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Readers Write: How Hospitals Can Harness Identity Access Management to Mitigate Cyberattacks

December 18, 2023 Readers Write No Comments

How Hospitals Can Harness Identity Access Management to Mitigate Cyberattacks
By Ferdinand Hamada

Ferdinand Hamada is managing director of healthcare cybersecurity for MorganFranklin Consulting of McLean, VA.

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On Thanksgiving Day, Ardent Health Services was hit by a ransomware attack that disrupted ambulance routes for hospitals in New Jersey, New Mexico, Oklahoma, and Texas and forced them into diversion mode, unable to accept new patients or perform some surgeries. This is just the latest alarming example of rising attacks on healthcare organizations, making it more critical than ever to maintain visibility over who and what is connected to hospital networks.

With these increased risks — coupled with an uptick in mergers and acquisitions (M&A) plus the ongoing issue of attrition in the industry with 60% of all healthcare support workers expected to leave their jobs within five years — ensuring that identities are managed appropriately is critical to mitigate these risks.

To improve security during these times of flux, hospitals should proactively develop a centralized identity access management (IAM) system to combat increased vulnerability to attacks. IAM systems help identify potential access and permissions risks, which makes them an essential part of hospital cybersecurity programs. By detecting access disruptions in advance and implementing solutions to manage them, hospitals can reduce their impact on patient safety, revenue, reputational loss, and operations.

To create a robust and sustainable IAM program, here are three areas that hospital IT and security teams should focus on:

Limit access to reduce risk

In many hospitals, staff have access to more systems than they need to perform their core duties. To keep information safe, access to data and other valuable assets should be limited and permissions requests should be accurately validated. There are several ways to reduce access across hospital systems, but no one approach stands alone. Determining the best combination of strategies will depend on how an organization currently accesses data and its larger security objectives.

  • Web single sign-on. Multiple parts of an organization’s internal and external web presence require user authentication and authorization to properly secure sensitive data. Web single sign-on frameworks simplify this process by maintaining a user’s authenticated state throughout their entire web session.
  • Adaptive access. Different information and resources carry different levels of risk. Adaptive access enables an organization to easily require more robust authentication for riskier assets while easing accessibility for low-risk resources.
  • Reverse proxy. A reverse proxy sits behind the company firewall and forwards web requests to a server for response. This simplifies the user experience and reduces the amount of information about an organization’s internal network structure that is shared with third parties.
  • Federation login. Contractors and partners require limited systems access, but creating accounts within an organization’s identity management system is time-consuming and adds complexity. Federation enables secure identity sharing across organizations by simplifying authentication and access management for partner organizations.

Implementing new or updated access procedures should also work with existing internal or external frameworks, policies, and technologies. This enables a seamless transition to a new IAM model, promoting appropriate access to data and resources across an entire organization.

Develop onboarding and offboarding checklists to manage employee permissions

While security programs are often focused on mitigating external threats, employees can pose the same or greater security risk to hospitals and patients, whether purposefully or accidentally.

Human security risks come in a variety of different forms:

  • Social engineering and phishing. Social engineering attacks aim to gain physical access to a secure area or system using human interaction. These attacks often occur using convincing messages for phishing. Phishing can happen via email, telephone (voice phishing or vishing), text message (SMS phishing or smishing), and even on social media.
  • Insider threats. Insider threats are caused by employees, contractors, and vendors who have access to the hospital’s systems, and they can occur unintentionally, intentionally, or collusively.
  • Negligent behavior. Employees can also inadvertently place data and security at risk by doing things like insecurely using applications and devices or sharing passwords.

These types of human-based threats can also increase during transitional periods, so it’s important to have IAM plans and processes in place to minimize their risks. Developing checklists to control access during onboarding and offboarding processes can help ensure smooth changeovers. Additionally, employee security training should include how to manage security risks within your specific organization in addition to traditional threats like phishing and reporting lost devices.

Implementing a centralized dashboard for IT teams that provides real-time monitoring, remote access and automated alerts

User rights and privileges, or simply who in an organization has access to what data and systems, need to be readily visible to an IT team. Using IAM platforms and tools provides a scalable and automated foundation for compliance controls, access requests, password management, and identity-enabled visibility.

Implementing a centralized IAM system enables an organization to achieve full visibility and control over its information. These solutions can also help reduce manual workload and save a security team’s time. For example, automating standard procedures and threat alerts can give IT teams more time to focus on real-time monitoring and intercepting potential remote access threats.

As the healthcare industry continues to face increased cybersecurity threats, hospitals will operate more safely by better-protecting data across their organization. Securing employee and device access and implementing a centralized management system to monitor sensitive information should be a key pillar of any hospital business plan. Ultimately, the robust protection of IAM programs mitigates risk and protects sensitive patient information, systems, reputations, and revenue.

Curbside Consult with Dr. Jayne 12/18/23

December 18, 2023 Dr. Jayne 1 Comment

Mr. H posed a question last week about how to streamline training for PCPs and asked me to weigh in as well.

To really answer the question, we have to ask ourselves what we as a society actually expect primary care providers to do and what kinds of experience we expect them to have. The answers to those questions directly impact how we could best train people to share the primary care load.

To help mitigate my own bias as a board-certified family medicine physician with 20 years of experience, I looked to MedlinePlus (which is an official website of the US government) to define “primary care provider.”  According to the site, “A primary care provider (PCP) is a healthcare practitioner who sees people that have common medical problems. This person is most often a doctor. However, a PCP may be a physician assistant or nurse practitioner. Your PCP is often involved in your care for a long time. Therefore, it is important to choose someone with whom you will work well.”

Some lay people might read that and think “common medical problems” are things like cough and cold, urinary tract infections, rashes, sprains and strains, and the like. Although those are common, those kinds of acute problems are only a small part of what primary care providers actually see. In a traditional primary care practice, we’re also caring for lifelong medical problems like asthma, diabetes, high blood pressure, heart failure, stroke, chronic obstructive pulmonary disease / emphysema, kidney failure, vascular disease, connective tissue disorders, cancer, neurological diseases, and more. Additionally, we care for more complicated acute problems like pneumonia, bronchitis, kidney infections, unusual rashes and suspicious lesions, and clusters of symptoms that don’t have a clear cause.

The latter is where primary care physicians really shine, being able to look at a set of related or seemingly-unrelated symptoms and pulling it all together to create a plan to diagnose the patient. That kind of clinical skill is far beyond evaluating cold symptoms and running a COVID or flu test.

The other thing that happens in primary care, but was not mentioned in the MedlinePlus definition, is the delivery of preventive health services. This is the part where we talk to patients about recommendations, present the options, discuss the risks and benefits and which options might be best depending on the patients’ other medical factors, and ultimately order the services. For a patient who is reluctant to undergo a screening test, this might involve ongoing conversations over a period of months to arrive at the point where a patient accepts a test.

Other preventive services include counseling on smoking, drugs, safe sex, diet, exercise, nutrition, mental health, family dynamics, and what to expect as you age. Speaking of the aged, we also have conversations about advance care planning. On the other end of the spectrum, those of us who see pediatric patients do a lot o bnf counseling and anticipatory guidance, making sure parents know what to expect as their children grow and what might be normal or not normal. Some days, we give a lot of reassurance.

In family medicine, we’re also trained to perform office-based procedures ranging from skin biopsies and toenail removal to joint injections to flexible sigmoidoscopy to colposcopy and cervical / endometrial biopsies. In some areas of the country, we provide full-spectrum maternity care, including c-sections. Some of us are trained to perform colonoscopy, and a small subset of us who have done extra training can even perform appendectomies and other urgently-needed surgical procedures. Most of the family physicians working at that level are either part of a residency / fellowship training program or are practicing in a more rural area, but it’s something that the majority of readers are likely not aware of.

Internal medicine training is similar, but with less of a focus on procedures and no care for infants, children, or pregnancy. Pediatrics generally covers people under the age of 18, but includes a full spectrum of conditions and procedures. Geriatrics is often left out of the primary care list, but as our population ages, it is becoming increasingly important.

That broad definition of primary care falls to the wayside if you listen to many of the talking heads in the healthcare industry today. They feel that primary care can be delivered in a transactional fashion without continuity, and don’t fully understand that when a patient has a lot of different seemingly-minor problems, they can actually add up to something much more significant. These organizations are happy to hire people who aren’t even trained in primary care to deliver primary care services, as long as they’re willing to work for cheap. You don’t have to be board certified when patients are paying cash. (Generally, you do have to be board certified or at least board eligible if you’re being added to insurance panels.)

The definition also morphs a bit when primary care providers become employed by organizations that see them as little more than referral mills, sending patients to subspecialists who perform high-dollar procedures. One of my primary care colleagues who works for a hospital-affiliated group was recently scolded for not sending her diabetic patients to an endocrinologist. Guess what? Her patients have excellent glucose control, are on evidence-based regimens, and aren’t having side effects. That combination of factors means that referrals weren’t warranted. The organization tends to make more money on patients when they are referred to endocrinology, though, so they weren’t happy.

Another role of primary care providers, according to MedlinePlus, is to “assess the urgency of your medical problems and direct you to the best place for that care.” When we actually know you (which means you’re probably not getting your care from a transactional non-continuity entity) we can better assess your symptoms and determine if you can see us in the office on Monday, whether you can go to an urgent care tomorrow morning, or whether you need to go to the emergency department immediately. That’s not to say that a primary care provider who doesn’t know you can’t do that assessment, but from experience, that’s when I see the most patients sent to a higher level of care than they need, usually at a higher cost.

Many primary care providers also see patients in the hospital, although that’s becoming less common every day. Being able to manage hospitalized patients in an environment where the goal is to get the patient out of the hospital as quickly as possible becomes difficult when you’re also seeing patients in the office. That has led a large number of primary care providers to turn over the care of their hospitalized patients to “hospitalists” for inpatient management. Sometimes this results in better coordinated care, sometimes it results in more disjointed care, and I’ve seen the whole spectrum. In an ideal situation, the hospitalists have close relationships with the primary care providers and coordinate discharge and follow up, but there can be misses when the focus is on patient throughput.

