News 4/28/23

Top News

Virtual care platform vendor EVisit acquires Bluestream Health, which offers digital front doors and virtual workflow tools.

Click the image above to enlarge.

I interviewed EVisit CEO Sachin Agrawal a few weeks ago and Bluestream President Brian Yarnell last February.

Reader Comments

From Wormser: “Re: Google’s C4 data set training web sources. Is it good or bad that your site was used?” Probably good, but with an asterisk. I was initially happy to see that HIStalk contributed 3.4 million tokens to the model in being among the top 2,000 of 15 million sites that it scraped, at least triple that of the next-highest health IT site (HIMSS-owned Healthcare IT News). The model also prioritizes the most important and well-regarded sites, so that’s a plus. Negative: that means I’m involuntarily contributing a lot of decades-long work for free, which I rationalize that it’s free to read anyway. The top-used sites were patents.google.com, Wikipedia, Scribd (which is kind of a surprise), the New York Times, and the PLOS open access journals. The real story is that it’s good to question a model’s training sources and to consider the commercialization rights of the owners of that information, which will be especially important in healthcare.

HIStalk Announcements and Requests

I hate getting names wrong knowing that spellcheck can’t help me, so I was appalled to see that I mistyped the name of RxLightning CEO Julia Regan as “Julie” in our recent interview. I fixed the error, but my self-beratement continues, and I am reminded yet again that everybody needs an editor.

A friend asked for help polishing their resume and creating a cover letter, which of course I pasted into ChatGPT to create documents that left even a persnickety writer like myself with nothing to correct. I was thinking during the process that employers will have a tougher time selecting candidates based on their writing skill as a proxy for intelligence and attention to detail since ChatGPT makes everybody seem smart.

Webinars

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

Acquisitions, Funding, Business, and Stock

Kaiser Permanente will acquire Geisinger Health in forming Risant Health, an independent, non-profit community hospital operator. Kaiser says it will invest $5 billion in Risant over the next five years, during which Risant will add up to six more health systems. The two organizations, both of which reported operating losses in 2022, say that Risant hospitals will benefit from Kaiser’s ability to invest in technology and preventive care.

LexisNexis Risk Solutions acquires Human API to create a seamless method of delivering health records for life insurance underwriting and care coordination.

People

Scott Sanner (Citra Health Solutions) joins Millennia as CEO.

Patient advocate, journalist, and “comedy health analyst” Casey Quinlan died this week of breast cancer.

Announcements and Implementations

Amazon shuts down its Halo Health wearables division and lays off its employees. The fitness tracker and subscription service was launched in August 2020 and Amazon announced its sleep tracking system Halo Rise in September 2022. The company started another round of layoffs Wednesday in its cloud computing and HR departments, pushing its total in the last few months to 27,000.

PMD – which offers solutions for secure communication, telehealth, charge capture, and RCM — launches a patient demographics management platform for medical practices

Eagle Ridge Hospital goes live on Meditech Expanse.

Rady Children’s Hospital and Sentara Healthcare implement Juniper’s AI-driven network technology to support reliable wi-fi and indoor location services.

AvaSure launches a virtual nursing application and care model, expanding its TeleSitter solution. I interviewed CEO Adam McMullin a few weeks ago.

Amazon Web Services increases its operational database workloads for Epic users by 61%, up to 42 million GRefs/s. 

The Columbus business paper profiles AndHealth, a chronic disease reversal telehealth company that was created by CoverMyMeds co-founder Matt Scantland. The company reports that its migraine patients had 70% fewer missed days of work. I interviewed him in February 2022.

A new KLAS report on health system capacity optimization management finds that LeanTaaS and Epic lead, while Qventus shows positive impact in the perioperative area. Users of Epic’s applications (Grand Central, Cadence, OpTime, MyChart, Cogito, Slicer Dicer, and Cognitive Computing) report strong out-of-the-box functionality that they home will be enhanced with AI/ML, actionable reporting and visualization, and a more consistent mobile experience, especially for Android devices.

Government and Politics

The VA, DoD, and Coast Guard experience another Oracle Cerner EHR downtime Tuesday, with the cause of the four-hour outage attributed to a failed database process.

Rep. Cathy McMorris Rodgers (R-WA) calls for the VA to terminate its contract with Oracle Cerner, calling it a “complete failure” that has harmed patients and employee morale. She says that “there is no coming back from the mess that the Department of Veterans Affairs has made with this deeply broken system.”

Privacy and Security

Six people, five of them former employees of Methodist Hospital in Memphis, plead guilty to HIPAA violations for selling the names of patients who were involved in car accidents to personal injury lawyers and chiropractors.

Other

Apple provides updates to its Hearing Study, which uses its Noise app for the Apple Watch to warn users of potentially harmful noise levels. It has found the one in three US adults are exposed to excessive noise levels, often involving traffic, machinery, and public transportation. I would imagine that many restaurants and bars would be embarrassed by their quantified noise levels, where one loud table can create a sonic escalation in which everyone is suddenly shouting. Surveys have show that while bad service tops the annoyance list of restaurant diners, noise levels are ahead of bad food, which is ironic given that some restaurants pride themselves on creating a noisy environment that conveys energy and hipness (65 dB is the maximum for comfortable conversation).

Sponsor Updates

• Flagstaff Surgical Associates (AZ) upgrades its EClinicalWorks software and implements Healow Pay and Healow Check-In.
• Elsevier launches an enhanced version of its ClinicalKey decision support tool, which includes an extensive drug compendium, mobile app, and deeper EHR integration.
• Consensus Cloud Solutions joins the AWS Independent Software Vendor Accelerate Program.
• GHX names 87 healthcare provider and supplier organizations to the 2022 GHX Millennium Club.
• HCTec will invest in expanding its operations in Hohenwald, TN, creating 100 jobs over the next five years.
• Clinical Architecture posts Episode 26, Discussing Data Quality, of “The Informonster Podcast.”
• Specialty medication technology company RxLightning wins a Disruptor of the Year Mira Award.
• Healthjump will exhibit at the NAACOS Spring Conference May 3-5 in Baltimore.
• Meditech congratulates 44 customers included among The Chartis Group’s Top 100 Critical Access Hospitals and Top 100 Rural Community Hospitals.
• Mobile Heartbeat’s MH-Cure clinical communication platform now integrates with Akkadian Provisioning Manager, enabling zero-touch provisioning for users.
• Google Cloud’s new Claims Acceleration Suite uses Myndshft prior authorization software to enable quick and seamless submission of PA requests.

Blog Posts

• Creating the Triple-Win of Healthcare (Enlace Health)
• Reduce Medication Alert Fatigue with Patient-Focused Clinical Decision Support (First Databank)
• Hospitals Suffer Financially Post-COVID: What That Could Mean For The Future (HealthTECH Resources)
• Healthcare Burnout: Impact, Consequences & Administrative Burden (GHX)
• Harnessing the Power of Healthcare Data Sharing to Improve Patient Care (Healthcare Triangle)
• HIMSS23 Recap: The HIMSSanity is Back! (HealthMark Group)
• What Does Nuvolo’s Sweden Release Mean for You? (Healthcare IT Leaders)
• Saved by the Lab: Medical Laboratory Professionals Week 2023 (JTG Consulting Group)
• Investing in Centralized Provider Data Management to Power Digital Health Initiatives (Kyruus)
• Beyond RPA, AI, and Machine Learning: The Promise of Care Orchestration in Healthcare (Lumeon)
• Health Equity Hinges on Healthy Data (Rhapsody)
• Hospital Performance Monitoring: Navigating Revenue Margins and Improving Metrics (Medhost)
• Catch up on Meditech’s solutions at the 2023 Clinical Informatics Symposium (Meditech)
• Revolutionize Home Health Care with Wound Digital Imaging Benefits (Net Health)
• The future of ambulatory care documentation, part 2: How speech recognition helps ambulatory clinicians focus on what matters most (Nuance)

Contacts

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

EPtalk by Dr. Jayne 4/27/23

Lately, it seems like my travel is never uneventful. The trip home from HIMSS added to my recent adventures.

I scored my usual exit row seat and everything went normally during the emergency briefing. However, we had a delay on the tarmac and one of the passengers in the exit row in front of me started asking “have we left yet?” followed by chanting “let’s go, guys, let’s go, guys” over and over before ultimately quieting down. After we reached altitude, though, his behavior became more erratic and he was bothering the passengers next to him while asking over and over if we had taken off yet.

The flight attendants were on top of it, arriving in a group to invite the passenger to move to a seat in the back of the plane near the galley. He acted a bit disoriented, but was able to follow instructions, although the lead flight attendant had to tell him several times to stand up, grab his backpack, and follow them. As he passed by my row, there was a strong smell of alcohol, which made me wonder whether he chugged his drink at the gate to comply with the rules to keep alcohol in the terminal or whether there was something medical going on.

