Skip to main content

Category Archives: Applications

Newsday: Practical AI, Data Governance, and Tech modernization with Vik Patel and Sarah Richardson

Posted on by

Vik Patel, COO at TIDO joins Sarah on This Week Health Newsday. Vik shares his journey from hospital IT to founding TIDO, discussing the nuanced challenges of integrating AI and the role of strong governance frameworks in avoiding unintended biases. Together, we tackle questions of strategic prioritization, from the intricacies of data migration and legacy archiving to the pressing need for reliable, responsive tech solutions in high-stakes clinical environments. Through the lens of real-world applications, the episode raises important considerations about balancing innovation with practicality in healthcare IT.

Key Points:

  • 04:09 The Importance of AI Governance in Healthcare
  • 07:27 Challenges and Solutions in Healthcare IT
  • 20:00 Practical AI Applications and Integration
  • 30:49 Conclusion and Final Thoughts

News articles:

This Week Health Linkedin

Alex’s Lemonade Stand: Foundation for Childhood Cancer Donate

3 Steps to Better Prepare for the Retirement of Your Integration Engineer

Posted on by
Healthcare Mergers and Acquisition

Our extensive experience managing integrations for various health systems has shown that it is quite common for organizations to depend heavily on one or two key engineers. When these engineers retire, it can pose significant challenges. As an IT director or CIO, it is crucial to prepare for this eventuality to ensure a smooth transition and minimize associated risks. Here are three steps to help you navigate this process effectively:

1. Planning for a Seamless Transition

a. Develop a Transition Plan:

  • Overlap Period: Plan for an overlap period where the retiring engineer works alongside new team members for 10-12 months. This period allows enough time for knowledge transfer and for new team members to encounter various interface issues. It also helps them learn organizational processes and build relationships with IT staff and other departments.
  • Engage an Integration Partner: Partner with a firm like Tido Inc., which provides integration solutions and has experienced integration engineers. Our engineers are familiar with every major EHR and integration engine, and they understand the importance of developing working relationships with IT and service departments like radiology and lab.

b. Assessment and Future State:

  • Comprehensive Assessment: Conduct a thorough assessment of the current integration environment. This allows the new team to learn the setup and interfaces and produces detailed documentation as a byproduct. This assessment should also include discussions with stakeholders to outline a future state and roadmap.
  • Enhance for Future: Tido’s integration assessments not only document the current state but also create a future vision that aligns with strategic initiatives and provides a roadmap for implementation.

2. Knowledge Transfer

a. Documentation and Guides:

  • Enhanced Documentation: During the transition period, ensure the current engineer works with the new team to update all system documentation, integration processes, and project details.
  • Create How-To Guides: Develop step-by-step guides for critical tasks and recurring issues. Tido’s team has templates to assist in creating comprehensive guides and manuals. We also use tools to make documentation easily searchable by any team member.

b. Training and Mentoring:

  • Knowledge Transfer Sessions: Organize training sessions where the retiring engineer spends dedicated time with the new team to transfer knowledge about different interfaces and special nuances.
  • Mentoring: Recognize that the retiring engineer has extensive knowledge of interfaces, organizational processes, and application workflows. Tido Inc. allows the retiring engineer to mentor and work closely with our team, who have been through similar transitions before.

3. Communication Plan

a. Internal Communication:

  • Inform Team Members: Clearly communicate the retirement plan and transition timeline to all relevant team members and stakeholders. This includes the IT team and other department managers and directors. Specially include communication about how to reach support for integration issues if this process will change. Tido’s team can share examples of previous communication plans and help draft these communications if needed.
  • Provide Updates: Keep the team informed about the progress of the transition and any changes to processes or responsibilities, especially support processes.

b. External Communication:

  • Notify Partners and Clients: If the retiring engineer has direct contact with external partners or clients, inform them of the change and introduce the new team.

Benefits of Partnering with Tido Inc.

  • Expertise: Tido’s team has over 15 years of experience providing integration management and support to health systems across North America.
  • Continuity: We ensure smooth, uninterrupted operations during transitions.
  • Scalability: Tido Inc. can scale services according to your needs, providing additional resources if required.
  • Cost-Effective: Our solutions are cost-effective, saving you the expense of hiring and training new personnel. You gain access to an experienced integration team rather than relying on a single individual.

