Readers Write: Why Data Quality Matters in Price Transparency Workflows

Why Data Quality Matters in Price Transparency Workflows
By Cory Deagle

Cory Deagle, is chief product officer of RxRevu of Denver, CO.

As a healthcare technology vendor, we often hear that data quality is critical. It’s true that without access to reliable data, providers will question or even ignore key notifications, patient information, and clinical data. Now more than ever, vendors have a responsibility to both identify and improve the data flowing through their pipes.

Real-time prescription benefit (RTPB) – one example of an integrated tool that brings patient-specific coverage and cost data to EHR workflows – has been adopted by thousands of health systems, hospitals, and clinics across the country. This technology allows patients to understand the cost of their medications, including if lower-cost alternatives are available, while they are sitting with their care provider. I’m sure many of us have experienced the unpleasant surprise of arriving at a pharmacy only to find out the medication prescribed had an outrageous price tag. As more and more providers adopt RTPB, this should become a thing of the past.

While RTPB has incredible power to transform the patient experience, unless the vendor is providing a heavy dose of quality checks against the data, providers will notice inaccuracies or incompleteness, rendering the tool useless when making prescribing decisions. In order to resolve this, RTPB vendors must work closely with PBMs and EHRs to translate indistinguishable codes, ensure clinical relevance, and filter unnecessary noise, all with the goal of providing meaningful information so that providers can have better cost conversations with patients.

Here are a few examples of data quality steps that can be taken to improve provider trust in RTPB:

1. Quantity translations. Providers often enter medication quantities in familiar “clinical” terms (4,500 units of a diabetes injectable, for example) instead of entering quantities in “billing” units. Without a correction of the quantity from insulin units to milliliters (the billing unit for this medication), the cost information displayed could be an astounding $101,000. This is due to the fact that the PBM is pricing based on the quantity of insulin units submitted, which can be 100 to 300 times the billing unit. Vendors must be able to translate intended input quantities to ensure an appropriate covered price of $25 is displayed and communicated to the patient.
   Code Mapping: In many cases, drug costs cannot be determined because the National Drug Codes (NDC) used for pricing are obsolete or not recognized by the PBM. In order to receive an accurate price, solutions must automatically find comparable codes to display relevant pricing information.
2. Clinical logic for improved outcomes. In many cases, solutions cannot display pricing information because of user input error. For example, providers often mis-select the days supply, which can lead to errors such as “maximum dose per day.” Best-in-class vendors are able to leverage intelligence to alter days supply issues and enable transaction success. Clinical expertise and medical literature can also be used to hide erroneous results and prioritize meaningful medication alternatives in the workflow.
3. Message normalization. Providers want to focus on patient experience, but unhelpful error messages in the EHR (e.g. drug not found), slow down the ordering processes and drive mistrust in integrated tools. Standardizing errors codes from payer and PBM partners allows for actionable messaging (e.g. this medication is not covered at the selected pharmacy, please select a different pharmacy) and can improve the care experience.

It is the combination of these quality-focused tactics that can create a truly exceptional  and reliable healthcare experience. Technology vendors can no longer meet the bare minimum when delivering data. If they do, providers will ignore data presented to them, and patients will no longer trust the healthcare system they rely on. However, superior data and technology enable better decisions and drive real value in healthcare.

Readers Write: Unleash Human Capacity – And Leave Time for More Breakfast Burritos – With Better OR Scheduling

Unleash Human Capacity – And Leave Time for More Breakfast Burritos – With Better OR Scheduling
By Michael Bronson, MD

Mike Bronson, MD is an anesthesiologist with Providence Mission Hospital of Mission Viejo, CA; CEO of the Ketamine Wellness Clinic of Orange County of Laguna Beach, CA; and founder and CEO of AnesthesiaGo, which was acquired by PerfectServe in January 2022.

My path to becoming an anesthesiologist was, by all accounts, pretty normal. I went to undergrad, moved on to medical school, completed my residency, then joined a private practice. That was always the goal, and checking each of those boxes was fulfilling.

After I joined the practice, though, I started to wonder what was next. My whole life had been structured around working hard and staying focused on the future, and it felt a bit like I had reached the final phase.

Boy, was I wrong.

Like many other physicians, I was eventually thrust into a position that I never expected to inherit. There was some dissatisfaction in our group with the daily case scheduling process, and before I knew it, I was holding the hot potato in my hands.

As I leaned into this new responsibility, I most often found myself wrapping up daily cases around 5 p.m., only to be handed a stack of papers—representing the next day’s cases—and a pencil that was always topped with one of those old-fashioned detachable erasers. Why, you ask? Well, let’s just say changes, mistakes, and oversights were an inevitable part of the process.

This probably sounds relatable if you’ve ever doled out OR case assignments, but I’ll explain for everyone else. Fundamentally, it doesn’t sound too challenging—just put a name next to every case, make sure they’re not in two places at once, make sure they’re qualified to do every case, and make sure they’re credentialed at all locations.

But then come the other considerations. First, the person on call should get the most complicated cases. Second, you’ll find that surgeons often have preferences about who they want—and do not want—in the OR because of prior experiences. And finally, the patient may have a strong preference for a particular anesthesiologist because they were assigned to them previously. We always try to accommodate those requests when possible.

When you put all of this together, things can get messy. Like clockwork, every time I sent out a proposed schedule, calls and texts from colleagues would begin. Maybe somebody was double booked, or maybe there wasn’t enough travel time to get from one location to another. The reasons varied, but changes were always necessary.

In the end, this almost always took an hour or more, and I’ve seen anesthesiology groups where scheduling—which is typically done by a senior anesthesiologist—can take up to two hours. And remember, this is adding time to the end of the scheduler’s day, preventing them from going home or doing other important non-work activities.

If you’re reading this wondering whether technology can be used to improve this process, you’re asking the same question that popped into my mind several years ago. The short answer is yes, there’s a better way.

Scheduling technology isn’t necessarily new, but for a long time, the only vendors that existed were the ones that could take care of monthly scheduling needs: who’s on call, who’s working every day, who’s on vacation, and so forth. That’s a different animal than building a daily OR case schedule.

With intelligent OR case scheduling technology, you can use automation to quickly generate and distribute schedules that are free of the common mistakes people like yours truly would make when building them by hand. We’re all smart and well intentioned, but in this instance, technology is definitely the answer.

Going a step further, we can even champion provider wellness in a meaningful way. If a surgeon works best with a specific anesthesiologist, why not pair them together as much as possible to create an ideal working environment? As it turns out, technology can do that too.

I want to reinforce that none of this means we need to remove the human touch from healthcare. The best technology will make clinicians’ lives easier every day, but it should also give them a chance to provide meaningful oversight. No system is perfect, after all.

But in the end, shouldn’t we all be hyper focused on identifying and improving dated processes like the one I described? For me, getting home later every day because of scheduling duties meant less time with my family, and I had fewer chances to enjoy a favorite pastime with my son: grabbing a breakfast burrito.

Let’s all continue to think of better ways to unleash more human capacity by freeing ourselves from age-old processes that require too much time and effort. Less time being frustrated, more time caring for patients, and more time getting breakfast burritos with my son.

Morning Headlines 4/4/22

RE: U.S. Federal Trade Commission and the U.S. Department of Justice Request for Information on Merger Enforcement

The American Hospital Association tells federal regulators that hospital mergers, including associated technology benefits, lower costs and create better outcomes, benefiting their patients and communities.

Gozio Health Announces Financial Partnership with Morgan Stanley Expansion Capital

Wayfinding software company Gozio Health secures an undisclosed amount of funding from Morgan Stanley Expansion Capital.

Visante and TRG offer expanded pharmacy informatics and technology

Hospital pharmacy consulting firm Visante acquires The Robertson Group, which offers pharmacy informatics and technology consulting.

Monday Morning Update 4/4/22

Top News

The American Hospital Association tells federal regulators that hospital mergers lower costs and create better outcomes, benefiting their patients and communities.

AHA specifically calls out the technology benefits of mergers:

• Expanded repositories of clinical and cost data.
• Real-time support of diagnoses and treatments.
• Advanced analytics.
• Large health systems making advanced technologies available to their smaller affiliates that otherwise couldn’t afford them.

AHA says the government’s merger guidelines don’t require big changes and should retain market definitions as a component of competition analysis.

AHA adds the FTC and DOJ should focus instead on “anticompetitive mergers and deceptive conduct by insurance companies.” It specifically supports DOJ’s lawsuit to block UnitedHealth Group’s planned acquisition of Change Healthcare.

Reader Comments

From Brody Brodock: “Re: solutions that connect patients to clinical trials. I know of one, Ciitizen, although they seem to do only cancer trials.”

