HIStalk Interviews Kevin Coloton, CEO, Curation Health

Kevin Coloton, MBA, MPT is founder and CEO of Curation Health of Annapolis, MD.

Tell me about yourself and the company.

We formed Curation Health in 2018. The primary objective is that the recognition that value-based care is extremely complex, and often a more difficult transition for organizations to take migrating from fee-for-service than many expect. It is particularly challenging for the providers at the front line of care delivery. 

We are obsessed with solving for the experiences that our end users need. In our case, that’s the providers and the support they need to have sustainable success in value-based care. We recognize who they are and what they need, and we design tools and solutions to make it easier for providers to do the right thing when engaged in value-based care activities.

The end result of that is we have built a clinical decision support platform that facilitates provider workflow with the goal of elevating care delivery and receiving the appropriate clinical and financial outcomes for good work being performed.

I’ve had the great privilege of working in the healthcare industry for the past 25 years in various roles. Specifically, in patient care as a physical therapist, hospital administrator, management consultant, technology executive, and entrepreneur. I’m also fortunate that we have been able to assemble a team at Curation Health of industry veterans that have served organizations in health technology, consulting, and value-based care for a long time. They hail from organizations like Evolent, Optum, and The Advisory Board Company in Clinovations. In many cases, I’ve had the great privilege of working with a host of my colleagues for a very long time.

We’ve heard for years that value-based care is just around the corner, but most providers continue to make most of their revenue and profit from fee-for-service. How will that change?

The evolution of value-based care is slower than many expected, but is making progress. One of the most interesting, catalyzing events has been COVID and the pandemic. If patient volumes decrease in a purely fee-for-service environment, the clinical and financial implications of care for patients is pretty significantly impacted. Many organizations have recognized the need, despite the fact that they have a primary focus on fee-for-service. A balanced portfolio across fee-for-service and value-based care makes good sense to allow organizations to have sustained success.

We are seeing the march to value-based care taking a dramatic turn in the last nine months, where organizations are seeing appropriately that they need to start building the infrastructure and participating in value-based care. In some cases in their regional and local markets, the health plan and provider collaborations have greatly encouraged migration to more value-based care. It’s an important effort for almost all organizations, regardless of their payer mix, to have begun investing in value-based care infrastructure, capabilities, and knowledge.

How do the clinical decision needs of providers change as they start to see patients under a value-based care arrangement?

When you reflect on what’s different between fee-for-service and value-based care, most organizations today — unless they are purpose-built for value-based care — rely on a fee-for-service infrastructure. Their operations, their scheduling process, their patient contact. Even the clinical operations themselves of registration, check in, rooming the patient, seeing the patient, and allocating time for visits are all very different if you’re in a fee-for-service environment versus value-based care. 

The provider challenge is that they are attempting to have more intensive, longer value-based care interactions with patients where they are reviewing the complete chart and trying to prioritize, what is the clinical focus for our time today? They are balancing that with fee-for-service interactions, which are typically 10 minutes or less and focused on the reason for the visit. Why is the patient here today? Certainly they take care of other healthcare priorities as well, but it’s a very different mindset and operational approach.

Our goal is to simplify, to take some of that cognitive load away from identifying which patient is in front of me today. Which plan are they associated with? If they are in a value-based care arrangement, what should be my clinical priorities to address today for this patient, oriented to the highest clinical impact? If I only have time to do one thing today, what’s the most important thing for me to do? Or, what are the top two priorities I should focus on to achieve with this patient today?

The other big transitional difference is that value-based care is managing thousands of patients over a calendar year. Fee-for-service is typically prioritized and focused on, what are the priorities for the 30 patients I have scheduled tomorrow or the patients I have scheduled across the next few days? It’s a pitching and catching delta, where value-based care is a strategic approach across the calendar year and fee-for-service has a tendency to be more reactive, where patients are coming to the clinic, in the home, or in a telemedicine visit with a particular urgent or emergent need or acute need. Those are very different operational approaches. We aim to simplify that.

The technology requirements of that “feet in two boats” situation, where a given patient may be covered by fee-for-service or a value-based care arrangement, must be complex.

Massively complex. The attribution of patients alone is a massively complex undertaking. Which patients in my care are mapped to which value-based care program? We have some clients that have four, five, or six different value-based care contracts with different health plans. That complexity is massive.

Our goal is to greatly simplify that by having the provider focus on one simple workflow, and have that workflow be agnostic to whatever plan they’re mapped to. We focus our technology to simplify, to say that “this patient has these priorities that would benefit from being addressed in this interaction for the provider” instead of the provider trying to figure out which health plan it is, and of that plan, which subset a VBC contract is aligned with that. What have I already taken care of this calendar year? We seek to greatly simplify it by producing insights that are prioritized by clinical impact and greatly simplified into the handful of items that the provider can take care of to maximize the health of the patient.

In some cases, they are not even aware of which value-based care contract that patient is mapped to, because they don’t need to be. Their focus is on rendering awesome clinical care for the patient. Having one simple workflow enables them to focus on what matters, which is, this patient needs my help in these areas.

The healthcare technology industry has a tendency to focus on what we describe as data maximalism, which is this mindset that bigger is better. It’s really the identification of massive amounts of data that holds limitless potential value, and it’s candidly the easiest and most exciting approach to take. You can use incredibly modern and precise technologies to harvest a tremendous amount of data at a patient level or across your whole community of patients you’re serving. 

When we launched Curation Health in 2018, we learned the hard lesson of having a data maximalism approach. The problem is that when you’re analyzing a massive amount of data — and in our case, we also compile this dataset with human review to find more and more items of opportunity — the results we found were counterintuitive. The more accurate and voluminous the data that we found and sent to providers, the less they acted on it. 

We quickly learned that the value is not on the potential of this information and what it could do to transform provider success. The only thing that matters is what information they are going to use when managing a patient’s health. Therefore, we came to this realization that value-based care, healthcare technology analytics and reporting, and clinical decision support are not really technology problems to solve. It needs to be a clinical workflow problem to solve. How do you make it easier for the provider to do the right thing?

We evolved this concept of data minimalism, which in our mind is the minimum dataset required for a provider to use to enhance the health of their patient. Instead of bigger is better, which is the data maximalism approach, data minimalism is that less is more. Once we prioritized and contextualized the information that we were sending to physicians, we saw adoption and use skyrocket. It was a really powerful lesson for us. It revolutionized the way we design our technology platform, how we build our user interface, and how we choose the information that we are serving. It made it simpler for providers to act. We learned more and more of the power of simplicity and the direct correlation with provider adoption and use.

How much detail and complexity is contained in a provider’s value-based care contract that is translated into plan-specific clinical decision support?

The contracts themselves are incredibly complex. They are very different from agreement to agreement. Some prioritize risk adjustment performance HCCs and related measures, RAF particularly. Some prioritize quality, HEDIS, and Stars. It is very dependent on the region, the health plan, and the provider partnership. Because of that, we spend a lot of time with our clients helping demystify the agreement that they are participating in. What would be the analysis of the return on investment clinically and financially for the organization? What are the KPIs that the provider group needs to focus on to achieve the results they’re hoping to achieve? If they have limited time, where would they emphasize their focus and dedicate their attention to serving particular metrics, measures, or activities that help everybody win in this equation?

The premise with this equation is that if we can prospectively manage the patient’s health and outcomes, then we can improve their health, and everyone wins in this model. The health plan, the provider organization, and ultimately the patient. The goal is to also understand that this particular value-based care contract prioritizes certain investments of energy and time and making sure that everybody is aware of those and keeping appropriate attention on those items.

How does the pre-visit review differ under a value-based care arrangement?

I had the great privilege of running ambulatory clinics for a period of time in a predominantly fee-for-service environment, so I have a good sense of how that works. The value-based care pre-visit activities are dedicated to figuring out ahead of a clinical interaction, what are the top clinical priorities that this patient is challenged by? Then, focusing the provider attention on those priorities.

In the traditional model, physicians would quickly scan the chart and go into the room, if it’s a clinic setting, and ask the patient something along the lines of, “What brings you to see me today?” to make sure that they are aligning what they see as the priorities with what the patient priorities are. That’s good practice.

In a value-based care world, it’s a little more complex, because you have to understand what you’ve already done that calendar year. What items remain to be managed? Also, what are the priorities that you haven’t yet covered with the patient that would greatly improve their health and wellness? 

That concept of pre-visit is leveraging good technology to discern clinical opportunities from the thousands and thousands of lab values, radiology reports, HIE data sets, EMR data, and claims data and narrow it down to a specific set of high priority items that the patient would benefit from having managed. In some cases, the pre-visit review also involves a human reviewing the output of the technology or the reports to further refine the data that gets to the physician. Ultimately, the goal is that when the physician enters the room with the patient, they are well aware of the clinical priorities that need to be addressed, but they also have the context as to why these are priorities.

One of the big challenges of working in a fee-for-service and a value-based care world is that providers are challenged by capacity, time, and resources in most cases. They have limited time with the patient. They may not have a lot of technology tools or humans to participate in that pre-visit analysis. So when they review the clinical opportunity while sitting in front of the patient, they often don’t have enough time to validate them, to go through the EMR and understand when this lab value is drawn and what this comorbidity and this medication might lead to. The goal with pre-visit is to take all of that clinical administrative research and have most of it conducted before the patient is being seen by the provide so that the provider is able to focus their attention on validation and action rather than just pure research.

