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Curbside Consult with Dr. Jayne 9/19/22

September 19, 2022 Dr. Jayne 3 Comments

One of the more thought-provoking articles I’ve read this week was in the Journal of the American Medical Informatics Association. Of course, the title caught my eye: “Do electronic health record systems ‘dumb down’ clinicians?” The abstract was compelling as well, although I was able to read it only after entirely too many clicks were needed despite my AMIA membership.

The abstract discusses a panel that was held at the 2021 AMIA Symposium and sponsored by the American College of Medical Informatics. The panel sought to answer the title question, looking at how the incorporation of EHRs might be negatively impacting care delivery. Discussions centered on how less-than-optimal EHR workflows might impact clinician efficiency, thought processes, and knowledge both during system use and during the longer term.

In broader coverage of the topic, the journal goes beyond the panel discussion, starting with the evolution of EHRs including both homegrown and commercially developed products. It notes that although early EHRs improved safety and efficiency compared to paper-based systems, “several critical perspectives were lost.”

The authors note that data showing impacts on patient outcomes were lacking and that most studies have focused on the processes involved in delivering care. Since early systems were concentrated among a small number of academic medical centers, there wasn’t much portability across institutions. They go on to explain how the Meaningful Use program and the HITECH Act of 2009 incentivized provider organizations to not only expand EHR use in the marketplace. but also to focus on a core set of functions that would lay the groundwork for broader improvements in care.

Having been part of an organization that was already knee-deep in EHR implementation and adoption before Meaningful Use came along, I can attest that it actually slowed us down, because we had to focus on ensuring that prescribed workflows were followed versus being able to customize or configure workflows that worked best for our clinicians. It’s validating that the article notes some of the same negatives that were created in the name of progress.

A series of great quotes are included in the piece. They’re attributed to a New England Journal of Medicine article that was penned by John Halamka and Micky Tripathi in 2017. They are quoted as saying that the HITECH Act had some less-than-ideal consequences. “We lost the hearts and minds of clinicians … We tried to drive cultural change with legislation. In a sense, we gave clinicians suboptimal cars, didn’t build roads, and then blamed them for not driving.” One of my favorite family physicians and clinical informaticists, Jan Lee MD, used to refer to this as “paving the cow paths” when physicians actually needed high-speed roads with no obstacles.

The article goes on to discuss in detail how EHRs might impair clinicians in the short term. Although there are many beneficial features in modern systems, including allergy checking, order sets, and often a treasure trove of patient information, there are also interruptive alerts and distractions. Sometimes users are unwilling to question information supplied by the EHR, and alert fatigue can cause users to ignore warnings and alerts that might in fact be useful. The article gave specific examples, ranging from hundreds of thousands to millions of interruptive alerts where only a fraction (2-4%) were accepted. The way that EHR notes are organized can obscure the details of a patient’s situation. The use of copy-and-paste functionality in progress notes was specifically called out as potentially misleading and dangerous.

As far as long-term impacts of EHR use, the authors noted that standardization of EHR documentation has led to less-granular terms being used during the creation of History and Physical documents. At one institution, EHR templates reduced the possible descriptors from 1,800 to 360, meaning that some clinician documentation might be hidden from view by other clinicians. An unintended consequence of this might be the shrinking of clinical vocabularies used by medical trainees. As those trainees become faculty, and older faculty members retire, the broader vocabularies are ultimately lost, and notes become less optimal. Additionally, after using templates to order certain treatments, such as total parenteral nutrition, clinicians lost the ability to order these treatments manually. The authors note that this can be dangerous during system outages or when clinicians move to a less-automated environment.

The panel also discussed solutions, which fell into four general categories: institutional and end-user readiness and competency; EHR design and capabilities; regulatory policies and healthcare system-vendor partnerships; and decoupling clinical documentation from billing and regulatory requirements so that clinical notes contain only that information necessary to care for the patient.

I think you would be hard-pressed to find a clinician in the US that wasn’t in support of the latter suggestion. Technology could be a great booster of the latter as well. I’d much rather have a photo of a rash in a chart than a rambling description of someone’s idea of a “lace-like reticular rash with mild to moderate erythema and occasional popular features.” Unfortunately, in many situations, the words will get you paid, but a photo will not.

As far as the other categories, the panel called for improved EHR training, expanded downtime simulations, and greater incorporation of learning about EHRs during undergraduate and post-graduate medical education. Medical students and residents need to understand the “why” behind various parts of the EHR as much as they understand the data that they’re keying in. They call for greater clinician involvement in the design and validation of EHR systems and improvements to alert messages to ensure that such interruptions are clinically important and obtain enough clinically relevant information for clinicians to take action.

It will be interesting to see how EHRs evolve over the next five to seven years. More interesting will be assessing the approaches taken by health systems in how they implement and optimize EHRs. I still see far too many organizations that think that installing an EHR is some kind of “set it and forget it” process.

Physicians constantly complain about the impact of EHR upgrades, but in the last conversation I was in about that topic, not a single physician admitted to having seen any kind of upgrade documentation or educational materials that told them what to expect or what benefits might arise. It feels like those kinds of communications might be casualties of the rampant understaffing I see in many organizations. Gone are the days when we used to send a member of the EHR implementation to every office to make sure clinicians knew what to expect and that their questions were answered. I’m sure the materials are probably out there on some intranet site that physicians have long forgotten how to access.

On the whole, I don’t agree with the premise that EHRs have made us dumber, but I do think they have impacted our workflows tremendously, and not always for the better. There certainly is room for improvement and evolution of technology, but everything comes at a cost. When hospitals are trying to figure out how to keep beds staffed, they are less concerned about things like EHR adoption or end-user satisfaction.

Do you think EHRs have dumbed-down clinical practice? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 9/19/22

September 18, 2022 Headlines 1 Comment

AMA: Physicians propelling health care’s digital transformation

An American Medical Association survey of digital health solution use finds that 80% of physician respondents used telehealth systems in 2022 versus 14% in 2016, with use of remote monitoring tools increasing from 12% to 30%.

Intelerad Acquires Life Image, Establishing the Clear Medical Image Exchange Market Leader and Path to a Global Open Image Exchange Network

Enterprise imaging company Intelerad Medical Systems acquires enterprise image exchange vendor Life Image.

Judge Rejects Pegasystems Motion to Overturn $2 Billion Jury Verdict

A state court orders low-code platform vendor Pegasystems to pay $2 billion to competitor Appian in a trade secrets case.

Monday Morning Update 9/19/22

September 18, 2022 News No Comments

Top News

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An American Medical Association survey of digital health solution use finds that 80% of physician respondents used telehealth systems in 2022 versus 14% in 2016. AMA has surveyed the same group of doctors in 2016, 2019, and 2022 about digital health.

Use of remote monitoring tools increased from 12% in 2016 to 30% in 2022.

Telehealth and remote monitoring technologies were also ranked highest in physician enthusiasm. Beyond telehealth, enthusiasm for digital solutions has been mostly stagnant since 2019. Still, nearly 60% of respondents believe that technology can improve chronic disease management and preventative care.

Older doctors and specialists are more likely to see no advantage to digital health, but number of doctors aged 51 and over who see a digital health advantage is growing.

(click the graphic to enlarge).


Reader Comments

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From LongLiveA4HealthMatics: “Re: Allscripts. Is rebranding its EHR to Veradigm EHR. Looks like the push to sanitize the word Allscripts from the company that is still called Allscripts has begun.” The email to customers says that ”the commercial brand for Allscripts will be Veradigm, while the corporate entity will remain Allscripts.” The logic behind the change, which was hinted at months ago, was not stated. MDRX shares are up 18% in the past 12 months versus the Nasdaq’s 24% loss, valuing the company at $1.8 billion.


HIStalk Announcements and Requests

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The employers of two-thirds of poll respondents require their workers to be vaccinated against COVID-19, and of those that don’t make it mandatory, one-fourth of them previously did but reversed themselves.

New poll to your right or here, which addresses the unproven but wildly over-discussed concept of “quiet quitting”: How much effort and sacrifice are you willing to put into your job now versus two years ago?

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Welcome to new HIStalk Gold Sponsor Cordea Consulting. The Edmond, OK-based company, which was founded in 2008 by CEO Jen Jones, specializes in the full life cycle of health IT solutions, exclusively serving the healthcare industry by working with clients to develop and implement systems, plans, and strategies. It offers advisory services (strategy, cost optimization, change management, IT governance, innovation programs); IT leadership services (program and project management, interim leadership, executive placement); and implementation and support (upgrades, go-live support, training, report writing, EHR data conversion and integration). A recent client survey finds that 100% would recommend the company, whose consultants average 12 years of real-life healthcare experience and many of whom are clinicians who know how to use informatics to improve patient care. Thanks to Cordea Consulting for supporting HIStalk.


Webinars

September 22 (Thursday) 1 ET. “ICD-10-CM 2023 Updates and Regulatory Readiness.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, marketing director, IMO; Julie Glasgow, MD, marketing manager, IMO. The yearly update to ICD-10-CM is almost here. Prepare your organization for a smooth transition, and avoid any negative impacts to your bottom line, with an in-depth look at the upcoming changes. Listen to IMO’s top coding professionals and thought leaders discuss the 2023 ICD-10-CM coding changes. This webinar will review additions, deletions, and other revisions to the ICD-10-CM code set and how to make sure you get properly reimbursed.