HIStalk Announcements and Requests

The employers of most poll respondents will focus this year getting and keeping employees and developing new offerings.

New poll to your right or here: For those who were laid off or terminated more than five years ago: what was the impact on your career? I did a similar survey years ago and it was shocking to see the super-high percentage of folks who said their unplanned job loss was a positive career event. As I often say, who wants to work for a company that lays people off, especially if you’re one of them? Although today’s truth is that nearly every company lays people off, kicking one set of “valued associates” to the curb while publicly bragging on company success that requires a fresh batch.

I received a large donation for Donors Choose and funded a bunch of classroom projects.

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

Webinars

April 6 (Wednesday) 1 ET. “19 Massive Best Practices We’ve Learned from 4 Million Telehealth Visits.” Sponsor: Mend. Presenter: Matt McBride, MBA, founder, president, and CEO, Mend. Virtual visits have graduated from a quickly implemented technical novelty to a key healthcare strategy. The challenge now is to define how telehealth can work seamlessly with in-person visits. This webinar will address patient satisfaction, reducing no-show rates to single digits, and using technology to make telehealth easy to use and accessible for all patients. The presenter will share best practices that have been gleaned from millions of telehealth visits and how they have been incorporated into a leading telemedicine and AI-powered patient engagement platform.

On demand: “Cybersecurity Threats Facing Healthcare Today.” Sponsor: Net Health. Presenters: Jason James, MS, CIO, Net Health; Monique Hart, MBA, CISO, Piedmont Healthcare; Jeffrey Rosenthal, , MBA CIO, Reliant Rehabilitation; David Jollow, MBA, CISO, Healogics. The panel of CIO and CISO leaders will discuss the cyberthreats that healthcare faces today. They will review security priorities for the increasingly complex healthcare IT environment that includes cloud-based applications, an increased number of endpoints that include connected devices and patient wearables, and patient portals.

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

Acquisitions, Funding, Business, and Stock

Buyouts magazine awards Francisco Partners its “Deal of the Year” recognition for carving out medical device integration technology vendor Capsule Technologies and selling it to Royal Philips for $635 million in early 2021 at a 233% gross internal rate of return. Qualcomm acquired Capsule Technologie (its original name as a France-headquartered company) in 2015 and made it part of Qualcomm Life, which Francisco Partners acquired in February 2019. FP renamed the business to Capsule Technologies, refocused it back on addressing inpatient hospital communications, hired former Spok CEO Hemant Goel to lead the company (he’s now at NThrive / FinThrive), and acquired clinical monitoring technology vendor Bernoulli Health, all in its first six months of ownership. FP sold the company to Philips two years after acquiring it, where it operates as Philips Capsule.

Hospital pharmacy consulting firm Visante acquires The Robertson Group, which offers pharmacy informatics and technology consulting.

People

Debra Carpenter, PhD (Crowe Healthcare Risk Consulting) joins Tri-State Memorial Hospital as CIO.

Change Healthcare hires Edward Baird (Spectralink) as VP of strategic accounts.

Industry long-timer Joyce Sensmeier, MS, RN retires as senior advisor of informatics at HIMSS.

Announcements and Implementations

Cerner won’t require non-client facing employees to be vaccinated until June 6, when workers are expected to return to in-office work.

Other

England scales back its pandemic surveillance programs in a move toward living with COVID-19 rather than trying to eliminate it, raising concerns among health experts that the dialed-back data systems will not support the early detection of new surges and variants. Britain was the global leader in performing random community testing, genomic sequencing, and combining the results with electronic medical records and epidemiology to provide the world with much of its COVID intelligence.

Amazon Web Services posts a job for head of worldwide health technology solutions, which involves building health system relationships, working with partners, and creating AWS business opportunities.

Sponsor Updates

• VisiQuate founders and staffers travel to Ensenada, Mexico with Baja Bound to build a house for a working family.
• The Urban Health Today Podcast features PeriGen CEO Matthew Sappern and his insights on rural maternity deserts, nursing burnout, and how AI is helping.
• Protenus will exhibit at the NADDI National Healthcare Facility Rx Diversion Summit April 25-26 in Raleigh, NC.
• TigerConnect will exhibit at AONL 2022 April 11-14 in San Antonio.
• TriNetX has signed a partnership agreement with Mitsui to expand its global research network in Japan.
• Consulting magazine names West Monroe partners Christina Powers and Melanie Prestridge Leading Women in Technology in the future leader and excellence in client service categories, respectively.

Blog Posts

• Pharma USA Takeaways: Implementing a Practical Approach to AI and Real-World Data that Improves Care Journeys (OptimizeRx)
• One Big Question: How can we improve the human experience of healthcare? (Olive)
• How Insurers Can Make Improvements for Medicare Open Enrollment (PatientBond)
• Use Technology in 5 Ways to Ease Administrative Burden (Symplr)
• Culture is Priority #1: The Cornerstone of Impact Advisors (Impact Advisors)
• Five Steps to a Successful Healthcare Analytics Program (Premier)
• How the Right Digital Health Tools Can Help Providers Operate at the Top of Their License (Quil Health)
• 14 phone-based customer support best practices (Talkdesk)
• Software in Cash-Based Practice, Part 3: Streamlining Clinic Communications (WebPT)

Contacts

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

Weekender 4/1/22

I will call this a “very special Weekender,” as the old TV shows used to say, as I limit this episode to a Donors Choose update. Feel free to skip this if you are looking for health IT news only.

Alex Benson, MPA is a long-time HIStalk reader, former Cerner executive, and SVP/GM of Bardavon Health Innovations since last year. He emailed to say that the company was interested in supporting the Donors Choose program. Which they did, in a generous way that needs its own post because the list of projects it funded is long.

Overland Park, KS-based Bardavon Health Innovations is a workers’ compensation digital health partner whose “clicks and mortar” technology connects its national network of physical therapists to self-insured employers to offer injury prevention, treatment, and work readiness solutions. There’s quite a bit of Cerner DNA in the company – Cliff Illig and Zane Burke are investors and board members, Ed Enyeart is CFO, and Jeff Steiner and Alex are general managers.

The company’s donation fully funded these Donors Choose teacher grant requests that I chose:

• Math manipulatives for Ms. F’s elementary school class in Miami, OK.
• Headphones for Ms. G’s elementary school class in Naples, FL.
• Science and STEM materials for Ms. W’s elementary school class in Miami, OK.
• Math learning tools for Ms. T’s middle school class in Montgomery, AL.
• Math learning tools for Ms. E’s elementary school class in Casa Grande, AZ.
• Math learning centers for Ms. P’s elementary school class in Washington, DC.
• Science sensory kits for Ms. H’s pre-kindergarten class in Washington, DC.
• Number recognition kits for Ms. G’s pre-kindergarten class in Columbus, IN.
• Robotics parts for the robotics teams of Mr. E’s magnet school in Van Nuys, CA.
• Sight words puzzles for Ms. B’s special education class in Brooklyn, NY.
• Storytelling kits for Ms. M’s elementary school class in Miramar, FL.
• Phonics and reading material for Mr. H’s elementary school class in Orlando, FL.
• Education centers for the kindergarten class of Ms. O in Staten Island, NY.
• Emotional support books and supplies for Ms. J’s elementary school class in Houma, LA.
• Math manipulatives for Ms. M’s elementary school class in Moore, OK.
• Flexible seating for Ms. R’s elementary school class in Kansas City, KS.
• Autism calm and focus tools for Ms. M’s autism preschool class in Glendale, AZ.
• Behavioral specialist supplies and games for the elementary school class of Ms. M in Las Vegas, NV.
• Dramatic play kits for language and social skills for Ms. K’s kindergarten class in Universal City, TX.
• Classroom organization mailboxes for Ms. B’s first grade class in Erie, PA.
• A set of 14 books for Ms. B’s elementary school class in Kansas City, MO.
• Science invention kits for Ms. M’s high school class in Kansas City, MO.
• 30 scientific calculators for Mr. F’s elementary school class in Kansas City, MO.
• Headphones and dry erase markers for Ms. C’s kindergarten class in Orlando, FL.
• STEAM bins for Ms. S’s elementary school class in Naples, FL.
• Sensory exploration kits for Ms. T’s special needs kindergarten class in Kernersville, NC.
• Soccer team supplies for Ms. F’s elementary school class in Yuma, AZ.
• Reading reward book purchase gift cards for Ms. S’s elementary school class in Bronx, NY.
• Building kits for Ms. G’s elementary school class in Sylmar, CA.
• A shelter and water cooler for the track team of Ms. M’s high school medical science class in Bronx, NY.
• Teaching resources for the speech therapy class of Ms. B in Detroit, MI.
• Mental health materials for the elementary school counseling sessions of Ms. R in Los Angeles, CA.
• Math and writing resources for the elementary school class of Ms. Z in Phoenix, AZ.
• Literary skills tools for Ms. D’s elementary school class in Eastpointe, MI.
• Behavior and sensitivity books for Ms. S’s elementary school class in Fresno, CA.
• English-Spanish dictionaries for Ms. G’s middle school ESL class in Indianapolis, IN.
• Classroom supplies for the autism elementary school class of Ms. H in Mesa, AZ.
• Headphones for the math intervention middle school class of Ms. P in Brighton, MA.
• Basketballs for the boys and girls teams of Ms. Q in Glendale, AZ.
• Decorations for the alternative prom for special needs students, voted by the school’s National Honor Society as an official project, for Ms. V’s high school in Buckeye, AZ.
• A mobile easel for the COVID-affected second grade class of Ms. M in Westminster, CA.

