Recent Articles:

Microsoft Acquires Nuance for $16 Billion

April 12, 2021 News No Comments

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Microsoft announced this morning that it will acquire Nuance for $16 billion, a 23% premium over the company’s share price at Friday’s close. The total deal value, including debt, is nearly $20 billion.

Microsoft says the acquisition represents its latest step in advancing an industry-specific cloud strategy. It says the acquisition will double its healthcare total addressable market to $500 billion.

Microsoft CEO Satya Nadella said in the announcement, “Nuance provides the AI layer at the healthcare point of delivery and is a pioneer in the real-world application of enterprise AI. AI is technology’s most important priority, and healthcare is its most urgent application. Together, with our partner ecosystem, we will put advanced AI solutions into the hands of professionals everywhere to drive better decision-making and create more meaningful connections, as we accelerate growth of Microsoft Cloud for Healthcare and Nuance.”

The deal is expected to close by the end of the year.

Morning Headlines 4/12/21

April 11, 2021 Headlines 1 Comment

Orange County Hospital Seeks Divorce From Large Catholic Health System

Hoag Memorial Hospital Presbyterian is attempting to leave the 51-hospital Providence system, saying the chain’s use of Epic to standardize treatments for cost effectiveness often conflicts with the judgment of its clinicians.

Microsoft in advanced talks to buy Nuance for about $16 billion, announcement could come Monday

Insiders say Microsoft will acquire Nuance for $16 billion, making it the company’s second-largest acquisition after its $27 billion purchase of LinkedIn five years ago.

Health and Human Services Awards TeleTracking with Six-Month Task Order for Continued COVID-19 Capacity Reporting

HHS extends TeleTracking’s COVID-19 hospital operating data collection and reporting for a third six-month term, presumably for another $10 million.

Google is exploring a health record tool for patients

Google is conducting a user feedback study as it prepares to develop a consumer-facing health record tool similar in functionality to Apple’s Health Record app.

Monday Morning Update 4/12/21

April 11, 2021 News 6 Comments

Top News

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US News & World Report highlights the legal efforts of Hoag Memorial Hospital Presbyterian to leave the 51-hospital Providence system, saying the chain’s use of Epic to standardize treatments for cost effectiveness often conflicts with the judgment of Hoag’s clinicians.

A Hoag cardiologist says the hospital can’t set its own treatment choices and instead is “bogged down by a bureaucracy that requires 51 hospitals to vote on it.”

Providence says the hospital knew that collaborative standardization was part of the affiliation deal.

Hoag also says that Providence illegally imposes restrictions on reproductive care by adhering to tenets set by the Catholic church, which controls four of the country’s 10 largest health systems.

Providence doesn’t own the hospital, but appoints a legal majority of its governing body. It says it will allow Hoag to disaffiliate if it pays an undisclosed amount that Hoag says is unreasonable.


HIStalk Announcements and Requests

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Eighty percent of poll respondents have received at least one dose of COVID-19 vaccine, while 95% plan to be vaccinated by HIMSS21.

New poll to your right or here: Which has contributed most to your overall health? Readers who resent the “one best answer from the list” form of a poll (as opposed to a survey or personal interview) will wail about not being able to choose more than one answer, that health factors are inextricable, or that the provided answer choices are subjective, but work with me.


Webinars

April 20 (Tuesday) noon ET. “The Modern Healthcare CIO: Digital Transformation in a Post-COVID World.” Sponsors: RingCentral, Net Health. Presenters: Dwight Raum, CIO, Johns Hopkins Medicine; Jeff Buda, VP/CIO, Floyd Medical Center. A panel of CIOs from large health systems will discuss how the digital health landscape is changing and what organizations can do now to meet future patient needs. Moderator Jason James, CIO of Net Health, will guide the panelists through topics that include continuum of care and telemedicine, employer-provided care delivery, consumerization of healthcare, and sustainability and workforce management.

April 21 (Wednesday) 1 ET. “Is Gig Work For You?” Sponsor: HIStalk. Presenter: Frank L. Poggio, retired health IT executive and active job search workshop presenter.  This workshop will cover both the advantages and disadvantages of being a gig worker. Attendees will learn how to how to decide if gig work is a good personal fit, find the right company, and protect themselves from unethical ones.

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


Acquisitions, Funding, Business, and Stock

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Reuters reports that Microsoft is in advanced discussions to acquire Nuance for $16 billion, with an agreement possibly being announced on Monday. The reported offer is $56 per NUAN share, a 23% premium to Friday’s close.

A private equity publication sets the value of KKR’s acquisition of a majority position in Therapy Brands, which sells 19 behavioral health EHR/PM systems, at $1.25 billion.


Sales

  • HHS extends TeleTracking’s COVID-19 hospital operating data collection and reporting for a third six-month term, presumably for another $10 million.

Announcements and Implementations

Varian and Google Cloud will develop a diagnostic platform for organ segmentation for radiation therapy, training Google’s NAS technology on Varian’s treatment planning image data.

FDA approves GI Genius, an AI-powered tool that highlights possible lesions in real time during colonoscopies.

MIT highlights the work of its Data to AI Lab on Cardea, an open source framework that uses FHIR to connect to EHR data to answer on-the-fly questions, for now focusing on resource allocation. The team notes that hospital decisions are too critical to simply present a black box answer, so Cardea will show the strengths and weaknesses if the model, then allow the user to start over.


COVID-19

CDC reports that 45% of American adults have received at least one dose of COVID-19 vaccine, along with 78% of senior citizens. Slightly interesting is that the three states with the lowest vaccination rates per capita are contiguous and are often challenged in other public health areas – Mississippi, Alabama, and Georgia, with Mississippi in particular being flooded with available vaccine doses that few residents want.

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Hospitals in COVID-overwhelmed Michigan are banning visitors, cancelling elective procedures, and re-implementing pandemic surge plans, as two dozen hospitals have reached 90% capacity and 15% of the state’s hospital beds are housing COVID-19 patients. Six counties in metro Detroit are reporting their highest numbers of COVID-19 patients since the first weeks of the pandemic last year. State health officials received 58 outbreak reports from restaurants and stores in the past week, warning bluntly that “indoor dining is one of the riskiest things you can do.”

Meanwhile, the White House says it won’t surge COVID-19 vaccine supplies to Michigan because population-based distribution is the only fair way to allocate supply, especially since new outbreaks could occur elsewhere.

Pfizer requests that FDA expand the Emergency Use Authorization for its COVID-19 vaccine to those who are 12-15 years old, citing Phase 3 clinical trials data of its effectiveness.

A large study finds that people who have had COVID are 84% less likely to be re-infected over at least seven months.

Early reports showed that few people with chronic respiratory disease were being admitted with COVID-19, leading to speculation that inhaled glucocorticoids might be an effective treatment. A small randomized trial concludes that early administration of inhaled budesonide to COVID-19 patients reduced the need for urgent interventions and reduced recovery time.

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The New York Times profiles 66-year-old Kati Kariko, PhD, whose early messenger RNA work at Penn failed to draw research dollars and resulted in her moving from lab to lab and never earning more than $60,000 as a low-level, untenured PhD whose job was always at risk. Moderna and Pfizer finally took notice and used her technology to develop their COVID-19 vaccines.


Other

In Canada, a man has struggled since January to remove an incorrectly entered drug overdose from his electronic medical record after the real OD patient, who didn’t have ID, gave paramedics a name and birthdate similar to his own. The health authority says it has removed the entry, but Kevin Robinson says that while the overdose no longer appears on his patient portal display, his doctor says they can still see it.

Cape Cod Healthcare (MA) goes through the technical and legal steps that were necessary to accept donations in bitcoin, as requested by a donor who has transferred $800,000 to the hospital in two transactions. The hospital converts the bitcoin to dollars that it banks immediately, concerned that unlike other forms of donations, its value could swing dramatically.


Sponsor Updates

  • PatientBond completes its study on COVID-19 vaccinations.
  • PatientPing publishes a new white paper, “Real-time, Right Partner: How One SNF Chain Uses Real-Time Alerts to Succeed in Value-Based Care.”
  • PerfectServe publishes the complete guide to “Clinical Collaboration Systems for Hospitals.”
  • Pure Storage is a 2021 Customers’ Choice in the “Gartner Peer Insights Voice of the Customer: Distributed File Systems and Object Storage” report.
  • Spirion wins three gold wards in the 2021 Cybersecurity Excellence Awards and four Globee Business Awards in the 2021 Cyber Security Global Excellence Awards.
  • The Chartis Group names Michael Brown (MD Anderson Cancer Center) director in its Oncology Solutions Practice.
  • Vocera earns Cyber Essentials Plus Certification in the United Kingdom.
  • Waystar earns HITRUST CSF Certified status.
  • Wolters Kluwer Health launches the open access journal Otology & Neurotology Open as part of its publishing collaboration with Otology & Neurotology Inc.