It was a short flight and the police were happy to meet us upon landing and escort the gentleman to an alternative destination, but I hope he was OK. I’ve got a few more flights planned for the next three months and I’d really like to have just one where nothing noteworthy happens.

While I was flying, a couple of readers sent me some pics on the last day of HIMSS:

Biofourmis had custom branded sneakers. Thanks to a reader for sending this picture along.

Spa Girl says she saw these in a shop on the Magnificent Mile and thinks I need these for my next beach trip. They are undeniably cute, but probably not the most practical for travel. I could see wearing them around the house with a plush robe, however, in the mode of a Hollywood starlet.

As long as the Wi-Fi works properly, I’ve found that I’m pretty productive on the plane. While cleaning up email, I spotted this article about the ongoing debate about policies that require workers to return to the office. The piece mentions a bizarre call where Clearlink CEO James Clarke questions his own employees’ ability to manage work/life balance. Apparently, there has been some confusion within the company over the last couple of months as to whether employees would be asked to return to the office or whether they had been hired under the assumption of a remote-first culture. The first group of employees asked to return include those who live within 50 miles of the company’s Utah headquarters.

During a company town hall meeting to explain the changes, Clarke went on a rant about employees that had not used their laptops for a month, which is as much a management issue as it is an employee issue in my book. Did those employees’ supervisors not notice that they weren’t working, or was Clarke just making this up? He went on to ask employees to increase productivity by “30 to 50 times” normal and challenged employees to outwork him. He went further to praise an employee who had gotten rid of the family pet as a result of the change to in-person work.

Not wanting to exclude anyone in his unhinged speech, he also criticized working mothers specifically and working parents in general, saying “only the rarest of full-time caregivers can also be productive and full-time employees at the same time.” Sounds like it’s time for the HR department to provide some education and the company’s executive leadership to consider an alternative direction.

Another article that caught my eye was about a golf cart accident at Wake Forest Baptist hospital in North Carolina. The tragic crash resulted in the death of a patient and injuries to the cart’s two other occupants. The cart had been used to transport patients and visitors between the facility and parking structures. An investigation is underway, but I hope it will prompt other facilities to look at how they’re using different modes of transportation on campuses. No one wears a seat belt on a golf cart, and in the event of a sudden stop or a collision, it’s not a lot different than being on a motorcycle as far as being ejected is concerned, except that you’re probably not wearing a helmet. The articles I saw didn’t specify whether the fatally injured party was a rider or was struck by the cart. My sympathies go out to the family of the deceased and those involved in the incident who will be forever impacted.

A recent article in JMIR Human Factors looked at the use of speech recognition technology in the exam room. This wasn’t the fancy AI-driven kind of speech recognition, but rather the old school dictation-style voice recognition approach that many of us have used in our careers. In the study, physicians completed the Assessment and Plan portions of the patient’s after-visit summary while still in the exam room with the patient. The summary was then printed and a survey performed. Compared to “usual care” without an in-room dictation, patients felt that providers were better at addressing patient concerns and felt that they better understood the providers’ advice. The authors concluded that patients have a positive perception of speech recognition use in the exam room.

I first saw this approach in probably 2011 or 2012, while shadowing one of the Oklahoma Family Physician of the Year recipients. He dictated every visit in the presence of the patient and gave them the chance to ask questions, and it had been part of his routine for years. It’s difficult to believe that more than a decade has gone by without more people using this fairly straightforward strategy.

As a clinical informaticist, I see plenty of examples of clinicians and their teams struggling to adopt strategies that have been proven to improve efficiency and reduce documentation burden. Nearly every health system I’ve worked with has a super-user program and many also have robust physician champion programs. However, there are always physicians who don’t want to take advantage of those options. I see people who will do the same inefficient workflows over and over because they don’t want to take an hour or two to personalize EHR features or save their own default Review of Systems or Exam templates. I see providers manually typing differential diagnosis paragraphs that they could save and use as a base for future notes when seeing common conditions. They say they’re too busy to save them as quick phrases, but I would argue that they’re too busy to not take the time to make their future lives easier. I’m not sure what the answer is or how to motivate some of the more resistant providers, but I’m open to ideas.

What good ideas can be found in your bag of EHR optimization tricks? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/27/23

UK’s TympaHealth sounds out $23M to expand its hearing diagnostics startup

London-based TympaHealth will use $23 million in new funding to begin marketing its digital ear and hearing healthcare platform to primary care providers, retailers, and pharmacies in the US.

VA’s new EHR hits another outage, as agency reconsiders FY 2024 request for project

The VA’s Oracle Cerner system experiences a nearly four-hour outage when one of its databases became unresponsive due to a failed background process.

Amazon closing Halo health division, lays off staff while offering hardware refunds

Amazon announces that it will shut down its Halo health wearables division at the end of July.

Healthcare AI News 4/26/23

News

Apple is developing a paid, AI-powered health coaching service called Quartz that uses the Apple Watch to encourage healthy behaviors. The company will also release a dedicated version of its Health app for the IPad.

Google merges its DeepMind and Brain team from Google Research into a single unit called Google DeepMind, which the company says will accelerate its progress in using AI to solve humanity’s biggest challenges.

Alphabet CEO Sundar Pichai says in the company’s earnings call that Google is investing heavily in AI, but downplays the potentially negative effect that it will have on search advertising. Microsoft CEO Satya Nadella says in his company’s earnings call that Bing has gained market share following early incorporation of AI in its search, and calls AI’s impact “a generational shift in the largest software category – search.”

OpenAI adds the ability for ChatGPT users to turn off chat history to avoid having their conversations used for model training.

Life sciences technology vendor Trinity Life Sciences offers its customers AI-driven insights powered by WhizAI. The conversational AI and visualization platform will provide analytics for Trinity’s enterprise reporting platform, allowing users to type or ask business questions to generate visualizations and dashboards.

PricewaterhouseCoopers will spend $1 billion over the next three years to automate parts of its tax, audit, and consulting services using ChatGPT and Microsoft Azure.

3M Health Information Systems will use AWS services, including machine learning and generative AI, to further enhance its clinical documentation and virtual assistant solutions that include ambient intelligence.

NIH awards Case Western Reserve University and University Hospitals a $6.2 million grant to study the use of AI to predict cardiovascular disease from the calcium scoring of CT images.

Unfold AI, an FDA-cleared prostate cancer management platform from Avenda Health, is being used in an unnamed US research hospital to offer treatment selection, planning, guidance, and follow-up.

Federal regulators will enforce existing civil rights laws when generative AI tools perform “digital redlining” in introducing bias into decisions about hiring, credit, and housing. EEOC Chair Charlotte Burrows says that rapid AI development is a “new civil rights frontier.”

Research

An analysis of the use of AI-powered conversational assistants for support inquiries shows a 14% increase in the number of issues resolved per hour, mostly improving the performance of inexperienced workers who are supported by the stored knowledge of their more experienced peers.

Opinion

The Verge notes the legal situation created by a viral song hit that was created using AI, prompting Drake’s record label to warn that training AI using the music of its artists is a breach of copyright laws. Skeptics question whether it was actually a record label PR stunt. The legal issue is that Google-owned YouTube pulled the track due to a take-down notice from the record label, but the record label doesn’t own the song, which then pits Google’s AI-enriched search against YouTube’s music partners about what constitutes fair use.

A HIMSS23 panel warns health systems that hackers will be launching AI-powered cyberattacks, predicting the rise in AI-operated ransomware and ChatGPT-crafted phishing emails that sound more authentic, but with security technology vendors also using the technology to build smarter defenses.

Other

Pharma bro and ex-con Martin Shkreli rolls out a medical chatbot called Dr. Gupta that he says will be a “replacement for all healthcare information” that will leave WebMD “dead in the water.” He says the new large language model was trained in data from the web and from online medical journals, using both GPT 3.5 and GPT-4 to improve performance with some sacrifice in response speed. Users can ask five questions for free, then sign up for a $20 per month subscription to Dr. Gupta. When asked about HIPAA concerns related to users submitting PHI to an online chatbot, Shkreli suggested on Twitter to read the terms to decide whether to use it. Meanwhile, Twitter has suspended Shkreli’s account, although his original post on Substack remains, where he argues that healthcare is expensive because of the artificially constrained supply of healthcare professionals. Shkreli also wrote a 200-page novel using ChatGPT. 

A Washington Post study of the 15 million websites on which Google trains its C4 data set places HIStalk at #1,996, representing 3.4 million of the data set’s tokens.

