EPtalk by Dr. Jayne 5/5/22

Those that follow me on Twitter know what I’ve been doing this week as I traveled to the rolling hillsides of Verona, Wisconsin. Epic’s Expert User Group (XGM) meeting was in its second week, with a heavy focus on clinical topics. It was great to catch up with some old friends, most of whom I worked with on other EHR systems across the last two decades. Each hospital and health system has certainly had its own healthcare technology journey, but it’s clear that for quite a few of them, all roads have led to Epic.

I’ve attended a variety of user groups across most of the major vendors and there are quite a few elements that set Epic apart as far as meetings. Rather than having to rely on hotels or conference and convention centers for meeting space, Epic’s purpose-built facility makes things incredibly easy for attendees. Presentation rooms are interestingly named, amusingly decorated, and full of light – unlike the cavernous spaces divided by portable walls that many of us are used to when we go to meetings. The meeting area also featured booths from various local vendors selling various kinds of cheeses, chocolates, locally produced soaps, and more. I enjoyed seeing everything Wisconsin has to offer and from the number of sales transactions, it appears others did as well.

Another thing that sets Epic apart is its outstanding culinary team. I’ve had plenty of questionable meals at conferences, but the menu selections at XGM were truly over the top. There’s a definite “farm-to-table” feel with lots of healthy offerings. Goat cheese and asparagus options appeared at several meals, which made me very happy, as I like them but don’t often cook them. Attendees were even able to download a 95-page document with recipes in the event they wanted to replicate the experience at home. I’ll definitely be availing myself of the recipe for scones.

Many attendees toured the campus, although rain on Tuesday put a small dent in that. It’s been great meeting other physicians involved in clinical informatics work, especially in disciplines that I haven’t worked in for a while. I enjoyed learning about different groups’ approaches to trauma-informed care and how to use EHR tools to better support patients. One of my favorite presentations was by UCLA Health, which has been using Natural Language Processing to identify patient portal messages that contain high-risk topics. It allows clinical care teams to address those messages more quickly, which hopefully will lead to improved outcomes. The team acknowledged the impact that the COVID pandemic has had on its work, and I know there was a lot of sympathy from audience members whose own projects may have been sidetracked or even canceled as a result of changes in organizational priorities.

It’s always a challenge to balance what’s going on at your day job with attending a conference, and I had a couple of conversations with physician informaticists who were reacting to the idea of a Supreme Court decision overturning Roe v. Wade. My OB/GYN colleagues are noting increased patient demand for appointments to place long-acting contraceptive devices as well as those to discuss prescriptions for emergency contraceptive medications. With several states having laws in place that would go into effect immediately upon the event of an overturn, I understand their desire to be proactive. There have been requests to alter physician schedules to add procedure slots as well as to create outbound patient portal messaging to try to reduce the number of phone calls the offices are receiving. Life as a clinical informaticist is certainly never dull.

The COVID-19 pandemic changed the landscape for virtual contraceptive services, which were offered by the majority of clinics surveyed for a recent article. Pre-pandemic, only 11% of those surveyed offered telehealth consultations for contraception, with the number rising to 79% after March 2020. Apparently, 22% of those surveyed had drive-through contraceptive clinics. Although I don’t recall hearing about any of those in my area, it’s a great idea. I found it interesting that 20% of people closed their in-person clinics and only offered services via telehealth. The study had a relatively small sample size of around 900 respondents. It will be interesting to see what happens to this landscape in coming months.

In speaking with other attendees, behavioral health continues to be a hot topic. There are too few providers to meet demand and organizations are looking to creative offerings such as teletherapy and self-service interventions for patients. Staffing challenges were also a common theme, and organizations are looking to use pre-visit questionnaires to help gather data prior to the visit so that the patient rooming process is more efficient. Automated alerts to let patients know when their care teams were running late are gaining traction. Many of the solutions presented by clients focused on shifting various tasks from the staff to patients. Although those moves can definitely support patient engagement, they’re also ways to help mitigate staff burnout. Many organizations are still struggling to hire office-based nurses, medical assistants, care coordinators, and patient care technicians, so they’re looking for whatever efficiency boosts they can find. It sounds like there are a lot of optimization projects going on, with hospitals trying to fit that work in before a potential next pandemic wave.

On Wednesday, which happened to also be Star Wars Day, a couple of presenters included Star Wars references in their slide decks, and I spotted several attendees in costume. I closed out my meeting experience with a trip to “Xtra Hour,” which was advertised as a social event for food and fun at the end of the day. The event featured a variety of food and drink, including a lovely crab and leek appetizer and sparkly galactic-themed lemonade. I heard the mini cupcakes were good as well as the mini meringue desserts. Attendees had the chance to take part in several activities including craft projects and giveaways, and of course there was plenty of good old-fashioned socializing. Then it was back to the hotel to put my feet up and to pack so I can head home in the morning. Overall, it was a great experience and I’m heading back with a notebook full of ideas and thoughts to make life better for my end users and their patients. I was also happy to be able to have in-person encounters with many of the people I work with regularly. Building relationships is always one of my favorite parts of these events.

What is your favorite part of a user group meeting? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 5/5/22

Offor Health Completes Series A Round With Additional $9 Million Led by AXA Venture Partners

Offor Health, which specializes in providing mobile surgical services to in-office settings, raises $9 million in a Series A funding round.

Workflow automation solution for post-acute care Element5 closes $30M in Series B round of funding

Post-acute care workflow automation vendor Element5 raises $30 million in a Series B funding round, bringing its total raised to $45 million.

Cruces-based telehealth company Electronic Caregiver to add 770 jobs

Remote patient monitoring company Electronic Caregiver will hire 770 employees as it expands its headquarters in New Mexico with the addition of a clinical triage center.

HIStalk Interviews Mariann Yeager, CEO, The Sequoia Project

Mariann Yeager is CEO of The Sequoia Project of Vienna, VA.

Tell me about yourself and the organization.

I’ve been in health IT virtually my entire career. I got my start years ago working for an insurance company, then a clearinghouse, and have been in health IT ever since. I got into the interoperability space, working with the ONC on the Nationwide Health Information Network project, which led to the formation of this particular project 10 years ago. We were formed as a non-profit, public-private collaborative. We are solely focused on advancing interoperability for the public good and working in collaboration with government to offset the burden of what they’re trying to accomplish.

Is the lack of interoperability a technical problem or a business problem?

All of the above. There are policy, business, and technical issues that impede the ability for information to flow seamlessly. That’s where we focus our energies at The Sequoia Project, identifying the issues that are impeding progress and systematically addressing them one at a time.

What other industries provide a model for competing organizations exchanging information about their shared customers?

Certainly we can learn a lot from financial services, telecom, and banking. In fact, as we were exploring and preparing to launch Carequality in 2014, we researched how things operate in the ATM and ACH world, where they have a non-profit that brings together different stakeholders to develop rules of the road so that ACH networks interconnect. Carequality was modeled after that type of activity. There’s a lot we can learn, but in some ways, what we’re dealing with is a far more complicated transaction than a banking transaction, so there are a lot more issues to unpack.

Arguments have been made that healthcare participants should be paid for sharing data instead of being penalized when they don’t. Is the sharing model yet to be determined?

From where we sit, there needs to be a baseline of technical and policy capabilities in place to interconnect our ecosystem.Then there needs to be a value to exchange and then an impetus to exchange. The value to the exchange usually comes from the value of the information and whether it offsets some administrative burden. Is there a return on investment, for instance, or does it somehow contribute to some other good? That’s the first thing to look at and explore — the value of exchange.

Then the impetus to exchange is, how do you get people to use the capabilities that exist? Again, it’s really derived from value. You can have opportunities to have better information more readily accessible and that makes the clinician’s life easier, makes supporting value-based arrangements easier. The impetus to change can also come from governmental mandates. What we are seeing in our space now is a combination of all the above, which creates an exciting opportunity to advance the ball within interoperability, because the stars are aligning in terms of all these things coming together.

How will ONC’s information blocking review work under a complaint-based system where it’s often a big health system that isn’t sharing patient data?

We’ve seen tremendous progress in healthcare organizations interconnecting for treatment purposes, of course, starting with health systems. There’s a tremendous volume of information being exchanged between health systems and now increasingly across the continuum of care. 

We have to take into account the maturity of the platforms that these other care settings are using to support their clinical environment, and then the other actors that have a need for health information but that aren’t even participating in the network. It makes it a lot more difficult if you’re trying to approach point-to-point arrangements versus if you’re a public health agency, a health plan, or a small physician practice. If you’re able to connect to a health information network, that is the mechanism that allows you to access information. Then of course if that network interconnects with other networks like to Carequality or an ONC-endorsed TEFCA framework, that’s where we’re going to see the seamlessness. I think it’s a reflection of, in part, the maturation of those capabilities, the ability to participate in networks and along that life cycle. 

Then we can’t even begin to speculate how ONC might and OIG may be approaching compliance. With respect to the different actors, health information networks, health IT developers, healthcare provider organizations, et cetera, that really remains to be seen from where we sit. It boils down the very practical issues that are impeding exchange — different interpretations of law, different interpretations of policy, different interpretations of what is even treatment-based exchange, care coordination treatment. We’re getting greater clarity around that. For us, it’s much more nuanced

What efforts are you seeing to connect public health to the healthcare system?

