News 4/5/23

Top News

Content services platform vendor Hyland Software lays off 1,000 employees, 20% of its workforce.

The company blames the layoff on economic conditions and the unexpectedly high cost of moving to a cloud-based system.

Private equity firm Thoma Bravo acquired a majority stake in Hyland in 2007 for a reported $265 million and has led it through a long string of acquisitions, which in healthcare includes Valco Data Systems, EWebHealth, and Lexmark’s Perceptive business. 

Reader Comments

From Dr. Jacoby: “Re: Novant Health. It’s interesting to look at the jobs of the three top executives who were among its recent 50 layoffs.” Novant’s announcement suggests that it has scaled back some departments along with the executives who ran them, so it’s probably more than just these folks in their respective areas:

• Jesse Cureton, MBA, EVP/chief consumer officer. He had held the job for 10 years, which focused on strategic planning and marketing and public relations.
• Angela Yochem, MS, EVP/chief transformation and digital officer.She took the job in 2020 and served for nearly three years before that as CTO. She was Novant’s top technology executive, with the CIO, CTO, CMIO, and CISO reporting to her, and also served as GM of NH Enterprises.
• Paula Kranz, MA, MPA, VP of innovation development. She was executive director of Novant’s innovation lab for the past 15 months, which it closed last week with all employees laid off.

From Stiletto: “Re: podcasts. Trough of disillusionment.” Media forms that lower the participation bar — web pages, online communities, blogs, video channels – can become fading fads when audiences realize that the lowered barrier to entry encourages lesser talents. Newly launched podcasts dropped sharply in 2023, several were eliminated by NPR, Spotify is laying people off from the podcast platforms it acquired, and advertisers are questioning ROI due to low audience numbers and unfavorable demographics. Content that draws a loyal audience will do OK, maybe even better once Darwinism weeds out the AV club types (of which I would be one, which is why I haven’t dabbled). I like the idea of podcasts for commuters or travelers, but otherwise they don’t seem to align with the TL;DR skimmer attention span.

From Flapjacks: “Re: HIMSS Accelerate. Dr. Jayne said she hasn’t heard it mentioned. Have you?” No, other than I think I recall the HIMSS conference registration form trying to get me to opt in to Accelerate. It was Hal Wolf’s pet project and even he leaves no trace there. I clicked Events and HIMSS23 wasn’t among the three that were listed.

Webinars

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

Acquisitions, Funding, Business, and Stock

Health data exchange vendor Lyniate changes its name back to Rhapsody, the original moniker of the company before it merged with Corepoint Health in 2019.

Wellth raises $20 million in a Series B funding round, bringing its total raised to $40 million since launching in 2014. Its behavior-change app incentivizes users to build and maintain healthy habits. Investor Frank Williams, co-founder and former CEO of Evolent Health, joins the company as chairman of the board.

A Rock Health analysis finds that six Q1 digital health funding founds accounted for 40% of the quarter’s total, although its definition of “digital health” covers a lot of ground:

• Monograph Health, $375 million (in-home dialysis).
• ShiftKey, $300 million (shift bidding).
• Paradigm, $203 million (drug trials technology).
• ShiftMed, $200 million (on-demand workforce management).
• Gravie, $179 million (health benefits management).
• Vytalize Health, $100 million (Medicare ACO).

Billionaire investor Barry Sternlicht resigns from Cano Health’s board, citing poor governance and a questionable collaboration with MSP Recovery. He and two other board members who also resigned control 36% of the company and will push for asset sales and removal of the CEO. The company was valued at $4.4 billion when it went public on the NYSE via SPAC merger in June 2021, but shares have since lost 90% of their value.

Fujifilm sells its Japan-only EHR to Wemex, which is owned by PHC Group.

CHIME will convene its members-only Healthcare CISO Boot Camp April 12-15 in Salt Lake City.

Sales

• UC Davis Health (CA) will offer Propeller Health’s remote monitoring program to high-risk patients with asthma and COPD. 
• Transcarent will use CareJourney’s provider cost and quality insights data.
• Northwell Health (NY) selects patient monitoring technology and services from Philips.

People

Andrew Miller (Engooden Health) joins Elucid as CTO.

Caregility promotes Wendy Deibert, RN, MBA to CNO.

CitiusTech names Rajan Kohli (Wipro) as CEO.

Announcements and Implementations

Morris Hospital & Healthcare Centers (IL) goes live on Meditech Expanse.

Kittitas Valley Healthcare (WA) goes live on AdaptX’s OR Advisor, ED Advisor, and Clinic Advisor.

The Coalition for Health AI releases its “Blueprint for Trustworthy AI Implementation Guidance and Assurance for Healthcare.” The PDF is here.  Among the founding members are Duke Health, Google, Mayo Clinic, Microsoft, MITRE, Stanford Medicine, UCSF, and several CMS groups including ONC.  

Uber Health adds same-day prescription delivery to its patient transportation app for providers.

Government and Politics

The FDA publishes proposed guidance that will enable developers of AI-reliant medical devices to automatically update products that are already being used in clinical settings.

Privacy and Security

Northwest Texas Healthcare System and Doctors Hospital of Laredo (TX), both subsidiaries of Universal Health Services, notify patients that a November 2021 phishing incident at Adelanto Healthcare Ventures, a consulting firm with ties to one of their mutual business associates, may have exposed sensitive patient information. Interestingly, CommonSpirit Health affiliate St. Luke’s Health (TX) notified its patients about the same incident last November, making sure to stress that the breach was not related to CommonSpirit’s ransomware attack the month before.

Other

A small study finds that GPT-4 can accurately turn free-text radiology reports into structured templates, although that tool raises privacy concerns in sharing data with third parties. 

A gated University of Pennsylvania study in Health Affairs determines that 98.6% of hospital websites use computer code that enables data transfers to third-parties that include tech companies, social media platforms, advertising firms, and data brokers.

Sponsor Updates

• AdvancedMD releases 31 updates with enhancements to telehealth, medication cards, claims status, and mobile prescription drug monitoring program features.
• Ascom will provide UniHA, a cooperative purchasing network for French public hospitals, with its medical alarm management systems including software, mobility solutions, and services.
• Baker Tilly releases a new Healthy Outcomes Podcast, “Mergers and acquisitions in the senior services sector.”
• Bamboo Health will exhibit at Rx Summit April 10-12 in Atlanta.
• Nordic releases another episode of its In Network podcast feature, Designing for Health: “Designing for Health: Interview with Dr. Archana Tedone.”
• Biofourmis and Current Health will participate in the Digital Medicine Society’s and Moffitt Cancer Center’s CancerX project to accelerate innovations for cancer prevention and treatment.
• CoverMyMeds issues a clarification regarding its recently announced layoffs, as well as the impact on its Columbus facility.
• CTG publishes a new case study, “CTG Helps Leading Medical Lab Improve Donor Insight and Client Service.”

Blog Posts

• Factors for Successful Offshoring of Revenue Cycle Management Services (AGS Health)
• How to improve your population health using SDoH data (Arcadia)
• Preventing Workplace Injuries is Best for Your Workers (and Your Budget) (Bardavon)
• Big and Small Ways Healthcare IT Can Address Technical Debt (CereCore)
• Putting Power in the Hands of Patients: The Human Side of Pharmaceutical Marketing (ConnectiveRx)
• What We’re Looking Forward to at HIMSS23 (Dimensional Insight)

Contacts

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

Morning Headlines 4/4/23

Global Interoperability Leader Lyniate Rebrands as Rhapsody

Health data exchange vendor Lyniate changes its name back to Rhapsody, the original moniker of the company before it merged with Corepoint Health in 2019.

Health Tech Startup Wellth Raises $20M Series B Funding for Continued Growth of Behavioral Science-Based Platform

Wellth will use $20 million in new funding to further scale its behavior-change app, which incentivizes users to build and maintain healthy habits.

Widespread Third-Party Tracking On Hospital Websites Poses Privacy Risks For Patients And Legal Liability For Hospitals

A University of Pennsylvania analysis determines that 98.6 percent of hospital websites use computer code that enables data transfers to third-parties that include tech companies, social media platforms, advertising firms, and data brokers.

Curbside Consult with Dr. Jayne 4/3/23

I was glad to flip the calendar to April this weekend. Travel, conferences, and a couple of big projects have had me hopping.

Other than going to HIMSS, I get to stay close to home this month. In addition to work responsibilities, I’ve had a couple of big projects at home and was able to put one of them to rest this weekend. Of course, there are always more things to work on, but it was a good feeling to know that it was done and I could move on to something else. Unfortunately, the project I picked up next turned into a bit of a mess. I was hoping to have it done before next weekend, so I’ll be working double time in the evenings to try to get it done.

To the positive, I discovered that the book I’ve been hustling to finish in time for tomorrow’s book club isn’t actually due until the following month, so that was an unexpected bonus. The book, “Demon Copperhead” by Barbara Kingsolver, is one of the most challenging books I’ve read in a long time. It’s fiction, but a big part of the plot revolves around the growth in high-volume prescribing of opioid pain killers and the resulting devastation across parts of the US. The book features a broad cast of characters – the pharmaceutical representative who assures physicians that the medications aren’t addictive to patients with legitimate pain, the well-meaning country doctor who prescribes liberally, the drug dealers who take advantage of patients who have become addicted, and the family members who have to cope with the aftermath.

It’s also a scathing portrayal of the foster care system and those who abuse not only the process, but also the children in their care. Those sections were difficult to read and I’m sure they would be triggering to many. It’s also the story of a child in crisis who grows up to be a teen who encounters crisis after crisis, and just when it looks like he’ll make it out the other side, tragedy strikes. As a physician who has cared for patients in some of the situations portrayed, I can’t imagine what it would be like to be confronted with so many and in rapid succession. Although I feel a sense of accomplishment at having finished the book, I’m not sure I would have read it if it hadn’t been chosen by my book club.

From a healthcare IT perspective, it’s always a slow news time in the lead-up to HIMSS. Companies save up their news to release it at the beginning of or right before the conference, when there is always the potential that it will get lost among other “big” news stories.

