Curbside Consult with Dr. Jayne 10/2/23

In my clinical world, I’m starting to see more patients who are struggling with the symptoms of Long COVID. That’s not surprising, since current data from the Centers for Disease Control and Prevention’s National Center for Health Statistics published a report that indicates that nearly 7% of US adults have experienced the condition.

The data brief from the 2022 National Health Interview Survey indicates that nearly half of those individuals also said they had Long COVID symptoms at the time of the survey. To meet the definition of the condition, patients must have a set of symptoms lasting three months or longer after the initial COVID-19 infection. These can include fatigue, brain fog, dizziness, digestive symptoms, heart palpitations, changes in smell or taste, chronic cough, chest pain, and more.

Many of the patients I see have tried to explain away their symptoms, blaming them on the overall stress of the pandemic, problems with work-life balance, or increased demands from employers due to inadequate staffing. A number of patients also come in with similar clusters of symptoms, but never had a formal diagnosis of COVID, either because they were ill before testing was widely available or were ill later in the course of the pandemic and never tested. Ohers don’t meet the criteria for Long COVID, but are struggling with symptoms like memory issues, insomnia, and fatigue that can be associated with a host of other conditions, including anxiety, depression, and burnout.

Let’s face it, we’ve all been expected to do more with less, and that has ultimately taken a toll. Many healthcare workers, IT folks included, are looking for strategies to make sense of all they’ve been through during the last three years. They’re also looking to find a way forward that doesn’t put them in the office or bringing work home to the detriment of their family time. They’re looking for ways to cope and the mechanisms they employ aren’t always healthy.

While institutions are putting resources behind setting up Long COVID clinics and creating programs to treat those patients, it doesn’t feel like they are setting aside ample resources to deal with COVID’s collateral damage to the broader healthcare world. It’s no surprise that all of us have taken on a substantially larger mental load in recent years, so I set out to find articles that looked at the concept of mental load and mindfulness both before the pandemic and since. How much is this constant need to burn the candle at both ends really impacting us?

The first article I came across was in the New York Times archives from 2016, and caught my eye because of its title: “Think Less, Think Better.” It’s an opinion piece, but references a study that looks at how mental load can negatively impact one’s capacity for original and creative thinking. I’ve certainly experienced that phenomenon, when I’m juggling too many balls or putting out too many fires and as a result tend to fall back on tried-and-true solutions rather than trying to find novel ones.

The author’s research at the time indicated that “innovative thinking, not routine ideation, is our default cognitive mode when our minds are clear.” The study cited in the piece found that “the mind’s natural tendency is to explore and to favor novelty, but when occupied, it looks for the most familiar and inevitably least interesting solution.” Companies that make it a priority for employees to have unstructured time for creative or innovative pursuits seem to have figured this out. Still, there are plenty of companies out there where employees are just marching from meeting to meeting (whether virtually or in person) without time to catch their breath, let alone time to think creatively.

It’s one thing to try to make space for creative thinking when you’re working in the software industry or in marketing or sales, but how does that apply to actually seeing patients or supporting those who do? I wondered how these ideas might be applied to the healthcare IT space. In an August 2023 article in the Journal of the American Board of Family Medicine (JABFM) titled “Thinking and Practicing Thoughtfully and Thoroughly,” an editor’s note offered examples of some of the challenges of trying to meet the needs of individual patients at individual visits while simultaneously advancing the overall health of the community.

That sounds a lot like what many of us do in healthcare IT, where we try to meet the needs of individual clinicians while balancing them with outcomes desired by the overall technology organization. Like physicians, those of us that work the technology front lines try to find the colleagues who have fallen through the cracks and aren’t getting the support they need, and we also try to fix the overarching structures that might be causing strife. Lobbying an EHR vendor to fix faulty software is a lot more similar to lobbying Congress to fix faulty healthcare policy than I had previously thought.

That particular issue of JABFM offered numerous examples of work being done by physicians to try to improve patient care. I would bet that the majority of the research wouldn’t have been possible without dedicated EHR and analytics teams behind the scenes creating ways to capture the data, extracting it, collaborating with investigators, and more. The examples made me wonder if those who might be far from the front lines think about the impact they’re having with every template build or every SQL query that they do in their daily work, or whether they just think of it as one more thing to check off the ever-growing list of things to be done. Does the data analyst think of how many grandmothers, or sisters, wives, or daughters are in the data set that’s being pulled for breast cancer screening? Do they find a way to make the work feel more valuable, or is it just part of the grind?

In many healthcare delivery organizations, understaffing is present at all levels, at the bedside, in facilities or maintenance, in technology infrastructure, and in the teams trying to pull it all together. When they claim an ever-eroding margin, how can leaders of those organizations try to make space for staffers to not only be mindful about their work, but to have the time to explore their creativity and truly try to innovate? Even if you wanted your staff to spend 10% of their time working on novel ideas, how do you backfill those four hours each week? How do you decide what projects don’t get done when there’s already a backlog? I think the answer in many organizations is to just keep pushing ahead and not look for creative solutions, which ultimately will likely deliver the same results as we’ve been seeing all along because we’re doing what we did all along.

I’d be interested in hearing from readers how their organizations are tackling these phenomena. Are leaders able to make space for thoughtful, meaningful work, or is everyone just back at it, possibly working harder than they did a few years ago? Have people just checked out or left the healthcare space because what we’re asking them to do is untenable? Are your leaders working to find a way forward? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Ben Hilmes, President, Healthcare IT Leaders

Ben Hilmes, MHA is president of Healthcare IT Leaders of Alpharetta, GA.

Tell me about yourself and the company.

I’ve been in the industry for 25 years, going back to grad school. I have an MHA and am a fellow with the American College of Healthcare Executives, so I’ve been active in all of those industry channels. I spent 22 years with Cerner in a variety of roles, and when I left, I was running our US not-for-profit client organization that was about a $2.5 billion business as well as the outsourcing function called ITWorks. I then transitioned to Adventist Health as a chief integration officer, where I had responsibility for IT, informatics, analytics, and enterprise PMO. In April 2023, I joined Bob Bailey and Healthcare IT Leaders as president of the company. It has been an exciting five months.

I’m also doing a podcast called “Leader to Leader.” We will have a guest every month who is relevant in the industry, names that people know. Our first topic was revenue cycle outsourcing, a good conversation with Doug Hire, former COO of OptumInsight. We also talk about leadership. I think this industry is starving for really, really good leaders. Any insights I can pull out of these incredible people about their leadership journey and share those with the audience, we’re doing that.

What services are clients seeking?

Our services fall into three categories. EMR, with the main players like Oracle Health, Epic, Meditech, and Athenahealth. A second grouping is workforce management, human capital management, and ERP, with players such as Workday, UKG, and Oracle ERP. The third area is helping clients on their cloud journey, which can be as simple as how to do rationalization and get them out of the data center all the way to helping them migrate even the most complex of things, including EMRs, to the cloud.

Vendors and suppliers are getting out of the services business. We’ve seen a massive migration away from services from the primary vendors. Secondly, health system cost pressures are challenging them to think differently about how they get things done. Doing those things with a large system integrator sometimes doesn’t achieve the price point that they are looking for. We have found ourselves in a unique and exciting spot for a lot of those clients that need work done across those portfolio of technologies, being able to go direct to them or even working with some of our great partners like Deloitte, Accenture, PwC, KPMG in partnership to get their overall price points to something that is acceptable and sustainable by these clients to get work done in a challenging market.

Why are EHR vendors moving away from running a separate services organization?

It’s pretty simple. It’s margin. If you think about the Cerner transition, Cerner was at its core a software company. Oracle is even more of a software company, from a focus standpoint, than Cerner. When they acquired Cerner, they started getting out of some of these services businesses that were low margin. Cerner was doing that a little bit toward the end, getting rid of revenue cycle, starting to jettison low-margin CommunityWorks, their community hospital deployments. They were pushing those out to a couple of partners to do those end to end.

We have seen that trend almost in all of the software suppliers. The services business creates risk. It’s hard work. It creates a lot of noise and then doesn’t generate the kind of margins that these organizations demand and expect for either their shareholders or their overall business performance.

If the vendor can’t generate adequate margins on services, how can a third-party company?

The poor health systems that end up with one or two points of margin feel like they’ve had a great success. Software suppliers are well above that 70% or 80% margin. Services business run somewhere in that 30% to 40% margin range. We do a really good job of managing our overall overhead and spend. We don’t have a tremendous cost pressures from R&D with all of the development activities that a software company needs. We find a nice margin spot somewhere in the middle. That works for us and our shareholders while enabling us to create price points for our customers and clients that work for them.

