News 11/19/21

Top News

Healthcare payment options platform vendor PayZen raises $15 million in a Series A round.

Reader Comments

From Clicker: “Re: clicks. You have said you track certain clicks on the site. I’m wondering which had the highest numbers.” I usually count clicks for announcement of a new sponsor, a webinar, or anything for which I’m trying to gauge reader interest for future coverage. The most-clicked items (3,000 to 4,000 clicks each) were new sponsor announcements (which make up the top five spots), webinars (six), top-of-page banner clicks (two), and an interview (one). The question made me wonder about our webinar recordings, where I found that the one Frank Poggio and the late Vince Ciotti did in 2014 about Cerner acquiring Siemens Health Services has drawn 8,700 views, including one from me today as I enjoyed hearing Vince’s voice again.

HIStalk Announcements and Requests

HIMSS22 starts in 116 days. Early bird in-person pricing of $895 is good until January 10. I’m still waffling on whether it’s worth my time and money to attend, so I haven’t registered or booked a place to stay. You?

Webinars

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

Acquisitions, Funding, Business, and Stock

Aptihealth, which matches health plan and health system customers with behavioral health providers, raises $50 million in a Series B funding round.

MedArrive, which offers at-home care from licensed professionals such as paramedics as an adjunct to virtual visits, raises $25 million in Series A funding. Co-founder and CEO Dan Trigub spent short stints at Uber Health and Lyft before starting the company last year.

Precision medicine vendor Tempus announces that eight institutions are live on integration with Epic’s genomics module, which embeds Tempus test ordering and genomic data delivery into existing clinical workflows. The companies say that integration timelines will be reduced from months to weeks in 2022.

CVS will close 900 of its stores over the next three years, nearly 10% of its total, as online shopping has reduced customer demand for near-home convenience and the additional of in-store health services creates new demands for layout and location.

Teladoc’s investor day presentation predicts that consumers will expect virtual-first encounters whose quality equals in-person ones and that offer them a variety of coordinated care services. The company says it has evolved from fee-for-service video visits and will become a partner with its customers in offering whole-person care at under value- and risk-based arrangements. It says it will be “the first place consumers turn to for all healthcare needs” for “whole-person care that is personalized, convenient, and connected.” TDOC shares dropped 8% on the day and have shed 25% in the past 12 months, with the company’s market value being $20 billion versus the $18.5 billion in cash it paid to acquire Livongo in late October 2020.

Sales

• Northeastern Center (IN) chooses the SmartCare EHR of Streamline Healthcare Solutions.
• Luminis Health (MD) will implement Cedar’s post-visit patient engagement and payment platform, integrated with Epic.

People

Ochsner Health hires Denise Basow, MD (Wolters Kluwer)  as its first chief digital officer. She has been president and CEO of Wolters Kluwer’s clinical effectiveness business unit for six years and was previously with UpToDate, which was acquired by Wolters Kluwer Health in 2008, since 1996.

Announcements and Implementations

The UK’s NHS chooses 46 companies to provide digital document services and related hardware and software. Among those named for the nearly $7 billion program are Nuance, Conduent, Hyland, and 3M MModal.

A HIMSS report estimates that the federal government will need to spend $30 billion to modernize federal, state, local, and tribal public health reporting and data systems, recommending that Congress provide a minimum of $1.57 billion per year for technology and workforce development. The funding would support electronic case reporting and contact tracing, laboratory information management systems, syndromic surveillance, electronic vital records (births and deaths), a national notifiable disease surveillance system, analytics and visualization staffing, creating incentives for provider data exchange.

HIMSS creates a certification program in digital health transformation strategy, with CPDHTS joining its existing offerings CPHIMS and CAHIMS. Cost ranges from $1,099 to $1,399, while the two-year renewal requires 45 clock hours of continuing education and a payment of $299 or $399.

A review of the de-identified Cerner EHR records of 490,000 COVID-19 patients finds that the use of SSRI antidepressants was associated with a 28% lower relative risk of death.

Three entrepreneurs, including Ricky Caplin (The HCI Group), form The Aurora Forge, which will grow seed-state healthcare and government technology companies and donate the majority of its profits to charity. Several health system CIOs are among its advisors.

Government and Politics

The US Coast Guard finishes its deployment of Cerner as part of the DoD’s MHS Genesis project.

Other

A retiree from Vietnam who was stranded in the US for 18 months because of the pandemic is stuck with a $38,000 emergency glaucoma surgery bill even though the daughter he was visiting had bought him traveler’s medical insurance that had preauthorized the procedure. The insurer declined to pay, saying that his condition was pre-existing even though it hadn’t been previously diagnosed. His only income is a $260 per month pension. The man’s daughter, who had bought him plane tickets home on 14 flights that were eventually cancelled, may be on the hook to pay his bill even though he was finally able to return home because of California’s filial responsibility laws.

In Canada, Halifax family physician Ajantha Jayabarathan, MD wins a family medicine “Big Ideas” contest for her GIS-powered Health Geo-View, which allows virtual visit doctors to visualize the patient’s neighborhood for socioeconomic information, proximity to health services, and environmental risk factors.

Sponsor Updates

• Olive offers its customers the ability to leverage DARVIS solutions including rapid hygiene check, bed logistics, medical inventory, and sterile equipment completeness.
• LexisNexis Risk Solutions will work with secure data collaboration company Karlsgate to develop a secure identity resolution platform for the healthcare market.
• Everbridge introduces the next generation of its Travel Risk Management Solution for business, healthcare, and government customers.
• Lumeon’s Remote Home Monitoring solution earns Gold in the 2021 EHealthcare Leadership Awards in the Best Business Process Improvement Products category.
• Magnolia Regional Health Center (MS) adds Prelude Software’s PayPilot to its Meditech Expanse EHR to save time and increase revenue.
• CareSignal publishes a case study titled “Utilizing Deviceless Remote Monitoring Within a Medicaid Managed Care Plan to Identify Rising Risk for Early Intervention with Promising Results.”

Blog Posts

• Improving Veterans’ Care through Digital Health Technology (Get Well)
• Taking a Deep Dive into Cloud Data Lake Performance: Making Sure Your Gold is Counted (Healthcare Triangle)
• Deliver Better Population Health by Avoiding 3 Mistakes (Health Catalyst)
• 5 Signs you Need a Managed Services Partner (Optimum Healthcare IT)
• Innovating With Health Plans: Focus on Outcomes (Dina)
• Veterans Day Reflection: Beyond Thank You (Health Data Movers)
• Flexible, Fast, and First: How UC Davis Health Opened Its Digital Front Door (InterSystems)
• How Leading NextGen Users Leverage our Revenue Cycle Engine (RCxRules)
• Preserving privacy while promoting interoperability in healthcare (Intelligent Medical Objects)
• Inside the Lifecycle of a Healthcare Claim with Medhost (Medhost)
• How to Perform an Analysis on Competitor PT Practices (MWTherapy)

Contacts

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

EPtalk by Dr. Jayne 11/18/21

Road warriors, get ready. United Airlines has resumed sales of hard liquor on flights after resuming sales of beer and wine in June. Other airlines continue to hold off on serving alcoholic beverages as incidents involving disruptive passengers continue to rise. American Airlines plans to suspend alcohol service in the main cabin until at least January 18. There is still plenty of alcohol for sale in the nation’s airports, and several where I’ve recently traveled now allow passengers to drink the gate area instead of just within specified areas. I’m one of those people who keeps my mask on the entire flight and doesn’t snack or drink except for an occasional sip of water. Hopefully, the changes won’t bring an uptick in bad behavior, but only time will tell.

HIMSS continues to try to push its Accelerate platform through email blasts. Honestly, I have absolutely no desire to join another social media platform, let alone one that is controlled by HIMSS. I was in the beta group for Accelerate and didn’t find the content to be useful. As for joining the groups they’re pushing now, I already participate in groups through my medical specialty society and through the American Medical Informatics Association, so I sort of feel like I have all the connections I need unless something really crazy happens. If readers have found value in Accelerate, drop me a line – I’d love to hear about your experiences.

From Jimmy the Greek: “Re: monitoring. I recently worked with an organization that was planning to roll out a software package that was embracing its Big Brother tendencies. It monitors how much time you spend in each application on your laptop, how much active typing/mouse time you have, etc. and provides a dashboard to your manager.” The system in question was advertised as allowing employees to “understand your personal work habits allowing you to maximize your workday and reach your potential.” For employees who are in roles that involve a certain amount of throughput, such as medical billing specialists, coders, claims processors, etc. this kind of solution might make sense if people are struggling with meeting their goals and need tools to understand their productivity.