It’s pretty ad hoc right now, for the most part. Everyone realized that in the midst of a pandemic is not the time to try to create an interconnected health IT ecosystem that the public health is plugged into. But there are tremendous opportunities to leverage existing infrastructure for that purpose. Naturally there are regional statewide HIEs and others that are doing interesting things to support public health and make it easier for public health agencies to get the information that they need.

Electronic case reporting is getting significant uptake and being supported both within nationwide networks and with others across and between networks. That is just an example that if you have a discrete use case and you have a trust framework in which to support it, that capability exists. This is an area where we think that TEFCA is going to play an important role in advancing this in a much more robust way for more public health capabilities.

Can you describe in simple terms the impact that TEFCA and Qualified Health Information Networks might have on consumers and providers?

The 21st Century Cures Act was passed into law in December 2016. It directed ONC to develop and support a Trusted Exchange Framework and Common Agreement, TEFCA, to support the exchange of information between different, disparate health information networks. ONC has been working since then to develop key elements to enable that to occur. They were given the ability to work with a private sector organization to help them implement the different components of TEFCA to operationalize it. The Sequoia Project was selected to serve as that private sector organization, an official designation as being a Recognized Coordinating Entity. We are working with ONC to develop the agreements, the implementation guides, and the onboarding process that would enable networks that want to receive special government endorsed designation as a TEFCA Qualified Health Information Network, or QHIN, where we would work to facilitate that process and do the onboarding and designation for those that comply.

How do the various elements of trust fit in with the ability to exchange information, including one provider not trusting another’s data?

It’s a policy issue, and there is a technical element and workflow element as well. The idea of having trust agreements and trust frameworks is so that a participant — a healthcare organization or participant or actor in one network — can rely on the information they’re getting from someone else. That it comes from a trusted source, that they’re abiding by the same rules of the road, and that the information is only going to be requested in accordance with certain rules of engagement. It will be appropriately protected. That is very foundational before someone would even be willing to share information at all.

The other part of that is, can you trust the information itself? Does the information have value? Is it semantically valid? We are doing a lot of work on that at The Sequoia Project through our data usability work group, which includes a group of subject matter experts, guests from across many different stakeholder groups, to try to define in a more clear way how data should be codified to improve the value and meaning of the information when it’s exchanged.

Is a national patient identifier essential to the process?

The issue around the national patient identifier is multifaceted. Some believe that it would be the linchpin to solving interoperability, while others say that it really has value for a small portion of identities that we can’t match through other means. At Sequoia, we tend to be practically oriented about what can we do today to improve matched results and increase it over time. We publish white papers to that effect and refresh and update white papers we published years ago. The use of secondary identifiers, and adding that onto the other identity traits used for matching, can be quite effective. We think that there’s a lot of value in continuing to look at methodologies like that. We tend to meet the market where it is and set our sights on what we can do to incrementally improve progress over time. A unique health identifier has its place, but there are also things we can do today to make tremendous progress. We look at that very carefully,

People often misunderstand HIPAA or misrepresent it to support what they want to do. Is the 1990s-era rule a barrier to what you would like to accomplish?

In some cases, HIPAA is very much an enabler, because it is a standard for privacy and security that we can leverage and it is well understood and established. In other cases, HIPAA predated most of the digitization of healthcare, and there are aspects of it that are, as you said, misunderstood or misinterpreted. Maybe it is an area that needs further clarification.

A good example that we saw in the pandemic was that healthcare organizations were reluctant to share summaries of patient records with public health agencies. They worried about exceeding minimum necessary. OCR issued guidance clarifying that if you receive a request from a public health official, you can trust that it’s for the information that they need. It was still an impediment that was more of a policy interpretation and a risk tolerance. It was more of an impediment in terms of interpretation and understanding. Trying to get that kind of clarity in the midst of a pandemic is quite challenging.

People who read about FHIR and interoperability APIs may think we’ve solved the problem, but many of us still have personal experience where a new provider is starting with a blank slate. Is consumer education needed to set expectations for information sharing and blocking in a complaint-based system?

FHIR, APIs, and the emerging role that apps will play in enabling consumers to access their health information are all tools in the toolkit. If you think about it from the perspective of individual access, you have obligations now to share information with individuals. It’s an imperative. We are working on how to operationalize that.

A good example of that is the work that we are doing with the ONC on TEFCA and those organizations that participate in TEFCA, others as a QHIN itself or as a participant or someone connected to QHIN itself. There’s an obligation that if someone requests their information and if you have information about that person, you must share it unless you are not permitted by law to do so, or somehow breach privacy or security.

We look at not so much information blocking as a compliance paradigm, which it certainly is, but if you turn it on its head, it’s an information exchange paradigm that TEFCA and other activities can reinforce. The more we address impediments to information exchange, the more we get down to the brass tacks of how to make this work seamlessly. Individual access is an excellent example, because we can support that on a wide scale basis today using the very standards and protocols that have existed for a long time and using new standards and protocols such as FHIR. The issues often boil down to policy. That’s really what we’re trying to unpack with respect to our work on TEFCA.

ADT notification is a lightly heralded success that took a lot of effort. Are you seeing significant uptake?

ADT notification is a great example of capabilities that were born out of market need and demand organically. You see so many health information networks supporting those capabilities, and have that reflected in regulation as well, as a way to demonstrate meeting certain measures with CMS. It’s an exciting paradigm to witness. We hope that the work that we foster here in the private sector can be pointed to in other ways. That’s why we work very much at Sequoia with boots on the ground, trying to resolve issues that have practical implication and get some traction that hopefully reinforces and supports policy goals.

What will be the most important interoperability issue over the next two or three years?

I would like to see us move beyond the sharing of information for treatment purposes. We’ve seen tremendous progress and very much take pride in what we, as a collective industry, have done in that regard. We can expand that to support other use cases, such as the exchange of information for payment, for healthcare operations, to individuals, and for public health purposes. I am very positive about our ability to reach that. We have good momentum. We are getting good traction. I think we will start to see some real progress in that respect.

Do you have any final thoughts?

I would like to reflect on the past 10 years and our journey here at Sequoia. We started in back in 2012 with the idea that there would be a need for an organization like us — a non-profit, public good-oriented organization; public-private; working to advance the ball on interoperability by solving practically oriented issues. We have seen the ability to make strides not by going it alone, but by having a broader community of stakeholders working with us side by side. We attribute the progress and our ability to have incubated and launched these initiatives and the work we’ve done with interoperability matters in TEFCA to the tremendous support that we’ve had from stakeholders. I just wanted to acknowledge and be thankful of that.

Morning Headlines 5/4/22

Cerner Reports Fourth Quarter and Full Year 2021 Results

Cerner reports Q1 results: revenue up 4%, adjusted EPS $0.93 versus $0.78, meeting earnings expectations but falling short on revenue.

VA secretary urges EHR rollout to continue, but ‘very concerned’ about system outages

VA Secretary Denis McDonough says the agency will continue rolling out its new Cerner software despite five recent outages that have caused some lawmakers to call for a halt to implementations.

American College of Physicians and the American Telemedicine Association Collaborate on New Digital Health Assessment Framework

The American College of Physicians and the American Telemedicine Association will develop a framework for assessing digital health technologies that are used by providers and consumers.

News 5/4/22

Top News

Allscripts closes the sale of its hospital and large practice software business to Constellation Software’s subsidiary N. Harris.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Global Healthcare Exchange. Founded in 2000, GHX pioneered healthcare’s largest cloud-based supply chain network, which today connects tens of thousands of healthcare organizations across the globe. The network represents healthcare providers operating more than 80% of licensed beds in the US and suppliers representing more than 85% of the medical-surgical products used in healthcare delivery. With the support of GHX, healthcare organizations have removed billions of dollars of wasteful healthcare spend. Over the last two decades, GHX has continued innovating alongside a passionate community of healthcare providers, suppliers, distributors, and other industry stakeholders, all united around a common purpose: to simplify the patient-centered business of healthcare to improve outcomes. The company’s passion for uniting the best of healthcare is driven by a powerful vision: create a viable and sustainable future for healthcare by arming organizations with the data, insights, and technology they need to thrive in healthcare’s value-based future, where patients are at the heart of every decision. GHX believes that by empowering organizations to move beyond process efficiency, and toward efficiency of outcomes, organizations will thrive and the vision of a viable and sustainable future for healthcare will become a reality. Thanks to GHX 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

Cerner reports Q1 results: revenue up 4%, adjusted EPS $0.93 versus $0.78, meeting earnings expectations but falling short on revenue.

Configo Health, a startup that has developed benchmarking analytics for pediatric hospitals, raises $2 million in a seed funding round.

Plug-and-play virtual care software developer Capable Health raises $6 million in seed funding. Its technology allows developers to launch digital clinics.

Kidney care-focused analytics and population health management vendor Healthmap Solutions raises $35 million, bringing its total funding to $136 million.

Online pharmacy Truepill stops filling Adderall and Vyanse prescriptions as online mental health companies such as Cerebral and Don Health raise concerns about overprescribing. Major drug chains such as Walmart and CVS have also reportedly delayed or declined to fill such prescriptions.

The American College of Physicians and the American Telemedicine Association will develop a framework for assessing digital health technologies that are used by providers and consumers. The US-focused framework covers privacy and security, clinical assurance and safety, and usability.

Sales

• Rochester Regional Health (NY) will incorporate TytoCare’s telemedicine software and hardware into its virtual care services.
• University of Michigan Health will use analytics from Loopback Analytics to improve its specialty pharmacy program.