Big healthcare organizations outsource big functions such as IT and revenue cycle management, but not infrequently bring them back in house not long after. Will we see the same buyer’s remorse with health systems who scale back data centers to move to the cloud and then find the eventual cost to be excessive or unpredictable?

I’ve been involved in outsourcing IT, revenue cycle, and hosting. Every one of those tends to be really, really strong out of the gate. But at some point, there is pressure to achieve margins. The overall service model changes over time. You see the vendors start tweaking that service model, whether it’s leveraging more offshore or leveraging less-expensive, less-experienced resources. We see it time and time again, trying to leverage technology to drive more efficiency or trying to do more with less. Every time I have seen that, there was a degradation in overall client experience. 

I suspect that you will see a similar trend as people move to the cloud. There may be enough incremental benefit in the movement to the cloud to offset that, so maybe it’s a little different business model. I think it’s too early to tell, but it’s interesting that when you are in a lot of those conversations, while it’s not the exact same thing, it sounds a lot the same. At the core, you are outsourcing this function to a different organization. It will be interesting to see if it follows the same trends.

How will Oracle’s ownership change the former Cerner business?

We can plainly see the number of clients that are transitioning away from Oracle Health to Epic or some other supplier. That trend continues to grow. It was eye-opening at Oracle CloudWorld to see  what Oracle is doing with Cerner. Some decisions are positive, while others make me scratch my head. But at the end of the day, Oracle is an incredibly formidable company that will eventually get it right. We need them to get it right. This industry needs a balance in that space. Having a strong player in Oracle Health is healthy for the industry.

I spent 22 years at Cerner, starting when we had 1,700 associates. We grew to 30,000 and had a lot of fun getting there all under the leadership of Neal Patterson and the vision that he had. It was almost emotional listening to Larry Ellison’s speech at CloudWorld, because if you listened closely and had the legacy information that I have, he is still talking about the same vision that Neal had around healthcare and the role that these systems can play in transforming this industry, whether it’s the national network, robotics, or analytics and insights. It was the race to get healthcare digitized. When we did, then it was going to be the fun stuff, and Larry is excited about that.

I would not count them out, as they continue to invest heavily. I heard it – he was very clear about healthcare being their number one focus. For a company the size of Oracle to boldly say that, coming from their chairman’s mouth directly, was a pretty big statement. But the clients are saying, let’s get on with it. We need to get there faster. We have real challenges today. You are seeing a lot of clients say, we can’t wait any longer and we are making the move. 

That creates a ton of opportunity for businesses like ours. As clients transition to Epic, we can play a meaningful role in helping them deploy that new solution. Secondly, there’s a large balloon effect. When you transition hundreds of resources over to a new project, such as Epic or some other system they have selected to deploy, you have to maintain all the legacy systems during that time. Our firm steps in incredibly nicely in that space with our managed service capabilities to provide all of that legacy support, all of that bridge strategy for these IT organizations as they go through the transition. Lastly, as they move to the new systems, we are rapidly stepping into the managed services space, being able to take on the application support for these organizations as they continue their journey on their new platform.

Where will innovation come from, or what areas will be ripe for a technology solution?

If you go through the major buckets of labor in healthcare, nursing is probably the best example. It’s a big spend and there’s a big gap. When I was at Adventist Health, we were spending 3X of our budget on contract labor, mostly in nursing. That’s not a sustainable model. So, how do I think about leveraging technology to create efficiencies? We were evaluating virtual options, such as patient care centers, to offset some of the work that nurses were doing in clinics. All the pre-work that could be done virtually.

Backing up, we were evaluating, on both the ambulatory and acute sides, going end to end looking at overall jobs to be done and breaking them down into two categories — things that have to be done in the physical environment and things that could be done in a virtual environment. As you start to think about those things that could be done virtually, you can start to think about virtual call centers, leveraging offshore capabilities, et cetera, to fill some of those voids. It was interesting on the acute side how many functions fall into the “we could do that virtually” category, and the same model could emerge. You’re going to see a lot of virtual nursing come to play, leveraging different technologies to provide those capabilities in a different way than physically being present.

The other place that is ripe for technology innovation is revenue cycle. You can’t just throw more people at it because we don’t have more people, people are expensive, and it doesn’t seem to be making any difference. Cost-to-collect for health systems is starting to get really out of hand. When I was at Adventist, we were looking at north of 5.5% cost to collect, which is unsustainable. We were at how we could leverage technology, offshoring, or some other business model to help us deliver a more efficient and higher-performing service.

Healthcare systems spend a lot of money on technology on the back end, but what patients see often remains clipboards and scanned documents. Are the technology changes in revenue cycle more consumer facing or more process oriented on the back end?

Revenue cycle is pretty broad. A lot of people think about it only on the back end. But a lot of the innovations are coming to play on the front end, engaging the consumer differently to create stickiness and increase and improve the overall patient experience. The challenge is that there are a lot of siloed solutions and data sets that don’t, at this point, create the intended outcome, which is to improve the overall experience, improve efficiencies, improve data capture, improve overall quality and outcomes.

For example, uniformity in how you communicate with your patient population or member population. You have four or five different technologies that do some sort of that, whether it’s a bot, a text, some kind of chat function, or a portal. How do you make those all seamless? We were faced with that challenge through our consumer strategy development when I was at Adventist Health. Working with these is almost like going back to the EMR of the early 1990 before you got to the single platform thought, the enterprise thought, You had silos of data, and the challenge was interop and getting these systems to communicate together. I think you’re facing the same challenges on the consumer side, and the front end of the rev cycle is front and center on that.

On the back end, there needs to be more innovation and stronger alignment with the payers. Providers and payers are going to have to come together and find unique ways to solve the real problems. Right now, providers have their agenda and payers have their agenda. I have been in tons of these dialogues with payers trying to think about new ways to address some of the challenges in the revenue cycle. In terms of innovation, I haven’t seen anything that’s leapfrog groundbreaking, but the business model tends to get in the way, which is unfortunate. But I still hold that promise that big orgs are going to come together. Clear minds are going to come to the table, and they are going to put the real focus, which is the patient, at the center of their objectives and start to find ways to bend the cost curve, create more efficiency, reduce the overall spend on revenue cycle, get claims adjudicated faster, all those functions. There’s an intersection between the payer and the provider that needs to be resolved

What are the key elements of the company’s strategy over the next few years?

We will continue to lean heavily in on our core focus around our staffing functions, across our three pillars of EMR, workforce management, and cloud. We will lean heavily into the managed service space. It’s about improving our overall revenue line to balance the staffing revenue with a recurring revenue. I believe we have the tools, the right people, and the capabilities to not only deliver a better managed service to our clients, but at a better price and with better outcomes. That’s exciting for us.

I could sit here and echo all the other pundits out there that talk about AI and all of the fun things around that, which is exciting, exciting stuff. But we don’t fully understand how it’s going to play out. So when I look out two to three years, we’re going to learn a lot about those things. It’s a little bit beyond that to really understand the true application of those things and how they can improve the overall healthcare experience, the delivery, the industry itself. But it will be exciting to see

.

Morning Headlines 10/2/23

AHA Responds to Senate RFI on Health Data Privacy

The American Hospital Association asks Congress to withdraw HHS OCR’s December 2022 rule that prohibits hospitals from tracking their website users using third-party technology.

Biogen shutters digital health group, nixes Apple study, as part of cost cuts

Biotech firm Biogen shuts down Biogen Digital Health and lays off 150 employees as the company cuts costs and restructures.

Syra Health Corp. Announces Pricing of Upsized Initial Public Offering

Digital health vendor Syra Health launches an IPO in an effort to raise $6.7 million.

Large Michigan healthcare provider confirms ransomware attack

McLaren Health Care confirms it was the victim of a ransomware attack, and is working to determine if any stolen data has been posted to the dark web.

Monday Morning Update 10/2/23

Top News

The American Hospital Association asks Congress to withdraw HHS OCR’s December 2022 rule that prohibits hospitals from tracking their website users using third-party technology.

AHA says the rule violates HIPAA, harms patients and public health, and incorrectly extends HIPAA to cover website visitors who aren’t patients.

The organization says that third-party web user tracking tools such as Google Analytics and YouTube give health systems insight into community problems and website navigation issues, allow them to offer of educational videos, and help patients find service locations.

AHA says that Congress should change HIPAA to preempt state requirements as a uniform, nationwide standard, but otherwise shouldn’t make major HIPAA revisions since changes would “create more challenges than benefits.”

