Curbside Consult with Dr. Jayne 6/17/24

We are deep into the summer doldrums portion of the healthcare IT hype cycle. Companies that have big news to share are saving it up for the fall conferences. Some are making announcements that seem to be recycling old content and hoping no one notices.

I’ve worked with a number of provider organizations and it always seemed like summer was slow there as well. With employees taking vacations, the appetite for major go-lives or launches of new initiatives was typically low. I’m working on roughly a dozen smaller projects right now, which sounds like it could be chaotic but actually is going well.

Earlier this week, I worked on a project to help an organization get ahead of the game on their influenza vaccine campaigns. Review of their most recent data on flu-related hospitalizations revealed an upward trend, so they’re planning to mobilize in the community well in advance of vaccine availability. They are in the prep stages, but it is exciting to work with someone who is thinking ahead versus the usual last-minute crunches that come my way. I’ve drafted all their clinical messaging and created timelines for the different phases of the campaign, now it’s off to their various committees for any requested modifications and approval.

I also spent the better part of a day writing demo scripts for a solution vendor that has limited physician support. They are relatively new to the market and don’t have any physicians on staff other than an extremely fractional chief medical officer. Before connecting with me, they were letting their sales reps construct their own demo scripts. Based on some of the scenarios I was presented with, I suspect that AI may have had a hand in their creation. They were technically correct, but the scripts were stilted and didn’t flow they way they needed to in order to resonate with a clinical decision maker.

People ask what makes a good demo. I have a short list of things that I think about as I create scripts. First, you have to understand the audience. Is this a high-level demo to put on a website or to make generally available? Or is it for a specific group of clinical decision makers?

If it’s for clinicians, we need to understand the practice setting (inpatient, ambulatory, or something else) and the clinical roles that are involved, as well as the spectrum of patient demographics. Although you can make decent high-level demos that have broad appeal, when you are showing your product in front of potential end users, the devil can be in the details. Content for a community health clinic demo that will resonate with the audience may look quite different than that for a private practice in an affluent area.

When you get into the details of a clinical demo, it’s important to make sure that the scenarios are typical and appropriate. For example, going in front of frazzled family physicians with a demo that only includes patients with sinus infections and urinary tract infections is superficial at best and may make them think that you don’t understand what they do all day. However, rolling in with scenarios where patients have three or four chronic conditions and suboptimal insurance coverage will be a bit more impressive.

It’s also important that the team that presents it uses the right vernacular for the audience, and especially that they pronounce medical words correctly. Know where abbreviations are typical and how to say them. For example, talking about a coronary artery bypass graft (CABG) as a “cabbage” is OK. Calling it a “see-aye-bee-gee” is less than ideal.

Using obscure Latin names for anatomical structures is a no-no, especially if clinicians are used to using lay terminology for those parts. “Second toe” is just as good as “digitus secondus,” when you’re talking to a family medicine physician. You don’t want me thinking “what is he talking about?” when I’m supposed to be focusing on your product.

The scripts went back to the vendor for review and we will meet later this week to discuss them. I’ll be crossing the phalanges of my second and third upper extremity digits that they accept the recommendations largely as recommended.

I spent a big chunk of hours working on continuing medical education requirements that need to be complete before I can renew my DEA number in the fall. As a telehealth physician, given my state’s laws and my clinical employer’s rules, I don’t prescribe controlled substances. However, that employer requires me to keep a current DEA number as a proxy for proving that I haven’t violated any rules with the DEA. As of last summer, federal legislation requires everyone who is renewing their DEA registrations to attest to completion of eight hours of education on the prevention and treatment of opioid use disorder and other substance use disorders.

I had initially started an educational module from a well-known continuing education provider. However, it was light on the educational content and heavy on questions that aren’t germane to the practice of many physicians. For example, the first module was all about orthopedic patients presenting to the emergency department who might require pain management. There were several “which of the following is the BEST option to treat this patient” type questions. Those are always infuriating because there may be several options that are technically correct but the authors are hoping you read the one specific study that says a specific option is best. Not to mention, the reality of “best” often revolves around the patient’s insurance coverage, whether they can get someone to take a prescription to the pharmacy for them, and other factors that are independent of an isolated clinical scenario. That module wouldn’t have been useful at all for a gynecological surgeon, who has a need to prescribe controlled substances but who probably last saw an orthopedic patient in the emergency department during their residency training.

I powered through to at least get an hour’s worth of credit, but then spent a bit of time trying to find a continuing education provider whose content better matched my own needs. Surprisingly, the American Medical Association was the winner with a 50+ hour curriculum from which I could choose my remaining seven hours in a way that meets my needs. 

None of this addresses the fact that my clinical employer is making their physicians cumulatively spend tens of thousands of dollars each year to demonstrate that they’re not bad guys because they hold a valid DEA number. It’s just another hoop that each of us has to just jump through, unfortunately.

I also spent some time working on a residency lecture that I’ll be giving later in the summer, and that was actually fun. I always look for good visuals and a friend sent me a recent presentation from a gastroenterologist as an example. All of the graphics were GIFs that tied back to the show “Schitt’s Creek,” which was great given stool-focused theme of the lecture.

All in all, it’s another week in the life of a clinical informaticist. It can occasionally be dull, but usually isn’t that way for long.

What part of the year is the slowest for your team or organization? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 6/17/24

Google-backed Tempus AI closes first day of trading up 9% in Nasdaq stock market debut

Tempus AI, which specializes in precision medicine and intelligent diagnostics, raises $410 million during its IPO, giving it a valuation of $6 billion.

London hospitals cancel over 800 operations after ransomware attack

NHS England reports that London-area hospitals have had to cancel over 800 appointments and operations as a result of the June 3 ransomware attack on pathology services vendor Synnovis.

Disrupted Access to Prescription Stimulant Medications Could Increase Risk of Injury and Overdose

CDC warns that people who have been getting Adderall from telehealth provider Done – whose executives were arrested last week on Adderall-related charges – should not resort to buying the drugs on the street as an alternative.

Monday Morning Update 6/17/24

Top News

Ascension restores EHR access across its organization, although it once again warns patients that it is still back-entering data that was collected manually since the May 8 ransomware attack.

Remediation of other systems continues, with no timeline provided.

Reader Comments

From Talkin’ Yankees: “Re: arrested executives of Done. What about the investors who funded their company?” Just about any local doctor could pocket lots of cash by writing prescriptions for whatever the customer / patient wants, even if it’s not good for them. Few doctors are willing to sell such prescription-writing services directly, and even those who might be tempted tread lightly because their customers and pharmacies are local and word gets around quickly. Investors flocked to Adderall slingers like Done and Cerebral, which were basically invisible behind websites and mailed prescriptions going all over the US. Both companies raised hundreds of millions of dollars from dozens of investors and weren’t about to let medical ethics stand in their way of scaling to keep those investors happy. I would not be opposed to holding board members equally accountable as executives, although investors who have less day-to-day involvement might rightly claim they didn’t know (and probably didn’t want to know). The fact that no Theranos board members are sharing a country club cell with Elizabeth Holmes suggests long odds of that happening.

From Big Red Zero: “Re: Oracle Health. Feinberg says the contract extension is a testament to its progress in delivering a world-class EHR to the VA.” Company cheerleaders David Feinberg and Seema Verma had to put a positive spin on the 11-month extension. They conveniently didn’t note that Congress was so frustrated with Oracle and the VA that it insisted on one-year extensions instead of the original five as contained in the original, no-bid contract. At least Oracle must have met whatever requirements were needed to earn the renewal and can justifiably celebrate not getting fired, for now anyway. The VA doesn’t really have a backup plan other than to re-implement VistA, which they claim is not only unsustainable, but more expensive than Oracle Health.

