News 9/8/23

Top News

Private equity firm Thoma Bravo will acquire NextGen Healthcare in a $1.5 billion take-private transaction, paying a 46% premium to the unaffected share price.

NextGen offers solutions for EHR/PM and interoperability.

The private equity firm’s portfolio includes Imprivata, Hyland, Qlik, and Bluesight.

NXGN shares had lost 8% in the 12 months before the acquisition rumors surfaced. They were down 20% over the previous five years.

Reader Comments

From DJ: “Re: Intermountain. Rumor is that it told caregivers this week that it will move from Cerner / Oracle Health to Epic.” Verified by an Intermountain media contact in response to my inquiry. Oracle Health losing former Cerner poster children Intermountain and UPMC in the same week is significant. A Redditor posted the internal Intermountain email announcement to caregivers, with these snips:

We are excited to announce that we will align to a single Electronic Health Record (EHR) across Intermountain Health, and all regions will begin moving toward using Epic … Epic will be the single EHR for the organization due to strong functional offerings and significantly higher physician and APP EHR satisfaction scores. For example, Epic EHR satisfaction scores at Intermountain are .49 points above the national average on a 5-point scale and the Cerner score is .52 points below the national average … Epic is currently being used by Intermountain care sites in Colorado and Montana. The renewal deadline for our Cerner contract, which supports the iCentra EHR across the Canyons Region and parts of the Desert Region, is coming up in November. Given this timeline, it’s the right time to take action. We have an urgent need to find an EHR solution that can best support operations in Idaho and Nevada, where our legacy EHR solutions are antiquated and in need of replacement. Our finance team completed a detailed review of our annual EHR operating costs, and moving to a single platform will help us achieve significant cost savings over time. Today we are simply announcing this transition. We have a lot of planning work ahead of us to go-live with Epic across the system by the fourth quarter of 2025. As we plan for the transition, we will be sunsetting EHR contracts with other EHR vendors (e.g., Cerner, Allscripts, etc.).

Meanwhile, another Redditor says that while Neal Patterson built Cerner, losing customers such as Intermountain was more his fault than that of his often-blamed successors Brent Shafer and David Feinberg:

• Patterson didn’t leave a succession plan when he died in 2017.
• A primary driver of Cerner clients moving to Epic was that Cerner didn’t develop a competent RCM system and continued selling both its own system as well as Siemens Soarian
• Cerner allowed clients to customize their system to the point that they couldn’t upgrade.
• CCL was the go-to reporting system instead of a robust reporting solution.
• Cerner didn’t develop a competitive offering to Epic’s MyChart.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Symplr. Symplr is building the bridge to enterprise healthcare operations and beyond. Together with its customers, it is creating the blueprint for how to not just survive, but thrive, by maximally using staff
and technology in tandem to bridge the gaps and increase efficiencies in healthcare operations. For more than 30 years and with deployments in nine of 10 US hospitals, Symplr has been committed to improving healthcare operations through its cloud-based solutions. Its provider data management; workforce management; compliance, quality, and safety; and contract, supplier, and spend management solutions improve the efficiency and efficacy of healthcare operations, enabling caregivers to quickly handle administrative tasks so they have more time to do what they do best: provide high-quality patient care. Thanks to Symplr for supporting HIStalk.

The HLTH conference is October 8-11, so I’ll post a list of participating HIStalk sponsors and their activities the week before. Watch for a data collection form link next weekend.

Webinars

September 21 (Thursday) 2 ET. “Unlock open enrollment best practices to stop future denials.” Sponsor: Waystar. Presenter: Lauren Tungate, solution strategist team lead, Waystar. Nearly half of insured Americans consider changing their insurance coverage each fall, necessitating provider safeguards to stop increased denials, find hidden coverage, and prevent uncompensated care. This webinar will crack open enrollment best practices, such as using different data sources to get an accurate picture of benefit details; leveraging automation to identify hidden coverage, confirm active insurance, and avoid lost revenue; and simplifying eligibility workflows to reduce the financial burden on patients and strain on staff.

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

Sales

• South Dakota’s Department of Health chooses Findhelp to built its statewide social care referral system.
• Aga Khan Health Services, East Africa will implement Meditech Expanse in Tanzania and Kenya.
• Intermountain Healthcare will implement Epic throughout its system, replacing Cerner and other products.

People

Industry long-timer Mark Hefner died Saturday of cancer. He was 64.

Announcements and Implementations

AvaSure adds video AI support to its TeleSitter solution to reduce elopement and falls.

Withings earns FDA clearance for its Body Scan smart scale, a $400 device with a retractable grab bar that detects atrial fibrillation along with monitoring body composition, heart rate, and vascular age.

Government and Politics

The VA will review its online disability systems after discovering that technical issues delayed disability claims for veterans who tried to update their dependency status or to file appeals online. The VA found that some disability-related cases going back to 2011 have not been addressed.

Other

A woman says that her brother died alone in a Las Vegas hospital because of the way the hospital assigns names to unidentified patients. Clifford Allen collapsed in a retail area on a 115-degree Las Vegas day and was lying in the full sun for eight hours with no help from bystanders, during which time someone stole his wallet and oxygen tank. His sister repeatedly called every hospital in Las Vegas asking about patients admitted under his name or John Doe, with no success. He died 10 days later as an inpatient of MountainView Hospital, which says that while it admits unidentified patients under the last name Doe, it assigns different first names to avoid merging the medical records of multiple patients named John or Jane Doe.

Sponsor Updates

• Direct Recruiters, Inc. hires Dave Emma (Teladoc Health) as practice leader of technology for digital health.
• Concord Health Partners makes an unspecified investment in NeuroFlow.
• Experity will accept nominations for its annual Industry Limelight Awards, to be presented at its 2024 Urgent Care Connect Conference, through October 27.
• EClinicalWorks releases a new podcast, “Unlocking Reporting Capabilities in EBO.”
• Ascom launches its new Myco 4 smartphone for clinical institutions and enterprises.
• Baker Tilly releases a new Healthy Outcomes Podcast, “Exploring aspects of leadership, management, innovation, and technology in healthcare organizations.”
• Censinet partners with Health Information Sharing and Analysis Center to provide free third-party risk management services to Health-ISAC members through its Community Services Program.
• CloudWave will co-sponsor the Meditech Live Welcome Reception on September 19 in Foxborough, MA.
• Five9 will be at the CCW Patient Experience Exchange in Atlanta October 17-19.
• Nordic releases another episode of its In Network podcast, “Designing for Health: Interview with CT Lin, MD, Liz Salmi, and Bryan Steitz, PhD.”
• Divurgent releases a new episode of The Vurge Podcast, “Bridging the Gap Between Operations & Technology.”
• Ellkay will exhibit at Oracle CloudWorld September 18-20 in Las Vegas.
• Everbridge publishes a new case study, “Improving patient communications with Everbridge: Children’s Hospital of Philadelphia.”

Blog Posts

• Liverpool Women’s CIO Perspective: Digital Maturity One EPR Milestone at a Time (CereCore)
• Mitigating the Risks Involved with High-Risk Diagnosis Groups (AGS Health)
• Bridging gaps: Data-driven approaches to patient outreach (Arcadia)
• What Hospitals Can Do To Move From Digital Tools to Digital Transformation in Healthcare (Ascom)
• An Expert’s Take on HCC Coding (RCxRules)
• Availity Expert Q&A: Unleashing Efficiency to Revolutionize Prior Authorizations (Availity)
• How a Security Controls Validation Assessment Optimizes Cybersecurity Investments (Clearwater)
• How Continuous Safety Monitoring Can Reduce Hospital Stays for High-Risk Oncology Patients (Current Health)
• Bridging the Gender Gap in Health Tech (Dimensional Insight)
• Increased Prevalence of Alpha-Gal Syndrome Impacts More Clinical Decisions (First Databank)
• Living Off the Land attacks: Unveiling the illusion (Fortified Health Security)

Contacts

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

EPtalk by Dr. Jayne 9/7/23

I enjoy giving back to medical schools and residency programs in my area, so I’m looking forward to teaching an upcoming class on clinical decision support and how clinicians use it in the real world. I had barely started culling research articles and building my slide deck when this New England Journal of Medicine article virtually dropped in my lap.

