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Curbside Consult with Dr. Jayne 1/11/21

January 11, 2021 Dr. Jayne 1 Comment

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My weekend took a decidedly positive turn after I was able to get my second dose of COVID vaccine. The side effects were a little more noticeable compared to the first dose, with a brief temperature elevation and headache. Tylenol and a nap vanquished them both, although I felt a little more tired than usual, but it’s unclear if that was from finally being able to let go of the anxiety of whether I’d be able to get a second dose or not.

It is unreal that frontline physicians who are actively caring for COVID patients would have to worry about getting a vaccine, but that’s the reality in many states across the US. I’m active in several nationwide physician forums and the majority of states are having difficulty vaccinating all frontline healthcare workers, while others are already vaccinating the general population based on age and comorbid conditions. We certainly live in interesting times. Artwork credit: physician Cindy Hsu.

I received the Pfizer vaccine and should reach target immunity two weeks after the second dose. I still don’t get to change any of my habits since the vaccine is only proven to reduce the risk of severe disease and/or death – we don’t have strong data on reduction of transmission at this point, although those studies are ongoing. There’s still the risk of being infected with COVID. I’m just less likely to die, which is a good feeling to have when you’re exposed to 20 or more COVID-positive patients a day.

My area continues to be in a surge that is being fueled by mass defiance of the county’s “safer at home” order, which means I still get to deal with heartbreaking situations at the office as people infect their grandparents and other loved ones when we are so close to getting vaccines for them.

A non-medical friend wasn’t aware of the lack of transmissibility data and asked me how long I planned to continue strict masking. After explaining the limits of the vaccine, I mentioned that I’ll most likely be masking forever. It’s not due to a concern about disease or contagion, but the fact that I’ve lost all ability to control my facial expressions simply due to the volume of ridiculous statements I have to hear on a daily basis. Plenty of patients still believe that the vaccine contains microchips or has the capability to modify human DNA, science be damned. As a physician, the most effective treatment I have right now is education, and although I’m happy to deliver it, I miss the days when I could solve problems with a flip of my electronic prescription pad.

The best side effect of the vaccine was the fact that I received it at a facility where I hadn’t previously been a patient, which exposed me to their version of Epic’s MyChart platform. Compared to the version being used by Big Medical Center where I usually receive care, it was amazing. Clean lines, no clutter, no distracting colors, and a much cleaner view of upcoming and past appointments. The medication list was easier to read without distracting color as well. Knowing that Big Medical Center is typically reluctant to take upgrades or to stay current with general release versions of software, I can only assume my new access is to a later and greater version.

I also haven’t been overwhelmed with announcements and updates from the new platform, so perhaps their communication plan or governance is a little tighter as well. It will be interesting how these contrasts play out now that I have access to both systems. I’m also curious to see how long it will take my previous employer to upgrade to the latest and greatest.

I spent a good chunk of time preparing my plan for the Consumer Electronics Show. I’ve never been in person, but have seen a lot of media reports and the in-person version sounds pretty overwhelming. The online schedule is a full one, but I suspect that like HIMSS, most of the interesting finds are found by checking out the exhibitors, which is a bit of an interesting process for most of the virtual conferences I’ve attended. I’ve been poking around the website and haven’t found anything that looks like a virtual exhibit hall yet, although there are lists of exhibitors and I’ve been getting plenty of emails from them. We’ll have to see if new features go live once the show officially starts tomorrow.

I’ve already identified quite a few digital health, wellness, smart home, and lifestyle vendors that I want to check out. I’m involved in some efforts to promote aging in place for older patients, so I hope there are innovative solutions that won’t cost an arm and a leg but will give patients and families greater peace of mind. Based on the lockdowns of the past year, so many people are afraid of moving to retirement communities or assisted living facilities even when they could benefit from expanded services. Hopefully, organizations have moved to fill that need. Kohler is scheduled to debut some smart home kitchen and bath accessories, but I’ll also be looking for design inspiration to finally complete what is possibly the world’s longest bathroom remodeling project.

Of course, there are also cool things that are not directly related to healthcare, but may provide interesting innovations in a secondary capacity, such as the unveiling of the world’s first autonomous racecar at the Indianapolis Motor Speedway. There are over 500 university students competing to win a $1.5 million prize in what’s billed as “the world’s first high-speed, head-to-head autonomous race.” The engineering types in my household are particularly excited to hear what that’s all about.

Some of my show sessions start as early as 6:30 a.m. local time, so I’d better get my rest this week if I’m going to keep up. Unlike the typical Las Vegas show, though, I’ll be able to readily access snacks from my own refrigerator and won’t have to wait in an eternally long line for a bad cup of convention hall coffee. I’ve stocked in extra martini supplies so I can pretend like I’m actually at a trade show.

If you’re attending CES, let’s have a virtual cocktail together. You can find me on Twitter: @JayneHIStalkMD

Email Dr. Jayne.

HIStalk Interviews Drex DeFord, Healthcare Strategist, CI Security

January 11, 2021 Interviews 2 Comments

Drex DeFord, MSHI, MPA is healthcare strategist for CI Security of Bremerton, WA.

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Tell me about yourself and the company.

I’m a recovering CIO. I have been a healthcare executive for most of the last 30 years and an independent consultant for the past four or five years. I serve as the healthcare strategist for CI Security. CI Security is a group of world-class security professionals who provide managed detection and response and cyber consulting services, with a mission to secure critical systems. We specialize in healthcare, but also cover other critical infrastructure.

What are the takeaways from University of Vermont Health Network’s month-long downtime from a cybersecurity incident?

This is one of those situations where the breach occurred long ago. The bad actor was in the system for a long time before they ultimately wound up revealing themselves. That’s part of the challenge today.

Historically, we have worked hard to build high castle walls to keep the bad guys out. But what we’ve realized, at least in the last few years since ransomware became prevalent, is that all of your frontline employees are now frontline cybersecurity people, too. One wrong click going to the wrong website and you’ve been breached.

You feel like you have to meet this challenge of building a tall castle wall, but the real opportunity is to find those bad guys as soon as they’re behind the castle walls, catch them, and throw them out. That’s a lot of what managed detection and response is about. Whether you’re in a big place or a small place, rethinking the strategy around security is critically important.

Is it true that human hackers aren’t involved until sometime after the technology back door has been discovered or opened via mass Internet probing?

This is another way that cybersecurity and attacks have evolved over time. You can certainly have nation state attacks, but now there’s ransomware as a service. We often find that health systems or other organizations are hit by ransomware as an accident. They are just collateral damage. Somebody was trying to make a quick buck, punched out a bunch of ransomware, and somebody in the health system clicked on it. It wasn’t directed, it wasn’t intentional, and it wasn’t focused on that health system. It’s just one of those things that the organization found themselves wrapped up in. 

As the types of ransom market and attacks evolve, we will see more and more and more of that, where it’s not really aimed at a health system or hospital, but the cybersecurity posture of many health systems leave them vulnerable to these collateral damage attacks.

How can CIOs convey that threat to board members who might see it as theoretically possible but so unlikely that it doesn’t warrant funding and focus?

A lot of this is keeping your board informed and helping them see the negative results on competitors or other organizations. Boards and other executives are very involved in this now, from what I see as I talk to CIOs across the country. Every time there’s a SolarWinds attack or something like that, board members start sending questions about, are we covered? How are we doing? Is everything OK?

You are right that it’s hard to prove a negative. If you’ve been doing a good job in your cybersecurity posture and you haven’t been breached, there’s still plenty of story to tell about the number of taps you’ve forwarded and the number of ransomware emails that don’t get through. A lot of those things are still happening to you, but you’ve been doing a good job of catching them. Those are the stories you should be telling.

Is healthcare more at risk because the many hospitals that are outside of big cities won’t have a lot of local cybersecurity expertise available and might not have the money to develop it?

That’s a real challenge in most places, especially with small and medium-sized health systems. The talent problem is real. It’s tough enough to try to hire the hire the people and get them to move to these areas. But once you get them there and you start teaching them some of these cybersecurity tools, you’re apt to lose them quickly, too. Retaining good talent is tough.

The other challenge I see over and over is that lots of vendors have silver bullet products that they would like to sell to organizations. The organizations get them, install them, and run them, but then quickly start to realize that it’s going to take more than a fractional FTE to actually get value out of that product. After they have accumulated a whole plate full of these products, they realize they have created a situation where they are more exposed. They know about these things, but they can’t do anything about them, or they don’t have the talent to actually run those products.

Being able to bring somebody in and let them do management section of response for you, 24/7/365, is the other big gap that we see. But being able to do it 24/7/365 — and having wraparound professional services that can help you get started through things like security, risk assessments, and penetration tests and all the other things that can be combined into a single package — makes a big difference to small and medium-sized health systems. They just don’t have the people to handle the challenges that face them. It’s not a core business skill that they would normally have.

Have recent incidents raised an awareness that cybersecurity breaches aren’t just an IT annoyance but in fact could put a hospital out of business?

There’s a cybersecurity and risk continuum that ranges from not very mature health systems to mature ones. There’s an understanding, or lack of understanding, that it’s not just about being hacked, It’s about the impact to the business. Short term, you have to get the systems back up and running and help get patients get back in. But long term, there’s the reputational impact. Especially for not-for-profits that have fundraising arms, being able to instill confidence in your donors that you’re a good place to donate money to because you take good care of patients and families and you never let them down. That’s how cybersecurity is tied to everything else, because it really isn’t standalone.

A simpler, relatively modern infrastructure is way easier to secure than one that has been built haphazardly over a number of years. That includes even infrastructure projects, upgrading switches, and upgrading end-user user devices. It doesn’t have to be bleeding edge, but that maturity and understanding makes the difference between mature organizations and relatively immature organizations.

Attacks in the past were usually focused on widely present misconfiguration vulnerabilities in JBoss servers or Windows Remote Desktop, where if an organization was paying even modest attention it could protect itself. Have attack methods broadened, and how do healthcare organizations share information about their experience and actions?

Trying to protect yourself against yesterday’s attack is a good thing to do, but lots of new types of attacks happen every day. It also comes back to doing simple, straightforward things. If you’re a CIO, you need to make sure that your network, server, and application teams have the time to apply patches to reduce your vulnerability. Cybersecurity is connected to everything else, including operations. Healthcare has gotten a lot better at sharing information through organizations such as CHIME.