Do patients know that they are being covered by a value-based care arrangement? Do they need to be educated about their role in it?

It varies. In some cases, patients are well aware of the program that they are participating in. They are able to make determinations of which network they want to participate in or who the provider group they want to have administering their care. In other cases, it’s more of an administrative function that happens in the background, and patients may or may not be aware of it or have much information or insight into what it means and the potential delta of how the physician may be managing their clinical interaction.

I think Medicare Advantage has become the largest area of focus in the value-based care realm. A lot of patients are becoming more understanding of why it’s important to have more of a prospective care approach than a retrospective care approach or a fee-for-service, real-time engagement. 

It definitely varies by region, by plan, and by other elements. But I have seen many cases where patients are very aware of it. I think you’re right, though, that the onus is on the provider, the practice, the organization, or the health plan to educate the patient as to the change in the model of care being delivered. From the feedback we hear, patients have appreciated the value-based care approach, because it feels like their care is being holistically managed and sometimes a bit ahead of time. We are biased, but we believe it’s a better model of care delivery where you’re trying to anticipate future need by focusing on current challenges and engaging the patient in that journey more directly.

What factors do you see impacting the company’s strategy in the next three or four years?

Several elements are going to be impacting our strategy. We highlighted one of them at the beginning of our conversation, which is how quickly organizations are adopting value-based care. Some organizations are in the early phase of their journey, while others have been doing this for some time. That progress directly impacts our ability to serve and elevate performance for those organizations. The ever-changing nature of the value-based care design model and contracts definitely are impacting how we do what we do. Every year we are constantly scanning regulatory changes. Compliance is a huge priority for us. Our clients are relying on us to greatly focus on that. We need to be very current, and the only constant in the value-based care structure to date has been change.

The other element is care model delivery has been greatly changing. We’re having a real increase of organizations focused on in-home primary care, in-home specialty care, and virtual care. How all of those align with value-based care models has been interesting and fun for us to design and partner with. I think that will keep us busy for some time.

Morning Headlines 5/11/22

Harris Completes Purchase of Allscripts Hospitals and Large Physician Practices Business Segment

Harris rebrands the hospital and large physician practice software business it acquired from Allscripts to Altera Digital Health.

Med-Metrix Announces the Acquisition of PatientPal, Bolstering the Company’s Front-End RCM Software and Service Solutions

RCM solutions vendor Med-Metrix acquires PatientPal, which offers patient engagement and front-end RCM software.

Omnicell Discloses Some Systems Affected by Ransomware

Omnicell reports that a ransomware attack last week impacted some of its systems, adding that customer operation of its medication management devices was unaffected.

Osmind Raises $40M Series B Round Led by DFJ Growth to Expand Platform for Breakthrough Mental Health Research and Treatment

Mental health EHR and research startup Osmind raises $40 million in a Series B round that brings its total funding to $57 million.

News 5/11/22

Top News

Harris rebrands the hospital and large physician practice software business it acquired from Allscripts to Altera Digital Health.

The business’s president will be Marcus Perez, MS, MBA, senior EVP of Harris Healthcare.

The $700 million acquisition, which closed May 2, included Sunrise, Paragon, TouchWorks, Opal, Star, HealthQuest, and DbMotion.

Allscripts has not removed the divested products from its website or announced how its developer program and App Expo will work post-acquisition.

HIStalk Announcements and Requests

Pondering: is intelligence deficit disorder, as evidenced by Facebook postings, a pandemic? Or, does Facebook attract a disproportionate number of users who can’t express a cohesive thought, use the Internet without help, or resist adding opinions even when they are irrelevant or poorly considered?

Webinars

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

Acquisitions, Funding, Business, and Stock

RCM solutions vendor Med-Metrix acquires PatientPal, which offers patient engagement and front-end RCM software.

Mental health EHR and research startup Osmind raises $40 million in a Series B round that brings its total funding to $57 million.

Sales

• Novant Health (NC) will implement Infor’s cloud-based healthcare ERP software with consulting help from Grant Thornton.
• ScionHealth selects R1 RCM’s software and services for its 61 long-term acute care hospitals.
• In the UK, NHS Lancashire and South Cumbria will implement Citadel Health’s laboratory information management system in $12 million project.
• Cleveland Clinic chooses Medically Home Group to develop a program to care for acute and post-acute patients at home via a virtual command center.

People

Martin Spence (Fujifilm Medical Systems) joins Clearwater as virtual CISO and principal consultant.

Telstra hires Monica Trujillo, MBBS, MPH (Cerner) as chief health officer.

Instamed, a J.P. Morgan Company hires Steve Sewell (Optum) as executive director of product management.

Brett MacLaren, MBA (Providence) joins Kaiser Permanente as SVP of data and analytics.

B.well Connected Health hires Nathan Weems, MBA (VitalConnect) as CFO.

Announcements and Implementations

Patient engagement software vendor PatientTrak announces GA of digital patient intake forms for outpatient facilities.

IatricSystems launches DetectRx drug diversion and automated evidence-based response software. Iatric was acquired by Harris in 2018.

Interbit Data launches Beacon, an enterprise care continuity solution that addresses downtime, including cybersecurity incidents.

Advance care planning organization Five Wishes creates a lifetime digital version of its advance directive, which will be stored on Vynca’s advance care planning platform.

Government and Politics

A survey of 701 DoD providers finds that 58% have identified inaccurate or incomplete data in the agency’s Cerner-powered MHS Genesis system, leading to inaccurate, delayed, or incomplete diagnoses; multiple patient visits to complete care; and longer patient visit times. Medical device integration with MHS Genesis was also found to be problematic, with respondents noting that “…eye care devices are not connected to the system and this creates significant delays and repeat imaging,” and “the process to get medical devices connected is CONTRARY to 21st century healthcare delivery. We just choose to ignore that equipment isn’t connected.”

Government-run psychiatric treatment provider directories — such as SAMHSA’s FindTreatment.gov that was intended to give patients a better option than having their Google searches exposed to marketers — contain outdated and incorrect provider information. Patients report reaching disconnected numbers, contacting facilities that aren’t accepting new patients, or finding that clinicians have retired or moved. The directory does not vet submissions beyond verifying licensure and does not include quality indicators.

Other

Apple retires my once-beloved IPod Touch, marking the end of the 20-year-old IPod line. Other IPod models along the that have been largely forgotten – I think I’ve had and/or gifted them all multiple times — were the Mini, Nano, and Shuffle. The Touch, ownership of which I bragged on starting in 2010, was basically an inexpensive IPhone without the “phone” part and free of ongoing cost, capable of just about anything as long as a WiFi connection was available.

Sponsor Updates

• AGS Health leaders work with United Way to create handmade educational kits for underprivileged students.
• Agfa HealthCare profiles a new customer success story, “Enterprise Imaging supports successful major transformation at Ziekenhuis Oost-Limburg (ZOL), Belgium.”
• The First Coast Worksite Wellness Council recognizes Availity with its Healthiest Companies Platinum Level Award for the eighth year in a row. 
• Baker Tilly releases a new episode of its Healthy Outcomes Podcast, “Key factors and trends impacting M&A activity in the healthcare industry.”
• Delaware documents 100,000 referrals in the third year of its use of Bamboo Health’s OpenBeds referral network.
• CareMesh names Martin Armitage (NaviHealth) director of strategic accounts.
• CHIME and more than 100 additional healthcare organizations sign a letter urging Congress to removal the ban on funding for a national patient health identifier standard.
• Interbit Data launches the next generation of its Beacon Platform, designed to help hospitals with communications and care continuity during downtimes.
• Ellkay will exhibit at the NEHIMSS Spring Conference May 12 in Norwood, MA.
• PerfectServe honors over 130 exceptional nurses in its second annual Nurses of Note Awards program.
• Wolters Kluwer Health adds diversity, equity, and inclusion content to its Ovid medical research platform.
• WebPT adds PVerify’s Advanced Eligibility solution to its EHR for physical therapists.

Blog Posts

• From Risky Business to Data-Backed Decision (Arcadia)
• Celebrating National Nurses Week with Bamboo Health’s Alycia Sepe, BSN, RN (Bamboo Health)
• 5 ways to improve patient satisfaction scores to prepare for OAS CAHPS reimbursements (Bravado Health)
• Meditech Expanse: Customizable Features that Improve Clinician Satisfaction (CereCore)
• How do you balance understaffing during the pandemic? By turning data into knowledge (Cerner)
• Did Your IT Project Fail? Here are 4 Ways Change Management Could Change the Outcome (Healthcare IT Leaders)
• 5 Key Questions You Should Ask Your IT Provider Annually (ChartLogic)
• The Evolution of Chronic Care Management (ChartSpan)
• Introducing A New Category of Technology for Innovation in Healthcare: the Healthtech Operating System. (Commure)
• Asembia 2022: Specialty Patient Access, Centricity, and Adherence (CoverMyMeds)
• How EClinicalWorks RCM Service Boosts Efficiency (EClinicalWorks)
• No Surprises Act Part 1: A Surprise for Providers (Enlace Health)

Contacts

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

Morning Headlines 5/10/22

CareCloud Reports First Quarter 2022 Results

CareCloud reports Q1 results: revenue up 19%; adjusted EPS of $0.23 vs. $0.19, beating Wall Street expectations for both revenue and earnings.

