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Morning Headlines 8/30/21

August 29, 2021 Headlines 1 Comment

Google confirms it’s pulling the plug on Streams, its UK clinician support app

Google shuts down its DeepMind-developed Streams app that displays patient information to UK clinicians.

Olive Launches Olive Ventures, an In-House Venture Studio

Olive launches an in-house venture studio for startups that are developing solutions for its automation platform.

Justice Department Settles with Large Health Care Organization to Resolve Software-Based Immigration-Related Discrimination Claims

Ascension pays $85,000 to settle charges that it violated federal immigration laws because of a software programming error that caused its employee eligibility verification software to send automated emails to all of its non-citizen employees whose documents were set to expire, requesting them (some erroneously) to submit proof of continued work authorization.

Monday Morning Update 8/30/21

August 28, 2021 News 9 Comments

Top News

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Google shuts down its DeepMind-developed Streams app that displays patient information to UK clinicians.

Streams was the only DeepMind app that didn’t use AI, and plans to incorporate the technology were never acted on. It uses algorithms that were developed by the UK’s NHS.

The UK’s data protection office objected to The Royal Free Hospital providing DeepMind with patient data without their consent or knowledge during its development of Streams. Royal Free is the only NHS Trust that is still using Streams.

Google acquired AI startup DeepMind in early 2014 for a reported $500 million. Most of the company’s work involves teaching computers to play games such as Go and Pong. Its DeepMind Health business was moved within Google Health in late 2018, raising privacy objections that DeepMind had promised repeatedly that its data “will never be linked or associated with Google accounts, products, or services.”

Google says it will focus instead on Care Studio, which is being piloted at Ascension and Beth Israel Deaconess.


HIStalk Announcements and Requests

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Cerner’s new CEO hire draws about a two-to-one negative among those who care.

New poll to your right or here: What background would you favor if you were hiring a CEO for your current employer? It’s an awkwardly constructed question, but my interest was piqued by IANAL’s comment last week that growing software companies usually hire CEOs whose background is strong either in sales or technology, and Cerner’s incoming CEO David Feinberg doesn’t fit that mold. I didn’t do a great job of incorporating what probably should have been a separate poll – at what point should a company’s hiring favor comparable CEO experience?

I was thinking about the prediction years ago and digital stethoscopes would replace their low-tech acoustic counterparts for a myriad of logical reasons. I get the feeling that it’s still mostly old-school instruments being used, but maybe someone has stats.

I’m taking a semi-break this week while still doing most of my usual HIStalk work, just from elsewhere and hopefully spending less time.


Webinars

September 16 (Thursday) 1 ET. “Patient Acquisition and Retention: The Future of Omnichannel Virtual Assistants.” Sponsor: Orbita. Presenters: Harris Hunt, SVP growth product, Cancer Treatment Centers of America; Patty Riskind, MBA, CEO, Orbita; Nathan Treloar, MSc, co-founder and COO, Orbita. Consumers want the same digital healthcare experience from healthcare that they get in online shopping, banking, and booking reservations, and the pandemic has ramped up the patient and provider need for frictionless access to healthcare resources and services. Health systems can improve patient acquisition and retention with the help of omnichannel virtual assistants that engage and delight. Discover how to open and enhance healthcare’s digital front door to offer care that goes beyond expectations.

September 16 (Thursday) 1 ET. “ICD-10-CM 2022 Updates and Regulatory Readiness.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, VP global clinical services, IMO; Theresa Rihanek, MHA, RHIA, mapping manager, IMO; Julie Glasgow, MD, clinical terminologist, IMO. IMO’s top coding professionals and thought leaders will discuss the coding changes in the yearly update to allow your organization to prepare for a smooth transition and avoid negative impacts to the bottom line. The presenters will review new, revised, and deleted codes; highlight revisions to ICD-10-CM index and tabular; discuss changes within Official Coding Guidelines, and review modifier changes.

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


Acquisitions, Funding, Business, and Stock

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Olive launches an in-house venture studio for startups that are developing solutions for its automation platform.


Sales

  • Wolters Kluwer, Health adds six UK customers of UpToDate and Lexicomp.
  • Whatley Health Services chooses RCxRules for revenue cycle automation.

People

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VitalTech hires Steven Scott (PointRight) as president and CEO.

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Clearsense promotes Kimberly Dickason, RN, MBA to COO and hires Pamela Fowler, MBA (University of Washington) as chief marketing officer.


Announcements and Implementations

Mayo Clinic and Verily will collaborate to develop an evidence-based decision support solution, starting with cardiovascular and cardiometabolic conditions. The tool will be driven by Mayo-developed content and de-identified health data and will use open standards to allow integration with commercial EHRs.


Government and Politics

Ascension pays $85,000 to settle Justice Department charges that it violated federal immigration laws because of a software programming error. The error caused Ascension’s custom employee eligibility verification software to send automated emails to all of its non-citizen employees whose documents were set to expire, requesting them to submit proof of continued work authorization. Some of the recipients had presented documents that did not require re-verification, such as permanent residents and refugees. The Justice Department concludes, “Employers are reminded that while software programs may seem efficient, there is still a responsibility to ensure that programming decisions do not result in discrimination.”


COVID-19

China delays its approval of the BioNTech COVID-19 vaccine because of concerns that availability of a more modern, more effective vaccine will undermine confidence in its old-school, made-in-China products that are key to its national vaccination program.

Texas reports that nearly 14,000 people are hospitalized with confirmed coronavirus infection, occupying 21% all all hospital beds, and 300 people died of COVID-19 on Friday. The entire state has 303 ICU beds available versus the nearly 2,500 that were free pre-pandemic. A 46-year-old Houston-area Army combat veteran died of gallstone pancreatitis last week because lack of ICU beds. An ED doctor who treated him says treatment is a 30-minute procedure that is nearly always successful. The doctor says, “We are playing musical chairs with 100 people and 10 chairs. When the music stops, what happens? People from all over the world come to Houston to get medical care and, right now, Houston can’t take care of patients from the next town over.”

CDC describes how an unvaccinated teacher who kept working while experiencing congestion and fatigue and later tested positive for COVID-19 infected 12 of her 22 students after removing her mask to read to the class. The attack rate of the students seated in the front rows of the classroom was 80% versus 28% in the back rows.


Other

A Wisconsin advocacy group for raising taxes on the wealthy says that the net worth of Epic CEO Judy Faulkner rose from $2.5 billion in March 2020 to $6.7 billion in August 2021. Its data source was a web page from Forbes, which has no way of knowing the net worth of anyone beyond their publicly reported stock holdings, but that earns click bait traffic by making its made-up numbers look authoritative.

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It seems obvious that the Internet’s robust supply of mean people seek health information online like everybody else, but it turns out that the headline writer misspelled “men.”


Sponsor Updates

  • EClinicalWorks releases a new customer success story, “Saving Summer with Kiosk, the Patient Portal, and More at MedRite.”
  • Symplr publishes a new whitepaper, “Workforce Management Strategies in Times of Uncertainty.”
  • Pure Storage’s FlashArray helps to improve the performance of Korea’s COVID-19 vaccine reservation system operated by the Korea Disease Control and Prevention Agency.
  • Quil Chief Customer Officer Roelf Kuitse will speak at the American Cancer Society’s Changemakers virtual series, Achieving Equity in the Telehealth Age September 21.
  • The MatrixCare podcast features Surescripts Manager of Product Innovation Rachel Petersen and Surescripts Key Account Executive Jill Lytwyn.
  • Visage Imaging parent company ProMedicus names Alice Williams a director.
  • Azara Healthcare and Luma Health form a technology partnership for their population health data reporting and patient journey platform, respectively.
  • Vocera will present at the Wells Fargo Healthcare Conference September 9, the Baird Healthcare Conference September 14, and the Morgan Stanley Healthcare Conference September 15.
  • West Monroe publishes a new report, “What’s Driving the Current Wave of Healthcare M&A and Investment?”

Blog Posts

The following HIStalk sponsors have achieved top client satisfaction and user experience rankings in Black Book’s latest survey on coding, transcription, CDI, and clinical information management software and services vendors:

  • Nuance – comprehensive mid-RCM coding, CDI, and compliance solutions; CDI software; medical speech recognition and AI solutions.
  • Infor – clinical data interoperability solutions.
  • Symplr – provider credentialing.
  • Agfa Healthcare – vendor neutral archive.

Contacts

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

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Weekender 8/27/21

August 27, 2021 Weekender No Comments

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Weekly News Recap

  • Allscripts sells 2bPrecise.
  • ManpowerGroup will acquire Ettain Group, which had previously acquired Leidos Health.
  • Ginger will merge with Headspace at a combined valuation of $3 billion.
  • Connect America will acquire 100Plus.
  • Two NextGen Healthcare board members, including its founder, attempt to install new board members in claiming that board chair Jeffrey Margolis is impeding shareholder value.
  • Former VA CIO Roger Baker warns that its homegrown Vista system will need to remain operational for several years as Cerner is installed and will require funding.
  • Google Health’s teams and projects are decentralized as its health division is shut down.
  • Inovalon announces that it will be acquired by a private equity firm for $7.3 billion.
  • Cerner SEC filings indicate that the compensation package given to incoming president and CEO David Feinberg totals $35 million in his first 15 months, although much of that is in the form of restricted shares that won’t vest immediately.

