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EPtalk by Dr. Jayne 3/25/21

March 25, 2021 Dr. Jayne No Comments

Last week marked Match Day 2021, which is the day that the majority of the graduating physicians in the US learn where they’ll spend the next several years training. According to the National Resident Matching Program, which runs the residency program application process, this was the largest Match on record. More than 48,000 people applied for 38,000 available positions, and 95% of the positions were filled. Nearly 6,000 programs participated in Match Day. Primary care specialties such as family medicine, pediatrics, and internal medicine made up about half of the positions available for first-year residents. The number of MD medical students applying broke records with 19,866 applicants; DO applicants participating in The Match also broke records at 7,101.

Due to the COVID-19 pandemic, residency programs had to conduct interviews online and students were challenged to figure out which schools might be a good fit without having the benefit of visiting them in person. Overall, nearly 95% of the offered positions were filled. Although many specialties recruited a majority of US seniors, some specialties like pathology had less than 50% of its positions filled by US grads. The number of international grads applying who are US citizens increased this year, although their success rate remained static. The count of international grads applying who are not US citizens grew by over 1,000, representing a 15% increase from last year and resulting in the highest number of matched candidates ever.

The success of non-US citizen international grads seemed to surprise some given the restrictions on travel, but I would argue that being able to interview via videoconference might have placed them on a more equal footing as their US citizen competitors. Although it might be harder to select your top training programs without in-person visits, the graduating seniors I’ve spoken with are happy that they didn’t have to accrue tens of thousands of dollars of additional debt crisscrossing the country. Congratulations to everyone heading off to training. It’s a brave new medical world and we’re happy to have you in it.

For patients suffering from prolonged symptoms related to COVID-19, the condition finally has a name. Anthony Fauci, MD announced that it will be called Post-Acute Sequelae of SARS-CoV-2 infection, or PASC. The National Institutes of Health will be starting research to further study the condition, which can happen even when patients have mild initial infections. Some of the symptoms include: fatigue, “brain fog” or trouble focusing, digestive issues, depression, anxiety, sleep disturbance, and decreased lung function. A recent study from the University of Washington found that 30% of the patients had symptoms that lasted up to nine months. Other viral infections such as varicella (chicken pox) can have manifestations that don’t appear for decades, as anyone who has experienced an episode of shingles can attest. I certainly hope COVID-19 doesn’t have another shoe waiting to drop in the future.

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DoorDash is slated to offer same-day delivery of COVID-19 test collection kits through partnerships with Vault Health and Everlywell. The kits will initially be available in Chicago, Dallas, Cleveland, Phoenix, Baltimore, Denver, and Minneapolis with other cities to follow. The test kits are approved under FDA Emergency Use Authorization. The Vault Health kit costs $119 and uses a saliva test that requires proctoring via Zoom. The Everlywell kit costs $109 and features a nasal swab that can be performed without observation.

Researchers at the University of Cincinnati are working on a drone that can facilitate telehealth visits and even enter the home to assess living conditions. The drone includes a compartment to carry laboratory specimens and supplies and includes audio-visual tools. Researchers liken it to the telehealth robots that hospitals are using within brick-and-mortar environments and hope that it can assist in management of chronic conditions, health coaching, and consultations.

I spend the majority of my time looking at how technology impacts healthcare, but the pandemic has uncovered ways that low-tech services could really make a difference. I was surprised to read a recent piece in JAMA Internal Medicine that addressed unmet basic healthcare needs. The study found that more than 42% of individuals with decreased ability to bathe or toilet independently lacked equipment that could help them – things such as shower chairs, raised toilet seats, and grab bars. As a representative sample, it could indicate that more than 5 million people have unmet needs. The study participants were followed for more than four years to determine if they eventually acquired the assistive equipment. Approximately 35% of those with bathing needs and 52% of those with toileting needs never received it. Such low-cost interventions can reduce injuries, promote independence, and improve quality of life. Sure, it’s not as sexy as mRNA vaccines or monoclonal antibodies, but we should be able to do better.

A headline on “How Hospitals are Using AI to Teach Physicians to Better Express Empathy” caught my eye recently. Startup company Virti has been working with hospitals, including Cedars-Sinai Medical Center (which is also an investor) and the UK’s National Health Service, to use AI-powered virtual patients to coach patients on bedside manner. The animations are designed to test users on empathetic interactions and interpersonal skills while collecting data on performance. The software can be used on smart phones or computers and there is also an option for virtual reality headsets. Users are scored on their speed, what questions they asked, and whether they arrived at an accurate diagnosis.

Mr. H recently ran a poll on company culture, asking respondents to compare current culture to a year ago. Responses had a fairly equal distribution – 33% “about the same,” 32% “worse,” and 26% “better” with 9% reporting they have changed employers, quit working, or don’t have an employer. I had the opportunity to think about this in depth this week as I spent some time with an executive recruiter. The conversation was made more enjoyable by the fact that it occurred in New Orleans and involved cocktails, which always makes things more interesting.

We also had a chance to talk about toxic workplace culture, which I’ve experienced several times in my career. It’s always interesting in healthcare when leadership promotes safety publicly, but does not support it behind the scenes. I’ve heard reports from several institutions recently as staff are refused adequate personal protective equipment (PPE) while caring for COVID-19 patients. One of my nursing colleagues reported that additional PPE was delivered to their unit for a media visit, and then the carts full of isolation gowns and face shields were removed once the reporters left. Another hospital was floating specialized nurses (such as labor and delivery nurses) to medical/surgical units, where they were not comfortable caring for patients outside their usual scope of practice. Only after a half dozen nurses resigned did they decide that it was probably not the best plan. Organizations are offering meditation rooms and wellness apps to employees that are stressed to the max rather than adjusting caregiver to bed ratios or looking at other tangible solutions.

How is your workplace culture evolving to meet the new normal? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 3/25/21

March 24, 2021 Headlines No Comments

Clearsense Secures $30 Million in New Funding to Fuel Growth as a Cutting-Edge Data Platform Technology

Health Catalyst Capital invests $30 million in health data management and analytics vendor Clearsense.

New York Life Accelerates Underwriting Through Collaboration with Cerner

Cerner works with New York Life to facilitate medical record retrieval as part of the life insurance company’s application and underwriting processes.

Ginger Announces $100 Million Series E Financing from Blackstone to Bring Value-Based Mental Healthcare to Millions of Employees and Health Plan Members

Mental health app company Ginger raises $100 million in a Series E funding round, bringing its total raised to $220.7 million.

Morning Headlines 3/24/21

March 23, 2021 Headlines No Comments

DexCare Announces $20M in Oversubscribed Series A Funding, the Providence Spin Out Delivers First Operating System for Digital Care

Providence Digital Innovation Group alum DexCare raises $20 million in a Series A financing round.

AppliedVR Secures $29 Million in Series A Funding to Make Virtual Reality the Standard of Care for Chronic Pain

AppliedVR, which offers virtual reality-based chronic pain treatments, raises $29 million in a Series A funding round.

Komodo Health Secures $220M in Funding Led by Tiger Global

Health data and analytics company Komodo Health announces a $220 million Series E funding round after raising $44 million in January.

News 3/24/21

March 23, 2021 News No Comments

Top News

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Providence Digital Innovation Group alum DexCare raises $20 million in a Series A financing round.

DexCare, which originally developed software for Providence’s ambulatory care sites, offers a platform to allow patients to self-schedule across multiple locations in dynamically routing them to the most appropriate care access point.

Co-founders Derek Streat and Sean O’Connor, who will run the company, came from University of Washington spinout C-SATS, which sold technology to make OR recordings of surgeries to allow outside experts to evaluate the skill of surgeons. That company was sold to Johnson & Johnson in 2019.

DexCare’s customers include Providence, Community Health Network, Houston Methodist, and Froedtert & the Medical College of Wisconsin.


Reader Comments

From Bedazzled: “Re: HIMSS21. I’m wondering if you will repeat your 1/29 poll about attendee plans? I’m sure many organizations are thinking through what their level of involvement will be.” I probably won’t run another poll for a while since I expect little has changed in less than two months, and at some point, everybody needs to just decide to either go or not instead of worrying until the last minute who else will be there. Two-thirds of HIMSS20 registrants said in that last poll I ran that they won’t attend HIMSS21, although I might be skeptical about generalizability. I figure I should be on hand to write it up whether it’s a success or a bust (maybe even more importantly if it’s the latter), so I booked the Palazzo at a great rate of $229 with no resort fee through HIMSS / OnPeak after wasting a ton of time trying to decipher their refund policy, which I think is that your card gets charged one night’s stay three weeks before the August 9 start date, then if HIMSS21 is cancelled afterward, that’s all you lose. I ordinarily would Airbnb a condo or house, but I’m not bringing a crew this time since there’s no HIStalkaplaooza or booth, so I’ll just Lyft from the airport and then everything will be just an elevator ride away.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Appriss, known in healthcare for its prescription drug monitoring program interface capabilities, acquires patient event notification vendor PatientPing for a reported $500 million.