By following these three steps and leveraging the expertise of Tido Inc., you can ensure a seamless transition, effective knowledge transfer, and clear communication, maintaining the integrity and efficiency of your integration systems. Need more information? Please contact us.

How to leverage your integration engine for seamless EHR Migration and reduce upgrade costs?

Posted on by
Health System Integration

In the complex landscape of Electronic Health Record (EHR) migration, having a robust integration engine managed by an experienced integration team can be a game-changer for health systems. Integration engines like Cloverleaf, CorePoint, InterSystems, Mirth, Rhapsody, Jaguar, Qvera, and others play a pivotal role in streamlining data flows and connectivity. Here’s why taking advantage of these engines can significantly ease the challenges associated with transitioning to a new EHR and also reduce costs associated with other vendor contract updates.

1. Streamlined Connectivity Timelines:

  • Having an integration engine already connected to downstream systems means a head start in the migration process. For instance, if your current EHR is sending Admission, Discharge, Transfer (ADT) messages and Orders to a Cardiology system, the workflow with the future EHR will likely perform the similar functions. This continuity significantly reduces the time spent on establishing new connections, as the connections between integration engine and the downstream system are already in place.

2. Cost-Efficiency and Resource Optimization:

  • Integrating a new EHR is a resource-intensive process. Utilizing an existing integration engine not only saves time but also contributes to cost-efficiency. The ability to repurpose established connections minimizes the need for additional infrastructure setup, ultimately optimizing resources. Depending on the workflows, timelines, etc. it may not be necessary for the downstream system to create any new interfaces, since the engine could be leveraged to send test messages from the new EHR test environment and also the existing EHR test environment. This could help significantly reduce contract update costs with the downstream system vendors.

3. Consistency in Data Routing:

  • When migrating EHRs, one of the challenges is rewriting existing interfaces. However, with an integration engine, you have the advantage of maintaining consistency in data routing. For example, even though the new EHR might require testing interfaces, your integration team can leverage the existing connections in the engine. This means that ADTs and Orders from the new EHR’s test environment can be seamlessly routed within the engine, eliminating the need for establishing new VPN tunnels or ports.

4. Optimizing Interface Reuse:

  • Many EHR vendors may create new interfaces to accommodate the testing phase of the new system. However, having an integration engine allows for intelligent interface reuse. The engine allows your integration team to review existing interface modifications, mapping etc. and provides a head start for interfacing with the downstream system. Existing interfaces could be cloned and modified as needed based on the messages from the new EHR.

5. Flexibility in Testing Scenarios:

  • The versatility of integration engines enables your team to adapt to various testing scenarios. Whether the new EHR necessitates specific configurations or adjustments, the integration engine provides the flexibility to handle diverse requirements without compromising on connectivity. Combining test automation with the engine can help clinical and IT teams test all possible scenarios without needing to take up valuable time from clinical resources.

Conclusion:

In the intricate landscape of EHR migration, the role of integration engines cannot be overstated. By leveraging the connectivity already established through these engines, health systems can navigate the migration process with greater efficiency, reduced timelines, and minimized disruptions. As technology evolves, integration engines stand as invaluable assets, ensuring seamless transitions and continuity in healthcare data management.

For over 15 years Tido Inc. has been partnering with health systems for EHR migrations and integration management. If you have any questions or need assistance with your health system’s ehr conversion, contact us today. We are here to support you in navigating the challenges of EMR migration and ensuring a smooth transition for your organization.

Get rid of avoidable re-admissions!

Posted on by
Hospital Readmissions Monitoring

Did you see this headline last month in Healthcare IT News? RPM brings 30-day mortality rate to almost zero for heart bypass procedure. Remote patient monitoring (RPM) offers to extend the reach of care and allow clinical teams to respond faster to changing patient conditions and reduce re-admissions for chronic conditions and post-operative care. While the article references a single site for the results of this RPM program, there have been numerous other studies and reports citing the promising results of these types of programs. Perhaps not a total elimination, but significant reductions are achievable.

There are a variety of companies out there trying to capitalize on utilizing various forms of RPM to capture early changes in the physiologic status of patients. Apple Watch and afib detection/monitoring is probably the most widely known out there of late. But remote monitoring or in-home monitoring devices have been around for decades, with a variety of connections, from dial-up to wifi to cellular. In addition to companies offering remote monitoring devices, there are a variety of companies offering to do the remote monitoring, hiring clinical teams to monitor patient connections. Often these companies can offer the benefit of scale to manage a smaller group of patients that would otherwise be an overwhelming administrative burden.

