Curbside Consult with Dr. Jayne 12/23/24

I enjoyed Mr. H’s recent survey asking, “Which winter holiday is most important to you?” It came at a time when someone had sent me a meme about how to best leverage holidays in 2025 for long-weekend travel, and my first thought about it was “yeah, if you’re not a frontline healthcare provider.”

In my first job as an employed physician, we received the minimum holidays: New Year’s Day, Memorial Day, Independence Day, Labor Day, Thanksgiving, and Christmas Day. The rest of the time, I was expected to have my office open and available to see patients, regardless of whether my entire staff wanted to take time off or not. There wasn’t any such thing as flexible holidays and the physicians had no autonomy to modify the schedules in a way that suited them. I’m glad to see that many organizations have evolved from this approach, although I’m sure there are some that still only recognize a minimum number of holidays.

When I moved from traditional primary care into the emergency department, we were assigned to Holiday Track A or Holiday Track B, which alternated years and made it clear which holidays you would be working each year. Honestly, it made things more straightforward and I enjoyed the predictability of the schedule. I suppose that’s why I selected New Year’s Day as my survey response. I’m nothing if not predictable, and I enjoy starting the year with fresh new spreadsheets to track my household budget, fitness goals, and various other things. I use some online tools as well, but there’s just something about seeing my data in the same format I’ve been using since 2009 before wearables and linked software really changed the game.

If your favorite holidays involve snow and you’re a physician, Epic is hiring for its physician team. It’s a relatively small team and I’m not sure if someone is leaving or if they’re expanding, but the job posting was shared in one of my online physician forums. Unlike other physician informaticist job postings I’ve seen over the years, this one doesn’t have a lot of detail as to the actual job description. It focuses on the positive aspects of working for Epic, including the campus, the food, and Epic’s sabbatical program for workers who stay at least five years. The posting received some scathing reviews on the forum where it was shared, primarily because the requirements specify “MD with several years of inpatient and/or outpatient experience” which raised the hackles of physicians who are DOs. I’m not sure if that’s an oversight or if Epic believes the MD credential is more relevant to the work. Others pointed out the fact that it requires COVID-19 vaccination, which isn’t something you often see in job postings in 2024. Let’s just say it was a lively discussion.

Although some people love the holiday shopping experience, I’m not one of them, so I made sure to time my Target run for 10 p.m., which seemed to work out well. In addition to the bathmat that I was in search of, I was surprised to see Oura rings for sale. It’s the first time I’ve seen them in person and the finishes available seemed nice. The store was sold out of sizing kits, so I’m guessing it’s likely to be a popular holiday gift.

Whoever does the merchandising at my local store has a sense of humor. There was an entire endcap display of “things you need to make fudge” but without any kind of signage or display. I only recognized what was going on with those particular shelves because I had just made a batch. I’m not sure others would make the connection. The Christmas section of the store was picked almost clean, but there were still a few things left in the Hanukkah section. I didn’t see specific areas for any of the other winter holidays and observances. Based on my recent mood, if they had anything for Festivus I would likely have considered it.

I wrote a couple of weeks ago about my decision to be part of a clinical trial, and I’ve just completed my first round of testing. Although completing the tests was straightforward, I’ve been told to expect to wait four to six weeks for release of my results. That experience is a departure from what we’ve all become used to over the last decade, with near-instant release of most labs performed locally. Even those that are send-out or complicated typically result within a week or so, unless they’re something really unusual.

It’s a good reminder of the progress we’ve made in healthcare, even when a lot of the other aspects of care delivery seem to be undesirable. Once the test results are back I’ll find out which of the screening interventions I’m assigned to. Not sure how long that piece will take, but at least it gives me something to look forward to in my email other than solicitations by other LinkedIn members looking to sell me something.

I receive hundreds of press releases each week and I admit I probably miss a lot of interesting news because there is just so much junk out there. I did enjoy reading a recent release that covered Providence Mission Hospital’s efforts to provide concierge services as an employee benefit. The goal is “to make life easier for hospital staff by helping them tackle everyday tasks so they can focus on what they do best: providing exceptional care to patients.” Services offered include running errands, scheduling personal appointments, arranging travel, shopping and gift wrapping, and managing household tasks. I’m sure the devil is in the details, but this sounds like a great benefit to me. I know I’m not the only one that puts off straightforward tasks because I don’t have the time to make phone calls during the day and can’t make appointments online – things like having my car’s tires rotated or scheduling a chimney inspection.

I know a lot of corporate employers offer conveniences at the office to increase employee willingness to work long hours, including dry cleaning services as well as discounted meals, gyms, and fitness classes. I’m wondering how many offer this kind of personal concierge service and how it’s working out. Does your employer offer unique benefits? Which is your favorite? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Erine Gray, CEO, Findhelp

Erine Gray, MPA is founder and CEO of Findhelp. 

Tell me about yourself and the company

Findhelp is 14 years old, based in Austin, Texas. We focus on simplifying the way that people find and enroll in social services in the United States.

Our company’s history began with the realization that understanding your options in times of need is not easy. We started by building a search engine that allows people to put in their ZIP code and find available social services, such as affordable housing, food, or even programs that are available through public entities, such as the federal government and state government like Medicaid, Temporary Assistance for Needy Families, Children’s Health Insurance Program, and the Supplemental Nutrition Assistance Program. Our platform supports many of the 1115 waiver programs in the United States, which are experimenting with allowing social services to be paid for with Medicaid dollars. We are doing that work in New York, California, and in other states throughout the United States and plan to be doing more in the coming years. 

The goal is that people will find those services and then click a few buttons to apply and get enrolled if they qualify. Once they do, we’re the largest closed-loop referral platform that allows people to circle back and say, yes, I did receive these benefits. 

Our customers hope to see whether these interventions improve long-term care. We are a full-stack platform for allowing that to happen. They will be able to see what actually occurred from the very beginning, when they were searching Findhelp.org to find a program, to the very end, once they’ve received the program and interacted with their health plan, the health system, or other community organizations. The goal is to study that information over time with the hope that some of these interventions will help them live a healthier life and get through their difficult moments. 

How has the safety net changed recently and how might it change going forward?

Generally it hasn’t changed in the last probably 50 years since the Great Society under Lyndon Johnson. My theory is that it has only changed at the margins. There have been two enormous events with respect to the American safety net. One is the New Deal under FDR and then the Great Society under Lyndon Johnson, where he created all sorts of new programs such as affordable housing programs, expansions, and SNAP benefits and things like that. 

For the most part, the safety net stayed the same. It’s only lately where people are beginning to think about, is this an efficient safety net? After indexing every program in the United States, I believe that the safety net is inefficient, with large cities hosting thousands of redundant non-profits. I think the safety net will see more consolidation among these non-profits as technology makes it easier. 

You’re already beginning to see that consolidation with mergers of different community-based organizations, different United Ways throughout the country. There was one within the last couple of years here in Austin between two of the neighboring United Ways. For those who don’t know, United Way is a great organization that works on collective impact by looking at the entire community and looking at the entire landscape of organizations that serve others. 

What I also think will change at this pivotal point in the future is that the federal government is experimenting with allowing social services to be paid for with Medicaid dollars. But the reality is that it’s still a theory, meaning that despite what vendors may tell you, there isn’t overwhelming evidence quite yet, at least through academic studies, that make the case that these interventions will drive down the cost of healthcare. There are so many variables that it’s hard to manage. It’s hard to study that and there’s not a ton of information.

My gut feeling is that allowing states to have more flexibility around what they spend their Medicaid dollars on will ultimately result in better health outcomes, but it’s going to take years to prove that. If we can prove that, then we as a society, or at least the states, will have the ability to decide what interventions are more relevant. For example, if a Texas Medicaid member is unhealthy and they can’t use their air conditioner because it’s broken or they can’t afford their electric bill, an intervention might make sense, if it’s medically necessary, to pay for that electric bill or that air conditioner repair with the dollars that came out of a Medicaid budget. That might be a different intervention in Maine, where transportation is a big issue, getting to the doctor is a challenge, and those Medicaid dollars could be used in Maine. 

I hope that with the change in administration, more flexibility can be given to the states to allow for them to design their own interventions with some flexibility of using Medicaid dollars to design these social drivers of health interventions that make a lot more sense at a local level. To allow local care coordinators to decide that they will help this family with the rides to the doctor or help with their electric bill based on everything that they see about the person. I’m also optimistic about the future that less regulation at the federal level of the Medicaid program, in this case, will lead to more innovation in the future. I feel like the states probably want that flexibility and are competent enough to administer innovative programs these days.

How are health systems using social determinants of health and what role do they play in addressing the needs that they might identify?

We work with a couple of hundred health systems nationwide. They have different requirements to look after the social needs of their patients. In some cases, those are driven by federal and state requirements. In some cases, those are driven by risk-sharing agreements with payers. Their goal is to make sure that the patient gets healthy and doesn’t consume unnecessary medical services.

Our customers integrate our platform into their system of record, whether it be Epic, Cerner, EClinicalWorks, or NextGen. We are integrated with hundreds of organizations so that they don’t have to do double data entry. We have the patient context when they click into our platform. We utilize SMART on FHIR integrations and some deeper API-based integrations. They want to be able to, within their medical record,  make a referral to one of the social service programs that we index and that we contract with. To be able to make those outbound referrals and also understand what happened after the person received those benefits. That allows them to have a whole picture of what’s going on with the person from right within their electronic health record. 

Different hospitals are doing different things. For example, Boston Medical Center has been innovative over the last five years that we have worked together by implementing all sorts of initiatives. Some are going as far as putting food pantries into their systems. Others are building community gardens. Others are contracting with non-profits to provide additional services for their patients. We’re the software platform that integrates with that and helps make those types of interventions happen.

Do the social services organizations receive the SDOH information in a standardized format and then have it integrated with the systems that they use?

We have indexed about 550,000 distinct program locations in the United States. These are all physical locations that provide social services to people in need. Probably the most common system of record is still on paper. Second to that is Excel spreadsheets or Google spreadsheets. 

There’s a long tail of proper case management systems that non-profits use to run their organization. One of the more popular ones is Salesforce. They have a program where they’ll provide up to nine licenses to non-profits that sign up for it. We’re building integrations on that side as well. We have built several integrations, but the critical mass is still in spreadsheets and on paper for tracking that information.