From PE Pauper: “Re: private equity buying hospitals and medical practices. Some members of Congress are trying to make laws to limit the damage they can do.” That’s well and good if it passes with teeth in it (unlikely in our political environment), but meanwhile, the cliché of blaming the game rather than the player rules:

• PE firms break no laws when they load hospitals with unsustainable debt, sell the real estate they sit on Hahnemann-style to immediately get their money back, slash costs dangerously, and then either close the doors or file bankruptcy hoping for a bailout. Like much of corporate America, all of this is unethical, but not necessarily illegal. It’s a bad healthcare system if the only thing propping it up is the assumption of pure intentions.
• So-called “non-profit” health systems aren’t much better given aggressive business practices, closing of unprofitable but vital services, and stashing piles of cash offshore. Not to mention suing patients into bankruptcy.
• Nobody notices the inefficiency or indifference of hospital bureaucracy until they move into the patient or caregiver role. Otherwise, more people would be storming the hospital castle with torches and pitchforks.
• I know to avoid a Chinese buffet that has a long track record of near-failing sanitation scores, but I don’t have that same information or choices when it comes to hospitals. The building is architecturally precious, the lobby has a piano and cabinets full of crystal awards, and they sell sushi in the cafeteria, so it must be a good place to obtain life-or-death care. Once I’m in a bed, the chances of transferring elsewhere are low.
• Health systems are politically untouchable due to aggressive lobbying and large community employment, so legislators would need to spank  PE firms directly without hitting hospitals with friendly fire.
• Like it or not, the health system that we have have allowed to develop – one that would not be accepted by any other developed country — will be run by interchangeable corporate suits who call the shots of what happens during your most vulnerable, painful, and life-altering moments. Whether they work for PE, insurers, or regional /national health systems won’t make much difference.  

HIStalk Announcements and Requests

Oracle EVP Ken Glueck wrote that “everyone in the industry” understands that Epic’s Judy Faulkner is the biggest obstacle to interoperability, a premise with which 78% of poll respondents disagree. See their comments. 

New poll to your right or here: Are government penalties effective in getting health systems to improve their cybersecurity practices? I would likely vote no since the business impact far exceeds any added-on penalty that the government might impose after the fact. But of course that begs an alternative question – what would provide that encouragement given that cybersecurity awareness is probably already adequate? Where did Ascension fall short, or is it simply impossible to protect against ransomware attacks like theirs?

Want to support what I do and gain company exposure in the process? Ask Lorre to sign you up as a new HIStalk sponsor – it takes one day, but you reap the benefit in 364 others by reaching my influential audience. Lorre can usually be persuaded to offer some first-year perks, which I pretend not to notice since I like the ego boost of bringing on new sponsors.

Today I learned that the term for the near-obsolete verbal practice of dropping the letter R in pronunciation is called a “non-rhotic” accent as practiced in the “pahk the cah” areas of New England, New York, and parts of the coastal South. Actors of the black-and-white era then latched onto the clearly phony “British Announcer Voice” to sound less regional and more sophisticated. Unrelated to R-dropping is R-adding, such as saying “warsh” instead of “wash.” Up next is the “Confederate A,” where people in parts of the deep South (and born-in-California actors trying to sound generically Southern) might pronounce “try” as “trah.”

Webinars

June 26 (Wednesday) noon ET. “Population Risk Management in Action: Automating Clinical Workflows to Improve Medication Adherence.” Sponsor: DrFirst. Presenters: Colin Banas, MD, MHA, chief medical officer, DrFirst; Weston Blakeslee, PhD, VP of population health, DrFirst. What if you could measure and manage medication adherence in a way that would eliminate the burdens of medication history collection, patient identification, and prioritization? The presenters will describe how to use MedHx PRM’s new capabilities to harness the most complete medication history data on the market, benefit from near real-time medication data delivered within 24 hours, automatically build rosters of eligible patients, and identify gaps of care in seconds.

June 27 (Thursday) noon ET. “Snackable Summer Series, Session 1: The Intelligent Health Record.” Sponsor: Health Data Analytics Institute. This webinar will describe how HealthVision, HDAI’s Intelligent Health Management System, is transforming care across health systems and value-based care organizations. This 30-minute session will answer the question: what if you could see critical information from hundreds of EHR pages in a one-page patient chart and risk summary that serves the entire care team? We will tour the Spotlight, an easy-to-digest health profile and risk prediction tool. Session 2 will describe HDAI’s Intelligent Analytics solution, while Session 3 will tour HDAI’s Intelligent Workflow solution.

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

Acquisitions, Funding, Business, and Stock

Amwell names co-founder, chairman, and co-CEO Ido Schoenberg, MD as sole CEO. Co-founder and former co-CEO, Roy Schoenberg, MD, MPH – his brother — will remain on the board. AMWL shares have lost 83% of their value in the past 12 months and are off 99% from their January 2021 high, when the company’s valuation was nearly $9 billion versus today’s $116 million.

Government and Politics

CDC warns people who have been getting Adderall from telehealth provider Done – whose executives were arrested last week on Adderall-related charges – should not resort to buying the drugs on the street as an alternative. CDC says that patients should ask their PCP about finding a new prescriber, noting that 7 of every 10 illicit pills that the DEA seizes contain a lethal dose of fentanyl.

Sponsor Updates

• Medhost’s Cloud Team sorts donations from local grocery stores at Second Harvest, which then distributes them to communities in need.
• For the second year in a row, Black Book Research survey-takers give InteliChart top marks for end-user satisfaction in the areas of patient engagement and consumer outreach solutions.
• QGenda publishes a case study, “Banner Health Uses QGenda’s Workforce Management Platform to Improve Patient Access and Time Allocation.”
• Redox releases a new Diagnosing Healthtech Podcast, “Overcoming challenges of delivering omnichannel healthcare at scale with Marcus Osborne.”
• CereCore hires Zach Grieshop as AVP of client technical services and names Kim Waters as principal to its newly formed revenue cycle advisory.
• RLDatix publishes a new resource, “The Joint Commission (JTC) Infection Prevention Updates July 1st – How RLDatix Compliance Solutions Can Help.”
• Wolters Kluwer Health Executive Director of Continuing Education Karen Innocent, DNP, RN, joins the American Nurses Credentialing Center Commission on Accreditation in Nursing Continuing Professional Development.

Blog Posts

• Integrating with your EHR: Comparing common data integration methods (Notable)
• Netsmart’s Top 5 Features for Physical Therapy Documentation Systems (Netsmart)
• Prioritizing patient-centered billing: HFMA report emphasizes clear and compassionate strategies (Nordic)
• How ServiceNow can Disrupt Healthcare – In a Good Way (Optimum Healthcare IT)
• Nurses of Note 2024: The Pediatric Nurse Practitioner (PerfectServe)
• Four Pieces of Wisdom to Accelerate Digital Health Innovation (Rhapsody)
• Ahead of the Game: Q&A on Upgrading E-Prescribing Standards (Surescripts)
• Beyond the 7 Elements: Preparing Your Hospital for Future Compliance Challenges (Symplr)
• Mitigating No-Shows with Appointment Scheduling and Reminder Software (TruBridge)

Contacts

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

Morning Headlines 6/14/24

Ascension cyberattack caused after employee accidentally downloaded malicious file

Ascension confirms that its May 8 ransomware attack was launched by a malicious email opened by an unsuspecting employee.

VA awards second option period to Oracle Health in support of Federal Electronic Health Record modernization contract

The VA extends its contract with Oracle Health for a second term of 11 months with an eye to deploying the EHR at new sites in 2025 once reset goals have been met.

Founder/CEO and Clinical President of Digital Health Company Arrested for $100M Adderall Distribution and Health Care Fraud Scheme

Federal agents arrest the CEO and clinical president of ADHD telehealth provider Done on charges of distributing Adderall, healthcare fraud, and obstruction of justice.

News 6/14/24

Top News

Ascension provides updates about its May 8 ransomware attack:

• The cyberattack was launched by a malicious email that was opened by an unsuspecting employee.
• The attackers took information from file services that employees use for daily and routine tasks, some of which are likely to contain PHI.
• Ascension is offering free credit monitoring and identity theft protection services to any patient or employee who requests it.
• EHR access has been restored in nine regions and in parts of two other regions. Organization-wide EHR access restoration is still on track for Friday, June 14.

