Giving a patient medications in the ER, having them pop positive on a test, and then withholding further medications because…
News 4/29/20
Top News
VA OIG evaluates the VA’s now-postponed first Cerner go-live at at Mann-Grandstaff VA Medical Center (WA) that was scheduled for March 28, 2020, observing:
- The VA assumed that access to care would drop 30% for 12-24 months after go-live based on the Department of Defense’s Cerner experience. However, planned mitigation actions were not completed due to the VA‘s lack of guidance and budget constraints for adding employees, expanding clinical space, expanding clinic hours, and extending appointment times.
- The VA could not alleviate potential backlogs by referring patients to community providers because the hospital is already falling short of VA standards in that area, with a backlog of 21,000 open consults and an average wait time of 56 days. Employees were asked to work 8-10 extra hours per week to manually copy and paste information from one system to another to process the consults.
- VA and Cerner concluded in July 2019 that some EHR capabilities would be missing by the March go-live, including requesting online prescription refills via MyHealtheVet, which presented a patient safety risk. The VA decided to turn off access to prescription refills in Cerner’s HealtheLife patient portal because it did not meet VA standards.
- Hospital staff would have needed to enact 84 mitigations for the 62 systems that were at moderate to high risk of being unavailable.
Reader Comments
From AnotherDave: ”Re: Scanadu. Too bad it fizzled now that there’s a run on pulse oximeters. I pulled my First Edition from its paperweight duties and it still works. I bought it for $149 in the early bird Indiegogo deal in 2013, finally received it in February 2015, and the company’s business plan fell apart in May 2017 when its investigational study was shut down. With the right investment and re-branding, it would be a Handy COVID-19 Screener.” I never quite saw the appeal of the Scanadu gadget, maybe because the Tricorder references got old fast, it didn’t do a whole lot, and early digital health fanboys were practically mounting it in lustful consummation of their naiveté-fueled enthusiasm. The company said FDA required it to brick the device because it was part of a Scripps study that had ended. Crowd-funders got nothing and weren’t happy about it. Founder and CEO Walter De Brouwer went on to launch Doc.ai, which allows researchers to conduct medical studies via the smartphone of participants. Meanwhile, Scanadu renamed itself as Inui Health in late 2018, launched an FDA-approved app for in-home urinalysis, and then pretty much went nowhere.
From Mo Money: “Re: stock market. Good time to invest in health IT companies?” I don’t buy or recommend health IT stocks because that seems like a conflict of interest, but I’ll instead offer my long-held opinions about investing in general:
- No investment performs better in the long term than stocks, and long-term investing is where you accumulate net worth (which is the only personal financial metric that matters – it’s what you own that counts, not what you make).
- Markets have always eventually roared back after an emotion-driven downturn. The first time that doesn’t happen will be the end of American society, in which case your mattress full of cash won’t buy you anything important anyway.
- You have to buy dispassionately and stay in the market regardless of the ups and downs, which are just bumps in the road. Discipline pays.
- Define your specific goals (“getting rich” doesn’t count). It’s always a balance between reward and risk, and your tolerance and timelines for the former drive the required degree of the latter.
- The time value of money is powerful. The investment decisions you make in your 20s and 30s, even with small amounts of money involved, will far outweigh the decisions you make in your 50s and 60s.
- Don’t look at your portfolio value more than one per quarter, rebalance holdings to meet your chosen model, and don’t change your plan just because it’s up or down. Especially if you, like me, would feel anxiety or depressive remorse in having lost money (I swear I was the only person who was buying high and selling low during the dot-com boom).
- Buy mutual funds, index funds, or an investment company’s trading model. The odds that you will out-earn experts with your consummate stock-picking skills are minimal. Take a look at how well health IT stocks have performed against the Nasdaq index or S&P 500 in the long term before you get excited about applying your industry knowledge to stock picking.
- Don’t be influenced by people who brag about their investing home runs since it’s their batting average that matters (it’s more “Moneyball” getting on base frequently than striking out consistently while waiting to send the next shot over the fence).
- Buying IPO shares means someone who knows a whole lot more about the company than you is anxious to unload.
- Don’t overload on your own employer’s shares in your 401(k). Not only are you are overexposed from a portfolio standpoint, any employer stumbles will probably bite you doubly hard as both an investor and an employee.