I don’t have a sense of how large HIMSS will be this year. The organization is notoriously quiet about discussing its projected attendance and I haven’t even heard any rumors this year. Last year’s event was a shadow of itself, and after attending some of the competing conferences, I understand how they are more attractive to attendees than the granddaddy. At least this year I haven’t seen HIMSS promoting its less-than-useful Accelerate platform in the lead-up to the conference. In fact, I’m not sure I’ve heard anything about Accelerate at all in the last year.

Last Thursday was National Doctors’ Day in the United States. It dates back 90 years to its first celebration in Winder, Georgia. Although the day was designed to recognize physicians for their work with their patients, their communities, and society, it happens on March 30 as a commemoration of the date in 1842 when Dr. Crawford W. Long used ether anesthetic for the first time. It became a national holiday in 1991.

This year seemed different for many of my physician colleagues, with little recognition even after the difficult years of hard service during the pandemic. One of my emergency department friends found it ironic that her hospital distributed the Doctors’ Day snacks via a lounge that the ED physicians were unable to access because they didn’t have the right permissions on their keycards. That contrasted mightily with the week of celebration that one of our mutual friends experienced, with breakfast on Monday, lunch on Tuesday and Wednesday, a dessert buffet on Thursday, and gift baskets of Girl Scout cookies on Friday.

As far as tangible gifts are concerned, it seems like most of the people that received something physical received an item with the hospital name or logo on it, including umbrellas, backpack coolers, and some less than thoughtful items like stress balls. One colleague posted a picture of the elegant wooden cutting board she received from her hospital, which given its 12×17 inch size, seems like an interesting choice. Other celebratory options included chair massages, gift cards, aromatherapy supplies, and the always popular visit by the therapy dogs. Several of the physicians I talked to said they planned to pass on some of the gifts to their staff members, who don’t often get recognition if they’re not nurses or other professionals with designated recognition days.

My hospital solicited patients to give financial gifts in honor of their care teams, while giving the actual physicians zero recognition, not even an email. I realize that I’m a community physician and not employed by the hospital, but I thought it was tacky that I received the solicitation email (I’m also a patient) but not any other kind of greeting. Several of my residency colleagues reported having a similar experience, although two eventually did receive emails but they arrived well after 3 p.m., making them seem like an afterthought.

I was surprised that I didn’t receive emails from some of the big hitters that should be celebrating physicians in the US, like the American Medical Association or even my own specialty societies. In an informal poll in one of my physician-only Facebook groups, less than 30% received any recognition at all. That’s surprising given the number of physicians who are thinking about cutting back or leaving the workforce.

The bottom line is that it’s not about the gifts or the meals or the puppy petting zones. For many physicians, it’s about feeling like their hospital administration appreciates them and the work that they do for patients. Each person in the hospital – whether they’re in engineering, housekeeping, food services, supply chain, pharmacy, or any of the numerous other roles – has a critical role in helping patients and it’s important to make sure that everyone feels like their organization appreciates them, especially after the struggles of the last three years.

What would make you feel like your organization appreciated you? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Shivdev Rao, MD, CEO, Abridge

Shivdev (Shiv) Rao, MD is co-founder and CEO of Abridge of Pittsburgh, PA.

Tell me about yourself and the company.

I used to be a corporate investor for a large hospital system, UPMC. A lot of my investments were focused on AI technology. We put a lot of capital into Carnegie Mellon University and started a machine learning and health program there. A lot of the founding DNA for Abridge comes from Carnegie Mellon, and a lifetime ago, I went to Carnegie Mellon myself. In the middle, I became a practicing cardiologist.

At Abridge, we’re building technology that can be a part of all of the conversations that I as a clinician have with patients, whether they are over the phone or even over telemedicine. The technology, in real time, creates clinical notes for me that can help with clinical care team communication. It also structures information for me, that can help with billing oriented workflows. And Abridge can also help my patients as an extension of my best intention, helping them better understand and follow through on everything we talked about, even when they’re not in front of me. Our goal is to unburden clinicians from clerical work and help them and their patients better understand and follow through on the healthcare plans that will improve experiences, and economics immediately, and also improve outcomes over time.

How do you differentiate Abridge from Nuance DAX? 

This space is ripe with opportunity. Between Abridge and other companies in this space, we are pointed in different directions, which will lead us to very different destinations. Abridge is based on this idea that healthcare is really about people. Upstream of all the diagnostics and therapeutics in healthcare, the most important people in healthcare – providers and their patients – are having conversations. Being able to structure and summarize conversations in real time without any humans in the loop, and then being able to structure that data, means that we can start to unburden clinicians from the three customers that they’re serving every time they see a patient.

First and foremost, there’s the patient. We know that’s the most important. But then there are colleagues on the care team for whom they need to create a different kind of clinical artifact. Then there is everyone in revenue cycle, everyone on the coding and billing side, that they also need to be thinking about. We’ve taken the tack of building technology that doesn’t have any humans in the loop, that we can democratize across every single doctor and nurse out there, that doesn’t anchor on scribing per se.

That’s a word that that company, and other companies, might leverage increasingly if they’re using AI to basically power more efficient scribing. But that’s not really our positioning. What we’re building is more of a co-pilot that can be a part of all of these conversations that can create these summaries in real-time to help everyone better understand and follow through. As a tech company, our mantra is cheaper, better, faster.

It would seem useful for the provider to set aside 30 seconds at the end of the visit to intentionally dictate a summary that could benefit that provider, the patient, and anyone who has to interpret the chart downstream. 

That is absolutely one of the key differentiators between Abridge and any other company in this space. While we are physician driven by me, we are also patient centered, and we are AI powered. We think that’s the key triad for clinician facing AI solutions. For everything that we are building from a product perspective, the person who’s going to benefit the most should be the patient. But we are AI powered. This is all about technology. We can partner with and help services companies, but what our offering is all about is being able to be in the workflow incredibly fast. We want to be able to create value for everyone involved, and that starts with patients and their clinicians.

When we started this company, we knew the kind of technology that we wanted to point at this challenge. We knew it was based on this new type of machine learning model called a transformer. One of the key papers about transformers came out in December 2017, and we started the company in March 2018. But from a mission perspective, we also knew that there’s such an opportunity to help patients better understand and follow through. Given the way healthcare is evolving, given all the increasing momentum around providers taking risk and payviders becoming a bigger phenomenon, being able to not just put the patient at the center of workflows, but actually demonstrate and measure how you can help them better understand, follow through, adhere to their care plan, and actually improve outcomes even over time, will be a game-changer in healthcare.

I started seeing patients eight or nine years ago as an attending after fellowship. I would pick up the phone after a procedure, like a Holter monitor or an echocardiogram, and I would start dictating the procedure report. People in the basement of the hospital were actively, synchronously on the line listening and typing, and then that report would end up in the medical record. In relatively short order, it evolved into this new world where I would pick up the phone and essentially do the same thing, but it would get recorded, and someone later on would listen to the whole thing and put the report in the medical record. Then it evolved in very short order to this other world, where there was a technology in the middle that was transcribing everything that I said into the phone and calling out where the speech recognition technology was less confident. The humans who were listening later could just focus on those words, correct those words, and get them back in the medical record. That created this huge efficiency.

But the final form of dictation of monologues was a product where I could pick up a Dictaphone and just dictate and see the words in real time show up in my medical record the way it does on our phones these days. I could correct things on the fly.

They say that history doesn’t repeat, but it rhymes. We think that this space of dialogues, not dictations, will follow a similar pattern. In this space, the first model was scribes or extenders in the corner of the room, writing the note in real time as I have an encounter with my patient.

For some companies, that evolved to humans who connect and listen in real time to the conversations through audio or video. More recently, we see companies record conversations for humans to listen to later on and be able to write the note.  Those companies are trying to build technology that can help them be more efficient in listening to the conversation, writing the note, and getting it back into the medical record.

This is a key point of differentiation for us, because at Abridge, we are generating a note draft along with structured data that we integrate into the medical record in real time. We are not comparing ourselves against a human and saying that AI is going to be better than all the things a human can do in the workflow, especially at the clinician level in relation to a doctor or a nurse and how they might want to document or think about, especially the decisions that they need to make.

Instead, what we comp against is technology that in real time is listening to the conversation, generating a summary, structuring data, and putting it into all the different slots of the medical records. Your workflow is that much more frictionless, but we still require the clinician end user to be in the loop and work with the AI-generated output. It’s apples versus oranges compared to an AI-powered scribe model, but we think it also follows a similar pattern of evolution to what we’ve already seen happen in the dictation space.

ChatGPT has sucked up a lot of the technology air in the room in its few weeks of public availability. What advancements and disappointments do you think we will see? 

In terms of advancements, there’s no question that there’s an ability to leverage this kind of technology, these sorts of what they call foundation models or large language models in healthcare technologies. There’s no question that there is incredible value. At the same time, we are seeing in real time that t’s pretty easy to create a flashy demo with these technologies, but that doesn’t mean that that demo can translate into actual enterprise workflows inside of hospitals, inside of clinics, that have a different kind of standard in terms of reliability, credibility, transparency, and auditability. Those are all the different dimensions of trust, which is a requirement, which is table stakes. 

Everyone is going to find a way to leverage this technology in some part of their stack, their modules, if you will. That doesn’t make an AI company, though. There will be also be AI-native companies like Abridge, and an AI-native company is not going to leverage one of those large language models in a superficial way. It’s not going to be a straightforward query or prompt. As an AI-native company, Abridge builds technology underneath those models and beside those models. We fine tune those models, we build technology on top of them, and we integrate them deeply into workflows. That’s where the magic actually ends up happening.

There’s a joke that every company in the United States is a healthcare company, because every company is offering healthcare benefits to their employees. There’s an interesting phenomenon now where every company will be able to say on some level that they are an AI company if they are leveraging an API like GPT. That’s not an AI-native company. AI-native companies will be able to commoditize different solutions in their space and drive value up the stack to new ideas. Those are the companies that are going to have to have the talent, the expertise, and the data to actually build their own models, which can coexist with the large commercial models that are out there.