Reader Comments

From System CIO: “Re: Altera Digital Health. Like many Paragon customers, we’re switching to Epic. Altera say they won’t renew our maintenance agreement that we need until go-live in many months. I’ve switched EHRs many times in my long career and this is a first.” Unverified. I don’t understand why a vendor would reject another year or more of support revenue, other than just to be petty over being displaced. The upside is that they justified your decision.

HIStalk Announcements and Requests

Poll respondents, presumably mostly health technology insiders, aren’t broadly convinced that technology will significantly improve US healthcare, and few of them expect it to reduce healthcare spending. Steve says its better than we think, as “innovation seems to progress glacially when you’re living it,” while Frank says that capital expenditures always increase costs.

New poll to your right or here: What is the single best reason that Epic dominates its markets? I’m not giving you the intellectually relaxed option of choosing more than one answer, so feel free to further elaborate in the poll comments after voting for the one best choice.

I was looking for a lazy way to compare various lists of my sponsors, so I tried ChatGPT instead of trying to remember how to do it in Excel or Word or finding an old source code comparison tool. Of course it works, leading me to consider downloading an archived copy of HIMSS23 exhibitors and comparing it to the HIMSS24 version to see which companies are new or dropping out. I then played around with downloading an AHA list of hospitals and cities in Alabama, pasting it unformatted into ChatGPT, and asked it which ones are in Birmingham, and then which ones are in the northern part of the state. It figured the answers and properly formatted the list with just the hospital names. However, it wasn’t able to tell me which ones are within 50 miles of Gadsden because it doesn’t have access to mapping services.

For the ladies who are optimizing their shoe wardrobe for the conference season, my little AI friend likes Clarks Un Loop Slip-On Shoe, Naturalizer Samantha Pointed Toe Flat, Skechers Cleo Bewitch Ballet Flat, New Balance 877 V1 Walking Shoe, and ECCO Soft 7 Tie Sneaker. However, when pressed to choose a potential winner for conference shoe contests, ChatGPT favors United Nude’s Mobius Hi (above), which seems like a good choice for Orlando and is not wildly expensive at $175 after discounts.

Webinars

October 25 (Wednesday) 2 ET. “AMA: The Power of Data Completeness.” Sponsor: Particle Health. Presenters: Jason Prestinario, MSME, CEO, Particle Health; Carolyn Ward, MD, director of clinical strategy, Particle Health. Is your healthcare organization looking to drive profitability and scale quickly? Our experts will explore how comprehensive clinical data can revolutionize the health tech landscape. This engaging discussion will cover trending topics such as leveraging AI and data innovation to enhance patient care and outcomes, real-world examples of organizations leading the charge in data-driven healthcare, overcoming challenges in data completeness and interoperability, and visionary perspectives on the future of care delivery.

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

Acquisitions, Funding, Business, and Stock

The New York Times reports how analytics firm Palantir is aggressively lobbying to win an NHS patient data system contract that could be worth $590 million. The company has also hired away NHS officials and enlisted the help of politicians to support its selection for the Federated Data Platform. Civil liberties groups have raised concerns about turning over patient data to a for-profit company whose products have been used for government surveillance, also labeling the selection process as a farce because of the company’s existing connections from its previous no-bid contract award and its advantage in a short procurement window. The bid winner is expected to be announced this month.

Biotech firm Biogen shuts down Biogen Digital Health and lays off 150 employees as the company cuts costs and restructures. The business was formed in 2021.

People

Wolters Kluwer Health hires Rafael Sidi, MA (Clarivate) as SVP/GM of its Health Research segment.

Other

A review of “Fragmented: A Doctor’s Quest to Piece Together American Health Care,” a new book by Stanford oncologist Ilana Yurkiewicz, MD, describes how “missing data kills” as patients are repeatedly asked to recite their medical history to new providers who can’t get it using technology. Snips:

• Technology-driven treatments have advanced dramatically, but doctors are still “operating in an era of oral history or as archeologists” in being forced to review CD-ROMs, faxed records, and the patient’s interpretation of important medical details “as though she were piercing together potsherds at a dig site.”
• The families of patients work as “unpaid secretarial assistants” to keep records and coordinate care that providers should be doing.
• Hospitals don’t often notice or report harmful errors that are caused by a lack of provider coordination.
• The doctor takes more time with patients than the insurance-paid 15 minutes “to prepare them to be living medical charts,” estimating that half of the primary care part of her job is unpaid work that happens outside the patient’s room.
• The review notes that Estonia requires use of compatible EHRs gives patient ownership of their chart, where they grant or revoke provider access and share data with family members without paying for copies.

A second  hospital in England reports that large numbers of digital documents weren’t sent to doctors and patients because a computer issue prevented them from being noticed for approval. Nottingham University Hospitals NHS Trust found 411,000 documents that remained unreviewed after several years, of which 23,000 contained action items for patients or doctors.

A 30-year-old woman sues Disney for negligence, claiming that her trip down a Typhoon Lagoon water slide left her with an “injurious wedgie” that required gynecologic treatment and denied consortium for husband, who is also suing. I am hereby announcing plans to add “injurious wedgie” to common business lexicon for describing layoffs.

Sponsor Updates

• Care.ai sponsors a new podcast series titled “The Smart Care Team Spotlight,” hosted by former Microsoft Chief Nursing Officer Molly K. McCarthy, MBA, RN.
• EClinicalWorks publishes a new customer success story, “Unlock Healthcare Benefits with Healow.”
• A new survey from KeyCare finds that consumers prefer virtual visits over in-office care for several types of visits.
• Meditech announces new AI use cases at a recent customer leadership event.
• NeuroFlow releases a new Bridging the Gap Podcast featuring BCollaborative founder and CEO Lili Brillstein.
• Nordic releases a new Making Rounds Podcast, “Under new (data) management podcast.”
• PMD reaffirms its commitment to health data security by passing the SOC 2 Type II evaluation.
• Ronin Chief Scientific Officer Christine Swisher will keynote the virtual NLP Summit October 4.
• Symplr adds Survey Management capabilities to its Compliance platform.
• Lindsay Zimmerman, PhD VP of Upfront Healthcare’s Bartosch Patient Activation Institute, wins three prestigious industry awards.
• West Monroe releases a new report, “The Digital Disconnect: Linking Vision to Real-World Execution.”
• Ellkay, HealthMark Group, Linus Health, Nuance, Sphere, and Surescripts will exhibit at Athenahealth’s Thrive conference October 9-11 in Austin, TX.

Blog Posts

• Navigating Digital: A Roadmap for Rural Hospitals (ReMedi Health Solutions)
• Look beyond the hype to find responsible AI solutions in healthcare (Meditech)
• Manage the Multi-Platform Dilemma with Fewer and Better Communication Tools (Mobile Heartbeat)
• Successful Value-Based Care Models Require Rich Data Insights into the Care Continuum (NeuroFlow)
• Chatbots vs conversational AI – what’s the difference? (Notable)
• Exploring quality assurance for AI diagnostic decision support technologies: Key takeaways (Nuance)
• 5 Questions for Receiving Community Connect (Optimum Healthcare IT)
• The Compounding Benefits of a Proactive Approach to Denial Management (RCxRules)
• Future-proof your healthcare strategy with a FHIR data store (Redox)
• The Difference a Day Makes: Accelerating Specialty Medication Access for Patients (RxLightning)
• How to Fax Without a Fax Machine (Surescripts)
• 5 Steps to Improve Contract Management in Healthcare Organizations (Symplr)
• 3 achievable strategies from Piedmont for healthcare collection success (Waystar)

Contacts

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

Morning Headlines 9/29/23

Hospital execs to Lamont, lawmakers: Seal the Yale-Prospect deal

Two hospitals ask the state to expedite their acquisition, with a recent cyberattack leaving them unable to pay bills, but Yale New Haven Health is questioning whether it wants to buy hospitals that use such outdated technology.

Nuance Announces the General Availability of Dragon Ambient eXperience Copilot to Further Improve Healthcare Experiences, Outcomes, and Efficiency

Nuance renames DAX Express to DAX Copilot.

Federal Budgetary Effects of the Activities of the Center for Medicare & Medicaid Innovation

CBO says that CMMI, which tests new payment models and was projected to produce savings when it was formed in 2010, actually increased federal spending by $5.4 billion through 2020.

News 9/29/23

Top News

Patient engagement software vendor Tendo will acquire healthcare marketplace operator MDsave for $150 million.

Reader Comments

From Squeamish: “Re: Adventist Health. Heard from someone at the corporate office that they will replace Cerner with Epic in all markets.” Unverified, although reported by readers several times recently.