In other roles, I question the need for it unless people aren’t getting their work done. Solutions like that that score people on how much they are “doing” don’t give any credit for the cognitive time preparing to do something or for analysis or strategic thinking. It doesn’t reflect any work done that doesn’t involve the laptop, such as diagramming on the white board, having non-electronic meetings with co-workers, or all the fabulous things that process improvement folks do with Post-It Notes and flipcharts. It’s one more way in which employers can devalue the actual thinking that people do for their jobs.

In medicine, we’re used to it since the cognitive specialties typically get paid far less than the procedural ones, but I don’t think such a focus on “doing” at the expense of “thinking” or “planning” is necessarily a good thing. Of course, it’s all about how the manager uses it, but as an employee, I’d be pretty annoyed by the concept.

I attended a small gathering this evening with some former co-workers from my last clinical position. Except for me, everyone is still working full time, pulling 12- to 14-hour shifts as COVID-19 cases start to rise again in our community. It was a departure from our usual sessions since most of the attendees brought their children for some s’more making around the fire pit as well as photos with a 10-foot-tall inflatable turkey. It was quite a spectacle, but it was good to see people getting away from the office and doing some normal things with their children (at least until bedtime approached and the meltdowns started).

I daresay none of us at the bonfire think that COVID-19 is “no big deal” or “fake” or any of the things clinicians continue to hear from patients on a daily basis. Most of us are glad we haven’t been infected, and if we have, that our cases have been mild because that’s not always the case with our patients. After I returned home, I was scanning through email and came across an article in the Journal of the American Medical Association that put things in perspective and made me want to tell the moms and dads to hug their children tighter. The piece is titled “Thousands of US Youths Cope With the Trauma of Losing Parents to COVID-19.” It’s something people don’t like to talk about but that those of us in the trenches have seen. In our area, we’ve had several situations where children lost both parents to the pandemic, which is for most of us an unimaginable tragedy.

The article details some of the COVID-19 specific factors that make the situations even more tragic, such as children only being able to interact with dying parents via video calls and inability to hold memorial gatherings. Recent data indicate that more than 142,000 children have lost a parent, custodial grandparent, or grandparent caregiver due to the pandemic, looking at dates from April 2020 through June 2021. The worldwide estimate counts more than 1.1 million children losing a parent or custodial grandparent.

The piece goes on to contrast the losses due to COVID-19 with those from natural disasters or mass tragedies, where intense mental health services are available and where the causative incident is limited. The authors note that surviving children may be “extremely fearful that the virus will kill a surviving parent or siblings or claim their own lives.” They also describe feelings of “intense anger or shame” that may be felt by children mourning the loss of a parent who was unvaccinated or who refused to mask or distance.

As we move into the holiday season, it’s important to pause and think about those families whose holidays will be different this year due to the loss of loved ones. Unfortunately, the death toll continues to climb, mostly among unvaccinated individuals. For those on the fence about vaccination, I would offer the suggestion that becoming vaccinated might be the best gift you can give your family and yourself. I’m looking forward to spending time with my vaccinated and boosted family members who are in their 70s, 80s, and 90s as well as doing the traditional holiday things we usually do, some of which are a bit kooky, but that’s what family is all about.

What are your plans for the holiday season? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 11/18/21

Aptihealth Raises $50 Million Series B to Scale Higher Acuity Behavioral Healthcare Services

Behavioral health telemedicine startup AptiHealth raises $50 million in a Series B round of funding, bringing its total raised to $65 million.

LifePoint Health launches health-tech incubator with $20 million seed

LifePoint Health (TN) will partner with private equity firm Apollo Global Management and venture studio 25madison to launch 25m Health, an incubator equipped with $20 million in funding.

Our Investment in MedArrive

On-demand and scheduled home healthcare company MedArrive raises $25 million in a funding round led by 7wireVentures.

Coast Guard completes MHS Genesis deployment

The US Coast Guard wraps up its nationwide rollout of MHS Genesis, the first US military service to fully implement the new Cerner software.

Readers Write: Protect Hospital Workers Now for a Safer and Brighter Future of Caring

Protect Hospital Workers Now for a Safer and Brighter Future of Caring
By Brent Lang

Brent Lang, MBA is chairman and CEO of Vocera of San Jose, CA.

Nurses, doctors, and other healthcare team members deserve working environments that protect their physical, emotional, and psychological well-being. They also deserve equitable support and access to resources and tools to care for themselves and the patients they serve. At the heart of safety is a commitment from hospital leaders to build cultures that empower employees with essential equipment, technologies, and protocols that protect their well-being and enable them to work at the highest level of their skills.

After nearly two years, COVID-19 continues to wreak havoc on exhausted nurses, doctors, and others frontline workers. The pandemic, causing needless death and elevated stress levels, has burned out many of our caregivers. Some are retiring early, some are changing professions, and others are leaving the workforce entirely. The cognitive burden that healthcare workers are carrying, and have been carrying even before the pandemic, is extremely heavy. The emotional toll is unimaginable.

We must find ways to protect and support every care team member or we risk losing more of them too soon. The future of our healthcare system depends on what we do now.

To start, we must identify the root causes of staff shortages. Let’s call out what is harming the physical, emotional, and psychological well-being of healthcare workers. COVID-19, cognitive overload, and burnout are not the only things threatening their well-being.

Workplace violence, racial disparities, and bias are also contributing to the trauma healthcare workers must endure. While these threats existed well before the pandemic, the last 24 months have put a spotlight on the urgent need to protect the safety of our nation’s healthcare workforce who have risked so much to protect us.

Several health system CEOs from across the country have signed The Heart of Safety Declaration of Principles to redefine safety in healthcare and drive action for meaningful change. The three pillars of the Declaration highlighted below are helping galvanize support by other healthcare leaders, technology companies, policy makers, and more.

1. Safeguard psychological and emotional safety. We must eliminate stigmas associated with seeking mental health support and advance a culture of open communication, so people feel safe to speak up and are empowered as equal and valued members of the care team. The Dr. Lorna Breen Health Care Provider Protection Act is an excellent start.
2. Promote health justice by declaring equity and anti-racism core components of safety. Healthcare team members deserve to work in environments free from bias and discrimination. A recent UCLA study showed the proportion of Black physicians in the U.S. has increased by only four percentage points over the last 120 years. Focused policies and practices are needed to advance diversity, inclusion, and belonging in healthcare environments, which in turn enables more equitable care delivery.
3. Ensure physical safety. Healthcare workers are five times more likely to suffer a workplace violence injury than staff in other industries. Zero-harm programs must be implemented to eliminate workplace violence, both physical and verbal.

Policies, protocols, and training staff how to handle a violent situation are important, but they are not enough. Hospitals and health systems need to give nurses, doctors, and other team members the ability to easily and quickly call for help when a situation escalates.

Many hospitals have equipped employees with wearable communication devices that enable emergency communication, such as a dedicated panic button, and understand simple voice commands while wearing the device under personal protective equipment (PPE).

Intelligent communication technology can also help safeguard team members from mental and emotional distress. All day long, clinicians are overloaded with complex processes, competing priorities, and interruptions by calls, texts, and alert and alarm notifications from nurse call systems, patient monitors, ventilators, and more. These communications are often not actionable, causing clinicians to feel lost and overwhelmed, spending valuable time looking for information or a colleague to help.

A unified communication and collaboration solution can reduce distractions, noise, and stress, which have increased during the pandemic. It can eliminate loud overhead paging and help organize and prioritize notifications so they only go with contextual information to the person or team who needs them and can act. Managing alerts and alarms creates a quieter healing environment, while helping reduce the cognitive burden on the healer.

There are many ways to help protect and connect team members. Together, with more collaboration and a renewed commitment to safety, we can accelerate the adoption of these solutions to safeguard our nation’s healthcare workers for a brighter future of caring.

Readers Write: Digital Healthcare Needs To Evolve, and the Cloud Is the Catalyst

Digital Healthcare Needs To Evolve, and the Cloud Is the Catalyst
By Kavita Khandhadia

Kavita Khandhadia is Amazon Web Services program manager for Infostretch of Santa Clara, CA.

The continued impact of the connected society means there is an increased need for decision makers to understand not only why digitalization matters, but where it can most benefit their companies. Digital evolution and maturity are key differentiators in most industry sectors, many of which are adapting to the demands of their customers and integrating the technology required.

This ongoing focus on a required digital transformation is hardly breaking news, but the decision to become more cloud-centric has particular significance for the healthcare and life sciences (HCLS) industry.

For organizations that are looking to move the digital journey forward, it’s a case of when and not if. In many cases, business optimization strategies have become increasingly cloud-based, with a consensus among analysts and researchers that HCLS companies that integrate cloud platforms and services into their existing workflows will be best placed to scale, innovate, and launch.