Primary care physicians have a bachelor’s degree, four years of medical school for a MD or DO degree, and a minimum of three years of residency. They graduate training with around 20,000 clinical contact hours, which makes it much more likely that they will have seen rare diseases or unusual presentations of common diseases. Physician assistants have bachelor’s and master’s degrees and typically graduate their training with around 2,000 clinical contact hours. Nurse practitioners have a bachelor of nursing degree and typically graduate their training with around 500 clinical contact hours. Although in the past many nurse practitioners had extensive experience as a registered nurse prior to going to NP school, most of my colleagues who have recently entered the field have two or fewer years in practice before starting their NP program. Boiling those hours into years of post-bachelor’s training using data on the quickest paths around — physician=7, PA=2, NP=2.

Keeping that all in mind, we can turn back to the question. What is the shortest time we could train someone to work as a primary care provider? It all depends on what we want them to do. If we want them to be able to find the zebras hiding among the horses (which is how medical school professors like to describe rare diseases) we probably need people with more education. If we want people to follow algorithms and guidelines and crank out referrals and orders, we can use resources with less education.

I think there is room to streamline the path for physician trainees, or at least to allow them to focus on the areas where they might want to dig deeper. For example, I knew early on in my training that I would not be practicing in a rural area and would not be delivering maternity care. Still, I had to complete multiple months of required labor and delivery rotations that could have been better spent learning geriatrics or weight management. I also spent several months staffing the intensive care unit even though I knew that I would be moving to an area that doesn’t allow family physicians to have ICU privileges.

Mr. H asked whether med school should be more training than education given the endless access to literature and resources. I think med schools have evolved over the last decade. I have watched my alma mater make significant changes to its curriculum. For example, they’ve shifted clinical education so that it starts almost on Day One.

For people who are committed to a career path, it could be streamlined a bit, but sometimes physicians don’t find their calling until their third or fourth year of medical school. My own school penalized me for wanting me to do family medicine from the get-go, but that’s another story. As someone who chose a path to deliver comprehensive care, though, I can only think of one clinical rotation in medical school that didn’t contribute to my future specialty-specific knowledge, although it taught me an unquantifiable amount in the realm of delivering compassionate care.

Mr. H also asked how much of a mid-career PCP’s practice uses their training from decades before. I’d say that 20 years out, my family physician colleagues in traditional practice are using a fair amount of their original training, minus the obstetrics, general surgery, ICU, and some of the emergency medicine procedural skills. They’ve also learned a considerable amount as medicine has changed. For example, many of the drugs used to treat diabetes today didn’t exist when I was in medical school. For me in the emergency and urgent care space, on a routine basis, I use about 70% of my training, but when something comes in that falls into the other 30%, I’m glad I have it deep in the recesses of my brain.

Mr. H asked whether some things can be eliminated because they’ll become obsolete, and I think that’s tricky because it’s hard to predict what exactly will be obsolete. For example, we’re still treating strep throat the same way we did 20 years ago, but not diabetes.

As a seasoned attending physician who formerly precepted students and residents, I’ve seen what can happen when less-trained individuals see patients. During the training period, however, there’s the opportunity for supervisors to educate and correct these situations. When less-trained individuals are out in practice unsupervised, regardless of their degree, there’s no process for correction until the patient sees another provider or something bad happens. There is a growing body of literature that demonstrates that less-trained individuals order more referrals, which leads to more expensive care, not to mention delays in patient care and poor patient experience.

Because of that, and what I’ve seen in practice, I personally don’t believe that less training or less education is what we need. Instead, I think we need to be using the resources we have more effectively. How do we do that, you may ask?

First and foremost, unshackle the highest-trained providers (the physicians) from the work that others with less training can do. Free them from their inboxes and hire adequate staff to support them. Use highly trained support staff to manage messages and triage patients using protocols and standing orders. Put registered nurses back on the team, not just medical assistants or patient care technicians.

Second, embrace team-based care. Bring nurse practitioners and physician assistants into specific roles. For example, seeing complex diabetic patients monthly for ongoing education and fine-tuning of treatments while the physician sees them quarterly. That way, the patient can benefit from both levels of education. Encourage patients to build relationships with the team so that there’s a larger pool of people that know them and can watch for changes in their status.

Third, bring in ancillary disciplines for support – registered dieticians, clinical pharmacists, certified diabetic educators, psychologists, social workers, care coordinators, health coaches, patient navigators, and more. Those disciplines have different education than primary care providers and can help deliver more focused interventions so that others can work at an appropriate level commensurate with their training and education.

Finally, I’m going to go out on a limb and mention the rise in the number of for-profit schools as contributing to the problem. For some of them, the focus seems to be on cranking out graduates rather than producing well-educated, well-qualified graduates. As an example, the local medical schools and PA programs (which are affiliated with comprehensive universities) all provide students with lists of “approved” preceptors for rotations. They are vetted and provide documentation about their teaching style and what they’ll allow students to do. The for-profit NP program in the area (which is not affiliated with a comprehensive university) allows students to select their own preceptors, and the students have to call around and beg people to allow them to rotate. I get two or three calls a month. I can’t imagine there’s much quality control over what some of those preceptors may or may not be teaching and the process seems predatory given how much tuition the students are paying.

To make a long blog short, I think there are some ways we can streamline training programs in the US, but we still need some primary care providers to have longer, more comprehensive educational experiences. By using those with shorter training programs or those that have a narrower focus alongside those with broader training, along with other ancillary professionals, we can provide not only the best care for patients, but also the most cost-efficient care with the best outcomes. I would be remiss if I didn’t mention the biggest barrier to people becoming primary care physicians, which is that they are among the lowest-paid specialties.

What do you want in a primary care provider? Or do you just want to get your care from Amazon? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Dan Schubert, CEO, Revuud

December 18, 2023 Interviews No Comments

Dan Schubert is co-founder and CEO of Revuud of Charlotte, NC.

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Tell me about yourself and the company.

Software technology has been pretty much my entire career for the last 25 years. I was a founder of a very early software-as-a-service platform in the commercial real estate industry back in the 2000 timeframe. I grew that and sold it to a large private equity firm in 2021. I started Revuud with my partner Eric Utzinger three years ago. We coined the idea in 2020 and officialized the business in 2021. The original premise for Revuud is to disrupt the staffing industry related to healthcare IT.

How do health systems engage with IT contractors?

Hospital CIOs and other hospital managers generally contract with full staffing firms, who then recruit talent or contractors who work directly for the staffing firm. The staffing firm places them with the hospital for employment. You call your recruiter, you say I need a certain kind of people for a project, and they go off and try to find people who meet the job description. They submit resumes to the health system, the health system reviews them and decides who to interview, and then they make a decision on hiring someone.

Revuud is replacing a lot of that process. You join the Revuud marketplace as a health system. Your users can search, or even better, they can create the job opportunity itself in the platform and it goes out to the entire talent database that has joined Revuud. Contractors create a profile in Revuud so they can be found for these health system job opportunities. 

There’s no need for the health system to call a staffing firm. They can simply log into Revuud, create a job opportunity, and see the results that match that  job opportunity instantly. Or they can search the talent database themselves, find the talent that they’re looking for, and then message them to set up an interview. They engage them through the platform, contract with them through the platform, and then Revuud pays the talent and we invoice the health system on a per-payroll period basis.

The workers are 1099 contractors to Revuud?

Correct. They are all 1099 contractors. We are a  gig economy platform, so it’s all about 1099 contract work.

Are most of those contractors supplementing a full-time job or are they doing gig work exclusively?

I’m not exactly sure of the percentage breakdown, but I would think that 60% to 80% are full-time contractors. The rest are full-time employed people who do contracting on the side.

How does your system make it easier for the health system to manage those contractors?

Instead of having to go through staffing agencies, we are cutting that middleman out. They log into the Revuud marketplace themselves, instantly find and recruit, and 1099 them through our platform. Revuud pays the contractor and we invoice the health system. The health system does not have to hire these people, either as a full-time employee or on a contract basis.

Do most of the contractors work remotely?

Yes. The vast majority are remote, although we do handle 1099 contractors on the platform who come on site as well.

In healthcare IT, you can only have contractors in place in the larger health systems all the time. Some of our clients have anywhere from 10 to 50 contractors on staff at any given time in their departments. Health system CIOs manage north of 100 applications at any given time. It’s normal to have contract IT workers as part of your staff.

Are health systems searching for a specific skill that makes it easy to explain what they need?

It can be that simple, but we have some pretty sophisticated AI-driven matching technology that we have developed, so that when a client’s hiring manager creates a job opportunity, it instantly matches it to qualified talents who meet the job opportunity’s requirements. They don’t even have to search because based on the job description, it instantly matches them with qualified candidates. A strength of our application is that matching, which also removes the non-qualified applicants that you would get through normal processes.

People who contract full time must always be looking for their next gig since they aren’t paid to sit on the bench. Does the platform make it easier to stay booked?

Yes. It has given contractors a platform or a marketplace, just like Uber drivers, so that they have a lot more opportunities for work. It’s the one place they can go that is specialized in their industry where they can find gig contracts to work on.

The other difference is that staffing firms no longer employ a lot of contractors on a bench. They don’t pay them when they aren’t working on contract engagements. That’s a thing of the past. Hospital systems and staffing firms, particularly staffing firms, don’t want to pay for bench time any more. It’s too costly, especially with platforms like Revuud that streamline the process and remove the human being third party from of the equation. 

Is it easy for health systems to onboard a contractor that they book through your platform?

Once that engagement is being worked on, the contractor logs into Revuud every day, or every other day, to record their time and their notes on what they worked on on that date. That gets submitted to their manager’s dashboard and reviewed for approval. There is specific time entry functionality within our application, and then the health system approves or declines that time. It’s a complete accounting package for both the contractor to manage all of their hours that they work for the different health systems through Revuud and also for the the health systems themselves, their bookkeeping on who worked on what, what they worked on on this day, how many hours they worked, and things like that. 

For the contractor, they typically have an LLC that they’ve set up. They don’t have to submit invoices to Revuud. We have detailed accounting functionality within the application for the contractors. We call the statement of work between the hospital and the contractor an engagement. That is executed through the platform electronically and approved by the talent and health system electronically. 