There remains an enormous opportunity to educate these community-based organizations and bring them onto our platform. We will build integrations with these non-profit systems of record, but when they don’t have one and they haven’t made that investment, we provide a free platform that they can use. We’ve done that ever since the beginning of our business, so we have been able to recruit many to come over and use our platform. 

It’s a big investment area for us going forward. In fact, just this spring, we acquired a company called Kiip. It’s a case management system that is designed for these community-based organizations to be their system of record. We have since launched in the fall a fully integrated version of Kiip that utilizes Findhelp’s network through our APIs to be able to use the Kiip case management solution, make those searches to find services, and make those outbound electronic referrals that hit the Findhelp network. The information is then stored within Kiip. 

We offer this for free, with an optional premium version for non-profits. But because there wasn’t a critical mass case management solution, that was an opportunity for us to create one and to put that out there in the world. We also see this as something that isn’t exclusive to the Findhelp network. If there are other networks that exchange electronic referrals for the purposes of social determinants of health, we think the Kiip solution can be utilized to recognize referrals in other networks.

In the long run, I see this going like the cell phone networks, meaning that you can use your Android phone to connect to a different network if you want to. The same thing should be happening in our space to eliminate the need for one monolith. We can lead by example to provide a system of record to these non-profits and then allow them to add as many networks as they would like so that they can see electronic referrals in one consolidated location. 

The challenge is that we have to find the motivation of the community-based organization. Why should they close the loop on referrals? Some might say that it would help the hospital or it would help the health plan in their community, but that motivation just isn’t enough. It takes good software design to build the closing of the loop into the workflow for reasons that the non-profits want themselves. 

We have a lead user experience designer named Phil Robinson, a great member of the team, who focuses on understanding the motivations of these non-profits. A big part of what they’re motivated by is having good, clean records of what’s happening. Building the loop closure into that workflow so that they have accurate reports that they can use reports for fundraising, for running their operation, is a much better motivator for the non-profits. That’s where we see a huge opportunity, not only in the short term, but in the long term, to have somebody on the other end of that referral closing the loop on that for their own reasons. We expect to see even more growth in that area. 

Who benefits from that? The hospitals benefit from that because they will see a higher closed loop closure rate. They will get information that would allow them to establish better interventions in the long run. If they see that a community-based organization is active in their city, they might want to work together and maybe even reimburse that non-profit for some of the work that they’re doing because it benefits their patients in the long run.

Findhelp is trying to solve the information problem that exists. A big part of that is bubbling up that information so that smarter people than I can do something with it. We believe the key lies in providing good user experiences, Not only at the hospital and plan level, but also at the non-profit level. 

Will AI affect what you do or how you do it?

I’m definitely not an expert on the subject, but I think that the number one benefit that AI can have, at least in our world, is to improve the workflow of the user.

I’ll give you a quick example. Our customers are continually telling us about changes in their community that they discover while using our software. They might discover that a program that serves people who are looking for affordable housing has changed their hours of operation. We built something called the Program Manager that allows our customers to make those updates directly. We have a curation team in-house here in Austin and we work together on those situations. But what we’re building into that application is the ability to proactively suggest those changes and to correct errors in real time.

We use a taxonomy called the Open Eligibility taxonomy. That’s a free and open source version that we built and put out there in the world. A user may not understand the tags as well as some of our employees might understand the tags, so we can build AI models that look at the descriptions of the programs and say, I think this tag is probably more accurate, would you like to select it?

Those are the tiny things around the edges that are going to make for a better workflow in the long run, which makes for a better data set in the long run. That will be an important part of decreasing the amount of time that our customers use to interact with our systems.

Another area is using AI models to help our customers understand which patients might need an earlier intervention. We have a lot of data about a patient, coupled with data that’s in eligibility files with the payers and other systems. When you have a large number of patients that you’ve made outbound referrals for, we learn a little bit of information about what occurred with those referrals. If I’m the case manager sitting in front of my computer the next day, sometimes it can be overwhelming. Building features that allow you to see that Hannah could probably use a phone call right now. That’s where we see our organization using AI to increase or improve on the user experience of our users. There’s probably many more that are there. 

As we uncover the use of AI for looking at large data sets, I’m interested in that in the long run.  We just crossed 50 million users on Findhelp, and over 20 million of those users were within the last year. We want to be able to study that data with the help of some of these models to understand trends that may be happening in a more regional level at the community. It would be more macro, but that’s another area where we think there’s a lot of possibility. The challenge is deciding which ones to focus on first. Right now we are focused on making our workflow better and better by using some of these technologies in the future.

What will affect company’s strategy over the next few years?

The number one thing that affects our strategy is that we are trying to build a new safety net, starting from scratch. When Social Security was first enacted, the business problem that came across was there was not a unique identifier for identifying every American. Hence, the Social Security number came out. If you fast forward to unemployment insurance, it was hard to come up with a rate for unemployment insurance because there wasn’t a centralized way of storing people who were unemployed. 

Information problems have presented themselves throughout our history. That same information problem is happening today with respect to organizing the safety net. I was reading this book by Henry Seager called “Social Insurance: A Program of Social Reform.” He wrote, “It is impossible, with our present knowledge, to estimate the extent to which illness and death are preventable.”  That was written in 1910. What is pretty amazing is that because of the work of a lot of your readers, that’s no longer a true statement. Today, that information has been digitized. The information problem that prevented people from estimating the extent to which these illnesses are preventable has been solved. 

The biggest thing facing us going forward is, how do we do the same thing for the social services sector? Our contribution to the world will be that every American understands what their options are in their time of need, but also trying to ensure that as many non-profits as possible have the tools that they need to solve some of these problems. Just like we’ve solved the unique identifier issue with respect to Social Security, your readers have solved the electronic medical records. Making them electronic in the first place was an amazing feat. We would like to do the same thing for the social services world.

Morning Headlines 12/23/24

US hospital operator Ascension says 5.6 million affected in medical data breach in May

The 140-bed health system’s May ransomware attack compromised the medical and insurance information of 5.6 million people.

Commure Acquires Memora Health, a Digital Care Navigation Platform, to Enhance Intelligent Care Navigation

Commure says that its acquisition of Memora Health will strengthen its suite of patient engagement, clinical documentation, revenue cycle management, and RTLS solutions

Medical Records Co. Wants Rival’s Antitrust Suit Tossed

Epic asks a federal court to dismiss Particle Health’s antitrust lawsuit, saying that it’s a revenge lawsuit that fails to prove anticompetitive behavior.

VA begins early-stage planning for the next Federal Electronic Health Record rollout in mid-2026, continues ongoing improvement efforts at existing sites

Four Michigan facilities will go live on Oracle Health in 2026.

Monday Morning Update 12/23/24

Top News

Ascension tells Maine’s attorney general that its May 8 ransomware attack exposed the medical and insurance information of 5.6 million people.

The 140-hospital system’s EHR was down for more than a month.

HIStalk Announcements and Requests

Not making the list above from last week’s poll – entering health tracking information, viewing OpenNotes, and using an app that a clinician prescribed or recommended.

New poll to your right or here: Which winter holiday is most important to you?

A Reader’s Notes from the Joint Annual Meeting of The Sequoia Project and Carequality

The meeting was held December 11-12 in Nashville.

Micky Tripathi

• Nothing groundbreaking or new. Mostly rehashed stats and updates that have been shared in other forums.
• HTI-2 final rule published that morning is a very lightweight set of changes related to TEFCA, mainly codifying terminology and procedures.
• Picture shows some TEFCA stats. Unclear why the number of participants per category doesn’t quite add up to the total of 10k.

Panel discussion on what qualifies as treatment

• Lively conversation and one of the most refreshing panels I’ve seen at a conference, if only because everyone didn’t get up there and agree with one another and pat each other on the back.
• Unstated but obvious was that the motivation for the session was the Epic-Particle dispute.
• Panel went through a few nuanced scenarios and debated whether they fit the definition of treatment (specifically, HIPAA treatment…TEFCA treatment has a slightly narrower definition). Example: provider group is part of an ACO and a physician wishes to query an HIE for records on their attributed patients to identify gaps in care, so that the provider can focus on closing those gaps. Deven McGraw (former HHS OCR Deputy Director for Health Information Privacy): once you start asking for patient information in bulk, you shift from a Treatment purpose to an Operations purpose. This led to an interesting debate on whether sending a bulk transaction (e.g., bulk FHIR) would count as Operations but writing a script to send many individual transactions patient-by-patient would count as Treatment.
• Tripathi: key thing to remember is that under HIPAA, the data responder has the prerogative to identify whether the request is for treatment or not.

Interoperability for public health

• Electronic case reporting was still a proof of concept by the end of 2019 but suddenly had to go big bang and scale due to COVID.
• Michelle Meigs (APHL): Public health has a business problem. The funding is piecemeal and focused on specific cases or reportable diseases, so it is challenging to build a comprehensive technology and interoperability framework. The fragmentation doesn’t help. Because public health is mostly handled at the state and local levels, there are 50+ sets of rules to follow.
• Craig Behm (CRISP HIE): data usability and alert fatigue are major issues for providers. They piloted public health data exchange through TEFCA with three provider organizations, .but they didn’t get any responses to their TEFCA queries in the first few months.

The theme of trust came up several times and was the focus of multiple sessions. That said, it would be more accurate to say “verification” as the main changes seem to be HIEs/QHINs introducing tighter guardrails and stronger vetting processes to prevent misuse of data.

Panel on the Carequality dispute process

• Purposefully avoided commenting on the Epic-Particle dispute, though everyone knows that’s the impetus for the discussion.
• Dispute process intentionally errs on the side of “minimum necessary” when it comes to sharing information with the public, to prevent sharing any sensitive info.
• Panelists (members of the Carequality board and steering committee) generally felt the timelines defined for the formal dispute are OK, given the time needed for the responding party to build a defense against the complaint. It also takes time to establish a dispute panel who will hear the arguments from both sides. These are all volunteers at the end of the day. Goal is that formal disputes are rarely or never needed since parties should work things out informally first.

Fireside chat with Daniel Polk (Special Agent, FBI Atlanta field office) on cybersecurity

1. Broke down the various types of malicious actors (picture attached).
2. Discussed common infiltration and deception tactics.
3. 2FA is critically important to good security, but it can be defeated. A common tactic today: hackers send you a phishing email with a malicious link. You click on it and are taken to a fake login page where you enter your username and password. Hacker receives a real-time notification and logins into the real account with your credentials. This triggers a 2FA code or push notification, which you enter or acknowledge, allowing the hacker to access your real account.
4. As soon as you believe you are the victim of ransomware, reach out to the FBI. They generally don’t publicize this, but they may have a decryption key that will work in your situation.
5. Polk highlighted the fines OCR has been leveraging on organizations who do not have good cyber hygiene and who have suffered from unauthorized disclosures.