Will technology companies see the danger in trying to promote their AI products as replacing the physician’s judgment?

It’s definitely a risk. There’s no question about it. The framework that makes the most sense is that AI can assist, augment, and automate. How you point any one of those — assist, augment, automate — frames at solutions is the key.

What does that heuristic look like? Imagine a two-by-two, where the risk, the consequences of making a bad decision, is on the X axis. The volume of decisions is on the Y axis. All the decisions on that half of the two-by-two that involve a high consequence for any given decision going sideways deserves a frame thinking about AI as something that can be assistive or that could augment, but not something that can automate anytime soon.

Whereas where there are low consequences of decisions, and where there’s a lot of volume of those low consequences of decisions happening as well, that’s low-hanging fruit for this kind of technology. When you think about the healthcare workflows inside of clinics, it’s probably not at the point of care that you’re necessarily automating doctors or nurses and the decision-making that they’re doing, the creativity that they are having to bring to the table. It’s probably way more likely that it’s in the back of the office in the rev cycle, authorizations, coding, and all those workflows where there isn’t the same sort of stakes from an outcome perspective.

How could technology in general help healthcare scale to address the clinician shortage and their uneven geographic distribution?

That’s part and parcel with the mission of Abridge. When we think about the current climate, healthcare systems are underwater. We hear from the president of UPMC on the physician services side that staffing is the number one concern for hospital CEOs, because nearly two-thirds of doctors are experiencing at least one symptom of burnout. We keep seeing headlines around hospitals actually closing departments or ending services. When you think about hospital margins, they are as slim as ever before.The cost of labor is a 19% expense growth per discharge. The drivers here are absolutely putting so much pressure on the system at large to figure out how they can increase productivity from a dwindling labor force, and at the same time, actually have that labor force be smiling all the while. How can they bring joy back to that labor force in such a way that they’ll actually end up seeing more patients? It’s a very, very tricky line to walk and pull off.

That’s where technologies like AI can come in, and generative AI specifically. The way that we leverage AI at Abridge is that this is technology that’s getting out of the way. You can bring it into your conversations. This is technology that can scale because it’s all technology, it’s real time, and it’s flexible enough that we have an API that can integrate with telemedicine, for example, or call center conversations. Not just doctors, but nurses, PAs, medical students, and trainees. Everybody can benefit from this technology. That will lead to people having better conversations with their patients, being more present, and patients having better experiences. In the case of Abridge, since we also have an offering on the patient side, we want to be able to demonstrate that it is improving understanding, and better follow through. The aspiration is to demonstrate better outcomes. 

Financial markets are down and health systems are struggling with their bottom lines. How will the market look in the next 3-4 years and how do you position the company?

The idea more than anything is to leverage technology to rise to the moment of this public health crisis. In terms of strategy, there’s a great quote that startups get disruption when they get distribution faster than incumbents get innovation. It summarizes all the Clayton Christensen books. The name of the game from a strategy perspective is finding a way to create as much impact as possible. That’s always the promise of technology, that it can scale infinitely and that we can distribute this at a price point that all the healthcare systems, all the clinics can actually afford. Not just for their doctors, but their entire staff over time. That that aspect of our strategy is crystal clear, that we have to be cheaper, better, faster. We have to leverage technology and all of the affordances that come with it to get this out there at this moment in time, right now in 2023 when the need has never been greater.

In the moment right now that we are in, it feels like we have two huge waves that are starting to intersect. At Abridge, we are riding both of them. One of those waves has to do with this public health crisis, clinicians burning out, margins remaining slim, and this challenge around us as a society of the healthcare system not having enough clinicians to actually deliver the care that everybody needs, that our communities require right now. How are we going to respond?

In parallel, we have this other huge wave around generative AI, and all of us as a society starting to understand that this is a solution, there is a lot of magic in this. How do we find a way to get them to intersect to point generative AI at this public health crisis and create value? 

Paradoxically, generative AI can be just the thing to highlight the humanity in healthcare, to help people be more present and focus more on each other. That more than anything is going to improve experiences, outcomes, and start to solve this challenge that healthcare systems are dealing with. At Abridge, that’s our mission, that’s what we’re all about, that’s what we’re focused on. We have been super excited to be able to partner with large healthcare systems, not just UPMC, but we recently announced University of Kansas Health System, where over 1,500 clinicians are going to be able to leverage our technology in real time in a very deeply integrated way with their healthcare electronic medical record system. We are excited to be able to demonstrate that we can scale this across systems and across the entire United States over time in a very short order.

Morning Headlines 4/3/23

Novant Health lays off executive team members

Novant Health (NC) lays off 50 employees, including EVP/Chief Transformation and Digital Officer Angela Yochem, MS.

Vendor Breach Event Notice: Adelanto Healthcare Ventures (AHCV)

Northwest Texas Healthcare System notifies patients that a phishing incident at Adelanto Healthcare Ventures, a consulting firm with ties to one of the health system’s business associates, may have exposed sensitive patient information.

FDA proposes a new plan to streamline updates to medical devices that use AI

The FDA publishes proposed guidance that will enable developers of AI-reliant medical devices to automatically update products already being used in clinical settings.

Monday Morning Update 4/3/23

Top News

Epic CEO Judy Faulkner reportedly tells attendees of AMGA that the company is testing the use of ChatGPT to create draft provider responses to patient emails.

She says ChatGPT is less terse than doctors.

This seems like a great idea since experiments have shown that ChatGPT excels at analyzing a transcript of what a doctor says to offer suggestions of how they can be more empathetic. In other words, the computer advises the doctor on being human.

Reader Comments

From Brisco County: “Re: online services such as WebMD. They must be sweating ChatGPT hard.” Any company whose livelihood is based on sending or receiving web traffic should be worried. Web commerce is driven by search engine discovery and the opportunity to create or steal content and surround it by ads. ChatGPT summarizes the web, so there’s less need for users to look elsewhere. Also worried are publishers, since much of their traffic relies on search engines. Add to the mix that Facebook and Twitter are dying and the web could look very different in a couple of years. I welcome the chance to see content that is personalized and useful rather than driven by an algorithm whose primary purpose is to enrich its owner. Which is another concern about OpenAI and other companies – what will the inevitable monetization of their platform look like?

HIStalk Announcements and Requests

Poll respondents think their health system does a pretty good job using digital tools.

New poll to your right or here: After a weekend car accident out of state, how much of your important health information could ED doctors immediately obtain electronically? Also, let’s assume you are alone and unconscious with only a driver license and insurance card in your possession. Also, that all of your providers don’t use the same EHR. Poll comments are welcome about how you expect that the process would work or what precautions you might take to improve it.

I checked Epic’s site as soon as I woke up Saturday, but perhaps their previous April Fool’s phony news items set the bar too high because this one wasn’t memorable. ONC saved the day with a clever Rickroll tweet.

Webinars

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

People

The Health Care District of Palm County (FL) promotes Daniel Scott, MS (Good Samaritan) to VP/CIO.

Eric Rose, MD (TenSixteen Bio) joins Logos Informatics as CMIO.

Digital Health KC hires Dick Flanigan, MAS (RFJ Advisory) as CEO.

Ardent Health Services promotes Lonnie Garrison, MS to VP of IT.

Announcements and Implementations

Coryell Health begins its rollout of Oracle Cerner, which hopefully isn’t the system shown in the modified stock art stock that features illogically freeform input fields and a misspelling of “widowed.” Something tells me that the touchscreen-poking user wasn’t sitting in the health system’s 25-bed flagship hospital in Gatesville, TX, which is mostly known for its several jails and prisons. They used to hold a Prison Boss Cook-Off there, but it died from lack of participation.

Twitter open sources parts of its platform software, with the most interesting part being the code that chooses the “For You” tweets you see from users you don’t follow, with the most important factor being how likely it is that people will like, retweet, or reply. The blog post doesn’t say how the code artificially boosts Elon Musk’s tweets as he demanded in a recent Twitter tantrum, where he raged that the President’s Super Bowl tweet got more impressions than his own.

Amazon opens its low-power Sidewalk network – powered by connected Ring and Echo devices, courtesy of their owners — and to developers who need an cheap Internet of Things type connection. The coverage map shows that 90% of the US population is in range. Use cases include health trackers, smart pill bottles, smart door locks, dog trackers, soil moisture sensors, and weather stations.

Novant Health lays off 50 employees, including EVP/Chief Transformation and Digital Officer Angela Yochem, MS.

Other

In an unrelated but interesting conference development, the Entertainment Software Associated cancels its June expo that is known as “video game Christmas” in Los Angeles. The event, which drew 66,000 attendees to its final conference in 2019, was cancelled in 2020 due to COVID, changed to an online event in 2021, and then cancelled again in 2022. The organizers say interest wasn’t strong enough to support a big, impressive event and that interested companies couldn’t overcome resource challenges. Participants say that the big game publishers were already moving to running their own events online at a lower cost.

Madison magazine profiles Roots & Wings Foundation, created in 2019 by Epic CEO Judy Faulkner and her husband Gordon – and run by their daughter, Shana Dall’Osto – that offers unrestricted grants for non-profits purely based on trust. It awarded $40 million to Madison-area organizations in 2022. Dall’Osto says that neither she and her parents were raised rich, as Judy attended University of Wisconsin-Madison on scholarships and she and husband (and now pediatrician) Gordon lived in assisted housing and used food stamps before starting a family. She says she wasn’t unhappy that Judy signed The Giving Pledge in 2015, in which the many-billion dollar fortune of her parents will go to charitable causes instead of to their three children, saying that her mom was always clear about her intentions and her concerns about ruining kids by handing them big inheritances.

Sponsor Updates

• Surgical Care Specialists (PA) and Fairview Community Health Center (KY) transition to the EClinicalWorks Cloud.
• Nordic releases a new Making Rounds Podcast, “Modernizing business intelligence for stronger data analysis.”
• Talkdesk publishes a new report, “The promise (and pitfalls) of self-service automation in customer service.”
• Tegria staff partner with One Roof Foundation and take part in a community clean-up in the South Park neighborhood.

