Healthcare AI News 12/4/24

News

Non-profit healthcare safety group ECRI names AI as its top healthcare technology hazard for 2025. Organization President and CEO Marcus Schabacker, MD, PhD said in the list’s announcement, “Balancing innovation in AI with privacy and safety will be one of the most difficult, and most defining, endeavors of modern medicine.”

Withings and the government of France launch Project DEEP, which will use AI and non-invasive medical device innovation to detect and prevent cardiometabolic diseases, with a $23 million investment.

Business

AI and precision medicine technology vendor Tempus will work with Northwestern Medicine to explore the use of AI in clinical care and research. Their first project involves cardiology, where the health system has deployed the company’s algorithm that helps physicians identify patients who may have a one-year risk of atrial fibrillation / flutter. The Tempus ECG-AF algorithm received FDA’s 510(k) clearance in June 2024.

Spectral AI completes its analysis of burn center images that will be used to train its AI-powered DeepView System for predicting wound healing outcomes.

Research

New York University Langone Health analyzes use of its private instance of ChatGPT by its employees, of whom 1,000 applied for access in a six-month period. Clinical and research users represented half of those requests, with the most common uses being writing, editing, summarizing, analyzing data, searching for new information, and generating ideas. Examples include creating teaching materials, drafting email responses, generating job descriptions, assessing clinical reasoning documentation, and translating SQL queries. Some users reported that they struggled to create prompts and saw occasional hallucinations.

Other

Politico reports that leading house Republications want HHS to end participation in non-government AI oversight groups, specifically the Coalition for Health AI. The lawmakers said in a letter to HHS that they are concerned about having ASTP’s Micky Tripathi serve as a CHAI board observer, stating that, “help us understand how putting the organization directly in control of market entry for innovative technologies does not represent a significant conflict of interest.”

A Brookings Institution report says that use of AI in healthcare could reduce the annual US budget deficit by 20% while expanding access. The analysts, who point out that every US industry except healthcare has improved productivity in the past 50 years, say that AI could help by automating appointment scheduling, patient flow management, and preliminary data analysis. They also predict that AI could improve preventative care and disease detection.

A developer creates They See Your Photos, which allows anyone to upload a photo to see the private information Google can glean from it. I sent it a HIMSS conference photo that it analyzed well, including a note that “many people are looking down at their mobile devices.”

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Readers Write: The Future State of AI and Automation in the Revenue Cycle

The Future State of AI and Automation in the Revenue Cycle
By Patrice Wolfe

Patrice Wolfe, MBA is CEO of AGS Health.

Like many heavily regulated industries, healthcare has seen limited progress towards the use of artificial intelligence (AI) and automation, despite the enormous potential they hold for improving productivity, accuracy, care access, and the bottom line. Much of that promise comes from use cases that span the revenue cycle management (RCM) continuum, where legacy automation tools are already having a positive impact through activities like patient reminders, insurance verification, coding, and claims status transactions.

Today, generative AI (GenAI) is poised to upend, in a positive way, healthcare’s approach to front- and back-end financial operations. It has the potential to re-imagine the massive volumes of historical and real-time revenue-related data that is flowing through RCM departments and create entirely new approaches to optimize revenue and minimize financial risk.

AI is an advanced set of tools run by algorithms that use data to simulate human intelligence. GenAI takes things several steps further by leveraging that same data to not only tell the story of what it sees, but to also create entirely new, more effective approaches to RCM.

Already present in many RCM functions, AI and automation represent a continuum of capabilities that can be broken down into four major categories:

• Basic. Rules-based processes for repetitive tasks that typically follow pre-defined instructions without exceptions. Examples include a claim status or transaction query submitted by a provider using a basic bot or ANSI transaction that returns a response based on a predefined set of values.
• Advanced. Leverages more complex algorithms and machine learning to make predictions based on past performance, which allows for proactive intervention based on those probabilities. For example, a machine learning model may be able to identify claims that are likely to be denied and can be corrected before being submitted to the payer.
• Intelligent. Here is where AI enters the continuum with the addition of natural language processing (NLP) that uses unstructured data and human-like reasoning to process ambiguity. An example in RCM would be the use of machine learning, deep learning, and NLP models that recommend “next best actions” to prevent denials from even happening in the first place.
• GenAI. Uses neural networking and large language models (LLMs) with deep learning and other techniques to automate design and do complex problem solving, often aided by visual and written materials. An example would be a human-like chatbot that negotiates with payers to reverse claim denials using the clinician’s notes and imaging studies to develop an argument complete with appropriate medical terminology.

While healthcare remains in the early stages of the AI continuum, more complex and sophisticated Intelligent and GenAI use cases are on the horizon.

While all eyes are on GenAI, earlier-stage AI and automation is already impacting RCM outcomes and efficiencies. Meanwhile, ample opportunity exists to further influence RCM as capabilities grow. In fact, just as AI and automation fall on a continuum, so too do the RCM processes and workflows that can be boosted by their adoption.

Scheduling and Registration

Legacy automation has a stronghold in scheduling and registration with the use of basics like automated patient reminders now nearly ubiquitous among healthcare organizations. Looking toward the future, scheduling chat bots, integrated scheduling across care sites and clinical specialties, and comprehensive scheduling packages for patients that include cost estimates are high-priority investments for their potential to reduce patient friction, enhance the patient experience, and make a provider “stickier” by strengthening the provider-patient bond and improving patient retention.

Patient Access

Insurance and benefit verification are already close to fully automated. RCM’s holy grail of future automation use cases is prior authorization, particularly as payers build more complex and ever-changing policy requirements for prior auth. AI can help manage the prior auth process, maximize the probability of approval, and automate the appeals process if an authorization is denied. The challenge is the enormous amount of information that is required from both providers and payers who have little incentive to be transparent with those details.

Coding/HIM

Computer-assisted coding (CAC) enjoys broad adoption for inpatient coding and billing, delivering reported productivity gains of 10% to 30% for hospitals. Computer-assisted professional coding (CAPC) is beginning to make inroads on the professional side. Future use cases include autonomous coding, which has limited use in a handful of specialties due to the significant amounts of data needed to properly train the specialty-specific LLMs. Early work is also underway around ambient charting, which converts voice dictation into coding and promises to save physicians up to 4.5 minutes per chart by some estimates.

Patient Financial Services

As with prior authorization, AI and automation adoption in patient financial services is influenced by increasingly aggressive payer policies around denials, delays, and underpayments. There is enormous potential for streamlining collection workflows, including touchless A/R. Other promising areas are automated denials management and the movement to a reduced friction patient experience.

Clinical Services

Though farther behind other stops on the RCM continuum, future AI and automation use cases within clinical services include real-time patient status monitoring in utilization management (UM) to ensure accurate reimbursement. Other potential applications include professional fee UM and automated clinical documentation integrity (CDI) that uses NLP and other advanced tools.

Revenue Integrity

Also behind the adoption curve, revenue integrity AI and automation use cases include charge master maintenance, late charge identification, and coding/billing compliance audits. AI and automation are also used to proactively identify and resolve problem areas.

Healthcare has taken a cautious approach to adopting GenAI and other advanced forms of AI and automation within RCM, due in part to the industry’s necessarily risk-averse nature. Also at play are the complexities that are involved with adapting critical workflows to advanced AI and the need to balance the application of limited resources between multiple and sometimes conflicting strategic priorities.

For example, while advancements like ambient documentation are crowd pleasers that promise to deliver improvements in physician productivity and satisfaction, they won’t necessarily improve the completeness of clinical documentation. As such, CDI will remain a critical part of the RCM process.

The reality is that while GenAI and its AI peers hold great promise for optimizing RCM, these technologies can be expensive to use, staff, and support. Health systems and other provider organizations will have to place bets with scarce resources, and it’s more likely that AI use cases that improve physician and patient satisfaction will come out on top.