The events of the last 18 months shone a spotlight on where digital healthcare is and where must improve. Over the last decade, the digitalization of legacy processes within the healthcare industry has moved at a steady pace, albeit that patient wellness is more likely to reflect physical as opposed to virtual insights.

The need for effective digital solutions becomes more apparent when you consider that the adoption of recent technologies within the sector as whole can often be labeled as a work-in-progress. HCLS companies, for example, have been both quick to accept the need for change and hampered by what needs to be done.

A research note by Gartner – Innovation Insight for Digital Health Platform (DHP) – applauded the “heroic efforts” that healthcare companies and providers had made to adopt innovative technologies, including virtual care and improvements to monolithic legacy systems such as electronic health records (EHR). The caveat was that the fundamental shift required was some way in the future.

However, the analyst noted that digital expectations of patients would lead to 75% of health providers reducing reliance on “EHR-native applications to deliver better experiences and outcomes, and improve efficiencies.”

That’s great news for digital healthcare, but it’s worth remembering that the technologies required to build a DHP are already part of existing wellness strategies. For example, companies that have integrated cloud solutions have access to data and predictive analytics while digital twins, artificial intelligence, and machine learning are having an impact on clinical and operational decisions.

The question that needs to be asked is whether the increased awareness of cloud-centric healthcare offerings will be the catalyst for the next stage of digital healthcare.

The simple answer is that access to platforms such as AWS Cloud is both changing the conversation over what modern wellness can be and how patient-centric cloud solutions are the future of healthcare itself.

A powerful argument for cloud migration is understanding that a culture of healthcare innovation already exists. Purpose-built HCLS offerings are part of the AWS for Health suite of solutions, for instance.

However, the concerns that have always been part of any cloud migration are often cited as reasons to maintain the status quo.

Healthcare remains not only a very traditional industry but also one that is subject to a plethora of regulatory requirements. And while the need for digital transformation may not seem as pronounced as it would be in, say, retail, the challenges of cloud migration can literally be the difference between life and death.

In many cases, the concerns are the usual suspects – security and governance, cost and time, workloads, solution availability, and cloud maturity.

When you invest in a cloud strategy, you are giving up a certain amount of control. Cloud computing is the on-demand delivery of compute power, database, storage, applications, and other IT services through a cloud services platform.

For instance, AWS is responsible for the security of the cloud (the protection of the infrastructure itself) while the customer provides security in the cloud (platform, applications, identity and access management). Known as the Shared Responsibility Model, this simple arrangement can be a daunting prospect for healthcare companies who have relied on their legacy infrastructure and working processes to maintain compliance and regional regulatory requirements.

Cost and time are also considered to be one of the main reasons for being hesitant about cloud migration. Companies may feel that the expense and potential downtime of cloud migration may not be worth it, despite all evidence pointing to the savings that can be achieved by moving to a cloud-based solution – migration can mean that a company focuses on products and innovations as opposed to maintaining an entire infrastructure and related applications.

And we must not overlook the importance of defined workloads. HCLS relies on data management and regulatory compliance, while the nature of the services companies provide requires low latency and processing requirements on a local level. That provides an additional challenge, even more so when these digital workloads must respond as quickly as possible to a patient or provider requirement.

However, the HCLS sectors are well placed to take advantage of cloud migration. Companies and providers are increasingly data-driven and already looking to digitally transform – the global healthcare market will be worth $11.9 trillion by the end of 2022, a recent industry report said – so it follows that patient wellness will be subject to the digital experiences that are part of the connected society.

Digital healthcare’s evolution has been years in the making. Providers and patients have become more digitally aware in recent years, because the tools required to make health-related decisions are now available.

What matters is how HCLS both integrates the solutions that exist and invests in ones that can make a difference to the physical and virtual services provided.

COVID-19 was not the catalyst for digital transformation that people wanted, but the industry became focused on how digital healthcare could move forward. Cloud migration is one part of the puzzle, the companies that understand this will be able to deliver the right patient and wellness outcomes.

HIStalk Interviews Bret Larsen, CEO, EVisit

Bret Larsen is co-founder and CEO of EVisit of Mesa, AZ.

Tell me about yourself and the company.

EVisit is the market-leading virtual care platform. We help the largest health systems in the country craft excellent consumer experiences for care delivery. I’ve been in telemedicine for the last decade, give or take. I started originally on the national provider network side with a company that was acquired by Teladoc. I saw an opportunity to help simplify healthcare delivery for local healthcare infrastructure.

Telehealth boomed not because consumers were demanding it, but because regulations and payment rules were adjusted to support virtual care as the only safe way to conduct encounters. To what degree do those temporary changes need to become permanent to keep telehealth as a mainstream service?

Telehealth needs to be an option in care delivery. Gartner estimates that telehealth utilization will normalize at about 30% over the next three to five years. As CEO of a virtual care platform company, I wanted to believe that the pandemic had accelerated and changed telemedicine and the utilization of telemedicine forever, but what I think it actually accelerated was the consumerization of care. It has caused local healthcare infrastructure, health systems, and hospitals to take a close look at their care delivery strategy and when and where to apply specific delivery mechanisms — whether it’s in-person, virtual visits, or asynchronous — to make sure that they are helping to support the delivery of the right outcomes.

Insurers are offering virtual-first health insurance, which should expose even more people to telehealth. Will those consumers remain in the telehealth fold?

We started the company to help local healthcare infrastructure maintain the relationships they have. Those virtual-first plan approaches can only work if they connect patients with local providers. A health plan or payer’s job is to manage and mitigate risk. I think that down the road, as we look back at the data, the outcomes diverged with the utilization of national provider networks, like call center-based national provider networks. They are working to do good. They are trying to change accessibility for the better.

But we will see a massive disconnect when you pull a patient out of the ecosystem and the PCMH that knows them best. Those will struggle to find efficacy, because when a patient needs specialty care, where does that patient get referred to? Does the provider on the other end of that virtual-first encounter have context of the market to know where to refer them to ensure the continuation of the right care for that patient?

How will the market shake out between companies like yours that sell the platform versus those companies that sell clinical services, which may augment but also compete with those offered by the local health system?

If you look at the strategic roadmap for these national provider networks – and don’t hear me saying “shame on them” – they are working to do what’s best for the end-user patient. But if you look at the strategy that they’re driving at, look at what they’re acquiring. They are acquiring specialty groups. When these large national provider networks showed up on the scene, there wasn’t a ton of concern from the health system side, because they were going after an ambulatory side of the business where we lose money anyway as a loss leader to feed our specialty groups. 

But the reality is that the acquisition strategies show that where they are headed long term is specialty groups. They are acquiring respiratory and chronic care groups, so they are moving into the specialty side. For health systems, that means that when a patient is in need of specialty care, and their first interaction is with one of these national provider networks, they will refer to their own specialists, not to the local group. Health system executives need to keep a close eye on this.

Health systems need to answer the question of, how do I craft an excellent consumer experience? Because that’s what they are competing with. The pandemic accelerated the transition, not necessarily the adoption, of telemedicine long term, because admins are still going to refer back to where they did from muscle memory. But rather it accelerated the consumerization of care. As consumers, many of us would never bring our business back to a service provider that didn’t show up on time to an appointment or was 45 minutes late. It’s really about, how do we craft excellent consumer experiences to serve the consumer, not the patient?

Some providers created ill will among their patients who felt abandoned during the pandemic, as offices were closed and calls weren’t returned. How much education or marketing do health systems need to provide to get consumers to value an ongoing relationship and to trust them to deliver it?

It’s a business strategy question. Where do your strengths lie? The strengths that I would expect health systems to have is in the care they deliver. There’s a lot of responsibility on the health system to educate the consumer and to help repair some of that disconnect. Having the right tools to accomplish that will make it easier. I would rather pull out my phone and order dinner from an app than call the restaurant and order it over the phone. Consumers want to be able to navigate to their own outcome.

I have allergies, so I could self-diagnose, but having the support of a provider to make sure that’s actually what’s going on and helping navigate efficiently to that reality and the corresponding care that I might need — if it isn’t allergies and is a sinus infection, a cold or the flu – that’s important. It can go a long way for health systems to help to start to find the right technologies to help consumers navigate to the most appropriate point of care for the issues they are experiencing and the value that comes with the downstream impact of that when they need more hands-on care.

From the food delivery analogy, we don’t yet know if telehealth shifts demand from in-person care or creates new demand. How will telehealth volume impact the availability of providers?

I saw a stat recently that for every hour a provider spends in delivering care, they spend as much as two hours charting care. That’s staggering. If you look at the top 10 compensated roles in commerce, in industry, those top 10 are all physicians. The number 11 is CEO. In a health system setting, it makes more financial sense for the CEO of the health system to be charting care than it does for the providers who are delivering it.

