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HIStalk Interviews Patrice Wolfe, CEO, AGS Health

December 7, 2022 Interviews No Comments

Patrice Wolfe, MBA is CEO of AGS Health of Washington, DC. This interview was focused on women as health IT executives.

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Not to hit you with the hardest question first, but if you see a company whose executives and board members are nearly all white males, how do you convince them that they may have chosen unwisely?

No kidding, you’re asking the hardest question first. Maybe I’m just an optimist, but I like to believe that the best way to convince people is through performance and through results.

I was on the board of a large company recently and it was nine white men, mostly in their 70s, and two women. I had a hard time convincing the rest of the board that when we had open positions, we needed to be a little more open minded in terms of how wide we would set the aperture for the candidates for the roles. 

I’ve noticed that often when we do searches for senior positions — whether it’s a board position or an executive member of an operating team — all the search descriptions end up sounding like the person must have won a Nobel Peace Prize and walks on water, because we are trying to make the job sound as complete and as attractive as possible. Sometimes we create job descriptions where we’re ratcheting down the aperture so much that five people in the entire country can fit this job description.

When you are trying to drive diversity, you have to make sure you open that up a little bit. You have to let in people who might not be traditional candidates, and you have to be willing to take a chance. To me, the thing that has been the hardest is convincing people that the answer isn’t, “We’re going to hire the best person for the job.” Because the best person for the job often looks like a very traditional candidate, and that does not help us gain ground on diversity.

Is that because it’s comfortable to hire candidates who are like us, or is it the perception that those other candidates aren’t as qualified as they actually are? And would you see the same biases toward female candidates if the company leaders were mostly women?

There’s an element in this that we all gravitate towards people who are more like us. That’s human nature.

I don’t have enough experience with all-women leadership teams to know if that bias exists. There’s not enough N’s out there for me to have a good feel for the answer to that. If I look at my own leadership team, we’re about 50/50 in terms of male/female. That puts me in a great position where I don’t have to worry quite as much about gender diversity.

I’ll tell you what I am typically the most focused on — cultural fit. Is the candidate someone who can thrive in the culture that I’m trying to cultivate? That’s definitely not a gender thing.

I don’t think I have a perfect answer to your question. I’d love there to be more examples of women-only leadership teams out there so that we could tell if they suffer from the same bias.

Given the frequent importance of networking in getting hired, how does networking work differently for women than men?

This is such an interesting point. It’s something that I talk a lot about when I speak about gender diversity at the senior executive level.

The good news is that if you are hiring at the executive level, you are most likely at some point, maybe not initially, going to use an executive search firm. For me, that has always been a great way to meet people I don’t know.

But in terms of the networking element, no doubt the more networked you are, the more likely you are to get tapped for a wider range of opportunities from a career perspective. One of the things that women have struggled with is finding themselves in those situations that maximize networking. Are they invited to certain types of meetings? Are they included in a small group of leaders who might be attending what now are incredibly expensive conferences?

What I’ve seen over the years is that you have to almost make a deliberate effort to include women in these types of activities that end up being great networking opportunities. It has to be a deliberate action. It works well when it is tied to things like recognition of high-performance employees. If you do a good talent review in your organization every year, you can pinpoint those members of your employee base who are high potential. You can deliberately do things such as say, we’re going to earmark these people for attendance at a particular conference, or we’re going to earmark them for presentations to the board on a particular topic that they’re focused on. If you don’t do that stuff, those people lose out on the networking that might make them more well known as a candidate for an executive role.

How do men and women apply and interview for leadership jobs differently?

The Harvard Business Review published a study on this many years ago. I may not quote this exactly right, but I believe that the findings were that women would put themselves forward for a role if they fit 90% of the criteria for the job, whereas men would put themselves forward if they felt they met 60% of the criteria. There’s definitely a difference there, obviously in general, but I do think that this is challenging.

When I mentor women, I raise this point a lot. What’s the worst thing that could happen? You could be told no, you’re not qualified enough for the role. Too often, people might build up in their minds an outcome to putting yourself out there that is far more daunting than what really happens. Sometimes I think it helps just to get people to talk through, how could this play out? And are you OK with how this might play out? Why not try?

This is a general challenge that we have to deal with through mentoring women. Also, modeling the behavior that comes from saying, what the heck, I’ll give this a shot. Maybe it won’t work out, but I’ll probably learn something in the process, at least.

Bias sometimes exists against women who have current or future family obligations. Are the trends of remote work and increased work-life balance changing that?

This is a really interesting point, because so much has shifted generationally. I was guest lecturing at a Wharton Business School class a couple weeks ago in the healthcare track, and I had several interesting comments from the students. They were interactive, it was so fun.

One of the students, a woman, raised the point that nowadays men and women are particularly focused on work-life balance. There is more of an acknowledgement, with younger professionals, of the important rule of maintaining both a balance in your personal and professional life, but also maintaining a level of mental health wellness that people my age never really paid attention to. This woman was saying, what about men taking paternity leave and other types of family related time off? Isn’t that part of how we achieve some of this balance in the workplace?

That is exactly right. Younger professionals are more focused on work-life balance in general, and it’s not a gender issue. We are seeing men taking this seriously also. That’s an interesting thing, that some of this gender distinction is going away.

In terms of work from home, I do believe that the trend towards work from home has made it easier for women to take on roles of greater responsibility. I see this in India, where there traditionally has been a big drop-off in women in management roles, because once they start having children, many women have enormous pressure to not go back to work. Work from home in India has helped to shore up the growth of women in management roles in all kinds of industries. I’m fascinated by how the whole workforce dynamic has shifted with work from home.

What career advice would you give to a woman who is in a director or senior manager role and wants to move to VP or the C-suite?

If you want to get to the top echelon of an organization, it’s important that at some point in your career, you get experience managing P&L. Maybe you just manage a cost center, and maybe there’s no revenue attached to it. Too often, you see women working their way up the ranks in support functions, things like marketing or HR, where they don’t get an exposure to enough of the business side of the organization. Having the ability to run some type of operating unit inside a health system or a software company is an extremely important role, because it gives you exposure to a wide range of the key operating metrics for the organization that are important when people are assessing you for the very top of an organization. I don’t often see that as a focus for people’s career paths, and it’s important.

Always be intellectually curious. Raise your hand when something interesting is going on in your organization that you think you could learn from and that you could add value to. Be willing to step out of your comfort zone to show that you can make a difference in a way that’s maybe a little bit different than how you’ve traditionally been spending your time.

Those are great opportunities to expand your understanding of your organization, to expand your networking. You might work with different people than you’ve traditionally worked with. Also, to expand your knowledge of what you personally enjoy, because too often, we find ourselves down a path incrementally that maybe we’re not happy with.

It’s  important for women to find mentors and folks at senior levels who will support them throughout their career,. I’ve been fortunate to have people in my life like that. Actively searching out the men or the women in more senior roles in their organization who they admire or they think they can learn from, and actively build a relationship with those people, because they can be hugely helpful to you.

The last thing I would say  is to believe in yourself. Stand up for and pursue things that you’re interested in, because we are always our own best advocates and we deserve to be good advocates for ourselves. Having a level of confidence to do that is important.

Morning Headlines 12/7/22

December 6, 2022 Headlines 1 Comment

Carle Health Partners with Health Catalyst to Achieve Data-Informed Improvement

Carle Health (IL) will transition its Clinical and Business Intelligence team to employment with Health Catalyst, which will continue to provide it with analytical support through 2028.

Amazon to End Support Next Week for Third Party Healthcare Alexa Skills with HIPAA Requirements

Citing ongoing evaluation of its offerings and less than a month out from layoffs within its Alexa division, Amazon tells third-party developers that it will stop supporting Alexa 3P HIPAA-eligible skills on December 9.

CMS Proposes Rule to Expand Access to Health Information and Improve the Prior Authorization Process

CMS publishes a proposed rule that would require some payers to implement digital prior authorization processes, shorten the time frame to reply to PA requests, and establish payer-to-payer data exchange, among several other requirements.

