Monday Morning Update 2/13/23

Top News

Terry Admirim, MD, MPH, MBA, program executive director of the VA’s EHR Modernization Integration Office, will leave the VA to pursue unstated other opportunities.

Serving as interim after her February 25 departure will be Neil Evans, MD, senior advisor to the assistant secretary for information and technology and CIO and head of the VA’s Connected Care program.

Reader Comments

From Tempus Fugit: “Re: Olive. I heard endlessly about their unicorn status and huge customer count, which sounded like BS and probably means they are counting some rando clinic that is using a tiny solution as a customer. I know a sales guy there and he said the company paid them a ton to sell consulting engagements, but with nothing meaningful deployed, they went back to selling small patient access solutions. He said customers were unhappy that they were promised a 5x ROI that hasn’t happened anywhere.” Unverified. Axios reviewed LinkedIn records in May 2022 to determine that among the 20 Olive employee departures in the previous month were its EVP/GM, senior director of partner programs. director of data engineering, chief marketing officer, and VP of product. Axios also reported in April 2022 that Olive overpromises, under-delivers, and doesn’t actually use AI/ML. The company told the reporter at that time that it had 1,000 hospitals in 200 enterprise customers using its products and services, although an Axios review of internal documents shows 80 customers. The company has raised $856 million in funding through a Series H round, with its last investment being in July 2021.

From Domainatrix: “Re: company layoffs. A positive aspect is that young workers will now know that their employer isn’t their friend, co-workers aren’t their families, and employers as well as employers are free to end their bargain for any reason.” Long-timers who have been negatively affected at some point by company decisions rolled eyes at the unquestioning willingness of fresh go-getters to work ridiculous hours or grind away at crappy jobs, convinced that they would be rewarded by their benevolent bosses. Fast-forward to the end of boom times that has put employers back in control with little fear of mass resignations. The result is a scaling back of work-from home programs and an insistence that “valued associates” work harder or longer because the company has found itself in a jam, often of its own making. Bosses aren’t friends, the job of the chief people officer is mostly to work against the interest of employees, and you would be replaced and turned into a break room trivia question within three months of your departure.

From Purported Victim: “Re: hospitals ending some services or closing in poor areas. So much for being a charitable non-profit.” You will always be disappointed if you expect any person or organization to take any action that isn’t the one that is most beneficial to them.

HIStalk Announcements and Requests

Patient portal, telephone, and online forms are the most common ways poll respondents have recently sent medical information to a clinician.

New poll to your right or here: Did your most recent clinician encounter, in whatever form, make you feel “cared for?”I voted yes because when I recently texted my direct primary care doctor about refill, she asked me how I was doing and mentioned that I hadn’t seen her for a while and might want to drop by for routine lab work and a health review, none of which increase her income.

Webinars

February 28 (Tuesday) 1 ET. “Words Matter: Simplifying Clinical Terms for Patients.” Sponsor: Intelligent Medical Objects. Presenters: Whitney Mannion, RN, MSN, senior terminologist, IMO; David Bocanegra, RN, nurse informaticist, IMO. The language of medicine can be confusing and contradictory to patients, challenging their ability to prepare for a procedure or pay their bills. This webinar will explore how the words that are used to communicate – online, in print, and in person – must be chosen carefully to allow patients to comprehend their diagnoses, treatments, and care plans. The presenters will also describe how the ONC Final Rule for the 21st Century Cures Act will make clinical and technical language more directly accessible through patient portals.

March 7 (Tuesday) noon ET.  “Prescribe RPA 2.0 to Treat Healthcare Worker Burnout.” Sponsor: Keysight Technologies. Presenters: Anne Foster, MS, technical consultant manager, Eggplant; Emily Yan, MPA, product marketing manager, Keysight Technologies. Half of US health systems plan to invest in robotic process automation by the end of this year, per Gartner. The concept is evolving to help with staff burnout and physician productivity. The presenters will introduce RPA 2.0, explain how to maximize its value, demonstrate how to quickly start on RPA 2.0 and test automation in one platform, and answer questions about healthcare automation.

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

Acquisitions, Funding, Business, and Stock

Business Insider looks at the “fleet of secret workers” who aren’t visible to customers but who perform much of the work that is attributed to sexy technology or who are required to keep that technology running. The author concludes that robots, automation technology, and AI chatbots won’t replace employees, but they may allow companies to shift less-visible offshore to lower their costs. I would say that we are in the early days of companies overstating their use of AI and other tools in failing to mention that behind-the-scenes humans are doing a lot of the actual work, the “10,000 diligent Indians” concept a vendor CEO once told me about. It’s kind of a sad state when companies brag on their tools rather than their humans, but investors love employee-lite scalability and companies yearn to be viewed as a technology high-flyer instead of a low-tech sweatshop.

NPR notes that hospitals are outsourcing their EDs to staffing companies that are owned by private equity investors, with a result being that doctors are being replaced by nurse practitioners and physician assistants to boost margins. The change is motivating some ED doctors to change their work setting because they went into medicine to see patients, not supervise lesser-trained employees.

Sales

• Norman Regional Health System selects VisiQuate Denials Management Analytics, Revenue Management Analytics, and PayFlo.
• Onsite Women’s Health will use Volpara Health’s analytics software to improve mammography quality by assessing positioning, compression, and radiation dose.
• Complete Care implements the EClinicalWorks EHR.

People

Health Catalyst promotes Cathy Menkiena, RN, MBA to GM/SVP Northeast.

Industry long-timer and former CHIME VP Tim Stettheimer, PhD died February 9 of ALS (Lou Gehrig’s disease). He was 56.

Announcements and Implementations

Stick around until the Friday morning keynote of HIMSS23 (which is asking a lot) and you can hear just-announced speaker and NFL player Damar Hamlin, who was saved by CPR and AED after suffering cardiac arrest in a game on January 2. He will speak on “Winning the Game of Life.”

A new KLAS report covers IT advisory services.

Sponsor Updates

• CloudWave launches its Cybersecurity Insider Program to offer members access to information about the latest cybersecurity trends and threats, as well as ongoing education.
• Nordic releases a new Designing for Health Podcast featuring UCHealth CMIO Dr. CT Lin.
• PeriGen partners with Baylor College of Medicine, Texas Children’s Hospital, and the Malawi Ministry of Health to assist with successful newborn in Malawi using PeriGen’s AI-augmented continuous electronic fetal monitoring.
• PerfectServe publishes a new case study, “How Savannah Neurology Specialists Reinvented Their Medical Answering Service Workflows.”
• Sphere releases a new e-book, “Unaffordable Medical Bills: A New Social Determinant of Health.”
• Spok receives ISO 13485:2016 certification from Dekra Certification.
• Talkdesk has been recognized as a Customers’ Choice in the 2023 Gartner Peer Insights “Voice of the Customer” for contact center as a service.

Blog Posts

• OpenAI and ChatGPT: A Primer for Healthcare Leaders (Orbita)
• The PINC AI Applied Sciences Team Partners with NWCF to Advance Health Equity and Expand Education (Premier)
• ChatGPT is coming to your contact center (Talkdesk)
• MIPS Extreme and Uncontrollable Circumstances Policy Update (WebPT)
• As Emergency Department Clinicians Struggle with Burnout, Clinical Decision Support Emerges as a Potential Lifeline (Zynx Health)

Contacts

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

Morning Headlines 2/10/23

Scoop: Olive AI lays off 215 employees

Robotic process automation vendor Olive lays off a reported 215 employees, about one-third of the company.

Mindstrong’s demise and the future of mental health care

Mindstrong, which has raised $160 million in funding from high-profile investors, will wind down its virtual behavioral healthcare service and lay off 130 employees starting in late March.

Center for Health Innovation Expands with $22 Million in Gifts

UC San Diego Health will use a $22 million donation to launch a patient health and safety monitoring hub that will aggregate data from across its EHR, bedside monitors, wearables, and other enterprise technologies.

NHS tech funding falls to less than £1bn

NHS England’s technology budget has reportedly been cut in half to just over $1 billion, which will likely impact requests for electronic patient records.

News 2/10/23

Top News

CVS Health will acquire primary care company Oak Street Health for $10.6 billion in cash.

Oak Street Health’s 600 primary care providers work from 169 medical centers in 21 states.

Meanwhile, CVS Health reports Q4 results: revenue up 9.5%, adjusted EPS $1.99 versus $1.98, beating Wall Street expectations for both. CVS shares are down 20% in the past 12 months versus the Dow’s 5% loss.

Reader Comments

From Another Company Debacle: “Re: Allscripts / Veradigm. Major layoffs this week in R&D and solutions involving employees in both the US and India. Veradigm (formerly Allscripts) Practice Management took a big hit. Veradigm Interface Engine too.” Unverified.

From Jay Glick: “Re: Oracle Cerner. Fared poorly in Best in KLAS, wouldn’t you say?” Agreed. Oracle Cerner finished last among software suites, 20 points behind Epic and mostly “well below average” scores in every product segment except for attaining “average” in virtual care. In the all-important large hospital market, Epic scored 89.4 versus Oracle Cerner’s 70.0. Oracle Cerner finished first in no categories versus its last-place showing in a bunch of them. In trying to come up with a “glass half full” conclusion, I have two thoughts: (a) at least Oracle Cerner will keep making a lot of money from the federal government unless it gets shown the VA’s door and loses its only prime contractor deal, not to mention that a lot of Oracle’s recent revenue and earnings growth came from the former Cerner; and (b) perhaps the corporate stumbles that followed Neal Patterson’s death, along with high-visibility revenue cycle product problems, made it inevitable that the keys needed to be turned over to a new owner who has the money and objectivity to right the ship. From the “glass half empty” perspective, few health IT examples exist where a big outside company improved a vendor by acquiring it. Another sobering thought for Oracle is that KLAS reports only what customers are saying, and some of the older Cerner sites may re-muster the fortitude and cash that would be needed to move to Epic.