Reader Comments

From Siri Soundalike: “Re: advice for my nurse colleague. He has many years of experience in several aspects of healthcare, earned an MBA, and was involved in starting an unrelated business. He is looking for other career opportunities and wondered what directions the diverse HIStalk readership suggests.” I will invite readers to add their thoughts. Their advice could be more targeted if they understood the type of work he wants to do (corporate employee, hands-on provider, entrepreneur,etc.) and whether he has geographic restrictions. Advice would also likely vary if he’s 30 with young children versus a financially secure 50-year-old. My first question would be, is his dream job as an employee or as a business owner? If he says “either is OK,” then more self-reflection is indicated before bringing others into the discussion.

From Kinko: “Re: healthcare disruptors. Just because a big company is dabbling in healthcare doesn’t make it a disruptor.” Agreed. You’re just a disruptor-wannabe until you actually disrupt something, which rarely happens in healthcare except in some niche where insurers and regulators don’t tread. The lumbering interlopers usually end their would-be role as healthcare disruptors and instead slink away as healthcare departers.

HIStalk Announcements and Requests

Maybe healthcare should do this. Mrs. H received an email from the shop that is checking out her car after it went into limp mode, requiring it to be towed and me to rescue her from anxious roadside pacing. A phone-recorded video that was attached to the email featured the mechanic walking around explaining what he found as he pointed at parts. An estimate or email summary would have been equally effective, but it felt more personal to have the expert explaining informally.

Webinars

June 26 (Wednesday) noon ET. “Population Risk Management in Action: Automating Clinical Workflows to Improve Medication Adherence.” Sponsor: DrFirst. Presenters: Colin Banas, MD, MHA, chief medical officer, DrFirst; Weston Blakeslee, PhD, VP of population health, DrFirst. What if you could measure and manage medication adherence in a way that would eliminate the burdens of medication history collection, patient identification, and prioritization? The presenters will describe how to use MedHx PRM’s new capabilities to harness the most complete medication history data on the market, benefit from near real-time medication data delivered within 24 hours, automatically build rosters of eligible patients, and identify gaps of care in seconds.

June 27 (Thursday) noon ET. “Snackable Summer Series, Session 1: The Intelligent Health Record.” Sponsor: Health Data Analytics Institute. This webinar will describe how HealthVision, HDAI’s Intelligent Health Management System, is transforming care across health systems and value-based care organizations. This 30-minute session will answer the question: what if you could see critical information from hundreds of EHR pages in a one-page patient chart and risk summary that serves the entire care team? We will tour the Spotlight, an easy-to-digest health profile and risk prediction tool. Session 2 will describe HDAI’s Intelligent Analytics solution, while Session 3 will tour HDAI’s Intelligent Workflow solution.

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

Acquisitions, Funding, Business, and Stock

Microsoft retires the GPT Builder part of its $20 Copilot Pro subscription three months after it announced it, saying that the company will shift focus to commercial and enterprise sales.

Sales

• Cloud PACS vendor Synthesis Health announces new customers Tahoe Carson Radiology, Naugatuck Valley Radiology, and Intermountain Medical Imaging.

People

Matt Wojcik, MPH (Crossroads) joins Solaris Health as CIO.

Announcements and Implementations

HealthLynked rolls out an online medical record request form that uses DocuSign to send patient information requests to hospitals, physician offices, and laboratories. The records are added to the company’s network, which allows patients to share their own records with providers.

Komodo Health announces Komodo Patient Insurance, which offers the pharmacy and medical insurance status of 200 million de-identified US lives.

Government and Politics

Federal agents arrest the CEO and clinical president of ADHD telehealth provider Done on charges of distributing Adderall, healthcare fraud, and obstruction of justice. The Department of Justice charged founder and CEO Ruthia He and Clinical President David Brody, MD for illegally distributing 40 million units of Adderall and other stimulants without medical justification, which DoJ says generated $100 million in revenue.

The Justice Department and FTC settle their claims under behavioral telehealth vendor Cerebral, which will pay $5 million in consumer refunds and $2 million in civil penalties for exposing user health information via deficient security practices and lax prescribing of Adderall. The government will continue charges against former CEO Kyle Robertson, who left the company in 2022 to start vanity online drug provider Zealthy, which targets patients who seek drugs for depression, obesity, erectile dysfunction, hair loss, and testosterone deficiency. The federal government has added Zealthy to its complaint.

The VA extends its contract with Oracle Health for an unspecified term, presumably the one-year period that Congress mandated to hold the company more accountable for the troubled implementation.

The VA moves several technology projects and 600 personnel under its Digital Health Office, which it launched on June 2. The office will include connected care, population health, health informatics, and AI programs as the VA’s central coordinator of digital health projects. The VA is recruiting for the office’s permanent leadership, with the interim being Nadia Smith, MBA, acting chief digital health officer, who joined the VA in September 2023 after 27 years of federal government consulting.

Real Time Medical Systems accuses post-acute EHR vendor PointClickCare (PCC) of information blocking, seeking a federal judge’s intervention to compel PCC to grant access to skilled nursing patient data. PCC argues that providing that access would expose its systems to hacker bots that could slow operations or compromise patient data. Analytics vendor Real Time contends that PCC, which offers a competing service, is attempting to drive it out of business. Real Time claims that PCC previously forced its employees to perform manual queries after completing a CAPTCHA challenge, despite Real Time’s HITRUST certification. PCC says provides information to 1,900 companies via a more secure method. Real Time claims that PCC told it directly that its own introduction of a competing product meant that it would no longer provide Real Time with data access.

CMS actuaries estimate that US healthcare spending will outpace economic growth with an average 5.6% annually from 2023 to 2032. Hospital spending increased an estimated 10.1% last year. Medicare has the highest predicted 10-year average annual increase of 7.4% among payers due to increased enrollment of baby boomers through 2029. The actuaries predict that healthcare spending will increase to nearly 20% of the gross domestic product.

A US Senate Finance Committee report finds that Vanderbilt University Medical Center failed to protect patient privacy when it provided the requested records of 82 transgender patients to Tennessee Attorney General Jonathan Skrmetti. VUMC says it did not violate privacy laws because it was required to provide the records, a premise that is being questioned by a patient lawsuit and an HHS OCR investigation. The affected patients were not notified until ACLU filed a lawsuit.

Sponsor Updates

• HCTec sponsors the Tennessee HIMSS Chapter’s annual golf tournament.
• FinThrive releases a new Healthcare Rethink Podcast, “Rebel Healthcare: The True Patient Lead Journey Toward Improving Healthcare.”
• Laudio will exhibit at the Organization of Nurse Leaders Annual Meeting June 13-14 in Newport, Rhode Island.
• Bizmatics will integrate DrFirst’s RxInform patient engagement solution into its EHR to improve medication adherence.

Blog Posts

• Findhelp & NextGen: Integrating to Support the Whole Patient (Findhelp)
• Cyber Security in Healthcare: How Providers Can Improve Data Safety and Cyber Resilience (FinThrive)
• CCW Panel Recap: How We Can Empower Those Around Us (Five9)
• Breaking Silos: How SOC and Compliance Teams Can Transform Healthcare Security (Fortified Health Security)
• Award-Winning Data Visualization Solution: A Deep Dive into SDOH Software for Life Sciences (Inovalon)
• Advancing GenAI Capabilities and Bringing Interoperability Solutions to Researchers and Patients (InterSystems)
• Meditech supports innovation and cultivates partnerships at MUSE Inspire 2024 (Meditech)
• Elevate Your Quality Scores: A Guide to Maximize MIPS/MVP in 2024 (MRO)
• Embracing AI in Healthcare: Overcoming Concerns Benefits All (Net Health)

Contacts

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

EPtalk by Dr. Jayne 6/13/24

I get a lot of emails advertising webinars and educational opportunities. I don’t usually take advantage of them because my schedule is busy and the invites don’t arrive with enough notice to allow me to attend. However, a recent email from one of our local HIMSS chapter sponsors caught my eye.

It met all the criteria. I received it several weeks in advance, the topic was interesting, and it was advertised specifically as an educational session. I blocked my calendar and registered. I logged in well in advance, only to find a blank screen and no indication that I was receiving the audio or video feed. I appreciate a moderator who addresses attendees with some kind of “Thank you for joining, the session will begin in three minutes” kind of welcome so that you know you’re in the right place and everything is working.