News 12/7/22

December 6, 2022 News 4 Comments

Top News

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Marshfield Clinic Health System (WI) lays off its 18-employee telehealth department and shuts down the service, citing system-wide financial challenges.

The health system launched the telehealth service in 2001.

Primary care staff will take over the team’s duties, with IT absorbing the technology functions that include several telehealth platforms.

The system has been transitioning from its 30 year-old homegrown Cattails EHR to Cerner over the last year. Marshfield Clinic said in its Q2 2022 report that the move to Cerner, in a project called One System EHR, has caused “greater disruption to reporting and revenue cycle billing and collections than anticipated and the realization of expected benefits from the system has been slower to materialize.”


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

Remote cardiac patient monitoring consulting and management company Rhythm Management Group acquires competitor Equis Consulting Group.

Carle Health (IL) will transition its Clinical and Business Intelligence team to employment with Health Catalyst, which will continue to provide it with analytical support through 2028.

Business Insider looks at the spectacular unraveling of startup health insurer Bright Health, which went public in June 2021 at a $11 billion valuation but now is worth $600 million as it has downsized to selling policies in just one state. Experts say the company priced its Affordable Care Act plans low to attract members in several markets, but couldn’t manage its costs and processed claims manually even though it bragged on being a technology company.

UnitedHealth Group expects to generate $360 billion in revenue in 2023 with EBITDA of $36 billion. The company expects its Optum businesses (Health for patient-centered care, Insight for technology and analytics, and Rx for pharmacy services) to generate $214 billion of the total.


Sales

  • Digital health platform developer Better selects Lyniate’s Rhapsody health data integration software.
  • Virtual care company Let’s Talk Interactive selects EHR integration capabilities from Redox.
  • Aesthetics practice software vendor Docovia will leverage Clearwater’s ClearAdvantage managed service for cybersecurity and compliance.

People

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The Guthrie Clinic (NY) promotes Terri Couts, RN, MHA to SVP/chief digital officer.

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SolutionHealth (NH) promotes Debra Dulac, RN, MBA to SVP/CIO.

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Baker Tilly partner Travis Drouin will also lead its technology industry practice.

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Herman Kalra, MBA (Orion Innovation) joins CTG as VP/chief people officer.

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Juno Health, the commercial division of Document Storage Systems, hires Michael Bond, MBA (Allscripts) as VP of commercial sales.

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NTT Data promotes Douglas Kelly, MBA to VP/federal healthcare practice lead.


Announcements and Implementations

University of California San Francisco Health and UCSF Dentistry announce they have become the first academic health system in the West to merge medical and dental records into one EHR.

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Russell Medical Center AL) converts from Meditech Magic to Meditech as a Service with help from CareCloud’s MedSR division.

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Mater Private Network in Ireland begins its Meditech Expanse implementation.

QGenda launches a mobile-first solution for nurse and staff workforce management.


Privacy and Security

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CommonSpirit Health reports that some patient data, particularly of patients of Franciscan Health (WA), may have been compromised during a ransomware attack that forced its nationwide facilities to downtime procedures for nearly a month.

As AIIMS struggles to restore its IT systems after a November 23 cyberattack, reports begin to surface that the 2,200-bed health system in India hasn’t upgraded its computers and IT systems in 30 years. Government officials investigating the attack have reached out to E&Y to find out if its cybersecurity audit of AIIMS earlier this year found any vulnerabilities.


Sponsor Updates

  • Censinet adds former Mass General Brigham VP/CIO James Noga to its advisory board.
  • Net Health adds new predictive models to its PointRight Radar care management software to better identify patients at high risk for falls, pressure ulcers, mortality, and hospitalization.
  • Access publishes a new patient e-signature case study, “Northern Regional Hospital: Creating a Better Experience for Healthcare Workers and Patients.”
  • Nordic releases a new episode of its DocTalk series.
  • Agfa HealthCare receives the Cybersecurity Transparent Leader award from KLAS and Censinet.
  • Artera receives the 2022 CHIME Collaboration Award for its work with TrueCare to improve no-show rates, create greater access to care, and help patients gain control of when and how they like to communicate.
  • Azara Healthcare becomes an Accelerate Partner with Athenahealth through its Marketplace program.
  • Oracle Cerner customer Hamad Medical Corp. Qatar has built and equipped the dozens of clinics needed for the World Cup.
  • CereCore wins Best of Staffing Client and Best of Staffing Talent Awards from ClearlyRated.
  • ChartSpan names Saylor Zechman sales development representative.
  • CHIME offers support for the Healthcare Cybersecurity Act.
  • Wolters Kluwer Health publishes a new report, “The Path to Open Medicine: Driving Global Health Equity through Medical Research.”
  • Healthcare IT Leaders adds ERP, EHR, and AMS consulting expertise with five new executive director hires and promotions.

Blog Posts


Contacts

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

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Morning Headlines 12/6/22

December 5, 2022 Headlines 2 Comments

Rhythm Management Group Announces Acquisition of Equis Consulting Group

Remote patient monitoring consulting and management company Rhythm Management Group acquires competitor Equis Consulting Group.

Medication Intelligence Leader Kit Check Rebrands as Bluesight

Medication supply chain software vendor Kit Check changes its name to Bluesight.

UCSF is First to Integrate Records Across Medical and Dental

University of California San Francisco Health and UCSF Dentistry announce they have become the first academic health system in the West to merge medical and dental records into one EHR.

Curbside Consult with Dr. Jayne 12/5/22

December 5, 2022 Dr. Jayne 2 Comments

This weekend was all about starting some end-of-year organization and making a plan for conferences and travel for 2023.

I’ll be attending many of the same conferences I did this year, but might throw in a couple of new ones if the dates work out. I had mentioned after the HLTH conference that I was disappointed in the lack of COVID precautions, so I was happy to see that HIMSS has an entire Health and Safety section that attendees must agree to. We all know that many people don’t read the details of “terms and conditions” type documentation, and even if they do, there’s no guarantee that they will follow the rules. However, it’s good to see a common sense approach to public health since it addresses not only COVID, but other communicable diseases.

Long story short: If you have symptoms of any communicable illness, including COVID, within five days preceding the conference, you need to stay home. You should also stay home if you’ve tested positive for anything, or if you’ve been in contact with anyone who is confirmed or suspected of having a communicable disease.

These are generally good rules for any gathering. I think that many people want to push back against any kind of health and safety measures because we’re all fatigued from talking about it the last few years. However, we seem to have forgotten the crud that everyone used to catch at HIMSS and bring home with its associated sore throat, runny nose, and fatigue.

HIMSS left the door open for other measures, including the possibility of “vaccination, proof of COVID status, self-monitoring, biometric screening, symptom checkers, contact tracing, use of personal protective equipment and social distancing, or other similar measures.” These will be determined at the time of the conference and will meet or exceed local public health requirements.

My in-person clinical colleagues are absolutely drowning in sick people right now, and the numbers they’re seeing in the emergency department and urgent care settings are commensurate with what they were seeing during the worst COVID surges. Flu is surging in my area and I’m not seeing any public health messaging encouraging people to stay home or to get tested, so I guess we’ve just collectively decided to let it rip.

This time of year, things are generally fairly slow in the realm of healthcare IT. Most of the large healthcare organizations I’ve worked with are out of money by now if they are on a calendar-based fiscal year and are waiting until January rolls around to sign contracts and start new projects. Given the economy, there are a lot of hiring freezes in place, and I don’t see that changing soon. Even in organizations that have fully funded and staffed healthcare IT projects that they were going to complete in December, I’m seeing things placed on hold because the clinical teams that the projects would involve or impact are being absolutely buried. If the flu season curves hold the same shapes they have had in pre-COVID years, it might be several months before these initiatives are pulled off the back burner.