- Stocks are worth what the market thinks they are worth, which may not track well to intrinsic valuation or reasonable expectations. No amount of stock-picking analysis will change that, and those who believe differently are efficiently separated from their money over the long haul. No formula, no matter how elaborately conceived, can take human foibles into account, and stock price is set by greed, fear, and hopes of finding a greater fool.
HIStalk Announcements and Requests
Welcome to new HIStalk Platinum Sponsor Spirion. The St. Petersburg, FL-based company has since 2006 offered accurate data discovery and classification solutions that give customers in several industries unparalleled data privacy, security, and regulatory compliance. Spirion’s platform gives healthcare organizations full visibility into their structured and unstructured data, both network- and cloud-based, to allow designing protection and monitoring without human effort or error. Spirion for Healthcare is a PHI management and data loss prevention tool that focuses exclusively on data at rest, which represents 100% of large breaches. Its rules-driven, sensitivity-tunable AnyFind technology uses contextual search discovery to find data sources such as payment card industry (PCI) data, PHI, and personally identifiable information no matter where it exists, while Sensitive Data Engine allows creating data deeper definitions to locate proprietary and unique organizational information. The company offers data security teams free 60-day use of Sensitive Data Manager during the COVID-19 crisis, also extending to stay-home employees free use of a Data Discovery Agent to identify the existence sensitive personal information on their computers. Thanks to Spirion for supporting HIStalk.
I found this Spirion explainer video on YouTube.
Webinars
None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.
Acquisitions, Funding, Business, and Stock
Cerner reports Q1 results: revenue up 2%,adjusted EPS $0.71 vs. $0.61, beating earnings expectation but falling short on revenue. The company expects the biggest COVID-19 financial hit to occur in Q2, after which project and sales activity will improve if pandemic-related restrictive measures are relaxed.
UnitedHealth Group’s Optum division is reportedly negotiating a $470 million acquisition of AbleTo, which offers virtual visits for behavioral care with its network of therapists and coaches. The company, which targets payers and employers, had previously raised $47 million through a Series D round, with Optum Ventures being one of its most recent investors.
Sales
- OU Medicine (OK) chooses Artifact Health’s mobile physician query platform to drive complete and comprehensive patient chart information.
People
Nicklaus Children’s Health System (FL) hires David Seo, MD (University of Miami Health System) as VP/CIO.
Nephrologist Burton “Bud” Rose, MD, who created the industry-standard UpToDate computerized medical reference in his basement in 1992, died of COVID-19 last week at 77.
Announcements and Implementations
A new KLAS report on ambulatory revenue cycle management services finds high customer satisfaction with Athenahealth, R1 RCM, and Bolder Healthcare, while EMDs, CareCloud, and Greenway Health experienced a significant drop in satisfaction over the past year. Six of the eight reviewed firms were acquired in the past few years, some with positive results (Allscripts, Athenahealth, Bolder, and R1) and one showing a significant decline in satisfaction (EMD’s 2019 acquisition of Aprima, with 80% of the latter’s former clients expressing dissatisfaction since). KLAS concludes that third-party players are gaining traction and raising the customer satisfaction bar as disruptive new entrants.
Another KLAS report suggests how health IT vendors should conduct business during COVID-19:
- Sell the customer what they need to become successful (prescriptive sales) instead of allowing them to pick and chose products and services themselves.
- Pass on sales that are not a good fit to avoid future reputation damage.
- Have account managers proactively reach out to customers to help them understand the company’s vision and the product’s impact.
- Empower lower-level employees to solve customer problems.
- Create contingency plans to avoid support disruptions that could be caused by COVID-19 impact on offshore support resources.
- Drive adoption through training.
- Use internal expertise to guide customers instead of just giving them data or new reports.
Oneview Cloud for COVID-19 is being used for virtual care and virtual visitation in the coronavirus units of four New York City teaching hospitals.
A TransUnion Healthcare analysis of 500 hospitals finds that visit volume declined 32-60% in March.
GuideWell launches COVID-19 Health Innovation Collaborative, which seeks solutions that address the categories of COVID-19 self testing, virtual in-home care, protection of clinical staff, reduction of social isolation, and home delivery of food and supplies to at-risk populations. The application deadline is May 8.