AMIA and HL7 Announce Partnership to Advance Interoperability in the Healthcare Community

The American Medical Informatics Association and Health Level Seven International will work together over the next two years to further interoperability standards.

Upswing Health, Whose Condition-Based Musculoskeletal Healthcare Eliminates Systemic Waste, Closes $5 Million Seed Round

Founded by orthopedic surgeons in 2017, virtual MSK care startup Upswing Health secures $5 million in seed funding.

Readers Write: Clinical Trials and the Data Diversity Problem

Clinical Trials and the Data Diversity Problem
By Liz Beatty

Liz Beatty is chief strategy officer for Inato of Guilford, CT.

Minority and marginalized communities have historically been underrepresented in dozens of private sectors globally. This includes pharma, where there exists a steep chasm that drug makers have yet to bridge concerning research and trials – a chasm that directly impacts the quality, quantity, and diversity of data that determine the efficacy of a drug and its applicability to broad patient populations.

One needs to look no further than a retrospective review of 302 drug submissions to the FDA to find evidence of data problems. That review found that nearly 16% of submissions had insufficient data to determine safe dosages, more than 11% had inconsistent results between study sites, and about 13% failed to demonstrate statistically significant benefits. These findings suggest data limitations, including diversity, influence the FDA’s rejection of five out of six submissions.

The longer the trend of incomplete data exists, the harder it becomes to address. The feelings of mistrust, resentment, and disenfranchisement only get more complex to overcome with time. While there has been a concerted push by the pharmaceutical industry to improve the situation over the past decade, it’s not moving fast enough toward a solution.

The time has come for technologies to step in and innovate solutions for this situation once and for all.

Significant progress has been made in the public sector, particularly among studies funded by the National Institutes of Health (NIH) and the National Cancer Institute (NCI). However, the same cannot be said for industry-funded studies. For example, NIH requires grant applicants to include plans for recruiting women and members of minority groups, while the FDA released guidance focused on expanding eligibility criteria for such trials and discouraging unnecessary patient exclusions, as well as boosting the recruitment process in order to attract diverse patients. NCI also reported a 14% increase in minority participation among clinical trials it has funded over the past decade.

Among private-sector trials, however, little progress has been made with regards to inclusivity and diversity. The FDA reports that 75% of enrollees in trials for drugs it had recently approved were white, while just 8% were black and 6% were Asian. An NCI-funded study found that 9% of those participating in its SWOG Cancer Research Network trials were black, compared to fewer than 3% in trials sponsored by pharmaceutical companies. 

Nor is the diversity problem limited to race. Under-representation also extends to gender and even disease. For example, just 8% of cancer patients enroll in cancer trials, and less than 2% of cardiovascular disease trials reported any female sex-specific cardiovascular risk factors.

Historically, one barrier has been a lack of medical facilities with the capacity to host clinical trials in underserved areas. One NCI study found that 75% of patients don’t participate in trials simply because there are none in their area. Additional barriers for underserved patient populations included distrust of clinical trials, insufficient information about the participation process, limited time and/or resources, and lack of awareness.

The resulting lack of diversity impacts sponsors and clinical trials in three key areas:

• Accurate, robust data. The scientific method is null and void when data sets are incomplete. Yet a multitude of clinical trials continue to enroll smaller, homogeneous groups of patients who predominantly reside within a short travel distance of major trial sites. This should ring alarm bells for any drug maker seeking the efficacy and side effects of the medications they intend to bring to market. Incomplete data is a risk to the patient and treating physician, and it’s a financial and reputational risk to the business.
• Trial efficiency. Including broader demographic and geographic groups can accelerate trial speed and boost efficacy, while testing on a narrow participant group can result in unanticipated results after approval. Additionally, pharma companies that run fully representative trials are likely to experience greater success in reaching FDA approval for their medications.
• Financial incentives. Greater patient participation enables speedier trials and reduces costs, while a wider prospective candidate pool can reduce recruiting time, which drives down opportunity costs associated with delays that can run from $600,000 to $8 million per day. Further, better detection of side effects that might otherwise be missed when enrollment is limited — resulting in an incomplete picture of the treatment’s actual impact on the broader population – can prevent post-approval FDA black box designations and millions in lost revenues.

Increasing diversity and minority recruitment requires more than simply making a greater number of trials available in underserved areas; it also involves increasing engagement by partnering with community sites, using digital tools to enhance accessibility, and employing a diverse staff to better translate trial information to broader patient populations, all of which can be accomplished by embracing community-based research centers.

Powered by advances in remote patient monitoring and telemedicine technologies, decentralized trials and distributed testing eliminate physical and geographic boundaries. When these technologies are combined with cloud-based marketplaces to connect trial sponsors with underutilized community sites and provide those smaller sites with additional enrollment support, the patient pool expands significantly. A larger patient pool allows investigators to recruit a more diverse and representative patient population, improving data quality, avoiding delays, lowering costs, and accelerating FDA submission and approval.

The benefits of trial diversity are apparent. And while steps have been taken in the right direction, there is always more to be done. The benefits of doing so, however, are clear. Prioritizing community sites and recruiting for and implementing equitable, inclusive clinical trials can have a significant impact from both a scientific and ameliorative standpoint.

Readers Write: Are HCC Codes and RAF Scores Enough?

Are HCC Codes and RAF Scores Enough?
By Sara Pastoor, MD

Sara Pastoor, MD, MHA is director of primary care advancement for Elation Health of San Francisco, CA.

The introduction of electronic health records (EHRs) has ushered in an age of data-driven capabilities that hold great potential to alter healthcare, both as an industry and at the front lines of care delivery. EHRs have apparently disrupted everything, for better or for worse. Well known are the complaints that the EHR has inserted a wall of hardware and electrons between doctor and patient, not to mention the documentation burden that has often decreased revenue by slowing the pace of care and adding hours to a physician’s work week. Yet EHRs capture, organize, and store large volumes of health information that can now be leveraged in unprecedented ways to help payers, providers, and patients all win.

One of the most transformational results of this data and information boom in healthcare is the ability to analyze the medical complexity of a patient population and use that analysis to inform resourcing and care. Sicker patients need more and different things than healthier patients do. Historically, a primary care doctor was paid relatively the same amount of money whether caring for a patient with one chronic condition or five. Today, the data encoded into EHRs can be leveraged in specific payment arrangements to justify higher reimbursement rates for sicker patient populations, with bonuses for delivering better care through reporting on defined quality metrics.

The most common example of this involves Hierarchical Condition Categories, or HCCs, which are part of a model for risk stratification originally designed by CMS in 2004 to predict future healthcare costs for patients. Each condition category, which is based on ICD-10 codes, is combined with a set of demographics (gender/age) to assign patients a Risk Adjustment Factor or RAF score. RAF scores are based on demographics and disease burden (determined by ICD-10 codes), and are used to adjust quality and cost metrics by accounting for differences in patient complexity. Using this scoring system, payers in capitated payment arrangements can provide higher payments to primary care practices with more complex patient populations. Payers can also use these scores to determine performance-based metrics and bonuses, by identifying patients with specific expected care needs based on gender, age, and chronic condition.

In value-based payment models, RAF scores work pretty well for getting paid. However, the concept of risk adjustment and stratification carries much greater potential beyond cost estimation and reimbursement structures. It carries tremendous power to improve outcomes and decrease total cost of care. While it is critical to compensate care teams for the resources required to properly manage complex patients, more enhanced risk adjustment models based on predictive analytics enable clinical interventions that change lives.

Consider my patient, who we’ll call Albert. Albert is a 72-year-old with diabetes, hypertension, obesity, obstructive sleep apnea, and chronic venous insufficiency. His wife died after a sudden and short battle with cancer. His diabetes and other conditions were previously well controlled, but he had one prior episode of venous leg ulcer complicated by cellulitis requiring a hospital admission in the past year. Following the death of his wife, Albert started to forget to take his medications, use his CPAP device for his sleep apnea, and wear his compression stockings for his venous insufficiency. His bereavement made it difficult for him to cope, and he began to neglect his care.

Additionally, his wife had been the one to check his feet for calluses, wounds, or infections since he could not reach them,  an important daily ritual for diabetics. Without his wife to cook for him, he began dining out more often, frequently defaulting to fast food. His weight increased, his chronic conditions spiraled out of control, and he developed a diabetic foot ulcer that went unnoticed until infection had invaded the bone, eventually requiring a partial foot amputation.

Albert’s diagnoses of diabetes, hypertension, obesity, sleep apnea, and chronic venous insufficiency make up a common constellation of conditions. Every family physician in America manages many patients like Albert. Yet Albert’s ICD-10 codes, age, and gender do not alert us to his quite predictable and extremely high risk of at least one bad outcome in the very near future. Albert’s RAF score is equal to that of every other patient with his same demographics and ICD-10 profile, but Albert is a ticking time bomb. With extra support and appropriate interventions, Albert’s diabetic foot ulcer, osteomyelitis, and subsequent partial foot amputation were entirely preventable, if only we had known.

