cohorts’ interview periods, since a significantly understaffed practice will yield different sentiments than one that is running with adequate staffing. Interestingly, information on respondent demographics wasn’t collected.

The authors also note that communicating through the EHR was felt to negatively affect team function and team well-being, namely by “promoting disagreement and introducing areas of conflict into team relationships related to medical-legal pressures, role confusion, and undefined norms around EHR-related communication.” There was specific discussion of physicians being expected to manage EHR-related messages across multiple platforms such as in-basket, email, and text.

One interviewee compared this to driving a car before stoplights were developed. “Some of my colleagues text; some of them send it in… email; some of them send it as Epic provider-to-provider messages. What a mess… there’s no sort of manners and rules. Right? Sort of like… before they developed stoplights, and there were starting to be more and more cars. Right? Man, this is nuts. It’s like, ‘Who’s going first. Who’s talking to who?’” I feel that frustration, especially when you look at the fact that different platforms might offer different subsets of functionality that can be confusing.

In some of my experiences with startups, we ran into this with differences in what IOS versus Android platforms would support, and even with IOS, on what might work on iPhone but not on iPad. This is magnified when you’re dealing with a full-feature EHR that people are trying to use from disparate platforms. You can also throw in some desktop support requirements and the Apple Watch and it’s a doozy.

I tend to only perform “real work” on a laptop or desktop, so I can’t imagine the cognitive overhead that people who try to manage on different platforms are experiencing as they try to remember which device will allow them to do what. Especially with portable devices, people are also trying to use EHR-based communication while doing other things, such as attending events with family, which adds a layer of distraction to what might already be some fairly brief communications.

Others in the study noted that “now that I can place an order from anywhere, everyone assumes I can place an order from anywhere, and expects me to do so anywhere, anytime.” In my experience, this blurring of personal and professional time adds to clinician burnout and resentment towards the workplace.

I was saddened to read the part of the article where they discussed the EHR being used to air disagreements, including clinicians who “would document petty, kind of nasty comments in the EHR about residents.” Others noted that concerns about potential litigation may “put people under the bus” in the EHR with documentation about who was paged and when, and whether the response from the contacted clinician was to their satisfaction. There were also the expected comments that delivery of care to the patient has “completely been subsumed in documentation requirements.”

The authors noted that there is a need for greater understanding of optimal EHR use and that “the development and improvement of local work culture is critical and may have a greater influence on physician burnout than EHR improvements alone.” They go on to suggest that “organizations support physicians in implementing small, structured peer-group discussions to enhance team function and individual well-being.” I’m a big fan of the concept of self-organizing teams and the latter comment resonated with me. People need to be able to talk about how they like to be communicated with, and any additional needs they have in processing information, but may not be likely to address these needs unless it’s clear that the workplace is supportive of accommodating them.

I received quite a bit of reader mail about my recent Curbside Consult that talked about May being graduation season. Many readers have graduates in their families and it sounds like there is an even split between those going into technology-related fields and those pursuing careers in the arts and humanities. A couple sent pictures of their graduates and it was great to see the proud parents and the excited faces of the graduates in the photos. One correspondent noted that her daughter is headed to work for Epic, with another sending a child to a public health organization. They’re looking forward to seeing what their children think about the industry after seeing it from another side. I’m sure new entrants to the healthcare field have an entirely different idea of what it will be like than many of us did 10 or even 20 years ago.

What did you think healthcare IT would be like when you first started in the industry? Has it met your expectations or crushed your dreams? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 5/18/23

Neura Health Secures $8M in Financing to Support Go-To-Market Expansion to Employers and Health Plans

Virtual neurology clinic Neura Health will use $8 million in seed funding round to expand into enterprise markets.

Ovulation Tracking App Premom Will be Barred from Sharing Health Data for Advertising Under Proposed FTC Order

Easy Healthcare, developer of the Premom ovulation-tracking app, will pay a $100,000 fine for violating the FTC’s Health Breach Notification Rule.

Investing in Hippocratic AI

Andreessen Horowitz’s A16Z invests $50 million in seeding funding for Hippocratic AI, which offers a safety-focused large language model for healthcare.

Readers Write: Bringing the Call Center Into the 21st Century

Bringing the Call Center Into the 21st Century
By Ben Moore

Ben Moore is chief product officer of PerfectServe of Knoxville, TN.

Like some of you, I was compelled to dip my toe in the healthcare waters because of a personal experience.  It was over a decade ago, but I still remember it like it was yesterday.

My wife was pregnant with our daughter, who came weeks before her due date. Both my wife and daughter faced serious complications, and my stress level was exacerbated significantly by care delays that seemed almost entirely caused by inefficient communication. Simple questions and follow-ups that should have taken minutes ended up taking hours. These delays put both my wife and daughter’s health and safety at risk. 

For example, to reach the specialist, a nurse would have to call the hospital operator, who then had to manually track down and page the correct specialist on call, which would often start a process of telephone tag among nurses, operators, and physicians. The physicians were, and in some cases still are, carrying one-way pager devices, which would cause lots of disjointed one-way communications.

At that time, we had purchased the first-generation 3G-connected iPad for my wife while she was in the hospital. She was able to instantly text friends and family from her hospital bed and engage in social media. I was perplexed. Why weren’t the care teams in the hospital equipped with similar state-of-the-art communication tools? My wife was able to engage in real-time and media-rich communication, but hospital staff were limited to 140-character alphanumeric pager messages, telephone callbacks, and voicemails. The contrast was stark, and to be frank, seemed a bit ridiculous.

I can tell you that archaic technology and processes like the ones I described above are still prevalent across healthcare today. As just one example, even though over 70% of communications into and out of a hospital run through the call center, these antiquated tools are still, in many cases, a major part of directing that very important traffic. That’s alarming.

By upgrading technology that has its roots in the 1990s, the call center can become a true hub for patient engagement and clinical collaboration. Here are four steps you can take to bring the call center into the 21st century. 