Many teachers responded quickly and I usually get updates (often with photos) to report how the donated items were used. Just to be clear, I receive these emails, but Bardavon Health Innovations provided the money.

Get Involved

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Morning Headlines 4/1/22

Thomas H. Lee Partners Acquires Intelligent Medical Objects

Private equity firm Thomas H. Lee Partners acquires Intelligent Medical Objects for a reported $1.5 billion.

Zephyr AI Raises $18.5 Million in Seed Funding Led by Lerner and M-Cor

Precision medicine and drug discovery analytics vendor Zephyr AI raises $18.5 million in seed funding.

Medical image sharing startup raises $16M

PocketHealth, a medical image-sharing startup based in Toronto, raises $16 million in a Series A funding round led by Questa Capital.

News 4/1/22

Top News

Private equity firm Thomas H. Lee Partners acquires Intelligent Medical Objects for a reported $1.5 billion.

Reader Comments

From Kaizen: “Re: HIMSS22. I meant to wander by the booths of Intetics (from the Ukraine) and First Line Software (Russia). Wondering if anyone checked them out and how their traffic was.” Offshore developer Intetics has (or maybe “had”) offices in Kyiv, Kharkiv, and other cities in Europe and the US. Software engineering firm First Line Software  has a US headquarters and lists offices in other countries that don’t include Russia. Anybody drop by their HIMSS22 booths? UPDATE: First Line provided an update – the US-based company formerly had a presence in Russia, but in protest of that country’s invasion of Ukraine, has pulled its people out and severed all ties with Russia. For that, I’m adding a little plug for its services with real-world evidence data, health data management and governance, AI/ML, systems development and integration, and clinical quality and safety systems.

From Green Lantern: “Re: clinical trials. Wondering if there are good systems that help patients find them?” I think most systems are aimed at physicians who are helping connect their patients to trials, so other than ClinicalTrials.gov, I don’t know of any that are intended for consumer use. Reader input is welcome.

HIStalk Announcements and Requests

Keep an eye on Epic’s website Friday for their annual creative April Fool’s shenanigans. I had a dream that the fake news included a retirement announcement from Judy that, in a bit of excellent Epic wit, turned out to be sadly real.

I’ll let others share their Dave Garets anecdotes since I have just this one. It was at the opening session at a long-ago HIMSS conference, and the stage curtains opened to a band playing some searing, nasty, surprisingly loud blues that made me want to drink a breakfast beer and take up smoking. Finally, I thought, HIMSS has hired some actual musical pros instead of bringing in the usual white bread “Up with People” Disney day-jobbers who shoot for “inspiration,” but instead hit “collective embarrassment.” The band wrapped up way too soon and its members turned out to be Dave, Jonathan Teich, and some other health IT folks I’ve forgotten, all of whom had spent time as professional musicians.

I’m trying not to snicker at the expert insight that is being widely offered unsolicited by attendees of “HIMMS.”

Webinars

April 6 (Wednesday) 1 ET. “19 Massive Best Practices We’ve Learned from 4 Million Telehealth Visits.” Sponsor: Mend. Presenter: Matt McBride, MBA, founder, president, and CEO, Mend. Virtual visits have graduated from a quickly implemented technical novelty to a key healthcare strategy. The challenge now is to define how telehealth can work seamlessly with in-person visits. This webinar will address patient satisfaction, reducing no-show rates to single digits, and using technology to make telehealth easy to use and accessible for all patients. The presenter will share best practices that have been gleaned from millions of telehealth visits and how they have been incorporated into a leading telemedicine and AI-powered patient engagement platform.

On demand: “Cybersecurity Threats Facing Healthcare Today.” Sponsor: Net Health. Presenters: Jason James, MS, CIO, Net Health; Monique Hart, MBA, CISO, Piedmont Healthcare; Jeffrey Rosenthal, , MBA CIO, Reliant Rehabilitation; David Jollow, MBA, CISO, Healogics. The panel of CIO and CISO leaders will discuss the cyberthreats that healthcare faces today. They will review security priorities for the increasingly complex healthcare IT environment that includes cloud-based applications, an increased number of endpoints that include connected devices and patient wearables, and patient portals.

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

Acquisitions, Funding, Business, and Stock

Precision medicine and drug discovery analytics vendor Zephyr AI raises $18.5 million in seed funding.

Sales

• Blessing Health System chooses Biofourmis for its hospital-at-home program that includes biosensors, a patient companion app, and analysis of wearable streaming data and patient-reported outcomes using the AI-powered Biovitals Analytics Engine.
• Carevive Systems will use technology from Datavant to de-identify its oncology patient experience data and connect it for sale to life sciences companies.

People

Dina promotes Tim Coulter to president, where he will also continue in his role as COO.

Keith Tode, MBA (IPM.ai) joins Net Health as VP of clinical research.

Sansum Clinic promotes Sean Johnson, MHA, RN to CIO.

Announcements and Implementations

New Zealand Health IT renames itself to the Digital Health Association.

Intermountain Healthcare will use a $100,000 grant from Intel to purchase 70 additional cameras for its Patient Safety Monitoring remote observation program. Intermountain says the program reduces room traffic and thus COVID exposure, frees up CNA time, and allows immunocompromised caregivers to continue caring for patients.

Telehealth vendor Hims & Hers Health will refer its patients who have complex clinical needs to primary and urgent care provider Carbon Health.

Medchart — which provides patient-authorized records release to legal, insurance, and research customers – announces Marble, an API that makes that information available to developers.

Athenahealth announces improved gender-affirming care capabilities for AthenaOne.

Surgical Information Systems moves to a new corporate headquarters in the Avalon community of Alpharetta, GA.

Government and Politics

Practice Fusion will pay $200,000 to settle federal charges that it failed to comply with the terms of its $145 million EHR opioid kickback settlement in January 2020. The US Attorney alleged that Practice Fusion failed to maintain and fund an Oversight Organization as the settlement required, which the company denied.

A former Yale University ED finance director pleads guilty to stealing $41 million from the medical school by repeatedly authorizing purchases of Suface Pros and IPads, which she broke into individual orders to fall within her $10,000 purchasing authority, then having the items shipped to a business that sold the devices and paid her a cut. Yale didn’t notice until an anonymous tipster questioned her high purchasing volume and why she was placing the equipment into her own car. Her purchasing limit means that she had to generate 4,000 purchases at $10,000 each over eight years – around two purchase orders per weekday — that the School of Medicine failed to notice. Federal investigators say Jamie Petrone-Codrington spent the money on cars, real estate, and travel, also raising the IRS’s interest for not filing tax returns that should have generated $6 million in federal taxes. She will forfeit $560,000 in her business’s bank account, two Mercedes, a Land Rover, two Cadillac Escalades, and a Dodge Charger, along with several real estate holdings. She faces up to 23 years in prison.

Other

Jonathan Bush explains that despite the impediments to interoperability – the challenge of building cross-app experiences, anti-competitive behavior, and broader networks that raise trust issues – he is optimistic:

To steal from Inigo Montoya: I know something that perhaps you do not know. COVID has ushered in a massive explosion in the number and funding of digitally forward, virtual-first healthcare providers. These companies have incredible outcomes, almost no fixed cost base (compared to old med), and an always-on, super convenient access layer. They are also almost all “focus factories” in that they take on one narrow problem, but solve it on a national level. As focus factories, they selfishly WANT a shared record. The amazing irritable bowel syndrome team at Oshi Health has absolutely no designs on taking over your diabetes care someday, but would really like a real-time holistic picture of their patients! They don’t just want federated data because it is clinically and ethically superior, but because they make more money when it exists. The incentives were not so for the Facebook application developer community of the Open Graph era and not so for the medical record guardians of Old Med.