H-ISAC – the global, non-profit Health Information Sharing and Analysis Center that crowdsources cybersecurity — has become a critical component in the sharing of cybersecurity information. You do preparatory work, such as doing tabletop and full-blown exercises where you connect to the organizations that you may need help from. You want to have your connections – such as state police, the FBI, or other healthcare organizations in your area – in place and on speed dial so that you are ready to connect. That’s not something you want to figure out after you’ve been breached. More connections and more collaboration puts you in a better position from a cybersecurity perspective.

ISACs exist for different industries and healthcare has a great team there who are always looking and working closely with the FBI, HHS, ONC, and others. They log, catalog, make recommendations, and share information about the kinds of breaches that are occurring.

It’s another reason too think about managed detection and response, because if you’re a standalone medium-sized hospital, you’re working off only the connections that you’ve been able to make as a small shop without a lot of time. A professional service organization like ours has lots of connections, not only in healthcare, but in other industries. This is what we do every day, so we are more likely to be looking for problems or openings for the bad guys that you may not have even heard about yet

What are the security risks involved with vendors and providers making initial moves to the cloud?

A cybersecurity professional company can help you navigate these waters. We have seen health systems, time after time, assume that software as a service means that if I don’t run this on my premises, and instead have it run by a company who does it for a lot of other people, I should be more secure. Generally speaking, that’s probably true, as long as you’re doing all your due diligence with that third party to make sure that they’re doing all the things that they should do to be secure.

When it comes to the cloud, the true cloud, this is another one of those situations where there are opportunities to make mistakes. You’re probably going to be more secure than you are. If you try to do it yourself — especially if you’re a small or medium-sized health system — engage a professional to look at the vulnerabilities and make sure you’re covered for what you’re trying to do.

Do you have any final thoughts?

CI Security is happy that 2021 has arrived and 2020 is in the rearview mirror. Cybersecurity is in front of boards and healthcare leaders.We look forward to supporting the need for critical healthcare infrastructure with easy to understand, easy to consume cybersecurity services and managed detection and response that is packaged up to be delivered in a better, faster, cheaper way.

Morning Headlines 1/11/21

January 10, 2021 Headlines No Comments

After SPAC merger, Clover Health president eyes membership growth this year

Shares in Medicare Advantage insurer Clover Health began trading Friday on the Nasdaq after it went public in a reverse merger with an SPAC.

CareDx Agrees to Acquire TransChart and Expands EMR Connectivity to Over 90 Centers

Transplant testing, lab, and software vendor CareDx acquires TransChart, which sells a transplant center EHR.

Carrum Health Raises $40 Million to Transform Healthcare Delivery and Lower Costs through First-of-Its-Kind Digital Marketplace

Carrum Health, whose marketplace connects employees of self-insured companies with company-screened, bundled-price surgery providers, raises $40 million in a Series A funding round.

Monday Morning Update 1/11/21

January 10, 2021 News 1 Comment

Top News

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Shares in Medicare Advantage insurer Clover Health began trading Friday on the Nasdaq. The company, which went public in a reverse merger with a SPAC, is valued at $7 billion despite a low Medicare star rating, availability in just some counties of eight states, and 50,000 members.

Clover Health offers doctors the free, web-based Clover Assistant, which provides access to patient data, personalized care plans, and faster payment.

Clover Health’s leadership team with health IT connections includes CEO Vivek Garipalli (co-founder of Ensemble Health and founding investor of Flatiron Health); Chief Clinical Informatics Officer Sophia Chang, MD, MPH (CareMore Health Plan and VP/medical director at Accretive Health); and Calvin Chock (McKesson).


Reader Comments

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From Plymouth Meeting:: “Re: hospital IT meetings. What would you do to improve them?” Ideas:

  • Identify the one person who is in charge. They don’t have to actually run the meeting, but they need to state why the meeting is being held, explain why each attendee was invited, and make assignments. It’s common for a hospital meeting to start with, “Whose meeting is this?” and nobody can answer.
  • Start and end on time. Do not wait for stragglers, which is almost everyone in hospitals, because that will encourage them and make the meeting seem less urgently important.
  • Send out an agenda days in advance with assignments. If nobody can find the time to do that, then cancel the meeting.
  • Implement a “no looking at electronic devices” policy.
  • Assign someone to keep the meeting moving and to take notes. I used to scoff at needing to record minutes until I attended my first meetings where they were scrupulously maintained and distributed by someone, and it was eye-opening. And someone needs to muzzle the attendees who can’t shut up (which is often a reflection of job title) and engage those who have tuned out because nobody’s listening to them or they are intimidated by higher-ranking or more verbally aggressive co-workers. A junior person who has little knowledge of the meeting’s topic is ideal for recording minutes – they have no skin in the game, they will follow up, and their lack of the understanding of the specific issue forces them to ask basic questions that nobody else noticed weren’t answered.
  • Don’t invite more than 5-10 people to a meeting where a decision will be made. Otherwise, the only decision that results will be to have more meetings.
  • When making a decision, do a voice vote and record each person’s choice to make sure they aren’t just coasting on in-room dynamics and that they understand that their consideration of the issues has consequences.
  • Don’t allow guests or uninvited add-ons. Hospitals are supportive democracies where most folks would never ask, “Why are you here, again?” and some people just love conference room gamesmanship.
  • Groups larger than a handful of people will never be able to reach consensus among all the position-jockeying. Get the ideas on the table in one or more larger meetings, but don’t give those big groups voting power beyond making recommendations to the smaller group. Big groups should be for brainstorming only.
  • Don’t make IT decisions without getting input from the users who will be most affected. Many IT attendees have quirky personality types, the inability see any nuance that isn’t black and white, and overreliance on either “I’ve been here a long time and that didn’t work when we tried it before” or “I’ve not been here long and I wish you would all stop living in the past and think boldly.” Make those users part of the brainstorming meeting, not the decision-making meeting, because they are seeing just a small part of the elephant at hand but will feel passionately that they are right.
  • Make sure standing meetings are really necessary. Those often waste the most time in hospitals because the only expectation of attendees is to show up and share their feelings, which hospital people do readily.

HIStalk Announcements and Requests

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My once-yearly and newly shortened reader survey takes seconds to complete and will earn you my gratitude and possibly a randomly drawn $50 Amazon gift card. I don’t know who’s reading otherwise since I don’t require registration or hide articles behind a paywall. Thanks.

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Less than one-fourth of poll respondents say their health is worse now than a year ago.

New poll to your right or here: Is more than 10% of your net worth invested in health IT-related company shares or equity? I make it a point to not hold any such ownership since I don’t think it would be right as someone who reports news and rumors, but I suspect it’s common and entirely reasonable for employees of publicly traded companies to hold shares in their retirement or incentive plans.

Sphere_HISTalk-Banner-Ad_120x240

Welcome to new HIStalk Platinum Sponsor Sphere. The Nashville-based financial technology and software company’s cloud-based platform is used by the country’s largest health systems to reduce friction and facilitate better, more secure patient payments in a single platform. Its integrated payments offering supports the native workflows of leading EHRs such as Epic, while its Health IPass solution enhances provider revenue collection and a streamlined consumer experience from appointment to final payment. It includes security and fraud tools, API integration, robust reporting and reconciliation, support for billing plans and tokenization, and support for all payment types and flexible spending accounts. Thanks to Sphere for supporting HIStalk.


Webinars

January 13 (Wednesday) 2 ET. “The One Communication Strategy Clinicians Need Now.” Sponsor: PerfectServe. Presenters: Clay Callison, MD, CMIO, University of Tennessee Medical Center; Nicholas E. Perkins, DO, MS, hospitalist and physician informaticist, Prisma Health. Healthcare organizations are leveraging their current investments and reducing their vendor footprint, so there’s no room for clutter in healthcare communication. The presenters will describe the one communication strategy that clinicians and organizations need today, how to improve patient experience and protect revenue, and how to drive the communication efficiency of clinical teams.

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


Acquisitions, Funding, Business, and Stock

Transplant testing, lab, and software vendor CareDx acquires TransChart, which sells a transplant center EHR.

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Carrum Health, whose marketplace connects employees of self-insured companies with company-screened, bundled-price surgery providers, raises $40 million in a Series A funding round. The company supports orthopedic, spine, cardiac, and bariatric procedures.

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Hinge Health, which offers employers and insurers sensors, apps, and coaching to prevent and treat chronic back and muscle pain, raises $300 million in a Series D funding round, valuing the company at $3 billion. The company plans to launch an IPO in 2022.


Announcements and Implementations

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KLAS takes a look at the hospital EHR market in Canada, which in many cases involves group- or province-led collective decisions that are intended to keep costs down. Meditech leads Epic in hospital count, but has lost some market share as 88 big-system hospitals have replaced Meditech with mostly Epic from 2015 to 2019, while 31 legacy Meditech hospitals have upgraded to Expanse. Customers report satisfaction with Expanse, but say they could have used more guidance and best practices before going live and a better idea of the maintenance requirements afterward. Satisfaction with Cerner is stable, but customers say the Citrix-heavy client-server footprint requires a lot of maintenance, although experience with Cerner’s recently introduced remote-hosted option is good. Allscripts hasn’t had a new Sunrise sale in Canada in the past 10 years, Harris Healthcare is rarely considered in new deals, and Telus Health’s Oacis is rarely considered and hasn’t sold since 2015.


Government and Politics

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The American Hospital Association lost its lawsuit challenging the federal government’s hospital price transparency rule last week, so it now asks HHS to not enforce it, saying that hospital IT employees are too busy with COVID-19 work.


COVID-19

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Saturday’s COVID-19 stats: 3,500 deaths and 130,777 patients in hospitals. Last week was the highest number of cases, hospitalizations, and deaths of any week in the pandemic.

CDC vaccination updates: 6.7 million first doses administered of 22 million doses distributed. At a goal of vaccinating 70% of Americans to reach herd immunity, we are less than 10% finished with first doses alone. Nursing homes have administered only 17% of the 4 million doses they have received.

Denmark’s CDC warns that the B117 variant is so contagious that it will become the dominant virus in the country and likely the world by mid-February. Even Tier 4 restrictions – stay-at-home requirements, closed shops, no public gatherings, no overnight travel – will not stop its spread, they say, as UK districts under Tier 4 stay-at-home orders are seeing a 10-fold increase in B117 cases every three weeks. US FDA says existing TaqPath and Linea tests can specifically identify the B117 variant and retesting previous positive samples to see whether B117 was involved does not require its approval.

The UK approves use of two rheumatoid arthritis drugs – tocilizubam and sarilumab – for treating COVID-19 patients in the ICU, where they appear to reduce the risk of death by 24% if given within 24 hours of admission.