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


People

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Oracle promotes Greg Aaron to group VP/GM of investor owned and emerging markets of Oracle Cerner.


Government and Politics

A JAMA-published study of telemedicine encounters by Medicare patients in the first half of 2021 finds that 423,000 involved an out-of-state provider, two-thirds of whom had seen the same patient in person previously. Nearly 60% of the out-of-state visits involved patients who lived in a county within a few miles of a state border. The authors conclude that restoring licensure restrictions that were eased during the pandemic would have the biggest impact on people who live near a state borders, those who live in rural areas, and patients who need primary care or mental health treatment.

A state court orders low-code platform vendor Pegasystems to pay $2 billion to competitor Appian in a trade secrets case. Pegasystems was accused of hiring an employee of a government contractor to give it access to Appian’s software so it could enhance its own system and teach its sales team. A circuit judge rejected the motion by Pegasystems to overturn the verdict, then tacked on another $24 million in attorney fees and 6% in annual interest. Pegasystems says it will appeal.


Other

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A social media celebrity posts her sister’s medical bill in which a medical practice charged her $40 – without offering consolation or inquiry – because she cried.


Sponsor Updates

  • Arcadia makes its de-identified EHR and integrated claims data available on the Snowflake Marketplace.
  • Psychiatric practice Talkiatry expands its use of EClinicalWorks technology to include Healow TeleVisits.
  • Premier releases a new episode of its InsideOut Podcast, “Merging the quality and access gap in healthcare.”
  • Relatient releases a new episode of its Dash Talk Podcast, “The End of the Phone Tag Era: Advancing Consumer Experience in Healthcare.”
  • ReMedi Health Solutions publishes a new white paper, “Best practices for improving patient care through clinical chart abstraction.”

Blog Posts


Contacts

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

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Morning Headlines 9/16/22

September 15, 2022 Headlines No Comments

Prealize Health Announces Acquisition of CentraForce Health’s Social Determinants of Health (SDoH) IP

Analytics vendor Prealize Health acquires the social determinants of health intellectual property of former partner CentraForce Health.

Tabula Rasa HealthCare Announces Leadership Transition

The two co-founders of medication technology vendor Tabula Rasa Healthcare, who are also husband and wife pharmacists, resign their executive and board positions under pressure from the hedge fund that holds a 25% stake in the company.

Columbus health IT firm Enzee raises $1.5M from Rev1, others to expand hospital software

Quality assurance and compliance software vendor Enzee raises $1.5 million in a seed funding round.

The DEA is investigating Done over ADHD drug prescriptions

The DEA is reportedly investigating ADHD telehealth vendor Done, which like competitor Cerebral, has been accused of overprescribing Adderall and other addictive drugs by taking advantage of COVID-relaxed telehealth rules.

Twilio to lay off 11% of workforce

Cloud communications software company Twilio, which powers Epic’s telehealth service, will lay off 11% of its workforce as part of a restructuring plan.

News 9/16/22

September 15, 2022 News No Comments

Top News

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Epic launches a life sciences program that will match providers and their patients with clinical trials.


Reader Comments

From Due App: “Re: Oracle Cerner’s new pharmacy app. EVP Mike Sicilia told the Senate on July 20 that a beta version will be available 6-9 months, which would be April 20, 2023 at the latest. Larry Ellison now says it will be finished within year. Odds of either happening?” Delivery by either date would be aggressive, even if progress is already quietly being made. That probably means accepting the existing product’s design as sufficient and refactoring it using the Oracle Apex low-code development platform to improve application performance and maintenance. That approach would bypass endless design sessions and make the project a purely technical exercise that hits Oracle’s sweet spot, allowing enhancements to be addressed later. The biggest challenge might be integration with legacy Cerner apps. Rewriting apps from scratch provides little user value and makes sense only if the underlying platform is outdated, developers are hard to find, and system maintenance and performance are lagging. Replatforming is easier when the same vendor that owns the app also owns the technology and cloud technology. Still, it always takes longer than expected, so consider the dates a target.


HIStalk Announcements and Requests

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Welcome to new HIStalk Gold Sponsor HealthTech Resources. The Phoenix-based company has served providers and payers for 20 years. Its mission is to help people and companies achieve their goals by providing the highest quality of outsourced employment and human resources services, taking the time to understand the needs and long-term growth objectives of large health systems, academic medical centers, public health plans, and more to empower them to focus on what they do best. The company is proud to concentrate specifically on healthcare, not only because this singular focus strengthens its service offerings, but also because it plays a role in supporting innovation within electronic health records, healthcare enterprise architecture, and the digital systems that help improve how people work and how people heal. Its employees enable improved care and treatment methods for patients, and improved workflows for essential workers allows them to focus more on what matters most, their patients. Thanks to HealthTech Resources for supporting HIStalk.


Another advantage of obtaining Mrs. H’s new contact lens prescription from a somewhat sketchy online exam that I just realized – the PDF prescription can be used throughout its one-year life by simply uploading it to any lens seller. You can also stock up on as many lenses as you would like by ordering before the prescription expires. Neither is true of a medication prescription.


Webinars

September 22 (Thursday) 1 ET. “ICD-10-CM 2023 Updates and Regulatory Readiness.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, marketing director, IMO; Julie Glasgow, MD, marketing manager, IMO. The yearly update to ICD-10-CM is almost here. Prepare your organization for a smooth transition, and avoid any negative impacts to your bottom line, with an in-depth look at the upcoming changes. Listen to IMO’s top coding professionals and thought leaders discuss the 2023 ICD-10-CM coding changes. This webinar will review additions, deletions, and other revisions to the ICD-10-CM code set and how to make sure you get properly reimbursed.

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


Acquisitions, Funding, Business, and Stock

The two co-founders of medication technology vendor Tabula Rasa Healthcare, who are also husband and wife pharmacists, resign their executive and board positions under pressure from the hedge fund that holds a 25% stake in the company. Shares of TRHC that peaked in mid-2018 at $88 are now worth under $5 following several unprofitable acquisitions and lowered sales projections, valuing the company at $129 million.

A study finds that drug makers file a “patent thicket” of post-approval patent applications to extend their US monopolies beyond their initial 20 years of patent protection. Three expensive, top-selling drugs – Humira, Eliquis, and Enbrel – have been available from cheaper competitors for years in Europe but not here, with Enbrel’s biosimilar not expected to be sold here until 2029, 13 years after it was first sold in Europe.

Analytics vendor Prealize Health acquires the social determinants of health intellectual property of former partner CentraForce Health.


Sales

  • North West London Integrated Care System chooses InterSystems HealthShare Health Connect Cloud via an AWS cloud deployment for interoperability.
  • Washington County Hospitals and Clinics (IA) will implement Epic using a $753,000 grant from the US Department of Agriculture.
  • Thailand’s new Srisawan Hospital will implement InterSystems TrakCare and IRIS for Health.

People

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Industry long-timer Bruce Brandes, MBA (Teladoc Health) joins Care.ai as president.

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InterSystem hires Andy Zook, MBA (SAS) as VP of North American sales.

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Virtual care technology vendor Wheel hires Sameer Merchant, MS (Autodesk) as CTO and Steve Manning (Autodesk) as SVP of product.

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Amwell hires Vaughn Paunovich (UnitedHealth Group) as EVP of enterprise platforms and Matthew McAllister, MBA (Amazon) as chief product officer. 

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Mark Dunnagan (Smartlink Health Solutions) joins Chess Health Solutions as VP of health informatics.


Announcements and Implementations

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Relatient launches Dash Chat, which allows patient inquiries that are entered as live chat from the practice’s website to be answered by providers and staff, reducing call volumes.

A survey of medical alert system users and caregivers finds that fall detection is the most-desired feature, affordability and battery life are key considerations, and 91% are more confident when performing daily activities knowing that they can reach immediate assistance. Two-thirds of users say they have used their system to get help. Thirty percent use in-home systems, while the rest use a home/mobile bundle, a watch-powered system, or a mobile device.

Epic will use Milliman MedInsight’s analytics in its Value-Based Performance Management module that will be released next year.

WebPT releases WebPT Billing, an integrated billing solution for the in-house billing teams of rehab therapy organizations. It’s the same solution that the company uses for its own outsourced physical therapy RCM service.

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KLAS asks 16 healthcare executives to review previous reports to choose the top emerging solutions that are most likely to disrupt their respective Quadruple Aim categories, with these topping the list:

  • Improve outcomes – Atlas, which connects health systems with philanthropic aid.
  • Reduce the cost of care – AvaSure, which offers remote patient monitoring.
  • Improve patient experience – DeliverHealth, which provides a digital front door solution.
  • Improve clinician experience – Nuance’s Dragon Ambient Experience.