Best Reader Comments

On social media over the past couple of days, I have seen C-suite execs of some of the most prestigious health systems in the country gloat over this or that recognition / award that they got from Epic. I have never seen executives at that level in any industry feeling rewarded by vendor recognition. That speaks to the genius of Epic / Judy / Carl. They have managed to create an amazing aura (or kool-aid or reality distortion field) around Epic to make this possible. This goes way beyond “we let our customers speak for us”. This is in another realm altogether. (Ghost of Andromeda)

[Allscripts] has zero debt and close to $1.5B in annual revenue. And two decades of clinical data. They should go private like Epic or sell for $4B. (NOM)

NextGen mostly has exited the affiliated market that Epic dominates. NextGen focused on large office practices, specialties, and multi-specialty practices while keeping or picking up affiliated practices whose hospitals don’t use Epic. That positioning seems smart since that’s the market where the deal size is large and the cost of getting and supporting the deal is low. They also acquire cheap add-ons to upsell to their existing customers and outsource all of their dev work. It actually seems like a reasonable strategy to me if you are looking for ROI in the current competitive ambulatory market. (IANAL)

If you poll Americans, they generally and somewhat surprisingly don’t resent large compensation packages for CEOs. What is a point which provokes ire and resentment across the entire political spectrum is the kind of compensation package that Feinberg gets. He’ll get rewarded handsomely regardless of what happens during his tenure at Cerner. It is the equivalent of fully rewarding a shipping captain in the 19th century before the vessel even left port. The captain gets paid even if he crashes the ship on to the rocks and all of the cargo & shipmates sink to the bottom of the sea. (Lazlo Hollyfeld)

As someone who likes to get as much out of a buck as possible, remember who pays for these exorbitant CEO salaries – you and I. Cerner is paid by hospitals, many supported by Medicare and Medicaid. Hospitals have to pay Cerner. It trickles down through our premiums. I find it disgusting, but the game of life is to acquire as much as one can, so he’s leading the game. Hopefully he’s a philanthropic soul, and much goes back to the other 99%. As colleagues wander wide-eyed through Epic, in awe of their campus, I’m secretly ill by all the dollars spent that should have actually gone to people’s health. Am I the only one who feels this way? (FrugalFrannie)

CEOs of growing software companies have qualities that help them do two things: sell and get their people to execute. Good CEOs normally either have a strong sales background or a strong technology background. These traits provide value to customers. CEOs of healthcare systems and division level executives at Google spend most of their time being politicians. They do PR type stuff for “innovation,” say different things to different stakeholders without appearing two-faced, make sure the unethical behavior stays behind the scenes, collect fat checks, etc. These traits do not provide value to customers. Also arguably the problem with Cerner is the board, not the CEO. (IANAL)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. E in Mississippi, who asked for an IPad and tripod kit to help her deliver online learning. She reported in December, “I truly appreciate the support you showed to my students and our school. The technology has provided my students with the opportunities to continue to learn even as we have moved to a hybrid schedule with rotating days of students at school and at home. My students have truly enjoyed being able to access enriching programs on the iPad when they are at school and it provides the opportunity for me to continue to reach them when they are at home. Thank you again for your donation. May God bless you for generosity.”

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Construction costs of the Denver VA hospital top $2 billion, making it one of the most expensive health facilities in the world. The hospital opened a decade behind schedule and $1 billion over budget, but work that was initially stripped out of the budget has been done after opening and fixing mistakes added another $20 million. The original budget was $600 million and increasing estimates forced the US Army Corps of Engineers to take over the project in 2016.

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The governor of Nebraska directs officials to recruit unvaccinated nurses, hoping to alleviate a shortage by hiring from hospitals that require employees to be vaccinated for COVID-19.

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A Paducah, KY hospital arranges visits by Nelson the therapy dog to boost caregiver morale.

A New Zealand children’s hospital asks college students in the dorm across the street to close their curtains after patients and families observed them engaging in “certain naked activities.”


In Case You Missed It


Get Involved


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Morning Headlines 8/27/21

August 26, 2021 Headlines No Comments

ManpowerGroup to Buy Ettain Group for $925M

ManpowerGroup will acquire IT staffing and services provider Ettain Group, which acquired Leidos Health several years ago, for $925 million in cash.

Recuro Health Announces Its $15 Million Series A Round Led by Arch Venture Partners: Funds Additional Acquisitions Expanding Digital Health Solutions Capabilities, Increased Marketing, Company Growth

Digital health startup Recuro Health, founded earlier this year by several former Teladoc executives, raises $15 million in a Series A funding round.

Mayo Clinic, Verily to Build Advanced Clinical Decision Support to Enhance Care

Mayo Clinic (MN) and Verily will co-develop a clinical decision support tool over the next two years, initially focusing on certain cardiovascular and cardiometabolic conditions.

News 8/27/21

August 26, 2021 News 4 Comments

Top News

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Allscripts sells its precision medicine software subsidiary 2bPrecise to laboratory diagnostics software company AccessDX. Terms were not disclosed.

The sale comes nearly a year after Allscripts sold CarePort Health to WellSky for $1.35 billion.

Readers pointed out at the time that 2bPrecise and Veradigm might be next in line to sell.


Reader Comments

From Legerdemain: “Re: job question. I get great reviews, but they say there’s no budget for a decent raise and promises of promotions never pan out. Is it time to look elsewhere?” Of course. In fact, it’s always time to be looking elsewhere, especially if your potential new job is one that can be performed remotely so you don’t have to uproot yourself and your family. Employers have no incentive to voluntarily offer higher pay to employees who otherwise seem content to stick around without it. Somehow the money magically appears only when you threaten to quit and they realize how hard or expensive it will be to replace you. But I’ll add this — don’t let your employer buy you back once you’ve received another job offer. Why would you want to keep working for a company that treats you fairly only when there’s a gun to their head and that will likely remember your perceived disloyalty unfavorably in future HR decisions?


Webinars

September 16 (Thursday) 1 ET. “Patient Acquisition and Retention: The Future of Omnichannel Virtual Assistants.” Sponsor: Orbita. Presenters: Harris Hunt, SVP growth product, Cancer Treatment Centers of America; Patty Riskind, MBA, CEO, Orbita; Nathan Treloar, MSc, co-founder and COO, Orbita. Consumers want the same digital healthcare experience from healthcare that they get in online shopping, banking, and booking reservations, and the pandemic has ramped up the patient and provider need for frictionless access to healthcare resources and services. Health systems can improve patient acquisition and retention with the help of omnichannel virtual assistants that engage and delight. Discover how to open and enhance healthcare’s digital front door to offer care that goes beyond expectations.

September 16 (Thursday) 1 ET. “ICD-10-CM 2022 Updates and Regulatory Readiness.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, VP global clinical services, IMO; Theresa Rihanek, MHA, RHIA, mapping manager, IMO; Julie Glasgow, MD, clinical terminologist, IMO. IMO’s top coding professionals and thought leaders will discuss the coding changes in the yearly update to allow your organization to prepare for a smooth transition and avoid negative impacts to the bottom line. The presenters will review new, revised, and deleted codes; highlight revisions to ICD-10-CM index and tabular; discuss changes within Official Coding Guidelines, and review modifier changes.

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


Acquisitions, Funding, Business, and Stock

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ManpowerGroup will acquire IT staffing and services provider Ettain Group for $925 million in cash. Ettain Group acquired Leidos Health, the commercial EHR consulting business of Leidos, in October 2019. Leidos Health was formed when Leidos acquired Vitalize Consulting Solutions and MaxIT Healthcare.

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Mental health app company Ginger will merge with meditation app startup Headspace. The newly combined company will be known as Headspace Health, a division originally created by Headspace in 2018 to develop FDA-approved, prescription-strength meditation apps. Ginger CEO Russell Glass will take on the same role with the new company, while Headspace CEO CeCe Morken will retain that title and become president of the new business. Ginger raised $100 million in a Series E round earlier this year. The combined companies have a reported valuation of $3 billion.

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Antidote Health, a virtual primary and urgent care company serving patients in five states, will use $12 million in seed funding to establish a health maintenance organization for its customers.

Not directly health IT related, but they cover the industry: Robert Albritton, the 52-year-old founder and owner of Politico, will sell the 14-year-old digital publishing group for more than $1 billion to a Germany-based media conglomerate.

Dollar General says in its earnings call that its healthcare push will take several years and involve services that aren’t readily available to its rural customers, such as eye care, telemedicine, and prescription drug delivery. The company has already partnered with GeniusRx, Higi, and telehealth provider Babylon.

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NextGen Healthcare’s board says in a surprisingly blunt public statement that two of its members – one of them company’s founder, Shelly Razin – are “obstructing the Board’s effort to drive Board refreshment” with their proxy campaign to add their own slate of board members. The board says that members Razin and Lance Rosenzweig don’t want their candidates interviewed. The other board members also accused Razin of previously presiding as board chair over “a deteriorating business” and pushed a capital allocation plan that would have prioritized paying $400 million in dividends that would have mostly benefited him personally, with the company turning itself around only after he stepped down as president and CEO in 2000 as board chair in 2015.


Sales

  • Axis Community Health and Tiburcio Vasquez Health Center choose CareSignal’s Deviceless Remote Patient Monitoring.

People

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Holon Solutions promotes Scott Tatro to chief customer officer.

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Albany Medical Center (NY) has hired Suryakant Kale as its first CTO and VP of information services, technology, and infrastructure.

