Morning Headlines 8/12/20

Navin, Haffty & Associates and Engage Join Forces to Provide Clients Complete MEDITECH Solutions

Providence-owned Providence Services Group acquires Meditech-focused consulting firm Navin Haffty.

Lumeon Raises $30M in Funding to Support U.S. Growth

Care pathway automation company Lumeon raises $30 million in a Series D investment round that brings its total funding to $78.6 million.

Health Catalyst Announces Agreement to Acquire Vitalware, a Revenue Workflow Optimization and Analytics SaaS Technology Solution

Health Catalyst will acquire RCM software and services company Vitalware for an undisclosed sum.

mPulse Mobile Announces Closing of Series C Funding of more than $16 Million, Led by Optum Ventures

AI-powered healthcare messaging vendor MPulse Mobile raises $16 million.

News 8/12/20

Top News

Providence-owned Providence Services Group acquires Meditech-focused consulting firm Navin Haffty.

Providence had previously acquired Meditech hosting and services vendor Engage, which will allow the combined companies to offer consulting, service desk, application support, staff augmentation, and technical services.

Providence also owns Epic consulting firm Bluetree and runs an Epic Community Connect hosting business.

The health system said last year that it planned to create a $1 billion business from its non-clinical investments. It  has 51 hospitals, over 1,000 clinics, and 120,000 employees.

HIStalk Announcements and Requests

Listening: new from Deep Purple, not excavated from a 1970s music vault along with related artifacts such as Hammond A-100s and Gibson SGs, but rather offering a fresh-sounding entry in the barren wasteland of new hard rock. It will be a certain nose-scruncher for most folks who were raised on Auto-Tuned singer-dancers and hip-hoppers, but let’s see how those musicians hold up after 50+ years, 21 albums, and one original member left (72-year-old drummer Ian Paice, a much lesser figure than former members Jon Lord and Ritchie Blackmore). Just turn it up to 11 and hope you end up being a cool septuagenarian like these grandpas who can take you back if you’ve been, or take you there if you haven’t. The part at 2:13 is a dead ringer for Yes’s “Starship Trooper.” 

Webinars

August 19 (Wednesday) 1:00 ET. “A New Approach to Normalizing Data.” Sponsor: Intelligent Medical Objects. Presenters: Rajiv Haravu, senior product manager, IMO; Denise Stoermer, product manager, IMO. Healthcare organizations manage an ever-increasing abundance of information from multiple systems, but problems with quality, accuracy, and completeness can make analysis unreliable for quality improvement and population health initiatives. The presenters will describe how IMO Precision Normalize improves clinical, quality, and financial decision-making by standardizing inconsistent diagnosis, procedure, medication, and lab data from diverse systems into common, clinically validated terminology.

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

Acquisitions, Funding, Business, and Stock

Private equity firm K1 Investment Manager makes a significant investment in Rethink Autism, which offers a development disabilities platform that includes assessment, treatment planning, e-learning tools, analytics, and practice management. Rethink recently acquired pediatric therapy telehealth provider TheraWe. Rethink’s co-founders came from a company that provided labels and tags for the retail clothing industry.

Investors are noting that the combined market value of Teladoc and Livongo has dropped nearly $10 billion in the week since the former’s $18.5 billion acquisition of the latter was announced. Above is the one-year share performance of Teladoc (blue, up 188%), Livongo (red, up 212%), and the Nasdaq index (green, up 38%). It’s uglier over the past five days, where TDOC and LVGO have dropped 25% and 19%, respectively, since the announcement. 

Sales

• New Mexico’s largest county will implement Netsmart’s CareManager for post-incarceration population health and care management.

People

Clearinghouse operator Jopari hires Tom Turi (The SSI Group) as chief sales and marketing officer.

Announcements and Implementations

Stanford University’s Stanford Center for Health Education launches “AI and Healthcare,” an online, four-course certification program that will be taught by its medical school faculty. Courses in the Coursera program include “Introduction to Healthcare,” “Introduction to Clinical Data,” “Fundamentals of Machine Learning for Healthcare,” and “Evaluations of AI Applications in Healthcare,” which are followed by a capstone project. The only cost specified is the $79 per course Coursera certificate fee.

Philips announces Virtual Care Station, a telehealth environment for public areas such as stores, libraries, and universities. The company developed the technology for the VA’s ATLAS program, which offers virtual clinics to American Legion and VFW posts.

Government and Politics

I wondered what happened to former Rep. John Fleming, MD (R-LA), who President Trump appointed to the newly created position of deputy assistant secretary for health technology in 2017. He seemed uncertain about the job when it was announced, initially stating that he was interviewing to become national coordinator, but then admitting, “I think it’s the same or a similar position – I really don’t know.” He apparently didn’t last long there – President Trump appointed him to become Assistant Secretary of Commerce for Economic Development in 2018, and then in March 2020 he was appointed Assistant to the President for Planning and Implementation. I can’t find any evidence that his former ONC position still exists. I interviewed him in January 2018.

Cerner VP of Strategic Growth Amanda Adkins, who took a leave from the company to seek a US House of Representative seat, wins the Republican primary and vows to defeat Rep. Sharice Davids, who is serving her first term. The healthcare platform of Adkins, a former state Republican party chairwoman, supports creating a national COVID-19 response plan and says the ACA is a failed experiment that increased cost. She says healthcare should be smarter, more transparent, and more affordable, but I haven’t seen her plan for achieving that.

COVID-19

Russia approves a COVID-19 vaccine that has not undergone widespread clinical trials and for which no Phase 1 and Phase 2 clinical trials data has been published, raising concerns that President Vladimir Putin may be placing national pride and political gain ahead of consumer safety. Another theory is that Russia is trying to goad the US into rushing its own vaccines to market or to confuse the issue following its rumored disinformation campaigns. Russia says it will start vaccinating teachers and medical workers this month with Sputnik-V, the name it chose for the vaccine that reflects the world’s surprise in October 1957 that the Soviet Union had launched the first artificial Earth satellite, which triggered a space race with the US.

Former FDA Commissioner Scott Gottlieb, MD notes that the US might get just one shot (pun intended, I assume) with a vaccine in a given season since it would be difficult to mount two vaccination campaigns in a short period. He says he would not take a vaccine like Russia’s that has been tested on only a few hundred people and says Russia is certainly not ahead of the US in that regard.

The New York Times questions whether federal government newcomer and FDA Commissioner Stephen Hahn, MD has the fortitude and political savvy to stand up for patient safety under White House pressure to release a COVID-19 vaccine quickly. Hahn is not allowed to speak to the press by phone without having HHS spokesperson and longtime Trump supporter Michael Caputo on the line. FDA has been criticized for delaying approval of alternative COVID-19 diagnostic tests after CDC’s were found defective, allowing untested antibody tests to flood the market with minimal oversight, and for granting emergency use approval – revoked three weeks later – for using hydroxychloroquine in hospitalized patients.

California public health director Sonia Angell, MD, MPH resigns for unspecified reasons, one week after the state reported that it had underreported new cases due to a technical issue with electronic lab reports.

Mexico’s high COVID-19 death count is understated because residents are justifiably afraid of hospitals. Mexico City’s hospitals report that 40% of patients who are admitted with confirmed cases die in house and half of those deaths occur within 12 hours of admission. People who die at home aren’t tested and thus aren’t counted as being among the country’s 53,000 COVID-19 fatalities, although Mexico reported 71,000 more deaths than were expected in the spring. President Andres Manuel Lopez has urged citizens to stay home and use religious amulets instead of going to the hospital, and 70% of people say they would not feel safe taking a loved one to the hospital, some because of conspiracy theories involving genocide and organ harvesting.

An eight-state review of COVID-19 cases in nursing homes finds that higher staffing levels – but not health inspection scores or quality measure ratings – are associated with fewer cases. I would be interested in seeing an expanded analysis that considers ownership since I would bet that for-profit homes, especially those owned by private equity-backed chains, fall short in areas like staffing levels and infection control.

One-third of polled Americans, including more than half of Republicans, say they would not take a free FDA-approved COVID-19 vaccine. On a slightly optimistic note, a 1954 survey about the then-new polio vaccine yielded about the same result.

A new study by Johns Hopkins Bloomberg School of Public Health finds that an area’s density (population plus employment divided by land area) isn’t the primary driver of COVID-19 infection rates – it’s the degree of an area’s crowding into tight spaces, such bars, restaurants, sporting and entertainment events, and beaches. The authors believe that while density increases the incidence of close contact that theoretically should increase infection rate, that isn’t the case because people who live in dense areas are better at social distancing and wearing masks. They also conclude that evidence does not exist to support the move of city dwellers and businesses to the suburbs to avoid COVID-19.

The beginning of the end may be near for the fall 2020 college football season as the Big Ten postpones all fall sports, with football to be played in the spring if at all. The other four Power Five conferences haven’t announced their plans, although insiders say the PAC-12 has also decided not to play and doubts that spring football will happen either. 

University of Florida researchers detect live coronavirus in air samples taken up to 16 feet from hospitalized COVID-19 patients, raising the possibility of air-only spread, although the low viral quantities make it unclear whether people would likely become infected. The six-foot distancing recommendation assumes that only large droplets carry the virus. 

Other

Epic delayed its mandatory employee return to campus after the county health department warned the company that “remote work” does not mean sitting alone in private, on-campus offices as Epic had interpreted. The health department told Epic that such action might violate the county’s order. They’ve asked Epic to justify why it needs employees to work from the office starting September 21, not mentioning the first wave of returnees that was to have taken place this past Monday or the 4,000+ employees that were already working voluntarily on campus.

In the Philippines, the government-owned universal health coverage insurer says the agency is losing $50 million per week due to corruption that is enabled by weak IT systems. The anti-corruption commission says that PhilHealth’s executives and employees are filing claims for non-existent patients, while hospitals are upcoding visits to obtain higher payment and are falsely claiming to be treating COVID-19 cases to obtain emergency funds. The agency denies charges that its executives pocketed $300 million last year.

Two former employees of Talkspace, which offers text messaging based psychiatric counseling provided by contractors, claim that the company mines session transcripts for marketing purposes. Other former employees say that the company, which was getting stung by bad app store reviews, asked employees to create fake positive reviews and gave them burner phones to avoid getting caught. Talkspace’s executives deny the claims. Some of its contract providers complain that the company advertises 24/7 therapy even though it tells them they can set their own business hours; gives users a “I need help now” button that therapists must respond to quickly to avoid having their pay docked; and advertises therapy services even though a former version of its user agreement made it clear that it offers a “therapeutic conversation” but not “therapy.” The company charges $260 per month for unlimited asynchronous message response or $396 with four live, 30-minute sessions.

