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Monday Morning Update 12/21/20

December 20, 2020 News 3 Comments

Top News

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Imaging worklow vendor Intelerad acquires Digisonics, which sells cardiovascular and OB/GYN information systems.


Reader Comments

From Money Heist: “Re: investment. Why the sudden overabundance of investment news in HIStalk? Are your interests changing?” Health IT investment activity is soaring, especially with the sudden popularity of backdoor IPOs via special purpose acquisition companies (SPACs) that are required to complete a deal within two years or give investors their money back. Accordingly, acquisition prices are way up and expectations from folks who paid high per-share prices will follow, meaning it’s important to see how customers and competitors are affected by these financial gyrations. There’s only so much to say about the Big Three inpatient EHR vendors now that the HITECH land grab is over (unless they make an acquisition, of course), so the industry is focused on new sectors and new players, especially those that aim to pick the deep pockets of insurers, pharma, drug store chains, and even masses of consumers who are happy to lay out cash for whatever prescriptions, diagnostics, and treatments they want in bypassing the usual gatekeepers. Healthcare is, unfortunately, almost entirely driven by profits, the actions of big companies, and the heavy involvement of government as an insurer, provider, and legislator — the rest of us, including patients, are just gawking bystanders. 


HIStalk Announcements and Requests

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Many poll respondents say that their job represents a big part of their identity and life satisfaction, which I guess is a good news-bad news sort of situation where they are happy with the work that contributes so heavily to the perceived quality of their existence, but that perhaps dangerously makes them dependent on an employer whose goodwill is situational (my personal experience is that a new boss, company sale, financial stumble, or backstabbing colleagues can end those happy workdays quickly). Look down the road as well to unintentional unemployment or retirement, when the well-meaning but misguided question of “What do you do?” (meaning, “to whom do you sell time and for doing what as your primary identity?”) has no easy, pat answer.

New poll to your right or here: What are your COVID-19 vaccination plans?

I’m fascinated by the argument over whether someone who has earned a non-medical doctorate should use the title of “Dr.” and in what setting. Even with medical doctors it’s not cut and dried — UK doctors earn an MBBS, which is a professional bachelor’s degree that is equivalent to MD, and I’ve heard that they called generalists “Dr.” and specialists “Mr.,” although I’m too lazy to look that up. I say we stop calling everyone Dr. as part of their name since that term is vague (I’m thinking of those chiropractors who place “Dr.” in front of their name instead of “DC” after it in their ads, hoping for some beneficial confusion.) Meanwhile, I’ll defer to the AP Stylebook, which says to use Dr. in the first reference to someone who holds specific medical degrees such dentistry, allopathic or osteopathic medicine, podiatry, or veterinary medicine – notice that list does not include pharmacists, doctorate-level nurses, physical therapists, or PhDs. Actually, I’m not sure that we even need any titles as part of names in our stridently informal society, especially with the gender-signifying issues that result – does someone really need to be Mr. Smith instead of just John? Meanwhile, feel free to address me as Reverend Doctor HIStalk since I bought those credentials from the Universal Life Church with college work-study money in hoping to created a higher-power aura that women would find irresistible (pretty much like a lot of people who wave their “Dr.” titles in the faces of strangers, in fact).


Webinars

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


Acquisitions, Funding, Business, and Stock

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Tenet Healthcare will sell 87 of its CareSpot and MedPost urgent care centers to FastMed Urgent Care for $80 million as it refocuses on the 45 ambulatory surgery centers that it is buying for $1.1 billion. North Carolina-based FastMed operates 104 locations in Arizona, North Carolina, and Texas. Googling suggests that CareSpot and MedPost use NextGen, while FastMed announced in January 2020 that it was implementing Epic in all of its locations.

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In Canada, Telus Health acquires virtual care provider EQ Care.


Sales

  • The State of Virginia will spend $10 million in federal coronavirus aid money to implement Unite Us to connect the EHRs of health systems and medical practices to manage social services referrals.
  • Highmark Health chooses Google Cloud in a six-year deal to develop Highmark’s Living Health Model, described by Highmark marketing committees who flung buzzwords like a zoo monkey’s feces until this vague “Curated Design” description earned the most colored sticky dots: “Our new design will have health care operating differently — better. It will become an experience that is simple, easy, and streamlined for all parties.” Highmark says it is changing a broken healthcare system (in which it profitably participates with $20 billion in annual revenue and an $8 million CEO) because of its sudden realization that “it’s the right thing to do.” Remind me to check back in a couple of years to see if Highmark makes good on its promise that its relationship with Google will end healthcare-related stress, confusion, fragmentation, reactive processes, complexity, and high cost.
  • NHS Greater Glasgow and Clyde Health Board join the TriNetX global health research network, which has presented 7,800 clinical trials opportunities to 170 healthcare organizations in 30 countries. 
  • Ochsner Health chooses Loyal for patient self-scheduling and website live chat. 

People

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Jason Dvorak (Hillrom) joins Lohman Technologies as president.


Government and Politics

HHS OCR publishes guidance on how HIPAA allows covered entities and business associates to disclose PHI via HIEs for public health activities. High points:

  • Covered entities can send patient data to HIEs when disclosure is required by law, such as sending infectious disease lab testing data.
  • Covered entities can assume that whatever information the public health agency requests is minimum necessary, such as the Common Clinical Data Set, without making their own determination. CDC’s request for COVID-19 patient data via Electronic Case Reporting and state influenza reports are examples. 
  • Covered entities may disclose bulk PHI to public health agencies via an HIE without individual patient approval as long as they verify that the agency has permission to collect the data.
  • OCR will not impose penalties on business associates or covered entities that transmit PHI for public health activities, regardless of whether their business associate agreement specifically permits such disclosure.
  • Covered entities must provide requesting individuals with an accounting of disclosures that includes public health reporting.

COVID-19

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Friday set a US COVID-19 hospitalization record of 114,751 and another 2,751 deaths. Tennessee has the world’s worst infection rate per capita at 1,300 per million residents and rising, joining California as the only state whose rate exceeds 1,000. Tennessee announced Saturday tat it has passed 6,000 deaths, has 2,893 people hospitalized, and is showing a test positivity rate of 30%. COVID Tracking Project keeps having to make up new colors in extending beyond red to illustrate the uncontrolled US coronavirus spread. 

A newspaper investigation concludes that Florida stopped reporting backlogged deaths from October 24 to November 17, creating big drop in the death count right before and after the election. Governor Ron DeSantis has changed the reporting requirements multiple times and is accused by fired state COVID-19 data scientist Rebekah Jones of falsifying the numbers to support the state’s aggressive reopening, which he denies.  

FDA issues its Emergency Use Authorization to Moderna’s COVID-19 vaccine, with the first doses to be administered Monday.

A CDC panel recommends that people over 74 years of age and 30 million frontline essential workers get COVID-19 vaccine first, with Monday’s expected approval of those recommendations being sent to states as guidance. CDC says that 556,000 people in the US got their first shot in the past week.

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Stanford Medicine medical residents and fellows protest at being mostly left out of its COVID-19 vaccine distribution plan, as only seven of the 1,300 made the list even though many of them are frontline COVID-19 caregivers. The health system and medical school apologized, explaining that their algorithm prioritized recipients based on work unit and age, but nobody noticed that house staff were skipped over because they don’t have an assigned location that indicates their involvement with COVID-19 patients. Stanford University is of course a globally recognized Silicon Valley center for AI excellence, but perhaps its humans – especially the non-executive ones — needed to be more involved in double-checking how its AI evaluates equitable access. 

In the UK, Boris Johnson imposes a full emergency lockdown of London and southeast England following the rapid spread of a new COVID-19 strain that is responsible for 60% of new infections, which doubled in London in the past week. The new strain is no deadlier and offers no new vaccine resistance and is therefore curious but not alarming to epidemiologists, but it does appear to be more contagious.

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A United Airlines passenger with COVID-19 symptoms dies on a flight from Orlando to Los Angeles, which his wife says he was able to board because he lied that he was symptom-free on the passenger declaration form. Three fellow passengers performed CPR for an hour until the flight landed in New Orleans after being diverted, and one of them is now experiencing COVID-19 symptoms.


Other

University Hospital (GA) says that hackers are attempting to penetrate its Epic MyChart system 550 times each day, while its email security system is rejecting 20% of incoming email due to security threats.

Seattle-area drugstore chain Bartell Drugs will pay $800,000 to settle DOJ charges that it failed to implement a computer system to verify prescriber licensure, which allowed pharmacists to fill 400 opioid prescriptions that were issued by doctors whose licenses had been suspended, some of whom had been sanctioned or indicted for federal violations. The chain is being sold to Rite Aid for $95 million.


