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EPtalk by Dr. Jayne 9/14/23

September 14, 2023 Dr. Jayne Comments Off on EPtalk by Dr. Jayne 9/14/23

Updated COVID-19 vaccines should be available soon, following approvals by the US Food and Drug Administration and the Centers for Disease Control and Prevention. They’re recommended for everyone age six months and older, so I anticipate that quite a few IT folks will be scurrying around to add the vaccine to EHRs near and far.

Although many healthcare folks seem to have stopped following the data, hospitalizations have been increasing recently, but might be leveling off. I’ve been traveling and have definitely seen an uptick in masking, with the most recent trip revealing about 5% of passengers and 20% of service workers being masked. The latter are less likely to have paid time off than other categories of workers and are likely to have negative impacts from illness, so it makes sense. Of the people who are masking, most seem to be wearing higher-filtration masks rather than basic surgical masks, and I didn’t see any cloth masks. Of note, two of my recent flights have been less than half full, so it appears the summer travel season is indeed winding down.

As far as masking in healthcare environments, I’ve seen a couple of articles addressing the topic. A recent opinion piece in the Annals of Internal Medicine suggests that healthcare organizations should make decisions that place patient safety first and should consider masking “as part of routine healthcare policies.” They suggest that care delivery sites “should be mindful of continuing areas of uncertainty while integrating the lessons learned into our hospital-based practices to prevent harm to vulnerable patients rather than reverting to suboptimal pre-pandemic behaviors.” I appreciate the fact that they called out the notion that the good old days weren’t necessarily that good in many care locations. In addition to vulnerable patients, there are plenty of vulnerable healthcare workers out there who deserve a safe work environment.

Regardless of the COVID case counts, the reality is that a lot of hospitals and health systems are still stressed. Some of the urgent care centers in my area have been closed for an extended time period due to lack of staffing, and many of my former colleagues have retired or left practice for other pursuits. My hospital colleagues tell me they’re still having staffing issues especially in labor and delivery, and apparently there’s a shortage looming for anesthesia medications, so it might be a bumpy winter.

I visited the local Costco for my flu vaccine this week and it was a seamless process, although I skipped the hot dog and soda combo and instead went for the sample of Kinder Bueno chocolate on the way out the door. There’s also a new vaccine out for Respiratory Syncytial Virus (RSV) intended for pregnant women as a way to protect their newborns, so I anticipate people are updating their EHRs and clinical decision support reminders to promote that one during patient visits as well.

This month’s issue of the Journal of the American Medical Informatics Association features an interesting back and forth about so-called EHR “gag clauses,” in response to a recent article that looked at whether those clauses had negatively impacted the inclusion of screenshots in peer-reviewed literature. Informatics guru Ross Koppel submitted a letter to the editor noting that informatics experts had been pushing for removal of those clauses since 2009. He also mentioned that informaticists may still be living in a climate of fear that vendors will punish them for publishing screenshots, regardless of moves by ONC or anyone else to remove such gag clauses. He concludes by stating, “Ethical vendors should have welcomed feedback about problematic EHR screens, rather than punishing medical informaticists who sought to improve those EHRs by demonstrating their dangers to patient safety.”

The authors of the original article responded to Dr. Koppel, agreeing with his comments but also pointing out that ONC and scientific journals should encourage the inclusion of screenshots in submitted articles and also that such screenshots should be included in safety bulletins and other documents covering EHR issues. They suggest that research needs to be done to understand why screenshots aren’t being included, and one way to do this would be to ask authors whether they’re aware of policy changes that prohibit gag clauses. They conclude by calling out Dr. Koppel’s comment that “…we should all be troubled by EHR vendor actions to prohibit sharing screenshots and that the EHR vendor insistence that the gag clauses are necessary for protecting intellectual property (IP) is meaningless if the IP is protecting poor design.” For those of us who have worked in EHRs that range from suboptimal to downright dangerous, that’s pretty much a mic drop right there.

As medicine has become more complex, the need for patient advocacy has increased. I was surprised to see a recent research letter in JAMA Internal Medicine about the prevalence of industry ties in patient advocacy organizations. The authors looked at the top 50 US patient advocacy organizations (ranked by revenue) and looked at ties between their senior leaders and the pharmaceutical or medical device industries. They found that a whopping 74% had board members or senior leaders with prior or current industry ties, with half of the organizations having conflicts of interest among paid staff or executives.

Although past ties are certainly worrisome, having a current conflict of interest seems particularly concerning. I appreciate the authors’ methodology. They used publicly available data from GuideStar to identify the high-revenue patient advocacy organizations and investigated the LinkedIn profiles of those listed on the organization websites. They also used other readily available sources such as annual reports, public tax documents, personal websites, and publicly posted biographies.

The authors listed some limitations, including “incomplete disclosure of board members, senior paid staff, or executive employment history, as well as the possibility of omissions from website profiles, limited (and likely underestimating) our characterization of industry ties.” Overall, they raise the concern that industry is influencing the advocacy organizations’ positions on patient education, policy making, and treatment guidelines. Definitely something to think about when you’re following the money in the complex web of the healthcare industry.

What do you think about conflicts of interest in patient advocacy organizations? Leave a comment or email me.

Email Dr. Jayne.

Comments Off on EPtalk by Dr. Jayne 9/14/23

Morning Headlines 9/14/23

September 13, 2023 Headlines Comments Off on Morning Headlines 9/14/23

Aspirion Acquires Infinia ML, an established leader in AI and Machine Learning

RCM technology vendor Aspirion acquires AI-powered intelligent document processing platform vendor Infinia ML

VA Going ‘Back to the Drawing Board’ for EHRM Deployment Schedule

The VA will develop a new deployment schedule for its EHR Modernization program, likely resuming in the summer of 2024 provided the scheduled March 2024 roll out of the Oracle Health system at the Captain James A. Lovell Federal Health Care Center goes well.

Carenostics helps clinicians prioritize at-risk patients

Carenostics,a clinical decision support software startup initially focused on chronic kidney disease, raises $5 million in seed funding.

Comments Off on Morning Headlines 9/14/23

Readers Write: Navigating the Early Days of Healthcare AI Integration

September 13, 2023 Readers Write Comments Off on Readers Write: Navigating the Early Days of Healthcare AI Integration

Navigating the Early Days of Healthcare AI Integration
By Michael Burke

Michael Burke, MBA is founder and CEO of Copient Health of Atlanta, GA.

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Have you tried using any of the AI tools that have taken the world by storm recently? This article will probably be more helpful if you have some knowledge or experience with ChatGPT, Google Bard, Anthropic Claude, or any other LLM/chat model tool.

If you haven’t already, try asking one of these tools a specific question or give it an assignment to produce a specific document and see where it leads. You may be surprised at just how useful the results can be.

If you’ve used these tools to answer questions or generate content (e.g., a legal document, a policy document, an email, or an article like this one), you have some sense of their potential. Imagine what could be done with a tool that leveraged an LLM like ChatGPT on your hospital’s data. The software vendors you use are all either investigating or actively releasing tools powered by LLMs to leverage your data. At Copient Health, we are, too.

It’s my belief that these tools will fundamentally change the way you interact with those vendor systems and ultimately, in both the way that you do your work and the results that you get.