It was well after the top of the hour and the webinar hadn’t popped up yet, so I refreshed the window and discovered that it had already started and I had missed the intros. It also was less of a formal education session than talking heads, with no agenda or educational objectives. I had yet to hear anything about healthcare IT in the first 20 minutes (although I did hear a lot about AI being used to predict the likelihood of a criminal reoffending and about autonomous vehicles), so I gave up.

If you’re putting on a webinar, here are my recommendations. Advertise your offering accurately. If it’s not going to be a formal educational session, don’t make it sound like one. Words like “chat” or “roundtable” indicate a less-formal presentation. Also, know how your platform works. If it won’t automatically refresh for early-arriving attendees, add a chat message to advise them to refresh the screen regularly so they don’t miss anything.

Anyone who has ever been in a clinical role in a hospital is used to hearing “The Joint Commission requires it” about policies that may or may not be subject to Joint Commission review. The Joint Commission recently released an update that clarifies its position on using secure texting for patient information and orders. Organizations can use that modality for orders as long as the information is secure, encrypted, and captured in the EHR with timestamps and author information. This brings The Joint Commission into line with CMS policies, although having providers enter orders directly into the EHR remains the best practice for order entry.

A friend clued me in to Spacetop, an augmented reality laptop that is under development and is available for reservation. Along with “the first spatial OS designed for productivity,” the G1 model is priced at $1,900 and will start shipping in October. Prescription lenses for the retro-looking glasses are included, although I would be more impressed if it included technology where the user could input the details of their eyeglasses prescription and have the system adjust the visuals automatically. It advertises a 100-inch visual canvas with a form factor that “fits a standard laptop bag with the glasses safely stored in hardcover.” The glasses include speakers and microphone for use during online meetings, although unless I’m interacting with a bunch of users with the same device, I think that would seem a little strange. If the company is looking for beta testers, I know a sassy CMIO who would love to give feedback.

From LaSalle Gal: “Re: MyChart. My health system sent me an email recommending that I turn on all the notification settings. Although it had technical instructions for toggling the notifications on, it seemed like a missed opportunity to educate patients on what it means to receive notifications, especially for patients who may not want to see test results before they receive a communication from their physician.” I reviewed the original email and I agree. It would have been easy to insert a sentence or two about how the organization releases results along with instructions for suppressing notifications that you don’t want to receive. I also thought this section was funny: “Even if a toggle is already green, you might not have all notifications turned on. To make sure all notifications are enabled, just switch each toggle off and then back on.” That doesn’t instill confidence to this user that the settings are accurate and functional. I’d be curious to see data about how many patients may have accessed the communication preferences settings in the weeks after this communication was sent.

Based on my comments about certain clinicians struggling with handwritten orders during downtime events, another reader sent this piece from NPR’s “Shots” blog that addresses the benefits of writing by hand. It summarizes some of the benefits of handwritten work, including better letter recognition in children and better conceptual understanding of material when adults take notes by hand. I own a set of amazing medical student notebooks from the 1920s (thanks, eBay!). It’s interesting to imagine the student sitting there, jotting his thoughts about the fact that “we are really just starting to understand the mysteries of the thyroid.”

Pet peeve of the week: the phrase “building an organizational muscle.” At best, it makes me think of bodybuilders oiled for competition, and at worst it reminds me of an old drug company ad for a diabetes medication that anthropomorphic characters such as Hungry Muscle, Burned-Out Pancreas, and Upset Stomach. (Side note: in trying to remember what the drug was, I discovered that you can buy the Hungry Muscle plushies online, so I know I didn’t imagine it. I also learned that there is a thing called the Medical Advertising Hall of Fame.) Whether you’re building an organizational muscle for change, for quality, or some other buzzword, there are better terms: “a culture of change” or “a commitment to quality” come to mind.

I spent part of the morning being a patient at my local health system. For the most part, the information I provided during the online check-in process was used, including an update to my health history and a review of systems. They required a new scan of my insurance card, however, even though I’ve had another appointment within the last 30 days and the card was scanned then. The receptionist also asked me the standardized COVID exposure questions that were appropriate several years ago, including whether I had any international travel within the last year or the last 30 days. I’m not aware of any recommendations for travel screenings in healthcare environments, so it felt like an organization that just isn’t staying current. It made me wonder how often the organization is reviewing its patient experience, as well as its ability to keep current with infectious disease recommendations.

How often do you reassess your patient registration and check-in processes? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 6/13/24

Veterans Health Administration creates new office to streamline tech initiatives

The VA creates a new Digital Health Office to unify the Veterans Health Administration’s technology initiatives, including those related to health informatics, AI, population health, and connected care.

Brightside Health Expands into Substance Use Disorder, Virtual Intensive Outpatient Treatment

Virtual mental healthcare company Brightside Health acquires Lionrock Recovery, which offers virtual intensive outpatient addiction treatment services.

Canary Speech Secures $13 Million in Series A Funding to Change How the World’s Top Healthcare Organizations Screen for Mental Wellness and Cognitive Health

Canary Speech, a health IT company specializing in the development of AI-powered vocal biomarkers, raises $13 million in a funding round led by Cortes Capital.

United States Sues Telehealth Providers and Executives for Unfair and Deceptive Conduct

Cerebral will pay $7 million to settle federal complaints of a variety of deceptive business practices, though the DoJ and FTC will continue to pursue Cerebral founder Kyle Robertson and several business associates for their role in subsequent, similar practices at telehealth companies launched after Cerebral shut down.

Koda Health Secures New Funding to Expand Advance Care Planning Capabilities

Koda Health, an advance care planning software startup spun out of Texas Medical Center, closes an oversubscribed seed funding round.

Healthcare AI News 6/12/24

News

Apple announces its long-awaited Apple Intelligence capability, which will be released in beta in IOS18 in September. It will work only on newer Apple hardware such as the IPhone 15 and IPads/Macs that are outfitted with the M1 chip. Its Siri voice assistant will use on-device AI to answer most questions, Apple-hosted LLMs for more complex questions, and OpenAI – with the user’s permission – to respond to more detailed questions. Planned features include a conversational Siri, word-based photo search, automatic photo editing, the ability to proofread and summarize documents, and the ability to summarize call audio.

The American College of Radiology asks members to weigh in on the request that was made to CMS by AI diagnostic software vendor Cleerly, which wants CMS to pay for its FDA-cleared CAD detection. The company says that using its $1,500 CT AI test reduced costs by avoiding invasive coronary angiography. Cleerly says that AI-enabled CCTA is better at diagnosing CAD than the traditional stress test.

Tampa General Hospital rolls out Nuance DAX Copilot to 500 of its affiliated physicians for ambient documentation.

UMass Memorial Medical Center uses Mednition’s Kate AI product for triaging ED patients.

University Hospitals deploys Aidoc’s AI platform across 13 hospitals and several outpatient locations. The company offers 17 FDA-cleared algorithms for triage, quantification, and care coordination.

Business

CCS launches PropheSee, an AI-powered predictive model that improves continuous glucose monitoring device adherence rates by up to 50%, saving an estimated $2,200 per patient per year.

Research

Researchers develop a publicly released trustworthiness benchmark for medical large vision language model that assesses trustworthiness, fairness, safety, privacy, and robustness.

Harvard-based pediatric physicians find that Google Translate and ChatGPT 4.0 perform expert-level translation of patient instructions to Spanish and Portuguese, but fall short of professional translations for Haitian Creole.

ChatGPT can generate expert-quality radiologic reports that are easier for patients to understand. The study authors note that it would be nearly impossible to expect radiologists to create patient-centered radiology reports at the required middle school reading level.

Researchers in China find that AI can accurately detect coronary artery disease using non-invasive facial temperature images. 

Contacts

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

Book Review: Designing for Health: The Human-Centered Approach

“Designing for Health: The Human-Centered Approach” is a compelling and concise read from industry long-timers Craig Joseph, MD and Jerome Pagani, PhD, a physician informaticist and behavioral neuroscientist, respectively. They argue that intentional, human-centered design is mandatory for making healthcare work better for providers and patients.