How do the parties arrive at a contract pay rate?

Talent contractors create their Revuud profile like they would on LinkedIn and indicate their rate and type of qualification. When the health system searches or creates a job opportunity that matches, they see the rate that the contractor is willing to accept for that work. That’s part of the hiring managers’ evaluation of who they want to hire. 

It’s a transparent environment, which is a key strength of the application. The talent indicates what they want to make on a per-hour basis and the health system can post what they want to pay for a particular job opportunity. When they match up and the talent contractor applies to the opportunity or is found during a search, they can then negotiate, decide what the agreed-upon rate is for the engagement, and then execute the contract for that particular project through the application.

It’s a transparent environment. The hospital system knows what the talent makes and what the Revuud platform makes.

Is it challenging to market the company’s services to both health systems and contractors?

It absolutely is. It’s a dual-sided marketplace. We are selling to both parties. We have resources that market to talent and attract them to the platform as well as our sales team going out and attracting health systems to go to the platform. We have functionality where talent can invite other talent resources to join the platform. Health systems can invite other health systems to join the platform.

Once the marketplace takes hold, it starts to take care of itself, where it grows organically as everyone in the platform is inviting others and making those connections happen. The more health systems that we have in the platform, the better it is to help us build the talent side of the database because more job opportunities are created. We are creating that public marketplace that allows health systems to join, talent to join, and to do gig work contracts together on their own terms.

What will be important to the company over the next three or four years?

The continued use of more technology features through the application to make the whole process much more efficient for both the talent and the health system. We’re talking about assisting our clients with the interviewing process, being the system of record for onboarding requirements, and offering health systems better analytics about their contractor pool, contractor spend, and the types of contractors they use. 

We will see a lot of advancements as has happened in other industries as Uber has done. We’re cutting out the middleman where they’re not necessary. Our intent is to make the entire process more efficient and less expensive for health systems, but at the same time, allowing talent to make more money on a per-hour basis with whatever opportunity that they want to work on. Talent on our platform are making more money than they usually do on an hourly basis, yet the health system is saving significant money, usually 20% to 30% over what they usually pay for contractor labor.  

It’s a decades-old process that we are changing and disrupting. It always takes some time. But we already have quite a few health systems that have come on board, including one of the top five health systems in the nation, that want to be those industry leaders and use technology to make things much more efficient and more organized, and at the end of the day, that also saves dollars. We’re here to take this industry that has been around for decades into the technology revolution.

Morning Headlines 12/18/23

December 17, 2023 Headlines No Comments

IT failures causing patient deaths, says NHS safety body

England’s Health Services Safety Investigations Body says that IT problems are among the most pressing in hospitals, noting that some of the reports it has reviewed involved patient deaths.

Trend Health Partners Acquires Advent Health Partners

Healthcare payment integrity solution vendor Trend Health Partners acquires Advent Health Partners, which offers technology for reviewing medical records for revenue cycle processes.

Ransomware gang behind threats to Fred Hutch cancer patients

Hunters International claims responsibility for the ransomware attack on and subsequent cyberextortion emails to patients of Fred Hutchinson Cancer Center in Seattle.

Certainly Health Raises $2.3M in Funding to Enable Consumers to Book Any Doctor With Upfront Prices

Certainly Health, which runs an online marketplace for booking medical and cosmetic procedures with guaranteed out-of-pocket pricing, raises $2.3 million in funding.

Monday Morning Update 12/18/23

December 17, 2023 News No Comments

Top News

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England’s Health Services Safety Investigations Body says that IT problems are among the most pressing in hospitals, noting that some of the reports it has reviewed involved patient deaths.

It gives examples of a patient who was found unresponsive and died being misidentified as DNR, a patient with cancer who died after IT problems prevented follow up, and a woman who died 18 days after she was given the wrong meds because of an electronic chart mix-up.


HIStalk Announcements and Requests

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Few poll respondents have padded their resume with questionable recognition. After thinking about it, I am an outlier in viewing Chief membership as being in that category since its acceptance criteria involves the same items that already appear on resumes ((job title, reporting structure, and size of team managed). The only thing Chief membership proves is that your employer thinks highly enough of you to pay for vanity credential (only 30% of its members pay their own way and its unstated membership retention rate is reportedly unimpressive). It’s like buying the “certified CIO” credential in which applicants must already be a CIO, meaning the certification is pointless duplication unless employers are retaining dangerously unqualified CIOs and need them to pass a test to prove otherwise.

New poll to your right or here: What will Oracle Health look like in five years? Perhaps nuanced options exist, but basically Oracle will either still own the business (making it either better or worse over time) or it will sell or close it. Industry precedent is that the acquirer’s brash gate-crashing usually gives way to its embarrassing lack of healthcare knowledge, and after a few years of corporate incompetence and impatience, the business is sold entirely or piecemeal once enough time has passed to be able to blame the previous regime. I’m thinking Misys, Sage, GE Healthcare, Siemens, IBM, and even Microsoft and Google as as examples of companies whose desperation to prop up slowing growth illustrated Mike Tyson’s point that everybody has a plan until they get punched in the face.


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For your winter holiday reading pleasure, kindly refer back to 2022’s “Netflix and Reed Hastings: Ghost of Christmas Past,” a Readers Write by Chuck Dickens. Also, remember to stock up on pomegranates for Thursday night’s Yalda celebration, which I’m designating as the official winter holiday of HIStalk since it doesn’t exclude anyone. I’m not a Festivus guy since I’m also not a “Seinfeld” guy and thus haven’t seen that episode, but it’s apparently equally inclusive in its celebration on December 23.  


Webinars

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


Acquisitions, Funding, Business, and Stock

Weight loss app vendor Noom, which labels itself as “the leading digital healthcare company helping people live longer, better lives,” replaces much if its C-suite following its hiring of a new CEO in July 2023. The company is pivoting into GLP-1 weight loss and selling services to employers.

Healthcare payment integrity solution vendor Trend Health Partners acquires Advent Health Partners, which offers technology for reviewing medical records for revenue cycle processes.

Certainly Health, which runs an online marketplace for booking medical and cosmetic procedures with guaranteed out-of-pocket pricing, raises $2.3 million in funding.

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Medical University of South Carolina profiles the success of QuicksortRX, which was founded as an internal project by a MUSC network engineer and one of its pharmacists to bring drug pricing transparency to hospital pharmacies. The founders licensed the system from MUSC for commercialization and have sold it to 25 health system customers so far. The company is hiring around 40 new employees.

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A former burn center director sues HCA for firing her after she notified her supervisors that 90 trauma nurses who were working in a newly opened burn unit were not named in state filings as required because they hadn’t earned the required credentials. Previous media investigations found that HCA sometimes charge fees in the tens of thousands of dollars for trauma center visits, making trauma care an important revenue center that encourages hospitals to seek Level 1 trauma center status. The lawsuit also claims that HCA was attempting a hostile takeover of profitable private burn centers by hiring their employees.


Sales

  • NHS Services Scotland will implement Sectra’s cloud-based enterprise imaging solution.

Announcements and Implementations

Researchers find that the UK ranks 21st of 38 countries in key patient safety indicators, suggesting that thousands of patients die unnecessarily each year, but at least they finished well ahead of the US, which places 33rd in beating only Latvia, Costa Rica, Turkey, Colombia, and Mexico.


Government and Politics

Patients file a federal lawsuit that challenges New Jersey’s return to pre-COVID telehealth restrictions, noting that 10% of interstate telehealth visits involve cancer care. The plaintiffs say that they were denied follow-up care from their doctors in Massachusetts and Pennsylvania when New Jersey reinstated its rule that telehealth doctors who provide services to state residents must be licensed in New Jersey. At least 30 states either ban or restrict telehealth sessions with out-of-state doctors. The law firm also notes with wry cynicism the exception that exists for the doctors of sports teams, who are allowed to treat the athletes across state lines via in-person or telehealth consultations without licensure concerns. Utah also has an interesting exception in that doctors in any state can practice telehealth on its residents as long as they don’t charge them.


Other

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A patient dies at HCA Florida Bayonet Point Hospital when a remote monitoring technician calls a code blue due to a displaced sensor, but responders couldn’t find the patient because an incorrect room number had been entered into its computer system. A state investigation found that the hospital was understaffed and failed to conduct remote vital signs monitoring appropriately. The review also noted that another patient was transferred for remote monitoring but wasn’t hooked up to the equipment until seven hours later. HCA responded to the findings by saying that it had replaced the CEO and chief medical and nursing officers.

The Seattle paper predicts that nurse shortages will worsen as 10,000 internationally hired nurses can’t enter the country because of delays and caps in obtaining a US visa. Green card processing takes several years even for employer-sponsored applicants and costs start at $10,000 before adding transportation and housing expenses. Sanford Health is waiting for the 160 nurses it has hired to enter the country, but has had to use travel nurses at triple the usual hourly wage due to the immigration delays. The health system is also running virtual sitting solutions and using AI to predict staffing needs.

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Politico observes that mining companies offer their employees good health insurance that they then lose when mines close. Local hospitals and other providers thrive during mining boom times to the point that they may turn away people with lower-paying insurance such as Medicare and Medicaid, forcing them to travel long distances to receive care if they lose their mining jobs. The article observes that Williamson Memorial Hospital in the “heart of the billion-dollar coalfields” of southern West Virginia made major expansions in the mid-1990s as a medical showcase, but closed – along with most of the previously thriving town – when the mines closed, leaving locals with little access to care.


Sponsor Updates

  • The National Health Insurance Authority in the Bahamas reports a significant uptick in cancer screenings since the implementation of its EClinicalWorks EHR and associated population health tools.
  • Nordic releases a new Designing for Health Podcast, “Interview with Lalita Abhyankar, MD.”
  • Waystar publishes a new e-book, “A 4-step plan for denial prevention.”

Blog Posts


Contacts

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

Morning Headlines 12/15/23

December 14, 2023 Headlines No Comments

HHS Finalizes Rule to Advance Health IT Interoperability and Algorithm Transparency

HHS and ONC approve the final HTI-1 rule, which addresses algorithm transparency, an enhanced information blocking requirement, a requirement that certified health IT developers report interoperability-focused metrics; and designates USCDI v3 as the baseline certification standard.