Resources and Tools

• DocLime – allows analyzing documents stored in PDF form to generate summaries, answer questions, or provide research citations.
• Zain Kahn, “The AI Guy,” lists ways to prompt ChatGPT for learning. Examples: “”Proofread my writing above. Fix grammar and spelling mistakes. And make suggestions that will improve the clarity of my writing” and “I want to learn about [insert topic]. Identify and share the most important 20% of learnings from this topic that will help me understand 80% of it.”

Contacts

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

Readers Write: HIMSS23 Recap

HIMSS23 Recap
By Mike Silverstein

Mike Silverstein is managing partner of the healthcare IT and life sciences practice of Direct Recruiters, Inc. of Solon, OH.

The HIMSS Global Health Conference & Exhibition was held April 17-21 in Chicago, where over 40,000 professionals gathered for educational sessions, visited vendor booths, and networked. Our company was excited to get back to HIMSS as a larger group and share these observations.

Trends

AI and tools such as ChatGPT are getting adopted into healthcare quickly. There were a few innovative companies already showing off their new ChatGPT features, which was extremely cool. We anticipate this trend continuing, with ChatGPT having strong use cases in many areas of healthcare tech. We’re just at the tip of the iceberg.

We noticed a pivot towards partnerships. With hospitals struggling, tech companies are putting a big focus on partnerships. Fundraising remains in a slowdown. However, we continue to hear about investments being made for companies going from seed to Series A or to A to B, not in later stages. Series B/C companies are conducting more inside rounds to sustain cash needs.

Direct-to-provider meetings seemed to be relatively slow. We saw a continued trend of companies who sell direct to providers that were looking at ways to break into the health plan space. As hospitals are taking a long time to buy and are very ROI-driven, RCM services are staying strong.

Interoperability has been a theme for over a decade now in healthcare and remains today. Conversation has shifted from inside the four walls of the hospital to how technology receives data and information from what is available globally. A “Designated Record Set” is pushing for provider compliance to ensure their technology integrates with all systems (HIE extender).

Hiring seems to be ramping back up, especially looking into Q3 and Q4. The emphasis remains mostly in revenue-generating roles at the moment. There is also a need for senior finance and accounting. Product and operations roles are hardest to come by.

General Observations

From an overall size and attendee standpoint, the conference seemed to be back to pre-COVID levels. It was key to have pre-booked meetings, but even then, some companies were no-shows. Microsoft’s booth (and Nuance), and surrounding areas were always packed with people. It was great to see a renewed energy at HIMSS despite the ups and downs of the industry over the past few years.

Constructive Feedback

The main hall was split into two sides. The north side felt a bit forgotten, and some did not venture out much to the booths on the fringes. In addition, there seemed to be a lack of places to sit, grab a good coffee, and most importantly, charge your phone.

The last piece of feedback is to bring back the carpet. We noticed one person trip and fall (luckily, they were OK) because of the lack of carpet-to-carpet transition at one of the booths.

Overall, our team is excited about the connections made and the new technologies we saw at HIMSS. We are energized by the passion and innovation of the industry as a whole and look forward to what’s to come.

HIStalk Interviews Julia Regan, CEO, RxLightning

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

Tell me about yourself and the company.

I’m a long-time health tech innovator. I carried a bag in pharma and started my career in sales. Early on in my career, in the infancy of health technology, I worked for a manufacturer organization. I fell in love with the opportunity to connect different people, roles, and responsibilities across the healthcare continuum to try to create a better experience and world for patients.

The specialty medication market is one of the fastest growing spaces in the industry for drug spend, representing 52% of dollar volume with high-cost medications such as biologics, infusion meds, cell gene therapies, and even those involving personalized medicine. RXLightning brings that specialty medication process and journey for patients and providers into the digital arena.

Our end-to-end platform automates multiple steps of this process while connecting doctor, patient, specialty pharmacy, and drug manufacturers and  their support teams. Our digital platform, for the first time, creates visibility into the experience. The goal is to reduce administrative burden and waste in the healthcare system for the providers and those organizations that are working to help patients, but ultimately to get patients on therapy quicker in a more affordable way.

What is the overlap between specialty medication prescribing and prior authorization?

Prior authorization is definitely a component of gaining payer access and approval for these medications. But it’s not just the prior authorization, it’s also the cost component, which for these medications could range from tens of thousands of dollars up to a million dollars. Because the cost is so high, there’s an affordability component. Drug manufacturers create programs to help patients get access to therapy, helping go through that benefit investigation and that prior auth process, and also more affordability programs. That could be a bridge program, where patients get samples of the drug while they are navigating the access barriers; free drug for people who can’t afford it; and research around foundations and grants. It’s everything from access through affordability as well. We are a little different than the PA, but the PA is still a component of the journey.

What is the manual process that you replace?

If a specialty pharmacy is used, the doctor will send the prescription to the pharmacy and then wait. The pharmacy will reach out to them and say that a prior authorization required, so they will either complete a paper form or use a digital solution. The next step involves affordability. The pharmacy traditionally works through that process, but because the prescription doesn’t have any of the clinical information or patient financial information, there’s just a lot of back and forth among the pharmacy, the provider’s group, the payer, and even sometimes the manufacturer and their programs. This paper-based system is slow and creates inefficiencies due to missing information or ineligible information.  

RXLightning has created a technology solution for just under 1,300 medications that turns those processes into a single solution that walks a provider through that process digitally and also allows them to track their patients throughout. Instead of using Post-its, Excel, or manual processes that live outside the EHR, our technology system tracks that journey with a CRM type of tool.  

Why do manufacturers choose the specialty drug distribution model and what information do they require?

Because of restrictions and cost, a lot of parties along the way want validation that the clinical steps that are required for approval for a given patient have been documented. The traditional prescription information is one component, but it’s also contact information and caregiver information. Sometimes it includes the clinical history, not only from medications, but also height, weight, allergies, and medications that have been tried and failed. Many components that are part of that traditional prior authorization process are part of these referral forms and enrollment forms.

Then there are REMS medications, which are in the FDA’s Risk Evaluation and Mitigation Strategy because of serious safety concerns. Those have different criteria around authorization codes and compliance that in some cases must be submitted monthly.

Another component is consent, opting into different programs for the patient to share information from a HIPAA compliance perspective, as well as the provider consent to allow another party to work on behalf of them to help navigate through that experience. Also for sharing household income information if they are looking at grants, foundations, or free drug programs.

How laborious is the provider’s process and how long does the patient have to wait for approval before starting the drug?

The work of going through access, affordability, and patient data collection isn’t done while the patient is in the office. A patient who is sick now may have financial constraints with affording a medication that can change their life or even save their life. The provider has to call the patient and ask them to fill out forms. They either have to come in to the office or have it mailed to them, which could get lost.

That paperwork process can take weeks or months. With RxLightning, we see it done sometimes in less than 10 minutes. We communicate and capture the patient consent and information via text and email. The majority of referrals are completed in less than an hour compared to the 2-3 weeks it was taking before. 

What is the implementation process? Do you work individually with providers in a health system, or do they need to reach consensus as a group?

Our platform is extremely flexible and nimble, so we can support all of the different scenarios that are out there. If a large health system wants to install it, we go through a corporate business associate agreement, because PHI and patient data is being entered into our system. We traditionally go through security assessments, and we are HITRUST certified.

We have crawl, walk, or run approaches to implementation. We have a standalone portal that providers and users can be up on within minutes once we get through the business associate agreement and security assessment, if it’s required. The crawl approach is that we use our standalone portal and power it with Secure File Transfer Protocol, or SFTP, data exchange. That’s really just around how we are going to exchange information, pulling exports out of the EHR, having that load patients into our system, and then pushing the data from our system back into the EHR.

Our run is being able to do fully single sign-on capabilities or API integrations with the EHR and embedding our platform into those systems. That requires an implementation group and technical support from the health system. Our standalone platform is completely free to provider groups. 

How are insurers managing biosimilars? Are they asking patients to change their specialty drug prescriptions or do they require a different process?

That’s a really interesting question, and I don’t think there’s a exact answer. Each payer is going to create their clinical policies into their rules based upon what their clinical team assesses coverage should look like. There are multiple steps in this process, and our platform does pharmacy referrals. If a health system doesn’t have access to limited distribution and it’s at a single-source distribution pharmacy, they can send the clinical information and package it up over to that pharmacy. Then we close the loop back to the health system pharmacy with the details so they can create a better experience for the patient.

We handle the investigation, pricing, and coverage. There is a PA component of our platform that could be used. It’s very modular, though, so if they already have a solution in one of those, we could plug those into the platform. Then we handle all of the foundation, grant, free drug, and affordability components in our platform. What we’ve looked at is that across that end-to-end experience, we’ve created a tool where it’s up to the health system, providers, and users on how they want to navigate through it and use it. 