Blog Posts


Contacts

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

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Weekender 4/9/21

April 9, 2021 Weekender No Comments

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Weekly News Recap

  • KKR acquires a majority interest in behavioral health EHR/PM vendor Therapy Brands.
  • Firefly Health raises $40 million.
  • A magazine article questions the claims and effectiveness of behavioral therapy apps.
  • Massachusetts General Hospital will collaborate with drug manufacturer AstraZeneca on digital health solutions for disease management.
  • The Indian Health Service seeks help with developing a strategic plan for IT.
  • Bright Health acquires Zipnosis.
  • The federal government’s information blocking and EHR transparency rules take effect.
  • A two-system study of EHR usage finds that ambulatory physicians spend five hours on the EHR for each eight hours of scheduled clinical time.
  • Bank of America acquires AxiaMed.

Best Reader Comments

I can’t believe after all these years I am still downloading summaries from patient visits that tell me nothing I didn’t know before walking in the door. I already know my Rx med, patient medical / surgical history, VS, etc. What I WANT is a summary of what the doc and I discussed because I don’t always remember all the details and occasionally have needed to refer to it. This is NOT what was intended when this whole notion of implementing EHRs (not to mention paying docs for doing that!) was first started. (JT)

Standardize and automate. Do as much of this as you can, and no more. (Brian Too)

I don’t understand why these health insurance + digital whatever always go for the low cost market. In the Firefly Health article, they say their cost is so much lower (doubtful). But I imagine the people who would want a digital insurance care plan are not the same people who are looking for bargain basement health insurance. (IANAL)

In primary care at least, so much easier when the horse brought doc to the house where they stayed until the crisis resolved. The physician was not interrupted at all. As a country doc by training, I knew we were going down a slippery slope when consultants started saying that all patients needed to be in gowns before doc would encounter them. And now, it is all about productivity first rather than quality. (Kevin Hepler)


Watercooler Talk Tidbits

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Readers provided the New York elementary school class of Ms. F with hands-on math kits, from which she created individualized math toolboxes to accommodate COVID-19 requirements. She says, “Thank you so much for donating to my classroom and supporting us for this year and years to come. We use our materials for math on a day to day basis. It truly has helped us transition to a new type of learning. Thank you so much for all of your help. My students are so grateful as well, they are still talking about the kind person who has helped out and donated to us in a time of need. Thank you so much for everything! We appreciate you.”

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The Department of Defense profiles Army Captain Tineisha Nagle, MSN, APRN, who was deployed under a FEMA program to support ICU staff at Yuma Regional Medical Center (AZ). She graduated from the United States Naval Academy with a degree in ocean engineering and then earned bachelor’s and master’s degrees in nursing, served 12 years in the Marines including deployment to Iraq as a lieutenant, and recommissioned to the Army Reserves, where she is completing her first year as a critical care nurse.

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A Minnesota hospital nurse who was fully vaccinated for COVID-19 in January is stuck in quarantine in a Playa del Carmen, Mexico hotel room after testing positive in preparing for her trip back home from vacation. She is restricted to a small room that is guarded around the clock, but at least she bought the hotel’s $30 insurance policy that covers room and meals for 14 days for guests who test positive.

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A Michigan baby who is nearly two years old goes home for the first time, having spent her first 694 days hospitalized in the pediatric cardiothoracic ICU with a congenital heart condition that required four open heart surgeries. It’s probably best to focus on the feel-good aspect and not the size of the University of Michigan bill or who ultimately will pay it.


In Case You Missed It


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Morning Headlines 4/9/21

April 8, 2021 Headlines No Comments

Emids Acquires Quovantis Technologies in Latest Expansion of Human-Centered, Design-Led Product Development and Software Engineering Capabilities

Emids acquires software design and development vendor Quovantis Technologies.

Vesta Healthcare Announces $65M in Growth Capital to Transform Care for High Needs Members and their Caregivers

Vesta Healthcare, which offers clinical services and a digital health platform to support high-needs members and their home caregivers, raises $65 million in growth capital.

MediSolution acquires Quebec-based Intégration Santé

Harris subsidiary MediSolution acquires Quebec-based, MIRTH-focused healthcare integration services vendor Intégration Santé.

Canvas Medical Raises $17 Million to Accelerate Value-Based Care Platform Growth

San Francisco-based EHR vendor Canvas Medical raises $17 million and announces a partnership with Anthem and its providers.

News 4/9/21

April 8, 2021 News 1 Comment

Top News

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Investment firm KKR acquires a majority interest in Therapy Brands, which sells behavioral health EHR/PM systems under 19 nameplates.

Thanks to reader Inchoate, whose tip allowed me to run a rumor of the acquisition a couple of days ago before the deal was announced.


Reader Comments

From Crass Credential: “Re: listing job changes. Why don’t you include fellowship credentials, such as FACHE?” I’m not a bit interested in (and thus don’t list) someone’s fellowship activities, certifications, or expensive weekends spent at a big-name school’s non-degree executive program. I always include an earned master’s or doctorate and, depending on what I’m writing about, I will generally mention past military service, but the rest tells me more about someone’s check-writing experience than their intellectual capability or perseverance.


HIStalk Announcements and Requests

I use LinkedIn mostly just to look up credentials, but top of increasingly irrelevant (and sometimes political or personal) posts, now I’m gritting my teeth at user writing that tries to humble-brag using this overly dramatic format:

Dramatic emphasis is being attempted.

With one sentence per line.

We hear about their setbacks and how they bravely overcame them.

To become simultaneously wonderful and humble, and you can do it, too.

Imitative marketing haiku writing for dummies. #lame.


Webinars

April 20 (Tuesday) noon ET. “The Modern Healthcare CIO: Digital Transformation in a Post-COVID World.” Sponsors: RingCentral, Net Health. Presenters: Dwight Raum, CIO, Johns Hopkins Medicine; Jeff Buda, VP/CIO, Floyd Medical Center. A panel of CIOs from large health systems will discuss how the digital health landscape is changing and what organizations can do now to meet future patient needs. Moderator Jason James, CIO of Net Health, will guide the panelists through topics that include continuum of care and telemedicine, employer-provided care delivery, consumerization of healthcare, and sustainability and workforce management.

April 21 (Wednesday) 1 ET. “Is Gig Work For You?” Sponsor: HIStalk. Presenter: Frank L. Poggio, retired health IT executive and active job search workshop presenter.  This workshop will cover both the advantages and disadvantages of being a gig worker. Attendees will learn how to how to decide if gig work is a good personal fit, find the right company, and protect themselves from unethical ones.

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


Acquisitions, Funding, Business, and Stock

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Virtual-first, employer-focused primary care provider Firefly Health raises $40 million in a Series B funding round. The company says it can save employers 30% of their healthcare costs by directing employees to less-expensive settings, reducing their use of specialists, and controlling unnecessary referrals. It operates in four northeastern states. The company’s executive chair is Athenahealth co-founder Jonathan Bush.

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Vesta Healthcare, which offers clinical services and a digital health platform to support high-needs members and their home caregivers, raises $65 million in growth capital.

Privia Health, which offers medical practices administrative services, technology, and its own medical group, files SEC documents to launch an IPO.

Signify Research examines the just-completed acquisition of DXC’s provider business by Dedalus for $450 million. It notes:

  • DXC was created in 2017 by the merger of CSC (which had previously acquired ISoft following its NPfIT struggles) and the enterprise services business of HPE.
  • Dedalus had previously acquired a majority position in France-based Medasys and the EHR and integrated care business of Agfa Health.
  • The combined entity is the largest EHR vendor in Europe, with annual revenue of $600 million. It offers legacy EHRs such as Lorenzo, I.CM, I.P.M., MedChart, Swift, Patient Care, and others.
  • The analysis says that Dedalus needs to retire its legacy solutions quickly and move customers to newer platforms without upsetting them, which it notes is not easy.

Fierce Healthcare covers the new Advocate Aurora Enterprises investment arm of the Advocate Aurora health system (the health system reported $558 million in profit for 2020, boosted by $786 million in federal COVID-19 relief funds, so this your taxpayer dollars at work.) Points:

  • AAE acquired in-home senior care franchisee Senior Helpers for a reported $180 million last week.
  • It recently led a $25 million funding round in Foodsmart, which offers telenutrition visits, meal planning, and online meal ordering and grocery lists.
  • Its investments will focus on established companies that address independent aging, parenthood, and quackery-rich “personal performance” (integration of mind, body, and nutrition.)
  • AAE will explore investments in digital health since its health system revenue is limited by Medicare and Medicaid payments.