GenAI and advanced automation also require close collaboration between operating departments like RCM and their IT colleagues to create and test APIs, move/share data between systems, and access datasets to test predictive models and train LLMs and other advanced AI models. This collaboration may be hampered by information and data silos that were created by legacy technologies. This also impacts the opportunity to leverage AI and automation to create a seamless patient experience, which requires integration across multiple settings of care, systems of record, and data siloes.

As GenAI and other advanced automation solutions continue to deliver on their promise, the impact on healthcare RCM has the potential to be transformational. They also have the potential to reduce the challenges that are confronting providers across the RCM continuum, while streamlining patient access, increasing coding and billing accuracy, improving utilization management, and speeding the revenue cycle.

When the productivity and accuracy promises are fully realized, investing in GenAI and its predecessors becomes a true win for the entire healthcare industry.

Readers Write: What We Can Learn about Mental Healthcare from a Cattle Farm

What We Can Learn about Mental Healthcare from a Cattle Farm
By Teira Gunlock

Teira Gunlock, MHA is CEO of First Stop Health.

What does mental healthcare in the United States have in common with a farm? As a healthcare executive who grew up on a cattle farm in Missouri, I can tell you there are more similarities than you might think.

Let’s start with what we know. Mental healthcare in the US is in crisis. One-third of Americans say they can’t get the help they need, and both individuals and employers face the same barriers to care of cost and access. Mercer reports that 94% of large employers have increased their investment in mental health coverage over the last three years, a trend we’ve also seen in small- and medium-sized businesses.

And yet, people aren’t getting the care they need because it’s too expensive and there aren’t enough providers to meet the demand. Costs will only continue to rise, making it increasingly more challenging for employers to provide adequate coverage.

Virtual care has the potential to fill this gap. For employers, virtual care offers the promise of low administrative costs, high utilization, ease of engagement, and a positive patient experience. For patients, virtual mental healthcare means that they can see providers on their own schedule, with fewer barriers to getting care.

Seems like virtual care is the silver bullet, right? Not exactly. A lot of virtual mental healthcare models have fallen short where it counts. With low engagement rates and poor patient satisfaction scores, the current model has proven unsustainable. Many providers are cutting out telehealth options altogether. 

Clearly, the system is broken.

This is where the farm analogy comes back in. On the farm where I grew up, things are constantly broken – fences, machinery, you name it. I learned that small fixes each day can make a big impact over time. A problem may seem overwhelming, and healthcare surely is, but big problems just don’t get solved overnight. They require a series of small, ongoing fixes rather than a one-and-done solution. I bring that mentality to my work in healthcare every day.

Revolutionizing the mental healthcare landscape is a lofty goal, and no one company can do it alone. It requires insights and innovative ideas from people with a wide variety of expertise and experience who are passionate about being part of the solution.

During the pandemic, when mental health services were desperately needed, we saw a proliferation of virtual mental health solutions enter the market. Those early solutions addressed some of the problems, but we learned there was more to fix.  

Effective care requires removing the barriers that prevent people from accessing it. In mental healthcare, high costs, difficulties in connecting with providers, and lack of long-term support all hinder patients from getting the care they need. Moreover, mental healthcare can’t be siloed from the rest of a patient’s care; it must be integrated to treat both the mind and body as a whole. 

The right virtual model can address many of these roadblocks. First, effective virtual care, particularly in rural areas, combined with on-demand access to licensed therapists and mental health coaches, can connect patients wherever they are. 

Second, a streamlined payment model allows for flexibility for providers and patients. It eliminates both out-of-pocket costs and the complicated and expensive reimbursement process.

Third, progress with mental health looks different for everyone, and care works best when it’s ongoing and sustainable. Long-term care models that also support provider selection allow patients to build a relationship with a provider they choose, making them more engaged and invested in their care journey. 

It’s unlikely that the demand for mental health services will decline any time soon, making it more important than ever to have sustainable models that can get patients the care they need. Virtual mental healthcare works best when patients have options that increase their access, are low-cost, and allow for relationships to build between patients and providers over time.

Just like on the cattle farm, fixing what’s broken requires constant problem-solving and resilience. To make meaningful change, we must leapfrog over the status quo and commit to reshaping mental healthcare into a system that emphasizes whole-person health, seamless access, and that puts patients first.

Morning Headlines 12/4/24

Soda Health closes oversubscribed $50M Series B led by General Catalyst to scale its Smart Benefits Operating System

Soda Health, whose platform allows members to use their health insurance benefit dollars on approved goods and services, raises $50 million in a Series B funding round.

Inside VA’s $369B FY 2025 Budget

The VA’s proposed $370 billion 2025 budget includes $900 million earmarked for the department’s Oracle Health-based EHR.

Healwell Acquires Control of Mutuo Health Solutions To Build Next Generation of AI-Powered Physician Co-Pilots

Toronto-based AI-enabled decision support vendor Healwell acquires a majority stake in Mutuo Health Solutions, which offers an ambient scribe product.

ECRI acquires The Just Culture Company to transform healthcare patient and workforce safety

Healthcare quality organization ECRI acquires The Just Culture Company, which addresses workforce culture.

News 12/4/24

Top News

The Drug Enforcement Administration says that criminals who have been committing prescription drug fraud are now using EHRs and e-prescribing systems to create bogus prescriptions that are often sent to pharmacies all over the US.

Those involved are generating up to 1,000 prescriptions per day for a given prescriber’s DEA number.

DEA says the solution will need to involve doctors, EHR vendors, prescription processing companies, and pharmacies. It recommends that providers check their profile in their state’s prescription drug monitoring program to look for irregularities.

Reader Comments

From Lattice: “Re: Bluesky. I was surprised by your strong endorsement of a platform you mentioned not having fully explored. Are you suggesting that it offers a superior experience compared to X?” I wasn’t endorsing Bluesky, just mentioning that I am using it. I like Bluesky for mostly superficial reasons — the absence of ads, the control I have over what posts I see, and a clubbier vibe that feels like a cool secret society (at least until the trolls and bots on X join me). It’s also open, so people are building apps on top of it whereas X has shut off most of its APIs to wall off its garden. My timing was triggered because of its huge influx of new users, whose reasons aren’t necessarily the same as mine, that give it critical mass. I like that I don’t have to pledge exclusivity since it’s free and easy to use both services, plus I wouldn’t be too smart if I abandoned my 14,000 followers on X versus the 140 I have on Bluesky. My plan:

• I’m not a very active user of X, but I will continue to post on both services, probably a bit more interesting stuff on Bluesky.
• I will spend far less time reading X’s “For You” algorithm-pushed posts that are designed to enrage, silo, and troll to boost engagement.
• I will still check X’s “Following” posts, probably a few times each day. I follow only 109 accounts, so I can zip through those quickly.

From Summoner: “Re: Chromebook. I’ve been meaning to thank you for recommending a ruggedized, small, light and cheap model a number of years ago, which I picked up for $150.” I love my Chromebook, which fills the gap between using my laptop at my desk versus my IPad from a comfy chair when I don’t need a real keyboard or Windows-only tools. I paid $99 in mid-2022 for my low-end Lenovo that has 4 GB of memory and 64 GB of storage. I like the 11.6 inch, 2.4 pound form factor, the automatic updates, and a battery that runs for days.

From Researcher: “Re: Altmetric. The social media citation measurement tool that journals use to measure interest in their article now cites HIStalk as both a news organization and a blog.” Thanks, I didn’t know that. The site calculates a real-time Attention Score for each journal article that is based on media mentions. I read this morning that it just added Bluesky posts. The value of such a service is that the feedback is immediate compared to measuring citations months or years later when new articles finally emerge from the research journal sausage maker.

From Old Aprima: “Re: CompuGroup Medical, which had acquired EMDs and Aprima. Just did its fourth round of layoffs this year, with 15 people let go, including some high tenure employees.” Unverified.

From Spellchequer: “Re: RSNA. Add this to your list of conference misspellings such as HIMMS.” A search of this site – which I won’t name even though I could shame them as an HIStalk competitor — surfaces dozens of examples of RSNA butchering, most often in headlines, going back to 2011.