HCC codes and RAF scores are a blunt instrument for managing a population. Patient complexity and the corresponding patient needs are far more nuanced than ICD-10 codes and demographics would suggest. Determining which patients need what interventions is a delicate and sophisticated science. Furthermore, the CMS HCC/RAF model does not generalize well beyond the Medicare population, and there is a need to manage clinical risk across all types of patients and ages.

To achieve the level of insight needed in a risk adjustment model for targeted population management, the model needs to factor in a number of additional determinants. My suggestions include functional status, severity of illness, the interplay between diagnoses and treatments, historical utilization patterns, pharmaceutical costs and risks, number of subspecialists involved, and social determinants of health. This more nuanced risk stratification serves to better inform the true risk of each patient, producing actionable information clinicians can use to intervene and make a difference for those who need it most.

In Albert’s case, his combined conditions of diabetes, obesity, and chronic venous insufficiency dramatically increased his risk of chronic limb ulceration and corresponding complications due to the interplay between these three conditions. According to scientific evidence, his prior history of venous leg ulcer with infection placed him at even higher risk of repeat hospitalization for a similar event. His bereavement, a pivotal life event, predictably increased his risk of worsening severity of illness for his baseline conditions. Exacerbation of his sleep apnea due to poor CPAP compliance predictably worsened his diabetes, hypertension, and obesity, even if he didn’t struggle with medication compliance and worsening of his diet. This complex interplay of factors had a dramatic effect on Albert’s health status, not reflected in a RAF score.

Sophisticated risk adjustment models are very effective at plucking patients like Albert out of the crowd and identifying him as high risk/high need. Evidence-based clinical interventions could very likely have spared Albert both his foot and significant mental anguish, also saving his health plan a chunk of change. If we apply this illustration to thousands or even millions of patients, the potential impact to the healthcare system and more importantly to society is staggering.

I envision a world in which the EHR has an integrated advanced risk adjustment model that alerts care teams to patients like Albert. Running in the background of an EHR platform, these analytic models can identify patients who are at highest risk of a health crisis and drive actionable information into the primary care workflow where care teams can not only intervene, but also capture their work for measuring, reporting, and follow up. This is a powerful intersection between technology and the physician-patient relationship for which rudimentary HCC/RAF coding falls short.

Any patient would be grateful to avoid hospitalization or a trip to the emergency room, but the benefits of such analytic tools go much further. This is the Quadruple Aim in action, with meaningful impacts to patient experience, provider experience, outcomes, and cost of care. In a payment arrangement involving shared risk, primary care is positioned to drastically reduce total costs of care with such technology while reaping significant financial benefits for doing this work. Often, the extra clicks and associated tasks related to EHR alerts for HCC reporting feel like administrivia, lacking direct clinical impact to the patient. Alerts that directly result in meaningful clinical intervention feel like time well spent. Payers win, providers win, and patients win.

Albert had interacted with the healthcare system both while his wife was dying and after his bereavement. His history of hospitalization for venous leg ulceration sat right there in his claims data. His poor CPAP compliance was transmitted wirelessly to the DME company managing the settings on his device. The information necessary to predict Albert’s escalating risk was known, but the systems and processes were not in place to identify his risk and notify someone who could do something about it. I learned about his unfortunate health debacle when he came to me with an advanced foot ulcer, well past the window of opportunity for meaningful intervention.

I have so many memories of patients over the decades for whom the trigger(s) leading to the trip down disaster lane toward catastrophic health outcomes only became obvious in retrospect, because we didn’t know what we should have known, so we couldn’t do what we should have done. We have the technology to do better. When we start putting that technology in the hands of primary care, lives will change.

Curbside Consult with Dr. Jayne 5/9/22

I spent a good chunk of the weekend outdoors, enjoying some quality lakefront time while spring is here. Despite the copious pollen, it was still much more enjoyable than when summer hits and you’re debating whether the humidity or the mosquitoes are more oppressive. Still, when I got home, my tent needed a full wash to get the pollen out, and my quick air out took a little more time than planned. Waiting for it to dry before I could finish packing up all my camping gear gave me an opportunity to complete the Continuing Medical Education evaluations that are required for me to get credit from my recent conference attendance, and to try to wade through all the email that accumulated while I was away last week.

I also spent some time today with my extended family, who wanted me to explain what it really is that I do for work. They know I don’t see patients in person right now, but think I see patients on Zoom, which is good enough for me. They don’t really get what a CMIO does though, or what clinical informatics is, and sometimes trying to explain that is difficult. I try to give examples of the kinds of projects I work on, but I think even those are sometimes hard for people to really understand.

The one thing that usually resonates is when I talk about coaching physicians how to better use computers when they’re seeing patients. That understanding is usually accompanied by one of two stories. The most common story used to be that their doctor spends too much time looking at the computer and not at them. That’s becoming less common, which is a good thing. Now I hear a lot more stories about people’s experiences messaging their physicians through patient portals, which is good as far as portal adoption.

I actually had a conversation about that topic a couple of weeks ago with an EHR colleague. We were talking about the ways that different healthcare organizations approach the idea of encouraging patients to sign up for their patient portals. Some organizations bend over backwards to get patients to sign up. They may have staff in common areas who use a kiosk to try to get patients enrolled, or they may initiate an activation process during the rooming activities in the exam room. If organizations have highly developed process for portal utilization, they benefit from having more patients activated. This could be a financial benefit through reduction in paper billing statements, reduction in the time it takes for patients to pay bills, or reduction in staff costs due to telephone volumes for patient messages and appointment scheduling.

Other organizations however are less aggressive, and it feels like they are just hoping patients will stumble upon the patient portal and decide to sign up. A third group of organizations seems to just want to make it easy for the patients to do the workflows that a patient portal brings to the table but doesn’t necessarily want to require patients to sign up for an account.

Although I totally understand wanting to make things easy for patients, I think that approach will ultimately undermine patient adoption. Why? Because I see it in other industries. I know plenty of people who will go online every month and pay their utility bills, but won’t take the time to complete the process of signing up for automatic bill pay. Having a streamlined monthly process reinforces the customer’s action and they’re willing to do it again. But they’re not making the logical leap to understand that they could spend five minutes once and never have to go to the website again, versus spending two minutes each month for the rest of their lives paying that bill.

Not to mention that by not starting to fully embrace the use of the patient portal, they’re not able to use features such as those that might help with health promotion and disease management. They may also be missing out on the bells and whistles of being a registered user, such as being able to serve as a proxy or delegate for the accounts of children or elderly relatives, which generally aren’t available in the more freestanding workflows. Every EHR vendor handles these workflows in a slightly different way, but I see quite a few moving in the direction of “portal-lite” functionality to try to streamline patient access.

One hospital administrator I spoke with a few months ago tried to justify the fact that his organization isn’t spending any money on portal enrollment or activation efforts by saying that “our patients won’t use it because of XYZ reason, so we don’t want to waste the effort.” I think he is sorely mistaken for a couple of different reasons. First, many of the reasons that are often cited are not necessarily valid. People often think that older patients won’t be willing to use patient portals and for those tech-savvy elders, nothing is farther than the truth. If a patient is following their children or grandchildren on social media, in my experience, they are likely to be willing to use a patient portal, especially if it makes communication with their physician faster or easier.

People also think that not everyone has access to a computer or smartphone, and although that’s true, the percentage of patients who have access to those devices is climbing. Looking at 2018 data from the US Census Bureau, 92% of houses had at least one type of computer and 85% had broadband internet. Smartphones were present in 84% of households where 78% had desktops or laptops and 63% had tablets.

When thinking about the access argument, the truth is this. You don’t need to have 100% adoption to have a successful patient portal initiative. Even if you can get a percentage of your patients to enroll, and a percentage of those enrollees become active patient portal users, everyone can benefit. Patients can take advantage of self-scheduling workflows, which frees up office or call center staff. They can receive test results quicker, which often reduces phone call volumes as patients try to follow up on results. They can access visit notes, patient education materials, and care plans, which can not only reduce phone calls, but might also contribute to improved clinical outcomes.

With all that potential, it’s difficult to understand why organizations are slow to push for patient portal adoption.

What is your organization’s current patient portal strategy? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 5/9/22

Vital computer system has gone down more than 50 times since launching in Spokane, VA confirms

The VA confirms that Cerner was unavailable 50 times for at least some users singe going live in its Pacific Northwest sites, though the outages were not widespread.

Cerebral Receives Subpoena From Federal Prosecutors

Federal prosecutors subpoena online mental healthcare startup Cerebral as part of an investigation into potential violations of the Controlled Substances Act.

Joint Audit of the Department of Defense and the Department of Veterans Affairs Efforts to Achieve Electronic Health Record System Interoperability

An OIG joint audit of efforts by the DoD and the VA to make their Cerner systems interoperable notes that migration of legacy data into Cerner could have been more consistent, medical device integration could be improved, and user access should be limited to information needed to perform job duties.