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Nikolas Green (Amazon) joins Mercury Healthcare (formerly Healthgrades) as chief data officer.

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ResMed promotes CTO Bobby Ghoshal to president of its SaaS business.


Announcements and Implementations

The Rural OB Access & Maternal Services network deploys Twistle’s text-based patient engagement technology to its network of providers in New Mexico.

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Upstate Medical University in New York will use $2 million in funding from the FCC to upgrade its telehealth services, including improved integration with its Epic system. Nearly 70% of Upstate’s clinics have offered telemedicine services since the pandemic began; the health system has sometimes averaged 6,000 virtual visits a week.

UT Health East Texas offers patients telemedicine services and remote physical therapy and rehabilitation treatment from TheraNow.


COVID-19

COVID-19 hospitalizations have hit 100,000 for the first time since January, when vaccines weren’t widely available, and ICU patient count has exceeded 25,000 for the first time in the pandemic. Pediatric hospitalizations topped 2,000 for the first time in a year. Florida has 17,000 COVID-19 hospital inpatients, while Texas has 14,000. CDC reports 154,000 new cases and 1,138 new COVID-19 deaths on Wednesday.

COVID-19 cases in Meade County, SD, home to the Sturgis motorcycle rally, have risen 1,500% in the past two weeks. South Dakota has the largest percentage case increase of all states. Neighboring states had a big jump in documented infections after last year’s scaled-back event.

A music and surf festival in England with 50,000 attendees has been linked to nearly 5,000 COVID-19 cases, most of them in people aged 16 to 21. The festival required attendees to prove their COVID-19 vaccination status using the NHS Covid app and for festival campers to take a second test during the event and log the result.

Montana’s schools struggle to comply with a recently passed state law that prohibits treating vaccinated and unvaccinated people differently, which means that schools can’t follow CDC guidelines to quarantine only unvaccinated employees and students after COVID-19 exposure. Some schools say they will ignore the law when they reopen this week or next, some say they will make quarantine optional, and others will force vaccinated students to quarantine unnecessarily. Montana is also the only state that prohibits public and private employers from requiring employees to be vaccinated, which it says is discrimination and a violation of human rights.

Four states with low vaccination rates and high COVID case counts – Florida, Texas, Mississippi, and Alabama – are using half of the shipped supplies of the Regeneron antibody treatment that is given early in COVID infection to reduce the chance of hospitalization. Federal taxpayers are paying $1,250 per dose, plus an administration fee of several hundred dollars for Medicare patients, versus the $20 that vaccine would have cost. The governors of Texas and Florida are touting the treatment and opening government-run centers to administer it. One Florida hospital has administered the antibody treatment to 2,000 patients, at least 90% of them unvaccinated. According to the hospital’s chief nursing officer, “What’s amazing to me is that a vaccine we’ve been working on for 10 years, they are deathly afraid of. But this highly experimental cocktail? They’re willing to run in there the minute that they’re sick to get this infused into their bodies.”

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An important review finds that airborne transmission of aerosolized respiratory viruses over longer distances and for longer time, including coronavirus, may be the dominant method of infection instead of droplets that fall quickly to the ground. Some mitigation measures overlap for both types of particles, such as distancing and masks, but the findings place extra emphasis on ventilation, mask type and fit, air filtration, and UV disinfection. For healthcare workers, medical masks and eye protection were designed for droplets and not aerosols and N95 types are best. The authors recommend using carbon dioxide sensors to monitor and optimize ventilation and the use of HEPA and HVAC aerosol filtration.


Other

University of South Australia researchers design an AI-powered facial digital camera system that can remotely monitor the vital signs of a NICU baby with ECG-level accuracy.


Sponsor Updates

  • Experity launches the next generation of its Experity EMR/PM software for urgent care.
  • EClinicalWorks releases a new customer success video, “Using Healow Check-In at Utah Orthopedic Spine & Injury Center.”
  • Everbridge has won the 2021 Service to the Citizen: Champions of Change Award for the deployment of its Return to Work and vaccine distribution software solutions over the last year.
  • First Databank publishes a new study, “Characterization of Pharmacogenetic Information in Food and Drug Administration Drug Labeling and the Table of Pharmocogenetic Associations.”
  • Bluestream publishes a digital developer checklist titled “Key Features to Look For in Virtual Care APIs.”
  • The Healthcare de Jure Podcast features Halo Health CEO Jose Barreau, MD.
  • Healthcare Growth Partners advises Symplr in its acquisition of SpinFusion.
  • The American Red Cross of Greater Atlanta names LexisNexis the 2021 Corporate Blood Sponsor of the Year.

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 8/26/21

August 26, 2021 Dr. Jayne 3 Comments

The big news of the week was the official FDA approval of the Pfizer COVID-19 vaccine, which in turn triggered a rush of corporations to mandate employee vaccinations. Those companies that want to offer alternatives will require regular testing in lieu of a vaccine. Others, such as Delta Airlines, will charge unvaccinated people a premium on their health insurance and will block them from receiving pay-protection funds if they become infected with COVID-19.

As a physician, I appreciate the Delta Airlines strategy since it’s trying to tie cause and effect. The reality is that unvaccinated people who contract COVID-19 have a much higher risk of hospitalization and higher odds of costing their employers money and hitting people in the pocketbook might be much more effective for some than current vaccination strategies.

Once a drug has formal FDA approval, that opens to door for clinicians to consider so-called off-label prescribing, where they recommend use of the drug outside of the official approval. Off-label prescribing is common with a number of medications. For example, while we were having a shortage of antibiotic ear drops last year, physicians substituted the same drug in an eye drop formulation, which is widely considered to be safe and effective.

The official FDA approval for the Pfizer vaccine was only for patients aged 16 and older. Those 12 to 15 are still covered under an Emergency Use Authorization. Still, in the early hours following approval, several sources in my area made a play to administer vaccine doses to 10- and 11-year-olds. A quick clarification from the FDA as well as the American Academy of Pediatrics made it clear that this shouldn’t be happening, and that prescribers need to wait for additional approvals in younger age groups. Part of the delay in younger patients involves evaluating the dosing, but given the relative size of some larger 11-year-olds compared to smaller 12- and 13-year-olds, the risk of harm in those few children who received “unauthorized” doses is likely to be small.

Regarding the potential for upcoming booster shots, a couple of my neighbors were discussing the idea of trying to jump the gun on a third dose. One of them heard that a local pharmacy was throwing away doses that were expiring, so went and presented herself like she was there to receive her first dose. My other neighbor was incredulous that someone would be able to do that, “because don’t they have a national database of who has received what kind of vaccine?” She was shocked to learn that immunization registries are a patchwork across the states, and that they’re often not bidirectional or fully interoperable with hospitals and health systems, let alone other states.

I had a similar conversation with a neighborhood mom after the local school district requested copies of vaccination cards for students so that they would have them on hand in the event of an exposure. She didn’t understand why the schools “just can’t get them from the pediatricians’ offices.” Lots of members of the general public assume healthcare technology is a lot farther along than it is. I look forward to the day we can really exchange data like we need to in order to better enable quality care.

Many of those organizations requiring vaccination are healthcare delivery organizations, who have a vested interest in not only keeping their workers healthy, but in helping reduce transmission between staff and patients. A recent Kaiser Family Foundation brief concluded that over the last two months, COVID-19 hospitalizations of unvaccinated patients has cost the health system $2.3 billion. For hospitals running on razor thin margins, there is likely to be a certain amount of uncompensated care that will never be recouped. Other costs will be absorbed by taxpayer-funded programs (Medicare, Medicaid) or passed on to workers or businesses. In other words, we’re all going to be paying for this debacle for a long time.

For those of us on the vendor side of the healthcare IT industry, this means hospitals will continue to be strapped for cash for the foreseeable future, reducing available funds for technology projects including upgrades and new solutions. In addition to funding challenges, hospitals and health systems are also focused on trying to recruit and retain staff while keeping overloaded clinical divisions working. They’re certainly not going to be as eager to hear from technology vendors as they might have been a couple of years ago unless they’ve identified something particular that needs resolution and can’t wait. I’ve watched many companies turnover their entire sales teams over the last year due to low sales, but it seems inevitable that organizations will be pinching pennies for months to come.

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The Medical Group Management Association has announced that its October Medical Practice Excellence: Leaders Conference in San Diego will require full COVID-19 vaccination for all attendees, suppliers, speakers, and exhibitors. Attendees will have to interact with plenty of other personnel – hotel staff, transportation workers, and those at dining establishments as well as members of the public who aren’t attending the conference, so the conference won’t be able to create a complete bubble. As for masks, MGMA says “masks are strongly recommended for attendees.” but it appears the organization is holding off on announcing a mask mandate pending changing conditions.

The Healthcare Financial Management Association’s Annual Conference slated for Minneapolis in November will also be vaccination-required for those attending onsite. Unlike HIMSS, registrants are able to cancel penalty-free or they can switch to the digital version of the conference if they do not want to comply with the vaccination mandate. In addition to attendees, vaccination is required for speakers, exhibitors, volunteers, staff, and backstage crew.

In speaking with some of my vendor contacts, everyone is already in the thick of their HIMSS22 planning. It will be interesting to see what the winter conference season looks like, starting with the Consumer Electronics Show kicking off in January. I’m planning to attend digitally this year as I did last time and looking forward to seeing innovative new technologies as well as things that are just quirky.