I also spent part of the weekend trying to clean up an ever-ballooning inbox. It seems like when I unsubscribe from a newsletter, two new ones take its place. I was happy, though, to stumble across this article from JAMA Network Open which looked at “Accuracy in Patient Understanding of Common Medical Phrases.” Now that patients have full access to most of the notes and documents generated in the course of their care, it is more important than ever for clinicians to write in a clear manner that patients can understand. The authors surveyed 215 adults outside the medical setting and gauged their understanding of commonly used phrases (in case you are curious, the outside venue was the Minnesota State Fair.) Where 96% of patients knew that “negative” cancer screening means they didn’t have cancer, fewer patients (79%) knew that “your tumor is progressing” wasn’t good news. An even smaller number (67%) knew that having positive lymph nodes meant that cancer had spread.

The authors discussed the possibility of confusion around words such as “negative,” which means something good when it is associated with a screening test, but means the opposite in other contexts, such as “negative reviews” or “negative feedback.” They also spent some time discussing medical jargon and noted a concept which was new to me: that of “jargon oblivion,” which refers to the mismatch between our intent to avoid jargon and the reality of our frequent use of it.

While medical jargon is one thing, acronyms are another entirely. I’ve seen plenty of patient-facing notes that have acronyms that don’t immediately register with me as a clinician, so I can only imagine the confusion that patients have as they are trying to understand it. If I search something and it’s four or five entries down on the Google results, then I would feel safe in suggesting that clinicians probably shouldn’t be using it. “NPO,” which is a Latin-based phrase for “nothing by mouth,” was one of the items tested. Other medical words such as “febrile” were included. The researchers noted that the use of the phrase “occult infection” was interpreted by those surveyed as having something to do with a curse than being associated with a hidden infection.

The authors noted a concern for bias since they selected state fair attendees who were attending a university-sponsored research exhibit. A more generalized sample of the community might produce differing results. Participants who agreed to take part in the survey received a backpack with the University logo. As a visitor to several different state fairs, I think I woud be more motivated to participate if there was the potential for a funnel cake or perhaps a fried Twinkie at the end.

The authors suggest that further studies would be helpful to boost understanding of how patients understand medical jargon, as well as to test recommended alternatives to improve communication with patients. The study involved both audio and written test questions and there was no difference in the results, allowing researchers to conclude that the less time-intensive written approach would be valid for future studies. If anyone is looking for a research assistant who knows how to deep fry things, I might know someone who is available.

What’s your favorite state fair food? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Matthew Condon, CEO, Bardavon Health Innovations

December 5, 2022 Interviews No Comments

Matthew “Matt” Condon, JD, MBA is founder and CEO of Bardavon Health Innovations of Overland Park, KS.

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Tell me about yourself and the company.

I’ve been in employer-driven musculoskeletal health for the  last two decades. I grew up in Iowa, went to grad school and law school, and got passionate about this space. I was fortunate post-law school to relocate to Kansas City, which was the home of Cerner. There’s a Cerner halo here in Kansas City and a lot of people, including the founders, were important to me in the early stages and helped guide me in my career.  

I have been on this journey for a couple of decades, building companies that were specifically aimed at supporting employers in how they optimize the musculoskeletal health of their employees. I’m really fortunate to have built a couple of companies here and I am proud and thankful to call Kansas City my home.

Bardavon was formed in 2014. It is absolute love of mine, intellectually. We partner with employers, or the carriers who represent them in some cases, to optimize the musculoskeletal health of their employees. This ranges from preventative through post-injury solutions that are offered in a hybrid manner at work, in the clinics, and at home. All coordinated, all collaborating, and all aimed specifically at improving the lives of the 60 to 80 million US workers that make up the labor workforce in this country.

Our biggest differentiating factor is that we have seen the spectrum move from all-in clinic to this digital-only focus, and I believe that we are the only people in this space that offer a truly hybrid approach. We have digital solutions that we incorporate, engage, and coordinate, but we also have a nationwide network of over 25,000 physical and occupational therapists that utilize our solutions in an integrated manner aimed at improving the health of the one patient-employee in front of them and the tens of thousands we serve on an annual basis.

How competitive or cooperative are you with the providers that contract with you?

They are partners and we are really proud of that. The first business I had was on the provider side, where I built a company and sold it to a publicly held company. That understanding of the provider realities, the environment that they work in, and what they are aimed at is important to who we are, and maybe why we bring such value to them. We partner with those providers. They get out of their EMR and into our platform for the patients that we send them from the employers that we work with, who want exceptional care for their injured employees.

It is double-sided marketplace, but one that I am proud of on both ends. We feel partner-focused. It is our job to get employers around the country the best healthcare for their injured employees. It is also our job to make that environment for the providers who are treating them efficient, clear and communicative, and collaborative so that they know what success looks like for their employers. They can aim at it and they are rewarded for achieving it.

We’ve seen MSK technology evolve from range-of-motion home exercise coaching that ran on consumer gaming systems and now to technology platforms that include apps and analytics. What is the best use of technology for MSK issues today?

Acuity levels drive the appropriateness of the solution that you put in place. But in the end, the in-person provider relationship experience has never been more important than it is now. Coordinating that with digital solutions that enhance it, especially as you get to a certain level of acuity, just makes sense, and it works. 

The provider community was maybe generally reluctant to engage with digital solutions, but now at least the 25,000 providers we partner with use it because they see that when it is added into their plans of care and added into their care experience for their patients, they are getting better outcomes.That is what those providers want, especially when they are rewarded for it with more referrals from those employers that are looking for that better experience.

All this digital solution application was thrust at the marketplace. Ironically and tragically, though, there weren’t a lot of innovative solutions provided for the American worker, that 60 to 80 million men and women that build our roads, build our buildings, fight our fires, and protect our streets. There’s a unique engagement environment for them. They are unique in that with regard to MSK, their job is the biggest risk factor to their health. No solutions were targeted specifically at them. We think that is a mistake and an opportunity that Bardavon is uniquely fulfilling.

Do employers see workers’ compensation as a problematic expense where providers may take advantage of them or bill for services whose value can’t be proven?

It’s all of that, and there is validity to all the reluctance to enter into this marketplace. Some of it is more structural. Workers’ compensation care — how we address and impact our associates that are hurt on the job — is siloed in a completely different and often disconnected part of the structure. It’s actually property and casualty that your workers’ comp comes under. Your trucks, your equipment, your property, and the workers’ comp injuries are housed in a different silo of the insurance industry. That has created an environment that historically had us treat these individuals as widgets and line items on Excel spreadsheets. 

Today’s reality is that we have this labor shortage and this massive need for these people to be healthy, happy, and productive at work. That has created an environment where the perspectives are evolving. That is tailwinds for us for sure, that employers and carriers are understanding that we have to reevaluate the way that we address this marketplace. They aren’t widgets and they aren’t line items, they are people and they carry with them functional issues that either do or don’t help them do their job effectively. Bardavon is leading in this solution set of providing that group with appropriate, effective tools that they can engage and utilize to improve their lives and improve their productivity and work culture as a result.

A lot of people are trying to solve MSK and workers’ compensation. The MSK health of the American worker has been historically neglected, but we feel that the evolution that needs to happen in the MSK space is best launched from workers’ comp. There’s a number of reasons that make it the most advantageous place to launch it, and we believe that that will happen and are excited about it.

You realized that your previous company, ARC Physical Therapy+, had reached a scale problem where you could only grow so much being tied to bricks-and-mortar operations. You also found that the insights available from data were more valuable than actually delivering the service. How did you apply that experience to Bardavon?

That’s exactly right. We went in with a belief in this unique way of addressing the marketplace, going to employers, building clear value propositions, and clearly aligning the incentives of the provider and the payer around the function of the patient. We believed that was the right thing to do. And as you indicated, we changed a marketplace because of it. We had employers change the way they helped their employees navigate the healthcare system to get access to our clinics for the data.

