Recent Articles:

News 7/14/23

July 13, 2023 News Comments Off on News 7/14/23

Top News

image

The Defense Health Agency announces that stateside roll out of MHS Genesis has been completed on time and on budget. The Oracle Health-powered EHR will be implemented at DOD facilities overseas in the coming months.

The DOD and VA will oversee synchronous deployment of MHS Genesis at the James A. Lovell Federal Health Care Center (IL) in March 2024.


Webinars

July 26 (Wednesday) 1 ET. “Lessons We’ve Learned Since Launching our Cancer Prevention Program.” Sponsor: Volpara Health. Presenter: Albert Bonnema, MD, MPH chief medical information officer, Kettering Health System, and Chris Yuppa, product owner for oncology services and cancer prevention, Kettering Health System. Kettering’s IT department has played a critical role in providing an EHR-driven framework to bring cancer risk assessment and individual prevention plans to more than 90,000 patients. Primary care, OB/GYN, oncology, and imaging providers are now able to assess the hereditary, genetic, and lifestyle factors that affect the risk of developing lung, breast, ovarian, colon, and prostate cancer in any patient encounter. Learn how Kettering brings together people, processes, and technology to be more proactive in the fight against cancer and where its cancer prevention program is headed next.

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

July 27 (Thursday) 2 ET. “Denial Prevention 101: How to stop denials from the start.” Sponsor: Waystar. Presenter: Crystal Ewing, director of product management, Waystar. There’s a reason denial prevention is prominent everywhere in healthcare RCM. Denials reduce cash flow, drive down revenue, and negatively impact the patient and staff experience. More than half of front-end denials don’t have to happen, but, once they do, that money is gone. It’s a pretty compelling reason to take some time now to do some preventative care on your revenue cycle. This webinar will help you optimize your front end to stop denials at the start. We’ll explore the importance of not only having the right data, but having it right where staff need it, when they need it.

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


Acquisitions, Funding, Business, and Stock

image

Wavely Diagnostics raises $1.35 million in seed funding. The company has developed a telemedicine app and companion medical device that can help pediatricians virtually diagnose ear infections.

Parker Health, developer of FHIR-based health management software that aggregates patient data from a variety of sources, raises $25 million.


Sales

  • Novant Health will offer NeuroFlow’s digital mental health resources and support to patients suffering from depression, and to its team members as a resource for self-care and burnout prevention.

Announcements and Implementations

image

North Country Hospital (VT) establishes a NICU telemedicine program that gives its pediatricians access to real-time video consults with neonatologists at University of Vermont Medical Center.

Censinet announces GA of its new HIPAA Security Rule enterprise risk assessment and remediation module.

Get Well announces eight new smart patient room implementations in conjunction with new hospital tower construction projects.


Government and Politics

VA officials say they are opposed to proposed legislation that would impose strict requirements on the department’s EHR Modernization program, but express support for legislation that would increase oversight of future acquisitions projects.


Other

UMass Chan Medical School will use a $17 million federal grant to launch the Center for Accelerating Practices to End Suicide through Technology Translation. The school will work with partnering organizations to establish best practices for implementing new and existing suicide-prevention technologies. CAPES will also focus on patient-centered care, business development, and ethics.

image

Nearly 60% of surveyed IT decision-makers are looking to adopt or replace patient engagement technologies, according to the latest research from Black Book. Survey-takers gave InteliChart top marks for its patient engagement and consumer outreach capabilities.

image

Epic is working to develop a sixth campus in its hometown of Verona, WI. Still in the preliminary design phase, the expansion will be preceded by a recently approved underground parking structure that will open in 2025. The company is already planning to add two new buildings to its Wizards Academy campus to accommodate an additional 1,700 employees. Those facilities are expected to open next year.

image

The State Medical Board of Ohio permanently revokes the license of former plastic surgeon Katharine Roxanne Grawe, also known as Dr. Roxy on TikTok, for neglecting patients as she livestreamed surgical procedures, spoke directly into the camera, and responded to live viewer questions.


Sponsor Updates

  • Divurgent releases a new podcast, “Mastering Epic’s Hyperdrive Migration.”
  • Primary Care Joliet (IL) enhances its patient experience with EClinicalWorks EHR and Healow patient engagement solutions.
  • Ellkay will sponsor CHIME’s CIO Boot Camp July 26-29 in Salt Lake City.
  • Fortified Health Security names Carrie Card accounts payable accountant.
  • Healthcare Triangle publishes a new whitepaper, “The Future of Healthcare Infrastructure: An In-Depth Look at the Infrastructure as a Code (IaaC) Landscape.”
  • Rhapsody publishes a new case study, “BioMerieux reduces deployment time by 66% with Corepoint Integration Engine.”

Blog Posts


Contacts

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

Comments Off on News 7/14/23

EPtalk by Dr. Jayne 7/13/23

July 13, 2023 Dr. Jayne Comments Off on EPtalk by Dr. Jayne 7/13/23

I’ve been surprised by how much conversation I’ve heard about this Epic study in the virtual physician lounge. One of the key purposes of the study was to look at trends in documentation over the time period since CMS made updates to the way physicians can code their office visits. I’ve been surprised to learn how few physicians understand that changes happened – and those that understood that something changed are often unable to articulate how those changes have impacted their documentation. The majority of physicians discussing it share the “nobody told me” narrative, which I struggle to believe is as common as people say.

The largest physician specialty organizations ran article after article about these changes when they happened, as did national multispecialty organizations like the American Medical Association. The health system where I was working at the time had a major educational campaign around this, in part because they hypothesized that physicians would be able to bill higher codes under the new paradigm. There was a lot of chatter about it, but of course this conversation was during the height of the COVID pandemic and I’m sure a lot of us failed to fully understand a lot of things that came across our desks and inboxes during that time frame. For those of you who haven’t seen the study, here’s the highlight reel: Although the time to create clinical notes has decreased, the average length of those notes continues to increase.