The authors found that although there has been a lot of attention to ensure that the clinical decision support tools themselves are safe, there hasn’t been enough attention to making sure that clinicians understand how they work or how best to use them in clinical settings. Over the last two decades, I’ve seen plenty of clinicians disregard even the most basic clinical decision support interventions, so the article definitely had my attention. 

The authors suggest that medical education curricula should include content on how clinicians should best incorporate algorithm-generated information into their own decision making, and to discuss the use of clinical decision support tools with patients. Trainees should also be taught to consider how different patient data inputs might change the output of a tool, as well as how to evaluate whether a tool might be missing key elements needed to appropriately evaluate a given patient.

The authors propose that learners should engage in practice-based training scenarios where they use an algorithm, discuss its predictive value, understand how it is using different data points, and understand its overall effectiveness. The article also included a brief history of clinical decision support tools, which have been around since the 1970s, and I’ll be using some of their examples in my presentation.

Speaking of presentations, I recently attended one delivered by some “experts” who advertised a session to help “technology people” better understand how to work with physician end users. There were some interesting statistics thrown out, many without citations. One that seemed very specific was the claim that the average physician can only type 22 words per minute. I decided to hit the medical literature and see what I could find, with scholarly articles putting physicians more in the range of 30 words per minute. That’s a pretty significant difference and I would caution folks that it’s not a good idea to throw that kind of data out without citations when you’re speaking to a group of technical experts.

I think they also failed to understand that there might be clinical informaticists in the audience or that some of the things they were saying about clinician end users were offensive. Comments such as “you have to dumb it down when you’re working with physicians” are a poor idea, especially when those physicians are on the webinar.

Another strategy they advised when working with physicians was that of creating special roles and/or titles for physicians to get them to be EHR ambassadors to their peers, particularly without additional compensation. In recommending that a physician be named something along the lines of Regional Site Director of EHR Adoption, they went on to say, “Titles are cheap. We give them away like candy.” They had some other ridiculous things to say, and I was glad I had a cocktail in hand to help make it through the session. Another clueless move: they failed to recognize that often EHR analysts, implementation specialists, and other “technology people” tend to be fiercely loyal to their end users, so I’m sure the speakers didn’t make many friends with those folks, either.

A friend recently mentioned his experience with EqualityMD, which is a technology platform dedicated to helping LGBTQ+ patients who are seeking healthcare providers who have been recognized for their delivery of respectful and affirming healthcare. The system gathers patient information, including biometric data, race, pronouns, gender identity, sexual orientation, ethnicity, and languages spoken. It also gathers information about patient preferences for their care teams and ultimately suggests physicians and other providers who might be a good match. Patients can then schedule with and engage providers through the platform. My friend has had a good experience with the solution and feels like the company is “the real deal,” so I’ll be interested in following them over the coming months.

Sometimes I get my news from HIStalk just like everyone else. Earlier this week, Mr. H mentioned Air Force physician complaints about issues where adolescent patients can’t access their records via patient portal. As someone who has been dealing with the challenges of privacy and confidentiality issues faced by healthcare providers who see adolescents for the last eight years, this didn’t seem too off the mark to me. Mr. H is always great about providing citations so I followed his handy link to the original article in Stars and Stripes.

Apparently one of the Air Force’s chief medical information officers told a gathering of people, “So there’s this weird dead zone as of right now with the portal. With children 13 to 17, you can’t see their medical information and your kid cannot create a login because they’re not 18 yet.”

Although this may sound wild to some, it’s actually the way that a large number of healthcare organizations in the US have to handle adolescent confidentiality and privacy due to clashes between state laws and EHR functionality. It’s certainly not unique to Oracle Health. Most of the EHR vendors have a long way to go as far as being able to allow teens to access their data online, but prevent parents from seeing information that might cause harm to the patient. Some systems are better than others at allowing different parts of the record to be parsed for parent view versus patient view. However, the fear of legal issues seems to be a driving force for many provider organizations who are deciding how to configure their EHRs and patient portals.

There have been quite a few presentations on this at conferences, ranging from the AMIA Annual Symposium to various EHR vendor user groups. I’d love to have policymakers sit down with adolescent patients, their parents, their guardians, and their care teams. That’s the only way they’re ever going to understand the complex situations around which they are trying to create rules which seem like a good idea, but ultimately backfire on many of the involved parties. Until then, or until EHR vendors step up, we will all be stuck with the current complex web of proxy access, parental rights, and different ages of medical consent not only across state lines but across medical conditions as well.

How is your organization handling adolescent privacy and confidentiality with respect to access in the patient portal? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 9/7/23

NextGen Healthcare Enters into Definitive Agreement to Be Acquired by Thoma Bravo

Thoma Bravo will acquire NextGen Healthcare in a take-private deal valued at over $1.5 billion.

Concord Health Partners Invests in NeuroFlow

Behavioral health technology vendor NeuroFlow secures funding from Concord Health Partners.

ERPHealth Acquires Manifesto, Expanding its Behavioral Health Outcome Tracking Platform to include Peer Support and Health Coaching.

Behavioral health outcomes tracking software vendor ERPHealth acquires Manifesto, which offers a peer support and behavioral health coaching app.

ModuleMD Acquires Diversified Healthcare and MedEase to Expand Revenue Cycle Management Footprint

Specialty-focused health IT company ModuleMD acquires Diversified Health Care Management and Professional Management Services, both of which offer practice management and RCM software and services.

Healthcare AI News 9/6/23

News

Google Chief Health Officer Karen DeSalvo, MD, MPH, MSc says in NEJM Catalyst that large language models will give patients “a more personalized and anticipatory experience” and that medicine needs to change to meet consumer expectations for a mobile-first digital health experience.

A hospital in Israel declares that an AI app saved a patient’s life when it detected brain bleeding from their CT scan and alerted doctors, who called him to return immediately for additional scans and surgery. The app was developed by Viz.ai.

Research

A study finds that consumer voice assistants such as Alexa as well as ChatGPT delivered poor results when asked layperson questions about performing CPR, with the authors suggesting that bystanders should call 911 instead of asking Siri. The voice assistants gave “grossly inappropriate” responses that often weren’t related to CPR and almost always failed to recommend calling emergency services.

National Taiwan University Hospital develops an ultrasound device that uses AI to assess a person’s risk of sleep apnea in 15 minutes instead of an overnight sleep study. The machine diagnosed sleep apnea with 95% accuracy in requiring patients to breathe a few times while awake. At-risk patients are then referred for traditional polysomnography.

Other

OSF HealthCare develops an AI model that predicts an inpatient’s death at admission using 13 commonly available data elements, allowing clinicians to work with the identified patients to document their end-of-life wishes.

Two teens launch Vytal.ai, whose app uses the camera of a laptop or mobile device to assess brain health using a 30-second gaze tracking exercise. The high school students have developed use cases that include early detection of neurological problems, clinical trials, and concussion screening. Co-founder, CEO, and CTO Rohan Kalahasty, who is 18, has spent three years as a researcher in Harvard’s ophthalmology AI lab and has performed AI research at MIT, while co-founder, COO, and CFO Sai Mattapali, aged 17, has spent time as an intern in both neurophysiology and business growth.

Contacts

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

Morning Headlines 9/6/23

UPMC is preparing for a massive transfer of medical records

UPMC will replace Oracle Health / Cerner and eight other EHRs with Epic over the next three years.

