Curbside Consult with Dr. Jayne 6/26/23

The clinical informatics community is buzzing with the news that ChatGPT was used to “pass” a simulated clinical informatics board exam. A recent article in the Journal of the American Medical Informatics Association describes the process used to evaluate the tool and goes further to question whether or not the general availability of AI tools is signaling the end of the “open book” maintenance of certification programs that many board certified physicians, including clinical informaticists, have come to enjoy.

Many of the medical specialty boards have moved to the ongoing maintenance of certification process, shifting away from the high-stakes exams that they used to require diplomates to take every seven to 10 years. My primary specialty board, the American Board of Family Medicine, began to pilot the maintenance of certification process in 2019. Since it had been a while since I practiced full-scope family medicine (which includes obstetrics), I was eager to try the new format, which delivered questions every quarter that could be answered using available resources such as textbooks, journal articles, or online references. This approach is a lot closer to how we actually practice medicine – which involves being able to investigate to find answers when we’re not able to pull the information from memory. High-stakes exams such as the ones we used to have aren’t reflective of our ability to deliver good care and such exams have been shown to negatively impact a variety of demographic groups.

The authors of the article tested ChatGPT 3.5 with more than 250 multiple choice questions drawn from a well-known clinical informatics board review book. ChatGPT correctly answered 74% of the questions, which leads to questions about whether or not it might be misused in the certification process. It was noted that ChatGPT performed differently across various areas within the clinical informatics curriculum, doing the best on fundamental knowledge, leadership and professionalism, and data governance. It did the worst on improving care delivery and outcomes, although statistical analysis didn’t find the differences across the categories to be statistically significant. The authors hypothesize that ChatGPT does better in areas where the questions are recall-based as opposed to those that emphasize application and reasoning.

They go on to propose that “since ChatGPT is able to answer multiple-choice questions accurately, permitting candidates to use artificial intelligence (AI) systems for exams will compromise the credibility and validity of at-home assessments and undermine public trust.” Based on some of the conversations I’ve had with patients over the last three years, I’m not sure patients are too impressed with the idea of board certification in the first place. It feels like some patients put more trust in what they see on TikTok and from various health influencers than in what I’ve learned over the last 25 years in family medicine. The phenomenon has definitely gotten worse since the COVID-19 pandemic turned healthcare delivery systems upside down.

The initial certification exams for specialties are still of the high-stakes format, and some specialties also require an oral examination. Those exams are proctored in order to ensure the integrity of the testing process. When I sat for the initial certification exam in Clinical Informatics nearly a decade ago, it was administered at a corporate testing center, and I took it alongside people taking the real estate licensing exam and other standardized tests. At least at the facility where I took it, I found the process to be nerve-wracking since there was a lot of waiting around and dealing with proctors who were trying to apply different standards to the different types of test takers. For example, my particular exam protocol required me to turn out my pockets and prove that there was nothing in them, but others didn’t have to go through the same steps. It created a feeling of overall uncertainty and was even worse when I needed a tissue due to a runny nose during the exam, when I was treated like I was trying to cheat somehow. Needless to say, I was happy when the maintenance of certification approach was brought to both of my specialty certifications.

One of my colleagues had asked why the use of ChatGPT was a problem since the process already allowed the use of external resources to answer the questions. (Examinees are prohibited from speaking with other people, however.) The authors addressed this in the article, noting that the current process requires examinees “to process and assimilate the information found online to determine the correct answer to the exam questions” where “when using LLMs like ChatGPT, exam takers can simply manually enter or automatically scrape the question into the freely available web interface and be given an instantaneous result. This transaction requires no prior knowledge of theory or application and eliminates the need for reflection, reasoning, and understanding but can still result in a passing score.”

The authors do note some limitations of their study, including the fact that they drew all the questions used from a single board review book. That approach may not be representative of the full range of questions used or content delivered on the actual board certification exam. Additionally, ChatGPT couldn’t be used to address questions that contained images. They go on to say that given the situation, certification bodies need “to explore new approaches to evaluating and measuring mastery.” They suggest that testing may need to include more complicated or novel question types, or may need to include images or graphics that can’t be easily interpreted by current AI technologies. They do suggest that “in some situations, there may be a need to consider reverting to proctored, in-person exams,” although I think there would be a general revolt of diplomates if the board actually considered this approach.

It should be noted that the maintenance of certification process currently includes an honor code attestation, where diplomates certify that they’re following the rules on the use of reference materials and that they aren’t consulting other people for help with the questions. It would be easy enough to broaden that statement and ask diplomates to agree to avoid using AI assistants or other similar technologies when completing their maintenance of certification processes. Personally, I’m glad to be at a point in my career where I might only have to recertify each of my specialty boards one more time. I don’t envy those in earlier phases of their careers who will have to tiptoe through the veritable minefields that new technologies are creating.

What do you think about ongoing proficiency exams, whether for physicians or other industry professionals? Are they useful for demonstrating competency and ability or just a way for certification bodies to generate cash? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Bart Howe, CEO, HealthMark Group

Bart Howe, MBA is CEO of HealthMark Group of Dallas, TX. He is also president of the Association of Health Information Outsourcing Services (AHIOS).

Tell me about yourself and the company.

I’m a problem solver. I like to work on big projects. I started in finance and quickly determined that my entrepreneurial bug was a little too strong to stay put there, so I started a solar energy technology company and worked in molecular diagnostics before getting into my career in health information management.

I’m the CEO of HealthMark Group, which is a digital health information management solution provider that is most known for our work in the secure and digital exchange of medical records. Oftentimes that’s referred to as release-of-information. That function is perceived at times by the rest of the healthcare industry as a bit archaic, but it can, and has, benefited greatly from the evolution of technology and the way that we maintain records and transmit records. HealthMark is committed to changing that dynamic by providing technology that drives digital self-service and immediate access to patient health information.

I’m an unapologetic patient advocate, so I’m always trying to think from the patient’s perspective. I am a consumer of healthcare, as are all of the end users of the clients that we serve. I always try to have my patient perspective hat on when we’re looking at how we can do things different and better at HealthMark.

I am also, as of a few months ago, president of the national industry association that represents release-of-information vendors. It’s called AHIOS, the Association of Health Information Outsourcing Services. In that, I take a pretty active role in speaking with regulators and legislators around the evolution of the health information management industry from a regulatory perspective. There are tons of opportunities to work with ONC, OCR, and even FTC as we see them starting to regulate more in this space, to make sure that we are creating the right pathways and incentives for organizations, providers, and digital health app developers to engage more in the interoperability solutions of the future. I’m a believer, and I think that opportunities are on the horizon that people don’t even realize exist yet in terms of what can happen when information flows more freely.

How has technology changed the release-of-information process over the past five years?

It continues to change regularly, so it has changed quite a bit in the past five years. I’m sure the next five will as well. What drove me to the space was the rapid change in the way that health information is managed and being transmitted.

I had a personal challenge in one of my prior roles. I was at a molecular diagnostics company, and we were pushing the bounds of scientific discovery in some of the tools that we were using to do oncology diagnostics and provide therapeutic guidance. One of the challenges was getting access to the longitudinal patient information to demonstrate that our diagnostic tool was actually generating better outcomes for patients, and therefore should justify better reimbursement. I saw a need for a better solution for accessing and transmitting health records. When I came across HealthMark, it struck a nerve as an opportunity to jump into an industry that is changing quite a bit and that has a lot of opportunities for improvement.