Webinars

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

Acquisitions, Funding, Business, and Stock

Commure acquires Memora Health, which offers a care navigation platform.

Norway-based healthcare software vendor Omda AS acquires Aweria, which offers a best-of-breed emergency department information system.

Streamline Health reports Q3 results: revenue down 28%, EPS –$0.61 versus –$3.15. STRM shares have lost 32% in the past 12 months, valuing the company at $15 million. CEO Ben Stillwel says that the company may need to seek additional non-equity capital resources to fuel growth and that he “needs to live and breathe sales.”

People

Mouneer Odeh, MA (Inova Health System) joins Cedars-Sinai as VP/chief data and AI officer.

Haffty Consulting promotes Erin Mueller to VP of client services.

Announcements and Implementations

The UT Health San Antonio School of Dentistry combines the dental and medical health records of its patients by integrating Epic’s Wisdom dental module with its EHR. Patients can view all their records and make appointments through MyChart. Epic replaces Exan’s AxiUm dental system for academic practices, which is owned by Henry Schein One.

Government and Politics

Epic asks a federal district court to dismiss the antitrust lawsuit that was brought against the company by Particle Health in September. Epic says the lawsuit fails to prove that Epic engaged in anticompetitive behavior. It adds that Particle filed the suit as revenge for Epic’s revelation that some of Particle’s customers were obtaining confidential patient information under false pretenses.

The Department of Justice sues CVS Pharmacy for knowingly filling prescriptions for controlled substances that lacked legitimate medical purpose or were invalid, many of them generated by known pill mill doctors. DOJ says CVS ignored internal data and information from its own pharmacists to keep filling the prescriptions so the company could meet corporate performance metrics that triggered field manager bonuses. CVS is also accused of preventing its pharmacists from warning each other about certain prescribers and setting pharmacist staffing levels so low that they couldn’t perform due diligence or even pay attention to computer safety alerts. One pain management doctor in Hawaii wrote prescriptions for specific patients, then picked them up himself and charged them to his own credit card, generating 60% of the prescriptions that the CVS store filled.

The VA will restart restart Oracle Health go-lives in mid-2026 at its Michigan facilities in Ann Arbor, Battle Creek, Detroit, and Saginaw.

In Canada, a former employee of Alberta Health Services is fined $12,000 for falsifying the COVID-19 records of 200 people in Meditech, which sends data to the province’s immunization system.

US healthcare spending rose 7.5% in 2023 to nearly $5 trillion, with prescription drugs showing the biggest increase due to GLP-1 drugs. Hospital services consumed $1.5 trillion of the total, rising by 10.4% in their highest growth in three decades. The US finished in near last place among 38 OECD countries in infant mortality and life expectancy despite spending four times the average dollars per capita.

Other

Doctors in Scotland voice concerns over the bankruptcy filing of In Practice Systems Limited, the provider of the Vision system widely used by the country’s GP practices, citing potential risks to system availability and access to medical records. The company is owned by Cegedim Group. NHS National Services Scotland has set up an incident response team.

Sponsor Updates

• Healthcare IT Leaders partners with Jackson Health System’s IT group to bring holiday cheer to children.
• CTG announces the retirement of long-time manager and director Christine Blanchard.
• Indiana University Student Health Center successfully uses AI-powered ambient listening solution Sunoh.ai, integrated with eClinicalWorks, to streamline clinical documentation.
• Nordic names Amy Ferro marketing content manager.
• Black Book Research releases the results of a survey highlighting how nations are leveraging advanced digital solutions to revolutionize population health management and address critical healthcare challenges.
• Nordic releases a new episode of its “Designing for Health” podcast, “Interview with Brian Urban.”
• RLDatix releases a new episode of “The Connection” podcast, “Technology + Humanity in Healthcare: Insights from Dan Michelson, CEO of RLDatix.”
• Sectra will provide its platform for medical education, Sectra Education Portal, to the University of Hartford in Connecticut.
• SnapCare co-founder and Chief Strategy Officer Jeff Richards receives the 2024 Georgia Titan 100 award.

Blog Posts

• From Compliance to Care: The Expanding Role of EVV in Personal Care Services (Netsmart)
• 3 top benefits of AI for the IT support desk (Nordic)
• CHIME’s Fall Forum: Shaping the Future of Healthcare with AI and Data Modernization (Prominence Advisors)
• Streamline Clinical Workflows with MEDITECH Expanse 2.2: A How-to Guide (CereCore)
• From Complexity to Simplicity: One Clinic’s Journey to Corepoint (Rhapsody Health)
• How to use QR codes in patient rooms (Sonifi Health)
• On the Same (Sheet of Music) in Healthcare (Surescripts)
• Key Insights From the 10th Annual NGPX Healthcare Experience Conference (Tegria)
• RSNA 2024: Visage’s Top Five (Visage Imaging)
• Year in review: 6 key milestones that advanced Waystar’s mission in 2024 (Waystar)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Follow on X, Bluesky, and LinkedIn.
Contact us.

Morning Headlines 12/20/24

Verily’s plan for 2025: Raise money, pivot to AI, and break up with Google

Alphabet’s Verily will reportedly shift focus in 2025 to offering AI tools, data aggregation, and privacy systems for healthcare providers and startups.

Oura Secures $200 Million in Series D Funding

Finland-based smart ring maker Oura raises $200 million in a Series D funding round that values the company at $5 billion, with glucose biosensing company Dexcom participating in the round.

Confido Health secures $3M to put AI-powered digital workers on healthcare’s front lines

Confido Health raises $3 million in funding to continue rollout of its no-code AI agents for appointment management, insurance verification, and care coordination in specialty practices.

News 12/20/24

Top News

Alphabet’s Verily will reportedly shift focus in 2025 to offering AI tools, data aggregation, and privacy systems for healthcare providers and startups.

The company plans to relaunch Lightpath, its diabetes and hypertension app with AI and human coaching, in 2026.

The most profitable business of Verily, which is often criticized for its unfocused life sciences projects, is Granular Insurance, which helps employers cut healthcare costs.

HIStalk Announcements and Requests

Long-time HIStalk Founding Sponsor Healthwise (they first signed up in 2011) is leaving the fold due to its acquisition by WebMD. That leaves a rare opening in the two ad positions at the top of the page, so if your company would like to join Medicomp up there in the HIStalk stratosphere, contact Lorre. Could be a new sponsor, could be an upgrading one … we usually go with whoever commits first.

Ms. G from Texas sent over some photos of her fourth graders using the headphones that were provided by a reader’s donation and matching funds from my Anonymous Vendor Executive. She says, “These students are more engaged and confident, showing improved focus during lessons and taking more ownership of their learning. The headphones have also encouraged collaboration, as students can now listen to different parts of a lesson at their own pace while sharing insights with classmates.”

Webinars

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

Acquisitions, Funding, Business, and Stock

Finland-based smart ring maker Oura raises $200 million in a Series D funding round that values the company at $5 billion, with glucose biosensing company Dexcom participating in the round.

Confido Health raises $3 million in funding to continue rollout of its no-code AI agents for appointment management, insurance verification, and care coordination in specialty practices. It provides the “AI workers” to customers at an hourly rate.

Sales

• Safety net, 150-bed Nashville General Hospital will implement Oracle Health CommunityWorks.
• Johns Hopkins Medicine will implement Abridge’s ambient documentation solution across its six hospitals and 40 care centers.
• Arisa Health selects Netsmart’s CareFabric.

People

Symplr names Steve Filler, MHA, MPH (Boston Consulting Group) as COO and Matt Grill (UKG) as chief delivery officer.

Advantus Health Partners hires Rick Roycroft, MBA (Huron Consulting Group) as chief commercial officer.

Amwell adds COO to the role of CFO Mark Hirschornm who joined the company in October 2024.

Announcements and Implementations

Doc.com will expand its AI-powered healthcare platform to provide initially free hospital tools for telemedicine and online pharmacy services. The company received $300 million in equity financing a year ago. The Mexico-based company has faced skepticism for making questionable product claims and its active involvement in the cryptocurrency market.

Agilon Health will integrate Navina’s AI engine with its value-based care platform.

Mesh Health Solutions and KONZA will partner to stream the prior authorization process.

Government and Politics

The VA will resume its implementation of Oracle Health this fiscal year after placing rollouts on hold in April 2023 due to problems in its first five live sites. The VA says that system crashes and performance issues dropped 50% after its latest round of software updates, also noting that it discovered that many users were logging in via VPN even while connected to its internal network, which caused performance lags. VA officials downplayed the possible impact of having the new administration’s political appointees taking VA leadership roles.

Sponsor Updates

• Five hundred Meditech employees donate a variety of items to support 32 households during the company’s annual Holiday Giving initiative.
• Black Book Market Research publishes its survey findings on population health applications in emerging markets.
• Wolters Kluwer’s new “25 for ‘25” report predicts key healthcare technology trends driving momentum amid dramatic change in 2025.
• EClinicalWorks announces that customer Fairfax Medical Facilities (OK) was recognized by HRSA with a ‘Health Center Quality Leader – Gold’ badge for its 2023 Uniform Data System submissions.
• RLDatix supports The Leapfrog Group’s Proposed Changes to the 2025 Leapfrog Hospital Survey, specifically revisions calling for greater specification in the collection of data related to ICU staffing and the nursing workforce.
• Black Book Research identifies top vendors of FHIR-based prior authorization interoperability solutions, including Availity, Redox, and Rhapsody.
• First Databank will present at the American Society for Automation in Pharmacy 2025 Annual Conference January 16 in Amelia Island, FL.
• Findhelp welcomes the Appalachian Children Coalition, Community Foundation of Elkhart County, Hospital Sisters Health System, and Nassau County Department of Health to its network.
• CTG announces the retirement of Managing Director Christine Blanchard after 27 years with the company and the national search for her replacement.
• Fortified Health Security launches its inaugural advisory board.
• Goliath Technologies publishes a new case study, “Leading not-for-profit health system isolates and resolves speed & reliability of Citrix related Epic and ChromeOS device issues.”
• Healthcare IT Leaders releases a new Leader to Leader Podcast, “From the Gift Shop to the C-Suite.”
• Impact Advisors releases a new Impactful AI Podcast, “The Ethics of Human Autonomy in AI.”
• Inovalon releases a new “Inovators” podcast, “AI in Healthcare: The Value of Innovative Technology, Paired with Clinical Expertise.”