What are you most looking forward to in 2022? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 8/26/21

August 25, 2021 Headlines 3 Comments

Ginger and Headspace Will Merge to Meet Escalating Global Demand for Mental Health Support

Digital mental health and wellbeing companies Ginger and Headspace will merge to form Headspace Health, with Ginger CEO Russell Glass taking on the same role with the combined company.

AccessDX Holdings Acquires 2bPrecise

Allscripts sells its precision medicine software subsidiary 2bPrecise to laboratory diagnostics company AccessDX.

Antidote Health raises $12 million to set up the first virtual HMO in the United States

Antidote Health, a virtual primary and urgent care company serving patients in five states, will use $12 million in seed funding to establish a health maintenance organization for its customers.

We just closed our $2.5m seed round. Here’s what that means.

Rezilient Health raises $2.5 million to launch its hybrid clinic concept for employees in St. Louis.

Readers Write: Sharing Your Medical Info with Providers from your iPhone – What You Need to Know About Apple Health, Patient Records, and Better Visibility into Patient Data

August 25, 2021 Readers Write No Comments

Sharing Your Medical Info with Providers from your iPhone – What You Need to Know About Apple Health, Patient Records, and Better Visibility into Patient Data
By Daniel Kivatinos

Daniel Kivatinos, MS is co-founder and COO of DrChrono of Sunnyvale, CA.

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Apple’s announcement of their new iOS15 feature demonstrates a major step forward in giving patients better control of their own health data in a more seamless, straightforward way. Coming this fall, this update will allow patients to share health app data with providers.

For background, here’s how it will work. When choosing to share health information from their iPhone, the patient’s care team will be able to view the information within the medical record patient chart from the electronic health record (EHR) software. Patients can share a range of information, including physical activity, heart rate, cycle tracking, sleep, irregular rhythm notifications, and falls, as well as certain health record categories like labs and immunizations.

As we move into a new world of digital health, we are tracking more data than ever, and an ever-present question is whether or not physicians will be able to aggregate and use all of this information. With new features like Apple’s, medical care teams have easy access to a more holistic view of their patients’ health information. For example, providers will not only be able to see a patient’s lab results, but their workouts, food tracking, genomics, and more should they opt to share that information.

The overload of data is an understandable concern, and some healthcare professionals wonder whether or not this onslaught of information will only overwhelm practitioners. But the issue isn’t about the amount of data we have around a patient. Rather, it is about having access to the precise information that is best needed for the medical care team, patient, and family members.

While more data is better when it comes to giving precise care, what technology companies must do is work toward ways to better present, manage, and interpret the data in ways that help providers at the point of care. There is only so much time with a patient during a visit, and the data that is reviewed needs to be relevant and clear to understand. As a point of comparison, regardless of what you may think about the Robinhood investment app, they have succeeded at presenting data in a quick, simple way for investors.

Over time in the healthcare industry, insights gleaned from machine learning will be increasingly accurate for care teams. If the technology is leveraged correctly, the most important data trends that need to be shared won’t be lost in the shuffle, and machine learning assistants will eventually become more useful and relevant for providers.

After all, it is better to have 40 years of data on a patient bubble up or emerge with contextual information when needed than not. For example, a 12-year-old patient gets stung by a bee and the provider notes in their chart that the child is allergic to bee stings. Later in life, the patient may not recall this event, but this data should still be available to the care team and patient in their electronic medical chart. With the right user interface, this data will be useful, rather than a nuisance, to a busy provider.

Thankfully, machine learning continues to improve. Think of it as a co-pilot with the provider driving the patient experience and ultimately determining what to do, but with machine learning also helping in giving indications and insights about a specific patient and their needs. The patient’s numerous health factors are always evolving, but understanding more clearly a patient’s overall wellness, genomics, and labs are all critical to giving a precise prescription.

Patients on Medicaid and Medicare with multiple comorbidities would benefit the most from sharing their daily data with a physician, and patients have more access to better devices at a cheaper cost every year. As Moore’s law states, the number of transistors in a dense integrated circuit doubles about every two years. What this means is that as the cost to buy an iPhone is going down, you are getting more for your money. Through hard work across engineering, technology is getting better and better to the point where patients will be able to get more data over time at a cheaper cost. This not only applies to phones, but wearables and all consumer health tech products.

We are also witnessing a renaissance taking place in healthcare data exchange through FHIR and other modern APIs. This is a game changer in the industry and one to keep an eye on. I am excited to see what Apple and other digital health companies do in the future, as Apple’s latest iOS feature is a massive milestone and a bright future for healthcare.

Readers Write: Three Common Email Security Compliance Misconceptions That Are Putting Healthcare Organizations At Risk

August 25, 2021 Readers Write 3 Comments

Three Common Email Security Compliance Misconceptions That Are Putting Healthcare Organizations At Risk
By Hoala Greevy

Hoala Greevy is founder and CEO of Paubox of San Francisco, CA.

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HIPAA violations are rapidly increasing. In 2020 alone, there were 188 PHI related data breaches via email, a 17% increase from 2019. As healthcare organizations look to stay competitive in the rapidly evolving digital landscape, they continuously search for more efficient and secure communication methods between employees and patients. HIPAA’s top priority is to protect a patient’s protected health information (PHI), requiring covered entities to take reasonable steps to accomplish this.

With the proper encryption and well-trained staff, email is an effective method to communicate with patients about their health. However, misconceptions about the difficulties or feasibility of HIPAA-compliant email often keep healthcare organizations using outdated communication tools like fax machines and the postal service to share PHI with patients. Providers shouldn’t let common misconceptions about email deter them from using it.

Misconception #1: You can’t send an email and maintain HIPAA compliance. HIPAA does not prohibit the transmission of PHI via email. In fact, according to the HIPAA Security Rule, healthcare providers may adopt new technologies, including email, as long as they:

  • Ensure the confidentiality, integrity and availability of PHI.
  • Identify and protect against reasonably anticipated threats.
  • Ensure employee compliance with HIPAA.

Email is perfectly acceptable as long as it is encrypted in transit and at rest. Under HIPAA, encryption is an “addressable” way to secure email rather than being required. However, since there is no other effective method to secure email besides encryption, it is de facto a requirement.

Misconception #2: HIPAA compliant email has to be difficult to use. Most email security solutions require employees to take several steps to encrypt a message, such as putting a special keyword in a subject line to trigger encryption. Recipients might also need to jump through hoops to read a message, such as creating an account to log into a patient portal.

These extra steps leave plenty of room for human error. An employee might not remember to encrypt an email containing PHI, or they might simply put a typo in the subject line keyword. A recipient can easily forget their password, requiring them to reset it the next time they have a message waiting from their doctor.

However, there are alternative methods that don’t require any extra steps from a patient or a provider. The safest way to ensure staff uses email in a HIPAA compliant matter is to partner with a HITRUST CSF certified email security provider that encrypts all outbound email by default and sends messages directly to patients’ inboxes. That way, staff doesn’t need to decide which emails to encrypt and recipients don’t need to worry about logging into a portal to read their messages.

By eliminating extra steps, healthcare organizations can easily and safely use email while remaining HIPAA compliant, thus allowing providers to focus on patients rather than encrypting messages.

Misconception #3: Extra steps increase email security. People often think that the harder something is to do, the more secure it must be. However, email solutions that include extra layers of complexity to send and read a message provide people with a false sense of security.

Patient portals, for example, give the appearance of more privacy as they require a separate login and password. However, portals also involve an email component to access messages. Although they might appear to be harder to break into, portals are only as secure as the email address they are associated with. Ultimately the number of steps in a process doesn’t dictate the security it provides.

Misconceptions like these have limited email’s adoption throughout the healthcare industry, but it need not be so. With a clear understanding of how to secure messages and maintain compliance, organizations can partner with a HIPAA compliant email provider that is both easier to use and more secure than other solutions that rely on security theater to lull their customers into a false sense of security.

Readers Write: Healthcare is Failing Overwhelmed Clinicians — Here’s How to Focus on Their Journey

August 25, 2021 Readers Write No Comments

Healthcare is Failing Overwhelmed Clinicians — Here’s How to Focus on Their Journey
By Michelle Davey

Michelle Davey is co-founder and CEO of Wheel of Austin, TX.

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Over the last few years, the health tech industry has invested billions into improving the patient experience. Direct-to-consumer healthcare companies raised $1.2 billion in Q1 2021 alone. Now patients can get prescriptions delivered to their door and avoid the pharmacy line. They can skip the waiting room and chat with a doctor from their couch. They can even get their blood drawn without leaving their home.

But it’s been surprising to see the industry pay so little attention to clinicians, especially with the critical role they play in the patient journey. They are setting expectations, determining treatment plans, and listening to patients’ concerns. Yet for some reason, we continue to set clinicians up to fail.

Think about how you feel on your worst day at work. Tired, stressed, and overwhelmed, right? That’s how clinicians feel every day with their patients. Nearly half of clinicians reported alarming rates of burnout before the pandemic. Over the last year, 80% of people said their doctor or nurse seemed burned out during a healthcare visit. Even more concerning, one in three said they believe their quality of care may have been affected by clinician burnout.

That’s why the digital health industry should look at “D2C” through a new lens: direct-to-clinician. It doesn’t matter how much time and investment we spend on improving the patient journey. When clinicians are burned out and overwhelmed, patients won’t feel satisfied. But if clinicians feel supported and set up for success, patients will be motivated to take charge of their health.

