Morning Headlines 9/12/23

Oracle comes up short on revenue but touts AI cloud contracts

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

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

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

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

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

CT hospitals unsure if patient records were breached in cyberattack

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

Curbside Consult with Dr. Jayne 9/11/23

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 Compared to my physician experiences with the senior population, I found some of their attitudes to be not only outdated, but their opinions to be inaccurate.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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Morning Headlines 9/11/23

Walmart Explores Buying Majority Stake in ChenMed

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

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

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

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

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

Monday Morning Update 9/11/23

Top News

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

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

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

Reader Comments

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

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

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

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

HIStalk Announcements and Requests

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

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

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

Webinars

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

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

Acquisitions, Funding, Business, and Stock

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

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

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

Sales

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

People

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

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

Announcements and Implementations

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

Government and Politics

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

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

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

Other

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

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

Sponsor Updates

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

Blog Posts

• EMR Consultants: Breaking Down Short-Term, Long-Term, and Permanent Placements (HealthTech Resources)
• The Benefits of Having Your Healthcare HCM, ERP, and SCM in One System (Healthcare IT Leaders)
• Navigating Change Management: Fostering Organizational Engagement (Impact Advisors)
• Living Fearlessly: Reflecting on Fear and Overcoming It (JTG Consulting Group)
• AI Deployment Success: Improving Adaptability Over Time (Lucem Health)
• Automated “risk stratification” is key to improving patient satisfaction and care team efficiency (Lumeon)
• Revamp Your Revenue Cycle: Billing Flow (Medhost)
• Attainable innovation: How trends shape the healthcare industry and its future success (Meditech)
• 5 Benefits of Offering Digital MSK at Your Outpatient Rehab Therapy Practice (Net Health)
• New Reports Show Health Plans Must Innovate Behavioral Health Risk Management Strategy (NeuroFlow)
• Preparing for the 2024 ICD-10-CM Code Updates (Nym Health)
• It’s Time to End Multi-Trigger Targeting for EHR-based HCP Engagement (OptimizeRx)
• Nurses of Note 2023: The Acute Neurovascular Advanced Practitioner (PerfectServe)
• An Expert’s Take on HCC Coding (RCxRules)
• Respite Care 101: From History to Modern Resources (Trualta)

Contacts

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

Morning Headlines 9/8/23

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

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

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

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

More technical problems found with VA’s disability claims system

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

News 9/8/23

Top News

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

NextGen offers solutions for EHR/PM and interoperability.

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

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

Reader Comments

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

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

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

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

HIStalk Announcements and Requests

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

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

Webinars

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

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

Sales

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

People

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

Announcements and Implementations

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

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

Government and Politics

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

Other

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

Sponsor Updates

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

Blog Posts

• Liverpool Women’s CIO Perspective: Digital Maturity One EPR Milestone at a Time (CereCore)
• Mitigating the Risks Involved with High-Risk Diagnosis Groups (AGS Health)
• Bridging gaps: Data-driven approaches to patient outreach (Arcadia)
• What Hospitals Can Do To Move From Digital Tools to Digital Transformation in Healthcare (Ascom)
• An Expert’s Take on HCC Coding (RCxRules)
• Availity Expert Q&A: Unleashing Efficiency to Revolutionize Prior Authorizations (Availity)
• How a Security Controls Validation Assessment Optimizes Cybersecurity Investments (Clearwater)
• How Continuous Safety Monitoring Can Reduce Hospital Stays for High-Risk Oncology Patients (Current Health)
• Bridging the Gender Gap in Health Tech (Dimensional Insight)
• Increased Prevalence of Alpha-Gal Syndrome Impacts More Clinical Decisions (First Databank)
• Living Off the Land attacks: Unveiling the illusion (Fortified Health Security)

Contacts

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

EPtalk by Dr. Jayne 9/7/23

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

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

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

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

Morning Headlines 9/7/23

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

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

Concord Health Partners Invests in NeuroFlow

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

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

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

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

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

Healthcare AI News 9/6/23

News

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

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

Research

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

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

Other

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

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

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Morning Headlines 9/6/23

UPMC is preparing for a massive transfer of medical records

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

Thoma Bravo Nears Deal for NextGen Healthcare

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

TeleVox Acquires Odeza Patient Engagement Business from Ensemble Health Partners

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

News 9/6/23

Top News

UPMC will replace Oracle Health / Cerner and eight other EHRs with Epic. Implementation in the 40-hospital system will begin in Q4 and be completed by mid-2026.