Emids acquires software design and development vendor Quovantis Technologies.

Harris subsidiary MediSolution acquires Quebec-based, MIRTH-focused healthcare integration services vendor Intégration Santé.


Sales

  • National post-acute care services provider AccentCare will implement Jvion’s clinical AI CORE to reduce avoidable readmissions that are related to social determinants of health.
  • Springfield Clinic (IL) will implement RCxRules HCC Coding Rule Set to identify HCC coding gaps in value-based contracts.
  • Tucson Gastroenterology and Midland Cardiac Clinic choose Greenway Health for revenue cycle management.
  • Health First (FL) will use the ThinkAndor Vaccine Management Toolkit for vaccine distribution.
  • University Hospitals of Cleveland chooses VisuWell’s browser-deployed telehealth platform. VisuWell CEO Sam Johnson is an industry long-timer with experience at Misys, Greenway, and Relatient.
  • Stanford Health Care will implement real world evidence-based guidelines from Atropos Health. The company was incubated through last October at the health system’s innovation program, uses Stanford-licensed technology, and was based on Stanford’s Clinical Informatics Consult service. The company’s product uses aggregated, anonymized EHR data to provide personalized evidence for decision-making in individual patients.

People

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Nick van Terheyden, MBBS (Incremental Healthcare) joins ECG Management Consultants as digital health leader and principal.

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Ken Boyett, MBA (TeleTracking) rejoins Healthcare IT Leaders as managing director of provider solutions.

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AGS Health appoints Eileen Voynick as board chair.

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Diameter Health names James Bradley, MS, MBA as its board chair.

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Lumeris hires Jean-Claude Saghbini, MS (Wolters Kluwer Health) as CTO.


Announcements and Implementations

Meditech announces Expanse Patient Connect, which uses Well Health’s text, phone, email, and chat messaging solution to send patients reminders, instructions, and follow-up instructions that can be accessed from Meditech’s patient portal and app.


COVID-19

University of Michigan begins cancelling surgeries to make room for accelerating COVID-19 admissions.

A study finds that 34% of COVID-19 survivors were diagnosed with neurological or psychiatric illness within six months, most commonly anxiety and mood disorders. They also found that 7% of patients went home after being admitted to the ICU with COVID-19 had a stroke within six months and 2% were diagnosed with dementia.

CDC reports that 42% of US adults and 76% of senior citizens have received at least one dose of COVID-19 vaccine.

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The Washington Post tests New York State’s IBM-developed Excelsior Pass “vaccine passport” that allows those who have been vaccinated or who recently tested negative to gain admission to public spaces by voluntarily presenting their phone-based green checkmark. It notes challenges:

  • Account setup via a website takes a fair amount of time, technical know-how, and a decent Internet connection.
  • It’s easy to set up a fake pass.
  • Users still have to present an ID along with the phone pass, which some will be reluctant to do.
  • Test results aren’t always uploaded to the state database quickly, especially by private providers, so users may still need to present their paper results to attend events that occur shortly after being tested.
  • The system is a voluntary alternative to simply showing a vaccination card or test result.

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People are selling forged COVID-19 vaccination cards on sites such as Etsy, Ebay, and Facebook, potentially violating trademark and identity theft laws while raking in cash from unvaccinated people who want to travel or attend events. It’s not just anti-vaxxers – some buyers are writing in phony first-dose dates in hopes of fooling pharmacies into giving them priority access to their “second” dose of the vaccine. I can’t imagine that the folks who are charged with checking the plain-looking cards will have the ability or time to weed out the fake ones – it’s not like currency or a driver’s license that contains a lot of counterfeit-detecting features.


Other

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Forbes profiles Epic in a click-baity article titled “The Billionaire Who Controls Your Medical Records.” The article opines, not very convincingly, that the company’s “build it alone” approach could become its biggest liability after the pandemic as people may continue to avoid hospitals. It also says, equally unconvincingly, that new federal rules giving patients some control of their medical records could erode the “health-data oligopoly” of Epic and Cerner. Then it was off to a rehash of easily Googled information cobbled into a non-story with a few harmless quotes thrown in. The writer apparently interviewed Judy Faulkner, but either didn’t ask the right questions or didn’t get the right answers since it’s the same-old, including the obligatory wonderment at its campus.

Johns Hopkins Bloomberg School of Public Health researchers find that non-profit hospitals spend even less on providing charity care than their for-profit counterparts, averaging $2.30 for each $100 in expenses, but in some cases less than $1.00. The authors conclude that non-profit hospitals, which are subsidized by tax revenues and are exempt from paying most taxes, “have their cake and eat it, too.” They also note that IRS doesn’t have specific requirements for the amount of care or community benefit that tax-exempt hospitals provide, they have no incentive to increase it. They suggest that hospitals be competitively ranked by the amount of charity care the provide and a reworking of the tax exemption rules to align charity care with tax status.

Radiation treatment appointments at four Rhode Island hospitals are rescheduled when radiation oncology cloud vendor Elekta is hit by a ransomware attack. The hospitals said the company restored its systems within a day.

New York Magazine examines “the therapy app fantasy,” in which the large number of mentally ill and suicidal Americans have drawn investors to “slickly marketed companies promising a service they cannot possibly provide.” The author notes that most apps don’t really offer therapy at all, but instead tout the benefits of relaxation games, journal-keeping, mood trackers, and chatbots. She says that actual therapy apps are unlike healthcare in general because the patient is the customer, but those customers don’t know what they need. She also observes that companies like Ginger and Lyra sell their services to employers, which allows those companies to address employee unhappiness while continuing to treat them poorly. Users report overloaded therapists, messaging therapists who don’t respond, and claimed 24/7 therapist availability that really means you can send a text message any time that may not get answered anytime soon. Therapists complain that the companies don’t set clear expectations, don’t have enough therapists to handle the workload, and pay them below-market rates based on factors other than time, which mostly attracts less-discriminating therapists who are moving, working multiple jobs, or caring for their children. .


Sponsor Updates

  • SOC Telemed earns The Joint Commission’s Gold Seal of Approval for Ambulatory Health Care Accreditation.
  • Wolters Kluwer Health adds two new payer solutions to Health Language’s reference data management capabilities.
  • Experity publishes a new case study, “Experity Meets CRH Healthcare Where Consumers, Retail, and Healthcare Intersect.”
  • Gyant publishes a new case study, “Hackensack Meridian Health Achieves 89% Screening Completion Rate with Virtual Assistant.”
  • HCTec and Impact Advisors will exhibit at the virtual CHIME Spring Forum April 15-17.
  • Optimum Healthcare IT joins the ServiceNow Partner Program.
  • East Alabama Medical Center goes live on the enhanced physician documentation system of Crossings Healthcare Solutions, decreasing transcription expense by 95%.
  • Cardinal Health will offer oncology practices Jvion’s CORE population health decision support system as part of its Navista Tech Solutions suite.
  • Health Data Movers appoints Monica Gupta and Alyssa Rapp to its Board of Directors.
  • InterSystems has joined the Gartner Peer Insights Customer First program for its adherence to transparency and integrity in managing the Gartner Peer Insights review process for customers.

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 4/8/21

April 8, 2021 Dr. Jayne 3 Comments

The big conversation around the virtual physician lounge this week was about the ONC information blocking rule that took effect this week. The majority of non-informaticist physicians who I spoke to really don’t understand what is required and have been receiving varying degrees of information from their employers and professional societies. The American Academy of Family Physicians had a nice article that summarized the situation for those who might not have been following for the last several years. AAFP points out the difference between HIPAA, which allows sharing of protected health information, and the new rule, which requires information sharing unless a short list of exceptions applies.

The exceptions identify when organizations can legitimately decline to fulfill a request for information, or when the surrounding procedures can be excepted. For most of the physicians I spoke with, their biggest use of the exceptions will be under the “do not harm” provision, which applies to adolescents being treated for things like pregnancy, sexual health issues, or mental health diagnoses. I was on an outstanding webinar earlier this week, presented by the American Medical Informatics Association. Natalie Pageler, MD, MEd from Stanford Children’s Health presented on strategies for managing the sharing of data within pediatric populations, where there are concerns not only about sensitive information, but also the capacity of the minor to consent for sharing. If you’re an AMIA member, it’s well worth tracking down the recording.

In the short term, organizations have to provide access to certain types of information: consultations, discharge summaries, histories, physical examination notes, imaging / laboratory / pathology reports, procedure notes, and progress notes. Additional types of information will be mandated in the fall of 2022, and penalties are in the future as well.