A comprehensive list of all use cases is impossible because we’re so early in the process, but here are a few obvious low-hanging fruit uses that are relevant for software vendors:

  • LLMs are already powering chart notes that are built in real time from patient conversations.
  • Dashboards and reports will become unnecessary, because you will always have the specific data or chart that you need just a query away. The LLM can even proactively push the appropriate information in the appropriate format for the appropriate context.
  • You can forget about manuals, indexed help systems, or frustrating first-generation chat bots that perform poorly. LLM-powered solutions are better at finding what you’re looking for using a similarity search of a vector database.
  • You might even abandon memorizing complex commands or menu hierarchies and ask the LLM to accomplish the task instead.

But ChatGPT and other public-facing LLMS were trained on public data. How can they be leveraged for use cases that require knowledge of private data?

The answer to that question used to take a lot of time, money, and a team of data scientists to train your own LLM, or at least fine tune an existing open source model. That has changed dramatically, mostly in the last 6-8 months, based primarily on a term that you may have heard: “prompt engineering,” and one that you probably haven’t: “in-context learning.” Here’s a quick summary:

LLM models are text-in, text-out black boxes. But the text-in doesn’t have to be limited to a simple question. It can include prompts of background information, examples of questions and answers to similar scenarios, chunks of data, or simply directing the LLM to “think step-by-step.”

These are all basic forms of prompt engineering. The LLM temporarily “learns” from this prompt data, at least enough for your current conversation. LLMs can be used as an inwardly-directed service to decide what data or tool to use based on the prompts that it receives. This design pattern has demonstrated better results than the more cumbersome fine-tuning approach for the smaller data sets that we’re talking about.

An entire ecosystem of software tools has emerged to support the use of these pre-trained LLMs on private data. These tools convert the challenge from what was once an arcane AI data science problem to a data engineering problem, primarily built around prompt engineering and in-context learning.

Here’s an illustration of how quickly these tools have evolved and been adopted. One of the most widely used tools in the ecosystem, LangChain, was first introduced in October last year as an open source project from two college students. In a few months, its use expanded globally. The founders incorporated and raised $20 million in venture funding from Sequoia Capital. Since last October, they have garnered 60,000 GitHub stars, which is a measure of its popularity among software developers. For context, Python, the language the LangChain toolset is written in, has fewer stars over a significantly longer time period: 51,500 stars over six years. ChatGPT itself captured one million users in just five days.

This head-spinning rate of change gives an advantage to startups, given their rapid iteration and integration of new tools and ideas. Some large healthcare software vendors that are infamous for relying almost exclusively on internally developed tools find themselves in a challenging situation. It’s impractical for them to build their own LLMs, as they would likely never rival the performance of commercially available options, and it would take forever. And since they are not used to relying on third-party software as part of their solution, they aren’t prepared for the rate of change at which these solutions are evolving.

For instance, just yesterday, LangChain had 18 separate commits (i.e., changes) to their codebase. That’s fast! Adapting to rapid changes and advancements requires a new level of agility.

We’ve recently heard announcements and partnerships from big tech and big healthcare IT. It will be interesting to see if these announcements produce real value in the near term, or if they are just a way to buy time for the vendor to figure out this rapidly evolving space.

Comments Off on Readers Write: Navigating the Early Days of Healthcare AI Integration

Healthcare AI News 9/13/23

September 13, 2023 Healthcare AI News Comments Off on Healthcare AI News 9/13/23

News

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A Harrisburg, PA TV station covers UPMC’s use of Abridge to create transcripts of doctor-patient encounter conversations. UPMC VP/CMIO Salim Saiyed, MD, says he has never had a scribe, but the system is like having a real-time scribe whose accuracy is 95%. He adds that the physician can focus on the patient instead of the computer and spends less “pajama time” completing documentation after hours.

Mass General Brigham and GE HealthCare will collaborate to develop an AI algorithm that will optimize radiology patient scheduling as part of GE HealthCare’s commercially available Radiology Operations Module.

OpenAI will hold its first developer conference on November 6 in San Francisco.


Business

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RCM technology vendor Aspirion acquires AI-powered intelligent document processing platform vendor Infinia ML. Aspirion says it will run Aspirion as an R&D development shop that will be run by Infinia ML executive chair Nick Giannasi, PhD,  who was previously chief AI officer of Change Healthcare.

Crunchbase News leads off its list of “failed and struggling AI-focused unicorns” with Babylon Health, which it notes mentioned “AI” 25 times in its SPAC filing, raised $600 million at a valuation of billions, then filed bankruptcy last month.

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Notable launches a conversational AI tool that helps patients find doctors, schedule appointments, create directions to a location, pay bills, and request prescription refills. It is fully customizable (including tone of voice), can converse in 130 languages, and can have its training extended by uploading training manuals or other documents.

A former Google AI researcher raises $100 million from big-name Silicon Valley investors for Inceptive, his startup that will use AI to develop drugs and vaccines.


Research

Researchers note that ChatGPT has accumulated 1,000 PubMed citations in nine months, which predicts its future influence even though one-third of the cited articles were opinion pieces. Google needed 14 years to hit the 1,000-citation mark.


Other

Attorneys note the healthcare regulatory risks of using AI:

  • Running afoul of privacy laws when training AI systems using patient data.
  • Using AI to replace rather than support clinicians, which could be construed as the unlicensed practice of medicine.
  • Providers deviating from the standard of care based on AI recommendations, creating malpractice risk.
  • Reducing physician supervision of lower-level employee who instead use AI, which could fail to meet payer requirements.
  • Running afoul of the Anti-Kickback Statue if using vendor-developed AI algorithms that favor use of their products.
  • Inadvertently practicing unlawful discrimination by using algorithms that use factors such as race, color, national origin, sex, age, or disability.

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The Today show features a mother whose son’s chronic pain and other symptoms had baffled 17 doctors who had seen him over three years. She pasted notes from his MRI into ChatGPT, which provided a diagnosis of tethered cord syndrome, a deformation that limits the movement of the spinal cord and is related to spinal bifida. He is recovering from surgery to repair the condition.


Contacts

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

Comments Off on Healthcare AI News 9/13/23

Morning Headlines 9/13/23

September 12, 2023 Headlines Comments Off on Morning Headlines 9/13/23

Bain & Company and KLAS study finds 80% of US healthcare providers are accelerating spending on IT and software with AI top of mind

A study of 200 provider executives finds that most health systems increased their spending on software and IT significantly in the past year, with revenue cycle management and clinical workflow optimization being the top investment areas.

Senate confirms deputy secretary at VA

The Senate confirms Army veteran and VA Chief of Staff Tanya Bradsher as deputy secretary, where she will be responsible for the VA’s Oracle Cerner implementation.

HSHS, Prevea restore health records system

Hospital Sisters Health System and affiliate Prevea Health restore their Epic system after a cyberattack forced both organizations to downtime procedures two weeks ago.

Comments Off on Morning Headlines 9/13/23

News 9/13/23

September 12, 2023 News Comments Off on News 9/13/23

Top News

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From the Oracle earnings call, following a Q1 revenue miss, slowed cloud sales, and lowered expectations that sent shares down 13% on Tuesday:

  • The company expects to sign two new Cerner contracts that are valued at over $1 billion in total in the current quarter. (Readers: who could this be? New customers, which would suggest an Epic displacement, or a new cloud contract for existing Cerner clients?)
  • Chairman and CTO Larry Ellison says that healthcare AI requires vast amounts of training data, including image information, and Oracle’s new vector database will contain anonymized EHR training data that will be good for its database business.
  • Ellison answered an analyst’s question about the one-year anniversary of Oracle’s acquisition of Cerner, saying that the move to “a new Millennium” involve rewriting the software one piece at a time using the Apex code generator, with the first step being hardening the system and moving customers to the cloud.
  • Ellison says that cloud-based revenue recognition has caused “a bit of a revenue headwind” since Cerner previously recognized a chunk of revenue at contract signing.
  • CEO Safra Catz added that Oracle is “always looking to save as much money as we can and spend as little” while modernizing the Cerner system and, as she has repeatedly said, working to “drive Cerner profitability to Oracle standards.”