Sponsor Updates

• Health Catalyst will participate in the virtual Verity Research HCIT/Services Conference on August 12, and the Canaccord Genuity Annual Growth Conference on August 13.
• BioWorld profiles the use of Saykara’s voice-enabled mobile AI assistant at MIMIT Health, which reports a 500% productivity boost. 
• CareSignal and Innovaccer partner to combine population health data technology and deviceless remote patient monitoring.
• The Chartis Group promotes Laura Stearns to VP of talent development.
• Norway’s Directorate of Health relies on Everbridge’s Public Warning software to alert citizens traveling internationally to mitigate COVID-19 risks.

Blog Posts

• The Importance of Collaboration for Epic Implementations (314e)
• Reduce Operating Costs and Total Cost of Care with the Right EHR (AdvancedMD)
• Summer Reading Part 2: Creating harmony and reducing TCO in Imaging IT (Agfa Healthcare)
• Blueleaf Banter: Driving Cost Savings Through EHR Innovation (Bluetree)
• Curbing COVID-19-Related Alert Fatigue (Capsule)
• Henry Ford Health System’s Experience During COVID-19 Surge (CarePort)
• Bringing Speed and Accuracy to Practice Quality Reporting (ChartLogic)
• FHIR Patient Access: Health Plans Between a Rock and a Hard Place (Diameter Health)
• Data Analytics and the Fight Against COVID-19 (Dimensional Insight)
• National Health Center Week: Continuing the Legacy (EClinicalWorks)

Contacts

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

Morning Headlines 8/11/20

Shares In Senior-Focused Oak Street Health Jump 90% In Market Debut

Primary care company Oak Street Health’s IPO raises $328 million, earning it a $5 billion valuation.

Medix Launches Medix Technology, Combining Medix IT and Alidade Group to Offer Clients Expanded Tech Solutions

Medix merges two of its divisions to create Medix Technology, which will offer health IT recruiting, consulting, and integration services.

Navicent Health’s Virtual Hospital to let some COVID-19 patients receive care from home

In an effort to free up beds for the acutely ill, Atrium Health (NC) expands its “Virtual Hospital” to partner organization Navicent Health (GA), enabling some COVID-19 patients to recover at home with around-the-clock remote patient monitoring.

Sift Healthcare secures $2.8 Million in funding

Milwaukee-based healthcare payments software startup Sift Healthcare raises $2.8 million.

Curbside Consult with Dr. Jayne 8/10/20

I thought I had previously registered for ONC’s tech forum this week, but when I noticed I didn’t have any meeting information, I figured I should double check. Turns out I didn’t register.

I would have definitely remembered, because I thought their registration form was a little problematic. First, one of the required fields for registering is a Twitter handle. Of course, one could just put junk in that field, but I found it odd that it was the first field required past name and email address. Another required field was “Affiliation” without any indication of what they were looking for. Did they mean employer?

I’m becoming quite the connoisseur of virtual conferences and have enjoyed doing a few more of them than I might otherwise have done had travel been required. For those of us who foot the bill for our own conferences and education rather than charging it back to an employer, it’s all about making the most of your time and your travel resources.

Speaking of, I cancelled my hotel for HIMSS21 “spring edition” today and worked on making my reservation for HIMSS21 “roasting hot desert summer edition.” Unfortunately, my hotel of choice isn’t taking reservations just yet, but I was able to book a backup for reasonably cheap. Like Mr. H, I’m a little uncertain on exactly where the conference will take place since the official notice includes Caesars Forum and Wynn as venues as well as the expected Venetian-Sands Expo Center. I loved my stay at The Venetian a couple of years ago, but it’s not in my current budget. My new hotel is fully refundable, as was the previous one (and the credit was already showing up in my online account before I had booked the next reservation).

The flight is in my budget, however, as I’m sitting on several thousand dollars of unused plane tickets that were supposed to take me to all kinds of interesting places this year. Now the challenge will be to use them before they expire. Some airlines have been more generous than others in pushing their expiration dates well into 2022, but I anticipate more than one will just become a loss. I’ve found charities that you can donate miles to, but haven’t figured out a way to donate tickets since they’re supposed to be nontransferable. If anyone has ideas, let me know. I doubt I’ll be rescheduling my trip to the Vancouver area anytime soon, given the current status of coronavirus transmission in the US.

Once I finished moving my hotel reservation, I was in an administrative mood, so I spent some time trying to do forecasting for what I’ll be doing the rest of the year. It’s a difficult time to be an independent consultant. Earlier in the year, I watched six months’ of bookings evaporate in a single afternoon, and it hasn’t been easy replacing that business. Many of my ongoing clients are mid-sized organizations that are in dire financial straits as they wrestle with continued shortages of personal protective equipment and struggle to try to figure out how to kickstart their revenue streams during failed economic re-openings across the US. My larger clients are experiencing across-the-board project freezes after furloughing internal staff. They’re more likely to reactivate those staffers than to use an external consultant, which is understandable.

For those clients who are continuing to have me work, I’ve seen some fairly extreme layoffs and restructuring, with one client literally moving the work of two departed project managers onto the one remaining one. The remaining project manager is struggling under the workload, but is afraid to complain because he fears he might be next. As you can imagine, the project management that’s occurring is fragmented, behind schedule, and generally ineffective, because you simply cannot just pile work on people and expect them to work magic. I’ve had a couple of conversations with the director of the program management office about it, but she just throws her hands up because she doesn’t have the authority to challenge decision-makers who still want all the projects running.

It feels like everything we’ve learned about happy staff being productive staff has been thrown out the door in the last few months, and people are operating from a position of desperation. This is only being magnified as various parts of the country head back to school and working parents are trying to figure out how they’re going to juggle childcare with assisting children who are expected to learn at home. I have a lot of friends who are able to work their IT jobs from home and have been successful during the pandemic, but all bets are off when they’re expected to support their elementary aged students in virtual learning plans that have varying degrees of planning and forethought.

Despite industry players like Epic pushing to have workers return in person in the name of “culture,” it feels like most of the health system folks I speak with are happy to let people work at home as long as possible while making plans to jettison the soon-to-be-unused office space and its associated costs.

Two more of my physician friends made plans to close their offices this week. One was already struggling with health issues when the pandemic hit, and the stress has definitely worsened her condition. Another is retiring early to move in with her physician daughter to help with her grandchildren. Both of these physicians thought they had much more time in their careers. Their patients will certainly miss them.

The local health systems have all stopped acquiring practices and one has laid off dozens of physicians, so there wasn’t an option to sell the practices. Since they each carry several thousand patients on their panels, I’m not sure where all those patients are going to receive specialty care, and they only have the state-mandated 30-day notice period to figure it out.

We’re certainly living in strange times. Although my practice hasn’t had to lay anyone off, they’ve made it clear that physicians aren’t getting any extra money regardless of our insane patient volumes and that we should be happy we are employed and working a normal number of shifts each month. They did give generous bonuses to the staff, which we appreciate, but you would think physicians seeing an extra 20-30 patients a day might be worth a little financial boost. I suspect that more than one of us is planning to depart after the end of the year because you can only work at this pace for so long before you start to crack.

In the mean time, it’s all about keeping your chin up, your mask on, and putting one foot in front of the other. We’re all looking forward to the time when this pandemic is under control . We are crossing our fingers that it’s not going to be confounded by a hellacious flu season once we ease into winter. Normally we start our flu vaccination campaigns in September and October, so only time will tell on this one.

Are you preparing to cope with children learning at home? Have any good strategies to share with the rest of us? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 8/10/20

Improving VA and Select Community Care Health Information Exchanges

A VA OIG report on how VA facilities and their community providers use HIEs finds utilization lacking for a number of reasons, and that the Cerner switch-over will improve the ease of exchange among VHA, DoD, and community providers.

Samaritan still dealing with effects of malware two weeks later, slowly restoring applications

Samaritan Medical Center (ME) brings its EHR, PACS, medication management, and care communication systems back online after a July 25 ransomware attack.

Epic adjusts staff’s return to work time frame

Epic changes its Monday mandatory return to campus, allowing employees who feel that their personal situation makes it unwise for them to return safely to campus to continue to work from home while Epic awaits further guidance from the county health department.

Monday Morning Update 8/10/20

Top News

VA OIG looks at how VA facilities and its community providers use HIEs.

The report finds that all 140 facilities have access to VA Exchange and VA Direct, but only 28 are using the latter because they weren’t offered training from DirectTrust or none of their community partners are using DirectTrust.

Twenty-two of 48 lower-acuity facilities still exchanging information via scanning, faxing, or mailing.

Users of Joint Legacy Viewer complain about cumbersome sign-on and poor data quality.

VA has 56 contracted VHIE community coordinators, but noted high turnover and engagement that “ranged from a high level of participation to little or no participation.”

OIG concludes that the Cerner implementation will improve the ease of exchange among VHA, DoD, and community providers.

The report recommends that the VA review barriers to using VA Direct, evaluate VA Exchange and VA Direct training programs, increase the number of community partners including other HIEs, and evaluate the work of the VHIE community coordinators. The VA accepted all four recommendations.

Reader Comments

From All the Marbles: “Re: newly rich Livongo executives. Does it even matter since they were all loaded before?” I’m speculating since I don’t know what it’s like having that kind of cash, but my reaction:

• Assets, not income, makes you wealthy, since you then have financial autonomy that nobody can take from you. Whoever signs your paycheck could stop doing so tomorrow. These folks are set for life.
• Everybody can find ways to spend ever-increasing amounts of money, but at some point pretty early in the wealth continuum, diminishing returns would kick in and the pleasure of buying a fourth house or third luxury car wouldn’t provide much of a thrill. I speculate that money makes things easier to some point, then starts making them harder and causes stress over losing a chunk of it via bad investment.
• Self-made people with big fortunes feel the psychological need to prove that earning it wasn’t a fluke, so they rarely sit poolside like a trust fund brat knowing they can’t outspend their interest and instead try new ventures (either the rich-person’s hobby kind or something a team can run day to day for them).
• I suspect rich, older folks realize that you don’t see hearses pulling U-Hauls, so they look for benevolent ways to publicly spend their money instead of bringing out the worst in squabbling, greedy family members.
• Everybody has some magic number that, given their personal expenses and ambitions, would allow them to live out their days comfortably free of job worries. In that sense, just as time is money when you’re making it, money is time when you want to stop making it. That might be a $1 million net worth for one person or a $50 million net worth for another and the combination of risk taken, luck, and the time value of money is what will or won’t  you there, hopefully in time to enjoy the result. I suspect that every one of those newly minted Livongo centimillionaires passed that point long ago, so while I’m sure they are thrilled to be sitting on an even larger embarrassment of riches today than last week, it won’t change their daily lives.