Blog Posts

• 2025 – The Year of AI Validation and Human-Centered Innovation (Medicomp Systems)
• Driving momentum in healthcare technology amid dramatic change (Wolters Kluwer Health)
• Boost Staff Productivity and Cut Costs with RPA in Healthcare (FinThrive)
• 5 Common Examples of Unintentional HIPAA Violations (HealthMark Group)
• Essential Customer Service Skills Every Contact Center Agent Should Master (Five9)
• 5 Ways an IT Partner Can Cure Physician Headaches and Boost Practice Efficiency (Med Tech Solutions)
• Essential strategies for value-based success in 2025 (Navina)
• How MUSC Leverages Telehealth to Reimagine Rural Healthcare (NeuroFlow)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Follow on X, Bluesky, and LinkedIn.
Contact us.

EPtalk by Dr. Jayne 12/19/24

The US Congress is delivering an end of year cliffhanger in the form of expansive legislation designed to fund the government so that there’s not a shutdown when current funding runs out on December 20. The continuing resolution that is under consideration is over 1,500 pages and includes some healthcare tidbits, including the extension of some Medicare telehealth flexibilities for another year and the extension of acute hospital at home flexibilities through the end of 2029.

The continuing resolution took a beating on the platform formerly known as Twitter this week, with Elon Musk personally posting about it more than 100 times. My heart goes out to all the families that will be impacted if there is indeed a government shutdown, especially essential workers who are expected to continue working but who might not be paid in a timely fashion. National parks and monuments will close in the event of a shutdown, so if those activities were in your holiday plans, stay alert. Even if the resolution passes, it will only cover the nation through March 2025, so there are plenty more budget conversations to come.

From Rotisserie Gal: “Re: predictions. I always make an email folder where store predictions that caught my eye, or announcements of seemingly hot new tech that I want to watch over time. With that, I give you a prediction from CES 2024 – the macrowave oven. I haven’t seen a word about it since then.” Looking back at the article, the device was called “the Tesla of kitchen appliances” and there was plenty of gushing over its ability to revolutionize cooking. I guess it wasn’t that revolutionary though, because an internet search today only brought up articles mentioning the CES debut. I even went to the manufacturer’s website and couldn’t find anything about it, so unless someone else informs us to the contrary, it seems to be a prediction that fizzled.

In addition to looking at predictions for 2025, I’m also a sucker for “year in review” articles covering the one that’s winding down. JAMA Health Forum released its list of most viewed articles for 2024. The titles are telling and align with the hot topics I’ve heard discussed in the physician lounge, whether virtual or in person:

• “Changes in Permanent Contraception Procedures Among Young Adults following the Dobbs Decision.”
• “US State Restrictions and Excess COVID-19 Pandemic Deaths.”
• “What Would Another Trump Presidency mean for Health Care?”
• “Evaluation of Changes in Prices and Purchases Following Implementation of Sugar-Sweetened Beverage Taxes Across the US.”
• “Differences in Home Health Services and Outcomes Between Traditional Medicare and Medicare Advantage.”
• “Projecting the Future Registered Nurse Workforce After the COVID-19 Pandemic.”
• “What Would a Trump Administration 2.0 Mean for Health Care Policy?”
• “Job Flows Into and Out of Health Care Before and After the COVID-19 Pandemic.”
• “Patient-Level Savings on Generic Drugs Through the Mark Cuban Cost Plus Drug Company.”
• “Patient Safety and Artificial Intelligence in Clinical Care.”

Another year in review article listed the most expensive Epic EHR projects worked on or completed in 2024. Top-tier spenders were in the $800 million to $1.2 billion range, with the low-end contenders seeming rather paltry at $50 million. I’d love to see someone approach the data in a different way to see how it resonates. Although it might be interesting to see the expenditure as a percentage of net and/or gross revenue, it might be even more intriguing to see it compared to patient stats that are commonly used when discussing volumes. I can just see health system CEOs standing around comparing their “Epic dollars per licensed bed” or “Epic dollars per emergency department visit.” I know that these large numbers often represent a cost savings, especially when an Epic implementation allows retirement of multiple unwieldy systems or the efficiencies of standardization. But it doesn’t change the fact that the numbers are indeed staggering.

I recently applied for a committee position and was asked to identify whether I was an early career individual versus mid career or late career. I asked for specific criteria and found that their idea for distribution was substantially different than what I had expected. They define “early” as five years or less, “mid-career” as six to 10 years, and “late career” as more than 10 years. Thinking back, there’s so much I didn’t know before hitting what they would consider late-career. I wonder how they would describe those of us who have been at this for 25 or 30 years, which is what I would truly consider late career. I’m curious how other organizations define this and if this was just an anomaly since I’ve never been asked this question.

I saw a headline about UnitedHealth’s Optum inadvertently making its internal AI-powered chatbot available to the public via an IP address, but I didn’t have time to read it. I finally circled back today and was glad I did, since the story goes well beyond the headline. The chatbot was trained on internal materials that describe standard operating procedures for managing claims. Optum claims it was a “demo tool developed as a potential proof of concept” but was never in production use by employees. That’s all pretty vanilla, but I was glad I read to the end and heard about what happened when TechCrunch asked the tool to “write a poem about denying a claim,” producing a seven-paragraph work which is featured in part at the bottom of the article. Well worth the read folks, well worth the read. I’d love to see the other five paragraphs, though.

Winter is upon us, and I’m wholeheartedly embracing the hygge lifestyle with plenty of books, sweaters, cozy socks, and of course seasonal baking. The different varieties of cookies amaze, me and whether you need a concentrated punch of chocolate in a lumpy form factor or whether you prefer a more demurely dunk able option with greater surface area, I probably have a recipe for you.

What are your favorite holiday cookies? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/19/24

House Bipartisan Task Force on Artificial Intelligence Delivers Report

The House Task Force on Artificial Intelligence publishes its findings and recommendations, which include five recommendations to improve the safety, security, and trustworthiness of AI in healthcare.

VA EHR in better shape to resume go-lives in FY 2025 after ‘incremental’ fixes

VA officials decline to share specific go-live dates for 2025 implementations of the department’s stalled Oracle Health-based EHR, but do stress that career VA employees who’ve been with the EHR modernization program from the beginning will continue their work under the incoming administration.

Aspirion Expands Revenue Cycle Management Capabilities Through Strategic Acquisition of Boost Healthcare

RCM company Aspirion acquires Boost Healthcare, which specializes in tech-enabled revenue recovery and advisory services.

Healthcare AI News 12/18/24

News

The House Task Force on Artificial Intelligence publishes its findings and recommendations, which include:

• Challenges include data availability and quality, incomplete or inaccurate responses, non-individualized recommendations, lack of decision transparency, data privacy, interoperability with existing systems, liability for AI-contributed errors, biased decision making, and deployment for financial gain rather than patient care.
• AI can help improve the percentage of drugs that are eventually approved by FDA by streamlining study design, finding study patients, and answering patient questions.
• AI can assist radiologists by performing first-pass image screening, cleaning up images, and applying consistent interpretation criteria across all patients and locations.
• Clinical decision support can be tailored to an individual patient’s symptoms and medical history and can compare their data to the medical literature or a “patients like this one” model.
• AI can use population health data to predict response to initiatives among population groups.
• Physician burnout can be reduced by deploying AI-assisted clinical documentation.
• AI can reduce the administrative burden of the prior authorization process.
• CMS will need to evaluate Medicare payment for algorithms and other AI tools.
• AI has potential in medical management, but could create unnecessary denials.
• Innovation will require standardization of EHR-specific data formats to be applicable to broader populations and for AI training.
• HIPAA may require updating to meet the challenges of provider AI deployment.

Principal Deputy ASTP/National Coordinator Steven Posnack, MS, MHS says that healthcare AI should not be strictly regulated since it is constantly changing and because risk tolerance varies by setting, such as back office support versus patient care versus research.

A technology reporter shares five weeks of her Apple Health information with ChatGPT and finds that with no prompting, it analyzes trends and makes personalized suggestions for improvement, weaving seemingly unrelated statistics into a fitness journey story.

OpenAI makes the ChatGPT search function available to free users (it was previously available only to paying users) and adds voice-integrated search.

ASTP publishes a downloadable inventory of HHS AI use cases, documenting 66% more than a year ago.

Business

Company insiders say that most of the work of EvenUp — which calculates the value of a personal injury case by analyzing customer medical records and case files — is performed by humans rather than the AI that the company touts to investors. Former employees of the startup, which is valued at $1 billion, say that the AI system misses injuries, hallucinates medical conditions, and is not reliable in analyzing doctor visits, leading managers to tell employees not to use it.

Other

Google Cloud’s healthcare solutions director Aashima Gupta, MS predicts the short-term use of AI to be focused on routine tasks such as appointment scheduling and processing forms, clinical documentation, communication, claims processing, marketing outreach, and use of AI agents for member and provider communications. She expects longer-term AI uses to include enhanced access, enhanced imaging screening and early detection, use of AI as a health concierge, multilingual support, medication reminders, and care navigation advice.

The UK’s National Health Service is using AI to identify patients who are at risk for high usage of emergency services, who are then offered coaching and in-home support.

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Follow on X, Bluesky, and LinkedIn.
Contact us.

HIStalk Interviews Frank Harvey, CEO, Surescripts

Frank Harvey, RPh, MBA is CEO of Surescripts.

Tell me about yourself and the company.

I am privileged to have been in healthcare for over 40 years now. Initially as a practicing pharmacist, then in the life sciences industry with Eli Lilly and Hoffman-La Roche, and with a number of health technology companies servicing healthcare. I was CEO of Liberty Medical, which was the largest diabetic testing supply company in the country. I had the privilege of being CEO of a company called Mirixa, which is a medication therapy management technology company. I ran my own venture fund for about three years. Now I have the privilege of being on the Surescripts team as CEO.

Surescripts is a trusted health information sharing company. We support the movement of clinical data between clinicians, physicians, nurses, and pharmacists across the nation. We are the e-prescribing backbone for the country. Our 24 billion transactions that we do in the movement of clinical data across our networks each year empowers clinicians to not only e-prescribe, but to get price transparency information and to make sure that they are making the right choice for each patient. The medication history information that goes across our network empowers physicians to make the right medication choices based on what a patient’s history has been historically. We are a mission-driven company focused on improving healthcare, reducing the cost of care, and improving patient safety.