As I mentioned early on, I was fortunate that we built a great company and I was really proud of it. It was, in part, the founders of Cerner — Cliff and Neal a little, but Cliff in particular – who challenged me that we had a national business that we were choosing to operate locally, and shame on us that we were not thinking bigger. At that time, the world had changed. The cloud had come along, and housing those solutions within the bricks and mortar of the couple of dozen clinics that we owned didn’t change a national marketplace, it only changed a local one. 

We believed that we could evolve the company to no longer be beholden to the bricks and mortar, but to partner across the country with providers and payers that cared. And in so doing, not just change the health and healthcare experience of the employees, but find out which providers in every ZIP code of this country were healing patients in a way that was quantifiable and objective.

That is an exciting part of what we do today. We get stronger every day in knowing who is actually healing patients in a way that we can measure, not based on CPT codes or bills, but whether or not their patients are returning to a level of function. That is, I believe, the most transparent and beautiful reflection of healing in healthcare.

How much of the company’s success and ability to scale was driven by requiring providers to document patient progress in your own proprietary platform?

It is bi-directional. It’s not just that they are documenting and sending us the data. We are telling them at eval what success looks like for that employer, what success looks like for that employee who is injured, and what their functional job demands are. There is no guessing, there is clarity. Then we create this beautiful feedback loop that updates and gets better every second of the day about what providers are doing in other parts of the country with like patients with like return-to-work requirements, that are optimizing their outcomes and doing it efficiently and effectively.

All of that is a dream and a vision. Healthcare providers went to school with the hope that they would be in that environment. Most of them, or maybe all of them, got pushed into an environment that historically and traditionally didn’t facilitate that. We had to ask the providers to do something unique to get there. 

Asking them to get out of their EMR and into our platform is not easy. It’s incumbent upon us to make it as seamless and intuitive as possible, but more than that, it is incumbent upon us to make the providers believe that their dream of why they went to school is our dream. To create a system where good providers get more patients and benefit from that, and bad providers don’t. Creating an environment where providers know what their incentive is, and where employers or payers know that because they are partnering with Bardavon, they are getting access to the best providers in every community that are uniquely focused on the same goal that the employer wants, getting that employee back to work and effectively doing their job.

You used the word “grind” several times in an interview, talking about your college athletics experience where a bigger and more athletically gifted opponent knocks you down and you have to get back up and do it again. How does that personal philosophy translate into a business culture, especially in an environment where employees might not be as willing to sacrifice their lifestyle for company benefit?

I was blessed to not be exceptionally good at anything. It taught me the importance of work and that I could succeed if I would outwork others. My parents and growing up on a farm were surely a part of that, but the fact that I wasn’t blessed with any exceptional talent really was a blessing. It helped me, and that transcended from sports to business. The Midwest is part of that.

In all of the healthcare, and specifically now in every industry like this, I guess there’s always a level of negativity and a level of suspicion about whether people are doing the right thing. This business has been my choice to pursue my entire life, in large part because if you spend time with these patients, they are incredibly inspiring.

My entree into workers’ comp was working with professional athletes who were hurt. I saw all the technology and all the science that was aimed at getting a professional basketball player back to the court or professional football player back on the field. When you are able to take a piece of that and provide it to firefighters, police officers, and laborers who are doing their job very specifically to support their husband, wife, kids, families, friends, whatever … there are always bad actors and characters, but predominantly it is a remarkably inspiring client base and I’m proud of what we can do. It keeps me guided to grind every day.

The other side of that is those providers, specifically the physical and occupational therapy providers who spend so much time with their patients. An hour a day, three or four times a week, for five to six weeks. It’s a very intimate relationship. They put their hands on them and they help them regain the function they once had. They hear about their families and they hear about their personal lives. It is a really beautiful sector of healthcare that has been historically neglected and forgotten. I’m proud of the focus that we can put on it through our own grinding effort.

How will the company change over the next few years?

Cliff and Neal were always clear about having a vivid description of a desired future state. Keep that at the forefront of everything you are doing and why you are doing it. We believe that Bardavon will continue to evolve into a company that represents excellence in the way that employers treat their employees, specifically around MSK health. We will facilitate meaningful and intuitive technologies, services, and when appropriate, exceptional patient care for those associates, so that they know that when choosing an employer, they will assess whether or not that employer works with Bardavon. The providers they work with around the country will see that as a part of brand associated with quality and caring for them as people in their roles and jobs and lives.

I believe that we are on the precipice of that. I believe that as we grow and become the company that we can, that others in this space copy us and take that approach to other parts of the healthcare spectrum and continue to improve their lives as well. That’s probably a bold prediction, but I believe it.

Morning Headlines 12/5/22

December 4, 2022 Headlines 1 Comment

National 988 mental health hotline back up after outage

The FCC and HHS will investigate the cause of the daylong outage of the national mental health emergency phone hotline, which is managed by emergency communications software vendor Intrado.

Telehealth department dissolving, Marshfield Clinic Health System facing financial difficulties

Citing financial reasons – some of which stem from the expense of its new EHR, Marshfield Clinic Health System (WI) lays off 18 employees as its closes down its telehealth service.

Hackers dump more customer data from Australian insurer Medibank

Hackers release onto the dark web what they say is the entirety of Medibank patient data stolen in an early November ransomware attack.

Monday Morning Update 12/5/22

December 4, 2022 News 4 Comments

Top News

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Healthcare consumer engagement company Carenet Health acquires Stericycle Communication Solutions, which offers online scheduling, automated messaging, and call center services.


HIStalk Announcements and Requests

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I could be convinced to change my “most important winter holiday” order of importance after reading a poll comment from Cyrus about Yalda. Yalda celebrants, most of them in Iran and nearby countries, observe the winter solstice (December 21 this year), the last day of autumn and the longest night of the year, after which hours of daylight start increasing again. People stay up all night, eat watermelon and pomegranates (their glowing colors symbolize dawn and life), read poetry, and dance and play drums when the sun rises in a triumph of light over dark. Yalda means “birth.” I like it even beyond my personal obsession with changing hours of daylight — nobody is excluded or favored since the same sun shines down on us all, although I suppose folks in the Southern Hemisphere would need to buy their Yalda pomegranates in June. 

New poll to your right or here: As a patient, would you be OK with your provider billing you personally for the time they spend answering clinical questions via patient portal or email? My immediate response to my own question was that of course professionals should charge me for their time that I consume voluntarily, regardless of the modality by which it is provided, but healthcare is different – will they tell me in advance that the clock is running, aren’t they already charging me ridiculously high prices without having to nickel-and-dime me over portal messages, will they bill only for new clinical work and not administrative questions or follow-up inquiries triggered by their lack of clear explanations, and should I be paying cash when I have insurance?


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Welcome to new HIStalk Platinum Sponsor Bardavon. The Overland Park, NS-based company partners with employers to optimize their employees’ musculoskeletal health with both preventative and post-injury solutions offered at work, in clinic and at home. Bardavon differentiates from digital-only players by combining a hybrid approach to MSK optimization that is bolstered by a nationwide network of 25,000 physical and occupational therapists who are focused on the holistic health of the American worker. Bardavon’s unique focus on an often-forgotten subset of the worker population, those who do the manual labor in America, positions them in a unique category as they launch into the commercial sector with a focus on a complete offering enabling both healthy and injured employees as they work to optimize their movement health resulting in positive, long-time health benefits for both the employees and the employer. Thanks to Bardavon for supporting HIStalk. Thanks also to the company and long-time HIStalk reader SVP/GM Alex Benson (who worked for Cerner for many years) for making a generous donation to my Donors Choose project this past April that fully funded 41 teacher grant requests.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Atrium Health and Advocate Aurora Health complete their merger to form Advocate Health, now the country’s fifth-largest health system with 67 hospitals, 1,000 sites of care, 150,000 employees, 21,000 physicians, and 42,000 nurses.

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Advanced primary care services and technology vendor UpStream Healthcare raises $140 million in a Series B funding round, increasing its total to $185 million.