People

OncoHealth promotes Jennifer Haas to chief marketing officer.

Divurgent names Ed Marx (The HCI Group) CEO. He replaces founder Colin Konschak, who will become executive chairman.

Lynne Nowak, MD (Evernorth) joins Lark Health as chief medical officer.

IKS Health hires Ben Crocker, MD (Massachusetts General Hospital) as SVP of care design and innovation.

Stan Opstad, MBA (Inovalon) joins Zipari as chief product officer.

Announcements and Implementations

Audubon County Memorial Hospital & Clinics (IA) staff will implement Epic this week.

Jefferson Radiology goes live on Philips Collaboration Live for diagnostic tele-ultrasound, allowing remote radiologists to connect virtually with patients during their imaging appointments to provide a diagnosis, answer questions, or request additional imaging from the sonographer.

Consumer-focused healthcare wearables company Withings launches enterprise remote patient monitoring devices and software for patients and providers.

Personal ECG app vendor AliveCor launches KardiaComplete, a remote personal monitoring and virtual cardiologist service for people with hypertension and arrhythmias, sold through employers and payers.

Government and Politics

Winn Army Community Hospital at Fort Stewart in Georgia will go live on Cerner next month as part of the DoD’s continued wave of MHS Genesis roll-outs.

VA Secretary Denis McDonough says the agency will continue rolling out its new Cerner software despite five recent outages that have caused some lawmakers to call for a halt to implementations. The VA’s Central Ohio Healthcare System in Columbus went live on the EHR over the weekend. McDonough said he is “very concerned about the execution of the program to date” and added that the first of the downtimes was so “egregious” that Cerner CEO David Feinberg, MD, MDA issued a signed apology.

Privacy and Security

Virtual chronic care management and remote patient monitoring startup MyNurse notifies users of a March data breach, adding that it will cease operations at the end of the month for unrelated reasons.

Good Samaritan Medical Center Director Amy Travland reminds staff to print their names and avoid abbreviations when paper charting during downtime, referring to a cybersecurity incident last week. Good Samaritan was one of two Tenet Healthcare facilities in Florida that took systems offline as a result of the breach.

Other

Cardiologists express concern that tens of millions of consumer devices that can issue atrial fibrillation warnings will consume doctor time and healthcare expense to confirm or rule out a diagnosis, all for uncertain benefit. Symptom-free patients will have medical-grade monitors attached for days and then potentially have expensive anticoagulants prescribed that can cause side effects. One cardiologist said that tech companies introduced such alerting “because they could” and said that doctors are trying to catch up to the “test doctors didn’t order.”

Mozilla finds that of 32 mental health and prayer apps it reviewed, 28 raise strong data management concerns and 25 fail to meet minimum security standards. Mozilla’s lead privacy expert called the apps “exceptionally creepy” and that the companies that offer them are “negligent and craven.” The biggest offers named are Better Help, Youper, Woebot, Better Stop Suicide, Pray.com, and Talkspace.

Authorities in Venezuela arrest Jose Lopez for working at several healthcare facilities with fake medical credentials. His crime came to light after several women became pregnant after he had supposedly implanted them with subdermal contraceptive coils. He had, in fact, implanted lollipop sticks.

Sponsor Updates

• AdvancedMD Director of Sales Operations Carla Huggard wins a Utah Women in Sales Award.
• Actium Health publishes a new report, “State of Patient Engagement in 2022.”
• Baker Tilly will sponsor the Maryland HIMSS 10^th Annual Golf Tournament May 9 in Valley.
• Bamboo Health will exhibit at the Skilled Nursing Clinical Executive Conference May 5 in Chicago.
• CHIME posts a podcast titled “Filling the Talent Pipeline” with guest Geoff Blanding, EVP of Optimum Healthcare IT.
• Cerner releases a new podcast, “Combatting clinician burnout.”
• GHX names 80 provider and supplier organizations to its Millennium Club that have achieved the highest levels of supply chain automation through the GHX Exchange.
• CTG will sponsor the AWS Summit Atlanta May 18-19.
• Divurgent names Andrew Wells (McCormack Plastic Surgery) senior director of business development.
• Change Healthcare will work with Luma Health to develop new patient engagement solutions that unify clinical, operational, and financial touchpoints.
• The Iowa Hospital Association will offer its members access to ChartSpan’s chronic care management services.
• Experian Health, PatientKeeper, ManpowerGroup, CereCore, Change Healthcare, CloudWave, Dimensional Insight, Ellkay, Elsevier, FDB, Healthcare Triangle, Intelligent Medical Objects, Interbit Data, Intrado, Nuance, OBIX Perinatal Data Systems by Clinical Computer Systems, Sphere, Tegria, and Meditech will exhibit at the MUSE Inspire Conference May 15-18 in Dallas.

Blog Posts

• Three Pillars of Single-Path Coding (AGS Health)
• More meaningful care through data (Arcadia)
• Healthcare Technology Can Drive the Fourth Industrial Revolution (Ascom)
• How Azara DRVS Supports Behavioral Health Services (Azara Healthcare)
• GHX Announces Upcoming GHX Summit 2022 Highlights (GHX)
• Leadership – What Does it Really Mean? (CHIME)
• Tips to Effectively Fund Your Enterprise Cyber Risk Management Program (ECRM) (Clearwater)
• The Link Between EHR Satisfaction and Clinician Burnout (Dimensional Insight)
• Managing Post-Acute Care: A Critical Success Factor for ACOs (Dina)
• Insights and Takeaways from the 2022 Internet 2.0 Conference (Divurgent)
• Who are the 29 Million Americans Who Use Health Centers? (EClinicalWorks)

Contacts

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

Morning Headlines 5/3/22

Virtual care enabler Capable raises $6 million

Capable Health, developer of plug-and-play virtual care software, raises $6 million in seed funding.

Guidewell and Highmark Ventures Lead $35 Million Funding Round in Kidney Health Leader Healthmap Solutions

Kidney care-focused analytics and population health management vendor Healthmap Solutions raises $35 million, bringing its total funding to $135.6 million.

Allscripts Closes Sale of Hospital and Large Physician Practices Business to Constellation Software

Allscripts finalizes the sale of its hospital and large physician practices business to Harris parent company Constellation Software for up to $700 million in cash.

Health startup MyNurse to shut down after data breach exposed health records

Virtual chronic care management and remote patient monitoring startup MyNurse announces it will shut down alongside its notice to users of a March data breach.

Curbside Consult with Dr. Jayne 5/2/22

Today is truly a cleanup day. I’m plowing through 2,300 unread emails. Some days you just can’t make things up with the stories that are out there.

The US Department of Justice announces that a Long Island cardiologist has been charged with crimes related to a COVID-19 healthcare fraud enforcement action. He is alleged to have defrauded Medicare and Medicaid of more than $1.3 million in payments related to COVID-19 testing as he submitted claims to those payers for office visits that were not performed in conjunction with COVID-19 testing. The defendant’s practice had mobile testing sites across Long Island, and apparently some of the billed office visits occurred when the defendant wasn’t even in the state. The prosecution is part of a larger effort by the Department of Justice to crack down on those exploiting the ongoing public health emergency. Criminal charges have been filed against at least 21 defendants for COVID-related healthcare fraud and total nearly $150 million in false claims. The overall Medicare Fraud Strike Force, which was formed in 2007, has gone after more than 4,200 defendants who fraudulently billed Medicare for over $19 billion.

Just a little over a month ago, medical students across the US learned where they’d be doing their training as a result of the National Resident Matching Program. This article about a participant who didn’t match caught my eye. Travis Hughes completed both MD and PhD degrees at Harvard and had a lengthy curriculum vitae with numerous publications and four patents, yet still didn’t match into his desired field of dermatology. More than seven percent of fourth-year medical students in the US failed to match, so he wasn’t alone, although his qualifications likely make him unique. Rather than lament his situation, Hughes used the experience as the push he needed to move towards a career in healthcare technology.

I’m often contacted by people in similar situations looking for advice on moving into healthcare technology or clinical informatics. Not only do unmatched graduates reach out, but those who are in their last year of medical school and who have decided that clinical practice is not for them.

I’m supportive of people finding their bliss in medical careers that don’t involve seeing patients, but have some advice for individuals in this situation. First, just because you graduated from medical school doesn’t mean that you understand what it takes to become a board-certified practicing physician. There’s a lot that happens during the three to seven years of residency training and no amount of reading about it or having friends who are in residency is going to help you become equivalent.

Second, if you’re going to try to find solutions for practicing physicians, you need to understand what happens once you are in practice. Learn what a RVU is or how physician compensation is influenced by patient satisfaction scores and clinical quality metrics. Learn how hard it is to keep a medical practice staffed to a level that provides high quality care but runs as cheaply as corporate employers require.

Third, please don’t talk to practicing physicians like you’ve been in their shoes. Over the past two years, I’ve had many patronizing encounters with physicians who have gone the start-up route. I don’t want to hear about how you dropped out of a surgical subspecialty residency the year before graduation, yet you think you understand what it feels like to be a practicing family physician or an emergency physician dealing with COVID. Sure, you can talk about how you understand the market forces and the pressures we’re under, but you certainly haven’t been there or done that. Also don’t talk about patients like they’re numbers or widgets, because those of us who really treasure the patient/physician relationship aren’t likely to warm to that strategy. If you want to impress us, make sure we feel like you understand that those patients are someone’s mother, grandfather, sister, or child.