My Takeaways

• This is a fun, information-packed, and relatively short read at 170 pages that will engage even skimmers and TL;DR types (I have read it twice, in fact).
• “Human-centered design” sounds preachy and academic, but it’s just the idea of developing solutions that meet the needs of the intended users.
• The concepts aren’t just about software design and implementation decisions.
• You are a designer if you, or a committee on which you serve, makes decisions about screen layouts, links, forms, edits, prompts, warnings, and even whether to turn entire functions on.

This is not a purely technical exercise. I recall that Steve Jobs attributed his accidental enrollment in a calligraphy class as forming the entire design-obsessed philosophy of Apple – making hardware so easy to use that the barrier between human and machine was nearly eliminated. Microsoft would unashamedly lead PC users to hacking their Windows registry or modifying obscure settings, while Jobs was adamant that even an “on” button was intrusive and superfluous. We don’t need to get to Jobs-like levels of obsession to improve the status quo and we can choose our battles by looking that the user benefit versus the effort required to deliver it.

This book primarily addresses the needs of physicians and other caregivers rather than patients, but the concepts certainly carry over into the patient experience, which is about as far from human-centered as you can get. Clinicians who aren’t burned out, overworked, or feeling yanked like ivory tower marionettes will deliver better, more human-centered care.

Intentional design matters, the authors say. Everything that gets put in front of a clinician, stuffed into their workflow, or even left to randomness is an intentional decision. Users apply mental shortcuts to get through their day, so the design goal is to make it easy for them to do the right thing.

Six Important Concepts

1. Make it easy to do the right thing.
2. GROSS: getting rid of stupid stuff.
3. Start with the end user (and their context) in mind.
4. Transparency and predictability.
5. The stupidity of not listening to your (real) experts.
6. Continuous improvement.

Go-Live is MVP

Go-live configuration is like a company’s Minimum Viable Product (MVP) that provides core functionality that needs to be refined continuously based on user feedback. However, those users shouldn’t be asked to provide solutions. It’s the designer’s job to review observations and user feedback make the best collective decisions that balance competing needs.

Next Comes AI

It occurred to me that while EHR decisions currently dominate clinician satisfaction and burnout, AI is the next frontier. Implementing AI in healthcare will require thoughtful, human-centered design. That would be an interesting topic for the authors to address.

Conclusion

Design decisions aren’t made solely by EHR application analysts or even CMIOs. Every decision that requires clinicians to collect information, monitor an event queue, respond to patient communications, accept or reject clinical decision support recommendations, or to incorporate new research instead of old habits into deciding which button to click involves intentional design decision.

This book is a good starting point for those who recognize the value of optimizing clinician performance and satisfaction, which will trickle down to better patient outcomes.

Morning Headlines 6/12/24

Oracle Announces Fiscal 2024 Fourth Quarter and Fiscal Full Year Financial Results

Oracle reports Q4 results: revenue up 3%, adjusted EPS $1.63 versus $1.67, missing Wall Street expectations for both.

NeuroFlow Acquires Owl, Creating the Largest End-to-End Platform for Behavioral Health Measurement and Engagement Across the Care Continuum

NeuroFlow, whose system helps risk-bearing healthcare organizations surface and support behavioral health needs, acquires Owl, which offers a measurement-based care platform.

HealWell AI to Acquire VeroSource Solutions and its Cloud-based Health Data Interoperability Platform to Help Large Enterprises Adopt AI-Powered Population Health Capabilities

In Canada, preventative care-focused digital health company HealWell AI acquires healthcare data software vendor VeroSource for $24.5 million.

News 6/12/24

Top News

Oracle reports Q4 results: revenue up 3%, adjusted EPS $1.63 versus $1.67, missing Wall Street expectations for both.

ORCL shares advanced in extended trading following the announcement as the company announced new cloud sales to Google and OpenAI.

Cerner was barely mentioned in the call and in none of the analyst questions.

From the earnings call:

• The company sold 30 contracts worth $12 billion in the past quarter.
• OpenAI will run deep learning and AI workloads on Oracle Cloud Infrastructure.
• Starting in September, Google Cloud customers can directly access Oracle database services running in Oracle Cloud Infrastructure.
• CEO Safra Catz said, “I will no longer be breaking out the Cerner business in my results. And even though it will begin to grow modestly throughout the year in both revenue and operating margins, it’s not necessary to break it out any more because it is now operating in a growth mode.”
• Larry Ellison says that the company can serve small customers, with Oracle deploying small data centers at its own expense – ones that will fit on a ship or submarine – that provide a fall Oracle cloud using six standard half racks in a conventional data center, with the client paying only for the service they use.
• Ellison says that Oracle is building a 200 megawatt data center and is planning some that are approaching a gigawatt.
• Ellison says the industry will move to support customers who choose to run multiple clouds:  “We’ll get rid of these fees for moving data from cloud to cloud, and all the clouds will be interconnected, and customers can pick their favorite service from their favorite cloud and mix and match whatever they want to use and do it easily and seamlessly.“

Reader Comments

From HIT Girl: “Re: Ascension. Covering itself in glory yet again.” A member of the Four Tops soul group sues Ascension Macomb Oakland Hospital, alleging that ED employees who were treating him for shortness of breath placed him in a straitjacket, denied him oxygen, and ordered psychiatric tests after he informed them that he was a celebrity with a history of issues with stalkers and fans. Employees believed him only after his wife showed them phone video of him performing with the group at the Grammy Awards, after which the hospital offered a $25 gift card as an apology. Perhaps their skepticism was justified since the singer – who also runs a Los Angeles-based ministry – is 53 years old and the group’s last hit charted three years before he was born. More shocking is that the group, which was formed in 1953, still has a founding member on stage, 88-year-old Duke Fakir. They have upcoming US concert dates.

Webinars

June 26 (Wednesday) noon ET. “Population Risk Management in Action: Automating Clinical Workflows to Improve Medication Adherence.” Sponsor: DrFirst. Presenters: Colin Banas, MD, MHA, chief medical officer, DrFirst; Weston Blakeslee, PhD, VP of population health, DrFirst. What if you could measure and manage medication adherence in a way that would eliminate the burdens of medication history collection, patient identification, and prioritization? The presenters will describe how to use MedHx PRM’s new capabilities to harness the most complete medication history data on the market, benefit from near real-time medication data delivered within 24 hours, automatically build rosters of eligible patients, and identify gaps of care in seconds.

June 27 (Thursday) noon ET. “Snackable Summer Series, Session 1: The Intelligent Health Record.” Sponsor: Health Data Analytics Institute. This webinar will describe how HealthVision, HDAI’s Intelligent Health Management System, is transforming care across health systems and value-based care organizations. This 30-minute session will answer the question: what if you could see critical information from hundreds of EHR pages in a one-page patient chart and risk summary that serves the entire care team? We will tour the Spotlight, an easy-to-digest health profile and risk prediction tool. Session 2 will describe HDAI’s Intelligent Analytics solution, while Session 3 will tour HDAI’s Intelligent Workflow solution.

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

Acquisitions, Funding, Business, and Stock

NeuroFlow, whose system helps risk-bearing healthcare organizations surface and support behavioral health needs, acquires Owl, which offers a measurement-based care platform.

Sales

• Landmark Hospital of Cape Girardeau (MO) selects telemedicine services from Doctors Anytime.
• Alliance Medical will implement Agfa HealthCare’s enterprise imaging software across its 120 imaging sites in the UK.
• Olympic Medical Center (WA) will enhance its telecardiology program with software and services from Eagle Telemedicine.
• The University of South Carolina will use Rimidi’s remote patient monitoring technology as a part of the postpartum care offered at an affiliated multispecialty clinic.

People

Jim Deischer, MBA (Nordic) joins Cardamom Health as VP of finance.

Teladoc Health names Chuck Divita (GuideWell) CEO.

Ed Glynn, MD, MBA (HCA Healthcare) joins RhythmX AI as chief clinical officer.

Ada Health names Nick Altebrando, MA (DayTwo) chief product officer and Yury Rozenman (Propeller Health) SVP of business development.

Announcements and Implementations

St. Luke’s (MN) will transition to Epic as a part of its acquisition by Aspirus Health. They have been running Meditech, I believe.

Belfast Health and Social Care Trust in Northern Ireland goes live on Epic.