But to answer your question more acutely, the way that it has changed over the past five years is that everything is going faster. Medical records requests take all sorts of shapes and sizes and they come from all sorts of different parties, such as patients, other physician practices, attorneys, and insurance companies. But expectations for turnaround time for delivery of those records have increased dramatically. They will continue to increase until we can truly hit that target that I’m shooting for with our organization, which is immediate. We want to be able to provide immediate access to that medical information for a variety of different purposes while maintaining the security and privacy of that information.

As EMRs have proliferated throughout the healthcare ecosystem, a lot of that information is now stored digitally instead of on paper, where it was copied or scanned and delivered via snail mail. Today, we try to digitize as much of that delivery as possible. You would be surprised how much of that information is still being requested via a snail mail pathway, but in every chance that we get, we’re pushing requesters towards receiving and ingesting that information in a digital form.

The molecular diagnostics example is a near real-time, business-to-business transaction. How you see the line drawn between release-of-information versus interoperability?

That line is blurring entirely, and that is a good thing. From my perspective, the release of information function, again, has historically been perceived as relatively archaic and lagging behind much of the rest of the industry in terms of moving towards interoperability. I would challenge you to look at HealthMark a little bit differently. We are definitely embracing interoperability as a tool to be able to help deliver digital self-service and immediate access to those records.

To your point, we deliver records for both B2B purposes as well as B2C purposes or B-2-patient purposes. It covers all aspects of what we do. I’m incredibly excited about the trajectory of the industry from an interoperability perspective, and I really want HealthMark to be a leader on the forefront of that push.

On the patient side, how has the Cures Act change how patients request and receive access to their medical records?

I don’t think we’ve seen yet the inflection point of adoption that I hope that we will see at some point, in terms of the adoption of FHIR endpoints and the delivery of information through API methods that will enable a digital healthcare app ecosystem that doesn’t yet exist. We certainly have elements of it and we’re starting to see more of it, but we haven’t hit the inflection point yet.

Do hospitals see release-of-information as a necessarily evil or as an opportunity and a touch point for patient engagement?

If they are not looking at it as an opportunity or as a necessary touch point for patient engagement, then they are looking at it the wrong way. It is absolutely one of the areas that can cause the most abrasion between patient and provider if they aren’t given timely access to their information. They certainly need to think about that as a core competency of either their organization or of a partner that they’re working with to help facilitate that information flow as easily and seamlessly as possible. Maybe it used to be viewed as a necessary evil, but certainly it is an opportunity today.

Much of the information requests that the release-of-information association or partners fulfill are still continuity-of-care requests, so a lot of that information used to treat patients is still flowing through those means. It is critical to the patient as well that they get access to that information for those purposes.

You offer services related to the Family and Medical Leave Act. What kind of information requests are involved?

It’s not just FMLA. There are disability requests and requests for other information that require the physician or physician practice to complete information related to that patient’s care or related to that patient’s treatment regimen. It’s not something that you can pull directly out of a discrete data field. It often takes physician know-how of the situation, or specifically what the request is about, to complete that information. We work on behalf of our healthcare provider partners to alleviate some of that administrative burden.

Ultimately, HealthMark is trying to alleviate, across the ecosystem of our clients, the administrative burdens that we see in our US healthcare ecosystem, which is two to three times the administrative burden that we see in other developed nations. We think there are opportunities to streamline a lot of that information flow, and FMLA paperwork is one of them.

There are requests for that paperwork on a regular basis, ranging from simple requests related to a pregnancy or a surgery all the way up to things that are much more complex. Provider practices are required to fulfill that information request on behalf of their patients because it’s necessary, often for the patient to get a paycheck, so it’s critical to that patient experience.

Everything that we work on ultimately drives back to that patient experience. We are completing that paperwork on in conjunction with the provider partners that we work with to make sure that information doesn’t get stuck with the front desk staff or stuck with an MA and ultimately fall to the bottom of the priority list because it doesn’t involve treating a patient right there in front of you. These things are still critically important to the patient. We are helping make sure that we can streamline the flow of that information.

It’s vexing as a patient to go to your regular medical practice that uses an EHR and having a clipboard full of empty forms immediately shoved at you every time, especially when you know that everything you are being asked to write is already on the computer screen five feet from the clipboard. Why does that happen?

Honestly, I ask myself why that is still so often the case. Filling out paper on a clipboard should be a thing of the past. There is virtually no other situation where we complete information on a clipboard. We provide a digital patient intake solution to help streamline the flow of that information. In this case, not out of the EMR or the practice management system, but into it. We are providing a digital experience for patients to be able to bring healthcare into the modern world, into the 21st century of technology adoption.

I understand why there is a laggard nature to the healthcare industry in terms of a adopting technology. It’s a heavily regulated environment where it is difficult to make changes overnight. That has created a situation where healthcare providers are slower to adopt technology than in other industries, but I think we see that changing as well. Certainly with the pandemic, we saw a rapid overnight need to adopt technology for solutions for things that didn’t exist previously. Telemedicine skyrocketed during that period, as did things like digital patient intake, pre-registration forms, and remote check-in opportunities. We are coming along and we are making progress, but it still baffles me when I walk into a healthcare facility and I’m handed the clipboard and a pen.

Where do you see the company in three or four years?

We are going to continue to lean into the interoperability landscape. I know that is a buzzword that has been around for decades, but I hope that we are reaching the inflection point for both technical and regulatory pathways to make true interoperability a reality. There is a ton of potential in things like the Cures Act and TEFCA. As we lean into that, it will open up downstream use cases for organizations like us, where we are a trusted partner of the healthcare providers that we work with and a steward of that most precious protected healthcare information that they hold on behalf of their patients.

As we sit in that position and start to facilitate better, cheaper, faster information flow, that opens up a ton of opportunities downstream for things like analytics and focusing on the potential for using things like AI to provide relevant insights from that data back to the provider and back to driving better treatment outcomes for the patient.

This is stuff that I care deeply about, and as I mentioned at the beginning, I am an unapologetic patient advocate who tries to think about things from the patient perspective and how to make their experience better. A better experience for them is a better outcome for our clients.

Morning Headlines 6/26/23

Babylon Announces Update on Take Private Proposal

UK-based digital health company Babylon will merge with brain technology vendor MindMaze in a take-private transaction.

AvoMD Raises $5M to Combat Clinician Burnout With No-Code Clinical App Building Platform

AvoMD, developer of a no-code platform that allows clinicians and hospitals to turn existing and new clinical evidence into their own point-of-care clinical pathway apps, closes $5 million in seed funding.

UNC Health Piloting Secure Internal Generative AI Tool for Teammates with Microsoft Azure OpenAI Service

UNC Health will launch an internal chatbot next month, powered by Microsoft Azure OpenAI Service, that allows employees to access reference materials, documents, and training libraries by asking questions.

Monday Morning Update 6/26/23

Top News

Struggling UK-based digital health company Babylon will merge with brain technology vendor MindMaze in a take-private transaction.

The companies say that their combination will create a digital-first, AI-driven business that will transform healthcare in moving to predictive and preventative services.

Shares in Babylon, which went public via a SPAC merger in October 2021 at a valuation of $4 billion, have since shed 99.8% in valuing the company at $20 million.