Monday Morning Update 5/9/22

Top News

From the Allscripts earnings call:

• CEO Paul Black resigned Friday, effective immediately, saying that a new generation of leaders is needed now that the company’s focus is its Veradigm business.
• President and CFO Rick Poulton, who has been with the company for 10 years and is 56 years old, took over as CEO on Saturday.
• Black will leave the company’s board when his term expires this year.
• SVP/GM Thomas Langan has been promoted to president, while SVP/GM Leah Jones has been named CEO.
• Poulton said that selling the company’s hospital and large practice software business to Constellation Software will leave Allscripts more focused and with 5,000 fewer employees.
• With the sale, Veradigm represents 95% of Allscripts revenue, along with a “small unrelated product line” that makes up the remaining 5%.

Allscripts shares dropped 6% Friday after the earnings announcement after Thursday’s market close. They are up 22% in the past 12 months versus the Nasdaq’s 12% loss, valuing the company at $2.2 billion. They are up 68% in Paul Black’s 10-year tenure as CEO versus the Nasdaq’s 309% gain.

Reader Comments

From Door Shower: “Re: HIMSS. Recently laid off several dozen folks. As usual when that happens, many others are leaving voluntarily.” Unverified, although I’ve heard this from former employees.

From Awardee: “Re: MedTech Breakthrough awards. Who runs this?” Parent company Tech Breakthrough, which runs dozens of cloned awards sites, apparently would rather you didn’t know who’s in charge since they provide no contact information or employee names and hide their domain registration information. They are equally protective of their awards criteria and how much companies pay the marketing company to tout their “wins” in press releases. I’ll speculate from experience given the company’s lack of forthrightness – it’s a handful of India-based tech people who are banking rupees for giving companies awards whose validity is questionable but rarely actually questioned. I’m happy to update with specifics should the company be interested in providing them.

From Punjab Pete: “Re: Ascension. Lost $884 million in Q1. CIO Gerry Lewis is out, HCL outsourcing contract is axed.” The loss is verified, the other items are not, although being discussed on layoff sites.

HIStalk Announcements and Requests

One-third of poll respondents have recently struggled to pay a medical bill. Northerner slyly expresses bafflement about the question because they live in Canada.

New poll to your right or here: What action should be taken when a clinician’s mistake kills a patient?

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

Webinars

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

Acquisitions, Funding, Business, and Stock

Shares in the Global X Telemedicine & Digital Health exchange-traded fund were down 20% in the past month versus the Nasdaq’s 13% loss. They’re down 26% since the fund’s inception in July 2020 versus the Nasdaq’s 15% gain.

Sales

• A Leidos-led consortium that includes MediRecords, Coviu, and Nous Group wins a $230 million contract to implement an EHR for the Australia Defence Force. The system will replace EMIS-powered DeHS, which went live in 2014 at a cost of $94 million versus an initial budget of $16 million.
• Three-hospital Appalachian Regional Healthcare System signs a management service agreement with UNC Health, under which ARHS will implement Epic. The health system went live on Allscripts Sunrise in 2013.

People

Consulting firm Avia hires Daniel Clark, MBA, RN (Optum) as SVP of its Center for Care Transformation.

South Georgia Medical Center promotes Chuck Marshburn, MBA to CIO.

Adam Landman, MD, MHS, MS, MIS (Brigham and Women’s Hospital) joins Mass General Brigham as CIO/SVP of digital. 

Definitive Healthcare promotes Robert Musslewhite, JD to CEO as of August 1. Founder and CEO Jason Krantz, MBA will move to executive chair.

Government and Politics

An OIG joint audit of efforts by the DoD and the VA to make their Cerner systems interoperable notes that migration of legacy data into Cerner could have been more consistent, that medical device integration could be improved, and that user access should be limited to information needed to perform job duties.

The VA confirms that Cerner was unavailable 50 times for at least some users singe going live in its Pacific Northwest sites, but the outages were not widespread. The VA’s Oregon and Idaho sites will go live next in June.

Sponsor Updates

• TigerConnect publishes a report titled “It’s Time To Modernize How Health Systems Connect.”
• Arcadia partners with Datavant to accelerate biopharma research.
• Optum partners with the Dallas Cowboys to host a mental health awareness event in Frisco May 9.
• Vocera publishes a report titled “Reimagining Nursing for the Future” by Chief Nursing Officer Rhonda Collins, RNP, RN.
• Quil publishes a new case study, “Penn Medicine Improves Discharge to Home Rates, Expands Partnership Systemwide with the Help of Quil.”
• TMC awards Talkdesk’s AI Trainer with its 2022 Customer Product of the Year award.
• Interbit Data will participate on MUSE in Dallas the week of May 15.
• TigerConnect sponsors the Nurses at the Heart of Healthcare Contest to recognize nursing professionals who have shown an unwavering commitment to their profession.
• TriNetX appoints Launch Therapeutics CEO Anshul Thakral to its Board of Directors.
• Healthcare Growth Partners publishes research titled “Seeking Balance in the Hyperactive Mental Health Tech Market.”
• Kyruus ProviderMatch for Consumers is named “Best Patient Registration & Scheduling Solution” by an independent marketing group.
• Twistle publishes a new case study featuring Ashley Clinic, “Controlling Blood Pressure with Remote Physiologic Monitoring.”
• WebPT has been certified as a Great Place to Work for 2022.
• Relatient, Change Healthcare, Experian Health, Myndshft, Well Health, and Vyne Medical will exhibit at NAHAM 2022 May 10-13 in San Diego.
• West Monroe hires Rissa Reddan (Equifax) as chief marketing officer.
• Wolters Kluwer Health will exhibit at the RISE Risk Adjustment Forum May 9-11 in Chicago.
• Zen Healthcare IT’s Gemini platform receives HITRUST CSF r2 Certification.

Blog Posts

• “Clickbusters” can bust more than clicks (Nordic)
• 5 Tips for Hiring and Retaining Top Talent (Olive)
• The Top 5 Reasons Why Hospitals Should Optimize Patient Engagement (PatientBond)
• The Great Resignation: Key Takeaways (Pivot Point Consulting)
• Focus on Access Management for Safety in Healthcare (Symplr)
• 10 Years of MSSP: 2012 Fears Versus 2022 Realities (Part 2 of 2) (Premier)
• Three Qualities to Consider When Selecting a Healthcare Technology Partner (Protenus)
• Nurses are Calling for Innovation. Let’s Listen. (Vocera)
• Takeaways from the MTMI breast cancer risk assessment webinar (Volpara Health)
• It’s All Up from Here: Advancing Our Profession Through Next-Level Data Intelligence (WebPT)

Contacts

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

Morning Headlines 5/6/22

Allscripts Announces First Quarter of 2022 Results

Allscripts reports an uptick in Q1 revenue and that CEO Paul Black will step down.

Office overseeing EHR interoperability between DoD, VA not having ‘active role’ in rollout

Lack of oversight and planning by the Federal EHR Modernization Program Office has hampered interoperability between the DoD and VA’s new Cerner systems, according to a new joint report from the DoD and VA inspectors general.

OptimizeRx Reports First Quarter 2022 Financial Results, Revenue Up 22%, Successfully Completes EvinceMed Acquisition

OptimizeRx reports Q1 results: revenue up 22%, adjusted EPS $0.01 vs. $0.04, beating revenue expectations and meeting those for earnings.

News 5/6/22

Top News

Allscripts reports Q1 results: revenue up 7%, adjusted EPS $0.13 vs. $0.08. Expectations are muddied, as the company has carved out Veradigms’s financials separately.

CEO Paul Black will reportedly step down, with President Rick Poulton taking on the role effective immediately.

Allscripts finalized the sale of its hospital and large practice software business to Constellation Software subsidiary N. Harris earlier this week.

Webinars

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

Acquisitions, Funding, Business, and Stock

OptimizeRx reports Q1 results: revenue up 22%, adjusted EPS $0.01 vs. $0.04, beating revenue expectations and meeting those for earnings.

Sales

• Oklahoma’s MyHealth HIE selects Orion Health’s Amadeus population health management software, and consulting services from HealthTech Solutions.
• Cardiac monitoring vendor MediLynx selects EHR integration capabilities from Redox.
• The Capital Region in Denmark will implement cloud-based enterprise imaging from Sectra at its hospitals.

People

South Georgia Medical Center promotes Chuck Marshburn to CIO and HIPAA privacy officer.

Announcements and Implementations

HCTec announces GA of staffing and consulting support for Epic Hyperdrive.

Magellan Federal integrates NeuroFlow’s digital behavioral healthcare assessment, triage, and management capabilities into its Military & Family Life Counseling program.

Mankato Clinic will implement virtual care software and services from Bluestream Health at its 13 facilities in Minnesota.

Other

Pivot Point Consulting’s latest report on healthcare IT trends suggests that hospital leaders should:

• Adjust staffing models to accommodate hybrid and remote workers.
• Evaluate supply chains and legacy applications in light of cyber risks from third-party risk management and managed services vendors.
• Carefully evaluate proposed remote patient monitoring technologies and services.
• Prepare to work with TEFCA-enabled Qualified Health Information Networks.
• Consider the ways in which ERP and business systems can be successfully adopted to enhance workflow efficiencies.