Here are three ways to put a D2C(linician) strategy in place:

Prioritize the Clinician As Your End User

When developing a clinician-facing product, get clinician feedback early and often. That includes surveys, interviews, demos, and beta launches, just like any company would do with consumers before launching a product. Feedback is a gift and bringing clinicians along the journey is worth the investment. Clinicians want, need, and deserve user-friendly tech, processes, and workflows.

Also, look for opportunities to hear the clinical voice outside of product development. In our company all-hands meetings, we share clinician feedback about what we’re doing well and where we can improve. This tight feedback loop helps us stay honest and it keeps us focused on clinicians and what they need to do their job well.

Invest in Ongoing Education and Coaching

Remember that clinicians are highly trained and educated. They love to learn and they’re eager to upskill throughout their career. That includes traditional opportunities like continuing medical education (CME), which offers the latest research and best practices in developing areas of their field. But they also want to stay on the cutting edge of technology and care models. Especially in light of the pandemic and the transition towards virtual-first care.

Clinicians now have 50 to 175 times the number of virtual visits compared to before the pandemic. Medical schools have largely failed to provide comprehensive training on virtual care. But it’s also the digital health industry’s responsibility to make it as easy as possible for clinicians to understand how to treat patients remotely.

Before clinicians start seeing patients with Wheel, for example, we provide them with “webside manner” training. This includes:

  • Testing their webcam, microphone, and speakers before a patient visit.
  • Looking into the camera throughout the visit to make eye contact with the patient.
  • Nodding their head during the visit to demonstrate active listening.
  • Dressing professionally to set a good impression.
  • Picking a neutral background to avoid distraction.

For those who have spent the pandemic on back-to-back Zoom meetings, some of this guidance may feel obvious. But clinicians are used to being in the same room as their patients. We need to help them feel comfortable and confident behind the screen.

Cultivate a New Work Culture

Doctors and nurses are well known for putting up with long shifts and demanding schedules, but they’re fed up, burned out, and overwhelmed. The toll and trauma of the pandemic has led three in 10 clinicians to think about quitting their jobs altogether. Digital health companies not only have an opportunity to create a new work culture for clinicians, they have an obligation. It’s incredibly challenging and expensive to recruit and retain clinicians. If the workforce continues to shrink because we aren’t providing them with the support they deserve, our innovative devices and services will go dark.

One of the ways we focus on retention is by getting to know clinicians as people, just like we do with our engineers and product managers. Our team regularly conducts surveys and interviews to better understand their motivations, their career aspirations, and how the pandemic has affected both their work and personal life. For example, we found the majority of clinicians in our network are the primary income earners for their family. As with many of us, the pandemic had placed them under extra stress to provide for their families. These findings prompted our team to offer free therapy services so they could get support during a tumultuous time without needing to worry about the cost.

The digital health industry should continue to focus on improving the patient experience, but we need to consider all the factors that impact the patient experience. Getting clinician feedback early and often, investing in ongoing coaching and education, and finding opportunities to better understand their career aspirations and motivations should be table stakes for every digital health company. This is our opportunity to address one of the biggest failures of our healthcare system — providing clinicians with the support they need to provide great care to patients.

Investing in a D2C(linician) model now will pay off in the long term, keeping our caregivers engaged, patients healthy, and investors impressed. Now that’s a winning strategy.

HIStalk Interviews Guillaume de Zwirek, CEO, Well Health

August 25, 2021 Interviews No Comments

Guillaume de Zwirek is CEO of Well Health of Santa Barbara, CA.

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Tell me about yourself and the company.

I started Well six years ago out of personal frustration. I was an athlete, an endurance athlete at the time. That was my hobby. I wound up in the emergency room. They had concerns about cardiac issues. I loved my doctors and I loved the facilities, but the process of coordinating my care was super frustrating. I just couldn’t escape the thought that I was in an industry that was in the top five in terms of gross domestic product, but worst in terms of customer service despite having everything going for it.

What drove me nuts was the phone and having to navigate many different people in the health system. I thought, how great would it be if there was a technology system sitting on top of all the individual systems and technologies at a hospital so that I could save one phone number in my address book, get all my needs handled, and something behind the scenes would take care of the logistics and coordination? That was the inspiration for Well.

Health systems could me automating communication and engagement to improve the patient experience, but some may be focused on the potential to save FTEs. What motivation are you seeing?

I’m glass half full. I rarely encounter health systems that are trying to reduce FTEs. Most people came into this field for the reason of bettering patient health, and they live that in the conversations that I have with them. Usually it’s about providing quicker resolutions to common questions, elevating their staff to the top of their pay grade where they can handle more complex issues versus routine, rote communications that really aren’t sophisticated and aren’t a good use of people’s time.

I also want to add that I don’t believe in automating the patient interactions. I actually think that has the potential to do a lot more harm than to help. You should only automate when you are positive that you can give patients the answer they are expecting. The rest of the time, you need to kick things to the right live agent. That’s where there’s a lot of sophistication, routing, rules, logic, and escalations.

I’ll give you an example. My wife is pregnant. If she is texting her health system because she has cramping, that should immediately go to a nurse to respond to her over text or call her to resolve her query. If that’s getting stuck in an automated machine, you’re just going to frustrate patients more than help. It might look like you’re saving FTEs, but really you’re hurting patient health. If you’re on any value-based contracts, you’re probably hurting your margin. That’s my point of view.

How are health systems managing their use of those systems to make sure that messaging is consistent, understandable, and appropriate based on patient preferences?

That’s part of the reason this should exist in a single technology provider that handles the last yard of patient communications across the entire life cycle of the patient journey, from acquisition into the health system through discharge and long-term health maintenance and chronic disease management. If you don’t have everything in one platform, it’s impossible to manage.

A patient going in for a primary care visit may need to get an MRI, go to radiology, and see a specialist like a cardiologist, like I did in my case. If they are all using different systems, you are guaranteed to burden the patient. If you bring all the communications into one engine, you can see what workflows are configured. You can see where there might be over-communication. You can control language and make it consistent across the enterprise. That’s why I think it’s so important to bring everything under one umbrella.

There’s still a lot of work that I don’t want to diminish. There are operating work groups that need to be set up to define the tone that we want to have and the frequency with which we want to communicate with patients. Analytics departments need to look at the data and determine what’s working, what’s not, and what’s most effective. Usually there is central administration, where you set specific rules that are consistent at the enterprise level. Then, let the individual practices customize things for their specific workflow needs. All of those are considerations that we’ve built over our six years of having Well in the market.

But it’s precisely what you’re describing. It’s hard to manage and it’s complicated, and that’s why I think it needs to be in one system. That’s the only way you get the visibility.

How can technology offer patients the “they know me” experience?

I’d like to answer this without centering on Well. When you think about the “they know me” concept, most people think about Customer 360, and they think about CRM, customer relationship management. EMR, CRM, and patient communications all live in a similar format. We personally are focused on giving you a complete history of the patient communications across departments so you’re not having to repeat redundant questions and tasks. Then, displaying that information in context of all the patient demographics and information that might be relevant to them.

CRM takes it a little bit further in terms of the context of the patient, bringing in psychographics and other things across different systems, applications, and licensed data. That can be a complement that we embed and integrate into EMRs and CRM tools to provide that full picture. We are focused on that entire communications history.

Going back to my wife, true story. She was going into labor and it was in the middle of COVID, so she was wearing a really thick mask and was concerned about giving birth in that mask. She texts and says, “Can you please greet me with a 3-ply?” When the health system gets that message, they know that Katie is 40 weeks pregnant. They understand that she is on the way to the hospital for her delivery. They can respond and say, “No problem. We’ll meet you at the front door.” That’s what happened.

There’s a lot of noise. There’s a lot of different solutions to solve for this. We’re focused on displaying that comprehensive record of all the interactions you have had with the health system so they can respond to you in context without repeating a bunch of questions.

Sorry that I’m talking a lot about pregnancy, but it’s highly relevant for me. We went through this recently because my wife is pregnant again. At 12 weeks, she had really bad cramping and it was like 4:30 in the afternoon. We were at a different care provider that doesn’t offer convenient access to patients — you have to call. So we called on the phone at 4:30 and they couldn’t recognize the phone number. I had to give all of my wife’s information. It took about 25 minutes just to get to the right department and get everything documented. At 4:55 p.m., the person on the phone said, “So, Guillaume, I’m putting a note in the record to have someone call your wife. But to be honest, I don’t think anybody will. If you can call us back in five minutes, we transition to our after-hours call center and they can help you.”

I said, let me get this straight. You want me to call you back in five minutes and go through all of this information again so that I can get an on-call doctor to give us a call back? She said yes. I was really frustrated. It would have been great if I could have had that same experience that we did with the 3-ply and just texted and said, “Hey, my wife’s having cramps, we’re 12 weeks in, and we’re concerned. Can you have the on-call doc call me back?” That to me is a great experience that will make my wife and I never leave that institution and get all our care there for the rest of our lives.

What have we learned from the pandemic-related rollout of conversational AI chatbots?

A lot of people are surprised by how accepting patients are of talking to somebody over digital mediums. Symptom checkers are a great example. A lot of companies sprung up to help patients self-triage and decide the next best course of action. I think the market as a whole is much more receptive to communicating with patients over different mediums that aren’t the telephone. That’s a really good move for the industry.