So what’s the catch? We know there’s always a catch! Remote monitoring sounds like a simple thing to do, and by and large the technology and FDA approvals already exist to make it happen. But as with anything data-related in healthcare, the data flows are a big pain point.

More connected devices from one ecosystem to another. There’s a lot of those in healthcare. Adding another tech burden for clinical teams to trouble shoot and figure out what happened can quickly render an RPM program ineffective. Even the most savvy clinical team and 100% compliant patients can be undone by connections that aren’t talking.

Whether the decision is to outsource and RPM program or handle it in-house, connections need to be reliable to get the right data to the right person at the right time. Anything less can result in a patient heading to an ER or Urgent Care for something that could’ve, and should’ve, been handled in the comfort of their own home. Not only is this detrimental to the patient, but it can also have a negative impact on reimbursement.

Reliable feeds and early notification of problems can keep clinical teams operating smoothly, ensuring patients receive timely care and interventions. Not only does this keep your teams working for the health of your patients, but it also gives patients confidence that your systems are working just as effectively as your clinical teams keeping them healthy.

Automated applications and integration monitoring can help quickly identify and resolve issues to minimize any downtime impact. For over 10 years Tido Inc. has been partnering with health systems to help maximize their IT systems and quickly resolve issues as they arise, often before the end user even notices. Contact us today so we can talk about how we can help you keep your systems working for you clinical teams and patients.

Rise of the [Diagnostic] AI Machines!

Posted on by
Radiologist reviewing diagnostic imaging

Are we ready to welcome our AI overlords into healthcare yet? Will we welcome a fully autonomous Dr. Crusher? We’re not likely ready to completely abandon our human healers, but there have been a variety of algorithms and machine learning applications that have been creeping their way into our clinical specialties for many years now. The first AI algorithm was approved by the FDA in 1995, in the beginning of 2023 there are 520. The specialty with the largest number? Radiology! Check out this article from HealthExec, it provides some more detail on the approval and advantages of AI in imaging.

Radiology, and similar specialties that utilize imaging, have long embraced computer systems to improve quality, productivity, and sharing. The complexity behind the scenes of these systems can be quite surprising. Once an image is captured it may still go through multiple systems just to be viewed, PAC Systems, VNA, Dicom viewers, the route is anything but direct. If we want to add another step in the process to have the image analyzed, we are faced with yet another connection.

In a previous blog post we pointed out the challenges that staff face when one of these systems aren’t communicating, these certainly impact our physicians as well. As we add more diagnostic solutions to aid our physicians in treating patients, we want to ensure that their time is actually spent doing what they are trained for. The average radiologist makes roughly $300,000 per year, if we assume that radiologist works 40 hours per week, that’s about $144 per hour.

What happens when the machines stop talking? Likely the radiologist calls the help desk… 5 minutes on hold ($12), they will take 3 minutes to explain the problem to the help desk person ($7.20), who will then transfer them to a specialist where they take another 5 minutes talking over the problem ($12). Helpdesk will then forward the issue to multiple analysts and integration team. At-least 2 different analysts getting pulled into diagnosing the issue. Typically, integration and system analysts make 90k-130k per year or on average $50 per hour. These 2 analysts will work on this issue for about 30min ($100) to diagnose the issue. $131.20 may not seem like a significant amount, but now that radiologist may not be reviewing images, may not be discussing treatments with patients, they may not be doing what they’ve been trained to do. If the radiologist is only 50% as productive without this solution, every hour of outage costs $132…  That’s just for one Radiologist. And typically system issues affect all users. So once you multiply the outage costs for all radiologists and other team members it really adds up fast. There can also be significant downstream impacts to other services waiting on imaging as well that become harder to calculate.

Moving beyond the frustration of the healthcare teams, there can be a detrimental impact to patient satisfaction as well. As results are delayed and the team gets backed up, every hour of delay adds to the patient’s anxiety and fear. Anxiety and fear are not feelings we want our patients to experience, we want them to have confidence in our teams and systems.