Sponsor Updates

  • Pivot Point Consulting releases its new Quarterly Pivot report, focusing on trends to watch in Q1 2021.
  • Pure Storage makes available Pure as-a-Service in the AWS Marketplace, and launches its Cloud Block Store Efficiency Guarantee to improve cloud economics.
  • Zynx Health publishes a review of COVID-19 vaccine administration guidelines as the FDA authorizes emergency use of the Pfizer/BioNTech COVID-19 vaccine.
  • Meditech customer Sunderland Royal Hospital becomes the first hospital in the North of England to earn HIMSS Stage 7 recognition.

Blog Posts


Contacts

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

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Katie the Intern 12/18/20

December 18, 2020 Katie the Intern No Comments

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This week’s focus was on how healthcare has begun to change from a fee-for-service model to a value-based model for some providers. I interviewed Matt Lambert, MD, who has served as chief medical officer at Curation Health for the past two years. Dr. Lambert is a practicing provider who has also authored multiple books about healthcare. 

Curation Health is a technology and services company that helps healthcare providers and organizations transition from fee-for-service to value-based care, Dr. Lambert said. Curation Health uses tools to sort data so that providers can capture certain diagnoses for their patients. 

“Physicians never signed up to be data managers,” Dr. Lambert said. “So anything that we can do to help manage data and the regulation for them is usually pretty well received by providers.” 

I know that 99% of HIStalk readers probably know the difference between the two models of healthcare application, but as someone new to the IT field, I asked Dr. Lambert just how different they are. Value-based care reimburses on outcomes, while fee-for-service reimburses on volume, he said.

“The currency of value-based care is some very specific diagnoses that need to be made and need to be managed on a yearly basis in order for you to get compensation for managing the complexity of your patients,” Dr. Lambert said. 

As we talked about what Curation Health does, we also focused on how the pandemic impacted the trend of shifting to value-based care.

“This shift was happening already,” Dr. Lambert said. “The payers are always more nimble than the providers. Providers are lagging in the transition into this.” Health systems and providers are built on a system that requires month-to-month, short-term investments, but value-based care gets reimbursed yearly.

“Just by definition, you have to have the ability to look a year down the road and say, hey, we’re going to make some changes to our business model now, it’s going to pay off in a year,” Dr. Lambert said. “But most health systems aren’t created that way. They’re built off of fee-for-service models.”

Establishing reimbursement for care isn’t the only struggle that providers face when adjusting to value-based care. Dr. Lambert said providers also have to learn how to document their care differently, as well as work against the typical workflow of an EHR. The typical workflow is designed to have an output of an E&M code (evaluation and management, got it), which is a fee-for-service model component.

“One of the reasons why providers are struggling in the shift to value-based care is because we’re asking them to do something they weren’t trained to do with a tool that is not designed to do it,” Dr. Lambert said. 

The shift towards value-based care was implemented in 2008, and providers are still struggling to make the switch. I wondered how COVID-19 affected it.

Dr. Lambert said that COVID-19 slowed down the ability for providers to physically see patients in a face-to-face manner because in order to get credit for managing a patient, providers have to physically see them. That is, providers used to have to do so. 

Dr. Lambert mentioned that the initial shift to value-based care was driven by CMS (Centers for Medicare and Medicaid Services, noted). When the pandemic hit, CMS was quick to deregulate the rules for reimbursement through value-based care.

“Telehealth became eligible for a risk-adjustment visit for value-based care visit,” Dr. Lambert said. Here, telehealth strictly means a video visit, as “telephonic” visits do not qualify as value-based care as of now. Dr. Lambert said CMS removed the HIPAA compliance requirements for a lot of visits, allowing more access to patients and a wider medium for providers. 

Though moving to value-based care is not the easiest task, adjusting to this new system of care is important for providers. According to Dr. Lambert, it isn’t just a care-based adjustment, but also a business one. 

“This is how the payers are going to reimburse you, and moving forward, if you continue to do things the same way, you’re going to fall behind in the way you get reimbursed,” Dr. Lambert said. 

Dr. Lambert also said value-based care is set up to compensate for and incentivize different things. It is set up to incentivize information sharing and care coordination, which encourages patients to be engaged with doctors and their health. It does so in a way that encourages outcomes, not just in the idea that a patient has to come back the following week or month, he said. 

Overall, Dr. Lambert says value-based care will to continue to grow through commercial and public incentives. He said there will be a lag into 2021 due to all the closures and limited care from the pandemic. But afterwards, there will be an increase in utilization and in compensation. He isn’t sure exactly where value-based care is going, but did say telemedicine improved dramatically through COVID-19 and will continue to do so. Perhaps that intersection of telemedicine and value-based care will be a sweet spot in providing better care and compensation for all. 

“It’s not very often in our lives that we try something new until circumstances force us to do that,” Dr. Lambert said.

That’s it for this week! Thanks, HIStalk! 

Katie The Intern

Katie

Email me or connect with me on Twitter.

Weekender 12/18/20

December 18, 2020 Weekender No Comments

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Weekly News Recap

  • Verily announces a $700 million funding round.
  • Diameter Health raises $18 million.
  • Kyruus acquires HealthSparq.
  • Report: Amazon will expand its employee-only telehealth program to other companies.
  • Cerner acquires Kantar Health.
  • KLAS finds patient accounting from Epic and Meditech to be strong, Cerner and Allscripts less so.
  • Sonoma Valley Hospital notifies 67,000 patients of an October 11 ransomware attack.
  • CMS announces a rule that requires Medicaid managed care and insurers that sell products on the Exchanges to facilitate the exchange of patient data between payers.

Best Reader Comments

Where were the quality monitors and guardrails to catch unreported results within a reasonable timeframe? And incomplete and/or incorrect reports? I am very familiar with Epic configurations, so I know that the tools exist to provide this information internally to lab management from receipt of specimens through final reporting. No patient should have to rely on the repeated intervention of friends and/or surgeons to move the pathology process along (I experienced this myself many years ago, when a biopsy was not read for more than 2 weeks time, and it turned out to be positive for cancer; a physician friend had to intervene to get the final report released). (Witty)

I worked with an org recently that has their own application, completely over MyChart. Nothing that you see is Epic-designed and it’s missing lots of standard Epic features, but plenty of people still refer to it as MyChart. Drives the Epic team nuts, especially since it’s meant a ton of work on COVID features that could have been plugged in straight from Epic. (B)

Healthcare organizations have some structural problems to work through. There is a worker caste system in healthcare. An exceptional manager who happens to be an MA cannot manage mid level providers or doctors. Also, healthcare organizations have only recently grown to require management; much of healthcare used to be delivered by the owner-operator model and a major portion of the workforce still has not matured out of that mindset. This type of thing won’t change for at least another decade or two. The system as it exists is inefficient but can’t be changed. It will consolidate to avoid pressure until it can’t. Then competition and innovation will be able to start. (IANAL)

An issue I see here is, where is the incentive for the health system to improve? Yes, when I worked in HIT for 25 years we frequently reminded ourselves that it could be our loved ones being affected by what we do. But that never seemed to stick at some of the organizations we worked with. What other incentive is there? The biggest incentive is to keep the revenue coming in, which explains why the bills came through electronically just fine. Some good old competition in this space would go a long way. The question is how to effectively do that without compromising essential services (such as ED services and indigent care) that can’t be improved through a competitive process. When I got quotes on an MRI a couple years ago, the local academic center quoted me $6,000. I got it at a retail site for $600. Service was wonderful. (Bob)

[On COVID-19 passport-style apps] So how do you ID the right person? This will work well in countries that have unique person IDs (like China) , but we can’t have that in US. So will they use SSN? Some made up number? and what if it gets hacked and the hacker sells your ID number to a person not vaccinated? Or maybe the government is going to send you a ‘all clear’ text that you can display on your smart phone? But what if you don’t have a smart phone? I am curious to hear how all this will be worked out w/o an unique ID. (Frank Poggio)


Watercooler Talk Tidbits

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Marvel and Allegheny Health Network develop a “True Nurse Stories” superhero comic book.

A Vanderbilt study of EHR data finds that musicians are more likely to have vocal cord problems, hearing loss, anxiety, and depression, but are less likely to have heart disease, possibly due to the physical effort involved with performing.

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The president of the American Veterinary Medical Association assures anxious children that he has performed telemedicine checkups of Santa’s reindeer (noting that 30% of veterinarians are now using telemedicine versus 10% before the pandemic) and has cleared them for their Christmas Eve flight.


In Case You Missed It


Get Involved


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Morning Headlines 12/18/20

December 17, 2020 Headlines No Comments

Diameter Health Closes $18M Series B to Accelerate Vision to Improve Health Data Interoperability

Healthcare interoperability technology vendor Diameter Health raises $18 million in a Series B funding round, increasing its total to $30 million.

Verily Announces $700 Million Investment Round to Accelerate Key Businesses, Including Baseline and Verily Health Platforms

Verily will use a new $700 million investment to expand its work in clinical research, population health, care delivery, and chronic disease management.