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After raising $44 million in January, health data and analytics company Komodo Health announces a $220 million Series E funding round.

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Ro raises $500 million in a Series D funding round that brings its total to $876 million, and valuation to $5 billion. The company, which now markets itself as a digital health clinic, offers telemedicine, online prescription delivery, in-home lab and nursing services, and smoking cessation programs. Hemant Taneja, managing partner at Ro investor General Catalyst, has also invested in the new Glen Tullman-led Transcarent, which helps self-insured employers guide employees to more cost-effective care.

Data aggregation and analytics company Evidation Health will use a Series E funding round of $153 million to offer more virtual health programs as part of its digital health research network.

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AppliedVR, which offers virtual reality-based chronic pain treatments, raises $29 million in a Series A funding round.


Sales

  • Mercy Iowa City (IA) will implement Allscripts Sunrise, delivered by Microsoft Azure.

People

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Patty Lavely, MBA (CIO Consulting, LLC) joins Health Care District of Palm Beach County as VP/CIO/CDO.

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Jennifer Anderson (North Carolina Healthcare Information and Communications Alliance) joins Intellect Resources as VP of client services delivery.

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Divurgent names Bob Farrar (Cognizant) as principal of payer services.


Announcements and Implementations

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Meditech works with Code, Dryrain Technologies, and ACS MediHealth to develop a mobile barcode scanning app that is compatible with its Expanse EHR.

Cone Health (NC) implements the Loopback Analytics platform to improve value-based care and specialty pharmacy initiatives.

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Hinchingbrooke Hospital in England goes live on enterprise imaging and Xero universal viewer technology from Agfa HealthCare.

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Lumeon adds patient self-scheduling to its care journey orchestration platform.


Government and Politics

Hospitals that have published their confidential prices to comply with the new CMS requirement have some cases intentionally coded their websites to hide those pages from web searches.

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FDA’s second-highest ranking official — Principal Deputy Commissioner and acting CIO Amy Abernethy, MD, PhD — will leave the agency next month. Abernethy, a hematologist-oncologist who was formerly a professor at Duke University School of Medicine and chief medical and scientific officer with Flatiron Health, said in a tweet, “If COVID has taught us anything, it’s that we need to rethink US digital health infrastructure. This transformation will require new ways of working across traditional silos in government & business/tech, ensuring we always put patients first.”


COVID-19

AstraZeneca issues a press release saying that US trials of its COVID-19 vaccine that is being used in Europe show a 79% efficacy against symptomatic infection and 100% protection against hospitalization and severe disease, but the independent review board that advises NIH says the company may have used outdated information from its trials and should enlist that board’s help to review the findings. The AstraZeneca vaccine is important globally because it costs just $4 per dose to manufacture and can be stored for up to six months under normal refrigeration. Observers say the vaccine is fine, but the drug company is not inspiring much confidence with its questionable communication and coordination with US regulators.

China’s efforts to enhance its global influence by offering countries its domestically produced COVID-19 vaccines are being hindered because the manufacturers of the two products — Sinovac and state-owned Sinopharm – still haven’t published data from their clinical trials from early 2020, raising questions about whether the efficacy of the vaccine is competitive with those made elsewhere. Sinopharm’s UAE distributor has suggested that some recipients take a third shot due to insufficient antibody response, while Sinovac’s studied efficacy rate has varied from 50% to 80%. The vaccines have been approved for use by 60 countries, many of which are unable to get the Pfizer and Moderna products that wealthier countries have bought up.

Texas Roadhouse founder and CEO Kent Taylor dies by suicide at 65 after experience debilitating long-term COVID symptoms that included severe tinnitus. 


Sponsor Updates

  • PatientPing achieves full certification status under the state of Massachusetts’ Mass HIway Event Notification Service initiative.
  • Cerner releases a new podcast, “A tale of two crises and the value of health data interoperability.”
  • Change Healthcare will exhibit and sponsor at Rise National 2021 March 26, 29, and 30.
  • CloudWave’s OpSus Live cloud hosting for healthcare service achieves a “Best Practice” rating after successful completion of the Meditech Infrastructure and Supporting IT Process Audit with Securance Consulting.
  • Wolters Kluwer Health releases Lippincott TelemedInsights to help providers implement sustainable virtual care models.

Blog Posts


Contacts

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

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Morning Headlines 3/23/21

March 22, 2021 Headlines 1 Comment

Digital Health Startup Ro Raised $500 Million At $5 Billion Valuation

Ro, which now markets itself as a digital health clinic, raises $500 million in a Series D funding round that brings its total raised to $876 million.

Clearlake, Insight-backed Appriss snags PatientPing

Appriss, known in healthcare for its prescription drug monitoring program interface capabilities, acquires patient event notification vendor PatientPing in a $500 million deal.

Evidation Raises $153M to Scale Virtual Health Capabilities of Achievement™ Platform

Data aggregation and analytics company Evidation Health will use a Series E funding round of $153 million to offer more virtual health programs as part of its digital health research network.

Curbside Consult with Dr. Jayne 3/22/21

March 22, 2021 Dr. Jayne 4 Comments

Both the virtual physician lounge and the informatics community were buzzing this week about the Amazon telemedicine announcement. For those that missed it, Amazon plans to expand its Amazon Care telehealth program nationally. The program will be available for all 50 states plus Washington, DC later this summer.

Amazon Care has been providing both telehealth and in-person primary care services to company employees and dependents in the Seattle area since September 2019 and expanded it throughout Washington state in September 2020. The first phase of the national expansion will cover other companies in Washington state, with the rest of the US following for in-person services in Washington, DC and Baltimore and virtual services in other locations. Planners note that the virtual clinic will offer both urgent care and primary care services as well as COVID-19 testing, flu testing, and vaccines. Patients also have the option of scheduling follow-up visits in their homes or offices. Patient can schedule them through the Amazon Care app, which also provides care summaries and follow up reminders.

Amazon has offered additional home services in the pilot program, including administering pediatric vaccines in patients’ homes as well as evaluation of the work-from-home arrangements of employees to help them avoid ergonomic issues. Employers will be able to access the service and offer it as a benefit to employees.

It will be interesting to see how it scales. In the current offering, patients are typically able to connect with healthcare providers in around a minute through the app, which offers live chat, messaging, and video. Unless they have a tremendous number of resources on standby, response times like that are typically only achieved when agents are managing multiple patient streams at a time. That’s what I’ve seen with some clinical call centers that add messaging to the mix. Maybe Amazon has some kind of secret sauce that will make things work differently.

The purported value as a workplace benefit is clear – employees would miss less time trying to seek care for minor illnesses or more straightforward services such as prescription refills. Those services are available through existing telehealth offerings. However, the Amazon name is likely to represent speed and efficiency, which are both attractive to employers. Amazon prescription delivery is also attractive.

Still, I wonder what their clinical quality data looks like in their pilots. How are they managing antibiotic stewardship? What are the metrics they are following to determine whether they are successful? Are they able to monitor downstream metrics, such as emergency department visits or hospital admissions? The availability of home visits is certainly a differentiator compared to other available offerings.

As a physician, I’m curious to understand what their compensation structure looks like for clinical resources. Are they using all employed physicians with enough licensure coverage to hit all 50 states? Are they using independent contractors? Most of the major telehealth organizations use independent contractors, who may have arrangements with multiple vendors and who practice on the different platforms depending on supply and demand factors. The Amazon press release notes that the service “allows employees and dependents to see the same dedicated teams of medical professionals, which creates long-term relationships that benefit overall health.” That would seem to describe employed physicians who would be focused on Amazon patients, but I would be interesting to understand how that kind of arrangement would compare to the salaries generated by brick-and-mortar physicians.

The Amazon press release also mentions same-day COVID-19 testing, so I’m curious to understand who they are partnering with to deliver the proverbial last mile of service for testing and vaccinations. That might not scale across the US in the same way it would in the Seattle area.

I’m concerned about the potential mismatch between patient expectations and reality, as well as how the extreme focus on convenience somewhat diminishes the value of the relationship with the physician. The release cites a patient who appreciates the convenience of Amazon Care and not having to wait at a doctor’s office. She states that using the services “makes me feel like I have more control over the healthcare system than the healthcare system has over me. It’s at my leisure. That’s power. I’m not waiting on someone else to show up on their schedule.”

I appreciate the need for patient convenience, but I think it’s important for patients to acknowledge that the vast majority of the time, physicians are not on schedule because they’re caring for other patients, whether in-person or asynchronously, because they are managing refills or completing paperwork. When my patients are frustrated because it’s taking 30 minutes for me to reach their exam room in my walk-in clinic, it’s usually because someone with a more acute need has arrived at the same time or before them. Although healthcare delays can be due to inefficiency or operational issues, they can also be due to me arranging a transfer to the emergency department or counseling a patient on a devastating diagnosis, such as a miscarriage.