UPMC was already using Epic in some areas, notably for ambulatory services.

Reader Comments

From SPAC Cadet: “Re: HIStalk. Have you thought about taking it public via a SPAC? Everybody is doing it!” Everybody was indeed doing it until the government cracked down on unproven companies that could not have passed the scrutiny involved in an actual IPO and instead “merged,” which left them free to pump shares via media promotion. Nothing says USA like celebrities, grifters, and the ever-present money people collaborating to pick the pockets of the little guy. SPAC king Chamath Palihapitiya used Twitter and CNBC shilling to earn himself a billion dollars in fees while shares in his average SPAC company were tanking 90%. His Clover Health, which he bragged was a surefire 10x win over 10 years, started trading at a $7 billion valuation that is now down to $650 million, so the 10x is looking accurate though directionally incorrect.

HIStalk Announcements and Requests

Health IT people may be professionally embarrassed by being the last holdout of fax machines, but most poll respondents wouldn’t walk out on a practice upon seeing one at the check-in desk (I purposely described it that way to indicate the presence of the lowest form of faxing, as opposed to the slightly sexier digital fax). One commenter astutely noted that not seeing a fax machine out front just means that they are using e-fax or have placed the machine out of sight. Another said it’s a lot more offensive shove a multi-page paper form at patients for whom the information is already in the clinic’s EHR. Bethany notes that even all-digital clinics needs a fax machine because they can’t receive referrals from other practices that insist on using them.

New poll to your right or here: Were you laid off, terminated, demoted, or forced to relocate so far in 2023?

Lorre always offers incentives for new sponsors to sign up in the last quarter when leftover marketing budgets need a home, so contact her to get on board.

Webinars

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

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

Acquisitions, Funding, Business, and Stock

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

The CEOs of Walgreens and Amazon-owned One Medical resign. The latter is less surprising since the CEOs of Amazon’s acquisitions rarely stick around beyond the kick-in of their golden parachutes, while the former looks like impatience that the ambitious plans to turn Walgreens into a a full-service healthcare provider via acquisitions involves too much risk and time.

Mercy Iowa City files for Chapter 11 bankruptcy protection, citing the poor implementation of a new Allscripts EHR in 2022 that has since contributed to problems with coding, billing, and collecting for $189 million in patient services. The hospital has filed a lawsuit against Allscripts, now known as Altera Digital Health, to which it still owes $1.8 million. It is considering a “below-market” acquisition offer of $20 million from the University of Iowa, the value of which has left some bondholders seeking an official investigation into the hospital’s downfall.

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

Sales

• Tennessee’s TennCare Medicaid agency will use Findhelp’s social services assessment and Closed Loop Referral System as a part of its Health Starts initiative.
• Franciscan Missionaries of Our Lady Health System will use Masimo’s remote patient monitoring hardware and software across its 10 hospitals in Louisiana and Mississippi.
• Blackrock Health Group in Ireland will implement Meditech Expanse at an additional three clinics as part of a three-year, $27 million digital transformation program.

People

Prairie Lakes Healthcare System hires Tim Pugsley, MBA (Mankato Clinic) as CIO.

The National Library of Medicine announces the retirement of Director Patti Brennan, RN, MSN, PhD on September 30. She is an informatics nurse and earned a PhD in industrial engineering from the University of Wisconsin-Madison.

Government and Politics

Air Force doctors say in a town hall meeting in Japan that DoD’s Oracle Health system — whose final go-lives are in the Indo-Pacific bases — is better than its predecessor, but has a quirk in which the records of children aged 13-17 won’t be available online and the children themselves can’t create a patient portal account until they reach 18.

The US Air Force Research Laboratory says that several military medic groups are interested in the EHR smartphone app that it created in 2019. The Battlefield Assisted Trauma Distributed Observation Kit (BATDOK) captures medical documentation at the point of injury and during transport

Privacy and Security

Carthage Area Hospital in New York gets phone systems up and running as it recovers from a cyberattack discovered last Thursday. The breach also impacted nearby Claxton Hepburn Medical Center, though its phone lines were not affected.

