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News 2/15/23

February 14, 2023 News No Comments

Top News

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HHS, ONC, and The Sequoia Project announce that CommonWell Health Alliance, EHealth Exchange, Epic Trusted Exchange Framework and Common Agreement Interoperability Services, Health Gorilla, Kno2, and Konza have been approved to implement TEFCA as prospective Qualified Health Information Networks.


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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Doximity launches a beta version of DocsGPT, which allows providers to submit prior authorization documentation to insurers using the AI chatbot technology of ChatGPT. In an “only in healthcare” convergence of cutting edge and ancient technologies, Doximity will also integrate ChatGPT with its fax solution. DocsGPT errored out every time I tried to use it, which I assume is because ChatGPT was overloaded.

In the UK, hospital software vendor System C acquires Clevermed, which offers the BadgerNet system for pregnancy and newborns.


Sales

  • Emirates Health Services will deploy Care.ai’s smart care facility platform throughout the UAE, with a focus on redesigning clinical and operational workflows through ambient monitoring and virtual inpatient care.
  • Mary Washington Healthcare (VA) will launch an inpatient virtual nursing program using technology from Caregility.
  • Montana’s Big Sky Care HIE selects Lyniate’s Rhapsody Interoperability Suite.

People

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Joe Sedlak, RN, MBA (Xealth) joins Vital as VP of client success.

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Regenstrief Institute names Rachel Patzer, PhD, MPH (Emory University School of Medicine) president and CEO.

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Alan Portela (AirStrip) joins Masimo as SVP of strategic business and hospital automation.


Government and Politics

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Senate Veterans’ Affairs Committee Chairman Jon Tester (D-MT) says the VA’s EHR Modernization Program must move forward, pointing out that issues with the new Oracle Cerner system do not outweigh those with the department’s legacy VistA system. Tester co-authored the VA Electronic Health Record Transparency Act, which was signed into law last summer, that requires VA Secretary Denis McDonough to update Congress on the software’s costs, performance, and outcomes.

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Oracle Cerner, meanwhile, continues to push back on recent legislative efforts to shut down or overhaul the VA’s EHR program. Oracle EVP Ken Glueck has followed up his February 3 criticism of those bills with a new blog post that outlines the benefits to veterans and end users and points out the folly of the “improvements” act, which places “the go/no go decision to migrate to the new EHR to …171 different medical centers.”

ONC announces that 95% of certified health IT developers met the December 31 deadline to update and provide their customers with technology that, among other things, enables access to information through FHIR-based APIs “without special effort.”


Other

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Malaysia’s Selayang Hospital, one of the first hospitals in the world to go paperless in 1999, struggles technically after shutting down its Cerner system, switching to a Notepad-like text editor called BHIS that it had developed for barebones data entry during downtime, and then overloading that system 18 months later in forcing a switch to yet another homegrown system that was designed for COVID-19 quarantine centers. The hospital has also shut down its IT department after outsourcing to a vendor whose contract was terminated. The radiologist who developed BHIS in just four hours says he was limited in that most hospital computers were running Windows XP with Internet Explorer 6.0, the hospital’s network speed was limited, and the virtual server the hospital gave him had only 1 GB of memory. The hospital’s website still declares that its now-mothballed Total Hospital Information System makes it “a showcase to the rest of the world.”

UnityPoint Health (IA) begins charging patients between $36 and $70 for messaging their physicians via its MyChart patient portal. UnityPoint Clinic President and CEO Patricia Newland, MD says the organization decided to start charging due to the “tremendous increase” in messaging seen since the beginning of the pandemic. Patients will not be billed for messages that are related to appointment scheduling or prescription refills.

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Duke University researchers discover that acquiring mental health data from data brokers is fairly easy, inexpensive, and typically comes with few strings attached. Researchers approached 37 data brokers for bulk mental health data and received offers from 11, that said they could provide potentially identifiable data on people with depression, anxiety, and bipolar disorder sorted by demographic information including credit scores. Some brokers offered information on 5,000 people for as little as $275.


Sponsor Updates

  • Availity CEO Russ Thomas joins the Florida Chamber of Commerce Board of Directors.
  • Azara Healthcare publishes a new customer success story, “Alaska Health Centers Improve Diabetes Care Through Data-Driven Healthcare Model.”
  • Baker Tilly publishes a new case study, “State health department captures more complete and timely data on highly transmissible diseases through ECR implementation.”
  • Censinet debuts its new Risk Never Sleeps Podcast, focusing on the people protecting patient safety across healthcare.
  • Thirty-two community, critical access, and specialty hospitals select Oracle Cerner’s CommunityWorks technology.
  • Clearsense publishes a new whitepaper, “How AI and Governance Can Transform Healthcare.”
  • Clinical Architecture releases a new episode of The Informonster Podcast, “The CDC Shares the Success of Collaboration During a Crisis.”
  • Direct Recruiters celebrates 40 years in business.

Blog Posts


Contacts

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

Morning Headlines 2/14/23

February 13, 2023 Headlines 8 Comments

Building TEFCA

HHS, ONC, and The Sequoia Project recognize CommonWell Health Alliance, EHealth Exchange, Epic Trusted Exchange Framework and Common Agreement Interoperability Services, Health Gorilla, Kno2, and Konza as the first set of networks to be approved to implement TEFCA as prospective Qualified Health Information Networks.

Top Senator Says Modernizing VA’s EHR ‘Is Not Optional’

Senate Veterans’ Affairs Committee Chairman Jon Tester (D-MT) says the VA’s EHR Modernization Program must move forward, pointing out that issues with the new Oracle Cerner system do not outweigh the fact that the department’s legacy VistA system needs to be updated.

Johns Hopkins Winds Down Pioneering Pandemic Data Tracking

Three years after launching, Johns Hopkins University & Medicine’s Coronavirus Resource Center announces it will stop collecting and reporting COVID-19 data on March 10.

Curbside Consult with Dr. Jayne 2/13/23

February 13, 2023 Dr. Jayne No Comments

I went to a birthday party Sunday night, which of course overlapped with the Super Bowl, turning it into an impromptu Super Bowl party. It has been years since I’ve actually seen the game played since usually I volunteered to work Super Bowl Sunday because it’s a historically mellow day in the emergency department and urgent care arenas. People would typically only come in if they were truly sick, which meant a fair amount of downtime, the deployment of numerous Crock Pots, food that you could cook in a microwave or toaster oven, and plenty of camaraderie.

The worst place I ever worked on Super Bowl Sunday was labor and delivery. That is primarily because no one came in during the pre-game or the game itself, but waited at home as long as humanly possible before coming in. Once the final scores were tallied, people started arriving in droves and every bed was full, with babies arriving quickly. One year we even had to deploy a team to the parking lot to assist a patient who didn’t quite make it.

It was nice to be able to hang out with family and friends, although I did have to manage a patient callback in the middle of it due to some pharmacy-related shenanigans. The after-hours exchange was flustered and I wasn’t sure about waiting for the usual process to work, but I was happy to give them a ring. My family hasn’t seen me on call in years, so they were wondering what could possibly be going on.

The planned menu was all about the birthday person. By halftime, I was wishing that I had some taco dip, smoked queso, or Buffalo chicken wings. Certain foods just go with football, at least from my past, so maybe I’ll have to make up for it with this week’s meal planning.

I haven’t seen some of my extended family in some time, and it’s always interesting to try to explain to them what exactly it is that I do as a CMIO and how I can still be a physician if I’m no longer working in the emergency department. Usually I explain that I help manage all the clinical systems behind the scenes, including the patient portal and the software that the physicians use when they write their notes, order labs and tests, or send medications to the pharmacy.

Even with advanced age, many family members are used to communicating with their physicians through a patient portal or following their lab results on their phones. It has been fun to watch some of them become more active participants in their healthcare, although there is always the one relative that takes everything they hear from their doctor as gospel and refuses to question anything, even when the only doctor in the family says they might want to ask some questions based on some concerning prescribing patterns.

