Monday Morning Update 11/27/23

Top News

The Department of Defense completes the last of 23 MHS Genesis go-live waves.

The military’s final Oracle Health implementation is scheduled for March 2024 at Lovell Federal Health Care Center, which it jointly operates with the VA.

DoD says that its teams are anxious to move on to optimization and applying analytics at the site and enterprise levels.

HIStalk Announcements and Requests

Poll respondents aren’t optimistic that any of the usual suspects can disrupt healthcare, but they choose retailers as the best hope. I’m intrigued that they chose employers as the least likely given that they are footing much of the bill and have the only significant amount of clout, which they never seem to use.

New poll to your right or here: What is your single biggest frustration with your primary care provider? I’m allowing only one answer to hide the noise of problems that aren’t the main one.

Webinars

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

Acquisitions, Funding, Business, and Stock

London-based Phare Health, which offers medical coding tools, raises $3.1 million in a seed funding round.

Sales

• Memorial Hermann Health System will implement Laudio’s worklfow automation tool for frontline leaders and has invested in the company.

Announcements and Implementations

Researchers develop a wireless acousto-mechanical system whose wearable sensors continuously transmit data about body movement sounds such as breathing, digestion, and cardiac activity.

London-based digital-first home healthcare provider Cera says it will provide 5 million care visits this winter to help address hospital capacity problems. Founder and CEO Ben Maruthappu, BM BCh. MPH was trained at London School of Hygeine and Tropical Medicine, University of Cambridge, Harvard, and University of Oxford.

A health official in China touts the country’s digital health success, listing online diagnosis and treatment, prescription services, fever clinic information, and hospital wait time.

A16z lists the jobs that AI could perform to reduce provider burnout and increase effectiveness, which it says should be supported by CMS in the form of increased payment for AI-assisted or augmented care (click the image to enlarge).

Privacy and Security

Saint Joseph’s Medical Center (NY) pays $80,000 to settle HHS OCR charges that it provided photos and information of three patients in April 2020 to the Associated Press for a COVID-19 story without their approval.

A notice filed by Virgin Pulse-owned Welltok says that the personal information of 8.5 million people was exposed in a breach of its Moveit file transfer system. Affected customers include BCBS plans, Sutter Health, Stanford Health Care, and The Guthrie Clinic. Virgin Pulse acquired the company in November 2021.

Other

Politico notes that a physician shortage will force the federal government to stitch together a primary care system that is delivered by nurses, physician assistants, and virtual visits, with no promise that people can get, much less keep, a regular doctor. Long appointment waits are sending sick people to the ED, urgent care, or pharmacy-located clinic where services are purely transactional with no promise of prevention or taking the patient’s personal or even medical history into account.

Cigna creates public outcry when it denies transplant coverage to a 47-year-old woman who was being prepped for a double lung transplant after being rushed to Vanderbilt University Medical Center when a matching donor had been found. VUMC sent her home and took her off the transplant waitlist. Cigna had previously approved the procedure, but found that the woman had the unapproved condition of terminal cancer. As is often the case, the insurer paid more attention to the bad press than to the patient and doctors in reversing its decision that it declared to have been an “error.” The patient now requires additional tests, the donor lungs are no longer available, and her only hope is to be placed back on the waitlist. Cigna got the black eye, while VUMC has drawn no public ire for declining to perform the transplant in the absence of Cigna’s willingness to pay.

Sponsor Updates

• Health Data Movers appoints Curtis Cole, MD (Cornell University) to its board.
• Through partnerships with Redox and Xealth, Tidepool develops EHR integrations for its diabetes data visualization software.
• Five9 will present at the UBS Global Technology Conference November 29 in Phoenix and the Barclays Global Technology Conference December 7 in San Francisco.
• Fortified Health Security names Kameron McNicholas senior SOC engineer.
• Health Data Movers names Curtis Cole (Cornell University) to its Board of Directors.
• Healthcare IT Leaders releases a new Leader to Leader Podcast, “Leading Through Growth and Change.”
• Inovalon develops Converged Analytics Benchmarking to provide health plans with monthly determinations of their relevant national and state benchmarking for quality measurement and improvement initiatives.
• InterSystems launches its HealthShare Health Connect Cloud solution in New Zealand.
• A recently published study on brain health, “Using digital assessment technology to detect neuropsychological problems in primary care settings,” features Linus Health’s Core Cognitive Evaluation digital assessment technology.
• Nordic names Claire Staple VP of strategy and country manager in Ireland.

Blog Posts

• ECW – Your AI-powered EHR (EClinicalWorks)
• Tech-Enabled Health Equity: Bridging Language Barriers in Health Education (Healthwise)
• Prevention is Key: How AI-driven Early Detection Can Enhance Population Health Outcomes (Lucem Health)
• The Hidden Recipe for Successful EHR Implementation (Medhost)
• Expanse Genomics: How we’re extending our industry-leading solution (Meditech)
• New Policy Changing the Mental Health Landscape: Better Mental Health Care, Lower-Cost Drugs, and Extenders Act (NeuroFlow)
• How NTT Data & Carpl.ai are revolutionizing medical imaging (NTT Data)
• DSN: Healing the Healthcare System (OmniSys)
• How Patient Journey Mapping Improves the Patient Experience (PerfectServe)
• Optimizing Workflows: 8 Benefits for Faster and Easier Credentialing (QGenda)
• California says goodbye to fax machines. Hello to DxF. (Redox)
• 6 Reasons Your Risk Reporting System is Failing You (Symplr)

Contacts

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

Morning Headlines 11/23/23

Tri-City Medical Center resumes nearly full operations after cybersecurity attack

Tri-City Medical Center (CA) resumes normal operations after a ransomware attack November 9 forced it to downtime procedures.

Company operating Nacogdoches Memorial Hospital files for bankruptcy

In Texas, Nacogdoches Memorial Hospital operating company Lion Star files for bankruptcy with debts of $10 million to $50 million owed to between 200 and 1,000 vendors, including $1 million owed to an EHR vendor.

Queensland Health fixes ieMR system crash after staff unable to login for hours

Queensland Health resolves an EHR log-in issue that had prevented users at its 24 facilities from accessing the Oracle Health system for several hours.

Morning Headlines 11/22/23

Patient privacy fears as US spy tech firm Palantir wins £330m NHS contract

NHS England awards a consortium that includes Palantir and Accenture a five-year, $415 million contract to develop and operate the Federated Data Platform data-sharing platform across NHS trusts and care sites.

TCS Q3 to take $125 million hit on Epic Systems Corporation legal woes

Tata Consultancy Services will pay $140 million in punitive damages to Epic related to a 2014 case in which Epic accused TCS of downloading confidential material from UserWeb by having its employees pretend to be Epic customer consultants.

McWilliams School of Biomedical Informatics researchers awarded $31M in grants for medical artificial intelligence innovation research

Fifteen faculty members of UTHealth’s bioinformatics school are awarded $31 million in grants, $19 million of which came from NIH’s National Institute on Aging.

News 11/22/23

Top News

NHS England awards a consortium that includes Palantir and Accenture a five-year, $415 million contract to develop and operate the Federated Data Platform data-sharing platform across NHS trusts and care sites.

Medical groups and other watchdogs immediately expressed concern that a US firm that is best known for providing military and espionage software to the CIA and foreign governments will be handling sensitive patient information. They also noted that founder and chair Peter Thiel in on record as declaring that NHS “makes people sick” and should be privatized. He has also stated that NHS support by Britons is a form of “Stockholm syndrome.”

The contract, which follows extensive government lobbying by Palantir, does not include Scotland or Wales.

PLTR shares dropped on the news, valuing the company at $43 billion.

Reader Comments

From Ossifier: “Re: Forward Health’s CarePods. Maybe when they fail in the US and the company pivots once again, they can offload their unused pods to the French government.” France’s national railway will install appointment-only Loxamed telemedicine setups in 300 train stations that are located in medical deserts by 2028, which will feature on-site nurses who use connected medical equipment and sessions with virtual physicians, with services are billed to the national social security system. France’s physician union has objected strongly to the plan, saying that “There can be no good medicine that comes from the touch of a button, at a distance, from a doctor who does not know the patient.” Loxamed was formed in March 2020 by an equipment rental company to offer COVID-19 diagnosis and eventually vaccination. My take is that people could initiate their own telemedicine visits from home, so the advantage of this plan is the ability to be evaluated by an in-person nurse who can take vital signs and perform assessment before the remote physician takes over.