At EVisit, we are big believers that the best interface for a provider is no interface at all. The tools need to come around the provider to help support the delivery of that. The provider’s willingness to adopt that technology will be directly correlated to how easy that technology makes their job.

I hesitate to say this because I’m not looking to be confrontational, but the only reason that electronic health records have a business today is because the people who buy it don’t have to use it. If they did, they wouldn’t buy it, because it’s not easy to use. It is solving a super complex problem. There’s a bunch of various issues that it needs to address. But it’s not built for users.

If I were on the strategic side of a health system executive team, it would be about choosing and crafting the tools that are around a provider to help them more efficiently deliver care in a remote setting versus forcing them into a two-way video visit where it requires seven more people than it would need to, hundreds more clicks, and three or four more interfaces that makes care delivery more complicated. The way health systems should be thinking about it, especially from the provider adoption side, is how do you make it as simple for the care deliverer as possible?

Unless the business model is different, providers still need to document for billing and legal purposes, recording the same information that is required for an in-person visit. How can virtual visits reduce that documentation burden?

My point in bringing that up isn’t the fact that they will have to document less, it’s that technology can make it more efficient. We are working on using natural language processing for auto-charting. The microphone that is listening to a provider can differentiate between what the provider is saying and what the patient is saying, pull out the relevant information around self-diagnosis and the provider diagnosis, and pull together a fairly accurate depiction of what’s happened in that visit, how it should be coded, and where it should be submitted. All with cursory review by the provider, not with the provider having to sit down, or use a scribe to sit down, and run through that interaction and spend the two-to-one ratio of time against it.

How many early adopters of offering video visits are revisiting their technology choices and what are they looking for?

The vast majority of them are looking. The sound bite that we consistently hear from CIOs of large health systems is, we recognize that two-way video is not virtual care. It’s not the same thing. Video visits are not the same as virtual care. We have some great data around the margin impact of using a two-way video solution like a Skype, FaceTime or Zoom versus using an all-in-one comprehensive virtual care solution like EVisit. The margin impact is almost triple on the gross margin side, because patients are able to self-serve through much of the experience.

Early video visits involved just the two-way video conversation. Will we see them evolve to look more like in-person visits, with waiting rooms where information is collected upfront and satisfaction surveys and patient education afterward?

Two-way video is a commodity. You can go to a number of places and find great solutions. It’s the workflows and the efficiencies that can be gained around that. The advancement of that is moving outside of just a single interaction of, I have a sinus infection, I need a Z-Pak, so let me go through this workflow to get it. How does it fit into the care delivery strategy that you’re crafting? What does it look like? When should a patient present to a synchronous video visit versus an asynchronous chat visit versus in person?

There’s an outcomes question there. There’s a financial implication question there. It’s important to answer that question appropriately, bring the right tools and the right integrations with the core electronic health record to make sure that the data is all sitting in one place and that there’s a comprehensive view of who the patient is and what they’ve experienced, and determine how that informs care going forward. The ecosystem grows by moving ahead.

Other forms of virtual visits got lost in the excitement over virtual visits. Doctors might provide expertise via email messages, telephone conversations, or asynchronous messaging that is appropriate given the patient’s need and preference, with the only difference in outcomes versus a virtual visit is that they might not bill for their time or get paid for it. To what degree will the choice of communications options be driven purely by payment?

It’s absolutely an important mechanism to consider. At the end of the day, we need to make sure that as an industry that we can support the services being delivered financially. I think what you’ll find is that many patients would opt to pay out of pocket in certain scenarios where convenience or accessibility comes into question. If an asynchronous visit isn’t reimbursed, I still would be willing to pay a fee for service.

Our data shows that one provider can handle up to 200 interactions in a shift asynchronously for minor things like sinus infections, UTIs, colds, and flu. But the efficiency gained there, if you look at the productivity of that provider and a nominal out-of-pocket fee in that scenario, is interesting. It’s also interesting from a patient retention perspective. As a business, I would rather provide a service that ensures my customers continue to come back to me. I may eat the cost on that rather than have them go elsewhere and potentially lose the opportunity to bring them back to my services when the time comes again.

We’ve seen a lot of investment, separately, in telehealth and remote patient monitoring. Do you see the services or the business of those two entities converging?

Yes, yes. In a lot of the RFPs that we’re seeing, remote patient monitoring is a key question. 

One of the key trends, and this existed before the pandemic, is that health systems and hospitals are trying to figure out how to transition care to home and the RPM ecosystem. How that plays into it is going to be a very important component of that. That transition’s happening, not because of the pandemic, but  because you can deliver care more profitably when the patient can be out of the physical setting and can be monitored and that feedback can be quick. When and where the patient needs physical attention, that can happen where appropriate. It absolutely will continue to converge. The market and the landscape are in early days in how that’s being addressed, but it is on every health system’s five-year strategic roadmap.

How do you see the company and the industry moving along in those areas that you monitor?

The key question that all healthcare IT companies need to answer is the consumer question. How do you craft an excellent consumer experience? The pandemic forced us as patients to become consumers. It helped us recognize we have choice. To your point, there were certain avenues that were closed to us and we had to find other ways to receive care that we needed. As you look at the various players in the market, what that turns into, and how it is shaped, the key question is, how do we create excellent consumer experiences that support the right outcomes? That is the question that we’re hearing most health systems ask themselves, either explicitly to the market or via the RFP questions that end up coming together. That entire ecosystem of how a solution handles acute ambulatory and RPM. Health systems want to deal with one vendor that can address a lot of the value chain versus cobbling together nine or 10 different point solutions that drive a semblance of that same outcome.

Morning Headlines 11/17/21

Ribbon Health Raises $43.5M Series B to Become the Leading API Data Platform in Healthcare

Ribbon Health, which has developed an API that enables health IT developers to access data on doctors, insurance plans, and costs and quality of care, raises $43.5 million.

QGenda Acquires Schedule360, Adding the Best in KLAS Nurse and Staff Scheduling Solution to its Market-Leading Healthcare Workforce Management Platform

Workforce management software vendor QGenda acquires Schedule360, which offers Best in KLAS nurse and staff scheduling software.

H1 Raises Series C

H1, which offers drug companies a platform to identify opinion leaders and to monitor the drug trials of competitors, raises $100 million in a Series C funding round.

News 11/17/21

Top News

Population health management company Lightbeam Health Solutions will acquire CareSignal, which offers more than 30 condition-specific remote patient monitoring programs, for an undisclosed sum.

I interviewed CareSignal CEO Blake Marggraff last year. He launched the company coming out of pre-med in 2015 at the age of 22.

Webinars

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

Here’s the recording of our recent webinar titled “Increasing OR Profitability: It May Be Easier than you Think,” sponsored by Copient Health.

Acquisitions, Funding, Business, and Stock

Ribbon Health raises $43.5 million in a Series B funding round. The company has developed an API that enables health IT developers to access data on doctors, insurance plans, and costs and quality of care.

Workforce management software vendor QGenda acquires Schedule360, which offers Best in KLAS nurse and staff scheduling software.

H1, which offers drug companies a platform to identify opinion leaders and to monitor the drug trials of competitors, raises $100 million in a Series C funding round.

Sales

• The Maryland Department of Health will use NTT Data’s consulting services to enhance its Medicaid Enterprise Systems Modular Transformation program with tech-enabled solutions.
• MetroHealth in Cleveland enters into a managed services agreement with Pivot Point Consulting for its Epic EHR.
• Ergotron will integrate Imprivata’s Confirm ID technology with its CareFit Pro Medical Cart, giving hospital staff password-free access to cart drawer contents.
• Premier’s PINC AI will conduct a hospital-acquired infections clinical trial with medical solutions company Mölnlycke using Premier’s anonymized clinical data and provider network to test interventions, including its TheraDoc clinical surveillance technology.

People

Nasim Afsar, MD, MBA (UCI Health) will join Cerner as its first chief health officer in January.

Oscar Callejas, MSE (Hillrom) joins Olive as SVP of customer programs.

Carrum Health hires Randy Hawkins, MD (ConsumerMedical) as chief medical officer.

Tony Burke (Pivot Health Advisors) joins Teladoc Health as SVP of partnerships and innovation.

Care transitions software vendor ReferWell hires Chad Baugh, MBA (Teladoc Health) as chief revenue officer.

Announcements and Implementations

PerfectServe brings together its clinical collaboration, physician scheduling, patient engagement, and practice communication technologies under the Unite platform.

Elevate Holistics launches a medical marijuana card platform that includes patient scheduling, an EHR that supports telehealth, an online store for selling nutraceuticals and CBD, and a partner marketing integration system with custom landing pages.