I believe where we need to go is to help the market understand that they can start with a use case, but they really need to think about the end-to-end patient journey and patient experience and deliver that level of access across every step of the life cycle. If they started with a symptom checker, great. How do we expand from that and start building workflows for post-discharge or transitional care management or pre- or post-operative directions? There are thousands of workflows that can be enabled through digital mediums that don’t have any friction and that relieve staff from a burden and allow them to act at the upper end of their license.

And when I say staff, I don’t just mean doctors, MAs, PAs, and NPs. I mean call center staff too, folks that can deliver a lot of value for healthcare, but are spending a lot of time cold-calling patients to try to get them to act and adhere or answer really, really simple questions that can be automatically resolved without a human being.

How can this kind of technology be applied to patient payments?

There are regulatory restrictions to what you can communicate with regard to billing and payments. There’s a special consent that you have to get. That and marketing messages have a different threshold of requirements under the Telephone Consumer Protection Act.

We have proven that establishing a strong, two-way, consistent relationship with patients, providing that access, will make them more likely to do the things you want them to do. It’s human nature. When you build strong relationships, you feel a sense of burden to deliver on your side of the relationship. If you go in to get care and you are responsible for a co-payment, being asked that in context of that relationship makes it much more likely that you will adhere.

There’s a lot of interesting things happening in the payment space. Companies like Experian and RevSpring are licensing data on your behaviors from companies like Amazon and others to determine what your propensity to pay is, and if they should offer you a payment plan or waive the payment completely. They deliver that to health systems. That’s a valuable asset for healthcare. We’re pursuing integrations with a lot of folks in the space to deliver that information natively over the same thread, where you’re having conversations about the 3-ply mask going into labor, your pain at 12 weeks, and your postoperative directions to handle your C-section after-care.

Weaving that all together is a really compelling message. We’ve proven that patients are more likely to adhere when they have that relationship. Armed with the intelligence that a lot of these rev cycle companies have, you can be precise with what you offer to the patients. It not like a catch-all, spray-and-pray method. You owe 30 bucks, I’m going to send you a mailer, but it costs me $2.50 to send. I can be thoughtful that Mr. H has different socioeconomic needs and he’s unlikely to pay, so let’s just waive this payment and not even bother chasing him. Perhaps somebody else would be more appropriate for a payment plan.

I’m seeing a lot of interesting innovation on the rev cycle side. Our goal is to integrate with those companies. I want to be Switzerland. We have the APIs to deliver that information in the context of a really strong relationship and increase the likelihood that the patient adheres.

Where you see the company’s focus being over the next several years?

I want to be the underlying technology that powers every interaction between patients and their healthcare providers. We started deliberately in the space of care, coordinating your care for the administrative logistical items. We did that because the laws were different six years ago and that was a space that we could enter that had little friction. It had a clean path into the healthcare organizations.

As I mentioned earlier, we want to own the end-to-end patient journey, starting from patient acquisition through to discharge from the health system and long-term care management, which will extend to the home and other areas. Over time, I think establishing a strong relationship will provide a lot of value up the value chain. Think payers, pharma, and life sciences. All of those industries exist to serve patient health. If you can inject and influence the patient journey to lead to the best healthcare outcomes and have a platform that handles that end-to-end last yard of communications, it can be really, really powerful. There are applications for clinical trials. There are applications for drug discovery. There are applications for changing jobs and your insurance changing and your historical provider no longer accepting your insurance. All of those things can be proactively intercepted when you have a strong relationship with patients.

Morning Headlines 8/25/21

August 24, 2021 Headlines No Comments

Connect America Acquires Leading Remote Patient Monitoring Provider 100Plus

Senior connected care vendor ConnectAmerica, whose brands include Lifeline following its acquisition from Philips last month, will acquire 100Plus, which offers remote monitoring technology for seniors.

Definitive Healthcare Announces Public Filing of Registration Statement for Proposed Initial Public Offering

Definitive Healthcare, which acquired HIMSS Analytics in 2019, files IPO paperwork with the SEC.

Equum Medical Raises $20 Million of Growth Equity from Heritage Group

Acute care telehealth and teleICU service provider Equum Medical raises $20 million in growth equity.

AllStripes Announces $50 Million Series B Financing to Advance Global Rare Disease Research

AllStripes, which offers real-world and patient data to support rare disease research, raises $50 million in a Series B funding round.

News 8/25/21

August 24, 2021 News 5 Comments

Top News

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NextGen Healthcare board members Sheldon “Shelly” Razin – who also founded the company — and Lance Rosenzweig nominate their own slate of four new director candidates, blaming “Chairman Jeffrey Margolis and his allies” for impeding shareholder value by “effectively assuming control of the Board.”

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Razin stepped down from his president and CEO position in 2000 in a power struggle with activist former shareholder Ahmed Hussein and retired as board chair in 2015 after 41 years. Both Razin and Hussein have been involved in other company lawsuits and proxy fights. Razin owns nearly 10 million NXGN shares worth $150 million.

Margolis assumed the board chair role in November 2015. Share price has increased 8% in that time versus the Nasdaq’s 191% gain.

NextGen President and CEO Rusty Frantz left the company by mutual agreement in June 2021. A search for his replacement is underway.


Reader Comments

From Changemaker; “Re: HIMSS. Why didn’t they share financials at the business meeting? How did they fund Accelerate, from money kept from exhibitors in 2020? Where is the 990 form that was released in July? Members should question Hal Wolf about how is leading, from a lack of transparency to a lack of diverse leadership. All Friends of Hal at the top.” Your comment reminded me to ask HIMSS for its 990 form, which they graciously sent quickly for my summarization. It covers through June 2020, so a lot of interesting information won’t surface until the next filing, which might not be soon since HIMSS is changing its fiscal year to end December 31 instead of June 30. HIMSS pays its executives extraordinarily well (Hal: $1.4 million) and six of nine of its executives are white males.

From EpicCustomer: “Re: UGM. Judy as the tooth fairy. Her outfits get more bizarre every year.” I like that she lets her wacky flag fly instead of being an empty suit who can’t say “good morning” unless reading from a teleprompter for fear of spooking shareholders with spontaneity. Customers understand Epic’s culture and have bought into it (literally).


Webinars

September 16 (Thursday) 1 ET. “Patient Acquisition and Retention: The Future of Omnichannel Virtual Assistants.” Sponsor: Orbita. Presenters: Harris Hunt, SVP growth product, Cancer Treatment Centers of America; Patty Riskind, MBA, CEO, Orbita; Nathan Treloar, MSc, co-founder and COO, Orbita. Consumers want the same digital healthcare experience from healthcare that they get in online shopping, banking, and booking reservations, and the pandemic has ramped up the patient and provider need for frictionless access to healthcare resources and services. Health systems can improve patient acquisition and retention with the help of omnichannel virtual assistants that engage and delight. Discover how to open and enhance healthcare’s digital front door to offer care that goes beyond expectations.

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


Acquisitions, Funding, Business, and Stock

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Senior connected care vendor ConnectAmerica, whose brands include Lifeline following its acquisition from Philips last month, will acquire 100Plus, which offers remote monitoring technology for seniors. Terms were not disclosed, but 100Plus had raised $40 million in funding. ConnectAmerica’s CEO is former Siemens Healthcare and Nuance executive Janet Dillione, while the founder and CEO of 100Plus is Ryan Howard, formerly chairman and CEO of Practice Fusion.

Acute care telehealth and teleICU service provider Equum Medical raises $20 million in growth equity.

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AllStripes, which offers real-world and patient data to support rare disease research, raises $50 million in a Series B funding round.


People

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Greg Ingino, MBA (Vertafore) joins WebPT as CTO.

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Dina hires Maryann Lauletta, MD (Inspira Health Network) as chief medical officer, Bob Maluso, RPh, MBA (Woundtech) as chief growth officer, and Ross Lipenta (Health Catalyst) as VP of platform architecture.

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Dina promotions include Brett Poirier, MBA as VP of operations, Jay Riggins as VP of engineering, and Travis Woyner, MBA as VP of product.

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Todd Johnson (Avia)  joins SomaLogic as EVP of business development and strategy.

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Fertility EHR vendor EIVF hires Nimesh Shah, MPA (Ingenious Med) as CEO.


Announcements and Implementations

WebMD adds Symplr’s provider search and scheduling to its online health information.

Adventist Health Bakersfield (CA) goes live on IPro Healthcare’s ambulatory order management system.


Government and Politics

Former VA CIO Roger Baker says in a FCW opinion piece that VA should not take risks in trying to hurry its Cerner replacement of the homegrown Vista. He notes:

  • Cerner should replace Vista only when its use is associated with improved care quality metrics.
  • The VA needs to consider that Vista investment has been frozen several times since 2000 as the VA attempted to replace it, but it will remain in use for at least seven more years, meaning that the last facility to go live on Cerner will have been running Vista without any enhancements for 10 years.
  • Cerner is missing about one-third of Vista’s capabilities, including registries, support for government-specific reimbursement and billing requirements, and medical equipment supply and maintenance schedules. Those functions will need to be supported even beyond the 10-year Cerner timeframe.
  • Vista is the only backup plan for veteran care if the Cerner project fails, which is concerning as schedules are slipping and given the government’s poor track record of big modernization projects.
  • VA and its contractors are losing the expertise needed to maintain and upgrade Vista.