I have a few pointers for physicians who are concerned about patients reading their notes. First, write your plans like you would talk to a patient in the office. Avoid medical jargon and be clear on what you discussed with the patient and what the next steps might be. Physicians who dictate their notes in front of the patient have been doing this for decades. Second, make sure your office has a policy and/or process for when patients contact you with concerns about something they saw in a note. Should they come in for an appointment, schedule a telehealth visit, or wait for a return phone call? Decide this now before there’s a time-sensitive issue in front of you. I’m interested to hear from readers who have had significant fallout from this week’s change, so if you’ve got a great story, let me know.

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I always scoop up cut-rate Easter candy and take it to my clinical team, because every urgent care shift is better with the addition of chocolate. We joked about having to go to the local Walgreens to get the best selection of candy, and of course the topic turned to retail pharmacies and their role in COVID-19 vaccination policy. Pharmacy appointments are widely available in my area at the moment, which seems somewhat surprising since my office was recently allocated a measly 100 doses (yes, one hundred) of Johnson & Johnson vaccine despite the fact that we see 2,000 patients a day and could be a force to be reckoned with if the state decided to give us adequate vaccine.

Others have noted the issues with retail pharmacies playing such a big role, including Politico, which featured a discussion of pharmacies using vaccine-related patient data for marketing and other purposes. I was trying to find an appointment at Walgreens or Walmart for a family member, but was stopped when I found that they require you to register for an account before searching for vaccine appointments, which means they have your email address. I didn’t want to create a new account for them in case they already had one, and certainly didn’t want anything tied to my own email. Privacy and consumer advocates are calling on state governments to investigate how the data is used and are asking retail pharmacies to avoid using the data for marketing purposes. At this point, patients are more interested in getting a vaccine wherever they can and probably aren’t reading the fine print when they sign up. We’ll have to see how this plays out in the longer-term.

I had a recent client project around home monitoring of blood pressure, weight, and blood sugar, so I was excited to see this article in the Journal of the American Medical Informatics Association regarding the impact of patient-generated health data on clinician burnout. There is a ton of data out there that patients want to provide us – information from wearables, home glucose monitors, blood pressure cuffs, and more. Many physicians are terrified to let this information into their EHRs for fear it will overwhelm them with data as well as that it might increase their liability. For many conditions it’s not so much the individual data points that are important, but the ranges in which a patient’s data typically falls or how often they have outlier values. For certain conditions such as heart failure, however, individual daily values are important, and action has to be taken if there are dramatic changes from day to day.

The authors identified three factors that they believe contribute to burnout related to the integration of patient-generated health data within the EHR. These factors are time pressure, techno-stress, and workflow-related issues. They suggest mitigating techno-stress through several interventions: ensuring that healthcare providers have clear roles and responsibilities for monitoring and responding to patient-generated data; improving the usability of data integrated in EHR; and greater education and training. They go on to suggest reduction of time pressure through standardized EHR templates, greater financial reimbursement, and incorporation of artificial intelligence and the use of algorithms to review data. Regarding workflow issues, they suggest better usability, policies around reviewing data and responding to patients, and identifying the types of data that are best suited to inclusion in EHR. All of these are easier said than done, so I’d love to hear from readers who have tried to tackle this particular issue.

How is your organization handling patient-generated health data? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/8/21

April 7, 2021 Headlines 3 Comments

This Startup Raised $40 Million To Build A ‘Mini-Kaiser Permanente’ And Lower Employee Healthcare Costs

Virtual-first primary care company Firefly Health raises $40 million in a Series B round of funding led by Andreessen Horowitz.

Privia Health Announces Filing of Registration Statement for Proposed Initial Public Offering

Practice management company Privia Health files paperwork with the SEC for an IPO.

KKR to Acquire Therapy Brands

Investment firm KKR has acquired a majority interest in Therapy Brands, parent company of 19 behavioral health IT businesses.

Agilon health Files Registration Statement for Proposed Initial Public Offering

Senior-focused primary care company Agilon Health hopes to raise nearly $1 billion in its forthcoming IPO.

Readers Write: Improving Adherence, Affordability, and Experience with Better Point-of-Care Data

April 7, 2021 Readers Write No Comments

Improving Adherence, Affordability, and Experience with Better Point-of-Care Data
By Christie Callahan

Christie Callahan is chief operating officer of RxRevu of Denver, CO.

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As healthcare leaders continue to focus on patient outcomes, preventive care, and total wellbeing, it is essential to keep cost at the center of the discussion. Affordability and access continue to be major barriers to care, with over half of Americans saying they have received a medical bill that they did not have the funds set aside to pay for, and more than 10% of adults reporting delaying or skipping care because of financial reasons.

While there are segments of the population that are uninsured or underinsured (a separate issue to discuss), even those with insurance coverage are unable to proactively manage their healthcare costs. Lack of data and pricing information often causes consumers to forgo care altogether or become frustrated with the burdensome process of researching coverage and cost details.

There is no question that a lack of transparency causes a negative healthcare experience, and nearly everyone knows somebody who has been overwhelmed or surprised by medical bills. The challenge is that the work required to effectively diagnose and treat a potential new condition is often extensive, and the costs aren’t understood until the work has been completed.

Many new regulations and solutions center around patient price transparency. But are we approaching the problem in the right way?

Patients on their own are often incapable of making specific choices about care options without the help of a provider.

Let’s use a simple drug order as an example. Common chronic conditions require near-perfect medication adherence to manage the condition appropriately. While costs can be quite low, if the wrong medication is prescribed, or the patient fills the prescription at the wrong pharmacy, costs can quickly escalate. In this case, a new prescription must be ordered by the provider, requiring additional research by the care team, an additional visit to the pharmacy, and additional time when the patient is not on the medication.

Policies like the Hospital and Health Insurance Price Transparency Rules and the No Surprises Act mandate that plans and providers disclose negotiated rates and cost estimates over the course of the next few years. These rules allow patients, and sometimes providers, to view coverage data and have conversations around the cost of available options to improve affordability.

However, in the prescription drug space, CMS created more specific rules for EHR vendors and Medicare Part D plans, mandating the availability of real-time prescription benefit tools for providers and creating a wave of interest and acceptance of point-of-order solutions. By focusing regulation and technology capabilities on driving transparency for the patient and the provider at the point of care, together they can better manage spend and find affordable care options.

It is essential that we give providers the right tools to view a full picture of their patients and allow for condition and cost management conversations to occur. We need different-in-kind solutions that can make a meaningful difference in the exam room and help drive comprehensive conversations and decisions.

What can be done to accelerate implementation, acceptance, and use of solutions like this?

What is most important today is starting a conversation around how we can better support providers, as we continue to ask them to do more in the exam room.

First, we need better tools and data at the point of care.

  • Solutions must be fully integrated into care workflows so providers can quickly and easily take action without feeling burdened by cumbersome tasks. There is often value in partnering with clinical system vendors who are instrumental in ensuring a consistent provider experience through the normalization of patient data and their ability to maximize payer coverage.
  • Every patient is unique, with unique insurance coverage, financial situations, and conditions. Therefore, the data displayed within the EHR can no longer be inaccurate, incomplete, or estimated. It must be patient-specific, detailed, and displayed in real time.
  • Solutions must allow for broader engagement and support from care team members. Payers and PBMs must be willing to allow access to patient data to create an open network for care providers, regardless of role.S

Second, we need to better align incentives across healthcare stakeholders.

  • When patients stay healthy, payers are the primary beneficiary. There continues to be an opportunity to shift that value to providers, as they are best equipped and have the most responsibility to impact patient outcomes. Price transparency tools, in particular, can help care teams better manage risk, as well as better participate in cost-based incentive models.
  • Interoperability and price transparency policies have seen recent acceleration. But more can be done to create a truly interconnected and open ecosystem where care teams have access to robust, accurate coverage data and, with patients, are able to deliver the lowest-cost care in real-time.

There has been tremendous progress in healthcare through technology and interoperability innovations, improvements in the ways provider teams manage difficult diagnoses, and advancements in personal health tracking. But high healthcare costs continue to be a top issue for many. While the issue of cost is incredibly complex, if we aren’t able to have informed cost conversations at the point of care, we risk delaying the shift to value and perpetuating a pattern of negative healthcare experiences for patients and providers alike.

Readers Write: Medication Decision Support Alerts Don’t Need to Go Away, They Need to Get More Specific

April 7, 2021 Readers Write No Comments

Medication Decision Support Alerts Don’t Need to Go Away, They Need to Get More Specific
By Bob Katter

Bob Katter, MBA is president of First Databank (FDB) of South San Francisco, CA.

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It’s no secret that clinicians are inundated daily with alarms and alerts that interrupt their workflows and cause cognitive overload, contributing to the industry-wide problem of clinician burnout. The National Academy of Medicine (NAM) even declared clinician burnout to be an “epidemic,” citing improved usability and relevance of health IT as one of six goals focused on addressing our current healthcare crisis.