Finally, if you’ve decided to take a different path in your career, get some training. If you want to go into clinical informatics, maybe you should join the American Medical Informatics Association. Consider taking one of the 10×10 courses that they offer in partnership with Oregon Health & Science University. Do a fellowship in clinical informatics. Don’t post on physician-focused Facebook groups that you’ve just decided to go into informatics and ask how to get jobs with no experience and no training. Definitely don’t demand that people call you and give you career guidance because you’re too lazy to spend some time on the internet figuring out what it takes to be qualified in the field.

I do wish good luck for all those who are contemplating career changes or who did not match. Much work is ahead and it’s a difficult road. Hopefully, this advice might provide a small amount of insight for those walking it.

I’m doing a fair amount of work with various vendors and have been invited to participate in multiple vendor user group meetings for the upcoming season. While some vendors are going back to their tried-and-true pre-COVID meeting plans, others are using the opportunity to make changes to format and desired attendee profiles. There have been a few recent in-person meetings since HIMSS, and by report, the attendance has been less than previous years. Epic kicked off its XGM Expert Group Meetings last week in Wisconsin and they continue through the end of this week. The American Telemedicine Association meeting is also happening this week in Boston. I’d love to hear from attendees as far as their boots on the ground experiences as well from others who have decided not to attend conferences right now. At least one major health system that I interact with has continued to restrict business travel for the remainder of 2022. They’re not saying employees can’t travel, they’re just refusing to pay for any of it, blaming it on COVID.

Although various states, jurisdictions, and businesses have collectively decided that COVID-19 is over, it’s starting to make a return in my area. Several schools are hitting the thresholds for which students and teachers have to resume masking. I’ve got a couple of flights this week, and despite the airlines’ movement to a mask optional arrangement, I’ll be sporting a KN-95. Even though the COVID infections that most people are getting now are relatively mild, we’re starting to see much more long-term data that shows that even people with mild infections are at higher risk for cardiovascular and other complications. I’ve dodged it so far and am hoping my luck holds.

From a patient care perspective, it’s the school and sports physical season as young people get ready to go away to camps or to prepare for fall sports. Our state has instituted a special process for return to play in youth who have had COVID, and we’re finding quite a few athletes who aren’t as healthy as they thought they were before we started asking some very pointed questions.

Is COVID-19 still playing a role in your habits or travel plans? Is your employer still requiring any mitigation strategies or is everyone back to the office as usual? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Carina Edwards, CEO, Quil Health

Carina Edwards, MBA is CEO of Quil Health of Philadelphia, PA.

Tell me about yourself and the company.

I have spent more than 25 years in healthcare technology. I have dedicated my focus and career on delivering experiences that delight customers and drive value and success in digital health. It has been fun being the CEO from the inception of Quil.

Quil is a digital health joint venture between Comcast NBCUniversal and Independence Blue Cross. We help people organize and navigate their health lives in partnership with their providers, their health plans, and their loved ones. We have two solutions. Quil Engage is the care engagement platform that delivers intelligently individualized care journeys to support patients during every step of their care, prescribed by providers and sold to provider organizations. We now have Quil Assure, the connected home platform sold direct to consumer, that helps seniors enjoy greater independence with exercising their preference for aging in place and strengthening that support between the family and friends serving as caregivers.

Seniors say they will accept some kinds of caregiver monitoring technology, such as fall detection and movement tracking, but draw the line at being monitored constantly by audio or video. How does that affect the ways in which monitoring can be performed?

In all of our research, we confirmed the same findings. We have 54 million unpaid caregivers in the country. There is a booming silver tsunami of seniors, and all of them want to live in their home as long as possible. When you start thinking about that dynamic, we need more technologies to help them live independently, but we need those technologies to be invisible to them. To support the caregiver, but also support the senior.

In our research, we focused on ambient sensing. We are leveraging some of the foundations that we know very well from the Comcast side of this joint venture, which is that connected home with motion sensors, door detectors, and connected hub. Being able to take machine learning and the bots that we’ve written to detect anomalies in daily patterns of living and notify on those anomalies. Then, also connect into the broader Internet of Things ecosystem that people have adopted across all ages.

With COVID, you are now seeing the 65-plus community being way more technology receptive. Being able to connect to their Apple Watch if they’re tech savvy. Being able to connect to their Alexa ecosystem for their weekly grocery orders. Having that open platform, but the importance being how the caregiver can verify that everything is OK. Did Mom get up on time? Are things going well? Has she been to the kitchen three times a day like normal? What going on that is abnormal? Did she leave the house for an extended period of time? All of those things to support the senior so that if they need help, it’s there.

How can technology address the key concerns of falls, wandering, and accidentally creating dangerous situations with normal household equipment such as stoves and bathtubs?

A lot of it is sleep quality, which is interesting. Are they getting around the house doing activities of daily living? Are they going to the kitchen? Are they not going to the kitchen? Are their bathroom patterns changing? In early trials, we’ve detected UTIs and other things because of just pattern anomalies. Temperature sensing is a huge one. We’ve had some seniors in the trial where they didn’t want to bother the caregiver, so when their heat went out, they just didn’t say anything. But then the system alerts when it’s turning to 55 in the room.

“Set it and forget it” ambient technologies don’t make them feel like they’re being watched. They’re not being actively probed. They don’t want to interact with the technology if they don’t have to. But then when it’s there, leveraging the pattern button, personal emergency response activation, or even if they’re connecting in the IoT ecosystem, “Hey Alexa, call Quil,” we can be there 24/7 to respond to those things. Sensors and triggers let us see certain patterns that would indicate a big abnormality, so we will start calling down the caregiver circle to make sure they’re checking in on Mom.

The old-school technology is to call the person daily to ask how they are doing and listen for anything concerning in their response or their voice. Do any technologies simulate that phone call type of monitoring?

We are doing insights in the app. The caregiver gets push notifications, text messages, and phone calls. They can see that Mom’s up and about and it looks like a great day. Those type of insights are coming back to the caregiver’s phone. The nice thing is if Mom is technically savvy, she also gets that same view. 

The interesting part is what we’ve learned from the caregivers. There’s this relationship that they are trying to form and it gets stressed when, every time you call, it’s about their health. There’s this fine balance between, “I know I’m aging and I know I have challenges, but don’t remind me of it all the time” and the caregivers saying, “I love being there for you, but it’s sometimes a little bit exhausting and I’m really worried that you’re not OK.” Bridging that relationship with insights that keep everybody on the same page — how things are going, any tasks and appointments coming up, medication reminders — and leveraging that technology to set those reminders so that Mom can acknowledge with their voice that they have taken that medication.

How does technology address those folks who are mobile and can run errands or visit a friend and the caregiver wants to make sure they get home when expected?

We detect when they leave the house, because then there’s no motion in the house and we have the door sensor. This is a learning system, so we learn their patterns over time. The caregiver can also set that they are on vacation or doing something abnormal. It isn’t sensing and triggering, but we are learning, “Looks like bridge club on Tuesdays, normal event. No worries, Mom comes back around 5:00 PM.” Those are the things that we are constantly fine tuning to make sure that we’re understanding the value that those insights provide. And respecting so that the senior in all of this knows what’s being shared, why it’s being shared, and how it’s helping with technology on their terms.

Big players like Best Buy and now Amazon, with Alexa Together, are involved in selling monitoring equipment and services directly to consumers. In Amazon’s case, it is powered by the same Echo devices that a competitor might use and is tied into third-party sensors such as fall detectors. How is the market evolving?

It’s the race to the connected home. I’m excited that we have a head start with Comcast. Then on the population basis, it’s that connectivity and receptivity of seniors to technology. As I mentioned earlier, I think that COVID has accelerated that comfort level with technology. I manage, or as I love to say, I love four people over 78 in my life. It’s hysterical that when I talk to them, if I’m not on FaceTime, there’s an issue – “Why aren’t you on FaceTime? I can’t see you.” Before the pandemic, that was never a thing. 

As we’re seeing this change in receptivity and now this race to the home, I’m also excited about the other side of our joint venture with Independence Blue Cross and the Medicare Advantage population. We see the joint venture through two very connected lenses. One being that we have “prescribed by provider” with Quil Engage. We have now the connected home. We are thinking about models of risk, pulling this all together to say, that’s what we mean by convergence with the home and health at home in a new way. 

It’s a really exciting time with lots of great players in this space. The question is, what level of depth in healthcare will each of the organizations go into? We’ve seen some early acquisitions that are indicators, but a lot more to come. I never dismiss Amazon ever, or Best Buy. Everyone is in this market.

Does the business model require running a 24/7 call center, or can companies provide just the technology without that escalation capability?

This goes back to what populations you’re serving for the level of escalation. We are looking at the market where safety protocols and emergency support are critical for a certain segment of the population. We think about this as a connected care circle, not just your daughter or your daughter’s husband, but even a neighbor just to check in. As we’re thinking about this, the setup and the onboarding process is critical to figure out and evolve with the senior and their patterns. Start with them. Call the house, “Hey mom, how’s it going? Everything OK?” I’m noticing some pattern detection. No answer, call the first person on the call tree, and then go down the list.

If we find something critical, we will absolutely send EMS, but we think about that person’s community and how they want to be escalated. We want to give them independence. With technology, we have so many different ways to turn on and off alerts and escalations based on their desire.