Sponsor Updates

• Myndshft joins enterprise automation software company UiPath’s Tech Alliance Program.
• Lyniate publishes a new case study, “Clinify Health helps improve financial stability for FQHCs with Lyniate Envoy.”
• Meditech recaps its virtual Home Care Symposium, which brought 275 attendees together to network and collaborate on strategies for the future.
• Nuance joins Athenahealth’s Marketplace to broaden physician access to the Nuance Dragon Ambient EXperience for automated clinical documentation.
• HCTec celebrates the opening of its expanded office space in Winston-Salem, NC.
• EClinicalWorks publishes a new customer success story featuring Innova Primary Care, “How Healow Payment Services Transforms Collections.”
• CloudWave will implement Tausight’s situational PHI awareness platform and deliver turnkey PHI monitoring, management, and response to healthcare providers.
• Cerner will offer its customers access to Akasa’s AI-based Unified Automation platform for healthcare revenue cycles.

The following HIStalk sponsors have won MedTech Breakthrough Awards:

• WebPT – Best patient registration and scheduling solution
• Kyruus – Best online search and scheduling solution
• GHX – Compliance management innovation
• Nym – Health administration innovation
• Talkdesk – Best patient relationship management solution
• Elsevier – Best patient education solution
• LexisNexis Risk Solutions – Best HIE solution
• Fortified Health Security – Best overall healthcare cybersecurity company
• Current Health – Best hospital technology implementation

Blog Posts

• Reduce Patient Leakage with More Care Options, Part 2 (EVisit)
• Better claims management: faster patient payments and reduced denials (Experian Health)
• How CISOs Can Guard Against Evolving Physical and Digital Corporate Security Threats (Everbridge)
• 10 reasons why hackers think your HDO is an easy target (Imprivata)
• How to Improve Patient Experience with Data Management (InterSystems)
• Data normalization: Working toward a common clinical terminology (Intelligent Medical Objects)
• 4 Key Steps to Creating a Holistic Find Care Experience (Kyruus)
• 4 Ways to Measure Chatbot ROI (Loyal)
• Healthcare Interoperability – How can Medhost help you comply? (Medhost)
• Physical Therapy Core Values for PTs & PTAs at Your Practice (MWTherapy)
• Why Automation is the Key to Fixing Prior Authorization (Myndshft)
• A Look at Current Unmasking Initiatives in OccMed (Net Health)
• How interoperability can support value-based care (Nordic)

Contacts

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

EPtalk by Dr. Jayne 5/5/22

Those that follow me on Twitter know what I’ve been doing this week as I traveled to the rolling hillsides of Verona, Wisconsin. Epic’s Expert User Group (XGM) meeting was in its second week, with a heavy focus on clinical topics. It was great to catch up with some old friends, most of whom I worked with on other EHR systems across the last two decades. Each hospital and health system has certainly had its own healthcare technology journey, but it’s clear that for quite a few of them, all roads have led to Epic.

I’ve attended a variety of user groups across most of the major vendors and there are quite a few elements that set Epic apart as far as meetings. Rather than having to rely on hotels or conference and convention centers for meeting space, Epic’s purpose-built facility makes things incredibly easy for attendees. Presentation rooms are interestingly named, amusingly decorated, and full of light – unlike the cavernous spaces divided by portable walls that many of us are used to when we go to meetings. The meeting area also featured booths from various local vendors selling various kinds of cheeses, chocolates, locally produced soaps, and more. I enjoyed seeing everything Wisconsin has to offer and from the number of sales transactions, it appears others did as well.

Another thing that sets Epic apart is its outstanding culinary team. I’ve had plenty of questionable meals at conferences, but the menu selections at XGM were truly over the top. There’s a definite “farm-to-table” feel with lots of healthy offerings. Goat cheese and asparagus options appeared at several meals, which made me very happy, as I like them but don’t often cook them. Attendees were even able to download a 95-page document with recipes in the event they wanted to replicate the experience at home. I’ll definitely be availing myself of the recipe for scones.

Many attendees toured the campus, although rain on Tuesday put a small dent in that. It’s been great meeting other physicians involved in clinical informatics work, especially in disciplines that I haven’t worked in for a while. I enjoyed learning about different groups’ approaches to trauma-informed care and how to use EHR tools to better support patients. One of my favorite presentations was by UCLA Health, which has been using Natural Language Processing to identify patient portal messages that contain high-risk topics. It allows clinical care teams to address those messages more quickly, which hopefully will lead to improved outcomes. The team acknowledged the impact that the COVID pandemic has had on its work, and I know there was a lot of sympathy from audience members whose own projects may have been sidetracked or even canceled as a result of changes in organizational priorities.

It’s always a challenge to balance what’s going on at your day job with attending a conference, and I had a couple of conversations with physician informaticists who were reacting to the idea of a Supreme Court decision overturning Roe v. Wade. My OB/GYN colleagues are noting increased patient demand for appointments to place long-acting contraceptive devices as well as those to discuss prescriptions for emergency contraceptive medications. With several states having laws in place that would go into effect immediately upon the event of an overturn, I understand their desire to be proactive. There have been requests to alter physician schedules to add procedure slots as well as to create outbound patient portal messaging to try to reduce the number of phone calls the offices are receiving. Life as a clinical informaticist is certainly never dull.

The COVID-19 pandemic changed the landscape for virtual contraceptive services, which were offered by the majority of clinics surveyed for a recent article. Pre-pandemic, only 11% of those surveyed offered telehealth consultations for contraception, with the number rising to 79% after March 2020. Apparently, 22% of those surveyed had drive-through contraceptive clinics. Although I don’t recall hearing about any of those in my area, it’s a great idea. I found it interesting that 20% of people closed their in-person clinics and only offered services via telehealth. The study had a relatively small sample size of around 900 respondents. It will be interesting to see what happens to this landscape in coming months.

In speaking with other attendees, behavioral health continues to be a hot topic. There are too few providers to meet demand and organizations are looking to creative offerings such as teletherapy and self-service interventions for patients. Staffing challenges were also a common theme, and organizations are looking to use pre-visit questionnaires to help gather data prior to the visit so that the patient rooming process is more efficient. Automated alerts to let patients know when their care teams were running late are gaining traction. Many of the solutions presented by clients focused on shifting various tasks from the staff to patients. Although those moves can definitely support patient engagement, they’re also ways to help mitigate staff burnout. Many organizations are still struggling to hire office-based nurses, medical assistants, care coordinators, and patient care technicians, so they’re looking for whatever efficiency boosts they can find. It sounds like there are a lot of optimization projects going on, with hospitals trying to fit that work in before a potential next pandemic wave.

On Wednesday, which happened to also be Star Wars Day, a couple of presenters included Star Wars references in their slide decks, and I spotted several attendees in costume. I closed out my meeting experience with a trip to “Xtra Hour,” which was advertised as a social event for food and fun at the end of the day. The event featured a variety of food and drink, including a lovely crab and leek appetizer and sparkly galactic-themed lemonade. I heard the mini cupcakes were good as well as the mini meringue desserts. Attendees had the chance to take part in several activities including craft projects and giveaways, and of course there was plenty of good old-fashioned socializing. Then it was back to the hotel to put my feet up and to pack so I can head home in the morning. Overall, it was a great experience and I’m heading back with a notebook full of ideas and thoughts to make life better for my end users and their patients. I was also happy to be able to have in-person encounters with many of the people I work with regularly. Building relationships is always one of my favorite parts of these events.

What is your favorite part of a user group meeting? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 5/5/22

Offor Health Completes Series A Round With Additional $9 Million Led by AXA Venture Partners

Offor Health, which specializes in providing mobile surgical services to in-office settings, raises $9 million in a Series A funding round.

Workflow automation solution for post-acute care Element5 closes $30M in Series B round of funding

Post-acute care workflow automation vendor Element5 raises $30 million in a Series B funding round, bringing its total raised to $45 million.

Cruces-based telehealth company Electronic Caregiver to add 770 jobs

Remote patient monitoring company Electronic Caregiver will hire 770 employees as it expands its headquarters in New Mexico with the addition of a clinical triage center.

HIStalk Interviews Mariann Yeager, CEO, The Sequoia Project

Mariann Yeager is CEO of The Sequoia Project of Vienna, VA.

Tell me about yourself and the organization.

I’ve been in health IT virtually my entire career. I got my start years ago working for an insurance company, then a clearinghouse, and have been in health IT ever since. I got into the interoperability space, working with the ONC on the Nationwide Health Information Network project, which led to the formation of this particular project 10 years ago. We were formed as a non-profit, public-private collaborative. We are solely focused on advancing interoperability for the public good and working in collaboration with government to offset the burden of what they’re trying to accomplish.

Is the lack of interoperability a technical problem or a business problem?

All of the above. There are policy, business, and technical issues that impede the ability for information to flow seamlessly. That’s where we focus our energies at The Sequoia Project, identifying the issues that are impeding progress and systematically addressing them one at a time.

What other industries provide a model for competing organizations exchanging information about their shared customers?

Certainly we can learn a lot from financial services, telecom, and banking. In fact, as we were exploring and preparing to launch Carequality in 2014, we researched how things operate in the ATM and ACH world, where they have a non-profit that brings together different stakeholders to develop rules of the road so that ACH networks interconnect. Carequality was modeled after that type of activity. There’s a lot we can learn, but in some ways, what we’re dealing with is a far more complicated transaction than a banking transaction, so there are a lot more issues to unpack.