Veradigm Inc. Announces that Nasdaq Hearings Panel has Granted its Continued Listing, Pending Return to Compliance with Nasdaq Filing Requirements

The hearings panel of Nasdaq extends the continued listing of Veradigm shares until February 27, 2024.

WeightWatchers Launches New Behavior Change Program Designed to Support the Unique Needs of Individuals on GLP-1 Medications

Nine months after acquiring telehealth-based weight management company Sequence, WeightWatchers launches WeightWatchers Clinic to offer members access to prescription weight loss drugs.

Volpara Health enters agreement to be acquired by Lunit, Inc.

AI-powered cancer imaging analysis system vendor Lunit will acquire New Zealand-based Volpara, which offers breast cancer detection software, for $198 million in cash.

News 12/15/23

December 14, 2023 News 4 Comments

Top News

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HHS and ONC approve the final HTI-1 rule that addresses:

  • Algorithm transparency.
  • Designation of USCDI v3 as the baseline certification standard.
  • An enhanced information blocking requirement.
  • A requirement that developers of certified health IT report interoperability-focused metrics.

Reader Comments

From Tax Bro: “Re: tech and health IT layoffs. Check out IRS Section 174 changes and ask executives if this has changed their company’s business.” An IRS change that took effect for the 2022 tax year no longer allows employers to expense their R&D costs in the same year in which they were incurred. Instead, companies must now amortize those expenses over five years, which triggers an immediately higher tax liability. Example: previously, a tech-heavy startup with $1 million in revenue and $750,000 in R&D costs (which is everything related to software development, including allocated overhead such as rent) would have paid taxes that year on $250,000. Now, that company will face an immediate IRS bill for taxes owed on $850,000, which creates a cash flow squeeze and a suddenly ugly balance sheet. It’s worse when paying offshore costs, where the deduction is spread over 15 years instead of five. In addition, companies must also amortize the capitalized cost of retiring or cancelling a software project over that same period. Folks in the know, how has that change affected your business, and has it triggered layoffs or hiring cutbacks?


HIStalk Announcements and Requests

Dear CEOs whose companies are laying people off right before Christmas. You speak confidently of right-sizing, becoming more corporately nimble, offsetting slowing growth, focusing on what matters to customers, and creating synergy from financial cuts. My question: shouldn’t you also lay off your executives, and perhaps yourself, for failing to predict and fix these problems back when you were wrong-sizing? Why drop a lump of coal into the stockings of your previously valued “associates” by pink-slipping them home for a miserable holiday? November and December layoffs are a strong indicator of executive incompetence or poorly masked corporate desperation.

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Ah, the cliché but slightly seasonally fun hospital door decorating contest. It’s too late to vote, unfortunately, for the “Welcome to Whoville” door of the IT department of 171-bed McAlester Regional Health Center (OK), as requested by Interface Specialist Anthony Master who asked nicely on LinkedIn. Still, I wish them luck in the vote tally, although my inner teen also likes the lab department’s “12 Days of Christmas: Lab Edition” that includes five golden pees, seven swimmers swimming (snicker), and eight stools a-stinking. You will probably not understand the sentimentality of such a competition unless you’ve spent a lot of years working for a small, non-profit hospital, where the money isn’t great, but your patients are your neighbors, someone’s always bringing in food, and random employees give you a hug without being asked when they sense you need one.


Webinars

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


Acquisitions, Funding, Business, and Stock

The hearings panel of Nasdaq extends the continued listing of Veradigm shares until February 27, 2024. The company blames an accounting software problem for missing its annual SEC filing for 2022 and three quarterly filings so far in 2023.

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AI-powered cancer imaging analysis system vendor Lunit will acquire New Zealand-based Volpara, which offers breast cancer detection software, for $198 million in cash. Volpara’s CEO and managing director is industry long-timer Teri Thomas, RN, MSN, who spent 21 years as an Epic VP through 2016.

Telemedicine addiction treatment provider PursueCare raises $20 million in a Series B funding round and acquire the software-based therapeutic for substance use disorder that were developed by the now-defunct Pear Therapeutics.

An 86-year-old woman and another plaintiff file a class action lawsuit against for Humana, claiming that the insurer used AI to deny care to Medicare Advantage patients. The lawsuit says that Humana uses the same NaviHealth algorithm as UnitedHealth Group, which owns the algorithm and was named in a similar lawsuit last month.

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Smartcare Software, which sells EHR and ERP systems for mobile care in the home, renames itself to Aaniie, a name it calls “unique and forward-thinking” that better represents its vision (and, it adds, is “a brand we could trademark.”) The company says it’s easy to remember the name and spelling because it stands for “An All-inclusive Network for Improving Insights & Engagement,” which creates a race to aabsurditiie between the chicken and the egg.


People

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Clinical trials technology company Slope hires Terry Edwards (PerfectServe) as COO.

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Industry long-timer Jerry McKenzie — whose 40-year health IT career included executive roles with Accu-Med, Apex, QuadraMed, T-System, and MedAssist — died December 9. He was 73.


Announcements and Implementations

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An AMA survey of physicians finds that two-thirds believe AI offers advantage, especially for documentation and prior authorization, but worry about its potential impact on the patient-physician relationship and patient privacy. One-third of them are using AI in practice, most commonly for documentation, translation, or diagnosis assistance. Their five-year plans include using AI to generate summaries of patient messages and chart information and predicting patient demand to support employee scheduling.

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Lucem Health releases Reveal for Stroke, which analyzes ECG and clinical data to identify patients who have undocumented atrial fibrillation. The solution was developed with ECG diagnostic company AccurKardia.


Government and Politics

The Illinois Supreme Court rules that hospitals can collect the biometric information of their workers, specifically their fingerprints for accessing drug dispensing machines, without being held accountable to the state’s Biometric Information Privacy Act (BIPA) that requires that the individual be notified in advance and prevents disclosure of their information without their consent. The court ruled that employing fingerprint access to retrieve patient drugs and supplies falls under HIPAA, but warns that its decision does not broadly excuse hospitals from compliance with BIPA.

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The White House announces that 28 provider and payer organizations have pledged their commitment to the safe, secure , and trustworthy purchase and use of AI in healthcare based on the principle of FAVES – seeking outcomes that are fair, appropriate, valid, effective, and safe.


Privacy and Security

In China, a hospital employee is fired and faces legal charges after sharing screen shots on social media of the hospital electronic medical records of a 57-year-old actress who died in the ED this week.


Other

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Houston Methodist Cypress Hospital CEO Trent Fulin lays out his “future bets” on becoming a smart hospital.

A jury awards a former Kaiser NICU charge nurse $41 million in her lawsuit over being fired for placing her bare feet in a NICU isolette. She claimed that Kaiser’s real reason for terminating her as a 30-year employee of the hospital was that she had raised repeated concerns about understaffing.

Awell Health Partnership Manager Rik Renard describes the company’s hiring of a highly credentialed account executive who they fired three weeks later after his poor performance led them to dig deeper into his background, where he was found to be holding another similar full-time job. He similarly held two full-time jobs at same time on three previous occasions, claiming that he was such a superstar that he only needed to work half-time to deliver full-time results. The company’s lessons learned:

  • Don’t skip calling the current employer for references. It turns out that his claimed six-year stint at another vendor was actually two since they fired him in 2020.
  • Trust your instincts if something seems off.
  • A slow start is a major red flag.
  • Sales pros are good at selling themselves.

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A liquidation trustee sues the former board chair, CEO, and CFO of Watsonville Community Hospital (CA), claiming that they forced the hospital into bankruptcy by pocketing $4 million of its dwindling reserves. The executives were appointed by the hospital’s for-profit acquirer as its only executives and board members, after which they allegedly paid $2 million to themselves and family members in consulting fees and reimbursed themselves for cars, restaurant expenses, and a beach house. They hired out IT management to a company with no experience that was owned by an executive’s friend, which the lawsuit says caused billing and medical records problems due to poor Internet access and the implementation of a problematic and “untested” cloud-based EHR. The executives amended their employment contracts just before the hospital filed bankruptcy to pay themselves $3 million in severance if the hospital changed hands. The local health district bought the hospital’s assets out of bankruptcy in September 2022, where it continues to struggle.


Sponsor Updates

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  • Healthcare IT Leaders hosts its annual Christmas tree giveaway that benefits families at Cristo Rey Atlanta Jesuit High School.
  • The “Interop Now” podcast features Ellkay VP of Interoperability Solutions G.P. Singh.
  • NCPDP’s Raising the Standard Podcast features First Databank VP of Editorial Content Julie Suko.
  • Meditech announces that Healthcare Policy Program Manager Philip Alcaidinho has been named co-chair of TechNation’s Health Advocacy Committee.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
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Contact us.

EPtalk by Dr. Jayne 12/14/23

December 14, 2023 Dr. Jayne No Comments

From Patient Satisfaction: “Re: patients navigating coverage choices during open enrollment. You are right on target. The challenge of navigating the maze between coverage and patient care is overwhelming. I sympathize with physicians and staff that have to navigate this mess. I appreciate their efforts. I am fortunate to have a great PCP and a network of specialists who care for me. I have been impressed by the coordination of care I have received in my area, even though all the practitioners are not with the same health system. They are all on Epic and share my medical information, which may account for this.” Having your records on a common EHR platform certainly makes some kinds of sharing easier. The most reliable sharing seems to be clustered around the data elements that were required as part of federal incentive programs and now have become table stakes: medications, allergies, and problem list.

Things become murkier when you’re trying to share laboratory data even among systems using a common vendor. Some require mapping of specific lab tests among all trading partners, which can be laborious. Even mapping the top 100 labs can be challenging when you’re dealing with different hospitals using different analyzers. Reference ranges and normal / abnormal flags have to be dealt with, and I’ve seen plenty of organizations just throw up their hands and avoid the problem by doing minimal mapping. Sometimes a thyroid test isn’t just a thyroid test, after all.