HIStalk Announcements and Requests

From Provider Sider: “Re: ChatGPT Pro. I work in risk management for a large practice group. ChatGPT Pro has saved me lots of time with tasks that would ordinarily take hours. For example, I am able to take bullets from chart review and remove PHI and then construct professionally written, clinically relevant summaries in responses to insurance grievances. The pro feature lets you set a static prompt that applies to every new prompt such as, ‘Write all responses as if written by an expert, with a risk management lens.’ I also use it  to write letters responding to patient complaints in patient-friendly terms using plain English. I’ve read opinions by AI experts that professionals who use AI like generative text will (eventually) outperform and leave behind those that don’t.” I agree. ChatGPT is great at analyzing documents and generating well-composed text from whatever input you throw at it, and for that alone it will have considerable healthcare value. I also agree that if implemented correctly, it should be invisible to patients in making humans better at their jobs.

I’m starting to receive the first HIMSS24 emails that include the name or logo of Informa Markets, which either owns or operates the conference, depending on the undisclosed structure of the deal. I also noticed that the HIMSS24 terms and conditions page references only Informa, not HIMSS, and that quite a few HIMSS folks have updated their LinkedIn profile employer this month to Informa Markets.

Welcome to new HIStalk Platinum Sponsor MRO. The Norristown, PA-based company is accelerating the exchange of clinical data throughout the healthcare ecosystem on behalf of providers, payers, and users of clinical data. MRO uses industry-leading solutions and the latest technology to help providers and payers manage and exchange clinical data. The company, which has a 20-year legacy and is a 10-time KLAS winner, connects 200 EHRs, 120,000 providers, 35,000 practices, and 900 hospitals and health systems while extracting 1.3 billion clinical records. Its proprietary Clinical Data Exchange Platform (CDXP) provides a digital front door that enables bi-directional sharing of information and reduces operational costs by streamlining processes, an orchestration and configuration engine to centralize connectivity across clinical data repositories and automate actions previously performed manually, and an infrastructure to light up the network of providers and accelerate interoperability with providers and payers within the MRO network. Thanks to MRO for supporting HIStalk.

Webinars

October 25 (Wednesday) 2 ET. “AMA: The Power of Data Completeness.” Sponsor: Particle Health. Presenters: Jason Prestinario, MSME, CEO, Particle Health; Carolyn Ward, MD, director of clinical strategy, Particle Health. Is your healthcare organization looking to drive profitability and scale quickly? Our experts will explore how comprehensive clinical data can revolutionize the health tech landscape. This engaging discussion will cover trending topics such as leveraging AI and data innovation to enhance patient care and outcomes, real-world examples of organizations leading the charge in data-driven healthcare, overcoming challenges in data completeness and interoperability, and visionary perspectives on the future of care delivery.

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

Acquisitions, Funding, Business, and Stock

Member engagement and wellness app vendor Virgin Pulse will merge with HealthComp, which provides health benefits administration.

Menopause virtual clinic operator Midi Health raises $25 million in a Series A funding round.

Two Connecticut hospitals that are owned by Prospect Medical Holdings urge legislators to approve their February 2022 agreement to sell the facilities to Yale New Haven Health, warning that they don’t have money to buy bed linen or laboratory supplies. Computer systems play a key role, as Prospect says it is still dealing with the financial effects a six-week cyberattack in August 2023 that has also caused Yale New Haven Health to question afterward whether the acquisition is prudent given the old systems the hospitals use. Prospect Medical says they can’t afford to upgrade.

Sales

• Mercy will use Microsoft Azure OpenAI Service to provide lab results to patients using conversational language, manage patient calls, and help employees access policy and procedure and HR information via a chatbot.

People

NeuroFlow hires Phil Vecchiolli (Capital Rx) as chief revenue officer and Robert Capobianco, MBA (NOCD) as chief commercial officer.

Announcements and Implementations

Case Western Reserve University goes live on Epic’s Lyceum EHR training system for its first-year medical and nursing students.

MHS Genesis goes live at Landstuhl Regional Medical Center in Germany and Royal Air Force Lakenheath in the UK.

Darena Solutions announces the launch of MeldRx, a development and deployment platform for apps that use FHIR.

Microsoft-owned Nuance renames DAX Express — which creates clinical documentation using conversational, ambient, and generative AI — to DAX Copilot.

OptimizeRx enhances its HCP engagement platform with AI and renames it the Dynamic Audience Activation Platform, which activates provider messaging across marketing channels for its life sciences customers.

A new KLAS report on physician scheduling finds that PerfectServe’s Lightning Bolt Scheduling tops the list due to ease of use and strong support.

Other

A 25-year-old man dies of brain cancer after doctors ignored a mass they saw on his CT scan because they thought it was a computer error.

A deceased patient’s family sues Adena Health, claiming that the hospital propped up the dead patient in her hospital bed to hide the fact she had died earlier during a cardiac catheterization procedure in which the cardiologist cut into an artery. The family says that staff urged them to approve turning off life support even though they knew that the patient had died two hours earlier, as documented in records they saw.

Sponsor Updates

• TLC Vascular adds RCM software and services from EClinicalWorks.
• Clinical Architecture releases a new episode of The Informonster Podcast, “How Datapult is Tackling the Challenge of Electronic Lab Reporting.”
• Divurgent will present at the North Carolina HIMSS Annual Conference October 3 in Raleigh.
• Healthcare IT Leaders releases the first episode of its new Leader to Leader Podcast, “Doug Hires on Leadership Perspectives on RCM in Healthcare.”

Blog Posts

• Highlights from the DIUC23 Keynote (Dimensional Insight)
• Next stop: Nashville (EClinicalWorks)
• Is the Drug You’re Dispensing a Controlled Substance or Not? (First Databank)
• Meeting the Needs of New Yorkers (Findhelp)
• Mastering Contact Center Metrics: A Guide for Success (Five9)
• AI Jobs in Healthcare (Healthcare IT Leaders)
• From Red to Black: Optimizing Healthcare Contract Management (Medhost)

Contacts

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

EPtalk by Dr. Jayne 9/28/23

From Former Cerner: “Re: Oracle CloudWorld meeting. It’s hard to hear about the company’s goal (which is becoming more of a mantra) to ‘drive Cerner profitability to Oracle standards’ when you see what they’re spending money on, including a Formula One race car and of course the racing yacht. When you think about in the context of the fact that they laid off the clinical resources that a lot of us depended on, it’s absolutely nauseating. But I guess it might be a short-lived situation, since all of us are waiting to wind up on a layoff list some time soon.” I have several friends who work for Oracle, and all have shared the same sentiments. In addition, they noted the ongoing global focus (including the CloudWorld Tour 2024, which visits Dubai, London, Milan, and Singapore, among others) as detrimental to understanding the realities of the US healthcare system. Sounds like a lot of people at Oracle are job hunting, and I wish them well as they look for their next adventures.

From Atlanta Express: “Re: updating systems when new vaccines are rolled out. The new COVID vaccines caused havoc with the Vaccines.gov website. What did they think would happen when they authorized a new vaccine on the same day they removed the old vaccine, and removed all the vaccine inventory in the system? Especially when locations don’t have any inventory for the new vaccine? Searching for a ’location near me’ produces zero results. Lots of assumptions were made and now people are surprised, and everybody is scrambling.” I’m not surprised by any government chaos anymore. This seems like a classic cutover-type project, although on a larger scale. We’ve known for weeks that the new vaccines were coming even though we didn’t have a specific data for the Food and Drug Administration and other approvals. Organizations go through a similar process every year with updated influenza vaccines, so it’s disappointing to hear that this was messy. Hopefully, the lessons learned will be well-documented for the next vaccine update, which might be happening every year for the foreseeable future.

There has been a lot of whining by large health systems about the federal requirements for price transparency that were implemented in 2021. Some organizations worked hard to make it difficult for patients to find information where others quietly complied but didn’t promote the availability of data to patients. A recent article posted in JAMA Internal Medicine compared hospital online price calculators with prices obtained via phone for the same services. The authors used vaginal childbirth and brain magnetic resonance imaging (MRI) as their service price points. They concluded that “…at US hospitals, price estimates for shoppable services posted online correlate poorly with prices obtained via phone; these findings suggest that patients will continue to face barriers to comparison shopping.” Only 14% of hospitals had matching prices given via phone and online for childbirth; the figure for brain MRI was 19%. The authors also noted that at up to 12% of hospitals, billing staff couldn’t provide a price estimate even though the hospital had a functional online pricing calculator. Of course, it’s nearly impossible to comparison shop for urgent or emergency services, such as a same-day appendectomy or a critical fracture, so it remains to be seen how useful these price transparency tools are in the long run.