Big news from HIMSS22: Michael Phelps, who used to swim fast, will keynote. Maybe healthcare experts Dana Carvey, A-Rod, and that mountain climber who sawed his own arm off weren’t available to reprise.

Other

Researchers at the University of Texas Health Science Center at Houston develop the Epilepsy Tracking and Optimized Management Engine, an informatics tool designed to help physicians better manage the care of epileptic patients. Neurologist Katherine Harris, MD says the software has helped cut her billing documentation time down from 20 clicks in her EHR to just three clicks using EpiToMe, which also includes modules for reports, statistics, and scheduling.

A Stat investigative report says that Ascension, the country’s largest Catholic health system at 140 hospitals, is running a $1 billion private equity operation like a Wall Street firm rather than as a passive investor.  The article notes that the tax-exempt health system isn’t required to disclose how its investment profits are used to benefit vulnerable patients.

Analysis finds that private equity-owned air ambulance services bill higher rates and generate surprise patient bills more frequently, charging 60% more than other carriers.

Former Sanford Health (SD) CEO Kelby Krabbenhoft, who left the system in late 2020 after making controversial remarks about his refusal to wear a mask, received a payout of nearly $50 million. The health system says he would have been contractually owed the money regardless of his departure circumstances, which involved $15 million in severance, $29 million in retirement payout, and $5 million in salary. Sanford Health ended its planned merger with Intermountain Healthcare because of the leadership change.

Sponsor Updates

• ConnectiveRx team members support Operation Gratitude with a financial donation and cards of support for veterans.
• Netsmart will integrate the American Society of Addiction Medicine’s Continuum and Co-Triage assessment tools with its EHR.
• Al Kindi Hospital in Jordan selects Wolters Kluwer Health’s UpToDate and Medi-Span Clinical solutions.
• EClinicalWorks releases a new podcast, “PDMP Software for Safe Prescribing of Controlled Substances.”
• The Behavioral Healthcare Executive Podcast features AdvancedMD President Amanda Hansen.
• Actium Health releases a new Hello Healthcare Podcast, “Physician Relations: A Love Letter.”
• Change Healthcare helps measure and reduce carbon emissions from the healthcare industry.
• Optimum Healthcare IT wins the CHIME Foundation Partner of the Year Award.
• Ellkay will exhibit at Modernizing Medicine’s Momentum Conference November 19-21 in Orlando.
• Waystar achieves top rankings in Black Book’s latest customer experience RCM technology and outsourcing report in the categories of end-to-end RCM software & technology, hospital chains, systems, corporations, IDNs & corporation; and end-to-end RCM software & technology, community hospitals & medical centers.
• OptimizeRx will host the second annual Innovate4Outcomes event virtually December 9.
• Health Catalyst partners with Datavant, enabling healthcare and life sciences organizations to exchange tokenized, de-identified data within Health Catalyst’s Research Network and Touchstone Match.

Blog Posts

• Healthcare 2030: Trends That Will Impact Healthcare in the Text Decade (Arcadia)
• Ascom Recognizes Veterans Amongst Our Ranks (Ascom)
• America’s Opioid Epidemic is Getting Worse (Bamboo Health)
• Virtual Consultations in Healthcare are Here to Stay (Bluestream)
• PPCP and CarePort: post-acute care workflows (CarePort)
• Value-Based Care Revenue – Which Programs Actually Deliver (ChartSpan)
• How Trust in Technology Affects Adoption Among Care Teams (CoverMyMeds)
• How to Engage Providers with Healthcare at Home (Current Health)
• Innovating with Health Plans: Focus on Outcomes (Dina)
• A Better Billing Solution for Modern Healthcare (EClinicalWorks)
• Alleviate the healthcare staffing crisis with automation (Experian Health)

Contacts

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

Morning Headlines 11/16/21

Lightbeam Health Solutions Announces Acquisition of CareSignal

Population health management company Lightbeam Health Solutions will acquire remote patient monitoring vendor CareSignal for an undisclosed sum.

Videra Health Announces $3 Million in Seed Funding to Scale Patient Interactions for Behavioral Health

Mental health-focused remote patient monitoring startup Videra Health raises $3 million in a funding round led by Artis Ventures.

Amazon’s healthcare business has landed Hilton as a key customer

Hilton Worldwide Holdings will offer its employees virtual and in-person care from Amazon Care.

Curbside Consult with Dr. Jayne 11/15/21

Big news this week, as CMS announced that it would automatically apply the “extreme and uncontrollable circumstances” exception to the 2021 Merit-based Incentive Payment System (MIPS) performance year. Previously, clinicians would have been required to specifically apply for the exception. The automatic exception will be applied for the 2021 performance year and only to those clinicians who are participating as individuals. Those participating as groups, virtual groups, or alternative payment model entities will instead have to apply for performance category reweighting. This can be done on the Quality Payment Program website prior to December 31.

Those who are carefully following how MIPS works will note that the exception reweights the MIPS performance categories to zero, which means that there will be a “neutral payment adjustment” (aka no penalty) for the 2023 payment year. Given inflation, even a neutral adjustment is still a reduction in payments, which adds to physician unhappiness. CMS also reopened the exception application for the 2020 performance year; participants can apply prior to November 29 by submitting a targeted review form.

As physicians consider the ongoing calculus of how they are paid, how they deliver services, and what their patients want them to offer, I’m starting to see more of my primary colleagues considering direct primary care practices. In that model, patients pay a monthly membership fee to see their physician. There is no third-party billing, and the model is designed to delivery quality care at a reasonable cost. The Direct Primary Care Coalition notes that “most DPC memberships / subscriptions cost less than the average cell phone bill” and that patients typically have greater access, shorter waits, and longer appointments with their physician. In addition to reducing administrative burden and costs, the model has the goal of building back the old-school physician-patient relationship and a mutually trusting therapeutic environment.

Many patients are demanding telehealth, especially during hours that aren’t considered traditional office hours. Those practices that remain part of traditional fee-for-service arrangements are continuing to advocate for payment parity for telehealth services so they can be reimbursed at the same rate for virtual visits as they would for in-person ones. On the physician side, the thought is that the visits require the same level of cognitive expertise and also the same amount of time as in-person visits. Opponents of payment parity argue that those visits should be less expensive due to reduced resources, but the reality for most physicians is that they’re still paying rent, they’re still paying staff to assist them and manage patient data, and they’re also paying additional fees for either freestanding video conferencing software or telehealth modules / content from their EHR vendors.

In New Jersey, Governor Phil Murphy recently rejected parts of a bill that would have required payment parity for telehealth services. He noted that the cost to state taxpayers may be “substantial” and that in-person care should be prioritized except when telehealth would increase access and improve patient outcomes. Murphy reinforces the idea that providers should have long-term cost savings with telehealth due to decreased clinical space and support staff. It didn’t sound like he spends a lot of time talking to physicians who are running low-margin practices and working hard to keep the lights on while they are struggling to retain staff in a market where solid clinical personnel are commanding premium salaries. I’ve performed telehealth visits with no support staff as well as those in a model where staff did all the same pre-visit prep as they would in a brick-and-mortar office, and I have to say the latter is much preferred.

Murphy also notes a concern that over the long haul, “pay parity could over-incentivize telehealth, further limiting in-person options” and that it might be “especially detrimental for those in underserved communities.” On the other hand, pay parity might allow those in underserved communities to have consultations with distant primary care physicians without an untenable wait, which is already the case in many rural and underserved communities. It could also provide opportunities to consult with previously inaccessible subspecialists when patients are unable to travel the distance to tertiary care centers. I agree that Murphy has a valid concern that CMS hasn’t fully made up its mind on payment parity, which could create confusion for Medicare and Medicaid beneficiaries.

Murphy goes on to make it clear that he believes that telehealth “was intended as a stopgap to preserve public health during an unprecedented emergency” rather than something that patients and physicians have decided serves both of them well. It’s unfortunate that he sees it as a way to deliver care of last resort as opposed to a rapid evolution in healthcare delivery. The bill received a conditional veto, which allows the senate to potentially incorporate his recommended changes and amendments. Those include a requirement that the state health department would revisit payment parity over the next 18 months and make a subsequent recommendation. In the mean time, payment parity would be in place through the end of 2023 if the recommendations are followed.

As a patient, I enjoy having options. I have two physicians who I see who really need to be seen in person due to the nature of the examinations involved. I see each of those physicians annually, which between the two of them, results in a comprehensive physical examination with a fair amount of overlap every six months. They’re part of the same medical group as my internal medicine physician, who has full access to both their records. When I see my internist in person, 90% of the visit is a discussion – what’s working for me health-wise, what’s not, and a review of laboratory results, my goals, and how I feel. Very little of it is dedicated to the physical exam and that’s OK given my current state of health. In reality, I’m seeing him for his brain much more than I’m seeing him for his exam skills, especially since I monitor the most important indicators of my health at home. As a patient, it would be much better for my schedule to be able to see him virtually and have him compensated fully for his expertise, which is why I value his care.