While it’s great that notes have taken less time to document, the persistence of longer notes continues to contribute to the problem. It still takes time for recipients to read those lengthier notes, and the impact is compounded the larger the size of the care team. Another interesting factor called out in the study’s key findings is the fact that, “while overall average note length increased, around 40% of providers reduced their average note length.” That means that 60% of providers had the same notes, with some of them having longer, so that the math for the average works out. In my clinical work, I still see plenty of bloated communications from other providers and wish they had the personal drive or institutional support to streamline their documentation.

A reader alerted me to this article that falls squarely in the column of “physicians behaving badly.” A North Carolina otolaryngologist was sentenced to 25 years in prison for committing Medicare fraud by reusing single-use surgical devices. Although she performed more than 1,400 sinus surgeries over a seven-year period, she was only able to provide records of having purchased 36 of those devices. She billed Medicare more than $46 million for the procedures, which most certainly would have raised red flags. Patients impacted by the fraud will have 90 days to present claims for damages. This kind of behavior is horrific and egregious and contributes to the rising distrust of patients felt by many physicians these days. I hope she spends the next couple of decades reflecting on the situation.

Last week, I commemorated the passing of July 1, which is the traditional day in the US that medical students start their internships and other medical trainees advance in their residency programs. I asked for people to share their best or worst memories of internship, and our readers did not disappoint. Dr. Nick van Terheyden shared a blog about his first days as a junior doctor. I was surprised to learn that there was little difference between his experiences in the UK during the 1980s and my experiences in the US in the 1990s. He also reminisced about some notes he came across when a hospital in London was being relocated. The notes were written during The Blitz and as much as we found practicing medicine stressful during the COVID pandemic, I can’t imagine trying to practice in the middle of an air raid.

One of my favorite correspondents shared the story of a July 4 night on call at a big city hospital. They were working in the emergency department but weren’t seeing a lot of patient volume, so their attending physician invited them to take a break to watch fireworks. The savvy attending had brought lawn chairs and led them up the secret stairs to the roof, where they had a great view of the city’s fireworks show.

Still, nothing beats the story of “interoperability” as it occurred in a hospital where the interns figured out how to liberate patient charts from the dialysis clinic when patients needed to be admitted to the hospital. Apparently the clinic had a divided “Dutch door” entrance and an enterprising intern figured out how to get the top half open without a key so they could consult the patient charts, write their notes, and return them before morning. It’s a good reminder of what life was like before electronic health records. I never had to climb into an office to grab a chart but I did spend a lot of hours in the medical records area digging through month-old, half-documented charts to try to make sense of them while I was in the process of readmitting recently discharged patients.

I’m a big fan of celebrating milestones, and today marks the 1,300th post I’ve written for HIStalk. It’s been a bit of a long, strange, trip. I started writing during the incentive-hungry boom created by the Meaningful Use program. Since then, the world of healthcare information technology has been through numerous ups and downs, including periods of wild growth and unbelievable scarcity. Still, I’m impressed every day by the physicians that continue to put their scrubs on one leg at a time and care for patients despite the frustration and hardships found in the practice of medicine today. I’m continually grateful for the IT professionals that support them and make sure the servers are humming, the desktops are cooperative, and that they have the access they need to take care of people. And to all the others who support patient care – be it housekeeping, nutrition, engineering, or the dozens of other departments – we salute you.

How do you like to celebrate milestones? Leave a comment or email me.

Email Dr. Jayne.

Comments Off on EPtalk by Dr. Jayne 7/13/23

Morning Headlines 7/13/23

July 12, 2023 Headlines Comments Off on Morning Headlines 7/13/23

Fold Health streamlines admin work for primary care providers

Primary care-focused administrative software developer Fold Health raises $6 million.

Parker Health Secures $25 Million in Series A Funding to Transform American Healthcare

Parker Health, developer of FHIR-based health management software that aggregates patient data from a variety of sources, raises $25 million.

Gradia Health Secures $4.2M in Seed Funding to Improve Ongoing Care for Patients With Chronic Conditions

Virtual concierge care startup Gradia Health announces $4.2 million in seed funding.

Comments Off on Morning Headlines 7/13/23

Healthcare AI News 7/12/23

July 12, 2023 Healthcare AI News Comments Off on Healthcare AI News 7/12/23

News

Lovelace Health System in New Mexico implements CareHarmony’s AI-powered care coordination software to help patients with two or more chronic conditions better manage their treatment, including medications.

image

Lehigh Valley Health Network (PA) will integrate Aidoc’s enterprise AI implementation and integration platform and imaging AI algorithms with its radiology department workflows. LVHN will also leverage Rad AI’s Omni and Continuity solutions, which, respectively, will automatically generate study impressions from a radiologist’s dictation and automatically send follow-up recommendations to patients and providers when incidental findings are reported.

image

Productive Edge announces GA of Generative AI-enhanced solutions for prior authorization, patient engagement and marketing, and health plan member engagement.

image

Mayo Clinic pilots Google’s Med-PaLM 2 AI tool in several hospitals. Built on the language model powering Google’s Bard chatbot, the tool is designed to answer questions about healthcare information.


Research

image

Researchers at the University of Pittsburgh and University of Pittsburgh Medical Center develop an easy-to-use, high-risk patient identification model using an algorithm that learns from the digital medical records of 1.25 million surgical patients. Deployed at 20 UPMC hospitals, researchers have found that the model does a better job of identifying high-risk patients than the standard – and manual – American College of Surgeon’s National Surgical Quality Improvement Program.