Although many organizations had already embraced electronic health records in the 1990s and early 2000s, it took until the US government’s so-called Meaningful Use program’s inception before other organizations fully embraced the concept. Over time, clinicians and their support teams have been asked to gather increasing amounts of information about their patients with the hope of improving clinical outcomes. First, it was basic medical information such as medications, allergies, and a problem list. Then, we moved on to smoking history, tobacco and drug use, and other factors that are linked to health outcomes. Now, organizations are being asked to collect information across a variety of domains, with social determinants of health receiving much of the current focus.

A recent Viewpoint article in the Journal of the American Medical Association cited the “Inadequacy of Current Screening Measures for Health-Related Social Needs” as something that needs to be addressed. The authors note the presence of new quality standards that are designed to promote health equity in the face of “an indisputable connection between social factors (e.g., low food security, housing instability), structural racism, poverty, and health.” In an unexpected twist, they note that “without additional considerations, these well-intentioned mandates will impede progress in health equity and have the potential to increase long-standing racial and socioeconomic inequities.” They point out that although policymakers use the terms somewhat interchangeably, there is a difference between social risks and social needs. Social risk screening requires validated screening instruments, and social needs screening involves asking the patient about desired assistance. Many health systems have created and employed their own screening instruments without looking at the difference between the two and that approach may lead to paternalistic care as opposed to trying to understand the patient’s perception of their unmet needs.

The authors have some specific recommendations for moving forward with screening in a productive manner, and not surprisingly, those approaches don’t involve standardized pre-visit questionnaires delivered via a patient portal. They recommend that regulatory bodies should provide incentives to health systems to better partner with their patients through a shared decision-making process. This involves cultural understanding and real conversations along with the flow of data among care delivery and social service agencies. They advocate for prioritizing social need screening over social risk screening, focusing on meeting the needs already identified by patients themselves. Staff members need to be trained to do this with empathy rather than just reading a canned questionnaire to patients and capturing their responses.

The authors call for strong social safety nets to better support patients, including nutrition programs and support of policies that promote equity. Unfortunately, in working with large health systems over the better part of two decades, I see a lot of people who still believe it’s easier and better to just throw technology at a problem, and I suspect we’ll be seeing more automated pre-visit questionnaires and fewer direct contact staff members as organizations try to tackle these issues.

How is your organization dealing with social needs data? Is it taking a technology-driven approach or using actual humans to make a difference? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 9/28/23

Virgin Pulse and HealthComp Announce Intent to Merge to Create Comprehensive Employer Health Platform

Member engagement and wellness app vendor Virgin Pulse will merge with HealthComp, which provides health benefits administration.

Nuance Announces the General Availability of Dragon Ambient eXperience Copilot to Further Improve Healthcare Experiences, Outcomes, and Efficiency

Microsoft-owned Nuance renames DAX Express — which creates clinical documentation using conversational, ambient, and generative AI — to DAX Copilot.

Tendo to Acquire MDsave, Creating Leading Platform for Patient Engagement and Shoppable Care

Patient engagement software vendor Tendo will acquire healthcare marketplace operator MDsave for $150 million.

Healthcare AI News 9/27/23

News

Nuance announces GA of Dragon Ambient EXperience (DAX) Copilot, formerly known as DAX Express, that uses conversational, ambient, and generative AI to help physicians create medical documentation.

OpenAI updates ChatGPT to support using browser-based data, effectively bypassing the previous September 2021 training cutoff. To activate, click GPT-4 and then “Browse with Bing (beta).”

Business

A planned share sale by OpenAI values the company at up to $90 billion.

OpenAI investor and competitor Microsoft is developing smaller, cheaper alternatives to ChatGPT using existing Microsoft technologies.

Drug maker Novo Nordisk, which sells weight loss drugs Ozempic and Wegovy, partners with AI-powered drug discovery vendor Valo Health to study cardiometabolic drug programs, also acquiring three pre-clinical cardiovascular drug discovery programs from Valo. Novo Nordisk will pay $60 million upfront, up to $2.7 billion in milestone payments, fund the R&D costs, and possibly pay royalties. The 45-year-old Valo founder, CEO, and board director David Berry, MD, PhD, has founded 25 companies and holds 200 patents.

Research

Researchers at Kennesaw State University will study the use of RFID clothing tags to capture body motion for the study of health problems in the elderly, especially those involving fall risk.

Other

Students at University of Calgary’s medical school create an app that allows students to practice their interactions with patients and receive feedback on their performance along with suggestions they could have asked.

Researchers find that using AI chatbots to find an ophthalmologist returned results that were biased and sometimes wrong, choosing a disproportionate percentage of male doctors and those who practice in an academic setting.

Contacts

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

Morning Headlines 9/27/23

Datavant Leads in Health Data Exchange: Surpasses Digital Connections to 70,000 Hospitals And Clinics, Acquires Healthjump

Datavant acquires Healthjump.

CommonSpirit Unaudited Financial Report

The140-hospital system says that last year’s ransomware attacked cost it $160 million and it still doesn’t know how much its insurer will pay.

Newcastle Hospitals says computer error lost patient letters

The hospital says a computer system caused 24,000 patient letters, some including clinical results and recommendations, to remain unsent.

Important information to know: Nuance Communication data breach

WVU Medicine announces that the information of some radiology patients was exposed in a breach of Nuance Communications.

News 9/27/23

Top News

Release of information service provider Datavant acquires Healthjump, which provides health data exchange for value-based care organizations.

Reader Comments

From Lillehammer: “Re: the apparent end of Oracle Health’s code Developer program. I suspect they are taking a similar route to Epic and will pare down their value-added offerings for API integrations and perhaps shut down the Cerner App Gallery. Cerner never seemed to be committed to making interoperability easy, as evidenced by years-ago mentions of non-FHIR APIs that never came to fruition and lack of documentation and support for non-FHIR integration methods, such as HL7v2.”

From Birdie: “Re: Robin Healthcare. Investors pulled $$, doors shut, doctors cut off from service. Just an overnight flameout. Ambient documentation was never really gonna succeed, was it?”

Webinars

October 25 (Wednesday) 2 ET. “AMA: The Power of Data Completeness.” Sponsor: Particle Health. Presenters: Jason Prestinario, MSME, CEO, Particle Health; Carolyn Ward, MD, director of clinical strategy, Particle Health. Is your healthcare organization looking to drive profitability and scale quickly? Our experts will explore how comprehensive clinical data can revolutionize the health tech landscape. This engaging discussion will cover trending topics such as leveraging AI and data innovation to enhance patient care and outcomes, real-world examples of organizations leading the charge in data-driven healthcare, overcoming challenges in data completeness and interoperability, and visionary perspectives on the future of care delivery.

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

People

McKesson-owned oncology real world evidence vendor Ontada hires Christine Davis, MS (Oracle) as president.

Clinical laboratory quality management software vendor MediaLab hires Tom Ormondroyd, MBA (Millennia Patient Services) as CEO.

Artera expands its executive team with promotions — Ashu Agte (CTO), Tom McIntyre, MS, MBA (COO), Adrianna Hosford (SVP of marketing and communications), and Zach Wood, MBA (SVP of product and partner ecosystem) – and hiring Nicole Ossey as VP of people.

Announcements and Implementations

Costco offers its members discounted, $29 primary care video visits from independent virtual provider marketplace Startup Health. Customers can also get a standard lab panel with virtual follow-up for $72 and book online mental health visits for $79. Sesame also offers virtual visits with specialists and a prescription refill service.

Open AI rolls out new ChatGPT capabilities for conducting voice conversations and analyzing photos.

Oncology data vendor COTA announces Vista, an EHR dataset for drug company research.

Tesla announces new capabilities for its Optimus robot, which can precisely locate its own limbs in real time and applies “video in, controls out” learning from its onboard neural network. The implication for industries that rely on an aging workforce that is trained to perform repetitive tasks in fixed environments using show-and-tell methods could be significant, as could the economic implications of relatively inexpensive 24-hour-per day employee replacements that have no geographic limitations. Elon Musk said in May 2023 that he expects the majority of Tesla’s value to come from Optimus, which he says could sell 10 to 20 billion units.

Privacy and Security

CommonSpirit Health, which operates 140 hospitals and 1,000 care sites, reports a $1.4 billion FY2023 loss, of which it attributes $160 million to its October 2022 ransomware attack. The organization acknowledges that it may face class action lawsuits related to the breach and does not yet know whether its insurer will cover some of the costs. CommonSpirit lost $1.2 billion in the previous fiscal year, when it paid its CEO $35 million.