Reader Comments

From Digital Health CEO: “Re: our news on your site. We get a lot of positive social channel feedback on our mentions on HIStalk, which still has the best reach in healthcare.” Thanks. This is a actual comment from a non-anonymous CEO just in case anyone suspects made-up self promotion. It’s a good audience, skewed hard toward decision-maker careerists.

From Keep Me Anonymous Health System CIO: “Re: the Cerner input you requested. Here’s mine.” A summary:

  • Millennium is a decent inpatient EHR that works after expending the effort, while ambulatory has improved and our providers are receptive to using it.
  • Millennium Patient Accounting significantly lags Epic in functionality, ease of use, and analytics.
  • The Soarian-based RevElate system that is supposed to replace PA is a better product than Millennium PA, but there’s only one GA option to integrate it and that requires interfaces. Integrating workflows is difficult and requires dual maintenance, such as charge masters and providers. It is still being developed with implementation partners, so the expected benefits have yet to be proven.
  • I’ve seen no positive improvements since the Oracle acquisition. Oracle Health (or is it Oracle Cerner?) has had multiple rounds of layoffs, going beyond duplicative functions such as HR and marketing in getting rid of the core workforce, which is baffling. They lack the bench strength to executive anything timely and customers find it difficult to get knowledgeable people for supports and projects.
  • The last round of layoffs eliminated most, if not all, of their clinical experts, such as physicians and nurses.
  • Most of Oracle’s promises to improve the Cerner project involve infrastructure and moving to the cloud, but Cerner’s remote hosting was its most reliable service. Oracle is fixing something that is not broken and that holds little value to customers.
  • I’ve seen no roadmap for system development.
  • Oracle promises to rewrite the EHR, but I’m not sure who will redesign it given the lack of clinical bench strength.

HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor Notable Health. The San Mateo, CA-based company is the leading automation platform for patient engagement and staff workflows. Deployed at over 3,000 sites of care, Notable automates over a million repetitive workflows every day across scheduling, registration, intake, referrals, and authorizations. The result: personalized, streamlined care for patients, the elimination of burdensome manual work for caregivers, and improved financial health for healthcare providers. Notable is backed by leading investors, including ICONIQ Growth, Greylock Partners, F-Prime, Oak HC/FT, Maverick Ventures, and 8VC. Find out why healthcare providers of all sizes, including Intermountain Health, Medical University of South Carolina, North Kansas City Hospital, and more have partnered with Notable to redefine what’s possible in healthcare. Thanks to Notable Health for supporting HIStalk.


Lorre is offering three companies a sweet deal – sign up as a Platinum sponsor and she will include the rest of 2023 for no extra charge. Contact her to see if three other folks beat you to it.

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A mostly forgotten memory for DoD-Cerner watchers, which I recalled while fondly re-reading the DoD series written for HIStalk by the mystical Dim-Sum. Part of the ultimately successful Leidos proposal to DoD was the involvement of Intermountain Healthcare.


Webinars

September 21 (Thursday) 2 ET. “Unlock open enrollment best practices to stop future denials.” Sponsor: Waystar. Presenter: Lauren Tungate, solution strategist team lead, Waystar. Nearly half of insured Americans consider changing their insurance coverage each fall, necessitating provider safeguards to stop increased denials, find hidden coverage, and prevent uncompensated care. This webinar will crack open enrollment best practices, such as using different data sources to get an accurate picture of benefit details; leveraging automation to identify hidden coverage, confirm active insurance, and avoid lost revenue; and simplifying eligibility workflows to reduce the financial burden on patients and strain on staff.

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

Online Medicare Advantage insurance sales firm Health IQ, which raised $200 million from big-name investors, files Chapter 7 bankruptcy with $1.3 million in assets and $257 million in debt. Co-founder Munjal Shah and some of Health IQ’s leadership are now involved with Hippocratic AI, which has raised $65 million from Andreessen Horowitz and which lost big on Health IQ.


Sales

  • Infirmary Health (AL) selects chronic care management and virtual care software and services from Wellbox.
  • Community Health Systems (TN) will use Mindoula’s virtual behavioral healthcare service as a part of its primary care offerings.
  • In England, Barking, Havering and Redbridge University Hospitals NHS Trust will implement Oracle Cerner in a $55 million project.

People

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CereCore names James Lobban (Meditech) regional VP of business development.

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Edifecs names practicing VA staff physician Summerpal Kahlon, MD, MS (Change Healthcare) chief medical officer.

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Julia Goebel (Symplr) joins Komodo Health as head of marketing.

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Surescripts hires Lynne Nowak, MD (Lark Health) as its first chief data and analytics officer.

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Kristen Lalowski, RN (VillageMD) joins LetsGetChecked as EVP of product.

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Fivos Health promotes Eric Nilsson to CEO.


Announcements and Implementations

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Geisinger will expand its in-home chronic care management program, which includes equipment setup by Best Buy’s Geek Squad and data collection and monitoring by Best Buy-owned Current Health.

Broadmeadows Hospital and Northern Hospital in Melbourne, Australia go live on Oracle Health as part of Northern Health’s systemwide implementation, first announced in late 2020.

In Oregon, Blue Mountain Hospital and its Strawberry Wilderness Community Clinic implement Oracle Health’s CommunityWorks EHR.

A study of 200 provider executives by Bain & Company and KLAS Research finds that most health systems increased their spending on software and IT significantly in the past year, with revenue cycle management and clinical workflow optimization being the top investment areas while patient engagement has moved up the list. Two-thirds of the respondents say they will look first at their existing vendors, especially their EHR supplier, when looking for new functionality. Few organizations have an AI strategy, but 50% are either developing one or will do so soon.


Government and Politics

The Senate confirms Army veteran and VA Chief of Staff Tanya Bradsher as deputy secretary, where she will be responsible for the VA’s Oracle Cerner implementation.


Privacy and Security

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Prospect Medical Holdings works to determine if patient information within its 16 hospitals was breached in a reportedly $1.3 million ransomware attack by the Rhysida group nearly six weeks ago. Prospect is also still working to bring all of its hospital systems back online.

Hospital Sisters Health System (IL) restores its Epic system after a cyberattack forced it to downtime procedures two weeks ago. Affiliate Prevea Health (WI), which was also a part of the attack, has yet to bring its systems fully back online.


Other

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HealtheLink, an HIE serving Western New York, will use a $1 million grant from ONC to gather advance care planning documents and make them digitally available to providers within its network.

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University of Utah Health research finds that poor EHR user experience strongly correlates with EHR-related patient safety concerns, particularly in the areas of medication alerts related to drug-drug interactions, patient allergies, duplicate orders, and excessive dosing.


Sponsor Updates

  • Artera names Nicole Ossey (Knock) VP of people.
  • DePaul Community Health Centers reduces days in accounts receivable by more than 50% with RCM solutions from EClinicalWorks.
  • The Agile Giants Podcast features Arcadia CEO Michael Meucci.
  • Nordic releases a new episode of its In Network podcast in partnership with Amazon Web Services, “Making Rounds: Emerging opportunities with cloud-based EHRs.”
  • Ascom Americas will sponsor the Hack the Building 2.0 Hospital Edition September 18-22 in Columbia, MD.
  • Bamboo Health will exhibit at NAACOS 2023 September 20-22 in Washington, DC.
  • CloudWave will exhibit at the Torch Fall Conference September 25-28 in Round Rock, TX.