In the case of Saturday night, the delay of care might have been due to the fact that our entire staff was busy performing cardiopulmonary resuscitation on a patient, trying to bring him back from the dead in the interval before the ambulance arrived. If you’re the patient in distress, you certainly don’t want me cutting you short because I have someone else who is waiting.

I struggle with understanding how they plan to balance the promised levels of convenience with the offered continuity, because they’re often in conflict. Team-based care can certainly help with this, but patients have to understand what that really means. As healthcare has become more transactional, I find that many patients don’t care who they see. While a brick-and-mortar practice can’t staff an unlimited number of physicians, online practices can certainly have a deeper bench. But we can only deliver face-to-face care (whether virtual or in person) to one person at a time, even if we’re running back and forth between exam rooms. The demand for instantaneous care has definitely impacted the relationships that we are trying to build with our patients, and at least anecdotally among my local peers, is one of the reasons some of them have changed jobs.

The devil will be in the details, but I can’t wait to see how this unfolds. Get your popcorn, folks. How do you think Amazon Care will play out nationwide? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Hal Baker, MD, SVP/CDO/CIO, WellSpan Health

March 22, 2021 Interviews No Comments

R. Hal Baker, MD is SVP and chief digital and chief information officer of WellSpan Health of York, PA.

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Tell me about yourself and the health system.

WellSpan is an integrated delivery system of about 20,000 employees over five counties in south central Pennsylvania. We’re locally governed and are committed to providing affordable healthcare in the region. We were formed through strategic affiliation of independent health systems in the region. We have a large medical group practice with multiple specialties and eight hospitals.

We went from “everything but Epic” to Epic in 2017, with our Summit Health recently going on Epic last October. We are finally on a unified electronic health record across our system and enjoying that in a region that has a lot of Epic. Care Everywhere provides good inter-system interoperability.

How are you using Nuance’s DAX (Dragon Ambient Experience) and what is the business case for implementing it?

I came to WellSpan almost 26 years ago and spent my first 10 years in education with the residency program. I’m still a practicing internal medicine doctor and I’ve been using DAX since the summer. I have found that it has dramatically increased my enjoyment of practicing and also increased my ability to concentrate on the patient. I’ve always been impressed that no judge tries to be their own court stenographer and no CEO tries to take their own minutes in a board meeting. We say it’s really not a good idea to try to text and drive, and yet all of our doctors are trying to text and treat.

That mental complexity of trying to handle the documentation and the invoicing of healthcare — creating the billable note with the HCC codes and the different number of bullets for the coding requirement — simultaneously while you are trying to listen to the person who’s telling you their problem and apply a thoughtful diagnostic acumen to it — that’s a hard juggling act.

In many other areas, we have said that that’s not safe. It’s the reason in aviation for having a silent cockpit from 10,000 feet down. In healthcare, we’ve tried to do that. I did not appreciate how much I was being exhausted by that until DAX came in and I had a virtual scribe through DAX that allowed me to just converse with the patient and stop worrying about the note. It seems like it would be a small thing that might increase my efficiency, but what I found is that I am so much more able to be present with the patient and to connect with them.

For me personally, I worried that it was because I’m an administrator most of the time, you’re always thinking about other things, and you have that executive halo sitting on your shoulder that’s watching. You’re more distracted than other doctors might be. But one of our urgent care doctors was on a call discussing our efforts to reduce burnout in our providers. He gave me permission to read this in the meeting. He wrote to people:

“It hit home with what I started yesterday. I started a demo of the DAX system. I was very skeptical prior to using it, which is why I was probably chosen to demo it. I consider this a game changer. Over the past few thousand patient encounters, this is the first time I could literally sit and talk with the patient without being preoccupied. There was a clarity during the patient encounter because I was not busy typing. I think this is going to be a game changer. It’s unfortunate we have made patient encounters so incredibly busy that we are now trying to revert back to the way medicine was and should be.”

He captured what I was feeling, so I asked him if I could use that quote. But it was nice for me to see that it wasn’t just me who perceived that.

Is the result immediately available following the encounter or is there a delay as behind-the-scenes humans complete the work? Do you have to make a lot of corrections?

I started out my career writing my own notes and handwriting, which was a primitive form of encryption, but pretty effective at that. I then came into my faculty practice. I was able to dictate. I still had to listen to the patient and then regenerate the note. I then moved to Dragon because it allowed the note to be present at the end of the visit, something Dr. Jayne commented on. I really liked that and Dragon was certainly good enough. We have deployed Dragon in the exam room.

I have always dictated in front of patients because it lets them correct me and it lets them hear that I’ve listened to them. I get the notes back in four hours. We’re one of the first places to apply it to primary care. DAX was developed in orthopedics. I have gone through being a patient with a doctor doing a DAX orthopedic visit. I threw in some obnoxious things just to see what would happen and got a note back within a few minutes from the AI. It wasn’t perfect. It would have needed some editorial tweaking. But it was remarkably on target for a conversation being converted into medicalese.

What we’re seeing now is that four-hour turnaround time. I only am able to review a certain number of notes before I leave for the day and I have to do some the next day. But it’s worth it for me to be able to be fully present with the patient. Some providers really like the note to be absolutely their note and others of us are OK with somebody else writing the note as long as it got the key facts and is basically telling the same story.

I will say that the DAX notes are high quality. They’re not exactly as I would have written them, but I don’t think they are inferior, and my partners don’t think they’re inferior when they read them. But relieving me of that responsibility of mental note-taking and compiling the note in my head while I’m trying to listen and think through the problem — that’s been a win. I would say that some doctors really want the notes to be their notes and it may not be for everybody. But if you can let go of the perfection of it being your note and allow a good process to generate a note, I think it’s doing a great job. And there’s something to be said that I underappreciated about relieving the doctor of the invoicing part of medicine and just having them focus on the clinical part.

We are rolling out a pilot of 50 doctors. We absolutely know we need to make the business case. We’re going to be looking at employee and patient satisfaction, pre- and post-DAX versus DAX versus control group, people doing the old way. We are also hoping that there’s some improvement in efficiency by removing the time that you had to re-dictate the note, essentially. I only spend about 75 to 90 seconds reviewing and signing a note. I clocked myself because I knew I would have this conversation with you coming up. So it’s certainly faster than me dictating, but we are looking for that business case you talked about in your blog a week or two ago. We don’t have it yet, but we know we need it to justify a further rollout.

So your business case will mostly focus will be on patient satisfaction and recapturing the patient-physician relationship in being able to look each other in the eye instead of the physician typing?

We are looking at everything we can think of that might indicate value so that we can justify the investment in DAX. As the AI learns how to write notes from the combination of AI and scribe, the timing will get shorter over time. We’re committed to being early and we are training it. It’s much further along in orthopedics than it is in primary care. The vocabulary range in primary care is huge compared to orthopedics, in terms of what we talk about in an encounter. That’s a challenge, but we think it is already bringing in value.

I was named one of the top 10 doctors for patient satisfaction recently. I think that’s the first time I’ve been called out for that, and it was while I was using DAX. That’s an N-of-1 result, but I’m wondering if the two are related. That’s part of the reason why we are studying it.

How is the health system addressing consumerism and patient relationship management?

That’s a very dedicated part of our effort. We want to become easier to use and reduce the friction of healthcare.

Like many people, we have had a rapid rollout of video visits. We’ve been very active in online scheduling. A woman can schedule her mammogram without an order, go in and get it, get her report back that evening, and click in and look at her mammogram images on our portal. We made a commitment long ago to put in the portal that we wanted when we were patients, even if it wasn’t the portal we were always comfortable with when we were providers. We give access to adolescents up until age 18 to the parents unless there’s a special court situation, which is something a lot of people have shied away from. We gave people access to their images online. We did that in February last year, then COVID happened and we completely blew up our marketing plan for communicating it. People still found it and we got to over 40,000 images viewed per month.

We are trying to get people where they are and offer them the services so that they can interact with us with the least amount of friction. We are experimenting with Livongo with our employees. We just managed to integrate it with Epic, which was a nice cooperation between Livongo and Epic.

What were your expectations in replacing everything with Epic and what opportunities have resulted?

We had done a lot of work to put the Allscripts notes into Cerner and the Cerner notes into Allscripts to make sure all the imaging results were available in both. But the ability to coordinate through secure chat with specialists … Johns Hopkins is down the road from us and we have a partnership with them in oncology. For me to be looking at a Hopkins pathology result from eight years ago in about five clicks from the Epic record is fantastic interoperability. I dramatically underestimated how good that would be.

For us to have a patient go from one of our hospitals to one of our offices and not have to start over is part of our promise to make you feel like we know you. We have a effort we call “Know Me” to make people feel like we know who they are. For instance, the name “Levine” can be pronounced three or four ways. We have a section in our record in our Epic storyboard where we have the pronunciation so we know whether to say lah-VINE, lah-VIN, or lah-VEEN.