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For years, I’ve been a keen follower of footwear fashion, but a reader recently clued me in to advances in surgical wear. Surgeons at Mayo Clinic have partnered with Cardinal Health to create the first commercially available surgical gown  with pockets. It boasts two instrument pockets and one holster, suitable for different users, “right, left-handed; any gender of clinician; standing or sitting procedures; etc.”

Although I like the sales talking points around reducing handoffs and drops, or avoiding breaches to the sterile field, I’m less enamored of the gown’s ability to give “an extra hand to understaffed ORs” since that feels like a way for administrators to justify continued understaffing. I reached out to a couple of colleagues. The first said “heck yeah, it’s amazing,” but it sounds like he hasn’t experienced it yet. The second colleague, a 20-year veteran scrub nurse, was a bit more skeptical. She felt it may create issues with lack of standardization in how different surgeons put equipment in their pockets, creating potential confusion for surgical assistants and scrub staff that could ultimately impact patient outcomes. In a salute to the litigious folks out there, Cardinal Health warns that “sharp, hot, heavy, or long instruments should not be placed in the pockets or holster.”

CMS recently released data on National Health Expenditures for the 2022 fiscal year. Here are some of the highlights:

  • Healthcare spending grew by 4.1% to reach $4.5 trillion.
  • The percentage of insured persons in the US reached 92%.
  • The share of Gross Domestic Product devoted to healthcare is 17.3%.
  • Hospital care is responsible for 30% of spending, followed by physician / clinical services at 20%, and retail prescription drugs at 9%.
  • Private health insurance pays 29% of the bills, followed by Medicare at 21% and Medicaid at 18%. Patients paid out-of-pocket for 11% of care delivered.

It’s important to keep in mind that although the percentage of insured persons has reached a historic high, that figure doesn’t say anything about the comprehensiveness of their insurance coverage, whether it’s affordable, or whether it’s delivering high-quality care.

The Association of Health Care Journalists has released a tip sheet educating reporters on how to spot and report on deepfakes, following concerns about cybercriminals trying to impersonate health system executives. Informatics guru Dean Sittig, PhD and professor of biomedical informatics at the University of Texas Health Science Center at Houston contributed to the document. Potential scenarios include using the technique to get employees to engage in activities that would allow criminals to gain access to technology, creating media that impacts an institution’s reputation, or creating media for use in blackmail efforts. The article also includes guidance from the Department of Homeland Security on how to spot faked images and videos and things to listen for in faked audio recordings.

From Renee’s Friend: “Re: lawsuit award. As a nurse, I’m always interested in stories about whistleblowers that address quality issues. This one about a Kaiser nurse who was awarded $41.49 million has me scratching my head a bit – check out the part about the isolette.” Apparently the nurse claimed retaliation and wrongful termination following her quality and safety complaints. However, the article notes that “In their court papers, Kaiser attorneys maintained that the 30-year employee admitted that in 2019 she took off her shoes and socks and placed her bare feet on an isolette, a medical device that holds sick or premature newborn babies. The defense attorneys included a photo of Gatchalian doing so in their court papers.” This seems truly bizarre and I can only imagine the events leading up to its occurrence. If anyone has more details, do share.

Axios reports on a recent survey that found patients are concerned about how their physicians may be using AI. The article noes that four out of five patients are concerned with the use of AI in making diagnoses or determining treatment plans, with the majority voicing concerns that they don’t know where the information feeding the AI tools is coming from or whether it should be trusted. Half are concerned about the creation of false information, while eight in 10 were concerned about AI using information from internet searches. That number fell to 63% when patients were told the tool was from a reputable healthcare source.

Even as a clinical informaticist who understands how various organizations are creating their AI-powered solutions, I am concerned about the frequency with which they engage clinical resources during the development process and the level of scrutiny present when engineering teams are determined whether a solution is ready for deployment.

An article published last week in the Journal of the American Medical Informatics Association looked at another angle to this issue – ethical perspectives on the development of algorithms used in healthcare. The authors identified areas where greater attention to ethics may be needed, along with technical challenges that influence clinical usefulness, and how solutions support the key ethical concepts of beneficence and justice. We are indeed living in interesting times.

What do you think about the role of ethicists in the development of AI solutions? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/14/23

December 13, 2023 Headlines No Comments

PursueCare Completes Fundraising Round and Acquires Digital Therapeutics Tools

Online addiction and mental health counseling company PursueCare announces a $20 million Series B funding round and the acquisition of prescription digital therapeutics developed by the now-shuttered Pear Therapeutics.

Class-action suit accuses another Medicare insurer of using AI to deny care

A class-action lawsuit claims Humana has used AI to deny seniors rehabilitation care recommended by their physicians, despite knowing that the algorithm is “highly inaccurate.”

Twin Health gets $50M injection for metabolic care

Metabolic care and technology company Twin Health raises $50 million in a Series D funding round.

Former Watsonville Community Hospital owners siphoned $4 million for personal use, bankruptcy trustee alleges

Chapter 11 bankruptcy proceedings reveal that three former Watsonville Community Hospital (CA) executives “grossly mismanaged” the hospital’s finances by making millions in unauthorized payments to themselves and mismanaging its EHR and billing systems.

Healthcare AI News 12/13/23

December 13, 2023 Healthcare AI News No Comments

News

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Elon Musk’s AI firm XAI releases its Grok chatbot to Premium+ subscribers of his X social media platform. Premium+ costs $16 per month and in addition to Grok access, includes editing of X posts, the ability to write longer posts, reply prioritization, the blue user checkmark, and removal of ads.

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The bioinformatics department of Yale’s medical school launches a 16-week, $5,000 online non-credit certificate program for medical professionals titled “Medical Software and Medical Artificial Intelligence.”

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Emory University’s two-day symposium on healthcare AI draws 450 attendees.

Google releases MedLM, two medically tuned Med-PaLM models that are being piloted by HCA Healthcare for drafting physician notes and by BenchSci for biomarker classification. MedLM is available to US users of Google Cloud who are whitelisted through its Vertex AI.


Business

The Federal Trade Commission and UK regulators will review any anti-trust issues that may have resulted from Microsoft’s investment in OpenAI.

Drug maker Sanofi invests $140 million in AI-powered molecule development startup Aqemia.

Darena Solutions, Leidos, and SLI Compliance launch a certification program for AI applications that are built using SMART on FHIR.

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Children’s Health (TX) rolls out a generative AI solution from Pieces Technologies that creates a 100-word summary of a patient’s visit using information extracted from Epic.


Other

Half of surveyed nursing students use generative AI tools to complete their assignments or tests, but just one-third of them think that it’s OK for colleges to use AI to make admission decisions.

The owner of Sports Illustrated fires the publication’s CEO, COO, media president, and corporate counsel for unstated reasons, two weeks after it was caught using AI-generated author bios and photos on published articles. The company blamed a third-party content vendor that insists that its articles were written by humans. 


Contacts

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

Readers Write: AI: The Prescription for Healthcare Troubles

December 13, 2023 Readers Write No Comments

AI: The Prescription for Healthcare Troubles
By Andrew Lockhart

Andrew Lockhart, MBA is co-founder and CEO of Fathom of San Francisco, CA.

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Healthcare in America is grappling with a severe workforce shortage, with the closure of physician staffing firm American Physician Partners (APP) earlier this year adding fuel to the fire. Healthcare leaders are searching for a solid solution to address the workforce shortage, and it looks like artificial intelligence (AI) is the answer.

APP’s shutdown follows Envision Healthcare’s footsteps. Both firms cited financial problems as the reason behind their closures. The shutdown of two staffing giants sent waves of panic throughout the already stressed and understaffed healthcare system, and the fallout has shone a light on the already glaring vulnerabilities within the industry.

The lack of workers is affecting emergency medicine, hospital medicine, and critical care management departments, among others, and the future looks even bleaker. An industry market report by Mercer predicts that by 2025, the US will have a shortage of a shocking 95,000 nursing assistants and 98,700 medical and lab technicians, among other worrying figures. This shortage is already negatively impacting the patient experience and safety, with the Joint Commission reporting a 19% rise in adverse events in 2022.

In response to these challenges, technology, particularly AI, is emerging as a crucial component in healthcare operations. Given the current state of healthcare, there is no way for organizations to provide the volume of level and care that patients expect and deserve without some form of automation. Here are three critical ways AI improves healthcare services.

Augmenting Workforce

As staffing shortages become increasingly prevalent, AI offers a scalable solution to address gaps in critical areas. AI provides a lifeline to stressed-out staff by reducing admin burdens and automating repetitive tasks. It frees up precious time for clinical and administrative staff to upskill and operate at the top of their license, maximizing the potential of the entire workforce.

For example, the American Medical Association (AMA) found that healthcare is facing a deficit of experienced medical coders, 30% to be exact. The average medical coder is aging out, and there are few coders ready to take their place. Autonomous coding helps health organizations improve accuracy, reduce denials, and make quicker reimbursements. Another bonus of AI coding is its ability to adapt to complicated new coding guidelines easily, ensuring compliance and accuracy.

Improving Operating Margins

McKinsey reports that healthcare organizations are feeling the strain of financial pressure because of rising inflation and a faltering economy. AI can support the careful balance of maintaining high-quality patient care and optimizing costs by streamlining revenue cycle management (RCM). AI optimizes RCM by automating processes and reducing paperwork, boosting patient satisfaction. More tangibly, it produces measurable cost savings, reduced denials, faster turnaround times, and improved revenue capture.

Attracting Top Talent

Incorporating AI tools into an organization’s workflow is a great way to entice top-tier candidates in an increasingly competitive labor market. Normalizing AI’s use throughout an organization signals to job seekers that innovation is a priority, which is incredibly appealing to the younger generation. Younger prospects also have higher expectations for AI to enhance their day-to-day operations and associate it with cutting-edge projects.

To proactively address workforce challenges, C-level professionals need to strategize for the future, and AI is a long-term solution to build a resilient healthcare workforce. When bringing on new technology, leaders must foster an environment that encourages using AI and be intentional about change management. Technology is only as good as the people who use it, and any solution requires a robust rollout plan with alignment from the entire company. To successfully deploy new AI, look for a vendor with a dedicated customer success team to walk you through any potential road bumps, or set up a steering committee or other governance to lead and finalize AI decisions.

