News 11/27/24

Top News

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

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

HIStalk Announcements and Requests

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

Webinars

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

Acquisitions, Funding, Business, and Stock

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

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

Sales

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

People

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

Announcements and Implementations

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

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

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

Other

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

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

Sponsor Updates

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

Blog Posts

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

Contacts

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

Morning Headlines 11/26/24

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

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

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

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

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

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

HIStalk Interviews Thomas Charlton, CEO, Goliath Technologies

Thomas Charlton is chairman and CEO of Goliath Technologies.

Tell me about yourself and the company.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Curbside Consult with Dr. Jayne 11/25/24

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

Morning Headlines 11/25/24

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

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

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

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

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

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

Monday Morning Update 11/25/24

Top News

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

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

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

Reader Comments

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

HIStalk Announcements and Requests

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

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

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

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

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

Webinars

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

Acquisitions, Funding, Business, and Stock

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

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

People

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

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

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

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

Government and Politics

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

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

Other

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

Sponsor Updates

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

Blog Posts

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

Contacts

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

Morning Headlines 11/22/24

House passes veterans’ package without EHR accountability measures

House lawmakers remove Congressional EHR oversight provisions before passing a VA legislative package that is now up for consideration by the Senate.

Headspace Axes 13% of Workforce, Transition Therapist Network to Part-Time and Contract Roles

App-based mental healthcare company Headspace lays off staff therapists and 13% of its workforce, and reshuffles executive roles as it looks to cut costs and improve revenue.

Alberta creates its own AI-powered scribe

ED physicians at Canada’s Alberta Health Services are testing a doctor-created AI scribe in a two-year project that is being funded by a Canadian Medical Association grant.

News 11/22/24

Top News

House lawmakers pass a VA legislative package with its original EHR oversight requirements removed. The bill will move to the Senate.

The originally submitted version would have increased Congressional oversight of the VA’s struggling Oracle Health implementation, which included requiring facilities to return to pre-deployment efficiency before moving on to the next go-live.

A House VA Committee spokesperson said that the EHR provisions were removed during negotiations “due to a lack of political viability in both the House and Senate.”

Rep. Mark Tarkano (D-CA) accused Oracle of using its “army of lobbyists” to kill the EHR requirements. Rep. Matt Rosendale (R-MT) said, “Oracle Cerner bought and bullied their way into getting this bill passed without their company being scrutinized.”

Reader Comments

From Sportsman: “Re: Oracle. This article says it will ‘trounce’ Epic.” This piece is an example of someone who (a) doesn’t know what they’re talking about in healthcare, or (b) is trying to spew hot takes for clicks and advertiser attaboys. Maybe both. My issues with it are these:

• The author who wrote the article – which is a facts-lite opinion piece — owns the cloud-focused media site that ran it. He is basing his conclusion on Oracle’s size and technology expertise.
• His site sells marketing services, with one of his clients being Oracle and one of his non-clients being Epic.
• Not only does the author have zero healthcare experience, he spent five years as an Oracle PR flack and is a fanboy of Larry Ellison, who he claims recruited him personally.
• Healthcare is an afterthought for Oracle, while it is Epic’s only business. That seems important.
• Oracle Health placed below Epic, Meditech, or both in every Best in KLAS 2024 EHR category. Oracle also finished #3 in a three-horse race in healthcare ERP and scored a dismal 60 versus Epic’s 92 in large hospital patient accounting, with customers raising serious concerns about Oracle Health’s lack of results, product roadmap, and ability to execute.
• He ignores Epic’s massive market share and fanatic customer loyalty and doesn’t mention that Oracle Health is headed south on those scales.
• He says that the entire resources of Oracle have been committed by Larry Ellison, while he’s alive anyway, to address “the entire $16 trillion healthcare industry.”
• He really hates that Epic accuses the former Cerner of interoperability foot-dragging, dramatically concluding that, “to the degree Ellison gives any thought to Epic as he undertakes that mission, Epic’s silly ankle-nipping will only serve to reinforce Ellison’s resolve.”

Notes from Wednesday’s “Oracle Health Inside Access: The Future of the EHR” webcast

The overly gushy host of the webcast ran the charitable foundations of Cerner and now Oracle Health (she has no healthcare or technical experience or education). Oracle Health Chairman David Feinberg, MD, MBA made a somewhat brief appearance from a room with a sweeping view that sent me Googling to see if it was the $18 million LA penthouse that he bought from The Weeknd (it apparently wasn’t, based on celebrity real estate listing photos).

Most of the webcast involved a nicely done demo with product director Jeffrey Wall, MD that had been recorded at the Oracle Health Summit. It was not clear on whether the work in progress that was shown is the new EHR, old Millennium with a facelift, or Oracle’s digital assistant.

• The functions shown were running in a browser and was apparently a mix of live code and mock-ups.
• Oracle’s Clinical AI Agent displays an input bar at the top. The physician clicks the microphone icon to initiate voice input, much like using ChatGPT in voice mode.
• The system covers ambulatory practice only. Non-physician use was not mentioned.
• It can answer questions about the day’s visits and create generative AI summaries of individual patient histories.
• A new concept is an AI timeline of encounters that helps the physician visualize the patient’s history.
• The information that is displayed by the AI references its source.
• The voice operation opens whatever function the user’s question references, and from there it’s clicking and scrolling to interact with the information that is displayed.
• The user interface is visually logical and offers a good presentation of information.
• The user can drill down into individual problems to see history, notes, and meds for that condition.
• It occurred to me in watching the demo that whatever the physician speaks to the AI will be heard by the patient who is in the room, which may be interesting in some cases. Also, the physician will need to stay close to keyboard and microphone.
• Incoming patient messages are displayed with full chart context.
• The physician can ask about medication doses and side effects from Oracle Health-owned Multum.
• Creating a new prescription brings up that user’s most common prescriptions as well as those of physicians like them.
• Patients can enter free text when confirming their appointment or checking in. AI will interpret and route based on what they enter.
• The new EHR will be open and connected as part of an ecosystem that will allow data to flow.