Children’s National Hospital and Virginia Tech will use new seed funding to expand the work of a collaboration that has sprung up between the hospital’s Research & Innovation team and the university’s Sanghani Center for Artificial Intelligence and Data Analytics. Research will focus on how AI can help to treat specific diseases, enhance smart surgery for pediatric health, and improve hospital management.

A majority of clinicians believe AI isn’t ready for medical use, according to a GE HealthCare survey of 7,500 clinicians in eight countries. Less than half of respondents – 26% in the US – are ready to trust AI.


Contacts

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

Comments Off on Healthcare AI News 7/12/23

Readers Write: Leveraging a Digital Ecosystem to Simplify Specialty Medication Onboarding

July 12, 2023 Readers Write Comments Off on Readers Write: Leveraging a Digital Ecosystem to Simplify Specialty Medication Onboarding

Leveraging a Digital Ecosystem to Simplify Specialty Medication Onboarding
By Julia Regan

Julia Regan, MBA is founder and CEO of RxLightning of New Albany, IN.

image

Specialty medication onboarding has historically been a manual and frustrating process, riddled with complexities, administrative hurdles, and delays. However, the convergence of technology, interoperability, and a robust ecosystem of partners can revolutionize this experience, offering a glimmer of hope and path to a smoother, more efficient onboarding journey for patients.

The Complexities of Specialty Medication Onboarding

Getting a patient started on a specialty medication goes well beyond the enrollment forms. In most cases, onboarding a patient requires enrollment paperwork, benefit verification, prior authorization, financial assistance, and ongoing communication between multiple parties. The trouble is that each of these steps has typically occurred in a standalone manner, without any connection to the other steps in the process. This creates an opaque and disjointed journey for patients and providers, slowing time-to-therapy and causing avoidable administrative burden.

In addition to the process being fragmented and unclear, some parts of the journey are still completed using paper, phone, and fax – hindering transparency from the start! Whether completing the initial enrollment, approving a PA, or submitting Patient Financial Assistance forms, we are living in a world in which the system we’ve created impedes patient outcomes – instead of improving them. We must do better.

The Power of Technology and Collaborative Ecosystems

Thankfully, the advent of interoperable technology and collaborative ecosystems are beginning to bring about significant improvements to the specialty medication onboarding experience.

The first step in creating a better onboarding journey is eliminating the need for paper-based forms and communication. By leveraging fully digital portals for documentation submission and collection, we can provide immediate feedback to users about missing information, statuses, and next steps. And once digital becomes the norm, providing transparency to key stakeholders is no longer an impossibility.

The next – and arguably most important – step is developing an open ecosystem, where each participant plays a vital role in the medication onboarding journey. Each interconnected partner must be aligned in achieving a shared vision, and each plays a critical role in the final delivery and adherence of the medication. Providers and pharmacies can review and confirm coverage information, care teams can find and submit financial assistance applications, and patients can be more effectively supported by manufacturer and hub support teams.

Stakeholders should not need to log into multiple systems to manage one patient journey; instead, they should have access to one platform with all the data and integrations they need. With a truly connected ecosystem, each stakeholder can make informed decisions based on accurate and up-to-date information, ensuring the timely initiation of therapy without unnecessary hurdles.

What’s Next for Specialty Medication?

While today’s specialty medication landscape is already complex, tomorrow’s is set to become even more convoluted. At the 2023 Academy of Managed Care Pharmacy meeting, IPD Analytics shared that nearly 80% of the drugs the FDA is expected to approve in 2023 are specialty drugs, up from 68% in 2020.

How the industry navigates this wave of specialty drug approvals could significantly influence patient care. From my perspective, a transparent, interoperable system could address many of the previously mentioned challenges by streamlining communication and providing real-time access to critical information that can be used to support patient engagement, affordability, and adherence.

As specialty pharmacy continues to expand and evolve, the need for a unified, comprehensive medication onboarding ecosystem becomes increasingly important. By harnessing the power of technology, interoperability, and a collaborative ecosystem, we have the opportunity to revolutionize this space. Together, we can build a world in which every stakeholder, from the provider to the patient, is empowered to navigate the intricacies of the specialty onboarding experience.

Comments Off on Readers Write: Leveraging a Digital Ecosystem to Simplify Specialty Medication Onboarding

Morning Headlines 7/12/23

July 11, 2023 Headlines Comments Off on Morning Headlines 7/12/23

Hello Pediatrics Completes Series B Funding Round Supporting Product Development Including Behavioral Health Services

After-hours pediatric telemedicine company Hello Pediatrics raises $3 million in a Series B funding round.

Data Usability Takes Root Nationwide Through a Joint Project Between The Sequoia Project and AHIMA

The Sequoia Project and AHIMA launch the Data Usability Taking Root initiative, which will bring together stakeholders committed to implementing data usability guidance developed by The Sequoia Project’s Interoperability Matters Data Usability Workgroup.

Indian health agency must improve review of patient harm data, watchdog says

A Government Accountability Office report finds that the Indian Health Service needs to review patient safety event data by location in order to improve its oversight of adverse events.

Comments Off on Morning Headlines 7/12/23

News 7/12/23

July 11, 2023 News Comments Off on News 7/12/23

Top News

image

HCA Healthcare announces that hackers have stolen patient data from an external storage site used to automate email message formatting and posted it for sale on an online forum.

According to DataBreaches.net, the dataset includes 27.7 million rows, personal patient details, and information related to appointment reminders. The hackers made contact with HCA around July 4, and gave the company until July 10 to meet their unspecified demands.

