News 3/18/20

Top News

HHS OCR won’t assess penalties on providers who use non-HIPAA compliant communication technologies to provide telehealth services during the COVID-19 public health emergency. This relaxation of rules applies to all healthcare services, not just those that are related to COVID-19.

Providers can use any form of personal audio or video communication, such as FaceTime, Facebook Messenger, Google Hangouts, and Skype.

Telehealth services may not be delivered via public-facing apps like Facebook Live, Twitch, and TikTok.

Reader Comments

From Convener: “Re: conference bridges. Is anyone reporting that they are giving busy signals?” The free services like the one I use – which make money by charging AT&T using a “last mile” telecommunications loophole that AT&T hates passionately – have complained that AT&T has blocked their customers from using the conferencing services following an FCC rule change. I haven’t heard anything otherwise. The demands placed on videoconferencing services for online meetings and education must be incredible, leading to rampant (but unfounded so far) speculation that they will “break the Internet,” along with heavy use of streaming video and audio by folks newly assigned to work from home. Microsoft Teams went offline for several hours on Europe’s first work-from-home day.

HIStalk Announcements and Requests

Poll respondents said they want to see more COVID-19 news and reports from the field on HIStalk. I’ll tread lightly in covering just the most important items.

I’ll add the COVID-19 items as a separate section and continue soliciting reports from the field, as on my open survey. It would be great to get provider entries that could benefit a lot of patients and healthcare workers.

I was thinking as I saw photos of under-40 folks packing bars, concerts, and beaches that perhaps they are frustratingly uninformed or irresponsible, but then I went to the dark side and pictured them convening  “boomer remover” gatherings to exploit their lower coronavirus mortality risk to extract revenge on their elders for mismanaging their economic or environmental futures. I bet Stephen King is working on that novel as we speak.

Webinars

March 25 (Wednesday) 1 ET: “Streamlining Your Surgical Workflows for Better Financial Outcomes.” Sponsor: Intelligent Medical Objects. Presenters: David Bocanegra, RN, nurse informaticist, IMO; Alex Dawson, product manager, IMO. Health systems that struggle with coordinating operating rooms and scheduling surgeries can increase their profitability with tools that allow for optimal reimbursement. This webinar will identify practices to optimize OR workflows and provider reimbursement, discuss how changes to perioperative management of procedures can support increased profitability, and explore factors that can impede perioperative workflow practices.

March 26 (Thursday) 12:30 ET. “How to Use Automation to Reduce ‘My EHR is Slow’ Complaints.” Sponsor: Goliath Technologies. A common challenge is that a clinician is ready to work, but their technology is not. EHRs can be slow, logins not working, or printers and scanners are offline. Troubleshooting these end user tickets quickly is nearly impossible, especially in complex environments that might include Citrix or VMware Horizon. This webinar will present real-world examples of how leading health systems are using purpose-built technology with embedded automation and intelligence to proactively anticipate, troubleshoot, and prevent end user performance issue across their IT infrastructure and EHRs.

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

Acquisitions, Funding, Business, and Stock

I’m studiously avoiding watching the stock market, especially when it comes to my 401(k), but here’s how some publicly traded health IT-related stocks have performed over the past month, compared to the big market indices (at Tuesday morning’s market pre-open):

1. Teladoc (up 4%)
2. Premier (up 3%)
3. NantHealth (down 18%)
4. Vocera (down 18%)
5. Cerner (down 21%)
6. Livongo (down 26%)
7. McKesson (down 28%)
8. Nasdaq composite (down 29%)
9. S&P 500 (down 29%)
10. Dow Jones Industrial Average (down 31%) 
11. CPSI (down 32%)
12. Nuance (down 35%)
13. Inovalon (down 35%)
14. Allscripts (down 41%)
15. Health Catalyst (down 43%)
16. Castlight Health (down 44%)
17. Change Healthcare (down 45%)
18. NextGen Healthcare (down 53%)
19. Evolent Health (down 68%)

An investor’s New York Times opinion piece predicts big problems for companies that piled up debt when borrowing was cheap, with the pandemic-demolished sectors of auto, hospitality, and transportation being the worst offenders. The author also says that companies that have been taken private by private equity firms carry debt averaging six times their earnings, leading to “zombie” companies that don’t generate enough profit to pay even the interest alone.  

Announcements and Implementations

LOINC publishes codes for COVID-19 lab testing.

OptimizeRx launches a free consumer text message alert program that delivers CDC-issued COVID-19 information to any SMS-enabled device. Text VIRUS to 55150.

Collective Medical offers free use of its ADT-based collaboration network through the end of 2020 to help with COVID-19 response. Healthcare organizations can go live on its lightweight solution in less than one week without cost or obligation for the rest of the year. It offers frontline providers quick identification of high-risk patients.