Government and Politics

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The DEA is reportedly investigating ADHD telehealth vendor Done, which like competitor Cerebral, has been accused of overprescribing Adderall and other addictive drugs by taking advantage of COVID-relaxed telehealth rules. Surely the doctors who took the money of these companies did so knowing that they were expected to ignore accepted medical practice, which doesn’t pay as well.

NIH announces an $8 million prize competition for developing home-based or point-of-care diagnostic devices, wearables, or remote sensing technology to improve postpartum care in underserved areas.


Privacy and Security

OakBend Medical Center (TX) is still restoring IT systems that went down in a September 1 ransomware attack.


Other

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I believe this press release has mistake’s.


Sponsor Updates

  • Newly named Oracle Health GM Travis Dalton is interviewed by the company about Oracle’s vision, the changes with Cerner over the years, and the client opportunities that the acquisition creates.
  • Nordic posts a new episode of DocTalk titled “Remote patient monitoring for chronic disease management.”
  • Everbridge adds external risk intelligence monitoring to its Control Center physical security management system.
  • Healthcare IT Leaders publishes a client profile featuring Northeast Georgia Health System.
  • CereCore and BridgeHead will jointly offer comprehensive data management services.
  • Meditech will host Meditech Live 2022 September 20-23 in Foxborough, MA. HIStalk sponsors supporting the event include CloudWave, CereCore, and Interbit Data.
  • Divurgent publishes a white paper titled “Digital Acceleration in Healthcare: Guiding Speed and Direction for Digital Health.”
  • NeuroFlow’s behavioral health technology platform has earned HITRUST Implemented, 1-year Certification.
  • Clearsense unveils a new website and updated company brand.

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 9/15/22

September 15, 2022 Dr. Jayne 2 Comments

A colleague recently asked me what I thought about “quiet quitting” and the attention that the concept has been getting recently in the mainstream media. There has been quite a bit of discussion around it in physician-specific social media groups, alongside discussion of burnout and the role of self-care in a post-COVID workplace.

Many workers in healthcare are still being asked to come in to work when they are sick, despite the fact that they have designated sick days allocated for such a thing. They are pressured that if they call off sick, they’ll be burdening their teammates. Others are told that they can only call off if they find a replacement, which really shouldn’t be the employee’s job.

By most definitions, quiet quitting is the idea that a worker only does what is required of them based on their job description. This means no extra work, no volunteering for additional projects, and in the case of many clinical workers, no picking up of extra shifts. Hospitals have been short staffed for years and the COVID pandemic only exacerbated a problem that was already there. During the first year, everyone was motivated by a sense of needing to pull together, to help humankind, and to be there for their co-workers, but after two and a half years in the grind with ever decreasing support and appreciation, people are simply done with it.

Hospitals (and medical practices, and other clinical organizations) have always had the ability to create safety nets for their workers. It’s easy to come up with excuses not to. I remember trying to implement a “float pool” for our medical group’s ambulatory practices more than a decade ago, similar to what hospitals had in place at the time. Staff could volunteer to be part of the pool on their days off and they would be paid a small amount to remain on call in the event they were needed to cover a shift. If they worked, they would receive their usual rate of pay. Instead, the group’s leadership balked at paying people “for doing nothing.” They failed to understand that it wasn’t about what the float pool member was doing, it was about what they were not doing on their day off in exchange for being on call.

The administrators decided instead to ask for people to volunteer to pick up extra shifts if there were shortages, and then if they had no takers, they offered various hourly incentives. Guess what? Staff learned not to pick up extra shifts until the incentives reached a certain level, which ultimately cost more than what someone would have been paid to be on call. Once a clinical staffing pool reaches a certain size, it’s a virtual guarantee that someone will be out sick on any given day, so the economics would have favored the float pool approach. Additionally, creating a float pool would have ensured people were ready to work on a given day rather than offices having to hope and pray that someone would volunteer, and then to cope with the scrambling that inevitably ensued when someone rolled in an hour or more after the practice opened.

These types of bad decisions have only been magnified in the last two years. Just look at travel nursing during COVID surges. A major driver behind that was the unwillingness of hospitals to appropriately compensate existing staff nurses. I had friends who quit their medical / surgical nursing jobs and then worked as “travel nurses” in a hospital less than five miles away for a significant salary bump. Hospitals went way over budget paying traveling and locum staff, when they could have avoided having those nurses quit if they addressed underlying drivers of low employee satisfaction. Those nurses who stayed put are now increasingly burned out and quiet quitting is the order of the day.

The other reality in our post-COVID world is that people’s priorities simply have changed. If they’re struggling with childcare, they’re not going to volunteer to work extra hours. Families with two wage earners where one has a significantly higher earning potential have redone the math and determined that it doesn’t make sense for both partners to work when there are children requiring care. People seem to be retaining some of the hobbies that they cultivated during the early days of the pandemic and want to ensure they’re spending time on activities that make them feel good and in which they find value.

It will be interesting to see how organizations respond to the shifts in productivity that will result from quiet quitting. Some high-profile companies have already signaled that they’ll just fire people, which doesn’t seem like the way to become employer of choice.

I had some travel this week, which always makes for good people watching. For the first time since spring of 2020, I actually had difficulty getting a space at my favorite airport parking garage. The airport was hopping, although many of the stores remain closed during peak times. I’ve learned to pack a lunch if I have any hopes of eating something that is healthy and convenient. I would estimate that 80% of the people waiting in the gate areas are on either laptops or phones, so I wonder what they would think about this study that looks at the relationship between chronic blue light exposure and accelerated aging.

Researchers at Oregon State University looked at the impact of such exposure on fruit flies. Where previous studies had looked at the consequences of light-related stress on retinal cells, newer studies have examined whether exposure to blue light caused reduced lifespan and degeneration of organs such as the brain. The authors looked at flies that were genetically altered to not have eyes, in an effort to study metabolism and cellular pathways. Some flies were kept in constant darkness and others in constant blue light, for varying durations. The authors noted that those kept in blue light for longer durations had changes in metabolism including impairments in cellular energy production. There was also neurodegeneration in the blue light group, with decreased levels of certain chemical transmitters in the brain.

The study found that if the impacted flies were placed in darkness, their lifespan could be brought back to normal. Reading the paper sent me straight back to my freshman year in college, where the fruit fly lab convinced me that I no longer wanted to be a biology major even though that was what pre-meds were expected to do. Even though I never want to see another diagram of a metabolic pathway, it was interesting to see how much research has evolved over the intervening years. The next step in research of this type would be to look at the impact of blue light on cultured human cells, which have similar metabolites.

Only time will tell the fullness of consequences that we’ll experience from prolonged screen time. I’m perfectly happy to spend my free minutes in the outdoors, reading an actual paper book, or doing some retro hobbies. I’m taking a stained-glass class next weekend, so we’ll have to see how that goes.

Do you have a pandemic hobby that you’ve kept? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 9/15/22

September 14, 2022 Headlines No Comments

Epic Launches Life Sciences Program, Unifying Clinical Research with Care Delivery

Epic debut its new Life Sciences Program, designed to help providers better match patients with clinical trials, increase trial efficiency, and offer data-driven insights into medication administration.

Pharos Capital Invests in Renal Care 360º, Capitalizes New Chronic Kidney Care Management Platform

Kidney care practice management and predictive analytics company Renal Care 360º secures an undisclosed amount of funding from Pharos Capital Group.

BabyLiveAdvice Announces $1.1M Seed Investment to Improve Maternal-Infant Health Outcomes

Maternal virtual care company BabyLiveAdvice raises $1.1 million in seed funding.

Morning Headlines 9/14/22

September 13, 2022 Headlines No Comments

Oracle Announces Fiscal 2023 First Quarter Financial Results

Oracle reports Q1 results: revenue up 18%, with Cerner contributing $1.4 billion to quarterly earnings; EPS $0.58 versus $0.89, meeting Wall Street expectations for revenue but falling short on earnings.

Kyruus Announces Acquisition of Leading Digital Patient Engagement Company, Epion Health

Provider search platform vendor Kyruus acquires Epion Health, which offers patient engagement solutions.

Our Mission to Redesign Health for Everyone

Startup builder Redesign Health closes a $65 million funding round, reportedly valuing the company at nearly $2 billion.

News 9/14/22

September 13, 2022 News 8 Comments

Top News

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Oracle reports Q1 results: revenue up 18%, EPS $0.58 versus $0.89, meeting Wall Street expectations for revenue but falling short on earnings.

Notes from the earnings call:

  • Unfavorable foreign currency exchange rates cost the company $0.08 in adjusted EPS.
  • Cerner contributed $1.4 billion of Oracle’s quarterly revenue, 12% of its total.
  • Cloud revenue increased significantly, representing 30% of total revenue.
  • CEO Safra Catz says that Oracle’s quarterly margin of 39% will increase “as we drive Cerner and its profitability to Oracle standards and continue to benefit from economies of scale in the cloud.”
  • The company says it has migrated Cerner’s back office systems to its Oracle Fusion ERP system.
  • CTO Larry Ellison says Oracle Cerner’s first newly developed application will be released within 12 months, developed with Oracle’s new Apex low-code tool and running on Oracle Cloud Database. He says Apex has security and fault tolerance built in, with the stateless application immediately failing over to another data center when problems arise.