Webinars

December 7 (Thursday) 2 ET. “Waystar + Epic Workflow 101: How to Maximize your Epic Investment.” Sponsor: Waystar. Presenters: Christine Fontaine, solution strategist, Waystar; Lori Anderson, channel partner director, Waystar; Ashley Rose, associate director of client consulting, Waystar. Many users are curious about enhancing their Epic environments, but how do you know which features your organization needs? During this session, you will be provided a proven process to help you evaluate Epic-related decisions, tangible examples of need versus want criteria, and concrete steps to extract full value from Epic workflows and environment.

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

Acquisitions, Funding, Business, and Stock

AstraZeneca launches Evinova, a separate business that will further scale digital health solutions that are already used by the pharmaceutical company; and develop and market digital products in the areas of clinical trials, remote patient monitoring, and therapeutics.

UpHealth will sell Cloudbreak Health and its Martti telehealth language interpretation services to private equity firm GTCR for $180 million. UpHealth is in the process of selling off or winding down certain service lines, with its focus now on its behavioral health business in Florida. Several UpHealth subsidiaries filed for Chapter 11 bankruptcy protection in September.

Novant Health (NC) will buy three South Carolina-based hospitals from Tenet Healthcare in a $2.4 billion deal that includes RCM services from Tenet subsidiary Conifer Health Solutions.

App-based chronic care company Vida Health raises $28.5 million, bringing its total raised to $216 million.

Clinical notes analysis startup Layer Health raises $4 million in seed funding. Its debut product, Distill, helps clinicians find and submit data to clinical registries. The company’s five co-founders all have MIT-related backgrounds in AI, machine learning, and computer science.

Likely sensing a vacuum since the departure of Cerner for greener Oracle pastures, non-profit Digital Health KC hopes to help launch or lure 20 digital health companies to the Kansas City area using $4 million in grants.

Sales

• NYU Langone signs a $115 million contract with Philips for enterprise informatics, pathology, AI-powered diagnostic imaging, and patient information technologies; as well as its Capsule Medical Device Information Platform.
• Oregon Health & Science University will implement Visage Imaging’s Visage 7 enterprise imaging software.
• McAlester Regional Health Center (OK) selects Smart Analytics from Sixth Sense Intelligence.
• Children’s National Hospital in Washington, DC will use IT infrastructure services and technology from Kyndryl.
• The Florida Department of Children and Families will implement Juno Health’s behavioral health EHR at Florida State Hospital.
• Teladoc Health will open a virtual ED in a rural, remote part of Canada’s Newfoundland Labrador Health Services under a two-year, $16 million contract in which the patient will first see an in-person clinician, then be diagnosed and treated virtually.

People

Joe Murad (WithMe Health) joins Vida Health as CEO.

Announcements and Implementations

Washington County Hospital and Clinics in Iowa goes live on Epic.

Fifteen faculty members of UTHealth’s bioinformatics school are awarded $31 million in grants. $19 million of which came from NIH’s National Institute on Aging.

Lincata launches an in-room hospital entertainment system that features patient engagement and health system marketing opportunities. The company’s executive board chair is industry long-timer Tom White, MBA, who is best known as co-founder and CEO of Phynd until the company was acquired by Symplr.

Government and Politics

Tata Consultancy Services will pay $140 million in punitive damages to Epic related to a 2014 case in which Epic accused TCS of downloading confidential material from UserWeb by having its employees pretend to be Epic customer consultants. The original award of $940 million has been reduced several times in court reviews. The US Supreme Court rejected TCS’s appeal of punitive damages on Monday, where the company argued that it had already paid $140 million in compensatory damages from the original award.

HHS OIG warns consumers that scammers are cold calling Medicare enrollees to obtain their Medicare ID, after which they are signed them up for phony remote patient monitoring services that are billed monthly from pharmacies or durable medical equipment companies.

Other

The South Eastern Health and Social Care Trust in Northern Ireland celebrates the birth of the first baby born with an Encompass digital health record. The trust went live on Epic November 9. The system will be rolled out to remaining trusts over the next 18 to 24 months.

An AvaSure study of virtual patient sitting technology versus in-person sitting at Providence finds that virtual sitting is correlated to lower levels of burnout.

KFF’s Bill of the Month involves a woman’s first prenatal checkup, during which the nurse suggested having the standard panel of blood tests drawn at an office down the hall for convenience. The office belongs to a hospital that is run by religious non-profits Texas Health Resources and AdventHealth, whose lab billed her insurance at hospital rates for $9,500. Anthem BCBS negotiated the price to $6,700 and paid $4,300, leaving the patient to owe $2,400 for standard blood chemistry and STI tests. The average price of a CBC in Texas is $6 in an independent lab and $58 in a hospital, while the hospital in this case billed her insurance $207. She spent 10 months trying to ask questions, during which the hospital sent her bill to collections and ignored complaints that she had filed with the state’s attorney general. The hospital responded only when KFF started asking questions for its story, after which it cancelled all charges that, as it turn out, had been incorrectly submitted as diagnostic rather than preventive, which BCBS would have covered even at the inflated prices. Experts contacted by KFF questioned how well insurers negotiate hospital contract prices.

Sponsor Updates

• Baker Tilly publishes a new case study, “Healthcare organization tests technical security controls and internal security awareness training with phishing campaign.”
• Bamboo Health adds discharge summaries to its Pings real-time care notifications platform.
• Prisma Health integrates Artera’s patient communications platform with Gozio Health’s location-aware mobile engagement platform.  
• The Northern Virginia Technology Council recognizes DrFirst as a top technology company for the fourth year in a row.

Blog Posts

• How a Growth Mindset Can Drive Automation Success in Healthcare (Vyne Medical)
• The Journey to True Autonomous Coding (AGS Health)
• How the data lakehouse will revolutionize healthcare (Arcadia)

Contacts

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

Morning Headlines 11/21/23

Medmo Raises $9M in Funding

Medical imaging technology company Medmo, which matches patients with partner imaging centers, raises $9 million.

Reed Jobs’ Yosemite makes first digital health bet on Maia Oncology

Maia Oncology, a virtual primary care clinic for cancer patients, raises $4.25 million in seed funding.

AstraZeneca launches Evinova, a health-tech business to accelerate innovation across the life sciences sector, the delivery of clinical trials and better health outcomes

AstraZeneca’s new stand-alone Evinova business will develop and market digital products in the areas of clinical trials, remote patient monitoring, and digital therapeutics.

Curbside Consult with Dr. Jayne 11/20/23

The Centers for Disease Control and Prevention (CDC) has launched an initiative to tackle burnout in healthcare. The Impact Wellbeing initiative falls under the auspices of the National Institute for Occupational Safety and Health (NIOSH). According to the tagline on its website, it’s designed for “building a system where healthcare workers thrive.” It will provide “evidence-informed solutions” and resources to hospital leaders on avoiding burnout and promoting wellbeing for workers.

I was pleased to see that the website encourages hospitals to use materials from the Dr. Lorna Breen Heroes’ Foundation to address how hospitals can help staff address mental health needs without being penalized. Many hospitals and healthcare organizations still have questions on their employment and credentialing applications that stigmatize mental health conditions rather than supporting those that live with them.

As an example, one job for which I applied asked, “Have you ever been treated for a mental health condition?” with boxes to check yes or no, but no way to provide explanatory information. A better way to approach this is to ask whether the applicant has any current impairment that will prevent them from performing the duties of the position. There are plenty of mental health conditions that are episodic, and asking about past conditions that may be resolved hasn’t been shown to do anything but prevent people from honestly answering the questions.

In looking at some of the other materials on the site, as well as interviews with NIOSH staff that appeared in the media at the time of the announcement, it feels like the organization’s leadership understands that talking about resiliency or offering wellness programs doesn’t scratch the surface where employee mistreatment is concerned. Healthcare workers encounter bullying, harassment, and moral injury on a daily basis and those elements need to be addressed as part of an overall solution.

The initiative also encourages the leadership of healthcare delivery organizations to involve those affected in the process of defining the issues and solving them. I don’t know when it became a revolutionary idea to talk to people in order to understand their needs, but I’m happy to see recognition of the idea featuring prominently in the campaign. Organizers can use the NIOSH Worker Well-Bring Questionnaire to better understand where their workers are across domains that include policies, culture, environment, personal health, and home/community factors.