Some days are more difficult than others, such as when you have to explain to clinicians that although they have great ideas about workflows, they are not always possible. Especially when you are using a certified EHR, certain things, including workflows that are deeply connected to coding, billing, and other regulatory requirements, just can’t be changed. I’m a fan of giving my users choices, though. If you’re not happy with your current state, here are two potential future states that we can actually accommodate based on the EHR and regulatory guidance, so  which do you prefer? Often they end up preferring the current state, especially when it has been designed by board-certified clinical informaticists who have observed thousands of patient care encounters and who have worked in numerous EHR and documentation systems. 

Other difficult days happen when end users are raging against third-party requirements, but blaming it on the EHR. Sometimes these third parties have created the requirements because they are good for patient safety, and I’m not likely to budge on those. For example, when a physician doesn’t believe that they should have to associated a diagnosis with a prescription. I can certainly empathize with those two extra clicks, but as a primary care physician, I think it’s important that patients know what condition they are taking a medication to treat.

Additionally, when you work for a healthcare organization that has decided that this is a good thing and has created a policy and procedure around it, there’s not much I can do for you as an informaticist other than teach you the most efficient workflows and show you how you can use your clinical support staff to help you make some of these associations as they prep patients for their visits.

I’m always shocked by physicians who don’t know where their grievances should be directed. For example, if they don’t like the clinical policy and procedure, they need to take that up with their department chair or the chief medical officer, not the CMIO or a member of the clinical informatics team. I think sometimes we wind up at the tip of the proverbial spear because we are actually in the clinics interacting with people on a regular basis, which might not be the case with a CMO or a department chair, especially in a geographically diverse organization.

The best days are when someone proactively reaches out to you to let you know that they think a feature that you have recently deployed is cool. I remember vividly the technology that I deployed that generated the first non-hate email from a physician. That was more than a decade ago, and those emails are few and far between.

At my current institution, we were recently early adopters of a solution that I think is pretty darned revolutionary, and most of my physicians don’t have any idea how cool it really is compared to other commercially available options. It’s leaps and bounds better for our patients, has multilingual support, and uses data already in the EHR to drive a better user experience. However, because it has a purpose that some of our providers don’t think is necessary, it’s not getting the love it deserves. We’ll see if more users start to engage with it as they develop a greater understanding of what it can do, and I’ll still hold out at least a little hope that some clinician eventually says thank you.

Valentine’s Day is coming up on Tuesday, so consider showing a little love to your favorite clinical informaticist. If you don’t want to impress them with a witty card, conversation hearts, or an edible treat, consider thanking them for trying to make your user experience the best that their budget and staffing allows.

Email Dr. Jayne.

HIStalk Interviews Eric Ly, CEO, KarmaCheck

February 13, 2023 Interviews No Comments

Eric Ly,  PhD, MS is co-founder and CEO of KarmaCheck of San Francisco, CA. He was a co-founder and the founding CTO of LinkedIn.

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Tell me about yourself and the company.

I am a technology entrepreneur. I have worked on B2B software for multiple decades. I was one of the co-founders of LinkedIn. What got me interested in background screenings and verifications was that I was interested in something like a blue checkmark that would verify the information contained on LinkedIn profiles. That led me to the background screening industry, where I saw an opportunity to bring efficiencies and transform the way that background screenings and verifications get done.

You’ve mentioned the possibility of allowing people to store verified credentials in a digital wallet. How do you see the company being involved in that?

That’s a vision that we are working towards. If we are able to provide a wallet of credentials to professionals in the future, those credentials that are verified can essentially be persistent. When they go for new opportunities, that information is mostly there already. That speeds up the process of applying and getting job opportunities, both for candidates themselves as well as for employers. They don’t have to go and check many of those facts again.

Certainly there is information that needs to be updated with recent changes, but that opens up a world where the onboarding process can be more efficient for both sides. As we are moving towards the world where there is a more flexible and contingent workforce, the need and the value that provides is going to be become even greater.

It would make sense that LinkedIn user identities would require verification, especially now that we are seeing LinkedIn scammers pretending to be both employees and employers. Do you think that will happen?

That’s an interesting scenario. LinkedIn has been successful in amassing the professional information and histories of professionals all across the world. There can be a layer on top of that that provides verification of the  information that has been entered by those individuals. We are creating value by bringing truth so that the information that is associated with those profiles — whether they are on LinkedIn or elsewhere, let’s say on a job site — can be trusted so that when employers are looking at candidates, they will know that the information about the backgrounds of those candidates is confirmed.

The Department of Justice recently announced that thousands of people purchased phony nursing educational credentials, and some number of those folks presumably ended up obtaining licenses and caring for patients. We’ve also seen examples of nurses who harmed patients intentionally in hospitals that declined to prosecute or publicize them, allowing them to take jobs with new hospitals and continue their crimes. What kind of analysis or AI review could detect these issues?

Those are some interesting cases. In healthcare, here’s an example of where verifying someone’s credentials and their background is especially important, because we are talking about life and death for patients that healthcare providers affect. It’s especially important that the backgrounds of clinicians are verified. Beyond verifying current credentials, which is a complicated and complex stack already, skill competency tests could be run to ensure that the individuals have the expertise and knowledge that they need to do their job.

Something we have seen recently becoming more of a problem is verifying the identity of a particular candidate. If it’s possible to hire someone in the place of a clinician without ever meeting them in person, there is also an increased chance of the identity of that individual being falsified as well. ID verification technologies that can be used not only to confirm someone’s background, but to confirm that that background actually belongs to the individual that is being placed on an assignment.

The US has low unemployment and a significant percentage of citizens who have been convicted of a felony, suggesting that employers are either unaware or unconcerned about their criminal history. How would hiring decisions change if finding criminal records at local, state, and federal levels became easy and inexpensive?

Numerous surveys have found that at any given time, 25% to 40% of people have falsified their backgrounds. That’s pretty consistent across the board, whether it’s on an online platform or from a resume. Knowing where the falsification happened becomes an important point.

In this historically low unemployment situation, there might be the temptation to bypass some of these checks in the name of bringing more people on board, placing them, and so forth. That puts the employer or the staffing company at risk, because if something goes wrong, that carries a pretty heavy liability. In a field like healthcare, we are talking about life and death situations, so it’s not a light topic.

Because of the complexities that are involved in doing credentialing and meet compliance, this is an area and opportunity where technology can help. If those processes, as complex as they are, can be made more efficient and perhaps more cost effective, the reason to skip, overlook, or miss some of the infractions or violations that happen don’t have to happen as much. Companies and employers can still protect themselves while going through these compliance processes just as much as they should in more normal times.

How much inefficiency in provider credentialing could be eliminated by technology?

We are entering into a new world in healthcare and the staffing of healthcare. The general trend is that the scale and the velocity at which placements are occurring is speeding up. Hospitals and staffing companies have had to manage their staff at a faster pace than they ever had to before. Based on this backdrop of complicated credentialing needs, it becomes an unmanageable situation. The challenge is even greater when you have costs going up.

Technology generally helps to deliver scale and to deliver efficiency, so there are certainly opportunities for technology to be applied in these kinds of situations to help increase efficiency. That translates into is operating efficiencies and lower costs for the facilities.

That scalability might provide the opportunity to assemble a deep candidate profile that includes social media posts, credit reports, driving, records, online photos or reviews, and any number of information items that aren’t directly related to being hired. Will we see a tension between what is possible versus what is fair or reasonable?

There has been a lot of recent talk about AI and the application of AI. It enables any user to sift through more and more information to catch information that might help enlighten the background of a clinician, for example. The ability to look at more information, to learn more about the candidate, ensures that a qualified candidate gets placed, such that problems and liabilities are reduced. There is ever more information out there, and technology is a tool to help look through that ever-increasing amount of information.

What healthcare opportunities will the company explore in the next few years?

For an industry like healthcare that has maybe traditionally been slower to adopt technology, there are some great opportunities to take a look at making operations more efficient and cost effective. The main reason for doing any of this is to deliver better patient care, which everybody wants. In doing that and evaluating technologies, my recommendation is to not necessarily take a look at point solutions, but instead to have a holistic sense of the technologies that will deliver value to an organization, how it fits into processes and workflows, and how existing workflows can be changed a little to create significant improvements in operational efficiency. To take a higher-level strategic look at how technology can be deployed within an organization would be helpful for the healthcare industry.