In England, University Hospitals Coventry and Warwickshire NHS Trust will go live on Oracle Health later this week. The organization announced last October that it had paused its rollout plans to work through unspecified issues that were discovered during testing.

Mount Sinai Medical Center (FL) implements remote patient monitoring capabilities from HealthSnap. Mount Sinai will deploy HealthSnap’s chronic care management services across its primary care facilities beginning next month.

CCS launches PropheSee, an AI-powered predictive model that improves continuous glucose monitoring device adherence rates by up to 50%, saving an estimated $2,200 per patient per year.

Privacy and Security

The White House partners with Microsoft and Google to offer rural hospitals free and low-cost cybersecurity resources. Google has also committed to launching a pilot program with select rural hospitals to develop cybersecurity capabilities that are tailored to their needs.

Australian e-prescribing vendor MediSecure faces insolvency as it deals with the effects of a ransomware attack in early May and being denied a government bailout afterward.

Sponsor Updates

• SmartSense by Digi sponsors the St. Louis Golf Classic benefiting Autism Speaks.
• EClinicalWorks publishes a new customer success story, “Streamlining Data Reporting for Primary Care Centers of Eastern Kentucky.”
• Wolters Kluwer Health announces that its UpToDate clinical decision support solution has been awarded accreditation with commendation from the Accreditation Council for Continuing Medical Education.
• A hospital in South Carolina prepares to go live on Ascom’s Unite software.
• KLAS recognizes Availity with its 2024 Points of Light Award for its collaborative work with prior authorization requests and approvals.
• CereCore releases a new podcast, “What Matters to a Healthcare CFO? EHR Implementation & Strategic Planning Advice.”
• Divurgent releases a new episode of The Vurge Podcast, “Aspire to Inspire: Chuck Podesta’s Journey of Healthcare IT Leadership and Reinvention.”

Blog Posts

• AdvancedMD & Salesforce: Integrating for patient intake, scheduling & reporting (AdvancedMD)
• Customer Exclusive: My life in flow – Part 1 (Agfa HealthCare)
• Millenial matters in medicine (Altera Digital Health)
• Emerging technologies’ impact on the future of healthcare delivery (Arcadia)
• Navigating Governance: Defining Outcomes in Your Patient Engagement Strategy (Artera)
• What to Expect During an OCR Audit or Investigation and How to Prepare (Clearwater)
• How Data Analytics Can Help Advance Your EHR Strategy (Dimensional Insight)
• Empowering Graduates: Navigating the Job Market as a Gen Z Professional (Direct Recruiters)

Contacts

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

Morning Headlines 6/11/24

CityMD Agrees to Pay over $12 Million for Alleged False Claims to COVID-19 Uninsured Program

CityMD, a VillageMD-owned chain of urgent care practices in New York and New Jersey, will pay $12 million to settle allegations that the company submitted false payment claims to a federal COVID testing program for uninsured patients.

Med-Metrix Announces the Acquisition of HBCS, Further Strengthening the Company’s End-to-End RCM Capabilities

RCM software and services vendor Med-Metrix acquires Hospital Billing & Collection Service, a competitor based in Delaware.

Biden-⁠Harris Administration Bolsters Protections for Americans’ Access to Healthcare Through Strengthening Cybersecurity

The White House partners with Microsoft and Google to offer rural hospitals free and low-cost cybersecurity resources.

Curbside Consult with Dr. Jayne 6/10/24

I have a lot of friends who work in the healthcare technology vendor space, and they are always curious to know my thoughts about health system priorities. A lot of them are on the sales side of their respective organizations and are trying to meet quotas, figuring out how they can get a hook with the health system executives that make purchasing decisions.

Of course, when they ask my opinion, they get just that. I can only comment based on the health systems that I know and the conversations that I’ve had. Priorities can vary based on community and regional factors, as well as based on specific challenges that a given organization has faced in recent months, such as cybersecurity incidents, labor challenges, and natural disasters.

McKinsey & Company recently released a report that looked at the investment priorities of health systems. AI always makes the list as something that organizations think will help in their transformation efforts, but it is unclear how much individual systems are investing in those technologies. McKinsey cites a 2023 working paper from the National Bureau of Economic Research as stating that machine learning could result in reductions of healthcare spending of up to $360 billion. However, McKinsey notes that while the majority of respondents to its survey say they are making digital transformation a priority, they also report challenges in resource allocation and planning.

In looking at data on already implemented capabilities, top priority areas include virtual health, revenue cycle management, digital front door, acute care throughput, and ambulatory care efforts. Leaders who were surveyed reported that those areas that might have the biggest impact include AI at the top, followed by virtual health and digital front door.

It’s interesting to see that the most impactful area fell lower on the spectrum of implemented technologies and roughly middle-of-the-road in being ranked as “unplanned” by leaders. From my discussions with leaders, it sometimes feels like AI isn’t being planned for in the same way as other technologies because of overall uncertainty in how to approach it.

The McKinsey survey gathered data on barriers to executing digital and AI transformation in the next two years. The item most commonly earning a number one ranking was “budget or capital limitations,” followed by “legacy systems are difficult to upgrade.” I was surprised that “unaware of the right digital solutions available” scored so low, with only six of 200 respondents ranking it as number one. That makes me wonder if those surveyed really believe that or if they’re just not admitting how challenging it is to find the right answers to some of the sticky situations that they are facing.

The report goes on to recommend five ways that health systems can evolve, including embracing the cloud, building partnerships, cautiously moving to AI, looking beyond off-the-shelf solutions, and changing up how they operate. For the latter two, they offer advice that I’ve been giving healthcare organizations for two decades now. Their example for looking beyond available solutions involves optimizing workflows “to enable more appropriate delegation” in order to save on nursing costs.

Process improvement advocates have been pushing the idea of delegation for years, yet I still regularly encounter physician offices that don’t have delegation policies for medication refills or scheduling overrides. I continue to see organizations that refuse to use proven strategies, such as data-driven float pools for staffing. Maybe now with the idea of technical enablement for delegation, as mentioned in the piece, people will get on board since adding technology often makes things appear more exciting.

As far as the recommendation to operate differently, the article calls for structures with “flatter, empowered, cross-functional teams,” which management consultants have been pushing for as long as I’ve been in the industry. In thinking across my career, I’ve probably only worked on three truly empowered teams the entire time. Too often, I see teams that are withering due to micromanagement and barriers they can’t seem to remove, such as absent organizational support, questionable corporate values, and lack of funding for key resources.

I asked a friend who is a health system administrator to weigh in on the recommendations. She agreed that many organizations need to get back to basics and to focusing their efforts on initiatives that might not seem sexy but that are needed to help build a strong base after the challenges of COVID. These include things like making employees feel valued, providing adequate resources for training and onboarding, and having a dedicated focus on removing the barriers that keep teams from meeting their objectives.

She told me a story about an operating room utilization project that another part of her organization worked on for months, crunching data about supplies, staffing, and room turnover rates. Despite recommendations from their on-the-ground process improvement staff, leaders wouldn’t negotiate with other departments to make frontline operating room staff available for interviews or workflow mapping activities.

It’s hard to fully understand a problem when you’re just looking at data and not talking to the people who do the job day in and day out. And if you’re not talking to the stakeholders, you definitely can’t get their buy-in or their support for your proposed changes.

The process improvement team was frustrated by the leadership barriers and their inability to make progress. They ultimately spent six months and who knows how much money designing a solution that made people feel disenfranchised, which automatically reduced its chances of success from the moment it was announced. After a failed pilot, the organization reopened the project and figured out a way to remove the barriers, with the team performing a significant amount of rework as they were able to get the input of those with the greatest knowledge of the process.

What would the outcome have been if the team had been empowered to do the job they were trained to do in the first place? In addition to providing process improvements six months sooner, they would have had the satisfaction of knowing that their expertise was respected and that they were treated as valuable members of the organization. I wouldn’t be surprised if the members of that team are a retention risk over the coming months, and anyone who has had to crunch staffing numbers knows that it’s always more expensive to replace someone then to use resources that you already have in place.