HIStalk Announcements and Requests

A reader’s donations funded the Donors Choose teacher grant request of Mr. M in Dallas, who asked for a wireless voice amplifier and microphone to help his pre-schoolers hear him without straining his voice. He sent a photo, although my face-blurring hides the brand new headset he wanted to show us. Speaking of Donors Choose, a donation from reader Natalie, boosted by some juicy matching funds including those from my Anonymous Vendor Executive, funded these projects:

• A laptop for the seventh grade science class of first-year teacher Ms. E in Grand Island, ME.
• Interactive STEM games for Mr. W’s high school class in Conyers, GA.
• Headphones for the second grade class of Ms. S in Paterson, NJ.
• Mini whiteboards for Mr. S’s English as a Second Language high school class in Chicago, IL.

Welcome to new HIStalk Platinum Sponsor SmarterDx. SmarterDx builds clinical AI that empowers hospitals to true the patient record to fully capture the value of care delivered. Founded by physicians in 2020, its proprietary AI platform understands the nuances of clinical reasoning, enabling hospitals to true every patient record. By doing so, hospitals recover millions in earned revenue, enhance care quality metrics, successfully overturn denials, and optimize healthcare operations. Discover how SmarterDx is transforming healthcare.

Here’s a recent SmarterDx explainer video.

Webinars

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

Acquisitions, Funding, Business, and Stock

Toronto-based AI-enabled decision support vendor Healwell acquires a majority stake in Mutuo Health Solutions, which offers an ambient scribe product.

Healthcare quality organization ECRI acquires The Just Culture Company, which addresses workforce culture.

Soda Health, whose platform helps members use their health insurance benefit dollars to pay for approved goods and services, raises $50 million in a Series B funding round.

Sales

• Great River Health System (IA) will switch from Oracle Health to Epic in 2026.

People

VillageMD names President and COO Jim Murray interim CEO following the departure of co-founder Tim Barry. Parent company Walgreens Boots Alliance, which has invested over $6 billion in the primary care chain, is considering selling all or parts of VillageMD due to struggling profitability.

Cotiviti hires Suvajit Gupta, MS (Appian Corporation) as CTO.

Former Intermountain Health CIO Ryan Smith, MBA (Graphite Health) rejoins the health system as chief digital and information officer.

Announcements and Implementations

Marshfield Clinic Health System (WI) implements Switchboard, MD’s MDAware inbox management technology at three facilities.

Xsolis launches an AI-powered solution for appeals documentation, with MultiCare Health System serving as its pilot site.

Academy Medtech Ventures releases Move PT, a home rehab care system that uses AI, computer vision, and remote therapeutic monitoring.

A new KLAS report on imaging AI reveals that high-volume organizations are leading adoption, with mid-sized ones poised to follow. AI is now more commonly used in neurology and stroke cases than computer-aided detection, with breast and mammography applications ranking second. The most widely used solutions are RapidAI and Viz.ai, while Aidoc and Nuance top the list of those under consideration for purchase.

Government and Politics

HHS secretary nominee Robert F. Kennedy, Jr. suggests that CMS, rather than the American Medical Association’s RUC panel of doctors, should be tasked with recommending provider payments amounts for individual CPT codes for Medicare billing. CPT products such as licenses generate $266 million annually, which represents half of AMA’s revenue.

Privacy and Security

HHS OCR levies a $1.19 million fine against Gulf Coast Pain Consultants, who it says violated HIPAA when a former contractor used patient information from its EHR to file 6,500 fraudulent Medicare claims. The contractor was previously indicted but found not guilty.

Holy Redeemer Family Medicine (PA) pays $35,581 to settle federal allegations that it potentially violated HIPAA when it disclosed a patient’s full health record to a prospective employer, including information about reproductive healthcare, rather than the single test result that the patient had authorized.

Other

Unity Health Toronto puts together a fun “Breaking News” video to celebrate its Epic go live across its three hospitals. You can almost smell the typical command center Eau de Parfum (picked-over “I’ll just have a half” everything bagels and congealed pizza).

Sponsor Updates

• Goliath Technologies publishes a case study about Intermountain Healthcare’s use of the company’s solution to identify reliability and response time issues to improve end user EHR experience.
• Agfa HealthCare Rubee AI customers can now access Carpl.ai’s marketplace of 140 AI applications, testing, deployment and monitoring tools.
• TheMuse.com recognizes Arcadia with its 2024 VIBE (Voted in by Employees) Award in the employee health and wellness category.
• Artera offers a new case study, “Jane Pauley Community Health Center Increases Access to Care Across Community-Based Populations in Central Indiana with Artera.”
• AvaSure publishes the results of its “Inpatient Virtual Care Insight Survey.”
• Capital Rx releases a “Best of 2024” episode of “The Astonishing Healthcare Podcast.”
• Clinical Architecture will present at the 2024 Assistant Secretary for Technology Policy Annual Meeting December 5 in Washington, DC.
• CliniComp shares insights from recent site optimization visits at VA facilities in Atlanta and Augusta, GA.

Blog Posts

• The Future of Medical Coding: Artificial Intelligence, Automation, and People (AGS Health)
• AMA Coding Overhaul: A New Era for AI Medical Documentation in the ED (Augmedix)
• Experts Predict Increasing Digital Health Investment in 2025: Innovators Can Turn Cybersecurity into Value Creation (Clearwater)
• You’re (Probably) Hiring the Wrong People (Divurgent)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Follow on X, Bluesky, and LinkedIn.
Contact us.

Morning Headlines 12/3/24

CoachCare Acquires Revolution Health Solutions, Marking Its Sixth Acquisition

Remote patient monitoring and virtual care management company CoachCare acquires competitor Revolution Health Solutions.

Power Diary Rebrands to Zanda with a Bold Vision for Health Practice Management

Practice management software vendor Power Diary rebrands to Zanda.

Elimu Informatics Secures an SBIR Grant to Develop an EHR-interoperable Asthma Care Solution

Elimu Informatics will use an NIH grant to develop a SMART-on-FHIR clinical decision support app for asthma management.

Curbside Consult with Dr. Jayne 12/2/24

This weekend marked the two-year anniversary of the debut of ChatGPT. This seems to be a good time to reflect on where generative AI has taken us during that interval.

When it initially launched, there were quite a few worries about AI becoming sentient and taking over the world, but it seems that we’ve been spared that. I’m not sure you’re capable of taking over the world when you can’t generate pictures of humans that have the correct number of digits per hand, so maybe we can use that as a benchmark for how worried we should be about generative AI coming after us.

Although ChatGPT is the original, there are plenty of competitors in the market. The majority of physicians I encounter cite using ChatGPT, Microsoft Copilot, Google Gemini, Meta Llama, or Perplexity. The last one has been on the rise when I ask my colleagues around the virtual water cooler, although I personally think that it’s the least capable based on my short list of medical searches that I use to kick the tires on the models over time. The last time I tested Perplexity, it gave me a clinical recommendation that was 180 degrees from standard care for a patient with a particular genetic variant, which if followed would likely have led to negative outcomes (such as preventable death).

Healthcare organizations see the risk that AI can bring to our environment are joining together to provide guidelines for development and use of AI in healthcare in a responsible manner. The Coalition for Health AI (CHAI) is looking at safe and equitable implementation of AI in healthcare and has information on model evaluation and standards on its website. Google, Microsoft, and Amazon are among the founding members, as are care delivery organizations, academic centers, professional organizations, retailers, payers, and standards organizations. The Coalition recently hosted CHAI on the Hill Day to educate lawmakers on healthcare AI, although it sounds like the event was heavy on developers and industry folks and light on care delivery organizations.

Care delivery organizations are also doing their own deep dives into AI, including Mass General Brigham, which recently announced its Healthcare AI Challenge Collaborative. Additional members include Emory Healthcare, the University of Wisconsin School of Medicine and Public Health, the American College of Radiology, and the University of Washington School of Medicine. Researchers will have access to an environment that includes AI solutions to “assess for effectiveness on specific medical tasks, such as providing medical image interpretation, in a simulated environment.” Users can provide feedback and the Collaborative is planning to use a crowdsource methodology for healthcare professionals “to create continuous, consistent and reliable expert evaluations of AI solutions in medicine.”