Based in Nashville, HCA Healthcare manages the operations of 180 hospitals and 2,300 outpatient facilities in the US and UK.


HIStalk Announcements and Requests

image

The pessimists slightly outweigh the optimists when it comes to health IT business conditions over the next year. IT/OPs_ProjectManager’s experience with recent IT staffing budgets certainly gives credence to the former: “The institution I work with has reduced budget for contracted IT staff and is purposefully throttling the IT project pipeline due to resource ($$ and people) constraints coming out of the pandemic. Knowing this plan makes me think the ‘non-core’ IT projects will be under much more scrutiny.”

New poll to your right or here: Has your organization recently pressed pause on or significantly scaled back IT projects? Feel free to share observations as to why project priorities are changing, and what types of projects are still getting the green light.


Webinars

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

July 26 (Wednesday) 1 ET. “Lessons We’ve Learned Since Launching our Cancer Prevention Program.” Sponsor: Volpara Health. Presenter: Albert Bonnema, MD, MPH chief medical information officer, Kettering Health System, and Chris Yuppa, product owner for oncology services and cancer prevention, Kettering Health System. Kettering’s IT department has played a critical role in providing an EHR-driven framework to bring cancer risk assessment and individual prevention plans to more than 90,000 patients. Primary care, OB/GYN, oncology, and imaging providers are now able to assess the hereditary, genetic, and lifestyle factors that affect the risk of developing lung, breast, ovarian, colon, and prostate cancer in any patient encounter. Learn how Kettering brings together people, processes, and technology to be more proactive in the fight against cancer and where its cancer prevention program is headed next.

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

July 27 (Thursday) 2 ET. “Denial Prevention 101: How to stop denials from the start.” Sponsor: Waystar. Presenter: Crystal Ewing, director of product management, Waystar. There’s a reason denial prevention is prominent everywhere in healthcare RCM. Denials reduce cash flow, drive down revenue, and negatively impact the patient and staff experience. More than half of front-end denials don’t have to happen, but, once they do, that money is gone. It’s a pretty compelling reason to take some time now to do some preventative care on your revenue cycle. This webinar will help you optimize your front end to stop denials at the start. We’ll explore the importance of not only having the right data, but having it right where staff need it, when they need it.

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


Acquisitions, Funding, Business, and Stock

image

Automated provider credentialing and compliance software vendor Verifiable raises $27 million in a Series B funding round, bringing its total raised to $47 million since launching three years ago.


Sales

  • Vandalia Health (WV) will implement Oracle Health across its system. Mon Health and Charleston Area Medical Center, both of which seem to have been Cerner customers, merged to create Vandalia last year. 
  • Adventist Health selects WinWire’s cloud-based data analytics and management software.

People

image

Aaron Neinstein, MD (UCSF) joins Notable as chief medical officer.


Announcements and Implementations

image

Consulting firm Healthcare IT Leaders forms an Elite Advisor group to offer peer-to-peer advisory services to healthcare executives.

Montage Health leverages Xealth’s digital health integration and digital prescription referral platform as a part of its digital health support programs for behavioral health, consumer wellness, orthopedics, and patient education.

Los Angeles Network of Enhanced Services adopts Google Cloud’s Healthcare API and BigQuery enterprise data warehouse.

image

Garrett Regional Medical Center (MD), part of the WVU Medicine health system, goes live on Epic.


Privacy and Security

Barts Health NHS Trust, the UK’s largest, reports a ransomware attack in which BlackCat hackers stole 70 terabytes of data. The group claims it is the largest healthcare data breach in UK history.


Other

image

Regenstrief Institute and Indiana University researchers develop natural language processing algorithms that can extract text data related to social determinants of health from within EHRs. The researchers say that their algorithms are easier to implement and use than more sophisticated risk models.


Sponsor Updates

  • Meditech releases a new podcast, “Making transformative care attainable with genomic medicine and informatics.”
  • Ethisphere recognizes Availity with its Compliance Leader Verification.
  • Bamboo Health will exhibit at the AHA Leadership Summit July 16-18 in Seattle.
  • CTG publishes a new case study, “CTG Helps Regional Healthcare System with Microsoft 365 Migration.”

Blog Posts


Contacts

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

Comments Off on News 7/12/23

Morning Headlines 7/11/23

July 10, 2023 Headlines Comments Off on Morning Headlines 7/11/23

Verifiable validates its healthcare credentialing software with another $27M

Automated provider credentialing and compliance software vendor Verifiable raises $27 million in a Series B funding round.

HCA Healthcare Reports Data Security Incident

HCA Healthcare announces that an unauthorized and unknown entity stole patient data from an external storage site used to automate the formatting of email messages and posted it for sale on an online forum.

VA medical center in NC notifies veterans of email breach

The Charles George VA Medical Center in North Carolina notifies patients of a data breach involving an email containing the PHI of 1,541 patients that was mistakenly sent to the wrong veterans.

Comments Off on Morning Headlines 7/11/23

Curbside Consult with Dr. Jayne 7/10/23

July 10, 2023 Dr. Jayne 2 Comments

In my past life, I did a fair amount of medicolegal consulting. Although I don’t regularly work in that space anymore, I’m mentoring a young clinical informaticist that finds himself thrown into that space without much warning. When you’re a front-line physician, you know that there is always a chance that a patient complication or a poor outcome could lead to a legal claim. Even when you’re not primarily responsible for the situation, if you’ve participated in the care of a patient, you might be contacted to serve as a fact witness. Regardless of the situation, depositions can be nerve wracking. No matter the industry you work in, generally people don’t really look forward to being dragged into a legal situation. Most informaticists don’t expect to be drawn into legal issues, but when complex systems are involved in documenting the care that was rendered, it’s becoming increasingly more common.