MindMaze has raised $341 million, including a 2017 investment by Leonardo DiCaprio as the company sought to expand its technology from patients regaining movement to adding interactivity to movies.

HIStalk Announcements and Requests

Most poll respondents don’t let a fear of getting fired compromise their work.

New poll to your right or here: In the 12 months, have you disagreed with a doctor who wouldn’t prescribe the drug or treatment you wanted? I’m fascinated by people who trust a doctor to guide their most important health decisions until that doctor’s well-considered logic conflicts with poorly sourced online advice or advertisements, which I’m sure annoys them to no end. On the other hand, I wouldn’t hesitate to choose a restaurant or movie that looks interesting despite critical disdain, so so if I’m paying and the risk is minimal (although neither are guaranteed in healthcare), I guess the customer gets to choose.

We have the usual summer-related travel and time off upcoming at HIStalk now that the longest day of the year is behind us, which fortunately coincides with the slowdown in industry news until Labor Day. We’ll be here as usual, but with less to write about, and that’s a nice break for writers and readers alike. As always, I guarantee that you won’t miss anything important even with skinnier updates.

Webinars

July 12 (Wednesday) 2 ET. “101: National Network Data Exchanges.” Sponsor: Particle Health. Presenter: Troy Bannister, founder and CEO, Particle Health. It’s highly likely that your most recent medical records were indexed by a national Health Information Network (HIN). Network participants can submit basic demographic information into an API and receive full, longitudinal medical records sourced from HINs. Records come in a parsed, standardized format, on demand, with a success rate above 90%. There’s so much more to learn and discover, which is why Troy Bannister is going to provide a 101 on all things HIN. You will learn what HINs are, see how the major HINS compare, and learn how networks will evolve due to TEFCA.

July 27 (Thursday) noon ET. “Why You Shouldn’t Wait to Use Generative AI.” Sponsor: Orbita. Presenter: Bill Rogers, co-founder, president, and chairman, Orbita. The advent of generative AI tools truly represents a paradigm shift. And while some healthcare leaders embrace the transformation, others are hesitant. Invest 20 minutes to learn why you shouldn’t wait. When combined with natural language processing, workflow automation and conversational dialogs, generative AI can help leaders address a raft of challenges: from over-extended staff, to the rising demand for self-service tools, to delivering secure information to key stakeholders. You will learn where AI delivers the greatest value for providers and life sciences, how it can solve critical challenges faced by healthcare leaders, and how Orbita has integrated generative AI into its conversational platform so healthcare leaders can leverage its full capabilities safely and securely.

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

Acquisitions, Funding, Business, and Stock

Group messaging app IRL, which has raised $200 million from investors, shuts down when a board investigation following the dismissal of its founder-CEO finds that 95% of its claimed 20 million active users are bots.

AvoMD, whose no-code platform allows clinicians and hospitals to turn existing and new clinical evidence into their own point-of-care clinical pathway apps, closes $5 million in seed funding. Co-founder and CEO Yair Saperstein, MD, MPH is double-boarded in internal medicine and clinical informatics.

Medicare Advantage insurer Clover Health settles several investor lawsuits involving failing to disclose that the company was the subject of a federal investigation when it went public via a SPAC merger in January 2021. CLOV share have since lost 94%, valuing the company at $425 million.

Announcements and Implementations

UNC Health will launch an internal chatbot next month, powered by Microsoft Azure OpenAI Service, that allows employees to access reference materials, documents, and training libraries by asking questions.

Government and Politics

Oklahoma’s governor rejects the formation of statewide HIE.

New York passes a bill that would prohibit any agreement that would prohibit or restrict an employee’s post-employment work, with language that goes further than the FTC’s proposed non-compete rule or California’s limitations. The bill has been submitted to the governor for signing.

Privacy and Security

The International Information System Security Certification Consortium will retire the HCISPP healthcare security certification credential as of December 1, 2026.

Contacts

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

Morning Headlines 6/23/23

Tennessee attorney general says seeking clinic’s transgender patient records part of fraud probe

Tennessee Attorney General Jonathan Skrmetti’s office, which compelled Vanderbilt University Medical Center to turn over the medical records of transgender patients to support its fraud investigation, has also demanded that VUMC provide copies of its physician contracts, their resumes, and their W2 and 1099 tax forms.

Jesse Jones: New charges for some MyChart messages

University of Washington Medicine will begin charging patients for answering MyChart messages that require more than 10 minutes  – including requests to complete medical forms or for referrals – at prices ranging from $7 for Medicaid patients to $98 for those without insurance.

VA official expects Oracle Cerner to deliver on $10B EHR contract despite layoffs

A VA EHR executive says that it continues to expect Oracle Cerner to deliver on newly strengthened contractual requirements even though the company’s recent significant layoffs reportedly include experienced members of its clinical teams.

ChatGPT and the clinical informatics board examination: the end of unproctored maintenance of certification?

ChatGPT passes the clinical informatics board exam, raising questions about how the unproctored, multiple-choice test will be used to evaluate proficiency.

News 6/23/23

Top News

Tennessee Attorney General Jonathan Skrmetti requests information from Vanderbilt University Medical Center that includes patient referrals, email records, and copies of W9 and 1099 forms that detail its payments to physicians. His office is investigating possible billing fraud related to VUMC providing gender-affirming services to people who are covered by state insurance.

Tennessee law does not require the attorney general to obtain a subpoena or court order to compel VUMC to provide the requested information, although HIPAA supersedes state law.

VUMC has already provided the medical records of a list of specific patients that the AG provided from unspecified sources. VUMC notified those patients months after the fact.

Skrmetti said last fall that he would investigate VUMC after a political commentator claimed on social media that the hospital had punished employees who don’t agree with its gender-related treatments, which VUMC denied. A new Tennessee law takes effect on July 1 that criminalizes the provision of gender-affirming services to minors.

An updated statement from the AG’s office says that it launched an investigation almost a year ago, when it says a VUMC doctor publicly stated that she was manipulating billing codes to bypass insurer coverage limitations on gender-related treatment.

The AG’s office says it was surprised that VUMC recently notified patients, adding that it has no desire to turn a fraud investigation into a “media circus.”

Reader Comments

From Sebum: “Re: NEJM article. Extraordinarily good piece.” A perspective article titled “Ellipsis” by CU Medicine hospitalist Samuel Porter, MD describes the disconnect of receiving texted questions and requests from other caregivers that he mostly doesn’t know, where pager messages that were a “faceless voice” have progressed to phone messages that are a “voiceless face” of avatars. He says, “My avatar stretches its influence across a vast complex of specialized structures to dictate care from its pixelated mouthpiece.” He says that hospital physical sprawl and time pressure don’t allow seeing the patient directly, so the only constant is his computer, and the measure of his day’s work is counting icons rather than seeing facial reactions. It’s interesting to think about practicing medicine without even the visual feedback of a video visit, and I’m picturing doctors sitting in dark rooms “processing” requests and orders like a video gamer shooting aliens for dopamine jolts.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Linus Health. The Boston-based digital health company is dedicated to transforming brain health for people across the world, with a focus on Alzheimer’s and other dementias. By advancing how we detect and address cognitive and brain disorders – leveraging cutting-edge neuroscience, clinical expertise, and artificial intelligence – the company’s goal is to enable a future where people can live longer, happier, and healthier lives with better brain health. Its digital cognitive assessment platform provides a proven, practical solution for early detection; empowers providers with actionable clinical insights; and supports individuals with personalized action plans. The company is proud to partner with leading healthcare delivery, life sciences, and research organizations to advance cognitive care. Visit its website to learn more about its practical solutions for proactive brain health. Thanks to Linus Health for supporting HIStalk.