Thoma Bravo Nears Deal for NextGen Healthcare

Private equity firm Thoma Bravo is reportedly in advanced stages of negotiation to acquire NextGen Healthcare.

TeleVox Acquires Odeza Patient Engagement Business from Ensemble Health Partners

Patient engagement technology vendor TeleVox acquires the Odeza patient engagement business of RCM company Ensemble Health Partners.

News 9/6/23

Top News

UPMC will replace Oracle Health / Cerner and eight other EHRs with Epic. Implementation in the 40-hospital system will begin in Q4 and be completed by mid-2026.

UPMC was already using Epic in some areas, notably for ambulatory services.

Reader Comments

From SPAC Cadet: “Re: HIStalk. Have you thought about taking it public via a SPAC? Everybody is doing it!” Everybody was indeed doing it until the government cracked down on unproven companies that could not have passed the scrutiny involved in an actual IPO and instead “merged,” which left them free to pump shares via media promotion. Nothing says USA like celebrities, grifters, and the ever-present money people collaborating to pick the pockets of the little guy. SPAC king Chamath Palihapitiya used Twitter and CNBC shilling to earn himself a billion dollars in fees while shares in his average SPAC company were tanking 90%. His Clover Health, which he bragged was a surefire 10x win over 10 years, started trading at a $7 billion valuation that is now down to $650 million, so the 10x is looking accurate though directionally incorrect.

HIStalk Announcements and Requests

Health IT people may be professionally embarrassed by being the last holdout of fax machines, but most poll respondents wouldn’t walk out on a practice upon seeing one at the check-in desk (I purposely described it that way to indicate the presence of the lowest form of faxing, as opposed to the slightly sexier digital fax). One commenter astutely noted that not seeing a fax machine out front just means that they are using e-fax or have placed the machine out of sight. Another said it’s a lot more offensive shove a multi-page paper form at patients for whom the information is already in the clinic’s EHR. Bethany notes that even all-digital clinics needs a fax machine because they can’t receive referrals from other practices that insist on using them.

New poll to your right or here: Were you laid off, terminated, demoted, or forced to relocate so far in 2023?

Lorre always offers incentives for new sponsors to sign up in the last quarter when leftover marketing budgets need a home, so contact her to get on board.

Webinars

September 21 (Thursday) 2 ET. “Unlock open enrollment best practices to stop future denials.” Sponsor: Waystar. Presenter: Lauren Tungate, solution strategist team lead, Waystar. Nearly half of insured Americans consider changing their insurance coverage each fall, necessitating provider safeguards to stop increased denials, find hidden coverage, and prevent uncompensated care. This webinar will crack open enrollment best practices, such as using different data sources to get an accurate picture of benefit details; leveraging automation to identify hidden coverage, confirm active insurance, and avoid lost revenue; and simplifying eligibility workflows to reduce the financial burden on patients and strain on staff.

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

Acquisitions, Funding, Business, and Stock

Private equity firm Thoma Bravo is reportedly in advanced stages of negotiation to acquire NextGen Healthcare.

The CEOs of Walgreens and Amazon-owned One Medical resign. The latter is less surprising since the CEOs of Amazon’s acquisitions rarely stick around beyond the kick-in of their golden parachutes, while the former looks like impatience that the ambitious plans to turn Walgreens into a a full-service healthcare provider via acquisitions involves too much risk and time.

Mercy Iowa City files for Chapter 11 bankruptcy protection, citing the poor implementation of a new Allscripts EHR in 2022 that has since contributed to problems with coding, billing, and collecting for $189 million in patient services. The hospital has filed a lawsuit against Allscripts, now known as Altera Digital Health, to which it still owes $1.8 million. It is considering a “below-market” acquisition offer of $20 million from the University of Iowa, the value of which has left some bondholders seeking an official investigation into the hospital’s downfall.

Patient engagement technology vendor TeleVox acquires the Odeza patient engagement business of RCM company Ensemble Health Partners.

Sales

• Tennessee’s TennCare Medicaid agency will use Findhelp’s social services assessment and Closed Loop Referral System as a part of its Health Starts initiative.
• Franciscan Missionaries of Our Lady Health System will use Masimo’s remote patient monitoring hardware and software across its 10 hospitals in Louisiana and Mississippi.
• Blackrock Health Group in Ireland will implement Meditech Expanse at an additional three clinics as part of a three-year, $27 million digital transformation program.

People

Prairie Lakes Healthcare System hires Tim Pugsley, MBA (Mankato Clinic) as CIO.

The National Library of Medicine announces the retirement of Director Patti Brennan, RN, MSN, PhD on September 30. She is an informatics nurse and earned a PhD in industrial engineering from the University of Wisconsin-Madison.

Government and Politics

Air Force doctors say in a town hall meeting in Japan that DoD’s Oracle Health system — whose final go-lives are in the Indo-Pacific bases — is better than its predecessor, but has a quirk in which the records of children aged 13-17 won’t be available online and the children themselves can’t create a patient portal account until they reach 18.

The US Air Force Research Laboratory says that several military medic groups are interested in the EHR smartphone app that it created in 2019. The Battlefield Assisted Trauma Distributed Observation Kit (BATDOK) captures medical documentation at the point of injury and during transport

Privacy and Security

Carthage Area Hospital in New York gets phone systems up and running as it recovers from a cyberattack discovered last Thursday. The breach also impacted nearby Claxton Hepburn Medical Center, though its phone lines were not affected.

Other

A former physician employee of Babylon, who left the company six years ago after just 12 months, describes what it was like to work at “the most expensive failed experiment on digitizing primary care to date”:

• He was shown the company’s “groundbreaking AI system” that was just some Excel worksheets containing decision trees that had been written by junior doctors. Attempts to improve the system failed.
• Employed clinicians were told to assign the probabilities of various combinations of diseases and symptoms, leading to illogical questions such as the likelihood that someone with abdominal pain has allergies.
• The company’s chatbot didn’t work and didn’t earn FDA approval.
• Babylon claimed that its product’s performance was better than that of doctors, then backtracked on that claim when doctors cut ties with the company.
• The company hired “slimy sales people” to push deals that almost always ended up failing, pushing whatever AI craze was making headlines, such as facial recognition and voice-to-text.
• The GP at Hand telehealth service was convenient for patients, but the service was not cost effective and its expense damaged the NHS services it replaced.

Sponsor Updates

• Wolters Kluwer Health announces that its drug diversion monitoring software received exceptional recognition from KLAS in its Drug Diversion Monitoring 2023 report.
• A new KLAS white paper shows that Nordic has one of the industry’s most robust selections of services aimed at streamlining the EHR experience.
• Ronin publishes a new white paper, “Clinician Experience: The Missing Link Between High-Efficiency and High-Tech Healthcare.”
• KLAS recognizes Vyne Medical in its latest Advanced User Insights report on next-generation digital fax management.
• The SaaS Fuel podcast features Zen Healthcare IT President Marilee Benson in “SaaS Founder Insights.”

Blog Posts

• How Meditech’s Critical Care solution can elevate your organization (Meditech)
• 5 Benefits of Offering Digital MSK at Your Outpatient Rehab Therapy Practice (Net Health)
• Speech recognition adoption made simple with Dragon Medical One (Nuance)
• Extreme Usability II: Enhancing the Client Experience (Netsmart)
• Automation in Revenue Cycle Management: Healthcare Providers Share Their Experiences with Autonomous Medical Coding (Nym Health)
• How to Reach the CMDB Summit (Optimum Healthcare IT)
• Real Results from RCxRules Users (RCxRules)
• Message Queue Service Oils the Engine Driving E-Prescriptions (Surescripts)
• How to Empower Family Caregivers During Hospital Discharge (Trualta)

Contacts

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

Morning Headlines 9/1/23

Firm behind NHS GP at Hand service places two divisions into administration

Babylon Health sells its UK business, including the GP at Hand app, to US-based in-home test kit vendor EMed Healthcare.