Time will tell how much cost reduction can really happen with virtual care. I think a lot of it has to do with how integrated various platforms are and how well physicians can learn to work with patients virtually. Will we have it all figured out by 2023? I’m not sure, but I’m committed to trying.

What’s your preference in the virtual versus in-person care debate? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Tom Cox, President, Experian Health

Tom Cox, MBA is president of Experian Health of Franklin, TN.

Tell me about yourself and the company.

The mission of Experian Health is to simplify administrative processes and improve operational efficiencies so that we can improve the healthcare journey. We primarily do that through patient access, revenue cycle management, and identity services. I’ve been with the company for two years, having joined through the acquisition of MyHealthDirect.

We’ve heard for years that collection of patient financial responsibility would become significant, and not only has that finally happened, investors are rewarding companies whose technologies and services support that collection. What trends do you see?

You will continue to see an acceleration of the digitization of healthcare. Certainly we’ve seen that through the pandemic, as folks were operating in a more remote environment. We saw the digitization of registration scheduling and even telehealth become more important. That trend was absolutely accelerated by COVID and I think you will see that trend continue in the future.

That dynamic of consumers paying a higher portion of their healthcare will drive a number of facts. First, it will require the whole healthcare system to operate much more like the rest of the economy. That is, to provide a better consumer patient experience from the beginning of the process through payments and collections on the back end. That will continue to accelerate.

From the provider’s perspective, the patient is paying a bigger portion, and what the patient pays is the hardest part to collect. Getting the right data upfront and collecting as much of the cost upfront will also be important for all providers and health systems.

How will healthcare use technology more other industries that use technology instead of handing their customer a clipboard and photocopying their documents?

You touched on a number of them. You will see scheduling, registration, and payments being digitized. You will also see healthcare start to use more data about consumers to improve the process of reviewing social determinants of health, understanding what challenges people might have in accessing the healthcare system, to make it easier for them to access the healthcare system and to improve their healthcare results. We know a lot about individuals that we’re not taking advantage of today to improve the healthcare system. You’ll see that change over time.

How do you see providers using consumer data insights, rather than just their own EHR data, to engage with their patients differently before, during, and after a visit?

That is still pretty nascent in healthcare. That provides a big opportunity for a company like Experian, which has a lot of consumer insights. The retail environment reaches out to individuals based on their desires and their wishes, engaging them in the process and then all the way through the process. That should happen similarly in healthcare. We know when patients need to engage in the healthcare system, so we should reach out to them proactively and get them engaged in the healthcare system so that they get the care that they need in a timely manner and improve their overall health. That’s what I think you’ll start to see changing going forward, but it’s still pretty early.

What technologies does Experian offer that would help providers treat their patients more like members?

We have a number of those tools to help the patient feel more like they are a valued patient, which is maybe is a better way to say it instead of as a member. I always worry about member because that tends to get associated with a health plan. From the consumer insights on the front end to anticipate the needs of an individual patient using our data and insights on consumers, to using our tools, to engage staff members through outreach, and to patient communications. Then facilitating the entire process, making that process easy for the patient along the entire journey through digital scheduling, digital registration, and online payments as a seamless, touchless process.

How do you see propensity-to-pay being used in a consumer-friendly way?

Having a propensity to pay will have help patients make more informed decisions. One of the challenges with healthcare, historically, has been that you make a very large purchase decision without any knowledge up front. Many times you only find out about that purchase decision on the back end. We are doing  couple of things to help that process. We provide estimates to patients so that they can make make an informed decision. Then, based on your ability to pay for that, you can then arrange different ways to pay for those services. Most healthcare systems are flexible in their payment terms because they know the patients need the care. They want to make that process as easy for them to get the care as possible.

Some diagnostic radiology practices offer patients a big discount if they pay cash upfront instead of using insurance or being billed. Will we see more of that?

I absolutely think that providers will continue to do all that they can to get the payment upfront. Providing that estimate is the best way to collect that upfront.

I recently experienced that myself with a procedure. I was offered a discount to pay in advance and certainly wanted to take advantage of that. The key to that process, though, is ensuring that the estimate is accurate so that there is no surprise on the back end. You are creating an expectation with the patient or with the consumer that your estimate is correct. When you make that advanced payment, you are not expecting to get another request on the back end. An accurate estimate is critical.

A significant part of patient satisfaction comes from the front end, such as ease of getting an appointment, to the back end, in getting a timely, accurate, and understandable bill. How are providers using those practices for competitive advantage?

In the US, the healthcare that individuals receive is always of really high quality, so you don’t get many complaints about care. The complaints come from the administrative processes, both on the front end of the process — scheduling, registration, asking for the same information repeatedly — and then on the back end, the lack of understanding of the billing, the explanation of benefits, and the statements. Providers are definitely realizing that improving those front-end and back-end administrative processes is a way to differentiate themselves in the market. Convenience and simplicity are the easiest outcomes to measure in healthcare and they drive how how many healthcare consumers make their decisions.

How important is it that providers react to negative patient feedback as part of their marketing efforts?

It’s important for the healthcare systems to engage with those patients who didn’t have a positive experience so they can learn and improve their processes going forward. Again, it’s most likely not related to the care that they received. It’s going to be most likely related to something on the front end or the back end of the administrative process.

What are the benefits of identity management beyond the obvious ones of efficiency, fraud prevention, and patient safety?

A number of benefits come from our identity solution. The first is eliminating any duplicate records that might be created when you’re going through the registration process or the intake process. Understanding that an individual may have moved or changed their names and making sure that you’re not creating a duplicate record. That has downstream effects of making sure that you have a complete view of that individual when you’re providing care, so that you don’t have a fragmented health record and information showing up in two different places.

A key element that we are seeing with identity getting access to digital tools. With COVID vaccinations, most health systems drove patients to their portals to register and then schedule the vaccines. Ensuring that the right identities and the right patients were getting the right vaccinations and attached to the right records was a key component that drove a lot of our growth for identity through the pandemic.

Would having a national patient identifier provide the benefits that people expect?

Having a unique identifier would certainly simplify things in healthcare. We have 328 million unique individuals that are represented through our universal identity manager tool. Using a tool like that, having a universal identity would make it easier to link your records from disparate systems to provide a holistic view of medical information.

Where do you see the company and the industry going in the next few years?

We are excited about the future and feel like the company is well positioned for growth. We think that many of the trends that were accelerated by COVID, like the digitization of healthcare, will continue. We think we are well positioned for that trend and are excited about our opportunity to deliver on our mission of simplifying the healthcare journey for all.

Morning Headlines 11/15/21

Blue Origin astronaut Glen de Vries dies in plane crash

Medidata co-founder Glen de Vries has died in a plane crash at the age of 49.

Tele911 Secures a Multimillion-Dollar Seed Round to Deploy Virtual Care into Emergency Medical Services

Tele911, a virtual care startup focused on emergency medical service triage, raises a multi-million dollar round of funding.

Rad AI Closes $25 Million Series A to Transform Radiology Workflow by Harnessing the Power of Artificial Intelligence

Radiology software vendor Rad AI raises $25 million in a Series A funding round.

Monday Morning Update 11/15/21

Top News

Glen de Vries, who rode a Blue Origin rocket into space with William Shatner and others last month, died in a plane crash Thursday along with a flight instructor. He was 49.

De Vries, who was also known as Captain Clinical, was co-founder of life sciences research platform vendor Medidata Solutions, which was acquired by Dassault Systèmes in October 2019 for $6 billion.

De Vries later wrote a book titled “The Patient Equation: The Precision Medicine Revolution in the Age of COVID-19 and Beyond.”

Reader Comments

From Bon Ivermectin: “Re: VPN Solutions in Richmond. I’ve heard from three practices that the hosting company was hit by ransomware on October 31 and their Allscripts clients have been unable to access charts since. Rumor is that the hackers demanded a $5.4 million ransom that was due Friday that won’t be paid.” I’ve emailed VPN Solutions and Allscripts but haven’t heard back so far. One of the practices mentioned — Piedmont Pediatrics in Charlottesville, VA — posted a notice on November 1 that its computers were down, but hasn’t updated since.

HIStalk Announcements and Requests

Video calls with cameras on are used more than any other one-to-one work meetings, poll respondents say. Some employers or teams mandate the use of video, commenters mentioned.