HIStalk Announcements and Requests

I suppressed my HIMSS23 indifference long enough to book my hotel, so the “am I going or not” question has been answered. The exhibit hall will be open full days on Tuesday (April 18), Wednesday, and a slightly shortened day Thursday. The hotel I was considering was nearly $500 per night on Expedia and on the chain’s loyalty club site, which would have kept me home, so kudos to HIMSS for making it available to attendees at barely more than half that price for the same dates. The website shows 764 exhibitors. I don’t think I’ve been to Chicago since HIMSS15. Opening day temperature highs going back from 2022 were 42, 55, 42, 76, and 43 degrees, and of course many remember the HIMSS09 opening reception near-blizzard where the McCormick Place coat check people had actual coats to manage instead of just last-day luggage holds.

I realized that I wasn’t seeing Altera Digital Health Sunrise (the former Allscripts Sunrise that is now owned by N. Harris) on the Best in KLAS report, where for years it topped the list of large-hospital inpatient EHRs. It had too few customers surveyed to be stacked up against Epic and Oracle Cerner (the only two products that were ranked), but its performance score was the lowest of all at 63.8. In the midsize category, it performed even worse at 54.6 (and Altera’s Paragon got a 37.6 score, also with too few responses to compare, and also pegged the lowest score in the small hospital category at 49.0). Also on the KLAS report, I also didn’t see segment categories for ED, anesthesia, laboratory, radiology, and pharmacy management systems, so I guess those products are no longer reported as part of Best in KLAS.

Webinars

March 7 (Tuesday) noon ET.  “Prescribe RPA 2.0 to Treat Healthcare Worker Burnout.” Sponsor: Keysight Technologies. Presenters: Anne Foster, MS, technical consultant manager, Eggplant; Emily Yan, MPA, product marketing manager, Keysight Technologies. Half of US health systems plan to invest in robotic process automation by the end of this year, per Gartner. The concept is evolving to help with staff burnout and physician productivity. The presenters will introduce RPA 2.0, explain how to maximize its value, demonstrate how to quickly start on RPA 2.0 and test automation in one platform, and answer questions about healthcare automation.

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

Acquisitions, Funding, Business, and Stock

Olive lays off a reported 215 employees, about one-third of the company. The company has reduced its headcount from a one-time peak of 1,400. The robotic process automation vendor, which once had a valuation of $4 billion, has been plagued by customer and executive defections along with reports that its promises of hospital savings have rarely materialized. 

A leaked internal email indicates that healthcare will remain a top priority of Oracle and is the primary focus on CTO and executive chair Larry Ellison. The company is also moving its data and AI unit under its cloud business.

Google’s valuation drops by $100 billion the day that its newly announced Bard chatbot was found to have given an inaccurate response in a company promotional video, raising questions about Google’s competitive position against Microsoft, which has already integrated ChatGPT functionality into its Bing search.

Virtual behavioral service company Mindstrong, which has raised $160 million in funding from high-profile investors, will wind down its operation and lay off 130 employees starting in late March.

Healthcare staffing marketplace operator Nomad reportedly lays off 20% of its headcount as pandemic-fueled demand and payment rates cool. The company has raised $200 million, including $105 million seven months ago.

Sales

• McClow, Clark, and Berk, PA Radiology Services (FL) selects Healthcare Administrative Partners for revenue cycle management.
• Southern Illinois Healthcare will implement Xealth to allow clinicians to find and order digital health tools and programs.
• Southern New England Health chooses Koan Health’s Datalyst for population health and medical economics.

Announcements and Implementations

Highlights from KLAS’s Best in KLAS in software and services for 2023:

• Epic, Impact Advisors, Nordic, Medasource, and Chartis were named for notable performances.
• Software suite rankings were topped by Epic and Meditech.
• Most improved software products were Veradigm’s FollowMyHealth and KPMG’s ERP business transformation and implementation leadership services.
• Top physician practice ranking went to Epic, followed by Meditech and Athenahealth.
• The overall IT services category was a tie between Impact Advisors and Nordic.

CareCloud integrates the Quippe Clinical Data Engine of Medicomp Systems into its EHR platforms.

Researchers at University of Missouri School of Medicine find that a small group of EHR testers identified 2.5 usability concerns for each new function, 70% of which were correctable before rollout.

Government and Politics

A KHN investigation finds that HHS has ignored repeated congressional mandates, going back to 2006, to implement a public health network that can detect and address infectious disease outbreaks. Experts say HHS didn’t follow through because the task is complex, funding is inadequate, consensus is lacking on the data that is needed in an emergency, and HHS can’t decide which of its operating divisions should lead the project.

Rep. Mike Bost (R-IL), chair of the House Committee on Veterans’ Affairs — who is involved with two bills that would change or end the VA’s Oracle Cerner implementation – says he will listen to more moderate proposals that are submitted by Democrat lawmakers to hold the company and the VA more accountable, but adds via a spokesperson that “the time for half-measures and tinkering around the edges is over.”

Other

NHS England’s technology budget has reportedly been cut in half to just over $1 billion, which will likely impact requests for electronic patient records. 

A survey of 9,500 consumers in six countries, including the US, finds that far fewer of them feel “cared for” than their primary care doctors believe. Key consumer issues are faster and more accurate diagnosis, convenient access, a focus on long-term health, and making healthcare more affordable. China leads the other countries in use of health portals, digital health apps, and telehealth. Half of consumers think that doctors and hospitals should be leading the charge to connect health information, but US physicians say they don’t do that because they aren’t paid extra, obtaining patient consent is a pain, they are experiencing data overload, they don’t know how to use the data, and technology doesn’t work well. Only 40 to 50% of US consumer respondents say they would share their health information even if the result was improved health, better-tailored services, safer treatments, or lower costs.

Sponsor Updates

• Healthcare consumer platform operator League will offer healthcare cost and quality information from Kyruus-owned HealthSparq.
• Everbridge adds DigitalOps Insights, a new AI-powered situational awareness tool, to its Digital Operations solutions bundle.
• Southern Ohio Medical Center reports a 30% drop in hospital-acquired C. difficile infections following the development of expedited testing tools by Meditech Professional Services.
• First Databank names Joe Bodkin (Franciscan Health) clinical informatics pharmacist specialist, Angela Johnston (Astra Zeneca) regional representative, and Shafer Grytness (Insight Global) software engineer.
• OSF HealthCare releases a new podcast featuring Get Well Supervisor of Clinical Digital Care Kate Johnson and Digital Patient Care Manager Kara Roat.
• InterSystems releases a new Healthy Data Podcast, “FFS vs. Integrated Care.”
• Intelligent Medical Objects secures SOC 2 Type 2+ HIPAA certification.
• Meditech shares the ways in which Valley Health System (NJ) clinicians have used its Surveillance tool to quickly identify patient conditions, provide relevant data, and expedite orders to initiate treatment.
• NeuroFlow completes its SOC 2 audit, reinforcing its commitment to protecting health data.
• Everest Group names NTT Data a Leader in its Provider Digital Services Peak Matrix Assessment 2023 report.

Blog Posts

• Unlocking the Power of Meditech Through a Robust Health IT Infrastructure (Healthcare Triangle)
• EHR Integrations: To Build or Not to Build (Healthjump)
• Most Popular Healthcare Technology Trends of 2023 (HealthTech Resources)
• Optimum CareerPath Spotlight: Meet Pratik Shekade (Optimum Healthcare IT)
• Newly Minted Rural Emergency Hospitals Face Old RCM Challenges (Medhost)
• Celebrating #1 Best in KLAS for image exchange: Innovative ways patients and providers are sharing without boundaries (Nuance)

HIStalk sponsors that were named as Best in KLAS Software and Services 2023 or Best in KLAS Global Software 2023:

• Agfa HealthCare (PACS Middle East / Africa)
• Arcadia (value-based care managed services)
• Azara Healthcare (population health management)
• Findhelp (social determinants of care network)
• Fortified Health Security (security and privacy managed services)
• Impact Advisors (security and privacy consulting services, ERP implementation leadership, financial improvement consulting)
• InterSystems (clinical portals Europe)
• Lyniate (integration engines)
• Meditech (acute care EMR small)
• Nordic (HIT core clinical implementation leadership)
• Nuance (computer-assisted physician documentation, speech recognition front-end EMR, image exchange)
• Oracle Health (acute care EHR Middle East /Africa)
• Pivot Point Consulting, a Vaco Company (managed IT services)
• Premier / PINC AI (value-based care consulting)
• Sectra (PACS large, PACS small, PACS Asia / Oceania, PACS Canada)
• Visage Imaging (universal viewer)
• Wolters Kluwer (infection control and monitoring, patient-driven care management)
• Zynx Health (clinical decision support care plans and order sets)

Contacts

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

EPtalk by Dr. Jayne 2/9/23

Mr. H’s current poll asks about the methods used by patients to send medical information to clinicians in the past year. I wasn’t surprised to see that patient portal messages are leading the way, followed by phone calls and electronic forms. Mailed paper forms and faxes are at the bottom of the list, as expected.