Investor-backed mental health startups – some of which were formed to exploit COVID-relaxed prescribing rules — failed to disrupt mental healthcare, Business Insider concludes, because they spent too much on advertising to attract patients and found that the direct-to-consumer model doesn’t work well because patients aren’t willing to pay. A former provider for Cerebral, which is best known for generating many prescriptions for Adderall and Ritalin, says she was allowed to spend just 15 minutes every three months with each patient.


Sales

  • Dayton Children’s Hospital will implement VisiQuate’s Denials Management Analytics and Revenue Management Analytics solutions.

Announcements and Implementations

I rarely mention open positions, but CHIME has an interesting one for director of innovation that does not require relocation.


Other

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A Washington newspaper describes the chaos at St. Michael Medical Center during a weeks-long ransomware downtime that affected parent organization CommonSpirit Health:

  • Staff could not access Epic, so switching to paper – by many employees who have never charted manually — caused ED and ambulance backups and caused an overwhelmed ED nurse to call 911 for help.
  • Employee timekeeping system caused payroll problems that still haven’t been fully resolved.
  • Staff had to take the word of patients about their meds, allergies, and recent procedures, even those who were probably not reliable.
  • Medications were dispensed without pharmacist oversight.
  • Patients were found in the ED waiting room who weren’t on their list to be seen.
  • Staff treated “scoop and run” patients who were brought in after incidents in assisted living without knowing their code status, intubation preferences, or if they wanted their families to be called.
  • Complaints that have been filed with the Department of Health claim that the hospital didn’t provide safety checks while Epic was down, allowed ED capacity to be exceeded by not allowing diversion, and required two hours or longer to provide lab and imaging results. One complaint says that routine labs for ICU patients took longer than 13 hours and stat labs weren’t reported for up to five hours.

A ProPublica investigation finds that publicly traded hospital operator Universal Health Services has pocketed $38 million in Washington state taxpayer funds over five years for running special education day schools in which underpaid, poorly trained employees taught students without a published curriculum and sometimes isolated and restrained them. The state paid annual tuition of $68,000 to $115,000 per enrolled student. Experts say that UHS, which earned $1 billion in profit last year, is one of several investor-funded companies that have targeted private special education and autism services because the revenue is steady and publicly funded.

Cardiologist Eric Topol, MD covers “medical selfies” in which he used a smartphone-based ultrasound device whose instructions came from YouTube. He says that US healthcare provides no incentive for using the devices because providers make money from traditional sonographer studies, but the technology is being used in other countries. He also notes the recent contribution of AI that allows anyone to perform a screening echocardiogram as guided by the app.

Police arrest a 72-year-old hospital inpatient in Germany who turned off the “noisy” oxygen machine of her room’s other occupant several times, requiring that patient to be resuscitated and moved to ICU.


Sponsor Updates

  • Premier’s Pinc AI Applied Sciences Division publishes a new study in Wolters Kluwer’s Journal of Wound, Ostomy, and Continence Nursing, “Characteristics, Hospital Length of Stay, and Readmissions Among Individuals Undergoing Abdominal Ostomy Surgery: Review of a Large Healthcare Database.”
  • Sectra publishes a new case study featuring St. Maria General Hospital, “How to save time on implementation while creating brilliant workflows.”
  • Volpara Health customer Virginia Mason Medical Center presents the results of the largest mammographic image quality evaluation to date, “Reduction in technical repeat and recall rate after implementation of [Volpara Health’s] artificial intelligence-driven quality improvement software.”
  • TigerConnect appoints former Cooper University Health Care CEO Adrienne Kirby to its board.
  • Wolters Kluwer Health adds a medication tray management solution to its Simplifi+ Compliance Suite.
  • Vyne Medical publishes a case study, “Refyne Connected Care Supports Virtual Collaboration among Montana Pediatricians.”

Blog Posts


Contacts

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

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Morning Headlines 12/2/22

December 1, 2022 Headlines No Comments

Carenet Health Acquires Stericycle Communication Solutions, Creating Industry’s Most Comprehensive Healthcare Consumer Engagement Company

Patient engagement vendor Carenet Health acquires competitor Stericycle’s Communications Solutions business.

UpStream Raises $140 Million Series B Round to Scale Value-Based Care Model Nationwide

Tech-enabled primary care services company UpStream Healthcare raises $140 million in a Series B round, bringing its total raised to $185 million.

Widespread outage shuts down 988 mental health hotline

Communications technology company Intrado works to restore service that powers the national 9-8-8 mental health hotline.

News 12/2/22

December 1, 2022 News 1 Comment

Top News

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NextGen Healthcare will acquire Chapel Hill, NC-based value-added reseller TSI Healthcare, which sells specialty-specific NextGen solutions, for $68 million.


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

Therapy Brands acquires behavioral health EHR vendor The Echo Group.


People

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David Graham, MD (Graham Healthcare Advisors) joins LifeBridge Health as VP/CMIO.

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AvaSure hires John Vaillancourt (RaySecure) as CFO; David Roth, MS (FDS) as chief marketing officer; Chris Kocsis, MPA (CoSource Consulting Group) as chief people officer; and Jacob Hansen, MBA (Calyx) as chief product officer.

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Bill Kloes (OnPointPX) joins Navenio as COO.


Announcements and Implementations

NHS England makes a last-minute change to its plan to automatically enable patient viewing of their primary care records via the NHS app, moving to phased rather than mass rollout in which individual practices will be notified in advance before records of their patients are made visible. Practices that asked EHR vendors EMIS and TPP to not enable the records access will have those requests honored as support plans are developed. The changes were announced on November 29, the day before the scheduled automatic activation.

Merative, the former IBM Watson Health, will stop making current and historic pricing information for specific drugs available to media outlets following complaints from drug companies.


Privacy and Security

An HHS OCR bulletin reminds covered entities and business associates that any website tracking tools they use cannot disclose protected health information. OCR specifically warns that sharing PHI with tracking technology vendors for marketing purposes, such as Meta Pixel, constitutes impermissible disclosure under HIPAA.

The Wyoming Supreme Court rules that a hospital must provide the parents of a newborn who was diagnosed with cerebral palsy the audit trail records of its Centricity EHR. Riverton Memorial Hospital provided records from its hospital management system, but refused to provide the Centricity audit trail, saying that the information was irrelevant, not part of the medical record, and had also been lost. The court ruled that the hospital hadn’t looked hard enough for the record, such as checking the backup server.


Sponsor Updates

  • First Databank names Tu Tran clinical pharmacist, Payton Corn operations technical analyst, and Alex Givens associate product manager.
  • Get Well will present at Next Generation Patient Experience 2022 December 5 in Indian Wells, CA.
  • Healthwise announces that it has been recognized by Avia Connect as a top company in patient education.
  • Sphere integrates its TrustCommerce platform with Veradigm Practice Management.
  • InterSystems releases a new Healthy Data Podcast featuring Divurgent CEO Ed Marx.
  • Meditech publishes a new case study, “Major Health Partners uses Meditech to improve home medication verification workflow in the ED.”

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 12/1/22

December 1, 2022 Dr. Jayne No Comments

There has been a lot of discussion in the patient engagement world, as well as around the virtual physician lounge, about the announcements of some health systems that they are going to start to charge for patient portal messages that involve medical advice.

Most physicians I’ve spoken with agree that the surge in patient portal messages during the last three years is contributing to burnout, not only among physicians, but with staff. EHR vendors have been hard at work helping their clients understand the types of messages they are receiving so that clients can work on optimization efforts. At least one vendor has even gone as far as working to filter out messages that contain little more than “thank you” in an effort to reduce the sheer volume of messages in clinician inboxes.

The elimination of the thank you-type messages is fairly controversial. Some clinicians like them and see them as a small bright spot in the drudgery of the inbox, but others see them simply as an annoyance.