Oracle offers a free OCI Cloud Tier that includes Apex Application Development and SQL Developer. It also offers a 10-minute tutorial on using Apex to transform a spreadsheet into a secure, scalable, multi-user web application.


Reader Comments

From Home Boy: “Re: Oracle. You should interview EVP Mike Sicilia, who is basically in charge of Cerner at this point.” I requested an interview with him a few weeks from Oracle’s press contact, who didn’t respond.

From Saving Private Orion: “Re: contact lenses. Your wife’s experience with the eye doctor’s receptionist is a reminder that most of what is awful about US healthcare isn’t the provider.” I agree. Nearly all of my healthcare frustration has been caused outside the exam room. Small practices often hire unwisely and manage poorly, and while hospitals often get better people, they drown them in customer-unfriendly policies. I would bet that clinicians are even more annoyed than patients in those environments since they have to live every day under the same management that created the patient-facing problems.

From Reese: “Re: Emerge. Customers say all modules and applications have been down for over two weeks with no root cause or ETA. Rumor is it’s legal trouble between Emerge and third-party database provider MongoDB, which has taken the systems offline.” Unverified, but reported by a couple of readers, one of whom summarized, “Practices that relied on Emerge for historical clinical documentation and imaging studies are SOL.”


HIStalk Announcements and Requests

I remember when your first day on a new job involved desk-side teammate introductions and lunch out with the boss instead of jumping on a video call while caressing a mailed box of company swag.


Webinars

September 22 (Thursday) 1 ET. “ICD-10-CM 2023 Updates and Regulatory Readiness.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, marketing director, IMO; Julie Glasgow, MD, marketing manager, IMO. The yearly update to ICD-10-CM is almost here. Prepare your organization for a smooth transition, and avoid any negative impacts to your bottom line, with an in-depth look at the upcoming changes. Listen to IMO’s top coding professionals and thought leaders discuss the 2023 ICD-10-CM coding changes. This webinar will review additions, deletions, and other revisions to the ICD-10-CM code set and how to make sure you get properly reimbursed.

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


Acquisitions, Funding, Business, and Stock

Provider search platform vendor Kyruus acquires Epion Health, which offers patient engagement solutions.

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Healthcare analytics company PurpleLab raises $40 million in a Series B funding round. The company had reportedly explored putting itself up for sale earlier this year.

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St. Elizabeth Healthcare (KY) launches an innovation center with a $25 million venture fund that it will use to invest in new healthcare companies and technology.

Startup builder Redesign Health closes a $65 million funding round that reportedly values the company at nearly $2 billion.


Sales

  • Digital health solutions vendor BrightInsight chooses Lyniate Envoy for interoperability.

People

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Seattle Children’s promotes Eric Tham, MD, MS to SVP and chief research operations officer.

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UC Davis Health hires Vimal Mishra, MD (American Medical Association) to lead digital transformation and care at home.

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Sean Brindley (Olive) joins Intelligent Medical Objects as VP of strategic partnerships.

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Telehealth genetic counseling company Genome Medical lays off 23 employees and announces the departure of its founder and CEO Lisa Alderson, MBA, who will maintain an advisory role. Chief Customer Officer Jill Davies, MSc will replace Alderson. Davies was co-founder and CEO of GeneMatters, which Genome Medical acquired last year.

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Mark Anderson (Accenture) joins Beth Israel Lahey Health as VP of EMR clinical strategy and implementation.

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ShiftMed hires Greg Rakas (Pearl Health) as VP of enterprise sales.

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Heath Chester (Infor) joins Lyniate as SVP of sales.

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Arcadia hires Michael Tiffany, MBA, MSPT (EarlySense) as SVP of operations.

David Gascoigne (GNS Healthcare) joins OneMedNet as COO.


Announcements and Implementations

Houlton Regional Hospital (ME) will go live on Meditech Expanse on October 1.

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Cody Regional Health (WY) will deploy Epic through a partnership with St. Vincent Healthcare.

Edifecs develops automated, point-of-care prior authorization technology.


Government and Politics

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The 81st Medical Group at Keesler Air Force Base (MS) and the 96th Medical Group at Eglin Air Force Base (FL) will go live on MHS Genesis September 24.

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A paper in Spokane, WA profiles the healthcare plight of veteran Charlie Bourg, who discovered that his delayed cancer diagnosis was caused by a system defect within the Mann-Grandstaff VA Medical Center’s Cerner EHR that put his primary care doctor’s follow-up appointment and urology referral in a scheduling queue limbo for months. An Oracle Cerner rep says the EHR isn’t responsible for Bourg’s now-terminal condition: “Our findings show that nothing related to the EHR’s functionality or performance had anything to do with the care this veteran received and was unrelated to their diagnosis or treatment. The Oracle Cerner EHR is successfully in use at many thousands of health care facilities across the United States without incident. We remain a committed partner to VA to ensure its EHR system, and everyone who uses it, is able to provide the best possible care that our veterans deserve.”


Other

A HBR article whose authors include health IT emeritus John Glaser says that we need better tools to improve outcomes using ever-increasing amounts of health data. It’s a big problem, they say, that quality measurement is limited to using insurance claims — which focus on revenue-generating information within a snapshot of care long after the fact — as their foundation. The authors list four imperatives:

  • Reduce the cost and improve the timeliness of data collection by adopting software and wearables to generate information as a byproduct of managing care.
  • Incorporate wearables data, patient-report outcomes measures, environmental data, and social determinants of health.
  • Enhance EHRs to give clinicians better real-time support that is personalized to each patient’s needs and desires.
  • Standardize clinical measures, reduce paper-based quality measure description, automate the work of human data abstracters, and audit and clean data using automated tools.

Sponsor Updates

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  • Availity associates, friends, and family raise nearly $3,000 for the American Heart Association during the 2022 First Coast Heart Walk.
  • King Abdulla Medical City in Makkah upgrades to the consolidated Agfa HealthCare Enterprise Imaging platform.
  • Arcadia publishes a new white paper, “Risk Adjustment – Simplified.”
  • Baker Tilly grants $10,000 to Leaps & Bounds Pediatric Therapy.
  • Bamboo Health names Caitlin Kolar (One Home Health Agency) account growth director and Rob Duarte (Clif) business development representative.
  • Clinical Architecture will exhibit at SNOMED CT September 29 and 30 in Portugal.
  • ConnectiveRx will present at Hub and Specialty Pharmacy Models West September 14-15 in San Diego.
  • Current Health will exhibit at DPharm September 13-14 in Boston.
  • Ellkay will exhibit at Mayo’s Leveraging the Laboratory September 21-22 in Rochester, MN.
  • Enlace Health donates $10,000 to an East Kentucky community grocery store affected by flood damage.
  • Surescripts publishes a new data brief, “Specialty Medication Experience: Obstacles & Opportunities.”
  • Wolters Kluwer Health makes its Lippincott ClinicalPulse CME platform available in an audio format.

Blog Posts


Contacts

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

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Morning Headlines 9/13/22

September 12, 2022 Headlines No Comments

Technology Company Akido Labs Launches New Medical Network Focused on Preventive Care for Chronic Disease

Akido Labs acquires Chaparral Medical Group to create a medical network that will leverage Akido’s predictive analytics-focused Care Delivery Platform.

PurpleLab, Inc. Raises $40M in Funding from Primus Capital

Healthcare analytics company PurpleLab raises $40 million in a Series B funding round.

St. Elizabeth launching Innovation Center

St. Elizabeth Healthcare (KY) launches an innovation center with a $25 million venture fund that it will use to invest in new healthcare companies and technology.

HIStalk Interviews Luke Bonney, CEO, Redox

September 12, 2022 Interviews 2 Comments

Luke Bonney is co-founder and CEO of Redox of Madison, WI.

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Tell me about yourself and the company.

I’ve been working at Redox, on Redox, for just about seven years. That’s a long time and a lot more gray hair. Redox is the platform to make healthcare data useful for healthcare’s builders, the people building and scaling healthcare technology.

What have been the most significant interoperability advancements of the past few years?

Our world at Redox is all about how to make healthcare data useful for builders, who to us are the people building and scaling technology and healthcare. We obsess about these people, because through enabling the people who are building technology, everybody will benefit. Patients will benefit, providers will benefit, and you and I will benefit. Great builders build great technology that drives incredible experiences. Those experiences are what drive outcomes. That’s where we need to see meaningful change in healthcare. How do we drive and inspire outcomes?

At Redox, we are constantly obsessing about imagining a world where people can build and scale healthcare technology and be completely unencumbered by the nastiness and complexity of healthcare data, which I know sounds crazy because it is nasty and complex. But we think about a world where with a couple of clicks, people could compose experiences for their users. That’s what we obsess about.

Over the last couple of years, we have continued to focus on healthcare data access and integration. Today, working with Redox means that you have access to existing connections to over 2,500 healthcare organizations across the US and now in Canada. We have integrations with dozens of major payer organizations. We have expanded to not just be focused on clinical data, but financial and payer data, connections into existing clinical networks like Carequality, CommonWell, and a whole bunch of HIEs. We are now connected to 50 out of 50 state public health departments.