Although I appreciate that the focus of the campaign is on hospitals since they’re such a critical part of our healthcare infrastructure, I’d like to see these elements addressed in other care delivery sites, such as urgent care centers. There are 14,000 urgent care centers in the US, and according to data provided by the Urgent Care Association, more than 25% of adults visited an urgent care center in the last year.

Unfortunately, the level of regulation for those facilities varies from state to state, and in talking to physician colleagues, abuses are becoming more common as private equity companies expand in the industry. For a while, we saw a lot of emergency department physicians leave those environments to go to the relatively slower pace of urgent care. However, as the complexity of patients presenting to urgent care rises, and the number of patients physicians are expected to see each hour increases, we’re seeing physicians leave those environments as well.

Given the reliance by hospitals on nurses to deliver patient care, there’s a lot of push by nursing organizations to improve things. Since urgent cares use many more non-nurse caregivers — such as medical assistants, emergency medical technicians, and unlicensed patient care technicians — to deliver care at a lower cost, there aren’t many advocacy organizations looking out for those workers.

Quite a few urgent care centers are physician owned and operate more under a private practice model than an emergency care model, so that adds another element to the problem. In my area, a local multi-site urgent care center recently closed after the physician owner was arrested, leaving staff and patients in the lurch. Other organizations have struggled to absorb those visit volumes in the face of their own staffing shortages, and it’s been a bit of a mess.

Meanwhile, capable physicians sit on the sidelines because they’re not willing to go back to abusive environments. At my former clinical employer, nearly all the physician employees left when the private equity company that acquired it started tightening the screws to squeeze out more profit. I know at least six of us who would return from our early retirements if the working conditions were less atrocious.

In speaking with colleagues across the country, this experience is in no way unique. One local urgent care chain classifies its physicians as hourly employees, but pays a “shift rate” that requires them to stay until all patients have left without additional pay for the additional time. I’m not sure how that’s legal under state labor laws, but they’ve gotten away with it for a number of years. On the other hand, it might be one explanation for why they have locations that are mothballed because they can’t staff them.

I admit I didn’t read every single word on the CDC website for the program and didn’t follow every link, but I didn’t see any mention of how organizations need to do more to believe workers when they complain or how to take action when issues are reported. There is still a culture at many organizations of just saying “it is what it is” or “suck it up” when employees report exploitive practices. People are suffering from compassion fatigue, which can lead to lack of empathy and may contribute to workplace bullying if left unchecked.

At one local hospital, nurses scheduled for 12-hour overnight shifts routinely have to stay for 14 or 15 hours due to staffing issues. I guarantee that situation is not doing much for morale or burnout prevention. Even among healthcare workers, I hear comments like “you chose healthcare, what did you expect?” which doesn’t help solve the issue. I have a handful of non-medical friends who understand what we go through, but when medical folks can’t even support each other, how can we expect outsiders to understand what we’re going through?

It will be interesting to follow the progress of the initiative over time and to see how many organizations are using the tools and trying to drive positive change vs. just paying lip service to the idea.

If you’re a care delivery organization leader, had you heard of the initiative before today? What steps are you taking to drive change? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 11/20/23

Over 80 St. Louis NextGen Healthcare workers to be laid off

NextGen Healthcare files WARN documents indicating that it will lay off 84 employees in St.Louis in the first months of next year.

Novant Health to acquire three hospitals from Tenet Healthcare

Novant Health (NC) will acquire three South Carolina-based hospitals from Tenet Healthcare in a $2.4 billion deal that includes RCM services from Tenet subsidiary Conifer Health Solutions.

Aya Healthcare Acquires Winnow AI, a Data Science Driven Platform to Recruit Passive Physicians

Digital staffing platform vendor Aya Healthcare acquires Winnow AI, which identifies physicians who are open to new positions and relocation who match open roles.

GTCR to Acquire Cloudbreak Health

Private equity firm GTCR will acquire telehealth language interpretation services company Cloudbreak Health from UpHealth for $180 million.

Monday Morning Update 11/20/23

Top News

NextGen Healthcare files WARN documents indicating that it will lay off 84 employees it St.Louis in the first months of next year.

Meanwhile, executives who are cashing in on the November 10 sale of the company to private equity firm Thoma Bravo by selling shares include President and CEO David Sides ($15 million), CFO James Arnold ($12 million), and board member Srinivas Velamoor ($9 million).

Reader Comments

From AnInteropGuy: “Re: Veradigm. Continues to miss their filing deadlines and met with NASDAQ about the delisting situation — no news on how they will rule — but they have not been able to restate any of the questioned quarters. Leadership continues to say ‘very close’ but the remains substantially quiet on what the timeline looks like. Their last claim in September was that they would file by early November ahead of the NASDAQ meeting. That was before the announcement of the delisting notice so they had been made aware that they were facing delisting. They are still trying to gather contracts, payments, etc for the previous quarters and years — now apparently reaching all the way back to 2015.” A final SEC de-listing hearing was held on Thursday, but the decision hasn’t been announced. I don’t know the extent of accounting work that is required, but it seems strange that a publicly traded company whose shares are about to be de-listed can’t muster the resources, as other firms have done, to meet ASC 606 revenue recognition requirements. As a skeptic, I wonder if other motivations may be in play.

From Epson: “Re: Forward Health’s CarePod. I’m interested in predictions.” OK, here’s mine: (a) the company will deploy less than 250 devices versus its 3,200 goal; (b) issues with maintenance, limitations of the clinical model it was developed around, and lack of member loyalty will stall rollouts and raise questions about the viability of that business; and (c) Forward will try yet another pivot and the CarePods will move from malls to landfills given that no other company would have a use for them. I could be wrong, but Forward Health’s core business doesn’t seem to be sound enough to warrant gadgetary distraction, not to mention that as an N-of-one analysis I can’t see myself paying for such a service as described.

HIStalk Announcements and Requests

Poll respondents report seeing diminished influence across many of the newly established C-level technology roles within healthcare systems. What’s your experience with these positions being eliminated or downgraded? A LinkedIn wizard could probably find examples.

New poll to your right or here: Who is most likely to disrupt the US healthcare system to benefit patients?

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4. Share news, rumors, and intriguing insights.
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Also, for companies that have 2023 marketing funds to spend, we can bill you now and you can send your ad and materials later when you are ready. You get a full 365 days of sponsorship starting when your ad is posted. I’m mentioning this because Lorre has received the question several times this week.

Webinars

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

Acquisitions, Funding, Business, and Stock

Digital staffing platform vendor Aya Healthcare acquires Winnow AI, which identifies physicians who are open to new positions and relocation who match open roles.

Mass General Hospital and Brigham and Women’s announce that they cannot accept new primary care patients because their appointment waitlists are months long.

Children’s Hospital of Philadelphia, Stanford Health Care, and Children’s Medical Center of Dallas implement Wolters Kluwer’s Ovid Synthesis for evidence-based practice workflow applications.

Open AI’s board fires high-profile co-founder and CEO Sam Altman for unspecified reasons in a surprise announcement that wasn’t shared in advance with investors such as Microsoft, which owns 49% of the company. The rumored issue was product safety versus profit and Altman’s work to raise funds to create AI hardware companies outside of OpenAI’s non-profit oversight. Greg Brockman, co-founder, president, and board chair, was removed from the company’s board and then resigned. Several senior scientists also quit. The blowback has reportedly convinced the board to negotiate for Altman’s return, although he says he’s not that interested and would require significant governance changes to return. Meanwhile, the action that has likely cost Open AI much of its $80 billion valuation and the confidence of developers who use its products has also resulted in speculation that Altman and the other departed executives will immediately start a competing company, along with speculation that Microsoft should save OpenAI by buying the rest of it.

People

Lynsi Garvin, MSN, RN (Google Health) joins Intermountain Health as associate chief clinical information officer.

Adrienne Morrell (SCAN Health Plan) joins MRO Corp. as VP of governmental affairs.

Announcements and Implementations

Oracle will hold a one-day health summit on February 13 in Nashville, where the company is significantly expanding.

A new report from Center for Connected Medicine at UPMC finds that the patient engagement potential of health system-owned ambulatory pharmacies is being threatened by drug chains and technology firms that offer more convenient and innovative services and digital tools. Top operational challenges are 340B limitations and staffing issues, while the biggest consumer issue is lack of physical accessibility due to location, lack of transportation, and limited hours of operation. Top tools include delivery service and text-based refill reminders, while telepharmacy kiosks and self-pickup lockers have low interest.