Blog Posts


Contacts

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

Comments Off on News 9/13/23

Morning Headlines 9/12/23

September 11, 2023 Headlines Comments Off on Morning Headlines 9/12/23

Oracle comes up short on revenue but touts AI cloud contracts

Oracle’s quarterly revenue falls short of analyst expectations, with Cerner’s revenue growth slowed by its “accelerated transition” to the cloud.

Cano Health Announces Plans for Regaining Compliance with NYSE Stock Price Criteria

The NYSE puts troubled primary care company Cano Health on notice for listing noncompliance, given that the average closing price of a share of its Class A common stock was less than $1.00 per share over a consecutive 30 trading-day period.

Thoma Bravo Weighs $1 Billion Private Credit Loan for NextGen Acquisition

Private equity firm Thoma Bravo considers arranging $1 billion in private financing for its acquisition of ambulatory health IT company NextGen Healthcare.

CT hospitals unsure if patient records were breached in cyberattack

Prospect Medical Holdings is working to determine if patient information within its 16 hospitals was breached in a ransomware attack by the Rhysida group more than a month ago.

Comments Off on Morning Headlines 9/12/23

Curbside Consult with Dr. Jayne 9/11/23

September 11, 2023 Dr. Jayne 1 Comment

I was recently in a meeting of healthcare executives where the topic in question was how to best leverage technology when working with “older patients.” Compared to my physician experiences with the senior population, I found some of their attitudes to be not only outdated, but their opinions to be inaccurate. I heard statements such as “retirees are technologically naïve” and “most of them don’t have smartphones.”

I’d like to see those executives join me in an exam room when a Medicare-age patient pulls out their phone and logs into their patient portal to provide data that I can’t otherwise access. They might also find themselves educated when a patient pulls out their phone to show me pictures that their grandchildren texted to them.

According to data from The Senior List, 98% of people older than age 60 have mobile phones, which splits to 81% smartphone users and 17% basic mobile phone users. Approximately 75% of seniors text at least once daily, with most indicating that texting is a preferred communication method.

A whopping 65% of adults in that age group spend three hours or more on their phones daily, and seniors have an average of 25 apps installed on their phones. The most popular apps are those addressing weather, shopping, social media, games, and news. Health tracking apps are present in around 49% of seniors’ app installations. As far as app use, social media leads the way as far as percentage of app usage, with Facebook being the favorite followed by Amazon, Google, and The Weather Channel. The data in question was gathered in 2021, and based on what I see in the community, I woud guess that smartphone use and app utilization have both grown since then.

One of the health system executives kept citing “the data” indicating that smartphones and seniors don’t mix, but didn’t have an actual citation. He said he had seen “multiple research studies in the news this week,” so I decided to try to figure out what he was talking about. I found a couple of articles in the lay press from mid-August that talked about COVID, seniors, and text messages not mixing, but they all linked back to the same scholarly article, so I hardly consider that an overwhelming amount of new research.

The study in question looked at text messages sent to more than 17,000 Medicare-age seniors during the initial distribution phase of the COVID vaccine. Patients were sent a text invitation to receive the vaccine, but 28% reported technical problems. The authors dug deeper into 4,200 responses, coding them based on issues experienced by the recipients. Approximately 7% of seniors had issues responding to the text invitation, including responding in the wrong format, delays in responding, or inability to get help when they requested it.

Based on the results, researchers recommended interventions including the use of natural language processing, flexible response formats, and improved feedback processes when conducting such text-based campaigns in the future. Based on my experiences as a consulting CMIO during the pandemic, I would also recommend that organizations look at the scripting they are sending out and whether the text of the messages is contributing to the confusion.

I was hired by a couple of organizations during the pandemic to support their efforts reaching patients, and some of the draft language that I was sent to proof-read or polish had definite room for improvement. Common themes I encountered during that time included reading levels that were too high, complex sentence structure, and questions with responses that didn’t have an appropriate response choice listed.

It should also be noted that some of these patients might have been receiving competing or conflicting messages from different organizations that added to the confusion. For example, they could have received different messages from their primary care physician, a subspecialty physician, a health system where they’ve had diagnostic or laboratory testing, a senior center, a retail pharmacy, and an insurance carrier. Duplicative messages might just have been ignored, confounding the data.

The article lists the specific language that was used as part of the campaign studied, and even I found it confusing. Recipients were prompted to select from three options, which were presented to them with a request to indicate their choice by keying in either “A” or “G” or “D” which were presented in that order. The offering of such choices ordered in that manner is counter to some key usability and patient engagement principles, especially in a population where recipients might be more conditioned to choose from an ordinal list – “ABC” or “123,” for example, rather than “AGD.”

The article noted that “the response options letters in the message were chosen from a set of letter groups and assigned at the time of delivery based on the next message service’s automated batch-processing system,” which is a statement I don’t really understand.

Had this script come across my consulting desk, I might have made it even simpler with yes/no questions and a bit more branching. Although it may have created complexity for those configuring the system, it would have been more straightforward for the potential patients receiving it.

Those patients who wanted to schedule online were told to enter their email address and that they would receive a link within two days. That requires additional steps for the recipient versus just providing a link right in the text exchange.

The study authors looked at some of the “non-conforming” messages that patients sent that the system was unable to process. Some of them included statements recognizing typographical errors (such as “Sorry, I sent wrong response, D is the response”) and requests to just go to a website. Others included statements around the patient having already received a vaccine or auto-generated replies that were sent because the patient was driving when the text message was received.

The authors also noted that the campaign wasn’t optimized to address the needs of patients whose primary language wasn’t English. Other limitations included medical records anomalies that may have led to the generation of messages to the wrong recipients.

It should also be noted that many of these campaigns were being done in the heat of the moment due to unpredictable vaccine availability. On some of the campaigns where I assisted, clients offered a premium for rush turnaround of content. Several of the outreach programs were built in a couple of days, and one was actually configured in less than 12 hours. Health systems were under immense pressure at the time and might not have had the luxury of constructing a campaign compliant with usability best practices.

Those all add to the idea of not using this type of data (which is now two years old in addition to the other flaws noted) to throw the proverbial baby out with the bath water as far as understanding how seniors will interact with technology. It will be interesting to see follow-up studies on the topic.

Does your organization do anything specific when tailoring campaigns to different demographic groups? Have you considered specific testing on your target audience? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: It’s Time for a National Patient Identifier

September 11, 2023 Readers Write 12 Comments

It’s Time for a National Patient Identifier
By Gregg Church

Gregg Church is president of 4medica of Marina del Rey, CA.

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Congress has the power to make healthcare safer and less expensive for patients, payers, and providers. It can do this by removing the ban that prohibits using federal funds for the development of a unique national patient identifier.

The patient identifier system would give each patient a single ID that would follow them through their healthcare journey, regardless of provider or payer, while still protecting their private information. It would reduce medical and billing errors and denied claims, while eliminating countless hours insurers and hospital systems spend resolving patient matching errors. It would also aid medical research and make it easier for our healthcare system to respond effectively during national emergencies, like the COVID-19 pandemic.