1. Head for the cloud. Eighty percent of call center systems still use on-premise technology. This is problematic, because you’re only going to reliably connect stakeholders across all sites of care with a cloud-based solution. I once witnessed a fan blow up on a hospital PC server, and it completely knocked out communication with incoming ambulances. With a cloud-based system, this kind of risk is gone. If your EHR is already in the cloud, your call center should be there, too.
2. Unify clinical and patient communication. Rather than forcing operators to play middleman, go with a system that allows providers to communicate directly with patients. This kind of setup can be achieved within a broader ecosystem that facilitates both clinician-to-clinician and patient-to-clinician communication, meaning all communication is initiated and captured in one platform. This means less complexity for providers, easier access for patients, and greater transparency — especially with EHR integration — for anyone who needs to reference communication history.
3. Integrate, integrate, integrate. Speaking of integration, I actually think it should be a bigger focus for the call center than things like analytics or standard performance metrics, which you find in most call centers today. A properly executed integration plan can reduce the manual labor of operators by over 80%. Key integrations should include the EHR, patient flow systems, CRM, and scheduling platforms to provide operators with a single pane of glass.
4. Embrace smartphones. You need a call center platform that embraces smartphones. The vast majority of physicians use them, and integrating them with the call center ecosystem allows for things like time-sensitive communication — say, a team alert initiated by an agent about an incoming hip fracture patient — that can actually be monitored to verify that recipients have received and read all necessary information. No more guesswork! And please, whatever you do, make sure to ditch the pagers. No agent wants the page-and-pray technique to be central to their everyday duties.

Clinical call centers — like hospital switchboards, patient transfer centers, and answering services — can have a tremendous impact on everything from care coordination to patient experience to health outcomes. After decades of neglect, it’s time to give them the modern infrastructure they deserve to unleash their true potential.

Healthcare AI News 5/17/23

News

OpenAI rolls out 70 third-party plug-ins for ChatGPT that allow Plus users to access Internet content, retrieve information from specific sites such as Expedia, analyze online PDF documents, and create integrations with Zapier. The Link Reader plug-in, which I tested above, allows ChatGPT to analyze live web pages.

The World Health Organization expresses enthusiasm for using AI in healthcare, but recommends cautious adoption to avoid errors and patient harm due to AI training bias, incorrect or incomplete responses that appear authoritative, and its possible use to generate convincing health disinformation.

Google enhances its Bard generative AI tool with a new version of its PaLM 2 large language model, adds connectivity to a user’s Google apps and services, and provides support for plug-ins.

Google also introduces Duet AI for Google Workspace, which adds AI creation to Gmail and Docs similar to Microsoft’s Copilot for Office 365.

Google’s Med-PaLM 2 is being tested to analyze diagnostic images and answer questions about its summary.

Business

Andreessen Horowitz’s A16Z invests $50 million in seeding funding for Hippocratic AI, which offers a safety-focused large language model for healthcare. The company says that its model outperforms GPT-4 and uses clinician-validated model training that avoids bias and sources that aren’t evidence based.

BeeKeeperAI announces GA of EscrowAI, which allows HIPAA-compliant research on full PHI without exposing patient data or the algorithm’s intellectual property. The company says it acts as a “middleman and matchmaker between data stewards and algorithm developers” to reduce the effort and cost of data projects by 50%. The company was created at UCSF’s Center for Digital Health Innovation by that organization’s founder, UCSF Health Chief Digital Transformation Officer Michael Blum, MD, who serves as BeeKeeperAI’s CEO.

BayCare Health System and HealthPrecision will co-develop AI tools for nursing decision support and clinical documentation, where the system will translate nurse dictation into EHR documentation and suggest additional steps. The co-founders are Eyal Ephrat, MD and Sonia Ben-Yehuda, who together created MedCPU and PeriGen.

Research

Kaiser Permanente will award grants of up to $750,000 to three to five US health systems to study the use of AI and ML to improve diagnoses and outcomes.

Opinion

FDA Commissioner Rob Califf, MD says that large language models appear to be ushering in a fourth industrial revolution that includes healthcare, but they need to be regulated now to avoid society being “swept up quickly by something that we hardly understand,” also adding that methods need to be developed to measure and adjust the operating characteristics of algorithms based on real-life experience.

Physician and author Elisabeth Rosenthal, MD, MA says in an opinion piece that startups are offering apps and devices that address mental health therapy as an alternative to short-supply professionals, but most of them aren’t supported by outcomes research, haven’t been reviewed by FDA, and contain small print that reminds users that they are not intended to provide actual clinical services. Experts say the apps use a workbook-like approach for specific problems, which doesn’t address complexity or offer the empathy between patient and doctor that many therapy types require.

Other

The UK government issues guidance about when sellers of software as a medical device must report adverse incidents to the Medicines & Healthcare Regulatory Agency.

Contacts

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

Morning Headlines 5/17/23

VA Signs New, Tougher Contract with Company Handling Faulty Electronic Health Records Rollout

The VA signs a one-year contract, renegotiable and renewable for up to five years, with Oracle Cerner to extend its work on the department’s EHR Modernization program

Ambient Intelligence Streamlines Clinical Burden, Patient Safety and Compliance, Black Book Survey Announces Top AI Workflow Solutions

A Black Book survey of health system IT leaders finds that Care.ai is the top emerging ambient intelligence solution.

Laguna Health gets $15M to be a Waze for care transitions

Care management technology startup Laguna Health raises $15 million in a Series A funding round led by SemperVirens and HC9 Ventures.

News 5/17/23

Top News

Connected health company Validic acquires Cox Communications subsidiary Trapollo, which offers technology and services that help healthcare organizations care for patients at home.

The companies had previously partnered to support a West Coast IDN’s personalized care program.

Cox will become an investor in Validic as part of the acquisition.

Reader Comments

From Vera Dime-a-Dozen: “Re: MDRX, formerly Allscripts and now Veradigm. Were supposed to restate their 10K on May 8, but it has been postponed to mid-June as the internal audit continues to identify issues.” The company says in a recent SEC filing that it hopes to file the 10-K by June 14, but can’t guarantee it. The company announced on March 22 that the year-end audit and 10-K filing would be extended because of “internal control deficiencies related to revenue recognition.” Veradigm expects the audit to have a revenue impact of $40 million that will require restating its 2021 financials.

HIStalk Announcements and Requests

Gmail suddenly started sending legitimate incoming emails to  spam a few weeks ago, I noticed yesterday, including entries from the Rumor Report and Contact forms. I added some inbox rules that should fix that, but let me know if you didn’t receive a reply that you expected.

Attention HIStalk sponsors that are participating in the MUSE Inspire conference June 7-10 in Aurora, CO — send me your details and I’ll include them in my online list of sponsor activities there. I see some sponsor names sprinkled among those companies that have booths in the sold-out exhibit hall of the conference’s 40th anniversary.

Webinars

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

Acquisition, Funding, Business, and Stock

Healthcare pricing transparency startup Cascade Health raises $1.7 million in venture funding. It has developed healthcare pricing APIs and an AI-powered chatbot that answers patient questions about procedure pricing and insurance coverage. Co-founders Ana-Maria Constantin and Pulak Goyal hail from Microsoft.

People

Divurgent CEO Ed Marx announces on LinkedIn that he has left the company after one year and will work as an independent consultant. The company made no announcement, but its leadership page shows that founder Colin Konschak, RPh, MBA, who stepped down from the CEO job in May 2022 but remained board chair, is again serving in both roles.