How do you see technology’s role in clinical and quality improvement?

This is kind of a hard concept, but our work in sepsis was so successful because we leveraged humans through technology. Rather than having a sepsis alert fired to busy ED doctors and nurses and reminding them with pop-ups that at best have about a 20% response rate, we instead fired it to a nurse who was watching over every patient in the hospital and figuring out whether that was a real problem or a false alarm. Then going to see if the team is doing everything they’re supposed to do. Not picking up the phone unless there was something that was being missed. But when they did call, the teams in the ED and the ICU quickly learned that eight out of 10 times, it was going to be a real situation.

That was a known person calling with a worry. They have actually done some research, looked at the chart, and said, “I think we’re missing sepsis here” or “I don’t see that you’ve ordered the fluids at the right rate” or “the antibiotics haven’t come down from pharmacy” and allowing us to rescue the sepsis bundle. We were able to get up to 90 to 100% compliance. With that, we are able to achieve O/E ratios — observed to expected deaths — of 0.6, 0.7 in some of our hospitals, our mortality saving over 200 lives in a year.

It was awesome when we received the Eisenberg Award for patient safety and quality for that. But I think if we tried to do it all with technology, it wouldn’t have worked. It was partly having that human voice in looking at the alerts and translating them into real or false alarm and then calling with an explanation of why I’m calling you and what you need to do in a trusted relationship. The magic part is when you put human beings with technology to create a trusted communication.

Is there an organizational effort to get rid of perceived barriers that give health systems the reputation of being impersonal, bureaucratic, and inaccessible for patients, physicians, and employees?

Absolutely. We borrowed the, “Get Rid of Stupid Stuff” from Hawaii Pacific Health. We are trying to do that. Our vision is as a trusted partner, reimagining health and reimagining healthcare and improving health. But that trusted partner thing is really important to us,. That’s what we commit to.

Our mission statement starts off with working as one. I think that is probably our biggest catch phrase — we want people to feel like we are one team, even if we are multiple offices. We’re not perfect by any means, but there’s a consistency of that exploration. I suspect that any WellSpan employee who is standing in a line in an airport hears somebody say, “That was a time when we really did a good job of working as one,” they would turn around and wonder if that was a WellSpan person, no matter where they are.

What projects will be most strategic over the next few years?

Trying to improve the efficiency of healthcare and reduce the cost. I’ve been intrigued with Livongo. Maybe we can take care of people with hypertension and only see them in the office every few years. Now that we have that integrated into Epic, it’s been really interesting to think about. With COVID, within 34 hours of the governor’s announcement, we had turned on COVID vaccine signup and had over 46,000 people signed up. You have to be ready and be able to move quickly when those kinds of things happen.

We’ve had over 100,000 people sign up for our portal in the last two months. A lot of that has been driven by COVID vaccinations. It’s up to us to retain that user who came in for one purpose and try to establish a trusted relationship that allows them to use us in an easier way online or wherever, by whatever means they want to use us with. We take care of the Plain community here, which you would probably call the Amish, so there are practices in WellSpan that have a hybrid charging station next to the hitching post. It’s all about meeting our community where they live.

Morning Headlines 3/22/21

March 21, 2021 Headlines No Comments

VA announces strategic review of Electronic Health Record Modernization program

VA Secretary Denis McDonough orders a 12-week strategic review of the VA’s Cerner EHR implementation that will include optimizing productivity and clinical workflow and looking into patient-facing functions.

Riva Health Launches, Raises $15.5M for Breakthrough Mobile Cardiology Technology

Riva Health will use a $15.5 million investment from Menlo Ventures to help launch its app for hypertension management this summer.

Omega Healthcare Acquires Himagine Solutions

RCM vendor Omega Healthcare acquires Himagine Solutions, which offers medical coding and registry services.

Monday Morning Update 3/22/21

March 21, 2021 News 6 Comments

Top News

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VA Secretary Denis McDonough orders a strategic review of the VA’s Cerner EHR implementation. He said in an announcement that while the VA is committed to Cerner Millennium, problems with its use at Mann-Grandstaff VA Medical Center make “a strategic review necessary.”

The VA says its ongoing post-deployment analysis at Mann-Grandstaff has necessitated a rollout schedule change, although Columbus remains as the next go-live site.

The VA’s 12-week review will include optimizing productivity and clinical workflow and looking into patient-facing functions such as the patient portal, data syndication, and revenue cycle.

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Rep. Cathy Rodgers (R-WA) asked McDonough last Wednesday to launch an inquiry following reports of problems with prescription ordering, the patient portal, and user training. She calls the system “broken” and suggested a review of Mann-Grandstaff staffing, productivity, staff morale, training resources, and remaining infrastructure improvements.

The GAO recommended in a report last month that the VA delay going live at additional sites until it resolves call critical problems at Mann-Grandstaff, which was its first center to go live in October. The VA responded that it agreed in principle, but would not delay further rollouts.

Cerner provided a statement in response to the VA’s review announcement, saying that it supports the decision, that the company’s priority remains veterans and delivering solutions that drive care transformation in the VA, and that it is proud of its successes that include one of the largest health data migrations in history and deployment of a joint HIE between the DoD, VA, and community partners.


HIStalk Announcements and Requests

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Poll respondents handily choose insurance companies over hospitals as offering the worst customer service in healthcare. It’s interesting to me how huge, profitable companies of the recurring revenue type nearly always offer embarrassingly bad service to their paying customers – cable companies, broadband providers, cell service providers, streaming subscription companies, and banks. Shouldn’t customer service be able to scale along with other  parts of the business, and don’t these companies deploy enough analytics to understand the net present value of a customer who only needs to be occasionally helped – often because of the company’s mistake — to keep writing those monthly checks?

New poll to your right or here: Which should be done to better protect patient data? I’m sure I didn’t think of all possibilities, but I did include a “no changes needed” option and you can always vote and then click the poll’s “comments” link to add your own thoughts. I’m always surprised by how many people – some of them in healthcare – forget that the 25-year-old HIPAA, which is a HHS/CMS rule, applies only to covered entities and their business associates, and even then only if those providers submit electronic claims. Maybe a legal expert can weigh on what privacy protections the general legal system offers to the medical records of individuals – if my neighbor steals a printout of my medical records from my car seat and posts them on Facebook, do I have legal recourse?

I’m at the “go or no go” HIMSS21 decision point since it’s probably time to book travel arrangements. I’m leaning toward “go” because I should write about it regardless of how it turns out, but only if I can get a refundable lodging reservation in case the conference is cancelled. A flight on Southwest would be ideal since they would give a refund or credit if the conference isn’t held. I always get my north-south orientation of the Strip mixed up, but Google Maps tells me that the Wynn (where some sessions will be held ) is 0.8 miles from the Palazzo, meaning either queuing up for a shuttle or talking a long walk through sidewalks that are steaming with the urine of panhandlers and trying to convince yourself that 110 degrees isn’t all that bad because it’s a dry heat.

Listening: The Bengsons, an award-winning indie-folk husband and wife who debuted their latest work in a self-filmed, commissioned documentary film that was recorded in their house. It’s a refreshing counterpoint to the usual glitzy celebrity musicians (who sometimes make millions even though they don’t write songs, weren’t committed enough to learn to play an instrument, and can’t read music) in which we see them just singing and playing unadorned, with a gut-punching, powerful personal narrative from Abigail midway through that also explains her joy. This kind of performance art should be the future, even when we are once again allowed to wildly overpay for seats in which we watch a huge monitor of someone lip-synching and prancing impersonally on stage a hundred yards away. If you need something more smoothly soulful, Xavier Omär’s NPR Tiny Desk concert from last week is excellent.


Webinars

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


Announcements and Implementations

Meditech adds vaccine eligibility checking to the self-scheduling component of its patient portal.


Government and Politics

The American Hospital Association asks the Department of Justice to review the proposed $13 billion acquisition of Change Healthcare by Optum. AHA says that the deal would reduce competition in health IT sales and would give Optum’s parent company, insurer UnitedHealth Group, access to claims data that would “further increase UGH’s already massive market power.”


COVID-19

CDC reports that 31% of American adults have received at least one COVID-19 vaccine dose and 17% have been fully vaccinated, as 121 million doses have been administered. A record 3.1 million vaccinations were given Saturday.

Some areas of the country are experiencing a COVID-19 case resurgence, which experts think is due to variants that can’t be verified because less testing is being done. Former FDA Commissioner Scott Gottlieb, MD says we need better ways to link clinical outcomes with each identified variant.

The New York Times observes that the US government will soon be issued a patent for the invention that made at least five versions of COVID-19 vaccine possible, providing one last chance to pressure drug companies to expand access to poorer countries. Some countries are asking the World Trade Organization to waive patent restrictions so they can produce their own, while Russia and China are taking advantage of “vaccine diplomacy.”