Despite the information that is available to organizations about the types of messages they are receiving, quite a few organizations I’ve worked with aren’t even taking the basic steps needed to help tame the inbox beast. Let’s take medication refills, for example. In some systems, this is a good chunk of patient portal requests. I don’t see people looking deeply at why patients are asking for refills via the patient portal. For years, even going back to the world of paper, practice management experts have advocated for providers who treat chronic conditions to issue up to a year of refills during the chronic condition visit. People still don’t do this, and when I shadow in physician offices, I hear statements like “just call us when you need a refill,” which is absurd in this day and age.

As organizations moved to EHRs, there was a migration to have refills requested through the pharmacy, where the transaction could come electronically and be vetted against the patient’s existing medication list for a quick refill. That workflow led to tools that were deployed on top of the EHR (one of the best ones I have ever seen was homegrown at a New York provider group in the late 2000s) that would evaluate certain metrics such as recent lab results and past visits and give the nursing staff a red-yellow-green indicator on whether they could issue refills through a standing order or a delegated refill policy. Other solutions followed, but organizations still didn’t fully embrace them.

Now the pendulum has swung back to where we were in the 1990s, which is the patient asking for a refill in narrative form via a patient portal message. This is the equivalent of calling the office and speaking with someone or leaving a message on a voice mail “refill line.” Patients aren’t even being asked to select a medication from their current medication list, but instead are typing it out. They may not have the name or dose correct, which increases the work for the practice as well as the risk of medical errors. Often there are better tools within the patient portal, but they simply haven’t been deployed yet because leadership feels they are not a priority.

Fast forward to every day in a primary care physician office, where everyone is at their breaking points. Physicians are spending hours each day, often at home, handling refills and messages. Two decades ago, we thought this was infrequent and somewhat subjective, but now our sophisticated EHRs can deliver reports about provider work after hours and it’s clear that a good portion of the workday is occurring in places other than the clinician office.

Often that after-hours work involves what we traditionally define as patient care, which includes explaining or re-explaining things to patients, looking through charts for information to send to a patient, coordinating referrals and follow-ups, and more. This is uncompensated work and it makes sense that clinicians are pushing back against it, leading organizations to consider hiring staff to assist in managing the inbox. Thse resources cost money, hence the move to charge for what has largely been uncompensated care. I say largely uncompensated because in value-based care models, compensation for these non-visit efforts is included in the payment equation in other ways.

In looking at some of the health systems’ documentation on how they plan to charge for patient portal messages, most of the approaches are well reasoned. Organizations are clearly saying that they will charge if a response requires the medical expertise of a licensed provider and requires more than a few minutes of time. Looking at one institution’s website, I found some details. Messages are primarily being billed to health insurance, with varying charges being passed on to the patient. For most Medicare patients, those messages will have no patient cost or a small charge ($5 or so), but for Medicare Advantage plans, it might be up to a $20 co-pay. Medicaid resulted in no charge to the patient, and private insurance ranged from a standard office visit co-pay up to a full $75 charge if the patient has not yet met their deductible.

That particular system is using the CPT codes for online digital evaluation and management, which are time-based. The codes can be billed cumulatively every seven days, so if a message generates a lot of back-and-forth responses, the work can generate a higher level of service. The websites are typically clear on what kinds of conversations will generate the code, including a new issue or symptoms requiring clinical assessment or referrals, medication adjustments, flares of chronic conditions, and requests to complete forms. The latter is a huge time suck for primary care offices and many practices have been charging for completion of forms for years, so I’m not surprised at all by that one. Refill requests or conversations that lead to a scheduled visit aren’t charged, nor are follow-ups related to a surgery with a global billing period.

This type of process is going to be an adjustment for patients because they are used to not having to pay the full value of the services they’re receiving. The presence of insurance in our society has led to a general lack of awareness of the value of provider and staff time, as well as the cost of truly delivering care. Consumers are already used to seeing surcharges on restaurant bills and other invoices for work that was previously free, so at this point, it shouldn’t be as much of a surprise as it feels like. Everyone’s just trying to stay afloat, and it will be interesting to see how the use of these charges plays out over time.

Is your organization charging for certain services delivered via the patient portal, and how is it going? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/1/22

November 30, 2022 Headlines No Comments

NextGen Healthcare Announces Agreement to Acquire TSI Healthcare

NextGen Healthcare acquires practice-focused health IT reseller TSI Healthcare for $68 million.

Therapy Brands Acquires New Hampshire-Based The Echo Group

Therapy Brands acquires The Echo Group, a behavioral health EHR vendor based in New Hampshire.

Automatic roll-out of Citizen Access to GP records halted at eleventh hour

Citing patient safety concerns and a lack of preparedness, NHS England halts plans to give patients access to their medical records via the NHS app.

Readers Write: It’s Time to Level Up Value-Based Care by Integrating Real-Time Patient Insights into Workflows

November 30, 2022 Readers Write No Comments

It’s Time to Level Up Value-Based Care by Integrating Real-Time Patient Insights into Workflows
By Rob Cohen

Rob Cohen, MS, MBA is CEO of Bamboo Health of Louisville, KY.

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The push for transformation in healthcare is ushering in a new era of care that focuses on delivering better patient outcomes, at better costs, and with better experiences to drive value-based care (VBC). In pursuit of this vision, governing bodies such as the Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS) are working to implement changes to improve the quality of care nationwide. While this work is a step in the right direction, it has major implications for healthcare providers on the frontlines of care delivery.

For example, CMS has set the expectation that all Medicare beneficiaries must be covered by VBC models by 2030, meaning that the need to meet quality measures will only increase in the coming years. This is concurrently happening when many of the adjustments that afforded health plans some flexibility in CMS Star Ratings measures during the COVID-19 public health emergency (PHE) are about to expire. As such, health plans and provider organizations are seeing a significant impact. Findings released from CMS this October highlighted that the number of Medicare Advantage plans with drug coverage with a Star Rating of four or more in 2023 is down 68% compared to 2022.

To combat these challenges, real-time patient data is one of the most critical tools available that can help improve quality measures in alignment with VBC goals. However, today, patient health data is often disjointed, delayed, and overwhelming for providers to manually sift through. Without patient information seamlessly flowing with patients as they go from one point of care to the next, healthcare professionals often lack an easy way to surface treatment gaps and provide context to the care they previously received. This fragmentation and data overload add friction for healthcare providers, which causes clinical and administrative burdens, and ultimately, leads to missed opportunities to positively impact patient care.

Digital healthcare technology solutions can address this disconnect by shifting the focus from simply sharing as much raw data as possible towards providing health plans and providers with real-time insights directly in their clinical workflows during high-impact moments. In turn, this helps providers ensure patients are receiving the right care interventions, at the right time, for the right outcome.

Accomplishing this requires technology that enables quick, fluid insights shared among providers, and between health plans and providers, to ensure the identification and solving of gaps in patient care. By offering healthcare providers actionable insights within their clinical workflows, they can more easily pinpoint patients who could benefit from follow up and transitions of care support.

This is especially true during high-impact moments in a patient’s care journey such as medication checks care transitions, post-treatment follow-ups and screenings, where complete insights can make timely follow-up care and achieving associated quality measures more attainable. During these critical moments, enhanced care collaboration efforts and improved real-time intelligence sharing help to bring care gaps to light, as well as support quality measures that have been built into VBC models such as CMS Star Ratings and HEDIS measures.

From there, providers can make informed care decisions and implement corresponding workflows for timely, effective post-discharge transitions and follow-up treatment to increase member engagement. Furthermore, the increased adoption of and adherence to evidence-based guidelines and technologies for care gap closure can help healthcare organizations lessen information barriers and misaligned workflows between providers and health plans to increase revenue and alleviate clinical and administrative burdens. 

As we look to the future of healthcare IT, technologies that identify and solve care gaps will position providers for the most success. By helping health plans and clinicians more effectively collaborate and engage patients during the high-impact moments that matter, these technologies can enable more-informed care. In turn, this improves patient outcomes, lowers costs and drives the industry towards a greater adoption of VBC.