FBI, Partners Dismantle Qakbot Infrastructure in Multinational Cyber Takedown

The FBI and its partners shut down the Qakbot bot that was used to perform several recent cyberattacks on US hospitals.

SoftBank, General Atlantic-Backed Biofourmis’ Founder Steps Down As CEO

Biofourmis CEO Kuldeep Rajput resigns from the remote patient monitoring platform vendor one month after the company laid off 120 employees.

News 9/1/23

Top News

Babylon Health sells its UK business, including the GP at Hand app, to US-based in-home test kit vendor EMed Healthcare.

The sale basically marks the end of the company, which has declared insolvency and sold the parts of its business that attracted buyers.

BBLN shares, which went public as one of many disastrous SPAC mergers, are at two-thousandth of one cent, valuing the former high-flyer whose market capitalization reached $4 billion at $5,000.

Webinars

September 21 (Thursday) 2 ET. “Unlock open enrollment best practices to stop future denials.” Sponsor: Waystar. Presenter: Lauren Tungate, solution strategist team lead, Waystar. Nearly half of insured Americans consider changing their insurance coverage each fall, necessitating provider safeguards to stop increased denials, find hidden coverage, and prevent uncompensated care. This webinar will crack open enrollment best practices, such as using different data sources to get an accurate picture of benefit details; leveraging automation to identify hidden coverage, confirm active insurance, and avoid lost revenue; and simplifying eligibility workflows to reduce the financial burden on patients and strain on staff.

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

Acquisitions, Funding, Business, and Stock

Wellstar Health System will acquire Augusta University Health System, pledging to complete AU Health’s implementation of Epic. 

Biofourmis CEO Kuldeep Rajput resigns from the remote patient monitoring platform vendor one month after the company laid off 120 employees. Its July 2022 Series D funding round increased its total to $464 million, valuing the company at over $1 billion. Insiders say that key investors were unhappy with the company’s strategy and burn rate.

Non-profit RIP Medical Debt, which purchases discounted patient-owed medical debt and pays it off, will work with RCM software vendor FinThrive to use social determinants of health to identify patients whose debt meets the company’s criteria for payoff.

Sales

• Bethany Children’s Health Center (OK) will implement Meditech Expanse using the Meditech as a Service platform.
• Parkview Health will offer Epic-based virtual urgent care from KeyCare.

People

Jeff Cutler (Ada Health) joins Validic as chief commercial officer.

Adam Seyb (Janus Health) joins ProRank as CEO. 

Announcements and Implementations

GoodRx announces a real-time benefit check for Provider Mode, which gives prescribers access to a patient’s insurance coverage and drug cost.

NeuroFlow announces a tech-enabled approach to psychiatric collaborative care (CoCM) that combines the company’s AI-driven analytics, care collaboration enablement, and enterprise consumer-grade activation for its health system users.

Government and Politics

CMS asks states to review the results of their computer-assisted Medicaid eligibility determination after identifying a software error that incorrectly flags children to be dropped automatically if their family fails to respond or is found to be ineligible.

Privacy and Security

The FBI and its partners shut down the Qakbot bot that was used to perform several recent cyberattacks on US hospitals. The FBI penetrated the system, found that 700,000 systems were compromised globally, and then set up a redirect function to forward incoming traffic to an uninstaller program.

Systems at Singing River Health System (MS) remain down following an August 20 cyberattack.

In Europe, a privacy watchdog sues Google-owned Fitbit in multiple countries for exporting user data outside the EU in violation of GDPR. The suits say that Fitbit includes data-sharing consent in its user agreement, but doesn’t specify how the data will be used and doesn’t give paid users a way to opt out.

A law firm reminds Florida healthcare providers — hospitals, nursing homes, labs, pharmacies, and mental health providers — that a new state law requires them to verify that their EHR data is physically stored in the continental US, US territories, or Canada. The firm says that that the law does not limit the ability of people outside the country to access patient information, but it does specify where the information must be physically stored, whether by the provider itself or third-party vendors.

Other

UNC gastroenterologist, vice chair, and professor of medicine Spencer Dorn, MD, MPH, MHA – who humorously says on his LinkedIn that “I literally work in the belly of the healthcare beast,” lists how managing the physician EHR inbox violates productivity principles:

• Messages arrive all day long and lead the physician reader down rabbit holes, conflicting with the day’s planned activities.
• High-value task prioritization gives way to having to read each message to determine its importance.
• Inbox noise creates distraction.
• Efficiency is sapped by multitasking, as the average PCP switches their attention to the inbox 80 times per day.
• Cognitive load is increased by context-switching among screens and windows.
• Message burden forces managing the inbox evenings and weekends when the physician’s energy and attention are lower.
• Solutions include redesigning the inbox itself, using AI to help manage messages, and provider organizations reducing the number of messages and delegating more of them to non-physicians.

One commenter on the inbox article above mentioned that EHR inboxes could be designing similarly to the Spark email client, which PC Magazine says is a lot cleaner and easier than Gmail, which keeps cramming in non-email features like to-do lists and meeting scheduling. Spark’s $60-per-year individual plan includes offers grouping and prioritization, “send later” and reminders, natural language email search, and an AI-powered email summarization and creation assistant. The team version adds collaboration functions. Twobird offers similar functionality for free.

Epic notes that all of the people who provide services to support its just-concluded UGM – including golf cart tour guides and A/V techs — are its own employees. The company ordered a record-breaking 9,000 doughnuts from a Madison doughnut shop for them.

Sponsor Updates

• EClinicalWorks offers a new customer success story, “Boosting Patient Satisfaction with Healow Secure Text.”
• First Databank releases a new Faces of Digital Health Podcast, “Bringing EPrescribing to the Next Level: To Patients.”
• Fortified Health Security names Lee Tomlin security analyst.
• Keysight enhances its Eggplant automated software test solution to enable multi-platform mobile app testing.
• Lucem Health releases a new This Week in Clinical AI Podcast.

Blog Posts

• Delivering the Right Information at the Right Time for Optimized Health Outcomes (Availity)
• Pharmacists can increase patient trust through aligned content (Wolters Kluwer Health)
• Lifting Up Patrons: How We Partner with Libraries (Findhelp)
• Five9 Advances to Platform Tier in ServiceNow’s Build Partner Program (Five9)
• Help Desk Updates: Your Super Weapon to Boost Clinician Productivity (HCTec)
• Community Partnerships: Empowering People Through Health Education (Healthwise)
• Building Community: Patient Engagement Solutions for Hometown Providers (Medhost)

Contacts

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

EPtalk by Dr. Jayne 8/31/23

Sometimes a marketing campaign just resonates with me, as did this one from Intelligent Medical Objects with its connection to “How to Train Your Dragon.”

I receive a tremendous number of emails from companies that are trying to get my attention or trying to get me to consider their products. The majority of them are annoying (especially the ones that address me as “Hey Jayne!”) but this one not only hit the mark, but gave me a smile as well.

Large language models are going to continue to be a hot topic for the foreseeable future, and the data used to train models can vary widely in quality. Bad data can lead to bias and unanticipated outcomes.

IMO continues to be a leader in the field of semantic interoperability, helping organizations make sure that data makes sense not only on the back end, but for the clinicians who have to look at it every day and the patients who are increasingly exposed to their healthcare data. I remember first implementing its products many years ago, and the fact that its ProblemIT solution was the only initiative for which my physicians actually sent me “thank you” emails.

New legislation is pending in the US Senate. The Behavioral Health Information Technology Coordination Act would provide $20 million in funding annually for behavioral health EHRs and would also require the development of standards for those products. Additionally, CMS would work with different bodies, including Medicaid, to promote EHR adoption and interoperability for behavioral health.