What do you think about the McKinsey survey and report on organizational investment priorities? Do their findings match what is happening where you are? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: The Role of Human-Centric AI in Virtual Patient Observation

The Role of Human-Centric AI in Virtual Patient Observation
By Christine Gall, RN

Christine Gall, RN, DrPH, MS is chief nursing officer at Collette Health.

The integration and expansion of artificial intelligence (AI) in healthcare has certainly seen its fair share of controversial conversations. Discussions about the potential benefits of utilizing AI to mitigate healthcare worker burnout, improve workflow and process efficiency, and enhance patient safety are met with reservations about the impact of AI being used carelessly or without precision.

Human-centric AI can address some of the concerns related to the algorithmic nature of task automation in traditional AI. The industry has seen a strong shift towards human-centric AI in hospitals for the purpose of prioritizing human needs and augmenting human capabilities rather than replacing them. The nursing community is eager for technology that supports the top priority of nurses — providing excellent and safe care to their patients.

In recent years, AI has enabled the healthcare system to implement revolutionary advancements for the betterment of both frontline healthcare workers and patient safety, particularly in the arena of patient observation.

Continual patient observation is an important tool to enhance patient safety for at-risk patients. Nurse staffing shortages, paired with ever-rising patient acuity, makes continual observation nearly impossible without the help of technology. Many patients in acute care settings are at high risk for falls and accidental self-harm. Human-centric AI-powered virtual patient observation is designed to sharpen the focus of the virtual observer to patients who begin to demonstrate risky behaviors so they can redirect the patient or call for assistance to prevent these events from happening.

A recent study from the American Organization for Nursing Leadership Foundation’s 2024 Longitudinal Nursing Leadership Insight Study found that 20% of nurses want to see an increased utilization of virtual nursing. Virtual patient observation specifically is driving a lot of innovative care practices. The end goal is to leverage human-centric AI to ensure patients’ and clinicians’ safety and well-being, as well as bolster the support systems for caregivers to optimize operational efficiency.

Imagine if hospitals could place a nurse in every single hospital room for an entire shift. That would be wonderful if it was possible. Hospitals have started gravitating towards human-enabled digital innovations that can provide a virtual observer in patient rooms. Virtual observation stations can be placed in rooms, hallways, and main corridors for seamless line of sight of the patient by the virtual observer, and human-centered AI is able to proactively signal subtle changes in patient activity that might lead to patient injury if not redirected. Human-centric AI enables technology to augment and enhance clinician capabilities by extending their reach with the virtual observer, allowing them the reassurance that all of their patients remain in a safe environment even when they are not physically present.

With the application of human-centric AI, providers and nurses can gain insight into overall patient well-being, including sleep patterns, movement, and state of repose. Proactive alerts, enhanced workflows, and intelligent video management provide nurses and caregivers with greater time to practice at the top of their knowledge and expertise, as each patient is continually monitored by virtual colleagues. The insights gained, paired with the uninterrupted observation, is a game-changer not only for hospitals but for the nurses who are caring for patients day in and day out.

Built-in AI tools have been developed to strengthen the impact of virtual observers. Presence detection features alert observers who may look away from their screens for too long and guide them back to focus through increasingly prominent alerts. This technology ensures that the attention of virtual observers remains on their patients, improving patient safety. This feature also supports improved buy-in from hospital leaders with the assurance that the virtual observers are always attentive to their patients.

One of the most important aspects of healthcare is the communication between patient and healthcare provider. Virtual observation powered by human-centric AI is designed to improve contact and communication between the patient and their entire healthcare team. When patients are at their most vulnerable, continuous observation and contact promote patient safety and security. Additionally, nurses and healthcare workers benefit from extended connection to their patients, with virtual observers providing an environment of safety. Patients experience more interaction with the virtual observers, which can enhance their positive perceptions of care.

It is an unfortunate reality that nurses face increased violence in the workplace. A recent National Nurses United report found that 8 in 10 nurses (81.6%) have experienced at least one instance of workplace violence within the past year and nearly half of nurses reported an increase in workplace violence in their unit. Healthcare workplace violence ranges from physical abuse to verbal threats. Virtual observation solutions can improve security for staff as well as patients by utilizing security staff trained in violence mitigation. They can alert a nurse that a patient is exhibiting signs of escalation prior to the nurse entering the patient’s room so that they may execute de-escalation tactics to prevent a violent encounter.

As more hospitals and health systems gravitate towards virtual patient observation solutions, the overarching objective is to improve care delivery for caregivers and enhance safety for patients. Human-centric AI technology can extend the reach of caregivers with continuous virtual observation of patients, ultimately protecting their safety and improving their experience.

Readers Write: How to Re-Imagine Clinical IT Support

How to Re-Imagine Clinical IT Support
By Chris Wickersham

Chris Wickersham is assistant VP of customer support at CereCore.

No one would argue that achieving provider satisfaction is a top goal for those of us who work in healthcare IT support. We also know that when employees on your IT support teams are happy, they provide better, higher quality service.

This led me to consider: how could I achieve both clinician satisfaction and employee satisfaction? What if a slightly different approach to IT service desk operations could lead to more efficiency and productivity for my help desk analysts and their satisfaction?

I began my career working as a healthcare IT analyst and have walked the halls of care settings providing support during go-lives. I have experienced first-hand how minutes matter when troubleshooting IT issues and that streamlined clinical workflows allow care teams to deliver higher quality patient care.

My quest to rethink IT support has been evolving over the past several years and has led to the creation of a clinical service desk. We implemented this service desk model with Epic-based facilities at HCA Healthcare. The results have been a win for clinicians and providers because they have been getting their issues resolved more quickly, and my analysts are working at the top of their license, especially those providing level 2 Epic support.

How is this possible? Here’s a peek into the building blocks of my IT support model.

First, spend time analyzing your organization’s goals for IT support and identify common challenges. I wanted to baseline provider, clinician, and even patient satisfaction as it relates to IT issue resolution and the effects on hospital operations. For example, if the hospital routinely experiences issues with printing discharge instructions, that will impact the timeliness of patients being discharged, patient and clinician satisfaction, and the efficiency of patient throughput.

We analyzed metrics from a variety of perspectives. What were the high-volume issues reported by providers, clinicians, and revenue cycle employees? Did we have recurring workflow challenges or training opportunities? What about EHR-build related incidents?

One of the toughest parts for healthcare IT support can be getting back in touch with a provider or clinician for additional information and follow-up. So, we examined the issue intake process for data quality and efficiency. Was enough information or the right type of information being collected during the first call? If we had had better data to begin with, could we have resolved the issue more quickly for a busy provider or clinical staff?

Next, we evaluated the tools and training. Looking at our high-volume issues in particular, would additional analyst training have helped with resolving the issue at the first point of contact? Would a different level of access enable the level 1 analyst the ability to resolve the issue sooner? Did we have an effective IT service management tool that allows for next-level analysis? Were there configuration, knowledge base, or workflow improvements within the ITSM that could help analysts resolve more issues during the first contact?

Healthcare IT is a team sport. That’s why we took a hard look at our culture and looked for ways to encourage more collaboration among all levels of our analysts. In fact, one of the key drivers in the evolution of our clinical service desk for Epic support has been the focus on “shifting left” the issues handled by our level 2 and level 3 analysts.

Our level 2 and level 3 application support and clinical informatics resources were finding it difficult to focus on project work. Their bandwidth for heads-down time to make progress on Epic initiatives often was limited because they were pulled into resolving support issues.

We began finding opportunities to cross-train and collaborate more. We also developed a training program to bolster application and workflow understanding. We made a significant investment in training our analysts through the Epic certification process, focusing on key workflows where we needed to increase our knowledge base and pairing the interests of service desk analysts with Epic certification opportunities. This training and collaboration have been key to making our shift left strategy a reality.

Finally, we established key performance indicators (KPIs) and reporting metrics to measure the effectiveness of training, analyst access changes, and process improvements. I focus on quality measures, such as first-contact resolution and customer satisfaction and the ability to shift support work left from level 2 to level 1.

If your organization is building an internal clinical service desk, prepare for the significant and intentional investment required, along with a willingness to let go and trust the process of building your own talent pipeline. Be ready to measure results so you can ensure you’re reaping the benefits of your investment and configuring your resource model appropriately.