Other

A former physician employee of Babylon, who left the company six years ago after just 12 months, describes what it was like to work at “the most expensive failed experiment on digitizing primary care to date”:

• He was shown the company’s “groundbreaking AI system” that was just some Excel worksheets containing decision trees that had been written by junior doctors. Attempts to improve the system failed.
• Employed clinicians were told to assign the probabilities of various combinations of diseases and symptoms, leading to illogical questions such as the likelihood that someone with abdominal pain has allergies.
• The company’s chatbot didn’t work and didn’t earn FDA approval.
• Babylon claimed that its product’s performance was better than that of doctors, then backtracked on that claim when doctors cut ties with the company.
• The company hired “slimy sales people” to push deals that almost always ended up failing, pushing whatever AI craze was making headlines, such as facial recognition and voice-to-text.
• The GP at Hand telehealth service was convenient for patients, but the service was not cost effective and its expense damaged the NHS services it replaced.

Sponsor Updates

• Wolters Kluwer Health announces that its drug diversion monitoring software received exceptional recognition from KLAS in its Drug Diversion Monitoring 2023 report.
• A new KLAS white paper shows that Nordic has one of the industry’s most robust selections of services aimed at streamlining the EHR experience.
• Ronin publishes a new white paper, “Clinician Experience: The Missing Link Between High-Efficiency and High-Tech Healthcare.”
• KLAS recognizes Vyne Medical in its latest Advanced User Insights report on next-generation digital fax management.
• The SaaS Fuel podcast features Zen Healthcare IT President Marilee Benson in “SaaS Founder Insights.”

Blog Posts

• How Meditech’s Critical Care solution can elevate your organization (Meditech)
• 5 Benefits of Offering Digital MSK at Your Outpatient Rehab Therapy Practice (Net Health)
• Speech recognition adoption made simple with Dragon Medical One (Nuance)
• Extreme Usability II: Enhancing the Client Experience (Netsmart)
• Automation in Revenue Cycle Management: Healthcare Providers Share Their Experiences with Autonomous Medical Coding (Nym Health)
• How to Reach the CMDB Summit (Optimum Healthcare IT)
• Real Results from RCxRules Users (RCxRules)
• Message Queue Service Oils the Engine Driving E-Prescriptions (Surescripts)
• How to Empower Family Caregivers During Hospital Discharge (Trualta)

Contacts

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

Morning Headlines 9/1/23

Firm behind NHS GP at Hand service places two divisions into administration

Babylon Health sells its UK business, including the GP at Hand app, to US-based in-home test kit vendor EMed Healthcare.

FBI, Partners Dismantle Qakbot Infrastructure in Multinational Cyber Takedown

The FBI and its partners shut down the Qakbot bot that was used to perform several recent cyberattacks on US hospitals.

SoftBank, General Atlantic-Backed Biofourmis’ Founder Steps Down As CEO

Biofourmis CEO Kuldeep Rajput resigns from the remote patient monitoring platform vendor one month after the company laid off 120 employees.

News 9/1/23

Top News

Babylon Health sells its UK business, including the GP at Hand app, to US-based in-home test kit vendor EMed Healthcare.

The sale basically marks the end of the company, which has declared insolvency and sold the parts of its business that attracted buyers.

BBLN shares, which went public as one of many disastrous SPAC mergers, are at two-thousandth of one cent, valuing the former high-flyer whose market capitalization reached $4 billion at $5,000.

Webinars

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

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

Acquisitions, Funding, Business, and Stock

Wellstar Health System will acquire Augusta University Health System, pledging to complete AU Health’s implementation of Epic. 

Biofourmis CEO Kuldeep Rajput resigns from the remote patient monitoring platform vendor one month after the company laid off 120 employees. Its July 2022 Series D funding round increased its total to $464 million, valuing the company at over $1 billion. Insiders say that key investors were unhappy with the company’s strategy and burn rate.

Non-profit RIP Medical Debt, which purchases discounted patient-owed medical debt and pays it off, will work with RCM software vendor FinThrive to use social determinants of health to identify patients whose debt meets the company’s criteria for payoff.