While medication alerts are only a portion of a comprehensive clinical decision support (CDS) system, they contribute significantly to clinician alert fatigue. Clinicians are presented with an abundance of low-specificity and interruptive medication alerts and may even overlook critical alerts while sorting through the noise. This contributes to physician burnout and likely compromises patient safety.

We need to do better.

The good news is that given the wealth of patient information now available in electronic health record (EHR) systems, low-value and non-specific medication alerts can become a thing of the past. Medication alerts displayed to clinicians today can be patient- and workflow-specific, resulting in greater relevancy and efficiency.

Health systems and hospitals should focus on replacing non-specific medication alerts with more targeted alerts based on information from the patient’s chart, while delivering these alerts at the most actionable points in the clinical workflow. This approach helps reduce clinicians’ alert burden and fatigue, increases efficiency, and results in better clinical decisions and patient outcomes.

Origins of Alert Fatigue

Drug-allergy and drug-drug interaction alerts were among the first types of CDS alerts introduced in the heyday of EHR implementations. They were required as part of the Centers for Medicare & Medicaid Services (CMS) EHR Incentive Program, commonly known as Meaningful Use, and remain part of the mandatory functionality in 2015 Certified Electronic Health Record Technology (CEHRT). But they can be made better.

The number of data sources and the amount of healthcare information flowing into EHR systems has increased exponentially since the original introduction of these systems in the 2000s. With the level of patient-specific data, clinical guidelines, research findings and other critical information now available, EHRs can and should deliver more relevant and targeted medication information.

Here is how we could flip the script on medication decision support to create greater specificity, reduce alert fatigue, and ultimately improve patient safety and outcomes.

1. Make Alerts More Meaningful and Actionable

Decision support alerts that rely on medication lists alone are helpful but often limited in the insight they offer clinicians. We can create more relevant prescribing guidance by factoring in not only standard demographic information, but also other patient-specific context, including lab values, genetic test results, patient care setting, clinical risk scores, and comorbidities.

Due to advances in diagnostics technology and in IT systems interoperability, this information is more easily accessible than ever, creating opportunities to support more precise guidance and better outcomes. A deeper dive into patient information can help clinicians evaluate risks for complications such as hyperkalemia or QT prolongation. It can also help quantify patient risk for issues such as opioid addiction and a whole host of adverse drug events.

2. Consider the Scenario

Building context around medication alerts should also include the clinical scenario. When a patient has just undergone heart surgery, for example, standard care guidelines typically recommend administering multiple medications post-surgery that would not normally be taken together. Although some of these medications may interact, which could be problematic in another context, these interactions can be monitored and managed in an acute care setting. In this case, surfacing standard interaction alerts would not increase patient safety but would create unnecessary noise.

3. Build it in the Workflow

In another study of CDS usage, one of the obstacles to clinician adoption cited was “disruption to workflow,” a common complaint about medication alerts. When evaluating drug risks, clinicians may need to search through the EHR or log in to a lab results portal to verify the information and to ensure that the alert is relevant. This slows them down and distracts from patient care.

Health systems should present relevant alerts with adequate supporting data when and where they are needed in the workflow. For example, when a patient’s potassium levels have reached a specific threshold due to an ongoing drug-drug combination therapy, the EHR should initiate an alert at the right point in the workflow when the issue can be best addressed.

This is not meant to say, however, that alerts presented at the point of ordering cannot be useful in some cases. For example, a general reminder to order a blood test to check potassium levels when ordering a certain drug therapy can be followed by a patient-specific alert later in the workflow to adjust the dosage once the lab results are returned.

4. Focus on Specificity

According to a recent study, clinicians are more likely to accept and act on CDS guidance when presented with patient-specific alerts based on EHR data.

Reducing quantity and repetition of alerts is also important, considering a recent study of clinicians found the likelihood of alert acceptance dropped by 30% for each additional reminder received per encounter. Reducing generic alerts and improving the patient specificity of the remaining alerts would go a long way toward improving the acceptance rate.

5. Optimize the CDS

Health systems should continually analyze how their clinicians are interacting with alerts and whether the alerts are doing more to protect patient safety or to distract providers. By reviewing the data generated during the medication ordering process, health systems can predict how clinicians will respond to specific alerts and strive to generate only those alerts that help clinicians make better decisions and ultimately protect patient safety.

Putting Patients First

The bottom line is that medication alerts do not need to go away, they need to get more specific. By taking a deeper dive into the relevant information about a specific patient, at the appropriate point in the clinician’s workflow, decision support can deliver more meaningful and actionable insights. If such a patient-specific approach were to be deployed across the industry, we could significantly reduce the cognitive burden that these systems place on clinicians while simultaneously improving medication-related patient safety.

HIStalk Interviews Andrew Smith, President, Impact Advisors

April 7, 2021 Interviews No Comments

Andrew “Andy” Smith is president and co-founder of Impact Advisors of Naperville, IL.

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Tell me about yourself and the company.

I’ve been in the healthcare IT field for 30 years. I started Impact Advisors with my brother 14 years ago.

How are CIOs spending their time and energy as the pandemic seems to be winding down?

This is not a unique thought, of course, but what an interesting year it has been. Needs evolved over the course of the year. At the beginning of the pandemic, basically all work stopped and CIOs were redirected into pandemic response, supporting their caregivers. There was a brief respite in the August timeframe, where everybody thought that the wave was over and they could get focused back on business as usual. The second wave hit, everything shut back down, and now over the last two months or so, it appears that the world is starting to open up a little bit. CIOs are focusing back on their agenda.

What’s interesting, though, is that when I talk to our CIO clients, they all remark similarly that the one thing they appreciated about the pandemic was that the pace changed and the expectations changed. Things that they thought were going to take three years took three months or three weeks. The common thought they have now is, how do we keep that kind of execution and pace going? Because now they are all a year behind on much of their agenda. I’ve seen a real uptick, in terms of interest, pace, and the agenda they are hoping to accomplish over the next year.

Did work of the CIO and IT departments gain internal respect as they were freed of the shackles of multi-year, multi-stakeholder projects and just told to quickly bring up technologies such as telehealth and chatbots under crisis conditions?

Yes, exactly. The consensus-building, governance, and bureaucracy that held back a lot of these technology advancements went by the wayside, and it became streamlined. They needed to stand up a telemedicine program overnight, and for most of our clients, their telemedicine programs increased by a hundredfold. That didn’t require an executive steering committee and three sub-levels of subcommittees to get there, which is typically how we make those decisions, for all the right reasons.

Much of the technology work is really just the point of the spear of huge change management efforts, and big change management takes consensus, time, and evolution. We didn’t have that liberty or that luxury, so we had to move quickly. The real question is, how do we balance those two ends of the continuum with this need for speed with a need for cultural change and adoption? That is going to be the interesting thing to watch.

Will they pick up existing budgets and priorities given that the pandemic overlapped fiscal years and the associated budgeting process?

That’s a really great question. I’m not sure I know that the answer to it, because we are figuring this out. Capital and operating budgets have been upended and redirected.

Again, I hope that we can move at a different pace. Many of our clients have had to lock themselves down. I’ve heard our clients say, “When it’s budget time, I can’t afford to miss a meeting. Otherwise, it could cost me millions of dollars of budget.” You hope we get into a new rapid cycle of opportunity identification, benefits analysis, and then move into execution very quickly.

I fear that we may fall back to the bureaucratic ways of old and the staid pace. But I hope that one of the outcomes of this pandemic is that we get comfortable moving quicker and reacting quicker and understand that the industry is moving at a different pace, and that we need to react to it with supporting technologies and change management.

How will the demand for consulting services change over the next couple of years?

We feel blessed in that respect, because we have a broad set of service offerings, and that starts with our advisory and strategy. We are working with our clients to solve a lot of these problems, where many companies have to react to the market and the client demand. It feels like we are trying to help figure this out alongside our clients, which is nice because that means we can develop our service lines, methodology, and tools in lockstep and even in advance of where we see the demand in the industry. We have evolved the company quite a bit over the last year in reaction to this, and we’ll continue to do that.

Are consumer-facing technologies getting executive and budgetary attention?

Yes. Digital health is one of our most active service lines right now, as you would fully suspect, and that would include telemedicine. This is going to become a competitive advantage or disadvantage, and our clients are all worried about it. When the pandemic hit and they had to rapidly stand up telemedicine programs, they did that with bubblegum and duct tape and tried to figure out how to make that work. They were using FaceTime, Zoom, and all sorts of different technologies to cobble together a solution. They have all been circling back to say, “OK, how do I create a standardized foundation for this?”