HIStalk Interviews Joshua Pickus, JD, CEO, Net Health

November 30, 2022 Interviews No Comments

Joshua “Josh” Pickus, JD is CEO of Net Health of Pittsburgh, PA.

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Tell me about yourself and the company.

I am a serial CEO of technology companies. This is the second healthcare tech company that I’ve run. Net Health is a EHR and analytics company that is focused on medical specialties, such as therapy and wound care.

How do the EHR needs of skilled nursing facilities, senior living operations, and home health differ from those of hospitals?

Let me give you an example to make this real. I’ll do it in terms of physical therapy. In some respects, there are real commonalities. In all cases, you need to accurately document the care in a way that is compliant with the reimbursement codes. You need to do that whether you’re in a hospital, a skilled nursing facility, or an outpatient clinic.

But there are very important differences, and they often end up having to do with things like integrations. In a hospital context, in most of our situations, it’s critical that our systems interoperate with major hospital EHR players such as Epic, Cerner, and Meditech. Making those integrations seamless is frankly as important as the functionality that we have in our own product.

If you contrast that on the other end with, say, a outpatient clinic or facility, that’s a much less critical piece of what they do. They probably don’t have a direct interface with Epic, and that’s not that important to them. Skilled nursing facilities are somewhere in the middle. There are key integrations, principally to PointClickCare and MatrixCare, but it’s different players. Our functionality may be quite different, but the integrations to other systems are quite different among settings and are very important.

The early days of COVID forced hospitals to coordinate with post-acute facilities to free up beds, and CMS added some requirements around that coordination. Is that data sharing relationship among types of entities improving?

Yes. We are unique in that in the specialties we serve, we are really hospital-to-home. We have to think about that stuff. You are right that the pandemic brought those issues to the fore. As a result, the pace of progress has improved.

But the core issue is still simple. There isn’t a common system or even a common accepted language to go from hospital to home, to transmit core patient data seamlessly, easily, and accurately. We are focused on the FHIR standard, which is the closest thing we have right now to a standard that lets different systems at different parts in the continuum talk to each other.

A lot of our work is on improving our FHIR capabilities and making it truly seamless, so that basic information can easily pass from one setting to another in a way that the recipient and the provider of the information actually know what’s going on. You would be shocked that basic stuff — like if you’re a nursing home and you want to know something beyond the patient’s name and age, such as the existence of any behavioral health concerns —  isn’t as easy as you would think given that it is a specific, easy thing that you get every time. Working through FHIR to improve that interoperability continues to be a key focus and challenge for us.

How do you expect the hospital-at-home and remote patient monitoring concepts to play out?

I would respond differently to the two things you mentioned, in terms of the timeframe. Remote patient monitoring is here. It’s real. It’s in use. It’s quite valuable. I think it will expand and pretty dramatically. Hospital-at-home is interesting, but in its infancy and less likely, in the near to immediate term, to affect the way that care is delivered. 

We are more focused on remote patient monitoring and all types of remote care, even if the locus of care is still a hospital-based physician. There are a lot of things that can be done by that physician or caregiver without the patient in the room. That feels real to us, and we are introducing all kinds of capabilities to support that trend.

Will device connectivity and integration issues present challenges?

In the grand scheme of things, the technology is the least of the problems. If you break it down, think about the most basic form of telehealth, which is simply a audio and video call between a caregiver and a patient. That exists, it works pretty well today, and it turns out that it is really valuable. I live in Utah, and about half the time when I see my providers at the University of Utah, we do it virtually. To me, that’s here, that’s ready, that works.

Then you get into slightly more sophisticated stuff. Can a patient who has a wound that needs monitored get that captured by their iPhone and send the picture to the hospital that’s caring for them so they don’t have to make a two-hour journey? It turns out that’s available, too. You could go on and say, can you monitor a patient who is undergoing physical therapy and you want to accurately gauge their range of motion through sensors? That’s available today. too.

I don’t want to minimize the technology challenge. There is plenty of improvement, but it is much more behavioral change that is the obstacle to that than the actual technology.

What are skilled nursing facilities doing with analytics?

SNFs don’t have the budgets that hospitals do. As a result, spending on analytics isn’t anywhere near as large as it is in hospitals. But they are doing important things. 

One that is critical to both hospitals and SNFs is readmissions of patients. If a hospital sends a patient to a SNF and then the patient bounces back, that is bad for everyone concerned, especially the patient. So, one of the things that SNFs are focused on is preventing hospital readmissions. How do you do that?

It turns out that oftentimes what causes a readmission is something as basic as a patient falling, reinjuring themselves and needing a more acute level of care. If you can monitor fall risk and accurately determine which patients are at greater risk and take steps to prevent that fall from occurring, you will reduce readmissions. And if you reduce readmissions, everybody, including the patient, is a lot happier. There are some tangible things that SNFs are doing with analytics, and many of them actually relate to the hospital that sent the patient in the first place.

Are hospitals rewarded for discharging patients to facilities that perform better, and do they provide technical or financial assistance to those organizations to improve outcomes?

There are two ways in which that is occurring, and it’s real. There’s kind of a formal and informal way.

In the formal way, you will have hospital-based ACOs, or accountable care organizations, and they will have formal arrangements with downstream providers. The payments to the provider will be dependent on specific metrics, of which hospital readmission is usually at the top. That exists, but it’s not yet terribly widespread.

The more common arrangement is that many, if not most, hospitals maintain networks of skilled nursing facilities and are deciding where to send the patient. Increasingly, they are focused on the patient experience. There are very different levels of sophistication that this is being done with.

Well-managed networks will pay attention to five or 10 metrics, ranging from readmission to customer satisfaction, about the patients who they send downstream. That will affect where the next placement goes. That incents the SNFs in a very real way to achieve against those metrics, because it will determine the patient flow. That became less powerful in some respects during the pandemic because there was such a bed shortage that it didn’t matter. But as we exit that period, that’s becoming relevant again. It does impact their top line, in terms of their census, based on whether hospitals are sending them patients.

How did your Tissue Analytics product earn FDA’s Breakthrough Device status and how are customers using it?

This is genuinely cool, and it is novel. In fact, it was novel to us, because it’s called Breakthrough Device status and we don’t make devices, we make software.

It turns out that software that makes predictions that affect outcomes in care is regulated by the FDA as a device. Breakthrough Device status means is that you have built something that is so novel and potentially so beneficial to patients that FDA is going to put you in this Breakthrough Device category. They will expedite the review that you need to get an approval to have your product sold and used for particular applications. It was a journey for us, as a software company, to enter the FDA regulatory scheme.

We are doing things like predicting the velocity at which a wound will heal, predicting amputation risk, and ultimately predicting which kind of treatments are most likely to lead to an expeditious and effective piece of care. We have demonstrated that we now have enough data that we can accurately predict that “this patient needs this many visits of this duration to achieve that result” or “this patient is at materially higher risk of amputation if action isn’t taken immediately.” It’s making a real-world difference out there. We probably have 50 or 70 customers using these modules, so it is becoming an accepted part of wound care practice.

Will the experience that the company gained from working with predictive AI and the FDA influence future product development?

Very much so. We view analytics as a key piece of where EHRs are going. If you think about it, EHRs have traditionally been systems of documentation. They exist so that you can document the care given. That’s a baseline requirement, but it’s not really where EHRs are going. EHRs are becoming systems of insight and systems of engagement, in addition to systems of documentation.

By systems of insight, I mean that if you are the system through which the clinical workflow is happening, you have a unique opportunity to collect data about what works and what doesn’t. This is the piece that people miss. You also have a unique opportunity to put insights back in the workflow to alert a clinician at the precise moment, which increases the quality of care that they can deliver.

The analytics piece for us and the predictive piece for us is very much about the next chapter in what an EHR is. It’s really about harvesting the data to yield insights that you can feed back to clinicians that enable them to deliver better and more cost effective care. It’s at the very heart of where we’re evolving our systems.