It would be interesting to see a poll around the topic of “In which ways have you had productive communication and/or a positive outcome” when looking at electronic communication and portal messages. I recently tried to use the online scheduling feature offered by my dermatologist, with whom I am well established. There were no spots available until June, so I used the feature located on the online scheduling page called “request an appointment.” I mentioned that the request was to be seen for a suspicious and changing mole that had already been seen by my PCP, who recommended I see dermatology. I listed my preferred days and times, but basically said that due to the nature of the issue, I was willing to take any open appointment.

Four days later, I received a portal message back that “we are not currently offering online appointment requests” and was directed to call the academic medical center’s access center. If you’re not offering online appointment requests, I might recommend disabling that feature so that patients can’t use it. I’ve used the access center before to request an appointment with this dermatologist and it’s a centralized scheduling nightmare. For urgent issues, they take a message and route it to the office who hopefully calls you, and then if you’re like me and tied up on calls and in meetings all day, you play phone tag, which is exactly what the online requests are supposed to prevent.

I mentally said, “forget it” and made an appointment with a new dermatologist who was happy to get me in within 48 hours given the history and PCP referral. Since my clinical issue was resolved, we will see if my original dermatologist ever follows up, who now has a concerning message documented in my chart. We are going on six weeks so I’m not holding my breath, but for a patient who isn’t as persistent in getting care, it could be tragic.

From Jimmy the Greek: “Re: chatter about using ChatGPT in healthcare. It might amount to the scene out of ‘A Charlie Brown Christmas’ where Lucy is listing off phobias and asking Charlie Brown if he has them.” I’ve certainly seen some interesting applications, or should I say attempted applications, of ChatGPT recently. Today brought an email from a colleague that was most likely produced by some sort of bot since the syntax didn’t sound anything like her usual written patterns. I found it pretty annoying since what she sent was a reply to a pretty straightforward question that could have been answered in five words or fewer. It’s fine if you want to play around with it, and since we are both informaticists, it could have been “hey, check out what ChatGPT created as a reply,” but since there had to be a few more back-and-forths to get the original question answered, it wasn’t much of a time saver.

Everyone is trying to figure out how to streamline workflows in ambulatory medical practices. Solutions being implemented for pre-visit flows include patient portal-based check-in that can be completed at home up to a few days prior to the visit; chatbot-based flows that can be completed either at home or upon arrival; and self-check-in kiosks. A recent article in the Annals of Family Medicine looked at a “self-rooming” process implemented in primary care clinics from October through December 2020. Researchers found that most patients preferred self-rooming, although some felt less welcomed, more lost or confused, more frustrated, or more isolated compared to escorted rooming.

Based on the overall positive response, the organization decided to roll out the process to all remaining primary care clinics, and it will become a permanent change for the institution. The process design included some decidedly low-tech features, such a laminated wayfinding card that was used by the patient to reach their exam room. Once the visit was over and the room had been cleaned and prepared for the next patient, the card was returned to the front desk so that another patient could be directed to the newly prepared room.

I recently learned that my residency training program is celebrating its 50th anniversary and will be holding a gala in honor of the milestone. Unfortunately, they didn’t start promoting the event until 60 days out, which isn’t nearly enough lead time when you consider that most of us open our clinic schedules up to a year in advance and on-call schedules are done at least 90 days in advance. I circulated the information to my class and the residents in the years above and below mine, but it looks like only the handful of folks who can travel without taking off work are likely to attend.

I had no idea the program had reached such a major milestone and it really seems like a missed opportunity to bring people together. Other organizations I’m part of that have had similar events have sent cards anywhere from six months to a year in advance telling people to save the date, which is key if you want to try to get a couple hundred physicians together in the same place at the same time.

It’s technology upgrade time at the House of Jayne and I’m very happy about my first purchase, which was a Kindle Paperwhite. I’ve been using the Kindle app to read on a decade-old iPad and decided I wanted something smaller and lighter for travel. Amazon was offering a deal on the high-end version as long as you didn’t mind buying it in Agave Green. I’m thrilled with the purchase and have already burned through two books. I’m still getting to know all the features, but it’s a significant step up from my previous reading situation.

I also had to break down and replace one of my monitors, which started having some issues with static electricity. Every time I touched my keyboard tray after walking on the carpet and accumulating a charge, the monitor would suffer a blue screen of death that required a reboot to bring it back to life. Tomorrow is unboxing and installation day, so wish me luck as I crawl around and under the desk to get things hooked up. Still on the to-do list after that is a new phone, but that’s a much larger project, especially since I want a full featured Android device that’s on the smaller side.

What’s your favorite piece of new technology? What’s the one thing you’d recommend everyone consider getting? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 2/9/23

CVS Health to acquire Oak Street Health

CVS Health will acquire Oak Street Health, a Medicare-focused primary care provider based in Chicago, for $39 per share in a deal valued at $10.6 billion.

Oracle reorganized its data and AI initiatives amid a leadership shake-up, leaked internal memo shows

Oracle moves its AI and data business units within its cloud infrastructure business amidst the departure of Oracle Cloud Infrastructure EVP Don Johnson and the company’s continued focus on healthcare.

NOCD Completes Additional Funding in its Quest to End the OCD Crisis

Digital OCD therapy startup NOCD raises $34 million in a financing round led by Cigna Ventures and 7wireVentures, bringing its total raised to $84 million.

Morning Headlines 2/8/23

Imperative Care Announces Formation of Stroke Recovery Digital Health Company Kandu Health

Medical technology company Imperative Care launches Kandu Health, which offers digital support for recovering stroke patients.

Senators probe telehealth companies for tracking and monetizing sensitive health data

A bipartisan group of senators ask executives at telehealth companies Cerebral, Workit, and Monument for details of their data-sharing policies including a list of all third-party sites they’ve shared data with over the last three years.

Albertsons Companies Launches Sincerely Health™ Digital Health and Wellness Platform

Grocery store operator Albertsons launches Sincerely Health, a digital health and wellness app that offers a questionnaire-calculated health score, linking to activity trackers such as Apple Health and Fitbit, and pharmacy management.

Oracle Unit Wins Fees After Beating Patent Case

A judge rules that CliniComp must pay nearly $1 million in attorney fees after losing a 2017 patient infringement lawsuit against Oracle Cerner.

News 2/8/23

Top News

A blog post by Oracle EVP and lobbyist Ken Glueck fires back at members of Congress with unusually aggressive criticism of two recent bills that would postpone or cancel the VA’s Oracle Cerner implementation. Some points:

• 1980s-era VistA can’t meet the health challenges of veterans, can’t communicate with DoD systems, and has always been nearly impossible to maintain and modernize, so reverting to it at live sites would be a disaster.
• There’s no magic wand for modernization, but moving to commercial off-the-shelf system workflows is always worth doing.
• It was a mistake to schedule the first VA go-live in the pandemic’s peak days of October 2020 when caregivers were overwhelmed.
• With the Oracle acquisition of Cerner, “VA now has essentially two vendors for the price of one” in providing both clinical and engineering expertise.
• DoD and public hospitals around the world have successfully rolled out Cerner as the VA struggles, suggesting that the VA’s issues aren’t related to product capabilities.
• A particular VA challenge is that it runs 130 instances of VistA, which Cerner attempted to fix by combining them into a single workflow that turned out to be too cumbersome, such as dozens of options for ordering a liver enzyme test when commercial instances of Millennium might offer four or five.
• Glueck reiterated Oracle’s commitment to have the first beta test of a rewritten Millennium EHR available in 2023 at no extra cost to the VA or DoD. The cloud-based application will include a modern, Web-based, mobile-friendly user interface and will support voice recognition and AI-based clinical decision support.

Reader Comments

From Krill Feeder: “Re: more slide decks from the J.P. Morgan Healthcare Conference. Are health IT vendors increasingly using the ‘land and expand’ investor pitch for growth prospects as is common in other industries? Get the customer using a low-cost initial sale, then cross-sell and upsell to create annuity-like profits. Do readers think this still works in a stock market downturn?” Incumbent vendors, unless they are inept, always have the upper hand in making add-on sales by gaining access to health system decision-makers and removing the uncertainty and effort that is required to onboard a new vendor. I like the concept since it encourages vendors to perform well after the sale, which is a win-win, but whether investors should believe such claims is a different issue. A variant is when one company acquires another purely to sell into its customer base, which is often traumatic for those customers whose carefully researched product and vendor assumptions are rendered uncertain by new ownership bearing ulterior motives.

From Pete Drucker: “Re: [vendor name omitted]. To exit the market. Last day for employees is Friday.” Unverified, so I didn’t include the company name. I could not find a press contact or employee email address anywhere, so I’ve sent a Twitter direct message to the CEO and will update with any response.

Webinars

March 7 (Tuesday) noon ET.  “Prescribe RPA 2.0 to Treat Healthcare Worker Burnout.” Sponsor: Keysight Technologies. Presenters: Anne Foster, MS, technical consultant manager, Eggplant; Emily Yan, MPA, product marketing manager, Keysight Technologies. Half of US health systems plan to invest in robotic process automation by the end of this year, per Gartner. The concept is evolving to help with staff burnout and physician productivity. The presenters will introduce RPA 2.0, explain how to maximize its value, demonstrate how to quickly start on RPA 2.0 and test automation in one platform, and answer questions about healthcare automation.