Many organizations have struggled with documentation of behavioral health care in EHRs, including keeping up with privacy regulations for different jurisdictions and age groups and dealing with information-sharing among the treatment team. Primary care physicians in the US provide a great deal of behavioral health services, but many find it difficult to get the information they need to adequately care for their patients, including histories of previous treatments and medication records. They sometimes struggle to coordinate with therapists, even when both are employed by the health system, because organizations are especially worried about inadvertent disclosure of this specially protected data.

In my area, it seems like the majority of non-facility behavioral health providers are not employed by large health systems. Many are independent and don’t participate with insurance companies, requiring patients to pay out of pocket. This shortage means that the wait time for a psychiatrist for Medicaid patients is 9-12 months, which pushes even more care to be delivered by primary care physicians. One health system recently opened a behavioral health emergency department to help address surging access needs, but it was quickly overwhelmed.

When you’re not taking insurance or participating in governmental payer programs, there is little incentive to use an EHR versus traditional paper documentation, especially when you’re not expecting to have to share data very much if at all. Behavioral health wasn’t initially included in the Meaningful Use incentive programs of the Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009, which also likely contributed to reduced technology adoption.

From Latent Luddite: “Re: technology’s unanticipated consequences. Did you see this article about autonomous car crashes in San Francisco? Great example.” I hadn’t seen the article before a reader sent it along, but the long and short of it is that General Motors is having a problem with its Cruise autonomous vehicles. As a result, they’re cutting the size of the San Francisco fleet in half while investigations are underway after recent crashes. In the most recent incident, a vehicle without a human driver was struck by an emergency response vehicle, leading to a request by the Department of Motor Vehicles to reduce the number of Cruise vehicles in service. The new guidelines call for no more than 50 vehicles in service during the day and 150 at night.

A recent decision by the Public Utilities Commission allowed competing autonomous taxi service Waymo to also operate in the city at all hours, so one can speculate as to what might be happening when services are competing for fares. The general manager of Cruise in San Francisco stated that the recent incident was “complicated by the fact that the emergency vehicle was in the oncoming lane of traffic, which it had moved into to bypass the red light.” I’ve been in plenty of situations in urban areas when an emergency vehicle is approaching and it’s difficult to figure out where it’s coming from due to echoes and clutter on the street. It’s also difficult to predict how other drivers might react when you’re deciding how to try to move your vehicle to get out of the way. Data from the company notes that Cruise vehicles have encountered emergency vehicles more than 168,000 times this year, which seems an amazing statistic to me.

The American Telemedicine Association recently rebranded its conference, which is now referred to as ATA Nexus 2024. The upcoming event will be held May 5-7 in Phoenix. I’m not a huge fan of conferences that run on the weekend and also spill into the workweek, making them the worst of both worlds. ATA has moved its conferences back and forth in the last couple of years, so it will be interesting to see whether this format is better attended over time. There is quite a bit of work to be done in telehealth, especially in the legislative and policy arenas. I anticipate this conference will continue to be a hot ticket for those focusing on that particular modality. The conference’s call for speakers is open and interested parties can submit proposals through September 22.

I recently met up with a colleague whose employer provides multi-week sabbaticals at certain employment milestones. We discussed that having time away from work often makes people think about how they manage their time, whether they have acceptable work-life balance, and how they want to manage their priorities moving forward.

My friend spent his sabbatical in a relatively spartan location, leading him to think twice about the luxury he came home to, with its large TV and what he describes as “entirely too much sporting equipment.” He said the most profound thing he experienced was a desire to better explore and experience his hometown, which he felt he’s been limited in doing by the hours he works.

I’m personally a big fan of the staycation, which is a great way to explore your surroundings and figure out what you might be missing out on. Our conversation reminded me of the need to take time for myself, so I’m hiking with a friend this long holiday weekend. Fortunately, the weather has calmed down a little bit, so I’m looking forward to seeing what the trail has to offer.

What are your plans for the long weekend if you’re able to take time off? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 8/31/23

OpenAI releasing version of ChatGPT for large businesses

OpenAI releases an enterprise version of ChatGPT that features enhanced security, privacy, and speed.

Better Life Partners Raises $26.5 Million in Series B Financing

Hybrid substance use disorder treatment company Better Life Partners raises $26.5 million, bringing its total raised to $38 million.

Houston hospital opens tech hub in the Ion

Houston Methodist opens a 1,200 square-foot Tech Hub to showcase innovative solutions it’s implementing in the hospital setting and to promote cross-industry collaboration.

Healthcare AI News 8/30/23

News

OpenAI releases an enterprise version of ChatGPT that features enhanced security, privacy, and speed. The product overlaps the offerings of the company’s investor Microsoft, which provides a similar offering as part of Azure. The ChatGPT service costs $30 per user per month.

Hackensack Meridian Health will work with Google Cloud on generative AI projects, while HCA Healthcare announces similar plans.

Business

Viz.ai will commercialize three ECG AI algorithms that were developed by UCSF. The algorithms detect cardiac amyloidosis, pulmonary hypertension, and supraventricular tachycardia.

AI-powered, message-based care provider Curai Health joins Amazon Clinic’s virtual care marketplace.

Drug maker Bayer expands its digital therapeutics business with a partnership with Mahana Therapeutics, which offers an FDA-cleared digital product for irritable bowel syndrome.

Research

A consumer research survey finds that 82% of Americans haven’t used ChatGPT, 81% of them don’t expect it to have a major impact on their jobs, and 85% don’t think it can help them do their work.

A study of EHR data in Israel finds that AI can predict food allergies in newborns, surprising researchers who found a significant correlation in the exposure of pregnant women to antibiotics. They conclude that the antibiotics may have interfered with the babies’ microbiome, which influences allergy development.

ChatGPT successfully improves the readability of patient consent forms, researchers find, creating versions that are shorter and easier to read. The required reading level dropped from college freshman to eighth grader.

ChatGPT-generated cancer treatment plans are full of mistakes, researchers find, where one-third of the tested plans contained incorrect information. ChatGPT also mixed correct and incorrect information together in a way that made it hard for even experts to detect.

Other

KFF News headlines a story about Bamboo Health’s NarxCare as “Artificial Intelligence May Influence Whether You Can Get Pain Medication.” The software predicts the likelihood that a patient will overdose based on their documented use of narcotics, sedatives, and stimulants. CDC has warned providers to make sure use of the algorithm doesn’t harm patients, such as turning them away for visits or denying them medications for documented chronic pain, and has voiced concern about “proprietary algorithms” whose methods are not transparent.

A startup sells Nextflix-type subscriptions to access the AI clones of celebrities who earn recurring earnings for doing little more than providing content from elsewhere and setting the guidelines for how their clones will operate. Experts fear the chatbot will worsen loneliness and encourage replacing human interactions with “parasocial” ones. The founders noted the success of a YouTube influencer whose “virtual girlfriend” earned her $71,000 in its first nine days.

Contacts

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

HIStalk Interviews Charlie Harp, CEO, Clinical Architecture

Charlie Harp is CEO of Clinical Architecture of Carmel, IN.

Tell me about yourself and the company.

I’m a developer by training. I’ve been building systems in healthcare for about 35 years. Back in 2007, after working for a bunch of different companies, I started Clinical Architecture to focus on the plumbing of healthcare, such as semantic normalization, data quality, and gaining insights by looking at patient data.

The industry has more technical pipes available to exchange data, but have we equally advanced terminology and semantic issues?

In the last few years, people have become a little bit more sophisticated in how they share data. USCDI has driven some folks, through the Cures Act, to at least try to share more data. The guidelines we have are still a little fuzzy in terms of being more guidelines than rules. We have made some progress, but we are still dealing with people that might have access to the data through something like data exchange. I think TEFCA  is going to continue this, but I still think there’s a lot of hesitancy to accept that data when you get it.

The last time we talked, you said that providers don’t trust each other’s data, and that one provider doesn’t have much incentive to clean up their own data that they have already used for someone else’s benefit. Has that situation improved?