Sales

• Bethany Children’s Health Center (OK) will implement Meditech Expanse using the Meditech as a Service platform.
• Parkview Health will offer Epic-based virtual urgent care from KeyCare.

People

Jeff Cutler (Ada Health) joins Validic as chief commercial officer.

Adam Seyb (Janus Health) joins ProRank as CEO. 

Announcements and Implementations

GoodRx announces a real-time benefit check for Provider Mode, which gives prescribers access to a patient’s insurance coverage and drug cost.

NeuroFlow announces a tech-enabled approach to psychiatric collaborative care (CoCM) that combines the company’s AI-driven analytics, care collaboration enablement, and enterprise consumer-grade activation for its health system users.

Government and Politics

CMS asks states to review the results of their computer-assisted Medicaid eligibility determination after identifying a software error that incorrectly flags children to be dropped automatically if their family fails to respond or is found to be ineligible.

Privacy and Security

The FBI and its partners shut down the Qakbot bot that was used to perform several recent cyberattacks on US hospitals. The FBI penetrated the system, found that 700,000 systems were compromised globally, and then set up a redirect function to forward incoming traffic to an uninstaller program.

Systems at Singing River Health System (MS) remain down following an August 20 cyberattack.

In Europe, a privacy watchdog sues Google-owned Fitbit in multiple countries for exporting user data outside the EU in violation of GDPR. The suits say that Fitbit includes data-sharing consent in its user agreement, but doesn’t specify how the data will be used and doesn’t give paid users a way to opt out.

A law firm reminds Florida healthcare providers — hospitals, nursing homes, labs, pharmacies, and mental health providers — that a new state law requires them to verify that their EHR data is physically stored in the continental US, US territories, or Canada. The firm says that that the law does not limit the ability of people outside the country to access patient information, but it does specify where the information must be physically stored, whether by the provider itself or third-party vendors.

Other

UNC gastroenterologist, vice chair, and professor of medicine Spencer Dorn, MD, MPH, MHA – who humorously says on his LinkedIn that “I literally work in the belly of the healthcare beast,” lists how managing the physician EHR inbox violates productivity principles:

• Messages arrive all day long and lead the physician reader down rabbit holes, conflicting with the day’s planned activities.
• High-value task prioritization gives way to having to read each message to determine its importance.
• Inbox noise creates distraction.
• Efficiency is sapped by multitasking, as the average PCP switches their attention to the inbox 80 times per day.
• Cognitive load is increased by context-switching among screens and windows.
• Message burden forces managing the inbox evenings and weekends when the physician’s energy and attention are lower.
• Solutions include redesigning the inbox itself, using AI to help manage messages, and provider organizations reducing the number of messages and delegating more of them to non-physicians.

One commenter on the inbox article above mentioned that EHR inboxes could be designing similarly to the Spark email client, which PC Magazine says is a lot cleaner and easier than Gmail, which keeps cramming in non-email features like to-do lists and meeting scheduling. Spark’s $60-per-year individual plan includes offers grouping and prioritization, “send later” and reminders, natural language email search, and an AI-powered email summarization and creation assistant. The team version adds collaboration functions. Twobird offers similar functionality for free.

Epic notes that all of the people who provide services to support its just-concluded UGM – including golf cart tour guides and A/V techs — are its own employees. The company ordered a record-breaking 9,000 doughnuts from a Madison doughnut shop for them.

Sponsor Updates

• EClinicalWorks offers a new customer success story, “Boosting Patient Satisfaction with Healow Secure Text.”
• First Databank releases a new Faces of Digital Health Podcast, “Bringing EPrescribing to the Next Level: To Patients.”
• Fortified Health Security names Lee Tomlin security analyst.
• Keysight enhances its Eggplant automated software test solution to enable multi-platform mobile app testing.
• Lucem Health releases a new This Week in Clinical AI Podcast.