In the past, fulfilling legal requests meant that the health information management department would pull hundreds of pages of paper records and photocopy them to send to the requesting attorney. When we started transitioning to EHRs, sometimes the records requests were fulfilled in a hybrid manner depending on where the hospital was in its EHR journey. There might have been a mix of documents, with some being photocopied and others being printed from the EHR. When I first started seeing these kinds of records, it amazed me how different the EHR output was from different hospitals. Some had better formatted notes than others; others were sometimes downright confusing. The transition of electronic flowsheets to paper output is particularly problematic at times, and when I used to work legal cases regularly, I’d sometimes have to put all the paper representations of formerly electronic flowsheets across the living room floor to try to make sense of them.

Now that the majority of care delivery sites are fully documented using electronic records, the size of documentation on a per-note basis has grown dramatically. Hospital daily progress notes that typically would have been a page or a page and a half in the paper world are now three to five pages long. Despite efforts to the contrary, they often exemplify the concept of “note bloat” with lots of copy and paste and more carry-forward documentation than most of us want. Even a short hospital stay, when converted from an EHR chart to a paper record, can generate thousands of pages of records. Wading through them can be challenging, even when you’re experienced in looking at EHR output. Lately, I’ve seen some notes from hospitals that are exposing metadata within the notes themselves. For example, tagging every sentence with its author in a superscript, or tagging sentences to identify whether the content was generated from a template or through manual entry.

My young colleague has been working in clinical informatics for a couple of years, but mostly spending his time as a super user and helping support his specialty colleagues at the point of care. He only recently started getting into more strategic areas of EHR management. He served on a couple of EHR committees, one of which was depicted last year in a glowing article in the health system’s public-facing newsletter. That particular article was about work that the informatics team had been doing to revisit procedure documentation in a particular specialty area as part of a preventable harms project. It was intended as a feel-good piece, describing how the hospital was using information systems to promote patient safety. Various people were quoted in the article, including my friend, who talked about how the committee was reviewing procedure note templates and order sets to ensure they were being kept up with current evidence and represented the highest standards of care.

Unfortunately, the quotation in the article also ended up tagging my colleague as a potential expert in how the hospital decided to redo its clinical content. Apparently, there was a potential legal claim after a procedure that resulted in a poor outcome, and there’s a hypothesis that an outdated order set contributed to the situation. Since the article appeared on the hospital’s website, it’s easily found in an Internet search, leading to a request for deposition from some enterprising attorneys. He’s now second-guessing the EHR Quality Committee’s strategy in deciding which documentation pathways to review now versus those that were marked for later analysis. Like all of us, his organization was struggling with the idea of having so much to do and so little time, so hard decisions had to be made.

In learning more about the case, it’s not clear how much influence the EHR really had on the situation, even if its documentation was outdated. Ultimately the clinician at the bedside is responsible for placing the right orders for the right patient and for ensuring that they meet the standard of care. Unfortunately, many of us have become so dependent on the EHR as our mechanism for ensuring we’re ordering what we should be ordering. I’ve seen plenty of physicians who have let their critical thinking skills slide and who don’t question what they’re seeing even when they know it’s not right. They’ve come to rely on the prompts and reminders given by the EHR, sometimes to the detriment of the patient when the EHR either doesn’t have any care pathways for a particular situation or when there’s a technology outage.

Plenty of us are speculating as to how artificial intelligence can help us be better doctors – whether it be through helping us write notes that make more sense than what humans are currently generating or whether we’re using it to suggest alternative diagnoses or treatments that might not be top of mind. However, such technology is only going to take us further down the proverbial rabbit hole of reliance on tech. Some of the most harrowing moments I’ve had in clinical practice have been during an EHR downtime and I don’t wish that experience on anyone. Particularly, I feel for those clinicians who work at hospitals that have been hit by ransomware and who have to resort to downtime procedures for extended periods of time. Technology may be making us dumber, in a way.

In the meantime, I’m helping my colleague through the legal process as much as I can, recommending additional training about how his system presents data and educating him on what it will be like to be deposed. He’s incredibly nervous and he never dreamed that EHR governance was going to be on his mind as much as it is now. No one ever said being a clinical informaticist was dull, but I hope for his sake that the next couple of weeks are fairly boring, including the deposition. Being in his position is certainly something they didn’t teach us about in medical school or residency, and definitely not in clinical informatics training. Fortunately, though, in those educational environments they do teach us critical thinking skills, logic, and the need for ongoing learning, so I hope my friend can use those skills to weather the current storm.

Has your IT department ever been cited as party to a legal action? Was it juicy enough to be the subject of a courtroom drama? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 7/10/23

July 9, 2023 Headlines Comments Off on Morning Headlines 7/10/23

Two Years After Coding Changes Sought to Decrease Documentation, Notes Remain ‘Bloated’

An Epic analysis of 1.7 billion clinical notes written by 166,318 outpatient providers during a nearly three-year period finds that average note length increased just over 8%, while the average time spent on documentation decreased 11%.

Intermountain Pediatric Telehealth Connects Local ERs with Primary Children’s Hospital

Intermountain Health expands its Pediatric Telehealth program to give its ER doctors access to virtual consults with pediatric specialists at Primary Children’s Hospital in Utah.

Lovelace hospital using AI to improve care for patients with chronic illnesses

Lovelace Health System (NM) implements CareHarmony’s AI-powered care coordination software to help patients with two or more chronic conditions better manage their treatment, including medications.

Comments Off on Morning Headlines 7/10/23

Monday Morning Update 7/10/23

July 9, 2023 News Comments Off on Monday Morning Update 7/10/23

Top News

image

An Epic analysis of 1.7 billion clinical notes written by 166,318 outpatient providers during a nearly three-year period finds that average note length increased just over 8%, while the average time spent on documentation decreased 11%.