A little bit. We started doing a data quality survey last February. People generally did not think very much of their own data quality. Most of them — depending upon the domain, whether it’s drugs or labs — had some level of confidence, but they didn’t have high confidence in the quality of that data. The only thing they had less confidence in was the quality of other people’s data, which I thought was interesting.

The problem we have in healthcare today is that we gather information as a byproduct of the process of providing care. Providers rely heavily on their notes to go from one patient encounter to another. They fill in the structured data because they have to.

We have this illusion on the analytics side of healthcare that the structured data is of high quality. When we go to share the data, most of these systems — whether it’s Epic, Cerner, Meditech, or whatever — are still using dictionaries that were developed for that EMR, with code systems that are specific to the EMR. They still have to be normalized on the outbound.

The challenge with people sharing data out, especially if it’s a regulatory requirement, is that it’s a “letter of the law” as opposed to “the spirit of the law” type of engagement. The data is leaving, and people tend not to care as much about the data that’s leaving as they do about the data that’s coming in. The problem with the data coming in is that, to the people who sent it, it was data leaving, so it wasn’t as important to them.

Do those clinicians who don’t trust their own data at least have confidence in the subset that they need to treat patients, or do they create their own notes or records?

It’s a combination of the time famine that providers have. They don’t have a lot of time. A handful are aware and plugged into what’s happening with health informatics and interoperability, but a lot of them in the trenches are just focused on how to provide the best care while complying with the things they are being asked to do by their organization. A lot of them, at least the ones that I talk to, tend to still rely heavily on their unstructured notes to go from encounter to encounter.

A few years ago, we looked at the structured data and did inferencing to find patients who were undocumented diabetics, patients who had no mention of it in the structured medical record. We looked for other indicators, like the fact that they had a hemoglobin A1C that was out of whack, or they were taking something like insulin or metformin. In six months, we found 3,600 undocumented diabetics. When the folks we were working with presented that finding to providers, the feedback was pretty universal — I know those patients are diabetic, that’s why I gave them metformin.

The problem is that there’s a disconnect between the provider, who is legitimately just trying to take care of people, and the unintended consequence of not having the structured data in the system. That means that your quality measures are out of whack, your patient management software is not scheduling foot exams. There’s still a disconnect between why you put in the structured data in the first place and all the downstream systems that consume that. Analytics, machine learning, and AI, all these things that we want to embrace and leverage in healthcare, depend on the structured data being there and being correct. We are pretty far off from that, unfortunately.

Does AI offer opportunities to structure that data using free text notes or audio recordings of encounters?

We have done a lot with NLP and also evaluated what’s going on with large language models. The problem in healthcare is that when it comes to data, it always falls back to trust.

If I could wave my magic wand and fix healthcare, I think what I would change is the way that we collect the data, so that we are collecting structured data without turning the provider into a terminologist to make that work. The problem we have is that providers don’t want to go to a list and pick something. They want to be able to articulate something in a way that is natural and organic for them, and then get it back in a way that’s natural or organic. We’ve had two worlds, one where you create a note and the other where you put things into a list.

I think the real answer is finding a way where the provider gets what they want. They say something in a way that’s granular and organic. We capture in a way that preserves the granularity of that information in high resolution, and can leverage that from an analytics perspective. When the provider wants to see the data, we can deliver it in a way that’s organic to them instead of them looking at a list and reconciling things. We’re a little bit off from that.

The problem with what we are doing now is that we are trying to find an easy way out. We’re saying, let’s just take the note and use NLP, a large language model, or something else to read the note and turn the note into something structured. You can do that, and we have had some success when it comes to high-certainty type data like pulling ejection fraction out of a procedure note or looking across a complete patient record and coming back with a sense of the patient’s diabetes because I found all these references that I can correlate to that. But you still run into the problem of, how can I trust that?

When you look at all the things that are happening in the industry now with AI, large language models, and NLP, there’s a lot of talk about transparency. In the past, when people have tried to do things in healthcare with these types of approaches using NLP or AI, it hasn’t been successful. The machine works great 60% of the time, and then 40% of the time it does something horrifically wrong. That comes back to this idea of trust. If you are taking care of somebody and their life is in your hands and the machine just happens to pick that day to follow the wrong probabilistic pathway, that’s challenging in healthcare.

Thinking back to providers not trusting their own data, is that a vague impression or is it measurable? What could they measure to assess or improve data quality?

When I’m working with clients, I sometimes ask them this question, so I’ll ask you. When it comes to healthcare data for an individual patient, who is responsible for the quality, accuracy, and integrity of that one patient’s data, regardless of where it is?

Some would say the patient, although that’s not a reasonable expectation for all types of data.

The problem is that patients aren’t really trusted to do that. You can fill out a form, hand it to somebody, and they’ll type it in, but rarely is a patient trusted to own and articulate, “Here’s my health situation.” It usually has to be vetted by some kind of clinical person.

That’s fine, but it goes back to this root problem that nobody is responsible. There is no data steward for an individual patient’s health record. When you talk about how you trust the data, the fact that I can take one patient and look across multiple venues of care and see different information. They don’t really trust each other and where their data is coming from. They don’t know whether that ICD-10 code was added for billing purposes or added for clinical purposes.

The problem we have in healthcare is that we don’t have a mechanism that allows us to objectively and quantitatively look at the data and say that the quality is good or bad. We are working with other organizations to do this taxonomy for healthcare data quality, because I think that we should be able to look at patient data in an abstract way and say, is the quality of this data good? Is there duplicate stuff? Is there old stuff? Is there stuff that’s clinically impossible? Are there things in the medical record that contradict themselves?

How can we automate the evaluation of that semantic interoperability so that you don’t need a sweatshop full of clinical people looking at 5 million patient records? How do you build something that can objectively, with some type of deterministic AI, evaluate an individual patient and any data that comes in for them to say, yes, this all makes sense. It looks real, and I just noticed that there’s no mention of this patient’s diabetes, whether you’re looking at unstructured notes and pulling it out.

At the very least, you should pull the data, check it against the integrity of the rest of the medical record, and say, yes, the fact that the note says they are diabetic resonates with the fact that they’ve got a funky fasting blood sugar and they’re taking these three medications that are indicated for diabetes. Let’s go ahead and suggest that they add diabetes to their official structured medical record so that we can take advantage of that. All these things that only look at the structured medical record and retain the evidence of where that came from. Those are some things that we could do to improve the level of trust and the reliability of the data.

My big fear is that we start to roll out some of these more sophisticated things that could be beneficial, but because the data quality is bad, we fumble the results early on and these things fail, and because we applied them before the data quality was ready, people don’t have confidence. You only have one opportunity to be credible. You come in with this new technology and say, “This is going to save lives. This is going to do great things.” But because the data that we are feeding it is bad, it is very possible and probable that the results of what it comes up with will be likewise bad. We will flip the bozo bit, as they used to say, on that thing. Then later, when we fix the data quality, we say, “No, we tried that and it didn’t work.” But maybe it would work if we fed good quality data.

What is the oversight structure and mechanism of reviewing the longitudinal patient record from multiple providers and identifying missing or conflicting data? Then, going back to the data source and either asking them to fix their problem or perhaps excluding their data as being unreliable?

The first place is the pipes. Look at what’s happening with TEFCA and QHINs. Let’s say the QHINs turn on their pipes and people start streaming data from Point A to Point B for every patient. The first thing we need to do is, somewhere in that pipe, we need to have something that looks at the message. Is the message right? Does the data look fundamentally correct? Not clinically correct, but is a valid code in the value set? Let’s say it’s an RXNorm code. Does the name match what RxNorm says that code stands for? So the first thing you do is evaluate someone in the network to determine whether they are a good data provider.