The federal ban on a national patient identifier was born from good intentions. Former US Rep. Ron Paul in 1998 added the provision to the Labor-HHS appropriations bill. The physician and libertarian cited concerns about patient privacy and the dangers of the federal government collecting and centralizing medical records. His son, Sen. Ron Paul, also a physician and libertarian, now leads the opposition with the help of the ACLU and other groups.

Congress has come close to ending the ban. For the past four fiscal years, the House has removed it from its version of the appropriations bill; the Senate did likewise the past two years. Each year, however, it has been reinstated in the final budget.

In 2021, Patient ID Now, a coalition of more than 40 healthcare organizations, including the American College of Surgeons, American Heart Association, American College of Cardiology, The Joint Commission, and American Health Information Management Association, was formed to push for a nationwide strategy to address patient identification.

The group noted that the ban was put in place 25 years ago at a time when patient records were still largely kept in manila folders. It’s now a hindrance to the necessary digitization of healthcare. While concerns over patient privacy are real, a national patient identifier could be implemented in such a way that it protects patients.

I like to believe that much of the opposition to a universal patient identifier is due to a lack of awareness of the volume of incomplete, duplicate, missing, and overlaid medical records and the problems they cause.

Imagine if your personal finance records had a roughly one in five chance of being duplicated or mixed up with someone else’s accounts by financial institutions. Think of the chaos and damage and the ensuing demands to fix the problem.

Duplication of patient records is one of the most serious problems with healthcare data quality, and it’s more common than many think. Duplication rates are as high as 30% in some healthcare organizations, and a 10% rate is common. Up to half of patient records are not matched in transfers between healthcare systems. 

Patients are endangered by low-quality records, particularly duplicate and overlaid records, in which the data for two patients is mixed.

Approximately 70% of care decisions are based on lab tests, which are performed by techs working in relative isolation from the care team. Labs frequently create duplicate records while entering patient information into computers. That bad data can then be multiplied and disseminated throughout a hospital system and between systems.

Clinicians working from bad data can misdiagnose, prescribe the wrong course of treatment, and order duplicate tests, which delay necessary treatment.

Black Book in 2018 surveyed health technology managers about problems with patient identification processes. It found that the cost of medical care due to duplicate records averaged $1,950 per patient per inpatient stay and more than $800 per ED visit.

Those surveyed also estimated that 33% of denied claims were due to inaccurate patient identification or information. That cost the average hospital $1.5 million in 2017 and the US healthcare system more than $6 billion annually.

That unnecessary expense could be eliminated with a standard patient identification system.

True interoperability among patients, providers, and payers is a goal of the healthcare industry, one that could be made more achievable through a patient identifier system that allows for the disruption-free exchange of patient records.

While recent improvements in patient identification processes, such as hospitals adopting Enterprise Master Patient Indexes and the use of machine learning, have improved record matching, it’s barely keeping pace with the explosion in medical records and the sharing of data among different healthcare organizations.

Adopting a national patient identifier would be a significant step toward building a safer, and more effective and affordable healthcare system. It’s time for Congress to listen to the experts and remove the ban. We’ll all be better off for it.

Morning Headlines 9/11/23

September 10, 2023 Headlines Comments Off on Morning Headlines 9/11/23

Walmart Explores Buying Majority Stake in ChenMed

Walmart reportedly considers acquiring a majority stake in Medicare Advantage primary care clinic operator ChenMed.

US indicts nine alleged members of Russian cybercrime gang that targeted hospitals

The Department of Justice indicts nine men with ties to a cybercriminal group that has accumulated $100 million in ransomware payments from US hospitals.

Ranking Member Cassidy Seeks Information from Stakeholders on Improving Americans’ Health Data Privacy

HELP Committee ranking member Senator Bill Cassidy, MD (R-LA) solicits solutions to protecting patient privacy related to wearables, smart devices, and apps, none of which are covered by HIPAA.

Comments Off on Morning Headlines 9/11/23

Monday Morning Update 9/11/23

September 10, 2023 News 10 Comments

Top News

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Walmart is reportedly considering acquiring a majority stake in ChenMed, which operates 100 Medicare Advantage primary care clinics in 15 states.

The family-owned ChenMed has made significant executive team changes this year, replacing five of six family members who held C-level roles. My quick eyeball of the leadership team web page changes since February show that only four of the 12 leaders remain.

If the deal goes through, it will likely be Walmart’s biggest healthcare investment, at several billion dollars.


Reader Comments

From Pure Envy: “Re: Epic. Why didn’t DoD and VA choose them in the first place? Will they switch from Cerner like everyone else seems to be doing?” Cerner paired up for the DoD bid with prime contractor Leidos, a skilled lapper at the federal trough, while Epic linked up with comparative federal lightweight IBM. Either that or the feds saw more promise in Cerner and the other companies that were part of the Leidos bid. The DoD has no reason to replace Cerner because its implementation is nearly finished and is free of the drama that has plagued the VA, which may be stuck with VistA forever given the embarrassment, cost, and likely similar outcomes of dumping Cerner for Epic under pressure from Congress. The one thing that is sure, given that the federal government is in charge, is that contractors will profit obscenely and indefinitely no matter which systems the DoD and VA are using, as the VA’s 40-year-old VistA is reportedly costing taxpayers nearly $1 billion per year to keep running. The VA rarely completes IT projects successfully and technology is seldom the problem – VA regions resist any form of central oversight and thus love their custom instances of VistA.

From Bemis Comfy: “Re: Cerner to Epic switches. Two big Cerner losses in one week. The trend will continue.” Probably, for these reasons: (1) Cerner sites that implemented its systems more than 7-8 years ago now have the money and fortitude to switch to the obvious market leader, while the Epic-to-Cerner migration history is minimal; (2) FOMO; (3) to the victor go the IT spoils, as acquisition-happy big health systems seem to have lost their temporary appetite for running multiple systems to avoid rip-and-replace in acquired hospitals and are now looking to reduce vendor complexity; and (4) the disastrous Brent Shafer Cerner years seeded frustration that is just now showing up as defections. Oracle’s interest in Cerner seemed to mostly be driven by the personal fascination of 79-year-old Larry Ellison, the opportunity to increase Cerner margins, and the chance to buy into a massive federal business, none of which necessarily boost the satisfaction of Cerner customers. However, Oracle executives are probably more worried about competing in cloud and AI than counting Cerner hospitals or strategizing how to compete more effectively with Epic. Maybe they will say more at next week’s Oracle Health Conference. If you’re a CIO with recent experience as a customer of both Epic and Cerner, what do you think?

From Pop Smoke: “Re: HIStalk. Have you considered changing the name to something that makes sense?” When I started HIStalk 20 years ago, hospital technology was referred to as “hospital information systems” and the department that operated those systems was “management information systems,” so HIS and MIS were universally understood industry terms that have since faded into obscurity. Readers can probably provide more examples (CPOE comes to mind). The name HIStalk does not refer to possessiveness, gender, religion, or anything else you’ve imagined. I’m too lazy and set in my ways to worry about anything except the content, so I’m not contemplating a rebrand, including canning the satirical smokin’ doc.

From Electric Eel: “Re: subscribing. How does one subscribe to HIStalk nowadays?” There’s a “Subscribe to Updates” menu drop-down under Contact, which takes you to this page. It ignores duplicates, so if you’ve stopped getting updates, just stick your email in there again. It is shocking how often emails aren’t delivered due to being rejected by an overzealous email system on the receiver’s end, and signing up again can’t hurt and might fix it.


HIStalk Announcements and Requests

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Quite a few poll respondents have had a rocky employment year so far in 2023.