Blog Posts

• Delivering the Right Information at the Right Time for Optimized Health Outcomes (Availity)
• Pharmacists can increase patient trust through aligned content (Wolters Kluwer Health)
• Lifting Up Patrons: How We Partner with Libraries (Findhelp)
• Five9 Advances to Platform Tier in ServiceNow’s Build Partner Program (Five9)
• Help Desk Updates: Your Super Weapon to Boost Clinician Productivity (HCTec)
• Community Partnerships: Empowering People Through Health Education (Healthwise)
• Building Community: Patient Engagement Solutions for Hometown Providers (Medhost)

Contacts

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

EPtalk by Dr. Jayne 8/31/23

Sometimes a marketing campaign just resonates with me, as did this one from Intelligent Medical Objects with its connection to “How to Train Your Dragon.”

I receive a tremendous number of emails from companies that are trying to get my attention or trying to get me to consider their products. The majority of them are annoying (especially the ones that address me as “Hey Jayne!”) but this one not only hit the mark, but gave me a smile as well.

Large language models are going to continue to be a hot topic for the foreseeable future, and the data used to train models can vary widely in quality. Bad data can lead to bias and unanticipated outcomes.

IMO continues to be a leader in the field of semantic interoperability, helping organizations make sure that data makes sense not only on the back end, but for the clinicians who have to look at it every day and the patients who are increasingly exposed to their healthcare data. I remember first implementing its products many years ago, and the fact that its ProblemIT solution was the only initiative for which my physicians actually sent me “thank you” emails.

New legislation is pending in the US Senate. The Behavioral Health Information Technology Coordination Act would provide $20 million in funding annually for behavioral health EHRs and would also require the development of standards for those products. Additionally, CMS would work with different bodies, including Medicaid, to promote EHR adoption and interoperability for behavioral health.

Many organizations have struggled with documentation of behavioral health care in EHRs, including keeping up with privacy regulations for different jurisdictions and age groups and dealing with information-sharing among the treatment team. Primary care physicians in the US provide a great deal of behavioral health services, but many find it difficult to get the information they need to adequately care for their patients, including histories of previous treatments and medication records. They sometimes struggle to coordinate with therapists, even when both are employed by the health system, because organizations are especially worried about inadvertent disclosure of this specially protected data.

In my area, it seems like the majority of non-facility behavioral health providers are not employed by large health systems. Many are independent and don’t participate with insurance companies, requiring patients to pay out of pocket. This shortage means that the wait time for a psychiatrist for Medicaid patients is 9-12 months, which pushes even more care to be delivered by primary care physicians. One health system recently opened a behavioral health emergency department to help address surging access needs, but it was quickly overwhelmed.

When you’re not taking insurance or participating in governmental payer programs, there is little incentive to use an EHR versus traditional paper documentation, especially when you’re not expecting to have to share data very much if at all. Behavioral health wasn’t initially included in the Meaningful Use incentive programs of the Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009, which also likely contributed to reduced technology adoption.

From Latent Luddite: “Re: technology’s unanticipated consequences. Did you see this article about autonomous car crashes in San Francisco? Great example.” I hadn’t seen the article before a reader sent it along, but the long and short of it is that General Motors is having a problem with its Cruise autonomous vehicles. As a result, they’re cutting the size of the San Francisco fleet in half while investigations are underway after recent crashes. In the most recent incident, a vehicle without a human driver was struck by an emergency response vehicle, leading to a request by the Department of Motor Vehicles to reduce the number of Cruise vehicles in service. The new guidelines call for no more than 50 vehicles in service during the day and 150 at night.

A recent decision by the Public Utilities Commission allowed competing autonomous taxi service Waymo to also operate in the city at all hours, so one can speculate as to what might be happening when services are competing for fares. The general manager of Cruise in San Francisco stated that the recent incident was “complicated by the fact that the emergency vehicle was in the oncoming lane of traffic, which it had moved into to bypass the red light.” I’ve been in plenty of situations in urban areas when an emergency vehicle is approaching and it’s difficult to figure out where it’s coming from due to echoes and clutter on the street. It’s also difficult to predict how other drivers might react when you’re deciding how to try to move your vehicle to get out of the way. Data from the company notes that Cruise vehicles have encountered emergency vehicles more than 168,000 times this year, which seems an amazing statistic to me.