New poll to your right or here: What would worry you most about being remotely monitored at home while recovering instead of being hospitalized? I didn’t specify a condition, but use your own experience and assume that use cases will be actively developed by organizations that offer these services.

A word that I just realized is odd as I created the new poll: “hospitalized,” given the uncommon usage of “hotelized” since etymologists say that “hospital” and “hotel” share the same Latin root that refers to guests or visitors. It’s also odd in that a hospital can be about as inhospitable as it gets.

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

Webinars

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

Acquisitions, Funding, Business, and Stock

A correction to last week’s post – Surescripts CEO Tom Skelton will retire on December 31, 2022 (not at the end of this year), leading the company through next year, participating with the company’s board to choose his successor, and working with the new CEO through the transition period.

OptimizeRx reports Q3 results: revenue up 53%, adjusted EPS $0.09 versus $0.07.

Sales

• Essen Health Care (NY) chooses Verustat for remote patient monitoring, offering its underserved community patients take-home kits for tracking blood pressure, blood sugar, weight, and oxygen levels.
• Woman’s Hospital (LA) chooses Spok Go for environmental services communication and real-time critical lab result notification.
• Home health services vendor Sholom Home Care (MN) chooses VitalTech’s VitalCare for telehealth and patient-care manager interaction. 

People

David Harse (Cerner) joins HealthMark Group as SVP/GM of patient engagement.

Culbert Healthcare Solutions promotes Julie McGuire, RN, MSN to VP of Epic IT consulting services.

Announcements and Implementations

NYU Langone’s Predictive Analytics Unit in the Center for Healthcare Innovation and Delivery Science will host the Symposium for Machine Learning Implementation and Evaluation (SMILE) to discuss the latest advances in mobilizing machine learning to practice and evaluating and bringing machine learning to patients. The free, non-sponsored virtual event will be Thursday, November 18 from 12:30 to 5:00 ET.

A group of AMIA members asks folks who are developing FHIR-based software to complete their short survey by November 30. The results will be used to create a worldwide catalog of FHIR applications.

Other

A ProPublica report looks at the money machine that is St. Jude Children’s Research Center, which despite being ranked behind nine other children’s cancer hospitals, raises more many than all of them combined. Its reserves are $5 billion as it has spent only half of its $7 billion in contributions over the past five years on research and care. The hospital doesn’t bill the families of children for their care, but 90% have insurance that it bills. St. Jude has 5,700 employees and just 73 beds, while its fundraising organization has 2,200 employees working from Memphis and 36 regional offices, with 400 of the fundraising employees making more than $100,000. The former pediatrics chair at Albany Medical Center (NY) says St. Jude raises money from its nearby office, but almost all children with cancer are treated locally instead of in Memphis, to which he concludes, “They think of every way they can to make money and the least amount of ways to spend it. They deceive people into supporting something that is totally dishonest.”

Sponsor Updates

• Sectra publishes a new e-book, “Radiology post-pandemic game plan.”
• Talkdesk wins the 2021 Public Relations and Marketing Excellence Award from the Business Intelligence Group.
• Visage Imaging contributes to a new report, “First PACS-integrated artificial intelligence-based software tool for rapid and fully automatic analysis of body composition from CT in clinical routine.”
• Waystar will sponsor Bounce Back Kit family care packages for the Bounce Children’s Foundation.

Blog Posts

• A Salute to Those Who Served (Netsmart)
• Is automation the future of 340B compliance? (Olive)
• The Cost of Patient Engagement: What Is Your ROI? (PatientBond)
• How and Why to Incorporate Veteran Talent into Your Supply Chain Hiring (Premier)
• Challenging and Critical, Compliance Takes Great Commitment (Protenus)
• HCC Coding Automation: NLP Technology vs HCC Coding Software (RCxRules)
• Creating a Personalized Prescribing Experience for Each Patient (RxRevu)
• 4 Factors Healthcare ISVs Should Consider When Choosing a Payments Platform (Sphere)
• Will Teamwork Deliver on the Promise of Value-Based Care? (Surescripts)
• How Artificial Intelligence and Machine Learning are Rapidly Changing Patient Engagement (Twistle)
• New Year, New Regulations: 2022 Final Rule Highlights (WebPT)

Contacts

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

Morning Headlines 11/12/21

Kansas health care app company accuses Mercy of ‘stealing’ trade secrets in new lawsuit

LifeScience Technologies sues Mercy, which it claims disclosed trade secrets about LST’s M.Care virtual care platform to telehealth competitor Myia Health.

OPKO Health Leads $5 Million Investment in HealthSnap, to Help Rapidly Scale Remote Patient Monitoring Platform to Empower Better Chronic Condition Management

Remote patient monitoring startup HealthSnap raises $5 million.

Definitive Healthcare Reports Financial Results for Third Quarter Fiscal Year 2021

Definitive Healthcare, which went public in mid-September and finished its first week of trading with shares up 81%, announces Q3 results: revenue up 43%, adjusted EBITDA flat.

News 11/12/21

Top News

LifeScience Technologies sues Mercy, which it claims disclosed trade secrets about LST’s M.Care virtual care platform to telehealth competitor Myia Health.

The lawsuit claims that LST customer Mercy shared its system log-in credentials to Myia Health’s developers, allowing the company to develop a “derivative product” that Mercy then implemented to replace LST.

LST also says that Mercy invested $5 million in Myia Health. 

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Current Health. The Boston-based company, which was acquired by Best Buy in November 2021, offers an enterprise care-at-home platform that enables healthcare organizations to deliver high-quality, patient-centric care at a lower cost. It integrates patient-reported data with data from biosensors – including its own continuous monitoring wearable device – to provide healthcare organizations with actionable, real-time insights into the patient’s condition. Leveraging clinical algorithms that can be tailored to the individual patient, it identifies when a patient needs clinical attention, allowing organizations to manage patient care remotely or to coordinate in-home care via the company’s integrated service partners. Its platform brings together telehealth capabilities, patient engagement tools, and cellular connectivity to provide a single solution to manage all care in the home. It has designed evidence-based care pathways that can be tailored to the needs of the individual patient, supporting a wide range of clinical conditions and acuity levels. To help its partners scale their care-at-home delivery, it also provides comprehensive logistics management, a Clinical Command Center, and integrations with in-home ancillary service providers, all serving as an extension of your team to help transform how healthcare is delivered at home. Thanks to Current Health for supporting HIStalk.

Webinars

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

Acquisitions, Funding, Business, and Stock

Definitive Healthcare, which went public in mid-September and finished its first week of trading with shares up 81%, announces Q3 results: revenue up 43%, adjusted EBITDA flat. The company’s market value is just under $4 billion. Founder and CEO Jason Krantz described the company’s business in the earnings call: “I founded Definitive Healthcare to help companies analyze, navigate, and sell into the complex healthcare ecosystem. We bring clarity and in-depth knowledge of the entire market that we have a deep understanding of the interconnected relationships between physicians, hospitals, providers, insurance companies, government regulators, and the patients themselves.”

Remote patient monitoring startup HealthSnap raises $5 million.

Sales

• SoftWriters will integrate First Databank’s Meducation medication adherence solution with its FrameworkLTC pharmacy management platform.
• Flagler Health+ (FL) will implement Halo Health’s clinical collaboration technology.

People

Surescripts CEO Tom Skelton will leave his role at the end of 2022 in a planned transition.

Former National Coordinator Don Rucker, MD joins interoperability startup 1upHealth as chief strategy officer.

Virtual nurse assistant software vendor Care Angel names Nick Martin (DuPage Medical Group) CIO.

Brad Rennick (Modernizing Medicine) joins NThrive as chief client officer.

Wolters Kluwer Health promotes Gregory Samios to president and CEO of Clinical Effectiveness and Peter Bonis, MD to chief medical officer of Clinical Effectiveness.

Announcements and Implementations

PeriGen announces GA of Vigilance Mobile, giving end users remote access to its AI-based early warning system and clinical decision support tools.

Government and Politics

Representative Kim Schrier, MD (D-WA), a former pediatrician and Cerner end user, shares her concerns with VA Secretary Denis McDonough about EHR usability and its impact on patient care after she toured a clinic that is connected to the VA’s first live Cerner site of Mann-Grandstaff VA Medical Center (WA). She notes that employees have told her the system frequently crashes, forcing them to re-type lost notes; and that its self-scheduling and prescription management features are so buggy that patients have resorted to calling the clinic, resulting in overwhelmed phone lines. “If they have to scrap this version of Cerner,” she says, “it’s probably better to do that and use something that’s tried and true than to try to fix a system that is just broken from within.”