New poll to your right or here, as suggested by a reader: In your most recent change to a new medical practice for an ongoing relationship, how did they obtain your medical records? My guess is that a surprising number of practices don’t really care about the laboriously collected and maintained information from other providers, preferring to start over with patient-provided basics such as demographics, meds, allergies, family history, known conditions, and immunizations that their new customer is expected to scrawl onto poorly designed clipboard forms. 

Thanks to the following companies that recently supported HIStalk. Click a logo for more information.

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Webinars

September 21 (Thursday) 2 ET. “Unlock open enrollment best practices to stop future denials.” Sponsor: Waystar. Presenter: Lauren Tungate, solution strategist team lead, Waystar. Nearly half of insured Americans consider changing their insurance coverage each fall, necessitating provider safeguards to stop increased denials, find hidden coverage, and prevent uncompensated care. This webinar will crack open enrollment best practices, such as using different data sources to get an accurate picture of benefit details; leveraging automation to identify hidden coverage, confirm active insurance, and avoid lost revenue; and simplifying eligibility workflows to reduce the financial burden on patients and strain on staff.

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


Acquisitions, Funding, Business, and Stock

Merative, the former IBM Watson Health, will lay off 100 of its 400 employees who work in Ireland, moving their jobs to India. 

A study finds that when PCPs enter into vertical relationships with health systems – by selling out to them, affiliating, or entering joint contracting deals – specialist visits, total patient spending, ED visits, and hospitalizations within the health system all increase. In other words, health systems get exactly what they hope for when they use their large piles of cash to buy independent doctors who are then “encouraged” to steer business their way.

Calibrate, which sells weight loss drugs online to people who sign up for its $1,749-per-year coaching package (which doesn’t include drug cost), is paying out big chunks of its revenue as refunds to address BBB complaints from customers for whom the company can’t provide them with high-demand drugs such as Wegovy. Insiders say the company’s layoffs have left too few employees to manage insurance company authorizations and to respond to customer questions. Its newly released app has earned a 1.1 rating out of five stars on Apple’s App Store as a skeleton crew of engineers can’t keep up with bug fixes. The company says it will pivot to working with employers and health plans, although insiders question whether it has the people and the focus to launch a new business given its low staffing and the competitive environment.


Sales

  • Clalit Health Services, Israel’s largest healthcare provider, will implement Sectra’s digital pathology solution.

People

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Industry long-timer Bill Carmichael, whose held IT roles at Franciscan Alliance, Information Resource Associates, and Eskenazi Health, died August 26. He was 71.

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Georgia-based family practice doctor Jim Morrow, MD, MS, who held health IT executive and advisory roles in his career of nearly 40 years, died August 31 at 69.


Announcements and Implementations

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The Healthtech Leader 3.0 conference – put on by CHIME, AEHIS, AEHADA, and AEHIT — will be held September 27-29 in Cleveland, OH, with CHIME members getting a discounted registration fee of $295 that includes breakfasts, lunches, and receptions. The Cleveland Clinic-connected InterContinental’s conference rate of $189 makes this a pretty inexpensive event, depending on your transportation cost.


Government and Politics

Nigeria’s federal government announces plans for a National Electronic Medical Record Platform that will unify the records of primary and federal medical centers. The newly appointed Minister of State for Health and Social Welfare, Tunji Alausa, MD – a nephrologist who founded and runs the Illinois-based Kidney Care Center and Dialysis Care Center – says:

We will embark on the digitalization of our healthcare system, because in this age,if you don’t have data, validated data, it’s just like still being in the dark. We need to make sure that the data we collect are accurate, they are validated,they can be trusted internally and locally. That will be used to deliver healthcare to our people. When we have validated data that we can trust,we can begin to see the indices where you are getting better,where you are doing well and where you are not doing well and then,you can direct your interventions to improving those outcomes.

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HELP Committee ranking member Senator Bill Cassidy, MD (R-LA) solicits solutions to protecting patient privacy related to wearables, smart devices, and apps, none of which are covered by HIPAA. He seeks input on expanding HIPAA beyond covered entities and traditional health data; whether safeguards that address disclosure to law enforcement officials are sufficient; if organizations that aren’t covered entities should be required to delete consumer data at their request as GDPR mandates; and whether location data should be considered health data. He also asks questions about safeguarding genetic and biometric data, whether HIPAA should address claims data, and the extent to which consumers can opt out of having their data used for AI training. Responses are due September 28.


Other

Odd: the fired CEO of Robert Wood Johnson University Hospital Hamilton sues the hospital, claiming that he was fired because the hospital foundation’s “Under the Italian Sky” fundraising soiree included naked body painting.

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An interesting VCU medical school poster notes that traditional physician clothes and accessories can spread bacteria. On the not-to-wear list: white coats (which are not laundered frequently), stethoscopes (unless they are disinfected between patients), watches, shirts that don’t allow “bare below the elbow,” ties (rarely cleaned), and cell phones. If white coats are required, providers should be given at least two of them with free on-site laundering and coat hooks should be available outside of areas where patients are seen so the coats can be removed. It recommends wearing sleeveless vests instead of white coats, although I wouldn’t want to be the person trying to rip traditional medical regalia from the cold, dead hands of doctors who aren’t about to hold court wearing an egalitarian vest.


Sponsor Updates

  • Lucem Health releases a new “This Week in Clinical AI” podcast.
  • Aga Khan Health Services in East Africa will implement Meditech Expanse.
  • Nordic releases a new Designing for Health Podcast, “Interview with CT Lin, MD, Liz Salmi, and Bryan Steitz, PhD.”
  • Optimum Healthcare IT’s ServiceNow offering, Clinician Connect, is now available in the ServiceNow Store.
  • Verato will exhibit at the ISM + PHSA Conference September 10-13 in Kissimmee, FL.
  • West Monroe launches the third season of its This is Digital Podcast.
  • Wolters Kluwer Health will sponsor the 2023 Patient Experience Summit September 11-12 in Nashville.
  • Ellkay, Nuance, Healthwise, Fortified Health Security, Ronin, Ascom, Elsevier, First Databank, Impact Advisors, Linus Health, Loyal, Nordic, Optum, ReMedi Health Solutions, HCI Group, Wolters Kluwer Health, Net Health, Surescripts, and Waystar will exhibit at the Oracle Health Conference September 18-20 in Las Vegas.

Blog Posts


Contacts

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

Morning Headlines 9/8/23

September 7, 2023 Headlines Comments Off on Morning Headlines 9/8/23

US healthcare tech company to lay off around 100 workers in Dublin

Michigan-based Merative, the former IBM Watson Health, will lay off 100 Irish employees ahead of opening three facilities in India.

Integral Secures $6.9 Million Seed Round led by Haystack to Maximize Data Privacy and Quality

Health data privacy automation startup Integral raises $7 million in seed funding.

More technical problems found with VA’s disability claims system

The VA will review its online disability systems after discovering that technical issues delayed disability claims for veterans who tried to update their dependency status or to file appeals online.

Comments Off on Morning Headlines 9/8/23

News 9/8/23

September 7, 2023 News 7 Comments

Top News

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Private equity firm Thoma Bravo will acquire NextGen Healthcare in a $1.5 billion take-private transaction, paying a 46% premium to the unaffected share price.

NextGen offers solutions for EHR/PM and interoperability.

The private equity firm’s portfolio includes Imprivata, Hyland, Qlik, and Bluesight.

NXGN shares had lost 8% in the 12 months before the acquisition rumors surfaced. They were down 20% over the previous five years.