Aside from the multitude of financial, administrative, and HR benefits, adopting AI will also make disruptive events like the closure of APP easier for organizations to bounce back from. With a sturdy AI strategy, organizations are well-positioned to weather any future storms.

AI is gathering speed and changing the face of healthcare. Leaders need to lean in and embrace it or risk getting left behind. Working with AI, healthcare organizations can help address workforce woes, attract a new generation of talent, and have long-term resilience. The time to act is now.

Readers Write: Embracing the Gig Economy: Why CIOs Should Leverage Digital Platforms for IT Talent

December 13, 2023 Readers Write 12 Comments

Embracing the Gig Economy: Why CIOs Should Leverage Digital Platforms for IT Talent
By Daniel Schubert

Daniel Schubert is co-founder and CEO of Revuud of Charlotte, NC.

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The gig economy has rapidly emerged in the corporate realm, commonly referred to as digital platform work or the freelance economy. It represents more than just a passing trend. It is a revolution that is significantly transforming the traditional work landscape.

While the broader workforce is attracted to the appeal of flexibility and independence, there is a particular emphasis on CIOs. They are encouraged not only to adapt, but to excel in the digital revolution by using talent marketplaces, enabling them to find high-quality IT resources at a significantly reduced cost

According to a recent study, 42% of the total workforce comprises 1099 workers, independent contractors, or freelancers. Additionally, the report highlights a significant trend, with 90% of companies transitioning towards a hybrid model that incorporates both full-time and freelance employees.

This data underscores the evolving landscape of employment in the enterprise tech sector, reflecting a notable shift towards flexible and diverse workforce structures.

Conventional recruiting for CIOs may seem extravagant. Gig workers present a cost-effective alternative, providing specialized skills without the substantial overhead costs tied to full-time employees. By leveraging hiring platforms, CIOs can experience on average 30% savings per contractor within the first six months alone.

The gig economy thrives on technology, and digital platforms can function as matchmakers and entire wedding planning committees. These platforms streamline the hiring process, eliminating the need for extensive recruitment efforts and minimizing the time investment required from CIOs and their teams.

Gigs in the IT sector are akin to short-term relationships without the emotional baggage. They align seamlessly with project-based, task-focused approaches, making them ideal for CIOs who are seeking flexible and efficient solutions to their talent needs. By leveraging hiring platforms, CIOs can scale their IT talent up or down based on organizational needs.

Gone are the days of the traditional 9-to-5 grind. Gig workers seek the freedom to craft their professional endeavors on their terms. The gig economy’s appeal lies in the liberation from conventional work structures, making it imperative for tech leaders to consider alternative approaches to sourcing talent.

Gig opportunities emerge and vanish swiftly. The conventional snail-paced recruitment processes are inadequate in this scenario and are unnecessarily costly. CIOs need to channel their inner Flash with a laptop, adapting quickly to the demands of the gig economy. Lengthy recruitment cycles are relics of the past. The emphasis is now on agility and responsiveness.

In the gig economy, it’s not about impressive degrees or a wall adorned with certificates. It’s about skills. For CIOs who are seeking high-quality IT talent, leveraging hiring platforms becomes paramount. These platforms connect businesses with IT professionals based on demonstrated capabilities rather than relying solely on formal qualifications. It’s akin to ordering a customized solution – precise and efficient.

In conclusion, the gig economy is not merely a passing trend. It signifies a profound shift in the professional landscape. As individuals increasingly gravitate toward the flexibility and independence offered by gig work, CIOs should abandon old norms and capitalize on the transformative potential of the gig economy to position themselves not just as adaptors, but as thriving pioneers in the ever-evolving digital realm.

HIStalk Interviews Sagnik Bhattacharya, CEO, Rhapsody

December 13, 2023 Interviews No Comments

Sagnik Bhattacharya, MS is CEO of Rhapsody of Boston, MA.

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Tell me about yourself and the company.

My background IS in computer science, and I started off as a software developer. I moved into product leadership roles and general management. Through the course of my career, I’ve been fascinated by healthcare and user workflows and have spent hundreds of hours shadowing clinicians, understanding how our healthcare policies and incentives work, how technology works, and how we can bring it all together. That has motivated me throughout my career. I spent a number of years on the EHR side of things. 

That journey has led me to my current role as the CEO of Rhapsody. Rhapsody is a technology platform that enables interoperability across healthcare systems, with the goal being digital health adoption. There are so many digital health solutions, and if they aren’t integrated into workflows, they won’t work. We help enable that. We serve both providers and health systems, which is about half our business, and a lot of the digital health companies — hardware, software, AI, or what have you – that have a need to integrate their solutions with clinical data.

We are a global company. We serve customers in 22 countries and growing with our technology.

How have the interoperability needs of hospitals and health systems changed as they run their businesses differently?

First and foremost, interoperability has become a broader term than eight or 10 years ago when it started as point-of-care interoperability.  When a patient is going from physician to physician or to the emergency room, how does their record follow them? Now it’s much broader. You have systems that interact with the patient virtually and physically, so how do they all talk to each other?

With respect to the changing climate, there’s consolidation happening on the provider side. On the other hand, there is also a lot of proliferation of digital health solutions that is happening at around the same time.

When any kind of M&A happens, part of the thesis is that you’re going to get economies of scale, because you will have consolidation of your IT vendors and your IT stack. In healthcare, though, that that sometimes takes a little bit of time. Almost paradoxically, in the early part post-M&A, you actually have more systems to manage, to make talk to each other, and to interoperate, than you originally thought about. It takes three or four years post-M&A before system consolidation and EHR consolidation really starts to take effect, when there’s a lot more energy and effort that goes into integration and interoperability of systems.

How is the healthcare technology market shifting?

So many healthcare technology companies out there, big and small, are trying to essentially make their solutions be available to providers. They are doing some very cool, innovative things.

A universal challenge is, how do you make yourself accessible available to the end users in their workflows? That challenge is growing, unfortunately, because on the IT teams that we work with on the hospital and health system side, they are working on tight margins. Their budgets are being cut. In fact, many of the CIOs that I’ve spoken with recently said that they are spending more time with their CFOs than they ever have. 

There’s this tension right now between digital health adoption, innovation, AI adoption, at the same time, having tighter and tighter IT budgets. How we make those two things happen at the same time is a bigger challenge now than it has ever been.

ONC said in the early days of interoperability discussions that it would create innovation and new business models. Did that play out as expected?

It’s a bit of a mixed bag. The market has stabilized a lot more, where you have to be focused on the value and ROI that you are  driving for your customers, whether it’s your provider, the patient, or whoever your stakeholder is. Interoperability is just part of it. I don’t think interoperability is a goal in and of itself. Better patient care, digital health adoption because you are going to get better patient engagement and so forth, is driving a lot of the conversation.

Then the interoperability part, along with some of the other cases. Can you integrate with my core systems? Are you secure? Do you match my security standards? Those are things that are really more about, can you do that? You have to convince people that you know how to do that. But those are not necessarily decision-making criteria that people are using to say, are you going to deliver value to me?

In the interoperability space, as happens with any kind of hype cycle, there’s always a lot of buzz. Some of that was driven by regulatory interoperability needs.

The way I see it, and the way we see it, is that interoperability is more about enabling others to do the work that they are trying to do. Interoperability is not a goal onto itself.

How well do the major EHR vendors support workflow integration? And related to that, will companies that offer AI solutions need to overcome that issue?

Let me break it up into maybe two parts in terms of integration with the EHRs. The first part is data integration. Can you seamlessly exchange the data that you need to, at the time that you need to? Most of the EHRs are doing a fairly good job of that. It’s more about making sure that you’re picking the right tool for the job, whether it’s EHR vendor APIs, FHIR, HL7, or whatever it is. With the data integration aspect of it, as long as you know what you’re doing, you can do that with every EHR.

The second part is workflow integration. Let’s say that you are an AI company that has insights about the patient —  a risk score, insights that from care gaps, and so forth. You can push that into the EHR. There are ways to do it. But then there is the second part around the workflow change management. How do you enable physicians, nurses, or whoever the right actor is to act on that information, to really take action? That’s where the rest of the challenge lies. Some of it is on the EHR side, but a lot of that is on the workflow change management side.

Physicians already have too much on their plate to react to, in terms of information overload. Having more information available to them to act on is a barrier, quite frankly.  The work to be done, and the innovation that needs to happen, is thinking about clever ways to do that in workflow integration without causing additional burden for the end users. EHR vendors, digital health providers, and AI companies that are providing these solutions need to work together on this, coming up with ways to reduce end user burdens while enabling them to act on that information.

Early discussions around APIs involved issues around user cost and data security. Have those challenges been resolved?

On the security side, there is a security part and a privacy part. On the technical security side, a lot of advancements are being made. I would say that all the technical concerns are solvable and people have become very aware of those things.

On the privacy side, there are still open questions around whether patients know where their data is going and how we can make sure that we have the right guardrails in place for the appropriate use of the patient data with the right level of transparency and accountability. There are still some open questions around that.

On the business models around APIs, we are seeing that evolve over time. I think there are probably three ways to do it. You can have a transaction-based model, where the more times you use the API, the more you pay. There is a data-based model, where you essentially monetize the data that is flowing through the pipes. There’s also a software-based model, where it’s not about how much you use an API or how much data you’re consuming, but you license the software or the appliance and that’s what you pay for.

There is still a little bit of tension in terms of the right model from a business perspective. My personal belief is that over time, it will gravitate towards the third model, where you are essentially licensing the software or using the software to either call APIs or exchange data. It can’t be as much of a system where the amount of usage or amount of data flowing across is tied to the business, because that creates disincentive for greater interoperability.

What are the opportunities and challenges of TEFCA?

A lot that is still TBD, and time will tell. I have served on the board of Carequality for a number of years, so I am relatively familiar with what’s going on. A lot of the insider talk around that is probably not as relevant or on the radar of most clinical end users. In the near term, TEFCA will probably be a bit of a non -factor for most providers. It will mostly replicate a lot of the work that national non-profit efforts like Carequality and CommonWell have done. 