From Prime Spot: “Re: hospital parking. Lots of Twitter chatter about how it’s expensive and unfair to charge patients and families to park.” Hospital parking is always a mess, and I was shocked the first time I took a job with a health system that charged employees and even visitors for parking. My reactions then:

• Hospitals never have enough parking due to an absurdly large number of employees, doctors coming and going, patients and visitors coming in for ambulatory services on the same campus, and car-driving salespeople running around all over the place. We did an analysis of where employees and visitors were parking off campus and it was shocking — they would walk a half-mile to park in a residential neighborhood, either to find an available space or to avoid paying.
• Sometimes as an employee you can’t get a spot even though you’re paying monthly for one, and if you’re really unlucky, you might get relegated to offsite parking that involves a bus ride each way that isn’t nearly as nice as  its off-airport counterpart
• Hospital and university transportation services departments, like most bureaucracies, keep finding new ways to spend money on employees, vehicles, and infrastructure because they seem themselves as generating big profit, and all of that profit comes from permits and tickets.
• Hospital garages and parking lots are often located in areas where unrelated parking is in high demand or as part of a school where students will take up any available space, meaning that visitors wouldn’t get a spot if the per-hour charge wasn’t a deterrent to those with less motivation. Hotels charge paying guests $40-80 for overnight valet parking given the same demand with lack of alternatives.
• Hospitals sometimes don’t own their on-campus garages or contract out parking / valet services (I always picture mob involvement).
• It’s always funny that despite all the ways hospitals extricate money from patients under sometimes questionable circumstances, the only services for which bitter comparisons are made are parking and cafeteria.
• I personally would avoid on-campus appointments whenever possible, foreseeing sitting in traffic amidst impatient employees and lost visitors and then hiking quickly knowing I’ll be late (assuming I even know where I’m going from the bowels of the parking garage, like the “follow the yellow lines to the blue elevator, go up one floor, then cross the annex bridge and go down one floor” kind of hospital directions). I don’t like having my first aggravating customer experience before it even begins. Buy a dying mall and stick your doctors there.

HIStalk Announcements and Requests

HIMSS21 attendance is, for the most part, out of the control of HIMSS and instead will be driven by pandemic status, poll respondents say.

New poll to your right or here: For those assigned to work from home: would you return to campus if the company required it in the next few weeks? Basically a yes/no answer is the only one an employer will offer, so do you feel strongly enough about not returning that you’ll accept termination for refusing?

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

Several readers saw my mention of new Donors Choose projects and sent generous donations to fund another round of them, with their dollars boosted by matching funds from my Anonymous Vendor Executive as well as third-party matching sources. Here’s what I fully funded:

• A document camera for Ms. E’s elementary school class in Salinas, CA.
• A webcam, laptop stand, and wireless keyboard for Ms. H’s elementary school class in Timbo, AR.
• Lighting, headset, device mount, and easel for Mx. Smith’s third grade class in Las Vegas, NV.
• Digital resources for Ms. G’s elementary school class in Seagoville, TX.
• Digital resources for Ms. D’s kindergarten class in Hoskinston, KY.
• Five headsets for Ms. S’s elementary school class in Santa Ana, CA.
• Daily journals for online sharing for Ms. M’s second grade class in Oxnard, CA.
• Math manipulatives for remote learning for Ms. S’s elementary school class in Waco, TX.
• Classroom supplies for Ms. D’s middle school class in Collinsville, IL.
• Flocabulary vocabulary learning for Ms. H’s elementary school class in Las Vegas, NV.
• Digital resources for Ms. R’s elementary school class in Philadelphia, PA.
• Agriculture books for Ms. J’s middle school class in Kinston, NC.
• Math manipulatives for Ms. F’s elementary school class in Wyandanch, NY.
• 50 take-home library books for Ms. C’s elementary school class in Calumet City, IL.
• 25 sets of headphones for Ms. S’s elementary school class in Houston, TX.
• A document camera for Ms. E’s elementary school class in Steelton, PA.
• Remote video learning equipment for Ms. R’s elementary school class in Oklahoma City, OK.
• Social distancing and teaching supplies for Ms. B’s elementary school class in Irving, TX.
• A document camera for Ms. T’s elementary school class in Apopka, FL.
• Sight word games for at-home use for Ms. C’s elementary school class in Hempstead, NY.
• A webcam, microphone, and earphones for online instruction for Ms. T’s middle school class in Chicago, IL.
• Online language proficiency tools for Ms. M’s elementary school class in Fairdale, KY.
• Digital social studies content for Ms. K’s middle school class on Connellsville, PA.
• Lighting for teaching virtual classes for Ms. T’s elementary school class in Mission, TX.
• STEM kits for Ms. A’s kindergarten class in Sacramento, CA.
• Headphones and a USB camera for Ms. N’s elementary school class in Harbor City, CA.
• A USB headset for Ms. B’s elementary school class in Kenner, LA.
• Take-home math materials for Ms. H’s elementary school class in Madera, CA.
• 20 magic boards and binders for Ms. M’s elementary school class in Chicago, IL.
• Math and science books for recording for online lessons for Ms. P’s elementary school class in Philadelphia, Pa.

Webinars

August 19 (Wednesday) 1:00 ET. “A New Approach to Normalizing Data.” Sponsor: Intelligent Medical Objects. Presenters: Rajiv Haravu, senior product manager, IMO; Denise Stoermer, product manager, IMO. Healthcare organizations manage an ever-increasing abundance of information from multiple systems, but problems with quality, accuracy, and completeness can make analysis unreliable for quality improvement and population health initiatives. The presenters will describe how IMO Precision Normalize improves clinical, quality, and financial decision-making by standardizing inconsistent diagnosis, procedure, medication, and lab data from diverse systems into common, clinically validated terminology.

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

Sales

• NIH will extend its use of OpenText’s Content Suite and AppWorks for electronic document management and workflows.
• Transaction Data Systems chooses Waystar for claims processing by its independent pharmacy customers.

People

Mee Memorial Healthcare System (CA) promotes Rena Salamacha, MS to CEO. She previously served as IT director, CIO, and chief strategy and technology officer, COO, and interim CEO.

Lisa Crymes, MBA (Change Healthcare) joins Preventric AI as chief marketing officer.

Announcements and Implementations

Elsevier expands its integration of its ClinicalPath (formerly Via Oncology) oncology decision support tool with Epic, including launching from Epic using SMART on FHIR, applying cancer staging data from Epic, navigating within Epic, queuing up treatment within Beacon protocols to reduce manual order entry, and documenting details as a note.

COVID-19

A New York Times analysis of CDC’s count of higher-than-expected death counts – probably caused by COVID-19 along with the situations it has created – at over 200,000 from March 15 through July 25 versus the official count of 161,000. This is a good full-impact number that would include the pandemic’s effect on stress, failure to seek medical care for other conditions, financial challenges, and failure to correctly account for deaths. I assume that it this number would also be subject to undercounting given the presumable decrease in deaths by accidents.

The field hospital created at Sacramento’s Sleep Train Arena sees just nine patients in 10 weeks, with $12 million in cost from rent paid to the Sacramento Kings, facility upgrades, and payment to 250 staffers. One traveling nurse company billed $428,000 to provide five pharmacists and five pharmacy technicians. Those involved say there was never a real plan on how to integrate with possibly overburdened hospitals and the state admits that it should have used local data to determine how to set up its 15 field hospitals.

Bill Gates says US COVID-19 tests are “complete garbage” because of delays in getting results, suggesting that paying companies for them only if the results come back in 24-48 hours would “fix it overnight.” He is optimistic overall, however, predicting that diagnostic and therapeutic innovation in the “rich world” will end COVID-19 by the end of 2021, with the rest of the world following a year later. However, he says it will take years to bring the global economy back to the levels of early 2020. He also notes that he would want remdesivir or dexamethasone today if hospitalized for coronavirus, but in 2-3 months the tool chest will expand with other antivirals and antibody therapy.

It’s been a busy COVID-19 week for one Georgia high school:

• The school suspended two students for taking a photo that showed a packed school hallway and sharing it to social media.
• After a national outcry, the school lifted the suspensions.
• Six students and three employees reported to the school that they had tested positive.
• Two brothers who reported experiencing symptoms were found to have gone to school Monday without wearing masks or social distancing, with a family member saying they didn’t realize the severity of the virus and weren’t encouraged to wear masks.
• The school moved to distance learning only for Monday and Tuesday while awaiting the results of contact tracing. They have told parents that they will notified Tuesday evening whether in-person instruction will resume.

Other

Epic changes its Monday mandatory return to campus, allowing employees who feel that their personal situation makes it unwise for them to return safely to campus to continue to work from home while Epic awaits further guidance from the county health department. Epic says Cleveland Clinic, a public health expert, and an epidemiologist are reviewing Epic’s plan, which originally called for bringing the first group of employees back to their offices on Monday and all employees working on campus by the end of September except for those at high risk, who could request an extension through November 2.

China’s Communist Party newspaper warns readers to “beware of health-tech firms’ snake oil,” which is pretty good advice. Its points, as written by a health policy lecturer in the London School of Economics:

• Big US tech companies have promised that analytics and AI will reduce costs and improve outcomes, but individual patient data is subject to subjective clinical judgment and is often plagued with missing records and lack of standardization.
• Those big US tech companies don’t know much about healthcare, and they rarely back up their black box algorithms with studies that prove their value.
• Predictive models are only as good as the data they are given, and since their assumptions are based on what is already know, they are best at reviewing the past and present rather than predicting the future.
• AI developers are, intentionally or not, just as biased as the rest of us, and using current healthcare data makes those systems prone to replicating past failures and successes.
• Hospitals and regulators shouldn’t just turn over patient data to developers – they should be actively involved in the design and deployment process.

Sponsor Updates

• The Dealmakers Podcast features PatientPing co-founder and CEO Jay Desai.
• Pure Storage’s Pure Good Foundation celebrates its fifth anniversary and announces that it has raised $2.3 million for charitable contributions.
• The Voice First Health Podcast features Gabe Charbonneau, MD and his use of the Saykara AI Assistant.