We have a lot to be proud of that we’ve focused on in the last couple of years. When we talk to our customers, they say they work with us because we help them focus their engineering efforts and their product efforts on building a truly differentiated product by taking all this nastiness off their plate. We also help them accelerate their sales cycle. We help them get live and implemented faster at all these different locations.

Today, it’s all about data access and integration. As we look to the future of Redox, we will focus on additional problems where we can make healthcare data useful and valuable for builders.

Looking at the industry, I would go to the pretty exciting impact of regulation. I know that might sound weird since regulation is almost always a nasty word, but when it comes to 21st Century Cures, I am definitely in the camp that 21st Century Cures is a game changer, and in a good way. It is definitely not perfect, like any regulation that runs 700 or 800 pages, but it absolutely redrew some of the major goalposts and expectations around healthcare data. The requirements around info blocking and enabling FHIR are good. I think they are incremental. Access is only one component. Standardization and normalization of data are equally if not more important when we think about downstream use cases. We have seen a huge amount of positive change in the impact in the payer world and the payer landscape.

The saying we use at Redox is that what Meaningful Use was for providers, 21st Century Cures, and specifically the CMS patient access rule, is for payers. It has been a major forcing function for payers to modernize their technology. 21st Century Cures is fundamentally making healthcare a friendlier place for builders and innovators by curbing a lot of the power of major incumbents. From where I sit, that is fundamentally a very good thing.

Explain TEFCA and how it changes your business and the industry.

Where I’m super excited about 21st Century Cures, I think TEFCA is a different situation. Had TEFCA been regulated in a way similar to 21st Century Cures, with clear incentives and/or penalties,  we would be a huge fan, because we are fundamentally aligned with the world that TEFCA imagines.

To just state what that is, TEFCA has two core components. It’s a technical framework and a legal framework that allows networks to communicate with one another. It imagines what they think of as a network-of-networks environment. We love that. We think that that would fundamentally change the landscape.

However, as it stands right now — and this is where I think there is huge opportunity — TEFCA completely optional. It provides the framework. In an industry where large change is so typically aligned to hefty incentives, reimbursements, and penalties, TEFCA doesn’t have any of that. Maybe the long story short there is that we believe in TEFCA, we believe in the future it imagines, but we don’t have strong confidence that it’s going to meaningfully shift the industry because of how it is structured.

Having said all that, there’s a number of products we support, connectivity to Carequality, CommonWell, and other networks that we support. But we’re just not convinced it’s the game changer.

ONC is reluctant to apply a heavy hand and instead wants to clear the way for market forces to drive advancement. Where would that market pressure come from to make TEFCA universal?

TEFCA has the framework around what’s called a Qualified Health Information Network, a QHIN. Without going into the tactical details of what qualifies as a QHIN, a couple of networks fit that mold at a high level. CommonWell and Carequality would be classic examples. They support a use case, which is the treatment of care or the transition of care use case, where data is exchanged. The classic example is that your primary care doctor is in New York, you’re in Florida, and you get in a bike accident. CommonWell and Carequality allow that record to get pulled from New York to Florida so that the doctors treating you there have your medical history. That’s a clear use case with appropriate incentives for hospitals and clinics to participate.

It’s harder to imagine future use cases where those alignment of incentives occur, where people would meaningfully come to the date table and agree to share data. There’s some compelling stuff around payments and patient payments where there could be meaningful market pressure.

Your question is a really interesting one because while the painted future is interesting and exciting, it’s hard to imagine a path to get there simply through pressure from market conditions. This is where we need to think about the actual incentives of these organizations, their willingness to share data, and whether they see it as the right thing given the specific use case.

Has the original interoperability idea of paying those who contribute data and then charging for its use gone by the wayside?

I don’t think that model is off the table. I just don’t think it has seen a ton of traction. Where there is traction involves life sciences companies that want to pay for large, de-identified data sets for R&D purposes. But beyond that, there just hasn’t been a ton of traction. That is not at all me saying that we should disqualify that or put it to the side. If there was, I think that would be super exciting. Those are the questions that will be interesting to track. Is it going to enable that world or not? Do we see the early signals that something like that could emerge?

Technology vendors, startups, and health systems themselves are finding it profitable to broker a data connection between providers and life sciences companies. Will additional use cases emerge?

I think we are early days. There’s a ton of opportunity. Costs are high to administer clinical trials. The match rate, how easy is it or hard is it to identify patients to enroll in the clinical trials, is still super high and inconsistent. The data itself is part of it. Another huge part of it is decentralized clinical trials, where there’s a ton of innovation. 

We are early days. That’s a fun and interesting spot to look for for innovation. Drug companies have lots of money that they are willing to put to work.

Do we have now, or will we have in the future, a healthcare technology ecosystem?

There has always been an ecosystem. It’s the question of how big and how impactful that ecosystem is.

Going back to the conversation around 21st Century Cures, you can look at a lot of interesting data. Look at the total amount of funding over the past five years that has gone into digital health. It has been one of the fastest growing categories compared to any other technology sector over the past five years. That’s an incredible sign that people everywhere see healthcare as not just a place where innovation is needed, but for anybody who has been a patient or provider, that innovation is needed and possible.

We’ve been saying for a long time and with a straight face that there is an ecosystem. Now it is probably more apparent to a growing audience. But we also think that it’s necessary. Like many other industries, there isn’t a single person or a single company that will meaningfully move the needle. It needs to be many people working on many problems.

That is one of the fundamental viewpoints we carry. It’s about empowering this entire class of builders. It hasn’t happened overnight, but it’s much more significant than it was yesterday, and I think three years from now, it will be twice as big. It is super exciting.

Now that cloud has finally found its healthcare footing, including technology companies like Oracle and Microsoft acquiring big health IT vendors, where does it go from here?

I’m glad you asked this question. Big tech is making serious moves in healthcare. For those of us who have been in this space for a while, we’ve seen different moments where bets were getting placed. I now have conviction — and not just me, but others — that fundamentally, healthcare delivery in the US is going to look different three to five years from now because of the impact of Amazon, Microsoft, and Google.

The other thing I would say is that it’s not just big tech, but also groups like CVS, Walmart, and others that are making big moves, such as Amazon buying One Medical and CVS’s purchase of Signify. An interesting detail that stuck out to me when Amazon purchased One Medical is that alongside that, they announced that they are winding down what they had previously been calling Amazon Care, which was their initiative around a nationwide telemedicine offering. That tells me that that Amazon, in this case, is moving out of testing different hypotheses, having multiple bets, and solving for optionality and they are moving into a more unified, aligned approach now that they have been in market for a little while. This is a trend that I see across big tech. They have spent some time studying healthcare and now they are making their big bets.

It’s not just the cloud. It’s the technology companies that offer the cloud that are super interesting. When it comes to big tech and the ongoing shift to cloud infrastructure, this has been a core part of the Redox thesis from the very beginning. Hospitals, clinics, payer organizations, and life sciences groups are all right now making massive investments in their cloud infrastructure. It’s because what they all have is data, and what they are realizing is that these big tech companies and their cloud infrastructure has the most robust functionality when it comes to driving value from that data.

I see big changes. The dollars being spent will threaten some incumbents in the space, because change is always scary. But I also think if we all take a step back and look at it from the viewpoint as a patient, I’m incredibly excited, because this is what has happened in other industries and the end result is ultimately a more user-friendly, consumer-friendly experience. It’s real. it’s big. We are in the midst of it right now, and three to five years from now, healthcare is going to look different.

How will  today’s financial market activity change the industry?

On the one hand, healthcare is, and will continue to be, relatively resistant to recessions. As we know, the demand for healthcare doesn’t closely associate with the state of the economy. I would say that overall demand hasn’t changed a ton. Where we do see impact is more specifically related to capital markets and the fact that valuations have come down significantly. Companies that need to fundraise in the short term are finding it harder. This is concentrated in some of the startup and SMB folks. This means that a category of customers and builders in the space that are tightening belts to extend runway. There’s some of that in the short term.

In the long term, I don’t see it having major, major impact. Any time we have a cycle like this, in some ways, it’s pretty natural. It will impact some more than others. We are watching it closely, but overall impact to us hasn’t been significant. We have it pretty balanced. We support SMBs all the way up to the Fortune 5.

As we all know, this story is also not done. It will be interesting to see how this unfolds over the next couple of quarters and year because there are tons of investment dollars available. It will be interesting to see when those investment dollars start to come back into the market. History can help us learn from other experiences, such as recessions, 2008, and the dotcom bubble bursting. It’s not totally uncharted, but we are paying attention to it pretty closely.

What will be important to the company over the next couple of years?

Most important for us is to continue to obsess about our customers. You heard me refer to them as builders. We are early days with the impact that builders are going to have in healthcare. It has never been more apparent to me that now is a great time to be a healthcare builder. We will continue to obsess about the people we support and continue to obsess about the use cases that we support. Doing that means we need to continue to power broader and broader sets of data to exchange. 