The American Telemedicine Association recently rebranded its conference, which is now referred to as ATA Nexus 2024. The upcoming event will be held May 5-7 in Phoenix. I’m not a huge fan of conferences that run on the weekend and also spill into the workweek, making them the worst of both worlds. ATA has moved its conferences back and forth in the last couple of years, so it will be interesting to see whether this format is better attended over time. There is quite a bit of work to be done in telehealth, especially in the legislative and policy arenas. I anticipate this conference will continue to be a hot ticket for those focusing on that particular modality. The conference’s call for speakers is open and interested parties can submit proposals through September 22.

I recently met up with a colleague whose employer provides multi-week sabbaticals at certain employment milestones. We discussed that having time away from work often makes people think about how they manage their time, whether they have acceptable work-life balance, and how they want to manage their priorities moving forward.

My friend spent his sabbatical in a relatively spartan location, leading him to think twice about the luxury he came home to, with its large TV and what he describes as “entirely too much sporting equipment.” He said the most profound thing he experienced was a desire to better explore and experience his hometown, which he felt he’s been limited in doing by the hours he works.

I’m personally a big fan of the staycation, which is a great way to explore your surroundings and figure out what you might be missing out on. Our conversation reminded me of the need to take time for myself, so I’m hiking with a friend this long holiday weekend. Fortunately, the weather has calmed down a little bit, so I’m looking forward to seeing what the trail has to offer.

What are your plans for the long weekend if you’re able to take time off? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 8/31/23

OpenAI releasing version of ChatGPT for large businesses

OpenAI releases an enterprise version of ChatGPT that features enhanced security, privacy, and speed.

Better Life Partners Raises $26.5 Million in Series B Financing

Hybrid substance use disorder treatment company Better Life Partners raises $26.5 million, bringing its total raised to $38 million.

Houston hospital opens tech hub in the Ion

Houston Methodist opens a 1,200 square-foot Tech Hub to showcase innovative solutions it’s implementing in the hospital setting and to promote cross-industry collaboration.

Healthcare AI News 8/30/23

News

OpenAI releases an enterprise version of ChatGPT that features enhanced security, privacy, and speed. The product overlaps the offerings of the company’s investor Microsoft, which provides a similar offering as part of Azure. The ChatGPT service costs $30 per user per month.

Hackensack Meridian Health will work with Google Cloud on generative AI projects, while HCA Healthcare announces similar plans.

Business

Viz.ai will commercialize three ECG AI algorithms that were developed by UCSF. The algorithms detect cardiac amyloidosis, pulmonary hypertension, and supraventricular tachycardia.

AI-powered, message-based care provider Curai Health joins Amazon Clinic’s virtual care marketplace.

Drug maker Bayer expands its digital therapeutics business with a partnership with Mahana Therapeutics, which offers an FDA-cleared digital product for irritable bowel syndrome.

Research

A consumer research survey finds that 82% of Americans haven’t used ChatGPT, 81% of them don’t expect it to have a major impact on their jobs, and 85% don’t think it can help them do their work.

A study of EHR data in Israel finds that AI can predict food allergies in newborns, surprising researchers who found a significant correlation in the exposure of pregnant women to antibiotics. They conclude that the antibiotics may have interfered with the babies’ microbiome, which influences allergy development.

ChatGPT successfully improves the readability of patient consent forms, researchers find, creating versions that are shorter and easier to read. The required reading level dropped from college freshman to eighth grader.

ChatGPT-generated cancer treatment plans are full of mistakes, researchers find, where one-third of the tested plans contained incorrect information. ChatGPT also mixed correct and incorrect information together in a way that made it hard for even experts to detect.

Other

KFF News headlines a story about Bamboo Health’s NarxCare as “Artificial Intelligence May Influence Whether You Can Get Pain Medication.” The software predicts the likelihood that a patient will overdose based on their documented use of narcotics, sedatives, and stimulants. CDC has warned providers to make sure use of the algorithm doesn’t harm patients, such as turning them away for visits or denying them medications for documented chronic pain, and has voiced concern about “proprietary algorithms” whose methods are not transparent.

A startup sells Nextflix-type subscriptions to access the AI clones of celebrities who earn recurring earnings for doing little more than providing content from elsewhere and setting the guidelines for how their clones will operate. Experts fear the chatbot will worsen loneliness and encourage replacing human interactions with “parasocial” ones. The founders noted the success of a YouTube influencer whose “virtual girlfriend” earned her $71,000 in its first nine days.

Contacts

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