A review of 62 papers that examined the use of AI for detecting COVID-19 from chest X-ray and CT images finds that every model was unsuitable for clinical use because of methodological flaws or underlying biases. The authors found that use of publicly available datasets is problematic because they often exclude groups such as children and don’t include demographic information, systems are sometimes trained on low-resolution images, timing of tests and the view chosen can affect conclusions, and doctors would rarely diagnose or differentiate COVID-19 from images alone.


Other

The commissioners of Rowan County, NC give Atrium Health 30 days to establish EHR sharing with the county’s emergency medical services department, which ended in later 2019 and left first responders with no ability to review the hospital records of transported patients for EMS quality assurance review.

Billionaire Denny Sanford, who made his fortune providing high-interest credit cards to people with poor credit scores, donates $300 million to Sanford Health for projects that include creating a virtual hospital. He has donated more than $1 billion to the health system that changed its name from Sioux Valley Hospitals and Health Systems in return.

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Taiwan-based Cloudmed raises $275,000 in an IndieGoGo campaign for its ICare cardiovascular tester, which it says is the world’s smallest. The phone-paired device includes real-time reporting, data sharing, lifestyle and dietary recommendations, and on-call clinical experts. Sensors include EKG, oxygen saturation, heart rate, blood pressure, and fatigue. Campaign supporters can get the device in May for $99, two for $159, or four for $269. Its $2 per month subscription offers SOS calling, medication reminders, summary reports, measurement journals, and advanced measurements. Thanks to reader AnotherDave for sending the link.

Kaiser Heath News says that COVID-related telehealth rules for out-of-state providers could have unintended consequences if made permanent – increased provider fraud, loss of profitable patients by local providers who may stop accepting money-losing Medicaid patients, and reduced access for patients who have limited technology literacy or internet access.


Sponsor Updates


Contacts

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

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Weekender 3/19/21

March 19, 2021 Weekender No Comments

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Weekly News Recap

  • Transcarent executive chairman Glen Tullman adds the CEO role to his responsibilities.
  • Social services referral platform vendor Unite Us raises $150 million.
  • Amazon announces plans to expand its employee-only virtual care service to 50 states, then offer it to other employers.
  • Analytics vendor Clarify Health raises $115 million.
  • A study finds that two-thirds of the country’s largest hospitals are not complying with new federal pricing transparency rules.
  • Tegria acquires Cumberland.
  • Tech-enabled kidney care company Strive Health raises $140 million.
  • Grand Rounds acquires Doctor On Demand.
  • HIMSS pays $2.8 million to settle a class action lawsuit brought by HIMSS20 exhibitors over unrefunded fees.
  • HIMSS21 registration opens.

Best Reader Comments

From Amazon’s announcement, the service and sales model is basically Teladoc. I think the big question is if Amazon expects the venture to ever make money or just make financial sense for their employment expenses? I think it will be like Walmart, where they initially focused on their own employees, that didn’t work too well, so they tried to pivot to selling via in-store clinics, which didn’t work, so they gave up and outsourced it to like VillageMD or something. (IANAL)

I think we are starting to see the growth of some subscription-based service for telehealth. Just a matter of whether it will be privatized or socialized subscriptions.(Elizabeth H. H. Holmes)

Most measures required for ambulatory and pop health purposes are designed with zero consideration of the reality of clinical data and patient journeys across siloed information systems. Appropriate that the story directly follows the analysis of the failures in COVID-19 data. When the measurement system is designed without consideration of the data sources, chaos ensues. (Quality4Evah)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. D, who asked for supplies and tote bags for her elementary school class in Maine. She reports,  “On the first two days of school, students were able to color their tote bags and pencil bags. They were so excited that they had new markers to use and could not believe that they could decorate their own bags. They could not believe that they were allowed to keep the materials at home. The white board and markers was the most exciting item in the bag. The students were yelling with excitement that they had their very own white board to use at home. They use it when they are learning remotely to show me math equations and math work. It is much easier than trying to write on a laptop with a mouse! The students take a picture of their work on the white board and send it to me so I can see it. Thank you so much for your generous donations to help my students engage while learning at home.”

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The founders of bankrupt digestive tract microbiome testing company UBiome are indicted on federal healthcare and securities fraud charges. The company started by selling a “Gut Explorer” test directly to consumers for under $100, but then expanded its business to offer similar tests for medical professionals for which the company would seek up to $3,000 in insurance payments, with the intention of boosting revenue to attract investors for its Series B and Series C fundraising rounds. The company billed $300 million and collected $35 million.

A federal grand jury charges a Florida doctor, clinic owner, and clinic employees with falsifying clinical trials data by enrolling ineligible participants, falsifying medical records, and falsely stating that participants were taking the drugs being studied. Martin Valdes, MD, the study’s lead investigator, was charged with mail and wire fraud, money laundering, and making a false statement to FDA inspectors.

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Spectrum Health launches an investigation after OB/GYN residents post photos of the removed organs of surgical patients to Instagram, saying that the OR staff regularly play “guess the weight” of the removed tissue.

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Washington University in St. Louis surgery and emergency medicine professor Tiffany Osborn, MD, MSc – who works in the ED and ICU of BJC — moves back into her house after a year of living in an RV parked in her driveway to avoid infecting her family. She would work three weeks without a day off, get tested, and then spend a couple of days with her family before going back to work. She moved back after receiving the COVID-19 vaccine.


In Case You Missed It


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Morning Headlines 3/19/21

March 18, 2021 Headlines No Comments

Glen Tullman Joins Transcarent as Chief Executive Officer

The executive chairman of employer health insurance cost management software vendor Transcarent takes on the CEO role as well.

Epic opens COVID-19 vaccination appointments to all employees

Epic engages VaxPro to offer on-campus immunization after the state declares its employees to be essential.

Senate narrowly confirms Xavier Becerra as Health and Human Services secretary

The former California attorney general and 24-year Congressman is confirmed in a 50-49 vote.

News 3/19/21

March 18, 2021 News 4 Comments

Top News

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Social services referral platform vendor Unite Us raises $150 million in Series C financing, increasing its total to $195 million and valuing the company at $1.6 billion.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Amazon will expand its employee-only Amazon Care virtual health pilot project to its workers in all 50 states, then will offer the program to other companies later this year. The company says in its explainer video that it will bring care to the person instead of vice versa in “reimagining the practice of medicine” and “we’re rebuilding the whole delivery system around the human at the center.” The full program includes 24×7 virtual visits, at-home tests and treatments, prescription delivery, and a dedicated care team.

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Healthcare analytics vendor Clarify Health raises $115 million in a Series C funding round, increasing its total to $178 million. The company says its database of claims, EHR information, prescription records, and behavioral health data spans 300 million unique patient lives.

Data management and analytics vendor Clearsense raises $30 million in funding.


Sales

  • Kuwait’s Health Assurance Hospitals Company chooses the InterSystems TrakCare EHR.
  • Citizens Memorial Healthcare will use cloud disaster recovery services from Healthcare Triangle.
  • Ochsner Health chooses CarePort’s care transition solution.
  • Devereux Advanced Behavioral Health will deploy Netsmart’s My Avatar EHR and CareFabric platform.
  • Muscogee (Creek) Nation Health System of Oklahoma will use Everbridge’s vaccine distribution system to manage registration, scheduling, administration, tracking, and reporting.
  • Speare Memorial Hospital (NH) will implement Meditech’s Expanse EHR using Meditech as a Service. 
  • Thomas Jefferson University and Jefferson Health will implement digital fingerprinting health information protection from Terbium Labs and will invest in the company.

People

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Glen Tullman (Livongo) joins Transcarent as CEO, expanding on his role as executive chair. The company helps self-insured employers guide employees to more cost effective care and takes a percentage of their savings. Tullman and Hemant Taneja are investors in the company as they were in Livongo, which they sold to Teladoc Health for $18.5 billion last fall.

AGS Health announces several executive hires: Proneet Sharma, MBA (Sutherland) as COO; Cheryl Cruver, MPA (Sonifi Health) as chief revenue officer; Ashish Mohan as CFO; Ekta Singh. MBA as chief human resources officer; and Phillip Park, MBA as VP of corporate development and finance.


Announcements and Implementations

Sphere launches an expanded patient payment platform that includes a mobile check-in, intake, and payment experience and the ability for patients to leave a card-on-file token for automatic payment of billing plan balances.

Remote patient monitoring solution vendor CareSimple incorporates health education material from Healthwise.

InterSystems offers its IRIS data platform as a managed service via Amazon Web Services.

Medhost announces YourCare Continuum, an enhanced care coordination solution.

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IllumiCare will add the Epic-integrated WHIRL user customization app that was developed by Wake Forest Baptist Health to its Smart Ribbon. WHIRL compresses the Epic information of 10 patients per printed page to create a customizable rounding list.