California’s slow COVID-19 vaccine rollout is being partially blamed on problems with PrepMod, the state’s vaccine management system that coordinates waitlists, tracks inventory, and sends proof of vaccination to patients. The system, which is used by several states, appears to have been developed by the non-profit Maryland Partnership for Prevention. California’s COVID-19 testing program was hampered last year by problems with the CalREDIE results data collection system. The state says it knew that both systems weren’t ideal for their current use and is designing replacements.

A large study of discharged COVID-19 hospital patients in Wuhan, China finds that three-fourths still have symptoms six months later, including fatigue, insomnia, depression, anxiety, and lung problems. Excluded from the study were the sickest people, such as those who could not be interviewed or who were readmitted in the six-month period.

Experts question whether health systems and states that use online systems and other technology for COVID-19 vaccine administration are limiting access to elderly, low-income, and rural populations.

The city of Nangong, China will pay $75 to anyone who reports a resident who has not received a mandatory COVID-19 test. Areas with outbreaks of a few dozen cases are being locked down, every resident is being tested, highways have been blocked, and some cities allow only one member of a household to leave their homes every days to buy supplies.


Sponsor Updates

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  • OpenText donates $15,000 to the Manna Food Center in Gaithersburg, MD.
  • Wolters Kluwer Health announces integration of its Health Language clinical interface terminology solutions with Henry Schein MicroMD’s EHR platform.
  • Rush University Medical Center expands its deployment of Nuance Dragon Ambient Experience to 14 clinical specialties.
  • OptimizeRx will present at the HC Wainwright Virtual BioConnect Conference on January 11.
  • Nordic releases a new podcast, “Creating and leveraging a successful Super User program.”
  • Pure Storage will participate in fireside chats during the Needham Virtual Growth Conference on January 11, and the Goldman Sachs Virtual Tech and Internet Conference on January 12.
  • The local news features a story on how one family stayed connected to their hospitalized infant through Vocera’s Ease app.
  • Saykara President and Chief Medical Officer Graham Hughes, MBBS publishes a guest article titled “Physician Groups Turning to AI for Relief from EHR Documentation Burden” in AI TechPark.

Blog Posts


Contacts

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

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Katie the Intern 1/8/21

January 9, 2021 Katie the Intern No Comments

Happy second week of 2021, HIStalk! It has proven to be interesting, in the least. I hope 2021 is treating you well so far. This column is a bit shorter than usual, so enjoy an easy read! 

This time around, I wanted to expand further on the conversation I had last week with TransformativeMed’s chief clinical officer, Rodrigo Martinez, MD. We talked about the concept of AI assistants, “spot solutions” in a clinical setting that aid in the treatment plan of patients. The idea for AI-powered assistants came first from a basic question — how can we help reduce some of the frustration that exists as part of the transcription process of being a physician? 

“The first phase for a lot of these [AI assistants] is that they are listening to the conversation between a physician and a patient,” Dr. Martinez said. “The ultimate intent of it is to transcribe that conversation, but also insert the different elements of text into the appropriate spot in the medical record.” 

That isn’t exactly easy to implement, though, as a large part of this AI software is reliant on machine learning. Say a patient and provider are both speaking in a room, and the AI assistant is listening through a microphone. In the initial phases of using this software, another person would have to be present to transcribe what is happening so that the machine can learn how to do so by itself. 

“It has to start to parse out, OK, when is the doctor speaking? When is the patient speaking?” Dr. Martinez said. “The machine learning over time starts to match and map and learn using natural language processing and converting a lot of those concepts. Rather, the algorithm starts to recognize it.” 

But the transcription doesn’t stop there. The AI assistant has to then learn how to place all of this information into a medical record correctly, learning where to place orders for future visits versus when the patient and doctor are talking about past symptoms. The software must take this information in in real time before converting it into orders. 

The concept of teaching AI to listen to a conversation and decipher it is not new. AI listening and problem solving software has been researched as early as the 1960s with Newell and Simon’s General Problem Solver. For healthcare IT, the application of AI-powered scribes has come leaps and bounds. 

A leading AI offering for this application is from Saykara, known as Kara the virtual assistant. Kara was developed to help eliminate charting and billing records after hours for OrthoIndy. Saykara works by pulling patient lists to capture, interpret, and transform data from conversation and summarization to then put it into the EHR. These types of services show a reduction in provider stress levels and eliminates after-hours charting. 

I asked Dr. Martinez if AI-powered assistants have helped relieve some of COVID-19’s burden. He said the potential to reduce contact with patients and provide hands-free care is promising. When it comes to telehealth and virtual appointments, AI assistants and scribes could grow to be the future of healthcare. 

“As more and more visits are moving to telehealth, there is a role for that AI-powered scribe to be recording that information and applying it,” Dr. Martinez sad. “I could see how the more and more you make things hands free, and make it easier to anticipate the next step that the nurse or physician needs to take, the better off folks are going to be.” 

The AI-listening concept may be off to a slow start, Dr. Martinez said, but the potential for outpatient treatment is more promising than in-person. In-person treatment usually has too many voices and people in a room for scribes to accurately transcribe. Ultimately, the future of these AI assistants lies in the hands of further development and machine learning.

Dr. Martinez said that the future of AI in medicine is promising, and that AI can be applied to a multitude of areas in healthcare IT and telemedicine. AI has the potential to make transcription and hands on care easier and safer, taking a weight off of healthcare providers in general.

“I think the concept of that is very fascinating and very interesting,” Dr. Martinez said. “I think there are a lot of potential applications to decreasing the administrative burden that is part of healthcare in the US.”

That’s it for this column! I hope you’re enjoying 2021 to the best of your ability, and stay safe out there! 

Katie The Intern

Katie

Email me or connect with me on Twitter.

Weekender 1/8/21

January 8, 2021 Weekender No Comments

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Weekly News Recap

  • Optum announces its intention to acquire Change Healthcare.
  • Harris acquires Obix.
  • TigerConnect acquires Critical Alert.
  • Intraprise Health acquires HIPAA One.
  • Cedar Gate acquires Enli.
  • Haven announces its shutdown.
  • ONC publishes Cures Act developer resources.
  • Hospitals begin publishing their negotiated rates and prices for shoppable services.

Best Reader Comments

This was the best hope for CHNG who hadn’t realized their IPO dreams, Optum was the only one that could afford them. For employees, the CHNG strike price for stock options was $18, so maybe some of the employees whose McK deferred bonus programs were transferred to CHNG stock options at the merger will be able to finally cash out 4 years later! (CHNG maker)

What users are GREAT at, is telling you that you did it wrong. Long after the job was done, and after the project stage that would allow you make it right. Mostly, the programmers are left to imagine the solution on their own. Some organizations employ systems architects, designers, and even plain managers who will do mock-ups, role-playing, workflow analysis. Not once have I ever had the opportunity with those people. They cost money and take a great deal of organizational willpower and discipline. Steve Jobs was famous for envisioning a finished system. He’d then follow the implementation to make sure the design & implementation followed the plan. He’d keep after managers and programmers, keep them on track. He’d even kill products that didn’t live up to his expectations. Steve Jobs was famous for being an exception, an outlier. In the real world, most systems go through a laborious process, slowly evolving from something terrible into something better. (Brian Too)

Community-based Pediatricians are also in vital patient-facing roles. I’ve heard too many reports of hospital billing staff and work-at-home admins getting their vaccines while non-hospital-employed primary care physicians are left to fend for themselves. (Chip Hart)

Online advertising is a massive industry, and healthcare providers and pharmaceutical companies participate the same as anyone else. Websites and internet service providers can very easily identify who you are. They know your name, age, sex/gender, and where you live by the time the page finishes loading. They know what other websites you go to. They know what medical conditions you look for on search engines. They are all legally allowed to freely sell, exchange, and reconnect this data however they want. Your healthcare provider doesn’t need to sell identified data when your online presence is basically screaming out your name, everything post you’ve liked, the web pages you’ve visited, etc. (Elizabeth H. H. Holmes)

Despite all the talk about upcoming consumerism in health care, the reason for such dismal patient experience is precisely this. Patients don’t control the purse string (even though it is their forking money). All they can do is fill up a toothless HCAHPS paper survey three months after their encounter with the health system. And this is of course true not only for hospitals but for every single aspect of our medical care “system.” (Ghost_Of_Andromeda)

Healthcare organizations need to change how they proactively reach out and engage customers as we enter 2021. We all understand the value of precision medicine, but we now need precision engagement. Other consumer service industries have long employed sophisticated data science to predict and influence customer behavior. It has resulted in (1) more loyal customer relationships and (2) increased lifetime value. In healthcare, we are still relying on generic notifications. We need to be identifying our highest risk customers, prioritizing what we talk to them about, and then personalizing the channel selection, the message selection, and the time of communication. (Michael Linnert)

The same people who rant about freedom and tyranny would do well to read about the smallpox epidemic that began in 1775. We have direct insight into how the Founders acted during a disease outbreak, and I can assure you they did not act in the interest of individual freedom, because they were intelligent and principled enough to understand responsible population health management even then. The United States doesn’t have a COVID crisis as much as we have a selfishness crisis. (Elizabeth H. H. Holmes)


Watercooler Talk Tidbits

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Readers funded the teacher grant request of Ms. B in South Carolina, who requested 12 books for her kindergarten class. She showed her class the books on a day in March and stayed late to create a book bin, but in-person learning was cancelled that same day. She contacted the publishers and authors to seek permission to record herself reading the books for her class, sometimes getting approval and sometimes getting a firm “no” or no response. She filmed herself reading those books where she received approval and reports, “My students LOVED seeing me reading books that they had chosen. I even had a parent contact me to let me know that her son couldn’t believe he was seeing me on TV and shared a short clip she filmed of him watching me read. I was excited to see how excited he was. Parents started engaging more and looking forward to these read aloud followed by book discussions on Zoom. Many parents were surprised to learn how deeply their student could dive into a book and understand not just overall themes, but also underlying themes. These books have given my students and their families so much more than I could have ever imagined. Thank you for believing in the power of print and giving me the opportunity to make such a huge impact.”

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In China, an ophthalmologist whose surgical career was ended a year ago by a patient’s knife attack gets a standing ovation from a TV audience after telling them that his injury was a “pleasant surprise” because it reinforced that his work is worth doing. He specializes in treating uveitis, working in a low-paying hospital job and often helping patients pay their medical bills from his own pocket and performing free cataract surgery. He joked that the patient was unreasonable because “there were so many people in the hospital at that time, yet you stabbed me with precision – doesn’t it show your vision has recovered well?”