We’ve broadened from being clinically focused to many types of data. Today, Redox is focused on data access and integration. As we look into 2023 and 2024, the interesting opportunity for us is to start to support more and more of that healthcare data journey on its path to ultimately being useful. We are working on some exciting things that you will start to hear from us later this year and early 2023. It will enable a whole other class of builders.

With all the craziness going on in the world right now, there has never been a better time than right now to be a health tech entrepreneur. Now more than ever, healthcare as an industry is primed for change. My closing statement is to all of the builders out there. Don’t wait on the sidelines. Come on, let’s do it. There’s plenty of work and plenty of opportunity for impact.

Curbside Consult with Dr. Jayne 9/12/22

September 12, 2022 Dr. Jayne 1 Comment

I was glad that Mr. H mentioned Friday’s opinion piece by former VA Secretary David Shulkin MD. With a title like “State lines should no longer be barriers to health care,” I was hooked.

Going through medical school, I had a passing exposure to the idea that one would need a state-specific license when they went into practice. Mostly this exposure came by watching the anguish that your supervising residents went through as they tried to obtain licenses so that they could earn extra money by moonlighting at rural emergency departments or by covering nights or weekends on the medical center’s newly created hospitalist service. The medical center had a variety of services to support the application process, including access to fingerprinting courtesy of campus police and notary services from the medical school office of student affairs.

Once out in practice, that process becomes more difficult. Especially in a post-COVID world, the process may require making various appointments in person and during normal business hours, which isn’t terribly helpful if you’re a busy physician. Although some states are members of the Interstate Medical Licensure Compact which can expedite this process, a significant number of states have yet to opt in. This can mean going through the licensure process from scratch – providing various transcripts, reports of test scores, copies of certificates, and more.

One state where I applied demanded a copy of my high school transcript, which didn’t seem terribly relevant for someone with a medical degree and a couple of decades experience under her belt. I had a very interesting conversation with the registrar at my high school who eventually found it on microfilm. It looked like something that couldn’t possibly be a legitimate document, with each semester’s results being contained on an address label-like sticker that was applied to a single sheet of copier paper that had my name handwritten on the top. But it had the all-important embossed school seal, so I guess that made it official.

Still, and especially since this was a state that bordered my own, I thought it should be easier since the same standards of care that apply on one side of the line apply to the other. They are called “community standards of care,” not “state-specific standards of care.”

I had been practicing telehealth part time when COVID hit, and the relaxation in licensure requirements boosted my volumes. Almost overnight, I could see patients from 17 states, and as more states relaxed their rules, our wait times for on-demand telehealth visits decreased dramatically. As the pandemic eased, however, many states ended these programs, thereby limiting their residents to a smaller pool of clinicians.

One of the reasons that was cited by multiple states was the concern that easier access to telehealth would result in higher healthcare expenditures and the states didn’t want to be on the hook for that. States were also lobbied by their own state medical boards, in the context of the boards wanting to be able to ensure quality care and discipline physicians. Those boards also receive licensing fees from the physicians who want to practice in a given state, so I’m sure that was a factor.

We knew it would take time to see whether patients would return to in-person care or if they’d continue flocking to telehealth visits. Although many of us have witnessed changes in our volumes, the evidence was largely anecdotal. This week also brought us some research, as the journal NPJ Digital Medicine published a study looking at “The impact of expanded telehealth availability on primary care utilization.” The authors looked at 4 million primary care encounters from 939,000 unique patients from three health systems during the period between 2019 and 2021. They found little change in overall primary care utilization as telehealth services became more broadly used. They noted that “our results suggest the availability of telehealth is not resulting in additional primary care visits, rather, telehealth is serving as a substitute for certain in-person encounters resulting in no overall increase in primary care utilization. Further, it seems telehealth was mostly utilized for patients whose medical needs required multiple primary care visits during each year, suggesting that these telehealth encounters enabled follow-up for patients with chronic illness.”

They noted that additional studies are needed to determine the impact of expanded primary care access on other types of visits, such as urgent care or emergency visits. The authors also noted some limitations to the study, including the inability to determine if patients received additional primary care services from other facilities outside the study dataset. They also could not assess the quality of telehealth encounters compared to in-person visits.

I would also note that although the study looks at visit volume, it doesn’t take into account the differences in the costs of different types of visits. I’ve seen lots of institutional data that shows that telehealth urgent care visits are extremely cost effective, with one organization reporting a savings of nearly $150 for each patient encounter that was handled virtually versus at one of their brick-and-mortar urgent care clinics.

Now that states are cracking down on licensure, it makes it difficult for organizations to maintain the flexibility they need to care for patients. I can barely practice telehealth urgent care now because I’m not licensed in enough states. As an independent contractor, I’m not about to shell about big bucks, and a bigger amount of my time, to obtain additional licenses, so I’m effectively a wasted resource in the primary care / urgent care space.

David Shulkin calls for the states to adopt a model that stretches the boundaries of care, much like the Veterans Administration has done. Many organizations continue to lobby state legislatures to allow continued licensure flexibility, and some states have created lower-cost, telehealth-specific licenses that allow continued practice with more acceptable overhead. Shulkin uses motor vehicle driver licensure as an example, with operators being obligated to follow the laws of the state they’re in regardless of where their license was issued. In that kind of model, physicians would agree to abide by the laws of the patient’s state.

Such flexibility would not only help telehealth programs, but would also help in-person care. Organizations that require support from locum tenens physicians would have access to larger pools of physician candidates and would experience fewer delays in a physician arriving onsite. Ultimately patients would win, which should be the goal of 99% of what we do in healthcare. This would be administrative simplification at its finest.

Unfortunately, I know how state medical boards think, and I don’t see them running to jump on this particular bandwagon. Still, a girl can hope. Maybe some day I’ll be able to see more than two patients a day again.

What do you think about cross-state licensure? Will we see improvement in this decade? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 9/12/22

September 11, 2022 Headlines No Comments

State lines should no longer be barriers to health care

Former VA Secretary David Shulkin, MD advocates for the creation of a licensure compact program that would allow states to recognize each other’s medical licensees.

Nearly 400 workers in Washington state will be laid off due to Amazon Care shutdown

The shutdown of Amazon Care will drive 159 Amazon layoffs in Washington, while another 236 will be let go from its medical provider Care Medical, according to company notifications to the state.

Genetic testing service cuts 23 jobs, CEO steps down as patient volume grows

Telegenetics company Genome Medical lays off 23 employees and announces the departure of its founder and CEO Lisa Alderson.

Verily Announces $1 Billion Investment Round to Fund Continued Growth and Shares Changes to Leadership Team

Verily announces $1 billion in funding earmarked for expanded precision health efforts, the replacement of its CEO, and the resignation of its CFO.

Monday Morning Update 9/12/22

September 11, 2022 News 7 Comments

Top News

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Former VA Secretary David Shulkin, MD says in an opinion piece that Congress should create a licensure compact program that would allow states to recognize each other’s medical licensees.

Shulkin says the process should work like the national driver license compact, where drivers obtain one license and can drive in any state as long as they follow that state’s regulations. That is different from telehealth laws, in which the patient’s location rather than the provider’s defines the licensure requirement.

Shulkin touts the VA’s success in relaxing geographic limits so that clinicians can be assigned to locations as needed and can perform home visits.

Jay Sanders, MD of The Global Telemedicine Group, notes in a LinkedIn comment that telemedicine is already a puzzling outlier – doctors can see any patient in person as long as that patient comes to their location, with telehealth being an electronic version of that same interaction. Also noted by other commenters, however, is that the similarly structured Nurse Licensure Compact has not been adopted by 11 states that still require their own specific licensing.


HIStalk Announcements and Requests

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Poll respondents who were recently involved in a health IT purchase most often attribute the initial interest to references or company recommendations.

New poll to your right or here: Does your employer require most or all employees to be vaccinated against COVID-19? Reports suggest that some companies have rescinded their mandatory vaccination policies not because of new scientific knowledge, but because they were losing employees to competitors who didn’t make vaccination required.


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Mrs. HIStalk’s (now-former) eye doctor practice was unyielding in its refusal to sell her a box of contact lenses to tide her over until their next-available appointment in November even though her prescription has never changed. A couple of minutes of Googling turned up several contact lens companies that let you do a quick-and-dirty (albeit questionably effective) online eye exam. She did a five-minute, $20 exam through 1800contacts standing in front of her computer, received a prescription PDF signed by a state-licensed ophthalmologist shortly afterward, and ordered contacts through Lens.com, which  was cheaper and faster than her usual supplier Costco (not to mention that their online exam is on sale for $10, I now realize). An online exam isn’t worth much other than for verifying that refraction hasn’t changed, if even that, but I assume it fulfills a market need in which doctors generate short-term prescriptions without the ability to offer short-term appointments.


Thanks to the following companies that recently supported HIStalk. Click a logo for more information.