How do you see the big picture of interoperability and the business and clinical opportunities that it might create?

The most important thing about clinical interoperability is how it’s going to empower the clinicians to be even more effective at treating patients. It gives them the full clinical history, the important information for what they’re working with the patient on. Last year we had 24 billion transactions across our database from virtually every physician, every pharmacy, every health system, and every EHR we are connected to, across all of healthcare working together. 

TEFCA, the Trusted Exchange Framework and Common Agreement, and the QHINs, the Qualified Health Information Networks, will make data more readily available for the clinicians to make sure they get a complete clinical record. Historically, patients move from health plan to health plan, and sometimes from physician to physician that may be on different EHRs. Many times the clinician didn’t have a complete clinical history to make the right choices. QHINs will help solve that issue and make it transparent to the treating pharmacist, physician, nurse, or physician’s assistant, giving them right clinical information that they need to make more appropriate clinical decisions for patients.

How does the use of an e-prescribing network empower patients compared to paper prescriptions?

The most effective prescription is the one that the patient will actually pick up and take. Many times historically, patients weren’t aware of the price of medication. A physician would write a prescription, the patient would take it into the pharmacy, and then it would be like, well, I can’t afford that. Pharmacists would have to take time to call back the physician’s office, or the patient would just abandon the prescription.

Real-time prescription benefit provides a number of things around transparency. It’s meant to be when the physician is right there writing the script with the patient. They can see not only the prescription that they are thinking of writing, but also the therapeutic alternatives. What medications could be used in place of that? What’s the cost of that prescription based on the patient’s benefit? What’s the cost of that prescription at different locations? Mail order versus retail versus preferred retail?  All of those factors are now at the physician’s fingertips. 

We have over 800,000 physicians in the US utilizing a real-time prescription benefit product. Having all of that information at their fingertips helps them make the right choice for the patient, because it’s not just a clinical decision. If the patient can’t afford the medication, there may be other medications that will be more therapeutically appropriate because the patient can actually afford to pick it up and take it.

What are the technology approaches for improving the efficiency of processing prior authorizations?

The concept around prior authorization was smart. It was to ensure that patients were taking the right medications and the right sequence to make sure they received the best treatments. Often it’s not just the most expensive medication that would be the best, but the most appropriate. There may be step therapy that a patient could go through. Since historically physicians didn’t always have complete medical records for patients, that was one additional way to help inform the treatment decisions.

What has happened with prior authorization is that it is much too cumbersome for the physicians and their offices and the pharmacies that have to delay things and step back. Most importantly, it is much too cumbersome and delays treatment for the patient. It’s really the patients that are being hurt by the delays that take place in the prior authorization process.

Fortunately, we are at the forefront of working on new technology to help solve a number of those issues. We’ve just published our pilot results with Optum and Cleveland Clinic Fairview, looking at what we’re calling no-touch prior authorization. It’s our ability to end the workflow for the physician to get that prior authorization approved while they are prescribing the medication. Because we are connected to every EHR, we have clinical history on these patients. We can reach out across those clinical records in a matter of seconds, pull that record back, and complete that prior authorization so that it goes through smoothly. The medication isn’t delayed for a couple of days because the pharmacy hasn’t received authorization.

New technology and our new advances are helping patients, most importantly, but also cutting down on clinician and staff burnout that is caused by all of this faxing, calling, and delaying work.

Are payers embracing the gold card type program, where prescribers who have history of responsible prescribing aren’t required to go through the same level of prior authorization scrutiny?

The gold card program is helpful for physicians who have proven that they always go through the right step therapy and put the appropriate medications first for their patients. It’s important since all that information is not always available to a physician and the cost of medications is extremely important to the overall system as well. It isn’t always the most expensive medication that is the most appropriate. Prior authorization was trying to solve some of the issues around that and to try to keep healthcare costs at a minimum while still providing good clinical care to patients.

Our real-time prescription benefit product shows what a patient’s coverage is, what their benefit is, and whether a product is covered or not. But in addition, our newest advances in prior authorization are showing those and filling out those electronic forms for physicians in a matter of 30 to 35 seconds in the prescribing process. That’s really freeing up a lot of time. It’s taking a lot of the burden off of the physicians having to do a lot of that work.

Physician offices have a number of people who are working on prior authorizations. Then there’s a whole host of people at the health plans and PBMs who are taking those calls and working through them as well. Creating efficiency through our new technology will help remove a lot of that provider burnout and get patients on therapy quicker.

How do you build a business plan around the possibility of incorporating AI into products and strategy?

We’re just starting to scratch the surface on the benefit that AI is going to be. Surescripts technology has been built around machine learning from the beginning of the company. Generative AI carries some surprises, and caution is needed because it can have hallucinations and make stuff up if it doesn’t have the right answer. Because of that, whenever you have generative AI involved in a recommendation or decision, it has to have human intervention in there as well. It has to be checked. You have to make sure that what that generative AI is coming back with is right. You have to have human intervention in that. I don’t see that going away anytime soon.

Where I think AI generative AI is going to have the most impact is with administrative functions, prior authorization and others, where it can help pull in that information from the notes fields and from other areas to show what a patient has been on. But again, always needing that human intervention to confirm what the generative AI is coming back with.

Does your network offer new opportunities to add value or improve care?

A good network takes a long time to build. We’ve been at it now for over 20 years. The Surescripts Network Alliance is all of our partner companies across that multi-sided network working together on these hard systemic problems. These problems that we are focused on are systemic across all of healthcare. When you find a solution or come up with a solution, it helps everyone in the process, including the patient. As we continue to build out the networks, QHINs are a great example of additional networks being added to the framework. Being attached to every prescribing physician, pharmacy, health system, and EHR lets us see the value that the network can bring to the patient.

What are the technology implications of the Drug Enforcement Administration’s recent warning about the security of e-prescribing systems?

It’s a multi-pronged effort. Bad actors are getting more and more sophisticated. They are looking for new ways every day, and you have to be vigilant. 

At Surescripts, it starts with the rigorous standards that it takes to become a part of the Surescripts network. We at times have heard complaints from some new health technology companies that are trying to get on our network. But once they understand that we’re responsible for protecting the security of this across the nation, and so it’s not easy to become a part of the Surescripts Network Alliance. But when you do, you’re sure that it’s at a level of security that is beyond reproach.

It’s also the standards that you put in place. At Surescripts, we follow the National Institute of Standards and Technology, NIST, Identification Assurance Level 2. This is a higher level of security than is required in general. Every health technology company and EHR on the Surescripts network has to comply with that higher standard.

We work hand in hand every week with the DEA or the FBI as they are investigating cases of prescriber fraud. Physician identities will be stolen and you’ll have somebody sending out 1,000 scripts in a matter of minutes. Our systems catch those sort of things. The tough ones are the onesies and twosies that don’t rise to the top. That’s why we have to continue to be diligent working with the pharmacy operating systems, pharmacies, the health technology vendors, and our systems to make sure that we are staying on top of that. 

There will always be bad actors out there and they will always be looking for new ways. The DEA is wise to recommend that you stay vigilant around that. We require our health technology vendor partners to be vigilant and to have a standard of what’s required of their prescribers on the network. We just announced a new partnership with Clear, which will add another level of ID proofing.

As a pharmacist, how has the profession evolved and how might it change going forward?

I graduated 40 years ago. I’m a  Bachelor of Science pharmacist. We had a couple of PharmDs when I was going through school, but most of them were going into hospital practice. Now every pharmacist is graduating with a PharmD. The rigor of their clinical training is beyond reproach. They are critical members of the overall healthcare team.

The other thing that is driving the need for pharmacists to become even more active is a lack of primary care providers. We know there’s going to be a shortage of about 130,000 primary care providers by 2030. Pharmacists are well equipped from a knowledge standpoint to step into that gap to be a part of that collaborative care team to help make life better for patients. That is the most significant advance I’ve seen in those 40 years, the role that pharmacists are playing as a critical part of that primary care team.

If you look three to five years in the future, I think that at most pharmacies, you’ll see pharmacists spending 70 to 80% of their time interacting with patients in that clinical interaction. Not just immunizations, but working with patients on insulin dose adjustments or with patients who have hypertension or CHF in those in-between visits when they would normally go to a primary care provider in the past where their primary care provider may now not be available.

The role of the pharmacist is going to continue to expand as the legislation expands the pharmacist’s authority. During the pandemic, the federal government stepped in with the PREP Act that allowed pharmacists to give immunizations and to be more active in a number of ways. The federal government just extended that I believe to 2029, maintaining the authority of the pharmacist to do those other clinical functions. We need to continue state by state, because it is a state-mandated or state-allowed monitoring of the practice of pharmacy and medicine. We need to have the states continue to authorize pharmacists to work across the full scope of their training, because they are critical to the care team. The physicians we speak with say they are so much more effective when there’s this collaborative care arrangement with the physicians and the pharmacist working together for what’s best for the patient.

Private equity firm TPG recently took a majority position in the company. How does that change your business?

I can’t overstate how important that is to us. We started about two years ago working with our board to say, what are the opportunities that Surescripts needs to focus on in the future? Those opportunities continue to focus on things like prior authorization, extending clinical practice for pharmacy and empowering them with the right information, and increased interoperability. All those things take a lot of financial wherewithal.

We met with almost 100 equity companies over the last two years, narrowing it down to what we believe is the finest healthcare technology-focused private equity company in the world. TPG is really there with us, enabling us, providing the financial backing that we will need to continue to not only build organically, but to look at the right acquisitions that make sense for Surescripts to add to our technology in areas that we focus.

What are complementary areas that you might consider?

We are focused on things that can help take out that administrative burden for patients, for physicians, and to help patients. Prior authorization. Thirty percent of the pharmaceutical spend goes through the medical benefit, which is another area that’s important. Also, the data and data insights as we look at 24 billion transactions a year. There’s so much value that can help with patient care in that, in the midst of all those data elements, helping us refine and look at the best recommendations that we can help make to providers on the patient’s behalf based on all the clinical data that we have. All of those are areas that TPG is excited about. 

One of the things we like best about them is that we share a similar culture. We know that we’ll do very well as a company by doing good — doing good for patients, doing good for providers. In one of the first meetings we had with TPG, they echoed that we’ll do well by doing good, and the financials of the company will take care of themselves. We share that same vision of healthcare and the impact that we can have in healthcare.

What does the health tech investment climate look like?