Here’s a Linus Health explainer video that I found on YouTube.

Webinars

July 12 (Wednesday) 2 ET. “101: National Network Data Exchanges.” Sponsor: Particle Health. Presenter: Troy Bannister, founder and CEO, Particle Health. It’s highly likely that your most recent medical records were indexed by a national Health Information Network (HIN). Network participants can submit basic demographic information into an API and receive full, longitudinal medical records sourced from HINs. Records come in a parsed, standardized format, on demand, with a success rate above 90%. There’s so much more to learn and discover, which is why Troy Bannister is going to provide a 101 on all things HIN. You will learn what HINs are, see how the major HINS compare, and learn how networks will evolve due to TEFCA.

July 27 (Thursday) noon ET. “Why You Shouldn’t Wait to Use Generative AI.” Sponsor: Orbita. Presenter: Bill Rogers, co-founder, president, and chairman, Orbita. The advent of generative AI tools truly represents a paradigm shift. And while some healthcare leaders embrace the transformation, others are hesitant. Invest 20 minutes to learn why you shouldn’t wait. When combined with natural language processing, workflow automation and conversational dialogs, generative AI can help leaders address a raft of challenges: from over-extended staff, to the rising demand for self-service tools, to delivering secure information to key stakeholders. You will learn where AI delivers the greatest value for providers and life sciences, how it can solve critical challenges faved by healthcare leaders, and how Orbita has integrated generative AI into its conversational platform so healthcare leaders can leverage its full capabilities safely and securely.

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

Acquisitions, Funding, Business, and Stock

Outbound AI, which sells virtual agent technology for healthcare revenue cycle management, raises $16 million in a seed funding round.

Real-world data company Verana Health launches a subscription-based tool to help ophthalmology-related clinical trial sponsors and contract research organizations find potential trial sites.

Sales

• University Hospitals will implement Nuance’s patient engagement solutions, including virtual agents and AI-powered call routing.

People

Chilmark Research founder and CEO John Moore died Wednesday after a long battle with cancer.

Government and Politics

VA officials say despite last week’s layoffs in Oracle’s Cerner business that may have been driven by the VA’s own stalled implementation, it expects the company to provide the talent and expertise that is needed to fulfill its contractual commitments.

Privacy and Security

UK physician groups urge NHS England to pause its tender for a $600 million contract for a federated data platform, predicting that nearly half of NHS patients will opt out if the government choose analytics firm Palantir – which has ties to US security agencies – as its vendor. They propose alternatives based around the open source platform Open Safely and OneLondon, which they say are more transparent. Meanwhile, Palantir – which the physician groups say spending big dollars on lobbying to win the bid – is awarded a 12-month, $32 million contract to transition existing NHS projects into the new platform, which critics say raises concerns about the procurement program’s transparency and scope.

Other

A NBC News investigation finds that publicly traded hospital operator HCA Healthcare used an algorithm to identify hospitalized inpatients who were likely to die, then pushed them into palliative or hospice care to improve hospital performance measures that are tied to executive bonuses.

ChatGPT passes a simulated clinical informatics board examination, raising questions about the future of unproctored, at-home certification testing.

Sponsor Updates

• CereCore publishes an e-book titled “Technical Debt and the Patient.”
• Nordic posts a podcast titled “Designing for Health: Interview with Denise Worrell.”
• Roni Jamesmeyer, senior healthcare manager at Five9, authors an article titled “TLC, not A&E: Reducing Emergency Situations through Proactive Communications.”
• Medhost’s Meadteam Solutions launches a security operations center for its community hospital customers.

Contacts

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

EPtalk by Dr. Jayne 6/22/23

I continue to receive emails from multiple vendors addressing me as “Hey Jayne” and demanding that I schedule a call, or alternatively, respond to the email to tell the sender I’m not interested. I can guarantee I’m not going to respond to an email with that salutation, nor am I going to respond to bullying.

I keep trying to block the senders, but they’re somehow still getting through from at least two organizations. You might think that continued non-response would also be a ticket to be taken off of their marketing list. I’m also getting hit with solicitations for speaking engagements at dubious “conferences” that sound decidedly pay-to-play, but those seem to be a little easier to block.

In his recent Healthcare AI News roundup, Mr. H mentioned the inclusion of skin conditions in the Google Lens visual search tool. I decided to give it a whirl and ran three pictures of known dermatological findings through it. The tool scored zero out of three, so I think there’s still some opportunity for improvement. Granted, one of the conditions isn’t super common and it suggested a condition that is often confused with the actual diagnosis, but the other two submissions were very common, and I was surprised it didn’t do a better job with those.

When technology companies are marketing directly to consumers, it’s hard for primary care physicians and others who have the patient’s interests at heart to get ahead of the messaging and explain how these tools might or might not be used. It’s one more thing that overburdened clinicians need to add to their list of anticipatory guidance for upcoming patient visits.

AI continues to be a hot topic both within the US and around the globe. Various European consumer protection organizations are calling for investigation of AI systems in the interim before European Union regulations on the systems go into effect. Concerns range from the risks involved when AI generates content that mimics human work to the risk that AI could manipulate humans into doing things that will harm them. The European Union is creating rules for technology use, but they won’t go into effect for a couple of years.

Other countries are addressing the issue on a case-by-case basis, with Italy ordering OpenAI to stop processing user information during the investigation of a data incident. Nations such as France, Spain, and Canada are also looking into the technology. The next few months will be interesting as far as the continued discussion of AI and how it can best be used for the greater good.

I started doing some clinical work with a new organization and they’re eager to get my informaticist opinion on their EHR and how they might improve it. The first thing I recommended was some optimization to improve usability by putting the most commonly selected items on various menus in positions where they will be the easiest to select for the greatest number of patient visits. The EHR analyst couldn’t figure out how to do it, so he had to open a ticket with their vendor. It turns out that the EHR doesn’t allow this level of configuration, but rather forces items on the menu to be displayed in the order in which the menu items were built in the system’s back-end utility.

I remember seeing that kind of nonsense on a system I implemented back in 2009, but I thought that vendors had moved beyond that. It’s no wonder that physicians are complaining about scrolling since they are having to do more of it than they should.

Registration is open for the LOINC conference being held October 17-20 in Atlanta. Sessions will focus on health data interoperability issues. Attendees include providers, patients, laboratory organizations, government entities, software vendors, device manufacturers, researchers, and students. The first day will be “devoted to LOINC learning,” with educational sessions to support newer users of LOINC and grow expertise in advanced users. Subsequent days will include public meetings of the LOINC committee as well as presentations from the LOINC community. Proposals are still being accepted, and for those unable to attend in person, there is an option for online participation.

Speaking of conferences, one of my favorite readers is attending a meeting this week and sent some musings about his experiences. The meeting is the Multidisciplinary Association for Psychedelic Studies annual Psychedelic Science conference,  being held in Denver. Organizers estimated the potential attendance at 10,000 and continuing medical education credits are being offered. The conference agenda is fascinating, and my reporter has found it to be “wildly informative” and full of information about topics he had not previously been aware of.