Other

England’s Newcastle Hospitals blames its computer system for failing to send 24,000 letters to patients over several years that included test results, care needs, and discharge instructions that were never delivered. The trust says that drafts of the letters require a second clinician’s signature before sending, but the letters were stored in a computer folder that few doctors knew about. Officials didn’t name the EHR, but the trust is a long-time user of Cerner / Oracle Health.

Patients of hospitals in Pakistan complain that a shortage of X-ray film has forced hospitals to take phone pictures of their radiology computer screens to make copies for patients, which the patients note are still being charged to them at full price.

Sponsor Updates

• EClinicalWorks supports community health centers with its continued progress towards enabling UDS Patient-Level Submission (UDS+) reporting via FHIR.
• Nova Scotia Health in Canada upgrades to Agfa HealthCare’s Enterprise Imaging Platform.
• Availity CEO Russ Thomas joins the Definitively Speaking Podcast.
• AvaSure publishes a new guide, “Fall Prevention in Hospitals: Key Results from Virtual Monitoring Programs.”
• Nordic releases a new episode of its In Network podcast, “Making Rounds: Under new (data) management.”
• Baker Tilly releases a new Healthy Outcomes Podcast, “Final Medicare hospital inpatient prospective payment system (IPPS) and proposed outpatient prospective payment system (OPPS) changes for fiscal year 2024.”
• Bamboo Health CEO Jay Desai will present at Health Evolution September 28 in Nashville.
• Clinical Architecture will sponsor SNOMED CT Expo 2023 October 26-27 in Atlanta.

Blog Posts

• Meditech Expanse Pharmacy: Wins and Benefits of Formulary Service Vendor Changes (CereCore)
• Addressing Healthcare Staffing Shortages and Improving Productivity through Technology and Outsourcing (AGS Health)
• Generative AI at point of care (Arcadia)
• RDCA-DAP and the Aridhia DRE – A platform to accelerate rare disease therapy development and regulatory engagement (Aridhia)
• How healthcare providers can implement a denials management program utilizing internal audit (Baker Tilly)
• SNOMED CT Facilitates Public Health IT Initiatives (Clinical Architecture)

Contacts

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

Morning Headlines 9/26/23

Costco members now have access to $29 online healthcare visits

Costco partners with Sesame to offer members in all 50 states same-day virtual primary care visits for $29, a lab panel and virtual follow-up for $72, and online mental health visits for $79.

Collaborative Intelligence to catalyze the digital transformation of healthcare

Authors recommend using AI for collaborative intelligence in which humans work in concert with algorithms and are responsible for ensuring their accuracy, completeness, and freedom from bias, with technology evaluated as part of the work it assists rather than on its own.

ChatGPT can now see, hear, and speak

Open AI announces that it is rolling out ChatGPT capabilities to conduct voice conversations and analyze photos.

Curbside Consult with Dr. Jayne 9/25/23

I’m not sure what the universe is trying to tell me about work life balance and people’s feelings about the return to the office, but my inbox this week was full of articles touching on the topic.

I’ve written in the past about the concept of so-called “quiet quitting,” where employees transition from going the extra mile for their employer to putting in the minimum effort required to meet the job description. The Atlantic took this one step farther with a piece — albeit recycled from 2021, yet presented as if it was something new — titled, “How to Care Less About Work.” Its premise is that workers need to evaluate how they want to spend their remaining time on Earth.

Spoiler alert: many employees agree that the days of working more than 40 hours a week for nebulous corporate goals are over: “It was seldom to create work that was meaningful or innovative, even if we could mumble something to that effect when asked what we like about our job. It wasn’t so that we could someday work less overall. We worked hard to prove that we were alert and available for more work.”

It turns out that The Atlantic piece is actually an excerpt from a book “Out of Office: The Big Problem and Bigger Promise of Working from Home” by Charlie Warzel and Anne Helen Petersen. I was intrigued enough to do some weekend reading and found it to be an interesting counterpoint to the numerous CEOs who are clamoring for a return to the office without clear goals for that change. The chapters keep it simple: Flexibility, Culture, Technologies of the Office, and Community. These are all topics that should be critical discussion in any work environment, whether remote, hybrid, or in-office.  I’ve been in several working situations where technology runs rampant and employees are struggling to even do basic tasks due to confusion about the best communication platforms to use for different situations, whether to call, e-mail, message, or text someone, and whether meetings really need to be had.

Like many of us who worked remotely prior to the pandemic, the authors had embraced remote work, moving from Brooklyn to Montana. They discovered it wasn’t as easy as they thought, and that it was important to figure out how to fit work into a rich home life versus always working because if was so easy to just log on without a commute.

As someone who struggled with one particular office-based consulting engagement a few years ago, I loved some of their descriptions: “unscheduled, drive-by meetings” were definitely one of the things I found challenging, especially since I was working from a cubicle on a main aisle in the office and was constantly barraged by people dropping by to say hi or ask questions. I’m always happy to help, but then it takes a few minutes to get back into the groove of the work you were doing, resulting in lower productivity.

There was one particular group manager that I swear never did work. If you popped your head above the partitions, he was always walking around chatting. Another favorite quote: “They [offices] elevate the feeling of productivity over being productive. They’re a breeding ground for microaggressions and toxic loops of hierarchical behavior.” That’s not to say that the latter elements don’t happen in the remote workplace, because I’ve definitely seen them.

The authors challenge companies to reconceptualize the workplace, “having honest conversations about how much people are working and how they think they could work better. Not Longer. Not by taking on more projects, or being better delegators, or having more meetings. Not by creating ‘more value’ for their employer at the expense of their mental and physical health. Instead, it means acknowledging that better work is, in fact, oftentimes less work, over fewer hours, which makes people happier, more creative, more invested in the work they do and the people they do it for.”

I think the idea of really exploring the concept of value is an important one, especially in companies that have a lot of meetings. It’s challenging to understand which meetings provide benefit for attendees and how to find the right balance of scheduled versus nonscheduled time. I worked for one company where its weekly product development meeting was simply an echo chamber for the chief product officer, and no one was allowed to question him. That, my friends, was not a value-added meeting.

Another quote that really resonated with me was around how companies monitor productivity of remote workers. Another part of reconceptualizing the workplace “entails thinking through how online communication tools function as surveillance and incentivize playacting your job instead of actually doing it.” I was at lunch recently with a couple of physician friends, one of whom had recently started working for a large health insurance company doing case reviews in a particular subspecialty where she has many years of experience. She whipped out her laptop and mentioned that although she had already finished her quota of reviews for the day, they went faster than expected, so she needed to log more online time to complete her day. Apparently since she’s new to the company, she’s being treated like a new employee rather than the seasoned reviewer she is, so she has to be sure to log a full eight hours until she reaches the end of her probationary period.

We all agreed that was ridiculous, but humored her in the situation, although it was less funny when her voice-to-text app started picking up our lunch conversation. If there was any AI involved, I hope it enjoyed our entirely too specific discussion of the best way to prepare fried pickles.

This reconceptualization, according to the authors, “will require organization based on employees; and managers’ preferred and most effective work times, and consideration of child-and eldercare responsibilities, volunteering schedules, and time zones.” I worked for a number of years at a large organization that had clients in time zones from Hawaii to London, with the majority of workers being remote. Although customer support teams were organized largely by geography (except for those supporting nationwide clients), we made it clear that we didn’t expect our Pacific time zone friends to be taking calls at 6 a.m. local time or for our Eastern time zone colleagues to still be working at 6 p.m. local time. It took commitment by leaders and team managers to realign meeting schedules into blocks that worked for everyone. We created a culture where it was perfectly fine to have lunch on camera (after all, many of us would regularly have working lunches in the office-based world) as well as to use the extremes of the day to complete personal errands outside of designated blocks where meetings were typically expected. Sure, there were fewer hours in the day which were acceptable for broadly attended meetings, but it caused us to really evaluate whether we really needed to be having so many meetings and how many people really needed to attend them.

The organization was ultimately acquired by another that didn’t share the same values on workday flexibility. The first thing they did was require people who were geographically located near one of the corporate offices, of which there were five at the time, to come into the office two days a week, just to be in the office. It didn’t matter if their teams were there or whether they would spend the whole day on Webex — management wanted to see bodies in chairs when they strolled through.