Blog Posts

• Continuing the Conversation: Our Commitment to IDD (Netsmart)
• Expanding women’s health: Addressing health disparities with innovations (Nordic)
• Our Culture of Giving: OptimizeRx Supports the American Foundation for Suicide Prevention (OptimizeRx)
• Bolder and Brighter: Key Takeaways from the 2023 ACHE Congress (Pivot Point Consulting)
• Unlocking the Potential of Your Answering Service: More Than a Cost Center (PerfectServe)
• Battling Drug Shortages: Novel Ideas for an Unprecedented Challenge (Premier)
• FHIR 5 is here (Redox)
• A Day in the Life of a Contact Center Scheduler (Relatient)
• Keeping Pace with Best Practices is Key to Prescription Safety, Affordability (Surescripts)
• Decoding the fiction: The myths of artificial intelligence (Talkdesk)
• Reimagining Master Data Management for Healthcare Organizations (Verato)
• The Federal Breast Density Inform Rule: Huge Leap Forward, But More to Do (Volpara Health)
• Monday: Medicare Advantage rules change – How much will it really hurt? (Wolters Kluwer Health)

Contacts

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

Morning Headlines 3/31/23

Murray, Tester, Brown Announce Comprehensive Bill to Overhaul VA’s Electronic Health Record Modernization Program

Senators Patty Murray (D-WA), Jon Tester (D-MT), and Sherrod Brown (D-OH) introduce legislation to overhaul the VA’s Oracle Cerner project.

Columbus-based CoverMyMeds to cut more than 800 jobs, close Arizona office

McKesson-owned CoverMyMeds will lay off 815 employees; close its Scottsdale, AZ patient support center; and rent out space in its $240 million Columbus, OH headquarters.

Florence Launches Modern Healthcare Experience With $20M Seed Round Led by Thrive Capital, GV, and Salesforce Ventures

Florence, which offers a patient engagement app, emerges from stealth with a $20 million seed funding round.

Cassidy, Moran Introduce Legislation to Improve Electronic Health Record System Before Rollout Continues

A group of Republican senators introduces legislation that would halt further VA go-lives on Oracle Cerner until significant improvements are made from a rigorous list of requirements.

News 3/31/23

Top News

Senators Patty Murray (D-WA), Jon Tester (D-MT), and Sherrod Brown (D-OH) introduce legislation to overhaul the VA’s Oracle Cerner project, which would require the VA to:

• Develop metrics for deciding when and how new sites are brought live.
• Fix the patient safety issues that were listed in the VA’s March 2023 Sprint Report.
• Place further go-lives on hold until the five facilities that are live show an improvement in performance metrics compared to those they reported while using their previous VistA system.
• Bring in outside experts to renegotiate the Oracle Cerner contract.
• Develop a Plan B strategy in case Oracle Cerner rejects proposed contract terms or VA can’t get the technology to work.
• Reform its technology acquisition process.
• Add outside healthcare experts who have EHR rollout experience to its advisory committee.

Meanwhile, a group of Republican senators introduces legislation that would halt further VA go-lives on Oracle Cerner until significant improvements are made from a rigorous list of requirements.

Reader Comments

From Roky Erickson: “Re: Oracle Cerner. Our organization had a project pushed back because the company is having resource issues, and other CIOs tell me they are seeing the same. One even said that Oracle told them that VA issues are taking priority and commercial customer projects are being delayed.” Unverified. Let me know if you’ve experienced this – I won’t use names or specific details, of course.

HIStalk Announcements and Requests

I’ve added a calendar reminder to check Epic’s website Saturday for the usual April 1 shenanigans.

Last call for HIStalk sponsors to be included in my HIMSS23 guide that I’ll run shortly. Send me your details and you are in.

I’ve started tuning out anything that is written in the form of, “I asked ChatGPT to …” It was clever for about five minutes, but now it’s just tedious.

ViVE Observations From An Attendee

An HIStalk reader who is attending the ViVE conference sent these notes:

• Tuesday’s keynote by Micky Tripathi was the most substantive thing I’ve heard all week. He breaks out ONC’s work into three categories: (1) building a digital foundation via standards, IT strategy, and coordinating between federal agencies. He played up USCDI and UCSDI+; (2) making interoperability easier with FHIR APIs and TEFCA. He wants to make sure those required APIs are truly usable rather than vaporware and are extended to CDC connections; (3) encouraging information sharing, with information blocking enforcement provisions coming this year, which I am guessing means a draft rule in September.
• Other Tuesday headliners sounded like talking advertisements.
• Loving the multiple snacks through the day and the music of Chapel Hart.
• Wednesday was a light crowd, maybe 20% of peak attendance. I felt bad for exhibitors that so few buyers were around.
• I thoroughly enjoyed a presentation by Shiv Rao (Abridge) and Joon Lee (UPMC) on generative AI. They advise trusting the technology to assist a human, such as autopilot on a plane, but not to fly the plane unsupervised. UPMC’s evaluation of potential AI partners includes integration with existing workflows and systems, auditable output, a clinician-led organizational structure, a patient-centric solution, and 100% AI driven.
• While the event isn’t as grossly transactional as I feared, there is certainly an undercurrent of deal-making, which is probably intentional.
• Attendee mix will probably evolve. On the provider and payer side, you see more venture investors and innovation teams instead of CIOs and CISOs. EHR vendors are low key and on the periphery. Services-based vendors probably won’t get value from a booth since traditional IT execs aren’t going to be around much for meetings.
• Most presentations were on the ViVE floor and I liked that, with several presentation areas of varying sizes. It never felt noisy to have presentations going on, it was easy to move from one session to another, and you could follow applause to find good sessions. I wonder how the vendors whose booths were near the stages felt, however.
• The CHIME track was mostly separate with several member-only events, but participants participated in some general sessions as well.
• ViVE shoots for a vibe of youth, energy, innovation, and fun in its branding, themes, opening remarks, and evening entertainment. Sounds great until you remember that your ticket cost nearly $3,000.

If you attended or especially if you exhibited, send me your thoughts about the conference and content, which I will share anonymously. Notes from the CHIME track would be interesting to readers, as would comparisons of ViVE to HIMSS.

Webinars

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

Acquisitions, Funding, Business, and Stock

Amazon brings its Health business to the website’s main menu, I noticed when looking for the new book “The AI Revolution in Medicine: GPT-4 and Beyond” ($15.49 for the Kindle version, which caused a collision between my curiosity and parsimony).

McKesson-owned CoverMyMeds will lay off 815 employees; close its Scottsdale, AZ patient support center; and rent out space in the $240 million Columbus, OH headquarters building that it moved into in May 2021.

Florence, which offers a patient engagement app, emerges from stealth with a $20 million seed funding round.

Sales

• Healthcare Triangle announces a $3 million cloud managed services sale to an unnamed life sciences company.

Announcements and Implementations

ViVE 2024 will be held in Los Angeles February 25-28 at the Los Angeles Convention Center downtown.

National Quality Form endorses nursing home hospitalization and re-hospitalization analytics solutions from Net Health, the first LTPAC EHR or analytics vendor to develop NQF-endorsed quality measures.

UnitedHealthcare will eliminate 20% of prior authorization items in the next few months. The insurer will also implement a Gold Card Program to eliminate most prior authorization requirements for provider groups that have been historically compliant.

Government and Politics

VA Secretary Denis McDonough warns that proposals to cap the agency’s budget at 2022 levels will harm its Oracle Cerner implementation. The VA’s 2024 budget request includes $6.4 billion for infrastructure modernization and $1.9 billion for the EHR project. Meanwhile, McDonough says the VA will review its contract with Oracle Cerner, which it signed in May 2018 with a five-year review built in, which he says will drive scheduling of the next go-live because “this contract may not be what we need.”

DoD will complete its Oracle Cerner deployment in March 2024, with 75% of its hospitals and clinics already live and most of the remaining sites being overseas facilities. A DoD official says the VA is where DoD was in the 2017-2018 timeframe, with challenges in infrastructure, governance, and standardizing workflows.

VA OIG says that a doctor at North Las Vegas VA Medical Center falsified patient blood pressure readings during virtual visits, always entering them as 120/80. The unnamed physician says they thought the virtual visit template required entry of a phony number and added that they had not been given virtual visit training, both of which OIG says are false. OIG also noted that the hospital didn’t report the physician to the state licensing board and falsely claimed that it had reviewed the 120/80 entries as OIG had requested.

New FDA guidance requires medical device manufacturers to submit a cybersecurity plan as part of their new product application, spelling out how they will monitor and fix newly discovered vulnerabilities. The guidance applies to any medical device that is connected to the internet.

A federal judge in Texas rules that an Affordable Care Act requirement that insurers cover some preventive services at no cost to the patient is not valid, a decision that applies nationwide.

Other  

IBM Watson Health doesn’t get mentioned much these days other than as a cautionary tale for overhyping and underdelivering, but I see that IBM is now pitching IBM Watson Assistant for developing virtual agents using its conversational AI.

Walter Reed National Military Medical Center names facility dog and Hospital Corpsman 2nd Class Luke as an honorary super user for MHS Genesis, where he has attended training sessions and sign-on fairs.

Sponsor Updates

• King Faisal Specialist Hospital and Research Centre expands its use of Oracle Cerner solutions across the Saudi healthcare sector.
• Five9 announces GA of Agent Assist 2.0, which uses OpenAI to summarize customer call transcripts in seconds.
• Fortified Health Security names Brad Arnold (Wellpath) security analyst.
• Healthcare Triangle reports fourth quarter and full year 2022 results.
• Health Data Movers publishes a new case study, “Software Development Advisory for an Integrated Experience Layer (IEL) Solution Discovery.”
• InterSystems releases a new episode of its Healthy Data Podcast, “Standards, Access & Meaningful Use of Data (ft. Zafar Chaudry, Seattle Children’s).”
• Medicomp Systems releases a new Tell Me Where It Hurts Podcast featuring HSBlox COO Lynn Carroll.
• Moving to Meditech Expanse has enabled St. Luke’s Health System to implement Meditech’s Smart Pump Infusion Integration with its Baxter Spectrum IQ infusion system.