H1 Closes $58 Million Series B Funding

H1, whose platform allows drug companies and health systems to target influential physicians, raises $58 million in a Series B funding round, increasing its total to $71 million.

Kyruus and HealthSparq Come Together to Transform Care Navigation Through Novel Payer-Provider Collaboration

Kyruus acquires the HealthSparq business of Cambia Health Solutions, which offers insurers provider search, cost estimates, reviews, appointment scheduling, and member rewards.

Sphere Acquires Patient Engagement and Revenue Cycle Management Platform, Health iPASS

Payments solution vendor Sphere acquires Health IPass, which offers patient engagement and RCM technology.

News 12/18/20

December 17, 2020 News No Comments

Top News

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Cerner will acquire the healthcare division of Kantar Group for $375 million in cash, hoping to expand its clinical research capabilities by selling real-world evidence to drug companies. 

Cerner says that Kantar Health’s annual revenue is more than $150 million.


Reader Comments

From Mark: “Re: Donors Choose. Remind me how I can donate.” Thanks for asking – I’m not comfortable asking for donations, but I’ll happily accept them and find matching money, including a guaranteed dollar-for-dollar match from my Anonymous Vendor Executive (you’ve seen me mention AVE’s matching for years, so imagine how much money they have provided to make this possible while insisting on anonymity). Instructions:

  1. Purchase a gift card in the amount you’d like to donate.
  2. Send the gift card by the email option to mr_histalk@histalk.com (that’s my Donors Choose account).
  3. I’ll be notified of your donation and you can print your own receipt from Donors Choose for tax purposes.
  4. I’ll pool the money, apply all matching funds I can get, and publicly report here which projects I funded, including teacher follow-up messages and photos.

HIStalk Announcements and Requests

My Gmail account was among the many that failed sporadically in the past few days, so if you sent me something and are wondering if I received it, feel free to resend. I also realized today that Gmail lost POP3 sync three days ago, probably due to the same outage, so it wasn’t catching up.

IPhone tip: if your charging cord seems loose or doesn’t connect reliably when you plug it into the phone’s jack, it is almost certainly a dirty port instead of a damaged one (especially if you carry your phone in your pocket). Just use a wooden toothpick to clean the schmutz out the port and be amazed by: (a) how solidly your cord now connects; and (b) how much stuff was impacted in that tiny space.

I checked the HIMSS21 exhibitor floor plan and it’s light on booths, with just 383 companies coming up in the exhibitor list versus the usual 1,300 or so. Quite a few booths are simply marked “on hold” and are presumably spoken for, some of those being big spaces right by Epic’s. The industry usually hits frantic activity levels right after New Year’s with the realization that the HIMSS conference is not far away, but I assume it will be eerily quiet this coming January.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Healthcare interoperability technology vendor Diameter Health raises $18 million in a Series B funding round, increasing its total to $30 million.

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Business Insider reports that Amazon will expand its employee-only Amazon Care pilot project for online visits to other large employers. BI says that Amazon hasn’t had any luck hiring salespeople, including three it was recruiting from Doctor on Demand, and implies that effectiveness has been limited because of internal competition between Amazon Care and its Haven joint venture.

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Curai Health, which offers an $8 per month chatbot-powered primary care service that is available only in California, raises a $27.5 million Series B funding round, increasing its total to $57 million.

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H1, whose platform allows drug companies and health systems to target influential physicians, raises $58 million in a Series B funding round, increasing its total to $71 million.

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Kyruus acquires the HealthSparq business of Cambia Health Solutions, which offers insurers provider search, cost estimates, reviews, appointment scheduling, and member behavior rewards.


Sales

  • Hendrick Health will deploy 2bPrecise for its cancer care precision medicine program.
  • State of Franklin Healthcare Associates chooses Emerge to optimize its Allscripts Professional EHR with solutions for search, population health management and emergency access.
  • Mount Sinai Health System will implement remote patient monitoring technology from Current Health for the at-home recovery of its cancer patients.
  • The VA will implement MDClone’s data discovery platform.

People

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UC Davis Health hires Ashish Atreja, MD, MPH (Mount Sinai Health System) as chief information and digital health officer.

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David Miller, MHSA (HCCIO Consulting) joins Bahrain’s American Mission Hospital as CIO.

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SOC Telemed promotes Hai Tran, MBA to president / COO and hires Chris Knibb (Agilis Systems) as CFO.


Announcements and Implementations

Alder Hey Children’s Hospital becomes the first hospital in England to allow NHS 111 operators to schedule patient appointments in a hospital’s EHR, in their case Meditech. The CareConnect-compliant solution also allows the operators to add their own caller notes in Meditech and supports the NHS’s support of NHS 111 as the first line of defense for managing ED capacity as COVID-19 demands increase.

Allscripts announces Sunrise 20.0, which includes the option for Microsoft Azure hosting.

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Clinical surveillance platform vendor VigiLanz launches software to manage hospital mass COVID-19 and flu vaccinations, available at no cost to customers.

Black Book announces its top-ranked vendors in RCM software and services. Software winners include Optum, Waystar, AdvancedMD, Hayes, and Avadyne, while its top outsourcing companies are Optum360, Parallon, Ensemble Health Partners, R1 RCM, and Athenahealth.

Wolters Kluwer Health launches Reference Data Management for Claims Processing, a Health Language solution to help health plans keep claims processing systems updated.

Payments solution vendor Sphere acquires Health IPass, which offers patient engagement and RCM technology.

Home health, hospice, and palliative care EHR vendor MatrixCare adds voice recognition technology for provider documentation.

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A new KLAS report on patient accounting solutions finds that Epic leads with the most functional solution, Meditech’s product is seen as sturdy and reliable and has the highest customer satisfaction, Cerner’s customers are “deeply discouraged” as promised improvements haven’t materialized, and the patient accounting solution of Allscripts is “not ready for prime time” despite sales rep promises.


COVID-19

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Wednesday’s COVID-19 records include 113,069 Americans hospitalized and 3,400 new deaths. The overall US death count is now at 308,000, exceeding the country’s combat deaths in World War II.

Moderna’s vaccine got a 20-0 thumbs-up from FDA’s external advisory panel, making it likely that FDA will grant Emergency Use Authorization Friday to bring a second vaccine to market. 

Pfizer will remotely disable the GPS-connected temperature monitoring sensors that are embedded in its vaccine shipping packages once they have been delivered, leaving providers unable to determine if the doses have thawed during storage at their own sites. Operation Warp Speed paid a company $25 million to develop a temperature monitoring system, which the contract says will be turned off by Pfizer upon delivery and then turned back on by the federal government for monitoring. HHS has not disclosed how that monitoring handoff will occur.

A San Diego judge grants an injunction that prohibits the county from shutting down strip clubs under new stay-at-home orders, also giving restaurants (with uncertain authority) the green light to reopen. The judge says that no evidence exists that restaurants that operate under health and safety restrictions increase COVID-19 spread. He also ruled that strip clubs and restaurants “enliven the spirits of the community” and provide income to employers and employees.

Orange County, CA suspends ED diversion, noting that every hospital is over capacity due to COVID-19 and ambulances would have no available EDs for emergency patients.

Pharmacists discover that Pfizer vaccine vials contain enough overfill to squeeze a sixth or even a seventh dose from a five-dose vial, with FDA giving its approval to use all full doses from a single vial but warning against combining the contents of multiple vials.

The New York Times notes that some of the people who were spreading election misinformation online have moved on to publishing lies about COVID-19 vaccine on social media, including conspiracy theories about government surveillance, implanted microchips, and their belief that Bill Gates created the virus and is profiting from it. Experts say that purveyors of political misinformation are choosing other controversial topics to keep themselves in the limelight with the same audience.

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FDA gives Emergency Use Authorization to an a no-prescription, at-home quick test for COVID-19. Australia-based Ellume, which developed the test with a $30 million NIH grant, plans to deliver 20 million of the $30 tests in the first half of 2021. FDA recommends that symptom-free people who test positive confirm their results by taking a different kind of test.

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UCI School of Medicine’s Center for Artificial Intelligence in Diagnostic Medicine creates an online tool to predict if a COVID-19 inpatient will need ventilator support or admission to the ICU.