Webinars

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

Acquisitions, Funding, Business, and Stock

Release of information vendor Verisma acquires Olah Healthcare Technology, which offers an enterprise archiving solution.

Clinical collaboration technology company TigerConnect acquires Twiage, whose software supports pre-hospital communication involving emergency medical services.

Sales

• UCHealth chooses competency management software from Kahuna Workforce Solutions.
• Sarasota Memorial Health Care System will implement Epic in a $160 million project, replacing Altera Digital Health’s Sunrise.

People

Chris Penwarden (Minerva Surgical) joins Eagle Telemedicine as VP of sales. He is a West Point graduate who served in combat roles in Iraq and Afghanistan as a US Army rifle and anti-tank platoon leader and company commander before retiring from the military after 14 years due to injuries sustained in combat.

HarmonyCares hires Jonathan D’Souza, MS (MedArrive) as chief product and technology officer.

Community Medical Centers President and CEO Craig Castro will retire after 22 years with the organization. He joined the health system in 2002 as SVP/CIO and held that position for 10 years before adding the CEO role at Clovis Community Medical Center.

Announcements and Implementations

Veradigm launches an ambient scribe platform for its EHR using AvodahMed’s generative AI.

ED physicians at Canada’s Alberta Health Services are testing a doctor-created AI scribe in a two-year project that is being funded by a Canadian Medical Association grant.

KLAS looks at security and privacy consulting and managed service providers.

Other

Fun fact: an article about businesswoman and sports teams owner Michele Kang’s $30 million women’s soccer donation mentions that she made her money in health IT. She was founder and CEO of federal IT healthcare contractor Cognosante, which she sold to Accenture Federal Services earlier this year (she had previously sold the company’s consulting practice to NTT Data). She emigrated from South Korea to the US as a student at the University of Chicago and then Yale.

Sponsor Updates

• Healthcare IT Leaders staff bring holiday cheer to Head Start families at the YMCA of Greater Kansas City with Christmas Tree Santas.
• Artera promotes Adrianna Hosford to chief communications officer and head of marketing, and Zach Wood to chief product officer.
• FinThrive announces new capital to support its accelerated growth.
• The Northern Virginia Technology Council recognizes DrFirst as a top technology leader for the fifth year in a row.
• ACOs participating in the Medicare Shared Savings Program that use a combination of Arcadia and CareJourney solutions achieve one-and-a-half times more savings compared to other ACOs nationally.
• Health Data Movers releases a new “Quick HITs” podcast titled “Dr. Aaron Neinstein on AI, Automation, and the Future of Healthcare.”
• Netsmart announces that several of its solutions, including its EHR for public health, have received Level 2 Certification from the Texas Risk and Authorization Management Program.
• Ellkay profiles Cook Children’s Health Care System SVP and CDIO Theresa Meadows as a part of its “Women in Health IT” series.
• Wolters Kluwer Health and the Australian College of Mental Health Nurses will partner to develop mental health resources available via the Lippincott Procedures Australia educational resource.
• Five9’s GenAI Studio wins Best New Product from the 2024 Big Awards for Business.
• Meditech lists its customers that have been recognized as CHIME Digital Health Most Wired.
• Fortified Health Security names Dow Perkins senior threat defense analyst, Kerry Shelton threat assessment analyst, and Guy Denton penetration tester.
• CHIME recognizes Impact Advisors co-founder and Managing Partner Andy Smith with its Foundation Industry Leader Award.
• Linus Health Director of Cognitive Science Ali Jannati, MD, PhD receives the 2024 Neuropsychopharmacology Editor’s Award for a Review from the American College of Neuropsychopharmacology.
• MRO publishes a new case study, “Healthcare Providers Explore Payer Direct Access to EHRs, but Most Are Still Awaiting the Benefits.”

Blog Posts

• Automate Your Fax Inbox with Image AI Assistant (EClinicalWorks)
• Medicare Bad Debt 101 (FinThrive)
• Understanding Communication Styles: A Guide for Customer Service Agents (Five9)
• Elevating data security with HITRUST certification, HIPAA compliance, and employee awareness (Healthmonix)
• Quality, Workflow, and Health Information Exchange (Konza National Network)
• Meditech customers share their innovations with the healthcare industry (Meditech)

Contacts

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

EPtalk by Dr. Jayne 11/21/24

The number one topic of discussion at a recent meeting of primary care physicians that I attended was how their health systems are using AI to help with documentation. The majority of the conversation was around using AI to create draft responses to inbox messages.

One physician was vocal when speaking of a specific vendor’s AI technology: “I don’t know who this guy is, but he seems to think I give out controlled substance refills like candy.” Apparently a lot of the inbound messages are asking for refills, but I would think it would be fairly easy to tune the algorithm to have different responses for controlled substances versus those that aren’t, especially since the medications are represented by discrete data in the EHR. I’ve not used the technology from that specific vendor personally so I can’t comment on it, but I suggested that he reach out to his IT department and provide feedback.