Automated applications and integration monitoring can help quickly resolve these problems. With early notifications to the right team in a timely manner, problems can be quickly resolved to minimize downtime impacts. For over 10 years Tido Inc. has been partnering with health systems to help maximize their IT systems and quickly resolve issues as they arise, often before the end user even notices. Contact us today and so we can talk about how we can help you keep your systems working for your clinical teams.

Are your charges still floating in the clouds?

Posted on by
Health System lost charges

How long did it take for those charges to drop? Was it halfway through the cycle? When did you find out they didn’t? Billing is seldom a simple process, with a variety of different systems required to communicate in order to get reports from the procedure to the billing department. Missing reports can prevent the charges from dropping, wreaking havoc on your revenue cycle.

Reconciliation can catch this, but how often is this done? Once a month? Once a week? 7 days and up to 4 weeks is way too long to find a problem. When you consider how long payment cycles can drag on, delaying them further can be problematic.

I’ve written often on the problems network breaks can cause on clinical teams. Broken networks can cause frustration for every department, not just the clinical teams. Billing is connected to almost every system in the hospital or practice, it’s even more vulnerable to these problems, relying on all these systems working to get an accurate picture of the supplies and time. If the report from Radiology didn’t cross over from the PACS to the VNA to the EHR, will it ever show as completed? If it shows as completed, is the report actually there and available to the billing department?

There are dozens of systems with dozens of different tech stacks, from reporting to supplies to pharmacy, getting a hand on each one to make sure they’re talking can be difficult. With most identification of issues coming from the end user, you often won’t know there’s a problem until its too late. Automated applications and integration monitoring can avoid many of these delays. Notifying the right teams early so problems can be addressed quickly, often before the end users even notice, can keep these teams working and the revenue cycling.

Tido Inc. can help you avoid these costly delays. How confident are we in this? Quite, confident. We have over 10 years of experience partnering with health systems and hospitals on their technology needs, from application monitoring to a variety of digital packages to support their operations.

Need more convincing? Contact us! We’re happy to talk about our processes and some of the results we’ve achieved. In fact, we’re willing to give you 3 months free to try it out, but there’s a catch… Only if you mention the song hinted at in this blog! Check out the next This Week in Health Tech podcast with Vik Patel and I’ll reveal the song!

We know convincing our colleagues in the finance office of the value of this service can be challenging just on the say-so of the vendor, so we’ll help you show the results with a free trial before you have to go and ask for a bigger slice of that pie.

Value Based Care Technology!

Posted on by
Value Based Care

Effective chronic disease management is the backbone of value based care and will be increasingly important in the coming decades. Value Based Care (VBC) has been getting a lot of press lately, currently it still represents a small fraction of revenue. This will likely be changing in the coming years as insurers look to reduce total spend and Medicare contracts with private enterprise increasingly rely on better chronic disease management to reduce complications.

Effective chronic disease management requires higher patient engagement and more frequent monitoring. These things typically require more time from clinical staff. There are increasing options to utilize different technologies to implement these programs, alleviating the burden on clinical teams while allowing them better insights to patient’s condition and better information to more effectively and quickly respond to changes.

There are a myriad of companies and apps promising to revolutionize chronic disease management, but how do they integrate? Does the intervention need to be all that complicated? What works for your patient population? If what works for your patient population is not available on the market today, can you effectively integrate remote monitoring technologies into your current environment?

Why do nurses always ask so many questions?!

Who knows your population better than your team of clinicians that works with them every day? They know what works and what doesn’t, the challenges patients face, the challenges they face in their daily practice. Building a whole platform can be complicated, and sometimes unnecessary. Monitoring weight for your heart failure patients can be accomplished with a scale, does the scale need to be connected? With that there will be a thousand more questions about the ability of the patient to have a connected device, want to know all the troubles? Ask the clinical staff, they already know, they’re already helping patients address these challenges.

Clinical teams can help get a remote monitoring program off the ground fairly quickly. The challenge? Getting the integration right. Rather than setting up a blue tooth connected scale, maybe it’s more effective to just text the patient every day and ask their weight. Simple, easy reminder, intuitive to use, doesn’t require a lot of support to get and stay connected.

Sometimes there is a ready made app for that. There’s an app for everything! Integrating and managing these different applications can be cumbersome. It can be beyond the expertise of IT teams who are focused on support and physical infrastructure. Poorly executed integration and support can reflect poorly on the organization, from the patient perspective and the clinician’s.