The Challenge will look first at radiology-related use of AI, which makes sense given that AI has been used in varying degrees in that field for years. It’s important to understand that fact, especially given the scare factor behind the use of the AI label since the emergence of ChatGPT. In my conversations, I find that people don’t really understand that there are different types of AI, many of which have been in use for a long time across a variety of industries. It’s only generative AI that is relatively new to the dance, but it has unfortunately triggered the creation of AI policies and AI review committees that have the chance to become cumbersome if they can’t differentiate between established low-risk AI solutions and higher-risk generative ones.

When I have this conversation with people, I point out the kinds of AI that we’ve all grown to depend on as examples of why not all AI is bad. These include spam filters, fraud detection and identification of suspicious transactions, sales forecasting, behavior analysis, and predictive models for a variety of things, including public health.

In my workplace travels, I’ve seen some of those go awry. One organization that I was consulting for had their email spam filter dialed up so high that anything with an outside address immediately went to junk mail with no way to add to a safe senders list. I asked for an in-house email address so that I could work effectively, and it took more than a month to get that provisioned. That kind of inertia didn’t make for a productive consulting environment, so my work with them was short lived.

Other health systems have jumped into creating AI centers to test and develop tools. New York’s Mount Sinai has opened the Hamilton and Amabel James Center for Artificial Intelligence and Human Health, which focuses on patient care such as diagnosis and treatment. Vanderbilt University Medical Center is creating the AI Discovery and Vigilance to Accelerate Innovation and Clinical Excellence center. That’s definitely a mouthful and doesn’t appear to be any kind of acronym or initialism, so I wonder if the name will be whittled down to something punchier. Hartford HealthCare is creating a Center for AI Innovation in Healthcare that includes research, development, education, training, ethical, and regulatory aspects of AI.

As a clinician, the biggest risk I see of AI in healthcare is for frontline clinicians who don’t have a background in clinical informatics or an understanding of the potential pitfalls of generative AI. These folks have a high likelihood to use non-medical AI solutions for clinical care support even though those solutions have plenty of disclaimers that say they shouldn’t be doing it. Get a group of physicians together and they’ll talk openly about what they’re using and how they’re using it, and there’s often little realization of the risks.

These physicians are the same ones who are also likely to not proofread their AI-generated notes before they go out, but then again, they’re also the ones who didn’t read their dictated notes either. They also have a high likelihood of using templated notes and not updating them consistently for the patient in front of them, so it all goes to a pattern of behavior. Still, there are too many clinicians taking this cavalier attitude for me to be comfortable with their ability to effectively and safely incorporate additional AI solutions into patient care.

I’m not worried about AI taking over my life, at least in the short term. No online presence is going to come into my house and create delightful baked goods such as the dinner rolls that I crafted for Thanksgiving. I appreciate that AI can make some tasks faster so that I have time for things like baking and creating, but there is still plenty of busy work that I’d like to offload to AI sooner than later, and I wish developers would get to work on that.

What are your favorite holiday foods? Care to share a recipe? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/2/24

Veterans Health Administration notifying Veterans of potential information disclosure

The Veterans Health Administration notifies 2,302 patients at six different VA healthcare systems of a third-party data breach that may have exposed their personal health information.

HHS Office for Civil Rights Settles with Holy Redeemer Hospital Over Disclosure of Patient’s Protected Health Information, Including Reproductive Health Information

Holy Redeemer Family Medicine (PA) pays $35,581 to settle federal allegations that it potentially violated HIPAA when it disclosed a patient’s full health record to a prospective employer, rather than the single test result requested by the patient.

CEO of Chicago-based VillageMD steps down as Walgreens considers selling stake in business

VillageMD CEO and co-founder Tim Barry steps down as parent company Walgreens Boots Alliance considers selling all or parts of the business.

Monday Morning Update 12/2/24

Top News

Business Insider reports that many digital health startups are cutting their valuations, shutting down, or being quietly acquired for parts after raising no new venture capital since the ZIRP heyday of 2021.

Venture capitalists provided bridge funds in helping their startups reach their next funding round, but have lost patience with those that haven’t performed as expected, choosing instead to put their money into AI startups.

The author says that quite a few health-related business that stalled at seed or Series A rounds have shut their doors with little attention.

Reader Comments

From Whaleback: “Re: HIS-tory. Folks on the former Cerner Reddit are looking for Vince Ciotti’s industry history and how Cerner’s acquisitions may have created a confusing patchwork of Millennium functionality.” Vince’s fascinating HIS-tory that I ran many years ago contains health tech’s early lessons that can be learned the easy way (by reading) or the hard way (by repeating those same mistakes). Vince retired from his 50-year health IT career in 2019 and died in 2021. He said in our 2019 conversation that he hoped to be remembered for his HIS-tory above all else. Click the graphic to see Vince’s recap of Cerner’s acquisitions, and if you open the big HIS-tory file, be aware that some PDF readers work better than others.

HIStalk Announcements and Requests

Poll respondents overwhelmingly named emergency response time as their biggest fear of hospital-at-home treatment.

New poll to your right or here: How will HHS change under the new administration? I’m not encouraging political conversation, but rather seek predictions of how companies and consumers will fare under expected new priorities and leadership. As a reminder, HHS runs a $2 trillion annual budget and includes CMS (Medicare), CDC, FDA, NIH, the Public Health Service, HHS OIG, AHRQ, Office for Civil Rights, and ASTP. 

Pondering: do RSNA attendees ever get to eat leftover turkey sandwiches?

I’m winding down my use of X in favor of Bluesky (you can follow me here), so as a noob who initially thought Bluesky was an unfamiliar ghost town even though it has 24 million users, I’ll offer some tips on what to do after opening an account. Add your own tips via a comment if you like.

• Choose a few X accounts that you like and follow them on Bluesky if they are there, which trains Bluesky’s algorithm to understand what you like. Commenting, liking, reposting, and quoting helps build your connection list and get more Bluesky participation.
• SkyBridge helps you find and follow your X connections, although I haven’t tried it.
• Click Profile on the menu bar to the left, then click Edit Profile at the top of your feed to add a display name, description, and an image. Otherwise you won’t get followers because nobody will know who you are. Some of my new followers are listed with the default profile of “johnsmith.bsky.social” without a display name or description, so add those to get more followers.
• Create custom feeds by clicking the #Feeds menu item, then look for new feeds that mirror your interests. Click the plus sign to follow them, which will then add them to the top of your feed as clickable options. For example, I added Popular with Friends, Mutuals (posts from fellow users who have followed you back), and News.
• Find another user’s relevant Starter Pack or search the 40,000 available ones. Click a starter pack to connect with all of the users it lists.
• Click the Notifications menu item to see who has recently followed you. Follow them back to expand the network.
• Click the Settings menu item and then Sort Replies to choose oldest, newest, most-liked, or random.
• Click the Settings menu item and then Moderation to filter posts by words, tags, or adult content. I need to figure out if this can be used to hide follower posts that relate to sports, politics, and pets.  
• Click the Settings menu item, then Content and Media to enable media players such as YouTube.
• Enjoy ad-free, bot-limited quiet and thoughtful conversations that aren’t pushed in your face by a profit-driven algorithm while simultaneously lamenting that bot farmers and trolls have discovered Bluesky just like everybody else.
• My wish list for Bluesky includes an easier verification process (fake accounts are already proliferating); and a native IPad app.