Although AI can be part of the plan, there are some fairly straightforward non-technical tactics that can help with inbox management. The American Medical Association summarized these in a recent piece on creating a “saner” inbox. The suggestions were not surprising:

• Set clear expectations for patients.
• Give new patients a printed handout that outlines reasonable expectations for responses and guidelines for portal use.
• Restrict the ability to send messages to patients who have seen the physician within a certain time period.
• Maintain uniform workflows and avoiding exceptions.

I have not seen anything like a printed handout in any of the practices where I’m a patient, but it seems like an inexpensive intervention that could help. It gets even cheaper when you send the document through the patient portal. The article also recommends discussing excessive portal usage directly with patients and setting boundaries if needed. Low tech as well, but also likely effective.

As more AI-enabled tools are brought into regular clinical use, finance types are going to look for ways to pay for them. A CPT code was recently issued for Eko Health’s AI-powered Sensora cardiac screening tool. The tool is designed to identify heart disease by detecting certain heart murmurs and irregular heart rhythms. It works with one of the company’s advanced digital stethoscopes that has built-in EKG functionality. Physicians can use the billing code starting July 1, 2025, although it’s unlikely that it will result in payments without buy-in from insurance companies.

From Greek Islands: “Re: consulting firms. I’m in all-day meetings with one that is trying to earn our business. I’m watching the high-priced consultant sitting nearby access various websites, including online bill pay. Not a good look.” Like they say, you only have one chance to make a first impression and this certainly was not a good one. I am reminded of the time when I was doing an EHR optimization project for an urgent care where the physicians complained bitterly that they didn’t have enough time to get their notes done. During a single day of workflow observations, I watched one of the most vocal members of the group look at over 200 offerings on the website of a major footwear retailer. If you are a compulsive multitasker, learn to close your laptop or take notes on paper so that you avoid doing something you might regret later.

I’m a nice, compliant patient with a well-controlled chronic condition, so I only have to see my care team once a year. Following best practices for ensuring patient follow up and reducing future phone calls, they schedule your next visit before you leave the office. When I get home, I download the appointment through the patient portal and add it to my trusty Outlook calendar.

This year when I went for my visit, I got a surprise. I discovered a sign on the darkened office door that they had moved up the street to a new building. Although I was plenty early for my appointment, I wasn’t early enough to backtrack to my car and drive to a different parking garage, so I had to hoof it down the block.

I looked at recent communications from the practice and found that some of them had the new address and some had the old address, but in none of them was it called out that the practice was moving or had moved. My primary method of contact for this practice is patient portal and none of its messages talked about the move. It takes at least 90 to 120 days to do a build-out on a new medical office, so it’s not like the practice made a spur of the moment decision to relocate.

Since they moved up the street, I suspect that many people won’t notice the address difference on a reminder message. When you have been going there for a decade, would you notice a change from 5200 Maple Lane to 5300 Maple Lane on the fourth line of the text message? Are you likely to plug the address into your GPS for a trip that you have made over and over? Some might, but it didn’t cross my mind, and I suspect that for many patients with varying levels of health literacy, it won’t cross their minds either.

Knowing how easy it is to send a blast message to all the active patients in a practice via a patient portal, I wondered why in the world they wouldn’t have done so. As I sat in the waiting room, the receptionist fielded a call from a patient saying that they were going to be late because they were in the wrong building, so at least I know it’s not just me. I provided feedback to the office that it would be useful to send a message to patients, especially those who only come in once a year, but they didn’t seem to be interested in improving their patient satisfaction scores in that way.

There were plenty of other unsavory things about the visit, so I’m eagerly awaiting my post-visit survey. Things I’ll be specifically mentioning besides the office relocation issue: failure of patient care team members to introduce themselves, lack of confidentiality of staff conversations in the waiting room, incorrect taking of vital signs, and inappropriate comments added to patient chart during medication reconciliation.

And one more thing – the colossal HIPAA violation when the medical assistant accessed the practice’s secure messaging app while doing my intake, allowing me to see other patients’ full names and medical information on the very large wall-mounted monitor. Not to mention her failure to lock the computer when she left the room. At least the rendering provider was appropriately horrified by that when she came in, so that’s something.

I tried to offer additional feedback in person during the visit and was directed to “include that in the patient survey when you get it.” Obviously people in the office don’t understand how those surveys work and how it would have been easier to take my feedback real time then for me to put it in writing. Or maybe they just don’t care.

What kind of communications do you do for your clinicians when their offices relocate? Should I plan to plug every visit into my GPS for the next 30 or 40 years? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 11/21/24

Verisma Acquires Olah, Streamlining Patient Data Management for Hospitals and Healthcare Facilities Nationwide

Release-of-information vendor Verisma acquires Olah Healthcare Technology, which offers enterprise archiving for legacy data.

Synapticure Raises $25 Million Series A to Expand Virtual Care for Patients and Caregivers Living with Neurodegenerative Diseases in all 50 States

Synapticure, a virtual provider of care for neurodegenerative disease patients, raises $25 million in Series A funding.

TigerConnect Acquires Twiage, Enhancing Real-Time EMS to Hospital Communication for Streamlined Emergency Care

Care collaboration and communication software company TigerConnect acquires Twiage, a New York City-based business that coordinates communication between EMS and hospital emergency departments.