Dale Sanders, chief strategy officer of Intelligent Medical Objects, resigns to take a one-year professional break.

CereCore promotes Peyman Zand, MBA to chief strategy officer.

HCTec hires Bill Lewkowski (Lewkowski Associates) as VP of strategic client services.

Rhapsody names Jeff Chiumiento (Rocket Software) as CFO.

Jason Prestinario, MS (Komodo Health) joins Particle Health as CEO.

Jane Casey, RN, MS (Humber River Hospital) joins Tampa General Hospital as VP of CareComm Operations, its clinical command center.

Zyter|TruCare names Kevin Riley, MBA (Salesforce) as  president and CEO.

John George (Validic) joins Gozio Health as chief sales officer.

Sales

• Piedmont Healthcare (GA) will launch a remote patient monitoring program using RPM software from Telemetrix and devices, care management, and coaching from Remote Care Partners.
• The University of Mississippi Medical Center selects remote patient monitoring software, services, and resources from AMC Health.

Announcements and Implementations

CHIME opens registration for its Fall Forum November 9-12 in Phoenix, AZ for its provider members.

The West Hawaiʻi Region of Hawaiʻi Health Systems will go live on Epic June 1 through a Community Connect partnership with The Queen’s Health System.

Hendrick Health (TX) launches a wayfinding app developed by Gozio Health.

A Connected Health Initiative survey finds that 89 million Americans use a wearable device, with fitness tracking being the most common use followed by sleep and weight monitoring. Nearly all of the users are sharing data with their healthcare provider or are willing to, while 40% of those with a chronic condition say that the device has simplified their health management. More than half of HSA/FSA participants who don’t have a wearable say they would be more likely to buy one if they could fund the purchase from those accounts.

Government and Politics

Minnesota lawmakers are planning make a single exception to the state’s proposed patient-to-nurse hospital staffing ratio regulation for Mayo Clinic, which threatened to pull billions of dollars worth of investments out of the state in protest over the bill and another involving price transparency. House Speaker Melissa Hortmann says the exception is justified because “Mayo is different” and “an asset that is known all over the world.” Draft legislation would exempt hospitals that aren’t in the Twin Cities, that use an electronic nurse acuity system, and that have 40% of patients coming from out of state, requirements that only Mayo in Rochester meets.

Other

Netsmart earns top user satisfaction rankings among behavioral health technology vendors, according to a Black Book survey of 2,847 end-users.

UF Health launches tele-pharmacy kiosks from MedAvail Technologies at three of its ERs. Newly discharged patients can virtually consult with a pharmacist and pick up medications within about five minutes.

A Black Book survey of health system IT leaders finds that Care.ai is the top emerging ambient intelligence solution. The company has deployed AI solutions for infection prevention and control, patient and protocol monitoring, workforce optimization, and virtual care in 1,500 organizations.

A researcher warns that companies are rolling out AI-powered search tools for academic databases and research journals without understanding the opportunities and limitations of those tools. The author calls for evidence-based groups to audit individual search tools and publish their suitable uses so that research projects aren’t skewed.

Sponsor Updates

• Ellkay, which participates annually in the Go the Distance for Autism biking event, seeks donations to help it meet its fundraising goal of $35,000.
• Artera expands its online learning center, Artera Academy, to include an improved user dashboard, integrated events hub, and more accessible learning resources.
• Baker Tilly releases a new Healthy Outcomes Podcast, “The current state of cybersecurity in the healthcare industry.”
• Nordic publishes a podcast titled “Designing for Health: Dr. Adam Wright.”
• Bamboo Health will exhibit at the Medicare Star Ratings, HEDIS, Quality Assurance & Risk Conference June 5-7 in Chicago.
• Biofourmis will sponsor the Hospital @ Home Leadership Summit June 5-6 in Boston.
• CloudWave will exhibit at the NRHA Annual Rural Health Conference through May 19 in San Diego.

Blog Posts

• Specialty Pharmacists Get a Seat at the Table (Surescripts)
• Happy Birthday to Advanced Reporting & Analytics! (AdvancedMD)
• Revenue Integrity: Healthcare’s Growing Need (AGS Health)
• The Modern Odyssey: How do I find a ‘good doctor?’ (Amenities)
• Looming crisis: managing Medicaid redetermination as the PHE ends (Arcadia)
• Three Lessons for Optimizing Corporate Events (Ascom)
• The Butterfly Effect: Azara 2023 Annual User Conference Highlights (Azara Healthcare)
• How high-fidelity data could drive better predictive care and research insights (Philips Capsule)
• Creative Staffing Coordination for Budget-Friendly Epic Implementations (CereCore)
• How CCM Can Help Your Urology Practice (ChartSpan)
• Connecting to Greater Possibilities and Providing Care Anywhere (CHIME)

Contacts

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

Morning Headlines 5/16/23

Personalized Care Company Validic Acquires Trapollo

Digital health company Validic acquires Cox Communications subsidiary Trapollo, which offers technology and services that help healthcare organizations care for patients at home.

Practice Perfect Acquires an Ownership Stake in Clinical Billing Solutions to Provide Revenue Cycle Management Services

Practice Perfect acquires Clinical Billing Solutions, and will integrate the RCM vendor’s software and services with its EHR and practice management system for outpatient rehabilitation clinics.

Cascade Health Announces Venture Funding Round to Build Intelligent Platform for Healthcare Transparency

Healthcare pricing transparency startup Cascade Health raises $1.7 million to further scale its AI-powered chatbot designed to answer patient questions about procedure pricing and insurance coverage.

Curbside Consult with Dr. Jayne 5/15/23

May can be a busy time for families who have graduates. When I was in Madison last week, I saw plenty of people who were taking pictures at the state capitol wearing caps and gowns. It was fun to see their excited smiles and to wonder where they are heading next on life’s adventures.

This weekend, I attended a graduation at my state’s flagship engineering and technology school, and it didn’t disappoint. It was inspiring to see so many people going into careers in science, technology, engineering, and math fields. It was particularly gratifying to see the number of women graduating in fields that have been historically male dominated, including geophysics, mining, metallurgy, and explosives engineering.

Due to the size of the ceremony, graduates of various departments were recognized in groups by their majors before coming to the stage individually to receive their diplomas. Although mechanical engineering was dominant at the ceremony I attended, there were quite a few aerospace engineers and a surprising number of metallurgical engineers who had the most stylish hair, shoes, and eyeglasses in the crowd. In addition to computer science and computer engineering, degrees from a new program in information systems and technology were also conferred.