Innovation is definitely happening within technology to specifically serve the healthcare sector. From a standpoint of cost savings and delivering better patient care, some good answers are starting to emerge.

Morning Headlines 2/13/23

February 12, 2023 Headlines No Comments

VA electronic health record modernization program director Terry Adirim to depart

Terry Admirim, MD, MPH, MBA, program executive director of the VA’s EHR Modernization Integration Office, will leave the VA to pursue other, unstated opportunities.

Healthtech firm Nomad Health lays off 17% of workforce

Healthcare staffing company Nomad Health reduces its headcount from 691 employees to 572, nearly eight months after securing an investment of $105 million.

NJ hospital admits data breach involving thousands of patients

CentraState Medical Center (NJ) announces that the December cybersecurity incident that impacted new admissions was a ransomware attack involving the data of 617,000 patients.

Monday Morning Update 2/13/23

February 12, 2023 News 3 Comments

Top News

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Terry Admirim, MD, MPH, MBA, program executive director of the VA’s EHR Modernization Integration Office, will leave the VA to pursue unstated other opportunities.

Serving as interim after her February 25 departure will be Neil Evans, MD, senior advisor to the assistant secretary for information and technology and CIO and head of the VA’s Connected Care program.


Reader Comments

From Tempus Fugit: “Re: Olive. I heard endlessly about their unicorn status and huge customer count, which sounded like BS and probably means they are counting some rando clinic that is using a tiny solution as a customer. I know a sales guy there and he said the company paid them a ton to sell consulting engagements, but with nothing meaningful deployed, they went back to selling small patient access solutions. He said customers were unhappy that they were promised a 5x ROI that hasn’t happened anywhere.” Unverified. Axios reviewed LinkedIn records in May 2022 to determine that among the 20 Olive employee departures in the previous month were its EVP/GM, senior director of partner programs. director of data engineering, chief marketing officer, and VP of product. Axios also reported in April 2022 that Olive overpromises, under-delivers, and doesn’t actually use AI/ML. The company told the reporter at that time that it had 1,000 hospitals in 200 enterprise customers using its products and services, although an Axios review of internal documents shows 80 customers. The company has raised $856 million in funding through a Series H round, with its last investment being in July 2021.

From Domainatrix: “Re: company layoffs. A positive aspect is that young workers will now know that their employer isn’t their friend, co-workers aren’t their families, and employers as well as employers are free to end their bargain for any reason.” Long-timers who have been negatively affected at some point by company decisions rolled eyes at the unquestioning willingness of fresh go-getters to work ridiculous hours or grind away at crappy jobs, convinced that they would be rewarded by their benevolent bosses. Fast-forward to the end of boom times that has put employers back in control with little fear of mass resignations. The result is a scaling back of work-from home programs and an insistence that “valued associates” work harder or longer because the company has found itself in a jam, often of its own making. Bosses aren’t friends, the job of the chief people officer is mostly to work against the interest of employees, and you would be replaced and turned into a break room trivia question within three months of your departure.

From Purported Victim: “Re: hospitals ending some services or closing in poor areas. So much for being a charitable non-profit.” You will always be disappointed if you expect any person or organization to take any action that isn’t the one that is most beneficial to them.


HIStalk Announcements and Requests

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Patient portal, telephone, and online forms are the most common ways poll respondents have recently sent medical information to a clinician.

New poll to your right or here: Did your most recent clinician encounter, in whatever form, make you feel “cared for?”I voted yes because when I recently texted my direct primary care doctor about refill, she asked me how I was doing and mentioned that I hadn’t seen her for a while and might want to drop by for routine lab work and a health review, none of which increase her income.


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

Business Insider looks at the “fleet of secret workers” who aren’t visible to customers but who perform much of the work that is attributed to sexy technology or who are required to keep that technology running. The author concludes that robots, automation technology, and AI chatbots won’t replace employees, but they may allow companies to shift less-visible offshore to lower their costs. I would say that we are in the early days of companies overstating their use of AI and other tools in failing to mention that behind-the-scenes humans are doing a lot of the actual work, the “10,000 diligent Indians” concept a vendor CEO once told me about. It’s kind of a sad state when companies brag on their tools rather than their humans, but investors love employee-lite scalability and companies yearn to be viewed as a technology high-flyer instead of a low-tech sweatshop.

NPR notes that hospitals are outsourcing their EDs to staffing companies that are owned by private equity investors, with a result being that doctors are being replaced by nurse practitioners and physician assistants to boost margins. The change is motivating some ED doctors to change their work setting because they went into medicine to see patients, not supervise lesser-trained employees.


Sales

  • Norman Regional Health System selects VisiQuate Denials Management Analytics, Revenue Management Analytics, and PayFlo.
  • Onsite Women’s Health will use Volpara Health’s analytics software to improve mammography quality by assessing positioning, compression, and radiation dose.
  • Complete Care implements the EClinicalWorks EHR.

People

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Health Catalyst promotes Cathy Menkiena, RN, MBA to GM/SVP Northeast.

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Industry long-timer and former CHIME VP Tim Stettheimer, PhD died February 9 of ALS (Lou Gehrig’s disease). He was 56.


Announcements and Implementations

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Stick around until the Friday morning keynote of HIMSS23 (which is asking a lot) and you can hear just-announced speaker and NFL player Damar Hamlin, who was saved by CPR and AED after suffering cardiac arrest in a game on January 2. He will speak on “Winning the Game of Life.”

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A new KLAS report covers IT advisory services.


Sponsor Updates

  • CloudWave launches its Cybersecurity Insider Program to offer members access to information about the latest cybersecurity trends and threats, as well as ongoing education.
  • Nordic releases a new Designing for Health Podcast featuring UCHealth CMIO Dr. CT Lin.
  • PeriGen partners with Baylor College of Medicine, Texas Children’s Hospital, and the Malawi Ministry of Health to assist with successful newborn in Malawi using PeriGen’s AI-augmented continuous electronic fetal monitoring.
  • PerfectServe publishes a new case study, “How Savannah Neurology Specialists Reinvented Their Medical Answering Service Workflows.”
  • Sphere releases a new e-book, “Unaffordable Medical Bills: A New Social Determinant of Health.”
  • Spok receives ISO 13485:2016 certification from Dekra Certification.
  • Talkdesk has been recognized as a Customers’ Choice in the 2023 Gartner Peer Insights “Voice of the Customer” for contact center as a service.

Blog Posts


Contacts

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

Morning Headlines 2/10/23

February 9, 2023 Headlines No Comments

Scoop: Olive AI lays off 215 employees

Robotic process automation vendor Olive lays off a reported 215 employees, about one-third of the company.

Mindstrong’s demise and the future of mental health care

Mindstrong, which has raised $160 million in funding from high-profile investors, will wind down its virtual behavioral healthcare service and lay off 130 employees starting in late March.

Center for Health Innovation Expands with $22 Million in Gifts

UC San Diego Health will use a $22 million donation to launch a patient health and safety monitoring hub that will aggregate data from across its EHR, bedside monitors, wearables, and other enterprise technologies.

NHS tech funding falls to less than £1bn

NHS England’s technology budget has reportedly been cut in half to just over $1 billion, which will likely impact requests for electronic patient records.

News 2/10/23

February 9, 2023 News 3 Comments

Top News

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CVS Health will acquire primary care company Oak Street Health for $10.6 billion in cash.

Oak Street Health’s 600 primary care providers work from 169 medical centers in 21 states.

Meanwhile, CVS Health reports Q4 results: revenue up 9.5%, adjusted EPS $1.99 versus $1.98, beating Wall Street expectations for both. CVS shares are down 20% in the past 12 months versus the Dow’s 5% loss.


Reader Comments

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From Another Company Debacle: “Re: Allscripts / Veradigm. Major layoffs this week in R&D and solutions involving employees in both the US and India. Veradigm (formerly Allscripts) Practice Management took a big hit. Veradigm Interface Engine too.” Unverified.