Healthcare AI News 11/20/24

News

Microsoft enhances Microsoft 365 Copilot with task automation, new agents for Teams meetings and employee self-service, and a Copilot Control System for IT management.

Samsung rolls out One UI 6 Watch features to older models, which adds AI-powered tools such as health recommendations, sleep analysis, and sleep apnea detection.

Vanderbilt University Medical Center’s Department of Biomedical Informatics and InterSystems will work together on biomedical informatics and AI research. VUMC-DBMI will develop FHIR and interoperability training coursework that includes hands-on labs that will use InterSystems products.

BrightHeart earns FDA 510 (k) clearance for its AI-powered analysis of fetal heart ultrasounds.

Washington University School of Medicine and BJC Health System launch the Center for Health AI, which will focus on using AI to personalize patient care.

The National Institutes of Health develops an AI algorithm called TrialGPT that matches patients to clinical trials for which they are eligible.

Business

Stepful – whose AI platform delivers training to working adults for medical jobs such as medical assistant, pharmacy technician, and surgical technician – raises $32 million in a Series B funding round. The company expects to train 30,000 students this year in programs that can be completed in as little as four months for $2,500. It matches its students to one of its 8,000 partner clinics and hospitals for hands-on training.

Research

Cedars-Sinai investigators develop an AI-powered process to automate the classification of patients by the severity of their cancer, which could help get them into clinical trials faster.

Other

The New York Times runs an article titled “Elon Musk Asked People to Upload Their Health Data. X Users Obliged.” Experts warn that posting images to any AI tool is not protected by HIPAA, also noting that X’s terms of service allows the company to share data with related companies.

Meanwhile, Elon Musk responds to a small study in which doctors who used ChatGPT to diagnose test patients using only their case histories performed only slightly better than those who didn’t use it, but ChatGPT by itself outperformed the doctors. Experts say that nobody really knows how doctors think, especially when they use their personal experience or intuition to diagnose patients.

A user of Google’s Gemini AI chatbot posts screenshots a session where it went off the rail when asked a question about households.

Contacts

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

Morning Headlines 11/20/24

Review of the Department of Health and Human Services’ Compliance with the Federal Information Security Modernization Act of 2014 for Fiscal Year 2024

HHS OIG rates HHS’s information security program as “not effective” in its annual review, the same rating it gave HHS last year.

Citizen Health Announces $14.5 Million Seed Funding and Strategic Partnership to Transform the Health Experience for Patients with Rare and Complex Conditions

Citizen Health formally debuts with $14.5 million in seed funding to offer patients health data technology tailored to those suffering from rare diseases.

ThoroughCare Secures $5 Million in Series A Funding from Empactful Capital

Care coordination software vendor ThoroughCare raises $5 million in Series A funding.

Sanford Health Unveils Physical Hub for Virtual Care

Sanford Health (SD) opens its new Virtual Care Center to offer areas for provider education and training, innovation, and patient and family experience simulations.

SIS Expands Capabilities with Strategic Acquisition of Surgical Notes

Surgical Information Systems acquires Surgical Notes, which offers billing, coding, and transcription services to ambulatory surgery centers.

News 11/20/24

Top News

HHS OIG rates HHS’s information security program as “not effective” in its annual review, the same rating it gave HHS last year.

OIG made six recommendations to HHS:

1. Update its inventory of enterprise architecture and software / hardware.
2. Complete the implementation of a cybersecurity risk management strategy.
3. Require operating divisions to assess the security impacts of planned changes.
4. Implement a supply chain risk management program.
5. Establish oversight of background investigations of employees and contractors.
6. Use automation to review the logging and activity of privileged user accounts .

HIStalk Announcements and Requests

I applied several sources of matching, including dollar-for-dollar money provided by my Anonymous Vendor Executive, to the annual donation of reader Mark to fully fund these Donors Choose teacher grant requests. I was reading today that teachers, who aren’t necessarily richly compensated in the first place, spend an average of nearly $1,000 of their own money each year to buy supplies and resources for their students, so the funded projects below are kind of a big deal:

• STEM activities for Ms. N’s high school class in Hatch, NM.
• Dry erase boards and markers for Ms. A’s elementary school class in San Juan, TX.
• Overhead lighting filters for Ms. P’s high school computer lab in Las Vegas, NV.
• Reading and math manipulatives from Ms. S’s kindergarten class in Wailuku, HI.
• Hands-on STEM activities for Mr. F’s middle school class in Brooklyn, NY.
• Laboratory safety supplies for Ms. V’s middle school class in Casa Grande, AZ.
• Drone supplies for Mr. D’s middle school class in Enid, OK.
• Science binders and supplies for Ms. O’s middle school class in Wilson, NC.
• Books, snacks, and classroom supplies for first-year teacher Ms. B’s elementary school class in Rocky Mount, NC.
• Headphones with microphones for Ms. E’s elementary school class in Chicago, IL.
• A virtual documentary workshop from a PBS documentary filmmaker for Dr. H’s high school early college class in Bronx, NY.

Webinars

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

Acquisitions, Funding, Business, and Stock

Care coordination software vendor ThoroughCare raises $5 million in Series A funding.

Sales

• Lee Health (FL) will implement remote patient monitoring technology from Biofourmis as a part of its new Hospital at Home program.
• Tenet Healthcare will deploy Commure’s AI medical scribe software across its Tenet Physician Resources physician network.

People

John Supra, MS (UpStream) joins Cone Health (NC) as chief digital health and analytics officer.