Government and Politics

Memorial Hermann Health System and Texas Attorney General Ken Paxton settle the AG’s investigation into reports that its patient portal could not be accessed by the parents of patients aged 13 to 17. Texas law gives parents and legal guardians the right to access the medical records of their children except in specific circumstances where the child can indicate that they don’t want their information shared. The health system agreed to provide better instructions for accessing family records on its patient portal and also cited its planned migration to Epic.

Other

Federal Trade Commission Chair Lina Khan, JD says that she has used ChatGPT to contest questionable medical bills. She didn’t say how she used it specifically, but ChatGPT suggests that it can provided detailed breakdown of charges, explain how insurance applies, identify discrepancies, offer negotiation tips, and draft appeal letters.

The Madison paper covers Nurse Disrupted, which offers a virtual nursing platform. The founder and CEO of the eight-employee company is Bre Loughlin, MS, RN, a former bedside nurse and Epic executive.

Sponsor Updates

• Vyne Medical publishes a case study titled “Cloud Fax Reduces IT Burden for Large Health System.”
• Mobile Heartbeat publishes a new customer success story featuring Henry Mayo Newhall Hospital.
• Lucem Health will incorporate AccurKardia’s ECG interpretation software into its Reveal solution to identify high-risk patients.
• NTT Data publishes a new report, “Innovation Index: How North American Organizations are Achieving Growth, Value, and High Performance.”
• Nordic releases a new Designing for Health Podcast, “Interview with Margaret Lozovatsky, MD.”
• PerfectServe congratulates customers Elmhurst Hospital, Beverly Hospital, and UNC Health Rex on receiving 24 consecutive “A” grades for safety from The Leapfrog Group.
• SmartSense by Digi’s second annual Live23 user conference sees a 300% increase in attendance year over year.

Blog Posts

• Overcoming 3 top workforce challenges driving RN turnover (Inovalon)
• Caring for the Caretakers: An Interview with Medhost SVP of Human Resources, Carla Stephenson (Medhost)
• Using Automation to Improve Payer Collaboration: On Air Insights (MRO)
• Intelligent patient experiences, part 4: How effectively can your clinicians manage patient care? (Nuance)
• How to Improve Compliance Processes in RCM with Transparent Medical Coding Automation (Nym Health)
• Beyond Gratitude: Ozark Center’s Transformative Impact on Veterans’ Lives (Netsmart)
• Empower with ServiceNow Knowledge (Optimum Healthcare IT)
• Empowering Community Health and Revenue Growth: The Test and Treat Advantage for Pharmacies (OmniSys)
• Six reasons to consider cloud migration (Rhapsody)
• Biosimilars are Changing the Game (Surescripts)
• The Evolution of the CMIO Role in Hospitals & Health Systems (Symplr)
• Finding a Way: The ABC Act’s Aim for Easier Access to Caregiving Resources (Trualta)
• Don’t Miss the Opportunity: G2211 Primary Care Add On Payment in 2024 (VisiQuate)
• From Exhaustion to Empowerment: How to Alleviate Patient Burnout in Healthcare (Vyne Medical)
• Ensure Successful Service Desk Partnerships with Preparation (CereCore)

Contacts

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

Morning Headlines 11/17/23

VA still has ‘significant concerns’ as Oracle works to get EHR modernization back on track

VA CIO Kurt DelBene tells a House committee that despite improvements, he has “significant concerns” about Oracle Health related to new incidents, failing to meet standards, end user responsiveness, and workflow.

AAPC Expands Its Technology Solutions Portfolio with the Acquisition of Semantic Health

RCM organization AAPC acquires Semantic Health, a Toronto-based startup specializing in AI-powered coding and auditing software.

3M Healthcare Spinoff Gets a Name: Solventum

The healthcare business that 3M will spin off in the first half of 2024 will be named Solventum.

News 11/17/23

Top News

VA CIO Kurt DelBene tells a House committee that despite improvements, he has “significant concerns” about Oracle Health related to new incidents, failing to meet standards, end user responsiveness, and workflow.

On the positive side, the VA has had no complete system outages in six months.

Also from the hearing:

• Rep. Matt Rosendale (R-MT) cited a KLAS survey of VA employees in which only 26% said the EHR is available when they need it, leading him to question whether the VA’s help desk makes it too hard for employees to report problems.
• Deputy CIO Laura Prietula, MS, EdD  blamed VA-approved customization of the base Oracle Health platform for its implementation struggle compared to the private sector. She added that the VA is now trying to reverse that customization and go back to out-of-the-box functionality.
• Rosendale cited a report saying that it will take Oracle Health 15 more years to match VistA’s functionality. Prietula responded that she doesn’t think it will take that long.
• Rosendale says that Oracle “hold themselves out as the experts in this field” but the VA’s VistA has 99.9% uptime and “it’s baffling that anyone could pay billions of dollars and set a lower standard.”
• Rosendale noted that the committee invited Oracle EVP Mike Sicilia to attend the hearing, but he didn’t attend or send an alternate.

Reader Comments

From Chip Ludd: “Re: CarePod. Serious Silicon Valley Kool-Aid is being slurped by anyone who thinks this will work.” The likelihood of success for this clinician-less health app kiosk in malls has two dimensions – whether it’s a viable business (which I doubt) or if it’s a medical breakthrough (which I’m sure isn’t the case). My reactions:

• HealthSpot went bankrupt in early 2016 after failing to gain traction for a similar offering even after installing its gadgets at the facilities of its partners Cleveland Clinic and Rite Aid. Higi offers a national network of free Smart Health Stations, but it was acquired for nearly nothing in early 2022 by Babylon Health, whose share price is also approaching near-nothingness. And everybody remembers the endlessly hyped but modestly featured Scanadu Scout tricorder-like device, whose 2017 shutdown after an 18-month study led some to call it Scamadu.
• Memberships cost $99 per month, and don’t include in-person clinic access. Insurance is not accepted.
• Customers still have to drive to a physical location, although finding a parking space at a dying mall shouldn’t be a problem.
• I would be hesitant about having my orifices penetrated by a machine that has a single, non-licensed attendant who will probably be so bored between breakdowns and reboots that they’ll hang out at Cinnabon.
• I assume that the company will need to navigate a regulatory maze in performing scans and blood draws using self-developed equipment that operates without clinician oversight.
• The company is investor-hungry, so it adds the obligatory AI connection – the box will perform AI searches of medical literature and generate a care plan that clinicians review. I’m not sure most of primary and preventive care requires real-time literature review.
• The gadget is a pivot for the company, whose core business is running a few clinic locations that they like to compare Apple Stores.
• The functions the technology can assess are limited compared to what a skilled human can perform in a real examination. Only so many sensors and algorithms are available and approved.
• The target audience seems to be young, worried well people who prefer faceless machines and tons of prevention-focused data or congratulatory test results to interacting with a clinician. That actually is a pretty good business model. Reviews for the company’s in-person clinics are almost all from customers in their 20s and early 30s.
• Forward attracted a fresh $100 million from investors, but this is an entirely different, capital intensive, and less-certain business mode than its actual operating business of running clinics.
• From a societal health perspective, convincing people that running app tests in a mall is equal or better to seeing an actual clinician is not a positive accomplishment, nor is a system that cares so little about consumerism and preventive health that people flee to the healthcare equivalent of a photo booth in front of a defunct Sears.

Also interesting is that the company’s clinics have mediocre reviews from their $149-per-month members, with comments like these making you wonder if investors are watching the company’s member retention rate (independent PCPs, especially direct primary care docs, everything you need for your marketing plan is right here):

• There’s no way to talk to a real human being on the phone, it’s all done through chat, and often the people I were chatting with didn’t understand the issue I was trying to explain to them. Wait times to see a doctor are horrendous, usually longer than 2 weeks. The app that they offer is mediocre and is much worse than record keeping systems used by other medical providers.
• Slow followup on things like bloodwork and other tests. Billing issues. Inconsistencies on providers & quality of care/advice. 10 out of 10 do not recommend.
• Tone def. Limited communication channels – no one available on phone. Virtual experience – not in person. They define your health priorities and disregard the health priorities that are important to you. They do not solicit your medical records – they rely on the patient to share that information. Not data backed guidance. The app is not intuitive – very poor user experience
• At my 1 year checkup recently, all that happened was collection of lab blood by staff and a report on my app without any guidance from my doctor. Fortunately, things are going well for me, but I would like to keep that going. I am looking for more of a partner in healthcare instead of a monitor.
• Initially had potential yet with physician turnover, outsourced labor and a lack of continuity in records and communication you are no better off than dealing with the typical primary care physician. Save yourself the money and perhaps try a different concierge-like medicine platform.
• I had a membership for several years and always had frustrations, mostly about the doctors and their poor advice. Eventually though I got tired of not getting prompt replies and having physicians change repeatedly, the new ones never seeming to bother with reading your history. They contradict each other. It really doesn’t feel safe. For example, they can’t administer the Covid vaccine. They can’t handle simple things like annual skin cancer exams. They take pictures of your moles and send them to someone. They have to send you to a specialist outside of their system for EVERYTHING.