Sponsor Updates

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  • Jvion donates toys to Children’s Healthcare of Atlanta.
  • Fortified Health Security publishes the “2021 Horizon Report,” highlighting COVID-19’s impact on healthcare’s cybersecurity infrastructure in 2020 and what’s to come in 2021.
  • Glytec publishes the results of a new study, “Association Between Achieving Inpatient Glycemic Control and Clinical Outcomes in Hospitalized Patients with COVID-19: A Multicenter, Retrospective Hospital-Based Analysis.”
  • Investor Refinery Ventures profiles Halo Health.
  • Healthcare Triangle releases a new case study, “Fort Madison Improves Resiliency of Meditech EHR Through HTI’s Backup and Disaster Recovery Powered by AWS.”
  • Healthwise donates to the Wassmuth Center for Human Rights after the vandalism of its Anne Frank Human Rights Memorial.
  • Imprivata joins Google’s Modern Computing Alliance.
  • Meditech adds a new FAQs page to its COVID-19 vaccine guidance.
  • Home care software vendor Axxess offers its customers integration with the Surescripts health information network.
  • PerfectServe announces that its Optimized Provider Scheduling, powered by Lightning Bolt,  is available on Epic App Orchard.
  • England’s Chelsea and Westminster Hospital adds patient-friendly discharge reports to its Lumeon-powered postnatal digital solution.

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 12/17/20

December 17, 2020 Dr. Jayne 1 Comment

I was excited to see joint press releases this morning from Abbott and EMed regarding FDA Emergency Use Authorization for their at-home COVID antigen test solution. The test is the Abbott BinaxNOW test, which is being used in schools and physician offices. According to the release, they plan to deliver 30 million tests in Q1 2021, with another 90 million in Q2. It’s the lowest priced at-home test and involves performing the test in front of a live EMed supervisor via video. After testing, Abbott’s Navica app will deliver a digital testing certificate, which may be used by employers or venues as evidence of a recent negative antigen test. The solution is approved for age 15 and up and a prescription is required.

Even though antigen testing isn’t the same as the gold standard PCR test samples collected in physician offices, it would certainly help keep people at home rather than being out and about. At our practice, we’re using a technology solution to manage a virtual waiting room so that people stay in their cars or return home to wait, rather than crowd a waiting room.

One unintended consequence is people running errands while they “wait” for their visit. It’s difficult to get the public to understand that if they have had a concerning exposure for COVID or are having symptoms, they shouldn’t be exposing other people through errand running. We’re also still struggling to get patients to keep masks on during their visits despite signage and education. I’d say one of every four rooms I walk in has a person with their mask down, often talking on the phone, which has the risk of spreading droplets and aerosolized particles. If anyone has better solutions to these problems, I’m open to suggestions.

Our practice went live with a new patient education vendor this week and it’s been a blessing and a curse. I really like the new content which has both regular and easy-to-read versions and it’s much more practical than our previous vendor. On the downside, there was a glitch in mapping the content to the existing order sets, so providers are having to manually add the patient education documents to each patient plan. They’re trying to get it fixed, but it’s frustrating. I haven’t had a scribe in many shifts because so many of our staff members are out sick right now, so it all falls to the providers to fix.

We also had a radiology system outage today, which happened as I had several CT scans in the process of being read. Fortunately, the images had already been sent to the radiologists and I was just waiting on readings, rather than having my scans stuck upstream in the process. Because patients are still having difficulty getting in to see their primary care physicians and their other usual caregivers, they are winding up in urgent care. One of the scans in question revealed a tumor which is likely cancer, based on the presence of metastatic-appearing lesions. The patient had waited three hours to be seen because there were so many COVID-related patients in front of her, and I put the entire office on pause while I sat with her to discuss the diagnosis. It was a humbling experience and I was surprised at how well she coped with the news, but I’m sure it would have been better coming from her trusted family physician rather than me.

COVID vaccinations have begun in earnest across the US. In most areas, vaccine has been allocated to major health systems and hospitals. Our area began vaccinating Monday, and it became quickly apparent that despite our city having a Regional Pandemic Coalition, that once the vaccines started, arriving everyone was doing their own thing. One health system is vaccinating strictly by age, oldest first. Another is vaccinating by service line, trying to prioritize ICU and emergency department workers. A third is vaccinating seemingly at random, with several of my friends in their 30s who have no chronic health conditions or risk factors and who don’t even see COVID patients being vaccinated on the first day. I understand allocating vaccines to the organizations that have capacity to get shots in arms, but it’s not going to help the overall cause as much as it could if the scarce vaccines aren’t going in the arms of the people for whom they would provide the greatest benefit.

My practice still has no idea when we will receive vaccine, despite diagnosing 500 COVID patients every day. Since we’re not part of a hospital or health system, we were overlooked in the initial allocation. I don’t think those making the decisions understand how much pressure that urgent care centers have taken off of the hospitals as we serve on the front line. My group sees close to 2,000 patients a day, 365 days a year. We’re constantly having staffing shortages due to people being out with COVID. It’s a shame that the players couldn’t figure out a way to work together and are just looking out for their own without much consideration of the regional healthcare ecosystem.

I knew it was going to be this way, but to be honest, I underestimated the emotional impact that seeing friends and colleagues getting vaccinated would take on me. Reaching out to a national physician forum for support, it turns out that urgent cares have been overlooked in many states. We’ve seen large-format newspaper headlines that “Hope Is On The Way,” but some of us feel pretty hopeless and helpless. I had to stay away from social media this week because after a 13-hour urgent care shift, I just couldn’t process the joyous pictures of people with bandages on their arms without feeling anger and despair.

This is what having no national strategy gets us, a patchwork arrangement where some high-risk workers are still shouldering a disproportionate amount of the risk burden. Some states are doing better than others, but my state can’t even figure out how to put page numbers on its 100+ page vaccination plan, so I’m not confident about their organizational ability.

What grade would you give your state for vaccine allocation? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/17/20

December 16, 2020 Headlines No Comments

Medical-data company Flywheel nearing goal on $15M Series B

Minneapolis-based medical research informatics startup Flywheel raises $14 million of a planned $15 million Series B funding round.

Cerner Announces Agreement to Acquire Health Division of Kantar

Cerner will acquire data, analytics, and real-world evidence and research consulting subsidiary Kantar Health for $375 million in an effort to help its customers more effectively engage in clinical research.

Khosla-Backed Health AI Startup Raises $27.5 Million To Supercharge Primary Care

Chatbot telemedicine startup Curai raises $27.5 million in a Series B funding round led by Morningside Group.

Workit Health, a digital rehab startup, raises $12 million

Workit Health raises $12 million in a Series B round of funding that will enable the addiction treatment telemedicine startup to expand beyond the five states it currently serves.

Morning Headlines 12/16/20

December 15, 2020 Headlines No Comments

67,000 hospital patients notified about data breach

Sonoma Valley Hospital (CA) notifies 67,000 patients of an October 11 ransomware attack that may have compromised patient information.

ConsejoSano Raises $17 Million in Series B Funding To Support Technology-Based Solutions That Help Reduce Health Disparities Among Multicultural Populations

Multicultural patient engagement software vendor ConsejoSano secures $17 million in a Series B financing round led by Magnetic Ventures.

TransUnion and Socially Determined Partner to Improve Health Outcomes By Using SDOH Data & Analytics

TransUnion Healthcare announces an undisclosed investment in and commercial partnership with social determinants of health risk analytics company Socially Determined.

News 12/16/20

December 15, 2020 News No Comments

Top News

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Sonoma Valley Hospital (CA) notifies 67,000 patients of an October 11 ransomware attack that may have compromised patient information.

The breach, which forced the hospital to take its computer system offline for several days, is SVH’s second cybersecurity incident in less than two years. Hackers hijacked the hospital’s website in August 2019, forcing it to change its domain.


Reader Comments

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From Frankly Speaking: “Re: Tim Kelsey. Has left HIMSS after one year to take up a CEO post of a boutique agency in Sydney, Australia. He was SVP of international analytics after leaving the Australian Digital Health Agency with a few loose ends. His deputy at ADHA, Ronan O’Connor, joined him at HIMSS in October and now his boss has moved on.” Kelsey’s LinkedIn says he left HIMSS this month to become  CEO of Pacific Knowledge Systems.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Precision medicine, analytics, and data-licensing company Tempus will use a $200 million investment to expand its work beyond cancer to infectious diseases, depression, and cardiology. The Chicago-based company has raised over $1 billion and achieved an $8 billion valuation.


Sales

  • Crook County Medical Services District (WY) selects EHR and RCM software and services from CPSI and its TruBridge subsidiary.
  • HealtheConnect Alaska will implement real-time care transition and coordination software from Collective Medical.
  • One Health Solutions will use Get Real Health’s patient engagement software as part of its health program for several coal mining communities in Pennsylvania.

People

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Provation names Bill Franck (Elsevier) chief sales officer.


Announcements and Implementations

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Dina develops a post-acute care bed availability service to help case managers find PAC facilities that have room for COVID-19 patients.

Audacious Inquiry adds patient medication history data from Surescripts to its PULSE Enterprise platform, which gives providers access to medical information for patients in times of emergency.

Chi Arthritis & Rheumatology goes live on Saykara’s mobile voice assistant, increasing patient capacity by 15% and eliminating after-hours charting.


COVID-19

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Another COVID-19 hospitalization record was set Monday at 110,549 inpatients. Arizona and Nevada have the highest hospitalizations per million residents.