Welcome to new HIStalk Platinum Sponsor TeamBuilder. TeamBuilder is the first predictive staff scheduling platform built specifically for ambulatory care. Staffing in ambulatory care is fundamentally complex, with fluctuating patient demand, varying specialty needs, multiple locations, and diverse staff preferences. Yet, 95% of ambulatory organizations still rely on outdated paper or Excel-based scheduling, which makes it difficult to optimize staffing effectively. This results in costly overstaffing, administrative inefficiencies, and a lack of visibility into critical operational metrics, such as cost per visit. TeamBuilder transforms this process by using predictive technology and advanced data science to deliver real-time, optimized schedules that meet both patient demand, clinical workflow and staff availability, ensuring the right staff are always in place. With TeamBuilder, you gain more than just a smarter scheduling tool— you unlock the ability to reduce staffing costs, improve patient access, eliminate administrative inefficiencies, and gain deep visibility into your operations. With TeamBuilder, you’ll always know exactly who you need today, tomorrow, and next month –empowering you to make smarter, more strategic decisions. Let TeamBuilder help you reimagine staff scheduling. Thanks to TeamBuilder for supporting HIStalk.

Here’s a TeamBuilder intro video.

Webinars

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

Acquisitions, Funding, Business, and Stock

Canada-based practice management software vendor Practice Better raises $13 million in growth capital.

Radiology platform vendor Sirona raises $42 million in a Series C funding round.

The Winston-Salem paper notes the 2023 compensation of top executives of Novant Health, which includes EVP/Chief Digital and Information Officer Onyeka Nchege at $947K in total compensation.

Sales

• Trinity Health will implement the cloud-based Visage 7 enterprise imaging platform in a $215 million, 10-year contract.
• NYU Langone Health, which was the first on-premise customer of Visage Imaging, extends its contract in a $24 million, five-year deal to implement the company’s full stack in the cloud.

People

CTG promotes Chad Alessi, MS, MBA to managing director of cybersecurity. He is a US Marine Corps veteran.

Health Systems Informatics promotes Joe Ranieri to VP of business development.

Brian Roy, MBA (Simplify Healthcare) joins Zyter TruCare as VP of sales.

The Garage In hires Stacy Fox (Acclivity Health Solutions) as SVP of market development and growth.

Announcements and Implementations

LGI Healthcare Solutions launches a healthcare workforce management platform for the Canadian market.

Government and Politics

The CEO of a bar association for Social Security attorneys and Epic’s policy team leader Ladd Wiley, JD describe how Epic’s integration with the Social Security Administration’s IT systems supports timely disability determinations. Epic facilitated the exchange of 2.5 million patient records between its hospital clients and SSA last year. However, the authors note that only 15% of disability claims are reviewed using data obtained via EHR interoperability, with the rest being managed by mail and fax. They recommend that TEFCA be expanded to include use cases involving government benefits determinations.

Privacy and Security

Texas Governor Greg Abbott threatens to end state funding of Texas Children’s Hospital because one of its cardiologists posted a TikTok video advising patients that while the hospital is required to ask their citizenship status based on Abbott’s November 1 executive order, those patients are not required to answer.

Other

Dean Sittig, PhD and Hardeep Singh, MD, MPH publish a JAMA viewpoint piece that makes recommendations for healthcare organizations to ensure the safe implementation and use of AI in clinical care, emphasizing the need for governance, real-world testing, clinician and patient engagement, performance monitoring, and risk mitigation to prevent harm and improve outcomes.

Multiple authorities in Sweden are investigating reported problems with the newly rolled out Oracle Health Millennium in the Västra Götaland region. Clinicians and other users in western Sweden reported significant problems with the $190 million project, some of them reportedly placing patients at risk.

New Mexico jurors award an all-time record $412 million malpractice judgment against a multi-state men’s health clinic. The lawsuit was filed by a 66-year-old man who visited one of the facilities complaining of fatigue and weight loss, for which he says the clinic ordered thrice-weekly penile injections for erectile dysfunction that caused damage. NuMale Medical Center offers hard-sell treatments for ED, premature ejaculation, hair restoration and transplants, testosterone replacement, and weight loss. 

Sponsor Updates

• CereCore releases a new case study, “Oklahoma Heart Hospital: Partnership for Interface Optimization.”
• The Digital Health Hub Foundation names Linus Health the 2024 Longevity Best in Class winner of its Digital Health Awards.
• The CH Béziers hospital in France will adopt Sectra’s digital pathology solution.

Blog Posts

• Use the “Holiday Diet” to Trim Your Clinical Productivity Variances (Impact Advisors)
• Navigating the CMS 2025 Physician Fee Schedule Final Rule (MRO)
• Future-Proofing Your Public Health Programs: Top 5 Things to Consider (Netsmart)
• How to improve bedside handoffs with digital whiteboards (Sonifi Health)
• Striking Gold: How Washington State is Empowering the Care Team Evolution (Surescripts)
• Unlocking Efficiency and Profitability with End-to-End Revenue Cycle Management (TruBridge)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Follow on X, Bluesky, and LinkedIn.
Contact us.

Morning Headlines 11/28/24

Practice Better Secures US$13 Million in Growth Capital from CIBC Innovation Banking to Accelerate Expansion of Holistic Health Solution

Practice Better, a vendor of practice management software for health and wellness organizations, announces $13 million in new capital.

Sirona Medical Secures $42M in Series C Financing to Enhance Customer Success With Its Cloud-Native Unify Platform

Radiology workflow software company Sirona Medical announces $42 million in Series C funding, bringing its total raised to over $104 million.

Care IO Secures Strategic Seed Funding to Revolutionize Healthcare Data Collaboration

New Jersey-based healthcare data governance and interoperability startup Care IO announces an undisclosed amount of seed funding.

Morning Headlines 11/27/24

Another ‘major cyber incident’ at a UK hospital, outpatients asked to stay away

England’s three-hospital Wirral University Teaching Hospitals NHS Trust cancels outpatient appointments due to an unspecified cybersecurity incident.

HHS Issues RFI for IT Staffing at Federal Occupational Health

HHS seeks companies that can provide IT staffing support services to Federal Occupational Health, an agency that provides occupational health services to federal employees.

Kyan Health raises $16.7M to upgrade workplace wellness with AI-powered preventative care

Kyan Health, an app-based provider of employee-focused mental healthcare, announces $16.7 million in funding.

News 11/27/24

Top News

England’s three-hospital Wirral University Teaching Hospitals NHS Trust cancels outpatient appointments due to an unspecified cybersecurity incident. Patients were asked to avoid visiting the emergency department for non-emergencies.

A hospital employee told a newspaper that “everything is down” and records can’t be accessed.

HIStalk Announcements and Requests

Welcome to new HIStalk Gold Sponsor CTG Health Solutions. With 35+ years of expertise, CTG stands as a beacon in today’s healthcare IT consulting market. The company’s Healthcare Consulting Solutions blend innovative services with cutting-edge technologies to address the unique challenges, requirements, and regulations of the healthcare market. Connect to explore how CTG’s healthcare experts can help transform challenges into opportunities, ensuring that your organization not only succeeds but thrives in a rapidly evolving landscape. Thanks to CTG Health Solutions for supporting HIStalk.

Webinars

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

Acquisitions, Funding, Business, and Stock

Cofactor AI, which offers AI-powered software to help providers appeal denied claims, launches with $4 million in seed funding.

Medication affordability, access, and adherence software company TailorMed secures $40 million in new financing.

Sales

• Self Regional Healthcare (SC) will adopt Agfa HealthCare’s Enterprise Imaging Cloud.
• Carle Health (IL) selects value-based care software and services from Lumeris.
• The Queen’s Health Systems (HI) will implement remote patient monitoring services from Health Recovery Solutions as a part of a new RPM program offered through the Native Hawaiian Health Department.
• Hartford HealthCare (CT) will use WellStack’s data integration and analytics software to enhance the efficacy of its Google Cloud Platform and overall digital health strategy.
• Cambridge Health Alliance (MA) selects Abridge’s AI-powered speech recognition and clinical documentation technology.

People

Steve McDonald (Nordic Global) joins Pivot Point Consulting as executive partner.

Announcements and Implementations

WVU Medicine goes live on DrFirst’s medication management platform.

Emory Healthcare (GA) implements Switchboard.MD’s MDAware Inbox Management software across four specialty clinics. Switchboard.MD founder, CEO, and CTO Blake Anderson, MD is also an Emory physician.