Based on his reports, it feels like the event was pretty mellow and lower key than some other conferences. There was at least one EHR vendor was exhibiting although I didn’t catch which one it was. I imagine the vendor has to have either some highly specialized content, or alternatively, a fairly significant ability for clients to customize to meet their needs.

Other interesting offerings included sessions on the convergence of wearables, neuroscience, and psychedelics; a history of the discipline; discussion of rituals; practical techniques for prayer practice; the use of psychedelics in alcohol use disorder; and a stomp class.

The use of drugs like ketamine and psilocybin also features prominently in the agenda. I have worked with a handful of patients who have had life-changing experiences with ketamine treatment, so I hope people are open minded when considering some of these non-mainstream treatments. The website’s chatbot told me the conference was sold out except for single-day passes for Friday, so it sounds like plenty of people are interested in learning more.

I don’t have any conference travel planned for a while, so I’ll just have to live vicariously through my readers. If you’re attending a meeting we haven’t historically reported on, feel free to send your thoughts and observations. Or if you have ideas of meetings that you think HIStalk should be covering, please pass those along as well. As I put together my conference plan for the rest of 2023 and the first half of 2024, nothing is off the table.

Do you have any work-related travel that you’re looking forward to? What makes it unique or appealing? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 6/22/23

AccurKardia Announces Final Closing of $2.7 Million Series Seed Round

AccurKardia, which sells AI-powered clinical-grade ECG interpretation software, completes a $2.7 million seed funding round.

AMA announces organizations selected for grants to research EHR use

The American Medical Association awards $589,000 in grants to nine organizations that will study EHR use for solutions that can prevent clinician burnout, enhance care, and improve workflows.

‘You’re not God’: Doctors and patient families say HCA hospitals push hospice care

An NBC News report says that publicly traded hospital operator HCA Healthcare used an algorithm to identify hospitalized inpatients who were likely to die, then pushed them into palliative or hospice care to improve hospital performance measures that are tied to executive bonuses.

Doctors urge ‘pause’ on Federated Data Platform bidding amid Palantir data security concerns

Doctors in England call for the government to pause the tender process for a new $600 million national federated data platform, saying that frontrunner Palantir is a private US company with ties to US security agencies that would discourage participation and that the procurement process favors the company because of its lobbying efforts and the waiving of procurement procedures during the pandemic.

DexCare Closes $75M in Series C Funding, Led by ICONIQ Growth, to Accelerate Market Expansion of its Care Access Platform

Providence spinout DexCare, which offers a customer acquisition and healthcare navigation system, raises $75 million.

Healthcare AI News 6/21/23

News

Google adds the ability to search for skin conditions to its Lens visual search tool. Users take or upload a photo of their skin condition and the system finds visual matches, which it says is easier than trying to describe the situation with words.

Startup Dandelion Health, which offers de-identified health system data for clinical research, launches a free public service that will evaluate the performance, fairness, and equity of health algorithms. It will initially focus on predictive algorithms for cardiology. The company’s pilot program – which uses data from Sharp HealthCare, Sanford Health, and Texas Health Resources – will evaluate if an algorithm trained on one area’s dataset performs equally well when applied to other populations and if it does so fairly for everyone.

Business

Korea-based AI medical solutions vendor SPASS receives FDA 510(k) clearance for its AI-based detection software for sepsis, anaphylaxis, and hypovolemic shock.

DeepX earns FDA clearance for its digital dermatoscope, which will acquire images for teledermatology review. The company is seeking FDA approval for integrating the images with an AI algorithm that will analyze lesions based on their light transferring properties to provide fast-track diagnosis of skin cancer.

A McKinsey report predicts that generative AI will add $4.4 trillion to the global economy, with leading use cases being in banking, technology, and life sciences.

ChatGPT creator OpenAI is reportedly planning to launch a marketplace for AI models that use its technology, which could raise competitive issues with its partners.  

Research

Researchers find that AI-powered analysis of EHR data can predict pancreatic cancer earlier, identifying heightened risk up to three years before diagnosis. Unexpected predictive symptoms include gallstones, Type 2 diabetes, anemia, and GI symptoms. The researchers believe that 320 of each 1,000 people the AI model identifies as high risk will develop cancer. The federal government doesn’t recommend screening symptom-free people for pancreatic cancer, but targeting AI-identified high-risk patients would make surveillance more affordable and improve long-term survival.

AI algorithms for predicting inflammatory bowel disease have been enhanced to offer personalized treatment recommendations and – by incorporating patient-reported outcomes, sensor data, and biomarkers – to detect early signs of worsening or to predict which treatments will be effective.

Other

Meredith Broussard, MFA, whose 2018 book “Artificial Unintelligence” coined the term “technochauvinism” in describing the belief that technology can solve any problem better than humans, describes her experience with running open-source AI models on her mammograms to see if it would detect the cancer that her doctor has already diagnosed:

The AI that I used did, in fact, work. But it doesn’t diagnose the way that a doctor does. It drew a circle around an “area of concern” on a single flat image and gave me a score between zero and one … I realized that I had expected more—not the Terminator, and not a Jetsons-style robot doctor, but at least a humanlike diagnosis based on my entire medical record. This is pretty typical. We often have imaginary expectations about AI, and the technology fails to live up to what we imagine it can do. It would be really great if we could diagnose more people earlier. It would be great if we could use technology to save more lives from cancer. We are absolutely all united in that goal. But the idea that AI is going to be our salvation for diagnosing all cancers in the next few years is a little bit overblown.

Contacts

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

Morning Headlines 6/21/23

Vanderbilt turns over transgender patient records to state in attorney general probe

VUMC notifies some of its patients that it has sent their medical records to the state’s attorney general, whose office is conducting an investigation into billing state-insured patients for transgender care services.

Creating the world’s largest medical imaging library – Gradient Health closes $2.75M round

Raleigh, NC-based Gradient Health, which offers developers a library of 350 million medical images for AI training, raises $2.75 million.

Caraway Secures $16.75M Series A Funding

Virtual care company Caraway – which offers mental, physical, and reproductive health services in six states, primarily to women aged 18-27 — raises $16.75 million in a Series A funding round.

News 6/21/23

Top News

Healthcare shift-bidding platform vendor CareRev will reportedly lay off one-third of its corporate workforce, about 100 employees, following the departure of founder and CEO Will Patterson, RN. He resigned after admitting to colleagues that he delivered an investor Zoom pitch – which resulted in a $50 million Series A round — while taking LSD.

Patterson announced in January 2023 that the company would focus on expanding its technology platform, which would require laying off an unstated number of employees. 

Reader Comments

From Amicus Briefly: “Re: Oracle Cerner layoff. A physician says in a private member group that its whole clinical team was eliminated, including nurse and physician executives.” Unverified since the company hasn’t said a word on that topic, but I haven’t seen that claim elsewhere. Layoffs in big, far-flung companies are often hard to quantify otherwise since those involved don’t have easy ways to compare information. It’s easier in a one-office business because you see the empty cubes or watch out the window to see who’s being marched out. Those who should eventually notice are the company’s customers, whose interests are not necessarily aligned with those of shareholders.