COVID-19

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New COVID-19 cases as a seven-day average are trending down slightly, as are deaths. The growth in overall number of COVID-19 hospital inpatients is rising, but a bit less sharply. Unfortunately, all are flattening at high levels. Florida and Georgia hospitals report that more than 25% of their inpatient beds are occupied by COVID-19 patients

Brown University public health school dean Ashish Jha, MD, MPH says that four factors are important in bringing kids back to full-time school: (1) all eligible faculty, staff and students should be vaccinated; (2) testing should be offered weekly to anyone who asks and rapid antigen tests should be offered to those with possible symptoms in a “test and stay” program; (3) masks should be required universally indoors, and (4) ventilation upgrades should be considered. He says distancing isn’t as important and masks alone are only modestly helpful.

FDA issues full approval to the Pfizer-BioNTech COVID-19 vaccine for people 16 and older, triggering some companies to require their employees to be vaccinated now that the product is no longer approved for emergency use only.

A Kaiser Permanente study of its EHR records finds that while the Pfizer vaccine’s efficacy at preventing COVID-19 infection with the delta variant drops off to 53% after four months, its protection against hospitalization remains at around 93%. This suggests that while prevention wanes, the delta variant is not escaping vaccine protection.

A new CDC study finds that unvaccinated people are 29 times more likely to be hospitalized with COVID-19 and five times more likely to become infected.

Anthony Fauci, MD says that full approval of Pfizer’s COVID-19 vaccine could increase vaccination rates, which would make it possible to “start to get some good control in the spring of 2022,” signaling his expectation of another bleak COVID-19 winter.

Israel, whose high vaccination rates nearly eliminated new COVID-19 cases and allowed all restrictions to be lifted, is back to near-record new cases, heavy deaths, and hospitals that can’t take new COVID-19 patients. Possible explanations include travelers returning from foreign vacations when restrictive measures were eased, rise in the delta variant, and vaccine efficacy drop-off. The country will aggressively roll out booster doses. Israel has 80% of those over 12 vaccinated versus 60% in the US.

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The mayor of Lake Ozark, MO asks his Facebook followers to pray that he is successful in smuggling the livestock de-wormer ivermectin into a hospital for treating a friend who is admitted with COVID-19.


Other

A Tennessee woman and her son sue the University of Tennessee Medical Center and two of its contractors, claiming that leaky sewer pipes overhead in the ICU burst, showering her and her son – who was an ICU patient on a ventilator – with hundreds of gallons of wastewater in a “downpour of human waste.”


Sponsor Updates

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  • CoverMyMeds employees volunteer during the company’s month-long CoverMyCommunity effort.
  • Ascom Director of Product Management Jeff McCormick shares his advice on facilitating relationships with health IT leaders.
  • Azara Healthcare publishes a new case study, “Lower Lights Christian Health Center Streamlines Population Health and Care Management with Azara Healthcare.”
  • Experian Health publishes a new white paper, “State of Patient Access 2.0: The Pandemic is changing everything from scheduling to collections.”
  • CHIME releases a new Digital Health Leaders Podcast, “A Conversation with Craig Richardville, CHCIO, SVP, and Chief Information and Digital Officer, SCL Health.
  • In a new report, KLAS rates Clearwater a top-performing security and privacy consulting firm.
  • Clinical Architecture releases a new episode of The Informonster Podcast, “Lab Data Interoperability.”
  • Divurgent VP of Technology Emily Carlson appears on the first Women Making Innovation Happen in Technology! Podcast.
  • Engage publishes a new case study, “From Chaos to Control: How Exeter Hospital Addressed Their Disaster Recovery Challenges.”

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Morning Headlines 8/24/21

August 23, 2021 Headlines 3 Comments

Two NextGen Healthcare Directors Nominate Four Additional Candidates for Election to the Board at 2021 Annual Meeting

NextGen Healthcare founder and Director Sheldon Razin and Director Lance Rosenzweig announce that they intend to nominate new directors in an effort to combat Chairman Jeffrey Margolis and his “imperial boardroom culture.”

Covera Health Raises $25M in Series C Financing to Fuel Growth of Its Healthcare Quality Analytics Platform

Analytics company Covera Health secures $25 million in a funding round led by Insight Partners, bringing its total raised to $32 million.

DuvaSawko, Abeo, and Gottlieb Join Forces as Ventra Health

After being acquired by Varsity Healthcare Partners nearly two years ago, RCM and practice management companies DuvaSawko, Abeo Management, and Gottlieb combine to form Ventra Health.

HIMSS Financial Highlights

August 23, 2021 News 3 Comments

This information is from the 2019 Form 990 of HIMSS, which covers the tax year ending June 30, 2020, as compared to last year’s filing for 2018. HIMSS has changed its fiscal year-end to December 31, effective 12/31/20. My analysis of the 2018 form is here.

Income and Expense

Total revenue: $28.7 million (down 74%)
Total expenses: $82.6 million (down 9%)
Revenue less expenses: –$53.9 million (versus a $21.2 million surplus)
Net assets: -$24.4 million (versus $33.3 million)


Program Service Revenue

Conferences: $1.9 million (down 96%)
Corporate sponsorships: $1.6 million (down 88%)
Membership: $12.1 million (down 6%)
Advertising and media: $10.4 million (up 4%)
Analytics and maturity models: $1.9 million (down 37%)


Revenue from Related Organizations

HIMSS Media: $10.9 million
HIMSS Analytics: $1.9 million
Personal Connected Health Alliance: $1.2 million
HIMSS Europe: $1.3 million

HIMSS also reported taxable partnerships through its Healthbox consulting firm. 


Major Expenses

Conferences: $11.9 million
IT: $7.5 million
Occupancy: $2.4 million
Travel: $3.0 million


Highest Compensated Employees

Harold Wolf, III, President and CEO: $1,381,794
Carla Smith, EVP: $671,788 (through February 2019): $1,295,912
Bruce Steinberg, managing director, international: $667,400
Stephen Wretling, chief technology and innovation officer: $662,149
Mitch Icenhower, chief relationship officer: $542,307
Blain Newton, EVP, HIMSS Analytics (through October 2019): $503,663
Ilene Moore, SVP, general counsel, and government relations: $497,851
John Whelan, EVP, HIMSS Media (through October 2019): $453,275

Total salaries and wages: $35.7 million for 225 employees, plus $5.2 million in pension plans and other employee benefits. HIMSS had 133 employees who received more than $100,000 of reportable compensation.

Curbside Consult with Dr. Jayne 8/23/21

August 23, 2021 Dr. Jayne 5 Comments

Part of the fun of being a consulting CMIO is working with a variety of clients that have needs across the clinical informatics spectrum. Sometimes I work with smaller organizations that need informatics leadership but don’t have the funding for a full-time position or qualified physicians willing to fill the role even in a part-time capacity. Other times I might be augmenting a large health system going through a transition, supporting a specific element of their informatics needs such as absorbing legacy systems they acquired through practice purchases or consolidating ancillary systems. There are always challenges and sometimes I run into areas where I’m not fully expert in the subject matter, but a big piece of being a good consultant is knowing when (and where) to get help when you need it.

Less fun in the arena of the consulting CMIO is when a client hires you for your expertise, and then proceeds to either ignore it, or worse yet, acts like you don’t know what you’re talking about. I was going round and round with a client last month who insists that the information blocking rule of the 21st Century Cures Act (which some of the analysts continue to refer to as the “Cares Act” despite corrections) does not apply to them. There are a number of outstanding resources that help organizations understand the requirements and how to implement them, and I’ve provided checklists, infographics, and even the relevant pages of the Federal Register in an attempt to get them on board.

In short, Open Notes requires that healthcare providers offer patients access to much of the health information in the electronic medical record without delay. Failure to provide the required access constitutes information blocking.

I had a meeting with one of the newly hired operations VPs a while back, when I again tried to talk the client into accepting their need to comply. The conversation I had was fairly comical:

Me: We need to talk about Open Notes again. You’re not in compliance, and this places the organization at risk. Additionally, it’s not good for patient satisfaction, as your competitors are all releasing their documents. We really need to figure out how to move this forward.

VP: My interpretation is that it only applies to health systems and we’re just a physician group.

Me: Actually, this applies to all healthcare providers. Since the organization is a physician group, it needs to comply.

VP: We think our patient will be harmed by this. Isn’t there an exception for harms?

Me: There are specific criteria for a “preventing harm” exception, but given the fact that the majority of visits performed in the organization are routine medical visits, it would be impossible to claim that across the board. [slides copy of FAQ document from a reputable organization across the table]

VP: This list of documents doesn’t apply to us. We don’t generate any of these documents.

Me: Let’s see – consultation notes, history and physical, lab reports, procedure notes, progress notes – there aren’t any of those in the EHR?

VP: No, we have encounter notes.

Me: It doesn’t matter what you call them, basically all of your encounter notes are consultation notes, history and physical notes, procedure notes, or progress notes.

VP: Our EHR isn’t certified, so we don’t have to do it.

Me: Actually, that doesn’t matter. The ONC FAQ page specifically says that it applies to healthcare providers “regardless of whether any of the health IT the provider uses is certified under the ONC Health IT Certification Program” or not. And we really should talk about that EHR …

This went on for a good 20 minutes, as the VP — who is half my age and has less than two years’ experience on the provider side of healthcare — tried to convince me that I didn’t know what I was talking about. The organization has been through several such VPs in the short time that I’ve been working with them. 