Teladoc adds AI-powered patient movement detection capabilities to its Virtual Sitter solution that will allow staff to intervene in fall risk situations. 

Other

Mount Sinai Health System opens the Hamilton and Amabel James Center for Artificial Intelligence and Human Health in a repurposed building on the campus of its hospital in Manhattan. The new center will serve as a space for the research, development, and application of new AI solutions.

Industry luminary and friend of HIStalk Ivo Nelson posted a link to this video of the Glaser Society presentation, at which Epic’s Judy Faulkner was named the recipient of the John P. Glaser Health Informatics Innovator Award. Check out the fireside chat with John, Judy, and Ivo at the 25:50 mark of the video that was made by the McWilliams School of Biomedical Informatics at UTHealth Houston.

Sponsor Updates

• CereCore publishes a new info sheet, “MEDITECH Regulatory Reporting and Submission Services.”
• EClinicalWorks publishes a new customer success story, “Smarter Patient Care with AI Technology.”
• AGS Health publishes a new e-book, “eBook Medical Necessity in Ambulance Coding.”
• Altera publishes a new client story, “Health New Zealand – Te Whatu Ora Advances Digital Transformation with Provation IPro: Streamlining Elective and Acute Care Pathways at Waikato.”
• CIO Outlook names Ascom Americas Managing Director Kelly Feist one of the year’s most influential female leaders in healthcare technology.
• The American Telemedicine Association Virtual Nursing Insights Summit recognizes AvaSure with its Best Case Study Award.
• Capital Rx releases a new episode of “The Astonishing Healthcare Podcast,” “Pharmacy Benefits 101: Formularies & Formulary Management, with Nisha Bhide, PharmD.”
• Cardamom Health sponsors and hosts the HFMA Colorado Chapter’s Women in Leadership conference.
• DrFirst publishes a new guide, “Navigating the New Norm in a Regulatory Storm.”
• First Databank will present at the American Society of Health-System Pharmacists 2024 Midyear Clinical Meeting and Exhibition December 8-12 in New Orleans.
• FinThrive publishes a new “Contract Management Case Study: Midwestern Health Network.”
• Fortified Health Security wins the Healthcare Cybersecurity Solution of the Year Award from CyberSecurity Breakthrough.

Blog Posts

• Empower Clinical Informaticists for Reimbursement Wins in 2025 (CereCore)
• National Rural Health Day: An RN’s POV (Altera)
• Artera’s Approach to AI (Artera)
• Clearwater Cyber Briefing: Key Trends and Takeaways for November 2024 (Clearwater)
• Getting Down to Business with AI: Key Observations from HLTH (Consensus Cloud Solutions)
• Beyond Legacy Systems: Unlocking Operational Efficiency and Cost Savings Through Application Rationalization in Healthcare (Cordea Consulting)
• AI in Healthcare is Only as Effective as the People Using It (Dimensional Insight)
• Redefining Patient Access: The Rise of Intelligent Contact Centers (EClinicalWorks)
• Medicare Bad Debt 101 (FinThrive)
• Modernization and Expansion of an Outpatient Surgery Center (Health Data Movers)
• Elevating data security with HITRUST certification, HIPAA compliance, and employee awareness (Healthmonix)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Follow on X, Bluesky, and LinkedIn.
Contact us.

Morning Headlines 11/26/24

Mount Sinai Opens the Hamilton and Amabel James Center for Artificial Intelligence and Human Health to Transform Health Care by Spearheading the AI Revolution

Mount Sinai Health System’s new Hamilton and Amabel James Center for Artificial Intelligence and Human Health in New York City will serve as a space for the research, development, and application of new AI solutions.

The Office for Civil Rights Should Enhance Its HIPAA Audit Program to Enforce HIPAA Requirements and Improve the Protection of Electronic Protected Health Information

HHS OIG makes several recommendations after reviewing OCR’s program for performing periodic HIPAA audits, including expanding its scope and defining and updating metrics for more effective audits.

Cofactor AI Launches Platform to Help Hospitals Fight Tidal Wave of Claims Denials and Announces $4 Million Seed Round

Cofactor AI, which offers AI-powered software to help providers appeal denied claims, launches with $4 million in seed funding.

HIStalk Interviews Thomas Charlton, CEO, Goliath Technologies

Thomas Charlton is chairman and CEO of Goliath Technologies.

Tell me about yourself and the company.

We offer software that plays a critical role in ensuring that clinicians have seamless access to clinical applications so that they can focus on delivering a high quality of care. As a company, our mission is to work with health IT and focus on the areas of availability, speed, and reliability of EHR systems, most commonly Epic, the Oracle Health EHR that was formerly Cerner Millennium, and Meditech.

How would you contrast  the use of end user experience monitoring and troubleshooting systems to the traditional model of waiting for users to open trouble tickets?

Users will assign blame when it comes to speed and reliability to whatever they see on the screen. If it’s the EHR, they will say Oracle Health is slow, or Epic is slow, or Meditech is slow. That reflects on the IT organization.

What we’ve found in health IT, which is unique relative to enterprise, is that clinicians are very busy. It’s the unreported issues that are the real problem. Clinicians can take their caseloads to other hospitals where they have privileges. There’s a significant amount of data around burnout.

Through our partnerships with Oracle Health, Meditech, and Epic, we give health IT executives, staff members, and clinical executives the ability to understand if clinicians are having experience issues or usability issues. Who is having those issues? How often do they occur and how long do they last? What is the cause? That is incredibly important, because if you are dealing in the realm of unreported issues, there’s a baseline of consistent dissatisfaction. We provide empirical data so that you don’t have to rely on feedback from clinicians or other users of the technology.

What changes in the first several months after a health system implements your system?

Our technology’s ease of use and price profile gives us the ability to scale to some of the largest health systems. Some of our current clients are CommonSpirit, Ascension, Oracle Health themselves, and small regional health systems such as Southwest General and Maine Health. If you talk to of those, they will say that it’s being able to quickly identify issues that affect clinicians. We do it with data. It’s easier to identify and fix problems when the root cause is identified.

They will also say that the clinician experience is substantially improved, because we’re not just solving reported issues more quickly, but providing visibility into unreported issues. They would cite a reduction in reported issues, a substantial reduction in the mean time to remediation, and immediate assessment of the criticality of issues.

Imagine that you are receiving a large number of complaints from the 10,000 users in your health system. That makes it seem as though there are problems everywhere. On demand, you can run a quick report through our technology so that you can frame up where the problems are occurring, who is having those issues, and very likely identify the root cause.

Probably one more thing to note is the vastly improved communication between health IT and the clinical sides of the health system. Conducting surveys is the traditional method that is used to gauge clinician and user satisfaction with EHR applications. But surveys are not timely. They don’t provide actionable data. They are subjective. We bring empirical data into that subjective conversation. Both sides of the organization, clinical and IT, are looking at a common set of facts and figures around end user experience.

How are user experience problems spread over application problems, infrastructure, connectivity, and third-party software?

If you look at KLAS’s House of Success, a number of factors support a good EHR experience for a clinician or user. One of the factors is application processes. How many clicks does it take to admit a patient or download a lab report? We don’t deal with that. We focus on availability, speed, and reliability.

In that situation with those three components, it is a complex mesh of technologies. If you think of just the simple logon sequence, are they using Citrix or VMware Horizon to grant secure access to these applications? Are they hosted, primarily like Oracle Health, or on-premise like Epic and Meditech, although that’s changing because they both have cloud offerings now.

You have the user. You have whatever their particular device is. You have where they’re connecting from, the service provider, the network, and then back into the back-end systems that support the application. We cover all of those variables. 

We’ve had years of experience and many man-years of development to be able to automatically correlate data from various sources, look at the end user experience specifically, and determine that of all of those factors, which are the most likely root cause of the issue. We use a combination of AI-enhanced data, automation, and embedded intelligence to be able to determine which of those. They are all silos in an IT organization – database, application, end-user device, server, et cetera. We use data to determine which of those silos, one or more, is the root cause of the various issues.