Asparia develops a COVID-19 tool for Epic App Orchard that contains three elements: a chatbot appointment scheduler, a patient questionnaire that alerts staff of possible infection risk, and enhanced appointment reminders that can extend character limits to allow including enhanced education and instruction. The app won’t be listed on App Orchard for several weeks, but can be requested through Epic or Asparia.

T-System will provide free influenza and COVID-19 T Sheets to providers that include point-of-care documentation, diagnosis, and treatment tools that incorporate the latest CDC guidelines. Templates are available for ED, pediatric ED, and urgent care.

Bluetree publishes a COVID-19 resource page that includes ideas for leading remote projects, developing reporting functionality, and clinical decision support build workflow.

Healthwise creates a Coronavirus Resource Center of consumer-friendly educational information and care instructions that are free to all.

Meditech offers Expanse Ambulatory customers use of its Scheduled Virtual Visits functionality for six months at no charge.

The White House’s Office of Science and Technology Policy joins Microsoft, Chan Zuckerberg Initiative, and other groups to create a COVID-19 open research dataset of scholarly literature. The groups have issued a challenge for AI experts to develop text and data mining techniques to help scientists answer high-priority COVID-19 questions.

Government and Politics

CMS issues a fact sheet on how Medicare will pay for virtual services during the pandemic. Medicare can pay for office, hospital and other visits via telehealth, unlike previously when those visits were covered only for patients in rural areas. Payment will be the same as for in-person visits.

Hackers attack HHS’s computer network in what insiders say was an attempt to undermine the government’s response to the coronavirus pandemic. It appears to have been a distributed denial of service attacked that was quickly stopped.

COVID-19 News

England’s Imperial College COVID-19 response team self-publishes a paper whose impact is reverberating around the US and UK, with the White House getting an early look a week ago that may have influenced its 180-degree turnaround in how the pandemic is viewed and managed. The team describes two strategies for the two countries: mitigation (flattening the curve to reduce peak healthcare system demand) and suppression (reversing growth and case numbers in an indefinite program will awaiting development of a vaccine). Summary points:

• Mitigation, such as home isolation of suspected cases and social distancing of high-risk people – is not preferred. It could reduce peak healthcare demand by two-thirds and cut deaths in half, but would still result in hundreds of thousands of deaths and overwhelmed hospitals, particularly in terms of ICU beds.
• Suppression, as was practiced in China, requires social distancing of the entire population, home isolation of cases, and household quarantines, possibly supplemented with closing all schools. The practice would need to continue until a vaccine can be developed and produced in adequate quantity to treat the entire population, which could take 18 months or more. A compromise may be to regionally relax and tighten social distancing based on public surveillance case numbers.
• In the absence of any action, the computer model suggests that peak US deaths will occur in June, 81% of the population will be infected, and 2.2 million people will die (not counting those whose deaths from other causes are related to overwhelmed hospitals). ICU bed capacity will be exhausted by the second week of April and demand will peak at 30 times the available number of ICU beds.
• A strong surge is likely again in the fall, so action now is urgent.

The government of Spain temporarily nationalizes all of the country’s hospitals and private health providers.

A hospital in northern Italy whose supplier ran out of oxygen mask valves uses 3D printing to create its own. The original is on the left, the 3D printed version is on the right.

A Premier survey of 179 skilled nursing / assisted living facilities finds that two-thirds of them can’t get personal protective equipment such as masks and face shields. Distributors have addressed shortages by allowing customers to buy quantities consistent with their historic usage to prevent hoarding, but many senior living facilities have never needed any until now and thus can’t get any.

Positive news:

• Scientists across the world are anecdotally reporting preliminary, sporadic success in treating COVID-19 with old drugs that were developed for something else. That’s a common story in pharma, and while individual patient impact may be limited, such treatment carries minimal risk and – like the HIV/AIDS fight in the 1980s and cancer today – provides encouragement that progress can be made even in the absence of guaranteed prevention or a complete cure.
• Regeneron says it plans to start widespread testing of an antibody treatment by summer. Former FDA Commissioner Scott Gottlieb, MD urges a “Manhattan-style project” to accelerate the rollout of this and similar antivirals that could be first used to protect healthcare workers and high-risk people.
• China and South Korea are reporting greatly diminished numbers of new cases, although their success is attributed to widespread testing and social limitation that was not done in the US.
• High-throughput testing systems are coming online in the US, with the new rate-limiting item being the supply chain for reagents and swabs.
• The US Army’s advanced medical technology group publishes a pre-solicitation notice for developing COVID-19 testing technology, studying repurposed drugs that could offer effective treatment, creating AI models that can track spread, and implementing patient monitoring technologies.
• Scott Gottlieb concludes, “We’ll remember spring of 2020 as a very hard time. It’ll change the way we do things, but it will end either by nature or at hand of our technology. We’ll get through this together.”