Sponsor Updates

• CTG publishes a white paper titled “Continued Acceleration—Digital Transformation in 2022.”
• Cerner recaps Children’s National Hospital’s go-live on its clinically driven revenue cycle as an ITWorks client.
• Symplr CEO B.J. Schaknowski is named to the board of Susan G. Komen.
• Everbridge teams with technology leaders to offer a critical communications platform to support humanitarian efforts in Ukraine.
• First Databank becomes the NCPDP Foundation’s inaugural Patient Safety Founder Gift Donor with a donation of $100,000.
• Well Health names Malissa Miot (Carium) Northeast enterprise director of sales.
• InterSystems is recognized with the Business Intelligence Solution Provider of the Year award in the Data Breakthrough Awards program.
• The InteropNow! Podcast features Lyniate Chief Marketing Officer Michelle Blackmer in a new episode, “Removing the Confusion of Interoperability Solutions with Lyniate.”
• Meditech congratulates its customers that were included in The Chartis Group’s lists of top 100 rural and community, and critical access hospitals
• NTT Data is accepting applications for the NTT Data Hackathon as part of TechGig Code Gladiators 2022.

Blog Posts

• Managing Epic Community Connect Recipients’ Loss of Control (Impact Advisors)
• ServiceNow Knowledge Articles Empower All (Optimum Healthcare IT)
• Intelligent Healthcare Orchestration Can Reduce Burnout (About)
• More Insights from HIMSS 2022 (Part 2) (EVisit)
• New Naloxone Formulation Signifies Progress in Preventing Opioid-Related Adverse Events (First Databank)
• Inclusive Innovation: Repurposing Technology in Service of Health Equity (Get Well)
• Choosing a Managed Services Partner for EHR Support – Part 3 (HCTec)
• Reflections on HIMSS22: The Importance of Reconnecting (Healthwise)
• Staving Off March (security) madness: Digital identity management is your key defense strategy (Imprivata)
• Why You Should Invest in Upcycling Clinical Data (Diameter Health)
• A helping hand for health information exchanges (Intelligent Medical Objects)
• How Provider Data Management Helps Health Systems Embrace Healthcare Consumerism (Kyruus)
• Using Personalized AI to Make Communities (Heart) Healthier (Loyal Health)
• Our HIMSS22 Reflections: Re-imagining Care and Innovative Partnerships (Medhost)
• Strategies to Mitigate the Physical Therapist Shortage in 2022 (MWTherapy)
• Responding to the Challenges with MHealth Apps for Depression and Suicide Prevention (NeuroFlow)
• Guidelines will rule the world (Nordic)

Contacts

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

EPtalk by Dr. Jayne 3/31/22

A recent survey conducted by the American Medical Association found that 85% of responding physicians are using telehealth in their practices. Approximately 60% of physicians agreed or strongly agreed that telehealth enables the provision of high-quality care. I wasn’t surprised by the breakdown of visit types – 93% of them are offering video visits and 69% of them are offering audio-only visits. More than half of respondents say they are motivated to increase the use of telehealth in their practices. Uptake of other telehealth services, such as remote monitoring, seemed low at only 8%. As far as other interesting statistics, more than half of physicians indicated that telehealth had improved job satisfaction. The online survey was conducted anonymously, with 2,000 physicians responding.

A lot of people think that true telehealth services have to include both audio and video, but in my experience as a telehealth physician, it seems that the majority of patients are happy with audio-only services. Physicians have mixed feelings about doing audio-only visits. It’s definitely easier to assess whether people have an increased rate of breathing when you can see them, and you can quickly gauge their overall level of distress. Especially when caring for sick children, I like to see if they are clingy and how consolable they are as part of the evaluation.

For many adults seeking telehealth services, however, observation and other elements of physical examination don’t add much to the clinical picture. Ultimately it should be a balance, taking into account the patient’s preferences and the clinician’s comfort level with different telehealth modalities. There are plenty of studies that indicate that inclusion of audio-only services results in greater telehealth access among underserved populations, older patients, those who seek care in safety net facilities, and some demographic subsets.

Although there’s a lot of enthusiasm about telehealth, other sources look at telehealth from a different lens. One survey commissioned by UnitedHealth Group found that 55% of physicians are frustrated by managing unrealistic patient expectations for virtual visits. About half are also frustrated by issues with audio and video technology. Providers who responded to the UnitedHealth survey were less optimistic about telehealth’s impact on job satisfaction, with only 25% saying it was improved. There was also division on the role telehealth plays with regard to physician burnout – 30% said it increased burnout, while 30% said it reduced it. I’m sure the perceptions are valid at both ends of the continuum since I’ve seen some outstanding telehealth implementations and some that are marginal at best. I do hope that those organizations that plan to continue making it a large part of their patient care strategies spend the time and money to optimize their offerings for both patient benefit and clinician satisfaction.

Henry Ford Health unveils a new brand, dropping the word “system” from its name. According to its press release, removing “system” places more emphasis on the word “health” and broadens the vision. The new logo drops the iconic Henry Ford signature and oval and adds three shades of blue as well as a swath of purple. The purple is certainly eye-catching, but I’m not sure what to think about the different blues. The organization plans to roll out the new branding to its largest facilities first, with others phasing in the new branding over the next few years. Along with the visual branding, Henry Ford Health is launching an omnichannel ad campaign titled “I Am Henry.” It includes stories from the organization’s patients, employees, and from the communities it serves.

The organization’s press release notes that the “new logo clearly transitions the identity from one steeped in the visual history of founder Henry Ford, to a brand expression focused on humanity, backed by a powerful heritage of innovation and drive.” I’m not sure I fully feel that, but I’m willing to play along. On one of my recent projects, I learned an incredible amount about marketing, branding, and how different visuals can evoke specific responses from viewers. Looking critically at the new logo, I find the font rather intriguing. The majority of the letters are strong and uncomplicated, but the leg of the R adds a bit of whimsy. The swooping crossbar of the leading H pulls you into the name, and the trailing H feels downright playful. The purple feels a little too bright compared to the blues, but that’s just me. I’d be interested to hear what the marketing gurus out there think of it compared to my decidedly amateur opinion.

I learned last night that a physician who I worked closely with during my residency took his own life on Monday. He was a few years ahead of me in training . The loss of a young and talented physician (as well as a father and spouse) is tragic. Each year, 300 to 400 physicians die by suicide. Even if we personally are not at risk, the odds are that someone we work with might be struggling. The grief was particularly heavy since Wednesday was Doctors’ Day in the US, which was created to honor physicians for their dedication and their service to humanity. Knowing that some physicians feel there is no way to get through the challenges is heartbreaking, especially since I’ve lost two colleagues this way in under two years.

Judging by the reports in some of my social media feeds, the day was subdued for many, with occasional “snacks in the breakroom” celebrations. One physician reported that their organization gave everyone a book on wellness, which for many frontline physicians has become synonymous with pizza parties and therapy dogs. Another received a heart-healthy cookbook that appeared to be left over from a recent cardiology department open house based on the sticker gracing the back cover. I doubt hospital executives think about the idea that their selections might be posted on nationwide Facebook groups as a humorous counterpoint to those “best places to work” lists. Sadly, some physicians reported receiving no recognition in the clinic at all. With all the work physicians have put in over the last couple of years, I’m hoping that for them Doctors’ Day 2023 will be a better one.

Did your organization do anything to mark Doctors’ Day? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 3/31/22

The United States and Practice Fusion, Inc. Resolve Allegations of Violations of Practice Fusion’s Deferred Prosecution Agreement

EHR vendor Practice Fusion will pay a $200,000 fine to resolve allegations that it failed to adhere to the terms of its deferred prosecution agreement, initiated to resolve criminal charges for its role in soliciting and receiving kickbacks in return for embedding electronic prompts in its EHR to influence the prescribing of opioid medications.

Ransomware group claims responsibility for cyber-attack on metro healthcare organization

Oklahoma City Indian Clinic announces that it was the victim of a cyberattack earlier this month by the Suncrypt ransomware group, which claims to have stolen 350 gigabytes of data.

Brightside Health Raises $50 Million in Series B Funding to Accelerate Delivery of Life-changing Mental Health Care For All

Mental health-focused online medication and therapy startup Brightside Health raises $50 million in a Series B funding round.

Readers Write: The Life and Times of Dave Garets, Healthcare IT Evangelist

The Life and Times of Dave Garets, Healthcare IT Evangelist
By Ivo Nelson

Ivo Nelson is an entrepreneur, author, and speaker of Huntsville, TX. Helping with this tribute were Mike Davis, Steve Lieber, and Phil Pead. 