If they’re not a good data provider, you can’t really remediate data quality in flight. You have to go back to the source and say, you’re not a good data provider. This is what our taxonomy is focused on. By identifying the nature of the quality failure, you can go back and say, you’re putting the decimal place in the wrong spot on your lab results. You are not using a valid RXNorm code set. Your maps are bad. Whatever the feedback is.

The first thing we need to do is to make sure that the people that are sharing data from their systems are good members of society who care about the data they are sending out and are making sure that the quality is good. QHINs are going to be in a great position to evaluate the data in flight at a basic level and say, OK, the data that you are sending looks clean, looks good, and has good intrinsic quality. That’s the first step, because that’s where you stop bad data from getting out.

We also need to do a better job of knowing where data’s coming from originally so that we can stop duplication. We worked with a partner who gave me a bunch of data to evaluate, data that was coming from a bunch of different sources. In a couple of million records, there were about 750,000 duplicates, the exact same lab result done at the exact same time. Because of the way the data was shared in some of these older formats, you had no idea that that was the same data. It just looked like this patient had 64 lab results on the same day at the same time.

That’s the other thing, if we want to trust data, we need to know where it originally came from, especially as we start sharing data across an entire network of participants.

The last thing is you need is a way where we are landing it or looking at the data in our own system, saying, does it look right for every condition that I have? Do I have a treatment for every drug that’s in their profile? Do I know why they are taking that drug? This goes back to what you are talking about when it comes to oversight. Within any repository of patient data, perhaps a large IDN doing analytics or population health on your patients, we need to have mechanisms that can identify issues in the patient. Data can alert a human operator. Let’s call them a data steward. The data steward can inform the systems that they are connected with on how to remediate the data.

There needs to be oversight. The trick is, how do we have enough automation in place so that instead of a human looking at 5 million patients, automation is looking at 5 million patients for things that are a concern, and streamlining the resolution of those things? Because it’s easy for a human to be presented with something and say, “Yeah, that looks right,” as opposed to humans poring over data looking for something. That’s why when we do semantic normalization, our software does like 85% of the work, where it tries to search for the right target and it suggests the target. A human can take two seconds to look at the target and say, “That’s right.” We need to get to the same place when it comes to patient data.

It’s one of those things where the idea of having people whose job it is to review issues that come up with patient data and resolve it at a patient level might seem a little daunting, but the problem is, that’s the only way we can fix it. You have to fix it at the atomic level to have the entire ecosystem be of high quality. There’s no way to do it at a macro level. You have to do it at an individual patient level.

What factors will be important to the company and the industry in the next few years?

For us to use artificial intelligence and some of these other things that we are coming up with in a meaningful way, we are going to have to move away from pre-coordinated terminologies as how we collect data for patients. We’re going to store patient information in a much more granular graph style, so that both software and people can make better use of it. Right now, everything we do with the terminologies and practices that we use today create these big pixels of information that limit our ability to do sophisticated reasoning over that data, whether it’s for research purposes or for decision support purposes. We’re going to have to dial up the resolution to get to where we want to be in terms of software providing meaningful assistance to people that are providing care.

Morning Headlines 8/30/23

In project ‘Secret Tiger,’ Nomi Health copied a Texas COVID-19 app, lawsuit claims

A federal judge orders COVID-19 testing firm Nomi Health to pay $7 million to Texas software developer OSGHD, who sued Nomi for licensing its product only long enough to copy its design to create its own system.

HSHS, Prevea get some phones back, but outages continue

Hospital Sisters Health System (IL) and affiliate Prevea Health (WI) revert to downtime procedures after an unidentified outage forces their systems offline.

TPG and Crowe LLP to Establish Crowe Healthcare Consulting as Independent Company

TPG will acquire a majority stake in revenue cycle software and services company Crowe Healthcare Consulting and rebrand it as Kodiak Solutions.

News 8/30/23

Top News

ONC renews The Sequoia Project’s TEFCA management contract for another five years.

The non-profit will also continue to oversee the development of Qualified Health Information Networks, with seven of them underway.

Webinars

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

Acquisitions, Funding, Business, and Stock

Healthcare market intelligence startup Bonfire Analytics raises $1 million in a pre-seed funding round.

Sales

• Zyter|TruCare integrates Findhelp’s care and social services referral software with its Connected Health data-sharing technology.

People

Chris Betz (Brightside Health) joins Aptihealth as CTO.

Ascom Americas hires Chris LaFratta, MBA (VieCure) as VP and head of strategic service innovation.

Adam Farren, MBA (Osmind) joins Canvas Medical as president and COO.

Virtual care and remote patient monitoring solution provider TimeDoc Health hires Brian Esterly, MBA (Centria Healhcare) as CEO.

Announcements and Implementations

IBM trains a Watson large language model to convert legacy COBOL applications to Java, noting that enterprise systems around the world execute 800 billion lines of COBOL code every day.

Government and Politics

A federal judge orders COVID-19 testing firm Nomi Health to pay $7 million to Texas software developer OSGHD, who sued Nomi for licensing its product only long enough to copy its design to create its own system. The state of Utah has paid $84 million to Nomi for COVID testing and vaccination, which it originally attempted to run on a system from Qualtrics that it claims couldn’t handle the required volume.

Privacy and Security

The Rhysida ransomware group claims responsibility for the cyberattack on Prospect Medical Holdings. The group has put the stolen legal and financial documents of 500,000 Prospect employees up for sale on the dark web. Prospect has been struggling to get networks at its 16 hospitals back up and running since the attack occurred on August 3. Crozer Health, a Prospect hospital in Pennsylvania, announced last Friday that all of its computer systems were again operational.

Hospital Sisters Health System (IL) and affiliate Prevea Health (WI) revert to downtime procedures after an unidentified outage forces their systems offline. All systems are unavailable at 15-hospital HSHS. Pediatric hospitalist Maddie Mier, MD reports on X that she’s not the “Improvise, Adapt, Overcome” kind of doctor and needs Epic for “my chart stalking routines & easy access to things like.. VITAL SIGNS.”

Other

Oracle Health Chairman David Feinberg, MD, MBA purchases The Weeknd’s furnished Los Angeles penthouse for a cool $19 million. Dubbed “The Mogul” by building management, the 8,000 square-foot pad includes four bedrooms, six bathrooms, a gym, wine vault, and views from four balconies.

Sponsor Updates

• CloudWave sponsors the Firelands Health “Caddyshack” Open Golf Outing.
• EClinicalWorks releases a new podcast, “Empowering Communities, Analytics for Better Patient Care.”
• Nordic releases a new Designing for Health Podcast, “Interview with Matt Sakumoto, MD.”
• CereCore publishes a new case study, “Next Generation EHR Meets Surgery Partners.”
• Healthcare IT Leaders refreshes its board.
• Constellation Research names Artera to its Shortlist for top vendors in the healthcare clinical communication category.
• A new KLAS report recognizes AvaSure as a complete virtual care platform that improves patient safety while reducing costs and staff workloads.
• Baker Tilly releases a new Healthy Outcomes Podcast, “Exploring home and community-based services: Insights and considerations for healthcare organizations.”
• CHIME releases a new Leader 2 Leader Podcast, “Workforce Issues in Healthcare Today: Top Challenges and How to Solve Them.”
• Clearwater enhances its managed security services capabilities, establishing a new partnership, hiring new experts, and signing on new customers.
• Clinical Architecture publishes a white paper, “Leveraging Artificial Intelligence to Enable Real-time Semantic Interoperability.”