Blog Posts

• Reducing No-shows Through Simple Patient Engagement Strategies (EClinicalWorks)
• An Urgent Care Business Plan – How and Why for Startups (Experity)
• Blueprint for the Contact Center: A New Path for IT Professionals (Five9)
• Future of Healthcare Supply Chains: An In-Depth Analysis (GHX)
• 3 Ways to Optimize Your Experience at HIMSS Global Conference (Healthjump)
• Engaging Minority Populations with Health Education (Healthwise)
• The Importance of New Types of Strategic Partnerships to Drive Innovation (Impact Advisors)
• Making bank or bankrolling waste: Why surgical schedulers need healthy dictionaries (Intelligent Medical Objects)
• Overcoming Staffing Shortages in the Lab: Finding the Right Fit Consulting Firm (JTG Consulting Group)
• The Many Digital Doors of Patient Access and Engagement (Kyruus)
• Marble Data Connections – Access Hundreds of Millions of Records from Our Network (Marble)
• The Importance of Interoperability in Addressing Healthcare Disparities (Medhost)
• Hate Being Off the Grid? Offline Functionality Provides Vital Wound Care Workflow Continuity for Home Care Providers (Net Health)

Contacts

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

ViVE and CHIME Wrap Up with Dr. Jayne 3/30/23

It was another busy couple of days at the conference. I had the opportunity to walk the show floor with a couple of friends yesterday and today as well as to hit a couple more sessions.

Overall, I liked the conference better than HLTH. It wasn’t as in your face trying to be cool as HLTH, but it was well organized. The exhibitor booths are all formatted the same way, depending on size and a couple of other factors, and I found it made for a less-distracting trip around the show floor. It’s less glitzy than you see at HIMSS, but it felt like it was easier to visually scan a booth. A vendor I spoke to said they like the setup because it helps level the playing field and also makes it easier to get the booth up and running compared to all the packing and unpacking at some other shows.

I’m still not a huge fan of having sessions on the show floor, but understand how it came to be. None of the panels I attended were jaw-dropping, but I had low expectations and wasn’t disappointed.

I thought the food service was better at HLTH, especially the grab and go options. At ViVE, the meal lines seemed long regardless of when I tried to eat during the scheduled blocks. On Monday, I ended up at the CHIME member luncheon that was held upstairs. It was a quieter venue to have a solid conversation with one of my colleagues about some healthcare IT problems I’m trying to solve.

CHIME provided several other networking opportunities, but my favorite was the CHIME League of Women luncheon on Tuesday. The program’s theme was “Mentorship in Action” and included a mentor-mentee pair among the speakers. The comments of panelist Kris Nessa from Innovative Insights really resonated with me. Kris was talking about the community of CIOs and other execs that has come together through CHIME and how the relationships and support have helped lift a lot of people up and encourage the development of the next generation of healthcare IT executives.

It made me think about the early days of my career, when our health system’s CIO was intent on crushing the IT project I was working on because it was being led by the operations group with IT support as opposed to being run by IT. He made it clear that he didn’t think clinical people should be working on IT projects and seemed particularly hostile to the women on the team, despite the fact that we were going live with some bleeding edge technology that ended up being the subject of numerous conference presentations. Thinking back, it’s likely he viewed innovation as a threat.

I’ve never had a non-clinical mentor. The conversation made me wonder what my career might have been like if someone from the technology side had taken me under their wing. I hope that in the current phase of my career I can be helpful to those working their way up the ladder or trying to break out of a mold that they might not have chosen.

Dr. Nick van Terheyden @drnic1 and I stopped by the Health 2047 booth to ask what it was all about, since “helping early-stage startups transform bold ideas into healthy returns” sounds interesting. It’s actually an initiative of the American Medical Association, and the year is tied to the anniversary of the founding of the AMA rather than the timing of any bold initiative.

Nomi Health’s booth reps were engaging. In addition to sharing the local favorite Goo Goo Cluster candies, we had a great conversation about the design of their booth and some of their ideas for enhancing it. I admire the knowledge or marketing folks. There’s so much more to color, graphics, and flow than most people appreciate.

CoverMyMeds was sponsoring haircuts, blowouts, and makeup applications. If you timed it right, you could get all fancied up then head over to the DrFirst booth for a complimentary headshot.

Speaking of DrFirst, their team did not disappoint, with matching shirts. Apparently they had matching shoes earlier in the week, but I missed those.

The Best Shirt award definitely goes to Perx Health’s VP of marketing. I think he said it was from Australia, and he was a great sport to pose.

The costumes at Teletalk reminded me of HIMSS of yore, when lots of exhibitors tried to be as catchy as possible. The boots were nice also.

The Best Shoe/Sock Combo was found at the Intelligent Medical Objects (IMO) booth. They’re always a strong contender in this category, and I can’t wait to see what they have in store for HIMSS. Since it’s local to their home base, folks might not even have to be choosy when they pack.

Hyro’s Whac-A-Task booth was a hit. I’ll have to use this pic to explain to some of my younger colleagues who never had the pleasure of playing the original Whac-A-Mole game.

Saving the best for last, Liberty Solutions hosted a bourbon tasting at their booth. They were giving solid advice on the characteristics of the different options, which makes sense given the fact that they’re a consulting firm.

The closing bash was a concert with the Black Crowes at the Wildhorse Saloon, although I preferred the opening group Chapel Hart. They were clearly having fun with their performance. The entire event was sponsored by Clearsense. From where I was standing on the second floor, I could see the decibel meter and it was interesting to see how it got louder as the night progressed.

I ducked out early but not before spotting the ultimate bedazzled ViVE jacket. Everyone seemed to have a good time, although threading my way through the crowds on Broadway as I headed back to the hotel seemed more like a contact sport than a walk.

On Wednesday, I had a little more downtime than planned at the Nashville airport and was glad to take advantage of some of the local food offerings that were better than the generic fare you find at most airports. Although the airport is undergoing construction, it didn’t feel chaotic. I decided to walk off some of the southern hospitality I’ve experienced this week with a lap through all the concourses. At the end of the A gates where some of the more commuter-type carriers arrive, I spotted some workers looking out the windows and acting generally giddy with excitement. It turns out that a Boeing 777 aircraft was diverted in from Atlanta last night and they were watching it being moved on the tarmac. Several of them couldn’t get over how large it was (towering over the other planes) or that a small tug was pulling it around the airport. Sometimes you just run across things that make you smile and I was glad to be part of that moment.

I wrangled the email beast and played catch up on the plane and was glad to see that the FDA has cleared the opioid overdose reversal drug Narcan for over-the-counter sales. Overdoses are a major problem across the US and we’re seeing lots of accidental ingestions by children as well. Hopefully removing the prescription hurdle will make a difference for people. I had to provide the date of my last COVID booster on a form I was completing, so I popped into my patient portal to confirm the dates. I was surprised to see a recommendation to schedule a flu shot. The flu season is long over in most of the US and I’m also current with a vaccine documented in the portal. It also recommended that I schedule my mammogram, and I’m current on that as well.

Alert fatigue is real and applies to patients as well as clinicians, and inappropriate reminders just encourage people to click through without reading. I’ll have to ask my IT friends at that institution what they’re trying to solve for with those reminders, which weren’t there a couple of weeks ago.

What aggravates you the most about your patient experience in patient portals? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 3/30/23

DoseSpot Acquires Bravado Health’s ePrescribing Platform TreatRx to Expand Solution Set for Healthcare Providers

E-prescribing vendor DoseSpot acquires Bravado Health’s TreatRx e-prescribing technology.

RhythmScience Secures $6M Series A Investment Led by Cedars-Sinai Health Ventures

Cardiac data integration and analytics startup RhythmScience raises $6 million in a Series A funding round led by Cedars-Sinai Health Ventures.

VA Secretary warns budget cap could hit agency’s telehealth and cyber programs

VA Secretary Denis McDonough says proposals to cap the department’s budget at fiscal 2022 levels will have a major impact on its telehealth and cybersecurity capabilities.

Healthcare AI News 3/29/23

News

OpenAI implements initial support for ChatGPT plugins that can access real-world data and third-party applications. Some experts say that people will spend 90% of their web time using ChatGPT, using a single chatbox to perform all tasks. Microsoft, Google, and Apple have already announced plans to provide that chatbox.

Zoom announces Zoom IQ, which can summarize what late meeting joiners missed, create a whiteboard session from text prompts, and summarize a concluded meeting with suggested assignments. Microsoft announces similar enhancements to a newly rebuilt Teams, which include scheduling meetings, summarization, and chat-powered data search across Microsoft 365.

Credo announces PreDx, which summarizes a patient’s historical data for delivering value-based care.

Sword announces Predict, an AI-powered solution for employers that identifies employees who are likely to have hip, knee, and back surgery and can be successfully managed with non-surgical interventions.

Research

Penn entrepreneurship associate professor  Ethan Molllick. PhD, MBA tests the multiplier effect of GPT-4 to see what he could accomplish in 30 minutes to launch a new educational game. Using Bing and ChatGPT, he generated a market profile, a marketing campaign, four marketing emails, a design for a website and then the website itself, prompts for AI-created images, a social media campaign with posts for each platform, and a script for an explainer video that another tool then created. 

Researchers apply a protein structure database to AI drug discovery platform Pharma.AI to identify a previously undiscovered treatment pathway for hepatocellular carcinoma in 30 days.

Opinion

High-profile figures, including including Elon Musk and Apple co-founder Steve Wozniak, call for all AI labs to pause development efforts on training systems beyond GPT-4 for six months. They say that planning and management has been inadequate in the race to deploy more powerful systems, raising the risk of misinformation, elimination of jobs, and unexpected changes in civilization.