Reader Comments

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From DJ: “Re: Intermountain. Rumor is that it told caregivers this week that it will move from Cerner / Oracle Health to Epic.” Verified by an Intermountain media contact in response to my inquiry. Oracle Health losing former Cerner poster children Intermountain and UPMC in the same week is significant. A Redditor posted the internal Intermountain email announcement to caregivers, with these snips:

We are excited to announce that we will align to a single Electronic Health Record (EHR) across Intermountain Health, and all regions will begin moving toward using Epic … Epic will be the single EHR for the organization due to strong functional offerings and significantly higher physician and APP EHR satisfaction scores. For example, Epic EHR satisfaction scores at Intermountain are .49 points above the national average on a 5-point scale and the Cerner score is .52 points below the national average … Epic is currently being used by Intermountain care sites in Colorado and Montana. The renewal deadline for our Cerner contract, which supports the iCentra EHR across the Canyons Region and parts of the Desert Region, is coming up in November. Given this timeline, it’s the right time to take action. We have an urgent need to find an EHR solution that can best support operations in Idaho and Nevada, where our legacy EHR solutions are antiquated and in need of replacement. Our finance team completed a detailed review of our annual EHR operating costs, and moving to a single platform will help us achieve significant cost savings over time. Today we are simply announcing this transition. We have a lot of planning work ahead of us to go-live with Epic across the system by the fourth quarter of 2025. As we plan for the transition, we will be sunsetting EHR contracts with other EHR vendors (e.g., Cerner, Allscripts, etc.).

Meanwhile, another Redditor says that while Neal Patterson built Cerner, losing customers such as Intermountain was more his fault than that of his often-blamed successors Brent Shafer and David Feinberg:

  • Patterson didn’t leave a succession plan when he died in 2017.
  • A primary driver of Cerner clients moving to Epic was that Cerner didn’t develop a competent RCM system and continued selling both its own system as well as Siemens Soarian
  • Cerner allowed clients to customize their system to the point that they couldn’t upgrade.
  • CCL was the go-to reporting system instead of a robust reporting solution.
  • Cerner didn’t develop a competitive offering to Epic’s MyChart.

HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor Symplr. Symplr is building the bridge to enterprise healthcare operations and beyond. Together with its customers, it is creating the blueprint for how to not just survive, but thrive, by maximally using staff
and technology in tandem to bridge the gaps and increase efficiencies in healthcare operations. For more than 30 years and with deployments in nine of 10 US hospitals, Symplr has been committed to improving healthcare operations through its cloud-based solutions. Its provider data management; workforce management; compliance, quality, and safety; and contract, supplier, and spend management solutions improve the efficiency and efficacy of healthcare operations, enabling caregivers to quickly handle administrative tasks so they have more time to do what they do best: provide high-quality patient care. Thanks to Symplr for supporting HIStalk.


The HLTH conference is October 8-11, so I’ll post a list of participating HIStalk sponsors and their activities the week before. Watch for a data collection form link next weekend.


Webinars

September 21 (Thursday) 2 ET. “Unlock open enrollment best practices to stop future denials.” Sponsor: Waystar. Presenter: Lauren Tungate, solution strategist team lead, Waystar. Nearly half of insured Americans consider changing their insurance coverage each fall, necessitating provider safeguards to stop increased denials, find hidden coverage, and prevent uncompensated care. This webinar will crack open enrollment best practices, such as using different data sources to get an accurate picture of benefit details; leveraging automation to identify hidden coverage, confirm active insurance, and avoid lost revenue; and simplifying eligibility workflows to reduce the financial burden on patients and strain on staff.

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


Sales

  • South Dakota’s Department of Health chooses Findhelp to built its statewide social care referral system.
  • Aga Khan Health Services, East Africa will implement Meditech Expanse in Tanzania and Kenya.
  • Intermountain Healthcare will implement Epic throughout its system, replacing Cerner and other products.

People

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Industry long-timer Mark Hefner died Saturday of cancer. He was 64.


Announcements and Implementations

AvaSure adds video AI support to its TeleSitter solution to reduce elopement and falls.

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Withings earns FDA clearance for its Body Scan smart scale, a $400 device with a retractable grab bar that detects atrial fibrillation along with monitoring body composition, heart rate, and vascular age.


Government and Politics

The VA will review its online disability systems after discovering that technical issues delayed disability claims for veterans who tried to update their dependency status or to file appeals online. The VA found that some disability-related cases going back to 2011 have not been addressed.


Other

A woman says that her brother died alone in a Las Vegas hospital because of the way the hospital assigns names to unidentified patients. Clifford Allen collapsed in a retail area on a 115-degree Las Vegas day and was lying in the full sun for eight hours with no help from bystanders, during which time someone stole his wallet and oxygen tank. His sister repeatedly called every hospital in Las Vegas asking about patients admitted under his name or John Doe, with no success. He died 10 days later as an inpatient of MountainView Hospital, which says that while it admits unidentified patients under the last name Doe, it assigns different first names to avoid merging the medical records of multiple patients named John or Jane Doe.


Sponsor Updates

  • Direct Recruiters, Inc. hires Dave Emma (Teladoc Health) as practice leader of technology for digital health.
  • Concord Health Partners makes an unspecified investment in NeuroFlow.
  • Experity will accept nominations for its annual Industry Limelight Awards, to be presented at its 2024 Urgent Care Connect Conference, through October 27.
  • EClinicalWorks releases a new podcast, “Unlocking Reporting Capabilities in EBO.”
  • Ascom launches its new Myco 4 smartphone for clinical institutions and enterprises.
  • Baker Tilly releases a new Healthy Outcomes Podcast, “Exploring aspects of leadership, management, innovation, and technology in healthcare organizations.”
  • Censinet partners with Health Information Sharing and Analysis Center to provide free third-party risk management services to Health-ISAC members through its Community Services Program.
  • CloudWave will co-sponsor the Meditech Live Welcome Reception on September 19 in Foxborough, MA.
  • Five9 will be at the CCW Patient Experience Exchange in Atlanta October 17-19.
  • Nordic releases another episode of its In Network podcast, “Designing for Health: Interview with CT Lin, MD, Liz Salmi, and Bryan Steitz, PhD.”
  • Divurgent releases a new episode of The Vurge Podcast, “Bridging the Gap Between Operations & Technology.”
  • Ellkay will exhibit at Oracle CloudWorld September 18-20 in Las Vegas.
  • Everbridge publishes a new case study, “Improving patient communications with Everbridge: Children’s Hospital of Philadelphia.”

Blog Posts


Contacts

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

EPtalk by Dr. Jayne 9/7/23

September 7, 2023 Dr. Jayne 2 Comments

I enjoy giving back to medical schools and residency programs in my area, so I’m looking forward to teaching an upcoming class on clinical decision support and how clinicians use it in the real world. I had barely started culling research articles and building my slide deck when this New England Journal of Medicine article virtually dropped in my lap.

The authors found that although there has been a lot of attention to ensure that the clinical decision support tools themselves are safe, there hasn’t been enough attention to making sure that clinicians understand how they work or how best to use them in clinical settings. Over the last two decades, I’ve seen plenty of clinicians disregard even the most basic clinical decision support interventions, so the article definitely had my attention. 

The authors suggest that medical education curricula should include content on how clinicians should best incorporate algorithm-generated information into their own decision making, and to discuss the use of clinical decision support tools with patients. Trainees should also be taught to consider how different patient data inputs might change the output of a tool, as well as how to evaluate whether a tool might be missing key elements needed to appropriately evaluate a given patient.