Blog Posts

• Addressing key questions and misperceptions of the 2021 E/M changes (Nordic)
• How to Beat the Prescription Drug Discount Card Game (OmniSys)
• Purpose Born of Frustration (OptimizeRx)
• From High Touch to High Tech: 5 Key Factors That Will Drive the Trajectory of Telehealth (Pivot Point Consulting)
• Better, Stronger, Faster: Leveraging the Amazon Cloud to Scale to the Demands of Telehealth (PMD)
• Five Reasons Health Systems are Prioritizing Integration with Specialists (Premier)
• (Re) Introducing Single-Sign On (SSO) (Redox)
• Why Remote Work is Not the New Normal (SailPoint)
• How healthcare prepares for cloud computing (Spok)
• Krames on FHIR: Blazing a trail in personalized patient education (StayWell)
• CMS Price Transparency Rule is Fast Approaching (Surescripts)
• Marketers, Clinicians, and Care Managers in the Patient 360 Ecosystem (SymphonyRM)
• Tufts Medical Center Elevates Human Experience in the Midst of the Pandemic (Vocera)
• How Advertising on LinkedIn Can Help Drive Patients to Your Physical Therapy Clinic (WebPT

Contacts

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

Weekender 8/7/20

Weekly News Recap

• Private equity firm Blackstone acquires 75% of Ancestry for $4.7 billion, which includes the DNA information of 18 million people.
• Teladoc reaches an agreement to acquire Livongo for $18.5 billion, digital health’s biggest deal ever.
• Epic announces plans to return employees to campus by September 21.
• Siemens Healthineers will acquire oncology technology vendor Varian Medical Systems, which includes several software products, for $16.4 billion.
• Virginia will become the first state to use the Covidwise exposure notification app from Apple and Google.
• CDC Director Robert Redfield, MD tells a House coronavirus committee that CDC was not involved in HHS’s decision to replace its COVID-19 hospitalization data system to a contractor-developed HHS system.
• Allscripts notes in its earnings call that the US Department of State’s 450 clinicians will use its TouchWorks and FollowMyHealth systems in its role as a subcontractor.

Best Reader Comments

[On Epic’s mandatory return to campus] Most egregious, for a company that beat into me from day 1 that I must make clear recommendations supported by data, they have no data. They released multiple products during the pandemic while working from home. Support ticket closure rates are up 10% in some applications. They have no metric for productivity, but are willing to die on the hill of “magical, spontaneous hallway conversations.” They’ve failed to create a culture that can exist outside of their physical workspaces; I was part of the very first inter-office chat pilot at Epic – Skype in 2017 – and had to fight tooth-and-nail for its roll-out. Even during non-pandemic times, I primarily called into my on-campus meetings because getting there would’ve taken 15 minutes. This is an abject failure of leadership from Judy, Carl, and the rest of the executive team. (Ex-Epic)

Bill Gates used to say that early on in the life of Microsoft, he used to eyeball how many cars were in the parking lot when he left (which often used to be late in the evening/night) to get a sense of how hard his people were working. He later admitted that it was a rather naive and inaccurate way of measuring productivity. And that was 40 odd years ago! Well, Bill G and Microsoft grew up! Seems like Judy and Epic haven’t. (Ghost_Of_Andromeda)

[On Teladoc’s acquisition of Livongo] Mr. Tullman and Mr. Shapiro poised to cash out (again). As has been proven with Allscripts and now here, it’s easier to raise money for a startup than it is to actually run a company. (It’s All Good)

[On Teladoc’s acquisition of Livongo] No quarterly profit ever and an 18.5 billion price tag… Is there that much waste reduction in the US healthcare non-system to account for such strange valuation? (Eddie T. Head)

Siemens acquires Varian. Ggreat news for Varian shareholders. Sad to see another technology company move to non-US ownership. Will be interesting to see how things shake out when Siemens decides to “integrate” the business. (Robowriter)

Watercooler Talk Tidbits

Readers funded the Donor’s Choose teacher grant request of Ms. S in Philadelphia, who asked for carpet and bean bag chairs to create a reading center for her after-school kindergarten program. She reported in February, “When my students first saw the new rug and bean bags in the library area, they asked me, how did we get that in our class? Can we keep it? I answered them how Donors Choose helped us get a funder to donate what we needed. They were surprised that a stranger gave us money . They were super excited and wanted to lay down on the rug to read. We follow D.E.A.R. (drop everything and read) in our schedule. With the new cozy area, the students are more interested in literature. The students enjoy sitting in bean bags, or laying down on the rug to read. They go and pick a book of their choice and start reading enthusiastically. We also use the rug to play different games, practice the numbers and the alphabet. Sometimes, the students just lay down on the carpet to relax. When they are having a bad day, they sit in bean bags and distract their mind. It helps students to calm them down and rejoin the class group when ready. Having a cozy and safe library area has been a life-changing experience for them.”

Maria Fareri Children’s Hospital (NY) designates eight-year-old Jorden Hutchins as an ambassador to the hospital after he survives a COVID-19 infection with Multi-System Inflammatory Syndrome in Children, which involved being placed on a heart-lung machine, undergoing heart surgery, and having multiple strokes and kidney failure.

Here’s a tech tip I learned for editing a web address or any other text on the IPhone or IPad. Hold down the on-screen keyboard’s space bar until it turns gray, which turns the keyboard into a trackpad for precise cursor positioning.

A furloughed urology nurse in Virginia sews cloth masks and 3D-prints 800 face shields for local teachers.

Volunteers for the non-profit Telehealth Access for Seniors are providing devices, instructions, and free tech support to seniors and low-income communities to support telehealth and digital connectivity with family and friends. Lia Rubel from Vermont (above) has collected 50 devices and raised $800 to help with the mental health of self-quarantined seniors. The organization overall has collected 1,500 used devices, $63,000 in donations, and has 315 volunteers in 26 states. The organization seeks IPhone 4 and above and second-generation or newer IPads, for which it provides data erasing instructions. Their GoFundMe has raised $29,000 so far. The founders are Yale undergrads Aakshi Agarwal, Hanna Verma, and Siddharth Jain along with high school junior Arjun Verma. Agarwal is double-majoring in molecular biology and political science, hoping to purse a law degree and then work in healthcare policy. She also co-founded a college admissions consulting service.

A nurse in an explosion-damaged hospital in Beirut runs to the NICU with a colleague to remove five newborns, captured by a press photographer who said that among the rubble and bodies, “The nurse looked like she possessed a hidden force that gave her self-control and the ability to save those children.”

In Case You Missed It

• News 8/7/20
• EPtalk by Dr. Jayne 8/6/20
• Teladoc To Acquire Livongo for $18.5 Billion
• News 8/5/20
• Curbside Consult with Dr. Jayne 8/3/20
• Readers Write: Five Strategies to Ensure Cybersecurity During COVID-19 And Beyond
• Readers Write: CMS’s E-Notifications Condition of Participation: Three Topics to Know
• HIStalk Interviews Jay Deady, CEO, Jvion
• Monday Morning Update 8/3/20

Get Involved

• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Morning Headlines 8/7/20

Blackstone to buy Ancestry for $4.7bn

Blackstone will acquire a 75% stake in Ancestry for $4.7 billion, giving the private equity firm access to the company’s DNA information on 18 million people.

On-demand mental health service provider Ginger raises $50 million

Virtual therapy and psychiatry startup Ginger raises $50 million, which it will use to further market its services to public and private payers.

Cerner and Xealth Collaboration Helps Patients be More Active Participants in Health Care, Well-being

Cerner and VC firm LRVHealth invest $6 million in Xealth, a Providence Health & Services spin-off that has developed software to help providers find and prescribe digital health apps and programs.

VA pushes on with troubled health data transformation

Politico reports that the VA will re-commence its EHR overhaul with a rollout at an unnamed facility in October.

Infermedica raises $10.25M in Series A funding

AI-powered diagnostics startup Infermedica raises $10.25 million in a Series A funding round led by EBRD and Heal Capital.

News 8/7/20

Top News

Blackstone will acquire a 75% stake in Ancestry for $4.7 billion, giving the private equity firm access to the company’s DNA information on 18 million people.

The genealogy company, which launched a consumer DNA testing service last year that it has expanded to include genetic health risks and insights, reports annual revenue of over $1 billion.

Ancestry was valued at $3 billion in 2017 and considered running an IPO twice since then, but faced slumping sales as both it and competitor 23andMe laid off employees. 23andMe has sold the genetic data of its customers to drug companies for clinical studies, an area in which Ancestry lags.

Reader Comments

From Bug Frowner: “Re: Epic’s return to work requirement. Ignores its county’s public health order.” Dane County, Wisconsin’s July 7 emergency order says business “should, to the greatest extent possible” facilitate remote work to minimize in-office presence. Epic is therefore not specifically breaking any law that I can see since the wording is more of a recommendation. I would struggle to return to campus work as an Epic employee if I were high risk and otherwise fastidiously isolating, but we all know that bosses make the rules and our choices are to comply or leave. Media coverage has, as it often does, lapsed into the sensationalistic in portraying the complaints of a tiny percentage of Epic employees as a topic for heated debate into which Internet cheap-seaters feel the need to insert themselves. More interesting to me is that Epic says that only 24 of its employees have tested positive, which seems like a tiny number out of 9,000+ mostly young employees, but I assume they haven’t yet mass tested the folks who will be returning to campus. Judy Faulkner has said the company is working on immunity passport capabilities for its EHR, so maybe they’ll run employee antibody testing even though that has limited value outside of healthcare provider organizations given relatively low overall infection rates.

From Al Lewis: “Re: Livongo’s sale for $18.5 billion. The entire employer community doesn’t even spend $18.7 billion on diabetes-coded admissions. Not even close. Nor have they claimed to reduce that one item, the item that should concern employees the most. And they never explained why they want everyone to test multiple times a day when Choosing Wisely says most Type 2 diabetics are more likely to harm themselves than benefit through overtesting. Meanwhile, as I will be posting in a few hours, the price of insulin is skyrocketing thanks to greedy PBMs and employers aren’t doing a thing about it.” I interviewed Al Lewis, who I titled “workplace wellness skeptic,” a few months ago and asked him for reaction to the acquisition news.