I immediately lost one of my favorite employees, who had been using her flexible schedule to help care for her husband following a serious illness. She would work from 6 a.m. to noon, take her husband to cardiac rehabilitation, then return after 3 p.m. to finish her day since it was easier to find an in-home caregiver to cover early morning and late afternoon than it was to find one to cover the full day and transport him to therapy. Of course, that meant she couldn’t come into the office two days per week, and the company was unwilling to accommodate her despite the fact that she supported teams that were all across the US and no one she worked directly would have been in the office.

I have so many other stories about what I’ve seen in my consulting travels, and so often when I give examples they fall into the category of “you can’t make this up.” It will be interesting to see what really happens with the remote work landscape over the next two years especially for technology and knowledge workers, like those of us in healthcare IT.

What’s the most egregious thing you’ve seen in a return to office strategy? Is there a way that your organization has done it well? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 9/25/23

Veradigm Inc. Announces Receipt of Nasdaq Delisting Notice and Intent to Appeal

The company says it will file its three overdue financial reports in Q4.

AMIA Announces the 2023 Signature Awards Recipients

AMIA recognizes the accomplishments of several informatics leaders.

FTC Challenges Private Equity Firm’s Scheme to Suppress Competition in Anesthesiology Practices Across Texas

The FTC’s lawsuit includes the company’s private equity owner in what may be a new strategy to hold healthcare company owners accountable.

Monday Morning Update 9/25/23

Top News

Nasdaq sends Veradigm a delisting notice for failing to file financial reports, which the company says it expected and will appeal.

Veradigm expects to file the overdue reports by the end of Q4. It blames its failure to file its annual report for 2022 and the two following quarterly reports on accounting software problems. 

Reader Comments

From Former Employee: “Re: ModMed. Acquired Klara last year for $135 million and has laid off 80% of the sales team. It’s an interesting story that unfolds on GlassDoor reviews.” Unverified. Specialty EHR vendor ModMed – formerly known as Modernizing Medicine – acquired the patient outreach messaging vendor Klara in February 2022. Privately held ModMed has raised a reported $400 million, none of it recently, and paid $45 million in November 2022 to resolve federal kickback charges related to referring business to a clinical lab partner.

From Interopguy: “Re: Oracle Health. Mysterious message on the end of code Developer program at Cerner, and uncertain path forward. What does this mean for app developers and for interop with Oracle Health?” The Open Developer Experience was created to help developers build apps for Millennium and HealthIntent that improve interoperability capabilities. Oracle Health developer Aaron McGinn, who appears to have had led the company’s presence with the developer community, has tagged his LinkedIn with “open to work.” Oracle moved its discussion forms to an Oracle site and users report lack of company response along with errors in the developer sandbox.

From Laminar Flow: “Re: Oracle Health. One of their recruiters says on LinkedIn that Adventist Health will end its Cerner ITWorks contract with Oracle in January 2024 and bring the IT function back in house.” The post seeks to hire people for Oracle now who will receive matching offer letters from Adventist Health. Adventist Health signed a big deal with Cerner in January 2018 to take over revenue cycle management and clinical applications, but terminated the RCM contract the following year and brought the 1,700 employees back in house, after which Cerner sold that business to R1 RCM.

HIStalk Announcements and Requests

A few poll respondents know or suspect that AI was used in a recent medical encounter.

New poll to your right or here: How will technology significantly improve US healthcare in the next five years? (multiple answers OK)

I greatly enjoyed reading Brian Too’s cynically relevant comments about VC folk in general and Epic-bashing Bill Gurley specifically:

You want investor capital and lots of it. There is a pathway to this that involves self promotion, a dynamic speaking style, outrageous theories that are unconventional and controversial, and chutzpah. Above all the chutzpah! When challenged on the facts, you just say something like, “It’s only a theory,” or you cite one fact that supports your story but doesn’t actually prove it. Then you get your skeptic to do all the lengthy, boring investigation. You drive off in your fully expensed Ferrari, confident you can stay ahead of any questions. These folks are fun at parties, but they will never come within a million miles of my money. 

Webinars

October 25 (Wednesday) 2 ET. “AMA: The Power of Data Completeness.” Sponsor: Particle Health. Presenters: Jason Prestinario, MSME, CEO, Particle Health; Carolyn Ward, MD, director of clinical strategy, Particle Health. Is your healthcare organization looking to drive profitability and scale quickly? Our experts will explore how comprehensive clinical data can revolutionize the health tech landscape. This engaging discussion will cover trending topics such as leveraging AI and data innovation to enhance patient care and outcomes, real-world examples of organizations leading the charge in data-driven healthcare, overcoming challenges in data completeness and interoperability, and visionary perspectives on the future of care delivery.

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

Acquisitions, Funding, Business, and Stock

The Federal Trade Commission sues US Anesthesia Partners and its private equity minority share owner, claiming that the companies executed an anti-competitive scheme to consolidate anesthesiology practices in Texas to drive up prices and profits. Legal experts say the action is notable because FTC included the private equity investor and not just the company itself in its lawsuit, potentially signaling a new type of federal scrutiny of healthcare.

People

Arrowhead Regional Medical Center (CA) hires CMIO consultant John Brill, MD as chief medical officer.

Announcements and Implementations

AMIA announces the winners of its 2023 Signature Awards:

• Donald A.B. Lindberg Award for Innovation in Informatics — Noémie Elhadad, PhD, associate professor and chair of biomedical informatics, Columbia University.
• Don Eugene Detmer Award for Health Policy Contributions in Informatics — Dean Sittig, PhD, professor, UTHealth Health Science Center at Houston.
• William W. Stead Award for Thought Leadership in Informatics — Atul Butte, MD, PhD, director of the Bakar Computational Health Sciences Institute and distinguished professor, University of California, San Francisco.
• Virginia K. Saba Informatics Award — Susan Newbold, PhD, RN, director, Nursing Informatics Boot Camp.
• AMIA New Investigator Award — Yifan Peng, PhD, assistant professor of department of population health sciences, Weill Cornell Medicine.

A Health Affairs article calls for healthcare ownership transparency so that patients will know if their physician practice is owned by – and perhaps likely to have their clinical judgment influence by — a private equity firm, insurer, health system, Amazon, or a conglomerate such as CVS Health or UnitedHealth. They also call for location transparency to support site-neutral payments, ending the practice of hospitals buying practices or ambulatory centers and then billing higher hospital prices using the parent facility’s provider number and thus preventing the payer from determining where services were provided.

CHIME offers a webinar to prepare potential ViVE 2024 speakers for submitting applications. The call for track speakers closes at the end of October.

Other

The Federal Trade Commission cracks down on the deceptive marketing claims of health influencers, one of them “The Liver King,” who claimed $100 million in annual sales of supplements to accompany his raw meat diet, which generated a net worth of $310 million. He later admitted that his ripped appearance was actually due to taking $11,000 worth of steroids each month, which is not exactly shocking since he sounds a lot like ‘roid rager Danny Bonaduce.

Marginally healthcare relevant, but interesting for a slow news day. Wired covers the “obituary pirates” who scrape death details from funeral home websites, create low-quality videos of themselves reading the deceased’s write-up, then use search engine optimization on the person’s name to draw in people who then hear about their death in the cheesiest possible way while being served ads. As has been noted, death is the ultimate total addressable market.

Sponsor Updates

• EClinicalWorks releases a new podcast, “Unlocking Reporting Capabilities in EBO.”
• NeuroFlow publishes a new case study, “Magellan Healthcare Expands Real-World Impact of DCBT, While Improving Member Access & Engagement.”
• Nordic releases a new Designing for Health Podcast, “Interview with Tricia Baird, MD.”
• Waystar will exhibit at the NJ & Metro Philadelphia HFMA Annual Institute September 27-29
• Wolters Kluwer nominates NextGen Healthcare President and CEO David Sides to its supervisory board.

Blog Posts

• Meditech’s Traverse Exchange Canada network advances health information sharing (Meditech)
• Conversational AI for healthcare is a significant step beyond the chatbot, here’s why (Notable)
• 10 Questions to Ask Autonomous Medical Coding Vendors (Nym Health)
• Fighting Opioid Addiction – One Life at a Time (Netsmart)
• Want to improve patient safety? Up your EHR’s usability (Nordic)
• Three Ways to Prove ServiceNow ROI (Optimum Healthcare IT)
• PLD Is Not Enough: Next-Best-Action HCP Engagement Needs the Patient (OptimizeRx)
• Solving the Top Healthcare Transfer Center Challenges (PerfectServe)
• 4 best practices for boosting your HCAHPS scores (Spok)
• Is Your Provider Data Getting Lost in Your Master Data Management? (Symplr)
• Your complete guide to Meditech Expanse (Tegria)

Contacts

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

Morning Headlines 9/22/23

AMA Future of Health issue brief: Commercial Payer Coverage for Digital Medicine Codes

The American Medical Association says that lack of alignment and adoption of CPT codes for digital medicine limits their use.