A JAMA Network opinion piece notes that AI algorithms can’t actually think and as such don’t product substantial gains over clinician performance, are based on limited evidence from the past, and raise ethical issues about their development and use. The authors note that several oversight frameworks have been proposed, but meanwhile, the production and marketing of AI algorithms is escalating without oversight except in rare cases where FDA is involved. They recommend creating a Code of Conduct for AI in Healthcare.

A JAMA viewpoint article by healthcare-focused attorneys looks at the potential use and risks of GPT in healthcare:

• Assistance with research, such as developing study protocols and summarizing data.
• Medical education, acting as an interactive encyclopedia, a patient interaction simulator, and to produce first drafts of patient documents such as progress notes and care plans.
• Enhancing EHR functions by reducing repetitive tasks and powering clinician decision support.
• The authors warn that clinicians need to validate GPT’s output, to resist use of the technology without professional oversight, and to realize that companies are offering GPT-powered clinical advice on the web directly to patients that may harm them or compromise their privacy.

Medical schools face a challenge in integrating chatbots, such as ChatGPT, for tasks like writing application essays, doing homework, and summarizing research. Some experts suggest that medical schools should accept its use quickly as its use goes mainstream in medical practice. Admissions officers acknowledge that ChatGPT can produce polished responses to questions about why a candidate wants to become a doctor, but caution that interviewers can detect differences between a written submission and an impromptu interview. They also emphasize the importance of developing thinking skills over the rote learning that ChatGPT excels at.

An attorney warns physicians who use Doximity’s beta product product DocsGPT to create insurance appeals, prior authorizations, and medical necessity letters that they need to carefully edit the output, noting AI’s tendency to “hallucinate” information that could trigger liability or the questioning of claims due to generation of boilerplate wording. They also warn that entering PHI into the system could raise HIPAA concerns or exposure to cyberattacks.

Brigham Hyde, PhD, CEO of real-world evidence platform vendor Atropos Health, sees three clear outcomes of generative AI:

• It has changed the expectation for user search to include conversational queries and summarized results.
• The training of those systems is limited to medical literature, which is based on clinical trials that exclude most patients and thus don’t have adequate evidence to broadly support care.
• The most exciting potential use is to query databases from text questions.

Resources and Tools

Are you regularly using AI-related tools for work or for personal use? Let me know and I’ll list them here. These aren’t necessarily healthcare related, just interesting uses of AI.

• FinalScout – finds email addressing from LinkedIn profiles with a claimed 98% deliverability.
• Poised – a communication coach for presenters that gives feedback on confidence, energy, and the use of filler words. 
• Textio – optimize job postings, remove bias, and provide fair, actionable employee performance feedback.
• Generative AI offers a ChatGPT-4 prompt that creates prompts per user specifications: “You are GPT-4, OpenAI’s advanced language model. Today, your job is to generate prompts for GPT-4. Can you generate the best prompts on ways to <what you want>”
• Glass Health offers clinicians a test of Glass AI 2.0 that creates differential diagnoses and care plans.

Contacts

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

Readers Write: Healthcare Delivery Must Evolve to Meet the Needs of a Generation in Crisis

Healthcare Delivery Must Evolve to Meet the Needs of a Generation in Crisis
By Bob Booth, MD

Bob Booth, MD, MS is chief care officer at TimelyCare of Fort Worth, TX.

A recent new report from the CDC shows startling trends about the never-before-seen levels of hopelessness and suicidal thoughts among teens.

The findings for teenage girls in the CDC’s 2021 Youth Risk Behavior Survey were particularly grim. Nearly three in five teen girls (57%) said they felt “persistently sad or hopeless,” the highest rate in a decade. And 30% said they have seriously considered suicide, a 60% increase over the past decade.

While boys generally fared better overall, more than 40% of boys and girls said that they had felt so sad or hopeless within the past year that they were unable to do regular activities, such as schoolwork or sports, for at least two weeks.

The members of Generation Z, born in 1997 or later, are experiencing unprecedented levels of stress and emotional turmoil. While some of this is likely to ease as they age out of adolescence, adulthood is certainly no cure for depression, anxiety, loneliness, and other stressors. Additionally, double the number of Generation Z members report feeling emotionally distressed compared to older Millennial and Generation X groups.

In order to meet the healthcare needs of Gen Z, particularly mental and behavioral health, the industry needs to become more proficient in its use of digital and virtual care tools. However, not all of these tools are equally effective or designed to meet these young patients where they are.

The digital-native generation that has never known a world without the Internet or smartphones expects that their preferred technology will deliver relevant information and an engaging experience as part of treatment. It’s something we can expect to see more of as part of the future of care for younger generations.

Artificial intelligence (AI) can play an important role in care delivery and engagement if the algorithms enable a highly personalized and patient-centric experience. For example, not all young adults are ready for, or want, 50-minute, one-on-one counseling sessions with a mental health professional. AI can accurately analyze and interpret intake screenings, so a patient’s selected care pathway is the most relevant and takes into account their unique health and personal needs. AI can even help guide digital-only care pathways through content and activity selection based on the young adult’s interactions with the solution.

The promise of AI is that it delivers an even more personalized experience as its algorithms learn more about young adults, which accelerates their growth and motivation to improve their mental health and well-being. These engagement-building concepts have been understood and applied in other consumer-facing technology for years. Healthcare is finally catching up, and that’s good for young adults and healthcare overall. It’s exciting to see where this will take us in the future.

Gen Z needs a solution that leverages personal technology to enable access to mental health and well-being at their fingertips. By seeking tech-enabled help from a healthcare platform that is designed for them and understands their unique challenges, Gen Z can develop the skills and resilience to help them prepare for college and beyond.

It’s time for healthcare to look beyond traditional models of healthcare delivery and meet a generation who so badly needs care where they are.

Readers Write: The Impact Intelligent Automation Can Have on Healthcare Costs

The Impact Intelligent Automation Can Have on Healthcare Costs
By Krishna Kurapati

Krishna Kurapati is founder and CEO of QliqSOFT of Dallas, TX.

RPA stands for robotic process automation. RPA uses technology to automate repetitive human interactions with a computing system. In other words, instead of a human clicking a button over and over to generate a desired outcome, the system automatically connects and completes the stipulated work process, eliminating significant amounts of manual steps and time for the care team.

A similar approach applies to robotic workflow automation, where a chatbot can automate manual and repetitive tasks between a care team member and a patient. For instance, in healthcare administrative and clinical support tasks, the end-to-end steps include reminding a patient of an appointment, sending them digital forms to complete before the visit, automating patient check-in, and reinforcing instructions after the visit. Each task’s workflow comprises a number of work processes to gather, upload the patient’s information to an electronic health record (EHR) system, and to communicate with and guide the patient.

To illustrate, let’s examine the case of patient intake: Today, the office staff creates a paper clipboard and shares it with the patient on arrival, who takes five to 15 minutes to complete the paperwork. Staff then looks up the patient record, scans and uploads the requisite forms to the EHR, and checks the patient in. Humans can be removed entirely from this sequence of steps with RPA and chatbots, which automate the workflow to capture and process the requisite patient data to meet clinical and billing purposes.

The benefits of intelligent automation in healthcare

Faced with a never-ending need for reporting and data entry, healthcare organizations must manage high volumes of administrative duties. A recent study found that the average employee spends 60 hours per month on easily automatable tasks, making healthcare an ideal use of RPA to digitize and scale manual, routine processes. The upshot is dramatically reduced labor costs while optimizing workforce usage for lower costs.

In a January 2023 paper by the National Bureau of Economic Research titled “The Potential Impact of Artificial Intelligence on Healthcare Spending,” the authors calculated that hospitals employing AI-enabled use cases could achieve total annual run-rate net savings of $60 billion to $120 billion (roughly 4% to 10% of total costs for hospitals) within the next five years using today’s technologies, without sacrificing quality or access. The Academy projected that 60% of clinical workflows can be automated through AI, including bots, signifying untapped potential in new revenue and cost reduction.

The role intelligent automation will play in transforming healthcare

Digital health is about delivering care and managing data electronically. Unfortunately, many patient experiences at healthcare systems and practices are handled through traditional communications, including paper transfer, phone calls, snail mail, and fax. This can lead to disconnected patient communication, misdiagnosis, medical errors, waste, and poor quality care. Digital capabilities help providers, innovators, payers, and other stakeholders come together collaborating in an agile, more communicative way to solve problems, overcome scalability limitations, empower patients, improve efficiencies, and speed up throughput.

Once digital infrastructure and capabilities are built, the robotic process automation sits on top to automate workflows. The conjoining of digital and RPA accelerates and scales processes and elevates innovation to create a new standard for the patient experience.

Current use of intelligent automation

Automation started in revenue cycle management processes and is relatively new to the clinical side of healthcare, where the initial focus is processing and management of large quantities of paper into the EMR or content management systems.

Although automation is now happening on the clinical side, it’s not yet well adopted. The most common focus areas are patient communication regarding appointment reminders, appointment scheduling, patient intake, billing, procedure readiness, documentation management, and evidenced-based content for patient education.

The future state of intelligent automation in healthcare

Automation’s ability to simplify healthcare is limited only by our imagination. The cost of labor has skyrocketed to 64% of total operating costs, creating new pressure to reexamine workflow and adopt automation. Healthcare has two broad categories where automation can be of service:

• Eliminating work by automating existing manual, repetitive administrative tasks staff are doing today.
• Supporting automated communication and monitoring needs not possible today because of staffing limitations, such as readmission prevention.

I expect intelligent automation to play a larger role in healthcare for years to come. The time is now to blend clinical and business efficiencies to improve operations and provide relief to overworked and understaffed healthcare professionals.

Morning Headlines 3/29/23

Primary Children’s Hospital launches new Neuro NICU telehealth program to better care for babies

Intermountain Primary Children’s Hospital’s new Neuro NICU telehealth service enables its pediatric neurologists to remotely monitor and suggest treatments for babies at several NICUs in Utah and Montana.