In Australia, charity gift shop workers who called an ambulance and comforted a homeless man who showed up in distress and later died alone hold a funeral for him in a local cathedral. The presiding bishop said during the service, “He went with full honors. I asked those present to imagine their own funeral one day and what they would like people to say about them, and how that really affects how we live now. We choose to do what is good and loving and virtuous, rather than the opposite.”

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A Pine Bluff, AR medical oncologist and UAMS professor who sold his clinic to the local hospital sends Christmas cards to 200 former patients to tell them that he and his family had decided in a Thanksgiving discussion to forgive their outstanding medical bills. Omar Atiq, MD explains that he wrote off $650,000 because, “I have never refused to see a patient for lack of funds or lack of insurance. To me, the highest honor comes when somebody puts his or her life in your hands. To be a physician or a nurse is, to me, something bigger than a transaction. But in the vast majority of the world, it is tough to be sick and it can be exorbitantly expensive to get the appropriate treatment … That people are interested in this story shows me that perhaps the less positive news we hear each day may just be a small part of who we are as humanity. Perhaps the larger part of humanity is just doing what they can to keep the world moving forward.”


In Case You Missed It


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Morning Headlines 1/8/21

January 7, 2021 Headlines No Comments

Harris builds its perinatal portfolio with the acquisition of Clinical Computer Systems, Inc.

Harris acquires Clinical Computer Systems, Inc., which offers Obix perinatal software.

Advanced ICU Care Announces Corporate Rebrand as Hicuity Health™

Tele-ICU services vendor Advanced ICU Care renames itself Hicuity Health.

Simplify ASC Acquires PhyBus Revenue Services

Ambulatory surgery center health IT company Simplify ASC acquires PhyBus Revenue Services for an undisclosed sum.

Rennova Completes Agreement to Separate its Software and Genetic Diagnostics Interpretation Divisions Into Innovaqor, Inc.

Hospital and practice operator Rennova Health sells its Health Technology Solutions and Advanced Molecular Services Group divisions to Innovaqor.

Computer Network Incident Update

Greater Baltimore Medical Center begins restoring its EHR after a December 6 ransomware attack forced it to take several systems offline.

News 1/8/21

January 7, 2021 News 1 Comment

Top News

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UnitedHealth Group-owned Optum will acquire Change Healthcare in a deal valued at $13 billion.

Optum will combine Change Healthcare with its OptumInsight software and analytics business.

Change Healthcare President and CEO Neil de Crescenzo will become CEO of OptumInsight when the acquisition closes in the second half of the year.


Reader Comments

From Mandrake: “Re: Obix being acquired by Harris. What does this mean to the health system? Any key executives departing What was the cost of the sale? Who is the buyer since I’ve never heard of them?” Harris Healthcare Group is part of a Canada-based company that has done a lot of health IT acquisitions. I’ve included a partial list is further down the page. I’ll invite readers to provide answers to any of these questions, especially with regard to how customers fared after Harris acquired their vendor. KLAS data would be interesting.

From Barry Gibberish: “Re: health system IT strategy meetings. You’ve written about the psychology involved. Repeat, please.” I don’t recall what I wrote and I’m too lazy to look it up, so here’s my off-the-cuff list of what hospital meetings are like:

  • Any hospital meeting will be full of people who are empowered to say “no” but nobody whose authority allows them to say “yes.”
  • Ever-larger meeting rooms are needed because people keep inviting themselves or others to validate their importance.
  • It’s almost guaranteed that none of the attendees have given the slightest thought to the issues at hand since the previous meeting, and any assignments they were given will be quickly thrown together while others are talking.
  • Clinicians will either be uninvited or marginalized because they are seen by the suits as being untethered from reality and dangerously unfiltered.
  • Nobody will argue for changing the status quo unless they see personal or departmental benefit. They are the people who thrive in the current state they built.
  • Some people can always be counted on to say why any given action shouldn’t be taken, but they never have ideas of their own because that would be bold. This is the dynamic in which every mid-level attendee takes a position to set themselves apart from everybody else in asserting their contrarian thinking (you don’t get points for agreeing). I guarantee that some of those folks enter the room planning to take the “let’s do it” position, but finding it already taken, flip-flip equally passionately to “this is a terrible idea.”
  • Hospitals are awkward, department-driven democracies where nobody except the million-dollar leadership club can be identified as inarguably in charge, so many meetings are free of agendas, objectives, facilitators, assignments, and conclusions. It’s fun talking about stuff, but the seriousness of actually making a decision and attaching names to it means it often doesn’t get done.
  • Committees that spend great amounts of energy and research to reach a decision will often be overridden by an executive afterward who believes their superior analytical powers and gut instinct takes precedence.

From Be the Ball: “Re: price transparency. Some providers are live with consumer-friendly searches. Examples of our Change Healthcare customers are Rush Health Systems, Levi Hospital, and South Central Regional Medical Center.”

From Wooster: “Re: J.P. Morgan Healthcare Conference next week. Usually there’s an entire subculture of meetings around the conference venue. What are everyone’s plans?” Readers are welcome to weigh in on how, if at all, they will participate in a virtual version of a conference whose biggest draw is what happens near but not actually in the actual conference venue.


HIStalk Announcements and Requests

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I could really use your help in completing my one-yearly, eight-question reader survey that takes maybe 30 seconds. You’ll earn my appreciation, feel good about voting, and be eligible to win a $50 Amazon gift card. Thanks for helping me out.

Reminder: we have dedicated news history pages for Cerner and Meditech, as requested by readers and maintained by Jenn. If you read HIStalk in desktop mode (not the mobile format), links are under the Company News History menu item. Let me know if you find those useful.


Webinars

January 13 (Wednesday) 2 ET. “The One Communication Strategy Clinicians Need Now.” Sponsor: PerfectServe. Presenters: Clay Callison, MD, CMIO, University of Tennessee Medical Center; Nicholas E. Perkins, DO, MS, hospitalist and physician informaticist, Prisma Health. Healthcare organizations are leveraging their current investments and reducing their vendor footprint, so there’s no room for clutter in healthcare communication. The presenters will describe the one communication strategy that clinicians and organizations need today, how to improve patient experience and protect revenue, and how to drive the communication efficiency of clinical teams.

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


Acquisitions, Funding, Business, and Stock

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Harris acquires Clinical Computer Systems, Inc., which offers Obix perinatal software. Other health IT brands owned by the acquisition-focused Harris – formally known as N. Harris Computer Corporation as an operating group of Canada-based Constellation Software – include Amazing Charts, Iatric Systems, IMDSoft, Just Associates, GEMMS, Picis, PulseCheck, and QuadraMed. The company looks for acquisitions that have a diversified customer base, offer mission-critical enterprise software, low customer attrition, leading or increasing market share, fragmented competition, and the potential to grow geographically or via product expansion.

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Healthcare communication platform vendor TigerConnect acquires Critical Alert, which offers middleware for nurse call, alarm and event management, and medical device interoperability.

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Cybersecurity services vendor Intraprise Health acquires HIPAA One, which offers HIPAA compliance automation software.

GE concludes that it has no legal recourse to try to reclaim the compensation it gave to former CEO Jeff Immelt, who disastrous operational and acquisition decisions left the company drowning in debt, selling off pieces and parts, and removed from the Dow Jones Industrial Average. GE says that independent counsel has advised that Immelt wasn’t guilty of misconduct, just incompetence (I’m reading between the lines here, and it should be noted that the board left him in charge for 16 years). Immelt, who was promoted from what was then GE Medical Systems (now GE Healthcare), was forced out in 2017, then spent a few months as executive chairman of Athenahealth in brokering a deal to sell the company to a private equity firm.


People

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Halo Health hires Steve Smerz (NovuHealth) as CTO.

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Carl Swart, MHA (Ensemble Health Partners) joins ApprioHealth as COO.


Announcements and Implementations

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Urgent care operator CityMD launches a virtual line solution using technology from urgent care software vendor Experity, hoping to eliminate hours-long lines of people waiting for COVID-19 tests.

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Tele-ICU services vendor Advanced ICU Care renames itself to Hicuity Health.

Walgreens will open up to 700 in-store Village Medical primary care clinics in the next four years following its previous $1 billion investment in VillageMD.

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Beebe Healthcare goes live with TransformativeMed’s Core Work Manager, which it will use to increase situational awareness of patients at both the employee and care team levels.

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A new KLAS report on rapid telehealth uptake during the pandemic finds that few Amwell and Teladoc Health customers plan to use their solutions to meet all their telehealth needs. More focused solutions have high satisfaction, such as Caregility for teleICU (it has multiple capabilities) and Mend for virtual clinic visits. Videoconferencing platforms from Zoom and Doxy.me feature easy rollout and low cost, but 30% of users will replace them with products that offer better support, EHR integration, and a simplified clinical experience. Microsoft Teams performs well but falls short on patient experience, while more than half of Vidyo customers are unhappy. Telehealth solutions from Epic and NextGen Healthcare earn high customer satisfaction because of integration with their EHR, a feature that customers of other EHR vendors are hoping to get.

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Another new KLAS report on credentialing during COVID-19 finds that Verge Health leads in remote credentialing; Verge Health, Modio, ASM MD-Staff score highly for emergency credentialing; and most vendors perform well at telehealth credentialing across state lines. 


Government and Politics

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Cerner VP of strategic growth Amanda Adkins leaves the company after losing her bid to unseat Rep. Sharice Davids (D-KS) in the November US House election. She had been with Cerner for 15 years, but took a leave of absence a year ago to campaign. She lost by 10 percentage points as the Republican candidate.


COVID-19

Wednesday’s COVID-19 hospitalization set another record at 132,476. Nearly 4,000 new deaths pushed the US total to 361,000. States are continuing to catch up with posting holiday-delayed data. The worst spread of any area of the world is in Arizona, where hospitalizations are at almost 5,000 and 297 people died of COVID-19 on Wednesday.

Scientists warn that the US is not equipped to track mutated versions of coronavirus since no national surveillance program is in place, with genomic sequencing being performed on only 3,000 of 1.4 million positive samples each week.

The Surgeon General urges states to aggressively expand vaccinations to other phases if their vaccine supply exceeds Phase 1a demand (healthcare personnel and long-term care residents). Phase 1b includes frontline essential workers and those over 74. Meanwhile, NYC Health and Hospitals says it has given every public hospital employee shots who wanted them – 30% did not – but the city has not received state permission to start administering the vaccine to first responders, corrections officers, and people over 74.