I worked at Philips years ago, and when we bought Lifeline, I got it for my grandmother. She was in an apartment building in Florida and had to do her laundry in the basement. She was taking a basket of towels down to the basement and she hit the button accidentally. EMS came and she was mortified, mortified. That button never went around her neck ever again – it sat in the basket by her bed. Unfortunately, she did have a fall in the house. Couldn’t get to the button. Thank goodness that she lives in the apartment building, because her neighbors checked in on her. It was her neighbor that found her three hours later.

We have learned so much about the sensitivity of the community, about what they want. Targeting their wishes. Do you want EMS to be initially protocoled or not?

The Echo devices have an option to connect with other devices in the neighborhood. Is there any movement to use that to create groups who can keep an eye on each other instead of going from zero to 60 in dispatching EMS?

We have that in the care circle pieces, where they can invite anybody they want, friends or family. They can designate who they are, what they can see, what they can’t see. You hit it spot on that there is a range between zero to 60, and the world of personalization matters to this generation. They want it on their terms. As we are fine tuning all of this, giving that control to the senior who could literally just turn off whoever they want, to turn off any time on their own device, because they’re seeing the same things that the care circle is seeing.

How do you contrast selling directly to consumers instead of to insurers or employers?

The fun part about this being a joint venture is that we get those great best practices from both parent organizations. Our direct to consumer approach was heavily influenced by best practices that Xfinity has done quite at scale with Comcast. Same with Independence. We’ve learned about routes to market for different populations and payers and self-insured employers and how they interact with companies. We’ve built models aligned with those best practices, and that’s allowing us the time to start this conversion piece and be different than some of the more traditionally funded companies. There’s always pros and cons for joint ventures, and this is one of the pros.

When you look at the entire market for remote patient monitoring and other work your company is involved with, how do you see the market evolving over the next few years?

The question that is so critical here is, what does convergence to the home actually look like? We keep on calling it the home like it’s a physical thing. I look at the home now in two different pieces, the digital home and the physical home, or homes plural in populations of different segments and demographics. 

As we start blurring these lines and we start seeing risk shift in different ways, this is where the models get really interesting. Whether it’s hospital  at home, in a risk-based sharing agreement with new signals from the home that are extended for this population as a benefit, wow, that’s an interesting model. If it’s, “I just had a health event, now the person that’s recovering is no longer steady and needs extra eyes,” there’s a referral model. Then there’s the direct to consumer model.

I dislike the word consumerism because really it does come down to, where is the risk, who’s the buyer, and what is the value being derived? How do you make sure you stay clear on that ROI to each of the parties? In a way, you start becoming this B2B to C2C connectivity arm that’s converging on the physical and digital home.

Morning Headlines 5/2/22

Walmart Health Introduces Telehealth Diabetes Program To Help Businesses Support Employees Through Education and Behavioral Care

Walmart rolls out a diabetes telehealth program for employers that includes diabetes education, behavioral health analysis and counseling, and discounts on insulin, diabetes medications, and test kits.

HST Pathways Announces Acquisition of Simplify ASC

Ambulatory surgery software vendor HST Pathways acquires competitor Simplify ASC.

Configo Health to relocate to Asheville, raises $2M for growth in Western NC

Configo Health, a North Carolina-based startup that has developed benchmarking analytics for pediatric hospitals, raises $2 million.

Monday Morning Update 5/2/22

Top News

Walmart rolls out a diabetes telehealth program for employers that includes diabetes education, behavioral health analysis and counseling, and discounts on insulin, diabetes medications, and test kits.

The program was developed with the American Diabetes Association.

The service is provided through MeMD, a Phoenix-based multi-specialty telehealth provider that Walmart acquired in May 2021.

Walmart will sell the program as a standalone offering or as part of a comprehensive telehealth program.

Reader Comments

From Enumerator of Beans: “Re: Teladoc’s share price. Stupendously bad, but take a look at Amwell’s enterprise value, which is less-famously awful.” Refresher: enterprise value (EV) looks beyond a publicly traded market capitalization to also include the company’s debt and cash, which is how a potential acquirer would evaluate it. Amwell’s market capitalization is around $900 million as Teladoc’s woes dragged AMWL shares to record lows, but even worse, Amwell’s EV has tanked from $3 billion a year ago to $150 million now, which seemingly provides a buying opportunity for the strong-stomached investor or down-trending competitor. Teladoc’s market cap has shed more than 80% in that same year as EV slid from $29 billion to $6 billion even as management was hyping the company’s business prospects (I can’t imagine that won’t trigger a bunch of lawsuits). The smartest person in the telehealth room turns out to have been invited visitor Glen Tullman, who found a buyer-in-heat in Teladoc who was willing to massively overpay for largely untested Livongo in that brief pandemic moment where telehealth looked unstoppable, insatiable investors were wildly overfunding digital health companies, and companies sought acquisitions that would arouse or confuse investors (or both). No wonder Glenn is ubiquitous as a conference keynoter, with the sometimes comical train wreck that was Allscripts under his watch being long forgotten.

From Curious from Across the Pond: “Re: American healthcare. Has all the money spent my vendors and the federal government actually improved patient care compared to Europe? It seems that most of the money is to make sure that health systems can bill and collect for ‘patient care’ and that it’s all about growing market share and preserving monopolies and patient care is the last thing on their mind.” US healthcare is bureaucracy-powered big business, not a social obligation, but governments love it because it creates high employment, big political donors, the illusion of economic growth, and shiny new buildings where politicians can pose cutting ribbons. Technology and policies that claim to have the power to improve outcomes and cost can only be as effective as the underlying healthcare system they support, and ours is a mess with no political will to change it given that the wealthy like it just fine. As far as health IT claims, vendors and fawning press cheer every announcement but fail to mention the frequent failure that follows or the user missteps that contributed.

HIStalk Announcements and Requests

Poll respondents say that the factors that are most important to AI’s eventual success in healthcare are maturation of the technology, proven outcomes, and building trust. Commenters noted the need for better-quality EHR data and the alignment of economic incentives.

New poll to your right or here: Within the past two years, have you had to pay a medically related bill that created at least a modest degree of financial hardship?

I received a brilliant spam email this week – Bitdefender warned me that the “unsubscribe” link pointed to a phishing page.

Webinars

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

Acquisitions, Funding, Business, and Stock

Weight loss app vendor Noom lays off 180 coaches and will part ways with 315 more employees in the next few days, according to a Business Insider report. The company is trying to pivot to scheduled video-based coaching instead of immediate text-based engagement that often involved canned messages and lessons. At least the company is loyal to the video-based model – the employees who were laid off were notified in group video calls.

Spok announces Q1 results: revenue down 6%, EPS –$0.37 versus –$0.12. The company says its strategic alternatives review resulted in no options to sell the company, so it will continue to operate as a standalone business.

Ambulatory surgery software vendor HST Pathways acquires competitor Simplify ASC.

People

Renee Emmer, RN, MS joins VCU Health as associate VP of clinical informatics.

Ann Baty (OmniSys) joins HealthMark Group as VP of marketing.

Announcements and Implementations

Olive releases Care Campaigns, an automated patient communication and outreach solution whose first user is Gundersen Health System.

Canada’s seven-hospital Hamilton Health Sciences will go live on Epic on June 4 in a rare move straight from paper charts that are scanned into CGI Sovera.

Aurora St. Luke’s Medical Center (WI) joins a clinical trial of UltraSight Echocardiographic Guidance, a machine learning app that helps medical professionals who don’t have advanced echocardiography training to position the transducer.

Rochelle Community Hospital (IL) goes live on Epic, replacing Meditech and Athenahealth. 

Oxford University Press launches Oxford Open Digital Health, an open access journal that will focus on digital health interventions in low- and middle-income countries. The editor-in-chief is Alain Labrique, PhD, MHS, MS, professor and founder of the Johns Hopkins University Global MHealth Initiative and chair of the WHO Digital Health Guidelines Development Group. 

In Norway, St. Olav’s Hospital trains volunteers from the local senior center on HelsaMi, its patient portal that is powered by Epic MyChart, so they can help other seniors.

Government and Politics

Interesting from Politico: a historical graph of how many years Medicare’s Part A fund for hospital expenses has left before running out of money. Today’s number is four years, as in 2026 the fund will go broke because the number of enrollees and their expenses has risen faster than funding from payroll taxes, and that doesn’t even account for pandemic-related impact. The long-term fix would be to shift to value-based care, which would require not only a lot of legwork, but rare political unity. The “gimmick fix” would be to shift some Part A services to Part B, which is funded by premiums and other taxes.

Other

Neonatologist Ross Sommers, MD, who recently founded NICU-at-home monitoring software company Firstday Healthcare, posted this on LinkedIn. I found it interesting given the cost and family disruption involved with NICU babies. The company offers continuous vital signs monitoring monitored by board-certified neonatologists, AI-powered deterioration prediction, a parent app that includes medical records, and care coordination.

A small University of Colorado survey of patients who were given online access to their radiology images and reports finds that most said it was helpful in understanding their condition and few reported being worried or confused. One-third of them saved a copy, one-fourth shared them with a doctor, 15% used them to get a second opinion, and 3% posted them on social media.