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Webinars

September 22 (Thursday) 1 ET. “ICD-10-CM 2023 Updates and Regulatory Readiness.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, marketing director, IMO; Julie Glasgow, MD, marketing manager, IMO. The yearly update to ICD-10-CM is almost here. Prepare your organization for a smooth transition, and avoid any negative impacts to your bottom line, with an in-depth look at the upcoming changes. Listen to IMO’s top coding professionals and thought leaders discuss the 2023 ICD-10-CM coding changes. This webinar will review additions, deletions, and other revisions to the ICD-10-CM code set and how to make sure you get properly reimbursed.

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


Acquisitions, Funding, Business, and Stock

A study of private equity-acquired ambulatory surgery centers finds that unplanned hospital visits, cost, and encounter volume were no different afterward compared to ASCs that were not acquired.

The shutdown of Amazon Care will drive 159 Amazon layoffs in Washington, while another 236 will be let go from its medical provider Care Medical, according to company notifications to the state.

Health coaching and wellness app vendor Twill lays off 10% of its headcount, two months after changing its name from Happify Health.

Verily announces a $1 billion funding round led by Alphabet, the replacement of its CEO, and the resignation of its CFO. The company says it will use the funding proceeds to expand its work on precision health, including real-world evidence generation, healthcare data platforms, and research.


People

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CommonSpirit Health promotes Jamie Trigg, MSITM to system VP of healthcare operating systems.

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Optimum Healthcare IT hires Cheryl Abbott (Precision Talent Group) as VP of marketing.

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John Curin (Burwood Group) joins Impact Advisors as VP.

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Ascension hires Kristi Roe (Qualtrics) as VP of patient and consumer experience.

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Nicole Bailey, PhD, MPH (Health Catalyst) joins Aetion as VP of real-world data. 

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Raintree hires Bill Sillar (Symplr) as VP of business development.


Announcements and Implementations

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A UCSF-led survey of digital health companies and their experience with EHR integration finds that:

  • About half rely partially or fully on proprietary APIs, with the remainder using mostly standards-based APIs.
  • Two-thirds of the companies that use non-RESTful APIs or don’t use APIs at all say it’s because RESTful APIs don’t meet their business needs.
  • The level of effort required to establish or maintain integration with EHRs doesn’t vary widely regardless of whether proprietary APIs, standards-based APIs, or third-party APIs are used.
  • Use of FHIR was reported by 84% of the companies.
  • EHR APIs were used for read access by 91% of respondents, 27% for update, 24% for write, and 7% for delete.
  • Top-reported barriers to EHR integration via APIs were high fees, lack of realistic clinical testing data, lack of standards-based APIs, and lack of valuable data elements.
  • Responding companies said that the federal policies that have most influenced integration progress are Cures Act API regulations, Cures Act information blocking regulations, and HL7 FHIR accelerators.
  • UCSF is seeking to expand survey participation beyond the 104 companies that have responded of 704 that were identified as integrating with EHRs or payer systems. The survey is open.
  • The preliminary survey results will be presented at the ONC Tech Forum on September 16.

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The Oracle Cerner Health Conference will return as an in-person event October 17-19, also offering a virtual track to those who prefer to attend remotely.

A study finds that expanded use of telehealth during the pandemic did not increase the overall use of primary care services, suggesting that it is serving as an alternative to in-person encounters instead of adding costs.


Other

In England, hospitals of Manchester University NHS Foundation Trust report delays of 12 hours and more along with cancelled appointments as they go live on Epic in a project they have named Hive.

I received a PR pitch from investor-backed, Toronto-based veterinary telehealth service Vetster, which cites a study that found that the US needs 41,000 additional veterinarians by 2030 as existing practices are being overwhelmed by a pandemic-driven increase in pet ownership that has backed up appointments for up to five months and cause some vets to stop taking new patients. The company says its telehealth marketplace for non-urgent services improves access, increases veterinarian income, and frees up clinics and urgent care hospitals to focus on cases that require hands-on treatment. The company also offers prescription delivery in some areas.

Hospitals are sending unprofitable outpatient primary care patients to independent, non-profit “Health Center Program Look-Alikes” that they create themselves, which are paid higher rates by Medicare and Medicaid, are eligible to buy discounted drugs under the 340B program, and can qualify newly hired doctors for federal help with student debt. KHN says that 108 look-alike health centers are in operation, sometimes on hospital campuses and sometimes staffed fully by hospital employees, to make it easy to divert non-urgent cases away from the ED. Lee Health says the program reduced unnecessary ED visits by 20%.


Sponsor Updates

  • Upfront Healthcare adds new features to its patient engagement and access platform related to content and patient experience, interoperability and integration, and provider experience and outcomes measurement.
  • Sectra publishes a new case study, “One for all – native support for automated breast ultrasound in Sectra’s expanded breast imaging PACS.”
  • Surescripts releases a new There’s a Better Way: Smart Talk on Healthcare and Technology Podcast, “Innovation, Please: What’s Next and What’s Needed in Specialty Therapy.”
  • Vocera releases a new Caring Greatly Podcast, “Managing the Polarity of Changing the System Versus Personal Resilience – Cynda Rushton.”
  • Optum is recognized as Best in Class in the Aite Matrix for Payment Integrity, Number 1 in the 2022 HFS Top 10 Report on IT/Business Services for Healthcare Provider, and a leader in Everest Group’s 2022 RCM Operations PEAK Matrix Assessment.
  • Well Health shares a new case study, “UNC Health App Increases Patient Engagement Through Well Health and Gozio Partnership.
  • West Monroe publishes a new healthcare communications client story, “Building a digital customer success platform drives a 75% increase in new customers.”

Blog Posts


Contacts

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

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Morning Headlines 9/9/22

September 8, 2022 Headlines No Comments

Walmart, UnitedHealth to offer preventive healthcare program for seniors

Walmart and UnitedHealth Group sign a 10-year deal to jointly offer preventive care for seniors and virtual healthcare for all age groups.

Morgan Health Announces New Investment in LetsGetChecked, Expanding Access to At-Home Health Care

At-home testing and virtual care company LetsGetChecked secures a $20 million investment from Morgan Health.

Vera Whole Health and Castlight Health Announce Health Tech Leader Donald Trigg as CEO, Rebrand Company Apree Health

Vera Whole Health and Castlight Health rename their combined value-based care and navigation company Apree Health and hire former Cerner President Donald Trigg as CEO.

News 9/9/22

September 8, 2022 News No Comments

Top News

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Walmart and UnitedHealth Group sign a 10-year deal to jointly offer preventive care for seniors and virtual healthcare for all age groups.

The deal gives Walmart access to new Medicare Advantage members while offering UnitedHealth a retail audience of potential insurance enrollees.

The venture will kick off in January at 15 Walmart Health locations in Georgia and Florida, with a focus on value-based care.

UHG’s Optum will provide analytics and decision support tools to Walmart Health’s clinicians, the companies will launch a co-branded Medicare Advantage plan in Georgia, and Walmart’s virtual care services will be added as an in-network offering of UnitedHealthcare’s Choice Plus PPO plan.

The companies plan to expand the collaboration across more insurers to include access to food, addressing social determinants of health, offering prescriptions and OTC medications, and providing dental and vision services.


Reader Comments

From EpicHiccup: “Re: Epic’s latest quarterly upgrade. Customers are being told to delay due to response time issues.” Verified. The company is telling customers to hold off until some fixes can be incorporated since the upgrade doesn’t contain any urgent regulatory or functionality updates.

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From MN Nice: “Re: CMS No Surprises act. Enjoyed seeing my local provider find a good spot for displaying ‘your rights.’” At least the obscuring plant doesn’t seem fake or dead, which is always a discouraging sight in the office of someone you are trusting to help you stay alive and healthy.


HIStalk Announcements and Requests

Being peevish, I humbly request that work experience not be stated in the form of, “Tom has over 21 years of sales experience.” Just call it 21 with the realization that the world doesn’t care about Tom’s fractional years of employment. Otherwise, every working human would waste space – except on their hiring anniversary — prefacing their years with “over.”


Webinars

September 22 (Thursday) 1 ET. “ICD-10-CM 2023 Updates and Regulatory Readiness.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, marketing director, IMO; Julie Glasgow, MD, marketing manager, IMO. The yearly update to ICD-10-CM is almost here. Prepare your organization for a smooth transition, and avoid any negative impacts to your bottom line, with an in-depth look at the upcoming changes. Listen to IMO’s top coding professionals and thought leaders discuss the 2023 ICD-10-CM coding changes. This webinar will review additions, deletions, and other revisions to the ICD-10-CM code set and how to make sure you get properly reimbursed.

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


Acquisitions, Funding, Business, and Stock

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Vera Whole Health and Castlight Health rename their combined value-based care and navigation company Apree Health and hire former Cerner President Donald Trigg as CEO. Vera acquired Castlight for $370 million in February 2022.

Mental health app and services vendor Headspace Health acquires Shine, which offers a meditation and self-care app.

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Investment firm Carlyle forms Atmas Health, which will acquire medical technology and life sciences companies as buy-and-build, carve-out and take-private transactions.

Streamline Health Solutions reports Q1 results: revenue up 109%, EPS –$0.07 versus $0.00. STRM shares are down 6% in the past 12 months versus the Nasdaq’s 23% loss, valuing the company at $81 million.