From Donor Here: “Re: matching Donors Choose funds from Tyson Foods and your Anonymous Vendor Executive. Is that still available?” Donors Choose still lists 24 unfunded projects for which Tyson Foods is matching donations 10-to-1 and I still have ample matching funds available from my Anonymous Vendor Executive. Many other projects offer 2x or 3x matching from companies and organizations, which is still a lot of bang for the buck. I just received an email today from middle school science teacher Ms. W in Washington, for which our $32 donation (which was then matched 10 to 1) bought distance learning tools (microphone, graphics tablet, lighting, and a camera mount) as well as a 15% optional donation to fund the work of Donors Choose.  She told me this morning that her school just announced 100% distance learning to start and she will immediately use the new technology to retool her her hands-on science classes for home learning. Donation instructions:

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

From Live Longo Glen Tullman: “Re: Teladoc acquring Livongo. Paid too much, in a hurry to cash in some of its own overpriced shares.” My thoughts on the deal:

• This is the third-largest acquisition of a US company this year. Teladoc will give $0.592 of its shares plus $11 in cash ($159 per share) to buy Livongo.
• I don’t get the synergy, other than that both companies have to keep employers and insurers subscribing for services their constituents may not use and that may provide minimal benefit.
• The implicit market value of the combined money-losing companies is an eye-popping $37 billion, nearly double that of Cerner.
• TDOC’s market cap is $16.5 billion, nearly quadruple that of a year ago, on just $716 million in annual revenue. LVGO’s market cap is $1.5 billion, eight times that of September 30, 2019 on $207 million in revenue (selling price is 90 times revenue).
• Shares of both companies regained some of their losses Thursday after dropping hard after Wednesday’s announcement.
• LVGO’s Q2 earnings report from Wednesday went mostly unnoticed in the acquisition news, but the company had a good quarter, with revenue up 125%, adjusted EPS $0.11, beating expectations for both.
• Livongo’s executives will pocket fortunes from the acquisition just 12 months after its IPO. Lee Shapiro’s shares are worth around $860 million, Glen Tullman’s around $700 million, and Zane Burke (who joined as CEO just 19 months ago) holds shares worth around $160 million.
• I’m skeptical in general about early-stage companies that sell services through employers and insurers with unproven promises about saving them money, so I’ll simply say (a) good job Livongo for convincing Teladoc of predicted synergies, and (b) good job Teladoc for riding the likely temporary share price bump even as virtual visits slack off and health systems launch their own competing offerings to diversify. I don’t see the value for shareholders, patients, or the healthcare system in general, but then again I’m not a centimillionaire stuffing wads of investor cash down my pants. 

Webinars

August 19 (Wednesday) 1:00 ET. “A New Approach to Normalizing Data.” Sponsor: Intelligent Medical Objects. Presenters: Rajiv Haravu, senior product manager, IMO; Denise Stoermer, product manager, IMO. Healthcare organizations manage an ever-increasing abundance of information from multiple systems, but problems with quality, accuracy, and completeness can make analysis unreliable for quality improvement and population health initiatives. The presenters will describe how IMO Precision Normalize improves clinical, quality, and financial decision-making by standardizing inconsistent diagnosis, procedure, medication, and lab data from diverse systems into common, clinically validated terminology.

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

Acquisitions, Funding, Business, and Stock

Nuance announces Q3 results: revenue down 10%, adjusted EPS $0.19 versus $0.20, beating analyst expectations for both. The company said in the earnings call that it has signed pilot agreements for its Dragon Ambient Experience with WellSpan, Boston Children’s, Children’s Atlanta, and Lehigh Valley.

CVS Health beats analyst expectations for Q2, reporting a 3% increase in revenue and adjusted EPS of $2.64 vs. $1.93. Utilization of telemedicine services through its Aetna network and MinuteClinics jumped over 700% during the quarter as patients stayed away from in-person office visits.

Cerner and VC firm LRVHealth invest $6 million in Xealth, a Providence Health & Services spin-off that has developed software to help providers find and prescribe digital health apps and programs.

Digital point-of-care prescription savings vendor OptimizeRx reports Q2 results: revenue up 25%, and adjusted EPS of $0.02 versus $0.09, beating analyst expectations for both.

CPSI announces Q2 results: revenue down 10%, EPS $0.12 versus $0.12, beating analyst expectations for earnings but falling short on revenue.

Signify Research says the crown jewel that Siemens Healthineers gets in its $16.4 billion cash acquisition of Varian Medical is the latter’s oncology software business, which has $600 million in annual revenue with an 18% year-over-year-growth. The report notes that oncology is positioned at the convergence of EHR, lab, radiology, and surgery systems and the need to collaborate for diagnosis and treatment creates complicated workflows. Elekta is Varian’s chief competitor in that area. Siemens Healthineers is focused on three digital areas — imaging AI, advanced imaging hardware, and lab diagnostics. Siemens Healthineers, spun  off from Siemens AG (which still owns 85% of its shares), is among a small group of medical technologies that have more than $20 billion in annual revenue, possibly coming in at #3 behind Medtronic and Johnson and Johnson.

Sales

• Michigan Medicine selects Mach7’s enterprise imaging technology. 
• CPSI selects cloud services from Google Cloud.
• The Iowa Health Information Network selects PDMP connectivity, analytics, risk assessment, and patient support technology from Appriss Health.

People

LexisNexis Risk Solutions promotes Josh Schoeller to CEO of its healthcare business.

Industry long-timer Andrew Eckert (Acelity) joins medical claims company Zelis as CEO. Eckert has held leadership positions at Eclipsys, TriZetto, and Valence Health.

Justin Manning (Nordic) joins Evergreen Healthcare Partners as principal consultant and VP of medical device and data integration.

Announcements and Implementations

UHIN adopts NextGate’s enterprise master patient index across its HIE network in Utah.

Redox announces GA of Data on Demand, giving developers the ability to query any EHR or health data sources via the company’s API.

AHRQ publishes an electronic patient-reported outcomes toolkit.

Government and Politics

Politico reports that the VA will re-commence its EHR overhaul with a rollout at an unnamed facility in October. The conversion from VistA to Cerner was halted earlier this year as VA facilities focused on preparing for and treating COVID-19 patients. The VA has switched its go-live plans from facilities in bigger metropolitan areas to those in smaller cities in the Pacific Northwest and Midwest, citing a lack of access during the pandemic to clinical experts who had been expected to help with system customizations for the larger facilities.

Politico also reports that two senators have introduced legislation that would make the post office’s address matching software available to EHRs via API for patient identification and matching.

COVID-19

An Ohio Department of Health contact tracing graphic shows how one infected church service attendee spread the virus to at least 91 people in five counties in less than three weeks. The graphic was tweeted by Ohio Governor Mike DeWine, who announced Thursday that he has tested positive for COVID-19 as part of the screening for his now-cancelled Thursday greeting of President Trump in Cleveland.

Virginia launches the Covidwise app, becoming the first state to launch an exposure notification app using technology from Apple and Google. The app notifies users if they come into contact with other users who’ve tested positive for COVID-19. Some public health experts have questioned the effectiveness of such apps, citing low and thus ineffective adoption rates, privacy concerns, false alarms, and a lack of nearby testing capacity.

University of Miami Health System launches a remote patient monitoring program for discharged COVID-19 patients using TytoCare home health devices.

The Harvard Global Health Institute and Google Cloud develop COVID-19 Public Forecasts, a free planning resource that offers healthcare workers 14-day projections of cases, hospitalizations, and deaths by county and state.

An MRI review of 100 recovered COVID-19 patients who had no pre-existing cardiac conditions — most of them who had experienced only minor COVID-19 symptoms and recovered at home — finds that 78% have cardiac involvement and 60% have ongoing myocardial inflammation. The authors conclude that cardiac involvement is unrelated to COVID-19 severity and warn that undetected inflammatory disease may present a large health burden in people who think they got over COVID-19 without incident.

The National Institutes of Health forms the Medical Imaging and Data Resource Center, which will use AI and machine learning to develop new diagnostic tools clinicians can use to better care for COVID-19 patients.

The New York Times explains how the US uniquely failed to control COVID-19:

• A tradition of prioritizing individualism over government restrictions, which has also saddled the country with a world-lagging and unequal healthcare system.
• Lack of effective travel restrictions in excluding from the ban the family members of American citizens and permanent residents returning from infection-ravaged areas, failing to address the infection’s spread to Europe promptly, exempting the UK from travel limitations, and failing to create a quarantine process.
• Lack of state travel restriction enforcement.
• Testing delays caused by the CDC’s distribution of faulty tests that it insisted be used over tests that were developed in other countries.
• Commercial labs charging patients for COVID-19 testing, which discouraged their use.
• Conflicting public mask advice from WHO and CDC, some of that based on the need to prioritize the limited supply of them for healthcare workers, and allowing masks to be turned into a political symbol with partisanship as its most accurate predictor.
• The push by federal and state governments to reopen the economy with the virus still uncontrolled, which caused outbreaks afterward and provided only a brief recovery as personal fear and unemployment caused people to limit spending anyway.
• Mixed and confusing messages from political leaders and partisan news media, including distributing medical misinformation and expressing unwarranted optimism.

Other

HIMSS hires a second Australian Digital Health Agency executive as CIO Ronan O’Connor joins former CEO Tim Kelsey. O’Connor’s new role was not specified, but Kelsey became SVP of HIMSS Analytics International in January 2020.

HIMSS will continue to publish the mobile health app best-practices guidelines of Xcertia, a now-dissolved project of HIMSS, the American Medical Association, the American Health Association, and DHX Group. The Xcertia standards body was formed in December 2016, last updated its guidelines in February 2019, and then went silent shortly afterward. The organizations haven’t announced why they pulled the plug. The three principals of non-profit app curation organization DHX Group seem to have moved on to other projects.

The local paper says that at least 13 Epic employees claim that the company has demoted team leads who expressed concern about its plan to bring employees back to campus, which Epic denies.

European Union authorities will investigate Google’s acquisition of Fitbit, worried that Google will target ads based on the user fitness data that Fitbit collects. Google says it has no such plans and has offered to sign a contract that limits its use of the data. A consumer group concludes, “It is hugely important that the E.U. carries out this in-depth examination because wearable devices like Fitbit’s could in future give companies details of essentially everything consumers do 24/7.”