Regardless of what the payer criteria are or the decision-making, around the biosimilars, for example, offices can use our platform to navigate those decision points, and complete the processes for all of them in one location, to navigate the patient quickly and efficiently to a therapy that the payer is going to cover and approve.

How have market conditions affected your strategy?

They haven’t impacted our strategy. So many inefficiencies exist across this journey that health systems and provider groups need a solution. RxLightning has approached it from a brand- and drug-agnostic perspective. We haven’t isolated it to one therapy, one disease state, or a limited portion of drugs. We’ve opened it up and said that we are going to try to solve this process for all of these medications across all of these different steps, which today is being done by different vendors or organizations, most of the time on paper. Organizations see that our platform solves many inefficiencies on their team and the work that they are doing. RxLightning helps alleviate provider burnout  because it makes this process so efficient.

It’s not just about the efficiencies upstream, because when you use paper and faxes, inefficiencies happen while you are awaiting a response. The communication back to the provider’s offices creates call lags and call volumes and it’s sometimes uncontrollable for organizations. We work to plug into the different destinations across this journey — manufacturers, different specialty pharmacies, different parts of the process — to close the loop with information back.

If a provider has a patient who needs a cancer medication and can’t afford it, they can go in our system, see all the grant information, and make a decision whether to apply for a grant. If the grants aren’t of open and foundations aren’t open, they can do the manufacturer’s program. We will provide the response back around the approvals or the denials so they don’t have to constantly look, make phone calls, or answer phone calls. That gives transparency through that whole process while also allowing the patient to see updates across the journey.

What will be important to the company over the next few years?

We are looking to expand our provider base. We know that when our platform is used, it saves much time for offices and helps patients get on therapy much quicker in a more affordable way. We are used by some of the largest healthcare systems today, so growing that base and then providing all the digital connectivity points into the drug manufacturer programs, the hubs, and the specialty pharmacies to have a 100% digital, interoperable ecosystem that exchanges information is critical to the success for the industry, patients, providers.

Morning Headlines 4/26/23

Tegria Acquires Meditech hosting and services firm Sisu Healthcare IT Solutions

Tegria acquires Sisu Healthcare IT Solutions, which offers Meditech-certified hosting and services.

Virtual nursing startup raises $1.5M to pivot and address hospital staffing crisis

Nurse Disrupted will use $1.5 million in new funding to expand its virtual nursing services to hospitals.

GE HealthCare Technologies Non-GAAP EPS of $0.85 beats by $0.06, revenue of $4.71B beats by $80M

GE HealthCare reports Q1 results: revenue up 8%, adjusted EPS $0.85 versus $0.96, beating expectations for both but sending shares down 9%.

GoodRx Expands Executive Team With New Interim CEO

GoodRx co-founders Doug Hirsch and Trevor Bezdek transition from co-CEOs to chief mission officer and chairman, respectively, upon the appointment of Scott Wagner (GoDaddy) as interim CEO.

News 4/26/23

Top News

Tegria acquires Sisu Healthcare IT Solutions, which offers Meditech-certified hosting and services.

HIStalk Announcements and Requests

Listening: Amanaz, which was part of the Zambia’s Zamrock movement of the early 1970s. When the country gained its independence in 1964, radio stations were required to play 95% Zambia-originated music, and bands met the sudden musical demand with Western-influenced blends of Afrobeat, garage rock, and psychedelic fuzz. Zamrock faded away with Zambia’s economic problems and massive AIDS devastation that continues today, but the 50-year-old music is enjoying a resurgence. Quality varies, but I like all forms of music that reflect the exuberant, non-commercial spirit of the times, whether it’s doo wop, early gospel, or punk.

I asked conference services vendor Freeman how it handles exhibit hall carpet. They referred me to their corporate sustainability practices page, which only says that they offer carpet that can be repurposed.

Webinars

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

Acquisitions, Funding, Business, and Stock

USPTO grants cyber risk management company Clearwater a patent for the Predictive Risk Rating capability within its IRM|Analysis software.

GE HealthCare reports Q1 results: revenue up 8%, adjusted EPS $0.85 versus $0.96, beating expectations for both but sending shares down 9%.

Sales

• Allina Health (MN) will offer patients Epic-based virtual care through KeyCare.
• Lexington Medical Center (SC) will implement healthcare and social services referral software from Unite Us.
• Jefferson Health (PA) selects Ada Health’s symptom assessment and care navigation technology.
• The University of Miami Health System and the Miller School of Medicine will roll out Clear’s identity verification technology for patients and employees.
• OhioHealth will implement EVideon’s Vibe Health smart room technology at its Pickerington Methodist Hospital in December.

People

Tabula Rasa HealthCare promotes Brian Adams to president and CEO.

Adam Mariano (HighPoint Solutions) joins LexisNexis Risk Solutions as president / GM of healthcare.

Artera names Karri Alexion-Tiernan (TigerConnect) VP of product marketing; Joanne Chen, PhD, MS (Strive Health) VP of data; and Mark Thomson, MS (TigerConnect) VP of customer success.

Cancer remote patient monitoring technology vendor Veris Health hires Gary Manning (PhysIQ) as president.

Reperio Health hires Naomi Levinthal, MS, MA (Memora Health) as chief growth officer.

Announcements and Implementations

Children’s Mercy Kansas City opens a 6,000 square-foot Patient Progression Hub, which uses AI-powered technology from GE HealthCare to monitor patient flow, manage staffing, and coordinate care.

Fortified Health Security consolidates its managed security services into the new Fortified Central Command platform.

AvaSure develops a Virtual Nursing application and Care Model to support six current virtual nursing implementations.

WellSky expands the capabilities of its CarePort care transition solutions.

Government and Politics

The VA establishes an Artificial Intelligence Institution Review Board and an AI Oversight Committee for its clinical and research operations.

Sponsor Updates

• AdvancedMD employees in Utah volunteer at the St. Vincent De Paul Dining Hall, Utah Food Bank, Clementine Ranch, and Encircle during its day of service.
• Agfa HealthCare joins the AWS Partner Network.
• Baker Tilly releases a new Healthy Outcomes Podcast, “Insights into the credit ratings of hospitals and health systems.”
• Care.ai’s virtual nursing solution is added to Google Cloud Marketplace.
• Surescripts posts a data brief titled “How Are Care Teams Evolving to Fill Primary Care Gaps?”
• Meditech is featured in an episode of HealthData Management’s video series titled “The Journey Beyond: Exploring uncharged territories.”
• Bamboo Health publishes a new case study, “Leveraging Real-Time Patient Data to Keep In-Home Care in Home.”
• KLAS honors CenterX with its 2023 Points of Light Award for improving prior authorization efficiency and easing administration burden for providers and payers.
• Nordic posts a podcast titled “Designing for Health: Interview with Chris McCarthy, Part 2.”
• Clearwater uses the Cyturus Third Party Risk Management module of the Compliance & Risk Tracker as its primary platform to support its Vendor Risk Management managed services program.
• Mubadala Health in Dubai will use Oracle Cloud Infrastructure to run its Oracle Cerner EHR.

Blog Posts

• The Power of Personalization & How Smartphones Reflect the Individual in Healthcare (Access)
• Make Your Revenue Cycle Management Vendor a Key Strategic Partner (AGS Health)
• Healthcare dashboard examples: Exploring 5 impactful models (Arcadia)
• Are your Clinical Order Sets built correctly? (Optimum Healthcare IT)
• How to Improve Patient Outcomes and Boost Your Bottom Line ASAP (Yes, in a Matter of Months!) (Artera)
• Empowering FHIR (Availity)
• Struggling with maintaining your Virtual Safety Team? You’re not alone. (AvaSure)
• DRVS & Autism Acceptance Month – This April & Beyond! (Azara Healthcare)
• Moving to the Oracle Cloud readies University of Texas Health Center for future growth (Baker Tilly)
• Future of Telehealth: What’s Next for Patient Care? (ChartLogic)
• A Physician’s Perspective: Bridging the HER, Healthcare IT, and the PAC (Physician Advisory Committee) (CereCore)
• Managing a Deluge of Data: CIO Strategies to Make Information Accessible to Clinicians (CHIME)
• 3 Ways to Achieve ‘Backward Compatibility’ Without Draining Health IT Resources (Consensus Cloud Solutions)
• The Seasonality of Risk: Your Q2 Action Plan (Curation Health)
• 4 Key Strategies to Maximize Value-Based Care with Data and Analytics (Dimensional Insight)
• Recruiting Through Social Media: A Guide to Attracting Top Talent (Direct Recruiters)
• How to Address Operational Debt in Healthcare (Divurgent)

Contacts

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

Book Review: Redefining the Boundaries of Medicine

“Redefining the Boundaries of Medicine” is a Mayo Clinic Press book that was written by Paul Cerrato, MA (senior research analyst and communications specialist, Mayo Clinic) and John Halamka, MD, MS (president, Mayo Clinic Platform). The authors have collaborated previously on three books and several journal articles.