From Dockside: “Re: BJC. I work there and the CEO aid in a town hall this week that the merger with Saint Luke’s in Kansas City is set to close on January 1, 2024. For now, the systems will operate as BJC HealthCare in eastern Missouri and Saint Luke’s Health System in western Missouri.” Unverified, but previously rumored as planned “by the end of the year” The merger would create a 28-hospital, $10 billion health system. I think they’re both running Epic.

HIStalk Announcements and Requests

I’m noting with grammarian interest the sudden pervasiveness of the word “lovely,” which I actually kind of like despite (or maybe because of) its time capsule images of grannies sipping tea pinkies-up on lace doilies. I hereby propose the resurrection of the similarly aged “splendid.”

Webinars

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

Acquisitions, Funding, Business, and Stock

Primary care chain Forward Health raises $100 million in growth capital to roll out CarePod, which it calls “the world’s first AI doctor’s office” for members who pay $99 per month for access to the app-equipped kiosks that will be installed in retail locations.

The estates of two deceased individuals sue UnitedHealth Group (UHG), alleging its AI algorithms, which came from its acquisition of NaviHealth in 2020, deny necessary care to Medicare Advantage seniors. The complaint highlights a 90% error rate in the AI system when its decisions are challenged, with the plaintiffs alleging that UHG’s Medicare Advantage patients receive substandard care compared to traditional Medicare patients.

The healthcare business that 3M will spin off in the first half of 2024 will be named Solventum.

Sales

• University of Miami Health System chooses Aidoc to identify and triage abnormalities in patient images.
• Lee Health (FL) will offer virtual urgent care from KeyCare, which patients can launch from MyChart.

People

Elation Health hires Tom Natt (ConnectRN) as chief growth officer.

Greg Tracy. MS joins Wondr Health (ResMed) as CTO.

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

Announcements and Implementations

Rimidi will provide its remote patient monitoring technology to Atlanta-based non-profit Brighter Day Health Foundation, which will offer RPM and chronic condition management services to underserved communities from local churches. Rimidi CEO Lucienne Ide, MD, PhD founded the company in 2011, and before her medical training, served as a signals analyst for the National Security Agency.

California health and social data-sharing organization Connecting for Better Health restructures as a non-profit and announces its initial board of directors.

Sectra will integrate its enterprise imaging diagnostic application for radiology with GE HealthCare’s AW Family Advanced Visualization applications.

A new KLAS report on patient engagement finds that patient portals, patient surveys, and telehealth are widely adopted and health systems are moving on to implement provider search and patient self-scheduling. Two-thirds of respondents say their plans involve their EHR vendor, either alone or with third-party solutions, with 58% of Epic-using respondents and nearly as many Meditech customers saying that the vendor aligns with their plans, while one-third of Oracle Health’s customers say the same. Technologies most mentioned for consolidation are virtual care and patient communications.

Privacy and Security

Mail order pharmacy fulfillment vendor Truepill files a breach notice that the information of 2.4 million people was exposed in an August cyberattack.  

Other

Snips from the Digital Health Most Wired 2023 survey:

• Health system IT budgets have stabilized, with most returning to pre-pandemic levels and likely to increase as they acquire technology to address labor shortages, wage inflation, and reduced margins.
• They are looking for solutions that offer a clear, measurable ROI.
• The average Digital Health Most Wired score has increased steadily from 63% in 2019 to 77% in 2023.
• An ever-increasing amount of stored data has increased use of advanced analytics, although often involving multiple vendor solutions across locations and departments, with limited integration.
• End users need to improve their understanding of how to use data, but scaling education programs is hard as systems rapidly evolve.
• Health systems are trying to integrate data from patient-wearable devices into their EHR.
• The role of the CIO is becoming complex as cybersecurity, innovation, and analytics require leadership that may or may not fall under the CIO’s oversight.
• Few large health systems place cybersecurity under the CIO, as 90% of them have a CISO or other VP-level position.

Mark Cuban disagrees with a tweet that says Big Tech won’t disrupt healthcare, offering a detailed response that I’ll summarize:

• Tech companies that claim to “optimize” the system are improving only its rent-seeking aspects.
• Healthcare consolidation has used lack of transparency to “extract rents everywhere and anywhere they can” so that nobody can see who pays how much.
• PBMs and insurers add complexity and are not needed given the ability for employers to contract directly with providers, adding that “is it really insurance if they do everything possible not to pay claims?”
• Providers know that contracts, pricing, and network games that big insurers play are ruining the quality and cost of care, but they are too scared to speak up.
• Employer CEOs don’t understand that they are enabling the status quo by working with incumbents, but they are finally realizing the need to change for financial and employee wellness reasons.

UCLA sues Mattel for reneging on its 2017 pledge to donate $49 million to its children’s hospital, claiming that the toymaker is instead offering a few million dollars plus a bunch of toys. UCLA wants the full $49 million plus damages, but Mattel says the donation was earmarked for adding a new tower to UCLA Mattel Children’s Hospital that UCLA decided not to build.

Sponsor Updates

• CHIME gives its 2023 collaboration award to Ellkay and Signature Healthcare. 
• Eric Sellari joins Health Data Movers as account manager.
• Biofourmis and HealthXL publish a report titled “Unlocking the Value of Digital Measures in Drug Development.”
• Ascom Americas names Kim Hendrix, RN regional director, Healthcare Alliance.
• The Outcomes Rocket Podcast features Availity AuthAI CTO Rob Laumeyer, “We Can’t Make Healthcare Error-Free, But We Can Make the Errors More Traceable.”
• AvaSure publishes a new guide, “AI Powered Enhancements for Your Virtual Care Workflow.”
• Nordic releases a new episode of its “In Network” podcast titled “Designing for Health: Interview with Margaret Lozovatsky, MD.”
• Bamboo Health will exhibit at the Medicare Star Ratings Summer December 6-8 in Orlando.
• Bardavon joins the National Safety Council’s TechHub Marketplace.
• Recent KLAS reports recognize Care.ai’s virtual care solutions based on the company’s expert staff, premium hardware, and advanced AI features.
• The This Week in Pharmacy Podcast features CereCore Physician Consultant Charles Bell, DO and CereCore Manager Andrea Corner, PharmD, “Pharmacists and Physicians Refining the EHR.”
• Clinical Architecture releases a new Informonster Podcast, “Documentation in the OR with AORN.”
• KLAS Research’s 2023 Data & Analytics Platforms Performance Report names Dimensional Insight a top performer.
• Divurgent releases a new Vurge Podcast, “Exploring the Power of Data and Analytics in Healthcare.”
• EClinicalWorks announces that Moreno Valley Physician Associates (CA) has successfully implemented its new AI assistant tools.
• First Databank receives the American Medical Informatics Association’s Silver Corporate Partner Award for its contributions to the association and the field of informatics.
• FinThrive relocates its corporate headquarters to Plano, Texas.

Blog Posts

• Minimizing administrative burden to maximize data insights and healthcare impact (Wolters Kluwer Health)
• The RCM Maturity Framework: A Path to Digital Transformation and Operational Excellence (AGS Health)
• Unlock healthcare productivity with data portability: A path to provider well-being and enhanced patient outcomes (Arcadia)
• Addressing Workforce Challenges and Keeping Patients Safer: How CHS is Deploying Virtual Patient Monitoring (AvaSure)
• How Technology Can Help Providers Get Paid and Common Challenges (CereCore)
• The Benefits of AI in Healthcare Are Vast, So Are the Risks (Clearwater)
• Using High-Impact Point-of-Care Messaging Without Third-Party Cookies (ConnectiveRx)
• Finding the Needle in the Tech Stack: What to Look for in a Platform Engineering Services Partner (CTG)
• 3 Takeaways from KLAS Research’s Data and Analytics 2023 Report (Dimensional Insight)
• The Evolving Role of Hiring Managers in Remote Work Environments (Direct Recruiters)
• Strategies to Prevent Coding Denials and Increase Revenue (EClinicalWorks)
• Beyond Alert Fatigue: Understanding Roadblocks to Customizing Medication Decision Support (First Databank)
• Supporting Mental and Behavioral Health (Findhelp)
• Improving the Efficiency of Healthcare RCM: A Key to Financial Health (FinThrive)
• Healthcare cybersecurity threats: October 2023 (Fortified Health Security)
• Hands Off! How You Can Protect Patient Data from Unauthorized Intruders (HealthMark Group)
• Tips for a Blended Content Strategy (Healthwise)

Contacts

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

EPtalk by Dr. Jayne 11/16/23

As a frontline physician who has dealt with my share of angry patients, I’m always worried that one of them will follow me home from work or show up at my house. I’m vigilant about my personal information and make sure that it’s difficult to find me through real estate or other public records.