Guidehouse names Mark Korth. MHA, MBA (Intermountain Healthcare) and Angela Hunt, RN, MBA (Vizient) partners in its health segment.

Virtual second opinion provider The Clinic by Cleveland Clinic appoints David Peter, MD, MBA – who was interim president, VP, and chief medical officer of Cleveland Clinic Indian River Hospital – to chief medical officer.

Fairfax Radiology Centers promotes Terry Johnson, MA, MBA to CIO.

Memorial Hermann Health System promotes Oliver Galicki, MHSA to VP of clinical applications.

Matt Ripkey (Redox) joins Blockit as VP of sales and marketing.

Episode Solutions promotes Kyle Cooksey to president and CEO.

Announcements and Implementations

Emory Healthcare (GA) will launch a population health collaborative across its primary care network using technology and value-based managed care services from Guidehealth.

Arcadia announces GA of Vista Push automated performance analytics and Enhanced Benchmarks, which incorporate recently acquired CareJourney’s market intelligence and analytics.

EHR vendor Canvas Medical announces Anova, an EHR for longevity medicine.

The Digital Medicine Society launches its International Regulatory Pathways project to help digital health technology developers understand country-specific regulatory insights to get products to market faster.

Smart ring maker Oura will integrate glucose biosensing data from Dexcom, which will invest $75 million in Oura’s Series D funding round. Oura says that 97% of its users are interested in the effect of food on their health.

In Scotland, Royal Aberdeen Children’s Hospital is piloting Kinetic-ID’s Bedside Intelligent Cabinet for patient self-administration of medications. The hospital will explore integration with its EHR to keep prescriptions current.

Other

Sanford Health (SD) opens its new Virtual Care Center, which offers areas for provider education and training, innovation, and patient and family experience. Accelerator rooms are also available for digital health startups that want to partner with Sanford on scaling their products.

Sponsor Updates

• AdvancedMD employees volunteer at the St. Vincent Dining Hall, Utah Food Bank, and the Green Urban Lunchbox organization during the company’s Day of Caring.
• Royal Adelaide Hospital in Australia implements Altera Digital Health’s IQemo electronic chemotherapy prescribing solution.
• Augmedix offers a new case study, “Augmedix in Primary Care: Enhancing Efficiency and Patient Engagement.”
• The WellSky Foundation donates $200,000 from its Week of Giving teammate project that will be used to furnish 75 new bedrooms that are operated by Kansas City-based non-profit Amethyst Place, which provides support services to single mothers and their children. 
• Capital Rx releases a new episode of “The Astonishing Healthcare Podcast” titled “Searching for Answers – Understanding Transparency, Alignment, and Incentives in Healthcare with Andrew Gordon.”
• AMIA honors Clinical Architecture CEO Charlie Harp with its Leadership Award.
• CloudWave will sponsor the annual Rural Health Association of Tennessee Conference November 20-22 in Knoxville.
• Wolters Kluwer Health releases the results of its third “Pharmacy Next: Health Consumer Medication Trends” survey.
• Surescripts expands its Sig IQ technology, first introduced for Medication History in 2022, to e-prescribing transactions, including NewRx and RxRenewal Requests and Responses.

Blog Posts

• Leveraging RCM and Coding to Address the Health Equity Gap (AGS Health)
• Three keys to unlock operational efficiency in the revenue cycle (Altera Digital Health)
• The Impact of KLAS: Improving Healthcare through Transparency (Availity)

Contacts

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

Morning Headlines 11/19/24

BrightHeart Secures FDA Clearance for First AI Software Revolutionizing Prenatal Fetal Heart Ultrasound Evaluations

Ahead of its launch in the US, Paris-based BrightHeart receives FDA clearance for its AI-powered fetal heart ultrasound assessment software.

Trust reverses £65m EPR procurement decision after court claim

Mersey and West Lancashire Teaching Hospitals NHS Trust decides not to implement an EHR developed by Altera Digital Health and Insight Direct due to ongoing legal wrangling it would likely face from disgruntled software competitor System C.

Guidehealth and Emory Healthcare Announce Population Health Collaborative to Expand Primary Care Access Across Georgia

Emory Healthcare (GA) will launch new a population health program across its primary care network using technology and value-based managed care services from Guidehealth.

Curbside Consult with Dr. Jayne 11/18/24

The practices in which I’ve spent the majority of my clinical time over the past few years don’t use AI-assisted or ambient transcription technologies. One uses human scribes, while the other leaves physicians to their own devices for finding ways to become more efficient with their documentation.

In the urgent care setting, my scribes have always been cross trained. They started out as patient care technicians or medical assistants, and if they had excellent performance and a desire to learn, they could request to enter the in-house scribe training program. During that multi-month period, they received additional training in medical terminology, clinical documentation, regulations and requirements, and understanding the physician thought process for history-taking, creating a differential diagnosis, and ultimately creating and documenting a care plan.

Many of our human scribes had the goal of attending medical school or PA school, so they had a strong drive to learn as much as possible while doing their job. As they learned our habits for seeing patients and describing our findings, they would sometimes prompt us for something that we might have forgotten to mention or might not have performed during the exam. Because of the level of cross training, they could also assist us with minor procedures during the visit rather than just standing there and waiting for us to describe some findings.

Towards the end of the visit, when the physician typically summarizes the findings for the patient and describes the plan of care, the scribes would review and clean up the notes so that they were ready for our signature as soon as the patient disposition was complete. I would often be able to sign my notes in real time, and even if I had to wait until the end of the day, it might take me less than a minute to review each note because of the diligence they used capturing the visit.