The “best decorated graduation cap” honors goes to the biology major who had three Petri dishes affixed to her cap, along with the metallurgical engineer who had gilded designs on the top of hers. Several of the biology majors had plush bacteria toys dangling with their tassels after being gifted them from their department chair. During the departmental recognitions, the audience figured out that there was a lone economics major among the hundreds of graduates, and he received some extra applause and cheering.

I sat next to the mother of one of the information systems graduates and was learning a bit about the new program and how it was founded as part of a major donation to the university. That funding led to the addition of a college that covers entrepreneurship, information systems, technology management, and more. Although some of those disciplines existed previously as part of the college of engineering, it’s interesting to see them grouped together under a new umbrella.

My assumption is that the new organizational structure also helps ensure that they’re funded in the way that the donor intended, rather than the money being washed through a larger department and potentially sidetracked. Since the new college carries the donor’s name, it also needed to contain actual departments, so I’m sure that was a factor as well. According to his mother, that new graduate interviewed at a healthcare software company, but she wasn’t sure which one it was.

Being well into my career, it’s sometimes easy to forget what those milestones that our younger selves experienced meant to us at the time. I don’t have deep memories of my college graduation other than lining up in the bowels of the basketball arena with other graduates in my department and singing our school song for what would be my last time. (I admit, I haven’t visited since graduation, but I’ll be doing that later this month as part of a milestone road trip with my former college roommate.) I remember my medical school graduation in great detail, especially the processional that involved bagpipers and a parade down a couple of escalators. With the bagpipes and the gowns and hoods and having been through the wringer during the four years prior, it seemed quite surreal at the time.

I also remember the fact that the main speaker failed to follow the program, which led to us not being administered the appropriate oath (in our case, the Oath of Geneva rather than the Hippocratic Oath) during the ceremony. They tried to rectify that after the ceremony concluded, but many of us had already scattered to meet with families and loved ones.

I’ve made use of that fact at least once in my career, when a patient was upset that I wouldn’t give her what she wanted and told me that I had to do it because “you took an oath.” I said very calmly that actually I didn’t take that particular oath, but that wasn’t going to keep me from giving her high-quality, evidence-based care regardless of the fact that it wasn’t what she wanted on that particular day. I think most of us in medicine would agree that the core values we follow are ingrained in us long before any oaths become topics of discussion, and that we don’t need to say prescribed words to do the right thing. Quite a few medical schools allow their incoming classes to write their own oaths during the first year, enabling them to memorialize values and intentions that are important to them.

There are situations where oaths are important, and I was able to experience one of those as well while attending my first ROTC officer commissioning ceremony as part of the graduation festivities. During that ceremony, a military officer administers the Oath of Office to each newly appointed Second Lieutenant, and then family members or loved ones help pin on their ranks. They also receive their first salute from an enlisted service member who has been important to them. It was interesting to see who the cadets chose to perform the different parts of the ceremony. Some of them had relatives who were officers administer the oath, one had a former scout leader who was a naval officer do his, and one woman received the oath from her husband who graduated and was commissioned last year. The most touching was the cadet who had his grandfather, a Korean War veteran, give his grandson the first salute. There were few dry eyes in the house after that one.

It was inspiring to see these young people, most of whom could have headed off to solid careers in engineering or technical fields, commit to serving their country. Instead of following the money, they’ll be supporting our military as cybersecurity resources, civil engineers, logistics coordinators, pilots, and missile operations officers.

The latter job role is one that most people don’t think about. It feels strange to understand that in a world where so many people are focused on what they see on TikTok or Instagram, we have officers underground 24×7 ready to launch what might be world-ending missiles should the order arrive. Knowing that gives me a new perspective on my daily work struggles or the things that some of us think are emergencies on any given day. There’s a lot of uncertainty in the world that these newly minted officers are headed into, but I have high hopes that this generation has leaders among it that can do a better job than what we might be seeing today.

Are you headed to any graduations this spring, and what are your hopes for the futures of these recently degreed individuals? Are graduates gravitating to technical fields or finding their futures in the arts or humanities? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: Should Health Systems Become Banks?

Should Health Systems Become Banks?
By David Stievater

David Stievater, MBA is a partner with CWH Advisors of Boston, MA.

Are healthcare organizations expected to now run banks in addition to delivering patient care services? To help patients pay for their care, providers have become lenders, offering patients the equivalent of unsecured, zero-interest loans backed by hospital balance sheets. It should come as no surprise that with additional financial stress lingering from the COVID pandemic, providers are looking for additional funding sources and financing alternatives for their patients.

Overall US healthcare spending hit 18% of GDP in 2021, up from 5% in 1960. Total patient out-of-pocket spending, not including insurance premiums, totaled $433 billion, according to the latest numbers from CMS. The out-of-pocket dollars owed by patients has risen at twice the rate of US GDP growth since 1960. More and more, patients find they do not have the cash on hand to cover medical expenses.

The financial challenges facing patients are well documented. In 2021, the Federal Reserve Board reported that 17% of adults had major, unexpected medical expenses in the prior 12 months, with the median amount between $1,000 and $1,999. The same research also said that 23% of adults went without medical care due to an inability to pay. These types of findings are corroborated by other reports, including Synchrony Financial’s Lifetime of Healthcare Costs study in 2022 in which one in four individuals said they delayed a recommended procedure due to cost. The Synchrony study also indicated that when care was delayed due to cost, respondents ended up with additional medical issues 50% of the time.

Patients will benefit from more funding sources and options to reduce and eventually pay off balances owed to healthcare organizations.

Unlike other industries, providers generally bill patients after care is delivered. They carry the patient balance owed to them as a receivable, to be collected once insurance has calculated its portion. By billing after the fact, providers essentially make unsecured loans to patients.

Many decades ago, when the patient portion of provider revenues was relatively small, it was common for unpaid patient balances to simply be written off. It wasn’t worth the effort to pursue them. Providers did not tend to accumulate large unpaid patient balances on their books for long.

Over time, as the size and frequency of uncollected patient fees grew, provider organizations looked to new propensity-to-pay algorithms, early pay discounts, early out vendors, recourse financing, pre-service collection of co-pays, in-house payment plans, and other tactics to increase the yield on the amount owed by patients. Debt collectors were asked to pursue patients deemed able to pay. In some unfortunate cases, the most aggressive health systems have sued patients (including their own employees) to recover unpaid balances.

Provider executives say they work hard to balance compassion for patient circumstances with a desire to collect from patients who they believe can afford to pay at least some of what they owe. Additionally, they would prefer not to be in the lending game and tie up so much of their balance sheet with unpaid patient balances.

We estimate that 45-55% of a typical health system’s patient balance, after insurance (including full self-pay), is never collected and is converted to charity care, some other form of financial assistance, or written off as bad debt. Providers too will benefit from offering patients more options to fund their care and reduce and eventually pay off balances.