From Jay Glick: “Re: Oracle Cerner. Fared poorly in Best in KLAS, wouldn’t you say?” Agreed. Oracle Cerner finished last among software suites, 20 points behind Epic and mostly “well below average” scores in every product segment except for attaining “average” in virtual care. In the all-important large hospital market, Epic scored 89.4 versus Oracle Cerner’s 70.0. Oracle Cerner finished first in no categories versus its last-place showing in a bunch of them. In trying to come up with a “glass half full” conclusion, I have two thoughts: (a) at least Oracle Cerner will keep making a lot of money from the federal government unless it gets shown the VA’s door and loses its only prime contractor deal, not to mention that a lot of Oracle’s recent revenue and earnings growth came from the former Cerner; and (b) perhaps the corporate stumbles that followed Neal Patterson’s death, along with high-visibility revenue cycle product problems, made it inevitable that the keys needed to be turned over to a new owner who has the money and objectivity to right the ship. From the “glass half empty” perspective, few health IT examples exist where a big outside company improved a vendor by acquiring it. Another sobering thought for Oracle is that KLAS reports only what customers are saying, and some of the older Cerner sites may re-muster the fortitude and cash that would be needed to move to Epic.


HIStalk Announcements and Requests

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I suppressed my HIMSS23 indifference long enough to book my hotel, so the “am I going or not” question has been answered. The exhibit hall will be open full days on Tuesday (April 18), Wednesday, and a slightly shortened day Thursday. The hotel I was considering was nearly $500 per night on Expedia and on the chain’s loyalty club site, which would have kept me home, so kudos to HIMSS for making it available to attendees at barely more than half that price for the same dates. The website shows 764 exhibitors. I don’t think I’ve been to Chicago since HIMSS15. Opening day temperature highs going back from 2022 were 42, 55, 42, 76, and 43 degrees, and of course many remember the HIMSS09 opening reception near-blizzard where the McCormick Place coat check people had actual coats to manage instead of just last-day luggage holds.

I realized that I wasn’t seeing Altera Digital Health Sunrise (the former Allscripts Sunrise that is now owned by N. Harris) on the Best in KLAS report, where for years it topped the list of large-hospital inpatient EHRs. It had too few customers surveyed to be stacked up against Epic and Oracle Cerner (the only two products that were ranked), but its performance score was the lowest of all at 63.8. In the midsize category, it performed even worse at 54.6 (and Altera’s Paragon got a 37.6 score, also with too few responses to compare, and also pegged the lowest score in the small hospital category at 49.0). Also on the KLAS report, I also didn’t see segment categories for ED, anesthesia, laboratory, radiology, and pharmacy management systems, so I guess those products are no longer reported as part of Best in KLAS.


Webinars

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

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


Acquisitions, Funding, Business, and Stock

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Olive lays off a reported 215 employees, about one-third of the company. The company has reduced its headcount from a one-time peak of 1,400. The robotic process automation vendor, which once had a valuation of $4 billion, has been plagued by customer and executive defections along with reports that its promises of hospital savings have rarely materialized. 

A leaked internal email indicates that healthcare will remain a top priority of Oracle and is the primary focus on CTO and executive chair Larry Ellison. The company is also moving its data and AI unit under its cloud business.

Google’s valuation drops by $100 billion the day that its newly announced Bard chatbot was found to have given an inaccurate response in a company promotional video, raising questions about Google’s competitive position against Microsoft, which has already integrated ChatGPT functionality into its Bing search.

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Virtual behavioral service company Mindstrong, which has raised $160 million in funding from high-profile investors, will wind down its operation and lay off 130 employees starting in late March.

Healthcare staffing marketplace operator Nomad reportedly lays off 20% of its headcount as pandemic-fueled demand and payment rates cool. The company has raised $200 million, including $105 million seven months ago.


Sales

  • McClow, Clark, and Berk, PA Radiology Services (FL) selects Healthcare Administrative Partners for revenue cycle management.
  • Southern Illinois Healthcare will implement Xealth to allow clinicians to find and order digital health tools and programs.
  • Southern New England Health chooses Koan Health’s Datalyst for population health and medical economics.

Announcements and Implementations

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Highlights from KLAS’s Best in KLAS in software and services for 2023:

  • Epic, Impact Advisors, Nordic, Medasource, and Chartis were named for notable performances.
  • Software suite rankings were topped by Epic and Meditech.
  • Most improved software products were Veradigm’s FollowMyHealth and KPMG’s ERP business transformation and implementation leadership services.
  • Top physician practice ranking went to Epic, followed by Meditech and Athenahealth.
  • The overall IT services category was a tie between Impact Advisors and Nordic.

CareCloud integrates the Quippe Clinical Data Engine of Medicomp Systems into its EHR platforms.

Researchers at University of Missouri School of Medicine find that a small group of EHR testers identified 2.5 usability concerns for each new function, 70% of which were correctable before rollout.


Government and Politics

A KHN investigation finds that HHS has ignored repeated congressional mandates, going back to 2006, to implement a public health network that can detect and address infectious disease outbreaks. Experts say HHS didn’t follow through because the task is complex, funding is inadequate, consensus is lacking on the data that is needed in an emergency, and HHS can’t decide which of its operating divisions should lead the project.

Rep. Mike Bost (R-IL), chair of the House Committee on Veterans’ Affairs — who is involved with two bills that would change or end the VA’s Oracle Cerner implementation – says he will listen to more moderate proposals that are submitted by Democrat lawmakers to hold the company and the VA more accountable, but adds via a spokesperson that “the time for half-measures and tinkering around the edges is over.”


Other

NHS England’s technology budget has reportedly been cut in half to just over $1 billion, which will likely impact requests for electronic patient records. 

A survey of 9,500 consumers in six countries, including the US, finds that far fewer of them feel “cared for” than their primary care doctors believe. Key consumer issues are faster and more accurate diagnosis, convenient access, a focus on long-term health, and making healthcare more affordable. China leads the other countries in use of health portals, digital health apps, and telehealth. Half of consumers think that doctors and hospitals should be leading the charge to connect health information, but US physicians say they don’t do that because they aren’t paid extra, obtaining patient consent is a pain, they are experiencing data overload, they don’t know how to use the data, and technology doesn’t work well. Only 40 to 50% of US consumer respondents say they would share their health information even if the result was improved health, better-tailored services, safer treatments, or lower costs.


Sponsor Updates

  • Healthcare consumer platform operator League will offer healthcare cost and quality information from Kyruus-owned HealthSparq.
  • Everbridge adds DigitalOps Insights, a new AI-powered situational awareness tool, to its Digital Operations solutions bundle.
  • Southern Ohio Medical Center reports a 30% drop in hospital-acquired C. difficile infections following the development of expedited testing tools by Meditech Professional Services.
  • First Databank names Joe Bodkin (Franciscan Health) clinical informatics pharmacist specialist, Angela Johnston (Astra Zeneca) regional representative, and Shafer Grytness (Insight Global) software engineer.
  • OSF HealthCare releases a new podcast featuring Get Well Supervisor of Clinical Digital Care Kate Johnson and Digital Patient Care Manager Kara Roat.
  • InterSystems releases a new Healthy Data Podcast, “FFS vs. Integrated Care.”
  • Intelligent Medical Objects secures SOC 2 Type 2+ HIPAA certification.
  • Meditech shares the ways in which Valley Health System (NJ) clinicians have used its Surveillance tool to quickly identify patient conditions, provide relevant data, and expedite orders to initiate treatment.
  • NeuroFlow completes its SOC 2 audit, reinforcing its commitment to protecting health data.
  • Everest Group names NTT Data a Leader in its Provider Digital Services Peak Matrix Assessment 2023 report.