Other

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Weird News Andy intones mellifluously (in my mind, at least) that, “It is better to have loved and flossed …” in hair-balling up this story, in which a woman experienced gingival hirsutism, i.e. she sprouted hair from her gums.


Sponsor Updates

  • Healthcare Growth Partners advises Digisonics in its sale to Intelerad, PatientMatters in its sale to Firstsource Solutions, and HIPAA One in its merger with Intraprise Health.
  • Health Catalyst will present virtually at the JPMorgan Healthcare Conference January 11.
  • The local news covers Cerner’s efforts to help Truman Medical Center (MO) streamline patient scheduling and registration for the COVID-19 vaccine.
  • Everbridge surpasses 5 billion communications in 2020 from its Critical Event Management Platform, supporting healthcare, business, and government organizations around the world.
  • Fortified Health Security will present at the ISACA Huntsville Chapter virtual meeting January 25.
  • Goliath Technologies enters an equity partnership with Cloud-Oculus to expand its cloud-monitoring product portfolio.
  • Healthcare Triangle publishes a new case study, “2020 Epic Program Spotlight: Tanner Community Connect.”
  • With support from InterSystems and its Veterans Data Integration and Federation Enterprise Platform, the VA has launched its COVID-19 vaccination program, while treating 130,000 cases.
  • Meditech adds the Northside Achievement Zone in Minneapolis to its charitable giving program.
  • Medrah IT expands its reseller agreement with NextGate.
  • Several HIStalk sponsors take home Best in Biz Awards: CoverMyMeds (Bronze, Most Innovative Product of the Year – Healthcare and Medical); Spirion (Bronze, Enterprise Product of the Year – Security Software); Lumeon (Gold, Best New Product of the Year – Healthcare and Medical); and Waystar (Silver, Best New Product of the Year – Healthcare and Medical).

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 1/7/21

January 7, 2021 Dr. Jayne No Comments

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ONC announced dates for the 2021 annual meeting, scheduled for the end of March. You can subscribe to updates to make sure you’re in the know.

I have to say I miss big meetings and getting to connect with interesting people. I’ve done several virtual conferences and they just don’t provide the level of randomness that we were used to in person. I was going to attend the Consumer Electronics Show in person for the first time in 2021 and that didn’t turn out so well. The event is scheduled to run virtually January 11-14 and I’ve been approved to attend as a member of the media. If anyone can hit a virtual conference out of the park, it should be CES.

I’m looking forward to seeing what companies have come up with as far as expanding the utility of wearables in patients’ personal health journeys. Wearable devices seem to have plateaued the last few years, so it’s going to take something novel to get people re-engaged.

I also want to see what companies are doing to make tech more accessible. Although we may be used to the majority of people around us having a smartphone in their pocket or purse, there are plenty of people in the world that don’t have that access. I’m also looking forward to seeing first hand some of the wild and crazy things that will debut at CES, and following them over time to see if they take off or not.

Speaking of conferences, HIMSS is planning a meeting for August, but I wonder what it’s going to look like in reality. A recent article described the downstream impact of the February 2020 Biogen conference. Its 100 confirmed cases were identified as causing 50,000 cases in the US alone within the first two months following the super spreader event, nearly half of which were in Massachusetts. By November 1, the virus strain from the conference was linked genetically to over 330,000 cases in 29 states plus Sweden and Australia. Even for those of us that will (hopefully) be fully vaccinated by the time HIMSS rolls around, it’s important to remember that the vaccine has not yet been shown to prevent COVID infection — it just dramatically reduces the risk of severe disease and death.

Mr. H has already reported on the wind-down of Haven, which hoped to lower healthcare costs and improve outcomes. One of the key reasons cited for its inability to disrupt healthcare is that each company continued to deliver its own projects separately, which reduced the need for the joint venture. The inability of large organizations to work together is being seen everywhere in the US, particularly with vaccine distribution. Physician colleagues are reporting from across the US that hospitals that have been entrusted with vaccine distribution are refusing to vaccinate frontline healthcare workers if they’re not employed by that particular institution. This is often in violation of state vaccinator contracts and agreements, but no one wants to enforce it. Until we understand that we can be stronger together than we can be separately, we will all continue to struggle.

My state isn’t the only one struggling: New Jersey’s vaccine registration site launched this week but immediately experienced issues attributed to high volumes. It may not be perfect, but I at least give the state credit for trying to create a list and communicate with people, which is much more than many other states have done. My home county finally received vaccine and has no way to manage a list of Tier 1a providers who are trying to get vaccinated – the only way to get through is to wade through a maze of phone prompts and hope you reach someone who can add your name to a paper list.

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JAMA Surgery published a piece this week looking at “the Empowerment/Enslavement Paradox” among surgeons and their personal communication devices. The authors note that “the same tools that empower people can also eliminate personal freedoms by increasing work pressure and blurring the boundary between work and personal life.” There are certainly benefits of being able to be continuously connected particularly with smartphones, such as being able to act quickly to care for patients and to be able to have the world’s medical literature literally at your fingertips. Unfortunately, technology can also function as an electronic leash, continuously tethering physicians to their work. I’ve experienced both extremes and it takes a tremendous amount of discipline to keep tech from taking over at times. It will be interesting to see if improvements in technology will help resolve this paradox.

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Like many of us, I tend to multitask, and I have to admit I was surfing the internet while listening to the US Senate speeches as our Congress reconvened following Wednesday’s unbelievable events. In hindsight, I probably would have benefitted from drinking a strong martini and making sure to take a sip every time a particular Senator used the word “hooligans” or “temple of democracy.” During my surfing, I enjoyed learning about a set of lava lamps that are used to drive internet encryption. The lamps are located at the Cloudflare company headquarters in San Francisco. Cameras capture the changes in the patterns and transfer them to a computer that translates it into encryption keys. The randomness inherent to lava lamps reduces the chance that hackers would be able to break the key. The Cloudflare site offers a great primer on random numbers, cryptography, and entropy. At its London office, Cloudflare uses a slightly less-groovy method of random data generation, using a double-pendulum system, which seems a bit more classically British. The Singapore office uses radioactive decay from a uranium pellet as its source.

Given the events of the day, I could use some quality time staring at a wall of lava lamps since I’m not traveling to see a nice waterfall or sunrise anytime soon. There’s also always that stout martini. Who’s with me?

Email Dr. Jayne.

Morning Headlines 1/7/21

January 6, 2021 Headlines No Comments

Optum Acquires Change Healthcare for $13 Billion

UnitedHealth Group-owned Optum will acquire Change Healthcare and combine it with its OptumInsight software and analytics business.

TigerConnect Acquires Critical Alert, Ends 2020 with Second Major Acquisition

Care team collaboration software vendor TigerConnect acquires Critical Alert, best known for its nurse call, alarm, and event management medical devices and software.

Intraprise Health Acquires HIPAA One

Cybersecurity and risk management software vendor Intraprise Health acquires HIPAA One, a Utah-based company specializing in security, privacy, and compliance software and services.

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Readers Write: AI and ML – Help Change the Course of the Pandemic and Make Money

January 6, 2021 Readers Write No Comments

AI and ML – Help Change the Course of the Pandemic and Make Money
By Jeremy Harper

Jeremy Harper, MBI is an independent consultant.

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Twenty million people in the USA and 75 million people worldwide have tested positive for COVID-19. Public health estimates that six times more people have had the disease and are not aware. A vaccine will slow the rate of growth, but no one is expecting it to eradicate the virus as it mutates and adapts.

Even as we hit a year since the infections began, we know very little about the long-term consequences and impact for those who have had COVID-19. We are looking at how those impacts are different for people who have asymptomatic, symptomatic, or hospitalization issues. The problem is that research study after study has been released on small populations that are seen at local health systems. That information has been better than not sharing at all, but the small populations of patients at local sites have led us down directions that wasted time, effort, and energy.

The National COVID Cohort Collaborative (N3C) is the largest central data repository in the history of the NIH targeted to a single disease. It has over 400,000 records of patients who have been positively identified as being afflicted with COVID-19 out of 2.5 million patients total. Each week as they onboard additional academic medical centers, the patient population grows. This large initiative is supported by academic centers around the nation, bringing together some of the best healthcare minds to identify solutions.

A large national dataset of people who have had COVID-19, which we call a disease cohort, is required because it gives us the opportunity to pool data to create groups of people to reveal patterns and help people cope with long-term consequences of having the disease. This dataset, however, isn’t only useful for NIH-funded research. This dataset will also be transformational for health systems. Models can be quickly built and deployed to predict the business needs we are experiencing, and will experience, at health systems over the next years. Models that may not have captured intellectual property with this freely available resource, but cannot be implemented within the standard health system without experts to explain and deliver specific actions to take from the information and models that are built.

There is so much that we don’t know as we move forward in the healthcare domain with COVID-19, but we have opportunities to make a difference. We are moving beyond the local environments that only leverage standard Structured Query Language (SQL) to a future with large data lakes. Without such pooled data, we may take a decade to understand the extent of the problem and be able to ask questions across health systems to understand the issues. This centralization will allow us to research and implement within months instead of years after the initial data collection.

Even with the multiple vaccines, this disease state isn’t finished. People who have been immunized with the vaccine can still get the disease, though at lower rates. The natural evolution of the disease has been impacted by the changes we have made to our societies and interventions in which we have engaged. We may never fully understand or be able to model with accuracy where we would have been without what has been needed to control the impact, but we do have fantastic natural experiments to compare variables. We know so little today and we must test and implement interventions that have been held back.

Let’s take some examples from the problems that people face after having COVID-19, the three most commonly known long-term impact areas in the lungs, brain, and heart. These are problems that are waiting for ambitious business solutions. 

LUNG: You may know at a local health system how many people have experienced lung scarring, but you won’t have a large enough population to predict the interventions that will be required over the upcoming years. This population is large and diverse enough to have concrete predictions for what will be required.