Our 2022 PatientPay study — which included 38 in-depth interviews with executives at health systems, hospitals, and large single/multi-specialty medical groups — indicated that providers will increasingly look outside their organization for solutions. One hospital CFO said that “a lot more people are going to finance their portion of what they owe,” Another revenue cycle executive said, “We are definitely going to provide more third-party financing options and less in-house over the next two years.” Overall, 61% of the executives said they expect to make greater use of third-party patient financing over the next 24 months.

Part of the impetus to look externally for payments solutions is that the COVID pandemic has made it harder for healthcare organizations to staff their revenue cycle operations. Still, much of the motivation to seek third-party assistance is simply the need to find more flexible payment and financing options for patients that free up the health system’s balance sheet.

The study noted that the biggest investments by large provider organizations are centered on creating a more retail-like payment experience for patients. COVID pushed more dollars here immediately in the form of contactless terminals and accelerated efforts around card-on-file and other portal-based technologies. Patients can expect improved communication via portal-driven emails, text to pay, and mobile applications.

Entrepreneurs are also putting their creative minds to work and generating new solutions to help providers match their patients with available financial assistance and philanthropic programs. Companies such as TailorMed/Vivor, Annexus Health (AssitPoint), RIP Medical Debt, and Atlas Health claim their approaches are generating meaningful ROI for providers.

Longer term, providers must focus on providing patients with an accurate estimate of their costs. This will enable them to collect the patient responsibility before care is delivered, without waiting for insurance adjudication and without turning their healthcare organization into a lender.

Morning Headlines 5/15/23

Prognos Health Raises $23 Million

Real-world healthcare data marketplace operator Prognos Health raises $23 million in growth equity.

HC3: Sector Alert – Veeam Backup & Replication Latest Threat Actor Target

The Health Sector Cybersecurity Coordination Center warns organizations that hackers are exploiting vulnerabilities within Veeam Backup & Replication software.

Just-launched initiative aims to capitalize on Kansas City’s promise as a global leader in health tech, renews call for KC investment

Digital Health KC launches to encourage health technology professionals, especially those who worked for Cerner or other Kansas City-based companies, to return to the area.

Monday Morning Update 5/15/23

Top News

Real-world healthcare data marketplace operator Prognos Health raises $23 million in growth equity.

The company offers life sciences customers access to the integrated lab and health record data of 325 million de-identified patients.

The co-founders are Sundeep Bhan and Jason Bhan, MD.

HIStalk Announcements and Requests

Most poll respondents say their employers haven’t dialed back remote work options.

New poll to your right or here, inspired by Dr. Jayne’s XGM recap: What behavior of fellow conference education session attendees do you find most annoying? I am most bugged by those who charge the microphone during Q&A to deliver pontification that is poorly disguised as a question, which clears the room like someone yelling “fire” in a theater. If your insecurity doesn’t allow you to sit quietly while someone else holds the audience’s attention, then sign up as a presenter next time.

My best HIMSS23 takeaway was an first-timer’s appreciation for Chicago’s chicken Vesuvio, which I made at home this weekend with great success. It sounds unexciting on paper, but is brilliant.

Welcome to new HIStalk Platinum Sponsor Lucem Health. The Raleigh, NC-based company transforms the science of clinical AI into trusted point-of-care solutions that scale. With its comprehensive, AI-agnostic platform for building, operationalizing, and improving clinical AI solutions, Lucem Health brings the full power and potential of clinical AI from the lab to the front lines of healthcare, where it can help clinicians deliver better care, improve patient outcomes, and lower costs. The company envisions a world in which clinicians detect problems before they become life-threatening and patients get world class care, everywhere. Thanks to Lucem Health for supporting HIStalk.

I found this overview of Lucem Health on YouTube.

Webinars

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

Acquisitions, Funding, Business, and Stock

Digital Health KC launches to encourage health technology people, especially those who worked for Cerner or other KC-based companies, to return to the area. The CEO is former Cerner executive Dick Flanigan.

Sales

• Emory Healthcare will implement NeuroFlow to provide behavioral services in a collaborative care model with its primary care clinics.

Announcements and Implementations

Victoria, BC-based Island Health celebrates Canada’s National Nurse Week by honoring the nurses who are working to implement its Oracle Cerner EHR.

The senior director of the Collaboration to Harmonize Antimicrobial Registry Measures (CHARM), which analyzes the EHRs of participating organizations for current prescribing practices, says that up to 80% of outpatient antibiotic use is inappropriate, either because the drug isn’t needed or is ordered incorrectly.

Epic updates its Epic Research Data Tracker to publish every-other-week metric updates on respiratory illnesses and other topics using data from Cosmos, allowing continuous monitoring that is often beyond the capability of public health organizations.

John Snow Labs posts demos of AI-powered models that can summarize clinical text, medical journal articles, consumer medical questions, and radiology reports.

Privacy and Security

HHS’s cybersecurity center warns that Veeam Backup and Replication software contains a vulnerability that hackers are exploiting.

Other

In England, the mother of a 19-year-old patient whose hand was bruised significantly during a blood draw shows the hospital a photo of the nurse watching soccer on his phone as he stuck her. The trust says the nurse was on break and decided to treat the patient anyway, which the mother says isn’t true. However, the trust adds that it will be more diligent about staff members using phones at work.

Sponsor Updates

• Netsmart customers celebrate key milestones at the company’s CONNECTIONS2023 conference in Washington, DC.
• Meditech recognizes the Institute for Health Metrics as their data collaborator to support and accelerate health equity at hospitals across the country.
• Surescripts releases a new episode of its There’s a Better Way Podcast, “Getting to Interoperability 2.0 with ONC’s Micky Tripathi.”
• Netsmart will integrate Findhelp’s closed-loop referral solution with its CareFabric platform.
• Magellan Healthcare details the success it has seen with NeuroFlow’s integrated behavioral healthcare solutions.
• Nordic will present at the AMIA 2023 Clinical Informatics Conference May 24 in Chicago.
• PerfectServe honors over 200 outstanding nurses in its third annual Nurses of Note Awards program.
• Tegria will exhibit at the MUSE Inspire Conference June 7-10 in Denver.
• Zynx Health parent company Hearst Health names Stanford Medicine the winner of the Hearst Health Prize in partnership with the UCLA Center for SMART Health.