Blog Posts


HIStalk sponsors that were named as Best in KLAS Software and Services 2023 or Best in KLAS Global Software 2023:

  • Agfa HealthCare (PACS Middle East / Africa)
  • Arcadia (value-based care managed services)
  • Azara Healthcare (population health management)
  • Findhelp (social determinants of care network)
  • Fortified Health Security (security and privacy managed services)
  • Impact Advisors (security and privacy consulting services, ERP implementation leadership, financial improvement consulting)
  • InterSystems (clinical portals Europe)
  • Lyniate (integration engines)
  • Meditech (acute care EMR small)
  • Nordic (HIT core clinical implementation leadership)
  • Nuance (computer-assisted physician documentation, speech recognition front-end EMR, image exchange)
  • Oracle Health (acute care EHR Middle East /Africa)
  • Pivot Point Consulting, a Vaco Company (managed IT services)
  • Premier / PINC AI (value-based care consulting)
  • Sectra (PACS large, PACS small, PACS Asia / Oceania, PACS Canada)
  • Visage Imaging (universal viewer)
  • Wolters Kluwer (infection control and monitoring, patient-driven care management)
  • Zynx Health (clinical decision support care plans and order sets)

Contacts

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

EPtalk by Dr. Jayne 2/9/23

February 9, 2023 Dr. Jayne 5 Comments

Mr. H’s current poll asks about the methods used by patients to send medical information to clinicians in the past year. I wasn’t surprised to see that patient portal messages are leading the way, followed by phone calls and electronic forms. Mailed paper forms and faxes are at the bottom of the list, as expected.

It would be interesting to see a poll around the topic of “In which ways have you had productive communication and/or a positive outcome” when looking at electronic communication and portal messages. I recently tried to use the online scheduling feature offered by my dermatologist, with whom I am well established. There were no spots available until June, so I used the feature located on the online scheduling page called “request an appointment.” I mentioned that the request was to be seen for a suspicious and changing mole that had already been seen by my PCP, who recommended I see dermatology. I listed my preferred days and times, but basically said that due to the nature of the issue, I was willing to take any open appointment.

Four days later, I received a portal message back that “we are not currently offering online appointment requests” and was directed to call the academic medical center’s access center. If you’re not offering online appointment requests, I might recommend disabling that feature so that patients can’t use it. I’ve used the access center before to request an appointment with this dermatologist and it’s a centralized scheduling nightmare. For urgent issues, they take a message and route it to the office who hopefully calls you, and then if you’re like me and tied up on calls and in meetings all day, you play phone tag, which is exactly what the online requests are supposed to prevent.

I mentally said, “forget it” and made an appointment with a new dermatologist who was happy to get me in within 48 hours given the history and PCP referral. Since my clinical issue was resolved, we will see if my original dermatologist ever follows up, who now has a concerning message documented in my chart. We are going on six weeks so I’m not holding my breath, but for a patient who isn’t as persistent in getting care, it could be tragic.

From Jimmy the Greek: “Re: chatter about using ChatGPT in healthcare. It might amount to the scene out of ‘A Charlie Brown Christmas’ where Lucy is listing off phobias and asking Charlie Brown if he has them.” I’ve certainly seen some interesting applications, or should I say attempted applications, of ChatGPT recently. Today brought an email from a colleague that was most likely produced by some sort of bot since the syntax didn’t sound anything like her usual written patterns. I found it pretty annoying since what she sent was a reply to a pretty straightforward question that could have been answered in five words or fewer. It’s fine if you want to play around with it, and since we are both informaticists, it could have been “hey, check out what ChatGPT created as a reply,” but since there had to be a few more back-and-forths to get the original question answered, it wasn’t much of a time saver.

Everyone is trying to figure out how to streamline workflows in ambulatory medical practices. Solutions being implemented for pre-visit flows include patient portal-based check-in that can be completed at home up to a few days prior to the visit; chatbot-based flows that can be completed either at home or upon arrival; and self-check-in kiosks. A recent article in the Annals of Family Medicine looked at a “self-rooming” process implemented in primary care clinics from October through December 2020. Researchers found that most patients preferred self-rooming, although some felt less welcomed, more lost or confused, more frustrated, or more isolated compared to escorted rooming.

Based on the overall positive response, the organization decided to roll out the process to all remaining primary care clinics, and it will become a permanent change for the institution. The process design included some decidedly low-tech features, such a laminated wayfinding card that was used by the patient to reach their exam room. Once the visit was over and the room had been cleaned and prepared for the next patient, the card was returned to the front desk so that another patient could be directed to the newly prepared room.

I recently learned that my residency training program is celebrating its 50th anniversary and will be holding a gala in honor of the milestone. Unfortunately, they didn’t start promoting the event until 60 days out, which isn’t nearly enough lead time when you consider that most of us open our clinic schedules up to a year in advance and on-call schedules are done at least 90 days in advance. I circulated the information to my class and the residents in the years above and below mine, but it looks like only the handful of folks who can travel without taking off work are likely to attend.

I had no idea the program had reached such a major milestone and it really seems like a missed opportunity to bring people together. Other organizations I’m part of that have had similar events have sent cards anywhere from six months to a year in advance telling people to save the date, which is key if you want to try to get a couple hundred physicians together in the same place at the same time.

It’s technology upgrade time at the House of Jayne and I’m very happy about my first purchase, which was a Kindle Paperwhite. I’ve been using the Kindle app to read on a decade-old iPad and decided I wanted something smaller and lighter for travel. Amazon was offering a deal on the high-end version as long as you didn’t mind buying it in Agave Green. I’m thrilled with the purchase and have already burned through two books. I’m still getting to know all the features, but it’s a significant step up from my previous reading situation.

I also had to break down and replace one of my monitors, which started having some issues with static electricity. Every time I touched my keyboard tray after walking on the carpet and accumulating a charge, the monitor would suffer a blue screen of death that required a reboot to bring it back to life. Tomorrow is unboxing and installation day, so wish me luck as I crawl around and under the desk to get things hooked up. Still on the to-do list after that is a new phone, but that’s a much larger project, especially since I want a full featured Android device that’s on the smaller side.

What’s your favorite piece of new technology? What’s the one thing you’d recommend everyone consider getting? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 2/9/23

February 8, 2023 Headlines 1 Comment

CVS Health to acquire Oak Street Health

CVS Health will acquire Oak Street Health, a Medicare-focused primary care provider based in Chicago, for $39 per share in a deal valued at $10.6 billion.

Oracle reorganized its data and AI initiatives amid a leadership shake-up, leaked internal memo shows

Oracle moves its AI and data business units within its cloud infrastructure business amidst the departure of Oracle Cloud Infrastructure EVP Don Johnson and the company’s continued focus on healthcare.

NOCD Completes Additional Funding in its Quest to End the OCD Crisis

Digital OCD therapy startup NOCD raises $34 million in a financing round led by Cigna Ventures and 7wireVentures, bringing its total raised to $84 million.

Morning Headlines 2/8/23

February 7, 2023 Headlines No Comments

Imperative Care Announces Formation of Stroke Recovery Digital Health Company Kandu Health

Medical technology company Imperative Care launches Kandu Health, which offers digital support for recovering stroke patients.

Senators probe telehealth companies for tracking and monetizing sensitive health data

A bipartisan group of senators ask executives at telehealth companies Cerebral, Workit, and Monument for details of their data-sharing policies including a list of all third-party sites they’ve shared data with over the last three years.

Albertsons Companies Launches Sincerely Health™ Digital Health and Wellness Platform

Grocery store operator Albertsons launches Sincerely Health, a digital health and wellness app that offers a questionnaire-calculated health score, linking to activity trackers such as Apple Health and Fitbit, and pharmacy management.

Oracle Unit Wins Fees After Beating Patent Case

A judge rules that CliniComp must pay nearly $1 million in attorney fees after losing a 2017 patient infringement lawsuit against Oracle Cerner.