Human scribes are also helpful when conducting sensitive visits, which often happen in the urgent care environment as we discuss a patient’s sexual history or perform sensitive portions of the physical exam. In those situations, our scribes served as both chaperones and assistants, providing support to patients when needed and assisting with specimen collection – uncapping and capping jars and tubes, ensuring accurate labeling, etc. I’ve had scribes help patients take their shoes and socks off and assist them in getting on the exam table and returning to a chair. When contrasting a visit that uses a human scribe to one where the physician has to perform their own documentation, there’s a substantial difference in the time that it takes to complete the visit, and not just from a documentation standpoint.

In speaking with my colleagues who have transitioned from human scribes to either virtual scribes or AI-assisted technologies in similar practice environments, they note that they miss the physical assistance of the scribe. No one is in the room with them who can step out and grab supplies or equipment when a situation occurs where it would be more efficient to do that instead of the physician stepping out to get what they need. There are also flow issues when chaperones are needed or when assistance is needed during a procedure, which can make the day bumpier.

Some colleagues with whom I recently discussed this mentioned that their organizations didn’t consider these workflow changes when moving to non-human documentation assistance strategies. One said that he felt that everyone thought it would be so much cheaper to not pay a person that they forgot to calculate in the time physicians would now be spending doing things that they didn’t have to do in the past.

It’s a classic parallel to what we experienced back in the early days of EHR implementation, when there were constant encounters with unintended consequences. One example: in a paper-based workflow where no one reconciled medications, implementing an EHR that requires medication reconciliation is going to increase visit duration, whether it’s done by an assistant or the physician. They should have been doing medication reconciliation in the first place because it’s a patient safety issue, but the EHR took the blame as forcing them to do something they didn’t think was important. Now we have different unintended consequences when we layer on more sophisticated technologies such as AI-assisted documentation.

One colleague described the problem of excessive summarization, where his organization’s AI documentation solution took a lengthy physician / patient discussion that included detailed risks and benefits of treatment or lack thereof and condensed it down into two sentences. When that happens, one has to consider the downstream ramifications. Will a physician even see that it’s been condensed in that way, or are they just signing notes without reviewing them to keep their inbox clear? That situation happens more than many would think. If a physician catches the issue, will they spend the time editing the note or will they just move on because they’re pressed for time? And if they do take the time to edit the visit note, will they capture all the nuances of the discussion exactly as it had occurred with that particular patient?

Another colleague, who is also a clinical informaticist, mentioned that having AI documentation solutions doesn’t fix underlying physician behavior challenges. The physician who never finished his notes at the end of the day and instead left them for Saturday mornings still leaves them for Saturday mornings, which means that he’s reviewing documentation that’s up to five days old and for visits that are no longer fresh in his mind. It’s creating issues with the technology platform, since recordings have to be kept until the notes are signed, and it’s skewing metrics for chart closure that were important to measure the success of the project. 

The team that implemented the solution could have anticipated this had they looked at baseline chart closure rates, but they were in such a hurry to get the solution rolled out that now they’re having to go back and examine that data retrospectively. They also missed the opportunity to coach those physicians during the implementation phase about the patient safety value of closing notes in a timely manner.

Others have noted issues with using AI solutions to examine documentation after the fact, such as only using data from structured fields. This is great when you have a specialty that does a lot of structured documentation, but doesn’t work well in one where the subtleties of the patient’s story are largely captured via free text.

I recently attended a lecture where they discussed the hazards of using AI tools in the pediatric population, since so much of the language used in capturing a child’s status varies based on the age of the patient. For example, saying a patient is “increasingly fussy” has a meaning that goes beyond the words themselves and has a different impact when treating an infant versus an older child or a teenager.

The pediatricians also mentioned the difficulty in obtaining consent for use of AI tools during visits, especially when only one parent is present or when the child might be brought to the office by a caregiver such as a nanny or sitter. Although those individuals may have capacity to consent to treatment, they may not have specific ability to consent to the use of AI tools. There is also the issue of the child’s consent to being recorded. Although the laws generally allow parents to consent on behalf of their children, obtaining the permission of an adolescent patient is an ethical issue as well, and one which physicians may not have the time to address appropriately due to packed schedules.

The dialogue around use of AI solutions has certainly changed over the last year, and we’ve gone beyond talking about how cool it is to addressing the questions it has raised with expanding use. It’s great to see people asking thoughtful questions and even better to see vendors incorporating ethical discussions into their implementation processes. We’ll have to see what this landscape looks like in another year or two. I suspect that we will have found many other areas that need to be addressed.

How is your organization balancing the addition of AI solutions with the need for human assistants and the need to respect patient decisions? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: Healthcare’s Hidden Cost Crisis: How Middlemen and Outdated Tech are Bankrupting America

Healthcare’s Hidden Cost Crisis: How Middlemen and Outdated Tech are Bankrupting America
By Navin Nagiah

Navin Nagiah, MS is co-founder and CEO of Daffodil Health.

Recent articles, including those in The New York Times, have shone a spotlight on how middlemen contribute to rising healthcare costs, notably out-of-network (OON) pricing companies like MultiPlan and pharmacy benefit managers (PBMs), whose fees often obscure and inflate costs. While these analyses are thorough, they often focus on single facets of a sprawling, deeply rooted problem.