When executed thoughtfully, the benefits of long-term operational efficiencies, improved clinician satisfaction, and happy employees are well worth the effort.

Morning Headlines 6/10/24

Oracle $16 Billion VA Health Software Scores Badly in Internal Report

An internal VA report finds that less than 20% of its Oracle Health users believe that the system helps them deliver high-quality care and just 13% believe that it helps keep their patients safe.

Anterior grabs $20M from NEA to expedite health insurance approvals with AI

Prior authorization automation startup Anterior raises $20 million in a Series A funding round.

Mount Sinai Health System named 2024 Hearst Health Prize winner

Mount Sinai Health System wins the 2024 Hearst Health Prize for its NutriScan AI application that identifies malnutrition in hospitalized patients by analyzing EHR data.

Monday Morning Update 6/10/24

Top News

An internal VA report finds that less than 20% of its Oracle Health users believe that the system helps them deliver high-quality care and just 13% believe that it helps keep their patients safe.

The survey of 2,000 VA users was conducted in March and April by KLAS, which told VA officials that their scores were the worst they have ever seen.

The Bloomberg article also notes that while Oracle is touting the DoD’s implementation, it fared only slightly better, with 30% of its surveyed users saying that the system helps them deliver high-quality care.

Another VA report says that while it hopes to raise user satisfaction scores to be comparable with those in non-VA hospitals, the $16 billion Oracle Health system – which has gone live in just six VA facilities since its first in October 2020 — may never reach the satisfaction levels of the VA’s homegrown VistA product.

HIStalk Announcements and Requests

The ratio of poll respondents who have a worsened opinion of Oracle Health compared to those with an improved opinion is 10 to 1.

New poll to your right or here: Do you agree with an Oracle exec’s claim that Epic’s Judy Faulkner is the biggest obstacle to interoperability? EVP Ken Glueck wrote that “everyone in the industry” understands that this is the case, so I’m interested in the poll results and any comments you would care to add. 

I’ll soon announce new sponsors who responded to my suggestion to wangle some freebies out of Lorre during the usual slow summer. She is also reaching out to a few companies that we had to cancel after they went radio silent due to staff changes or other internal disarray. Note: the only thing you can buy from me is a sponsorship — I don’t sell video interviews or sponsored content, although marketing people seem shocked to hear that since many sites do.

Webinars

June 26 (Wednesday) noon ET. “Population Risk Management in Action: Automating Clinical Workflows to Improve Medication Adherence.” Sponsor: DrFirst. Presenters: Colin Banas, MD, MHA, chief medical officer, DrFirst; Weston Blakeslee, PhD, VP of population health, DrFirst. What if you could measure and manage medication adherence in a way that would eliminate the burdens of medication history collection, patient identification, and prioritization? The presenters will describe how to use MedHx PRM’s new capabilities to harness the most complete medication history data on the market, benefit from near real-time medication data delivered within 24 hours, automatically build rosters of eligible patients, and identify gaps of care in seconds.

June 27 (Thursday) noon ET. “Snackable Summer Series, Session 1: The Intelligent Health Record.” Sponsor: Health Data Analytics Institute. This webinar will describe how HealthVision, HDAI’s Intelligent Health Management System, is transforming care across health systems and value-based care organizations. This 30-minute session will answer the question: what if you could see critical information from hundreds of EHR pages in a one-page patient chart and risk summary that serves the entire care team? We will tour the Spotlight, an easy-to-digest health profile and risk prediction tool. Session 2 will describe HDAI’s Intelligent Analytics solution, while Session 3 will tour HDAI’s Intelligent Workflow solution.

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

Acquisitions, Funding, Business, and Stock

Waystar raises $968 million in its IPO, which values the company at $3.7 billion. Nasdaq-traded WAY shares opened Friday morning at $21.50 and closed at $20.70. Waystar lost $50 million in each of the past two years.

OHSU will lay off at least 500 of its 21,000 employees. The health system is pursuing an acquisition of Legacy Health, touting its own financial strength and its intention to use $1 billion in bond offerings over 10 years to improve infrastructure.

People

Specialty EHR/PM vendor Nextech hires Rusty Frantz, MS (NextGen Healthcare) as CEO.

Announcements and Implementations

Mount Sinai Health System wins the 2024 Hearst Health Prize for its NutriScan AI application that identifies malnutrition in hospitalized patients by analyzing EHR data.

A McKinsey survey finds that most health system executives see digital transformation as a high, but underfunded, priority. They named virtual health and digital front doors as potentially offering the biggest benefit. Top challenges are the limitations of their legacy systems, lack of budget, and workforce readiness. Satisfaction with digital investments is high, but the self-assessed lack of rollout progress leads McKinsey to question whether they are scaling their digital programs effectively.

Government and Politics

The VA completes its rollout of VA Health Chat in all VISNs, offering VA health services by chat as powered by CirrusMD.

Idaho ends its contract with the Idaho Health Data Exchange, citing its lack of financial transparency and previous bankruptcy. State watchdogs found that the non-profit had spent $94 million, most of it from federal grants, but the state’s creation of it as a private, non-profit corporation allowed it to operate with minimal state oversight.

Privacy and Security

Ascension’s cybersecurity event update indicates that it has restored EHR access to six of its markets and remains on track to complete all of them by June 14. It warns patients that their patient portal may not show medical record data after May 8 – the date its systems went offline – since the information that was collected on paper must now be entered into the EHR.

Sponsor Updates

• Healthcare IT Leaders staff stock shelves and help shoppers at The Our Neighbors’ Table Market in Amesbury, MA.
• Visage Imaging will exhibit at the Society for Imaging Informatics in Medicine (SIIM 2024) Annual Meeting in National Harbor, MD, June 27-29.
• CereCore publishes the latest edition of its “Partnership Perspectives” digital magazine.
• Wolters Kluwer Health partners with the Black Nurse Collaborative to increase focus on improving advocacy for underrepresented groups in nursing.
• Nordic releases a new “Designing for Health” podcast titled “Interview with Kit Delgado, MD.”
• Redox publishes a new case study, “Ambience Healthcare selects Redox to integrate their AI Operating System – reducing clinician documentation time by 80%.”
• Rhapsody publishes a case study, “OU Health standardizes on Epic & Corepoint Integration Engine amidst M&A activity.”
• RLDatix launches the RLDatix Safety Institute to research safety design and care delivery risk reduction best practices.
• Sectra launches a new diagnostic IT module for genomics within molecular pathology, developed in collaboration with the University of Pennsylvania Health System.
• Surescripts publishes the “QHIN Use Case Guide: 17 Clinical & Business Scenarios.”
• Tegria will present at the International Performance Management Institute Healthcare IT Institute June 10 in Orlando.

Blog Posts

• How to Think About Healthcare Data During AI Integration Planning (CereCore)
• Integrated Care: Uniting Physical and Behavioral Health with One Vision (Netsmart)
• From burnout to balance: The untapped power of medical assistants in healthcare (Nordic)
• How GenAI is Humanizing the Healthcare Employee Experience (Optimum Healthcare IT)
• 4 Best Smartphones for Nurse Communication (PerfectServe)
• Credentialing in Healthcare: Understanding the History, Hurdles, and Opportunities (QGenda)
• Empowering Healthcare IT Leaders in the Tech-Driven Staffing Landscape (Revuud)
• Transforming Specialty Medication Access: Spotlight on Allergy, Oncology, and Dermatology (RxLightning)
• Leadership Spotlight: Meghan Seus, Vice President of Product Management (Sonifi Health)
• How to Address Social Determinants of Health Factors Impacting Patient Payment Experience (TrustCommerce)
• Proof in the Pudding: More Pharmacists are Prescribing (Surescripts)
• Leadership Insights to Inspire Teams & Drive Innovation (Symplr)
• Innovating Rural Healthcare: Insights from the 2024 TruBridge National Customer Conference (TruBridge)
• Breast cancer screenings have been dialed back to age 40; plan ahead to tackle emerging care gaps (Upfront Healthcare)
• Need to improve revenue capture? Start with charge capture + DRG accuracy (Waystar)
• AI and Healthcare Data Interoperability: Opportunities and Challenges Ahead (Zen Healthcare IT)

Contacts

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