Other

I ran across the COVID-19 online screening tool of Medical City Healthcare (TX), which offers a slick questionnaire powered by Zipnosis. I intentionally answered just enough questions positively to make my diagnosis uncertain, after which it offered one-click access to a free online virtual visit for screening. Medical City Virtual Care offers visits for minor conditions such as pink eye, lower back pain, diarrhea, and yeast infection for $45. I saw it from the consumer’s point of view and was impressed.

Nashville-based Center for Medical Interoperability was awarded a $3 million grant from the CDC last year to extract EHR information from hospitals that would allow CDC to monitor the inventory and demand for personal protective equipment, but hospitals haven’t been willing participants. According to Melanie Thomas, CIO of pilot site Nashville General Hospital, “It’s difficult and scary sometimes to share data and equipment, especially with your competitors, because you want to have the advantage.” She says it’s easier for her taxpayer-funded hospital to share information because they don’t have the money to stockpile masks and gowns anyway. CDC has added $600,000 to the project’s funding and is hoping for an accelerated go-live schedule starting in May, with participation optional.

Cerner announces the actions it is taking in response to COVID-19, including creation of a client update web page:

• Employees who jobs allow them to work from home are asked to do so from March 16-30, with extensions possible.
• Offices will remain open for employees who need to be physically present, but social distancing strategies will be implemented.
• No non-critical and international travel is allowed.
• Employees who are returning from high-risk locations or cruises are required to work from home for two weeks.
• Critical travel will continue for clients who want Cerner people on site, but higher-risk employees (over 60, immunocompromised, those with chronic conditions, and those exposed to high-risk others) have been asked to avoid travel.
• A COVID-19 update has been pushed to Millennium clients, while Soarian clients already have strong communicable disease screening tools.
• Ready-to-use, staffed telehealth services will be offered to clients via Amwell.

The local paper profiles Sentara Healthcare professional development specialist Heike Nicks, MSN, RN, who worked with IT and nursing employees to automate the process of screening newborns for inherited disease, including sending blood samples to the state lab and getting results back within five days. She got the idea from a commercial product, but Sentara ended up enhancing its EHR to collect the needed information and to process secure messages.

Newport, OR’s police department urges residents to stop calling 911 when they run out of toilet paper. The department added a lengthy, humorous list of alternatives.

Sponsor Updates

• Integration technology vendor Summit Healthcare partners with data management vendor BridgeHead Software to offer healthcare data extraction and consolidation services.
• The Jacksonville Business Journal profiles The HCI Group’s hiring and expansion plans.
• KLAS recognizes Imprivata as one of the 2019 “Revenue Cycle Unicorns” in its latest performance report.
• Omni-HealthData parent company Information Builders embraces FHIR to harness and harmonize data across healthcare systems.
• OptimizeRx offers a free interactive text message alert program that delivers COVID-19 information issued by the CDC.
• Netsmart postpones its Connections 2020 event originally scheduled for March 29-April 1 in Denver.
• Avaya offers complimentary work-from-anywhere contact center solutions to help address COVID-19 challenges.
• CompuGroup Medical offers its CGM ELVI Telemedicine service for free to medical providers.

Blog Posts

• Brown Clinic: Community Values With Leading-Edge Technology (EClinicalWorks)
• A Wishlist for ERP Software Improvement in the Next Decade (Optimum Healthcare IT)
• Making a rapid shift to online training (Nordic)
• How to Build a Business Case for ESignature in Registration (Access)
• 5 Ways to Unleash Your Practice’s Full Potential (AdvancedMD)
• CMS Interoperability and Patient Access Final Rule (Audacious Inquiry)
• Best practices for a remote worker strategy (Avaya)
• COVID-19 & Digital Health (Bright.md)
• ONC-CMS Final Rules, Part 2 – Information Blocking (Datica)
• What is IT and Clinical Engineering Convergence? (Burwood Group)
• Patient Matching 101: Why Getting it Right is Critical (ChartLogic)
• Health IT Crisis and Disaster Planning Recommendations for COVID-19 (CereCore)
• InfoSec Pros Should Do These 8 Things During the Coronavirus Outbreak (CI Security)
• Elevating the Patient Journey Through Innovative Solutions (CoverMyMeds)
• Cash Posting: No Longer a Data Entry Role (Culbert Healthcare Solutions)
• ONC & CMS Interoperability Regulations: Part 1 – Payer Impact (Diameter Health)
• How Data Visualization Can Help During the Coronavirus Pandemic (Dimensional Insight)
• Hospitals Shift to Digital Engagement in Response to Coronavirus (Dina)
• Preventing Medical Errors with Patient Monitoring and Integrated Device Data (Capsule)

Contacts

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