The book is written for readers who are knowledgeable about the “only in the US” healthcare mix of research, medical practice, consumerism, and hardcore capitalism where money has an outsized influence on both individual health and the business of healthcare. Its dense typography and layout is hardly inviting, but it provides an excellent history of how we got to where we are in healthcare (hint: often illogically, stubbornly, and parochially) and how healthcare can be improved.

The book delivers what its title promises. The authors are predictably precise in their citations and conclusions, and they are on the provider front lines rather than ivory tower academics. In addition, Mayo Clinic Platform is working actively to apply data science and technologies to healthcare.

I admit that I wasn’t aware of the previous books that these authors co-wrote and wasn’t exactly sure what Mayo Clinic Platform does or what happened with John Halamka after he left BIDMC three-plus years ago. But I think these authors might be the go-to-experts that the healthcare industry needs as it rushes headlong into artificial intelligence and re-examines itself with an opportunity (or requirement) to change dramatically.

Here are some of the notes I took.

Artificial Intelligence

The book leads off with a chapter on artificial intelligence, where the authors observe that the human brain cannot process the amount of new information from journals and conferences, much less apply it at the bedside, and can’t analyze all available information to arrive at an accurate diagnosis. AI is also better than humans in analyzing diagnostic images, although system training must be carefully designed in an environment that has never-ending changes in scanning technology, coding and terminology, EHR configuration, changed institutional practices or order sets, and a changing patient mix that may not be applicable elsewhere.

A fascinating idea is that all broad research, whether powered by AI or not, overgeneralizes to the entire population instead of digging into patient subgroups. For example, a large study on the effect of lifestyle modification on cardiovascular disease was abandoned when no differences were seen between the intervention and control groups, suggesting that lifestyle doesn’t matter. However, applying sophisticated analytical technique found that lifestyle intervention actually worked in two subgroups that were otherwise lost in the large numbers: patients whose diabetes is poorly controlled and in those with well-controlled diabetes who self-report their health as good.

They also note that FDA’s approval of AI devices is inconsistent and often involves retrospective and/or single-site studies.

The authors conclude AI algorithms need to be more equitable and better validated before being placed into clinical use.

Medical Knowledge

Medicine’s history in the US involves paternalistic physicians; diagnosis and treatment protocols that were based on GOBSAT (good old boys sat around the table); and slow acceptance of research findings in favor of personal experience, anecdotes, and opinions lacking evidence.

Randomized controlled trials, especially those that conclude that a therapy was not beneficial, have weaknesses such as too-small sample size and inclusion criteria that may introduce bias or reduce clinical usefulness. RCTs should be supplemented with real-world evidence and cohort studies. 

The “heterogeneity of treatment effect” acknowledges that treatment benefit and risk can vary widely among patients. Patients know their conditions and see the effects of treatments firsthand, so N-of-1 trials comparing active treatment with placebo are a good idea.

“Patients like mine” data can help support decisions in the absence of RCT or observational studies now that EHR data is widely available, although it may require experts to turn patient data into actionable evidence.

Rethinking Medical Expertise

The public questions the value of medical expertise. Experienced clinicians use Type 1 thinking, in which pattern recognition can lead to quick conclusions involving common conditions as “disease scripts.” But sometimes it fails dramatically when a patient’s symptoms fall outside the norm. Type 2 reasoning starts with a hypothesis that is refined via logic and critical thinking, which can be more accurate and avoid bias and thinking shortcuts, but takes too long to conduct in high-volume settings.

The authors cite previous studies that found that peer-reviewed journals often rejected research that turned out to be important, questioning whether that publishing process is the best way to gestate new ideas.

Replacing “One Size Fits All” with Personalized Medicine

Full genomic sequencing is increasingly useful. Some experts say it should be performed at birth, whereas now newborns are screened for a small number of genetic disorders.

Large studies on using the antiplatelet drug clopidogrel for blood clots found that the drug outperformed aspirin in just two of each 100 patients, but the real challenge is to identify those two instead of incurring the cost and risks of giving it to everyone.

“Normal” lab ranges are just a statistical convention, and each person’s “normal” may be different and deviation from it may not indicate the presence of disease. Insurance will often pay for only drugs and treatments that appear effective for broad segments of the population.

Researchers search for one or two primary causes of a disease, such as HIV as a cause of AIDS or striving to control the blood sugar of diabetics, and immediately refocus all research on those causes. The outliers are rarely studied, such as the people who are exposed to HIV but don’t develop AIDS and why that might be. Correcting the condition for a given patient doesn’t necessarily deliver the expected benefit.

Communication

Too many clinicians still practice the “doctor knows best” model when patients don’t agree with their evidence-based interventions. Policy decisions are rarely made on science alone since beliefs and core values will usually win.

FDA knows that most drugs that it approves offer only slight benefit, but consumers aren’t capable of analyzing studies, especially when faced with direct-to-consumer advertising. The public is easily confused by correlation versus causation and relative value versus absolute risk, such a miracle drug that reduces the risk of some disease by 50% that really means that one person instead of two out of 1,000 patients will get it, which is hardly impressive. Schools do not teach critical thinking skills and the US doesn’t follow the lead of other countries that teach media literacy.

Interdisciplinary Patient Care

Researchers and clinicians need to communicate better. Experts say that NIH-funded research focuses on silos for particular conditions of interest without looking at how they relate to, or are affected by, other factors, which is an outdated understanding of medicine. DARPA might offer a better model.

Clinician fragmentation increased with the growth of specialty medicine, medical group consolidation and insurance programs networks that separated people from their specific doctor.

More than three-fourths of chronic diseases are caused by or exacerbated by lifestyle choices that can’t be easily explained or encouraged in the allotted 15-minute office visit.

Patient-generated data should be fed into EHRs.

You will be stimulated by the ideas the authors express in this book if you are comfortable reading journal abstracts and understand clinical practice, especially if your specialty is informatics. It seems like a slim read at under 200 pages, but is packed with information in being free of self-aggrandizement and pontificating (and again, the typeface is pretty crammed, so it’s got more content than you might think). If you or your organization want to be considered disruptive in healthcare, the authors are giving you great ideas of where you might focus.

Morning Headlines 4/25/23

CompuGroup Medical Buys Majority Stake in German Digital Healthcare Platform m.Doc

Germany-based CompuGroup Medical acquires patient communication software vendor M.Doc, also based in Germany, for an undisclosed sum.

ClaimsXten Becomes Lyric, Welcomes Raj Ronanki as Chief Executive Officer

Claims payment and editing software business ClaimsXten rebrands to Lyric and names Raj Ronanki (Elevance Health) CEO seven months after its sale by Change Healthcare to TPG for $2.2 billion.

Children’s Mercy Kansas City, GE HealthCare Launch Nation’s First Pediatric Hospital Operations Center to Improve Patient Care

Children’s Mercy Kansas City opens a 6,000 square-foot Patient Progression Hub, which uses AI-powered technology from GE HealthCare to monitor patient flow, manage staffing, and coordinate care.

Curbside Consult with Dr. Jayne 4/24/23

As a primary care physician at heart, I know how important it is for patients to learn how to make better food choices. A friend clued me in to the Plateful app, which helps consumers make better choices by providing information that may be more understandable than the typical “Nutrition Facts” label. Once a user scans the UPC found on a packaged food, or uses the PLU code on a fruit or vegetable, the app displays a Nutrition Value and an Eco Value, each of which ranges from 0 to 100. In addition to the numbers, star values also display to help users understand the relative value of a food choice.

The Nutrition Value is based on the Tufts Food Compass Score, which was validated over nearly two decades. I wasn’t familiar with it before seeing the Plateful app. This isn’t surprising given the huge lack of nutrition education at medical schools when I was in training. I think we had a four-hour block to cover the entire topic, and you can bet that people paid less attention to it than they did to competing educational priorities like the surgical skills lab or cramming for the USMLE licensing exams. If I remember correctly, it was tacked on to the end of second year almost as an afterthought.

Although medical education has become more well-rounded since then, I’d bet that nutrition still gets less coverage than it probably should. Some of the most damaging chronic health conditions, including coronary artery disease, stroke, diabetes, and certain cancers can be impacted by nutrition, but it seems that our society would much rather spend its healthcare dollars on pills and injections rather than addressing the root causes of the diseases.