Blog Posts

• Healthcare Hinges on Interoperability and Exchanging Quality Information (Surescripts)
• Why a 4K video about Meditech’s Might? Because it’s a once in a generation story we can all learn from (Meditech)
• Healthcare Compliance Risk Management Strategies for Effective Implementation (Net Health)
• The future of ambulatory care, part 3: The practical benefits of Dragon Medical One for ambulatory care clinicians (Nuance)
• The Top 6 Things That Pharmacies Need to Know About the Ending of the PHE (OmniSys)
• AI Interventions to Quench Burnout (Pivot Point Consulting)
• Nurses of Note Awards 2023: The Nursing Team at Blue Mountain Hospital, a Critical Access Facility (PerfectServe)
• Optimizing Front-End Revenue Cycle Management: The Power of Prior Authorization (PMD)
• Five Ways AP Automation Can Ease Burnout, Turnover in a Healthcare Organization’s Finance Department (Premier)
• The Unique Challenges Facing Caregivers of Veterans (Trualta)
• We must do better: alignment, evidence & clear care pathways are available now (Volpara Health)
• Develop a data-rich dashboard: Which medical billing metrics matter? (Waystar)
• How to Make a Hybrid PT Practice Work (WebPT)

Contacts

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

Morning Headlines 5/12/23

Amino Health Secures $80 Million in Financing to Accelerate Growth and Product Innovation

Amino Health, whose platform guides members to cost-effective providers, raises $80 million in financing.

Lavita AI Raises $5M Seed Financing to Launch the First Patient-Driven Health Information Marketplace to Accelerate Life Sciences Innovation

Lavita, whose health data marketplace platform allows people to control and monetize their digital health information for purposes such as clinical trials recruitment, raises $5 million in seed funding.

Richmond University Medical Center suffers ransomware attack; unclear if patient info compromised

Richmond University Medical Center (NY) works to recover from a ransomware attack that has caused network outages for the last week.

Meta punts pixel tool responsibility, says privacy fault is on providers

Meta files a motion to dismiss a class action lawsuit that accuses the company of privacy violations for sharing the medical data of users with advertisers via its Facebook Pixel website tracking tool.

News 5/12/23

Top News

London-based, digital-first primary care operator Babylon Health will take itself private, 18 months after it went public in a SPAC merger that the CEO says was a “big mistake.”

The company just reported Q1 results: revenue up 17%, EPS –$2.53 versus –$1.71, with shares falling 84% in the past two days on the news.

BBLN shares have lost more than 99% of their value since trading began on October 22, 2001, with the market capitalization of the one-time high flyer sliding from $4 billion to $30 million.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Amenities. The Dallas-based company helps health systems grow top-line revenues and earn scalable ROI. Its Digital Membership Platform is a suite of e-commerce tools designed explicitly to: (1) Acquire new patients: Verify identity and register new patients with full EMR and patient portal accounts in under 30 seconds, with just one question. That means zero data entry, photo uploads, or duplicate accounts. (2) Upgrade tools (i.e., MyChart). Improve the design, usability, and conversion rate of critical revenue drivers like provider search, provider profiles, appointment scheduling, and proxy management. Additionally, aggregate and promote same-day care options in one simple place and maximize the visibility and usage of all access options.(3) Win patient loyalty. Create memberships designed explicitly to help keep patients in network. Build personalized experiences for members (i.e., health plan, ACO, D2E, MA, or other VBC groups) with custom networks, care options, vendor services, pricing, and more. Or, better yet, offer highly unique and market-tested features like a financial package that includes “no surprise billing” guarantee, transparent pricing, affordability scores on providers, and more. You may well know CEO Aasim Saeed, MD, MPA, who launched the company in 2021 after serving as VP of digital health for Baylor Scott & White Health. Thanks to Amenities for supporting HIStalk.

A wise company has taken advantage of my “Small Booth Special” first-year sponsorship discount for non-sponsors that occupied a 10×20 or smaller HIMSS23 booth. Get with Lorre by June 1 to shed the small-booth stigma and enjoy the same ad size as everyone else, a prime location that isn’t just a waypoint on the way to the bathrooms, and a 365-day audience of heavy hitters instead of those looking for a quiet part of the exhibit hall to make phone calls.

Webinars

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

Acquisitions, Funding, Business, and Stock

National medical group Envision Healthcare is planning to file Chapter 11 bankruptcy as it struggles with $7 billion in debt, high labor costs, and federal legislation that has limited the company’s key business model element of surprise medical billing. KKR, which took the company private in 2018 in a $10 billion deal, will likely lose its entire investment.

Amino Health, whose platform guides members to cost-effective providers, raises $80 million in financing. The company previously pivoted from direct-to-consumer sales to focus on self-insured employers, health plans, and third-party administrators.

Lavita, whose health data marketplace platform allows people to control and monetize their digital health information for purposes such as clinical trials recruitment, raises $5 million in seed funding.

Business Insider lists the digital health market predictions of several healthcare bankers, which include:

• Behavioral health care companies will consolidate by merging.
• Companies that sell to employers will need to consolidate to improve their clinical models in an environment where companies are reducing their vendor count.
• Companies that will address healthcare labor shortages with AI will be attractive to buyers if they can prove ROI.
• Companies that address value-based care will continue to draw funding and interest.
• Startups that are struggling to reduce costs or raise money will need to consolidate to find a path to profitability, and private equity firms will sell some of their holdings even at less-attractive valuations.
• M&A, rather than IPOs or funding rounds, will dominate digital health.
• The digital health market will make a comeback within a year and well-capitalized firms are already targeting acquisitions, especially of companies that can use data to reduce waste and administrative complexity, automate standard protocols, and increase health system productivity.

Sales

• Center for Minimally Invasive Neurosurgery chooses EClinicalWorks and Healow.
• Victoria, Australia’s health department will implement Altera Digital Health’s DbMotion for a statewide HIE.

People

Henry Archibong, MS (Inovalon) joins HealthMark Group as head of interoperability and innovation.

Scott Jones, MBA (ConnectiveRx) joins Equiva Health as COO.

Athenahealth hires George Hamilton, MBA (UnitedHealth Group) as chief corporate strategy and development officer.

Announcements and Implementations

Medhost launches an interoperability solution that meets ONC’s expanded requirements with an AWS data store, FHIR APIs, and common interfaces.

A small study finds that radiologists of all experience levels who use AI-supported mammography systems are prone to “automation bias,” in which they accept the technology’s assessment even when it is wrong.

A group of 21 Ontario hospitals launches the Ontario EHub HIE with technology and services from Oracle Health.

Government and Politics

The COVID-19 Public Health Emergency officially ended at end of day Thursday. US COVID-19 deaths are at 1.1 million and continue increasing at more than 1,000 per week.

CHIME asks people to email and tweet members of Congress asking them to repeal the Section 510 funding ban on creating a unique patient identifier.