Dave Garets passed Monday morning at the age of 73, having battled Parkinson’s disease for several years. Dave made a huge impact on the healthcare IT industry.

It is hard to separate the man from his mission. For in Dave, he had the goodness of the human being coupled with the mission of improving healthcare. Dave believed that if technology was uniformly adopted in healthcare, then caring for patients would be greatly enhanced and outcomes would improve and become more predictable.

Two ideas formed from his healthcare IT experience. One was that the technology had to meet certain standards, because after all, healthcare IT was affecting people’s lives. The second idea was that healthcare IT had to be universally adopted to obtain the maximum benefit to society.

As a result, Dave left his mark on an industry that has now become almost entirely dependent on technology, the capture of healthcare data that is used in research to improve care outcomes and care safety, and delivering standardized care protocols to support lower cost and higher quality of care.

The early days of Dave’s exploits are told about his nightly guitar playing at local Idaho bars. He used this musical skill at several HIMSS venues over the years to create a unique identity for his presentations. Dave’s introduction to IT was developed by AT&T, where he would tell people that he used to code in assembler. Gartner analysts gave Dave the benefit of the doubt about his programming skills. Dave was an accomplished CIO for Magic Valley Hospital in Twin Falls, Idaho for several years, where he became a thorn in the side of Meditech.

He then moved on to management consulting with Arthur D. Little before joining Gartner as a VP for healthcare research and analytics. At Gartner, Dave demonstrated his executive management skills by successfully managing a group of research analysts who were highly intelligent, accomplished, and opinionated. The research and advisory team he built at Gartner is considered one of the best in healthcare.

Gartner provided the platform for Dave to truly shine. Dave loved being at the front and center of emerging healthcare technologies and regulations. He relished being on stage, presenting well thought out and defensible positions for using healthcare IT to improve healthcare. He promoted healthcare IT across the US and at international venues. Dave’s involvement with driving healthcare research provided him the platform to establish relationships with other powerful healthcare IT executives in provider, payer, and vendor organizations. Many vendor executives considered him a nuisance, especially when then did not deliver what they promised to the market.

I recruited Dave to my Healthlink consulting company to help drive consulting services for providers. Once again, Dave recruited the best and the brightest to join Healthlink during a pivotal point in the company’s growth. Under his leadership, Healthlink built one of the best strategy practices in the healthcare IT industry.

It was during his time at Healthlink that Dave was asked to be the chairman of the largest association in the healthcare industry, HIMSS, a byproduct of a merger between CHIM (healthcare IT vendors) and HIMSS (healthcare IT provider members).

Two major components of the deal struck from the CHIM-HIMSS negotiations were to change the formal membership structure to include a corporate member category (vendor companies) and to change the volunteer leadership succession in such a fashion that guaranteed that a CHIM (vendor representative) board member would become the next HIMSS chair. While this would not be the first time an employee of a vendor served as the volunteer chair of HIMSS, it would be the first time under the new membership structure.

The planned CHIM succession, which would determine who that new HIMSS chair would be, wasn’t the best approach for the organizations’ strategic objectives for the merged association. To solve this, Dave was instead elevated within CHIM leadership rotation and thus setting the stage for him to serve as HIMSS chairperson.

Dave was instrumental during his HIMSS leadership tenure in gaining widespread acceptance of the corporate community as full-fledged members of HIMSS. As both a former CIO and vendor, Dave was able to speak to both audiences and helped reinforce the strategic concept of HIMSS as a big tent, a place that was open and welcome to all points of view to get to the right answers for the American health systems and the patients they served.

It was during his term as HIMSS chair that HIMSS acquired survey research and data assets from The Dorenfest Group and set into motion a series of events that took Dave, HIMSS, and the entire health information technology sector in new directions that shaped HIT adoption trends and federal HIT policy for more than a decade.

Upon the acquisition of Dorenfest by HIMSS, a national search was conducted for the management head of the new initiative, which became HIMSS Analytics. Dave resigned as HIMSS chair and was hired to lead this group. Dave again demonstrated his executive management skills by converting a demoralized and toxic employee base into an empowered and progressive culture that generated an accurate and highly respected provider IT market database solution.

It was at HIMSS Analytics that Dave helped develop the EMR Adoption Model (EMRAM) that was used to objectively identify acute care EMR capabilities in hospitals. This model provided a simple and accurate assessment of provider EMR capabilities for supporting healthcare delivery.

In the early days, the model was challenged, and at times, maligned. Dave’s relentless promotion of the EMRAM in the US and internationally was the key factor in its market adoption, success, and impact on the EMR market and federal health policy. Much of the early dissatisfaction was how the model showed the lack of not only coherent HIT adoption, but also how the healthcare delivery system significantly lagged other business sectors in its technology adoption. The model’s enduring success proved that the thinking behind the model was right, and it ultimately became deeply connected to the US government’s efforts to spur the adoption of electronic medical records.

After achieving success with HIMSS Analytics, Dave was recruited by The Advisory Board Company to create a research and advisory service. Dave recruited several of his old Gartner team members to help create and launch it, the first at the Advisory Board to be completely electronic in format, replacing an outdated and expensive paper publishing research service. Dave also helped promote new consulting services for the company related to Meaningful Use regulations and the emerging ICD-10 coding system.

Dave retired from the Advisory Board, almost. He continued to take on consulting projects that kept him busy working with his wife Claire with their company ChangeGang that kept him connected to the healthcare IT market.

Dave helped drive healthcare IT advancements that resulted in considerable improvements for the market. He is irreplaceable in his zest for driving healthcare IT to enable higher levels of high-quality healthcare services. He created and developed strong corporate teams, he played the politics necessary to keep his team from experiencing corporate disruptions, he was the chair of HIMSS and participated in CHIME’s CIO boot camp training curriculum for several years, and he mentored his teams that generated several successful IT professionals.

Dave lived life large. He once owned three yachts at the same time (not on purpose). He traveled globally and immersed himself in the local cultures. He always had a well-stocked wine cellar that he gladly shared with friends. He married Claire, who was his intellectual match and had the character to keep him on his toes.

Dave slid into the home plate of life with a torn uniform, dirt on his face, bleeding, and missing a few teeth on March 28, 2022. But what a ride he had.

May God bless him and welcome him into heaven.

Readers Write: Thirty Years in Healthcare IT, An Accidental Pilgrimage

Thirty Years in Healthcare IT, An Accidental Pilgrimage
By Jim Fitzgerald

Jim Fitzgerald, MBA is founder and EVP/chief strategy officer of CloudWave of Marlborough, MA.

Friday is my last day at CloudWave, my latest and likely last team in which I labor full time in the healthcare IT space.

Whether you work at a healthcare provider, an industry software vendor, or a managed cloud services company like ours, healthcare IT is by nature a team sport. It is also often as much a vocation as a career. There are darned few deep thinkers, deeply technical people, or talented managers in HCIT who could not make more money outside of it. But on the flip side, could probably not muster the directed passion for the work outside of HCIT.

That has been a recurring theme from the time I entered this business in 1993 by joining a firm weirdly and appropriately called JJWild. Everything along the way needed to be designed, built, and managed so that to the greatest extent possible it could ease and empower the safe delivery of healthcare,while being where possible, “minimally invasive.” You would have to be a heartless megalomaniac (not that we notice many on the world stage these days) not to be able to buy into that mission. After all, short of a handful of blessed protected natives sequestered deep in the Amazon who have never had to read an Explanation of Benefits, we are all healthcare consumers. Some combination of spiritual awareness, concern for our neighbors, and enlightened self-interest continues to drive the space as powerfully as financial motives. At least I hope so.

What was the road like? In 1983 (yeah, I’m that old), I was working in a non-healthcare oriented technical and marketing support role at a modem company called Microcom. Our modems were unique in that the analog / digital conversion and signaling engine was overlaid on a Z8 breadboard with a whopping 64K of RAM that booted its own device OS and loaded code from EPROM that allowed the serial interface to be programmable and also allowed the modems to run their own in-band data communications protocol to protect the data stream.

This caught the attention of a rapidly growing HCIS vendor called Meditech, whose founder, Neil Pappalardo had invented a proprietary color terminal for their Magic OS that would deeply impact the industry. The appealing interface could do block and character color graphics at about 20% of the cost of a PC and almost no maintenance. The catch was that for remote data access, it needed a connection between the terminal and the remote terminal server that had no data communication errors, as the terminal server and the terminal were in constant “chatter,” both to transmit and receive HCIS data and to manage screen formatting and behavior.

That’s how I got to know Meditech, and it changed my path. Nine years later, I joined the team at JJWild at the urging of one of Meditech’s system gurus, Chris Anschuetz, whose simple explanation was, “We are moving from Magic to TCP/IP. Our customers are going to need open networks and we need partners who can build them.”