Greenway Health launches GRS Select, a customizable RCM offering.


Government and Politics

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The Senate confirms Xavier Becerra, JD – who served as California’s attorney general and as a member of Congress — as HHS secretary.


COVID-19

CDC reports that 113 million COVID-19 vaccine doses have been administered in the US, with 28.5% of adults having had at least one shot and 12% being fully immunized.

Epic will offer its 10,000 employees COVID-19 vaccination on its still-closed Verona campus as approved by Wisconsin’s Department of Health Services, which has deemed the company’s software and its employees as critical. The program will be run by Mequon, WI-based flu shot clinic provider VaxPro.

Researchers will study the effects of COVID-19 vaccination on people with long COVID following anecdotal reports that their symptoms improved or disappeared shortly after injection.


Other

A Vanderbilt University Medical Center study finds that an EHR-based, real-time suicide risk model performed well in non-psychiatric clinical settings, using EHR demographics, diagnoses, medications, previous healthcare utilization, and Area Deprivation Indices that are driven by ZIP code. The authors note, however, that the model can’t capture potentially important information that is stored in free text or outside the institution’s EHR.

A review of the 100 largest US hospitals by bed count finds that two-thirds are not in compliance with CMS’s price transparency rule, either by failing to post the files at all or not included payer-specific negotiated rates.


Sponsor Updates

  • The local paper profiles Redox’s recent growth, including new funding; and expansion plans.
  • OptimizeRx’s recurring revenue grows as it secures 19 new enterprise-level engagements in Q1 2021.
  • PatientPing publishes a new white paper, “The COVID Rebound: How Real-Time Alerts Can Help SNFs Solve Three Key Challenges.”
  • Diameter Health summarizes the research it published with KONZA that demonstrates that quality score calculation is more accurate when using data from an HIE rather than a single EHR.
  • Pure Storage announces the GA of its Pure Cloud Block Store on the Microsoft Azure Marketplace.
  • Spirion publishes a new report, “Deliver Effective Sensitive Data Protection with 3 Must-Have Standards.”
  • Hospital Alemao Oswaldo Cruz joins the TriNetX network to expand its clinical research capabilities in Brazil and Latin America.
  • Zen Healthcare IT publishes a new case study, “Zen Healthcare IT Fast Tracks EHealth Exchange Onboarding for AdVault.”
  • WEDI features Fortified Health Security CEO Dan Dodson on its podcast.
  • Forbes includes Impact Advisors on its annual list of “America’s Best Management Consulting Firms” for the fifth consecutive 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 3/18/21

March 18, 2021 Dr. Jayne No Comments

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I completed my HIMSS21 rollover registration, so we can finally get some return on the money Mr. H fronted back in the fall of 2019. HIMSS is pre-managing any future refund requests by noting that it’s not a true rollover of the registration fees – it’s a “complimentary registration” for 2021 due to the cancellation of HIMSS20, and as such is non-cancellable, non-refundable, and not subject to the documented cancellation and substitution policies. If you’re going to do the rollover, you have to follow a specific link you receive via email. Interestingly, the link arrived in my inbox shortly after another one from HIMSS announcing a decrease in individual membership prices, so my previous membership is now good for an additional six months.

I’m not thrilled about the campus-style venue, which means traipsing or shuttling from the Venetian-Sands Expo Center to the Caesars Forum Conference Center and the meeting space at Wynn. I’m sure they’re doing it so that events can allow for social distancing, so I get it from a public health standpoint. When I’ve been to conferences that did the campus approach, the experience ranged from successful to downright painful. Hopefully, they’ll keep similar programs or tracks together to make it more likely to achieve the former.

HIMSS is not announcing its specific health and safety protocols at this time, but promises to deliver the info as it gets closer. I expect a fat waiver absolving HIMSS of any and all responsibility should attendees be exposed or infected during the conference. Since the badges are going to have headshots on them this year, I’m going to bring some stickers and put a mask on my badge so my photo matches the in-person version. There were some issues with the photo upload process where my picture was clear at the time of upload but grainy when I came back to the screen later, so who knows what it will look like in reality. I also got a kick out of the registration page’s recap of demographics, which due to the magic of formatting, displayed my professional title as something that evokes Pinocchio:

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Since HIMSS will also have a digital track this year, it will be interesting to see what post-event surveys reveal about attendee satisfaction and perception of value. The boom in videoconferencing has created plenty of psychological research around its impact on users. Researchers at Washington University in St. Louis are looking at perceptions of self-image from those who are having increased video interactions. The findings were published in the International Journal of Eating Disorders and found that most women have not had a change in their satisfaction with personal appearance despite increased time spent on Zoom. They noted that people spend 40% of their time on Zoom looking at their own image, with some reporting 100% self-gaze.

I’m glad I ran across the article because it introduced me to Zoom’s “touch up my appearance” feature, which I had not been aware of. The researchers plan to follow up with a study to look at the same factors for male users. They note limitations of the study in that the research began in May 2020, and as the year has progressed, we all have spent more time on video chat, with the lead researcher noting that, “What it means to us now might be very different than what it meant to us then.”

The American Medical Association ran a recent piece that is targeted at helping physicians adjust to the new reality of patients seeing their visit notes. For many physicians, the idea of patients seeing their own documentation is terrifying, with physicians wondering if they are going to have to completely change their documentation style to avoid creating anger, confusion, or resentment in their patient population. The idea of open notes is not new for many organizations, and I’ve watched several physicians who come from institutions where this is practiced coaching those who are afraid.

The AMA encourages physicians to think about how greater transparency can benefit patients or help them have more buy-in with their care plans. Still, I think there will be opportunity for physician consultants to coach individual providers through the process of creating notes that adequately paint the clinical picture while avoiding potentially inflammatory content. I’ve done this a couple of times in the past and am always happy to put my literature background to work.

Best Buy Health has partnered with Apple to offer remote monitoring services via Apple Watch. Users can access the Lively app to contact Urgent Response Agents to assist with everything from medical emergencies to roadside assistance. Best Buy is also credited for working with Apple to create an upcoming fall detection features that “make it easier for older adults to stay safe, healthy, and connected.” Consumers who agree to a two-year Preferred Health & Safety contract will receive a discount off a watch purchase at Best Buy.

An article in the Journal of the American Medical Informatics Association caught my eye this week. It looks at how technology can be used to detect if people in video streams are wearing masks. Being able to pick up if people are wearing masks is a good thing, but even better would be to identify those who are not wearing them properly and perform some kind of remediation. It still amazes me that people are unwilling to wear masks properly now that we’re a year into this adventure. My state recently opened the vaccination tier that includes teachers, and my hometown newspaper prominently featured a photo of a teacher being vaccinated who had her entire nose exposed out the top of her mask. If the teachers can’t model correct mask-wearing, I’m not sure how they’re supposed to make sure students are doing the right thing.

By this point in the game, those of us who want to wear masks full time or those of us who have to wear them for work should have figured out what mask style works best for us and how to keep it from moving around. I have a handful of go-to styles depending on what kind of activities I’m doing and how long I have to wear it. What have you found as the most comfortable and practical mask, or just the one that makes you smile? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 3/18/21

March 17, 2021 Headlines 2 Comments

Amazon is expanding Amazon Care telehealth service nationally for its employees and other companies

Amazon plans to expand Amazon Care, its virtual and house call care service, to employees in all 50 states and other employers.

Clarify Health Announces $115m Series C Funding to Accelerate the Adoption of On-demand Healthcare Analytics

San Francisco-based analytics company Clarify Health raises $115 million, bringing its total funding to $178 million.

Unite Us Announces It Has Raised $150M to Scale Nationwide Social Care Infrastructure

Care and social services coordination software company Unite Us reaches unicorn status with a $150 million Series C funding round.

Viz.ai Raises $71 Million Series C Round Led by Scale Venture Partners and Insight Partners

Viz.ai, developer of AI-powered care coordination software for stroke patients, raises $71 million.

Harmonize Health Announces $10 Million Series A to Help Medical Groups Better Serve High Risk Patients

Harmonize Health, which offers remote patient monitoring, chronic care management, and outcomes tracking for elderly and high-risk patients, raises $10 million in a Series A funding round.

HIStalk Interviews Ann Barnes, CEO, Intelligent Medical Objects

March 17, 2021 Interviews No Comments

Ann Barnes is CEO of Intelligent Medical Objects of Rosemont, IL.

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Tell me about yourself the company.

This is my 13th year of running healthcare companies, both on the services and now on the software side. IMO is a fun company that was founded in 1994. The founder’s vision was that software companies and technology companies that wanted to make a difference in healthcare had to think like doctors and clinicians. Everything we do at IMO, both with terminology and data insights, stems from giving clinicians and doctors what they need to be able to get off the computer, stop focusing on that, and instead focus on patients. Then, how we can help provide better data and better insights to improve patient outcomes.

What are the terminology challenges with interoperability and aggregating data from multiple hospitals?