Mercy and Perry County Approve Lease Agreement for Perry County Memorial Hospital

In Missouri, Mercy will take over management of county-owned Perry County Memorial Hospital and will invest $6.5 million to transition the facility from Cerner to Epic this fall.

Philips Virtual Care Management offers a comprehensive approach to telehealth for patients, providers and payers

Philips launches its Virtual Care Management suite of technologies and services for providers, payers, and employers within the US.

News 3/29/23

Top News

HL7 publishes FHIR Release 5.

I will break my journalistic fourth wall in noting once again the industry contributions of “Father of FHIR” Grahame Grieve, who from interviews I’ve done with him always strikes me as an almost painfully humble, accolades-deflecting expert who led the charge that made FHIR a thing and just keeps on quietly doing the work.

Reader Comments

From Peony: “Re: huge health system losses. It’s all about their investments, not necessarily operations.” True in many cases. Health systems made annual fortunes from investing their big profits (which they don’t call that, of course) into investments that ranged from prudent to wildly speculative. Every investor looks smart in a bull market, but health systems are moaning at their investment losses much more loudly they did when bragging about their previous gains. I’m not an accountant, but headlines about shocking losses require further investigation. Did they lose money selling, or are these just paper losses that could be reversed when the market rebounds? How much money did the health system have stashed away that allowed them to play Warren Buffet, and did they buy and sell wisely? If they made money from operations, then should anyone care that their investments generated losses? Sometimes losses are real and critical — such as those in which a health system runs out of cash or sees their bond rating collapse — but I always suspect that it’s like plutocrats who claim crippling losses to the IRS while summering in the Hamptons.  

HIStalk Announcements and Requests

Listening: REM, whose early 1980s concert videos started popping up in my YouTube feed. Lots of people know dramatic singer Michael Stipe and arpeggio guitar master Peter Buck, but the subtle contributions of Bill Berry on the drums and Mike Mills with clean bass lines and high harmonies are underappreciated. The onstage energy and “I can’t believe we get to do this” smiling glances at each other are inspiring. Mills looks like an awkwardly shy teen and Stipe had the charm and appearance of a young Elvis. You can forgive the band for “Shiny Happy People” by watching them work the small crowd from a tiny stage in their dues-paying early days, perhaps with extra points for walking away as friends in 2011 with no plans to milk the reunion tour cash cow.

HIMSS guide reminder for sponsors: I’ve received information from four companies, two of which aren’t HIStalk sponsors, so now’s the time to send your information.  And speaking of conferences, sponsor Consensus Cloud Solutions is at ViVE this week, so I’ve added them to my conference guide.

Were a lot of cattle raised on the open ranges of Tennessee, I pondered upon seeing ViVE attendees posing with cowboy hats like citybilly country music crooners whose need for them is equally questionable, especially indoors and/or at night? I’m pretty sure cowboy hats and boots are, like mouse ears in Orlando, a sure way to self-identify as a tourist.  

ViVE Observations From An Attendee

An HIStalk reader who is attending the ViVE conference sent these notes:

• Announced attendance is 7,500, represented by 650 startups, 425 investors, and 330 hosted buyers. (Mr. H note — I’m surprised that only 330 attendees had their registration comped for agreeing to sit through vendor pitches. That means that a ton of people paid the high registration fee, although I then wonder how many are provider decision-makers).
• The conference had an easy start. You could get into town, take in some scenery, network, and have fun. There was enough going on to feel worthwhile but not jam-packed.
• Sessions were heavy on panels instead of individual speakers. That gives more companies a chance at the front of the room, but in losing the ability for someone creative to kill it with a great presentation instead of answering run-of-the mill moderator questions.
• Content is mediocre rather than thought-provoking or bold. As someone said, “everyone is simply tossing out headlines.” I would like to see a contrarian track where people point out where the shiny objects and overhyped solutions have failed to deliver.
• Live music is everywhere, included a performer in the registration area.
• A brief moment of silence was observed for the Nashville school shooting victims.

Webinars

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

Acquisitions, Funding, Business, and Stock

Value-based care enablement startup Wellvana Health raises $84 million, bringing its total to $140 million.

Sales

• Cone Health (NC) will use Lirio’s Precision Nudging intervention software, initially focusing on patients with hypertension.
• Lee Health (FL) selects B.well’s Connected Health technology to power its forthcoming Lee HealthPass app, which will aggregate patient data into a single interface.
• Catholic Care Center chooses Medsphere’s EHR and PM solutions.
• Netherlands-based Maastricht UMC+ chooses Epic to replace its SAP/Cerner system.

People

Clearsense names Alan Scott (Red Hat) chief enterprise architect.

Scott Cullen, MD (Accenture) joins Avia as EVP of strategic innovation and chief clinical officer.

Louis Raya (Waystar) and Tyler Wells (Waystar) join ADVault as VPs of business development.

Ann Joyal , MS, RD (Wolters Kluwer) joins Symplr as VP of marketing communications.

Announcements and Implementations

Carle Health (IL) implements Scanslated’s AI-powered radiology reporting software, which offers patients easier-to-understand radiology reports accessible through their patient portals.

ConnectiveRx develops a new Enterprise Data Platform that integrates data from every patient and prescriber interaction across its lines of support for enhanced reporting.

Marshfield Clinic Health System implements automated patient registration technology from Notable at its facilities in Wisconsin and Michigan.

UR Medicine (NY) uses DexCare technology to offer on-demand video visits across care settings as part of its Get Care Now program.

Censinet announces GA of Censinet Connect, a service that enables healthcare vendors to digitally share completed security questionnaires and supporting documentation with prospects.

Labette Health (KS) implements chronic care management software and services from ChartSpan.

Philips launches its Virtual Care Management suite of technologies and services for providers, payers, and employers within the US.

Mercy will take over management of county-owned Perry County Memorial Hospital and will invest $6.5 million to transition the facility from Cerner to Epic this fall. Both providers are based in Missouri.

Masimo opens pre-orders for its Freedom smart watch that provides continuous readings of pulse oximetry, ECG, and respiration as well as fall detection. It also features a data privacy switch that can turn off sharing of all data, including location tracking and microphone. A $100 deposit buys a place in line for fall delivery at a $400 discount from a list price that wasn’t mentioned. Masimo, like AliveCor, is fighting Apple over health tracking patents.

Government and Politics

FDA seeks sources for large-scale, de-identified healthcare claims data along with full access to their EHR data for its biologic product surveillance programs. FDA says EHRs provide more granular patient clinical information that is useful for validating claims data, although they won’t serve as the primary data source since they cover smaller populations and aren’t always longitudinal.

Walter Reed National Military Medical Center (MD) goes live on MHS Genesis.

The Health Sector Cybersecurity Coordination Center within HHS publishes a mobile device security checklist.

Carin Alliance publishes a report that describes how patients could provide their identities once to create a credential that could be shared across other systems without using individual portals. It envisions a person-center approach that allows people to interact with various systems in a scalable, low-cost manner.

Other

Humbled and honored to be recognized by Nora, who is immensely pleasured (HE-llo!) to tell me I’ve potentially won a “seal of recognition” from an unnamed organization that will recognize me at its unnamed conference, with no contact information provided except for Nora’s Gmail address. I’ll speculate that graduation from “potential honoree” status involves a transfer of funds. I’ll also speculate that given the conference date, the amply pleasured Nora works for Health 2.0, which has somehow started using a once-respected, HIMSS-owned conference name that it operates from India by way of a Las Vegas mail drop and from the Birmingham Bargains store in an Alabama outlet mall. In case you need an ego-stroking, self-nominated award that requires and offers little, they are “now accepting applications from industry stalwarts!” I assume that the industry stalwarts who have proudly posted a photo of their award failed to realize that this isn’t the actual Health 2.0.

Sponsor Updates

• CarePort will exhibit at AMGA March 29-31 in Chicago.
• CHIME releases a new Leader2Leader Podcast featuring Oracle Health Chairman David Feinberg, MD “The Future of Health Equity with Oracle Health.”
• Clinical Architecture releases the results of its “2023 Healthcare Data Quality Survey.”
• Nordic publishes a new episode of its In Network podcast.
• CloudWave will sponsor the MUSE New England Area Community Peer Group event March 29 in Pittsfield, MA.
• Current Health publishes a new case study, “UMass Memorial Health Builds Leading Hospital at Home Program.”
• Censinet and KLAS Research recognize AGS Health, Clearwater, Divurgent, Ellkay, Fortified Health Security, JTG Consulting Group, Nordic, and Upfront Healthcare for achieving and sustaining their KLAS Cybersecurity Transparent designation.

Blog Posts

• Medication Adherence: A simple workflow for improvement (Arcadia)
• The Burning Platform: Healthcare is in Dire Need of Change (CareMesh)
• How L1 Support and Hosting Services Made Customers Happy and More (CereCore)
• 3 Ways Analytics Can Help Fight Burnout in Healthcare (Dimensional Insight)
• Solve Independent Diagnostic Testing Facility Billing Challenges with Practice Management Software (ChartLogic)
• RapidAWV – Now optimized for any device! (ChartSpan)
• How to Track and Measure Provider Support Activities in Real Time (RCx Rules)
• Improve Operational Efficiency and Reduce Costs and Complexity with 1Clearsense (Clearsense)
• Hybrid Resiliency: Managing Healthcare Cyber Risk with the Best of Reactive and Proactive Security (Clearwater)
• Real-time Messaging Options Blows the Door Off Traditional Channels (ConnectiveRx)
• Healthcare Organizations: Electronic Faxing is Better with eFax and Unite (Consensus Cloud Solutions)
• Training Practices to Help Physicians Succeed at Risk-Based Documentation (and Beyond) (Curation Health)
• 5 Soft Skills to Look for in Prospective Employees (Direct Recruiters)
• Top Priorities for Healthcare CIOs Entering New Organizations (Divurgent)

Contacts

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

Morning Headlines 3/28/23

Wellvana Health announces $84 million capital raise to drive innovation in value-based care enablement

Value-based care enablement startup Wellvana Health raises $84 million, bringing its total raised to $140 million.