The truth is more intricate and defies simplistic solutions. High costs in US healthcare have accrued over decades, shaped by actions across the board, from government policy to insurer practices, provider pricing, and patient behavior.

The presence of intermediaries such as PBMs, OON re-pricing firms, and healthcare consultants reflects the US healthcare model’s structural complexity. As a hybrid of public, private, and even cash-based systems, it has produced a $4.1 trillion industry — 22% of the total economy — where $1 trillion alone goes toward administrative costs, with an estimated $500 billion of that deemed unnecessary or wasted.

For ordinary Americans, this complexity translates into hardship. Forty-one percent are burdened with medical debt; 46% forgo needed care due to cost; and 58% of debt collection involves medical bills. This financial strain is unsustainable for individuals, society, and the nation at large.

An underlying issue is healthcare pricing, which is inelastic, opaque, and tethered to outdated systems. Unlike typical markets, healthcare prices in the US do not respond to supply and demand. The pricing framework is labyrinthine, requiring deep domain expertise to navigate tens of thousands of procedural codes and varied pricing methods. Additionally, administrative systems used by both payers and providers often rely on outdated technology, exacerbating inefficiencies.

However, this does not make the primary actors — whether insurers, providers, or third-party entities — the villains of the story. In a capitalist framework, each stakeholder is incentivized to prioritize revenue and profits. Healthcare is no exception. It’s probable that any rational actor in similar roles would make comparable decisions.

The question we must address is: How do we move forward? What changes are necessary to begin mending this broken system?

The solution demands both regulatory and technological reform. First, let us take a closer look at regulation, where bipartisan consensus on the need for reform offers rare common ground. The No Surprises Act, for instance, was enacted under one administration and implemented by another, underscoring shared political will to mitigate healthcare’s impact on everyday Americans. Yet if we are to achieve genuine change, regulatory bodies need to adopt a more thoughtful and strategic approach.

Understand the market dynamics of payers and providers

Insurers and providers operate with the goals of revenue and profit growth, which regulators and regulations often fail to consider. Laws that don’t account for potential loopholes simply shift costs rather than reduce them, creating the illusion of progress. It is imperative to keep in mind that rising healthcare costs implies higher revenue for providers; a higher revenue for providers means higher premiums, i.e. revenue for payers.

The stock market rewards revenue growth way more than improved margins. This provides extensive incentive to payers and providers to be innovative in how they “shift costs” when regulations are passed.

Regulation must be crafted with an understanding of its potential impact on healthcare costs for ordinary people, avoiding the squeezed balloon effect, where costs shift without any overall cost reduction.

Recognize healthcare’s local monopolies

While other sectors, like technology, are subject to national antitrust scrutiny, healthcare operates across many local micro-markets with localized monopolies. Regulation should reflect this structure, addressing these micro-monopolies with tailored policies that account for regional market dynamics.

Stop adding to the middlemen problem

Regulations must be enacted with caution to avoid inadvertently inflating the healthcare sector’s administrative footprint. The Transparency in Coverage Act, for example, while intended to increase transparency, has spawned a cottage industry of compliance tools companies and consultants — more middlemen — with minimal impact on consumer costs. Future regulations should include clear expectations and mechanisms for affordable, effective compliance without adding new categories of middlemen to the already bloated system. Additionally, regulatory enforcement should be robust, ensuring that non-adherence results in significant penalties that deter cost-shifting practices.

Without these considerations, regulatory measures may perpetuate the inefficiencies they aim to resolve. Now more than ever, Americans need a healthcare system that prioritizes access, transparency, and genuine affordability. Legislative reform, combined with strategic enforcement, could be the first step toward this elusive goal.

Second, let us take a closer look at technology. Once a system, any system, reaches a certain level of complexity, simplifying it again becomes a near-impossible task. However, technology offers a pathway to managing complexity in ways that improve usability and efficiency. Consider the internet. It’s an enormous, convoluted system, yet search engines allow us to find information quickly and (usually) accurately.

In healthcare, however, technology has so far largely added to both complexity and the cost burden rather than easing it. Generative AI could mark a turning point. This technology is unique in its ability to emulate human skills like storytelling, a talent that was once thought exclusive to humans, which helps achieve shared understanding and collaboration. The potential is enormous. AI systems can now analyze, interpret, and convey information much like a human, which could impact healthcare administration, a sector valued at $1 trillion, half of which is estimated to be wasteful expenditure.

Take the process of claim re-pricing and payment as an example. After a doctor generates a bill for reimbursement, that claim may pass through as many as 10 companies and 12 software systems, each with its own requirements and procedures, before the doctor is paid. This labyrinthine process stems from decades of regulations, changing market dynamics, and piecemeal ad hoc solutions. Yet by deploying Generative AI and semi-autonomous agents, we could digitize and automate this entire process from end to end, significantly cutting down on time, costs, and redundancies.

Similar opportunities exist across other healthcare administration processes, whether in prior authorizations, member enrollment, or patient management. I am not suggesting that technology or Gen AI is a silver bullet. This is a long-term undertaking, demanding deep expertise in both healthcare and technology, a rigorous attention to detail, and considerable patience. Still, nothing in the nature of the problem makes it unsolvable.

Companies routinely embark on “moonshot” projects that demand decades to bear fruit, like Facebook’s Metaverse, Elon Musk’s SpaceX and Neuralink, and Google’s Waymo, Wing, and Loon. These projects capture public imagination and dominate media cycles, but moonshots in healthcare administration, though less glamorous, offer far greater potential for transforming lives.