The last 18 months has been a little slower on technology investment. I think you will see that start to ramp back up again. The impact of AI in the short term is going to be less than people are stating, but in the long term, I think people are underestimating AI’s real impact on healthcare and on multiple industries. It will help us continue to reduce the cost of healthcare. The climate is favorable for that investment.

Healthcare is such a large part of our overall economy. Healthcare is still broken in a number of areas, and it needs fixing. We don’t need just little point solutions, because many times a point solution solves one problem, but it can create a problem upstream and downstream from that point solution. We need larger, systemic solutions that can solve across the whole healthcare spectrum. That’s what we’re focused on as a company.

What are your priorities over the next few years?

The most important priority is what it has been historically, which is to continue to have the best employees that you can have. I am so proud of our team, the quality of the individuals on our team, and the caring nature that our culture has. We’re really focused on what’s best for the patients and the providers, and that comes through in the quality of the work. Continuing to have the best members of the Surescripts family will always be job one for us. Then it’s continuing to partner across the Surescripts Network Alliance, which is how we will go further faster in working with all of our partners in healthcare to solve these big systemic issues.

A lot of the parts of healthcare are still broken. We need to work as a collaborative across all the healthcare technology companies, the EHRs, the PBMs, the pharmacies, the physician groups, and the health systems. Working on these problems together, we can help fix that healthcare system, take a lot of cost out of that healthcare system, and do what’s best for the patients.

Morning Headlines 12/18/24

Health Data, Technology, and Interoperability: Protecting Care Access

ASTP publishes the HTI-3 final rule, which addresses information blocking, adds a definition of “reproductive health care,” and protects patients from legal action where an actor limits the sharing of their electronic health information that may relate to reproductive healthcare.

Texas Tech University System data breach impacts 1.4 million patients

Texas Tech University Health Sciences Center announces that a September ransomware attack compromised the information of 1.4 million patients, some of which has been put up for sale by hackers on the dark web.

Kahuna Workforce Solutions Receives Funding from Memorial Hermann Health System

Memorial Hermann Health System invests in Kahuna Workforce Solutions, which offers skills and competency management solutions.

The Innovation Design Unit: Unveiling the future of inpatient care

Nebraska Medicine opens the 17-room Innovation Design Unit at University of Nebraska Medical Center, enabling clinical staff and researchers to design, test, and validate advanced care models, new technologies, and facility designs.

News 12/18/24

Top News

ASTP publishes the HTI-3 final rule, which addresses information blocking.

The rule adds a definition of “reproductive health care” and protects patients from legal action where an actor limits the sharing of their electronic health information that may relate to reproductive healthcare.

HTI-3 will likely require review by the new administration, which may have motivated the publication of the HTI-2 rule and its reproductive healthcare section separately to avoid delaying HCI-2’s USCDI standard version, certification program standards, and TEFCA standards. ASTP said that HTI-2, whose draft version was slimmed down by 85% for the final version, will be spread over several separate rules.

Reader Comments

From Bexley: “Re: charges for insurance appeals. See this BCBS notice to clients in which the company has decided to charge $205 for second-level appeals. I have never seen anything like this and am frankly appalled that insurance would put such an onerous demand on rural and CAH markets. My fear is that there will be more to come that will tilt the deck against financially struggling facilities. My suspicion is that they are doing this because automated appeals have broken their revenue models, which depend on a majority of claims never been appealed by hospitals and other providers.”

From Elucidate: “Re: conferences. HLTH was always for-profit and investor-backed, and now the HIMSS conference is, too. Is that the new standard?” Apparently. Member non-profits have done a good job in creating and managing their conferences, but it takes a lot of expertise and focus to scale them up and to extract the maximum all-important revenue from corporate supporters. For member groups, conferences are the core revenue generator but not the core business. One might speculate that the Big Daddy of healthcare conferences, RSNA and its 40,000 attendees, has had options for its future extended. Here’s a fun fact to know and tell: with the HIMSS conference and HLTH/ViVE acquired in just over 12 months, both conferences are now operated by London-based companies, where the sun never sets on the British conference empire.

This item made me think of my previous areas of uncertainty about HIMSS:

• IRS Form 990 — still hasn’t filed one since FY2021 that I’ve seen. I’m still wondering if they converted to for-profit since IRS requires yearly reporting for non-profits.
• Listed as a non-profit on the IRS website — no.
• HIMSS Accelerate — seems to have been finally shut down as the previous link now redirects to the HIMSS membership page and former Accelerate Managing Director Dennis Upah’s LinkedIn says that “much of the functionality was ultimately reorganized within HIMSS itself” as he gave up his Accelerate managing director role in September.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Navina. Navina is the market-leading clinical intelligence platform, leveraging AI to transform fragmented patient data into a concise patient profile with actionable clinical insights. Designed for and loved by physicians, Navina enables proactive and empathic patient care, increasing clinician satisfaction, reducing burden, and improving value-based care outcomes. Privia Health, Agilon Health, and Millennium Physician Group are among some of the leading value-based care organizations leveraging Navina’s AI platform to transform clinical workflows and improve quality performance. The company won recognition in the 2024 MedTech Breakthrough Awards, KLAS Emerging Solutions Top 20 report, and the CB Insights Digital Health 50 list. Founded in 2019, Navina is used daily by over 7,000 clinicians across the United States, impacting the lives of more than two million patients. Thanks to Navina for supporting HIStalk.

Webinars

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

Acquisitions, Funding, Business, and Stock

Toronto-based Healwell AI will acquire global healthcare technology company Orion Health, based in New Zealand, for $116 million. Healwell acquired a majority stake in Mutuo Health Solutions earlier this month, and acquired Canadian healthcare data software vendor VeroSource for $24.5 million in June.

Tuva Health, an open-source healthcare data and analytics startup, raises $5 million in seed funding. Co-founders Aaron Neiderhiser and Jorge Zuloaga spent time in executive roles at Health Catalyst and Strive Health, respectively, before launching Tuva in 2021.

Enterprise identity security company SailPoint Technologies acquires Imprivata’s identity governance and administration business.

Kahuna Workforce Solutions, which offers skills and competency management solutions, receives an unspecified investment from Memorial Hermann Health System.

Sales

• Mid and South Essex Foundation Trust and Essex Partnership University NHS Foundation Trust in England will implement Oracle Health in 2026-27.
• Rural healthcare cooperative Cibolo Health selects population health management software from The Garage.

People

Mari Spung, MBA (Clinical Computer Systems) joins Medhost as SVP of research and development.

Adele Merritt, PhD (Office of the Director of National Intelligence), joins the National Institutes of Health as CIO.

HealthEdge hires Julie Coviello (E4health) as VP of professional services – delivery executive.

Aptarro, formerly Alpha II, hires Lori Jones (Agiliti) as chief growth officer and promotes Dave Douglas, MBA to COO.

Announcements and Implementations

MultiPlan announces GA of CompleteVue healthcare pricing analytics.

Black Book Research offers free access to the 2025 edition of “The Black Book of Global Healthcare Information Technology,” a 540-page guide to healthcare IT adoption worldwide. The company also releases its ratings of 175 EHR vendors across 110 countries, based on 18 critical performance indicators. 

Epic announces that its Nexus QHIN has connected 625 hospitals since it joined the framework in December 2023.

Government and Politics

Nebraska Attorney General Mike Hilgers sues Change Healthcare, UnitedHealth Group, and Optum for allegedly violating the state’s consumer protection and data security laws during and after the ransomware attack on Change in February 2024 that exposed the information of 575,000 residents. Hilgers says that while Nebraska is the first state to file such a lawsuit, it likely won’t be the last.

Privacy and Security

An unidentified ransomware group threatens via fax to publish data stolen from PIH Health (CA) during a December 1 ransomware attack that continues to impact the provider’s IT systems. PIH staff are “scrambling,” according to one employee. “It’s a day-to-day thing. The majority of locations have not used paper in 15 years. It’s a stark awakening.”

Watsonville Community Hospital (CA) restores its EHR after a ransomware attack the day after Thanksgiving forced its staff to move to paper-based documentation.

A new federal breach report from Phreesia indicates that 900,000 people that their personal health data was exposed in a May breach of its ConnectOnCall telehealth and on-call answering platform, which it acquired in October 2023.

Other

Houston Methodist and Rice University establish the Digital Health Institute to develop new AI-enhanced solutions for telehealth, patient self-management, medical devices and wearables, predictive analytics, and early detection and diagnosis of conditions.

Nebraska Medicine opens the 17-room Innovation Design Unit at University of Nebraska Medical Center. The patient care unit will allow clinical staff and researchers to design, test, and validate advanced care models, new technologies, and facility designs.

Sponsor Updates

• CereCore releases a new podcast, “Physician CIO on the Value of Clinical IT Support.”
• Linus Health announces that its Core Cognitive Evaluation solution has earned European Union Medical Device Regulation Class IIa certification. 
• Artera offers a new customer success story, “Jane Pauley Community Health Center Increases Access to Care Across Community-Based Populations in Central Indiana with Artera.”
• Ascom launches the Myco 4 DECT-WiFi smartphone, combining DECT and WiFi capabilities.
• AvaSure becomes a founding sponsor of the American Telemedicine Association’s new Center of Digital Excellence.
• Capital Rx releases a new episode of The Astonishing Healthcare podcast, “What Project 2025, RFK Jr., and Dr. Oz Could Mean for the Business of Healthcare Under Trump.”
• DrFirst offers a new whitepaper, “The Perils and the Promise of AI in Healthcare.”

Blog Posts

• How Outside Partners are Changing Epic Implementations for the Better (CereCore)
• Agfa Insights: RSNA 2024 Key Takeaways (Agfa HealthCare)
• State of Patient Access: Survey Results and Insights Centralization, Analytics, and Automation (AGS Health)
• Extending your reach: How outsourcing your revenue cycle drives better financials (Altera Digital Health)
• Risk adjustment in healthcare: The ultimate guide for payers (Arcadia)
• Embracing Diversity and Inclusion in Recruitment: Building a More Inclusive Workforce (Direct Recruiters)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Follow on X, Bluesky, and LinkedIn.
Contact us.

Morning Headlines 12/17/24

Healwell to Acquire Orion Health, Creating a Global Market Leader in Healthcare Data Interoperability & Artificial Intelligence, and Launches $50 Million Bought Deal Financing

Toronto-based Healwell AI will acquire global healthcare technology company Orion Health, based in New Zealand, for $116 million.