Arguments have been made that healthcare participants should be paid for sharing data instead of being penalized when they don’t. Is the sharing model yet to be determined?

From where we sit, there needs to be a baseline of technical and policy capabilities in place to interconnect our ecosystem.Then there needs to be a value to exchange and then an impetus to exchange. The value to the exchange usually comes from the value of the information and whether it offsets some administrative burden. Is there a return on investment, for instance, or does it somehow contribute to some other good? That’s the first thing to look at and explore — the value of exchange.

Then the impetus to exchange is, how do you get people to use the capabilities that exist? Again, it’s really derived from value. You can have opportunities to have better information more readily accessible and that makes the clinician’s life easier, makes supporting value-based arrangements easier. The impetus to change can also come from governmental mandates. What we are seeing in our space now is a combination of all the above, which creates an exciting opportunity to advance the ball within interoperability, because the stars are aligning in terms of all these things coming together.

How will ONC’s information blocking review work under a complaint-based system where it’s often a big health system that isn’t sharing patient data?

We’ve seen tremendous progress in healthcare organizations interconnecting for treatment purposes, of course, starting with health systems. There’s a tremendous volume of information being exchanged between health systems and now increasingly across the continuum of care. 

We have to take into account the maturity of the platforms that these other care settings are using to support their clinical environment, and then the other actors that have a need for health information but that aren’t even participating in the network. It makes it a lot more difficult if you’re trying to approach point-to-point arrangements versus if you’re a public health agency, a health plan, or a small physician practice. If you’re able to connect to a health information network, that is the mechanism that allows you to access information. Then of course if that network interconnects with other networks like to Carequality or an ONC-endorsed TEFCA framework, that’s where we’re going to see the seamlessness. I think it’s a reflection of, in part, the maturation of those capabilities, the ability to participate in networks and along that life cycle. 

Then we can’t even begin to speculate how ONC might and OIG may be approaching compliance. With respect to the different actors, health information networks, health IT developers, healthcare provider organizations, et cetera, that really remains to be seen from where we sit. It boils down the very practical issues that are impeding exchange — different interpretations of law, different interpretations of policy, different interpretations of what is even treatment-based exchange, care coordination treatment. We’re getting greater clarity around that. For us, it’s much more nuanced

What efforts are you seeing to connect public health to the healthcare system?

It’s pretty ad hoc right now, for the most part. Everyone realized that in the midst of a pandemic is not the time to try to create an interconnected health IT ecosystem that the public health is plugged into. But there are tremendous opportunities to leverage existing infrastructure for that purpose. Naturally there are regional statewide HIEs and others that are doing interesting things to support public health and make it easier for public health agencies to get the information that they need.

Electronic case reporting is getting significant uptake and being supported both within nationwide networks and with others across and between networks. That is just an example that if you have a discrete use case and you have a trust framework in which to support it, that capability exists. This is an area where we think that TEFCA is going to play an important role in advancing this in a much more robust way for more public health capabilities.

Can you describe in simple terms the impact that TEFCA and Qualified Health Information Networks might have on consumers and providers?

The 21st Century Cures Act was passed into law in December 2016. It directed ONC to develop and support a Trusted Exchange Framework and Common Agreement, TEFCA, to support the exchange of information between different, disparate health information networks. ONC has been working since then to develop key elements to enable that to occur. They were given the ability to work with a private sector organization to help them implement the different components of TEFCA to operationalize it. The Sequoia Project was selected to serve as that private sector organization, an official designation as being a Recognized Coordinating Entity. We are working with ONC to develop the agreements, the implementation guides, and the onboarding process that would enable networks that want to receive special government endorsed designation as a TEFCA Qualified Health Information Network, or QHIN, where we would work to facilitate that process and do the onboarding and designation for those that comply.

How do the various elements of trust fit in with the ability to exchange information, including one provider not trusting another’s data?

It’s a policy issue, and there is a technical element and workflow element as well. The idea of having trust agreements and trust frameworks is so that a participant — a healthcare organization or participant or actor in one network — can rely on the information they’re getting from someone else. That it comes from a trusted source, that they’re abiding by the same rules of the road, and that the information is only going to be requested in accordance with certain rules of engagement. It will be appropriately protected. That is very foundational before someone would even be willing to share information at all.

The other part of that is, can you trust the information itself? Does the information have value? Is it semantically valid? We are doing a lot of work on that at The Sequoia Project through our data usability work group, which includes a group of subject matter experts, guests from across many different stakeholder groups, to try to define in a more clear way how data should be codified to improve the value and meaning of the information when it’s exchanged.

Is a national patient identifier essential to the process?

The issue around the national patient identifier is multifaceted. Some believe that it would be the linchpin to solving interoperability, while others say that it really has value for a small portion of identities that we can’t match through other means. At Sequoia, we tend to be practically oriented about what can we do today to improve matched results and increase it over time. We publish white papers to that effect and refresh and update white papers we published years ago. The use of secondary identifiers, and adding that onto the other identity traits used for matching, can be quite effective. We think that there’s a lot of value in continuing to look at methodologies like that. We tend to meet the market where it is and set our sights on what we can do to incrementally improve progress over time. A unique health identifier has its place, but there are also things we can do today to make tremendous progress. We look at that very carefully,

People often misunderstand HIPAA or misrepresent it to support what they want to do. Is the 1990s-era rule a barrier to what you would like to accomplish?

In some cases, HIPAA is very much an enabler, because it is a standard for privacy and security that we can leverage and it is well understood and established. In other cases, HIPAA predated most of the digitization of healthcare, and there are aspects of it that are, as you said, misunderstood or misinterpreted. Maybe it is an area that needs further clarification.

A good example that we saw in the pandemic was that healthcare organizations were reluctant to share summaries of patient records with public health agencies. They worried about exceeding minimum necessary. OCR issued guidance clarifying that if you receive a request from a public health official, you can trust that it’s for the information that they need. It was still an impediment that was more of a policy interpretation and a risk tolerance. It was more of an impediment in terms of interpretation and understanding. Trying to get that kind of clarity in the midst of a pandemic is quite challenging.

People who read about FHIR and interoperability APIs may think we’ve solved the problem, but many of us still have personal experience where a new provider is starting with a blank slate. Is consumer education needed to set expectations for information sharing and blocking in a complaint-based system?

FHIR, APIs, and the emerging role that apps will play in enabling consumers to access their health information are all tools in the toolkit. If you think about it from the perspective of individual access, you have obligations now to share information with individuals. It’s an imperative. We are working on how to operationalize that.

A good example of that is the work that we are doing with the ONC on TEFCA and those organizations that participate in TEFCA, others as a QHIN itself or as a participant or someone connected to QHIN itself. There’s an obligation that if someone requests their information and if you have information about that person, you must share it unless you are not permitted by law to do so, or somehow breach privacy or security.

We look at not so much information blocking as a compliance paradigm, which it certainly is, but if you turn it on its head, it’s an information exchange paradigm that TEFCA and other activities can reinforce. The more we address impediments to information exchange, the more we get down to the brass tacks of how to make this work seamlessly. Individual access is an excellent example, because we can support that on a wide scale basis today using the very standards and protocols that have existed for a long time and using new standards and protocols such as FHIR. The issues often boil down to policy. That’s really what we’re trying to unpack with respect to our work on TEFCA.

ADT notification is a lightly heralded success that took a lot of effort. Are you seeing significant uptake?

ADT notification is a great example of capabilities that were born out of market need and demand organically. You see so many health information networks supporting those capabilities, and have that reflected in regulation as well, as a way to demonstrate meeting certain measures with CMS. It’s an exciting paradigm to witness. We hope that the work that we foster here in the private sector can be pointed to in other ways. That’s why we work very much at Sequoia with boots on the ground, trying to resolve issues that have practical implication and get some traction that hopefully reinforces and supports policy goals.

What will be the most important interoperability issue over the next two or three years?

I would like to see us move beyond the sharing of information for treatment purposes. We’ve seen tremendous progress and very much take pride in what we, as a collective industry, have done in that regard. We can expand that to support other use cases, such as the exchange of information for payment, for healthcare operations, to individuals, and for public health purposes. I am very positive about our ability to reach that. We have good momentum. We are getting good traction. I think we will start to see some real progress in that respect.

Do you have any final thoughts?

I would like to reflect on the past 10 years and our journey here at Sequoia. We started in back in 2012 with the idea that there would be a need for an organization like us — a non-profit, public good-oriented organization; public-private; working to advance the ball on interoperability by solving practically oriented issues. We have seen the ability to make strides not by going it alone, but by having a broader community of stakeholders working with us side by side. We attribute the progress and our ability to have incubated and launched these initiatives and the work we’ve done with interoperability matters in TEFCA to the tremendous support that we’ve had from stakeholders. I just wanted to acknowledge and be thankful of that.

Morning Headlines 5/4/22

Cerner Reports Fourth Quarter and Full Year 2021 Results

Cerner reports Q1 results: revenue up 4%, adjusted EPS $0.93 versus $0.78, meeting earnings expectations but falling short on revenue.