News 2/8/23

February 7, 2023 News 3 Comments

Top News

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A blog post by Oracle EVP and lobbyist Ken Glueck fires back at members of Congress with unusually aggressive criticism of two recent bills that would postpone or cancel the VA’s Oracle Cerner implementation. Some points:

  • 1980s-era VistA can’t meet the health challenges of veterans, can’t communicate with DoD systems, and has always been nearly impossible to maintain and modernize, so reverting to it at live sites would be a disaster.
  • There’s no magic wand for modernization, but moving to commercial off-the-shelf system workflows is always worth doing.
  • It was a mistake to schedule the first VA go-live in the pandemic’s peak days of October 2020 when caregivers were overwhelmed.
  • With the Oracle acquisition of Cerner, “VA now has essentially two vendors for the price of one” in providing both clinical and engineering expertise.
  • DoD and public hospitals around the world have successfully rolled out Cerner as the VA struggles, suggesting that the VA’s issues aren’t related to product capabilities.
  • A particular VA challenge is that it runs 130 instances of VistA, which Cerner attempted to fix by combining them into a single workflow that turned out to be too cumbersome, such as dozens of options for ordering a liver enzyme test when commercial instances of Millennium might offer four or five.
  • Glueck reiterated Oracle’s commitment to have the first beta test of a rewritten Millennium EHR available in 2023 at no extra cost to the VA or DoD. The cloud-based application will include a modern, Web-based, mobile-friendly user interface and will support voice recognition and AI-based clinical decision support.

Reader Comments

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From Krill Feeder: “Re: more slide decks from the J.P. Morgan Healthcare Conference. Are health IT vendors increasingly using the ‘land and expand’ investor pitch for growth prospects as is common in other industries? Get the customer using a low-cost initial sale, then cross-sell and upsell to create annuity-like profits. Do readers think this still works in a stock market downturn?” Incumbent vendors, unless they are inept, always have the upper hand in making add-on sales by gaining access to health system decision-makers and removing the uncertainty and effort that is required to onboard a new vendor. I like the concept since it encourages vendors to perform well after the sale, which is a win-win, but whether investors should believe such claims is a different issue. A variant is when one company acquires another purely to sell into its customer base, which is often traumatic for those customers whose carefully researched product and vendor assumptions are rendered uncertain by new ownership bearing ulterior motives.

From Pete Drucker: “Re: [vendor name omitted]. To exit the market. Last day for employees is Friday.” Unverified, so I didn’t include the company name. I could not find a press contact or employee email address anywhere, so I’ve sent a Twitter direct message to the CEO and will update with any response.


Webinars

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

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


Acquisitions, Funding, Business, and Stock

CVS Health is reportedly close to acquiring primary care operator Oak Street Health for $10.5 billion.


Sales

  • WellSpan Health (PA) selects Epic-based KeyCare as its virtual care partner for its on-demand care service. The health system was part of the startup’s Series A investment round.
  • VirtualHealth adds automated prior authorization capabilities from Edifecs to its Helios utilization and complex care management technology.
  • Virtua Health (NJ) will implement Memora Health’s automated clinical intelligence software as a part of its care programs for congestive heart failure, specialty pharmacy, and colonoscopies.

People

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April Saathoff, DNP, MS, RN (Harris Health System) joins Johns Hopkins as VP/CNIO.

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ChartSpan names Dan PIessens, MS (RevealRx) CTO.

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Emids names Sean Narayanan, MS (Apexon) as CEO. He replaces founder and CEO Saurabh Sinha, who will transition to board chair.

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Medsphere promotes Jeri Judkins to CEO, replacing Irv Lichtenwald.

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Mass General Brigham promotes Fran Hinckley to VP of digital solutions delivery of its community division.


Announcements and Implementations

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Grocery store operator Albertsons Companies launches Sincerely Health, a digital health and wellness app that offers a questionnaire-calculated health score, linking to activity trackers such as Apple Health and Fitbit, and pharmacy management. The company’s merger with Kroger is pending approval.

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OSF St. Francis Hospital (IL) launches a tele-NICU program using technology from Teladoc Health.

Alpine Health develops AI-powered predictive analytics to help hospital case managers ensure that at-risk patients transition to the right care settings with appropriate social services upon discharge. The startup is the product of a partnership between OSF Healthcare (IL), its innovation center, and consulting firm High Alpha Innovation.

Virginia Mason Franciscan Health (WA) uses hospital-at-home services and technology from Contessa to launch its Home Recovery Care program at St. Joseph Medical Center in Tacoma.

Microsoft launches previews of Bing and Edge that are enhanced with the big brother of AI chat tool ChatGPT. Meanwhile, Google rushes chatbot AI tool Bard to testers in reaction to ChatGPT’s threat to Google’s search.

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Medical technology company Imperative Care launches Kandu Health, which offers digital support for recovering stroke patients.


Government and Politics

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The Defense Health Agency’s National Capital Region — which includes Walter Reed National Military Medical Center and several other facilities — will go live on MHS Genesis next month.


Privacy and Security

Federal officials attribute last December’s 988 mental health helpline outage to a cyberattack on Intrado, the emergency communications software company that has managed the service since it launched last summer.


Other

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Moffitt Cancer Center (FL) researchers determine that 25,500 virtual visits conducted through its Department of Virtual Medicine during the pandemic saved patients 3.4 million miles and between $147 and $186 per visit. The center plans to expand its telemedicine capabilities to include clinical trials.

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Sentara Healthcare creates a remote patient monitoring department to oversee the installation and management of 108 remote cameras in rooms across its hospitals in Virginia and North Carolina. The $1.7 million project follows a four-year period of product evaluations, pilot projects, data compilation, and establishment of policies and procedures. Trained technicians at two control centers are responsible for monitoring patients at a dozen facilities.

Did you see this in person as I did? A 3,875-foot scanned document that was created at HIMSS08 in Orlando holds the Guinness World Record as the longest ever. Attendance that year was 28,000 and keynote speakers included former AOL CEO Steve Case, “Freakonomics” author Steven D. Levitt, PhD, and former Google CEO Eric Schmidt.


Sponsor Updates

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  • Availity presents scholarships to students from Jean Ribault High School as part of its Beyond School Walls program with Big Brothers Big Sisters of Northeast Florida.
  • Diameter Health, now Availity, earns Certified Data Partner designation in NCQA’s Data Aggregator Validation Program.
  • King’s College Hospital London – Dubai will implement Oracle Cerner, utilizing Oracle Cloud Infrastructure.
  • AdvancedMD publishes “The Top 6 Healthcare Trends Making an Impact on Medical Practices in 2023.”
  • Nordic publishes a podcast featuring UCHealth CMIO C.T. Lin, MD.
  • Agfa HealthCare announces the successful go live of its breast imaging AI solution at Dubai Academic Health Corp.’s Dubai Hospital.
  • Artera expands its multilanguage support to 109 languages.
  • Baker Tilly releases a new Healthy Outcomes Podcast, “Creating an effective corporate compliance program for healthcare providers.”
  • Bamboo Health names Missi Ledbetter senior program manager, Courtney Forrest onboarding specialist, and Omer Khalil software engineer intern.
  • Emirates Health Services implements Care.ai’s ambient healthcare intelligence platform to enable its smart facility initiative.
  • ChartLogic integrates FlexScanMD’s inventory management and tracking system into its ambulatory practice management solution.
  • Clearwater publishes a new whitepaper, “Understanding Cloud Security Basics: How to Ensure HIPAA Security and Compliance in a Cloud Environment.”
  • CloudWave will exhibit at the North Carolina Healthcare Association Winter Meeting February 15-17 in Cary, NC.
  • WellSky announces that its CarePort Care Management and CarePort Discharge care transition solutions can now coordinate with Dialyze Direct service sites.
  • Azara Healthcare adds cost and utilization analytics and visualizations to its DRVS population health management platform.

Blog Posts


Contacts

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

Morning Headlines 2/7/23

February 6, 2023 Headlines 3 Comments

Feds say cyberattack caused suicide helpline’s outage

Federal officials attribute last December’s 988 mental health helpline outage to a cyberattack on Intrado, the company that has managed it since its launch in July.

Veterans Deserve Better than VistA

Oracle EVP Ken Glueck pushes back against recent Congressional efforts to potentially scrap or overhaul the VA’s Oracle Cerner-powered EHR modernization project, pointing out that the software is being successfully rolled out across the DoD, and has been installed at thousands of hospitals around the world.