Sam Johnson, fired last year as CEO of telehealth vendor VisuWell after he was caught on video telling high school senior Dalton Stevens that they “look like an idiot” for wearing a dress on their way to the prom, sues comedian Kathy Griffin for making fun of him. He says the ridicule triggered a backlash against him and his family. Johnson says he is suing “to stand up against the woke social mob that wants to strip of us of our livelihoods and careers.” He says his issue wasn’t the student’s attire, but rather that the group was being obnoxious and profane in one of his favorite restaurants. Johnson says that he will never again sign an employment agreement that doesn’t contain a “slow action cause” that subjects employment actions resulting from a news story, social media post, or boycott demand to a 30-day cooling-off period. Johnson says that VisuWell and “several health systems” made false statements that were published and urges followers to read the coverage on Fox News. Two months ago, he accused the Nashville Business Journal, VisuWell, and LinkedIn of flagging one of his LinkedIn posts as harmful, which he summarizes as “scared pansies.”

The metaverse quickly got creepy. Bored Carnegie Mellon researchers fit haptic sensors into an Oculus Quest 2 headset that transmits kissing sensations to the wearer’s lips, teeth, and tongue. They describe mundane game-playing uses such as brushing teeth, smoking, and drinking coffee, either naively or coyly overlooking more lucrative integration. SecondLife perverts have a new home.

Sponsor Updates

• KLAS research ranks Meditech among the top two EHR vendors market share growth.
• EClinicalWorks releases a new podcast, “How EClinicalWorks RCM Service Boosts Efficiency.”
• OptimizeRx will exhibit at MedDev 2022 June 7-9 in San Diego.
• Optum donates COVID-10 test kits to increase access to free testing among underserved communities in Chicago.
• PatientBond will exhibit at the UCA/CUCM 2022 Annual Convention through May 4 in Las Vegas.
• PerfectServe will present at the Powderkeg Unvalley virtual conference May 11-12.
• Premier’s S2S Global donates urgently needed medical supplies to Ukraine via United Help Ukraine.
• The HIT Like a Girl Podcast features Tegria Director of Patient Access and Technology Rodina Bizri-Baryak.

Blog Posts

• Stop Making Patients Work So Hard (Orbita)
• Preventing Violence Against Healthcare Workers: Perspective From a Former CEO (Commure)
• How the Pandemic Changed Patient Experience, and Why It Matters (Symplr)
• X12 got you down? Light it on FHIR with Redox. (Redox)
• 10 interesting facts about nurses (Spok)
• Innovation Allows for Swifter, Smarter Specialty Prescribing & Fulfillment (Surescripts)
• How payers can improve member experience with modern contact centers (Talkdesk)
• Improving Healthcare Communication and Collaboration within Doctors’ Offices and Beyond (TigerConnect)
• Top Things to Know About Patient Engagement Technology (Twistle)
• Filler Words to Avoid in PT Treatment Notes (and Other Documentation Missteps) (WebPT)

Contacts

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

Morning Headlines 4/29/22

Teladoc Health Reports First Quarter 2022 Results

Teladoc Health reports Q1 results: revenue up 25%, EPS -$41.58 versus -$1.31, with the loss driven by a somewhat expected $6.6 billion impairment charge from its $18.5 billion acquisition of Livongo in 2020.

Syllable Raises $40 Million Series C Led by TCV to Improve the Patient Experience with Intelligent Voice Solutions for Health System Call Centers and Medical Practices

Syllable, which sells intelligent voice systems for health system call centers and practices, raises $40 million in a Series C funding round.

Cerner ticks higher on report Oracle likely to see smooth European review

A European antitrust review of Oracle’s planned acquisition of Cerner is likely to surface no concerns, according to a recent report.

News 4/29/22

Top News

Teladoc Health reports Q1 results: revenue up 25%, EPS -$41.58 versus -$1.31. The loss was driven by a $6.6 billion impairment charge from its $18.5 billion acquisition of Livongo in 2020. Teladoc had warned in early March 2022 that it would write down up to $4 billion of the Livongo acquisition.

Teladoc also cut its full-year revenue and earnings outlook.

TDOC shares dropped 40% on Thursday. They are down 82% in the past 12 months versus the Nasdaq’s 9% loss. The company’s market cap is $5 billion, with Teladoc having lost $39 billion of shareholder value in 14 months.

From the earnings call:

• The company says it remains confident in its whole-person care strategy, which it describes as “the future of digital health.”
• Performance of its BetterHelp direct-to-consumer mental health service was less than expected, which the company believes is due to smaller competitors going after potential customers and taking advantage of pandemic-relaxed controlled substance prescribing regulations. Three-fourths of the company’s projected revenue reduction is attributed to BetterHelp.
• Sales to employers slowed as companies focused on COVID and return to offices. Teladoc also blames “noise in the marketplace” from smaller point solutions.
• Teladoc reports 54 million paying members, with 731,000 of those enrolled in chronic care programs.
• CEO Jason Gorevic says that increased customer acquisition cost, mostly due the cost to buy advertising in search results and social media,  was caused by smaller private competitors that have been “recently well funded with a rash of venture capital money” that are making “economically irrational decisions.”

Reader Comments

From Down Underware: “Re: Australian Medical Association. Wants hospitals to eliminate fax machines to improve communication and patient safety.” Banning fax machines would most likely cause communication and patient safety to tank in the absence of solid interoperability. The market will gratefully accept a substitute that checks these boxes and is documented to improve cost and outcomes:

• Faxes are universal. You only need someone’s fax number, not their permission or prearranged terms, to send them something and then walk away.
• They are cheap, easily maintained, and never go down.
• They can be used anywhere there’s a copper telephone wire even in the absence of broadband or cell coverage.
• Issues of sending and reading protocols don’t exist – the piece of paper on one end pops out as piece of paper on the other end that doesn’t need to be printed as an extra step. What is sent is exactly what is received, with no chance of misinterpretation or sender technology changes that render the information unreadable.
• Delivery is immediate and verifiable.
• The recipient is more likely to notice a new paper popping out of the fax machine than an on-screen alert.
• Fax machines don’t host viruses, there’s not much hacking risk, a malicious fax can’t take your network down, and incoming faxes are as secure as the physical location they are sitting in.

Webinars

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

Acquisitions, Funding, Business, and Stock

A report says that a European antitrust review of Oracle’s planned acquisition of Cerner is likely to surface no concerns.

A former engineering VP of mental telahealth vendor Cerebral sues the company, saying that they fired him after he complained about its plan to prescribe stimulants to 100% of its ADHD patients. Matthew Truebe says he told the company that patients were setting up multiple accounts to buy extra drugs, as evidenced by 2,000 duplicate addresses in the shipping database. He also says the company ignored his concerns about thousands of patient records that were exposed in a breach.

Syllable, which sells intelligent voice systems for health system call centers and practices, raises $40 million in a Series C funding round.

Microsoft chairman and CEO Satya Nadella says in the company’s earnings call that its Nuance acquisition gives it a platform layer for AI-driven applications in healthcare and contact centers. He says the company will aggressively innovate with Nuance and expects to increase its impact on healthcare, specifically with physician burden.

Sales

• Prisma Health (SC) chooses Philips for patient monitoring, enterprising imaging, and analytics.

People

Intelerad hires A. J. Watson (Doubleclick) as chief product officer and Paul Johnson (Amwell) as chief delivery officer.

Well Health hires Sarah Shillington, MS (TigerConnect) as SVP of customer experience and Ashu Agte, MS (Autodesk) as SVP of engineering.

Susan Worthy (Optum) joins Amwell as chief marketing officer.

Adventist Health promotes Jennifer Stemmler to chief digital officer.

Salesforce hires Maura King, MBA (Workday) as RVP of enterprise healthcare providers.

Bruce “Skip” Lemon joins Impact Advisors as VP.

Announcements and Implementations

A Panda Health survey of 100 C-level health system executives finds that more than half of them get more than 11 calls and emails each week from digital health vendors, leading 95% of them to conclude that it’s hard to decide which products are worth investigating. Half of the health systems don’t have a strong digital health strategy, and three-fourths of those that have bought digital health solutions are not confident that they chose wisely. Two-thirds say that it takes them at least six months to get to contract signing, with most of the time spent vetting integration capabilities and comparing product functionality.

Tenet Healthcare admits that its recent computer downtime was caused by a cybersecurity incident. The for-profit hospital operator scolded a South Florida TV station early this week for interviewing a patient who worried about the possibility of downtime-caused medication errors, calling it “preposterous” to suggest that paper-based downtime procedures are less safe.

1upHealth announces SQL on FHIR, which allows organizations to make decisions using SQL tools such as Microsoft Power BI and Tableau without coding in FHIR.

Privately insured patients who receive a new diagnosis from a telehealth visit are no more likely than their in-house visit counterparts to visit the ED or be hospitalized within 14 days, a study finds. However, three of 21 conditions were exceptions – upper respiratory infections, bronchitis, and pharyngitis, which researchers think is because those patients required COVID-19 evaluation.

A CoverMyMeds survey of 400 nurses identifies these medication-related technology needs:

1. A centralized location for medication information.
2. Knowing the medications that a patient’s insurance covers.
3. A seamless way to provide medication information to prescribers, such as prior authorization requirements, symptoms, allergies, medication history, and plan formulary.
4. A better way to perform prior authorization requests proactively instead of waiting for pharmacy rejection.
5. Ways to reduce pharmacy telephone time, ideally with solutions that provide information at the point of prescribing.
6. Easy access to a patient’s medication history, including the active meds list that less than half of patients remember, as well as a list of medications that have been tried unsuccessfully as needed for prior authorization requests.
7. Real-time formulary and benefit updates.
8. Efficient ways to identify covered alternative medications.
9. Clearer job expectations, with one option being creating a centralized team to manage prior authorization and insurance interactions.
10. Moving tasks to EHR workflow, as half use non-EHR applications at least once per day and 20% use their smartphones after the patient leaves.