Recently Doximity announced a free service called DocDefender that can help physicians remove their personal information from public websites. I decided to give it a whirl. I initially tried to find it through my Doximity account, but wasn’t successful. A web search took me to the right site, but I had to go through an email authentication process to get started. From there, the system started scanning and found my information on 17 out of 35 targeted websites.

The removal process is supposed to begin automatically with results in two to 60 days. I should be receiving regular updates on the removal process, so I’ll provide updates in the coming weeks. It’s also supposed to provide periodic checks to identify new listings, so we’ll see how that goes.

While I was digging around my Doximity account, I stumbled upon Doximity GPT, which is described as “A medical writing assistant that can compose patient education, recommendation letters, grant proposals, ortho poetry – basically any writing task you can think of.” I found the idea of ortho poetry to be intriguing but not compelling, so I asked it to write a haiku about clinical informatics instead. It did not disappoint:

Data flows like streams,
In clinical realms it gleams,
Healing in light beams.

Telehealth organizations across the US are jumping into the weight loss business, making it easier for patients to obtain prescriptions for costly injectable medications, although their ability to jump through the hoops imposed by payers is highly variable. Employers are starting to try to control costs, and Mayo Clinic’s employee health plan has announced that it will cap weight loss medication expenditures at $20,000 per patient as a lifetime maximum. Since some of the medications run up to $900 per month, for patients who are already in treatment, we’re going to see what is essentially an unregulated, uncontrolled clinical trial where time and financial means will be influencing outcomes. The caps don’t go into effect for patients using the drugs for diabetes, which creates a strange “chicken or the egg” situation where prevention or risk reduction isn’t covered but treatment of disease is.

This is largely the result of our payment system, where everyone is trying to control costs for their attributed patients, but doesn’t have the means to take advantage of long-term savings. For example, let’s look at an obese 55-year-old patient with pre-diabetes. If they can achieve weight loss, they likely reduce their chances of developing diabetes, which saves money down the line. When you look at the costs of diabetes care or the complications of diabetes, those expenses would likely occur in 10 to 15 years, when Medicare might be paying them as opposed to commercial insurers.

There’s no incentive for a commercial payer to absorb the cost today in order to realize the savings down the road, because the patient won’t be on their books then, and might not even be on the books in a year or a month, if they work for a healthcare IT company that includes them in a reduction in force as we’ve seen plenty of recently. The math just doesn’t work, but inability to get treatments that could improve quality of life and reduce disease burden is a reality for so many patients today.

Mayo Clinic is just following the example of other healthcare employers that have dropped coverage, including Hennepin Healthcare, Ascension, and the University of Texas System in Austin. All of those popped up in a web search as being in the same situation. My crystal ball predicts that many more organizations will be changing coverage over the coming months unless the prices of the drug come down or there’s evidence of a way they could save money by covering it.

This week included my regularly scheduled annual visit to Big Medical Center for follow-up imaging and a consultation with my care team. I received the email reminder of my visit and confirmed it by completing the electronic check-in process the same day the reminder came out. The next day, I received a phone call, right in the middle of typical dinner hours, asking me to again confirm the appointment. However, I had to listen to a minute and a half of recordings about parking and arrival times before I could confirm. They should have told us to allow an extra 20 minutes to deal with the parking and construction situation, because it was rough and I barely made it to my appointment on time. Good thing they didn’t check my blood pressure because I’m sure it was up there.

I was seeing a new provider at this visit, since they’ve changed how the department runs. I wasn’t impressed by the fact that she had a bunch of handwritten paper notes about me, or that she didn’t use the EHR at all during our visit. It would have been one thing if her notes were accurate, but they weren’t, as I discovered when she tried to offer me genetic testing that I’ve already had.

We discussed the existing results, which I wonder if she missed because they’re scanned into the EHR as opposed to being discrete data, and she relied on my memory to tell her what testing I had completed. From there it was off to the imaging department, only to be told that they’re not doing real-time results anymore, which is one of the reasons I use this facility. Results will come to me via the patient portal in a few days, which I suppose is adequate, but the availability of real-time results was one of the reasons I tolerated the long drive and the general hassle of using this facility.

As a last bit of frustration, they used to schedule your follow up at the checkout desk, and they don’t do that any more. The new process is a bit bumpy and I had to wait for the clerk to write the appropriate phone number on a sticky note so I can call back and self-schedule. At a minimum, someone needs to make a half-sheet handout they can give patients that includes all the pertinent information. In the time it took her to write it down, she could have scheduled the appointment since it’s for a year out and my calendar is wide open. I wonder how many patients will be lost to follow up this way, as those sticky notes disappear into purses and tote bags.

As a final insult, when I returned to the parking garage, the car next to me had parked over the line to the point where I couldn’t get into my car. Fortunately, I’m spry enough to do the gymnastics needed to climb in the passenger side and crawl over the console, but I’m betting a good portion of those visiting a world-renowned cancer center might not have the ability to do so. Still, I’m glad it happened to me and not someone who just finished a treatment or who just received life-altering news, so I’ll view it as my good turn for the day.

After I got home and decompressed from the experience, I walked to the mailbox and found a fundraising solicitation from the organization. I’m no stranger to the concept of so-called “grateful patient” fundraising, but the timing on the solicitation gave me an idea. What if I challenged them to fix their messed up processes in exchange for a sizable donation? I’m sure I could solicit patients and family members to participate, as well as physician colleagues who don’t want their patients to be frustrated by the care delivery experience. I’d even throw in some complimentary consulting services to sweeten the deal.

What are the simple things that facilities could do to improve the patient experience? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 11/16/23

Forward Raises $100M and Announces Forward CarePod

Primary care provider Forward Health announces CarePod, a self-contained, unstaffed “doctor in a box” that is available to members who pay $99 per month to access AI-powered apps that perform screening and create care plans.

UnitedHealthcare’s broken AI denied seniors’ medical claims, lawsuit alleges

The estates of two deceased men sue UnitedHealth Group, claiming that the company uses an algorithm to override physician assessments in denying care to its Medicare Advantage enrollees.

Aranscia Acquires YouScript from Invitae

Precision diagnostics vendor Aranscia acquires select assets of the YouScript personalized medication management platform from digital medical genetics company Invitae.

Health Disinformation Use Case Highlighting the Urgent Need for Artificial Intelligence Vigilance

Researchers find that ChatGPT can rapidly and effortlessly create medical disinformation blog posts about vaccines and vaping, including impressive but fake patient and clinician testimonials and literature citations.

Healthcare AI News 11/15/23

News

The estates of two deceased men sue UnitedHealth Group, claiming that the company uses AI algorithms to deny care to seniors who are enrolled in its Medicare Advantage plans. The complaint says that the AI system that UHG gained in its 2020 acquisition of NaviHealth has a 90% error rate and creates generic care recommendations that are used to override physician assessments of medical necessity, placing the Medicare Advantage patients at a disadvantage compared to traditional Medicare. A previous report found that patients who were entitled to up to 100 days in a nursing home following hospital discharge were usually cut off within 14 days by UHG.

Elsevier and OpenEvidence create an early access version of ClinicalKey AI, which allows doctors to enter patient information that is matched against Elsevier’s medical journal data to help them make clinical decisions. OpenEvidence’s original system is available for demonstration.

OpenAI pauses new signups for ChatGPT Plus due to a user surge following the company’s November 6 DevDay. The company also acknowledges that it is working on GPT-5, which will require more public and proprietary data sets.

Business

The CEO of an AI-powered robotics company says that the factors that made ChatGPT successful – training on a vast and diverse dataset and aligning the model’s response with what humans find useful – are being applied to AI robots that can understand their surroundings, make decisions, and adapt to changing circumstances. He predicts widespread deployment of robots that can perform object manipulation in 2024.