A new poll finds that nearly 25% of Americans probably or definitely won’t take a COVID-19 vaccine, with the highest percentage of skeptics being Republicans (42%), those aged 30-49 (36%), rural residents (35%), and black adults (35%). One-third of essential workers say they will pass on being vaccinated, as do 29% of people who work in healthcare delivery. The biggest concerns are side effects, lack of trust that the government will ensure safety and effectiveness, the vaccine’s newness, and the role of politics in their development.

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FDA’s review of Moderna’s COVID-19 vaccine finds it to be protective, according to data distributed Tuesday, with FDA’s Emergency Use Authorization of the second vaccine expected Friday and injections to begin on Monday. The Moderna vaccine’s efficacy rate was 94.5% with the usual expected but not dangerous side effects. The trials data also showed that the vaccine group had two-thirds fewer virus-positive nasal swabs, suggesting that it prevents some asymptomatic infections after just one dose. The data also noted that zero of 3,500 vaccine group patients who were over age 65 became infected, a performance similar to that of the Pfizer vaccine that gives hope that the products can stop long-term care deaths quickly.

The federal government has contracted for 300 million doses of the two vaccine products through Q2, which with the two-shot regimen is enough for less than half of Americans.

Two dozen companies are working on at-home rapid tests for COVID-19, many of them connected to smartphone apps that provide instructions and data reporting, but FDA requires them to be sold only with a prescription.

Former FDA Commissioner Scott Gottlieb says that while recent COVID-19 case spikes haven’t been as dramatic as he expected, the case peak won’t occur for three more weeks, while the highest pressure on health system and patient deaths won’t be seen until the end of January.

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Google offers an end-of-year update on the adoption of the exposure notifications system it developed with Apple earlier this year, touting the fact that more than 50 countries, states, and regions have rolled it out as part of their public health apps. Adoption in the US is likely not as high as public health officials would like, with only Colorado (20%) and Washington, DC (53%) meriting mentions. Uptake in the UK has reached 40%.

DocASAP announces GA of its COVID-19 Vaccination Coordination Solution, including online appointment scheduling and reminders, pre-appointment messaging, and post-appointment wellness tracking.

Walgreens and CVS will require long-term care residents in Washington to sign a paper consent form and provide photocopies of their insurance cards before their employees administer COVID-19 vaccines. They will also make just three trips to each facility in a two-month period, making it more likely they will miss employees who are not at work.


Other

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San Antonio’s city government will use telemedicine to triage some 911 callers, making sure that an ambulance is truly needed before dispatching one. The rollout uses technology from UK-based GoodSAM, which allows callers to share their location and live video without installing an app. The company uses AI to measure heart rate from the video at what it says is a 92% accuracy rate.

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The University of Kentucky profiles UK HealthCare’s Enhanced Care through Advanced Technology Intensive Care Unit, which acts as a remote patient monitoring command center for 168 beds across two of the health system’s hospitals. ECAT ICU nurses use six or seven stations with eight monitors each to help bedside nurses stay abreast of vital signs and lab results, and help to perform urgent assessments based on real-time data.


Sponsor Updates

  • Cerner releases a new podcast, “One year later: Fighting COVID-19 in Asia.”
  • Good Morning America features Change Healthcare in a segment on COVID-19 vaccination passport apps.
  • Ellkay VP of Interoperability Solutions G.P. Singh joins the Carequality Advisory Committee.
  • Lumeon’s COVID-19 Remote Home Monitoring Solution earns a best new healthcare and medical product in the 2020 Best in Biz North America Awards.
  • PM360 magazine recognizes OptimizeRx’s TelaRep virtual communication solution as one of the most innovative product for life sciences.

Blog Posts


Contacts

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

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Morning Headlines 12/15/20

December 14, 2020 Headlines No Comments

Pair Team Secures $2.7M to Build Primary Care Operations Infrastructure

Automated patient engagement software startup Pair Team raises $2.7 million in seed funding from Kleiner Perkins, Craft Ventures, and YCombinator.

Cityblock Health Raises $160M Series C to Address Systemic Healthcare Inequity

Community care provider and software developer Cityblock Health wraps up a $160 million financing round that brings its valuation to over $1 billion.

Blueprint Maps Out Data-Driven Mental Health Platform With $3.4M Seed

Blueprint will use $3.4 million in seed funding to further develop its assessment, analytics, and reimbursement software for mental healthcare providers.

Curbside Consult with Dr. Jayne 12/14/20

December 14, 2020 Dr. Jayne 18 Comments

I’ve written a couple of times recently about some healthcare misadventures. The first story involved a delay in care due to COVID-related office shutdowns and the subsequent fallout when a close friend of mine ended up with an abnormal cervical cancer screening test. A couple of weeks later, I mentioned a glitchy pathology results interface that failed to send out results in a timely fashion, leading to delays in notifying patients of their results and subsequent delays in follow up for abnormal findings. I had the physician’s perspective for that one, feeling my colleague’s angst as she had to notify her patients of their delayed results. I also felt her frustration at her healthcare IT team’s poor management of the situation and the potential impact on the patients whose results were delayed.

I had hoped to not encounter any further stories like these in 2020, because heaven knows we’ve had enough stress, challenges, and outright disasters this year. Unfortunately for my friend the patient, her story has continued, and not in a good way. Although we’ve been talking about it on a daily basis in text messages, emails, and screenshots of her MyChart account, she has given me permission to write about the episode as a cohesive story.

Although I’m glad that I’ve been able to provide support and help her navigate the system, the reality of this is that none of it should have happened, and there should have been better systems in place to protect the patient.

Following the initial abnormal test, she went through an office-based biopsy procedure and waited more than two weeks for her results. The delay which was attributed to a continuing backlog in the hospital’s pathology department following some COVID-related furloughs. Although her surgeon expected some degree of abnormality, the result revealed a significantly worse problem that required further surgery and additional biopsies.

The scheduling process was frustrating due to ongoing games of phone tag and the perceived need for real-time communication rather than using email or text to schedule. My friend voiced her frustration: “I don’t know why they can’t just text me the open times. I’ve given them permission and it’s not like they’re talking about anything medical. It’s about as confidential as scheduling to rotate my tires.” Throughout this, her sense of humor has stayed largely intact, but reading statements like that gave me a hollow feeling in my gut as I had a ringside seat to watch the brokenness of the US healthcare system play out.

Instead of sending pre-procedure instructions and patient education via MyChart, the office sent them via postal mail. They were delayed by issues with the postal service that were likely related to the run-up to the US general election. When they finally turned up two days before the procedure, she was glad to confirm what she had already read via Google, but was still baffled at why the health system can send her bill through MyChart but not other items: “I mean seriously, they send me a bill in MyChart two days after the visit before insurance has even paid, but they can’t send me the important stuff like patient ed?” I agreed with her assessment, but didn’t know how much this statement would come into play later.

Finally, procedure day rolled around. Although I was able to drive her, due to COVID, she had to go by herself with no support person. Many in healthcare overlook the impact this has on our patients. She was definitely a little off when she got back in the car, and apparently she’d had an atypical reaction to one of the medications and was having some lingering effects from that. Although I understood as a physician why the rules are the way they are, as a friend, it didn’t seem to be the best thing for the patient to let her leave the facility the way she did. I went through a similar solo experience at my recent colonoscopy and they at least called my driver to pick me up at the door and made sure I got into the vehicle in one piece.

Her surgeon told her that pathology was still backed up and to expect a two-week turnaround for the results. She describes those two weeks as “eternal” from the patient side and joked that they should have tracking on the pathology specimens like online shopping: “Imagine it! You could get an email that said we’ve received your order, then we’ve received your biopsy jars, and it could just go through the whole process. We’ve prepared your slides! You’re next under the microscope! We’re writing your results! We’ve sent your results to your doctor!” It would be funny if it wasn’t so true that patients have more understanding of the flow of goods through Amazon then they do with regards to critical tests affecting their health. Putting on my vendor / consulting hat, I’d love the opportunity to write those messages, if anyone is interested.

She also lamented the fact that during those two weeks, she received numerous messages in MyChart about “complete nonsense that has no bearing on whether I have cancer or not.” Apparently, there were two more billing messages, along with several broadcast messages regarding COVID screening and the availability of telehealth visits at the university medical center. She had a good point: “Why can’t they set this up with a different notification if it’s something important versus something generic? All the emails just say there’s a new message in the chart. It could still be HIPAA friendly – ‘you have a new message in your patient chart’ means it’s about you, and ‘you have a general message from Big Health System’ means your heart can stop racing.”

We joked about taking it further to modify the notification sound on your phone, to a gentle “whoosh” for regular messages, an alert siren for the big stuff, and a cash register noise for the billing messages. We also thought about the ability to snooze general messages for 30 days just like we can snooze annoying Facebook friends.