Webinars

June 22 (Thursday) 2 ET. “The End of COVID Public Health Emergency is Here. Is Your Rev Cycle Ready?” Sponsor: Waystar. Presenter: Vanessa L. Moldovan, commercial enablement + insights program manager, Waystar. This webinar will describe the proactive steps that are needed to avoid increased rejections and denials. It will cover regulatory waivers and flexibilities, major shifts in telehealth, changes to reimbursement, and the impact of the end of the PHE on Medicaid coverage.

July 12 (Wednesday) 2 ET. “101: National Network Data Exchanges.” Sponsor: Particle Health. Presenter: Troy Bannister, founder and CEO, Particle Health. It’s highly likely that your most recent medical records were indexed by a national Health Information Network (HIN). Network participants can submit basic demographic information into an API and receive full, longitudinal medical records sourced from HINs. Records come in a parsed, standardized format, on demand, with a success rate above 90%. There’s so much more to learn and discover, which is why Troy Bannister is going to provide a 101 on all things HIN. You will learn what HINs are, see how the major HINS compare, and learn how networks will evolve due to TEFCA.

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

Acquisitions, Funding, Business, and Stock

Gradient Health, which offers AI developers a library of 350 million raw and labeled medical images from 1,000 partner hospitals for system training, raises $2.75 million.

The founders of India-based vanity drug telehealth vendor Mojocare admit — following an investor-commissioned forensic audit after the company laid off 80% of its employees — that they were falsifying sales. A report says that the “judgment-free wellness platform” vendor was selling products to companies that were owned by the relatives of the founders, then restocking the delivered products, inflating its gross merchandise value. The money-losing company raised $21 million in a Series A funding round in August 2022 after reporting that its revenue had increased 38-fold. The two founders have no healthcare experience.

Sales

• In England, Leeds Teach Hospitals NHS Trust will implement Flatiron Health’s real-world data for oncology research.

People

Evergreen Healthcare Partners promotes John Evans to SVP of operations.

Announcements and Implementations

Malaysia’s Health Ministry will implement an expanded, cloud-based EHR nationwide in 2026.

Silver Cross Hospital expands its use of Kyruus ProviderMatch to include scheduling of primary care, gastroenterology, and cardiology.

Microsoft opens a public preview of Azure OpenAI Service that allows running models on client-owned data, eliminating the need for training.

Government and Politics

A Tennessee news site reports that Vanderbilt University Medical Center has notified some of its patients that it has sent their medical records to the state’s attorney general, who it says is investigating VUMC’s billing for transgender care services for patients who are covered by state-sponsored insurance. Commenters question the legality of providing the records under HIPAA and how VUMC chose the patients whose records it sent. HHS advises under its HIPAA “Court Orders and Subpoenas” guidance that providers can share PHI under a court order, or in the case of a subpoena, if the patient has been notified in advance to give them the chance to object or seek a protective order. The cited VUMC communication refers to a “civil investigation” in which the patient records were “requested.” The AG’s chief of staff says that the office is “surprised that VUMC has deliberately chosen to frighten its patients like this,” adding that its billing investigation involves only VUMC and certain providers, not patients.

Contacts

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

Morning Headlines 6/20/23

How Palantir is helping hospitals with tasks that used to require spreadsheets and whiteboards

A CNBC report looks at Cleveland Clinic’s work with Palantir’s AI software to manage resource allocation.

CareRev Plans to Cut Roughly a Third of Staff

Healthcare shift-bidding platform vendor CareRev will reportedly lay off one-third of its corporate workforce, about 100 employees, following the departure of CEO Will Patterson over claimed conduct issues.

Biden picks North Carolina’s former health chief, Mandy Cohen, to run CDC

As previously speculated, the White House will name Aledade EVP Mandy Cohen, MD, MPH as new CDC director effective with the resignation of Rochelle Walensky, MD, MPH on June 30.

Curbside Consult with Dr. Jayne 6/19/23

I mentioned a few weeks ago that I have been having issues with my health system’s online billing functions. I was receiving paper statements before I received the online bills and couldn’t figure out how to adjust it so that I didn’t get paper statements.

At a recent visit, I asked the staff to see if they could adjust it on their side, and they said they would try. Interestingly, they also refused to accept my co-pay at the time of service, which is a big negative as far as revenue cycle management, so I wasn’t hopeful that they’d be able to get my account set up in a best practice fashion.

It looks like the “turn off paper statements” piece worked because I received an online invoice today. It included the co-pay (no surprise there) but also an unexpected co-insurance amount that doesn’t match how my insurance works. I haven’t even received the Explanation of Benefits document yet, so I’m not about to pay it. We will have to see how this cycle continues to unfold.

We had some family adventures in healthcare this weekend, with an unexpected injury that required attention beyond what I could manage with my first aid kit. Of the urgent care facilities in the area, some had spots available for online check-in, but others didn’t. Since we wanted a minimal wait, we opted for the one that was displaying available capacity, which is also an organization that I know fairly well.

As expected, walking in with a bleeding injury of the head puts one at the front of the line whether you have an appointment or not. Unfortunately, the provider wasn’t a great communicator and was mentioning how busy she was and how many other patients she was tending to rather than making the patient feel at ease.

She tried to downplay the injury a little, but fortunately the patient followed my advice and advocated for the treatment that is actually standard of care – they only knew that because I had prompted them after evaluating the injury and referring them to in-person care. The alternative treatment offered is typically less time-intensive for the provider, but results in poorer outcomes for this specific patient scenario. Most patients don’t know the difference, and it’s sad when our healthcare system is repeatedly putting time pressures ahead of patients.

After resolving the situation, we headed out for some Father’s Day celebrations, and then I came home to catch up on some work. It was timely that Mr. H called out this New York Times story on the level of moral crisis that physicians in the US are facing. Not a day goes by that I don’t hear a story from a colleague about this issue.

I’ve worked for organizations whose relentless focus on profits led to inappropriate prescribing behaviors as well as excessive ordering of tests. In one urgent care position, management justified these actions by saying, “we’re still only one-sixth the cost of a visit to the emergency department” and regularly presented me with reports that illustrated how much of an outlier I was to my peers when looking at the sheer number of prescriptions ordered. It should be noted that this organization had its own in-house pharmacy for which it didn’t submit insurance claims, so all prescriptions generated revenue.

From a conscience standpoint, by the time I worked for this organization, my prescribing habits were well established. I didn’t fall into the trap of trying to keep up with my peers in a way that didn’t make sense for clinical quality. Due to my training and prior experience, I also tended to make more clinical diagnoses using decision support tools and algorithms rather than tests and imaging studies, so of course that was an issue as well.

Eventually the organization figured out that my clinical skills and procedural abilities allowed me to see patients at a pace and volume that still made them money, so they left me alone, and eventually, the reports stopped coming my way. At the same organization, I also had to deal with some occasional patient safety issues as they encouraged me to practice outside my comfort zone with certain procedures, forcing me to have difficult conversations about my refusal to treat patient care like the Wild West.

Once they transitioned from being physician-owned to being owned by non-clinical investors, I knew my time there was limited. Others saw the writing on the wall as well, and now the organization can’t even keep its locations staffed. Not because there’s a shortage of clinicians, but because there’s a shortage of those who want to work there.

The article details many of the issues I’ve run across while in practice or in talking with my colleagues. Physicians are reluctant to speak out when they find themselves in these situations, because it’s been reinforced that they need to be team players, or they have experienced that reporting their concerns can lead to retaliation.