The technology isn’t that interesting, quite honestly, but it’s all of the foundational elements, the process elements, and the care delivery elements that are so different. The challenge our clients are going to have is that if you try to layer digital health on your existing inpatient ambulatory infrastructure, that’s not going to be a real recipe for success. You need to think about this in a disruptive way of how to connect with the consumer in the community and how to interact with them in a way that’s convenient for them. You almost have to build a separate infrastructure. You need to think about this with an entrepreneurial mindset. But all our clients are worried about it.

Who drives that process in health systems?

A really interesting question, and I know you have some perspectives on this because I’ve seen you interview others around the concept of a chief digital officer or a chief patient experience officer. It is not a singular person, most commonly. It’s not typically the CIO, although the CIO is a major component and evangelist for some of these technologies. It could be the chief marketing officer, or one of those newer types of “chief” titles like chief experience officer, chief digital officer, or chief transformation officer. The real concern about that is that if you bifurcate that from the CIO and the technology, you’ve got an opportunity to layer complexity or miss an opportunity to streamline these things, to make it easier for the consumer and the caregivers.

Will people from outside healthcare be brought in since other industries are ahead of ours with consumerism?

Yes. We have seen that as a growing trend. The concern about that is that we have seen many waves of people from outside of healthcare coming in to rescue us. They don’t have a keen awareness or understanding of the complexities.

It’s a very odd industry we serve, where the consumer may be disintermediated from the bill they are paying or the cost of the services they are consuming. Although this is changing, in a lot of respects, the caregiver isn’t always completely controlled by the delivery system. It’s just a very strange industry that we serve. It doesn’t follow regular economic laws. I get concerned that people come in and think they can solve healthcare with a lot of outside industry experience.

But contrary to that is that we have been subject to a lot of groupthink inside healthcare, with fixed mindsets and the idea that we can’t do things differently because of the way it was in the past. Instead of standing up digital health, we’ll build a new building. That’s very dangerous thinking, too. The answer is somewhere in the middle. You need to infuse a lot of new thinking and also understand the restrictions or the models that work inside healthcare.

When you said “build a new building,” my first thought was that a progressive health system would sell an existing building and use the money move services to where consumers are. Along those lines, considering the rise of digital health and virtual hospitals, who will set the direction that defines exactly what a health system looks like?

The healthcare system of the future will continue the evolution we’re on, which is that health systems are looking to manage the breadth that they provide, give a closed ecosystem, so that they can care for their communities. They’re going to look to contract in broader ways for the health of the population. Now we’ve been saying that for decades, but we’re going to be right one of these days. That makes too much sense that we’re going to get into these Kaiser or Mayo-like health systems that are going to be resplendent across the entire nation. That just makes too much sense for it not to be true. There’s always going to be a need for a physical footprint for high-acuity people. But more and more of the care is going to move outpatient, more and more of the care is going to move to the home, and more and more of the care is going to move to a virtual environment.

What I fear is going to happen is that the haves and the have-nots are going to continue to become more disparate. That’s going to be a real problem, in terms of health equity, rural care, and the underserved. That’s trend that we need to be careful about, because the haves are willing to invest and gain some efficiencies, and the have-nots aren’t getting reimbursed at the level they need to continue to invest and evolve.

While we were all setting up vaccination sites and figuring out telehealth, federal rules took effect that covered price transparency, information blocking, and ADT notification. Are hospitals ready to address those?

They are aware of it. We did quite a number of advisory projects last year just to make sure that our clients are prepared for it, so I know it’s on their radar screen. I know they are reacting to it. My suspicion is they’ll be able to thread the needle, but your broader point is absolutely accurate. A lot of things have been changing.

There’s been a lot of scrutiny on information sharing and that trend is going to absolutely continue. We need to continue to move to pure interoperability and data sharing for the benefit of the consumer.That’s going to require a lot of change from the vendor landscape and from the health systems. I’ve talked to a lot of health systems and we, as an industry, still view that relationship between the health system and the patient as parochial. We view our knowledge of that patient, that consumer, as a differentiator. That thinking is probably going to have to break down over time and we will have to differentiate in other components, such as efficiency, cost, safety, and quality.

What level of interest are you seeing in robotic process automation?

There is this new uptake of RPA, which looks a lot to me like the screen scraping technologies that we used to talk about 10 years or so ago, Those certainly have their place and can be effective, but they are somewhat brittle technologies. If any of the underlying systems change, it’s a labor intensive process to identify and mirror your systems to it. The next evolution of RPA needs to be more dependent on AI and machine learning to fulfill the promise of robotic process automation, not just serve as a veneer on top of a screen scraping technology with its benefits and limitations.

Do you have any final thoughts?

In the last year, we’ve been through a black swan event. There was this period of rapid change, much of it negative. But we need to work hard to preserve the positive elements of it — the speed of change, the adoption of consumerism, and digital health. It’s an exciting time to be in our industry. We are starting to fulfill the promise of these big, monolithic EMRs. We have installed these and now can start to turn this data into information. 

I’m excited about what the next 10 years are going to bring. We have an opportunity to pivot the healthcare delivery system, and I’m excited that we will be along for the journey.

Morning Headlines 4/7/21

April 6, 2021 Headlines No Comments

AstraZeneca Announces Collaboration with Massachusetts General Hospital to Accelerate Digital Health Solutions

Massachusetts General Hospital will collaborate with drug manufacturer AstraZeneca to develop and validate digital health solutions using AstraZeneca’s Amaze disease management platform.

Critical Event Management (CEM) Provider Everbridge to Acquire xMatters

Public warning and vaccine distribution management vendor Everbridge acquires XMatters, a digital services management company, for $240 million.

Verizon Business Launches BlueJeans Telehealth for Better Connected Health

Verizon Business launches telehealth software for providers as part of its BlueJeans secure video conferencing service.

News 4/7/21

April 6, 2021 News 1 Comment

Top News

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The Indian Health Service seeks help from industry stakeholders with drafting a strategic plan to guide its IT efforts over the next three to five years.

The agency is in the midst of upgrading its IT infrastructure. It will use $140 million of COVID relief funds to bolster its telemedicine and EHR systems.


Reader Comments

From Inchoate: “Re: Therapy Brands. Just acquired by KKR. It is the parent of TenEleven and 18 other behavioral health-focused companies.” Unverified. The 19 companies owned by Therapy Brands sell behavioral health EHRs and systems for practice management, data collection, and electronic prescribing. CEO Kimberly O’Loughlin, MS joined the company in February 2020 after serving as president of Greenway Health.


HIStalk Announcements and Requests

Someone tweeted — and then apparently deleted —that they were annoyed by meeting organizers who omit time zones in assuming “EST” (their term). If you’re going to get preachy about time zone assumptions, be aware that it’s “EDT” rather than “EST,” implied or otherwise, for nearly eight months of the year unless you’re in Arizona or Hawaii. My annual public service announcement for the time zone impaired — just write “ET” and those of us who have a handle on it will translate for you, which is much nicer for you than appearing to be incapable of basic communication. The most entertaining aspect of social media is when people try to show off how smart they are, but create the opposite result.


Webinars

April 21 (Wednesday) 1 ET. “Is Gig Work For You?” Sponsor: HIStalk. Presenter: Frank L. Poggio, retired health IT executive and active job search workshop presenter.  This workshop will cover both the advantages and disadvantages of being a gig worker. Attendees will learn how to how to decide if gig work is a good personal fit, find the right company, and protect themselves from unethical ones.

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


Acquisitions, Funding, Business, and Stock

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Medical billing and patient communications startup Inbox Health raises $15 million in a Series A funding round.

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Minnesota insurance and managed care startup Bright Health acquires Zipnosis, which offers telemedicine services to health systems.


People

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Craig Miller, MBA (Culbert Healthcare Solutions) joins Newfire Global Partners as chief of staff.

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PatientBond hires Todd Helmink (QliqSoft) as SVP of business development.

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Brian Roy, MBA (HMS) joins ZeOmega as RVP of sales.


Announcements and Implementations

3M Health Information Systems announces GA of Social Determinants of Health Analytics, which enhances its Clinical Risk Groups with social risk intelligence from social risk analytics vendor Socially Determined.

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Verizon Business launches telehealth software for providers as part of its BlueJeans secure video conferencing service.

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A KLAS Arch Collaborative report finds that the manner in which health systems implement and support EHRs is a bigger driver of physician and nurse EHR perception than the vendor’s own delivery of functionality and support for quality care. It cites OrthoVirginia, whose efforts to improve the EHR experience of orthopedic physicians increased their “Epic is a high-quality EHR” opinion from 49% to 81% over three years.