Almost two weeks to the day, she received a text from her doc: “Path back, margins clear, all good, will send in MyChart” which she forwarded to me, followed by a copy of her doctor’s note and the report. I saw something odd on my first reading of the report, and after re-reading it half a dozen times, I knew I had to call her. It wasn’t in fact all clear, but there was a mismatch between the summary portion of the report and the actual microscopic description of the slides. The translated version is “all the cancer is gone, but cancer is present.” She messaged her doc, who agreed to call the pathology lab to have the slides and report reviewed.

Cue more waiting time, as the lab was vague on how long it would take for a repeat reading. As a good friend, and without naming any names, I reached out to a pathologist who works in the same health system to ask about the process. She was shocked that the report went out, since there was supposed to be a human review of all reports to make sure nothing like that was released. She also told me that re-reads are supposed to be done the same day.

Three days had passed and finally it took another phone call from the surgeon to get things moving. According to my friend, “that lab is in shambles due to COVID cases and quarantines.” She also noted that errors have been on the rise across her system since they replaced the human transcriptionists with voice recognition software, which is why they instituted human review. Although I sympathized with the quarantine and technology issues, I was still shocked at what a mess was going on within the healthcare organizations that we rely on.

After the surgeon’s second phone call, an amended report showed up at 11 p.m. Fortunately, my friend’s doctor was still up working her inbox when it hit, and my friend was still up as well. I was up too, and she texted it over. We chatted the next morning, and although the amended report was reassuring, she still didn’t know if she should trust the lab “since after all, this is just my life, right? They can’t even proofread?”

It’s a good point, and I encouraged her to ask for the samples to be sent to an outside pathologist for a second read, which she did. The overread took another two weeks. Personally, I think the first lab should absorb the cost of the overread since it was their error that triggered it, but I’m sure she’ll be getting a bill. At least though she has peace of mind that the reading is accurate.

Although she has received a reprieve for the next several months, there is still more testing to come. Even if all is good, she will be looking at ongoing followup for a few years. I hope that by the time she goes through this again that the systems have recovered to the point where she doesn’t have to endure anything near what she went through last time.

Many of the factors influencing these outcomes can be laid at the feet of the relentless cost-cutting that is everywhere in healthcare. As a clinical informaticist, this story is going to haunt me for a long time, because some of the work we’ve been collectively involved in is designed to prevent incidents like this debacle. Although we push hard to try to make things more patient-centric, money always gets in the way, not to mention the impact of a global pandemic. There are lessons to be learned here:

  • Patient self-scheduling can be an OK thing as long as there are guardrails around it, even for procedures. I’ve helped clients do it, and they’ve not only survived, but thrived.
  • It is unclear why a practice would send paper patient instructions to a patient with an active MyChart account, especially during a time of elevated concern about the US Postal Service.
  • COVID is going to be with us a long time, and we need to think out of the box on how to get patients the support they need when they’re engaging with healthcare institutions. Asking them to go it alone isn’t the answer, even if they appear young and healthy.
  • Hospitals are penny-wise and pound-foolish, and that’s not likely to change.
  • Amazon does a better job communicating about the status of a laundry detergent purchase than hospitals do regarding life and death matters.
  • Voice recognition software may be cheaper than human transcriptionists, but cost isn’t everything.
  • No matter what the technology is, human error still occurs, and multiple people missed the mismatch in the report including her surgeon. Not everyone has a friend who is a doctor to provide an additional line of defense.
  • Communication is EVERYTHING.

No matter where you are in this industry, please think about this story and think about how it impacts you professionally and also personally. If this patient were your mother, your sister, your daughter, or anyone you care about, is this how you would want it to play out? Regardless of who we work for, our ultimate customer is the patient, and doing what’s right by them should always be in front of us.

How does your organization tackle some of these missed opportunities? Leave a message or email me.

Email Dr. Jayne.

HIStalk Interviews Luke Bonney, CEO, Redox

December 14, 2020 Interviews 1 Comment

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

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Tell me about yourself and the company.

Redox is the world’s leading cloud integration platform for healthcare. We help great healthcare technology companies integrate with thousands of providers on our network. We accelerate the adoption of these tools at healthcare organizations across the country. We are live or installing at 19 of U.S. News & World Report’s top 20 health systems across the country.

I am first a husband and then a father of two. Zeke is our son. He’s two and a half. Leona is our eight-week-old daughter. Our chocolate lab is Leroy. We call Madison, Wisconsin our home.

Large health IT vendors are partnering with cloud services such as those offered by Amazon, Google, and Microsoft. What opportunities or challenges does that introduce?

We see that as a massive opportunity. We see healthcare embracing the cloud as a key to the overall realization of bringing technology innovation into this space.

The whole bet of Redox from the very beginning  has been on the cloud. When we got started back in 2014-2015, we had to say “no” 100 times in order to get one “yes.” That was because we refused to compromise on that vision of the cloud being a key component to what healthcare was going to need in the future. We saw that initial inflection point of healthcare as an ecosystem getting more comfortable with the cloud sometime in late 2017 and early 2018. That’s been a big trend that has accelerated Redox and all of our customers.

As provider organizations pick and choose the technology that they see as adding the most value, a a greater and greater percentage of those companies that they work with are cloud native. Whether they are hosted in the cloud or not, they are cloud native. More and more of them are SaaS based, fully managed services that they pay a subscription for. We see that as a massive change that will allow healthcare to catch up to how the rest of the world sees the technology and innovation sector working.

The industry’s news is filled with unfamiliar company names that are creating buzz and investment activity. How much of that was driven by technology advances versus business needs?

Digital health as an investment sector has been growing at an accelerated rate for the past five to seven years. That’s a predictable extension of what we have seen over the past four to five years, with an accelerant being that the world now has a clearer understanding of the importance of technology in healthcare. That’s because so many of us have come face to face with it as part of COVID. How many people have had their first video visit with a doctor, or scheduled online for the first time with their doctor, because of COVID?

The trend has been pretty consistent. The difference in 2020 has been that we’ve seen a lot of investment come from outside of healthcare. People who haven’t historically invested in healthcare and digital health are starting to write pretty major checks. That goes hand in hand with provider organizations being more comfortable purchasing tools, purchasing technology, that is hosted and built in the cloud.

The big EHR vendors don’t get most of the splashy headlines or credit these days, but their decision to open up their systems fueled these other capabilities in allowing these upstarts to connect. How do you see that model playing out?

Redox has always had a vision that healthcare is best served when there’s a thriving ecosystem of technology and tools, whether we’re acting as patients, providers, or administrators. Single, large incumbents can solve many of healthcare’s problems, but they will never be the best at solving a long tail of what those problems could look like.

We’ve always had a vision that the role of the EHR will always be critical. There will always be a core need for data. There will be a core need for closed loop workflows. But we also see what we’ve experienced so far, which is the explosion in third-party applications that add significant value, that have targeted tools, that have targeted workflows. Regardless of the incumbents or the situation, we’ve always seen the demand for this kind of thriving ecosystem.

This is where our vision and that of regulators are aligned. We need an open and thriving ability to integrate data, wherever that data might be. We are excited about where the 21st Century Cures Act and TEFCA, these big pieces of legislation, are pointed. This is what the industry needs and what we have been building towards all along. We see it as a significant accelerant to what we do and to our ability to help a growing number of customers.

What impact will result from the Cures Act’s API requirement?

The exciting thing is that it is already changing the industry. A lot of the major EHR vendors who are at the center of this regulation are moving faster than expected. There are major pushes to enable FHIR endpoints and to help large provider organizations turn them on and start to use them. We’ve seen a number of delays in the enforcement of things like information blocking and some of the API mandates, and those delays make sense given the impact of COVID, but we see some of the major groups in this space leading that instead of lagging behind.

What that means for us as people who focus on integration is that we’re seeing a slight uptick in the total number of integrations that we can support as we embrace FHIR. FHIR won’t be a panacea that solves all the different problems and there’s a ton of complexity that remains, but it is definitely a step in the right direction. We are focused on that.

We’re also excited about looking at the opportunity that the Biden administration has, specifically looking at TEFCA, which is not yet finalized. There’s an opportunity to put some real teeth into TEFCA. How do we build this idea of a network of networks where data can really be liquid? As we look at TEFCA and understand the world that it contemplates, we get excited about how that could accelerate the overall adoption of technology in healthcare.

Where the regulators are pushing the industry is highly aligned with where we think things need to go. We are positioned to be helpful and to continue to provide great service to our customers.

What interoperability shortcomings has the pandemic exposed?