Former physician peers have lied on exit interviews because they were afraid that what they said would make the rounds in the physician lounge and come to haunt them in their new positions. Even in large cities, the physician community can be small. Powerful physicians on a given hospital’s medical staff can make things difficult for physicians who are younger, newer, or who otherwise have less political clout.

When I initially entered practice, I was once called out by a senior physician who felt I wasn’t giving him enough referrals and demanded to know why. I’m not sure who I could have complained to about that since he was not only chair of his department, but president of the medical staff.

That situation is relatively mild compared to some of the pressures that physicians experience today, especially those who work in segments that are largely controlled by private equity organizations or who are under strict productivity models for their compensation. Many physician contracts have clauses that would be problematic for other classes of employees.

I was recently presented with a contract that specified compensation based on the concept of a 12-hour shift, with no extra pay for additional time spent. When I asked for the language to be changed, I was told no, that all the other physicians already working had agreed to it and they weren’t willing to alter it. Needless to say, I won’t be working for that organization. Whether they’re lying about what other physicians have agreed to or just being difficult, it’s a decent indicator that they don’t value their physicians’ time. I guarantee they wouldn’t offer that contract to a nurse.

When physicians don’t feel valued, it creates psychological challenges that make it difficult to deliver good patient care. Whether consciously or subconsciously, decisions are made in the heat of the moment that can impact patient care but are based on the provider’s current situation.

I suspect that’s what my family member experienced today, when they were offered two different but non-equivalent management plans with a comment that it was up to the patient to decide. The difference in the clinician’s time was about 10 minutes, but sometimes that 10 minutes is what keeps you from going to the bathroom, eating lunch, or taking care of two more patients waiting for care. It’s a sad commentary on what many of us are facing every single day with patients caught in the middle.

If you’re in a non-clinical role, do you consult clinical colleagues for advice prior to seeking care for yourself or a loved one? Have you had to advocate for yourself or someone else for medical care in the last year? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: The Shift Toward an Employer-Driven Market in Healthcare Technology

The Shift Toward an Employer-Driven Market in Healthcare Technology
By Mike Silverstein

Mike Silverstein is managing partner of the healthcare IT and life sciences practice of Direct Recruiters, Inc. of Solon, OH.

Throughout the last few years, the healthcare technology market has been largely candidate driven. During the “grow at all costs” period that started in late 2020 and continued through fall of 2022, capital was cheap, and companies were doubling down on product that was to be delivered by expensive and newly hired engineering and data talent.

That has slowed tremendously in recent months and has been coupled with significant layoffs across most of big and medium tech. What felt like an inelastic demand for technical talent over the last number of years, which corresponded to growing compensation demands, has flipped.

Below are three market trends we are seeing that signify a shift toward an employer-driven market.

Technological Advancements

It’s no secret that technology continues to change the landscape of the global workforce. The continuous stream of new AI and automation tools being introduced has the potential to change processes, procedures, and potentially even replace human labor in some situations. According to a March 2023 report from Goldman Sachs, the automation of certain tasks could disrupt a staggering 300 million jobs worldwide.

As these changes evolve, employers’ expectations of current and prospective talent are to be able to adapt and leverage new technology to their advantage versus letting it replace them.

An Emphasis on Talent That Has a Near-Term ROI

Sales, business development, demand generation marketing, customer success, and FP & A roles are crucial right now. Investors are demanding greater discipline from their portfolio companies as the cost of capital has increased and the bottom has fallen out of company valuations, particularly in tech. Right now, each company is tasked with showing a path to break even and/or profitability. No investor wants their portfolio company to have to go out for a fundraise right now for fear of a down round.

While healthcare technology employers hire and retain talent, the pressure is high for candidates to showcase that they are results driven to land great roles. If you can help make a dollar, protect a dollar, or count a dollar – sales and marketing, customer success, and accounting and finance, respectively — there are still strong opportunities in the market. As companies strive toward profitability in a tumultuous time, there may be more uncertainty for roles further away from revenue.

The Abundance of Tech Talent

With recent layoffs, there is now an abundance of healthcare technology talent on the street with far less demand for its services. As a result, passive candidates have become more risk averse. Clients are realizing there is a bit of an opportunity to buy low(er) on some needle-moving talent.

A lot of mediocre candidates did really well for themselves over the last couple of years. Healthcare technology companies are seeing an opportunity to top grade on positions where they settled in the last 24 months, and there is added scrutiny on every candidate in the hiring pipeline.

As we face this potential shift in the market, talent that has a track record of being able to perform and execute in a capital-constrained environment will continue to thrive. Candidates who are more entrepreneurial in the traditional sense — in that they are comfortable doing more with less, versus relying on the ability to obtain unlimited growth capital whenever needed — are still in high demand, along with those with a strong accounting and operations acumen.

Morning Headlines 6/19/23

Optum health startup incubator on ice

Optum dissolves its Startup Studio incubator after three years and 100 health companies incubated.

Amazon called to account – on health data

Senators Peter Welch (D-VT) and Elizabeth Warren (D-MA) express concern to Amazon President and CEO Andy Jaffy that the company’s virtual Amazon Clinic may be collecting and sharing health data from customers.

Hackers claim responsibility for Norton Healthcare ‘cyber event’ as Louisville patients await answers

The BlackCat ransomware group claims responsibility for last month’s attack on Norton Healthcare (KY), the effects of which are still impacting the health system’s network and services.

Monday Morning Update 6/19/23

Top News

Oracle has declined to comment about its layoffs in the former Cerner business last week, but affected employees have cited numbers ranging from 500 to 1,200.

Reddit commenters said that recently hired managers were targeted, along with the HealthIntent and CommunityWorks teams, support service owners, and employees who were assigned to the VA’s stalled implementation.

Reader Comments

From Innit: “Re: [cancer screening technology vendor name omitted.] Fired the CEO and two of four salespeople after missing financial goals.” I left the name out pending a company response. Its leadership page and the LinkedIn profiles of the CEO and salespeople have not changed.

From Staffer: “Re: Children’s Mercy KC. Brought in expensive consultants to train the entire workforce on culture. Executive leadership talks the talk, but some are not changing or are almost weaponizing the culture concepts against staff. I’m curious about reader experience – how is the perception of your organization, has it run a culture initiative, did leaders change or did they get swapped out, and did the organization change following the initiative?” My only experience with this was in my short, long-ago stint with a for-profit company, but I suspect the same challenges remain:

• The organizations that undertake these projects are already in trouble and expect consultants to fix their most pressing problems.
• Executives who created the problems pretend to participate, but don’t actually plan to change their own behavior.
• Hiring a bunch of expensive consultants creates pressure to deliver ROI quickly, but culture change is slow and uncertain.
• Companies are paying consultants to ask their employees what they think instead of talking to them directly, which pretty much says it all with regard to the disconnect between management and employees.
• It’s a big de-motivator to ask for opinions that are then ignored.
• It’s easier to recognize a good or bad culture than to turn one around.

HIStalk Announcements and Requests

Nearly half of poll respondents have experienced a negative impact of a previously signed non-compete agreement. A couple of folks mentioned that non-competes should include compensation – either the old company pays you while your time-out ticks away or gives you vesting or other benefits to offset your potential lost earnings – but the Epic model of pushing the non-compete onto providers and consulting firms means that you might not get offers and won’t know why.