The authors propose that learners should engage in practice-based training scenarios where they use an algorithm, discuss its predictive value, understand how it is using different data points, and understand its overall effectiveness. The article also included a brief history of clinical decision support tools, which have been around since the 1970s, and I’ll be using some of their examples in my presentation.

Speaking of presentations, I recently attended one delivered by some “experts” who advertised a session to help “technology people” better understand how to work with physician end users. There were some interesting statistics thrown out, many without citations. One that seemed very specific was the claim that the average physician can only type 22 words per minute. I decided to hit the medical literature and see what I could find, with scholarly articles putting physicians more in the range of 30 words per minute. That’s a pretty significant difference and I would caution folks that it’s not a good idea to throw that kind of data out without citations when you’re speaking to a group of technical experts.

I think they also failed to understand that there might be clinical informaticists in the audience or that some of the things they were saying about clinician end users were offensive. Comments such as “you have to dumb it down when you’re working with physicians” are a poor idea, especially when those physicians are on the webinar.

Another strategy they advised when working with physicians was that of creating special roles and/or titles for physicians to get them to be EHR ambassadors to their peers, particularly without additional compensation. In recommending that a physician be named something along the lines of Regional Site Director of EHR Adoption, they went on to say, “Titles are cheap. We give them away like candy.” They had some other ridiculous things to say, and I was glad I had a cocktail in hand to help make it through the session. Another clueless move: they failed to recognize that often EHR analysts, implementation specialists, and other “technology people” tend to be fiercely loyal to their end users, so I’m sure the speakers didn’t make many friends with those folks, either.

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A friend recently mentioned his experience with EqualityMD, which is a technology platform dedicated to helping LGBTQ+ patients who are seeking healthcare providers who have been recognized for their delivery of respectful and affirming healthcare. The system gathers patient information, including biometric data, race, pronouns, gender identity, sexual orientation, ethnicity, and languages spoken. It also gathers information about patient preferences for their care teams and ultimately suggests physicians and other providers who might be a good match. Patients can then schedule with and engage providers through the platform. My friend has had a good experience with the solution and feels like the company is “the real deal,” so I’ll be interested in following them over the coming months.

Sometimes I get my news from HIStalk just like everyone else. Earlier this week, Mr. H mentioned Air Force physician complaints about issues where adolescent patients can’t access their records via patient portal. As someone who has been dealing with the challenges of privacy and confidentiality issues faced by healthcare providers who see adolescents for the last eight years, this didn’t seem too off the mark to me. Mr. H is always great about providing citations so I followed his handy link to the original article in Stars and Stripes.

Apparently one of the Air Force’s chief medical information officers told a gathering of people, “So there’s this weird dead zone as of right now with the portal. With children 13 to 17, you can’t see their medical information and your kid cannot create a login because they’re not 18 yet.”

Although this may sound wild to some, it’s actually the way that a large number of healthcare organizations in the US have to handle adolescent confidentiality and privacy due to clashes between state laws and EHR functionality. It’s certainly not unique to Oracle Health. Most of the EHR vendors have a long way to go as far as being able to allow teens to access their data online, but prevent parents from seeing information that might cause harm to the patient. Some systems are better than others at allowing different parts of the record to be parsed for parent view versus patient view. However, the fear of legal issues seems to be a driving force for many provider organizations who are deciding how to configure their EHRs and patient portals.

There have been quite a few presentations on this at conferences, ranging from the AMIA Annual Symposium to various EHR vendor user groups. I’d love to have policymakers sit down with adolescent patients, their parents, their guardians, and their care teams. That’s the only way they’re ever going to understand the complex situations around which they are trying to create rules which seem like a good idea, but ultimately backfire on many of the involved parties. Until then, or until EHR vendors step up, we will all be stuck with the current complex web of proxy access, parental rights, and different ages of medical consent not only across state lines but across medical conditions as well.

How is your organization handling adolescent privacy and confidentiality with respect to access in the patient portal? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 9/7/23

September 6, 2023 Headlines 3 Comments

NextGen Healthcare Enters into Definitive Agreement to Be Acquired by Thoma Bravo

Thoma Bravo will acquire NextGen Healthcare in a take-private deal valued at over $1.5 billion.

Concord Health Partners Invests in NeuroFlow

Behavioral health technology vendor NeuroFlow secures funding from Concord Health Partners.

ERPHealth Acquires Manifesto, Expanding its Behavioral Health Outcome Tracking Platform to include Peer Support and Health Coaching.

Behavioral health outcomes tracking software vendor ERPHealth acquires Manifesto, which offers a peer support and behavioral health coaching app.

ModuleMD Acquires Diversified Healthcare and MedEase to Expand Revenue Cycle Management Footprint

Specialty-focused health IT company ModuleMD acquires Diversified Health Care Management and Professional Management Services, both of which offer practice management and RCM software and services.

Healthcare AI News 9/6/23

September 6, 2023 Healthcare AI News Comments Off on Healthcare AI News 9/6/23

News

Google Chief Health Officer Karen DeSalvo, MD, MPH, MSc says in NEJM Catalyst that large language models will give patients “a more personalized and anticipatory experience” and that medicine needs to change to meet consumer expectations for a mobile-first digital health experience.

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A hospital in Israel declares that an AI app saved a patient’s life when it detected brain bleeding from their CT scan and alerted doctors, who called him to return immediately for additional scans and surgery. The app was developed by Viz.ai.


Research

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A study finds that consumer voice assistants such as Alexa as well as ChatGPT delivered poor results when asked layperson questions about performing CPR, with the authors suggesting that bystanders should call 911 instead of asking Siri. The voice assistants gave “grossly inappropriate” responses that often weren’t related to CPR and almost always failed to recommend calling emergency services.

National Taiwan University Hospital develops an ultrasound device that uses AI to assess a person’s risk of sleep apnea in 15 minutes instead of an overnight sleep study. The machine diagnosed sleep apnea with 95% accuracy in requiring patients to breathe a few times while awake. At-risk patients are then referred for traditional polysomnography.


Other

OSF HealthCare develops an AI model that predicts an inpatient’s death at admission using 13 commonly available data elements, allowing clinicians to work with the identified patients to document their end-of-life wishes.

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Two teens launch Vytal.ai, whose app uses the camera of a laptop or mobile device to assess brain health using a 30-second gaze tracking exercise. The high school students have developed use cases that include early detection of neurological problems, clinical trials, and concussion screening. Co-founder, CEO, and CTO Rohan Kalahasty, who is 18, has spent three years as a researcher in Harvard’s ophthalmology AI lab and has performed AI research at MIT, while co-founder, COO, and CFO Sai Mattapali, aged 17, has spent time as an intern in both neurophysiology and business growth.


Contacts

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

Comments Off on Healthcare AI News 9/6/23

Morning Headlines 9/6/23

September 5, 2023 Headlines Comments Off on Morning Headlines 9/6/23

UPMC is preparing for a massive transfer of medical records

UPMC will replace Oracle Health / Cerner and eight other EHRs with Epic over the next three years.

Thoma Bravo Nears Deal for NextGen Healthcare

Private equity firm Thoma Bravo is reportedly in advanced stages of negotiation to acquire NextGen Healthcare.

TeleVox Acquires Odeza Patient Engagement Business from Ensemble Health Partners

Patient engagement technology vendor TeleVox acquires the Odeza patient engagement business of RCM company Ensemble Health Partners.

Comments Off on Morning Headlines 9/6/23

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