The potential for TEFCA over the next three to four years would be to enable some additional use cases, such as for payment and operation, which will allow not just provider-to-provider and patient access, but also allow data to seamlessly flow between payers and providers and other non -treatment stakeholders for the patient. That’s when TEFCA could start to have a bigger impact. But it will take a few years to get there. The second part of that is a little bit more of a risk.

Part of TEFCA is the QHINs that are being formed and will keep forming over the next year or two. For some of the larger QHINs where this is not their primary business, they will do fine. But there will be a business model question that will come up for the smaller QHINs because you ultimately need a sustainable business model. It’s a hyper-competitive QHIN model where 80% of the market might be rendered by the EHR vendors. There probably won’t be enough business for the rest of the QHINs to justify a full business model based on that alone. The value-added services that you are trying to build on top of that will be key.

When the HITECH Act came about back in 2010 and 2011, health information exchanges were a big thing, A lot of those health information exchanges are operational today and successful because they had a business model that went beyond just the initial push that they got from the government. I think something similar is will play out here. The QHINs that are successful in the longer term will have solid business models that go beyond just the basics.

What lessons did you learn from your many years at Epic?

I lived in Madison, Wisconsin for 16 years, and lesson number one is to always support the Green Bay Packers on Sundays. That is in my bones and will be a forever thing.

Epic was a wonderful learning ground with the sheer wealth of knowledge that you assimilate on the healthcare side. It’s just amazing. I wouldn’t have been able to get that anywhere else. Judy is a remarkable person and a remarkable leader. She has an orthogonal way of thinking that I really have appreciated.

My time there influenced how I think about leadership, which is to hire really smart people and give them responsibility and autonomy early on and watch them thrive. Culture is key and putting the customer first always, even when it’s difficult or inconvenient, and keeping your promises. A lot of those cultural aspects have been really ingrained not just through me, but a lot of the Epic alumni that are out there in the industry.

Over time, the other thing that comes from my Epic upbringing and also from my time in healthcare and healthcare technology is the importance of focus and thinking long term. Those are really important, because in the typical hype cycle, there is some buzz going on every two or three years. It is so important to stick to it and focus on doing what you believe in so that you eventually get to the goal. To Judy’s credit, she has done that exceptionally well.

What will be important to the company’s strategy over the next three or four years?

First and foremost, it’s focus. We are going to single-mindedly focus on how to build a technology platform to make interoperability easier across the board for healthcare. Not just in the US, but globally. We often end up talking about US-related interoperability challenges, but this is a global problem, and we aim to be focused on solving that. That is what we will focus on. This is not a side business for us. We are not trying to build EHRs or CRM systems or what have you. We will just be focused on this.

Our approach will be technology first. How do we use technology to make sure that we are making things better and better over time? A good analogy from years past would be Cisco. It was a networking company and still is, and then over time, they kept improving technology and then they added more and more things to help their customers around that core. That’s how I see our trajectory.

On the software and product side of it, we want to build generalizable software and make it flexible so that our customers don’t have to buy point solutions for different things. Customers shouldn’t need to buy different things for APIs, FHIR, and something else. We want to be more. We can create generalizable software that can fit all needs.

Last but certainly not the least is to just stay focused on the customer. We take a lot of pride in our customer satisfaction and our KLAS scores and so on. That is something that we will forever hang on to.

Interoperability is a broader problem than it seems. A given hospital might have 200 systems that need to talk to each other, if not more. Sometimes these systems are within the hospital’s four walls and sometimes they are outside. A huge amount of effort goes into making all of that happen. The work of Carequality, CommonWell, and TEFCA is probably just 2% of interoperability and data exchange. I would encourage everyone to think about interoperability more broadly and how to make sure that all parts of the healthcare system have the data that they need to deliver the value that they are supposed to deliver.

Morning Headlines 12/13/23

December 12, 2023 Headlines 5 Comments

Oracle shares slide as revenue misses estimates

Oracle’s Q2 results beat earnings expectations but fall short on revenue, with CEO Safra Catz calling Oracle Health, the former Cerner business, “a drag on Oracle growth.”

ONC and The Sequoia Project Designate First TEFCA QHINs

ONC and The Sequoia Project officially recognize KONZA National Network, EHealth Exchange, Epic Nexus, Health Gorilla, and MedAllies as QHINs.

Kaiser Permanente Slashes IT Jobs Across Bay Area

Kaiser Permanente lays off 115 IT employees, 65 of them in Northern California.

News 12/13/23

December 12, 2023 News 11 Comments

Top News

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Oracle announces Q2 results: revenue up 5%, adjusted EPS $1.34 versus $1.21, beating earnings expectations but falling short on revenue. CEO Safra Catz said the former Cerner business, acquired for $28 billion in June 2022, produced “a drag on Oracle growth.”

Shares dropped 12% on Tuesday as investors became concerned about the company’s two straight quarters of disappointing cloud revenue.

From the earnings call:

  • Total revenue for the quarter grew 4%, but would have increased 6% excluding the contribution of the former Cerner.
  • Catz once again mentioned the imperative to “drive Cerner profitability to Oracle standards.” She says that Cerner’s impact on Oracle’s growth will be “sort of negative one to two points” this fiscal year, then it will end.
  • Chairman and CTO Larry Ellison says that half of Cerner Millennium customers will move to Oracle Cloud Infrastructure by February. He adds that a rewrite of Millennium will be completed next year and that HealtheIntent is now full SaaS.
    Ellison says that all Millennium applications will be moved to OCI and will switch to subscription pricing.
  • He adds that Millennium is being upgraded and modernized “one piece at a time” and will be extended via applications for public health, pharma, and hospital inventory and workforce management as Oracle goes after a bigger piece of the healthcare ecosystem.
  • Ellison says in responding to an analyst’s question about generative AI that it can create a patient visit summary from the conversation without using a human scribe, which he says “has shocked a great many people.”

Reader Comments

From Oracool Not: “Re: Oracle. The earnings report is not good news for whatever is left of Cerner.” I said a week ago that it would get ugly if ORCL shares reacted negatively to financial news that could be attributed in any way to the former Cerner business. The CEO’s reaction to Tuesday’s revenue miss was even more direct than I would have expected, where she threw Cerner under the bus for being an underperforming drag on company revenue. Given Wall Street’s quarter-by-quarter fixation and Oracle’s competitive AI and cloud battles with powerhouse tech companies, the obvious answer would seem to be cutting Cerner costs even more, and about the only ways that companies can do that is to reduce headcount, sell real estate, discontinue or sell lower-margin business, and reduce R&D. All of these actions are good for investors and bad for customers.

From Slambob: “Re: Health Gorilla. Co-founder and Chief Strategist Sergio H. Wagner has been relieved of his position and board seat following layoffs of 44% of the workforce and missing two consecutive quarters by more than 80%.” Wagner’s LinkedIn shows that he left the company this month. Health Gorilla was just named as one of the five initial QHINs.

From Banzai Bill: “Re: training doctors. Ask readers how they would shorten the training for primary care doctors.” I’ve asked Dr. Jayne to weigh in and invite physician readers to respond as well. The issues that come to my mind:

  • Schools love to collect tuition and the post-graduate donations of physician graduates, but is it really necessary to earn a four-year degree and then attend a four-year medical school before beginning years-long hands-on training?
  • Given the speed at which medical knowledge becomes obsolete and how little of it is used by the time a PCP reaches mid-level practice, would it be better to shorten the pre-practice education while moving to continuous learning in a CME-type model?
  • Endless amounts of vetted medical data is available electronically and potentially by AI. Is rote memorization of a subset of that same information a waste of time?
  • How much could the eight-year classroom time of graduate medical school – before another three or more years of residency – be shortened to create the same outcome?

Webinars

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


Acquisitions, Funding, Business, and Stock

Fruit Street files a $25 million lawsuit against former partner Sharecare, claiming that the company violated the terms of their agreement by launching its own diabetes prevention program rather than continuing to offer Fruit Street’s solution to its members. Both companies offer digital health and wellness programs to employers and payers. Sharecare, meanwhile, contends that Fruit Street owes it $3 million. I had a lot to say – none of it good, but all of it fun reading – about Fruit Street in 2014 and 2021.

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Private equity firm KKR opens talks to acquire a 50% stake in healthcare payment and analytics software company Cotiviti from Veritas Capital in a deal that would value the business at between $10 billion and $11 billion. Veritas, which took Cotiviti private in 2018 at a $5 billion valuation, rejected a similar deal from Carlyle Group earlier this year. KKR has invested in such healthcare technology companies as Zeus Health, Clarify Health Solutions, and Therapy Brands.

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Data and generative AI company ConcertAI will acquire American Society of Clinical Oncology subsidiary CancerLinQ, which offers real-world oncology data and quality-of-care technology services.

Kaiser Permanente lays off 115 IT employees, 65 of them in Northern California.


Sales

  • WellSpan Health (PA) will use Arcadia’s data analytics software to enhance its value-based care efforts.
  • Nascentia Health (NY) will implement the Biofourmis Care remote monitoring and care management platform as a part of its new care-at-home programs.

People

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Tushar Hazra, PhD (EpitomiOne) joins Parker Health as CTO.

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UC San Diego Health names Karandeep Singh, MD (Michigan Medicine) as its first chief health AI officer.

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Eagle Telemedicine promotes Jason Povio to CEO. He takes over from Talbot “Mac” McCormick, MD who will take on the role of chief physician executive. CFO Timothy Horton will take on the additional title of EVP.

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Impact Advisors hires John Lanari (Nordic) and Kristi Lanciotti, MBA (Optimum Healthcare IT) as VPs.

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Howard Landa, MD (Sutter Health) joins Adventist Health as CMIO.

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VCU Health hires Jeffrey Kim, MD (Loma Linda University Health) as CMIO.


Announcements and Implementations

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Riverwood Healthcare Center (MN) will go live on an OCHIN-hosted Epic system next month.

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Phelps Health (MO) begins offering virtual urgent care through KeyCare’s Epic-based technology.