New poll to your right or here, as suggested by a reader: does the fear of losing your job force you to work in a suboptimal or unethical way?

Listening The Descendents (that’s how they spell it), inserted into my YouTube feed because I’ve been listening to the Hives. An HIStalk search finds that I mentioned them in 2017, where I noted that the lead singers of at least three punk rock bands have earned PhDs – Bad Religion, The Offspring, and The Descendents. They look like Walmart-fashioned grandpas waiting for the Applebee’s early bird special, but then they just rip into blazing fast and highly skilled punk rock that sends youthful moshers flinging themselves off the stage. The band formed in 1977, with Milo Aukerman stepping down temporarily to earn a UCSD PhD in molecular biology followed by postdoctoral research. Also on my playlist: the reader-suggested collaboration between Dolly Parton and Judas Priest’s Rob Halford, in which Parton’s warbling pairs surprising well with Halford’s growl as collaborators whose combined age is 148.

Lorre always offers Summer Doldrums incentives to new HIStalk sponsors this slow time of year, along with some first-year perks for small startups that need a boost. Contact her.

Webinars

June 22 (Thursday) 2 ET. “The End of COVID Public Health Emergency is Here. Is Your Rev Cycle Ready?” Sponsor: Waystar. Presenter: Vanessa L. Moldovan, commercial enablement + insights program manager, Waystar. This webinar will describe the proactive steps that are needed to avoid increased rejections and denials. It will cover regulatory waivers and flexibilities, major shifts in telehealth, changes to reimbursement, and the impact of the end of the PHE on Medicaid coverage.

July 12 (Wednesday) 2 ET. “101: National Network Data Exchanges.” Sponsor: Particle Health. Presenter: Troy Bannister, founder and CEO, Particle Health. It’s highly likely that your most recent medical records were indexed by a national Health Information Network (HIN). Network participants can submit basic demographic information into an API and receive full, longitudinal medical records sourced from HINs. Records come in a parsed, standardized format, on demand, with a success rate above 90%. There’s so much more to learn and discover, which is why Troy Bannister is going to provide a 101 on all things HIN. You will learn what HINs are, see how the major HINS compare, and learn how networks will evolve due to TEFCA.

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

Acquisitions, Funding, Business, and Stock

Optum dissolves its Startup Studio incubator after three years and 100 health companies incubated.

Sales

• The VA awards Sierra7 and partner AvaSure a contract to provide a TeleCare Companion solution to seven VA medical centers in VISN 9, powered by AvaSure’s TeleSitter solution.

People

John Noseworthy, MD (Mayo Clinic) joins Northwell-created virtual-first care ecosystem vendor Caire as executive chair.

Brent Averette (Komodo Health) joins Transcarent as SVP of enterprise sales.

Damo Consulting founder and CEO Paddy Padmanabhan, MBA died Thursday of cancer.

Privacy and Security

Politico reports that Senators Peter Welch (D-VT) and Elizabeth Warren (D-MA) have expressed concern to Amazon President and CEO Andy Jaffy that the company’s virtual Amazon Clinic may be collecting and sharing health data from customers. They ask in a letter that Amazon provide its patient authorization form, which they have heard requires prospective patients to consent to data disclosure that waives HIPAA protections. They also want to review sample provider contracts and how collected is shared.

A newly declassified report confirms that US spy agencies routinely purchase commercially available data on US citizens that includes their browsing history and cell phone location.

Other

Anthem Blue Cross Blue Shield — noting that 60% of the claims it receives for Ozempic suggest that it is being prescribed for weight loss rather than diabetes — sends letters to prescribers warning them that it will alert law enforcement and state licensure boards when it suspects inappropriate use or fraudulent activity. The letter provides few details, but since prescribers can legally order drugs for off-label uses, it seems likely that the insurer is going after doctors who improperly claim that patients have diabetes in getting insurance to pay.

A New York Times report says that the corporatization of healthcare has alienated physicians whose bosses order them to behave in profit-seeking ways that don’t align with their values. It notes that some doctors have been fired for raising issues related to patient safety or poor working conditions and are forced to hit productivity targets that preclude showing empathy or support. They also have to manage patients whose don’t have the insurance or cash to afford potentially beneficial treatments.

A TV station in Australia profiles the country’s first standalone, nationally accredited virtual hospital.

Sponsor Updates

• CereCore publishes a case study titled “Epic Advisory Services: An Acquisition and Install Story.”
• Experity celebrates a successful investment cycle with an employee trip to Orlando.
• Meditech publishes a new e-book, “A strong revenue cycle begins and ends with a satisfied patient.”
• Nordic releases a new Making Rounds Podcast, “Turning data into insights with managed services.”
• OmniSys parent company XiFin names Kyu Rhee, MD senior strategic advisor.
• Surescripts publishes a podcast titled “Bringing Healthcare to the People: How Dr. Brett Giroir Serves His Nation.”
• Le Bonheur Children’s Hospital, Children’s Hospital of Richmond at VCU, and Virginia Children’s Care Network join Premier’s Kiindo pediatric-focused collaborative and purchasing alliance.
• Verato publishes a new white paper, “What Is Referential Matching?”
• Waystar customer Alivi Health announces that it has achieved a 99.89% clean claim rate.

Blog Posts

• Vyne Medical Introduces Fax Complete (Vyne Medical)
• Building a Data-Driven Culture: A Conversation with NeuroFlow Senior Director of Data Science Bill Lynch (NeuroFlow)
• How AI helps healthcare organizations achieve the Quintuple Aim (Nuance)
• Getting to grips with chronic disease management (Nordic)
• ChatGPT, Telehealth, and Financial Burdens: Is It Here to Stay? (Optimum Healthcare IT)
• The Journey of an Electronic Prescription (Surescripts)
• EHR-Based Targeting Strategies for Medical Device Marketing (OptimizeRx)
• Do Doctors Still Use Pagers? (PerfectServe)
• What is Revenue Integrity in Healthcare? (PMD)
• Lessons from a Top-Performing Health System on Lowering Mortality Rates (Premier)
• 2023 HL7 FHIR DevDays Top 3 Takeaways (Redox)
• The Joint Commission’s new emergency management guidelines: What they mean for your organization (Spok)
• CMS Introduces Prior Authorization Regulations for Medicare Advantage (WebPT)
• Three key strategies to harmonize digital health data and improve health equity (Wolters Kluwer Health)
• How Population-Based Clinical Decision Support Encourages Holistic Patient Care (Zynx Health)
• Healthcare CIO Advice on Leading through the Complexities of Change (CereCore)

Contacts

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

Morning Headlines 6/16/23

Oracle Cerner cuts more jobs, focusing on roles with VA, federal contracts

Oracle conducts another round of layoffs in the former Cerner business, according to employee reports on Reddit and LinkedIn.

Snooping in Medical Records by Hospital Security Guards Leads to $240,000 HIPAA Settlement

Yakima Valley Memorial Hospital (WA) pays $240,000 to settle allegations that several of its security guards accessed without permission the medical records of 419 patients.

Veradigm’s plan to regain compliance with Nasdaq receives approval

Nasdaq gives Veradigm another extension to submit its annual and quarterly reports, with the company expecting to file Form 10-K on September 18, 2023 rather than June 14.