Simple HealthKit Raises $8M to Transform Health Diagnostics and Follow-Up Care; Expands Portfolio to Include Solutions for Sexual Health, Tripledemic

Simple HealthKit, which offers a digital health platform encompassing diagnostics and follow-up care, raises $8 million in a Series A funding round led by Initialized Capital.

CVS Nearing $10.5 Billion Deal for Primary-Care Provider Oak Street Health

Sources say CVS Health’s plan to acquire Medicare-focused primary care provider Oak Street Health may come to fruition as soon as this week, with the deal valued at $10.5 billion.

Curbside Consult with Dr. Jayne 2/6/23

February 6, 2023 Dr. Jayne 2 Comments

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As a CMIO, there’s a lot of pressure on you to make sure that the healthcare information technology systems that are being implemented provide a solid return on investment. For many years, EHRs were promoted as a way to improve coding and charge capture. This led to physicians billing higher Evaluation & Management codes, which of course raised suspicion with auditors.

It also led to note bloat, as organizations created macros and templates that would ensure that clinical documentation was compliant with even the most rigorous audits. That meant that a certain percentage of notes actually became less useful than before since they were hard to read and full of nonsense that was required to support billing.

Fast forward to the Meaningful Use era and the rise of value-based care, when more organizations began entering into risk-based contracts. That meant that they needed to get a handle on how sick their patients really were to get the most money to care for those patients.

The Hierarchical Condition Category (HCC) coding paradigm had been created in 2004 and started to rise in prominence over the rest of the decade. HCC codes are tied to ICD-10 diagnosis codes. When combined with demographic information such as age or gender, those HCC codes are used to create a Risk Adjustment Factor (RAF) score for each patient. RAF scores can be used to predict costs, which were tied to payments. The higher your RAF scores, the more money you could bring in.

EHRs were also promoted as the solution to playing the RAF game. They were enhanced to remind physicians to document well so that HCC scores could be assigned and to make sure that they were documenting on those conditions at least annually. ICD-10 selection screens were enhanced to more prominently display codes that would lead to creation of a more complex patient picture.

Professional organizations also got into the game. My own organization published a series of “practice hacks” to encourage physicians to use team-based strategies to improve risk adjustment, essentially leveraging staff to massage documentation in the EHR with a goal of achieving higher payments. Sometimes this led to medical assistants or coders assigning additional codes as charts were reviewed following visits. Often these updates were not approved by a physician.

Practices that bet heavily on participation in Medicare Advantage plans became really good at playing these coding games. Technology made it easy to add highly specific billing codes to better capture patient complexity and to add those codes to the chart, even in visits where they might not have been actually managed.

As consulting clinicians, we could tell if organizations were playing these games. You would see a note for a straightforward visit for a self-limited illness and it would end up with six or eight diagnoses for chronic conditions, all with “continue current management” noted in the assessment and plan. As expected, payments to these organizations rose. However, when dealing with governmental payers, there’s always a piper who will get paid.

CMS is starting to play a mournful tune for many physicians and care delivery organizations with the release of a new rule that calls for organizations to pay back what could be billions of dollars in what CMS now considers overpayments. Auditors will be going after providers who may have indicated that patients were sicker than they actually were, or that they required higher levels of care than the charts can actually substantiate.

CMS won’t just be going after the overpayments, though. It will be using a revised Risk Adjustment Data Validation tool that uses the overpayments that are found during actual audits to extrapolate repayments for all the claims that were submitted during a given year for a given diagnostic subgroup or set of codes. The incorporation of extrapolated repayments applies to the 2018 plan year and subsequent payment periods.

CMS predicts that it will recover $479 million for the 2018 payment year alone, with a forecast of $4.7 billion in repayments over the next decade. An accompanying CMS press release quotes HHS Secretary Xavier Becerra as stating, “For years, federal watchdogs and outside experts have identified the Medicare Advantage program as one of the top management and performance challenges facing HHS, and today we are taking long overdue steps to conduct audits and recoup funds. These steps will make Medicare and the Medicare Advantage program stronger.”

CMS plans to focus its audit strategy on Medicare Advantage Organizations that have been “identified as being at the highest risk for improper payments.” I’ve been involved in consulting engagements at organizations that took fairly substantial liberties in their coding, so it will be interesting to see who winds up on the wall of shame first.

For the tech teams that support organizations that are heavily involved in Medicare Advantage, get ready to be on the looking for requests to look at current functionality and compare it to other features that may be available from EHR vendors or might be on the near-term horizon. It’s also an opportunity for startups to try to fill the gaps, making sure that care that is documented actually gets delivered, even if it’s through lower-cost third parties or use of technology.

For historically conservative organizations that might be quaking in their boots over this, it might lead to requests to restrict access to certain functionalities or workflows or to change the approval workflows when a coder or other personnel want to suggest that a visit’s coding should be changed.

This will also be a win for consulting organizations, who will now be out selling services to help organizations understand their audit risk and how to reduce it, as well as to help support them during the inevitable audit and request for repayments. It’s just one more example of how the complexity of the US healthcare system leads to gamesmanship as everyone tries to get a larger share of the money that makes up the healthcare pie.

Speaking of pie, this week’s pastry therapy includes Blueberry Sour Cream Scones, courtesy of King Arthur Baking. I got a little crazy with the powdered sugar drizzle, but they were the perfect addition to a chilly Sunday morning.

What’s your favorite weekend breakfast food? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: I Know You’re Not Thinking About Blocking Patient Data

February 6, 2023 Readers Write 4 Comments

I Know You’re Not Thinking About Blocking Patient Data
By Troy Bannister

Troy Bannister, MS is co-founder and CEO of Particle Health of New York, NY.

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If you’ve worked in healthcare for 10+ years, this is probably the one hundredth time you’ll read an article about patients being unable to access their own medical data. Here’s why I think that trend might be coming to an end soon.

During healthcare’s slow digital transformation, care providers moved from fax machines to 1:1 digital pipelines to manual portal scraping tools, just to get the charts of their patients. In many instances, these processes are occurring in what are negatively referred to as data silos.

Technology solutions for improving healthcare data accessibility have evolved over the years. The legal requirements for complying with data accessibility have followed closely behind. Most clinicians are connected to nationwide interoperability networks through an EHR, theoretically giving them at least some ability to exchange patient records. Now, the US government has made it clear that their patients have the right to access their medical records in those same technically feasible ways.

Enter the Anti-Information Blocking Rule, the culmination of government efforts to legislate clinical data accessibility. Just like it sounds, its goal is to eliminate practices that interfere with the access, exchange, and use of electronic health information.

Whereas HIPAA has long made it clear that individuals can request their own records in paper format, information blocking rules theoretically give patients access to the same advanced Health Information Networks that care providers use to digitally exchange data.

The Office of the National Coordinator for Health IT (ONC), which sets the rules for information blocking, is working particularly hard to prevent cases where an individual is arbitrarily blocked from access to their own personal health information.

Despite ONC’s intentions, repercussions for information blocking were nonexistent. For that reason, healthcare organizations have continued to drag their feet when it comes to allowing patient data exports.

I’m here to spread the news that information blocking is coming to an end. As of October 2022, the HHS Office of the Inspector General began collecting reports of information blocking on its new online portal, with a mandate to issue fines of up to $1 million per violation. It is no longer in question that healthcare organizations will be held accountable unless they improve patients’ access to their own data.

Information blocking regulations don’t have any health IT loopholes. Providers can’t implement patient-only release delays, turn information into an unreadable format, or seek other ways to water down the rule’s provisions. Generally speaking, EHR vendors, Health Information Networks, and provider organizations must release the entire HIPAA-established designated records set of electronic health information (EHI) to a patient upon request.

In other words, if information exchange is doable for doctors, it’s doable for patients too. Information must be in the manner a patient initially requested. That could entail release over the same efficient digital channels, including APIs, that clinicians have access to.

The lack of access to clinical data at scale remains a core problem for US healthcare that can be linked to many of our system’s inefficiencies. These issues have a fundamental impact on healthcare costs, care quality, and ultimately on patient outcomes. Stakeholders cannot continue to wait for healthcare organizations to make their data-sharing preparations. Information blocking is no longer an acceptable policy, and yet we see it every day.