Analysts also determined that providers spent less time on reviewing clinical activities within the EHR, and that providers who decreased their use of copy/paste functionality and smart documentation tools reduced their average note length.

The analysis was undertaken to determine if CMS changes made in 2021 to evaluation and management CPT billing codes did indeed lead to a hoped-for reduction in administrative burden.


Webinars

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

July 26 (Wednesday) 1 ET. “Lessons We’ve Learned Since Launching our Cancer Prevention Program.” Sponsor: Volpara Health. Presenter: Albert Bonnema, MD, MPH chief medical information officer, Kettering Health System, and Chris Yuppa, product owner for oncology services and cancer prevention, Kettering Health System. Kettering’s IT department has played a critical role in providing an EHR-driven framework to bring cancer risk assessment and individual prevention plans to more than 90,000 patients. Primary care, OB/GYN, oncology, and imaging providers are now able to assess the hereditary, genetic, and lifestyle factors that affect the risk of developing lung, breast, ovarian, colon, and prostate cancer in any patient encounter. Learn how Kettering brings together people, processes, and technology to be more proactive in the fight against cancer and where its cancer prevention program is headed next.

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

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


People

image

Loyal names Lauren Struck (BioDigital) chief people officer.


Announcements and Implementations

image

Lovelace Health System in New Mexico implements CareHarmony’s AI-powered care coordination software to help patients with two or more chronic conditions better manage their treatment, including medications.


Government and Politics

CMS proposes a voluntary pathway, dubbed Transitional Coverage for Emerging Technologies, that will enable companies with emerging medical “breakthrough devices” to more easily secure Medicare coverage.


Other

Intermountain Health expands its Pediatric Telehealth program to give its ER doctors access to virtual consults with pediatric specialists at Primary Children’s Hospital in Utah.


Sponsor Updates

  • CereCore publishes the latest edition of its Partnership Perspectives magazine.
  • Meditech makes available to customers presentations and recordings from its Clinical Informatics Symposium.
  • NeuroFlow releases a new Bridging the Gap Podcast featuring EvolvedMD co-CEO Erik Osland.
  • KLAS Research names Nuance as the clinical documentation integrity leader in partnering with customers to drive efficiency and outcomes.
  • PerfectServe announces that customer satisfaction with its clinical communication solutions have been highlighted in a new KLAS Research report, “Clinical Communication Platforms 2023: A Closer Look at Customer Adoption.”
  • Surescripts releases a new There’s a Better Way Podcast, “Mayo Clinic CIO Criss Ross: Finding Opportunity in the Face of Adversity.”

Blog Posts


Contacts

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

Comments Off on Monday Morning Update 7/10/23

Morning Headlines 7/7/23

July 6, 2023 Headlines Comments Off on Morning Headlines 7/7/23

Telehealth startup TytoCare lays off 10% of workforce

TytoCare will reportedly lay off 20 employees, or 10% of its workforce.

Johns Hopkins Medicine joins national move to charge patients for messaging their doctor

Johns Hopkins Medicine (MD) joins at least 14 other healthcare providers across the country in charging patients for certain types of messages sent through their patient portals.

After years of planning, Finger Lakes Health will join URMC becoming UR Medicine Finger Lakes Health

Finger Lakes Health will implement Epic when it becomes a part of the University of Rochester Medical Center (NY) system in August.

Comments Off on Morning Headlines 7/7/23

News 7/7/23

July 6, 2023 News 1 Comment

Top News

image

Sleep management technology company ResMed acquires Somnoware, a sleep and respiratory care diagnostics software vendor based in California.


Webinars

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

July 26 (Wednesday) 1 ET. “Lessons We’ve Learned Since Launching our Cancer Prevention Program.” Sponsor: Volpara Health. Presenter: Albert Bonnema, MD, MPH chief medical information officer, Kettering Health System, and Chris Yuppa, product owner for oncology services and cancer prevention, Kettering Health System. Kettering’s IT department has played a critical role in providing an EHR-driven framework to bring cancer risk assessment and individual prevention plans to more than 90,000 patients. Primary care, OB/GYN, oncology, and imaging providers are now able to assess the hereditary, genetic, and lifestyle factors that affect the risk of developing lung, breast, ovarian, colon, and prostate cancer in any patient encounter. Learn how Kettering brings together people, processes, and technology to be more proactive in the fight against cancer and where its cancer prevention program is headed next. 

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

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


Acquisitions, Funding, Business, and Stock

Constellation Software’s Harris Computer business acquires the US-based EHR, practice management, and RCM assets of Canadian company CloudMD for $6.3 million.

TytoCare will reportedly lay off 20 employees, or 10% of its workforce. The company, which has offices in Israel and New York City, offers a virtual care app and companion diagnostic devices.


Sales

  • Northwell Health (NY) and Nebraska Medicine select healthcare workforce management software from Laudio, which announced a $13 million Series B funding round last month.

People

image

Cincinnati Children’s promotes Tony Johnston to VP of information services and CIO.

image

CMS Digital Service Director Andrea Fletcher takes on the additional role of chief digital strategy officer.


Announcements and Implementations

image

Habersham Medical Center goes live on Epic as part of its transition to the Northeast Georgia Health System.

In New York, Finger Lakes Health will implement Epic when it becomes a part of the University of Rochester Medical Center system in August.


Government and Politics

image

The Georgia Health Information Network will use a $1 million USDA grant to develop a telehealth network that will improve patient access to care in rural communities. GaHIN will work on the project with HealtHIE Georgia, Jefferson Hospital, Emanuel Medical Center, Wills Memorial Hospital, Washington County Regional Medical, Ready Computing, and InterSystems.