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

Acquisitions, Funding, Business, and Stock

CVS Health is reportedly close to acquiring primary care operator Oak Street Health for $10.5 billion.

Sales

• WellSpan Health (PA) selects Epic-based KeyCare as its virtual care partner for its on-demand care service. The health system was part of the startup’s Series A investment round.
• VirtualHealth adds automated prior authorization capabilities from Edifecs to its Helios utilization and complex care management technology.
• Virtua Health (NJ) will implement Memora Health’s automated clinical intelligence software as a part of its care programs for congestive heart failure, specialty pharmacy, and colonoscopies.

People

April Saathoff, DNP, MS, RN (Harris Health System) joins Johns Hopkins as VP/CNIO.

ChartSpan names Dan PIessens, MS (RevealRx) CTO.

Emids names Sean Narayanan, MS (Apexon) as CEO. He replaces founder and CEO Saurabh Sinha, who will transition to board chair.

Medsphere promotes Jeri Judkins to CEO, replacing Irv Lichtenwald.

Mass General Brigham promotes Fran Hinckley to VP of digital solutions delivery of its community division.

Announcements and Implementations

Grocery store operator Albertsons Companies launches Sincerely Health, a digital health and wellness app that offers a questionnaire-calculated health score, linking to activity trackers such as Apple Health and Fitbit, and pharmacy management. The company’s merger with Kroger is pending approval.

OSF St. Francis Hospital (IL) launches a tele-NICU program using technology from Teladoc Health.

Alpine Health develops AI-powered predictive analytics to help hospital case managers ensure that at-risk patients transition to the right care settings with appropriate social services upon discharge. The startup is the product of a partnership between OSF Healthcare (IL), its innovation center, and consulting firm High Alpha Innovation.

Virginia Mason Franciscan Health (WA) uses hospital-at-home services and technology from Contessa to launch its Home Recovery Care program at St. Joseph Medical Center in Tacoma.

Microsoft launches previews of Bing and Edge that are enhanced with the big brother of AI chat tool ChatGPT. Meanwhile, Google rushes chatbot AI tool Bard to testers in reaction to ChatGPT’s threat to Google’s search.

Medical technology company Imperative Care launches Kandu Health, which offers digital support for recovering stroke patients.

Government and Politics

The Defense Health Agency’s National Capital Region — which includes Walter Reed National Military Medical Center and several other facilities — will go live on MHS Genesis next month.

Privacy and Security

Federal officials attribute last December’s 988 mental health helpline outage to a cyberattack on Intrado, the emergency communications software company that has managed the service since it launched last summer.

Other

Moffitt Cancer Center (FL) researchers determine that 25,500 virtual visits conducted through its Department of Virtual Medicine during the pandemic saved patients 3.4 million miles and between $147 and $186 per visit. The center plans to expand its telemedicine capabilities to include clinical trials.

Sentara Healthcare creates a remote patient monitoring department to oversee the installation and management of 108 remote cameras in rooms across its hospitals in Virginia and North Carolina. The $1.7 million project follows a four-year period of product evaluations, pilot projects, data compilation, and establishment of policies and procedures. Trained technicians at two control centers are responsible for monitoring patients at a dozen facilities.

Did you see this in person as I did? A 3,875-foot scanned document that was created at HIMSS08 in Orlando holds the Guinness World Record as the longest ever. Attendance that year was 28,000 and keynote speakers included former AOL CEO Steve Case, “Freakonomics” author Steven D. Levitt, PhD, and former Google CEO Eric Schmidt.

Sponsor Updates

• Availity presents scholarships to students from Jean Ribault High School as part of its Beyond School Walls program with Big Brothers Big Sisters of Northeast Florida.
• Diameter Health, now Availity, earns Certified Data Partner designation in NCQA’s Data Aggregator Validation Program.
• King’s College Hospital London – Dubai will implement Oracle Cerner, utilizing Oracle Cloud Infrastructure.
• AdvancedMD publishes “The Top 6 Healthcare Trends Making an Impact on Medical Practices in 2023.”
• Nordic publishes a podcast featuring UCHealth CMIO C.T. Lin, MD.
• Agfa HealthCare announces the successful go live of its breast imaging AI solution at Dubai Academic Health Corp.’s Dubai Hospital.
• Artera expands its multilanguage support to 109 languages.
• Baker Tilly releases a new Healthy Outcomes Podcast, “Creating an effective corporate compliance program for healthcare providers.”
• Bamboo Health names Missi Ledbetter senior program manager, Courtney Forrest onboarding specialist, and Omer Khalil software engineer intern.
• Emirates Health Services implements Care.ai’s ambient healthcare intelligence platform to enable its smart facility initiative.
• ChartLogic integrates FlexScanMD’s inventory management and tracking system into its ambulatory practice management solution.
• Clearwater publishes a new whitepaper, “Understanding Cloud Security Basics: How to Ensure HIPAA Security and Compliance in a Cloud Environment.”
• CloudWave will exhibit at the North Carolina Healthcare Association Winter Meeting February 15-17 in Cary, NC.
• WellSky announces that its CarePort Care Management and CarePort Discharge care transition solutions can now coordinate with Dialyze Direct service sites.
• Azara Healthcare adds cost and utilization analytics and visualizations to its DRVS population health management platform.

Blog Posts

• 3 Ways Pharmacy Technology Creates Efficiencies that Reduce Staff Stress (OmniSys)
• The Power of the Smartphone & How Consumer Behavior is Shaping the Future of Healthcare ESignature (Access)
• Most Popular Healthcare Technology Trends of 2023 (HealthTech Resources)
• Risk-Adjustment & Hierarchical Condition Category Coding: What Are They and Why Do They Matter? (AGS Health)
• 5 Key Healthcare IT Trends to Watch in 2023 (Keysight Technologies)
• What are the 12 social determinants of health factors and why do they matter? (Arcadia)
• How to Think Differently to Find Talent in 2023 (Ascom)
• CMS National Healthcare Directory RFI Blog Series: (A Quiet) HealthTech Response (CareMesh)
• Sese Bennett Shares How Hospitals Can Be Best Prepared for Cybersecurity Breach (CereCore)
• Effective Cloud Migration is Crucial for Your Organization – Here’s How to Get it Right (CTG)

Contacts

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

Morning Headlines 2/7/23

Feds say cyberattack caused suicide helpline’s outage

Federal officials attribute last December’s 988 mental health helpline outage to a cyberattack on Intrado, the company that has managed it since its launch in July.

Veterans Deserve Better than VistA

Oracle EVP Ken Glueck pushes back against recent Congressional efforts to potentially scrap or overhaul the VA’s Oracle Cerner-powered EHR modernization project, pointing out that the software is being successfully rolled out across the DoD, and has been installed at thousands of hospitals around the world.

Simple HealthKit Raises $8M to Transform Health Diagnostics and Follow-Up Care; Expands Portfolio to Include Solutions for Sexual Health, Tripledemic

Simple HealthKit, which offers a digital health platform encompassing diagnostics and follow-up care, raises $8 million in a Series A funding round led by Initialized Capital.

CVS Nearing $10.5 Billion Deal for Primary-Care Provider Oak Street Health

Sources say CVS Health’s plan to acquire Medicare-focused primary care provider Oak Street Health may come to fruition as soon as this week, with the deal valued at $10.5 billion.

Curbside Consult with Dr. Jayne 2/6/23

As a CMIO, there’s a lot of pressure on you to make sure that the healthcare information technology systems that are being implemented provide a solid return on investment. For many years, EHRs were promoted as a way to improve coding and charge capture. This led to physicians billing higher Evaluation & Management codes, which of course raised suspicion with auditors.

It also led to note bloat, as organizations created macros and templates that would ensure that clinical documentation was compliant with even the most rigorous audits. That meant that a certain percentage of notes actually became less useful than before since they were hard to read and full of nonsense that was required to support billing.

Fast forward to the Meaningful Use era and the rise of value-based care, when more organizations began entering into risk-based contracts. That meant that they needed to get a handle on how sick their patients really were to get the most money to care for those patients.

The Hierarchical Condition Category (HCC) coding paradigm had been created in 2004 and started to rise in prominence over the rest of the decade. HCC codes are tied to ICD-10 diagnosis codes. When combined with demographic information such as age or gender, those HCC codes are used to create a Risk Adjustment Factor (RAF) score for each patient. RAF scores can be used to predict costs, which were tied to payments. The higher your RAF scores, the more money you could bring in.

EHRs were also promoted as the solution to playing the RAF game. They were enhanced to remind physicians to document well so that HCC scores could be assigned and to make sure that they were documenting on those conditions at least annually. ICD-10 selection screens were enhanced to more prominently display codes that would lead to creation of a more complex patient picture.

Professional organizations also got into the game. My own organization published a series of “practice hacks” to encourage physicians to use team-based strategies to improve risk adjustment, essentially leveraging staff to massage documentation in the EHR with a goal of achieving higher payments. Sometimes this led to medical assistants or coders assigning additional codes as charts were reviewed following visits. Often these updates were not approved by a physician.

Practices that bet heavily on participation in Medicare Advantage plans became really good at playing these coding games. Technology made it easy to add highly specific billing codes to better capture patient complexity and to add those codes to the chart, even in visits where they might not have been actually managed.

As consulting clinicians, we could tell if organizations were playing these games. You would see a note for a straightforward visit for a self-limited illness and it would end up with six or eight diagnoses for chronic conditions, all with “continue current management” noted in the assessment and plan. As expected, payments to these organizations rose. However, when dealing with governmental payers, there’s always a piper who will get paid.