Privacy and Security

Meta files a motion to dismiss a class action lawsuit that accuses the company of privacy violations for sharing the medical data of users with advertisers via its Facebook Pixel website tracking tool. Meta says it’s the website developer’s job to understand how the technology works and to decide which information to send to advertisers.

Other

ProPublica notes that federal law requires insurers to share claims-related documents with the insured person and offers a form for requesting the information. The file can include notes, phone call audio, and internal correspondence that was involved with deciding whether to pay a claim.

In Canada’s Prince Edward Island, a family physician is closing his practice because of burnout that he says was caused by the province’s dysfunctional EHR. Thor Christensen, MD touts the value of electronic records, but says the Telus system is inefficient, is unconnected to the systems other providers, and has forced him to take on technology and billing tasks that eat up his evening hours. The 39-year-old doctor says that issuing a prescription takes up to five minutes versus 15 seconds on paper. PEI chose the Telus Health system in February 2021 as the island’s single EHR.

Bizarre: a 23-year-old Snapchat influencer expects to make $5 million per month from her $1-per-minute “digital girlfriend” voice chatbot, which was created from her YouTube videos and ChatGPT.

Sponsor Updates

• Black Book Research announces the top comprehensive RCM solutions for laboratories and ancillaries based on the feedback of 2,663 healthcare and medical users.
• Care.ai joins The Leapfrog Group’s Innovators for Leapfrog collaborative as a charter member.
• EClinicalWorks releases a new podcast, “Experience a More Efficient EMR with V12.”
• Technology executive Philip Pead joins WebPT’s board.
• Surescripts publishes a new podcast titled “Talking the Future of Pharmacy with Rina Shah.”
• Direct Recruiters Inc. promotes Aaron Kutz, Shayla Jastrzebski, and Kim Jaber to partner.
• Divurgent partners with HIMSS as a preferred digital health technology partner.
• Healthcare Triangle will present at the 2023 MUSE Inspire Conference June 9-10 in Denver.
• Konza National Network will present at WEDI’s virtual Annual Spring Conference May 24.
• Nordic posts Episode 205 of its DocTalk podcast titled “Decentralized care supports the health of older adults,”
• Jon Lauck joins Rhapsody’s board as chair.

Blog Posts

• 3 Takeaways from the HIMSS 2023 Global Health Conference (Divurgent)
• Medicaid Updates: How Eligibility and PHE Changes Impact Urgent Care (Experity)
• Creating Education That Helps People Advocate for Their Health (Healthwise)
• UKG Dimensions Latest Release (R9 U3): What’s In It for Healthcare Clients? (Healthcare IT Leaders)
• How Value IQ + EQ Creates Sustainable Improvements (Impact Advisors)
• Building long-term ROI with BI modernization (Nordic)
• Innovating a Better Future (InterSystems)
• Surescripts Calls on the Industry to Make Pharmacists a Permanent Part of Patient Care Teams (Surescripts)
• Looking inward: How your tech stack can help improve data quality (Intelligent Medical Objects)
• Reasons to Transform Your Current Software Test Approach (Keysight)
• Demystifying Compliance: How Interoperability Solutions Can Simplify Healthcare Regulations (Medhost)

Contacts

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

EPtalk by Dr. Jayne 5/11/23

I’ve been in Wisconsin this week attending the first week of Epic’s annual XGM, or Xpert Group Meeting. Although there’s always a lot of chatter about the fabled User Group Meeting in late summer, I hadn’t heard of XGM until a couple of years ago. I’ve spent the majority of my clinical informatics career working with other EHR platforms (McKesson Horizon, anyone?) and had only interacted with Epic in an end-user capacity previously, but this has been my favorite of the Epic conferences so far. XGM is split across two weeks.

This week seemed more clinical in nature, with the more technical sessions following next week.  Although I’m confident that I could learn plenty at either, this is the one that worked best with my schedule, and it’s been jam-packed. Unlike some of my experiences at HIMSS, I’ve been surrounded by thought-provoking presentations that have a lot of applicability to my ongoing work, and I’ve met lots of people who are beyond energized about working in the industry. 

Some random thoughts. Epic requires you to attest to being fully vaccinated as a condition of registering for the conference. For those of us who came home from HIMSS with the plague, I appreciate it. I’ve seen a number of people who are wearing masks, including plenty of staffers. It seems prudent when you are interacting with large numbers of people, because there are plenty of circulating viruses other than COVID that I wouldn’t want to bring home to my family, and interacting with a couple of thousand people from across the country and around the world is a risk factor. I saw a couple of N-95 masks on people’s elbows or clipped to their backpacks, which isn’t doing anyone much good, but there were quite a few being worn properly as well. Distancing was possible in most of the sessions, and although mealtimes were busy, there was the option to take a carry-out box outside except for the day when it was raining.

The sessions that have been the most packed include those on clinical decision support and Epic’s Cosmos database, which includes de-identified data from millions of patients. Telehealth sessions were also popular, as were those on optimizing clinical alerts. It feels like a lot of attendees are serious about making sure that their technology investments are generating value for clinicians and making sure that patients are being included as beneficiaries of those efforts as well as clinicians and other end users.

As far as the sessions themselves, the Epic moderators run a pretty tight ship, keeping sessions on time. They’re also good at making sure that audience members who are asking questions remember to use a microphone so that the session recordings include all the questions. Of course, there are still some people who don’t want to wait for a microphone and jump right in, but the presenters were good at addressing those, too. As with any conference, there are always audience members who confuse the Q&A portion with their own personal story time, but it seemed less than what I have encountered recently at other conferences I’ve attended.

Even the “attendees behaving badly” weren’t that bad, although I was ready to throttle the person I’ll call “crinkly bag guy” who seemed to have everything in his messenger bag double-shrouded in cellophane, resulting in a tremendous amount of noise every time he looked for something, which was often during the 40 minutes we were together. His nearest neighbor even shushed him librarian-style. There was also the guy who spilled coffee on the bus (and also on himself) because he put his partially full coffee cup in the side pocket of his backpack.

Generally, though, everyone was pleasant and patient with any lines or crowded situations, which made the entire meeting feel smooth. The weather was fantastic Tuesday and Wednesday and I was able to get out and stroll the campus and have some random interactions with other attendees who were doing the same thing. The continued campus construction was a common topic, as was the legendary Epic culinary department. Highlights of the menu included the spinach-asiago breakfast tart as well as a chocolate cake that was enrobed in a delightfully crispy coating.