Sponsor Updates

• InterSystems launches T2020, the latest version of its TrakCare EHR, which includes COVID-19 functionality, an enhanced user experience, and a unified workspace for patient records and documentation.  
• Cloud Computing Outlook names Goliath Technologies a Top Virtualization Solutions Provider.
• HCI Group Chief Digital Officer Ed Marx publishes a new book, “Healthcare Digital Transformation: How Consumerism, Technology, and Pandemic are Accelerating the Future.”
• Spok announces that all 20 adult hospitals and all 10 children’s hospitals named to US News & World Report’s 2020-21 Best Hospitals Honor Roll use Spok clinical communication solutions.
• Saykara’s voice-enabled mobile AI assistant  is named as a healthcare innovation awards finalist.

Blog Posts

• Fear: Circling the Wagon vs. Innovating (Access)
• A Diabetes Educator’s Guide to EGlycemic Management Software (Glytec)
• Halo Health Top Performer in KLAS Clinical Communications Report (Halo Health)
• Steps for Effective Patient and Staff Contact Tracing to Defend Against COVID-19 Spread (Health Catalyst)
• Health Payer Priorities in Face of Ongoing Pandemic (Imat Solutions)
• COVID-19: What we know and where we’re headed (Intelligent Medical Objects)
• No time for guessing games: Three things payers need to consider if they are to survive the impacts of deferred care (Jvion)
• How Hospitals Can Thrive in the Midst of Constant Change (LiveProcess)
• Healthcare’s COVID-19 Response is a Window to the Industry’s Future (Loyale Healthcare)
• 2021 Medicare Proposed Rule Released for Physical Therapy (MWTherapy)
• Patient Matching in the Era of COVID-19: Maintaining Control Over Patient Privacy and Data Governance (NextGate)

Contacts

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

EPtalk by Dr. Jayne 8/6/20

CMS continues to forge ahead as if providers have nothing else going on, releasing final scores for the 2019 Merit-based Incentive Payment System (MIPS) program. Every time I see one of these announcements, I’m again grateful that my practice decided to opt out and take the associated penalties. It’s worth seeing an extra patient here or there to cover any losses so we can focus on care delivery and not clicking boxes.

Other hot federal topics include a Medicare proposal to expand telehealth benefits permanently. I’ve seen what a benefit it can be for patients who don’t want to risk going to a physician office, but I’d like to see more practices offering it as a routine part of their care rather than patients having to go to third-party vendors for care.

A good chunk of what I do in the telehealth arena should ideally be managed by either the primary care provider or a subspecialist managing a particular condition, but our healthcare system continues to be broken in even basic ways. Several recent calls were around medication refills, not only for patients unable to make appointments with their regular physicians, but to even get a response to a refill request for a medication. When you hear some of the stories, you wonder if they’re made up, but based on the recent runaround I’ve had with my own family’s physicians, I have no reason to doubt the stories patients tell.

They also released the 2021 Proposed Rule for the Quality Payment Program via the Medicare Physician Fee Schedule Notice of Proposed Rulemaking. They did at least note that “in recognition of the 2019 Coronavirus (COVID-19) public health emergency and limited capacity of healthcare providers to review and provide comment on extensive proposals, CMS has limited annual rulemaking require by statute to focus primarily on essential policies including Medicare payment to providers, as well as proposals that reduce burden and may help providers in the COVID-19 response.” Although that’s small comfort to the people who have to wade through the original content of any proposed rule, at least they’re recognizing that most of us have other things on our minds. For those of you still in the game, comments are due by October 5 at 5 p.m. ET.

Props to Google Cloud for their “oops, that didn’t go so well” email after a bulk mail failure. It’s always good to tackle errors with a sense of humor, and I appreciate the acknowledgement rather than just getting another email. I also appreciated that their email linked directly to case studies about their products rather than forcing me to give my contact information to download an e-book or other fluff piece.

I’ve heard a lot of talk lately about EHR vendors that plan to use “AI” to help with physician documentation. In reading between the lines of some of these articles and ad pieces, the devil is truly in the details. One client was bragging about his vendor’s plans to add AI to their application and I was glad I was on a voice-only call because I’m sure I wouldn’t have been able to contain my facial expression. You have to have a reasonably robust backbone to add AI to an application, and this particular vendor is far from it. Their EHR is about two steps away from being a Microsoft Word document, and I can’t fathom how they think they’re going to “AI enable” that unless they’re just adding voice recognition and putting a lot of lipstick on it.

I think there is a tremendous amount of promise for AI-enabled documentation technologies, but to be as effective as a live scribe, they also have to be able to handle questions on information recall and analysis. I’m constantly asking my scribes to provide information from previous visits or to see if there are patterns with interactions. There are certainly technologies that can provide these functions as well and I’d love to see them be able to handle mainstream primary care and urgent care encounters like I see day-in and day-out. So far the only ones I’ve seen that are able to do a decent job are only able to do so in the subspecialty realm.

Low tech, but literally cool: Shipping giant UPS is readying freezer farms in preparation for the eventual shipping of vaccines against the novel coronavirus. Each unit can store up to 48,000 vials of medication, with a total of 600 units being placed at facilities in Kentucky and the Netherlands. I’ve only been on the receiving end of vaccination shipping and know what a major logistic undertaking it is for flu season, so I can’t imagine what it might look like when people are clamoring for the vaccine across the globe. (I am betting that for the 60% of US residents that say they won’t get it, there will be plenty of takers in the rest of the world.)

Since we don’t know what COVID will look like when flu season hits, many clinical organizations are already ramping up their plans for vaccination campaigns. There is plenty of good technology out there for the patient outreach piece and getting those patients who typically receive a flu vaccine should be easy. It’s also easy to identify the patients who have high-risk conditions and alert them to the benefits of the vaccine.

What’s not easy, however, is ensuring that practices have enough personal protective equipment for their staff members, which is still a struggle in many practices. Despite the availability of testing supplies in my community, many primary care offices are choosing not to test because of concerns about PPE, which sends patients to urgent cares, other health systems, or the CVS Pharmacy drive through. Fragmentation of care is still the order of the day for many patients, and until we get a national coordinated strategy, I imagine it will continue to be this way.

In the meantime, I’ll keep helping my clients ready their campaigns, prepare their word tracks for patients who are reluctant to vaccinate, and look at creative ways to leverage their technology assets to maximize scheduling and vaccine delivery. Just another day in the clinical informatics trenches.

How is your organization preparing for flu season? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 8/6/20

Teladoc Health reaches agreement to buy Livongo in a $18.5 billion deal

Virtual care provider Teladoc Health will acquire chronic condition management app vendor Livongo in a deal that values the company at $18.5 billion.

CVS Health raises forecast for year as it adapts to changing health-care habits

CVS Health beats analyst expectations for Q2, reporting $65.3 billion in revenue and adjusted EPS of $2.64 vs. $1.93.

Virginia First State To Try Pandemic App From Apple, Google

Virginia launches the Covidwise app, becoming the first state to launch an exposure notification app using technology from Apple and Google.

OptimizeRx Reports Second Quarter 2020 Revenue Up 25% to a Record $8.8 Million; First Half Revenue up 34% to Record $16.4 Million, with Accelerated Growth Expected in Second Half

Digital point-of-care prescription savings vendor OptimizeRx reports Q2 results: revenue up 25%, and adjusted EPS of $0.02, beating analyst expectations for both.

Teladoc To Acquire Livongo for $18.5 Billion

Virtual care provider Teladoc Health will acquire chronic condition management app vendor Livongo in a deal that values the company $18.5 billion, the companies announced this morning.

The announcement characterized the transaction as a merger, but the deal is structured as an acquisition. The combined companies will operate under the Teladoc name, Teladoc CEO Jason Gorevic will continue in that role, and Teladoc’s board chair will also remain in that role.

The share price of both companies dropped sharply midday Wednesday following the announcement. Both have seen their shares run up by multiples so far in 2020.

The companies expect their combined revenue to reach $1.3 billion in 2020. Teladoc just reported Q2 revenue of $241 million, up 85% as virtual visits increased by 203%.

Neither company has ever booked a quarterly profit. Teladoc went public in 2015, Livongo in 2019.

Morning Headlines 8/5/20

Centauri Health Solutions Adds New Analytics Capabilities with Acquisition of AppRev

Medicare and Medicaid reimbursement services vendor Centauri Health Solutions acquires Applied Revenue Analytics, which offers business intelligence solutions.

Epic Systems to require 9,100 employees to return to work at its Verona campus on Sept. 21

Epic pushes back plans to have all of its employees return to on-campus work by August, shifting to a deadline of September 21.

CPSI Announces Second Quarter 2020 Results

CPSI announces Q2 results, missing on its revenue of nearly $60 million but beating analyst expectations for earnings.

Rush and R1 Launch Innovation Lab to Drive Industry-Leading Quality and Patient Experience

Rush University System for Health (IL) and R1 RCM launch an Innovation Lab that will develop and commercialize analytics and solutions for value-based care.

News 8/5/20

Top News

Siemens Healthineers will acquire radiation oncology technology vendor Varian Medical Systems for $16.4 billion.

Varian’s software offerings include treatment planning, treatment delivery, QA, image sharing, patient-reported outcomes, and the Aria oncology information system.

Reader Comments

From Spoofer: “Re: LinkedIn. It’s turning into Facebook now that Microsoft owns it.” I steer clear of LinkedIn except when looking up someone’s title or job history for the “People” section, but I have noticed that is becoming a home for folks (many of them salespeople) who believe themselves to be inspirational or instructional. It’s also drawing in users who litter it Facebook-like with personal musings, political commentary, and of course endless pitches for their employer or themselves.