Darena Solutions, Leidos, and SLI Compliance launch a verification process for AI applications that use SMART on FHIR to integrate with EHRs. 

Mitre, the independent trusted third party for the FDA’s voluntary Medical Device Information Analysis and Sharing (MDIAS) program, announces that Atrium Health has signed on as its first health system member.


Government and Politics

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ONC and The Sequoia Project officially recognize KONZA National Network, EHealth Exchange, Epic Nexus, Health Gorilla, and MedAllies as QHINs.

A Verato-commissioned survey of 197 executives finds that two-thirds of healthcare organizations aren’t ready to meet Cures Act requirements such as sending electronic patient activity notifications, obtaining consent for sharing data, managing infrastructure for secure information exchange, and sharing patient-level information with patients and other healthcare organizations. Nearly all expect to receive more data requests, and more than half expect patient data-matching to be a major problem.

A congressional investigation finds that chain drug stores are handing over patient records to police and government investigators who present a subpoena rather than a judge-approved warrant. Legal experts raise concerns that chain stores share prescriptions across all locations, creating a national “digital trail” that could be used against patients or pharmacies by states such as Texas, which has threatened to file criminal charges related to the mailing of abortion-inducing drugs to state residents.


Other

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London Health Science Centre officials come under fire for spending $50,000 to send 13 IT staff to Oracle Health and Oracle CloudWorld conferences in Las Vegas last September. The Canadian healthcare provider, which is in the midst of a staffing shortage and faces a $76 million deficit, is already under government investigation for spending $470,000 to send staff to conferences in Portugal, Australia, and the UAE.


Sponsor Updates

  • Frost & Sullivan recognizes Inovalon’s One real-world data and analytics platform with its 2023 North American Product Leadership Award.
  • Agfa HealthCare supports Leeds Teaching Hospitals in the UK in its education initiative.
  • CereCore releases a new podcast, “Ways to Overcome the Gap Between IT and Physicians.”
  • Consensus Cloud Solutions achieves HITRUST risk-based, two-year recertification.
  • Konza names Katy Brown director of marketing.
  • EClinicalWorks announces its intent to become a QHIN.

Blog Posts


Contacts

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

Morning Headlines 12/12/23

December 11, 2023 Headlines No Comments

ConcertAI to Acquire CancerLinQ to Build the Leading Healthcare Learning and Research Network in Oncology

Data and generative AI company ConcertAI will acquire American Society of Clinical Oncology subsidiary CancerLinQ, which offers real-world oncology data and quality-of-care technology services.

KKR Nears Deal for Cotiviti Valuing Firm at $11 Billion

Private equity firm KKR is in talks to acquire a 50% stake in healthcare payment and analytics software company Cotiviti from Veritas Capital in a deal that would value the business at between $10 billion and $11 billion.

Fruit Street alleges Sharecare cannibalized diabetes product in $25M lawsuit

Fruit Street files a $25 million lawsuit against former partner Sharecare, claiming the company violated the terms of their agreement by launching its own version of Fruit Street’s diabetes management program.

Curbside Consult with Dr. Jayne 12/11/23

December 11, 2023 Dr. Jayne 4 Comments

I’ve been doing some locum tenens work in a traditional family medicine practice. I can attest that the negative feelings that primary care physicians have towards performing uncompensated work are real.

I was brought in to provide coverage for a physician who is on family leave. I was impressed that the practice would go through the work effort to bring in a locum tenens physician. Many practices just expect the rest of the staff in the practice to absorb the excess work, which often causes resentment when there are partners who take more frequent family leave and others who feel that physicians should “power through.”

That was an interesting dynamic that played out during my interview process with the practice. The partners who were making comments about why they didn’t think my assistance was needed were generally older and/or male, and those who voiced support for having a locum were generally younger and/or female. However, there were some exceptions to the rule.

I hadn’t been told what kind of family leave the physician I’d be filling in for was taking, but was surprised at how willing some of the partners were to share another physician’s private information. One told me, “I worked every day during MY chemo, so I’m not sure why she thinks she needs to be out for her chemo.” On the surface, it’s an unprofessional comment, but it also clued me in to the potential for burnout in this practice since burnout is often associated with lack of empathy.

Another physician told me how glad he was that there would be locum coverage because he was tired of covering his partners because “so many of them have been popping out babies.” He mentioned that he didn’t ever feel the need to take paternity leave and his kids turned out OK. It was good to be clued in about the fact that I would be taking a trip to the cultural 1970s in this wayback machine of a practice, but I agreed to take the job anyway.

Although I have deep experience with the EHR the practice uses, I went through all the onboarding steps, which was good because I got to know the practice’s in-house trainers and super-users well. Fortunately, the practice’s use of technology didn’t mirror their attitudes, and I was impressed by how much delegation and automation they had in place for patients who had medical needs in between their office visits – things like refills, questions about lab tests, etc. Most of those were handled by appropriately trained staff members using standing orders and clinical protocols, which were also built into the EHR for efficiency. I’d give them an A-minus grade for overall efficiency compared to other practices I’ve seen, so I was surprised to hear some of the physicians complaining bitterly about their inboxes.

After getting my feet under me for a bit, I was able to explore what was really going on with patient messages since I was getting a lot of them. It’s been a while since I’ve been in an ambulatory practice during the typical open enrollment period for health insurance, and it turns out that questions about insurance plans, medications, coverage, and the like were making up a high volume of patient questions. Not only were employed patients sending in questions, but plenty of retirees had questions, too, thanks to some recent marketing campaigns on TV that tout the benefits of Medicare Advantage plans. It sounded like many patients were facing dramatic premium hikes and were trying to figure out how to get what they needed in the most economical way possible, but like most patients in the US, they lacked the context to be able to formulate the right questions.

For example, one question was, “Is Cigna better than BCBS for my medicines?” Since this question wasn’t addressed by any of the existing triage protocols, it came to the physician to address. No physician, care coordinator, or health navigator can answer the question with the facts provided. What kind of Cigna or Blue Cross Blue Shield plan are we talking about, HMO, PPO, or something else? Is it a commercial Cigna plan, or one that’s for a self-insured employer that just uses the Cigna network? Are there carve-outs for religious exemptions for employers in this predominantly red state? Is the patient using mail order or retail coverage? Are they stable on their medications or do they have new conditions that are being optimized? Patients were asking their primary care physicians because they felt they had nowhere else to turn to try to figure out what to do for their families.

One of my colleagues mentioned that he saw an article “where someone fed the plan data into AI and then asked it to make comparisons,” but noted that it would be nearly impossible unless you had all the plan details for the various options. Another mentioned that he just tells patients to call their employers and see if they have someone who can help. One noted that he had done that in the past, but found that employers were telling patients to call the office since they didn’t have any idea what the patient’s medicines were to determine the level of coverage. All of this together just goes to illustrate some of the key failings of our healthcare non-system in the US.

The idea that patients should be seen as consumers is part of the problem. Historically, consumer education in the US relies around people being able to make comparisons around price, looking at products with features that they generally understand. It’s one thing to compare the per-ounce price of two brands of pasta sauce, but things get more complicated when you’re trying to compare major appliances like washers. It’s another thing entirely to compare interest rates and mortgage terms to figure out which loan is the best option for a new home purchase. Looking at even more complex consumer comparisons, such as the purchase of an electric versus gas-powered vehicle, it’s different for people to assess because that decision also injects somewhat less-tangible values and feelings about renewable energy, tax policy, and more.

Now, take it to the highest level. Trying to perform comparisons of health insurance coverage is more like graduate-level consumer education. Given the levels of health literacy in the US, it’s no wonder that patients often have little understanding of their coverage.

Recent efforts to make price transparency data available to the public aren’t helpful for the majority of patients. A lot of healthcare is unplanned, and those are the costs that typically push people over the edge. Data from 2022 shows that nearly 40% of people in the US couldn’t cover an unexpected $400 expense. When someone’s child gets bounced off the trampoline and breaks their arm, parents aren’t going to head into the house and price-shop the internet to find the best deals on x-rays and orthopedic consultations. If they’re savvy, they’ll call the number on the back of their insurance card, make sure the emergency visit is authorized, and go to the facility they’re directed to. But a good number of patients are just going to hop in the car and go to the nearest hospital.

At the other end of the spectrum, when you’re diagnosed with a life-changing condition like cancer, what patient has any idea of all the healthcare charges they’re about to get hit with? How are you supposed to shop that around?

For patients with longstanding primary care relationships  — which are becoming fewer in this transactional healthcare landscape that is riddled with third parties trying to pick off the easiest and most profitable patients — these questions roll downhill to the primary care physicians, who are barely better equipped to answer them than the patients themselves. I took the issue to the office manager, who hadn’t previously been made aware of the volume of inquiries the practice was receiving. I’m glad I brought it up because it turns out that the practice’s affiliated health system has volunteers within their patient advocacy department who are tasked with helping answer those questions.

The practice was able to quickly throw together a protocol, including the creation of some quick phrases in the EHR to respond to patient questions and get them headed in the right direction. For those skeptical about having a locum in the practice, I guess I provided a little value-add that day. Now that open enrollment is largely over, those new workflows will be dormant for a while, but it’s nice to know that they’ll be ready for next year. 

As I thought through the whole process, it made me think about the use of AI to make this easier. All of the data needed to make true meaty comparisons lives in the EHR and its corresponding practice management or revenue cycle management system. You have all the medication data, including patient compliance and stability of the treatment regimen. You know what pharmacy the patient uses. You have the data on the different insurance plans such as contracts that at least give an idea about allowable charges and expected adjustments. You also have the data on other physicians the patient sees and their past history.

Certainly some smart people could figure out a way to pull that together along with the data from the insurance plans’ Summary Plan Descriptions, the employer and employee costs, and cost data from the local market. I’d pay money for something like that to help me make the hard decisions and I’m betting I’m not the only one.

What’s the solution to the chaotic problem of choosing your insurance coverage for the year? Is AI the answer? Leave a comment or email me.

Email Dr. Jayne.

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RECENT COMMENTS

  1. Unfortunately, I can't disagree with anything you wrote. It is important that they get this right for so many reasons,…

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