A couple of presenters got into the ChatGPT spirit, with one using the tool to write the introduction to his presentation and another asking it to detail some thoughts about the future of patient experience. I took what felt like a million pages of notes, trying to capture every useful thing I heard. Many of the client presentations dealt with issues that are common no matter what EHR platform you use, and I’m surprised that they’re still being discussed. This includes such advice as “put the things you want used most often at the top of a menu and the things you want used least at the bottom of the menu” which can make a huge difference for providers being able to order common tests as efficiently as possible. It can also make a difference when you’re trying to steer patient behavior, such as encouraging them to use a refill request workflow or an appointment scheduling workflow rather than just defaulting everything to a message to their primary care physician.

Reducing the continued increased in post-pandemic patient portal messages was a common theme, with several clients sharing their strategies as well as Epic giving information on its features to support their efforts.

Speaking of features, one non-technical feature that I’ve only seen at Epic conferences is the inclusion of local and regional businesses for attendees to shop in between sessions. Several Wisconsin-based businesses were featured, including one that had handmade soap and gift items, gift boxes, everything badger-themed, and local snacks. There were also chocolatiers and creameries selling a variety of cheese, snacks, honey, sweet and savory pecans, truffles, and more. This is on top of the Epic shop, where attendees could pick up themed t-shirts, notebooks, jackets, water bottles, and other items that are offered at cost. The conference also knocked it out of the park from a sustainability standpoint by having dedicated recycling and trash bins everywhere you turned, but also by including recycling instructions on the standard slides that played in the meeting rooms between sessions.

The Epic campus is known for its quirky art. The piece that gave me the most delight on this trip was this planter that appeared to have microscopes mounted on it. Instead, the eyepiece revealed a kaleidoscopic view of the plants that changed as the planter was spun, reminding the viewer that what you see is not always exactly as others see it. This will be important to remember as I bring back a virtual treasure trove of presentations of cool things that work at other institutions but might not work at my own or might be beyond what my own users are ready to experience at the moment. I met some new people who will be great to bounce ideas off of down the road as well as some who can commiserate with the challenges I run into on a regular basis.

I’m sad that I’ll miss the second week but trust that my team will bring back lots of other ideas.

What’s the best idea you’ve picked up at a conference in the last year? Leave a message or email me.

Email Dr. Jayne.

Morning Headlines 5/11/23

Shares in Babylon fall sharply on news of moves to take private

London-based virtual care vendor Babylon Health will revert to a privately-run company as part of a debt restructuring plan and new funding arrangement with Albacore Capital.

VA Pharmacists Don’t Trust new EHR System, Survey Finds

VA pharmacists surveyed by the House Veterans’ Affairs Technology Modernization Subcommittee say they don’t trust the new Oracle Cerner system in use at their facilities, causing them to work in a constant state of hypervigilance.

Norton Healthcare Network Update

Norton Healthcare (KY) works to restore systems impacted earlier this week by a cyberattack on its computer network.

Healthcare AI News 5/10/23

News

AI-powered drug discovery could represent a $50 billion opportunity for big pharma according to a Bloomberg article, which notes that one drug company paid $4 billion for drug that was developed by a startup in just six months. The psoriasis drug is expected to generate up to $3.7 billion in annual sales.

Microsoft eliminates the waitlist for the AI version of its Bing search engine, adds persistent chats and visual capabilities, and announces third-party plug-in capability.

Microsoft expands access to the preview version of Microsoft 365 Copilot, which adds AI capability to the whiteboard function of Teams, integrates the DALL-E image generator into PowerPoint, offers writing suggestions from within Outlook, helps users create lists and generate ideas in OneNote, and creates a learning plan in Viva Learning.

AI drug discovery platform vendor Insilico Medicine offers a free course on using its PandaOmics generative AI tool for disease modeling and target discovery.

Salt Lake City-based AI drug discovery company Recursion, which has five products in Phase 1 or later studies, acquires two competitors.

The CEO of Databricks says that the best way to invest in AI is to think of it as a gold rush, in which you want to be the company selling picks and shovels to gold-seekers. He also recommends investing in companies that control proprietary data, such as from medical records.

Lucem Health, a portfolio company of Mayo Clinic Platform that turns AI advancements into point-of-care solutions, raises $7.7 million in a Series A funding round.

Research

Researchers apply AI to early, large-scale diagnosis of pancreatic cancer, projecting that analyzing the EHR data of one million people could identify 70 who are highest risk who have not been diagnosed with the aggressive cancer.

Opinion

An Atlantic article warns that ChatGPT is following a similar trajectory as mostly-forgotten IBM Watson, whose over-publicized rush to commercialization left it with little market visibility as it ended up being used to automate mundane, back-end B2B tools. The article dismisses IBM’s failed Watson oncology work with Memorial Sloan Kettering and MD Anderson Cancer Center as “a swole Clippy fed on enterprise data and techno-optimism, [that] could barely read doctors’ handwriting, let alone disrupt oncology.” The author says that ChatGPT, like Watson, is being commercialized to create “banal consumer and enterprise software” that is invisible to users.

A BMJ Global Health analysis piece calls for regulation of AI and a moratorium on self-improving artificial general intelligence, saying that AI poses threats to health and well-being.

Former VA Secretary David Shulkin, MD lists “25 Ways Generative AI Will Change Healthcare” that include specific companies:

• Ibex – improve diagnostic accuracy from pathology.
• Galileo – patient navigation of health and treatment options.
• Cadence and Kaii – remote patient monitoring.
• Google Health and Babylon Health – improved diagnosis using electronic patient records.
• Saama – drug discovery.
• Dexcare – access to care.
• Indegene and Edocate – new methods of interactive medical education.
• Cedar – billing.
• TriNetX and MD Clone – clinical trial design.
• Theator – surgical learning systems.
• Eleos – analysis of behavioral health session to improve outcomes.
• CareJourney, Datavant, and Voiceitt – reducing disparities and addressing disabilities.
• Aldoc – early intervention using unstructured data and image analysis.
• Ixlayer and TytoCare – point-of-care testing.
• Sparta Science – identifying fall risk.

In a preview of how ChatGPT might find its way into health system digital front doors to improve access, Expedia is testing a chat-based trip planner, while a Zillow add-on allows conversational access to its real estate listings.

Other

UPMC CTO Chris Carmody says that the health system is working on AI chatbots that can answer patient questions about insurance coverage, but adds that the goal is to support rather than replace healthcare professionals.

A Tennessee radiologist writes 16 research papers in four months, five of which were published in journals, using ChatGPT.

An ED doctor uses ChatGPT to perform roleplay that teaches doctors how to break bad news to patients. ChatGPT provided the scenarios and feedback.

Resources and Tools

• Holly – sends weekly lists of LinkedIn candidates for open positions and engages them in conversation to book interviews.
• EvidenceHunt – performs advanced searches of PubMed entries.
• Law ChatGPT – creates legal documents from user prompts and templates.

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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