My personal education on TCP/IP had come from a product manager at Microcom, Eugene Chang, an MIT engineer with a gift for making the complex simple. He had helped build DARPANET while at the semi-legendary consulting firm Bolt, Beranek, and Newman. I was excited. Shortly thereafter I found myself counting wires in hospital closets, ceilings, repurposed laundry chutes, and ceiling chases. Lab visits were always the frightening highlight of those network walkthroughs.

One thing led to another. JJWild helped Digital Equipment / Compaq introduce the Alpha to the Meditech community. Data General, Meditech’s larger systems partner, got sold to EMC. JJWild started offering applications, tech consulting, and managed disaster recovery services to hospitals.

Oddly, this tech support guy turned sales engineer turned sales guy (also known by “pure” engineers as the path to the dark side) was kicked into a CTO role at JJ to cap my cost to the organization. It was insane in scope, but could be a lot of fun. I got to work with a large cross section of the company – sales, consulting, engineering, support, and partner management — while still being able to work daily with our hospital customers. A group of us from inside and outside the company constantly debated and schemed to figure out how to build unbreakable systems to support healthcare apps. We got support to launch a private cloud-based disaster recovery service, JSite, at JJWild.

Perot Systems gobbled JJWild up in 2007 and put us to work before the ink was dry on harnessing emerging cloud tech to host legacy healthcare apps. A hosting solution called MSite was introduced by Perot in 2008. Dell bought Perot in 2009 with the intent of becoming more services-oriented, but the Meditech team at Perot barely showed up on their financial radar at the time.

When it became clear we were not a core strategy for Dell at the time (they sold Perot to NTT Data in 2013), 27 of us quietly left Dell from October 2011 to May of 2012 and joined with Park Place International. Its founders agreed to fund a new hybrid cloud managed services venture that would evolve into CloudWave and a suite of secure, highly available managed services called OpSus that today hosts over 125 diverse applications from EHR to enterprise imaging for more than 200 hospitals, securely backing up petabytes of data to both public and private cloud, and disaster recovery protecting over 175 hospitals.

Our services, with a cross-cloud platform sourced from our own secure private cloud data centers as well as AWS and GCP, began to transcend the Meditech realm and are gaining new customers from hospitals running Epic and Cerner, as well as smaller ISVs who need somebody to provide an ops center that can “take them to cloud.”

What do I see coming? The 20-year cycle in IT that goes from everything centralized to everything decentralized will continue and perhaps compress. The ongoing migration to cloud is driven by economic, operational, and security forces and will continue, but the cloud edge will also get built thoughtfully to support advances in genomics, analytics, and machine learning. Either PHRs will become real and the consumer will be their own best health data steward, or the vaguely and mostly unintentionally evil government / medical / pharmacy / insurance megaplex that wants no one to really have a private life will win and someone other than you will own your EHR.

Consumers will reassume financial responsibility for their own healthcare with some kind of underlying insurance for big bills or will surrender to a central system that doles out equal misery and lack of excellence for all. Black hat hackers will be heavily prosecuted instead of modestly slapped and sent to abandoned monasteries to do something useful for the rest of their days, like crush wine grapes with their feet. All but the largest integrated healthcare systems will get out of the IT business in a similar fashion to how they got out of the laundry and food service businesses and buy IT services modularly, the way individuals mix apps on their tablets. No matter where you sit in the space, it’s still going to be a wild ride.

What have I learned? Most hospital IT teams I have worked with over the years are understaffed, underpaid, and hugely dedicated to their work. They have capacity for X projects per year, demand for 3x projects, and funding for X/2 projects. They adapt like ADHD chameleons traversing a mosaic. Intended and unintended poop is flung at them by regulators, vendors, colleagues, and customers.

You are collectively some of the best people I could have hoped to serve. Thank you for the privilege.

Morning Headlines 3/30/22

Novant Health launches new business division to accelerate clinical, operational and technological advances for the healthcare industry

Novant Health (NC) launches Novant Health Enterprises, an independent business focused on developing, acquiring, and scaling clinical, financial, and patient-oriented solutions.

With tech launches, Epic Systems looks to future of healthcare accessibility

Epic expands its 1,100 acre campus in Verona, WI with the opening of its 350-office Mystery building, the forthcoming opening of its Castaway building, and the addition of three more facilities within the next five years.

Life Sciences and Healthcare Leader ConcertAI Raises $150 Million Series C from Sixth Street at $1.9 Billion Valuation

Enterprise AI and real-world data software vendor ConcertAI raises $150 million in a Series C funding round, bringing its total raised to over $300 million.

News 3/30/22

Top News

AmplifyMD, which connects hospitals to specialists via telemedicine, raises $23 million in a Series A funding round. The San Francisco-based startup’s software also incorporates care management, billing, and analytics.

Webinars

April 6 (Wednesday) 1 ET. “19 Massive Best Practices We’ve Learned from 4 Million Telehealth Visits.” Sponsor: Mend. Presenter: Matt McBride, MBA, founder, president, and CEO, Mend. Virtual visits have graduated from a quickly implemented technical novelty to a key healthcare strategy. The challenge now is to define how telehealth can work seamlessly with in-person visits. This webinar will address patient satisfaction, reducing no-show rates to single digits, and using technology to make telehealth easy to use and accessible for all patients. The presenter will share best practices that have been gleaned from millions of telehealth visits and how they have been incorporated into a leading telemedicine and AI-powered patient engagement platform.

On demand: “Cybersecurity Threats Facing Healthcare Today.” Sponsor: Net Health. Presenters: Jason James, MS, CIO, Net Health; Monique Hart, MBA, CISO, Piedmont Healthcare; Jeffrey Rosenthal, , MBA CIO, Reliant Rehabilitation; David Jollow, MBA, CISO, Healogics. The panel of CIO and CISO leaders will discuss the cyberthreats that healthcare faces today. They will review security priorities for the increasingly complex healthcare IT environment that includes cloud-based applications, an increased number of endpoints that include connected devices and patient wearables, and patient portals.

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

Acquisitions, Funding, Business, and Stock

RCM software vendor NThrive will change its name to FinThrive. The company acquired TransUnion Healthcare late last year for $1.7 billion, and is in the process of purchasing Pelitas, which specializes in patient access, intake, and RCM software.

Change Healthcare will reportedly sell its ClaimsXten claims payment and editing software business to Availity as potential acquirer UnitedHealth tries to work through DoJ antitrust concerns. Legal experts suggest the sale of ClaimsXten may weaken the DoJ’s lawsuit against the proposed sale of Change to UnitedHealth. The companies have until April 5 to walk away from the $8 billion deal.

Novant Health (NC) launches Novant Health Enterprises, an independent business focused on developing, acquiring, and scaling clinical, financial, and patient-oriented solutions.

Cardiologist John Spertus, MD files a copyright infringement lawsuit against Epic claiming that it has made some of his diagnostic questionnaires available in its EHR. Spertus is the director of health outcomes research at Saint Luke’s Mid America Heart Institute in Kansas City, MO.

Sales

• In Ireland, Mater Private Network will implement Meditech Expanse across its hospitals and clinics.
• Digital home care company Vesta Healthcare selects Bluestream Health’s virtual care platform-as-a-service.

People

David Garets, whose long health IT career included leadership roles with Gartner and HIMSS Analytics, died Monday at 73.

Inderpal Kohli (Hospital for Special Surgery) joins Englewood Health (NJ) as VP of IT and CIO.

Other

A local website’s profile of Epic Systems hints at a forthcoming app that will enable physicians to research best patient care practices using real-world evidence culled from the company’s Cosmos dataset, and outlines the company’s plans to continue expanding its 1,100 acre campus in Verona, WI. It opened its new 350-office Mystery building last week, and will open a similar building, dubbed Castaway, later this year. Three more additions will open within the next five years.

Vanderbilt University Medical Center’s Clickbusters program has helped reduce alert fatigue through a six-month review process that has modified 42 clinical decision support alerts and turned off 10. Eighty-four alerts were reviewed by physicians, nurses, and pharmacists, ultimately resulting in 71,227 fewer interruptive alerts being sent per week, and a 15% reduction in total interruptive alerts.

Sponsor Updates

• The Ascom marketing team has worked with Habitat for Humanity to paint two houses in Cary, NC.
• Healthcare IT Leaders publishes a new managed services case study featuring Northeast Georgia Health System.
• AdvancedMD awards Client Support Specialist Hannah Dixon an FIT Award.
• Arcadia publishes a new case study, “How Summit Health’s transitional care management creates value for patients and practices across multiple payment models.”
• Baker Tilly will present at the Pennsylvania Association of Directors of Nursing Administration Convention March 29-April 1.
• Bamboo Health will present at the Rx Drug Abuse and Heroin Summit April 19 in Atlanta.
• Dina will present at the TAG Digital Health Summit March 30 in Atlanta.