Other

image

Johns Hopkins Medicine (MD) joins at least 14 other healthcare providers across the country in charging patients for certain types of messages sent through their patient portals. Beginning July 18, patients with private insurance can expect to incur charges of between $10 and $50 for messages pertaining to health issues that require clinical judgment and more than five minutes to answer.


Sponsor Updates

  • Central Virginia Health Services upgrades to the latest EClinicalWorks technology to enhance efficiency and care coordination for more than 50,000 patients.
  • AGS Health publishes a new e-book, “Does My Healthcare Organization Need Computer-Assisted CDI?”
  • Baker Tilly publishes a new case study, “MedTech company launches digital health platform with help of effective clinical study design.”
  • Biofourmis unveils its innovation lab at its offices in Boston.
  • CereCore releases a new podcast, “Healthcare CIO Advice on Leading Through the Complexities of Change.”
  • Elsevier launches ClinicalKey Now in India to accelerate access to localized clinical guidelines and content for clinicians at the point of care.
  • Fortified Health Security names Anton Mekhael strategic account manager.
  • MedPeds (MD) successfully upgrades to EClinicalWorks V12.
  • Konza National Network announces that an additional 123 Konza-powered members have been awarded NCQA’s DAV accreditation, bringing the total to 348.
  • Rhapsody publishes a new guide, “Enterprise Master Person Index (EMPI): Everything healthcare product leaders need to know now.”
  • OSF HealthCare (IL) details its use of Current Health’s remote patient monitoring technology.

Blog Posts


Contacts

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

EPtalk by Dr. Jayne 7/6/23

July 6, 2023 Dr. Jayne 1 Comment

I mentioned recently that July marks the traditional start of the new training year for medical education in the US. Those interns are approaching the end of their first week on the job and are likely to be using a variety of coping strategies to figure out how they’re going to make it through the next three to 10 years of their lives. Figuring out when and what you’re going to eat when you have little time is usually a big part of that survival strategy. Jenn clued me in to this cooking contest for vegan hospital food. The District of Columbia Hospital Association recently held its third annual Healthy Hospitals Initiative Cooking competition with a “secret ingredient” this year of carrots. The event is also sponsored by the Physicians Committee for Responsible Medicine and winners included MedStar National Rehabilitation Hospital with its purple carrot ravioli and carrot halwa pistachio trifle.

image

I read with interest this piece about Cleveland Clinic opening a new telehealth hub at one of its hospitals. The facility’s 57 rooms are equipped with technology to allow patients to have consultations with physicians who are at other locations. Knowing that they plan to staff cases remotely, it will be interesting to see what kinds of providers and staff are actually in place at the facility. I’m guessing they’ll go with a minimum staffing approach, and as far as licensed providers, probably will leverage nurse practitioners and/or physician assistants more than you might at a facility with traditional staffing. I hope someone is doing outcomes research and looking at how these patients fare compared to those being cared for under usual care models. If research proves this approach is equivalent but less costly, or drives better outcomes with the same cost, it will truly be a game changer.

Speaking of telehealth, it’s often cited as being key to solving the access problem for patients in need of mental health services. Author Health, which has a platform for seniors on Medicare Advantage, just announced a $115 million funding round with Humana as a payer partner in south Florida. The platform also addresses substance use disorders. Author Health delivers care both virtually and in-person with a cross-functional team including physicians, therapists, nurses, and community health workers. All of the resources are virtual except the community health workers. They’re hoping to manage workforce issues by recruiting providers first and getting them licensed in target states, rather than trying to recruit those who already have specific licensure. That’s easy in some states but harder in others, so I’m sure it will drive their expansion plans.

In reading more about the Author Health arrangement with Humana, it appears to be based on a fee-for-service model with a goal of transformation to a value-based model in the future. They also hope to be able to demonstrate improved outcomes for patients’ comorbid medical conditions, such as diabetes. It will be interesting to see how the platform grows over time and whether or not the partnership with Humana helps it yield results faster than competitors. I enjoyed learning a little about their branding – the name Author Health is drawn from the idea that patients should be writing their own life story and defining how they want the next chapters to unfold. I’ve got the company on my tracking list, so we’ll see how it fares over the coming months to years.

Mental health apps are also a big topic of conversation as a way of solving the access issue. I ran across this article looking at the pros and cons of direct-to-consumer virtual mental health apps. Before reading the article, my major concern with these offerings was the protection of patient data. Most patients don’t realize that the majority of apps aren’t required to protect the privacy of patient data nor do they know that some app developers are actually selling their personal data. I’m sure the number of consumers that actually reads the full Terms and Conditions when downloading an app is very small. According to the article, there may be between 10,000 and 20,000 mental health apps out there. Although the sheer number might be a good thing, the article brings up additional pitfalls beyond privacy and security concerns. It notes that we don’t know for sure whether apps can deliver the same quality of care as existing treatments do, and that traditional healthcare providers and payers need to play a role in making sure that quality is assessed.

Given the fact that digital therapeutics companies who have the proof of their outcomes have struggled to make a go of it, I’m not optimistic about the ability of front-line care providers to participate in the process to prove whether an app meets the standard of care. The boom in app use in other disciplines has contributed to provider frustration, as many have to spend already scarce clinical time explaining why some apps might be a bad idea. Many of my colleagues in women’s health have spent a lot more time counseling patients on the risks of using period tracking apps because patient privacy cannot be guaranteed, especially for patients in states that have restricted abortion care. I used to occasionally have to counsel patients about the validity of various home blood pressure cuffs and the data they generated, and with current technology patients can send me hundreds of data points at the click of a button that I now have to figure out how to reconcile. There can be a lot of effort needed for physicians to figure out what to do with all this information, and given the conversation in the physician lounge, people may be less than enthusiastic about rising to this particular challenge.