The Tufts Food Compass looks at 54 attributes across nine categories, including: ingredients, nutrient ratios, vitamins, minerals, fiber/protein, lipids, phytochemicals, additives, and processing. Foods with a higher Food Compass Score are associated with more favorable Body Mass Index, blood pressures, lipid profiles, and fasting blood glucose values as well as being associated with lower all-cause mortality rates. The validation studies were performed with a nationally representative sample of nearly 48,000 adults aged 20-85 in the US.

As you may guess, whole foods get higher scores, where heavily processed or additive-laden options get lower scores. Consumers are encouraged to use the app to scan similar foods and compare them. One of the use cases mentioned on the app’s website is comparing two loaves of bread to see which one has a higher Nutrition Value. The Eco Value looks at a food’s relative level of environmental friendliness, with a nod to climate, land, and water impacts. Foods with an Eco Value of more than 50 are more associated with a sustainable food system. While reading the website, I was surprised to learn that some foods that are conventionally thought of as healthy are actually less great for the environment due to water and climate impacts.

According to the website, parent company Opsis Health has more cool tools on the horizon, including the ability to take a picture of a plateful of food and have it converted to detailed nutrient information. That’s going to be a lot more accessible to most people than weighing or measuring food, which is often the first step in trying to take control of your eating habits. We’ve had so much portion inflation in the US that people often have no idea what a realistic serving of anything is any more. (I had to guess the weight of the amazing bone-in pork chop I had in Chicago, so I’m among the masses who might benefit from this innovation.) Turning your phone into essentially what is a 3D food scanner sounds a lot cooler than logging things into Nutritionix or MyFitnessPal or any of the other tools that are out there.

In learning more about Plateful and the company, I liked the website’s clean look and bright colors, and the amazing food photos as well. I also liked the fact that I had to dig pretty deep before I saw mention of AI as being part of the upcoming solution. It seems like many other companies are entirely in-your-face with AI-this and AI-that, so it was refreshing to find that it’s part of the solution but they’re not leading with it. I’m looking forward to following them over the coming months to see how the solution evolves and will definitely have fun doing some food comparisons in the coming months.

For the chocoholics out there who may be wondering, my go-to “survival chocolate” vendors were pretty much neck and neck, with the Hu Kitchen Salty Dark Chocolate (vegan, paleo) leading with a slightly higher Nutrition Value while the Ghirardelli Intense Dark Sea Salt Almond squares squeaked by with a higher Eco Value. I give them both five stars for their mental health boosting properties, so it would be a toss-up to choose one over the other. As the Plateful website says, “Lower NV foods, eaten on occasion, can fit into a healthy eating pattern if the majority of foods you eat over time are nutritious.” Sometimes you just need a little bit of dark chocolate to get you through the day.

It would be interesting to learn about the business model for the coming solution and whether it will be presented as a consumer-driven offering or whether it will be made available as part of an employee benefits plan or as part of a payer-based offering. The latter two would be smart as potential enhancements to reduce overall healthcare costs. I don’t have a frame of reference for what kind of databases are out there to create the library of UPC codes, PLU codes, and nutritional values, let alone what the R&D lift looks like for the “scan your plate” app that will be coming. I always enjoy learning about something that’s not in my usual lanes of EHR, HIE, and patient portal, so learning about this was a welcome diversion. Knowing that it may be able to help patients with healthy food choices, which is one of the solutions to healthcare crisis of our times, was a bonus.

Is your organization doing anything to promote nutrition education or healthy eating? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Frank Harvey, CEO, Surescripts

Frank Harvey, RPh, MBA is CEO of Surescripts of Arlington, VA.

Tell me about yourself and the company.

I have been interested in healthcare since I was six years old. My father used to take me on Saturday mornings to the soda fountain at the local pharmacy. I was interested in what our local pharmacists were able to do with patients and the members of the community. From that time on, I’ve wanted to be in healthcare, specifically as a pharmacist.

I’ve been in pharmacy throughout my career. I have been fortunate to be a part of life sciences, with Lilly and Hoffman-LaRoche, and companies such as Liberty Medical and Mirixa, which is a medication therapy management company. I ran my own venture fund for bit. I was excited to get the opportunity to come to Surescripts because it’s such a wonderful company. Surescripts is a mission-driven health information network that is focused on enhancing the prescribing process and forming care decisions. Our mission is to continue to lower the cost of healthcare, improve patient safety, and improve the overall quality of care.

How has the role of the pharmacist, along with the technologies and data that are part of their work, changed?

During COVID, pharmacists really raised their level and used the full scope of practice of their degree. It was critical during that time, because in many cases, physicians weren’t available because they were tied up with so many COVID patients. Pharmacists stepped in to do much more, such as administering vaccines and  counseling chronic care patients.

We expect pharmacists to continue operating through the full scope of their license, particularly because there’s such a shortage not only of primary care physicians, but also of endocrinologists and rheumatologists. We’re seeing a burnout of physicians and many of them are retiring. Pharmacists will have the opportunity to step up their level of their practice to be operating more at the full scope of their license.

How has the Surescripts network changed over time?

When Surescripts first came into being over 22 years ago, prescriptions were transferred back and forth, either by patients carrying the prescriber’s handwritten prescription to a pharmacy or having it called in. Surescripts was put in place to make that process electronic, as the first health interoperability network, if you will. Now the vast majority of prescriptions go from the physician to the pharmacy electronically through our health information network. 

We have continued to expand far beyond that to help with price transparency and to support pharmacists and physicians being able to message each other electronically, with no more faxes or having to jump on the phone. We’ve continued to focus on enhancing the prescribing process and informing the care decisions that physicians, nurse practitioners, and PAs make by providing medication histories of the patients to the physician.

Has the launch of a competing e-prescribing network changed your strategy?

No. We will continue to focus on being a mission-driven company and will continue to enhance the prescribing process and informing that care decision. Competition is always good. We welcome competition that helps move our mission forward. Whether it’s Surescripts doing it or other companies doing it, we’re happy about that.

How will you continue to enhance the Surescripts network?

Even in the last four years, we’ve improved the quality of prescribing, the prescriptions coming across, by about 85%. We continue to focus on enhancing that prescribing process. The other thing we continue to work on is ensuring that, from an administrative standpoint, we’re providing the right information at the right time to physicians, so they don’t have to cull through volumes of information to get to what’s important at care decision time.

How much emphasis is placed on inserting the connectivity result into the prescriber’s EHR workflow?

It is really critical that it’s in the workflow. We’re integrated in every EHR across the country. Last year, over 2 million practitioners prescribed over 7 billion transactions. All of those were integrated into the electronic health record that the physician was working with.

An example is that at the time of prescribing, when the physician is with the patient, transparency apps allow the physician to see not only the therapeutic alternatives, but also the pricing of each based on the insurance coverage that the patient has. It allows a physician to make the right therapeutic decision for the patient as well.

Are you seeing benefits for both the prescriber and the patient?

Absolutely. That’s one of the most important things about having a real-time prescription benefit tool in the physician’s EHR. They can see everything about the prescription and the therapeutic alternatives. Before, they would write a prescription without understanding the price consequences. The patient would take it to the pharmacy, find that they couldn’t afford that medication, and then ask the pharmacy to call back to have the prescription changed to a different medication that they could afford. Integrating that into the overall workflow cuts down a lot of demonstrated burden of the physician, the pharmacy, and the physician staff.

Have you seen statistics documenting outcomes improvement since cost issues might have led to the patient either not having the prescription filled or taking it in lower doses to stretch it out?

We absolutely have. Most recent studies shows that the prescription pickup rate increases by 3% to 5% with use of a price transparency tool with real-time prescription benefits. The patient knows what they are facing from a pricing standpoint, they’re more likely to pick it up, and the doctor is more likely to have written a medication that is affordable to the patient. The most expensive medications are the ones that the patient never picks up, because they never get their health condition taken care of. These tools help the patient.

How has the federal government influenced interoperability?

Micky Tripathi and his team have done a tremendous job. They have so much energy behind their efforts. Interoperability is so critical in being able to get that full patient’s record. A new proposed rule focuses on advancing that interoperability and improving transparency, supporting the access and exchange of electronic health information. 

The role that Micky and his team have played has been critical to moving us forward more rapidly than would have happened without their participation, their urging, and their hard work over a long time. We are a great example of what interoperability does, with 21.7 billion transactions a year across all of our products. We are looking forward to everything that’s happening with TEFCA.

What will the company’s strategy be over the next few years?