Getting the workflows right is key to digital adoption and getting the most out of IT investments. Partnering with clinical teams to get this right is key to a successful program, making sure information is going to the right place, getting to the right people, and being addressed in a timely manner.

Tido Inc. can help with a variety of digital packages, services like digital app management, custom mobile and web applications and EHR integration. For over ten years we’ve been partnering with health systems and practices on digital strategy, and systems monitoring. As more pressure is put on revenues, leveraging the most out of the current IT infrastructure will pay bigger dividends down the road, contact us and we’re happy to see how we can work with you.

Harnessing that free energy in healthcare.

Posted on by
healthcare free employee time

This isn’t about powering your data center with solar cells on the helipad. It’s actually about capturing the creativity and time that you’re already paying for. Clinical staff inside hospitals are powerhouses of innovation and creativity. Have you seen what a nurse can do with a roll of 3M transpore tape?!

I only half kid about the tape, but anyone who has tried to introduce new solutions and technology into a clinical workspace has undoubtedly been met with skepticism. Anyone who has gone back to see how those systems and tools are actually used, has undoubtedly been surprised to see how and if they were used.

Are those tablets waterproof? They make great trays for carrying medications and water.

Giving clinical staff back time to focus on their patients and get creative with solutions for systems, processes, and technology innovation can be invaluable. In a time when doctors, nurses and technologists are leaving the bedside and joining tech companies, it can be more important than ever to retain that staff and capture those ideas. Many of these ideas are not large scale changes to the macro environment, they are small and relatively simple ideas that make interactions and workflows easier that can lead to better engagement.

How do you give back time? When we think of the time wasted on inefficient processes, especially when it comes to inefficient IT systems, there is a large opportunity to free up time. In previous posts I’ve written about the inefficiency of reporting application and integration outages and how early notification can save clinical time.

How do you harness that “free” energy? Since you’re already paying for it, it’s not really free, maybe it’s more akin to installing a co-generation plant. When you alleviate the burden of reporting IT issues by clinical staff, they are free to focus on their patients, to address their patient’s needs, concerns, and monitor for their safety. Time and attention lead to fewer safety incidents and better outcomes. Beyond that when clinical staff have time to consider their workflows and systems interactions they will come up with better ideas.

Consider all the money spent on “solutions” and upgrades that do not yield expected results. When a new solution is proposed how much engagement are clinical staff able to give before a purchase? How much time and energy are they able to spend making the new solution work? How much thought are they able to give to iterating and improving EHR user interfaces and workflows? All of these things take time, and if they don’t have time, all these solutions will seldom achieve their full potential.

Leveraging IT assets to their fullest potential will improve the ROI, in addition to improving margins. For over 10 years Tido Inc. has been partnering with hospitals and healthcare organizations to leverage the most from their IT infrastructure. Automated applications and interfaces monitoring and alerts, application integration, and assisting with digital strategy. Contact us today to see how we can help capture some of that energy!

I wonder if solar panels on a helipad would work? I think I’ve found today’s rabbit hole!

Is there an orchard full of apples just outside the windows of the hospital?

Posted on by

Have you ever switched from an Apple iPhone to a Samsung or other Google based phone, or vice versa? It looks familiar, but it’s just different enough to be confusing. I know… I’ve done it. Work issued iPhone, personal Samsung phone. I was able to turn my iPhone notification to vibrate when I first got it… For the next 5 years I could not turn any notification sound on. I’m not new to smart phones, but I’ve always had a Samsung, the IOS screen looks familiar, but it just doesn’t work the same.  I only used the work phone for texting and phone calls, everything else was my personal phone, good thing my scrubs had two pockets.

Websites and apps can experience similar issues with back-end functionality. With the patients, visitors and employees all having different smart-phones, ensuring a seamless end-user experience can be more important than ever. Developing a website or app for a Windows based system may not be able to viewed in the Apple ecosystem.

Everything from way-finding apps, employee intranet sites, public websites, to patient access apps all need to be customized to ensure an end-user experience that is accessible and usable. Imagine telling a patient “there’s an app for that!” only to have them frustrated when they can’t access the information they were directed to. It doesn’t provide a good experience for the patient that can negatively impact things as serious as missing important appointments, to just experiencing un-warranted stress when trying to get to an appointment. Is a patient going to rate you 5 stars if they can’t find the doctor?