We saw demand for healthcare technology narrow dramatically in March, April, and May. The digital health and healthcare market is like 30 technology categories, and about 25 of those were put on hold, while five had unprecedented demand — telemedicine, remote patient monitoring, anything related to diagnostics, anything related to automation where folks could save money. While there was this extreme narrowing of demand, the urgency was unlike anything we had ever seen. We were putting integrations into place that would typically take six weeks in 3-5 days because of the clear need for those technologies

One of the most amazing things we experienced back in Q2 and Q3 was the sense that everybody was willing to pitch in. Everybody understood how dire the situation was. We brought together 15 applications from 15 vendor customers of ours and offered a free package to healthcare organizations that includes the tools that they could need or would need to combat COVID-19. Everybody was clear on what we needed to figure out with incredible urgency.

We also saw, and this talks directly to some of the current archaic methods of integration, that we had to make a big shift, because there was clear demand to do types of integration that we’d never done. Our historical bread and butter is helping technology organizations integrate with provider organizations and their EHRs. What we got asked to do was to work more with groups like LabCorp to support lab workflows.

We also had customers who needed to be able to report COVID results to public health agencies at the state level across the country, so in about two and a half or three months, we built infrastructure in 48 out of the 50 states to report COVID results. We built it because it didn’t exist. We didn’t want to. We would have used things had they already been there, but we built it because it didn’t exist. For Redox customers that are providing COVID testing capabilities, we are processing 10% of all the COVID tests in the country, looking at the volume of results messages that come back across our platform. That’s number one. It’s super interesting.

We are thinking about whether the same infrastructure that we put in place to support a lot of this diagnostic testing can be valuable or helpful as we look at rolling out this massive vaccine work, which will include administering and tracking vaccine distribution.

We’ve seen a lot of change. We are doing integrations that we’ve never done. We are doing it at scale. It has all been because we, along with everybody else, have felt that we have a role to play in helping the country and the globe come back from COVID-19.

How does the changing demands, employees working from home, and your significant investment funding guide you in planning what happens with the company next year?

There’s an art and a science to that question. This is a big part of what we have been focused on. The first is taking this view of how we can support those different categories of technology. One of the big things we will be doing in 2021 is sharing much of what we’ve learned over the thousands of integrations we’ve done, offering those as packages to our customers so that they can go so much faster. If there’s one thing we learned in 2020, it’s how to do things faster than we’ve ever done them. We want to share that learning.

The second big thing is that we are excited about a couple of our big partnerships. We are working with Salesforce as one of the only certified integrators to help stand up and streamline integration into their Health Cloud product. We recently announced a partnership with Amazon Web Services, speaking of cloud hosting providers. We are making it a lot easier for anybody who is either  using AWS or planning to purchase AWS to use Redox and to purchase it straight off the AWS marketplace.

The third thing is the exciting announcement that we will be talking about in February. I can’t tell you what it is because my marketing team would be very upset with me, but you should come check out our event in February, where we will talk about some product work that we will be releasing.

Do you have any final thoughts?

2020 has been a remarkable year. We have seen a lot of collective pain and suffering, but it is inspiring to see how parts of society have responded. We were inspired by all the work folks are doing as it relates to social justice and Black Lives Matter. We are inspired by the speed at which the global workforce adopted working from home. We are inspired by how quickly healthcare adapted as COVID took hold.

I would just end by saying that 2020 has been a really long year. Here’s to a great 2021.

Morning Headlines 12/14/20

December 13, 2020 Headlines No Comments

Reducing Provider and Patient Burden, and Promoting Patients’ Electronic Access to Health Information

CMS announces a rule that requires Medicaid managed care and insurers that sell products on the Exchanges to facilitate the exchange of patient data between payers.

eHealth Technologies Announces Expansion in Virginia

Medical record retrieval and image-sharing company EHealth Technologies, based in Rochester, NY, announces plans to open a location in Scott County, Virginia, and hire 160 employees over the next five years.

Tempus Announces $200 Million Series G-2 Financing

Precision medicine and analytics company Tempus will use a $200 million investment to expand its work beyond cancer to infectious diseases, depression, and cardiology.

Monday Morning Update 12/14/20

December 13, 2020 News 1 Comment

Top News

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CMS announces a rule that requires Medicaid managed care and insurers that sell products on the Exchanges to facilitate the exchange of patient data between payers.

The rule would require payers to create a FHIR-based API so that providers can determine the documentation that a particular insurer requires and also manage their prior authorization requests.

The PA requirement also requires insurers to respond more quickly, to provide specific reasons for any denial, and to publish metrics to show how many procedures they are authorizing and denying.  


Reader Comments

From Award Cleaver: “Re: Most Wired and HIMSS EMRAM. You haven’t been posting the winners, like us.” I’m skeptical of “awards” that lazily measure tools rather than results in hopes of milking sales of those tools to the benefit of the awarder. The ultimate award is improving quality and lowering cost, and if you can do that with index cards instead of AI, then good for you even if that won’t win you an IT cheerleader’s award. I hire a plumber because their reviews say they do good work at a fair price, not because they bought a cool IPad for creating estimates.

From Bias Boy: “Re: healthcare bias. Doesn’t that exist when solutions like contact tracing assume that people have cell phones?” Yes, and many other technology biases are inadvertently created by privileged developers who can’t conceive of people who don’t have cell phones, who use Android instead of Apple, who don’t have access to broadband, or who have physical or cognitive limitations that limit their technology use. However, the notion of “equity” in any form, including and perhaps especially health, is a goal that sometimes can’t be quickly met in trying to advance the majority.


HIStalk Announcements and Requests

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Most poll respondents grade their preferred local hospital well in being patient-friendly, trustworthy, and effective.

New poll to your right or here: How important is your job in your overall life?

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I was searching my Gmail account every day for an important email that I was expecting, worried it would go to spam and get missed, when I thought of a two-minute solution – I set up a Gmail forwarding address to my cell carrier’s text messaging service (which is in the form of phonenumber@txt.att.net for ATT or phonenumber@vtext.com for Verizon), created a Gmail filter to look for the particular word or sender I was expecting, then set the filter to forward a copy of those emails to the texting address. Result: those important emails will send an immediate text message to my phone.

Listening: Octavision, shockingly precise prog metal rock (even more note-for-note perfect than Rush) that features guitarist Hovak Alaverdyan and one of the world’s best bassists in Victor Wooten, a five-time Grammy winner and founding member of Bela Fleck and the Flecktones. Their new album sounds good if you like their sort of music as I do.


Webinars

December 15 (Tuesday) 1 ET. “Highlights from the 2021 CPT Code Set Update.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, senior director of global clinical services, IMO; Shelly Jude, RHIA, RHIT, mapping manager, IMO. Top coding professionals will highlight the most important changes to the Current Procedural Terminology code set that take effect on January 1, including crucial additions, deletions, and revisions; how to communicate Official Coding Guidelines changes to the healthcare team; and a description of the impact that the code set update could have on practice.

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


People

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PerfectServe promotes Kelly Conklin, MSN to chief clinical officer / VP of account management and Mary Piepenbrink, RN, MBA to SVP/GM of Optimized Scheduling. 


Announcements and Implementations

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DarwinAI and Red Hat work with Boston Children’s Hospital to develop a deep neural network chest X-ray AI tool for COVID-19 diagnosis, notable in that it (a) employs “explainable” algorithms instead of being deployed as an opaque and potentially unreliable black box, and (b) has been released as open source.

Thailand’s universal healthcare program will require Bangkok-area patients to present a smart ID cart to receive services, which will help prevent fraud in verifying that patients are covered and to allow their medical records to be shared among providers.


COVID-19

States reported a record 108,847 COVID-19 inpatients on Saturday and another 2,477 deaths, increasing the US death total to just under 300,000.

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Shipments of Pfizer’s COVID-19 vaccine began early Sunday following Friday’s FDA Emergency Use Authorization, moving the focus from science to the unprecedented logistical and marketing challenge of getting doses delivered and administered.

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Major airlines will soon roll out apps to check the COVID-19 test and vaccination status of passengers, likely followed by employers, college campuses, sports venues, and cruise ships. CommonPass, developed by the non-profit Commons Project, was quickly developed to check the negative test result status of truckers in Africa and is being tested by airlines to guide passengers to testing locations and then verify the resulting confirmation code. 

In Sweden, 500 specialty nurses are quitting each month even as ICU beds fill, with hospitals in Stockholm asking for military help and moving pediatric nurses to cover ICUs. Nurse there cite low pay and a lack of time off as their reason for leaving.

Another group of scientists questions the “hygiene theater” of businesses that are spending big money to perform deep-cleaning even though zero COVID-19 cases have been documented from surface spread. They remind that shared air, not shared surfaces, is the problem.


Sponsor Updates

  • OpenText donates $1 million to food banks around the world.
  • OptimizeRx CEO William Febbo spoke at the Bank of America 4th Annual HCIT and Digital Health Symposium.
  • Nordic releases a new video featuring Scripps Health, “How to implement a successful Community Connect program.”
  • Premier names St. Luke’s University Health Network the winner of its 2020 Richard A. Norling Premier Alliance Excellence Award.
  • Redox releases a new podcast, “Reproduction & Pediatrics pt 1: Dr. Elina Berglund, CEO of Natural Cycles.”