Terminology is not static. It is constantly changing. You need clinicians to keep terminology current, which is hard for hospitals that try to do it on their own. We specialize in not only keeping the terminology current, but adding new terminology as it becomes necessary for the medical field. COVID was a strong example. We started in January working side by side with the CDC in adding new descriptors and terms so that physicians could describe the symptoms of COVID differently than they were describing the symptoms of the flu. Otherwise, it would all look the same.

Does demand exist, beyond public health, for immediately retrievable patient information that originates in hundreds or thousands of hospitals?

Yes. Probably one of the biggest challenges across healthcare right now is that as data is aggregated, details are lost because it is not standardized or it’s coded. Somebody wants to get back to that level of specificity about a patient or about a group of patients that they are monitoring or trying to find, but that is difficult once you get back at the granular level.

We are fortunate at IMO that one of the initial values of our product is that we let physicians speak physician and write something just like in Google, any way they want, and we make sure they have the freedom to document how they want. We translate that to 24 global code sets, but more importantly, we maintain the specificity of the data so that it can be unlocked on the other side. We are spending a lot more time thinking about insight products and how to normalize the data that’s coming out of disparate systems and then pull insights from that data in an easy way that is maintained and updated.

At least we didn’t force physicians to do their own manual terminology lookup and translation for someone else’s benefit, as was done with other scribing chores.

Exactly. Clinicians don’t want to have to think about what the data is going to be used for downstream. They are focused at that time on the patient and describing as specifically as possible what is going on with the patient and any sort of diagnosis. Whether that data is being used for reporting, billing, or quality reporting doesn’t matter to the physician. They are trying to capture the data and take care of the patient who is in front of them.

As value-based care increases and the focus on patient outcomes increases, that intensifies. We are trying to take off the plate of that physician the worry about what’s going to be done downstream with this data. Let’s capture the specificity as you want to share it.

Has the challenge become easier with consolidation in the number of EHRs being used?

We actually we see the number of EHRs increasing in health systems. They will have Epic, Meditech, or Cerner, but then they also have an ambulatory EHR, behavioral health EHR, or other EHRs in their clinics. The are sitting there in their health system trying to pull data.

COVID was again an example. Health systems were struggling to find the COVID-symptomatic patients or the COVID-positive patients with underlying conditions across the health system. That is one of the reasons we released some free COVID insight products during the timeframe to help our customers do that. We released terminology for free, open source terminology for non-IMO customers, so that everybody could be speaking the same language.

You have a couple of challenges. You have the systems being used. You have the terminology that is the base in that system. Then you have how it was implemented. All these complicating factors make it difficult if you can’t pull that data out, normalize it, and then pull insights from the normalized data.

Why is it hard to get a list of COVID-diagnosed or COVID-positive patients?

It’s easy to get a list of diabetic patients. But it’s harder if you are looking for Type 1 diabetic patients with BMIs over a certain level who have retinal problems.It’s more difficult to search disparate data systems. The way that those diagnoses are described continuously changes. It’s not good enough to create a group, or a cohort search, once. You have to constantly maintain and update it so that you are capturing all of the patients that should be in that cohort. That makes it difficult.

Does it take a lot of coordination and discussion to populate research databases using data from many hospitals?

Yes. It generally takes a back-end tool. We are finding that across healthcare now, beyond the hospitals, there’s this large need with data aggregators, top health companies, HIEs, and point-of-care solutions. Anybody who’s pulling from that same data has the same challenges. Each use case is different, but they are all trying to do the same thing. They are pulling from multiple platforms and multiple ways of describing things.

How much progress has been made so that a healthcare startup can get hospital data that is immediately useful, even if only from their own client?

It’s an enormous problem. For a while, people tried to rely on coded data or claims data, which is summarized data. It’s good for the purpose it was summarized for, but it doesn’t work when you get back to the specifics of a group of patients or a patient themselves. A lot of effort is being done across the industry to make this better. Our EHR partners are working on it and we certainly are. We launched a product last year called Normalize that allows an entity to normalize the clinical data and and then pull insight from that data. The way things are described is standardized.

Was it hard to get a historical picture of COVID infection after the fact once code sets were finally updated?

It was difficult, but that’s why we focus so much on letting the physician describe it clearly and specifically. We can go back to the specificity that the physician used in the description to sort through that. But it is much, much more difficult.

That’s why 2020 was an interesting year for us. We generally do four to six terminology releases per year for our customers. We had releases going out every single month because so much was changing with COVID and we needed to get the descriptors in there as quickly as  possible. Each time there’s a new learning, we have to get those descriptors in so that the data is a little bit cleaner early on, and you’re not trying to go back for as many months.

What have we learned from the need to get near real-time hospital data for urgent research?

We have learned, especially in a pandemic year, how critical it is to get the right information into the right hands of the right people and make sure the tools they are using can support it quickly, so that you can take care of the patient and create better patient outcomes. That isn’t happening, as you said, in the old traditional ways any more. There’s much more need to create networks of information and ways to disperse that information out to clients as quickly as possible. Not just from a company like IMO, but from many vendors in healthcare IT, who are working side by side with our hospital partners and with physician organizations across the country to make sure the information is shared, is accurate, and is complete and up to date.

How are health systems using value sets?

Value sets are searches that allow you to filter to find a specific cohort or group of patients. Then, to monitor them, reach out to them, and communicate with them.

Hospitals are using them in many ways. They are using them proactively to reach out to patients, such as in the vaccine situation, where you are trying to find a specific group of patients. They are also using them after the fact to monitor patients and do post-communication or information sharing.

It becomes critical to create these value sets accurately and to include all of the specific descriptors, not just the code sets. That changes every month, as in COVID, where we were changing descriptors and information and adding new information every month. You have to maintain those and update those to continue to be accurate. It’s not a one-time event. Not just hospitals, but others in the industry are using those as well, to monitor groups of patients or find information on groups of patients at a more specific level than a high-level search, as I described earlier.

Has the need changed from retrieving a set of patients whose characteristics support a research hypothesis to instead hoping that technology, perhaps using AI or other techniques, can take a seemingly diverse group of patients and figure out what risk factors and outcomes they share?

AI and other technology is useful, as long as you maintain the specific information. Searching or using AI on summarized or aggregated data doesn’t work because you have the same problem as if a human was doing it. You can’t find the information. You have to make sure that the specific information is in there and that you are using some common language. Words become important and descriptors become really important so that you can pull from both the structured and unstructured data in the same way.

The biggest challenge, still, is the common language. But as we continue to create tools that can standardize that language and can normalize that data, then there’s an opportunity to start to use more technology to mine the data.

Here’s an unrelated question about your interest in creating opportunities for women in health IT and business in general. I can go to Company X’s leadership page and see rows of white male faces. How would you convince that company that the people they chose for those jobs weren’t optimal?

So much of it is awareness and being intentional. I spend a lot of time talking to different groups about this. I can tell you that first, the leadership has to recognize that diverse teams outperform non-diverse teams. Helping them understand that and showing them proof sources of where that’s really true makes sense. This isn’t an indictment of, “Hey, men can’t do it.” It’s just that men can do it and women can also bring a unique aspect to it. When you are serving something like healthcare, it’s obviously made up of many, many women as part of your decision-making. You are missing out on the unique opportunity to deliver what you need to, to an audience, if you aren’t looking at it from a diverse perspective, which actually goes way beyond men and women. It begins with believing that.

Once you believe that, stop talking about it and turn it into action. Many companies are good at executing, mine included, but if it isn’t a focused goal that you are executing on, then like anything else, it’s just a theoretical, conceptual conversation, and maybe it happens and maybe it doesn’t. Because women are so underrepresented, you have to be intentional about your hiring process, making sure that the candidate pools are diverse, because if the candidate pools don’t start out diverse, it’s difficult to get diverse hiring decisions.

I focus on it being intentional. I was intentional with how I built my team. I was intentional about specifically putting a female in the CFO role because we had a strong cultural belief in the company that men were CFOs and women ran HR. My chief people officer is a man, intentionally, and my CFO is a woman, intentionally. I found incredible candidates just by making sure that the pool of candidates was diverse.

So white men often get these jobs because somebody down in the company pushed them to the forefront as candidates?

That’s right. There’s a larger pool of those candidates. I gets even even more challenging when you race to that mix. We all have a responsibility to reach out to the college age kids and the high school aged kids, because we don’t have enough women. We don’t have enough black or Hispanic students going into majors around STEM, going into focus job opportunities or internships around STEM. You also have to get intentional about helping make a difference to help the candidate pools get better over time. We focus an intern program there to help our candidate pools become richer.

This definitely isn’t about hiring a lesser candidate. Nobody should hire a lesser candidate for the job. You need to hire the right person for the job, but it starts with having diverse pools of candidates to choose from.

Where do you see the company focusing in the next 3-5 years?