Attorney General Mike Hilgers Files Lawsuit Against Change Healthcare for Critical Failures to Protect Consumer Data and Prevent Against Harm from a Widespread Cyberattack

Nebraska Attorney General Mike Hilgers sues Change Healthcare for allegedly violating the state’s consumer protection and data security laws during the ransomware attack in February 2024 that exposed the information of hundreds of thousands of residents.

Rice, Houston Methodist launch groundbreaking Digital Health Institute to transform the future of health care

Houston Methodist and Rice University establish the Digital Health Institute to develop new AI-enhanced solutions for telehealth, patient self-management, medical devices and wearables, predictive analytics, and early detection and diagnosis of conditions.

SailPoint and Imprivata Enter Strategic Partnership to Deliver Unified Identity Security and Access Management for Healthcare Organizations

Enterprise identity security company SailPoint Technologies acquires Imprivata’s identity governance and administration business.

Curbside Consult with Dr. Jayne 12/16/24

It’s that time of year when well-known people are delivering their predictions for 2025. I’ve seen plenty of them talk about how “transformative” AI will be. The most commonly cited use cases include the nebulous “operations” and “workforce challenges.”

I’d love to see people put their nickel down and give us a tangible prediction along the lines of, “AI will help us reduce nursing turnover by 10%” or something that’s even remotely measurable. Many of us have been through a middle school science fair, either as a participant or as a parent or coach of a participant, so it shouldn’t be too hard to craft a measurable hypothesis. Unless, of course, you’re just talking to talk and to get exposure so you can “elevate your brand” and figure out how to launch yourself to the next big thing – in which case you’re better off staying in the realm of the nebulous prediction.

I saw one article where an executive was talking about how organizations are going to start collaborating with each other to create networks for delivering more holistic care for patients without having to own all the services. If I’m thinking positively, that means that we might see some health systems considering joint ventures with physician groups or other organizations that can create new options for patients to receive needed care in lower-cost environments. In many communities, though, I doubt we’re going to see much out of this due to the multi-decade turf wars that led to network monopolies with certain insurance carriers, which can make it difficult for patients to get the best care because it might be out of network.

I think of my own city, where a couple of decades ago a handful of otherwise independent hospitals came together in a loose affiliation to try to fight against the two largest players in town. That affiliation lasted less than a decade, with two hospitals spinning back to independence while the others became part of a larger multi-state system. Fast forward again and that organization now owns all but one of those former “independent” members of their alliance. Regardless of current affiliations, the quality measures coming out of those hospitals are largely the same, so I’m not sure what all the merging and unmerging did for anyone other than potentially lowering overhead costs and most assuredly causing confusion for patients.

Executive predictions can also highlight how clueless some individuals are about the current state of healthcare in the US. One mentioned the importance of ensuring that we don’t have a two-tiered healthcare system, with some patients receiving private-pay care and others receiving care paid for through governmental plans. I’m sure she was trying to draw comparisons to the UK and Canada, but it didn’t appear that she was at all aware of the fact that we currently have such a two-tier system in the US right now, in 2024. According to information from the Centers for Medicare & Medicaid Services, the 2022 breakdown for healthcare expenditures was 39% for Medicare and Medicaid and 40% for private health insurance and patients spending out of pocket.

That sure looks like a two-tier system to me, and if you ask a physician who sees the full spectrum of patients regardless of payer, they’ll quickly tell you that patients get different treatment entirely when you try to refer them for subspecialty care. Those with so-called Cadillac insurance plays that pay at the top of the fee scale often receive the quickest appointments, followed by patients with Medicare. In my city, Medicaid patients have ridiculously long waits for specialty care. This means the primary care physician has to try to muddle through and ask colleagues for informal opinions about how to manage a patient for the nine to 15 months it might take for them to actually get an appointment with the appropriate specialist.

When I was in traditional family practice, I literally had patients die while waiting to see a specialist. You can imagine how non-credible many of us find it when someone suggests that care rationing and a tiered system isn’t already here.

I’m sure that over the coming weeks we’ll see even more of these predictions pop up, and I’ll be ready to read them for amusement purposes. What I won’t be reading are content producers that start every single post with either the megaphone emoji or the emergency light emoji. (Side note: the official name of the latter is “Police Cars Revolving Light,” and is that really what you want to have at the beginning of your post?) I’ve decided to change how I’m curating my content in 2025, and anyone using those particular attempts at attention-grabbing for every single post will just go to the bottom of my list. Once in a while, I get it, but after a while it’s just distracting.

There have been a couple of predictions I’ve seen for 2025 with which I can agree. First, I agree with the prediction that while executives say that they’re going to focus on generative AI, only a fraction of them will actually make them a top priority in the next 12 months. I think there are a lot of people out there saying they’re “doing AI” because they don’t want to seem like they’re missing the boat. Or, they may have selected vendors that claim to have an AI-powered solution which is really little more than a souped-up decision tree. There are plenty of those out there, for sure. It’s also difficult to spend on AI when you have things like high nursing turnover that’s directly related to poor company culture, which isn’t going to get better by using AI.

I agree that ambient documentation will remain one of the industry’s darlings in the coming year, because physicians seem to love it. It remains to be seen, however, whether the use of it will lead to improved patient outcomes or clinical quality or true burnout reduction. I’m still skeptical about the burnout studies that I see because a portion of the most burned out clinicians have left the field, which will make the data look better regardless of the true prevalence and severity of burnout. I have a couple of colleagues who are moving away from ambient documentation due to medicolegal concerns, so it will be interesting to see how the industry addresses those.

I personally predict that people in the US will continue to spend plenty of money on unproven treatments in the name of wellness. I had the opportunity to see some financial data on a local med spa, and the amount of profit flowing through there for therapies that aren’t evidence-based is staggering. Vitamin B12 infusions, electrolyte infusions, and even therapies that have been officially debunked are all on the menu and the business is expanding rapidly. Many people don’t have the desire to investigate whether medical things they see on TikTok or other social media platforms are evidence-based and are more focused on following influencers rather than people who have spent decades in school learning the science. Having seen what I’ve seen in emergency and urgent care in the last five years, I don’t see that changing any time soon.

I also predict that the least-paid specialties will continue to be those with the most shortages, a concept which should surprise no one. I guarantee that if you paid primary care physicians based on their actual worth in being able to help prevent disease and reduce disability, and actually supported them appropriately with the ancillary services needed to help patients make lasting changes, people would flock to those disciplines, because they can be incredibly rewarding when you’re working in a supporting environment. When you’re not, though, they can be soul-sucking, and we’ll continue to see people voting with their specialty match preference lists.

Bring out your crystal ball. What are your predictions for healthcare in 2025? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: The Path To Getting Value From AI In Healthcare

The Path To Getting Value From AI In Healthcare
By Vikas Chowdhry

Vikas Chowdhry, MS, MBA is founder and CEO of  TraumaCare.AI.

What are the three most critical elements for deriving value from AI in healthcare? In my view, it comes down to: Workflow! Workflow! Workflow!

What does workflow mean in practical terms? It means a deep understanding of:

1. The jobs that your users are doing.
2. The constraints in which they are doing those jobs.

And then figuring out how (if) AI can be used precisely to help them with those jobs.

Here, I use “jobs” in the sense of Clayton Christensen’s “jobs to be done” framework, which focuses on the core tasks users need to accomplish.

In healthcare, workflows vary widely. A surgeon’s daily routine differs drastically from that of a critical care nurse or a radiologist. Even within the same specialty, factors like location — an urban hospital versus a suburban health system — further shape how work is done.

A scene from the movie “Shocktrauma,” which portrays the life of Dr. R Adams Cowley (often called the father of trauma medicine), captures this point well. In this scene, William Conrad, playing Dr. Cowley, discusses trauma care with a skeptical hospitalist, Dr. “Tex” Goodnight:

Conrad: “Shock! Think of it as a pause in the act of dying.”

Tex: “So what do you do about it? What’s different here?”

Conrad: “You tell me, a patient comes to see you, what do you do? What’s the first thing?”

Tex: “Well, I first take history.”

Conrad: “OK, so you tell him to sit down, you sit in your chair, and you smile at him, and then you say very slowly and very quietly – have you ever had a heart attack sir, are you a diabetic, is there cancer in your family?”

Tex: “That’s right”

Conrad: “And then what?”

Tex: “Then I examine him.”

Conrad: “Which prompts more questions. Where does that scar come from, does this hurt, have you always had those bumps? All right. Now that the history and examination have been done, now what you do?”

Tex: “I make a diagnosis.”

Conrad: “And then you can start to treat, is that right?”

Tex: Nods.

Conrad: “Except by then, our kind of patient is dead. We’ve got to get them fast.”

This conversation highlights how a clinician’s workflow — what steps they take, in what order, and under what time constraints — defines what information they need and when.

More recently, our potential users have expressed similar sentiments. During a brainstorming session to redesign our user interface, a trauma surgeon we closely collaborate with said, “I think the differentiator now is not just ‘Give me data.’ Don’t just hand me a number from your predictive mode Give me information I can act on. I need something that helps me do something next, right? Give me information so I can make a decision in a very short period of time.”

That’s workflow!

If you’re providing AI software to trauma surgeons, you must deliver actionable insights to them within seconds. If you’re providing solutions for a clinician like Dr. Tex, the functionality and interface need to reflect his more measured diagnostic process. That takes research, effort, and a deep commitment.

In the health tech ecosystem, workflow-oriented solutions are sometimes trivialized as point solutions and the goal often is to become a platform, for two reasons:

1. Platforms suggest a larger total addressable market and lofty growth projections, which investors love.
2. Healthcare organizations often prefer fewer vendors to manage, which makes a single platform appealing.

But to truly realize value from AI, we need to see platforms and workflow solutions as complementary rather than competing approaches. Think of it this way: a strong foundation and solid structure are essential for any house. But designing a home that people actually want to live in demands attention to how they will use each space. Healthcare workflows, if anything, are infinitely more complex and variable than day-to-day needs of people living in a house. So, a healthcare AI platform might provide the technical backbone, but truly valuable solutions require deep understanding of the day-to-day workflows of the people who rely on it.

By prioritizing workflow-oriented AI solutions, we ensure that healthcare professionals get the support they need, in the form they need it. That’s the key to driving adoption, improving the quality of care, and ultimately realizing meaningful value from AI in healthcare.

HIStalk Interviews Bob Katter, President, First Databank

Bob Katter, MBA is president of First Databank.