We need to encourage visionary entrepreneurs to pursue these difficult challenges within healthcare. Initiatives that, though unglamorous, offer substantial benefits to consumers and society at large. Government support is also crucial. Legislation that promotes competition within local healthcare markets and policies that encourage innovative solutions for complex healthcare issues would drive meaningful progress.

Readers Write: Tackling Diabetes Distress in Dual Eligibles Requires Integrated Care Management

Tackling Diabetes Distress in Dual Eligibles Requires Integrated Care Management
By Barbara Greising

Barbara Greising, MBA is chief commercial officer at Podimetrics.

Diabetes is a demanding condition. Slipping up even a little can quickly lead to devastating outcomes, and there’s never, ever a day off. 

The constant stress can lead to feelings of discouragement, isolation, frustration, and exhaustion, especially when the consequences of suboptimal self-management can be so severe. For example, every 3.5 minutes, someone in the US loses a limb due to complications of type 2 diabetes (T2D), and up to 50%of those individuals may face death as a result within just two years.

For people living with diabetes and behavioral health challenges, such as a large number of the socioeconomically complex dual-eligible Medicare/Medicaid (DE) population, the outcomes could potentially be even more catastrophic, with mortality risks up tofour times higherthan people with either condition alone.

Up to 45% of mental health conditions and cases of severe psychological distress go undetected among people being treated for diabetes. And with nearly a third of DEs experiencing a serious mental health disorder of some kind, including major depression, that’s a potentially huge number of high-needs people who are not getting appropriate care.

Without proactive, personalized mental health support for these individuals, “diabetes distress” can take root, leaving up to half of people with diabetes feeling overwhelmed, defeated, disengaged, and less equipped to manage their everyday needs at some point in their health journey.

It is crucial to understand the root causes of diabetes distress, particularly in high-risk, highly complex DE populations, and develop proactive, personalized strategies rooted in integrated case management techniques that merge effective mental healthcare resources and socioeconomic support with more traditional approaches.

The first step for assisting people with diabetes is knowing if they need help. Standardized questionnaires like thePHQ-9 can be helpful, but these tools are not usually designed to uncover diabetes-specific concerns, nor are they always used at the most effective points in the diabetes management process.

Providers and health plans may consider augmenting data collection efforts with more targeted measurement tools for diabetes distress, such as the American Diabetes Association’s Problem Areas in Diabetes (PAID) Scale. This check sheet asks detailed questions, such as if the person feels scared, angry, or discouraged when thinking about living with diabetes, what their support system looks like, and how much energy diabetes care takes from them each day.

Providers should also look at patient barriers from every angle to reveal hidden challenges. For example, when one patient stopped engaging in daily self-monitoring for diabetic foot ulcers, it wasn’t because she didn’t understand the importance. It was because she couldn’t get to her doctor’s office to get a refill of her blood pressure medication. The frustrating situation and negative health effects from being off her meds meant she wasn’t feeling able to take care of herself fully.

When the patient received help to get connected with plan-based home care benefits to see a primary care provider for a refill, she reengaged with her foot care immediately, and at the same time, avoided an ED visit for potential hypertension complications.

Regularly fielding holistic questions about self-care competencies in the routine primary care environment is important, but plans and providers should also consider refreshing their data at other key points, such as during specialty visits for associated complications and before discharge from a hospital due to a diabetes-related event. This can ensure that individuals get the help they need when they need it, before diabetes distress becomes overwhelming.

Case managers can assist with this process by spearheading the development of compassionate, informed patient-provider and/or member-health plan relationships. These care team “quarterbacks” can help connect individuals with social workers, psychologists, psychiatrists, substance abuse counselors, and other behavioral health professionals to augment clinical care. 

Case managers, especially those with nursing backgrounds, often have the training, intuition, and experience to identify people who may be struggling with a variety of non-clinical concerns and can successfully pair these insights with their clinical knowledge of diabetes management to support and guide people with diabetes to better glycemic control and improved overall mental health and well-being.

To be effective, however, case managers must be equipped with the tools and resources to perform this work appropriately. For example, health plans and provider networks will need to ensure that high-quality mental health resources, such as patient support programs, social workers, and counseling options, are consistently available for referral in a timely and affordable manner. 

Case managers also need digital infrastructure to make referrals to socioeconomic support organizations, monitor the use of personal medical devices like continuous glucose monitors, and interact with individuals according to their preferred communication channels.

Diabetes distress is not a condition that can be wholly cured by a single pill or one-and-done injection. Instead, it requires ongoing attention and flexible degrees of management to establish and maintain emotional and mental equilibrium in the face of prolonged stress.

That means Medicare and Medicaid health plans, providers, case managers, patients, and unpaid caregivers must collaborate closely at all times to build a scaffolding of support around every individual.

Care team leaders should ensure that people with diabetes understand how, when, and why to use their medications and personal devices, especially when adding new technologies to the mix. Regular follow-ups around socioeconomic concerns and mental health status will be essential to success, including periodic refreshes of questionnaires and other patient-provided data. Health plans, health networks, and other industry stakeholders will need to remain dedicated to expanding access to mental and behavioral healthcare resources, especially in communities with a higher prevalence of diabetes.

By collecting the right information and getting people connected to the most appropriate resources for their needs, case managers can reduce the impact of diabetes distress on dual-eligible individuals and create the conditions for success for the tens of millions of people living with diabetes.