As all the VPs do, he said he would “have to take it to legal,” who always refuses to do anything. It’s the ultimate brush off since “legal” really means “our outside counsel since we can’t keep anyone on staff” and no one ever takes responsibility for a decision. The physician CEO of the group perceives himself to be too busy running the group and dealing with disgruntled physicians to get involved in escalating this with the legal team, dumping it back to me “because this is why we hired you.”

It’s disheartening to have to work with people like this when you’ve been hired to do a job that you’re good at and have a proven track record of helping other organizations achieve what you’re trying to accomplish. Not to mention, as a patient who has uncovered some pretty significant misses in my own medical record through the magic of patient-facing notes, I’m a believer in the power of the tool regardless of the regulatory requirements around it.

This particular VP is the same one who tried to convince me that certain data elements in the patient chart — including blood pressure records that the patient brought to the office and the physician signed, dated, and had scanned into the chart — aren’t technically part of the legal medical record, despite the fact that the physician used them to support the Medical Decision-Making component of an office visit and referred to them in his dictation.

Fortunately, I use a standard contract that lets me terminate clients like this with relatively short notice, so I opened the escape hatch a couple of weeks ago. I’m wrapping up some final transition items this weekend and am looking forward to moving on. I’m not fond of putting my professional credibility on the line for organizations like this.

I find the CEO’s attitude particularly unsettling and I understand why he might be dealing a number of disgruntled physicians if they are having to interact with people like the operations VP. I’ve built some good relationships with several of the physicians and I’m sure they’ll keep me posted on what happens with this over time.

Is your organization on board with Open Notes, or are you holding out? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Jessica Cox, RN, Director of Product Solutions, Holy Name Medical Center

August 23, 2021 Interviews No Comments

Jessica Cox, RN is director of product solutions for Holy Name Medical Center of Teaneck, NJ.

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Tell me about yourself and the hospital.

I’m the director of product solutions at Holy Name Medical Center. The hospital is located in Teaneck, New Jersey, with about 360 beds. It’s a regional health system serving the patients in the Teaneck community and surrounding communities in northern New Jersey and also folks in New York.

My role at the hospital is to manage the product offerings for software products that are deployed throughout the hospital and the health system itself. Mainly for the last two and a half years, I have been leading the development of a new in-house EHR that we just recently deployed in May in the hospital’s emergency department.

What led the hospital to decide to self-develop an EHR?

The hospital has always had an interest in technology. Close to 30 years ago, the hospital developed its own EHR, long before EHRs were prevalent and certainly long before they were mandated in the industry. The hospital, up until about two and a half years ago, was still running on that same system. It was certainly time to make a decision – do we buy, or do we build?

The hospital and the health system believe in a good mixture of both, but the leadership felt like the needs that Holy Name has were not going to be met by any EHR in the market today. The focus of Holy Name is an enterprise solution and a person-centric solution. Often systems claim to be interoperable and they are, but they certainly don’t fit the needs of an enterprise with multiple physician practices, health centers, and hospitals in the network. So the decision was made to build, and that’s what we did.

What was the makeup of the development team and how much effort was involved?

With this decision came a new leader, a new chief information officer, at the hospital. He started about three years ago and the team that he had was zero, so he had to form a team. He brought me in to manage the product side and my colleague to manage the development and architecture side. We formed a team from there. Three years ago, we had no one in place to manage this type of technology. The folks that were in place are still managing the existing legacy software.

We started with a team of basically three of us and now the team is greater than 50 folks. We have a mixture of onsite and offshore developers, QA engineers, and product managers. We are a nimble team. That’s where we’ve gotten our success and the ability to go from a concept to a minimum viable product, MVP, in just a little over two years. We are hands-on, close with our team, and we work pretty much around the clock to get the job done. We can remain agile and nimble and give the hospital what they need, but also some of the newer features and technology that they might not have even thought of without us bringing that to the table.

What does the tech stack look like?

The existing software was very legacy, as I mentioned. It was a technology that I was not even aware existed until I came on board. It was time for something new. It’s a web-based platform developed mainly on a Microsoft stack. We pride ourselves in the UI. We would love to share it with anyone that’s interested, but we brought some of the latest and greatest techniques for the UI and certainly for the behind-the-scenes architecture. We felt like it was time to modernize. A couple of other new features that we brought were facial identification for person management and person recognition when folks are coming in to be registered.

The software itself is modernized, but has some new technologies there as well. We feel like instead of looking at this as just a replica of existing EHRs, we wanted to bring technology that is not as often used in healthcare and bring it into that space. What technology is available at airports? What about banking software and technology that we can bring to healthcare and make the workflows of the hospital much more efficient?

What features were you seeking that commercial EHRs don’t have?

One of the hurdles that we had to achieve while we were developing for our own peers and our own colleagues at the hospital was that we were asking a lot of them to completely change from what they had been used to using for so many years to something from scratch. We knew that this was an MVP product, meaning the first deployed product is not going to be the most robust that can be. We are releasing new versions constantly.

Part of that advantage that you asked is to get a little buy-in from our peers. We wanted to provide them some neat, exciting kind of new-age tools that they could be excited to use. But more importantly than that, we feel like there’s a lot of advantages that we can improve the workflows that exist in the hospital today by using these technologies that aren’t traditionally in place. Our goals have been to get buy-in and interest from our colleagues, but make sure that that software is usable and that we’re not only meeting their needs, but we’re exceeding them. So far, we’ve gotten some really nice feedback.

How did your approach of using Medicomp’s Quippe differ from that of a vendor that doesn’t use it?

I will say that we are the first hospital EHR that has engaged with Medicomp to use their Quippe solution in the EHR. I really can’t imagine our charting feature without Quippe. When faced with the decision of how to manage physician, nurse, and clinician documentation, we knew that we had to have a competitive advantage there because physicians are counting seconds and counting clicks. They have high expectations that their documentation not only be complete and satisfy regulatory requirements, but that it is also readable and provides the narrative of that patient story.

The decision was to build our own database of clinical findings, or maybe integrate with another system that has just a simple database of findings, or to engage with someone like Medicomp, which provides not only that dataset, but the relationship between the findings and the ability to thread those together to tell a nice story of the patient, but also provide all of the data that’s necessary for reporting and quality measures. We feel like our chart is one of our most special features in the system and we’re really most proud of it.

Is a demo video available that would make it obvious how your product differs from commercial EHRs?

We don’t have one as of yet. Our main focus has been to ensure that Holy Name is well taken care of. Migrating to a brand new EHR is difficult. In my past, I worked on the physician practice side, and common practice was to reduce the schedule by about 30, 40, or 50% to make sure that the volume was low and everyone could ease into the new implementation. Certainly you can’t do that with the ER. So our focus has been on them and making sure that their needs are satisfied.

But we certainly would love to do that and to share. I will say our colleagues and friends at Medicomp, every time they see a demo of the software, they’re so excited and they feel like it’s something unlike anything that’s out there in the market today. We are very excited to share it with other hospitals when that time is right.

Will you commercialize the system on your own or partner with a vendor to acquire or license it?

The plan is commercialization. The route that we take, we are still navigating. But yes, I think our leadership at the hospital realizes that technology can enable hospitals to achieve much more than they currently are. I think a lot of hospitals feel like technology slows them down, and we feel like there is a need for this type of solution that is usable and easy to implement. We feel like that need is there in other regional hospitals like ourselves.

The plan certainly is commercialization. Our roadmap also involves expanding into other areas of the health system beyond the ED. I think maybe next year, when hopefully HIMSS is in a little bit of a better place, we will be excited to share what we’ve been doing.

What other technologies are you looking at or considering or developing?

We’ve been working closely with a couple of departments. One is our facilities management department. When the COVID crisis hit , our area of the country in northern New Jersey and New York was one of the hardest hit. We have worked hand in hand with our facilities management group to provide state-of-the-art exam rooms and hospital rooms that not only protect the patient, but protect the nurses as well.

Another technology that we have just implemented with our ICU — we renovated and completely built a new ICU right after COVID – is smart screens in each of the rooms that identify the clinician via facial recognition. There’s no need for tapping on the screen to access the patient’s record. There are tablet devices on the outside of every ICU room that provide indicators for the patient. They provide access into the room. 

We are continuing to dive down the software development path with our roadmap to expand, but we’re also engaging with our biomed and our facilities department to enhance the experience, the patient experience, at our hospital too. That’s been something really fun and interesting.

What advice would you give a nurse who wants to become more involved with technology?

Dive right in. Nursing is one of the best fields that anyone can enter because it is so diverse. I realized after a couple of years that bedside nursing wasn’t quite for me, and I just happened onto technology about 12 to maybe 15 years ago now. Now, I would never look back. My advice would be to work hard in nursing and make sure that you learn everything you can about patient care, but then take it further.

This industry needs nurses that have the knowledge of clinical needs and background, but who also know the workflows of the day-in and day-out of taking care of patients. That’s something that a lot of tech companies are missing these days. We need to take a step back and make sure that we understand the needs of the folks serving on the front lines of the hospital. Sometimes it’s a little more simple than we think, and so having more nurses in technology to convey that will only make us better over time.

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Reader Comments

  • Ernie Riddle: Good insight and a note that there is a lot of change ahead. Many technology platforms are active in Healthcare and the...
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