University of Miami Health System will use Aidoc’s technology system-wide  to identify and triage abnormalities in patient scans. The Israel-based company offers 13 FDA-cleared algorithms. The CEO is a former AI leader in the Israeli Air Force and co-founded the company with military peers one year after discharge.

Montreal-based Pathway, which provides evidence-based responses to clinician queries, raises $5 million in seed funding.

Research

Researchers in Australia refer to large language models that have limited guardrails as “weapons of mass disinformation” in a JAMA Internal Medicine article, where they describe using ChatGPT to create 102 disinformation blog posts about vaccines and vaping. Creation of the posts that totaled 17,000 words, which included fake patient and clinician testimonials and scientific-looking references, took just over one hour. Additional OpenAI tools contributed realistic images and a deep-fake video.

AI outperformed tissue biopsies in grading the aggressiveness of retroperitoneal sarcoma, which could potentially spare low-risk patients from unnecessary treatments and tests.

Tech-heavy medical practice operator Forward Health develops a standalone, app-powered  medical station it calls the CarePod, which it hopes to place in malls and office buildings where members will pay $99 per month for access. Founder and former Google computer scientist Adrian Aoun, who says “I don’t even believe a doctor’s office should exist,” hopes to turn healthcare into a product rather than a service. CarePods are powered by a large language model that uses medical research data to create care plans. The company just raised a $100 million Series E round and hopes to launch 25 CarePods initially and scale to 3,200 within one year. Aoun says he hopes to enhance the machines to perform open heart surgery within the next 20 years.

Other

AI expert Mark Hinkle builds a GPT into which users can upload PDFs of their health insurance plan options during open enrollment, then ask ChatGPT specific questions and have it compare plans.

A Nebraska oncology research nurse’s lung cancer is detected by Methodist Hospital’s AI-powered LungGPS, a Medtronic system that double checks radiology images and reports for incidental nodules. She was X-rayed for pain in her left side, but LungGPS noted nodules on the other side, with the early detection allowing her stage 1 lung cancer to be cured via surgery. LungGPS caught 26 patients with undetected cancer in 2022 and 15 so far this year.

Contacts

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

Morning Headlines 11/15/23

Henry Schein Reports Third-Quarter 2023 Financial Results and Updates Full-Year Guidance

The medical supply vendor misses estimates for both revenue and earnings and lowers guidance even though the quarter was over before its October cyberattack.

UnitedHealth pushed employees to follow an algorithm to cut off Medicare patients’ rehab care

The company reportedly threatened to fire employees who failed to hit targets to limit the rehab care of Medicare Advantage patients to an algorithm-predicted appropriate number of days.

The Next WebMD: An LLM as Your Front Door to Healthcare

A16Z predicts that the model of Googling symptoms and then asking a medical friend or relative could be replaced by AI chatbots that could refer people to a marketplace of services offered for sale, giving the LLM company control of revenue streams worth billions.

AristaMD and Sitka Form Single Company, Secure Series C of $16.5M for the Expansion of Specialty Care Access via Electronic and Video Consultation Services

EConsult and referral management solution provider AristaMD acquires Sitka, which offers a platform for primary care providers to request video consultations from specialists.

News 11/15/23

Top News

New York Governor Kathy Hochul proposes regulations that would require hospitals to establish a cybersecurity program led by a CISO, assess their cybersecurity readiness, and develop and test response plans.

The state budget includes $500 million for healthcare facilities to upgrade their technology.

Reader Comments

From Kvetcher: “Re: investigative reporting. I would like to see more of that.” I always appreciate reader ideas for doing more, while simultaneously noting that all the writing you see on HIStalk is done by a two of us part-timers, or about 1 FTE, who have to be careful about overcommitting.

From Spock: “Re: SPACS. Maybe you’ve posted before, but I’m curious on the logic and money flow. Seems like I read every day another whose value has declined tremendously.” My SPAC opinions summarized:

1. Special purpose acquisition companies were a popular, backdoor method of going public in a “blank check merger” while offering minimal opportunities for investor due diligence, thus attracting low-quality companies whose financials could pass only superficial examination. SPAC sponsors could and did make wild, unsupported financial projections and lit up their social media accounts with self-serving bunk the SEC couldn’t do anything about it because IPO rules don’t apply to mergers. Most people haven’t noticed that the now-bankrupt WeWork went public via a SPAC merger, taking investors for a rough four-year ride as its valuation sank from $47 billion to less than $100 million while making its former CEO a billionaire (everything you need to know about SPACs is contained in that last sentence).
2. SPACs mostly benefitted their hype-spewing sponsors, who skimmed 20% or more of the overvalued proceeds immediately as their fee and then left less-knowledgeable investors ending up like Halloween night homeowners at their front doors stomping out a flaming bag of excrement .
3. SPACs were legally required to find merger partners within two years or else shut down, and mating became desperate as closing time neared.
4. The result was the companies that couldn’t pass IPO muster often failed spectacularly, leaving investors holding the bag and SPAC sponsors moving on to find new ways to move money from investor pockets to their own.
5. Some of healthcare’s big SPAC mergers were Babylon Health (went public in mid-2021 at a $4.2 billion valuation, since declaring bankruptcy for key businesses and selling parts for scrap); Clover Health (valuation dropped from $7 billion to less than $500 million); Cano Health (once valued at nearly $3 billion, now at $38 million and likely to shut down); 23andMe ($6 billion to $400 million); Butterfly Network ($3 billion to $230 million); Sharecare ($3 billion to $400 million); SOC Telemed ($1 billion to being taken private for $300 million); and ETAO ($1 billion to $17 million).
6. Struggling digital health companies were a favored SPAC target because they were already overhyping their prospects and performance, making them the perfect partner for scammy SPAC sponsors.
7. My takeaway is that SPACs were just another manifestation of greed as usual. Nobody forced investors to buy shares in obviously poor-quality companies – they did so voluntarily hoping to find a greater fool down the road who would buy them at an even more inflated price.

From Bergamoot: “Re: HIMSS. What business are they in selling tech services to Taiwan?” HIMSS sold its annual conference and now seems to harbor ambition for doing global consulting, which doesn’t seem like a core competency of a membership group. They signed a deal with Taiwan’s national insurance organization to provide “subject matter experts, thought leadership, and advice” in cybersecurity, analytics, and national education programs. HIMSS would not come to my mind in thinking of organizations who provide these services regularly and arguably well, although I would likely list the names of companies that support HIMSS financially and now find themselves as its competitors. Maybe HIMSS sees revenue opportunity in offering a marketplace for vendors who pay it for matchmaking them with clients.

From Horse Pistol CIO: “Re: CHIME. Made a pretty big tactical error by running its fall forum from Friday to Sunday. The number of CIOs who exited early was palpable. The final event on Saturday night was basically a vendor fest which is not ideal for anyone. It’s probably not surprising that folks would prefer to not give up an entire weekend for a conference and then have to go to work the very next day. Rumor was that it ran through the weekend due to prior feedback and that they won’t do it again. To me it was a big miss. Lots of heavy hitters were gone by Friday. Bummer.”

HIStalk Announcements and Requests

It’s funny how much stupider my Alexa devices and Google searches seem now that I’m using ChatGPT to selectively replace them.

Webinars

November 16 (Thursday) 1 ET. “How Scheduling Helped Streamline Memorial Hermann’s Communication.” Sponsor: PerfectServe. Presenter: Amee Amin, MD, hospitalist, Memorial Hermann-Texas Medical Center. Dr. Amin will discuss the challenges she experienced in creating schedules for her team of hospitalists, and how an optimized solution transformed her workflow. Attendees will learn now TMC gleans crucial data and analytics from their scheduling system, the impact of real-time schedules being pushed out to other applications, and how Lightning Bolt’s optimized, auto-generated schedules improve provider satisfaction and work-life balance.

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

Acquisitions, Funding, Business, and Stock

A former employee’s LinkedIn post says that Health Catalyst laid off another 120 employees this week, as suggested in last week’s earnings call in which the company said it would lay off 10% of its people in late Q4. The same call touted the company’s high level of employee engagement and winning five “best places to work” awards. HCAT shares are down 19% in the past 12 months versus the S&P 500’s 12% gain, valuing the company at $456 million.