CMS is starting to play a mournful tune for many physicians and care delivery organizations with the release of a new rule that calls for organizations to pay back what could be billions of dollars in what CMS now considers overpayments. Auditors will be going after providers who may have indicated that patients were sicker than they actually were, or that they required higher levels of care than the charts can actually substantiate.

CMS won’t just be going after the overpayments, though. It will be using a revised Risk Adjustment Data Validation tool that uses the overpayments that are found during actual audits to extrapolate repayments for all the claims that were submitted during a given year for a given diagnostic subgroup or set of codes. The incorporation of extrapolated repayments applies to the 2018 plan year and subsequent payment periods.

CMS predicts that it will recover $479 million for the 2018 payment year alone, with a forecast of $4.7 billion in repayments over the next decade. An accompanying CMS press release quotes HHS Secretary Xavier Becerra as stating, “For years, federal watchdogs and outside experts have identified the Medicare Advantage program as one of the top management and performance challenges facing HHS, and today we are taking long overdue steps to conduct audits and recoup funds. These steps will make Medicare and the Medicare Advantage program stronger.”

CMS plans to focus its audit strategy on Medicare Advantage Organizations that have been “identified as being at the highest risk for improper payments.” I’ve been involved in consulting engagements at organizations that took fairly substantial liberties in their coding, so it will be interesting to see who winds up on the wall of shame first.

For the tech teams that support organizations that are heavily involved in Medicare Advantage, get ready to be on the looking for requests to look at current functionality and compare it to other features that may be available from EHR vendors or might be on the near-term horizon. It’s also an opportunity for startups to try to fill the gaps, making sure that care that is documented actually gets delivered, even if it’s through lower-cost third parties or use of technology.

For historically conservative organizations that might be quaking in their boots over this, it might lead to requests to restrict access to certain functionalities or workflows or to change the approval workflows when a coder or other personnel want to suggest that a visit’s coding should be changed.

This will also be a win for consulting organizations, who will now be out selling services to help organizations understand their audit risk and how to reduce it, as well as to help support them during the inevitable audit and request for repayments. It’s just one more example of how the complexity of the US healthcare system leads to gamesmanship as everyone tries to get a larger share of the money that makes up the healthcare pie.

Speaking of pie, this week’s pastry therapy includes Blueberry Sour Cream Scones, courtesy of King Arthur Baking. I got a little crazy with the powdered sugar drizzle, but they were the perfect addition to a chilly Sunday morning.

What’s your favorite weekend breakfast food? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: I Know You’re Not Thinking About Blocking Patient Data

I Know You’re Not Thinking About Blocking Patient Data
By Troy Bannister

Troy Bannister, MS is co-founder and CEO of Particle Health of New York, NY.

If you’ve worked in healthcare for 10+ years, this is probably the one hundredth time you’ll read an article about patients being unable to access their own medical data. Here’s why I think that trend might be coming to an end soon.

During healthcare’s slow digital transformation, care providers moved from fax machines to 1:1 digital pipelines to manual portal scraping tools, just to get the charts of their patients. In many instances, these processes are occurring in what are negatively referred to as data silos.

Technology solutions for improving healthcare data accessibility have evolved over the years. The legal requirements for complying with data accessibility have followed closely behind. Most clinicians are connected to nationwide interoperability networks through an EHR, theoretically giving them at least some ability to exchange patient records. Now, the US government has made it clear that their patients have the right to access their medical records in those same technically feasible ways.

Enter the Anti-Information Blocking Rule, the culmination of government efforts to legislate clinical data accessibility. Just like it sounds, its goal is to eliminate practices that interfere with the access, exchange, and use of electronic health information.

Whereas HIPAA has long made it clear that individuals can request their own records in paper format, information blocking rules theoretically give patients access to the same advanced Health Information Networks that care providers use to digitally exchange data.

The Office of the National Coordinator for Health IT (ONC), which sets the rules for information blocking, is working particularly hard to prevent cases where an individual is arbitrarily blocked from access to their own personal health information.

Despite ONC’s intentions, repercussions for information blocking were nonexistent. For that reason, healthcare organizations have continued to drag their feet when it comes to allowing patient data exports.

I’m here to spread the news that information blocking is coming to an end. As of October 2022, the HHS Office of the Inspector General began collecting reports of information blocking on its new online portal, with a mandate to issue fines of up to $1 million per violation. It is no longer in question that healthcare organizations will be held accountable unless they improve patients’ access to their own data.

Information blocking regulations don’t have any health IT loopholes. Providers can’t implement patient-only release delays, turn information into an unreadable format, or seek other ways to water down the rule’s provisions. Generally speaking, EHR vendors, Health Information Networks, and provider organizations must release the entire HIPAA-established designated records set of electronic health information (EHI) to a patient upon request.

In other words, if information exchange is doable for doctors, it’s doable for patients too. Information must be in the manner a patient initially requested. That could entail release over the same efficient digital channels, including APIs, that clinicians have access to.

The lack of access to clinical data at scale remains a core problem for US healthcare that can be linked to many of our system’s inefficiencies. These issues have a fundamental impact on healthcare costs, care quality, and ultimately on patient outcomes. Stakeholders cannot continue to wait for healthcare organizations to make their data-sharing preparations. Information blocking is no longer an acceptable policy, and yet we see it every day.

Ahead of the October 2022 information sharing deadline, there were concerted efforts from several healthcare organizations urging HHS to postpone enforcement, and not for the first time. However, regulators felt there was too much at stake to keep patients and digital health pioneers waiting any longer. Information blocking rules have survived multiple presidential administrations, and there’s bipartisan agreement that they are here to stay.

In reality, not every health system is at the same level of readiness when it comes to anti-information blocking compliance. Patient access to EHI has been a complicated task for many healthcare institutions, especially those that are not prepared to share patient data electronically. Many organizations are scrambling to find their own tools to support such efforts.

Fortunately, the technical challenges of anti-information blocking compliance are addressed by the 21st Century Cures Act, the law which led to information blocking rules in the first place.

The Cures Act aims to increase innovation by fostering an ecosystem that supports the development of data-driven applications. The rule also calls on the healthcare industry to adopt standardized APIs, which will help allow individuals access structured EHI using smartphone applications securely and easily. From new health tools to transferring records between providers, information blocking rules will help patients to take greater ownership of their care.

“In 2023, the vast majority of docs and hospitals will have FHIR APIs live,” Steven Posnack, the Deputy National Coordinator of ONC, predicted last month. With the ONC incentivizing this change, digital health organizations should urgently consider a single, comprehensive API that enables a seamless data sharing experience for institutions of all shapes and sizes. Integrating a pre-built API lets providers retrieve medical records in just a few clicks, eliminating reliance on faxes, portals, and other tired forms of data exchange.

For large organizations that support value-based care models, being able to work with patient health records at scale lets providers proactively address patient needs. This is especially critical when it comes to evaluating patients with chronic disease and comorbidities, leading to reduced readmissions. For example, on an ongoing basis, an API can help kidney care organizations that track glomerular filtration rate (GFR), endocrinologists who chart A1c values, and cancer care institutions that research case histories. In these instances, the ability to easily query patient health records allows healthcare providers to more efficiently and effectively care for their patient populations.

Moving ahead, digital organizations can look forward to obtaining data quickly and easily, powering tools that deliver more effective care. But it’s not just the data itself that matters; it’s how you get it. Leveraging advanced technology like a single API helps healthcare organizations and their patients tap into their health history when they need it.

Morning Headlines 2/6/23

Tallahassee Memorial Making Progress Managing IT Security Event

Tallahassee Memorial Hospital (FL) continues to operate using downtime procedures following “an IT security event” – reportedly a ransomware attack — that occurred late Thursday.

Duke Health enters deal to share de-identified patient data

Duke Health (NC) will sell de-identified patient data to drug companies via Nference, with which it may also create a for-profit spinoff business.

Athenahealth announces layoffs, possible office move

Athenahealth will lay off 178 employees, re-deploy 100 to more high-priority areas, and consider making changes to its office space in Watertown, MA.

Monday Morning Update 2/6/23

Top News

Democrats on the House Committee of Veterans’ Affairs are working on an alternative to last week’s two Republican-sponsored bills that would end the VA’s Oracle Cerner implementation and convert live sites back to VistA.

FedScoop cites sources who say that the proposal may involve changes that would affect all of the VA’s IT projects.

Reader Comments

From Krill Feeder: “Re: more slide decks from the J.P. Morgan Healthcare Conference. All vendors know, want, and fear the trademarked Gartner Magic Quadrant, which can have a strong impact on sales and corporate fate. Is NextGen Healthcare’s use of a similar graphic in a May 2022 investor deck without mentioning Gartner sketchy, smart marketing communications, both, or neither? And was its absence from the JPM event deck due to brevity constraints, Gartner objections, or evolving corporate spin?”

HIStalk Announcements and Requests

Nearly three-fourths of poll respondents who attended HIMSS22 will go to HIMSS23, while 80% of those who didn’t go to HIMSS22 will repeat their absence in April.

New poll to your right or here: Which ways have you used in the past year to send medical information to a clinician? I like nearly everything about my direct primary care doctor, but most of all I like being able to text, call, or email her directly without having to pierce the veil of inept, self-important gatekeepers (she practices alone).