Blog Posts

• Debunking three common misconceptions about gateway edits (Availity)
• How a Virtual Care Platform as a Service enables better care (Bluestream Health)
• What orthopaedic surgeons need to know about surprise billing legislation (Bravado Health)
• Unleashing the Power of Communications for Healthcare (CareMesh)
• 5 Qualities That Add Value to a Managed IT Services Partner (CereCore)
• Why RHCs and FQHCs Should Care About Chronic Care Management (ChartSpan)
• 7 Things Healthcare Leaders Should Know About 405(d) HICP (Clearwater)
• It’s Time to Rethink Healthcare Data Backups (CloudWave)
• Clinical Research Study Aims to Improve Obstetric Outcomes in Uganda (Current Health)
• HIMSS22 Outlines Opportunities in Healthcare (EClinicalWorks)

Contacts

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

Morning Headlines 3/29/22

AmplifyMD snags $23m in F-Prime-led Series A

Specialty telehealth startup AmplifyMD raises $23 million in a Series A funding round.

Clearlake Capital-Backed nThrive Announces Name Change to FinThrive as Part of a Forthcoming Rebrand

Following its acquisition of TransUnion Healthcare late last year, RCM software vendor NThrive will change its name to FinThrive.

Change Healthcare said to announce buyer for ClaimsXten business as soon as next week

Change Healthcare will reportedly sell its claims payment and editing software business to Availity as potential acquirer UnitedHealth tries to work through DoJ antitrust concerns.

Private equity firms back Ensemble Health Partners in $5B+ deal

RCM software and services company Ensemble Health Partners secures funding from Berkshire Partners and Warburg Pincus that pushes its value to $5 billion.

Curbside Consult with Dr. Jayne 3/28/22

The only thing being discussed in the virtual physician lounge this weekend was the trial of Tennessee nurse RaDonda Vaught, who was found guilty of criminally negligent homicide following a medication error. Criminally negligent homicide is a lesser charge than reckless homicide, of which she was found not guilty.

For anyone who hasn’t been following the story, the short version is as follows. Vaught, who was a nurse at Vanderbilt University Medical Center, was managing a patient order for the drug Versed. The patient had been admitted to the hospital’s neurological intensive care unit following a brain bleed. The drug was ordered to help manage anxiety and claustrophobia prior to a PET scan. Vaught couldn’t find Versed in the automated medication dispensing cabinet and used an override to unlock a broader menu of drugs, leading her to obtain the drug vecuronium instead. Versed is the brand name for the sedative midazolam. Vecuronium is the generic name for the drug Norcuron, which is used to aid in “surgical relaxation” for general anesthesia or to create paralysis for patients who are on ventilators in the intensive care unit.

Vaught failed to validate the name of the drug, didn’t notice a warning on the medication vial itself, and didn’t stay with the patient after administration.

Vaught’s attorneys argued that although she admitted making errors with the medication, those errors were part of normal operations at Vanderbilt and reflect systemic dysfunction. Prosecutors alleged that she ignored multiple warning popups, including one that would have said the drug was a “paralyzing agent” and that would have required a reason for the override. Other nurses working on the same unit testified that overriding the medication dispenser was a common occurrence and that a recent EHR upgrade had created delays in obtaining medications from the cabinets. They cited organizational emails instructing nurses to override warnings to reduce delays. Additionally, there was no barcode scanner in the imaging department, where the medication was administered. A scan of the patient’s hospital ID bracelet against the medication might have prevented the fatal drug administration.

As a clinical informaticist and process improvement specialist, I think about these kinds of errors all the time. Our system of having both generic and brand names for drugs causes a lot of confusion. I trained in a residency program where we were only allowed to refer to drugs by their generic names, which probably prevented some errors by newly minted physicians. However, when I entered private practice, there was a lot to learn, as many of my patients referred to their drugs by brand name. I ran across a couple of situations where the patient was on two drugs from the same class that would have been caught had the generic names been used. Fortunately, none of the patients were harmed before we could modify their regimens.

This error also brings up the issue with “look alike” or “sound alike” drugs. In the EHR realm we’ve taken steps to manage the former with interventions such as Tall Man Lettering for drug names ,which help to differentiate names that are close. One could argue that Versed and vecuronium aren’t close other than that they both start with the letter V, but it’s important to understand the level of baseline confusion that might exist when hundreds of drugs are used within a patient care unit on any given day. The practice of medicine has become significantly more complicated over the last two decades with hospitalized patients often being “sicker” than they were in the past. Due to medical advances, patients who previously might have died are living longer, often with a dozen or more drugs to address their health conditions as well as to mitigate issues caused by the drugs themselves.

There are also issues with the setup of the automated drug dispensing cabinet. At the time, the Vanderbilt system only required two letters to be entered to access a drug menu. One organization I worked with had their cabinets set to require five letters to locate a drug. They also had all paralytic agents in a specially colored locked container to make it clear that nurses were accessing something that required additional diligence. Additionally, Vaught was administering medications outside her usual department and didn’t document the administration of the drug. Its lack of inclusion in the medical record led to a death certificate that noted a natural death following a brain bleed rather than being related to the medication administration.

Vanderbilt didn’t report the medication error to the state. Only a year later when an anonymous tip was sent to state agencies did an investigation begin.

Anyone who has practiced in a complex care environment, such as an intensive care unit, understands how even a small distraction can have significant consequences. As a sleep-deprived resident physician, zoning out even for a second could mean missing a critical part of a patient’s information. In past times, ICU nurses may have cared for one or maybe two patients. Today I see them caring for three or more patients, which certainly isn’t helping with attention issues or distraction.

In a hearing before the Tennessee Board of Nursing, Vaught stated that she was distracted while precepting a trainee, but admitted responsibility for the incident. Although this incident occurred long before the COVID-19 pandemic, I can only imagine the level of distraction that nurses faced over the last two years.

In response to this case, I hope all facilities are reevaluating their processes for overrides on automated drug dispensing cabinets and how they store critical drugs such as vecuronium. In speaking with a pharmacist friend about this case, she noted that not all hospitals have increased their search requirements to five characters as my client did. If you’re at one of those institutions, I’d encourage you to quickly prioritize an evaluation of your processes.

This case is a perfect example of the Swiss cheese model of process safety. The more holes that are present, the easier it is for a mistake to happen. When the holes are particularly large, such as when medication overrides have to happen on a daily basis, people become desensitized to the safeguards that are designed to protect patients.

Certainly there were individual actions that led to this tragedy. Policies weren’t followed and literal bright red warnings were ignored. But without the combination of circumstances, the patient would not have received the wrong medication.

Those of us on the clinical front lines have all made mistakes. Some of those mistakes become near misses because of systems that protect patients (and also us as caregivers). But some of those mistakes become true medical errors that have devastating consequences. Comments from my peers run the spectrum from “it’s all Vanderbilt’s fault” to “she deserves the death penalty.” The reality though is that we could all benefit from a closer look, as well as a slower and more thoughtful one, at how a situation like this might unfold in our worlds.

Have you ever been responsible for a medical error? What advice would you give for those who design and maintain the systems upon which you rely? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 3/28/22

DOJ joins whistleblower case against EHR vendor Modernizing Medicine and co-founder

The US Department of Justice joins a whistleblower lawsuit brought against Modernizing Medicine (now ModMed) and its CEO that accuses ModMed of falsely attesting that its EHR met Meaningful Use criteria, which caused users to submit inaccurate reports to CMS in earning MU incentives.

Cloud21 receives major investment from US healthcare technology consultancy, Tegria, to deliver digital transformation at scale

Tegria makes an unspecified “major” investment in England-based digital health consulting firm Cloud21, whose customers include several NHS hospitals.

Chapel Hill startup focusing on healthcare analytics, raises $2.5M, to expand

Quinsite, a healthcare analytics startup that markets its software to radiology practices, raises $2.5 million in seed funding.

Monday Morning Update 3/28/22

Top News

The US Department of Justice joins a whistleblower lawsuit brought against Modernizing Medicine (now ModMed) and its CEO Daniel Cane.

The lawsuit, which was filed in 2017 by former VP of Product Management Mandy Long, accuses ModMed of falsely attesting that its EHR met Meaningful Use criteria, which caused users to submit inaccurate reports to CMS in earning MU incentives.

The lawsuit claims that the company ignored patient-endangering software defects in favor of developing new products to increase revenue; illegally paid kickbacks; and sold systems with promises of increasing provider revenue that were enabled by inappropriately upcoding E/M codes and procedure code modifiers.