Value-based payments are making it harder to see your primary care doctor on short notice

Jeffrey Millstein, MD says that value-based care has made it hard to get short-notice appointment with PCPs who are refocusing on managing populations and meeting payer metrics.

Diligent Robotics Closes $25 Million to Advance Systemwide Expansions of Socially-Intelligent Service Robots, Empower Healthcare Professionals

The company expects to triple its Moxi healthcare robot market footprint of 22 health systems using $25 million in new funding. 

News 9/22/23

Top News

Digital-first care management and virtual care infrastructure vendor UpHealth files Chapter 11 bankruptcy after a court rules that it owes an investment bank $31 million for arranging a SPAC merger to take the company public.

UPH shares that peaked at $28 in late 2021 are now worth $1, valuing the company at $17 million.

Reader Comments

From Nasty Parts: “Re: Verinovum and Robin Healthcare. Both are being shut down by their primary funding entities. First time I’ve seen that.” Unverified, although several Verinovum employees recently added “open to work” to their LinkedIn profiles and Robin is no longer listed as a Khosla Ventures portfolio company. Verinovum offers healthcare data curation, while Robin Healthcare sells a smart assistant that creates clinical documentation for orthopedics.

HIStalk Announcements and Requests

Last call: sponsors who are participating in the HLTH conference can be included in my guide by completing a short form with their details.

I was checking something on the HIMSS24 website and noticed that it will offer exhibitors a reverse expo. I don’t recall that HIMSS has done this in the past, but HLTH and ViVE tout their hosted buyer programs and new HIMSS conference operator Informa specializes in that. I’m also reminded that HIMSS is no longer based out of Chicago, at least from a legal standpoint, having followed many corporations that moved their HQ to the tax haven of Netherlands.

A Reader’s Notes from the Nashville Healthcare Sessions

• HCA says its nursing school will have 30,000 students when it reaches capacity by the end of the decade.
• One investor says their firm is interested in behavioral health investments but is considering AI solutions for staffing and recruiting. They are worried that policymakers could pass knee-jerk AI regulations.
• Another investor says they aren’t interested in point solutions and those that are narrowly focused on management of single conditions and will instead look at platforms or something that ties into bigger workflow and tools. They predict AI use in drug discovery, supporting payer-provider services, and radiology image analysis.
• A Humana executive says interoperability will be a $1 billion opportunity by 2025.
• A16Z sees a lot of AI noise that the industry can’t absorb and predicts that many of the ideas will fail or will be merged into something else. They are concerned about ONC’s proposed algorithm transparency rule and the requirement that EHRs implement risk management practices for third-party predictive models.
• Aneesh Chopra thinks providers will be biggest beneficiary of AI, with the best opportunity being to help patients interpret their own data.

Webinars

October 25 (Wednesday) 2 ET. “Live Ask Me Anything Webinar: The Power of Data Completeness.” Sponsor: Particle Health. Presenters: Jason Prestinario, MSME, CEO, Particle Health; Carolyn Ward, MD, director of clinical strategy, Particle Health. Is fragmented data impacting your organization and its ability to scale quickly? Our experts will discuss the advantage of having a 360-degree, real-time view of your patients. Access to analytic-ready data supports proactive care by enabling rapid clinical decision-making, stratifying high-risk patients, developing and using personalized treatment plans, lowering cost, and quickly closing care gaps.

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

Acquisitions, Funding, Business, and Stock

Hospital-at-home technology vendor Inbound Health, which was spun out of Allina Health in late 2022, raises $30 million in a Series B funding round.

Denmark-based Corti, whose AI platform analyzes medically related telephone calls to make recommendations and generate documentation, raises $60 million in a Series B funding round.

Virtual digestive health vendor Vivante Health raises $31 million in Series B funding.

People

Angie Franks (About) joins Kalderos as CEO.

About hires Jonathan Shoemaker, MA (Allina Health) as CEO.

Impact Advisors promotes John Stanley, MBA and hires Roger Weems, MSHA, MBA (Premier) as chief growth officers.

Announcements and Implementations

Symplr adds survey management capabilities to its compliance platform, allowing healthcare organizations to conduct internal surveys to document conflict of interest, safety culture, and vendor compliance.

Biofourmis enhances its Digital Clinical Trials solution with AI-powered data management automations and integration with 40 devices.

The American Medical Association reviews the use of CPT codes for digital medicine, noting a lack of alignment across insurers and limited widespread use. The report finds that while payers are working directly with health tech companies to provide services for specific disease areas – hypertension, behavioral health, and physical therapy – those services are often disconnected from the patient’s PCP or medical home.

Meditech will add the Suki Assistant ambient listening solution to Expanse via a new Suki extension for Chrome.

Scripps Health will pilot the use of generative AI to draft responses to patient messages, saying that message counts have increased by 50% since the onset of COVID-19, with the average doctor receiving 44 per day.

Arcadia announces an AI assistant that creates patient summaries, which it says will save 50% of the case manager time that is required to gather and interpret medical record data.

Texas Tech University Health Sciences Center launches the Institute of Telehealth and Digital Innovation.

The American Academy of Pediatrics warns about the unintended consequences of auto-populating a newborn’s EHR with pertinent data from the charts of the parents. It cites a newborn’s record in which one of the mother’s listed problems was intimate partner violence by the baby’s father, who didn’t have access to the mother’s records, but could have seen the entry via his legal access to the baby’s chart. An employee noticed the entry and removed it. It concludes that EHRs allow clinicians to limit access to potentially harmful information without running afoul of information blocking regulations.

Other

The Madison newspaper describes how Epic’s growth affects the Verona, WI area as the company begins construction on its sixth campus and considers building a seventh. Epic plans to increase its headcount to 13,300 by next year and has bought more farmland to expand its Verona footprint to 1,700 acres, requiring the construction of new roads, interchanges, and widened bridges that officials hope will ease traffic backups for commuters.

Penn Medicine internist Jeffrey Millstein, MD says that value-based care has made it hard to get short-notice appointment with PCPs who are paid to manage populations and meet payer metrics rather than treating infections and acute pain. Patients are turning instead to urgent care centers and EDs, disappointed that the doctor with whom they have developed a rapport is not available. He recommends limiting comprehensive annual visits to highest-risk patients and replacing routine physician visits with support team virtual outreach for low-risk patients.

The Marshall Project covers for-profit prison medical provider Corizon Care, which attorneys say is using the “Texas Two-Step” bankruptcy method to avoid paying malpractice claims and debts. Corizon created a new company, moved its debt to it, then filed bankruptcy for the new company. It offered plaintiffs $5,000 each to settle their lawsuits, advising them they would probably get nothing otherwise. Meanwhile, the now debt-free and malpractice-free part of the business, much of it involving taxpayer-funded contracts, was moved to another newly created company. Several companies have used the Texas-only tactic – including Johnson & Johnson, which was trying to dodge talcum powder lawsuits – but all were either rejected by federal courts or remain in litigation.

Sponsor Updates

• RCxRules adds 11 private equity-backed specialty medical groups to its Revenue Cycle Engine customer base.
• AGS Health publishes a white paper titled “Optimizing HCC Coding for Accurate Reimbursement in Healthcare.”
• Findhelp releases a new report, “Meeting the Moment: Community Organizations Nationwide See Challenging Times Ahead.”
• Lucem Health releases a new episode of the This Week in Clinical AI Podcast.
• Medhost will exhibit at the TORCH 2023 Fall Conference September 26-28 in Round Rock, TX, and at the NRHA Critical Access Hospital Conference September 27-29 in Kansas City, MO.

Blog Posts

• Want to improve patient safety? Up your EHR’s usability (Nordic)
• The Top 4 Things Healthcare Organizations Want in an IT Vendor (Impact Advisors)
• Embracing DE&I in Your Recruitment Strategy (Direct Recruiters)
• Ensuring EMR Data Can Support Strategic Performance Improvement from the Start (Divurgent)
• Leveraging Networking as a Strategic Approach for Patient Acquisition in Weight Loss and Medical Spa Clinics (EClinicalWorks)
• Improve Your Call or Contact Center Experience (Five9)
• Healthcare cybersecurity threats: August 2023 (Fortified Health Security)
• Maximizing Your Investment: EHR/EMR Consulting (HealthTech Resources)
• Defining Change Management for Your Organization (Impact Advisors)
• Thoughts on AI Consciousness (Keysight)

Contacts

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