Henry Schein reports Q3 results: revenue up 3.1%, adjusted EPS $1.05 versus $1.09, falling short of estimates for both even though the quarter was impacted by its October cyberattack. The company lowered full-year revenue and earnings estimates. It says it will file a cyber insurance claim, but its policy has a $60 million limit. Schein expects to restore online ordering next week, which represents most of its business, and said on the earnings call that it hopes to regain the 10 to 15% of its sales that were to customers who order exclusively electronically without a sales rep who took their business elsewhere when systems were offline.

Well Health reports Q3 results: revenue up 40%, adjusted EPS $0.05 versus $0.07.

Hackensack Meridian Health signs a partnership with Amazon’s One Medical primary care service, the latest of a couple of dozen big health systems opening brick-and-mortar locations together, sell One Medical memberships to employers (the same package that Amazon Prime members get for $99 per year), and then the health system gets the referrals for specialty care from all over the state in claiming to offer coordinated care and connected technologies. Amazon doesn’t like low-margin business, so it would be interesting to see contract details to know whether the health systems are paying Amazon for referral exclusivity or a share of the business it generates. Also, this deal seems to be based on signing up employers to pay the membership fee, which would seem to keep the health system from getting referrals of uninsured patients.

MIT spinoff Layer Health comes out of stealth mode with $4 million in funding. Its Distill product uses AI to use unstructured patient data for a variety of chart review tasks.

Sales

• Presbyterian Hospital (NM) chooses the social services referral platform of Unite Us.

People

Availity hires Sean Keneally, MBA (Elevance Health) as COO.

Announcements and Implementations

Australian Capital Territory Government notes the one-year anniversary of its Epic go-live, listing statistics about MyDHR use, internal messaging, and turnaround time for diagnostic studies.

Surescripts applies to become a QHIN.

A Stat investigation finds that UnitedHealth group used a computer algorithm to cut off rehabilitation services to Medicare Advantage plan members, threatening to discipline or fire employees who failed to hit a 1% variation target even when Medicare coverage rules warranted more days of service. Ironically, the algorithm that was developed by NaviHealth – a company that UHG acquired in early 2020 – was designed to help patients meet their rehab goals, not to cut off their financial access to it. Algorithm-denied care isn’t exactly the poster child that AI healthcare proponents are seeking.

Marketing and PR firm Amendola Communications wins awards for its work with KeyCare, DrFirst, and Equality Health.

John Muir Health implements Epic integration with Ambience Healthcare’s ambient AI scribing system, which allows clinicians to view their Epic schedule in the Ambience app, record audio of their visits on desktop or mobile, and immediately view and edit AI-generated documentation within Epic.

FDA designates Mednition’s AI early sepsis detection solution as a breakthrough device.

Mercy launches The Chen Chemotherapy Model, which sends a daily text message to outpatient chemotherapy patients and uses their responses about symptoms to proactively manage their care. It was named after former Mercy data scientist Jiajing Chen, PhD, MPH, who developed it before dying of cancer in January 2023 at 42.

Other

The American Medical Association reviews at its interim house of delegates meeting a previously rejected member proposal to ban the corporate practice of medicine. A radiologist member who spoke on behalf of reviewing the measure said,

We are being picked clean by private equity. There are people who don’t know where their next paycheck is even going to come from because their groups have been flipped so often … [This resolution] is protecting both physicians and patients, it is preserving physician autonomy and preventing burnout. Seventy-four percent of physicians [are] employed; just four years ago it was 50 percent. Private equity has spent $1 trillion in the last decade on acquisitions in buying medical practices. We need to have something to talk about with respect to private equity at this meeting.

Andreessen Horowitz predicts that the “Google –> WebMD –> Friend” protocol of patients entering the health system via a doctor friend or relative will be replaced by personalized large language models that will use a few rules to send instructions to third-party software while simulating empathetic guidance. It describes a potential experience in referencing the Baymax healthcare robot from the movie “Big Hero 6,” which it argues could give companies control of revenue streams worth billions of dollars in connecting an LLM to a marketplace of services that consumers can book directly:

One day, you wake up with a hint of a headache and a sniffle. You sneeze. What do you do next? You turn to your Baymax-like app, input your symptoms, and after a few follow up questions, it predicts— given your current location, the weather, your recent sleep scores, your diet, and your personal trends—that you’ve got allergies. It offers you a same-day appointment with a nearby allergist covered by your insurance to confirm the diagnosis. In the meantime, it recommends you try an over-the-counter allergy medication, offering to have it delivered to your house. It orders extra tissues for you, for good measure.

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Morning Headlines 11/14/23

Governor Hochul Announces Proposed Cybersecurity Regulations for Hospitals Throughout New York State

New York State will require hospitals to establish a cybersecurity program, implement protective measures, assign a chief information security officer role, and implement two-factor authentication for external access, with the plan including $500 million in available grants to help fund compliance.

Dutch hospital uses AI to answer patients’ questions

Groningen University’s teaching hospital UMCG rolls out chatbot to help answer patient questions, which scans their records and providers a clinician-reviewed response in what the hospital says is the first such use in Europe.

How Generative AI Could Help Us Predict the Next Pandemic

Harvard researchers develop an AI tool that can predict the emergence of concerning variants of COVID-19 and other viruses.

A majority of Americans are optimistic that AI will improve healthcare in 2024

A survey of randomly sampled Americans find that half expect AI to create major advancements in healthcare next year, especially in diagnosis and access, although few of them would prefer to work with a doctor who uses AI extensively.

Readers Write: Navigating the Telehealth Regulatory Labyrinth

Navigating the Telehealth Regulatory Labyrinth
By Sheeza Hussain

Sheeza Hussain is chief growth officer of SteadyMD of St. Louis, MO.

Telehealth has the potential to amplify its impact on healthcare access while further reducing costs, but a web of state regulations is hindering that promise.

Telehealth became a household term for millions of Americans in 2020, emerging as a vital component of healthcare delivery. It helped bridge the gap caused by clinician shortages, tackled certain social determinants of health, and facilitated care for rural patients who otherwise struggle to access it.

However, the rapid expansion of telehealth has exposed a glaring issue – a labyrinth of regulatory and legal obstacles. State licensure variability, reimbursement policies, telehealth parity laws, cross-state regulations, and other hurdles continue to impede adoption.

Licensure is just one complicating factor in the telehealth regulatory maze. Many states have differing regulations on nurse practitioner scope of practice, with variance in whether NPs can operate independently, require physician oversight, or are restricted entirely. This patchwork hinders multi-state advanced practice clinician telehealth.

Additionally, certain modes of virtual care like asynchronous visits face ambiguity, as some states allow reimbursement while others prohibit or fail to address it. Like licensure, these state-by-state discrepancies in nurse practitioner and asynchronous visit policies make scaling telehealth availability and minimizing legal risk complex for providers. Overcoming the regulatory headaches requires close tracking of each state’s evolving rules.

Among the three primary challenges, the perplexing variations in state licensing rules are the most significant.

Healthcare providers are required to be licensed to practice in the state in which their patient resides. In some cases, patients are forced to cross state borders to receive telehealth services from their chosen physicians.

The disparities in telehealth policy between states are glaring. For instance, North and South Dakota, as well as Virginia and West Virginia, don’t see eye to eye on telehealth regulations. This patchwork of policies is emblematic of the broader problem – 50 states, each with its own set of laws, medical communities, and stakeholders, all contributing to the complexity of telehealth regulation.

The existing state-by-state licensure processes are antiquated, leaving telehealth companies that operate in multiple states grappling with a complex and ever-changing regulatory landscape. A common requirement is that telehealth providers must hold licenses in the state where their patients are located. However, this doesn’t simplify telehealth; it complicates it further. Most providers are licensed only in one or two states, limiting their usefulness to telehealth companies operating across several states.

Obtaining licenses in additional states is a costly and time-consuming endeavor for telehealth companies. They must build a roster of multi-state providers, carefully manage supply and demand, and ensure compliance with the laws of each state they serve.

Calls for modernizing licensure portability have gained momentum, with some advocating for a standardized federal system akin to driver’s licenses. However, this transformation won’t occur overnight. As telehealth becomes increasingly integrated into healthcare, state regulations may eventually become more uniform, but this change is unlikely to happen soon. The healthcare industry can advocate for greater licensure portability, such as the implementation of a standardized federal licensing system, but providers need relief now.

In the meantime, telehealth providers are seeking alternative solutions. Many are opting to partner with telehealth infrastructure providers that guarantee compliance with state laws, recruit and manage providers, and stay current with shifting regulations. By entrusting an external partner to navigate the intricate regulatory landscape, telehealth providers can focus on what truly matters – providing the best care to their patients.