Reader Comments

From Friend to Nurses: “Re: burned-out nurses. HCIT needs people with clinical experience, not wild ideas from Silicon Valley, and I have several friends who are in their early 30s with 10+ years of nursing experience. Do your readers know of companies that are hiring nurses, or perhaps would companies step up here and say they want to hire nurses?”

From From Great to Horrible: “Re: Tegria.Laid off at least 50 people Friday with no warning or explanation. As someone who became an employee via the acquisition of Bluetree, it hurts to see an organization transform so quickly from having an amazing culture to one that most people dread working for.” A company spokesperson provided this response to my inquiry: “Tegria is implementing changes to better serve our customers and streamline our organization. Like all companies, we evaluate our business on a regular basis in response to ever-changing market needs, which can involve reductions in some roles and hiring in other roles.”

From Payola Pavlova: “Re: companies paying for running their own ‘news.’ Here’s a new example.” It’s not new that some industry sites are auctioning off their editorial space (and ethical principles) with the zeal of Nascar plastering ads on race cars. It doesn’t bother me in health IT as long as it’s made clear, as in this case with the prominent “sponsored” label, that objectivity was bribed to look the other way.

HIStalk Announcements and Requests

Three-fourths of poll respondents say that patients don’t get ROI in indirectly paying for attendance at industry conferences, including 58% of those who attended ViVE, HIMSS22, or both.

New poll to your right or here: What will your employer focus on most in 2022 to ensure long-term success?

Welcome to new HIStalk Platinum Sponsor Net Health. Net Health Employee Health and Occupational Medicine offers total compliance tracking and employee wellness oversight in one specialized and paperless documentation solution. Rely on integrated telehealth technology to provide care and services across locations. The Pittsburgh-based company provides EHR software and predictive, actionable analytics for medical specialties, including rehab therapy, wound care, home health and hospice agencies, and employee health. Its solutions are trusted by 23,000 facilities, including the nation’s leading hospitals, skilled nursing facilities, senior living facilities, home health and hospice agencies, and outpatient clinics. Thanks to Net Health for supporting HIStalk.

I found this Net Health explainer video on YouTube.

Webinars

April 6 (Wednesday) 1 ET. “19 Massive Best Practices We’ve Learned from 4 Million Telehealth Visits.” Sponsor: Mend. Presenter: Matt McBride, MBA, founder, president, and CEO, Mend. Virtual visits have graduated from a quickly implemented technical novelty to a key healthcare strategy. The challenge now is to define how telehealth can work seamlessly with in-person visits. This webinar will address patient satisfaction, reducing no-show rates to single digits, and using technology to make telehealth easy to use and accessible for all patients. The presenter will share best practices that have been gleaned from millions of telehealth visits and how they have been incorporated into a leading telemedicine and AI-powered patient engagement platform.

On demand: “Cybersecurity Threats Facing Healthcare Today.” Sponsor: Net Health. Presenters: Jason James, MS, CIO, Net Health; Monique Hart, MBA, CISO, Piedmont Healthcare; Jeffrey Rosenthal, , MBA CIO, Reliant Rehabilitation; David Jollow, MBA, CISO, Healogics. The panel of CIO and CISO leaders will discuss the cyberthreats that healthcare faces today. They will review security priorities for the increasingly complex healthcare IT environment that includes cloud-based applications, an increased number of endpoints that include connected devices and patient wearables, and patient portals.

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

Acquisitions, Funding, Business, and Stock

Tegria makes an unspecified “major” investment in England-based digital health consulting firm Cloud21, whose customers include several NHS hospitals.

Sales

• OmniLife chooses Redox for EHR integration of its newly developed referral and status update modules to its transplant center platform.

People

Canada-based Quinte Health Care hires Gina Johar (Brockville General Hospital) to the newly created position of VP / chief digital officer.

Paige Lisk, MBA (DrFirst) joins Verato in the newly created role of chief people officer.

Huron CEO Jim Roth will resign at the end of the year, replaced by President and COO Mark Hussey, MBA. The healthcare segment of the publicly traded management consulting firm generates 42% of its revenue.

Announcements and Implementations

Google recaps some of its health AI developments and projects in its “The Check Up” event that features Chief Health Officer Karen DeSalvo, MD, MPH, MSc.

• Smartphone screening for diabetic retinopathy.
• Using a smart phone’s microphones to record heart sounds as a basic stethoscope.
• Applying AI to pregnancy ultrasound.
• Upcoming: Google Search will show provider appointment availability and allow booking a visit, starting with CVS MinuteClinic.

The VA launches its second site on Cerner as Walla Walla Health Care goes live.

Other

John Roach, who in the late 1970s turned Tandy-owned Radio Shack – mostly known for selling weird electronic parts and CB radios — into a pioneer of the home computer market as the company’s chairman and CEO, died last week at 83. The home computer industry was arguably born in 1977 with the introduction of the Radio Shack TRS-80 (the TRS stands for Tandy Radio Shack, but the system was widely panned as the “Trash 80”), the Apple II, the Commodore PET, and Digital Research’s CP/M operating system that paved the way for Microsoft’s MS-DOS and 1981’s IBM PC.

A former Vanderbilt University Medical Center nurse is found guilty of criminally negligent homicide for killing a patient by administering the wrong medication. RaDonda Vaught ignored several drug dispensing cabinet warnings and failed to perform basic medication checks in administering the paralyzing drug vecuronium to a 75-year-old patient instead of the ordered sedative Versed before an imaging procedure. A nurse colleague who worked in the same neuro ICU unit said that VUMC’s Epic conversion had caused delays in updating the drug dispensing cabinet information, forcing hospital administration to tell nurses to perform system overrides to obtain patient meds. The imaging area did not have a barcode scanner to verify the drug chosen. A nurse advocate says that medication errors are common and can be made by anyone, adding that a jury of Vaught’s peers would have been ICU nurses. Experts question whether VUMC’s systems and processes were at least partly to blame and ponder the potentially negative impact on error reporting of holding medical professionals criminally responsible for making mistakes. VUMC was not penalized even though it did not report the error as required by law and paid a settlement to the patient’s family that barred them from commenting public on the incident, which was revealed months later in an anonymous tip to CMS. VUMC also told the medical examiner that the patient died of natural causes.

Saint Francis Hospital (CT) stages a “clap out” for the departing team of 20 US Air Force personnel who completed a 30-day FEMA assignment to help with the COVID-19 surge. The hospital offered a similar welcome when the service members arrived in February.

Sponsor Updates

• OptimizeRx will present during the virtual RWE Symposium April 11-12.
• Olive teams up with Akava through its Deploy Partnership Program to accelerate the delivery of cybernetic solutions to the healthcare market.
• PatientBond helps national PBM WellDyne boost member engagement to achieve increases in text message engagement, actions taken on text-based refill reminders, and medication adherence.
• Pivot Point Consulting publishes a new case study highlighting how long-time customer Indiana Hemophilia & Thrombosis Center has found strategic and operational value in interim CIO services.
• PerfectServe accelerates speed to care with faster delivery of critical lab results.
• Curation Health Chief Medical Officer Matt Lambert, MD writes a Physicians Practice article titled “No doctor is an island.”
• Spok has reduced the size of its board to six members to better align its size and composition with the company’s recently announced business strategy.
• Talkdesk introduces new mobile apps to its On-the-Go suite of contact center solutions.

Blog Posts

• 5 Tips to Increase Patient Engagement Through Personalization (PatientBond)
• Quality Measurement 101: Risk Adjustment Isn’t Risky Business (Premier)
• Preventive Compliance Monitoring: Why It Matters (Protenus)
• Key Takeaways from Rise National 2022 (RCxRules)
• Evolving Prescribing Practices and Payer Coverage Throughout the COVID-19 Pandemic (RxRevu)
• Addressing the Burnout Challenge in Healthcare (About Healthcare)
• 4 ways interactive technology can help anxious parents (Sonifi Health)
• Affordable Medication and Adherence: Two Sides of the Same Coin (Surescripts)
• 3 key takeaways from ViVE 2022 (Talkdesk)
• HIMSS22: Connection, Equity, and The Patient Experience (TigerConnect)
• Healthcare Workplace Violence. Staffing Pressures. We Have Solutions. (Vocera)
• How to Tell if a Clinical Case Study is Bogus (WebPT)
• Like Everyone Else, Seniors are Texting (Well Health)
• One Year into Hybrid Work, the Digital and Talent Imperatives are Clear (West Monroe)
• SNOMED CT: Why It Matters to You (Wolters Kluwer Health)

Contacts

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