Webinars

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

Acquisitions, Funding, Business, and Stock

Constellation Software delays posting its Q4 and annual reports, blaming the complexity of its May 2022 acquisition of the hospital and large physician practice business of Allscripts, which is now known as Altera Digital Health within Constellation’s N. Harris Computer Corporation business.

Announcements and Implementations

A regional network of OB-GYN practices and hospitals in New Jersey will collaborate to launch a statewide, value-based maternity care initiative that will be powered by the maternal digital tools of Wildflower Health.

Jefferson Center goes live on Netsmart’s MyHealthPointe consumer engagement platform for remote patient monitoring and engagement for behavioral health services. It has launched a pilot with assessments for medication check-in, patient health questionnaires, and weekly check-ins and developing new technology services for family support, text communication, wearables, and notifications.

Privacy and Security

Tallahassee Memorial Hospital diverts patients and cancels non-emergency procedures following “an IT security event” – reportedly a ransomware attack — that occurred late Thursday.

Duke Health will sell de-identified patient data to drug companies via Nference, with which it may also create a for-profit spinoff business. Bioethicists contacted by the local newspaper question whether it should be made more clear to patients that their data may be used to generate profit. Duke Health announced its relationship with NFerence on January 4, 2023, where it talked a lot about community health and research breakthroughs without mentioning that it was being paid for providing patient data.

Other

Colorado counties report being overwhelmed with 911 calls that start coming in every morning when the ski lifts open and skiers start falling, which sets off the fall detector in their Apple Watches. The interim director of Summit County’s emergency service, which responded to 185 false alarm calls from Watch-wearing skiers in a single week, says that “Apple needs to put in their own call center if this is a feature they want.” She also notes that operators rarely receive false 911 calls from Android phones. The Watch gives wearers 10 seconds to suppress the call before it starts dialing, but those who are wearing ski gear often don’t notice the warning and don’t respond to the 911 call-back, which requires responders to be dispatched. One county’s sheriff has instructed 911 operators to ignore all automated calls from ski slopes, reasoning that there’s nearly always someone around who would call 911 in a real emergency.

In Germany, a nurse in a top teaching hospital confesses to killing two elderly patients by overdosing them on sedatives (unintentionally, the nurse says) so they wouldn’t bother him while he suffered from a hangover. He admits that he did as little work as possible in his job, ignored patients, turned their wheelchairs toward the wall so they couldn’t talk to others, and found it easy to obtain sedatives because “in the hospital, they don’t pay much attention to this.” He has been charged with two counts of murder and six counts of attempted murder. Note: the newspaper article says without explanation that the man “pretended to be a nurse,” but they incorrectly translated the original report from a German publication – he really was a nurse, but working in an area where he had minimal qualifications.

Political anthropologist and medical resident Eric Reinhart, MD, PhD says in a New York Times opinion piece that physicians are getting burned out and leaving the profession not because of working conditions, but rather because they are “witnessing the slow death of American medical ideology” and feel complicit in putting profits over people. He says that the AMA convinced doctors to fight healthcare as a public service because it would threaten their autonomy and income, forcing doctors to lecture patients on personal health responsibility and their duty to avoid health risks that are mostly driven by economic disparity. He urges doctors to unionize, then demand universal healthcare.

Sponsor Updates

• Nordic releases a new podcast, “Making Rounds: The up and downside of disintermediation.”
• Everest Group names NTT Data a leader in its Healthcare Provider Digital Services PEAK Matrix Assessment 2023 report.
• Sectra publishes a new case study featuring St. Maria General Hospital in Belgium, “How to save time on implementation while creating brilliant workflows.”
• MGMA’s Insights Podcast features Surescripts Clinical Informatics Pharmacist and Manager of Product Performance Bri Palowitch.
• Talkdesk names Miles Ennis (Aspen Technology) SVP of sales for North America.
• WebPT wins three awards from TrustRadius in the categories of Best Feature Set, Best Value for the Price, and Best Relationship.

Blog Posts

• AHCA Population Health Summit Recap: Four Takeaways from Industry Experts (Netsmart)
• Cybersecurity Threats in Healthcare – Protect Your Patients and Business (Optimum Healthcare IT)
• Are You Ready to Shift Test-to-Treat into Hyperdrive? (OmniSys)
• 12 Steps of an EHR Roadmap and Why It’s Essential (Pivot Point Consulting)
• Real Risks Involved With Blockchain Technology (HealthTech Resources)
• Debunking Five Myths Healthcare Providers Have About AP Automation (Premier)
• Five steps to creating a competitive care delivery model with healthcare automation (Relatient)
• Finding the Why: Driving innovation in the cloud through process and workflow analysis (Tegria)
• Improving Patient Safety Through Unified Clinical Collaboration (TigerConnect)
• All Virtual Care and Care Management Must Be Grounded in Evidence (Wolters Kluwer Health)
• Controlling Hospital Expenses: No Margin for Error (Zynx Health)

Contacts

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

Morning Headlines 2/3/23

DrFirst Acquires Diagnotes Secure Messaging and Care Coordination Platform

DrFirst acquires the caregiver collaboration tools of Diagnotes.

HHS Office for Civil Rights Settles HIPAA Investigation with Arizona Hospital System Following Cybersecurity Hacking

Banner Health will pay $1.25 million to settle HHS OCR HIPAA charges from a 2016 data breach that involved the records of nearly 3 million patients.

Democrats working on ‘comprehensive’ VA electronic health record reform bill — sources

Congressional sources say Democrats are drafting a bill that would seek to reform the VA’s EHR modernization program, rather than scrapping it as proposed by some of their Republican counterparts.

Machine learning model predicts physician turnover

Yale researchers are using machine learning to predict physician turnover, using de-identified EHR and physician data to review the amount of time they are using EHRs, their patient volumes, and their ages and length of employment.

News 2/3/23

Top News

Prescription discount site GoodRx will pay $1.5 million to settle Federal Trade Commission charges that it shared the health data of users with advertisers using the Meta Pixel website user tracker.

This is significant because GoodRx is not a covered entity under HIPAA, but was charged under FTC’s Health Breach Notification Rule that covers any vendor of personal health records and third-party service providers. This is the first enforcement of the rule, which was created in 2009.

The company also agreed to obtain consent for any use of patient information, notify users whose information was exposed, demand that companies that received the information confirm its deletion in writing, create a privacy program, and commission a third-party privacy assessment.

GoodRx comments on the action:

• The issue was addressed nearly three years ago, before FTC stared its inquiry.
• The company admits no wrongdoing, but says the settlement avoids the cost of litigation.
• The advertising pixel, which GoodRx removed in early 2019, remains in common use, including by hospitals and the federal government.
• The company disputes the charge that it violated the Health Breach Notification Rule, saying that it believes its use of the advertising pixel was compliant.
• The only information that was shared was IP address and website URLs of content that the user reviewed, with confidentiality agreements in place.

A follow-up tweet from the author of the GoodRx article linked to above says that despite the permanent ban, GoodRx is still sending health data to advertisers. The company responded to his inquiry by insisting that it isn’t a problem because it is tracking such use as required by its new compliance obligations.

Reader Comments

From SeekingEmployment: “Re: Kyruus. Seventy people were let to Wednesday morning.” Unverified, but layoffs were reported by several now-former employees on LinkedIn. A company spokesperson responded to my inquiry by saying that while Kyruus is streamlining operations in integrating three organizations under the Kyruus umbrella, it will not comment on specific changes.

From Krill Feeder: “Re: more slide decks from the J.P. Morgan Healthcare Conference. Health Catalyst uses a happy-flywheel graphic, albeit without inclusion of the textual ‘virtuous circle’ claim that was used by aggressive e-commerce vendors. Is it persuasive?” The virtuous circle (or cycle), as the opposite of a vicious circle, refers to a recurring series of events in which each positively improves the effect of the next as a never-ending cycle of good news. Whether it is inevitable or aspirational probably depends on who is displaying it and for what reason. Company investor pitches are of the “never is heard a discouraging word” variety except for the 2-point font “forward-looking statements” section that is mostly ignored because it is as entirely negative as the rest of the slide deck is positive. Readers, what say you about virtuous circles and flywheels in particular and the use of descriptive graphics in general?

From Fry Salter: “Re: hospital websites taken down by Killnet hackers. The hospitals aren’t admitting that they were breached.” Probably because they weren’t. Taking a website offline via a DDoS attack is like spray-painting your name on a hospital’s billboard – the hospital IT folks can bring it back quickly to restore their few mission-important functions (like paying bills or scheduling appointments). It’s the technology equivalent of angry truck drivers clogging up highways to bring attention to their plight, except that most hospitals aren’t going to suffer much from lack of website availability. The pro-Russian Killnet group that is behind the attacks claims that it has exfiltrated data from unnamed hospitals, which would be a much more important development.

From Ibis: “Re: HIMSS Accelerate. It launched 18 months ago. I haven’t heard it mentioned by any colleagues even once.” All I see on the site is endless cross-posts from Healthcare IT News. It looks like it was expensive to develop and payoff seems minimal. I give HIMSS credit for trying something new, especially after the HIMSS20 cancellation brought it to its knees and raised sobering questions about the future of running profitable in-person conferences.

HIStalk Announcements and Requests

You may have had problems reaching us by our HIStalk email addresses over the past week due to two problems (warning: geek talk) that I hadn’t noticed with the server migration: (a) required changes to the SSL certificate and SMTP server name and port changes weren’t made; (b) the webhost didn’t update the email A record to point at the new server. Anyway, all appears to be fixed and working now.