A VA OIG review of its implementation of Cerner’s patient scheduling system finds that while many schedulers prefer the more user-friendly Cerner system over that of the replaced Vista system, they didn’t receive adequate training on complex scheduling scenarios and weren’t given enough time for practice. The VA also went live without resolving significant lapses in functionality, such as Cerner’s inability to automatically mail appointment reminder letters and to switch a scheduled visit between telehealth and in-person. Scheduling supervisors also reported confusion over measuring wait times, a nationally critical problem that the Cerner scheduling system was supposed to help resolve. After going live, care was delayed as permissions issues limited the ability of schedulers to book certain types of appointments, data migration problems required some information to be manually deleted, and reminder calls had to be turned off because patients were being told to check in at the front desk for visits in which on-site care was not available.

Privacy & Security

Southern Ohio Medical Center reverts to downtime procedures and diverts ambulances as it deals with a cyberattack that occurred early Thursday morning.

Sponsor Updates

• DirectTrust recognizes Cerner Director Greg Meyer as an Interoperability Hero during the third quarter.
• Vocera Communications signs a reseller agreement with MDI Medical in Ireland.
• Vyne Medical releases a new podcast, “How Patient Experience is Leading Hospitals Toward Digital Transformation.”
• Olive adds ClosedLoop to its marketplace for healthcare solutions.
• Fortified Health Security hires Joe Anderson (Geodis) as solutions architect.
• Goliath Technologies rolls out enhancements to Goliath Performance Monitor.
• For World Diabetes Day, Meditech shares stories of access to care.

Blog Posts

• Halo Health acquisition highlights benefits for customers (Halo Health)
• Get Your Head in the Cloud: Managed Cloud Services Help Healthcare Organizations Attain Digital Transformation (Healthcare Triangle)
• The Healthcare Research Network: 5 Modernizing Features (Health Catalyst)
• Engaging Our Community with Event-Based Vaccine Information and Advocacy (Healthwise)
• Why You Should Plan Your EHR Post Go Live Support Before You Go Live (Impact Advisors)
• Talent & the IT Skills Gap – Opportunities to Change the Way we Hire (Optimum Healthcare IT)
• Clinicians on the move: Is there more to the healthcare exodus than COVID-19? (Imprivata)
• Infor Cloverleaf continues to outperform the competition in the latest Black Book survey (Infor)
• The Right Tools for the Job: Here’s What Health IT Developers are Telling Us (InterSystems)
• Meds 101: Challenges for interoperability in healthcare (Intelligent Medical Objects)
• The Evolution of SDOH and Health Data Exchange (LexisNexis Health)
• Autonomous Care Journeys – Who Is Driving Your Care? (Lumeon)
• Best Practices for Reducing Supply and Inventory Waste in Your OR (Medhost)
• Anderson Hospital’s strategy to remain independent affords better community care (Meditech)
• What Could the SMART Act Mean for PT Practices? (MWTherapy)
• From Fragmented to Frictionless: The Next Stage of the Health Tech Revolution (NextGate)

Contacts

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

EPtalk by Dr. Jayne 11/11/21

I had dinner with one of my friends from residency tonight. She’s considering leaving practice even though she’s not even 50. She had two unvaccinated patients die from COVID this week, one of whom was only 46 years old and who died after being in the intensive care unit and on a ventilator for over two months. Her late patient left behind several children, and apparently their father spent the last several days harassing my colleague because she had refused to treat the patient with ivermectin. The harassment included threatening comments and a visit to my friend’s house, resulting in a call to the police and my friend bundling her own children off to their grandparents’ just in case. Physicians have been fighting this pandemic for more than a year and a half and they certainly didn’t sign up for what she experienced.

On top of that, her partner quit and the health system she works for has been unable to hire a replacement who is willing to join a rural practice, leaving her to care for more than 6,000 patients on her own. She has also developed a severe skin reaction from the soap and sanitizer used in the office, resulting in a worker’s compensation claim after multiple product changes failed to yield results. She’s had to miss work due to numerous physician visits, including second and third opinions from dermatologists at the local medical schools. Every time she takes off for a physician visit, it negatively impacts her office productivity, and the medical group’s newly appointed administrator asked her why she can’t schedule her visits after hours. As she was telling me the story, I wondered if the administrator had ever been a patient or caregiver, because that’s just an asinine suggestion.

She had a lot of questions about telehealth and whether that might be an option for her if she isn’t able to find a solution to her allergic skin reactions. Her only experience with telehealth was during the height of the pandemic, when the health system encouraged physicians to embrace virtual visits because patients didn’t want to come in. However, in her particular community, many patients didn’t think COVID-19 was a big deal and thought that dealing with a computer was a bigger nuisance than risking infection, so telehealth never really took off. From a technology standpoint, they were using a solution that was completely cobbled together and had no integration with their EHR, so I encouraged her not to judge her options based on that experience.

We talked about some trends in telehealth, including insurance plans that have a virtual-first focus. I would propose that such plans would be most effective if continuity could be preserved, either with the same care team providing both in-person and virtual care, or if dedicated virtualists had full access to the patient’s medical records. There are concerns about physicians providing virtual-only care as far as not being able to perform a physical exam. The new plans are designed to have networks of in-person physicians that can perform hands-on services when required, and who can coordinate with the virtual physicians. Although payer-sponsored plans might have their own patient records, they might have difficulty coordinating when patients receive services from non-network physicians or other care providers. Some of the plans have high deductibles for in-person care, which may serve as a deterrent. Additionally, they may not be compliant with the Affordable Care Act.

We also talked about the challenges of practicing telehealth, including technology issues. A recent piece in JAMA Network Open looked at factors influencing whether patients and physicians were able to successfully complete telehealth visits. The authors looked at over 137,000 video visits and found an overall success rate of 90%. Patient factors were “more systematically associated with successful completion of video visits” where “clinician comfort with technology was associated with successful video visits or conversion to telephone visits.” Certain factors were associated with conversion to telephone visits, including lower clinician comfort with technology, greater patient age, lower patient socioeconomic status (including low availability of high-speed internet), and racial/ethnic minority status.

The study has some limitations, including having been conducted at the height of the COVID-19 pandemic when most of us were still getting used to the idea of video visits and many providers were using substandard technology platforms to try to connect with patients. Visits at that time were often sporadic and urgent, and there was little lead time to help patients with technology or their comfort level with video encounters. The study also was conducted in the Midwest and at a single healthcare organization. Longer duration studies with a broader cross section of patients would be beneficial.

Our conversation crossed into a lot of different elements of practice, and she was interested to hear about my recent experiences in EHR training. We’re both veterans of multiple EHR conversions and implementations, and she asked if I had seen the story about the US Department of Veterans Affairs being ordered to pay $160 million to clinicians for extra work hours spent updating EHR data. I hadn’t seen it until she mentioned it, but the short version is that 3,200 nurse practitioners and physician assistants who were employed by the VA at the time worked overtime doing various EHR functions and weren’t compensated appropriately. The court ruled that employees should have had received overtime pay any time they worked more than eight hours in a day. In the class action suit, each member will receive about $50,000 in compensation.

The last thing we talked about as our bottle of pinot noir became depleted was an article that looked at whether physicians could accurately predict the out-of-pocket costs for medications they were prescribing. The authors found that only 21% of physicians could do so, which sounds like what I might expect given the craziness of medication pricing and the challenges in figuring out various formulary coverage, deductibles, co-pays, and annual caps. We’ve both used EHRs that were supposed to display formulary and eligibility data in a way that should help physicians figure this out, but have found that none of them were particularly effective, especially since different payers use different formulary levels that resulted in confusing EHR displays and data that just didn’t make sense.

The evening ended with a discussion of her children and their career plans and the fact that she’s completely baffled her children want to pursue careers in medicine despite her obvious dissatisfaction with it and eagerness to leave it. They’re still relatively young, in middle and early high school, so of course things can change. Given the way things are now, I know quite a few physicians who wouldn’t choose the career again, or if they did, would choose a different specialty. It’s a sad commentary on what healthcare has become for a lot of physicians.

If you had it to do over again, would you still choose healthcare? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 11/11/21

Health Catalyst (HCAT) Reports Q3 Loss, Tops Revenue Estimates

Health Catalyst reports Q3 revenue of $61.74 million, with a quarterly loss of $0.18 per share.

Surescripts Announces Planned CEO Transition

Surescripts CEO Tom Skelton will formally step down from his role at the end of the year, but will remain with the company while his successor is found.

Oneview Healthcare raising $23 million via Canaccord

Patient engagement technology vendor Oneview Healthcare seeks to raise $23 million to expand its sales, marketing, and product development efforts.

CPSI Announces Third Quarter 2021 Results

CPSI’s Q3 revenue increases to $70.1 million, with total revenues at the nine-month mark also experiencing a bump up to $206.6 million.