Government and Politics

The federal government’s Cerner system – spanning the DoD, VA, and Coast Guard — goes down twice this week, once because of a system update that was delivered at lunchtime and the second due to load imbalance, VA and Cerner officials explain at a congressional hearing. Cerner executives told lawmakers that it may commission an independent review of its system to make sure it is stable enough to deploy further.

The Texas Medical Association says in a comment to ONC that 42 of the proposed USCDI Version 3 data elements are not backed by a standard, which will create a lot of work, limit data transfer, and require rework once standards are developed. It cites an example of a hospital that is blasting out ADT information to meet CMS requirements, but a small primary care practice had to hire people manage the flood of information that is not human-readable or and often isn’t useful.

Other

A NEJM article questions whether the time and money that is spent on hospital quality improvement is worth it, as entire industries are created as soon as a measure’s score is tied to payments. The definition of quality remains hard to pin down, it says. It notes the irony of CMS suspending quality reporting requirements early in the pandemic so that “the healthcare delivery system can direct its time and resources toward caring for patients.” Experts say that QI is a billing-driven, box-checking exercise that still can’t answer basic questions about preventable deaths or overutilization of services. The article says that Medicare Share Savings Programs have been expensive to operate and have done little to reduce costs or improve quality in their patients. It also notes that profitable hospitals can afford to hire teams to optimize coding (averaging 50 to 100 employees who do nothing but support measurements), while safety-net hospitals and those serving the highest-risk patients bear the brunt of financial penalties. The administrative costs of quality measurement cause community doctors to retire and small practices to be acquired by hospitals.

This is not an early draft of Prince’s Love Symbol, but rather parietal art from the scientifically unsound early days of the pandemic, when stores like my local Walgreens above decided that the virus could be stopped dead in its tracks by making aisles one way to prevent masked customers from facing each other for five seconds. The permanently embedded tape marks obviously aren’t the only reason this ratty carpet needs to go. Also featured in this Walgreens is a Pompeii-like abandoned back section whose surviving sign suggests that it was once a health center, now occupied by carelessly parked carts of inventory awaiting displaying or disposal. The pharmacy metal doors were locked down when I dropped by this week, which has happened three times in maybe eight total visits — once because the power was out, once because the employees had locked themselves out of the pharmacy, and this time because the pharmacist had a death in the family and the store couldn’t find coverage. On the other hand, once the garage-like doors were again rolled up, a patron could obtain a COVID shot, frozen White Castle hamburgers, a rectal thermometer, and a Paw Patrol life jacket within a 10-step radius.

Sponsor Updates

• AdvancedMD employees join Catholic Community Services of Utah to serve 2,000 meals to community members.
• The Sheffield Teaching Hospitals NHS Foundation Trust adds Agfa HealthCare’s enterprise imaging solution.
• Healthcare Triangle publishes the results of a new survey, “Acceleration of Blockchain Adoption in Pharma & Life Sciences.”
• Nordic posts a new monthly episode of its “DocTalk” series titled “Cloud Approaches for Modernization.”
• Imprivata secures additional funding from Thoma Bravo to finance its acquisition of SecureLink.
• Wolters Kluwer Health’s Lippincott Nursing Education solutions have been selected as 2022 SIIA CODiE award finalists in seven categories.
• Medhost celebrates Patient Experience Week.
• Texas Association of Community Health Centers offers its members remote patient monitoring from CareSignal.
• Newman Regional Health (KS) uses Meditech to transform sepsis treatment.
• Nordic Consulting joins the ServiceNow Partner Program.

Blog Posts

• Dr. Nishi Rawat presents a personal story about substance use, stigma, and solutions at the 2022 NCQA Quality Talks (Bamboo Health)
• Telehealth’s Role in Emergency Triage (Pt. 2) (EVisit)
• How ACOs can close gaps in care with better patient matching (Experian Health)
• How to take a Diversity, Equity, and Inclusion Pulse Check (Optimum Healthcare IT)
• Why More Visuals and Less Text are Key for Health Education (Healthwise)
• It’s What’s on the Inside That Truly Counts (Impact Advisors)
• While you were sleeping: The crucial, quiet role of anesthesia (Intelligent Medical Objects)
• Best Practices for Reducing Waste in Your OR (Medhost)
• 3 blogs on how to improve patient engagement (Meditech)
• Workers’ Compensation Physical Therapy Guidelines for PTs (MWTherapy)
• Net Health’s Newly Launched Waystar Integration to Boost Rehab Therapy, Wound Care Reimbursements (Net Health)
• How to Improve Engagement, Access, and Outcomes with a Personalized Care Platform (NTT Data)
• The antidote to the burnout pandemic (Nuance)

Contacts

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EPtalk by Dr. Jayne 4/28/22

Half a dozen people sent me this article about Teladoc’s stock woes following recent statements on its outlook. Based on the comments of company leaders, it seems their customer acquisition costs are higher than anticipated. They also cited lengthy sales cycles as a barrier to growth.

Having been on both the health system side and the vendor side of the process, everyone underestimates the length of the sales cycle. My former hospital employer locked in budgets in July of the preceding year, and if you wanted to buy anything that wasn’t previously budgeted, you had to figure out how to fund it from your allocated bucket. Even if you were replacing a system with something newer and more efficient, you better not cross the red line with implementation or consulting fees. This ultimately led to a glacial experience for vendors trying to bring new solutions to the organization.

There have been some interesting articles in the telehealth literature of late. One looked at rates of antibiotic prescriptions for acute respiratory infections and compared performance by hospital-employed physicians to that of third-party contractors. There was a higher rate of antibiotic prescriptions by the contractors. Although the conclusions have received a lot of publicity, I think the results demonstrate that additional analysis is needed. The study looked at telehealth visits for health system employees and dependents between March 2018 and July 2019. The study was controlled for patient age, day of the week, and overnight visits. It only looked at 257 telemedicine encounters for acute respiratory infections.

In my experience as a telehealth provider and CMIO, the study didn’t look at some variables that can influence prescribing patterns. Number of years post-training can indicate whether the physician’s formative years occurred in the “less is better” era of antibiotics. There have been a lot of semi-retired physicians in my telehealth groups who might not be as close to current evidence as we’d like. Importance of patient satisfaction scores is another factor, and I’ve seen plenty of prescriptions issued in both the telehealth and in-person arenas by physicians who didn’t feel empowered to say no because of the potential impact on patient satisfaction scores. Method of compensation can also be an influence when physicians are paid on volume – it takes more time to explain why you’re saying no, which means lower wages for those providers versus those who are being paid a shift rate or who are compensated using other variables.

It also didn’t note whether the physicians were practicing on the same EHR system or whether the telehealth vendor had its own platform. I’ve practiced with three national telehealth vendors and none of them had the same level of clinical decision support that I’ve had in a health system or large practice EHR.

Last, it didn’t look at the presence or absence of quality metrics and reporting. In my health system-employed jobs, I’ve received a monthly quarterly metrics package that directly impacted my pocketbook as well as my understanding of my behavior. In my telehealth-only gigs, quality was only addressed robustly by one vendor and two of them didn’t deliver reports packages to me at all. None of the telehealth-only organizations offered bonuses or penalties tied to quality. I suspect that even if you had third-party physicians, if they were practicing on the same EHR and received the same quality measures reporting, compensation structure, etc. that the numbers would be similar.

It would also be interesting to look at data from the post-COVID world, when most organizations made significant leaps forward in their application of telehealth. Systems used in 2018-2019 were fairly rudimentary compared to what we have today, not to mention that physicians’ experience with telehealth visits has grown exponentially. Hopefully someone will do research to look at the impact of the rest of these factors as I suspect there is more to the story than meets the eye.

Telehealth also took a hit in this JAMA Network Open piece looking at follow-up patterns for acute conditions compared to chronic conditions. For acute problems, patients who had an initial telehealth encounter were more likely to have a follow-up encounter, including emergency department encounters and inpatient admissions. For patients with chronic problems, patients who had an initial telehealth encounter were less likely to have a follow up encounter. The authors note that there are some potential problems with uncontrolled confounding bias. They provided the example of the bias in deciding whether to deliver an encounter via telehealth or in person. They also noted the need to look at other clinically important factors, such as frequency of laboratory testing and prescribing or adjusting of medications. The study was limited to commercially insured patients and didn’t include subjects with Medicare, Medicaid, or no insurance. We know those patients often have significantly different care experiences that would be worth examining.

Thank you to all who reached out regarding my recent post on EHR downtime and medical errors. Many of you had gut-wrenching EHR downtime stories to share. I appreciate the stories but am saddened that we are all part of this club we never wanted to be a part of. Several readers noted the need to have ongoing downtime education – not just when people join the company or at the same time of year that everyone has to churn through annual HIPAA, Compliance, and Fraud / Waste / Abuse training. Others suggested practice downtime events to make sure people know when and how to declare a downtime, as well as where materials and supplies are located. Both strategies would certainly help, so thanks for bringing them front and center.