Ahead of the October 2022 information sharing deadline, there were concerted efforts from several healthcare organizations urging HHS to postpone enforcement, and not for the first time. However, regulators felt there was too much at stake to keep patients and digital health pioneers waiting any longer. Information blocking rules have survived multiple presidential administrations, and there’s bipartisan agreement that they are here to stay.

In reality, not every health system is at the same level of readiness when it comes to anti-information blocking compliance. Patient access to EHI has been a complicated task for many healthcare institutions, especially those that are not prepared to share patient data electronically. Many organizations are scrambling to find their own tools to support such efforts.

Fortunately, the technical challenges of anti-information blocking compliance are addressed by the 21st Century Cures Act, the law which led to information blocking rules in the first place.

The Cures Act aims to increase innovation by fostering an ecosystem that supports the development of data-driven applications. The rule also calls on the healthcare industry to adopt standardized APIs, which will help allow individuals access structured EHI using smartphone applications securely and easily. From new health tools to transferring records between providers, information blocking rules will help patients to take greater ownership of their care.

“In 2023, the vast majority of docs and hospitals will have FHIR APIs live,” Steven Posnack, the Deputy National Coordinator of ONC, predicted last month. With the ONC incentivizing this change, digital health organizations should urgently consider a single, comprehensive API that enables a seamless data sharing experience for institutions of all shapes and sizes. Integrating a pre-built API lets providers retrieve medical records in just a few clicks, eliminating reliance on faxes, portals, and other tired forms of data exchange.

For large organizations that support value-based care models, being able to work with patient health records at scale lets providers proactively address patient needs. This is especially critical when it comes to evaluating patients with chronic disease and comorbidities, leading to reduced readmissions. For example, on an ongoing basis, an API can help kidney care organizations that track glomerular filtration rate (GFR), endocrinologists who chart A1c values, and cancer care institutions that research case histories. In these instances, the ability to easily query patient health records allows healthcare providers to more efficiently and effectively care for their patient populations.

Moving ahead, digital organizations can look forward to obtaining data quickly and easily, powering tools that deliver more effective care. But it’s not just the data itself that matters; it’s how you get it. Leveraging advanced technology like a single API helps healthcare organizations and their patients tap into their health history when they need it.

Morning Headlines 2/6/23

February 5, 2023 Headlines 1 Comment

Tallahassee Memorial Making Progress Managing IT Security Event

Tallahassee Memorial Hospital (FL) continues to operate using downtime procedures following “an IT security event” – reportedly a ransomware attack — that occurred late Thursday.

Duke Health enters deal to share de-identified patient data

Duke Health (NC) will sell de-identified patient data to drug companies via Nference, with which it may also create a for-profit spinoff business.

Athenahealth announces layoffs, possible office move

Athenahealth will lay off 178 employees, re-deploy 100 to more high-priority areas, and consider making changes to its office space in Watertown, MA.

Monday Morning Update 2/6/23

February 5, 2023 News 3 Comments

Top News

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Democrats on the House Committee of Veterans’ Affairs are working on an alternative to last week’s two Republican-sponsored bills that would end the VA’s Oracle Cerner implementation and convert live sites back to VistA.

FedScoop cites sources who say that the proposal may involve changes that would affect all of the VA’s IT projects.


Reader Comments

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From Krill Feeder: “Re: more slide decks from the J.P. Morgan Healthcare Conference. All vendors know, want, and fear the trademarked Gartner Magic Quadrant, which can have a strong impact on sales and corporate fate. Is NextGen Healthcare’s use of a similar graphic in a May 2022 investor deck without mentioning Gartner sketchy, smart marketing communications, both, or neither? And was its absence from the JPM event deck due to brevity constraints, Gartner objections, or evolving corporate spin?”


HIStalk Announcements and Requests

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Nearly three-fourths of poll respondents who attended HIMSS22 will go to HIMSS23, while 80% of those who didn’t go to HIMSS22 will repeat their absence in April.

New poll to your right or here: Which ways have you used in the past year to send medical information to a clinician? I like nearly everything about my direct primary care doctor, but most of all I like being able to text, call, or email her directly without having to pierce the veil of inept, self-important gatekeepers (she practices alone).


Webinars

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


Acquisitions, Funding, Business, and Stock

Constellation Software delays posting its Q4 and annual reports, blaming the complexity of its May 2022 acquisition of the hospital and large physician practice business of Allscripts, which is now known as Altera Digital Health within Constellation’s N. Harris Computer Corporation business.


Announcements and Implementations

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A regional network of OB-GYN practices and hospitals in New Jersey will collaborate to launch a statewide, value-based maternity care initiative that will be powered by the maternal digital tools of Wildflower Health.

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Jefferson Center goes live on Netsmart’s MyHealthPointe consumer engagement platform for remote patient monitoring and engagement for behavioral health services. It has launched a pilot with assessments for medication check-in, patient health questionnaires, and weekly check-ins and developing new technology services for family support, text communication, wearables, and notifications.


Privacy and Security

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Tallahassee Memorial Hospital diverts patients and cancels non-emergency procedures following “an IT security event” – reportedly a ransomware attack — that occurred late Thursday.

Duke Health will sell de-identified patient data to drug companies via Nference, with which it may also create a for-profit spinoff business. Bioethicists contacted by the local newspaper question whether it should be made more clear to patients that their data may be used to generate profit. Duke Health announced its relationship with NFerence on January 4, 2023, where it talked a lot about community health and research breakthroughs without mentioning that it was being paid for providing patient data.


Other

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Colorado counties report being overwhelmed with 911 calls that start coming in every morning when the ski lifts open and skiers start falling, which sets off the fall detector in their Apple Watches. The interim director of Summit County’s emergency service, which responded to 185 false alarm calls from Watch-wearing skiers in a single week, says that “Apple needs to put in their own call center if this is a feature they want.” She also notes that operators rarely receive false 911 calls from Android phones. The Watch gives wearers 10 seconds to suppress the call before it starts dialing, but those who are wearing ski gear often don’t notice the warning and don’t respond to the 911 call-back, which requires responders to be dispatched. One county’s sheriff has instructed 911 operators to ignore all automated calls from ski slopes, reasoning that there’s nearly always someone around who would call 911 in a real emergency.

In Germany, a nurse in a top teaching hospital confesses to killing two elderly patients by overdosing them on sedatives (unintentionally, the nurse says) so they wouldn’t bother him while he suffered from a hangover. He admits that he did as little work as possible in his job, ignored patients, turned their wheelchairs toward the wall so they couldn’t talk to others, and found it easy to obtain sedatives because “in the hospital, they don’t pay much attention to this.” He has been charged with two counts of murder and six counts of attempted murder. Note: the newspaper article says without explanation that the man “pretended to be a nurse,” but they incorrectly translated the original report from a German publication – he really was a nurse, but working in an area where he had minimal qualifications.

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Political anthropologist and medical resident Eric Reinhart, MD, PhD says in a New York Times opinion piece that physicians are getting burned out and leaving the profession not because of working conditions, but rather because they are “witnessing the slow death of American medical ideology” and feel complicit in putting profits over people. He says that the AMA convinced doctors to fight healthcare as a public service because it would threaten their autonomy and income, forcing doctors to lecture patients on personal health responsibility and their duty to avoid health risks that are mostly driven by economic disparity. He urges doctors to unionize, then demand universal healthcare.


Sponsor Updates

  • Nordic releases a new podcast, “Making Rounds: The up and downside of disintermediation.”
  • Everest Group names NTT Data a leader in its Healthcare Provider Digital Services PEAK Matrix Assessment 2023 report.
  • Sectra publishes a new case study featuring St. Maria General Hospital in Belgium, “How to save time on implementation while creating brilliant workflows.”
  • MGMA’s Insights Podcast features Surescripts Clinical Informatics Pharmacist and Manager of Product Performance Bri Palowitch.
  • Talkdesk names Miles Ennis (Aspen Technology) SVP of sales for North America.
  • WebPT wins three awards from TrustRadius in the categories of Best Feature Set, Best Value for the Price, and Best Relationship.

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