CVS Health to Close Acquisition of Signify Health

CVS Health will wrap up its $8 billion acquisition of home healthcare provider Signify Health this week.

Atlantic General Hospital Provides Notice of Data Privacy Event

Atlantic General Hospital (MD) notifies patients of a data breach after discovering hackers had encrypted files on certain computer systems.

HIStalk Interviews Robbie Hughes, CEO, Lumeon

Robbie Hughes, MEng is founder and CEO of Lumeon of Boston, MA.

Tell me about yourself and the company.

I’m an aerospace engineer by background. I got excited about healthcare when I was given a problem coming out college, which looked to me like the normal sort of problem you would see in any industry. Fifteen-plus years later, I’m still doing it, because this is healthcare and things are a bit different.

Our product is the Lumeon Care Orchestration platform. We are a companion app for EHRs that automates clinical and patient workflows. The end result is a massive improvement in care team productivity that transforms the patient experience and improves the wellbeing of the care team more broadly. It’s a tricky thing to do, but we are lucky in that it works extremely well.

You said the last time we spoke that your product helps standardize decision-making rather than standardizing care. Can you give some perspective or examples?

There is a common misconception in the way people think about care processes, that a journey of care starts on the left hand side of a sheet or a screen and ends up on the right. That’s just not the reality we live in. Every patient is different, every disease progression, every care process is different. Things unfortunately don’t happen the way we expect them to.

But if you were to present yourself in front of a physician or a care team member more broadly, they would work you up following a relatively common set of protocols and methods. The output of that workup would essentially be a personalized care plan for you, based on what they see right there in front of them. Standard decisions are being made inherent to how care is delivered, but the way that we implement care from a technical perspective is to assume that care is linear and standardized.

The question becomes, how do you embrace that personal aspect of care that is delivered by care teams, but try to bring the operational efficiency that comes through standardization as you might see in other industries? This personalized yet standardized thing is a bit of a Rubik’s Cube that people struggle to conceptualize and to use in reality. But it actually boils down to one very simple thing, which is that the decisions of around what care should be delivered should always be consistent and should always be repeatable.

For a given presentation, you should always get the same output. That should result in some specific personal action, some specific personal activity for that patient. That inherently means that for every decision, you’re going to get a personalized output, and every patient’s care journey will be the product of a bunch of personalized actions — not standardized actions, but personalized actions based on standardized decisions. The trick to all of this, the trick to delivering great care, is how do you repeatedly and reliably deliver that personalization in a scalable form to create predictable — not standardized, but predictable — processes. Lumeon has worked at how to do that very well, one of the biggest misconceptions that sits at the heart of why scaling healthcare can be difficult. That’s the core of what our business does.

We’ve laid out EHRs so that other clinicians and even the patient themselves have to reverse engineer a bunch of chart elements to try to follow the thought process behind the actions. Are patients themselves usually aware of what their doctor is thinking and could technology help them understand?

That is the $84 billion question, isn’t it? I would reframe that a little bit. Why do we do what we do today? It’s worth saying I’m not a physician, I’m an engineer, so everything looks like a problem to be solved to me [laughs]. The way I think about this particular problem is that if you look at the way a care team practices today, there are these interactions I have with the patient, there are interactions I have with the EHR, and a lot of this stuff is based around this notion that I, as a care team member, don’t, necessarily trust what’s documented in front of me. I’m going to ask the patient or about their history. I’m going to order another MRI. I’m going to do all these things because I as a responsible clinician need to understand that what I’m doing is the right thing for that patient, and that’s a perfectly rational place for them to be. And in a world where people are paid on activity on a fee-for-service basis, that makes economic sense as well.

But in a perfect world, they would be able to look in the EHR and see a complete record with everything there. As a result, they wouldn’t need to reorder things and redo things, because they look at the documentation and say, OK, this is  complete, I trust it, life is good, I will do the right thing by the patient.

So back to your question, the way the patient perceives this is maybe inconsistent delivery, repeating things that they’ve already done, potentially gaps in care where mistakes are made or things aren’t followed up, et cetera. From a care team perspective, what they experience is the repetition of things that should have been done already, but they don’t have necessarily 100% confidence have been done to their satisfaction or done well.

The more we fragment care through increased specialization and more handoffs, the more this problem permeates. In a perfect world, all the documentation would be there. This is actually one reason that what Lumeon does is hard. If you’re trying to introduce automation into clinical care processes, there’s this pyramid of need, and at the bottom of it is complete and accurate data. If the complete and accurate data doesn’t exist in the EHR today, then how on earth can you hope to safely implement automation on top?

You get to the same situation that the care team has, which is that most of it is there, but not enough for them to be able to run it completely, so they ask the patient or they go to secondary sources of data. It’s similar to what we do. We create a composite record, we ask the patient, we ask the EHR, and we ask other secondary data sources and other authoritative records systems that we can speak to. We create this composite synthetic record that says, the EHR says this, the patient says that, the Surescripts or DrFirst or whoever else says these three things, and therefore we believe that the complete picture of the patient is this. And by the way, there’s a conflict between those two things, so we had better give that to someone to reconcile.

If you can create that trust in the data through this super record or composite record, and you can then use that to provide a basic level of cleansing and then ideally automation on top of it because that you’re missing things or things need to be sourced, et cetera, then you are automatically eliminating a huge amount of the stuff that plagues the care team from a busy work point of view. But you’re also joining things up incredibly efficiently for the care for the patient, because what they’re experiencing is direct, precisely choreographed outreach and engagement that is specific and individualized to them.

The psychology is interesting that providers don’t trust each other’s data and instead ask the patient or repeat the test.

It’s very unfortunate, isn’t it? The way that our chief clinical transformation officer would put this is, if we have to go hunting and pecking inside the EHR for something and can’t find it within 10 seconds, we just order another one. Because once you end up in this situation where you have a giant system of record with a huge amount of stuff in it, if it isn’t immediately available and reliable it, you automatically create this need for hunting and pecking.

Once you get into that situation, then immediately you are demotivating the care team. They have better things to do, so it’s easier to place an order, because obviously we have massively optimized for order creation instead of looking through retrospective or historical data to see if something exists. From a Lumeon perspective, or more broadly, from a care orchestration perspective, a lot of the value is bringing that relevant data to bear in the form of specific and automated action so that we can identify even before the encounter is open that we’re missing a couple of things and so we need to do something about it.

In fact, we are missing so many things perhaps that maybe this encounter isn’t worth having face-to-face. Maybe it needs to be diverted to a phone call or something else. That sort of intelligence, I use the word choreography, can be a massive driver of efficiency because it is eliminating that waste work that shouldn’t exist.

How has the business model evolved of an ecosystem between EHR vendors and companies like yours that can add value if given access to EHR data?

It is becoming increasingly clear. From a regulatory perspective, that the roles and responsibility of the EHR are very clear. It is a documentation system, a quality system, and a billing system. There is an entire industry based around the creation, maintenance, and support of that and the regulation around it. That is a treadmill that exists and will continue to exist for a long time. There is a further regulatory point around giving others access to the data that sits within that. Again, that’s only going to get stronger as payment models become more exotic and the need for data and the application of data becomes more acute. Now from an ambition perspective beyond that, it comes down to a cultural question, which is, what is the culture of the company and what are they trying to solve for?

A huge amount of the work that we do as a company is effectively services led. We are sitting with our clients. We are listening to what they do. We are listening to their challenges. We are applying our best practices and our tooling to address their specific challenges, which may be actually unique to them, but against a standard set of models that we have developed over time that we know to be good practices. What that creates is an organization that is obviously strong in product, but also strong in services, change consulting, data and insights, and integration. There’s a bunch of core capabilities that we need to have there and muscles that we are working, which are inherently different to other companies where, for example, maybe they sell something online, it’s very light, you click and you install. The muscles they are working are different.

Just as the comparison between those two companies is different, so the comparison between EHR company and a EHR partner company is going to be. Every company in its DNA has a purpose and has a trajectory that is set based on the things that they do that differentiate them. When a company tries to be everything to everybody, then they will end up losing some of that discipline and some of that excellence. That doesn’t mean that they won’t create a solution that is good enough for some use cases, but it would be exceptional if that company ended up creating the best-of-breed solution in all of those use cases. I don’t believe that you’ll ever see companies that dominate everything everywhere. My belief is that we will find that focus and discipline of execution creates companies that are differentiated through that focus and that discipline. That’s true for the EHR as it is for any other company.

The market has changed due to COVID, hospital financial problems, and hospital consolidation. How do you get a prospect’s attention when they are experienced change management fatigue or have a full plate?

The reason people buy Lumeon is because they have a urgent need to effectively do more with less. They will have strong opinions around how they want to deliver care. They’ll have a strong desire to grow, and they need to work out a way to do that in a way that they haven’t done before, which is to change their care delivery model so that it is supported through technology.

Our experience is that right now we are at a fascinating time in the market, where people are effectively creating rolling budgets. If you can walk in and partner with a health system and say to them, we are going to both improve the quality of care you deliver, drive more revenue, and make your care team happier, and do that on an ROI that pays back on a same quarter or same year basis, everyone is open to that conversation today. That’s a testament to how open people are today to change. They’ve seen what happened in COVID and what was possible. There is an urgency that I’ve never seen in the market to drive that kind of change. It’s incredibly exciting.

What are the company’s goals over the next three or four years?

From a product perspective, we are continuing to develop our knowledge library, our repository of best practice recipes of how to effectively do what I’ve described, do more with less, but in very specific areas. From a personal perspective, that’s the thing that I’m the most excited about. Its truly a knowledge and a knowledge library of how you go into particular use case areas — surgery, inpatient case management, ambulatory care, whatever it might be — what are the specific recipes that work, how do they get done, and what are the outcomes? That is my passion and that’s what we do exceptionally well.

We have started on this journey. We have more to do, but in the space of three years, we will have the most unbelievable content and evidence behind it. That’s the thing that I’m focused on, because it ultimately comes back from, we’ve done this because we’ve delivered these results for our customers.