Webinars

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

Acquisitions, Funding, Business, and Stock

DrFirst acquires the caregiver collaboration tools of Diagnotes.

Spotify founder and CEO Daniel Ek launches Neko Health, which will offer 15-minute, full-body diagnostic scans followed by a physician’s consultation for $164. The Sweden-based company was founded in 2018 as HJN Sverige prior to Ek’s investment.

A newly laid off employee of Seattle-based consulting firm Brightwork Health IT reports on LinkedIn that the company has closed. Several former employees have updated their profiles with a January 2023 job end date. One of those is Tabitha Lieberman, former president of the company’s EHR and healthcare applications business, who was laid off after just eight months on the job after a long career with Providence St. Joseph Health. She says on LinkedIn that “Brightwork will continue, but in a smaller form.”

Business Insider lists the 15 formerly highest-valuation healthcare startups, most of which haven’t raised funds lately and some of which may struggle to find operating cash:

1. VillageMD – $16 billion valuation (primary care operator).
2. Devoted Health – $15 billion (health insurance).
3. Tempus Labs – $10 billion (precision medicine software).
4. Datavant – $7 billion (health data software).
5. Ro – $7 billion (prescriptions for erectile dysfunction and hair loss, telehealth for skincare).
6. Cityblock Health — $6 billion (Medicaid clinics).
7. Hinge Health – $6 billion (virtual physical therapy and surgical rebab).
8. Lyra Health – $6 billion (mental health services for employers).
9. Cerebral – $5 billion (therapy and prescriptions for ADHD and depression).
10. Color — $5 billion (genetic testing for health risks).
11. Olive – $4 billion (services automation).
12. Noom – $4 billion (weight loss).
13. Commure – $4 billion (healthcare data integration).
14. Everly Health – $3 billion (home lab testing).
15. Komodo Health –- $3 billion (healthcare data analysis).

Health IT investor John Gorman predicts “an impending extinction-level event” for many early and mid-stage health tech companies that will start late this year, as most startups raised two years of cash in 2021 and 2022, cut their burn rate to extend their runway, but still have less than 12 months to try raising again in a difficult market or either selling the company or merging. He advises his own firm’s portfolio companies:

• Raise money now before the rush later this year.
• Cut burn rate decisively, although recognizing that R&D and sales are must-haves.
• Focus on survival rather than valuation.
• Bring in veteran C-suite operators since launch teams often struggle in difficult environments.
• Go on offense to gain market share while competitors are struggling.
• Consider mergers and joint ventures to better compete on RFPs.

Sales

• Beacon Health System chooses Biofourmis for remote patient monitoring technology for its eight hospitals, initially focusing on congestive heart failure and COPD.
• In Canada, the Nova Scotia government will implement Oracle Cerner in a 10-year, $275 million project.
• Floyd County Medical Center (IA) upgrades to Meditech Expanse with assistance from Healthcare Triangle.
• Atlanta Women’s Health Group chooses EClinicalWorks and Healow.
• Wellity chooses EClinicalWorks and Healow.
• Samaritan Health Services will replace its legacy PACS with Visage 7 Enterprise Imaging Platform in an eight-year, $9 million agreement.

People

Johns Hopkins University and Medicine hires Richard Mendola, PhD, MBA (Emory University) as VP/CIO.

Bhaskar Sambasivan, MEng, CEO of CitiusTech for 16 months, posts on LinkedIn that he will resign once a replacement is found.

Scott Frederick, RN, MSHI (RPM Advisory Group) joins newly launched vestibular rehabilitation remote monitoring platform vendor TheraVista Health as CEO.

Announcements and Implementations

Azara Healthcare launches a cost and utilization application for its population health platform.

Clew Medical launches a program to convert users of Philips EICU software to its virtual ICU platform in 12 weeks, including FDA-cleared predictive models, a workflow platform, and integration with EHR, monitoring devices, and AV equipment. Industry long-timer Paul Roscoe came on as CEO in November 2022.

Yale researchers are using machine learning to predict physician turnover, using de-identified EHR and physician data to review the amount of time they are using EHRs, their patient volumes, and their ages and length of employment. The small study of 319 physicians in a single health system correctly predicted departures 97% of the time. The authors note as an example that the risk of departure was highest for doctors between the ages of 45 to 64. They also noted that higher levels of EHR documentation time was associated with a lower departure risk for doctors who were hired within the past 10 years,  but a higher risk for longer-employed doctors.

Government and Politics

A press update indicates that HHS will recognize the first set of organizations that will be approved as QHINs under TEFCA on Monday, February 13.

Banner Health will pay $1.25 million to settle HHS OCR HIPAA charges from a 2016 data breach that involved the records of nearly 3 million patients.

Other

A woman is billed $14,000 for her newborn’s NICU stay at in-network Northwestern Medicine Prentice Women’s Hospital because that hospital covers using doctors from Lurie Children’s Hospital – which is connected to Prentice Women’s via a walkway – which was not in her insurer’s network. Lurie turned her balance over to collections, but wouldn’t talk to reporter about why, citing HIPAA even though the woman signed a release. Faced with media coverage, Lurie suddenly decided after months that she owned nothing after all. Lurie denied knowledge of a 2011 state law that prohibits billing out-of-network rates for certain types of doctors, including neonatologists, and the state attorney general’s office says it has never enforced it.

Sponsor Updates

• CTG earns AWS Service Delivery designation for the Amazon Connect cloud-based contact center service.
• Ellkay publishes a new client success story, “Seattle Children’s: The Value of Choosing the Right Data Management Partner.”
• Fortified Health Security names George Srour (Critical Insight) regional sales director.
• Nordic publishes DocTalk Ep. 202, “The Marvel of In-House Business Intelligence.”
• Juniper Networks expands its global Juniper Partner Advantage Program with a host of new updates in 2023.
• Healthtech Consultants, a Nordic Global company, earns the top performance score in KLAS’s first report on EMR consulting services in Canada.
• Pennsylvania’s HAPevolve will offer hospitals the care transition platform of WellSky-owned CarePort.
• Meditech AVP Cathy Turner, BSN, RN receives the 2023 HIMSS Changemaker in Health Award.

Blog Posts

• Patient Engagement as a Strategic Priority: How to Get There, and Why You Should (Get Well)
• Why Cloud is Ideal for Healthcare Backup and Disaster Recovery (Healthcare Triangle)
• EMR Technology: Closing the Communication Gap Between Patients and Providers (HealthTech Resources)
• Increasing access to behavioral health resources (Nordic)
• With TEFCA, Interoperability in the United States Launches Ahead (InterSystems)
• 5 things to know: IMO’s January clinical terminology release (Intelligent Medical Objects)
• Three Ways Medical Groups Can Leverage Digital Self-Service to Drive Growth (Kyruus)
• The Front-End Steps to RCM Optimization (Medhost)
• Identify and Overcome 5 Common Patient Engagement Challenges in Outpatient Rehab Therapy (Net Health)
• The Stand-Alone Mental Health App is a Dead End (NeuroFlow)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Contact us.

EPtalk by Dr. Jayne 2/2/23

I don’t change the clock on my laptop when I travel because it’s just easier for me to continue to operate in my home time zone. I also display multiple time zones on my Outlook calendar even when I’m at home, so it’s not difficult for me to sort out the local time from my usual time.

In the past, I have found the Microsoft Viva employee engagement platform to be mildly annoying, but last week it decided to tell me to stop burning the midnight oil based on what it thought was late night laptop usage. For those of you who haven’t experienced Viva, it also tells you things you already knew, like how busy your calendar is and that there isn’t any time between meetings for you to get work done.

According to the website, Microsoft charges extra for these insights. I wonder how many employees actually think they are beneficial. Employers should take note of these add-ons and make sure they are providing benefit. I know a lot of employees that would rather receive a Starbucks gift card every couple of months for the same price as “engagement” communications that make us feel busier than we already feel.

I have always found public health informatics to be fascinating, but I haven’t had the opportunity work in the field beyond the population health management that is done by CMIOs. I was excited to see this write-up about reorganization at the Centers for Disease Control and Prevention (CDC). Director Rochelle Walensky, MD, MPH has announced the creation of new offices, including an Office of Health Equity and an Office of Public Health Data, Surveillance, and Technology. The latter will be charged with creating the infrastructure needed to solve the mess of federal, state, and local public health data management.

Walensky stated that the 75-year-old organization “did not reliably meet expectations” during the COVID pandemic, necessitating the reorganization. Those of us that worked the front lines at the beginning of the pandemic still feel acutely the fear and disillusionment we felt when the CDC told us we could wear bandanas as masks if our employers couldn’t provide appropriate personal protective equipment. Many providers have lost faith in the CDC and it will take years for it to attempt to recover to the chaos and confusion of the pandemic and the role the agency played in all of it.

Organizations are having to get creative to deal with ongoing nursing shortages, and I was interested to see that Trinity Health will be piloting the use of virtual nurses to care for hospitalized patients. The creation of the virtual roles provides an opportunity for nurses to continue practicing when they are unable or unwilling to continue in demanding bedside care roles. The so-called Virtual Connected Care Program was piloted at Trinity Health Oakland Hospital in Pontiac, MI during January 2022, with an update in June 2022.

Trinity is creating nursing teams with three nurses: one direct care nurse, one virtual nurse, and one licensed practical nurse. Virtual nurses will be used to make sure patients and families understand the daily care plan and manage patient concerns that might otherwise be reported through a call light or call bell system. Virtual nurses may also provide discharge teaching and help coordinate care with other professionals.