Massachusetts General Hospital will collaborate with drug manufacturer AstraZeneca to develop and validate digital health solutions using AstraZeneca’s Amaze disease management platform, starting with heart failure and asthma management. Amaze, which was launched last month, is built on BrightInsight’s regulated digital health product development platform.

The HCI Group launches StrategyNxt, which delivers a customized digital strategy in 12 weeks for a fixed price of $250,000.


Government and Politics

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ONC officials remind healthcare stakeholders that the Cures Act’s information blocking provision has taken effect. EHR transparency is also required as of Monday, in which providers are required to give patients all of the information stored in their EHR in electronic format, including provider notes of all types as well as imaging, lab, and pathology report narratives.


COVID-19

The number of American adults who have received at least one COVID-19 vaccine dose is up to 42%, while 76% of those 65 and over have been at least partially vaccinated.

A New York Times analysis finds that COVID-19 cases are increasing, deaths are decreasing (although as a lagging indicator), and eight of the top 10 metro areas with the highest new case count per 100K population are in Michigan. Michigan’s case count is approaching its all-time high, hospitalizations are moving toward record levels, and deaths have taken an upturn after a long decline.

California will fully reopen activities and businesses on June 15, as long as vaccine remains available and hospitalization rates remain low.

The White House announces that every US adult will be eligible to be vaccinated by April 19, eliminating individual state phases.

CDC finally confirms that “deep cleaning” businesses is pointless since infections are spread by air, recommending instead that employees wash their hands regularly and use hand sanitizer only when soap an water aren’t available. This is a significant change as businesses reopen their indoor services and many people are still phobic about getting COVID-19 from items they touch.

A new COVID-19 vaccine is being tested in Brazil, Mexico, Thailand, and Vietnam that stimulates more potent antibodies while also being cheaply manufactured using chicken eggs, same as flu vaccine. Phase 1 trials will be completed in July. The developer of the vaccine platform is structural biologist Jason McLellan, PhD of University of Texas at Austin, of whom a Gates Foundation officer says, “He should be proud of this huge thing he’s done for humanity.

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Northwell Health will expand a program to place Amazon Echo Show two-way video devices in COVID-19 patient rooms to allow providers to communicate with them without using PPE. Physicians can initiate a conversation from their own device and patients can just start talking without pushing buttons using Alexa’s “drop in” option. Northwell said a year ago that it would add 4,000 of the devices to the 2,800 it had already deployed.


Other

A study of EHR usage at Yale-New Haven and MedStar Health systems finds that ambulatory physicians spend five hours on the EHR (Epic and Cerner, respectively) for every eight hours of scheduled clinical time, with 33% spent on documentation, 13% in inbox management, and 12% on orders. The authors warn that the use of system audit logs to compare the proposed seven EHR use metrics across vendors and provider organizations in a normalized manner will be challenging.

A former IT security support coordinator of Trillium Health pleads guilty to computer fraud, charged with using his administrative access to read employee emails and social media accounts. Trillium says it spent $150,000 to determine the extent of his hacking, also noting that his computer contained thousands of photos of employees, their credit cards, and their driver licenses. He could be sentenced to up to five years in prison and fined $250,000.


Sponsor Updates

  • Elsevier adds MIPS measures validated by MDinteractive to its STATdx radiology diagnostic decision support solution.
  • The Canisius Wilhelmina Ziekenhuis Hospital in the Netherlands goes live on Agfa HealthCare enterprise imaging.
  • Premier signs an agreement with Ascom, giving its members special, pre-negotiated pricing and terms on the company’s nurse call systems.
  • Vocera Chief Marketing Officer Kathy English is selected as a Hall of Femme honoree for 2021.
  • Cerner publishes a new client achievement story, “Cancer center improves chemotherapy infusion efficiency after transition from paper records to EHR.”
  • Change Healthcare wins a 2021 Cloud Computing Product of the Year Award from Cloud Computing Magazine for its Enterprise Imaging Network.

Blog Posts


Contacts

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

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Morning Headlines 4/6/21

April 5, 2021 Headlines No Comments

Inbox Health Raises $15 Million in Series A Financing Round

Medical billing and patient communications startup Inbox Health raises $15 million in a Series A round of funding led by Commerce Ventures.

Indian Health Service Wants IT Strategic Planning Help from Industry

The Indian Health Service seeks help from industry stakeholders with drafting a strategic plan to guide its IT efforts over the next three to five years.

Zipnosis Has Been Acquired by Bright Health

Minnesota insurance and managed care startup Bright Health acquires Zipnosis, which offers telemedicine services to health systems.

A New Day for Interoperability – The Information Blocking Regulations Start Now

ONC officials remind healthcare stakeholders that the Cures Act’s information blocking provision has taken effect.

Curbside Consult with Dr. Jayne 4/5/21

April 5, 2021 Dr. Jayne 4 Comments

A major part of my consulting practice involves trying to help physicians become more proficient EHR users. As I evaluate their current state workflows, I usually discover a number of operational processes in their practices that are adding to their workload. Often the perception is that the EHR is causing more work when it’s really a combination of poor EHR implementation, poor EHR configuration, and continuing to try to use processes that were designed for paper even though the paper is long gone.

Increasing practice-related stresses contribute to physicians feeling like they’ve lost control of their work lives, which can ultimately result in burnout. I’m always on the lookout for strategies to help my clients beyond optimizing their EHRs and their office processes. Sometimes this involves referring them for executive coaching to discuss work-life balance and their willingness (or lack thereof) to alter their work schedules to try to reduce stress. Other times, physicians are resistant to any advice that advocates for work habits different than what they’ve grown to accept.

I ran across an article from the AMA this week that advertised four approaches to reduce the mental workload that physicians face. This was presented as a strategy for reducing burnout. Cognitive workload is a real phenomenon that a lot of organizations don’t think about. I’ve had many conversations with EHR designers and UX experts about it over the years, and certainly systems can be designed in a way to make things easier on the user. However, what users see on the screen is only a small part of the stressors they face each day.

The article cites a recent webinar with Elizabeth Harry, MD, who is senior director of clinical affairs at the University of Colorado Hospital. The first point that the article makes is that an individual’s attention is a limited resource, and that we need to “have space to actually give proper attention to things” in order to avoid making mistakes. She suggests that people use a task-based approach, where they focus on a single task for a period of time in order to saturate their working memory. An ideal time for focused attention would be 25 minutes, followed by a break during which the cognitive load would be discharged.

That sounds well and good from an academic perspective, but I’m not sure how to apply it to the typical workflow physicians face in the outpatient setting, where they’re bouncing from 10- to 15-minute visits with “breaks” in between, during when they are expected to finish documentation, field telephone messages, address medication refills, and perform numerous other tasks.

Dr. Harry goes on to suggest four strategies to address systems issues that contribute to burnout.

The first strategy is to increase standardization. She cites Steve Jobs and his standardized wardrobe as an example. She notes that building intentional habits can reduce stress and that organizations should try to standardize as much as possible across medical care unites.

I wholeheartedly agree with this idea. My urgent care employer has more than 30 locations, and all of them are built on the same blueprints except for three locations. I work at two of the three non-standard sites from time to time and find them incredibly frustrating. One site was acquired from another urgent care organization and has different cabinetry, so the drawers are laid out differently and the rooms have different configurations, which results in the physician opening random cabinets trying to find things. I’m sure that doesn’t build confidence for patients, and it definitely injects a small amount of stress into your day. The other site has the standard layout in the rooms, but the doors to the exam rooms all open opposite of how they should, resulting in some shimmying and dodging of trash cans and exam tables as you enter the room. It also makes you try to grab for a handle on the wrong side of the door as you exit, which just makes you feel foolish as well as slowing you down.

The second strategy she advocates is decreasing redundancy so that organizations have a single high-reliability process for completing a task rather than having multiple ways a process can run. She uses the example of notifying a physician regarding lab results. We need to receive results the same way each time rather than a different way each time we order labs. I think most organizations are doing a fairly good job with this, although there are some levels where redundancy is important, especially where critical patient safety situations are involved.

The third anti-burnout strategy involves consolidation of clinical data. This is where she cites EHR design as an example, setting up the workflow so that key information is located in a single space rather than requiring users to bounce around to find the information they need. Disease-specific workflows are an example of this, where users can find relevant patient history, clinical indicators, and labs all in the same place. This approach builds on the concept of reducing split attention as well as creating routines and habits.

The fourth strategy involves reducing interruptions. Dr. Harry notes that physicians need to have agreements with their support staff about what merits an interruption and what doesn’t. Interruptions can disrupt important thought processes, and she again advocates for physicians to have blocks of time where they can focus.