Blog Posts

• An Operation Leader’s Take on Partnering for Meditech Expanse Projects (CereCore)
• Advancing Revenue Cycle Management Maturity Through Technology and Interoperability (AGS Health)
• Success in transitional care management (TCM): The first 30 days (Arcadia)
• How Arrive Health is Creating a Better Prescribing Experience, Including Eliminating 87% of RTPB Noise (Arrive Health)
• Top 5 eligibility mistakes to avoid for a healthy revenue cycle (Availity)
• Key strategies for healthcare providers implementing the No Surprises Act (Baker Tilly)
• The True ROI (and Cost) of Legacy Data in Healthcare (Clearsense)
• CMMC 2.0 Compliance is Around the Corner: Is Healthcare Ready? (Clearwater)
• Role of Epic Consultants in Epic Upgrades (HealthTech Resources)

Contacts

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

Morning Headlines 8/29/23

AI-Powered Bonfire Analytics Raises $1 Million in Pre-Seed Round

Healthcare market intelligence startup Bonfire Analytics raises $1 million in a pre-seed funding round.

ONC Awards The Sequoia Project 5-Year TEFCA RCE Contract

The Sequoia Project will continue to manage the implementation of the Trusted Exchange Framework and Common Agreement and associated establishment of Qualified Health Information Networks.

Healthcare Governance Body Warns Hospitals Face Debilitating Cyberattacks

The Joint Commission issues new cybersecurity guidelines that advise hospitals to be prepared for at least a month of downtime in the event of a cyberattack.

Curbside Consult with Dr. Jayne 8/28/23

I enjoy working with residents and students, so I was glad to see this recent article looking at the role of electronic health records in medical residency training programs.

When I was working in the EHR industry, I saw a tremendous variation in how organizations wanted to treat learners with respect to electronic documentation. Some organizations would not allow students to access the EHR in any capacity other than read-only, which almost certainly hampered their abilities to learn how to manage the EHR when conducting patient interviews or when taking a medical history. Others would allow students to have limited interaction with the EHR, but placed their documentation in a separate clinical note, distinct from the attending physician and others on the care team. This approach is problematic because it fails to see the student as a member of the care team, and also creates additional work for the attending physician to perform completely separate documentation rather than being able to update and affirm the student’s documentation.

As far as residency programs, I’ve seen a wide spectrum of access and EHR usage there as well. I’ve seen organizations that have graduated security groups, where interns have less access than lower-level residents who may have less access than the highest level of residents. It can be complicated to advance everyone to different security groups from year to year, especially if an entire class doesn’t advance at the same time due to taking family or medical leave or having to repeat a rotation.

Generally speaking, in the US, a physician who has completed the intern year and who has passed the appropriate licensing exams can get a permanent medical license (as opposed to a training license), which might bring with it their own DEA number and state controlled substance number. This becomes fun when the resident might be rotating on some services as a learner and needs to operate under one set of credentials but also moonlights on a different service at the same hospital under their permanent credentials.

A friend of mine who works in the process improvement department at a major health system has been asked to do a pilot project around these issues at one of the hospitals, which is having challenges getting its residents the right access to do their jobs. It will be interesting to see how that unfolds since they won’t have the opportunity to pilot the new workflows until the next class of interns is selected in March 2024.

Back to the JAMIA article, it looks at the ways in which EHRs impact resident clinical skills and how the systems’ use impacts patient encounters. The authors conducted qualitative interviews with 32 residents and 13 faculty members or clinical staff in an internal medicine residency program affiliated with a US medical school. The latter point is an important differentiator, because not all training programs are affiliated with medical schools. Those that aren’t are referred to as community-based programs, and although some provide the same experience as those programs that are associated with medical schools, there may be some subtle differences in how residents interact with preceptors and other members of the teaching staff. Although that’s a relatively small sample size and only represents the experiences of those in a single medical specialty, the authors had some interesting findings.

For background, the authors note the breadth of EHR use in the US, with 96% of hospitals and 78% of office-based practices using certified EHRs. I visited one of that remaining 22% of medical practices just last week and gazed with nostalgia at their giant rolling racks of patient charts. I didn’t envy the physician scribbling away during my visit, but I felt I received good care in a timely way, so I didn’t miss the presence of an EHR in the visit. Interestingly, I also received an invitation to visit the practice’s patient portal, so I’ll have to see what it actually contains when I get some free time. The authors also note the continued increase in EHR documentation requirements in the US, which has been partially enabled by the presence of EHRs.

I found it interesting that the researchers interviewed residents on days when residents were scheduled to be in an outpatient clinic, although they noted that they selected days where “resident schedules at the clinic were typically less busy.” The authors, who are also faculty members at the residency program, would ask the residents to be interviewed “during a break in their day,” which is interesting as to the other stressors that residents might have been experiencing at the time of the interview. I’ve done plenty of qualitative research in my career, and I think I might have been more inclined to schedule interviews outside of the clinic environment. The approach they took only allowed them to interview 32 of the program’s 54 residents, but the authors noted that “repetition of responses and minimal novel information in later interviews indicated we had reached sufficient saturation in our sample.” The average interview lasted 23 minutes and was recorded. Interestingly, the recordings were initially transcribed using an AI-based web site, then were reviewed by paid assistants, with one of the authors conducting a final verification of the transcripts.

During the interviews, residents noted that the need to address quality measures during patient encounters added some challenges to the use of the EHR and contributed at times to shifting focus away from the primary reason for the patient’s visit. Addressing those measures also took time that some felt could have been spent coming to a diagnosis and creating a treatment plan for the patient’s presenting concern. The study methods indicated that patients were roomed by a medical assistant who took some preliminary information from the patient but who didn’t address quality measures. Based on some of the participant comments, it’s clear that data was in the chart for the provider to update the quality measures, so it’s unclear why the organization wouldn’t use a less-expensive resource, such as the medical assistant, to update the quality measures as opposed to expecting the physician to do it. That seems to violate one of the key tenets of clinical efficiency, which is to have all members of the team working at the top level of their licensure.

Most of the residents said they spent more than half of their clinic time working in the EHR and often had to access it at home. Although some residents felt that use of the EHR became easier as they worked through the training program, multiple senior residents felt they were still struggling with the EHR. Additionally, residents often had to ask questions about EHR use on the fly. Although that’s a great way to develop lifelong learning skills, it can be frustrating when you’re early on in your training and trying to learn the nuts and bolts of seeing patients. The authors found that due to these sentiments, some residents actively tried to avoid or at least minimize EHR use during patient visits.

Some of the raw resident comments were included. I found this one very telling as far as whether a good clinical informaticist was involved in the system build: “They just have these yellow boxes and some administrators told our attendings that we absolutely have to click these yellow boxes. But it’s basically just redundant because I’m already doing it. But if I don’t do it their way, then it doesn’t give them a little green light in their system.” It makes me sad to know that there are still systems out there that lack intelligent design and configuration.

The authors note that while it’s important to develop a culture where residents ask questions about EHR use, it’s also important to note that not everyone enters residency with the same experience with EHRs, the same computer skills, or the same motivation to learn. One faculty member described the EHR training that residents and faculty received as “frankly terrible and doesn’t really prepare you for the actual application or use of this software.” Residents reported learning from each other and from medical assistants as well as from the faculty, but I didn’t see any mentions of them reaching out to dedicated EHR trainers for additional support beyond their initial orientation training.

It definitely seems like a missed opportunity for education, especially since best practices for EHR implementation involve regular follow-up training to solidify skills and teach new content. This would also help counter any inhibitions that residents have about asking for help, if follow-up training is just part of the program for everyone.

The authors conclude by calling on residency programs to “find ways to effectively support their residents’ learning to incorporate EHRs into their work and streamline documentation requirements to maximize the development of residents’ clinical skills.” Since the authors are faculty at the residency program where this study was conducted, it would be interesting to see some follow-up on whether they were successful in changing some of the roles and responsibilities distribution found in team-based care in order to meet this objective. For example, did they hire additional medical assistants to better support the residents? Did they arrange for additional training to ensure mastery of the EHR? If anyone is connected with the University of Nevada Reno, I’d be interested to hear any updates.

What are your thoughts about EHR use by residents and other trainees? Leave a comment or email me.

Email Dr. Jayne.

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