We are going to continue to focus on what has been our bread and butter, which is our mission of improving the quality of care, improving patient safety, and lowering cost. We will do that by broadening the areas that we work on across enhancing prescribing as well as informing care. We are looking to work to help broaden the care team, to enable the care team as it expands and pharmacists take a more active role, to make sure that they’ve got the right data to make the right decisions and can communicate that information back into the health record. We will continue to lobby for the right legislation to be in place to enable and empower pharmacists to do what they’re able to do, in partnership and collaboration with physicians, nurse practitioners, and physician assistants.

Healthcare in this country is at a critical phase. We are seeing the continued burnout of our healthcare practitioners and a lack of enough healthcare practitioners, particularly in rural and urban areas. We have areas where patients may have to travel 100 miles to see a physician. It will be important that pharmacists can play a larger role. I believe that we will see, over the next five years, that the healthcare team will continue to evolve, and that will be the best thing for the patient.

Morning Headlines 4/24/23

VA suspends rollout of Oracle Cerner electronic health record system as part of major ‘reset’

The VA pauses its Oracle Cerner implementation indefinitely until issues at its live sites are resolved, and stresses that “everything is on the table” as it negotiates the scheduled five-year extension of the original 2018 contract.

Oracle Appoints Seema Verma to Lead Oracle Life Sciences

Oracle hires former CMS Administrator Seema Verma, MPH as SVP/GM of life sciences, which includes leading the Oracle Cerner Enviza business.

Electronic Health Information Exchange:Use Has Increased, but Is Lower for Small and Rural Providers

An analysis from the US Government Accountability Office points out that TEFCA may help small and rural providers overcome some barriers that keep them from exchanging health information at the rate of their larger, more metropolitan counterparts.

Monday Morning Update 4/24/23

Top News

The VA pauses its Oracle Cerner implementation indefinitely until issues at its live sites are resolved.

It also says “everything is on the table” as it negotiates the scheduled five-year extension of the original 2018 contract.

Oracle EVP Mike Sicilia indirectly placed blame for the delay on the VA, responding with a statement that Oracle supports the VA’s use of the time to “institute governance, change management, and standardization changes … similar to what DoD did a few years ago.”

Reader Comments

From Bonhomie: “Re: paying your way to HIMSS. Have you considered monetizing your presence by offering vendors the opportunity to purchase booth interviews or social media coverage from you, in order to offset your expenses?” That seems unbelievably slimy to me, although I’ve seen plenty of folks who were clearly taking money for interviewing company executives, hosting events, or shooting out suspiciously laudatory tweets. At least their sites and outlets are not known for covering actual news anyway, so reputational damage is minimal. Still, I would rather pay my own way, remain anonymous, and leave with my soul unsold.

From Phone Waver: “Re: HIMSS23. You didn’t mention booth people staring into their phones.” Two reasons: (a) I don’t think it happens as much as it used to, or maybe I’m so accustomed to it that I no longer notice; and (b) I’m more empathetic to exhibitor staff who have tasks they can accomplish online while waiting for someone to show interest. However, I still maintain that the free time that allows you look at your phone is created by your unapproachability in doing so, and your employer bought an exhibit booth rather than a telephone booth (OK, I admit that’s a dated reference).

HIStalk Announcements and Requests

Most poll respondents aren’t using ChatGPT regularly. I’m not a power user, but I stay logged in in case I want it to check my wording, summarize what a company does given its web address (the fact that the website isn’t clear enough to easily tell is its own issue), or suggest interview questions that are not very good. I’ve also used it to plan events and to find obscure bands I might like, while Mrs. HIStalk jumped on it immediately to to help plan a complex vacation to Europe involving drives among several countries. I’ll add that the amazingly fast rise of ChatGPT means that the dabblers who evangelize their experiments are already yesterday’s news, with the new table stakes being actually accomplishing something with it that wasn’t previously possible.

New poll to your right or here: How would you grade your in-person attendance of HIMSS23? I would probably give it an A for the first time since 2019. HIMSS is surely happy that its relevance seemed little diminished, at least based on attendance, exhibitors, and general energy, when situations both within and outside its control had created an opening for competing events. My early read is that the HIMSS and ViVE conferences will co-exist with differing attendee demographics, but with enough business case for both to attract exhibitors.

HIMSS23 was the first opportunity see my Apple AirTag in action as it tracked my checked bag from the plane to the luggage carousel, a pretty slick and multi-use technology for $29. Mrs. H and I use the Find My app and our phones to tell if we’ve left work or the grocery store or whatever, so I’m sure many other AirTag use cases exist that I haven’t thought of.

I was annoyed that the #HIMSS23 Twitter hashtag was hijacked by some would-be “technology influencers” to constantly spout random conference updates and tourism recommendations without actually being at the conference. Blocking them doesn’t seem to hide them from Twitter search results.

I mentioned previously that HIStalk’s searchable history goes back to 2007, so it’s the one place you can find significant news events without the fluff, see what we’ve said about long-ago HIMSS conferences, or ponder the life cycle of companies, technologies, and even people that have gone from fame to forgotten. Suggestions: search for anything of interest or scroll through the very long article archive.

Webinars

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

People

Oracle hires former CMS Administrator Seema Verma, MPH as SVP/GM of life sciences, which includes leading the Oracle Cerner Enviza business.

In England, physician and digital health pioneer Elizabeth Murray, MSc, PhD dies of cancer at 63. She studied the impact of the internet on doctor-patient communication at UCSF in 2001 and set up an e-health unit at University College London in 2003.

Other

Bizarre, as forwarded by a reader. A data scientist at healthcare revenue integrity vendor Multiplan – improbably named Jack McQuestion — is charged with impersonating an FBI agent after trying to lure an OnlyFans adult performer from her house claiming to be an FBI agent with a warrant for her arrest. He left when she called police, but police used his doorbell camera image to find him and his Madison, WI apartment, a search of which turned up phony FBI credentials, pepper spray, and a garrote that he had ordered from Amazon. His job history before his data scientist job includes being an “artistic model” and a Pizza Hut delivery driver. Searching Amazon for “garrote” turns up sellers offering those products for supposed non-strangulation purposes that include cheese slicing and sculpting, but the seller’s choice of search keyword says a lot.

Contacts

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

Morning Headlines 4/21/23

Augmedix Secures Strategic Financing from HCA Healthcare and Redmile Group

Ambient medical documentation company Augmedix secures a $12 million investment from HCA Healthcare, which will help with product development as it pilots Augmedix technology in emergency rooms at two of its hospitals.

ADHD prescription startup Done pivoting to in-person care following DEA rule change

Online ADHD prescription company Done pivots to a hybrid care model care in light of the May 11 expiration of the Public Health Emergency, after which physicians must see certain patients in person before prescribing controlled substances.

SA Health investigating 30-hour data outage that left hospital staff in limbo

In Australia, SA Health officials begin investigating a 30-hour computer systems outage and why backup systems were not turned on.

From HIMSS with Dr. Jayne 4/20/23

Wednesday opened with me feeling a little draggy, which wasn’t surprising since my trusty Garmin watch revealed that I had walked more than 13 miles the day before. Looking through my past HIMSS activity histories, that’s about par for an opening day and it wasn’t anything a couple of ibuprofen couldn’t resolve.

A change in the weather and my meeting plans led me to take the shuttle from the hotel to McCormick Place. It was a quick trip down Michigan Avenue, but a long and winding trip around the underbelly of the convention center as the bus reached its unloading area at Gate 20-something. I ignored the signage and just picked a random escalator that popped me up in the middle of the exhibit hall, which was much better than the “up down and all around” journey from yesterday.

I started the day with some casual meetings, both with former colleagues who are in various places in the industry, but whose spheres overlap my current one. Topics were far ranging and included rural health, clinical terminology, regulatory issues, and suggestions for good books to read. We’re all doing our best to keep up with what’s going on in healthcare and how it applies to our individual IT roles, but it’s daunting.

Still, it was good to catch up and get some advice from seasoned professionals that I trust. I’m also helping with some matchmaking magic, trying to introduce clinical informatics friends looking for work to vendor friends who might benefit from their knowledge.

From there, it was on to the exhibit hall, where the Ellkay team wins the “friendliest” title for the day by having people actually say good morning to those walking past.

I found the Puppy Park in the North exhibit hall. It was populated by some energetic doggos. The people playing with them all seemed to be having a good time.

Less exciting was the grime next to one of the pillars in the South exhibit hall, which was quite visible due to the lack of carpet. I was also annoyed by the large blue open-topped bins in the hall that were marked “recycle” but had no specialized drop slots for cans, paper, etc. which led to them being used as all-purpose trash cans. The only designated recycling bins that I could find that were being used as designed were in the lobbies by the escalators or over in the West building.

I was amazed to capture the bright shoes and even brighter suit all in one photo.