BRAIN: We have no idea how the widely reported COVID brain impacts will play out, but it’s certainly going to require new interventions. Working with health systems in conjunction with the N3C may help us tease apart genetic, environmental, or disease specific areas that are vital for patient intervention. By being on the forefront for identification of those afflicted, we will be able to package and deliver opportunities to help individuals. Influenza and pneumonia vaccinations have been tied to lower risk of Alzheimer’s Dementia. There is a very real risk that we will see higher prevalence in the future, and monitoring and helping health systems will impact lives

HEART: We have entire hospitals dedicated to this vital organ. We know that myocarditis, which is an inflammation of the heart muscle, is occurring frequently in COVID-19 patients. This has the danger of leading to heart failure in the future. Patients will need to be flagged to be monitored for this going forward. Health systems will need to potentially reach out and notify patients that they need to be vetted for early symptoms of heart failure. As this grows and progresses, health systems will need to pivot to be able to handle the underlying disease states in their patient populations.

The healthcare industry is experiencing disruption as a result of these external forces that is unprecedented. Any time an industry experiences this level of disruption, it provides opportunities for improvement and adoption of third-party solutions. We have the ability to create many metrics, create many perspectives, and work through many issues. The N3C gives us many opportunities to connect and collaborate across organizations. While the N3C will not be appropriate to answer every question, it can answer many urgent scientific and operational questions through its different data access levels.

Examples of the types of questions that can be difficult to tackle include those that look for discrete answers, such as whether someone is asymptomatic or not. There are swaths of people who have been positive without any symptoms. While we can identify the primary cause of some hospital stays, we don’t have a consistent answer over whether someone came into the hospital because of COVID-19 or if they came because of another reason and happened to test positive. There is currently no universal standard to track the new vaccinations and which brand of vaccination may have been administered.

Than N3C has a higher potential for business to partner with research in an agile rapid manner than do most research infrastructures. The N3C team is a team of distributed participants, allowing for communication with the team in real time, while at the same time retaining full opportunity to query the data. The N3C team is also able to work dynamically upon normalizing and rationalizing what is being found within the database. Data can be created and archived in a single location for future analysis, and analysis within a team could provide a new way of communication for your business.

A combination of cloud computing, open data, and hosting ensures that your business can utilize the N3C Data Enclave. This cloud-based platform has taken research from an expensive system that we each need to implement into an inexpensive solution that we can all access. This is the new technology that has replaced outdated and slow research & development (R&D) methods.

It is the time to make it available for your business and your team. The solution ensures the business will eliminate the traditional costs and time associated with large, expensive research facilities. It allows business to do what it does best: rapidly innovate and leverage data to deploy solutions at facilities around the nation.

If you are interested in learning more, onboard to N3C or email me at owlhealthworks@gmail.com.

HIStalk Interviews Diana Nole, EVP/GM, Nuance Healthcare

January 6, 2021 Interviews 3 Comments

Diana Nole, MBA is EVP/GM of the healthcare division of Nuance Communications of Burlington, MA.

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Tell me about yourself and the company.

I run the healthcare division for Nuance. I joined the company in May, but I have known Nuance for about 15 years, which was right around the time when I started my work within healthcare, always being around technology and companies that were transforming their portfolio. This is a great opportunity. Nuance is well regarded in terms of being respected by customers. They have a large installed base, wonderful partnerships with everybody that’s in the ecosystem such as the EHRs and Microsoft, and a lot of great growth opportunities. While I wasn’t looking, it was an intriguing opportunity and time to come to the company.

Where would you place ambient clinical intelligence in your personal version of the hype cycle?

We are in the earlier stages of how it will be used within healthcare. It is focused right now on the particular area of physician burnout and patient experience.

The elements of the documentation burden that is placed on the physician is causing them to feel overwhelmed. They are not being able to produce the type of experience they want with patients, but patients are also feeling disengaged. This is a solution that is going to evolve from not just being the element to fix or to support better clinical documentation, but to expose opportunities that we haven’t appreciated or realized. 

For example, wouldn’t it be helpful to have the complete diarized elements of the conversation between patient and physician for other people that are supporting the patient in their treatment plan, perhaps family members? My specific example is that my aging parents go to the doctor. It’s not always clear what the doctor has asked them to do when they get back home. As a family member, wouldn’t that be great?

We are in the very early stages of how we see the uses and the use cases of this. The technology needs to continue to mature when you think about ambient and conversational AI versus more structured use of voice recognition.

Does a model exist in other industries that healthcare will follow, where software extracts discrete data elements from a conversation between a professional and their client?

Nuance used to be directly involved with conversational AI that took place in an automobile. It had to distinguish between conversations that were going on in a car and the aspects of what should be done with that communication. We have leveraged that a lot within our own organization. We are starting to see other interesting use cases. We also participate in law enforcement, where we can capture the conversation that’s going on and understand where that might be applicable.

How do you see that diarized speech of basically the full transcription of the patient encounter being used?

We are intrigued to see where that area evolves. As I mentioned, there’s definitely a use case where the patient may want to be able to provide that to other people who are of interest. There has always been a bit of a worry about whether that will open up even more concern about what is said and whether that will tamper the conversation and constrict it. There are elements of compliance and concerns about what gets said.

It’s not necessarily the direct clinical elements of the conversation, but maybe more of the conversation that is not directly related to the medical outcome for the patient or the treatment planning. There will be people who will be concerned that, “If I didn’t say this, will it come back to haunt me?” but I believe that we are at a point where the benefits can outweigh those risks.

The industry at large is being more open minded. In our first use cases since the product became commercially available 10 months ago, there is definitely an appreciation, even by the physician, that this is beneficial for them as well. They can’t always remember everything that is communicated, so if they aren’t transcribing or doing something in the course of the actual patient visit, could they have missed something? It is beneficial even for their own purposes to remind them of what was discussed and said. Those users have said that it is helping them to improve the quality of the documentation that’s provided.

We are going to see where it evolves, but I’m definitely pleased that people on both sides, patient and physicians, seem to be open minded about the benefits of the full diarization of the conversation.

What are customers doing with Dragon Ambient EXperience, or DAX?

They have fully deployed it. We have evolution of the maturity levels in particular specialties. Orthopedics is probably the most advanced, but they are fully deploying it.

What’s been interesting in the COVID era is that they also have been deploying it, in many cases, in a telehealth environment in addition to an office environment. Some of them use the mobile app, while some of them actually use the office device that we have. They have typically rolled it out to anywhere between 15 to 25 doctors. They see the process and change management that is associated with it, which is very limited in terms of burden to them. They are up and running right away.

Then we are already into the elements expansion and going into maybe more orthopedics in a particular location, going to the entire department, or they’ll go into the other specialties as we’ve been maturing them. It is an element that continues to include a quality review process as part of that, as that helps the ongoing algorithm in AI and the neural nets that … I can’t describe it to a deep degree, but all of that is continuing to be fed back and making the process more and more accurate. So it’s gone quite well.

What preliminary results have clients seen with regard to physician burnout?

We do data analytics around turnaround times and patient satisfaction. Before DAX, roughly 72% of physicians were feeling burnout and fatigue. After DAX, that was reduced to around 17%. We get quotes that just the thought of taking DAX away is stressful or would make them want to quit.

We are definitely seeing reduction on the physician burnout side and the benefits we offer, but patients are also describing more engagement from the physician. They feel more attended to and feel that they are being listened to. We have also seen patient wait times down, maybe about 10 minutes, which is almost 50% reduction in wait time, so it’s also an element of either being able to have the opportunity to see more patients if a physician wants to do that or to utilizing the time to feel less overwhelmed from an administrative perspective. Early feedback has been quite positive.

I assume the patient’s perception is due to the clinician paying attention and looking at them instead of typing while they are talking.

That’s exactly right. It is an element of feeling like I was listened to — you weren’t distracted. There was feedback that almost all patients are saying that the physician spent less time focusing on the computer. Very high percentages, 90%, said their visits felt more like a personable conversation. The patient elements are also very satisfactory for the physician.

Technology can now make talking to a machine seem like talking to a human, and people are comfortable interacting with virtual assistants in ways that can border on the scary. Does that capability provide new healthcare use cases?

There are a few different cases, so you are exactly right. One of the exciting things that I learned when I was going through my interview process was the opportunity within Nuance to focus on intelligent engagement, as they referred to it. We use that a lot on our enterprise side, but we recently have launched it under the umbrella of patient engagement solutions within healthcare. We have some early wins in terms of customers that we will be announcing soon.

We are focused on exactly that. Customers have reached out, in particular COVID providers, and said, “We are completely overwhelmed with calls coming in with patients wanting to understand their options. ‘Can you just remind me what am I supposed to be doing? If come into the office, where am I supposed to go?’” These basic things potentially restrict a patient from following up for treatment and getting things done if they can’t find easy access to the information that they’re looking for. We are excited to be taking this technology from the enterprise side and doing more with it in intelligent engagement.

People are also thinking about how to use DAX, the ambient clinical intelligence solution, for example, an inpatient hospital room. You could have more interaction and diarize that with multiple providers within a patient room, where the patient could interact with it. They are also asking if it could be viewed as being an ambient opportunity for check-in, where you don’t need so much human-to-human contact and could check in via the ambient device in a particular check-in room.

I don’t know how many of these things will immediately stick, but it’s interesting that people are thinking about where else it can be applied.

Speech recognition is now ubiquitous, accurate, cloud-based, and accepted by consumers. How does that support using it new ways?

We’ve talked about speech, particularly on the healthcare side with the physicians. We’ve also been working on solutions for other parts of the care teams, such as nurses. In many cases, nurses provide the same kinds of things, but in different ways and in a different structure. We have talked about the patients and the intelligent engagement. It’s an element of the environment. What is the setting? DAX has initially been rolled out as an office visit type of setting, where there is a tremendous amount of clinical documentation burden. But obviously the interest would be how to do more of that in the hospital inpatient setting or in other types of clinical settings. People have also asked if it will be more interactive in areas such as mental health.

It will evolve. I don’t want to get over our skis a little too much here, because there certainly is a lot that goes in just with the initial use cases. But certainly as you said, people are now saying, OK, it’s not just hype. It really does work and it is going to evolve. There are opportunities to deploy it into these various use cases, which I’m excited about. Especially in a COVID year, to see the ongoing investment in evolution of has been motivating for me and certainly for our team.

Do you have to evangelize the idea of developers building software with speech recognition as the primary input mechanism instead of just bolting it to keyboard-centric applications?

There is enough evolution that has occurred on the consumer-oriented side that you have to do less. People believe that it’s there, it can happen, and it can work. There is an element of skepticism of how well it can work in a clinical documentation setting where you have to be highly accurate. Not pretty highly, but highly accurate. You’re going to use this not just for coding and reimbursement, but for the treatment of the patient. There is this element of prove it out, prove it out in all of the specialties, and prove it out beyond the structured specialties that we have initially focused on.