VA secretary urges EHR rollout to continue, but ‘very concerned’ about system outages

VA Secretary Denis McDonough says the agency will continue rolling out its new Cerner software despite five recent outages that have caused some lawmakers to call for a halt to implementations.

American College of Physicians and the American Telemedicine Association Collaborate on New Digital Health Assessment Framework

The American College of Physicians and the American Telemedicine Association will develop a framework for assessing digital health technologies that are used by providers and consumers.

News 5/4/22

Top News

Allscripts closes the sale of its hospital and large practice software business to Constellation Software’s subsidiary N. Harris.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Global Healthcare Exchange. Founded in 2000, GHX pioneered healthcare’s largest cloud-based supply chain network, which today connects tens of thousands of healthcare organizations across the globe. The network represents healthcare providers operating more than 80% of licensed beds in the US and suppliers representing more than 85% of the medical-surgical products used in healthcare delivery. With the support of GHX, healthcare organizations have removed billions of dollars of wasteful healthcare spend. Over the last two decades, GHX has continued innovating alongside a passionate community of healthcare providers, suppliers, distributors, and other industry stakeholders, all united around a common purpose: to simplify the patient-centered business of healthcare to improve outcomes. The company’s passion for uniting the best of healthcare is driven by a powerful vision: create a viable and sustainable future for healthcare by arming organizations with the data, insights, and technology they need to thrive in healthcare’s value-based future, where patients are at the heart of every decision. GHX believes that by empowering organizations to move beyond process efficiency, and toward efficiency of outcomes, organizations will thrive and the vision of a viable and sustainable future for healthcare will become a reality. Thanks to GHX for supporting HIStalk.

Webinars

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

Acquisitions, Funding, Business, and Stock

Cerner reports Q1 results: revenue up 4%, adjusted EPS $0.93 versus $0.78, meeting earnings expectations but falling short on revenue.

Configo Health, a startup that has developed benchmarking analytics for pediatric hospitals, raises $2 million in a seed funding round.

Plug-and-play virtual care software developer Capable Health raises $6 million in seed funding. Its technology allows developers to launch digital clinics.

Kidney care-focused analytics and population health management vendor Healthmap Solutions raises $35 million, bringing its total funding to $136 million.

Online pharmacy Truepill stops filling Adderall and Vyanse prescriptions as online mental health companies such as Cerebral and Don Health raise concerns about overprescribing. Major drug chains such as Walmart and CVS have also reportedly delayed or declined to fill such prescriptions.

The American College of Physicians and the American Telemedicine Association will develop a framework for assessing digital health technologies that are used by providers and consumers. The US-focused framework covers privacy and security, clinical assurance and safety, and usability.

Sales

• Rochester Regional Health (NY) will incorporate TytoCare’s telemedicine software and hardware into its virtual care services.
• University of Michigan Health will use analytics from Loopback Analytics to improve its specialty pharmacy program.

People

OncoHealth promotes Jennifer Haas to chief marketing officer.

Divurgent names Ed Marx (The HCI Group) CEO. He replaces founder Colin Konschak, who will become executive chairman.

Lynne Nowak, MD (Evernorth) joins Lark Health as chief medical officer.

IKS Health hires Ben Crocker, MD (Massachusetts General Hospital) as SVP of care design and innovation.

Stan Opstad, MBA (Inovalon) joins Zipari as chief product officer.

Announcements and Implementations

Audubon County Memorial Hospital & Clinics (IA) staff will implement Epic this week.

Jefferson Radiology goes live on Philips Collaboration Live for diagnostic tele-ultrasound, allowing remote radiologists to connect virtually with patients during their imaging appointments to provide a diagnosis, answer questions, or request additional imaging from the sonographer.

Consumer-focused healthcare wearables company Withings launches enterprise remote patient monitoring devices and software for patients and providers.

Personal ECG app vendor AliveCor launches KardiaComplete, a remote personal monitoring and virtual cardiologist service for people with hypertension and arrhythmias, sold through employers and payers.

Government and Politics

Winn Army Community Hospital at Fort Stewart in Georgia will go live on Cerner next month as part of the DoD’s continued wave of MHS Genesis roll-outs.

VA Secretary Denis McDonough says the agency will continue rolling out its new Cerner software despite five recent outages that have caused some lawmakers to call for a halt to implementations. The VA’s Central Ohio Healthcare System in Columbus went live on the EHR over the weekend. McDonough said he is “very concerned about the execution of the program to date” and added that the first of the downtimes was so “egregious” that Cerner CEO David Feinberg, MD, MDA issued a signed apology.

Privacy and Security

Virtual chronic care management and remote patient monitoring startup MyNurse notifies users of a March data breach, adding that it will cease operations at the end of the month for unrelated reasons.

Good Samaritan Medical Center Director Amy Travland reminds staff to print their names and avoid abbreviations when paper charting during downtime, referring to a cybersecurity incident last week. Good Samaritan was one of two Tenet Healthcare facilities in Florida that took systems offline as a result of the breach.

Other

Cardiologists express concern that tens of millions of consumer devices that can issue atrial fibrillation warnings will consume doctor time and healthcare expense to confirm or rule out a diagnosis, all for uncertain benefit. Symptom-free patients will have medical-grade monitors attached for days and then potentially have expensive anticoagulants prescribed that can cause side effects. One cardiologist said that tech companies introduced such alerting “because they could” and said that doctors are trying to catch up to the “test doctors didn’t order.”

Mozilla finds that of 32 mental health and prayer apps it reviewed, 28 raise strong data management concerns and 25 fail to meet minimum security standards. Mozilla’s lead privacy expert called the apps “exceptionally creepy” and that the companies that offer them are “negligent and craven.” The biggest offers named are Better Help, Youper, Woebot, Better Stop Suicide, Pray.com, and Talkspace.

Authorities in Venezuela arrest Jose Lopez for working at several healthcare facilities with fake medical credentials. His crime came to light after several women became pregnant after he had supposedly implanted them with subdermal contraceptive coils. He had, in fact, implanted lollipop sticks.

Sponsor Updates

• AdvancedMD Director of Sales Operations Carla Huggard wins a Utah Women in Sales Award.
• Actium Health publishes a new report, “State of Patient Engagement in 2022.”
• Baker Tilly will sponsor the Maryland HIMSS 10^th Annual Golf Tournament May 9 in Valley.
• Bamboo Health will exhibit at the Skilled Nursing Clinical Executive Conference May 5 in Chicago.
• CHIME posts a podcast titled “Filling the Talent Pipeline” with guest Geoff Blanding, EVP of Optimum Healthcare IT.
• Cerner releases a new podcast, “Combatting clinician burnout.”
• GHX names 80 provider and supplier organizations to its Millennium Club that have achieved the highest levels of supply chain automation through the GHX Exchange.
• CTG will sponsor the AWS Summit Atlanta May 18-19.
• Divurgent names Andrew Wells (McCormack Plastic Surgery) senior director of business development.
• Change Healthcare will work with Luma Health to develop new patient engagement solutions that unify clinical, operational, and financial touchpoints.
• The Iowa Hospital Association will offer its members access to ChartSpan’s chronic care management services.
• Experian Health, PatientKeeper, ManpowerGroup, CereCore, Change Healthcare, CloudWave, Dimensional Insight, Ellkay, Elsevier, FDB, Healthcare Triangle, Intelligent Medical Objects, Interbit Data, Intrado, Nuance, OBIX Perinatal Data Systems by Clinical Computer Systems, Sphere, Tegria, and Meditech will exhibit at the MUSE Inspire Conference May 15-18 in Dallas.

Blog Posts

• Three Pillars of Single-Path Coding (AGS Health)
• More meaningful care through data (Arcadia)
• Healthcare Technology Can Drive the Fourth Industrial Revolution (Ascom)
• How Azara DRVS Supports Behavioral Health Services (Azara Healthcare)
• GHX Announces Upcoming GHX Summit 2022 Highlights (GHX)
• Leadership – What Does it Really Mean? (CHIME)
• Tips to Effectively Fund Your Enterprise Cyber Risk Management Program (ECRM) (Clearwater)
• The Link Between EHR Satisfaction and Clinician Burnout (Dimensional Insight)
• Managing Post-Acute Care: A Critical Success Factor for ACOs (Dina)
• Insights and Takeaways from the 2022 Internet 2.0 Conference (Divurgent)
• Who are the 29 Million Americans Who Use Health Centers? (EClinicalWorks)

Contacts

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

Morning Headlines 5/3/22

Virtual care enabler Capable raises $6 million

Capable Health, developer of plug-and-play virtual care software, raises $6 million in seed funding.

Guidewell and Highmark Ventures Lead $35 Million Funding Round in Kidney Health Leader Healthmap Solutions

Kidney care-focused analytics and population health management vendor Healthmap Solutions raises $35 million, bringing its total funding to $135.6 million.

Allscripts Closes Sale of Hospital and Large Physician Practices Business to Constellation Software

Allscripts finalizes the sale of its hospital and large physician practices business to Harris parent company Constellation Software for up to $700 million in cash.

Health startup MyNurse to shut down after data breach exposed health records

Virtual chronic care management and remote patient monitoring startup MyNurse announces it will shut down alongside its notice to users of a March data breach.