You’ve said previously that a lot of EHR frustration is due to entry of that isn’t used to change outcomes and doesn’t directly support the clinician who is expected to enter it. How will that evolve?

General purpose hospital EHRs like Epic and Cerner will also include analytics and predictive analytics as key parts of what they are doing. Those are sophisticated companies. They understand that this is the next chapter for EHRs, and they will participate in that. We view ourselves as additive to what they do, because the workflows and the data that we capture are unique to the specialties we serve. To be able to deliver accurate predictions and useful clinical insights, you need that unique workflow and unique data.

We think that what we are doing and what they are doing are complementary. We work in many hospitals with both Epic and Cerner. Virtually every installation of our Tissue Analytics product is with a system that runs Epic or Cerner, so it is important for us to be complimentary and to interoperate with them.

What changes do you expect in the company and the industry over the next few years?

If I were going to give you two words, it would be more interoperability and more analytics, especially predictive analytics. Both of those things will become so embedded in what we do that you can’t really separate that piece from us. The importance of connecting with other systems and the importance of using the data that you have to deliver insights is really the future that we see as Net Health continues to evolve.

Morning Headlines 11/30/22

November 29, 2022 Headlines No Comments

Athenahealth CEO looks to take Watertown health IT company public, for a second time

Athenahealth CEO Bob Segert is preparing to take the company public for a second time.

Talkspace – value destruction created by greed for a big and quick exit

Virtual mental therapy provider Talkspace is reportedly in talks to be acquired by Amwell for $200 million in shares.

Medical Informatics Corp. Raises $27 Million in Financing to Help Hospitals Manage Staff Shortages and Create New Standard of Data-driven Care

Virtual care and analytics vendor Medical Informatics secures $27 million in financing, bringing its total funding to $39 million.

Canon strengthens medical business with establishment of Canon Healthcare USA Inc.

Canon launches Canon Healthcare USA, hoping to strengthen its business in imaging diagnostics, health IT, and in vitro diagnostics.

News 11/30/22

November 29, 2022 News 5 Comments

Top News

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A paywalled Boston Globe article says that Athenahealth CEO Bob Segert is preparing to take the company public for a second time.

Private equity firms Veritas Capital and Evergreen Coast Capital acquired the company in 2018 for $5.7 billion, bringing Segert on as CEO after his stint as chairman of Virence Health, which Veritas owned and combined with Athenahealth as part of the deal.

Athenahealth first went public in 2007. Veritas took the company private in 2019.


Reader Comments

From A Friend of Abry: “Re: Sensato acquired by Cloudwave. Sources say they paid a high multiple, hoping to create the first end-to-end healthcare operating platform that spans the public/private cloud and on-premise environments and will offer the first network and security solution that is specifically designed for healthcare.”


HIStalk Announcements and Requests

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Vicki’s donation, matched dollar for dollar in a Giving Tuesday program, fully funded these Donors Choose teacher grant requests:

  • Math resources for Ms. R’s elementary school class in Richmond, VA.
  • Math manipulatives for Ms. D’s elementary school class in Tallahassee, FL.
  • Science flashcard supplies for Ms. M’s elementary school class in Brownsville, TX.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Healthcare data security company CloudWave acquires managed cybersecurity services vendor Sensato for an undisclosed sum. Sensato founder John Gomez will become Cloudwave’s chief security and engineering officer.

Virtual mental therapy provider Talkspace is reportedly in talks to be acquired by Amwell for $200 million in shares, barely more than the value of its cash on hand and representing a loss of 90% of Talkspace’s value in less than two years. TALK went public in a SPAC merger in June 2021, with shares closing at $9.19 per share versus today’s $0.89 following a 36% jump on the rumor. AMWL shares that closed at $23.07 on their first day of trading in September 2020 are now worth $3.49, valuing the company at $960 million.


People

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Air Force veteran and former White House physician Benjamin Barlow, MD (American Family Care) joins Experity as chief medical officer.


Announcements and Implementations

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Adventist Health Mendocino Coast (CA) will go live on Oracle Cerner December 1.

Visage Imaging will offer an adapter to Amazon HealthLake Imaging from Amazon Web Services as part of its Visage 7 Enterprise Imaging Platform.

Canon launches Canon Healthcare USA, hoping to strengthen its business in imaging diagnostics, health IT, and in vitro diagnostics.


Privacy and Security

Hackers reportedly demand $50 million in cryptocurrency to restore the servers of India’s 2,200-bed AIl India Institute of Medical Services.


Other

ProPublica looks at how half of Americans die while under hospice care, with a lack of regulation encouraging fraud and exploitation that has turned hospice care into a $22 billion industry that is mostly paid for by federal taxpayers via Medicare. Salespeople knock on doors in low-income areas offering free medications and housekeeping services in return for allowing their chronic conditions to be portrayed as fatal. The authors note that hospice companies get the highest rate of return for the least amount of work of any healthcare sector, with per-day payments requiring only twice-monthly visits, for which a hospice with only 20 patients can generate $1 million in annual revenue. A previous study found that 12% of hospice patients were not visited in their last two days of life and that for-profit hospices regularly discharge patients whose life has extended long enough to raise Medicare suspicion. An attorney says that expecting whistleblowers to keep for-profit hospices honest places “a ludicrous amount of optimism in a system with a capitalist payee and a socialist payer.”

A Washington Post opinion piece says that US healthcare inefficiency subsidizes the rest of the world, as profit-seeking providers and a lack of price controls allows drug, device, and IT companies to make most of their profits here and sell elsewhere for a fraction of our price. The US has 4% of the world’s population but 50% of its $8 trillion healthcare economy.

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The State Medical Board of Ohio suspends the license of plastic surgeon Katharine Roxanne Grawe, MD for violating rules pertaining to maintaining patient privacy when sharing photos or video via social media, and for inappropriately treating and/or failing to appropriately treat three patients who suffered severe post-surgical complications. The board specifically notes Grawe’s repeated failure to cease live-streaming surgical procedures, during which she responded to viewer questions and comments in real time.


Sponsor Updates

  • Nuance announces that Baptist Health (KY) and Einstein Healthcare (PA) have joined the Nuance Precision Imaging Network.
  • Agfa HealthCare has been named to the Leaders Category in the IDC MarketScape: US Enterprise Medical Imaging 2022-2023 Vendor Assessment.”
  • Bamboo Health names Christopher Conway (Brown & Toland Physicians) legal ops manager and Madeline Lally (Pathways Healthcare) business development representative.
  • Biofourmis wins a bronze Digital Health Award in the connected digital health category for telehealth/remote patient monitoring.
  • CHIME releases a new CHIMEcast Leader to Leader Podcast, “Unlocking the Digital Front Door to Improve Patient Care & Provider Efficiency.”
  • Nordic publishes a video titled “The Download – Harnessing Data and Analytics to Freeze the Squeeze.”
  • Clearsense will present at the Data Governance & Information Quality Conference December 5 in Washington, DC.
  • Clearwater will sponsor the H-ISAC Fall Americas Summit December 6-8 in Phoenix.
  • Vyne Medical’s FastAttach, Trace Web Application (Hosted), and Refyne Denials Management systems earn Certified status for information security from HITRUST.

Blog Posts


Contacts

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

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Morning Headlines 11/29/22

November 28, 2022 Headlines No Comments

CloudWave Expands Its Healthcare Cybersecurity Portfolio with the Acquisition of Sensato Cybersecurity; Appoints John Gomez as Chief Security and Engineering Officer

Healthcare data security company CloudWave acquires competitor Sensato for an undisclosed sum.

CentralReach Joins Bell Works in ‘Office of the Future’

Behavioral health EHR vendor CentralReach expands with the opening of a 25,000 square-foot collaborative work space in the Bell Works development in Holmdel, NJ.

HHS Proposes New Protections to Increase Care Coordination and Confidentiality for Patients With Substance Use Challenges

HHS seeks feedback on a proposed rule concerning the confidentiality of substance use disorder patient records.

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