This may be a possibility for outpatient visits in certain subspecialties that are allowed longer appointments for complex consultations, and might be even more of a possibility where physicians own their own practices and can control their own schedules. However, I can’t see how it would be much of an option for specialties where physicians are expected to juggle multiple patients who are having acute problems simultaneously, such as in the emergency department or in the intensive care unit. In those settings, our attention is constantly drawn away from what we’re looking at and towards something that is potentially less stable or more serious.

The reality is that inability to focus doesn’t just lead to stress for physicians and caregivers, but it also leads to poor care when patients don’t have our complete attention. Having time to focus has become a luxury and our patients deserve better.

What are your organizations doing to help physicians achieve greater focus, and is it helping reduce burnout? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Rob Culbert, CEO, Culbert Healthcare Solutions

April 5, 2021 Interviews No Comments

Rob Culbert is founder and CEO of Culbert Healthcare Solutions of Woburn, MA.

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Tell me about yourself and the company.

I started with IDX in the 1980s and worked with them for almost 10 years before switching over to the consulting side of the world. I started Culbert Healthcare Solutions in 2006, so it’s our 15th anniversary, although we didn’t get to celebrate it yet because of everything that’s going on in the world. We have been able to continue our passion for working with healthcare providers around the country, helping them improve the patient experience, improve financial performance, and solve strategic business problems.

How has the pandemic affected your business?

Initially, it was a shock, as was to everybody. It changed our business on a dime. For the first time in my consulting and work experience in 30-plus years, in April and May, we had zero invoices with expense reports on them. I never have experienced that in my life.We had a lot of things in place to be able to flip over to remote work. We had some projects pause, some ended, and some new ones kicked in, but we were able to make that transition as best we could.

We are a pretty conservative company and privately held, so we focused on making sure that we kept our people and took great care of the customers that we had and the new ones that had needs. We tried to be as creative as we could be to help them through their own crises. While I don’t think any of us are out of the woods yet until this thing really gets behind us, we have been able to weather the storm and continue the good work we try to do.

How are hospitals and health systems looking differently at their relationship with patients?

Pre-COVID, we dedicated a lot of effort to helping organizations improve patient access. There are lots of systems and functionalities out there. When you are doing a large-scale implementation like Epic, Cerner, or Allscripts, you don’t get to become an advanced user overnight. A big portion of our work has been helping to look at the patient access functionalities. It’s all about making sure that the physicians and the clinical staff have all the tools in place to be able to maximize utilization, to be able to have the right information to take good care of the patient before, during, and after the visit, and make that as seamless as possible. Some of that was for financial improvement. A lot of it was to prepare for changes and and the way payers pay providers for their work.

When COVID came, it was an easy process to flip to being as touchless as humanly possible. We had several engagements where there could have been pauses on the project, given all the uncertainty. But in the areas of patient access, customers said, keep going. The work that you have done so far has made those practices able to change on a dime. How do we deal with nobody in the waiting room? How do we remove all of the in-person touches that typically have happened? They were able to more easily adapt their schedules to follow best practice COVID protocols.

Are you seeing a lot of provider interest in buzzy technologies such as AI, robotic process automation, and life sciences research?

We are. Machine learning is, as with robotics and data analytics, a term everybody uses that means different things to different people. But everybody is dying to start using the data more effectively to make their jobs better. Especially during COVID, but we had started seeing it in the last few years. 

There’s a lot more for-profit investment firm interest in healthcare technologies. When a for-profit entity is looking to acquire a healthcare technology or provider, their approach to evaluating it, doing the due diligence, and then the speed of moving to realize the full value of that investment is different than what we historically have been used to in healthcare. It’s a welcome change, and in many cases, a needed change. It has been quite a transformation to see how more investor-led organizations are changing healthcare, much more that we saw in the first two-thirds of our healthcare career.

How will consolidation of both companies and health systems change the experience and outcomes of patients?

Unfortunately, the complexity of healthcare technology that we are trying to optimize is overwhelming for smaller organizations. It is more difficult and challenging for them to take full advantage of that technology, whether it’s from an expense standpoint or a skills perspective. There are definitely opportunities for larger organizations to be able to offer more complex technology with better support and more cost effectiveness. Economies of scale definitely make a difference.

There are different motives for some of the getting bigger. Some of it is to spread costs amongst the larger population. For others, it’s a business opportunity to be able to leverage that cost and provide a better service.

We have definitely seen cycles where there was lots of coming together, then there was lots of splitting apart. We’ve seen it come and go. This time, because of the complexity of the electronic data and the opportunities to streamline the healthcare process for the benefit of patients, it will be rocky in some cases, but the end game is going to be positive.

What is driving the sudden emergence of the chief digital officer title?

It’s a huge positive. When EHR implementation started, you had a lot of physician champions. The CIO was very much about managing risk and managing costs for those systems. It was much harder in the beginning to prove an ROI compared to the traditional revenue cycle system that makes your revenue cycle cheaper and more effective.

The concept of chief digital officer is different. It’s not just about managing the Epic system or the bread and butter system. It’s about managing the experience of the patients for the benefit of providers, so that they can have access to the information they need to do their job in a cost-effective and well-informed way.

Some of the vendors will hate me for saying this, but there is no one technology that does it all. We constantly see customers trying to take full advantage of the collection of technologies to be able to do as good a job as they can for the patient experience. That ranges all across the board. We have seen companies like CueSquared , which provides a mobile pay technology to allow patients to view and pay their statements on their phone. The world of self-pay has changed dramatically over the years, but that’s just one small example.

That digital experience has been interesting to watch, because a lot of organizations have created a serious digital approach to their world. Where does this fit into the patient experience we want? That’s where technologies get dropped and that’s where technologies get put in. Technologies that prioritize what’s important to the patient and help provide the patient great service, which might not have been given a look in the past because they aren’t a module within the larger system, are getting opportunities. They are doing some pretty cool things with it.

How will the cancellation of HIMSS20 and the delay in HIMSS21 affect the industry?

I don’t think it has had a negative impact on our company. I say that because the whole world has had to change on a dime. Everybody recognizes that as much as those in-person conferences can be invaluable for learning and networking, it just is impossible. But I’m still amazed by the amount of virtual opportunities that have, as best they can, replaced the in-person conference for now, the explosion of using Zoom, Teams, and GoToMeeting to be able to try to have some of that face-to-face.

One of our strengths as a company is that we have deep relationships with the industry and our customers. For those organizations that we know and they know us well, it was easier to go into a remote engagement opportunity. We were known quantities, there was a trust, and there was a relationship in which you knew that both sides were going to get good value. We were going to kill ourselves to make that remote process work, given historically that it was always an in-person or on-site type of opportunity.

For those that don’t know us and vice versa, it’s harder to build that trusting relationship. We have slowly started to see some of our engagements where there has been a strong desire to at least have some sort of on-site presence. Some of those have gone very smoothly. We have been creative, such as people staying over a two-week window as opposed to coming Monday and leaving for home Friday, to get through the window of time to build that relationship. And, to manage the COVID travel policies of the state that the consultant is going to and the state that they are coming from. That has probably been the toughest one for us, to make sure that we are managing those travel requirements between the two states.

We are starting to see many of our consultants getting the vaccine. We have had opportunities where they have qualified for the vaccine based on the work that is being asked of them. So far, that has made life a lot easier. Many of our consultants have no issue with traveling, because they have been doing it almost their entire careers. Others have been nervous about it, but we have been able to manage those nerves because we have been able to keep a fairly large percentage of our business on a remote basis. Each month that we are able to continue waiting for the world to be ready for the ongoing travel, then that concern will keep going down.

We are on the 10-yard line of hopefully the vaccine helping us to get to the other side of this thing. Just a little more patience is what we expect. Our people and clients have been flexible around managing that in a good way.

Do you have any final thoughts?

I am hopeful for everything that is going on with the vaccine and all the lessons learned to get us through this thing. Every customer and every business that we work with has had to adapt. We are at the top of that list as well. As hard as this year has been, it has been an exceptional learning experience. We are doing things that we probably never would have thought to do prior to COVID. In many cases, those things are incredible positives.

I am very positive in terms of the outlook. While this hurt everybody, we are going to benefit tremendously for years to come from some of the changes that were forced upon us. Creativity will stay with us in a good way for a very long time.

Morning Headlines 4/5/21

April 4, 2021 Headlines No Comments

Bank of America Acquires Axia Technologies, Inc.

Bank of America acquires patient payments technology vendor AxiaMed for undisclosed terms.

Notice of Data Privacy Incident

Aspirus joins other health systems in notifying patients that its vendor MedData exposed their protected health information on a public-facing website.

SOC Telemed Reports Fourth Quarter and Full-Year 2020 Results

SOC Telemed, which went public via an SPAC merger last fall, announces Q4 results: revenue down 13%, adjusted earnings –$3.9 million versus $0.2 million.

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Reader Comments

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