We will continue to grow terminology. More and more needs to be added, but we also will begin to focus more on the insight space and on new markets that need that. The way that I look at the ecosystem is that there’s this large pool of clinical data. No matter where you are in the ecosystem, everybody is pulling from that same data. There’s not a different data set somewhere else. There’s different use cases driving the need to get at that data, but there’s a variety of people — some that I described, some in the payer space, some in life sciences — who are all pulling from that same clinical data. I see an expansion for opportunity for IMO to help expand in the terminology space, but also expand who we are helping in the use cases we can provide solutions for, to actually accomplish more from the data.

Do you have any final thoughts?

We are improving in healthcare. As challenging as COVID was for the whole world, it put an exclamation point on where there are holes and where we need to make improvements. There’s a lot of opportunity for healthcare IT technologies to come in and fill some of those gaps. I’m excited about the movement in healthcare and the movement towards patient outcomes and the actual fact that the data can and will support it as we move forward.

Morning Headlines 3/17/21

March 16, 2021 Headlines No Comments

Tegria Acquires Cumberland To Provide New and Enhanced Offerings for Healthcare Providers and Payers

Tegria, Providence’s recently formed rollup of its nine health IT acquisitions, acquires health IT consulting firm Cumberland.

Glooko Raises $30 Million Financing Round

Digital diabetes management company Glooko raises $30 million in a Series D funding round that brings its total raised to over $100 million.

Karuna acquired by Commure

Healthcare development platform vendor Commure acquires Karuna Health, a digital patient communication startup based in San Francisco.

Strive Health Raises $140 Million Led by Alphabet’s CapitalG to Tackle $410 Billion of Unmanaged Kidney Disease Spend

Strive Health, which focuses on kidney care optimization using analytics and care navigators, raises $140 million in a Series B funding round led by CapitalG.

Grand Rounds merges with Doctor On Demand to form multibillion-dollar digital health company

Employer-focused care navigation company Grand Rounds merges with Doctor on Demand.

News 3/17/21

March 16, 2021 News 3 Comments

Top News

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Tegria, Providence’s recently formed rollup of its nine health IT acquisitions, acquires health IT consulting firm Cumberland.

Cumberland, which was founded in 2004, will operate as an independent Tegria business unit. It will add to the company’s capabilities in claims and benefit administration systems, care management systems, managed services, and technology optimization.

Tegria’s other consulting and technology brands include Bluetree, Community Technologies, Engage, and Navin Haffty.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Healthcare development platform vendor Commure acquires Karuna Health, a digital patient communication startup based in San Francisco.

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Employer-focused care navigation company Grand Rounds merges with Doctor on Demand. Grand Rounds CEO Owen Tripp will lead the new company, which will retain the Grand Rounds name. Doctor on Demand CEO Hill Ferguson will remain head of that brand.


Sales

  • UC Davis Medical Center (CA) will implement adverse event tracking and disease management software from Qview Health across all of its departments and services.
  • Emory Healthcare in Atlanta selects enterprise imaging technology from Sectra, which it will link with neighboring Grady Health System.
  • Kidney Disease Medical Group in Los Angeles will use Emerge’s platform to enhance its Athenahealth EHR.
  • The Massachusetts League of Community Health Centers will leverage PatientPing’s real-time admission, discharge, and transfer alerts to monitor patient events across its network of 52 centers.

People

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Cone Health (NC) interim CTO Doug McMillian takes on the additional role of CISO.

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Bright.md names Steve Giannini (Opal) as CEO. He takes over from co-founder Ray Costantini, who remains on the board.


Announcements and Implementations

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Vyne Medical adds auto-indexing to its Trace integrated communication exchange engine, which allows health systems to transform documents and unstructured patient information into structured, shareable data without hand-keying information.

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Spectrum Health (MI) incorporates TytoCare’s home medical exam kit into its virtual care services.

Newport Hospital and Health Services (WA) implements Epic through the software vendor’s Community Connect program.

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Kingman Regional Medical Center (AZ) works with Meditech Professional Services to redesign workflows based on key performance indicators.

Digital health engagement platform vendor Quil launches Caregiving Circle, which allows a patient’s family and friends to join them for addressing health events or navigating day-to-day activities. The initial user is Penn Medicine’s orthopedic department, which will use the product for geriatric hip events.


Government and Politics

The Defense Health Agency works with Cerner to develop MassVax, a COVID-19 vaccine management system the DoD is incorporating into MHS Genesis.

The Texas Health Services Authority receives additional funding from ONC’s STAR HIE Program to expand its work with the SANER Project, a collaboration led by Audacious Inquiry that is working to develop better COVID-19-related data-sharing processes.


COVID-19

CDC reports that 28% of US adults have been given at least one COVID-19 vaccine dose. Total administered doses are at 111 million. US deaths are at 533,000.

Several EU countries suspend their use of AstraZeneca’s COVID-19 vaccine after reports of abnormal blood clotting from Norway. WHO advises that no proven link exists for the 37 cases in 17 million vaccinations and thus recommends the product’s continued use. AstraZeneca notes that the occurrence of thrombotic events among vaccinated people is actually lower than in the general public and no such events were observed in 60,000 clinical trials participants.

WHO’s chief scientist says that better COVID-19 vaccines could be released later this year or next year, possibly products that don’t require needles and that can be stored at room temperature.

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Zocdoc founder Cyrus Massoumi, MBA launches Dr. B, a website that helps eligible people locate COVID-19 vaccines in danger of going to waste. The service, largely a volunteer effort so far, is sending out availability alerts for two providers in New York and is working to onboard 200 more across the country.

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The Atlantic writers who founded the just-completed COVID Tracking Project — which for all of 2020 was the most-reliable, best-vetted source of US coronavirus testing, infection, and hospitalization, even including the CDC’s failed dashboard — say US data reporting systems failed because they were working as (poorly) designed:

  • Pandemic preparation plans emphasized data-driven decision-making without considering that the required information might be unavailable or unreliable.
  • States inconsistently rolled up their detailed data into simple federal feeds that appeared to be standardized, but really weren’t, leading to errors in the epidemiological models that were created from that information.
  • Data “travel at different speeds,” so coronavirus testing and case data is always a snapshot in time of information that can’t just be combined, such as with fast-reported case counts and slow-reported negative test results.
  • Reports of deaths are delayed from a handful of days to months, meaning that an outbreak’s death toll can’t be accurately reported until weeks after it is already over.
  • The federal government says that 4 million antigen tests are being performed daily, but state records show a small percentage of that number, and nobody has been able to explain the difference or whether the unreported results are significant.
  • The data the authors trust most is HHS’s hospital-reported data.
  • Data-driven thinking isn’t necessarily better than other forms of reasoning, and could even be worse if the underlying data deficiencies aren’t understood. A recent example was CDC’s March 1 warning about an uptick in case and death counts caused by variants, which the authors knew wasn’t accurate since case counts had been falling sharply for the previous month. Those numbers jumped because states were processing a backlog of death certificates, especially in storm-crippled Texas.
  • At least five states regularly submit incomplete data, yet that flawed information is being used by CDC to advise those states on school reopening.

Other

A study finds that quality measures that are calculated from a  single provider organization’s EHR data differ from those calculated from aggregated HIE data in 19% of patients, which the authors attribute to patients who see multiple providers. Pneumonia vaccination of older adults, for example, was 7% better when looking at the data of all participants than when calculated from a single provider’s data. The authors conclude that information exchange is essential for accurately calculating quality measures that drive provider payment.

Kaiser Health News says that even though millions of Americans are wearing prescribed, expensive continuous glucose monitoring patches, little evidence exists that the extra cost over cheap daily finger sticks provide better outcomes for people with Type 2 diabetes who don’t use insulin. The manufacturers are aggressively pushing them for Type 2 use because of the large potential customer base as compared to Type 1 diabetics.


Sponsor Updates

  • Ascom Americas Senior Product Mobility Manager Jack Langsam raises $5,000 for Susan G. Komen.
  • CarePort CEO and founder Lissy Hu, MD will speak at the Whole Person Care Summit March 23.
  • Central Logic welcomes back Jodi Hubler to its board.
  • Impact Advisors is named to the Forbes list of America’s Best Management Consulting Firms for 2021.
  • KLAS ranks Cumberland’s payer IT consulting services number two in the “2021 Best in KLAS: Software & Services Report.”
  • EClinicalWorks publishes a guide to choosing a vaccine administration management system.
  • Lyniate names Christy Evans (Surescripts) director of strategic partners, and announces new partnerships with Sensato and Secure Exchange Solutions.

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Reader Comments

  • Vikas Chowdhry: Will AI (I prefer the term Machine Learning - ML) magically fix all the incentives that have been created in the US heal...
  • Brian Too: I dunno. Seeking an answer in AI for America's healthcare woes seems a little desperate. LIke, adding one magic new in...
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  • IANAL: So what should Cerner do though? They have some market issues because the largest potential or current customers have at...
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