HIStalk Announcements and Requests

Tyson Foods offered a $10 match for each $1 donated for specific Donors Choose projects, so I put my Anonymous Vendor Executive’s money to work in fully paying for these requests, most of which involve the rapid transition to remote learning. Donors Choose also sent me a note observing that this is the eighth consecutive year that HIStalk readers have supported classrooms, funding 631 projects that have impacted more than 50,000 students. I’ve already heard from several of these teachers:

• A camcorder for virtual learning and an air purifier for Coach H’s high school class in Sebastopol, MS.
• Online materials and lessons for Ms. D’s middle school class in Fort Smith, AR.
• A GoPro camera for virtual physical education and dance classes for Coach K’s elementary school class in Fort Smith, AR.
• Five Amazon Fire tablets and cases to replace the book corner activity that was cancelled because of COVID for the elementary school class of Ms. C in Nebo, KY.
• Two Chromebooks for Ms. P’s elementary school class in Forest, MS.
• Two Chromebooks for Ms. W’s elementary school class in Forest, MS.
• Classroom library supplies, organizers, clipboards, pads, pencils, cushions, earbuds, and file folders (which are no longer allowed to be shared) for the elementary school class of Ms. B in Omaha, NE, who is a second-year teacher.
• 30 headphones for Ms. S’s elementary school class in Vicksbug, MS.
• Bean bag chairs, dry erase boards, pencils, gloves, Play-Doh, balance balls,fidget toys, lanyards, pillows, charts, learning resources, and a long list of supplies for the elementary school class of Ms. R in Omaha, NE, who is a first-year teacher.
• 60 social emotional learning lesson books for Ms. S in Madisonville, KY, who is an elementary school counselor.
• An IPad, tripod, and tablet mount for the elementary school class of Ms. C in Lake, MS, who will create an online library of instructional videos for absent students or if the school closes due to COVID.
• A yearbook camera and all supplies for Mr. G’s middle school yearbook club of gifted and talented students in Madisonville, KY.
• Two IPads and a webcam to teach virtual learners at Ms. G’s elementary school class in Forest, MS.
• Supplies for at-home learners of Ms. D’s second grade class in Portland, ME.
• Math materials for Ms. P’s elementary school class in Sterling Heights, MI.
• 30 sets of headphones and 20 water bottles to allow Ms. J’s first grade school class in Chicago, IL to practice healthy behaviors.
• Digital and online learning resources for Mr. V’s high school class in Lake, MS.

Webinars

August 19 (Wednesday) 1:00 ET. “A New Approach to Normalizing Data.” Sponsor: Intelligent Medical Objects. Presenters: Rajiv Haravu, senior product manager, IMO; Denise Stoermer, product manager, IMO. Healthcare organizations manage an ever-increasing abundance of information from multiple systems, but problems with quality, accuracy, and completeness can make analysis unreliable for quality improvement and population health initiatives. The presenters will describe how IMO Precision Normalize improves clinical, quality, and financial decision-making by standardizing inconsistent diagnosis, procedure, medication, and lab data from diverse systems into common, clinically validated terminology.

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

Acquisitions, Funding, Business, and Stock

Medicare and Medicaid reimbursement services vendor Centauri Health Solutions acquires Applied Revenue Analytics, which offers business intelligence solutions.

Sales

• The US Department of State medical health units will implement Allscripts TouchWorks and FollowMyHeath, with the company serving as a subcontractor to MicroHealth. MicroHealth co-founder and CEO Frank Tucker served as a physician assistant, platoon leader, preventive medicine officer, and healthcare administrator for the US Army, CTO for Tricare, deputy CIO for the US Army Office of the Surgeon General, and an adjunct professor for several universities including the bioinformatics program of the Uniformed Services University of the Health Sciences. He has earned three master’s degrees (including in Physician Assistant Studies) and a doctorate of health science. The State Department chose the company for a $250 million project to manage the PHI of overseas government employees in 2019.

People

Brown & Toland Physicians (CA) hires Anne Barr, MBA (Counterpoint Advisors Network) as CIO.

Tom Foley (Cerner) joins AMD Global Medicine as VP of growth.

Ellkay hires Marc Probst, MBA (Intermountain Healthcare) as CIO.

Leidos promotes Liz Porter, MBA to president of its health group.

Amwell hires Serkan Kutan (Haven) as CTO.

Raymie McFarland (Glytec) joins glycemic management software vendor Monarch Medical Technologies as president and CEO.

Announcements and Implementations

Surescripts announces two new network capabilities for specialty pharmacies, a Medications Gateway that gathers information from the patient’s EHR and electronic prior authorization.

PerfectServe announces GA of Patient and Family Communication, which delivers health updates to patients and caregivers; provides a virtual room with appointment reminders and mobile check-in; supports video visits; and provides a patient inreach module for responding to on-call patient needs with direct messaging and video. Development of the system was driven by customer feedback during COVID-19.

Vyne renames its dental practice data exchange systems that were formerly sold under the NEA nameplate (claims processing, electronic claims attachments, and encrypted email) as Vyne Dental.

Imprivata publishes a digital identity framework that offers health systems advice on creating an identity and access management strategy.

Black Book surveys find that lack of interoperability has detracted from COVID-19 care and that progress has stalled, partly due to CMS’s delayed enforcement of rules. Nearly all respondents say COVID-19 clinicians don’t get complete patient records and most say manual processes fall short in submitting pandemic information to public health agencies. Another survey of 324 COVID-diagnosed patients finds none of them had their full patient record available electronically when seen by their COVID treatment provider.

Canada’s Health Sciences North goes live on Agfa enterprise imaging at 15 sites.

North Carolina’s state HIE NC, HealthConnex, goes live on real-time event notification built on Audacious Inquiry’s Encounter Notification Service.

COVID-19

CDC Director Robert Redfield, MD tells a House coronavirus committee that CDC wasn’t involved in HHS’s decision to move COVID-19 hospitalization data from the CDC’s system to HHS Protect. He says he was told only after the decision was made and did not discuss it with Vice-President Pence or HHS Secretary Azar. Redfield says it was the right decision since the driving factor was the need to track remdesivir supplies.

“CBS This Morning” runs a news item about Epic employees who are worried about the company’s return to campus. CBS News obtained an Epic employee survey in which several hundred respondents (out of Epic’s 9,000+ employees, which CBS labels a “backlash”) expressed concerns. Epic sent an employee email Monday night saying it will bring in national experts to review its plan, also noting that 24 employees have tested positive for COVID-19, with none of those cases being attributed  to Epic. Epic will require its Wisconsin employees to return to campus on September 21.

Ellen MacKenzie, PhD, dean of the Johns Hopkins Bloomberg School of Public Health, says that COVID-19 is providing a lesson to “invest in public health or else” in failing to be prepared for the next crisis, concluding, “We cannot let the legacy of a public health crisis be the devaluing of public health itself.”

President Trump says that it is unreasonable to compare the US’s COVID-19 death rate per population to that of other countries with lower numbers, saying, “You have to go by the cases … we’re first, the best … you’re not reporting it correctly … because we do more tests, we have more cases … death is way down from where it was.” He concluded, “They are dying, that’s true. And it is what it is. But that doesn’t mean we aren’t doing everything we can. It’s under control, as much as you can control it.”

New York City’s health commissioner Oxiris Barbot, MD resigns, saying Mayor Bill de Blasio has underused the department’s disease control expertise. A notable example was his reassignment of contact tracing responsibility to Health + Hospitals. She also created controversy in COVID’s early days by urging residents to visit restaurants and festivals as usual and said in a press conference that masks should be work only by those showing symptoms of infection. NYC Health + Hospitals Chief Population Officer Dave Chokshi, MD, MSc has already been chosen to replace her.

Rutgers University’s football program has 28 COVID-infected players and employees who have tested positive after several players attended an on-campus party. Meanwhile, 18 players and coaches of the Miami Marlins baseball team have tested positive and the team admits that it played a game on July 26 knowing at that time that four players had tested positive. Thirteen players and staff of the St. Louis Cardinals tested positive in the past week.

San Antonio Metro Health removes 619 COVID-19 cases from Sunday’s count after finding duplicate entries as it prepared to switch to a new contact tracing system. The agency says the data it receives from labs, hospitals, and doctors, as well as for people who have been tested in multiple locations, may contain misspellings, dates of birth, or different street abbreviations That can cause the same patient to be reported as multiple cases.

Delays in receiving COVID-19 testing results, caused by basic supply shortages and lack of a national strategy, are hampering the efforts of businesses and schools to reopen to employees and students who test negative. Delays of several days to weeks render the tests pointless.

Other

The New York Times examines whether telemedicine is here to say, raising these points:

• CMS’s coverage will end when the pandemic is no longer a declared public health emergency unless Congress passes legislation making it permanent.
• Insurers haven’t yet committed to paying for telemedicine visits comparably to in-person ones and may view telemedicine as a way to pay less.
• The cost and quality of telemedicine remains unproven for managing chronic conditions.
• Many or most patients prefer or require in-person visits.
• Insurers worry that telemedicine will increase visits without improving patient health, raising costs unnecessarily.
• Telemedicine may provide justification for doctors to bill phone calls that weren’t charged before, such as providing lab results or advising a patient to come in to the office.

A federal judge denies the plaintiff’s request to move a privacy lawsuit against UPMC to state court. UPMC is accused of sharing patient data with third parties for marketing purposes without their consent. The judge says the the lawsuit was correctly sent to federal court because UPMC was participating in HITECH.

In Argentina, an apparent server configuration error exposes the information of 115,000 people who had applied for COVID-19 quarantine exemptions. Researchers found that they could use basic information that had been exposed (ID number, gender, and phone number) to email the “circulation permit” to any email address. The exposed database was almost immediately attacked – but not disabled – by a “Meow bot” that finds and destroys exposed online data, speculated to have been created by a vigilante security expert who was annoyed by administrators who fail to secure online databases.

Sponsor Updates

• Bret Kinsella of Voicebot.ai hosts a podcast with Saykara founder and CEO Harjinder Sandh to talk about the company’s AI assistant for physicians.
• CareSignal and Innovaccer will partner to offer their remote patient monitoring and population health data technologies, respectively.
• ESolutions and Homecare Homebase collaborate to help home health agencies manage CMS Review Choice Demonstration.
• The Voicebot Podcast features Saykara founder and CEO Harjinder Sandhu.
• Surescripts earns Black Book’s #1 ranking in patient data exchange and interoperability.
• Fortified Health Security publishes its “2020 Mid-Year Horizon Report” on the state of cybersecurity in healthcare.
• QliqSoft incorporates Elsevier’s Interactive Patient Education with its Quincy chatbot and Virtual Visit software.

Blog Posts

• Preparing your stakeholders for new information blocking rules (Nordic)
• Hurricane Prep During the COVID-19 Pandemic (Optimum Healthcare IT)
• What is the Role of a Project Manager in EHR Implementation? (314e)
• Where to Find COVID-19 Reimbursement Rates & Billing Change Information (AdvancedMD)
• Better control, a single, intuitive interface and scalable to your needs (Agfa Healthcare)
• Blueleaf Banter: Trends in the Community Connect Space (Bluetree)
• Recapping Our Virtual Care Coordination Summit, “COVID-19 in Detroit” (CarePort)
• ATA Conference Opioid Panel: Three Perspectives, One Goal (CareSignal)
• Care Collaboration: The Key to SNFs Addressing COVID-19 (Collective Medical)
• Service! Nonprofit Offers Help to Industry Peers When They Need It Most (CoverMyMeds)
• Healthcare Technologies Set to Break Out as a Result of Pandemic (Dimensional Insight)
• 3 Steps to Protect Home Care Workers in a COVID-19 Era (Dina)
• Hire the Best! Tips for Finding Office Talent (EClinicalWorks)
• Manual Care Transitions Are Having a Bigger Financial Impact Than You Think (Ensocare)
• CMS Rolls Out Review Choice Demonstration (ESolutions)
• Digital Wayfinding and COVID-19 Response for Hospitals (Everbridge)
• Delivering Primary Care in an Urgent Care Clinic (Experity)

Contacts

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

Morning Headlines 8/4/20

Allscripts Cloud-Based EHR Solution to Support MicroHealth, LLC for Use Within the United States Department of State

MicroHealth will implement EHR and PHR technologies from Allscripts as part of its work to transition the US Department of State’s Health Units to a cloud-based EHR system.