People ask, how well does it work in family medicine practice, where you do have such random things that you might be seeing the doctor for? I fell this weekend when I was skateboarding and broke my ankle. How does that relate to all of my past history, and how is it going to interact with all of the various elements of what the doctor needs to think about when they are prescribing treatment or patient outcomes? There is a belief that it will get there, but there is also a bit of skepticism on remembering how difficult it is for some of these use cases with particular specialties, and every patient situation is quite different.

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

The heavy focus is on reducing physician burnout from the specific element of clinical documentation. But then as your comments and questions have mentioned, what can you do in the course of hearing something from a conversation? What could you actually do?

For example, three to five years out, could you have the computer help the physician with reminders in the course of that conversation with the patient? Like surfacing things that it may hear that you need to be reminded of. Such as, remember for this patient in their medical history they had XYZ. And coming from a company that I just left in Wolters Kluwer, there’s a new topic in UpToDate that would be applicable for this particular conversation, would you like to look at it?

The elements of how broadly you can take the conversational AI and incorporate it with the information that’s residing either in clinical decision support tools or in the course of the actual medical record for the patient will be intriguing. Then, how you can continue to be better and better at structuring the clinical documentation so you can do more data analytics and predictive analytics and tie it into things that go as far as into the world of life sciences initiatives. It does start to open up the creative ideas of what could happen and what could be out there in the future.

Do you have any final thoughts?

Even during the challenging time that we’ve had with the pandemic, I’m optimistic about what I have seen occur during this time from our customers. They have been able to adapt to this change and take on new technologies, such as those associated with telehealth and beyond. We are going to come out of this a stronger industry.

Optum Acquires Change Healthcare for $13 Billion

January 6, 2021 News 1 Comment

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UnitedHealth Group-owned Optum will acquire Change Healthcare and combine it with its OptumInsight software and analytics business, the companies announced this morning.

Change Healthcare President and CEO Neal de Crescenzo will serve as CEO of OptumInsight.

The acquisition price is $25.75 in cash, a 40% premium over Tuesday’s closing price of Change Healthcare shares. That represents $8 billion plus the assumption of $5 billion in Change Healthcare debt.

OptumInsight generates about $9 billion per year in annual revenue of UnitedHealth Group’s $225 billion, but is its highest-margin segment at around 20%. Change Healthcare’s annual revenue is $3 billion.

Morning Headlines 1/6/21

January 5, 2021 Headlines No Comments

Cedar Gate Technologies Acquires Enli Health Intelligence

Value-based care performance management company Cedar Gate Technologies acquires population health IT vendor Enli Health Intelligence.

New Resources to Help Health IT Developers Understand ONC Cures Act Final Rule Requirements

ONC publishes Cures Act developer resources, including a summary of compliance dates and an API resource guide.

BerryDunn Expands Healthcare Industry Offerings with VantagePoint Merger

Healthcare compliance, consulting, and credentialing firm VantagePoint Healthcare Advisors merges with assurance, tax, and consulting firm BerryDunn.

Hinge Health has raised $310M Series D at a $3B valuation

Hinge Health, a telemedicine company specializing in chronic back and joint pain, raises $310 million in a Series D funding round.

News 1/6/21

January 5, 2021 News 9 Comments

Top News

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Value-based care performance management company Cedar Gate Technologies acquires population health IT vendor Enli Health Intelligence.

Enli earned “Best in KLAS” designation for population health management in 2017, 2018, and 2020.

Enli’s roots go back to 2001 as Kryptiq, which then worked with Providence Health & Services to commercialize the latter’s CareManager starting in 2016. Kryptiq acquired CareManager in 2012 and was then itself acquired by Surescripts the same year, and Surescripts spun off Kryptiq in 2015 as Enli.

Kryptiq was founded by Luis Machuca (Enli CEO), Jeff Sponaugle (CTO of Surescripts), and Murali Karamchedu (Enli CTO).


Reader Comments

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From Peony Picker: “Re: Haven. Why do you think it failed?” We don’t know much about the company’s mission, priorities, and plans, but  here’s my armchair quarterback opinion:

  • The idea that Haven’s three big bureaucracy owners would join hands and fix healthcare was naïve from the start. Companies that size can’t change the impenetrable fortress of healthcare by halfheartedly forming a company that was barely bigger than their bathroom supply expense task force. Politics and conflicting objectives make just about every joint venture a failure.
  • Amazon was the only one of the three participants that knows anything about healthcare beyond what it costs and had little incentive to share its knowledge instead of creating new business lines, as it is doing now with PillPack. I would bet that most of whatever commercially viable “learnings” can be plucked from the ashes of Haven will end up as Amazon products.
  • It took 14 months for the company to even choose a name for itself and it never made it clear exactly what it was doing. Haven basically disappeared immediately without displaying any anger, joy, or boldness, basically launching itself like wheezing legacy business that was just trying to hang on under journeyman leadership.
  • Atul Gawande is big-picture influential, but was probably not necessarily the best person to lead this kind of business, not to mention that we don’t know what kind of marching orders and resources he was being given by his many bosses.
  • The three owner companies have employees scattered all over the place, and other than maybe Seattle in the case of Amazon, they weren’t going to scare big health systems very much by threatening to take their business elsewhere. Those health systems have spent fortunes building their brands, and while their self-developed reputation may not always be matched by their outcomes, their employees wouldn’t be thrilled to be excluded from the gleaming skyscrapers downtown and instead turfed off to lesser-known but better and/or cheaper hospitals.
  • Health systems hold nearly all of the useful personal and aggregated health data and don’t share it freely with competitors, making it easy to starve out an outsider whose business model is based on analytics.
  • All big companies hate paying high healthcare costs and getting poor outcomes in return, but none of them have had any success whatsoever in disrupting the status quo. The idea that employers hold power over the healthcare system has been repeatedly proven to be untrue.
  • Employers want to reduce healthcare costs to the maximum extent possible without driving away their most valuable employees. That tension varies by company, region, and overall benefit design. It would be easy for companies to either reduce their healthcare costs to zero (by not offering any healthcare benefits) or to spend a lot to make recruitment and retention easier, but anything in between is hard to tailor to meet those competing company objectives.

From Rants On Fire: “Re: grammar. It’s like wearing masks — you do it for others.” Actually, it’s like masks in that correct use benefits both parties. Many in the anti-mask cohort are perceived rightly or wrongly as lacking intellectual ability, possessing little empathy for others whom they could protect with the tiniest of efforts, and choosing a puzzling platform to convince themselves of their illusory autonomy. Taking the extra time to communicate clearly within the broadest rules of the road is the same — you look smarter, it shows that you value your own message, and it demonstrates that you’ve found meaningful ways to display your rugged individualism beyond exhibiting sloppiness and defying anyone to criticize you for it. Most of us are knowledge workers in which rewards seldom accrue to those who appear lazy, ill-informed, or selfish.


Webinars

January 13 (Wednesday) 2 ET. “The One Communication Strategy Clinicians Need Now.” Sponsor: PerfectServe. Presenters: Clay Callison, MD, CMIO, University of Tennessee Medical Center; Nicholas E. Perkins, DO, MS, hospitalist and physician informaticist, Prisma Health. Healthcare organizations are leveraging their current investments and reducing their vendor footprint, so there’s no room for clutter in healthcare communication. The presenters will describe the one communication strategy that clinicians and organizations need today, how to improve patient experience and protect revenue, and how to drive the communication efficiency of clinical teams.

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


Acquisitions, Funding, Business, and Stock

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Haven, which launched in 2018 with the goal of improving healthcare costs and outcomes for employers, notifies its 57 employees that it will shut down by the end of February. The joint venture among Amazon, JPMorgan, and Berkshire Hathaway started losing executives in 2019 with the departure of COO Jack Stoddard, followed by high-profile CEO Atul Gawande, MD last May, Head of Measurement Dana Safran in July, and CTO Serkan Kutan in September. Analysts believe the company’s efforts to improve care access, insurance benefits, and prescription prices were stymied by separate, employee-focused projects that were being conducted by its founding members.

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Population health technology company Color raises $167 million in a Series D funding round led by General Catalyst, bringing its total financing to $278 million.

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France-based Volta Medical, which has released AI-powered arrhythmia management software and is working on software to improve the first-procedure accuracy of ablation surgery for atrial fibrillation, raises $28 million. President and co-founder Julien Seitz is an interventional cardiologist at Saint Joseph Hospital in Marseille.

Healthcare compliance, consulting, and credentialing firm VantagePoint Healthcare Advisors merges with assurance, tax, and consulting firm BerryDunn.


Sales


People

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Sam Hanna, PhD, MBA joins Divurgent as EVP of innovation and consulting / chief strategy officer.

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Direct Recruiters promotes Mitchell Herman to partner.

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Ken Levitan, who served as CIO of Einstein Healthcare Network for 10 years through 2015 and is now EVP/CAO, is named as its interim president and CEO.

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Industry long-timer Jay Deady (Jvion) joins claims cost and payment optimization solutions vendor Zelis Healthcare as president. He rejoins fellow Eclipsys alumnus Andy Eckert, who is CEO.


Announcements and Implementations

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Arcadia announces GA of solutions to help providers with COVID-19 vaccine programs, including patient-focused resources for education, targeted outreach, engagement, stratification, and dose tracking; plus reporting and analytics.

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The University of Vermont Health Network pushes back the second and third phases of its Epic implementation, citing the need to focus its resources on COVID-19 response efforts and continuing recovery from an October ransomware attack.

West Virginia OrthoNeuro implements Emerge’s ChartGenie to convert data to its new Athenahealth EHR and archive legacy data.

Ochsner Health (LA) goes live on Vynca’s advanced care planning software, giving physicians access to Louisiana Physician Orders for Scope of Treatment forms from within Epic.

Retia Medical uses the Device Driver Interface development strategy from Capsule Technologies to connect its Argos Cardiac Monitor to other systems.

Independent urgent care provider FastMed goes live on EvoHealth’s zero-footprint PACS in its 100 locations.


Government and Politics

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ONC publishes Cures Act developer resources, including a summary of compliance dates and an API resource guide.