What is the cultural change of an organization that moves from a complaint-based system of clinician satisfaction to a fact-based, measurable data approach?

It’s phenomenal. If you can’t frame up the problem, if you don’t know who is having problems, the frequency of those problems, the duration of those problems, and why they occur, it is literally impossible to take any action.

Clinical executives would hear complaints from their clinicians. Health IT wants to provide a good clinician experience for all the reasons that we’ve talked about, including the impact on patient care. But if you don’t have data, how do you determine where the root cause is? You can’t frame up whether there is a critical issue or not. 

We find from the health systems that use our technology that communication between the clinical side of the house and IT is vastly improved. You have engineers on one side and scientist clinicians on the other side, and now they are able to look at data. Data is friendly. It may not be welcome data, but it is objective. We are bringing actionable data into what is typically a subjective dialogue. They can look at our data as a team and put together a productive plan to resolve issues permanently.

How is the experience of clinicians affected by off-campus locations, remote work, and the use of mobile devices?

We have a great example from the University of Kansas Health System. A clinician is working in the hospital. They have great system performance during the day. They go home at 6:00 or 7:00 at night and their performance using Epic is fine. Around 11:00, a call comes in. The clinician is in their bedroom, they need to access Epic, and now the performance is slow. The performance should not be slower because there are fewer people using the systems at that time of night, yet there is the reality of that.

The IT folks can run a report in our product and show the varying degrees of connectivity that happen. They can sit with the physician and say, if you look at your entire day over the last 30 days, the problems that you are having are always at this time at night. Where are you at those times? They were able to determine, oddly enough, that it was because there was a lack of connectivity on the other side of the physician’s house. They were too far away from their router in their home.

This is what changes the paradigm. We are able to deliver both to health IT as well as to clinical executives on demand that visibility into the clinician’s experience with their EHR application as it relates to availability, speed, and reliability. You no longer have to be in a reactive mode. You can be proactive and understand where issues might be occurring so that they can be preemptively solved. It really changes the dynamic and improves the satisfaction of the clinicians. It’s not uncommon for health IT executives to say that we’ve helped improve the reputation of IT.

What opportunities are you seeing to be able to use AI to enhance your products?

We’ve had AI in our product now for about eight months, so this is Version 1. AI makes fault isolation and resolution easier. It reduces the mean time to resolution.

It also democratizes deep IT knowledge. A ticket or complaint comes in, it goes to a help desk, and then it’s escalated. When it’s escalated to Level 2 or Level 3, these are very serious issues. They are causing clinician experience issues, and very likely have patient impact. Those very experienced IT technicians have to spend a tremendous amount of time without our technology trying to understand where the root cause is. 

We use a combination of AI-enhanced data to show them where the issue is. We also offer suggestions about how to resolve the issue.That has given our organizations the ability to push the resolution of those issues down to lower levels.

You may have a clinician who is interfacing with a patient and is having speed and reliability issues. Every one of those help desk escalation points is a delay to reaching a solution. Our technology allows resolving issues at Level 1 support, as opposed to being escalated to Level 3, where it’s put in a the working queue of an experienced IT engineer and can take quite a bit of time to resolve the issue. By pushing resolution down to lower levels, we are able to reduce the mean time to resolution, which impacts clinician satisfaction and ultimately delivers a higher quality of patient care.  It allows the clinician to focus on patient care and not technology enablement.

What are the key parts of the company’s healthcare strategy over the next few years?

We’re going to add more and more enhancements that give our health IT organizations the ability to resolve issues more quickly and be able to prove the root cause so that permanent fix actions can be put in place. Reducing the mean time to remediation and providing empirical data so that the quality of the clinician experience with Cerner, Epic, or Meditech can be improved demonstrably over time.

When looking at clinician EHR satisfaction. speed and reliability are the easiest things to change. They have the highest impact on clinician frustration. It’s easier to identify where these issues are. The fixes are quicker than training, education, and application changes. They impact physicians greatly, because when they are experiencing speed and reliability issues when they are in a environment with a patient, it’s visible to the patient and therefore the most frustrating to them personally.

Curbside Consult with Dr. Jayne 11/25/24

At several conferences I’ve attended lately, there has been discussion among clinical informaticists about how increasing use of technology might be affecting our ability to process information and retain items in memory.

In speaking with medical students, it’s clear that they are learning in ways that are dramatically different from the options that we had when I was in school. At that time, the primary method of teaching was lecture based, with or without slides or visuals. Accompanying paper textbooks had chapters that roughly aligned with the material that was being presented in the lectures, but sometimes presenters would go deep into their own personal research areas, which left students scratching their heads trying to figure out what was important. Not only for testing purposes in a highly competitive environment, but for the not-so-distant future when we would actually be expected to care for patients.

If you didn’t want to go to lectures or wanted supplemental materials for the fast-paced sessions, each medical school class ran its own transcription service. Designated people agreed to attend each lecture and record audio cassettes of the content, then placed them in the mail slots of other students who had agreed to listen to and create transcripts of the lectures. Other students printed those transcripts and took them to the local copy shop, returning with paper copies that they dutifully stuffed into those mail slots for the rest of us to gather. For those of us who attended class, this was a great backup for the times that content was going over our heads or for when we inevitably zoned out due to information overload.

The only time we ever had lectures that were formally recorded by the university was for those classes that were presented during certain religious holidays. In those situations, videos were made, but they were only available to the students who observed those holidays. I remember wondering what it would be like if they just recorded all the lectures and made them available to everyone so that those who learned differently could use that modality, but the university said it would be cost prohibitive to do so. Thinking back, these were the days when we thought Lotus Notes was the be the end-all of software suites, so it’s hard to know what the true cost would have been when looking through the lens of today.

Fast forward to my 20-year medical school reunion, where a student tour guide told us that the university was recording all lectures and making them immediately available. At least in her class, she said very few students attended lectures, with most learning from videos that they watched at 1.5x or greater speed. It sounded like the focus of learning had changed, too. Since they weren’t “wasting time in class” they could spend more time studying for the medical licensing exams, which were viewed as being more important for the ability to match into a competitive residency training program.

I’ve learned that in recent years that they have added AI-assisted transcription to the recordings. I wonder if students even take notes anymore or just highlight and annotate those transcripts. I haven’t seen any of those materials myself, so I don’t know how well the transcription does with medical words and complicated scientific concepts.

When I was a student, we still carried pagers. I remember that when the Motorola text-based pagers came out, we thought we had really arrived. Cell phones were still a rarity. Now, every medical student holds the entirety of human knowledge in their hands on a near-continuous basis. It’s easy to look things up and we’ve become dependent on always having that ability, at least until it comes crashing down during a hack or other loss of service.

Students still memorize things, especially if they know they will be on a test. Some information becomes ingrained because of common use, such as the ability to quickly recall certain clinical formulas or calculations. Depending on how those resources might be presented in an EHR or online resource, it’s likely faster to be able to do them yourself, although accuracy is always a risk (but then again, it can be a risk in the EHR as well).

There are studies that look directly at how the internet may be changing our ability to think — attention spans, memory processes, and understanding social interactions both online and in person. I’ve done a lot of work during my career on understanding learning styles and trying to maximize how patients receive information, and much of that applies to understanding how clinicians receive information. The major differences are overall educational level and health literacy. I’ve spent more than 20 years working with teams to create training materials for EHRs and HIEs as well as patient-facing educational materials that address procedure preparation and chronic conditions.

Requests for specific lengths of training segments have decreased over time. When I first began working in educating clinicians, classes were way too long. We thought that we were progressive when we reduced them to 90-minute blocks, knowing that anything presented after that mark was unlikely to be absorbed. From there, we worked to shorten courses to 60-minute blocks. When technology evolved enough to be able to do recordings that we could park on our learning management system, our goal was to have 10- to 15-minute segments that went together to form a larger body of material. Since the advent of social media, the push has been to get those down to 3-5 minute blocks.

Now I’m starting to see requests from physicians for TikTok-style videos for continuing medical education, and I struggle to see how that might work. Healthcare concepts are often complex and I don’t know how you can even explain them in 30 seconds or less, let alone do so in a way that allows the learner to achieve mastery.