DAS Health Acquires New England IT Company

Health IT and consulting firm DAS Health acquires managed IT and cybersecurity company Technology Seed for an undisclosed sum.

President Donald J. Trump Is Expanding Access to Telehealth Services and Ensuring Continued Access to Healthcare for Rural Americans

President Trump signs an executive order extending telemedicine flexibilities and provisions after the public health emergency ends.

Curbside Consult with Dr. Jayne 8/3/20

I’ve written about business continuity planning previously. It seems like every year it becomes a germane topic as we experience tropical storms, hurricanes, wildfires, and floods across the US and around the world. Throw in a global pandemic that shuts down medical offices and curtails hospital services and you’ve created a situation where continuity planning is an absolute necessity. Did I mention cyberattacks and ransomware? These are a couple of other good reasons to go through a planning exercise if you haven’t done so already.

Business continuity planning is part of the consulting work I do, so I’m no stranger to helping organizations walk through some of the circumstances their practices might encounter. As a CMIO, people expect me to be versed in the IT side of things, and many clients are concerned with the obvious things like EHR outages, power outages, etc. Clients living in coastal areas typically have a decent hurricane / storm plan, but many organizations haven’t thought about the natural disaster aspect. One summer my little corner of the world experienced floods, tornadoes, an earthquake, and locusts, so it was a bit of a sign that we all need to think about these things.

As I’ve worked with clients on this the past couple of years, we’ve spent more time discussing cyberattacks and ransomware, as numerous healthcare organizations have been hit by this. As of the last couple of weeks I have a great new case study for this with Garmin. They were hit by an attack that disabled their services for more than a week. They claim they didn’t lose any client data from their sites, but the reality is that clients lost data because they couldn’t sync their devices with the Garmin services. Understanding the anger in the client community about exercise data from wearables should make physicians think twice about how patients would feel if their actual medical information were lost or held for ransom.

When I go through a business continuity planning exercise with a client, I usually include a discussion of what it would look like if key human resources became unavailable. For example, what would happen if the CEO or COO departed the organization? Do others have signatory or contracting authority, and how would day-to-day operations run? For smaller practices, what is their plan if they lose a key biller or scheduler? Most of the time we’re focused on the operational and financial side of the house, with a brief but general discussion on the clinical side.

The clinical side of business continuity planning certainly came into focus earlier this year with COVID-19, as practices shifted to a telemedicine models and looked for new technologies to be able to safely reopen their patient care operations. I added a couple of different dimensions to my client-facing materials based on those experiences and they’ve been well received by organizations I’ve worked with. Still, I was thinking in more broad strokes about how organizations might be impacted if they can’t see patients and looking at it from a macro level.

Unfortunately, this week I had to think about it from a micro level, as my practice suddenly lost one of our full-time providers. Since I’m just a worker bee at my brick-and-mortar practice, I’ve never been privy to their business continuity planning and didn’t worry about it too much since my clinical work isn’t my main source of support. One would think that in the event of the loss of a provider, they could use the same checklists they might use when a provider quits or retires. It quickly became apparently, however, that they either didn’t have such checklists or were so overwhelmed by grief that they hadn’t worked through the process.

My involvement started when one of the nurse practitioners called me, as the most senior physician working at the time, asking what to do about the fact that the EHR was still putting my late partner’s DEA number on her prescriptions. Pharmacies in our area have an issue with NPs who write controlled substances and often ask for the supervising provider’s information as well, so we’ve added that to our prescriptions. I’m not sure if it’s custom code with our EHR vendor or a feature that they offer, but it’s how we roll. This was three days after his passing, so I can only guess that the other midlevel providers for whom he was the collaborating physician either didn’t write any controlled substances prescriptions in those days or didn’t think about what went out on the script since it hadn’t yet been addressed. In the short term, I supervised the NP for the prescription in question so the patient could be managed, but it made me wonder about the plan.

I also had the unique experience of staffing my late partner’s primary practice location, where our staffers had created a temporary memorial with flowers, photos, candles, and other tokens representing his personality. I’m not sure the organization had thought about how that would impact patients or the staff working at the location, since many patients had questions about the memorial and what had happened that our employees were unprepared to field. I was surprised by one particular patient who hounded me for details. I learned later that she had already posed the same questions to the receptionist and the nurse, but wasn’t deterred by their comments about the situation. Having to constantly respond to questions certainly weighed on the staff throughout the day.

As someone who has led other organizations, part of me wanted to go ahead and raise the question to leadership about the handling of the memorial and potential word tracks for staff, but didn’t want any inquiry to be seen as interfering with our practice’s collective grief. Knowing there are often no good answers to these issues, I opted to say nothing and let the organization figure it out. It felt like a bit of a cop out since usually I’m one to tackle problems head on, but maybe it was part of my own grief reaction. It was hard enough to get through the day with his presence all around us, and after a long day of COVID patients, I was ready to let it go.

It also served to illustrate something I’ve acutely questioned this year, the idea of “who cares for the caregivers?” Most of us are getting burned out and certainly all of us are tired, and the worst part is we know that there is no end in sight. My colleagues who have been in military operations have had the best advice for coping, but I’m concerned that this recent loss will put some of our team over the edge.

I hope sharing this story encourages organizations who may not have thought about these issues to add them to your to-do list, because it’s only a matter of time before a similar loss might impact them. If you haven’t done business continuity planning, you need to do it now. If you’ve already done it, take a moment to look at your plan to see how your organization plans to handle the loss of key staffers and consider how co-workers and the community might be impacted by such a loss. Having a plan and implementing it during stressful times certainly beats feeling like everything is swirling around you.

Email Dr. Jayne.

Readers Write: Five Strategies to Ensure Cybersecurity During COVID-19 And Beyond

Five Strategies to Ensure Cybersecurity During COVID-19 And Beyond
By Patrick Yee

Patrick Yee is chief technology officer of Ensocare of Omaha, NE.

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To quote New Zealand-born novelist and playwright Anthony McCarten, “We’re living in extraordinary times.” To which I’ll personally add, “that call for extraordinary security measures.”

In March, the Office for Civil Rights (OCR) at the US Department of Health and Human Services (HHS) issued COVID-19 HIPAA waivers to promote data sharing and telehealth, relaxing laws over the good faith use and disclosures of protected health information (PHI). The resulting explosion of COVID-19 demonstrates that providers need fast access to tools that identify, collect, track, and exchange data on the flux of infected patients.

Protecting the privacy and security of patient data is the health IT industry’s fundamental civic duty during a nationwide public health crisis. While a hospital’s core competency has never been and will never be information technology (IT), taking care of patients is.

As providers rightfully focus on saving lives, their IT teams have undergone a massive shift to working from home while tackling first-time coronavirus related challenges and juggling data security maintenance. Compounding the situation are short-staffed medical facilities where IT resources are needed the most.

Here are five strategies to help you protect and secure your organization’s patient data and network from cyber attacks.

Make sure your escalation procedures are sound.

A healthcare worker who spots a questionable issue must be free to report their concern so it can be addressed swiftly. Most every IT department has in place a reporting process, either a formal ticketing system or an on-call employee who accepts phone calls. Once the IT staffer quickly escalates the issue to the appropriate leader or medical professional, the healthcare worker can resume their day job. Whether the issues involve coronavirus or basic security breaches, e.g., an email phishing attack from an unfamiliar source, all team members, even those on the clinical side, should be empowered to bring up potential dangers to the appropriate parties.

Instruct your IT team to be extra diligent investigating unknown emails, links, and websites.

Cyberattacks targeting hospitals, practices, and healthcare organizations are on the rise dramatically, which can be at least partially be attributed to the exploitation of the coronavirus.

Unfortunately, remote workers are also being singled out. A recent McAfee report uncovered a correlation between the increased use of cloud services and collaboration tools during the COVID-19 pandemic, along with an increase in cyberattacks targeting the cloud. External attacks on cloud accounts grew 630% from January to April. Cisco WebEx, Zoom, Microsoft Teams, and Slack saw an increase of up to 600% in usage over the same period.

Healthcare staff members working remotely are more vulnerable and understandably distracted supporting COVID-19 patient care, which could make them easy prey for cybercriminals. The pandemic represents a huge opportunity for bad actors to compromise your systems with things like phishing emails that include faulty links and websites, ransomware attacks, and intrusions on sensitive data. Regularly remind your remote workforce to report suspicious activities by following your organization’s security protocols.

Review your intrusion detection strategy (IDS) or continue to monitor if you already have one.

An IDS is a network security technology that was originally built for detecting vulnerability exploits against a target application or computer. Intrusion prevention systems (IPS) add the ability to block threats in addition to detecting them, and have become the dominant deployment option for IDS technologies. More broadly, think of intrusion protection as personal computer security, but in a format that can look between different servers and flag suspicious activity. You should be reviewing and updating your technology and strategy regularly to ensure that you’ve kept up with all applicable best practices.

Ensure that your remote employees have corporate VPN and two-factor authentication services.

This telework protocol should already be part of your business continuity plan. It should be reviewed and updated periodically to ensure traffic is handled securely.

Home internet networks simply are not as secure as your office network. VPN and two-factor authentication services are recommended for remote connection to support the goal of making remote work as seamless as possible. Be aware that, short of completing mission-critical projects, at-home internet outages will not necessarily cause a security issue. A larger issue is whether the remote worker has the right modem installed to handle many different in-home users.

Encourage employees to use corporate laptops with encrypted hard drives that are not shared with family members.

Keep doing all of the good things you were doing before the pandemic.

Everything in your systems security plan is still valid with some possible changes for critical business continuity that should be maintained and exercised. HIPAA compliance might be relaxed, but security protocols remain doubly important in our current health crisis.