I’ve been having difficulty sleeping since the recent time change, which was confounded by multiple trips from one coast to another. I’m not into pharmaceuticals and even some popular supplements like melatonin have fallen out of favor. It’s been a rough couple of weeks, so I’m back in pastry therapy. For your consideration, I present a new take on the classic pineapple upside-down cake. With the right amount of brown sugar and butter, you really can’t go wrong.

What’s your favorite stress-relieving pastime? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/28/22

HHS puts $90M toward improving health center data collection

HHS allocates $90 million to help health centers modernize their data and reporting capabilities, enabling them to gain a better picture of social determinants of health.

Tenet Reports Cybersecurity Incident

Tenet Healthcare confirms that a cybersecurity incident disrupted patient care last week at several acute care facilities, though normal operations are now being resumed.

Implicity Raises $23M to Broaden Use of Its Cardiac Remote Monitoring Platform

Cardiac remote monitoring and data management technology vendor Implicity raises $23 million in a Series A funding round.

Introducing Source: The Infrastructure Layer for Virtual Care

Virtual care tech startup Source Health launches with $3 million in funding.

Readers Write: Public Health Agencies Share the Blame for COVID-19 Misinformation

Public Health Agencies Share the Blame for COVID-19 Misinformation
By Peter Bonis, MD

Peter Bonis, MD is chief medical officer of Wolters Kluwer Health.

Surgeon General Vivek Murthy, MD, MPH asked big tech companies to provide data related to COVID-19 misinformation and issued an advisory on confronting health misinformation, reflecting the vital importance trustworthy health information plays in public health. The consequences of misinformation can be deadly to individuals and, tragically, to entire populations, as we have witnessed during the pandemic.

The surgeon general’s approach is, however, unlikely to achieve a meaningful impact on online health misinformation even if big tech companies comply with his request. The impact of misinformation is rooted in the trust that people place in it over alternatives.

The public has good reason to be mistrustful of official sources of information, making our nation’s health agencies partially culpable for the misinformation problem we face today. During the pandemic, we received conflicting guidance that changed frequently, didn’t satisfy our information needs, and was politicized. No “official” source of information has earned unalloyed trust, a role the CDC should own.

Well-intentioned spokespeople delivered inconsistent messages and disagreed in public forums, sometimes acrimoniously, leaving us with serious doubts about what to believe. At the same time, we have been terrified by the uncertainty and bewildered that the agencies charged with protecting us did not have the equipment, distribution systems, regulatory processes, and other operational mechanisms that we’d expect.

These factors contributed to making us less than confident in official sources of information and hence receptive to misinformation. Thus, the issue is bigger than addressing misinformation, it is a matter of restoring trust in our public health system and the policies and recommendations it delivers.

Fortunately, the White House just appointed Ashish Jha, MD, MPH as the new face of the federal coronavirus response. He will be instrumental in coordinating the response across federal agencies. It’s critical that Dr. Jha and Dr. Murthy collaborate, as misinformation and the coordinated federal response are intertwined. 

The Senate Health Education Labor and Pensions (HELP) committee is also addressing the topic. It is working on the PREVENT Pandemics Act, bipartisan legislation aimed at improving coordination between public health agencies. One component of the proposed legislation will require a senate-confirmed CDC director, a recognition that the public has lost faith in the CDC.

Now to a possible solution that Drs. Jha, Murthy and the HELP committee might consider. We can help tackle misinformation, fortify our public health system, restore the CDC’s reputation, and be better prepared for the next pandemic, all with the same set of actions. The best way to reduce the impact of misinformation is to create a preferred and trusted alternative.

The creation, maintenance, and dissemination of reliable health information are complex. I have spent the last 20 years helping to create and oversee UpToDate, one of the most rigorously vetted sources of medical information that millions of healthcare professionals worldwide rely on every day. From my vantage point, it’s clear where and how public health agencies are falling short and what solutions are needed. The CDC needs support to better tackle the curation and dissemination of information for healthcare professionals, policymakers, and the public. 

Curation involves identification of relevant clinical and policy questions, use of relevant data, and expert peer-review with stakeholders. Questions must be addressed directly, even when information is incomplete or evolving. It should include relevant perspectives, incorporate feedback, and be updated continuously. Controversies should be addressed, the evidence should be transparent, and recommendations that reflect the strength of convictions should be explicit.

Dissemination involves having clear communication approaches across multiple reading abilities, languages, and user types; intuitive user experiences tailored for healthcare professionals, policymakers, and the public; and a content platform that is easy for search engines to index. Major public health announcements should be published and disseminated with coordinated efforts across public health agencies, media, and social media. Officials speaking on behalf of public health agencies should confidently refer to the guidance, distinguishing extemporaneous comments and reflections from consensus opinion.

Applying these principles to develop a trustworthy clinical information service will reduce the impact of misinformation. Search engine and social media algorithms (and policies) will point to and prioritize such guidance. The public would still be free to pursue alternative points of view, but they could be compared against a trusted reference standard while fringe, conspiracy and unscientific information could be more easily de-prioritized—or dismissed.

Readers Write: The Scale of Interoperability: Healthcare Data is at Zettabyte Level and Growing

The Scale of Interoperability: Healthcare Data is at Zettabyte Level and Growing
By Jason Brantley

Jason Brantley is president and general manager, provider solutions at Datavant of San Francisco, CA.

We are swimming in an ocean of healthcare data. It is everywhere, yet it is incredibly hard to get complete health data for an individual.

Data on the health of anyone individual is being collected everywhere we turn, including when visiting our doctors all the way to the wearables we have on our wrists. All of this health data combined amounts to approximately 30% of the world’s data, and that number is steadily increasing year over year. If we were to consolidate all the healthcare data in the world, we would have an estimated 2 zettabytes, which means 2 trillion gigabytes, of data .

The amount of healthcare data generated has reached the zettabyte level and shows no signs of slowing. And that’s just the digitized healthcare data – there is still a lot on paper and on film.

With over 2 zettabytes of data, we should be able to do some really high-powered research studies to understand rare and complex diseases, personalized treatment for each person, preempt onset of debilitating diseases, among many other ways to ensure that every health decision is based on data.

The current reality is starkly different. Although there are many examples of health data being used to understand diseases, the efficacy of treatment, or how we can detect illness earlier, it is estimated that 97% of the data produced in a hospital goes unused.

How do we ensure that more of the data that is already being generated in the healthcare industry can be used to benefit patients? This is not a new problem, and neither is the answer, which is interoperability.

Interoperability in healthcare has been talked about for years, and has not been achieved yet for a number of reasons. Some of these reasons include lack of communication standards between different systems, integration costs that reduce motivation to become interoperable, and apprehension of organizations to sharing data due to security and safety concerns.

Although there are barriers, improving the ease of exchanging and using data in healthcare will mean complete access to patient information at the time of care, improved care coordination, and the ability to study complex diseases in real time. The zettabyte of healthcare data that is already being generated could actually be used to improve patient outcomes, and more importantly, save lives.

The first step to this vision of interoperability is making sure that health data can be connected and can also be exchanged easily while maintaining patient privacy and security. Data in the healthcare ecosystem will remain fragmented across many different systems until we have efficient and easy ways to exchange health data. Once we have solutions to solve the fragmentation of healthcare data, the right data will be in the right hands at the right time.

Digitizing health data exchange is essential to solving fragmentation. It means that the owners of health data, typically healthcare providers, enable digital retrieval and distribution of the data. This is not a trivial problem, but it is solvable with current technologies. The systems to enable digital exchange must offer easy and intuitive controls such that the data privacy, security, and any other protocol set by the providers are enforced for each exchange of data. A digital network with adequate control mechanisms will ease providers’ concerns on data privacy and security, while dramatically improving speed and cost of health data exchange. It is a giant step towards enabling interoperability.

Readers Write: Chief Nursing Officer Checklist for Healthcare Technology Implementations

Chief Nursing Officer Checklist for Healthcare Technology Implementations
By Robert Wittwer

Robert Wittwer is SVP of professional services at Ascom Americas of Morrisville, NC.

CNOs and CIOs know that patient-centered technology projects perform their best when clinical workflows drive the selection, integration, and adoption of solutions. However, there are several key considerations they should keep in mind before investing in their next technology-driven patient care improvement project:

1. Bring the right people to the table early. Gather the right set of stakeholders across IT, nursing, finance, etc. to define your needs and be part of the selection team for a technology vendor.
2. View technology-driven solutions as implementations that require a more complex set of adoption principles than an installation. Begin with the end in mind and not the technologies available.
3. Define the objectives and strategy the technology should achieve. A CNO can look across the overall landscape and consider bigger patient care questions. Instead of asking, “Can it be done?” ask, “Should it be done?” Avoid the temptation to use all the capabilities or features of a technology if they don’t benefit your objectives. For example, an alert may not need to be sent if it doesn’t require a nurse to respond to it. Alert fatigue is a leading reason for unanswered alerts.
4. Think long term. Whether it’s future-proofing your investment or ensuring it’s agile enough to respond to unanticipated events like COVID-19, think about your technology solution’s shelf life. Ensure you’re updating software frequently and having regular conversations about using the technology to adjust your workflows so your technology can support how you do nursing today.
5. Prepare for organizational adoption. While adopting new technologies and workflows requires nurses to change habits, by having clearly defined objectives for its impact and involving stakeholders in the process, you are better prepared to shorten the time it takes to adopt new ways of working.