Premier-owned Contigo Health pays $178 million in cash to acquire contracts with 900,000 providers and cost containment technology from TRPN, from which it will create a new out-of-network health plan administration product for self-funded employer health plans.


Sales

  • Michigan Medicine expands its use of Loyal’s digital experience technology by adding chatbot functionality to answer consumer questions about locations, providers, bills, and COVID support.
  • Patient education video company Mytonomy chooses Redox to integrate its video-based patient engagement solution with EHRs.

People

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Therapy and rehab EHR/PM vendor Raintree hires Nick Hedges, MBA (MomentFeed) as CEO, Darian Hong, MBA (Act) as CFO, and Rob Rust (Wondr Health) as CTO.

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Health Catalyst promotes Kevin Freeman to chief growth officer, Tarah Bryan, MA to chief marketing officer, and Dave Ross to CTO. President Patrick Nelli will transition to advisor.

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Cue Health hires David Tsay, MD, PhD (Apple) as chief medical officer.


Announcements and Implementations

CloudWave launches OpSus Cloud Services with seven healthcare clients, bringing its total customer count to 250 in completing the company’s best-ever quarter.

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Cipher Skin, which offers a sensor-powered musculoskeletal rehabilitation remote monitoring platform, rolls out biometric extremity sleeves, a chest motion sensor, bill capture for RTM services, and EHR data sharing with Kno2.

Augmedix releases Prep, a service that organizes chart details to allow physicians to quickly prepare for an encounter.


Government and Politics

An HHS OIG report finds that telehealth use by Medicare beneficiaries jumped 88-fold early in the pandemic, which also resulted in flagging 1,714 providers for submitting questionable bills that totaled $128 million. An interesting finding is that more than half of these high-risk providers practice in a medical group that has a least one other high-risk provider, suggesting that certain practices are encouraging questionable billing. OIG also notes that many providers billed questionably but under the threshold of this report, including 18,000 of them who billed the same service to both Medicare and Medicare Advantage and 5,700 who added a facility fee to a telehealth encounter bill.


Other

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A new Compliance Today article not only has a fantastic title that references “When A Stranger Calls,” but brings attention to the non-EHR data that providers should consider in preparing for the next round of information blocking requirements that goes into effect on October 6. Examples of what an organization probably needs to be able to provide:

  • Radiology images to outside providers.
  • The ability to bring in records of outside providers to be used for diagnosis and treatment decisions.
  • Data submitted to cancer and tumor registries.
  • Pharmacy, case management, and billing data that is stored outside the EHR.
  • Information in legacy EHRs and billing systems that wasn’t brought into the current one.

Insider asks several VCs which health tech startups are the most promising. Those that are health IT focused and have no financial connection to the recommender:

  • Commure (data exchange tools).
  • Flexpa (allows patients to collect and share their health information).
  • Infinitus (voice-powered provider-insurer insurance verification).
  • Lasso (healthcare marketing).
  • Ribbon Health (automatically collects data about providers, insurers, and care quality).
  • Truepill (telehealth, at-home lab testing, and mail-order prescription delivery).
  • Turquoise Health (consumer healthcare and insurance price comparison).

Sponsor Updates

  • Quippe Clinical Lens from Medicomp Systems is added to the Cerner App Gallery.
  • First Databank names Kim Hart customer success consultant, Chris Buckley inside sales manager, and Kyle Doneth talent acquisition manager.
  • Clearwater will sponsor the AEHiS Healthcare Security Leaders Forum September 26-28 in Lake Buena Vista, FL.
  • HCTec publishes a new case study, “HCTec’s Legacy EHR Support Enables Prisma Health’s Epic Transition.”
  • CHIME releases a new Leader to Leader Podcast, “Rapid Change, Remote Success, and RPA with Andy Smith,” founder and managing partner of Impact Advisors.

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 9/8/22

September 8, 2022 Dr. Jayne No Comments

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I’m one of the few people in my social and work circles who has yet to have COVID, so I was eager to get one of the new bivalent vaccine boosters. There’s already a lot of misinformation going around with this booster and I feel more credible as a physician being able to genuinely say that I trust it enough to get my own dose on the leading edge of the rollout. I also have quite a bit of work travel coming up and am looking forward to the extra protection.

I initially scheduled a booster through my hospital’s patient portal, only to receive a phone call that they aren’t yet offering the bivalent version and aren’t sure when they’ll get it. However, I was able to find a convenient 8 p.m. slot at my local CVS HealthHub, so I decided to check it out.

Online scheduling and registration processes were quick and easy, and I immediately received a confirmation via email and text. About an hour before the appointment, I received a text with a link to check-in when I arrived, although the check-in button was locked out until 15 minutes before the appointment.

I quickly found the vaccination area in the store, although the signage for where patients should check in for vaccines was difficult to see given all the Halloween candy displays that were stealing my attention. Since I had registered online, the check-in process only involved verifying my name and date of birth. The pharmacist mentioned that they had been giving vaccines all day, which was good to hear.

The vaccination cubicle wasn’t soundproof, but it was clean and well organized. Barcode scanning was used to capture information from the vaccine vial prior to administration. I needed a new vaccine card since mine was full and the pharmacist had to hand-write, it which I’m sure becomes tiresome during the day. They may not be at a volume of administration where it makes sense to print labels as some of the high-volume hospital vaccine clinics do. I was in and out before my actual appointment time, making it back through the gauntlet of Halloween candy without a purchase.

I felt fine the rest of the evening, doing a little work and binge-watching the first part of the new season of “Call the Midwife.” I received a patient satisfaction survey from CVS, which I completed. Upon reading the questions, I realized that they didn’t offer me a Vaccine Information Statement like they should have. An interesting part of the questionnaire is where the patient can record a video snippet instead of a typed review. Any submission becomes the property of CVS and they can use it for marketing, so I wondered how many people actually do that. I took a pass on that one.

I slept well, but woke up terribly achy and felt like the joints in my fingers didn’t want to work at all, which is rough for someone who types all day. I also had significant pain in my underarm, which made me remember the issue I had in 2021 where my COVID vaccines caused an abnormal mammogram, sending me down a diagnostic rabbit hole with ultrasounds, extra mammogram views, and more. I was so excited to get the vaccine that I completely forgot about the follow up at the high-risk breast cancer clinic that I had scheduled for later in the month, and immediately cursed my enthusiasm. I mean, how do you forget something like that?

I’d like to chalk it up to the fact that I think I’ve blocked most of 2020 and 2021 from my mind as a coping mechanism for what I experienced on the front lines. Current recommendations call for waiting several weeks after a COVID vaccine before having a mammogram, so I hit the patient portal and messaged my surgeon to find out what she recommended. I was pleasantly surprised to receive a reply within the hour giving me a specific recommended time frame, so I called the office to start the rescheduling dance.

Any time you try to reschedule an appointment with a busy surgeon, especially if it has to be linked in time with a diagnostic study, it’s stressful. The staff did their best to find me a slot within a month of my “clearance” date, so I was happy with that. While I was on hold so they could dig through the schedules and try to make something work, it got me thinking – if I’m a professional who should know better, especially from my own previous experiences, and I couldn’t remember how this works, what are the odds that the average patient isn’t going to do the same thing?

It would be useful if the breast center could send a reminder to patients educating them on the need to space their vaccines and their mammograms so that others don’t wind up in the same predicament. Especially for a high-risk individual, that reminder would be most appreciated, and it should be pretty easy to send out a message through the patient portal. Any time spent crafting and managing that outreach would more than recouped by not having to deal with numerous patients calling to reschedule.

A couple of hours later, about 14 hours after the vaccine, my immune system was apparently doing a really good job of reacting to the vaccine because I started feeling terrible. Headache, crushing fatigue, nausea, and shaking chills came first, then hot flashes, followed by dizziness. I literally had to lie down between conference calls. Then came the drenching sweats. I’m sure the people on my afternoon calls got a kick out of my wardrobe changes.

Then, as quickly as the symptoms started, they were gone – no more headache, significantly reduced achiness, and with nausea giving way to feeling hungry. It was like a switch had been flipped. I had some dinner, did a quick Zoom with one of the organizations where I volunteer, and felt back to normal enough that I went out and walked a couple of miles.

All in all, this was similar to the experience I had with the second dose of the original COVID vaccine, with symptoms right at the 12-hour mark that totally resolved within 24 hours of the vaccine. I didn’t have anything like this with the first or third doses, however.

Although I wouldn’t want to repeat the experience, I’d rather have it than some of the debilitating cases of COVID I’ve seen in the last few months. It’s certainly preferable to the ultimate “bad outcome” that is dying, and which we still see (most recently in my world in a 42-year-old, which was truly tragic). The long COVID clinic at our local children’s hospital has a one-year waiting list, so hopefully vaccines will be helpful in preventing the need for those services. Everyone’s mileage varies as far as how they experience this vaccine. I don’t share this to frighten anyone, but as a longstanding early adopter of many technologies, including this one, knowing what to expect or what might happen might allow someone to plan ahead.

Have you received the new bivalent vaccine, and what was your experience? Leave a comment or email me.

Email Dr. Jayne.

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