A Nature paper by health privacy expert Deven McGraw, JD, MPH and Boston Children’s Hospital’s Kenneth Mandl, MD, MPH says that US privacy and security protections are not sufficient to fuel a learning health system, making these points:

  • Non-traditional health data is used widely for commercial purposes without regulation.
  • Social determinants of health information could be improperly used by companies, such as to avoid high-cost areas and populations.
  • Health data protections need to include penalties for uses that harm people or populations.
  • HIPAA coverage is based on which organizations hold patient data rather than the data type itself, and much of the health-related information that is being collected (such as by apps) falls outside of HIPAA.
  • Regulatory authority shifts from HHS OCR to the Federal Trade Commission as data flows from covered entities through APIs to consumer apps. FTC’s authority does not extend to non-profit organizations and insurers and FTC’s protections and enforcement mechanisms are not comprehensive to healthcare.
  • The public is realizing that HIPAA offers them little protection, such as allowing covered entities to sell their de-identified data that can be readily re-identified.
  • Big tech companies are getting involved in healthcare who have behaved questionably in their data collection and consumer tracking.
  • It isn’t adequate to provide consumers with a notice of how their data will be used as a condition of using an app or service. The notices are hard to understand, seldom read, sometimes changed without notice, and require consumers to consent to just about any use of their information that companies might come up with in the future. It also puts the privacy burden on the consumer. 
  • GDPR and state privacy laws, such as the California Consumer Privacy Act, continue to rely on consent and haven’t limited how businesses collect and use personal data.
  • De-identified patient data can be re-identified and no penalties exist for doing so.
    HIPAA focuses more on what covered entities can do with data rather than which information they collect in the first place and for what purpose, which might be something that should be spelled out, and companies could be prohibited from collecting and selling patient information except for uses that consumers might expect and that would benefit them.
  • Companies that collect, use, or disclose both identifiable and de-identified patient data should establish independent data ethics review boards.
  • Stronger protections are needed for discrimination so that marginalized populations will be confident that they can allow their data to be collected for healthcare learning purposes.

COVID-19

Monday saw another record day of COVID-19 hospital inpatients at 128,210.

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CDC’s data tracker says that 15.4 million coronavirus vaccine doses have been distributed and 4.6 million administered, both falling far short of projections. The states with the lowest percentage of people injected are Michigan, Arizona, Kansas, Mississippi, Alabama, and Georgia.

FDA declines to adjust its approved COVID-19 vaccination regimen to speed up rollout by stretching the interval between doses, giving lower doses, or mixing and matching products, warning that such use has not been studied for effectiveness and may place the public at risk. FDA also warns that studies didn’t continue following participants who failed to get the second shot  in the designated time, so assessment of one-shot effectiveness is not possible without additional studies.

Meanwhile, a just-published analysis (not a preprint) in Annals of Internal Medicine finds that the best use of the limited supply of vaccines would be to vaccinate more people initially — using most of the available initial supply and production for the first three weeks instead of holding back half for second doses as is being done today —  then holding more vaccine for follow-up injections.

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Los Angeles County orders ambulance crews to not transport patients with low survival odds and to conserve oxygen for the most critical patients. Ambulances are waiting up to eight hours before they’re allowed to take their patients into the ED.

New UK research finds that family members who are under 17 are more likely to bring coronavirus into the household than adults and those aged 12-16 are seven times as likely as adults to be the household’s first case. Data consistently indicates that coronavirus transmission is lower when schools are closed.

COVID frontline primary care doctors who aren’t affiliated with hospitals have no access to COVID-19 vaccine, with most of those surveyed saying they don’t even know where they will get the vaccine. Most states seemed to have forgotten that not all doctors work for hospitals, whose highest priority is vaccinating their own employees and those doctors who generate the most revenue.

UCHealth (CO) uses Conversa Health’s automated vaccine monitoring software as part of its employee vaccination program. Data collected from a wearable two days before and seven days after vaccination will be analyzed to help researchers better understand the vaccine’s effects, particularly on high-risk patients and long-term care residents.

States that were somehow caught off guard by the release of COVID-19 vaccines and don’t have online appointment systems for signups are instead using free party RSVP sites such as Eventbrite and SignUpGenius. Others are using sign-up sites that are crashing under heavy volumes and some are simply telling people to join long lines and hope that the shots don’t run out.


Other

ED residents are finding few available jobs upon completion of their programs, as COVID-lowered ED volumes caused hospitals to stop recruiting ED doctors. More than half of US ED doctors work for investor-owned staffing companies that have been more aggressive in cutting back staffing. Some of the residents are doubling down on emergency medicine by signing up for low-paying fellowships.

Private equity-owned medical practices — many of them in dermatology, gastroenterology, and obstetrics — are requiring patients to sign binding arbitration agreements to prevent them from filing medical malpractice lawsuits.


Sponsor Updates

  • ReMedi Healthcare Solutions publishes a white paper titled “Increase Go-Live Efficiency with a Virtual Model.”
  • Audacious Inquiry customer Texas Health Services Authority receives ONC’s STAR HIE Program Award.
  • Change Healthcare announces the successful introduction of its first cloud-based medical tools for radiologists and other specialties.

Blog Posts


Contacts

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

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Morning Headlines 1/5/21

January 4, 2021 Headlines 1 Comment

Haven, the Amazon-Berkshire-JPMorgan venture to disrupt health care, is disbanding after 3 years

Boston-based Haven, which launched in 2018 with the goal of improving healthcare costs and outcomes for employers, notifies its 57 employees that it will shut down by the end of February.

Color announces $167 million in Series D financing to help build public health infrastructure across the U.S.

Population health technology company Color raises $167 million in a Series D funding round led by General Catalyst, bringing its total financing to $278 million.

Allscripts Closes Previously Announced Sale of CarePort Health Business

Allscripts wraps up its sale of care coordination business CarePort Health to WellSky for $1.35 billion.

Curbside Consult with Dr. Jayne 1/4/21

January 4, 2021 Dr. Jayne 1 Comment

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The new year is upon us, and other than hearing quite a few more fireworks and gunshots at the appointed hour, my celebration wasn’t terribly different from years past.

As someone who has worked big-city emergency departments on New Year’s Eve, it seems like a holiday that is ripe for trouble if you decide to go out, so I kept with tradition by celebrating at home. During the day, I binge-watched “Bridgerton” on Netflix, sparing anyone else from a tour through 19th century London. As the evening unfolded, it was time for “The Mandalorian” with the rest of the household. I feel like I’m finally caught up with the rest of the sci fi-loving community now, and can move into 2021 with a full appreciation of Baby Yoda.

I took January 1 off, then returned to the clinical trenches for a full day of adventure. Our region is going through a prolonged peak for COVID cases, and we’re perpetually running our locations with a skeleton crew in part due to illness. More than 50% of our physicians, NPs, and PAs have been infected with COVID, so I count myself fortunate to have avoided it and am thankful to the folks who have been helping me source additional PPE beyond what my employer has been able to provide.

Another segment of our staff has left the healthcare labor market entirely, deciding that perhaps dealing with COVID isn’t part of their ongoing career paths. We have a lot of staff that are from dual healthcare worker households, and if the cost of childcare is a factor, it makes a lot of economic as well as health-related sense.

Our state is still woefully behind in vaccinating healthcare workers. Our organization received a limited number of doses that were shared from a local hospital. The state still doesn’t understand that urgent cares are also on the front lines of the COVID fight.

It was great to see people starting to receive vaccine and beginning to feel a little bit of hope that we may be truly rounding the corner on our battle against COVID-19. Many of the individuals who have had COVID recently deferred vaccines so that those who have not yet been infected could go to the front of the line. We still need several hundred doses to finish the first round of vaccines, plus enough to perform Round Two. I never thought that a group as big as ours, which performs over half a million patient visits a year, would be overlooked. Hopefully, we’ll get more doses soon because we still have plenty of unprotected Tier 1a healthcare workers among our ranks.

Judging from some national Facebook groups I belong to, the vaccine distribution plans in many other states are poor as well, but I would rank us in the bottom 10% for having our act together. I learned today that our state department of health violated CDC prioritization guidelines and vaccinated its non-clinical office workers, even those who can work from home. I also learned that the department has no plans to hold hospitals accountable for going outside the guidelines, which many are. With that kind of leadership, it’s no wonder that they’re not able to meet the needs of the actual patient-facing healthcare workers.

The other adventure of returning to work in 2021 was the debut of the new CMS Evaluation & Management coding guidelines. As a consultant, I did some behind the scenes work for a couple of medical groups creating educational curricula for their physicians and teaching classes to help them get ready. We’ve been working on it for several months and most of the physicians felt confident going into the new year. As a physician, my practice waited until the eleventh hour to reveal their plan and it was pretty underwhelming. They’re so worried about the coding that they’re going to let Certified Professional Coders assign the codes.

They sent us a two-page document on December 29 letting us know of a few new EHR screens we needed to be aware of. They also sent instructions about documenting free-text information to bolster our “medical decision making” discussion in an area of the chart where we don’t usually put it. Because many of us write that information in patient-facing language in the patient plan for “cover yourself” purposes, we now have to put it in two places, which seems like a pain.

I asked for clarification and was told it was for consistency for the coders to know where to look. I’d think it’s cheaper to tell the coders to look in two places rather than have the providers do double work, but I’m just a worker bee in this scenario. Given the labor cost of the coders and the sparseness of some of my colleagues’ documentation, I give this approach no more than 90 days before they decide to retool it.

Even though the new coding rules are supposed to simplify documentation for the History and Physical portion of the note, my practice didn’t change expectations for those areas, still asking us to document Review of Systems and Exam elements that are beyond what is needed for the kind of problem-focused visits that occur at an urgent care. They make sense for some of our more complex patients, where we may be co-managing chronic conditions because the patients can’t get in to see their regular care teams, but I refuse to do them when the visits are straightforward. You can bet I didn’t document a multi-point Review of Systems on the guy who came in with the 6 cm scalp laceration after having fallen into a door while tripping on his son’s skateboard.

I’m curious what other organizations have been doing to prepare their physicians for the transition, and how well they’re handling it. It will be interesting to see if groups are seeing revenue dips due to lack of documentation or whether they actually see a little bump because they’re not being nitpicked on data elements that physicians may feel aren’t meaningful. Many physicians may also choose to code their visits based on time, which may result in an increase in code levels.

It will be at least 30 days before we can see trends, and possibly longer depending on patient volumes. Traditionally January is a slow time of the year for patient visits because no one has met their deductibles. We’ll have to see if 2021 holds true for this and how long that depression lasts. Of course, it will be confounded by the pandemic, so it may be hard to tell.

How did your organization handle the rollout of new E&M coding rules, and how is it going? Leave a comment or email me.

Email Dr. Jayne.

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