I had lunch at the CXO experience lounge in the West building, meeting some new CIO friends and learning about the projects their organizations are working on. The lounge was hopping and seating was at a premium – they definitely could have a larger area next year and still fill it. Top themes include chronic disease management, avoiding ransomware attacks, trying to meet behavioral health needs, and updating their telehealth strategies pending the end of the public health emergency declaration.

From there it was off to my annual booth crawl with Nordic Consulting’s Chief Medical Officer Dr. Craig Joseph. We checked out the art at the Epic booth then started combing the aisles for things that were interesting or at least eye-catching. We noted only two multi-story booths this year. Nuance’s double-decker featured a theater complete with people waiting in line to get in. Pure Storage also had a two-level booth, but we missed their bourbon tasting.

From there, we headed to the Edifecs booth to check on the progress of their #WhatIRun message wall. It was filling up with messages of what attendees run at home and in their work lives. I give full credit to the person running their son’s den meetings. As someone who has spent a bit of time in the scouting world, I know how much work that can be. Mentions of the #WhatIRun hashtag trigger donations to BrightPink.org which is an advocacy organization for breast and ovarian cancer.

When hanging out with Craig Joseph, you never know where the conversation might go. Topics included adventures in specialty pharmacy, patient education solutions (triggered by a stop by the Healthwise booth to look at their new Healthwise Advise offering), the Mastodon social network, and more. We definitely went down the social media rabbit hole, and I introduced him to networking resources for the physician mom interested in casual (or not so casual) doomsday prepping – talk about your niche audience. We decided that in the event of a zombie apocalypse we would barter our physician skills for survival, so perhaps it’s time to practice our laceration repair and minor surgery skills.

After dropping him off at his booth, I needed a little rest and found a mysteriously large area in the South exhibit hall that had grass-colored carpeting and park benches. It seemed like an odd use of real estate in a high-traffic part of an exhibit hall that otherwise had inadequate seating areas. It made me wonder if a vendor had backed out and they were trying to fill the space, but I was grateful for a place to sit for a few minutes and find the last remaining ibuprofen at the bottom of my conference bag.

Matthew Holt and the team at First Databank sent their submission for best shoes.

Unfortunately for them, however, IMO dominated again with this submission, earning the company the “best all-around footwear of HIMSS23” championship title. I’m glad so many people have joined the challenge to find the best HIMSS shoes and receiving your pictures definitely puts a smile on my face. After two full days of exhibit hall adventures plus miles of walking on Monday, I’m ready to put my feet up, then pack my suitcase and get ready to head home.

If you’re at HIMSS, what has your favorite part of the conference been? Leave a comment or email me.

Email Dr. Jayne.

From HIMSS 4/20/23

Tell me without telling me that today is the last exhibit hall day of HIMSS23.

Today is also when all of the previously defended booth swag is dumped out on the table for anyone to take (even other vendors) to avoid dragging it back home, which is how I ended up with socks from document management vendor Vasion, whose booth person urged me to take one small step to reduce his two suitcases full of them to a manageable number. I also had a nice conversation with folks from Amazon S3 data recovery vendor Clumio, who wanted to hand off one of their bags that I now realize is actually quite nice.

Of course I had to scan the QR code on the HIMSS bus window. It went to a website that described how to get out in an emergency. I think I would find a way out more quickly, approved or my own, than reading a website or watching a video.

It wouldn’t be a HIMSS conference without the always-entertaining Magic Boy in the booth of Hyland, although I don’t think he was involved with the company’s pre-conference magic trick of making 1,000 employees disappear.

I don’t know how many takers Jeron Electronic Systems got for its factory tours, but I thought the offer was smart. The family-run business makes nurse call and other healthcare communications systems right here in the Chicago area, with no supply chain product delays.

I went by the Ellkay booth many times and not only were employees paying heads-up attention, I was greeted every time. I didn’t eat anything but booth snacks all day until late afternoon all this week, so I got through Day 1 purely on their honey-caramel popcorn.

Hybrid infrastructure vendor Element Critical provided a great “Live Lucky” hat and fun conversation. 

Today was goodbye group photo day, or video in the case of Clearsense. They had a sharp-looking booth. The quick video, which popped up on LinkedIn, is a super idea.

This observation is supportive even though it might sound critical, but for folks in the startup area’s mini-booths, HIMSS23 could have been your best chance of the year to find prospects, partners, investors, and employees. I know it’s hard to remain alert, make eye contact, and initiate friendly conversation versus staring at your phone or conversing with your co-worker, but to be here otherwise doesn’t accomplish much. If your space holds two people, one of them should be someone who can confidently and energetically draw people in. I walked through the startup area several times and nobody seemed all that interested in initiating a conversation. If you’re going to be there anyway, take advantage of the foot traffic just to shoot the breeze with whoever walks by if nothing else.

These guys from Rocket.chat didn’t get a great booth location as a first-time exhibitor, but they were friendly and positive. The company’s HIPAA-ready messaging app supports communication with patients, colleagues, and vendors. They offer a free self-hosted team collaboration version.

The reps from digital transformation services vendor Cardinal Integrated earned our “Tiny Booth but Great People” award, as the person on the left admirably worked the perimeter to cheerfully engage passersby and her colleagues were quick to join in.

The rep at first-time exhibitor Solid, which offers public safety communications technology, was outgoing, informative, and energetic despite light foot traffic and reps in neighboring booths being lost in phoneland. The company offers a guide to improving poor cell service to support BYOD and bandwidth for IoT and 5G.

The friendly, sequined folks at Raleigh, NC-based Bandwidth were happy to describe the company’s messaging, voice, and emergency telecom platform.

Doximity provided today’s lunch. Their cupcake bites are like finger-scooping cake batter from the bowl, then repeating with the icing before shoving it home.

Avadin, which sells solutions for senior care agencies, uses AI – and now, apparently, ChatGPT – to listen for “help me” requests, monitor for falls, assess mood, and allow remote check-in.

I was initially a bit put off by HIMSS turning its tweeting over to someone who is actually good at it instead of old-school stuffy, but I’ve grown to like it.

Where have all the vendor puffer vests gone? Gone to Goodwill, all but one.

Conversations Overheard

According to one executive, the respective CEOs of CHIME and HIMSS never got along all that well after Hal Wolf took over at HIMSS, but it was the refusal of HIMSS to cancel the 2020 conference until the last minute that sent CHIME off to form the competing ViVE conference with HLTH.

I overhead high-level executives of two significant companies saying that HIMSS23 has been a good conference for them, but also expressing delighted surprise at how much business they expect to generate from the ViVE conference. Both reported that in both conferences, their booths were packed, their scheduled events were waitlisted, and even casual booth-lookers ended up being significant decision-influencers who will likely result in new business. Both said that the secret is in booking meetings long before the conference starts, guaranteeing that the booth will generate ROI no matter what.

Someone commented that unlike HIMSS, ViVE provided water bottles and food freely to all attendees. However, those water bottles reportedly cost ViVE $500,000.

I overheard from two different executives that unlike HIMSS, repping the company at ViVE didn’t seem like actually working.

Someone described how the HIMSS conference has changed in the last 20 years by citing similarly sized gaudy booths back in the day, but with provocatively clad booth staff, jugglers, and booths that were turned into near restaurants with endless trays of deli food. It was also recalled how once upon a time HIMSS closed the exhibit hall during education sessions. I overheard one person lamenting the demise of HIStalkapalooza, which reminded me that I’m staying near the best place that we ever had it at the House of Blues Chicago. That also reminds me that I have recaps of all HIMSS conferences and HIStalkapaloozas starting at 2008 on the site, and although the earlier ones disappeared with a platform change in 2007, it’s a pretty engrossing memory lane of trends, companies, and people that in some cases are no longer with us.

A rep eating lunch was telling someone how surprised he was that Microsoft has suddenly starting dominating healthcare with Azure, its Nuance acquisition, and now its work with generative AI.

A vendor executive said they personally pledged to remain visible in their booth any time the exhibit hall is open instead of retreating to conference rooms or off-campus lunches.

Folks were speculating whether HIMSS will admit that the “no-carpet HIMSS23” was an mistake that will be corrected next year. I heard more people speculating that HIMSS didn’t want to pay overtime for carpet installation and decided to skip it with an unrelated excuse. One vendor said they were happy to have had their booth setup finished before the weekend, when overtime rates became exorbitant.

News

HCA Healthcare is piloting Augmedix’s ambient medical documentation system and has invested in the company in a $12 million funding round. AUGX shares jumped 90% on the news, valuing the company at $128 million. It went public in a SPAC-like reverse merger in 2020, with shares down 15% since their first day of trading.