Similarly for employees, frustrations can abound when apps are not optimized for different mobile devices. Apps for time and attendance, intranet sites for policies and procedures, are all often made accessible for employees to use on their mobile devices. Apps and sites that are not optimized for their device can frustrate staff trying to request a vacation, or trying to look up policies for titrating insulin drips.

Accessibility in the physical world is important for healthcare, it is just as important in the digital age to have accessibility online as well. Ramifications can be a minor inconvenience or a major frustration. More and more information resources are moved online to save paper and ensure the most up-to-date information is being used, having access is vital to smooth patient experience and care.

How do you test apps and mobile sites for compatibility against thousands of different versions of mobile devices? Ten thousand engineers typing on ten thousand phones for ten thousand years? That might work, or you might get a mobile friendly version of Shakespeare. Hope you have a good IT recruiter!

Automated testing at every stage of development can help ensure accessibility is maintained across desktops and mobile devices. For over 10 years Tido Inc has partnered with hospitals and health systems to provide automated mobile and web testing at every stage of development. Ensuring minimal issues on launch, and faster development times. Contact us today to see how we can help, from development of custom apps and intranet sites, we can extend your IT teams when you need.

It’s winter, are your data pipes frozen?

Posted on by
Frozen data pipes

Winter can be brutal on pipes, one little spot of missed insulation can cause an air leak that freezes your water pipes. Fortunately there are various systems that can alert you to problems, infrared cameras to detect leaks before there’s a problem, and water sensors to alert when there is a leak.  Imagine testing or monitoring our IT systems like we test and monitor our homes.  Check the systems before there is a problem, or alert us early to take action when there is a problem.  Healthcare is ever more reliant on data flows and pipes to connect the various systems and ensure smooth operation. But how are these problems recognized? Who reports them? Is there an early detection system to alert when there is a problem?

When we build a house it is important to ensure all the pipes are connected and all those insulation trouble spots are tightly sealed to prevent problems down the road when the new owners move in. Fortunately there are infrared cameras and blower door tests for homes to discover potential problem areas. When we’re building new solutions into healthcare networks there are countless points of failure that can occur when systems go live, and with the proliferation of new applications from patient monitoring to clinician web-based and mobile apps, the number of potential points of failure increase. Do we have an infrared camera or blower door test for the maze of networks in a healthcare facility? Testing every connection for a new system, upgrading systems, or implementing a new mobile app will quickly overwhelm even the most well-staffed IT department. Test automation can quickly, efficiently, and repeatedly test systems to ensure that all functionality will perform as expected and provide the end-user experience that is desired.

As much as we can prepare our home ahead of time, sometimes there are events outside of the home that will cause things to go awry. Problems with the electrical grid, gas network or even water distribution can lead to unexpected problems in the home and cause catastrophic leaks. Fortunately we also have tools to monitor the state of our home in the event a change on the outside causes a problem on the inside. Leak detectors can alert homeowners to potential problems, allowing quick action to prevent flooded basements and avoid the physical and emotional stress that comes with clean-up. Similarly in healthcare continuously monitoring networks and automatic notification of an issue can prevent stress on the end-user that relies on these systems for patient. Too often when networks go down, often due to an upgrade or issue beyond the walls of the facility, the end-user is the first to notice. It’s not just one end-user that’s impacted, it can be thousands, and they will start calling the help desk. Applications and Integration monitoring can sound an early alarm and allow IT teams to respond quickly to an event, end-users can be notified early, and IT teams can work quickly to minimize disruption and stress. IT teams should be aware of an IT issue before the end-user, network monitoring can facilitate this.

Back in 2021 research found that one-third of healthcare workers felt that technology contributed to emotional exhaustion, and were frustrated at least 3-5 days per week. In the past 2 years since the study was done, the number of applications and solutions has only increased, as has the technology burden on clinical staff. Clinical staff works to take care of the patient, they seek to prevent problems for patients before they occur, shouldn’t IT systems do the same?

Nobody wants to deal with frozen pipes or disconnected networks. For over 10 years Tido Inc has helped healthcare organizations save over $30 million with our integration and testing packages. Connect with us today and see how Tido Inc can partner with your teams to help build a tighter, better connected, healthcare house.