I also worry that the shift towards that style of learning will penalize those of us who learn best through the written word, even if it’s via digital media. I’ve always been a reader and use a variety of paper and digital sources. I find that if I’m in “hey, let’s learn something” mode, I do best with a traditional paper book. If I’m reading for leisure, either paper or electronic is fine. If I’m traveling, I’m not going to read it unless it’s on my Kindle since I’m a fast reader and tend to devour novels (I love a good mystery) and there’s not enough luggage space to accommodate paper for a long trip. I also love audiobooks and am trying to embrace those for learning as well as for entertainment. As someone who learns through written language, I’m grateful that my organization has digital transcription enabled for recorded meetings, because often I’ll turn off the audio and just read the transcript along with viewing the slides.

I’m curious how other informatics and educational experts have perceived this shift, and what other perspectives might be. Hopefully readers will weigh in. I’m happy to share comments, whether attributed or anonymous.

In the mean time, I’m making my reading list for 2025. What’s the best book you’ve read recently, and why? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 11/25/24

Forward’s leaders are already recruiting for a new startup, just a week after the healthcare company shut down

Executives of Forward — the CarePods and medical office company — have moved on to start a new venture just one week after Forward shut down after raising $650 million.

Mega US healthcare payments network restores system 9 months after ransomware attack

Change Healthcare restores its clearinghouse services, nine months after they went offline in a February ransomware attack.

TailorMed Secures $40 Million to Expand the Largest Affordability Network into an End-to-End Platform, Transforming Patient Access to Care Nationwide

Medication affordability, access, and adherence software company TailorMed secures $40 million in new financing.

Monday Morning Update 11/25/24

Top News

Executives of Forward — the CarePods and medical office company — have moved on to start a new venture just one week after Forward shut down after raising $650 million.

Forward founder and former CEO Adrian Aoun says that one of Forward’s biggest investors called him the day the company closed with an offer to back his next startup, which amazed him:

We just burned not quite half a billion dollars on an idea. A lot of people’s reaction is, what are you doing next? Let’s do it again. What sort of special ass culture did we create in Silicon Valley where this is reality? This is absurd.

Reader Comments

From Slipknot: “Re: Oracle. When Cerner Millennium was new, I watched it get thrown out by a big health system when Cerner couldn’t deliver anything that worked, not to mention that the salespeople were like stereotypical used car salesmen. I’ve been mortified watching the VA implementations go as I expected they would. Now Congress has decided not to keep monitoring them. I wanted to believe that they would do better or that Oracle would force changes to their business model.” The new administration will have to decide whether to continue the flailing project in a cost-cutting environment and amid Congressional criticism. Larry Ellison has strong connections to Elon Musk and Oracle commands a formidable army of lobbyists, so that may be a factor. Hacking away at the sprawling, plodding VA bureaucracy might improve the project’s chance of success. Saber-rattling politicians may or may not realize that the VA has only two unsavory alternatives – attempt to move to Epic (knowing that the company probably wouldn’t deal with the VA’s VISN fiefdoms and political meddling) or stick with its wildly expensive, endlessly customized VistA dinosaur. I would probably bet on VistA at this point since it’s the only option that does not require the VA to change.

HIStalk Announcements and Requests

Forty percent of poll respondents who have taken a DNA test received results that surprised them. I should probably have asked whether that surprise was good or bad.

New poll to your right or here: What would concern you most about receiving hospital-at-home treatment?

I strayed onto the IPhone / IPad automation feature Shortcuts. I used it immediately to create an icon that shuts the phone down, another that opens the camera app ready to take a photo, and one that opens the Amazon app and displays my orders. You can also create an icon to turn on Do Not Disturb until you change locations, speed dial a given contact, open a ChatGPT session, turn on low power mode when the charge reaches a given percentage, and text someone the ETA from your current location to your destination using Apple Maps. Other than tapping an icon, you can also tell Siri to run a shortcut by name.

In further technical exploration, I decided to try Bluesky as an X alternative. I was initially dismayed at the lack of a native IPad app, but the webpage works great. Hopefully it can get enough network effect users to avoid becoming another Clubhouse or Mastodon. Unlike certain similar services, it is ad-free, gives users instead of its owner control of their feeds, and has sane moderation practices. Follow me there if you like since I’ll probably post HIStalk updates there along with X.

My Anonymous Vendor Executive topped off my supply of Donors Choose matching money. Does anybody have ideas for encouraging corporate donations so that I have something to match with? Teachers have a lot of classroom needs and I can usually match a donation at least 3x from various sources. About all I can offer in return, other than the satisfaction of supporting a good cause, is company exposure for a job well done.

Webinars

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

Acquisitions, Funding, Business, and Stock

Change Healthcare restores its clearinghouse services, nine months after they went offline in a February ransomware attack.

Three hundred academic primary care doctors at Mass General Brigham petition the National Labor Relations Board to unionize with an affiliate of SEIU. MGB medical fellows and residents voted to unionize in 2023 but are still negotiating their first contract.

People

Brian Dixon, PhD, MPA is named director of the Regenstrief Institute’s Clem McDonald Center for Biomedical Informatics after serving as interim since June 2022.

MetroHealth promotes Nabil Chehade, MD, MSBS to senior EVP /  chief clinical transformation, innovation, and strategy officer.

Brian Gildea (FinThrive) joins Simple Health as chief sales officer.

JoAnn Ploen (Optum) joins DexCare as VP of enterprise sales.

Government and Politics

The VA posts an RFI for a cloud-based human capital management system that its 6,300 HR employees will use to process one million personnel actions per year, including 487,000 mass pay adjustments. One might speculate that Oracle will pitch its Fusion Cloud HCM.

Today I learned that Hopkins surgeon and FDA commissioner nominee Marty Makary, MD, MPH is chief medical officer for weight loss telehealth vendor Sesame, which can legally sell compounded GLP-1 drugs because of an FDA-declared shortage of the brand name products. 

Other

A Texas ED patient’s TikTok video goes viral in which staff at Houston Methodist Hospital questioned her about citizenship status and assigned sex at birth as required by Governor Gregg Abbott’s executive order from August. The employee asked the questions in a public waiting room that offered no privacy barriers. The hospital responded that they are legally required to ask the questions and record the responses in Epic, but the law doesn’t require patients to answer.

Sponsor Updates

• PerfectServe announces that it has been positioned as a Leader and furthest for Completeness of Vision in the 2024 Gartner Magic Quadrant for Clinical Communication and Collaboration.
• Notable successfully completes SOC 2 Type 2 compliance.
• Nordic releases a new “Designing for Health” podcast titled “Interview with Scott MacDonald, MD.”
• Sectra releases a new episode of its “Let’s Talk Enterprise Imaging” podcast titled “Greater Manchester’s path to AI in chest x-ray imaging.”
• The “AI @ HLTH” podcast features WellSky, “From Data to Care: How WellSky is Revolutionizing Healthcare.”
• Vyne Medical announces the expansion of the company’s cloud fax services and email-to-fax technology in a major academic medical center.

Blog Posts

• Bridging the gap between evidence and practice in healthcare (Wolters Kluwer Health)
• Future-Proofing Your Public Health Programs: Top 5 Things to Consider (Netsmart)
• Is the gold card the golden ticket to fixing prior authorization? (Nordic)
• Hydrate your cloud environment with Redox’s new Cloud Connectivity Tools (Redox)
• Understanding the Role of a Pediatric CNA: A Comprehensive Guide for Clinicians (SnapCare)
• How to improve bedside handoffs with digital whiteboards (Sonifi Health)
• Top Trends in Patient Payments and Artificial Intelligence in Healthcare (TrustCommerce, a Sphere Company)
• Innovating for Impact: Easing Burdens & Increasing Medication Safety (Surescripts)
• Building a Data Culture Helps Hospitals Stay One Step Ahead (Tegria)
• The Link Between Efficient Billing and Positive Patient Experiences (TruBridge)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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