Blog Posts


Contacts

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

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Katie the Intern 12/11/20

December 11, 2020 Katie the Intern No Comments

Today’s column focuses on the data usage side of healthcare IT and telemedicine, which applies data and research to ongoing studies of both cancer and COVID-19. I’ll focus on the cancer side first and then end with how COVID both impacted and fueled the research of Boston-based Cota Healthcare.

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I spoke with Mike Doyle, MBA, who has been president and CEO of Cota for the past two years. Cota uses advanced technology and analytics to provide and advance care and research for many types of cancer. 

“Our mission is bringing clarity to cancer,” Mike said. “Cota was founded on the ability to create objective ways of treating patients and tracking patients based on their outcomes.”

Cota was born from the idea that when cancer patients are seeking treatment, they are looking for answers to two questions: How many people have you treated just like me, and what were their outcomes? The founding doctors and engineers paired up with data scientists to provide a way to answer those questions. Their answer was something called a Cota Nodal Address, or CNA for short.

“What the Dewey Decimal system did for library books, the CNA can do for oncology,” Mike said. “It incorporates all of the relevant pieces of information that the treating physician needs to know about the patient.” 

Relevant information about a patient can include genomic information, disease progression, and other characteristics that would help to eliminate variation in cancer care. Organizations, Mike said, would help providers apply care as their patient’s needs changed over time. The CNA number is a snapshot of where the patient in their care. It adjusts as care is provided based on information from their EHRs.

The CNA number is something that had to be developed over time using trial data from hundreds to millions of cancer patients. Most interestingly, Cota wanted to replace real-world patients who receive placebo drugs in trials with data, thereby almost eliminating the risk that participants in trials might receive an ineffective placebo drug. When Mike was thinking about this process, he was thinking about making trials fair and effective. The 21st Century Cures Act also pushed for this change. 

“If there was a better way to use data to take the place of the placebo group, you’d actually have a much better way of speeding drug trials and greatly reducing potential deaths,” Mike said. “We thought that this was a good place to … work with clinical science companies in clinical trials to speed up drug discovery.”

Cota possesses some of the largest data sets for cancer patients in the United States, and either uses or supplies that data for trials and research. Cota has access to almost 2.5 million records, all data that can be used for quicker research. These large data sets are used by life science companies, Mike said, but they aren’t the only ones interested in the data the Cota has available. 

When COVID-19 began to take over the world, the FDA wanted specific information from Cota. Cota helped study the records of 3,000 records of COVID-19 patients to identify that hydroxychloroquine is not effective for inpatient treatment and may even increase risks in those with comorbidities. The FDA then asked Cota to continue its research on COVID-19 data. 

“We weren’t necessarily in the business of COVID, but rather quickly had to become in the business of COVID,” Mike said. Cota had signed into a partnership with the FDA three years prior, and their research on COVID-19 data prompted a new partnership for another three years to study COVID-19 and cancer.

Mark said the FDA wanted Cota to look at COVID-19 as a comorbidity to cancer. Cota’s ability to adapt to the study proved important to both the pandemic and to the continuation of cancer research. In ways, COVID-19 fueled the company’s already growing data sets.

As far as the future of Cota, Mike said that its research will remain cancer focused, but it will continue to study COVID-19 and cancer together. Data is the driving factor behind the trials and research on cancer. Cota will work with multiple institutions and providers that use its data for different studies, and Mike says they will continue to create partnerships with institutions to further research. 

In regards to HIStalk, Mike has read the website for years. He found HIStalk during his time at a different company, but now reads it twice a week to stay in the know. He has visited HIStalk receptions at HIMSS and now follows posts for the editorial and objective content that they offer. 

“To stay close to providers, I like to read it to stay close to what providers are thinking about,” Mike said. “I read about how we can help providers do a better job on the front lines with patients.” 

That’s the column for this week! I enjoyed learning about data usage in information technology and how a company has used COVID-19 to further its data and research abilities. I’d love to learn more about the application of data in a trial and how data can be used as a placebo in place of a person.

“Adversity creates innovation,” Mike said at the end of our interview. I am inspired to be learning about an industry that continues to help others by creatively innovating and applying tools. 

Have a great one! 

Katie The Intern 

Katie

Email me or connect with me on Twitter.

Weekender 12/11/20

December 11, 2020 Weekender No Comments

weekender 


Weekly News Recap

  • Ro acquires Workpath.
  • LeanTaaS raise a $130 million Series D funding round.
  • Amazon announces HealthLake.
  • Baxter is reportedly offering to acquire Omnicell for $5 billion.
  • HHS OCR publishes draft HIPAA changes.
  • The federal government warns users of GE Healthcare radiology equipment that default passwords and open ports pose a serious security risk.
  • PointClickCare will acquire Collective Medical for $650 million.
  • HHS publishes hospital-level COVID-19 data for the first time.
  • Non-profit Commons Project announces that it has connected its CommonHealth Android health records app to 230 health systems.

Best Reader Comments

Kudos to GBMC as it was obvious they were prepared for this [systems downtime]. We walked through the downtime command center where I saw an HR station for dropping off time sheets, a clinical station with plentiful stacks of every form, and a wall of giant sticky notes with schedules and protocols including shift sign ups for taking on specific down-time roles include Runner and Safety Nurse – complete with a rack of different colored safety vests that had those roles printed in big letters on the backs. Sadly this situation seems to be more common so it was reassuring as patient that they still seemed to be maintaining safe and effective operations. (SEH)

Baxter might buy Omnicell? Surprising considering that Omnicell is the only one in this space who has kept their original structure. I’ve lost count of how many times Pyxis has changed hands. Then Omnicell ended up with Accu-Dose. Then I recall that back in the mid or late 90’s, Omnicell bought the dispensing business from Baxter. Strange. (David N)

The quality of that data [UHG’s patient data] is quite bad from what I’ve seen. The complexity of that intervention is also hard to scale. Internet advertising has a similar model of collecting data, then trying to deliver an intervention. It is really hard. People get toaster advertisements right after they bought the only toaster they will use for a decade. The successes seem to come when a company dumps a ton of money into buying ads for when someone searches or buys something even remotely related to the company’s product. New toaster means you get a ton of appliance ads and some targeted consumers actually did move and the company snags a few more sales. UHG can’t spam their members without driving up utilization and destroying their margins. (IANAL)

Here is my UHG call summary for big healthcare providers. UHG knows they can do the procedures you make your money on. They know they can do them much cheaper and they actually know exactly how much cheaper. They need to get between you and the patient to direct them to that cheaper service. They intend to do that in a couple ways. First, they intend to be much more convenient for the patient. They want to be the getting an Uber to your calling a cab. Second, they want to track the patient through time and intercept them at the right moment to get them to cheaper care. The first is possible and happening as we speak. The second is harder within the current healthcare landscape. (IANAL)


Watercooler Talk Tidbits

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TikTok names Minnesota family medicine resident Rose Marie Leslie, MD to its top 100 list of most impactful creators for her videos in which she provides health and COVID-19 information.

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A Wisconsin chiropractor tells his Facebook Live viewers that they should use pepper spray on anyone who asks them to wear a mask in a store, saying the “cool part” is that it is legal (it is not) because they are predators.

The Association of American Medical Colleges says that medical school applications are up 18% this year in what admissions officers are calling the Fauci Effect. Anthony Fauci, MD says that’s flattering, but a more realistic assessment is that prospective students are inspired by local doctors who are trying to improve individual and population health.

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A healthcare communications training company offers a telehealth version of its “Breaking Bad News Program,” in which actors simulate real-life scenarios and physicians and nurses are coached to communicate compassionately and effectively when delivering bad news to patients over a video connection. The Orsini Way company was founded by neonatologist Anthony Orsini, DO.


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Morning Headlines 12/11/20

December 10, 2020 Headlines No Comments

Ro Acquires Workpath to Offer In-Home Care Services Nationwide

Consumer telehealth vendor Ro acquires Richmond-based Workpath, which offers an API-powered platform for dispatching workers to provide in-home blood draws and nurse visits.

LeanTaaS Raises $130 Million to Strengthen Its Machine Learning Software Platform to Continue Helping Hospitals Achieve Operational Excellence

Capacity management, access management, and analytics software vendor LeanTaaS raises $130 million in a Series D funding round, increasing its total to $250 million.

CitiusTech Completes FluidEdge Consulting Acquisition and Appoints Eric Schultz as President of FluidEdge Consulting

CitiusTech acquires Philadelphia-based healthcare management firm FluidEdge Consulting.

Elation Health Announces $40M Series C To Power Independent Primary Care

Physician practice-focused health IT vendor Elation Health raises $40 million in a Series C funding round led by Generation Investment Management, bringing its total raised to $55 million.

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