Speaking of virtual care, the Centers for Medicare & Medicaid Services (CMS) plans to add a telehealth indicator to clinician profile pages on its Medicare Care Compare and Provider Data Catalog sites. The Telehealth Indicator is designed to help patients and their caregivers identify providers who deliver telehealth services, as indicated by a low-key graphic near the physician’s name in their listing. The indicator will appear for clinicians billing telehealth visits using Point of Service codes 02 and 10 or using modifier -95 on claims. They intend to use a six-month lookback period and refresh the indicator bi-monthly, along with other provider director information. The code will appear only on individual clinician profile pages, not pages for groups.

This announcement comes at the same time as one about a new federal telehealth program designed to treat COVID-19 patients at home. The new Home Test to Treat program from the National Institutes of Health will allow patients in select communities to receive home rapid test kits, telehealth consultations, and antiviral treatments, all from the comfort of their homes. The program will launch in Berks County, PA, which has up to 8,000 eligible residents. Telehealth services will be provided by EMed and UMass Chan Medical School will work with the provider organization to analyze data to determine what kind of impact the program has on patient outcomes.

I’ve been party to several discussions around the virtual water cooler about hospitals and healthcare delivery organizations contacting patients to recruit them to the donor ranks of associated healthcare foundations and endowments. In some reports, physicians have even been asked to approach patients while they are still hospitalized, laying the groundwork for future donations. I haven’t run across this personally (although I did care for a number of patients in my hospital’s VIP wing during medical school) until I started getting solicited after a series of visits at the local academic medical center. The messaging isn’t even remotely subtle. It makes clear suggestions that patients can “express their gratitude” and “inspire a healthier future” by making donations in the name of care team members who participated in their treatments.

The most recent mailing provided tips on how to solicit donations through an obituary, along with instructions for employer matching and estate planning. These were part of an ultra-glossy magazine that I’m sure wasn’t cheap to produce or distribute.

As a physician, I don’t like the idea of someone trying to coerce my patients into making donations in my honor, and I definitely dislike the concept of approaching people when they are vulnerable. Not to mention that these mailings might be arriving at homes where recent treatments weren’t successful, and I’m sure not all family members would appreciate such a delivery. The hospital in question is sitting on billions of dollars that could certainly be released to the community more generously than is currently happening, so they won’t be getting any of my donation dollars right now.

What do you think of hospitals and health systems soliciting patients and families for donations? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 2/2/23

GoodRx illegally shared health data with tech giants to target ads, government alleges

Prescription savings company GoodRx will pay $1.5 million to settle FTC allegations that it shared the sensitive, personal health information of its users with third-party sites like Google and Facebook without their knowledge.

Province signs deal to bring electronic health records to Nova Scotia

Oracle Cerner wins a 10-year, $275 million contract to design, build, and roll out an EHR across Nova Scotia.

Iowa telehealth startup OpenLoop plans massive downtown Des Moines expansion

White label telehealth company OpenLoop Health expands its headquarters in Des Moines, IA to accommodate growth from 25 to 175 employees in the last year, as well as plans to hire several hundred more in 2023.

HIStalk Interviews Angie Franks, CEO, About

Angie Franks is CEO of About of St. Paul, MN.

Tell me about yourself and the company.

I’ve been in healthcare technology for 33 years, so this is definitely my passion. I have spent the last six years with About Healthcare, formerly Central Logic. We match the demand for acute and post-acute services with the optimal setting of care to get patients to the best place for the care that they need.

How do EHRs fall short in care coordination as health systems expand their range of services and geographic coverage?

EMRs do many things well. But when you move patients across settings of care, or need to optimize the resources inside of your health system by pulling together different silos and different systems, there’s a lot of data that’s not in the EMR that becomes important and instrumental for making decisions around hospital operations and then executing on that. The EMR is more suited for capturing specific data about a patient, ordering tests, getting those results back, and then billing the insurance company.

When you are making decisions about where a patient should go for the care that they need, how to get them there, choosing the best physician, and then executing on those logistics, you are pulling from data that is not in the EMR. You need information that is in a lot of systems. What we see is that hospitals have lots of silos. They don’t work well as a system of care when it comes to the operations and the logistics. That’s where we focus, which involves connecting to, talking with, and interoperating with the EMR as well as a bunch of other systems.

The data inside of an EMR is impressive, especially when you think about the clinical data and all the work that organizations like Epic can do with disease and tracking all of this clinical information. When you look at it from an operational lens and a growth or a strategy lens, none of these EMRs capture and track this data in a way that is useful to strategy and operations. As a result, many health system leaders don’t look at information even though it could change how they operate as a business. That’s a real benefit of looking at your operations differently than how you look at clinical pathways and the billing systems. You get data out of these tools that inform decisions that you make as a health system executive team that have a impact on your bottom line. Data is an important area of focus for us over the long term.

Bed management and bed visibility became important during the pandemic. Will that have a permanent impact on health system operations?

One of the things that the pandemic showed is how silos create bottlenecks in the organization that prevent patients from getting access to the care that they need. Getting somebody out of the acute bed and getting them to a post-acute setting by doing that electronically and in interoperability setting instead of creating a bottleneck for patients who were trying to get in the front door and into a bed of a particular health system. Those bottlenecks exist all over our care delivery system and impact access to care.

We have gained a lot more visibility into the bottlenecks. Health system EDs were overrun during the pandemic and they couldn’t service all those patients, but maybe a hospital down the street had capacity, but nobody knew about it. Even when we put the USS Comfort and 1,100 beds in the harbor inside of New York City, we placed only 107 patients there. It wasn’t because there wasn’t demand for all of the beds. It was because there wasn’t an ability to access them, to communicate and efficiently see what was available, and then match the patient and move them. That speaks to the need for more interoperability in our healthcare IT ecosystem. We have a long way to go.

How well are health systems operating transfer centers and how do they fit into their business strategy?

It is an important front door for health systems. Acute settings have three entry points — the emergency department, scheduled procedures such as the operating room, and patient transfers. Patient transfers are least known and understood. 

A lot of health system leaders and executives may not have spent much time thinking about access points and access channels. They have business development teams and people who are responsible. It’s almost like a sales channel, but putting in place a conscious strategy and an infrastructure to capture more of the demand that is inside of the geographic service area that a health system serves and that net new patient demand for that hospital system. Those are lucrative patients, and every health system wants to capture more market share and then keep those patients inside of their network.

It is competitive for those patients. When you have an optimally functioning transfer center, you capture more of that demand. You impact your top line with revenue and your bottom line with improved margins. It is predictable. You can start achieving an ROI quickly if you invest the time. It’s not a technology implementation. Technology is important for enabling consistency and execution of a business process, but it is changing the way a health system operates and changing the way they utilize all of their resources for matching that patient demand with the right setting of care. If you just defer your front door to the ED, you pretty much get whoever walks in the door at whatever facility they show up at.

Do patients and physicians agree with a health system’s definition and approach to what they call “patient leakage?”

There will always be an amount of leakage. There are appropriate times where the patient is in a setting of care and they need to be somewhere else, which results in a transfer. They need a higher level of service or acuity. That could show up on a report as leakage. You had the patient, then you lost them. They leaked and they went to another system. Some amount of leakage will always happen and that is appropriate.

Hospital operators need to focus on when there is leakage that didn’t need to be. A patient comes into your emergency department, you offer those services, you have capacity, but it was hard to get that patient moved out of the ED into the right bed. It was easier for that ED doc to call their buddy, who is a cardiologist down the road, and move that patient into a different health system. That’s a costly leakage problem, and it happens every day.

It is costly to let patients just walk out the door instead of helping coordinate follow-on services or referrals to a specialist as they take that next step in their care journey. When you leave it up to the patient to just figure it out, it’s not a great experience for the patient, but it also results in a lot of leakage for the health system. It is an important metric to look at, calculate, and focus on, because it has implications to revenue and operationally and it can be a bad experience for the patients as well.

How are health systems changing their business model to address new competitors, telehealth, and new generations of consumers who would rather use urgent care?

What I see health systems doing over the last couple of years, and the pandemic was instrumental in this, is talking about operating as one system of care. How they use all of their capabilities to care for the patients in the community, and do that more efficiently and in a more streamlined manner. The conversations that are happening are really good.

I could give you many examples of what health systems are focusing on. We help them think about the acute and the post-acute patients. That is a  small population of their overall patients and the communities that they serve, but hospitals and health systems have an enormous amount of competition for those healthy patients and the outpatient visits, whether it’s CVS, One Medical, or even Dollar General in some smaller communities. The margin erosion and the patient attrition for services that were maybe more easily captured in the past is an issue, and that revenue has to be replaced some other way.

Health systems are figuring out their population health strategies, figuring out their access channels how to deliver service not only to the patients, but to their referring community. Managing those referring networks as an important growth channel is a different way of thinking. I’m seeing more conversations about that today than I have in the past.

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

I see our company continuing to focus on solving this problem and helping health systems operate as one system of care, doing that by connecting their silos and disconnected systems into a streamlined process so that they can operate more effectively. It is a passion of mine. For everybody who works here at our company, this is what we jump out of bed to do every day. As I’ve gotten older, I see my parents needing to access healthcare services in different ways, and it sure gives you a lens on the importance and the mission orientation of the work that we do. We are going to continue focusing on this. It’s a big problem, and we are in the early innings of the game.