Bad news for those of us who like our downtime: There may be a link between napping and esophageal cancer. Researchers at Washington University School of Medicine in St. Louis have identified prolonged sleep as a risk factor for esophageal adenocarcinoma, with those sleeping nine hours per night having double the risk of individuals sleeping seven hours per night. They also found increased risk in patients who slept less than six hours per night. In looking at patients who slept or napped during the day, they also identified increased risks. Researchers think that the link to increased cancer risk might be due to disruption of sleep/wake cycles that leads to reflux of stomach acid, or to immune dysfunction that might cause increased cancer risk. Thinking as an average person, it sounds like this isn’t terribly conclusive. There may be other factors involved such as obesity, although the researchers did adjust their data for sex, smoking status, body mass index, and whether or not patients engaged in shift work. I consulted my favorite otolaryngologist and we both agreed that a good afternoon nap is probably worth the risk.

When is the last time you had to do an all-night upgrade or IT work that made you want to nap the next day? If you’re a napper, are you willing to give it up to lower your cancer risk? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 7/6/23

July 5, 2023 Headlines Comments Off on Morning Headlines 7/6/23

Mount Sinai Launches Center for Ophthalmic Artificial Intelligence and Human Health

In New York, Mount Sinai’s Icahn School of Medicine launches the Center for Ophthalmic Artificial Intelligence and Human Health to help ophthalmologists diagnose eye disease and assess underlying health conditions.

CloudMD Divests Non-Core U.S. Electronic Medical Records and Practice Management Business

Constellation Software’s Harris Computer business acquires the US-based EHR, practice management, and RCM assets of Canadian company CloudMD for $6.3 million.

ResMed Acquires Somnoware, a Leader in Digital Sleep and Respiratory Care Diagnostics Software

Sleep management technology company ResMed acquires Somnoware, a sleep and respiratory care diagnostics software vendor based in California.

BlueKey Equity Partners Invests in Telemetrix

Remote patient monitoring vendor Telemetrix secures an undisclosed amount of funding from BlueKey Equity Partners.

Anatomy IT Enhances Value-Based Care Services Through Acquisition of MIPS Business Unit from MarsdenAdvisors

Health IT and cybersecurity business Anatomy IT acquires the MIPS/value-based care business of MarsdenAdvisors.

Comments Off on Morning Headlines 7/6/23

Healthcare AI News 7/5/23

July 5, 2023 Healthcare AI News Comments Off on Healthcare AI News 7/5/23

News

image

In New York, Mount Sinai’s Icahn School of Medicine launches the Center for Ophthalmic Artificial Intelligence and Human Health to help ophthalmologists more quickly diagnose eye disease and assess underlying health conditions. The center will initially work with AI models in Mount Sinai’s ophthalmology tele-consult program, tele-retina program, and eye stroke service.


Business

image

A local Dallas media outlet profiles Sniffle, an AI-powered virtual care app that offers telemedicine to patients, and white-label virtual consult capabilities to physicians. The State of Arkansas has invested in the company, and its technology is now used by 85 physicians in 10 Arkansas clinics.


Research

image

Crisis call support line operator Protocall Services and Lyssn will use a $2 million grant from the National Institute of Mental Health to customize Lyssn’s AI technology for use in the analysis and review of crisis calls. Lyssn’s call evaluations and summary dashboards are intended to help call center counselors improve their assessment of a caller’s suicide risk. The companies will soon begin an 18-month study to determine whether or not Lyssn’s software improves the performance of counselors over time.

image

UPMC researchers develop a machine learning algorithm for the ECG diagnosis of occlusion myocardial infarction in patients with chest pain that outperforms providers and other ECG interpretation software.


Other

image

The Responsible AI in Healthcare consortium launches to help health systems and other providers safely use AI. Backed by the Responsible AI Institute, Harvard Business School, and NHS in the UK, the group is working to develop a Responsible Generative AI Safety Index scoring system for healthcare.

image

Mayo Clinic scientists develop an AI-augmented kidney stone test to help providers pinpoint any underlying health conditions that may have contributed to the patient’s condition.


Contacts

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

Comments Off on Healthcare AI News 7/5/23

Morning Headlines 7/4/23

July 3, 2023 Headlines Comments Off on Morning Headlines 7/4/23

Alfie nets $2.1M for obesity management

Virtual obesity management clinic Alfie raises $2.1 million in a pre-seed funding round.

WHO and HL7 collaborate to support adoption of open interoperability standards

The World Health Organization and Health Level Seven International will work together to support the global adoption of open interoperability standards.

Apple closes at $3 trillion market cap

Apple becomes the first company to close a day of trading with a $3 trillion market cap.

Comments Off on Morning Headlines 7/4/23

Text Ads


RECENT COMMENTS

  1. Very disappointing for the AI /CTO/digital employees at HHS. They could have quintupled their salaries in the private sector and…

  2. Per RFK Jr., I predict the following. Very soon, one of his entities (the NIH perhaps) will discover that severed…

  3. 1. RFK. JFC. 2. Holmes can pound sand - delusional as she ever was. And I would know - it's…

  4. Oracle snippy email: reminds me of Neal's famous pizza email.

  5. In a delicious twist of irony - the legal and funding framework for DOGE was created by Obama.

Founding Sponsors


 

Platinum Sponsors


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Gold Sponsors


 

 

 

 

 

 

 

 

RSS Webinars

  • An error has occurred, which probably means the feed is down. Try again later.