Tell me about yourself and the company.

I’ve spent my entire career in healthcare, primarily health IT and a little bit of health services. Before joining First Databank about 15 years ago, I was with RelayHealth and then McKesson for several years. At First Databank, I’ve previously headed up the commercial and consumer-facing functions, and then at the start of 2020, right in time for the pandemic, I took on the role of president.

First Databank, which I think is referred to by most in the industry as FDB, is one of those companies that few people outside of the industry or even inside it have heard of. We play an important role. Many healthcare delivery organizations, probably a majority, count on us to provide timely and accurate medication information. We support a whole range of clinical, administrative, and financial workflows. We aren’t an application, per se. We’re the content that supports it. That can be an EHR system, a pharmacy management system, a claims processing system, and other types of systems.

We recently expanded beyond that core business to get into the e-prescribing network business with FDB Vela. It’s different than our core content business, but also related, in the sense that a lot of the customers, the people who use the network, are the same people who use our medication content. We think that our expertise with the content gives us a unique and special way to do that e-prescribing network.

How has medication decision support changed in terms of personalization and making the information actionable to the correct person? 

You’re absolutely correct. That is our core business, and in many ways, is the most important thing that we do. It is changing a lot, and I think it’s about to change a lot more because of the advances in technology and generative AI. 

Everyone is probably saying something similar, but even prior to these recent advances in AI, just through FHIR and those types of things, we’re seeing a much greater ability to pull information from whatever clinical system in which our content is being used to make the content or the decision support that we provide more patient specific and more actionable. The clinician not only gets the patient-specific information, but is in a good position to act on it right then. A clinician should consider a number of patient-specific factors when ordering a med, for instance. Those include demographic factors, which we’ve also always had, but also clinical factors such as diagnoses, allergies, other meds the patient is on, lab values, risk scores, and increasingly, a patient’s genetic profile.

The technology is evolving to the point where we can access this information in real time and provide that succinct kind of impact statement. “Here’s what that means for this patient in this order,” and even give some sense to the clinician not just as a safety check, but potentially a more actionable, “Here’s what you ought to do.” We are doing that in the hospital setting. We are also doing that in the pharmacy setting. We’ve rolled out a program with CVS that we’re excited about. They don’t call that decision support, they call it DUR, drug utilization review, but it’s a pretty similar process. It is focused on very patient-specific information and focuses on the actions the clinician should take as a result of this information.

How might that process be changed with generative AI, which could help make sense of the information in context or tie into external references?

As you can imagine, that is question that my senior team and I are spending a lot of time on. In terms of building on what I was talking about a minute ago about patient-specific decision support, one thing that these large language models can do better than any other technology that we have worked so far is to take unstructured data and do a reasonable job of structuring it. Through standards, there are ways to pull structured data out of an EHR and put structured data back into an EHR. We are doing that with several EHR partners. But a lot of the data inside a chart, including meaningful and useful data, is in text form, in an unstructured form. The LLMs provide a lot of promise in terms of being able to pull data out. We are working on that right now to support several clinical and administrative workflows.

Something else that this type of technology can do is in the area of so called real-world evidence that people have been talking about. You can essentially ask the technology, what have clinicians done for thousands of other patients that look very similar in terms of clinical context to this patient? I don’t think that necessarily provides a definitive answer, but it’s another perspective that you can surface in front of the clinician that would be useful advice when combined with the so-called traditional evidence that FDB and companies like us have based our content on to this point.

In our AI testing, it’s very good, but it’s not at the near-perfect or perfect standard that I think our industry will require for clinical decision support. There remains a role for experts to guide and manage the technology. In our business, 99% is not nearly good enough. We’re talking about a 99.9999% standard. Based on what we’ve seen, to get to that level of accuracy and consistency will require expert humans along with it. That said, there’s no doubt the technology is very powerful and is continuing to advance. For pulling things that are unstructured and structuring them, as well as offering that real-world evidence component, we think the technology is going to become very useful.

What opportunities does a prescribing network such as Vela provide in connecting not just providers, but other types of participants, such payers?

In terms of other types of participants, the current network and Vela support all of the NCPDP standards. The currently available networks already support connectivity between the prescribers who use an EHR system; the payers, if you consider the payers to be PBMs in this case; as well as the pharmacies. But one constituent that is left out of that equation is the patient themselves. We think that is important. 

Vela supports a workflow where the patient doesn’t receive an actual prescription that they can do anything with other than forward it. Patient choice becomes an important component, and the networks should support that. That has been done in the past by having a patient-facing app mimic a pharmacy, but we don’t think that’s the right workflow because it removes subsequent pharmacy-to-physician communication that the standards support. You need to have a different role. Thankfully, NCPDP has worked with us and there is a standard that supports that. You need to have a different role for the patient, and that’s an important constituency.

When you get into specialty drugs, you can use the prescribing network for all the standard things. But when you get to prior authorization, specialty enrollment, and patient financial responsibility, those are all separate transactions that the provider’s office has to manage separately. We think there’s a real opportunity to pull all of that into one unified system. The provider would write the prescription in the EHR system. Then, all of the information that you need to support those subsequent workflows — whether that’s a real-time patient benefit request, a prior authorization request, or specialty enrollment request – can be done with data or content from the EHR. That’s where you get back into pulling things out of the EHR that are unstructured and the promise that AI has for that as opposed to just structured information. There’s a lot of opportunity to innovate in that area.

We’re up to somewhere around 10 or so partners that have consumer-facing applications. Something that the patient can use, typically on their phone, to manage their prescriptions. Our network supports the standard by which that application can essentially receive a copy of that prescription, and then the patient has the ability — depending on which application it is — to do all sorts of things that include choosing a pharmacy from the pharmacy network and decide where they want that prescription sent.

It’s also an excellent opportunity to surface other things. You mentioned real-time pharmacy benefit. That, along with a coupon from a company like GoodRx, allows the patient to make intelligent decisions based on their financial responsibility. They can seek to fill the prescription at a pharmacy where they can afford their co-pay or co-insurance, for instance. We also think that here’s an ability, once the patient is in that workflow, to provide information around adherence and things that are going to help that patient fill that drug initially and stay on that drug subsequently. We’re not an application company per se, but we will support any kind of NCPDP-compliant application that can manage and forward prescriptions.

How extensive is the use of precision medicine and genomics in in ordering drug therapy?

There are several hundred drugs that have good, published clinical evidence to support it. A lot of those are in the central nervous system area, mental health drugs, pain drugs. There are certain therapeutic categories where there tends to be more evidence. It’s very specific, such as if you have this particular genetic variant, you’re going to metabolize this particular drug differently, so you need to change the dosing. Sometimes it’s an absolute contraindication given a genetic variant, where we would advise the clinician to prescribe a different drug.

A couple of years ago, I would have said that this is something that we love talking about, but we’re a little out in front. It’s very much going mainstream now. We’re getting both public and private hospitals adopting it, particularly those that use Epic and Meditech EHRs. We are finally starting to see this come into clinical practice in a major way.

What is the status of recording and using medical device information?

For several years, we have published a database called Prizm. It’s a comprehensive database of Class I, Class II, and Class II medical devices. It’s fairly different than medications, and maybe even we didn’t understand how different it was initially. Medical devices are not managed in the same way as drugs. There isn’t that definitive set of content or set of therapeutic categories anywhere near to the same extent as drugs. We are continuing to work with health systems and starting to see traction.

In terms of the use cases, there are almost too many to list, but I guess I could just throw out a couple of pretty obvious ones. One is inventory management. If you truly understand which devices are in which categories, even to the point where you could substitute this particular device for this other device if supply is short or the price goes way up, then hospital systems should be able to manage their inventories much better and probably save a lot of money in the meantime.

There’s also a patient safety aspect to this. Somebody in a hospital told me a couple of years ago, and I hope it’s not completely true, that, “We probably have a better idea of what cans of food are on our grocery store shelves nationwide right now than we do of which devices we’ve implanted in which people.” This idea that we’re putting implantable devices in people and we’re not able to completely keep track of which patient has which device or which generation device it is, affects decision support as well as recalls. I may be being a little too critical of how that’s managed, but I think that with a more standardized content source, the industry can do a much better job.

What consumer-facing use cases do you see for your products?

There’s a big gap in what patients are prescribed. Maybe a Medicare patient has a number of meds and doesn’t understand why they’re taking them, how to take them in cases where it’s more complex than just swallowing a pill, or which meds they should take at different times. We provide specific information beyond the long, industry-approved monograph that covers everything. What are the most salient points that the patient needs to know?

There’s also a need to provide patient information at an appropriate reading grade level, which might involve using pictures or so-called pictograms that are more universal and easier for people to understand. Also making the information available in multiple languages. We have an incredible number of people living in the United States for whom English is not their first language. They might not understand something as complicated as medications in English. This is obviously another area where AI will provide tremendous assistance.

What are the company’s priorities over the next few years?

I’ve been spending a lot of time in the past year or 18 months thinking about that, given how fast things are changing. With the ongoing advancement and adoption of AI technology, clinical practice is going to change pretty dramatically. The amount of information that can be made available to clinicians to aid in their decision-making process will be immense, even relative to what it is today.

The priority for our company is to say,  how do we play?  If more hospitals are using ambient AI technology in patient encounters for charting, that might  kick off a different workflow for how decision support works. We’re going to want to make sure that our information is made available in that setting. Maybe the clinician won’t be typing in the order and managing it the way they traditionally have. Maybe it will be more of a verbal process. A huge priority for us is to understand how those clinician workflows will change and how we can participate and remain valuable to the clinician in that process.

We will determine how we can leverage AI and real-world evidence in new ways. Not to stop doing what we do now in terms of the traditional evidence, but combine it with the larger amount of content and data that we can get using real-world evidence and how that combination of things can be more powerful. 

Morning Headlines 12/16/24

American Telemedicine Association Launches Center of Digital Excellence (CODE) to Accelerate Digital Integration in Care Delivery

The American Telemedicine Association launches the ATA Center of Digital Excellence, whose big-name health system members will work to advance the integration of digital care pathways.

Cyber criminals claim they hacked 17 million patient records at PIH Health hospitals

An unidentified ransomware group threatens via fax to publish data stolen from PIH Health (CA) during a December 1 ransomware attack that continues to impact the provider’s IT systems.

Tuva Health Launches Open-Source Platform to Transform Healthcare Analytics Industry

Tuva Health, an open-source healthcare data and analytics startup, raises $5 million in seed funding.