COVID-19
Overall fatality rates compared to pre-pandemic numbers suggest that coronavirus-related deaths are up to 60% higher than official counts. New York City averages 6,000 deaths from mid-March to late April, but had 27,000 in the same period this year versus the 17,000 deaths that were officially attributed to confirmed or probable coronavirus.
Sixty Mayo Clinic physician volunteers are helping manage New York City’s COVID-19 ventilator patients remotely using an audiovisual connection and access to New York-Presbyterian’s Epic system. The doctors note that COVID-19 is like prolonged respiratory failure with unusual twists, such as blood clots and kidney failure.
EHR vendor Kareo becomes one of the first companies in Southern California to offer free COVID-19 antibody tests to its employees and their families, with 40 of the 415 who were tested in a drive-through program showing antibodies that indicate previous or current infection. Of the 15 who showed a possible active infection, only one had symptoms. The company hopes the testing will give employees peace of mind and help it transition back to on-premises work.
Vice-President Pence was allowed to violate Mayo Clinic’s campus mask-wearing requirements during his visit there Tuesday, even as he met with employees and a patient who all wore them. Senior White House officials have never been shown wearing masks in public or in photo opportunities. Mayo said they told Pence’s team about the policy and referred further questions to them.
Quest Diagnostics announces availability of a $119 COVID-19 antibody test via its QuestDirect service that does not require a prescription, although purchasers must visit a Quest draw station to provide a blood sample. Public health officials again warn that nobody knows what the presence of coronavirus antibodies means with regard to immunity.
Former FDA Commissioner Scott Gottlieb, MD says in a Wall Street Journal op-ed piece that the US must create a COVID-19 vaccine because the country that does so will inoculate its own citizens first to restore its economy and gain global influence.
A New York Times report says that China’s factories have reopened, but job losses, reduced wages, and people staying home to avoid infection have left its economy sputtering from low consumer spending.
Other
Patients complain that they are being unexpectedly charged for virtual visits despite political proclamations and insurer announcements of waived co-pays and deductibles for COVID-related services, mostly because of the fragmented health system. Among the issues:
- Some doctors and insurers are charging patients upfront for the full cost of the virtual visit even when it is covered by insurance because insurers aren’t paying and the cash-strapped practices are anxious to collect revenue immediately.
- 100 million people get their insurance from employers that are self-insured and the big insurers don’t control the telemedicine benefits in that case.
- Insurers have waived patient charges only for in-network doctors.
- Some practices are charging for routine telephone calls now that Medicare and insurers are paying for virtual visits in all forms.
A New York Times article warns that parents are postponing well-child checkups for fear of COVID-19, leading to concerns that reduced immunization will cause outbreaks of measles and whooping cough. Pediatric EHR vendor PCC found from the records of 1,000 independent pediatricians that MMR vaccinations are down 50%, diphtheria and whooping cough 42%, and HPV 73%.
Physician and author Sid Mukherjee, MD writes in The New Yorker that the US healthcare system caused several issues in our coronavirus response:
- US medical infrastructure fell apart in failing to inventory adequate supplies of PPE and a Strategic National Stockpile that saw its role as supplementing, rather than meeting, state and local public health emergency needs.
- Testing failed because of the CDC’s distribution of faulty COVID-19 tests, the FDA’s requirement that only CDC tests be used (instead of the WHO tests that the rest of the world uses), and CDC’s distribution of tests only to military, state, and public health labs that perform a tiny fraction of all testing. The author notes that South Korea has so many test kits that it is exporting them to the US, which they did by quickly identifying potential vendors, certifying their products, and turning their factories loose to meet demand.
- FDA’s process for validating diagnostic tests that had been developed by other labs was inefficient, with criticism then causing it to overshoot in allowing 90 companies to sell antibody tests even though FDA has reviewed only four.
- The value of distributing real-time, anecdotal treatment findings via social media and preprints was obvious though imperfect.
- Vital drugs fell in short supply because their low profit margins left manufacturers complacent and some of them are made in single factories that were disrupted, such as by Hurricane Maria in Puerto Rico.
- The “market-driven, efficiency-obsessed culture of hospital administration” caused leaders to fail to account for “organizational survival time” in the absence of a functional supply chain and the time required to recover from such disruption afterward.
- The difficulty of searching for information in EHRs and the time required to obtain institutional approval to do it left researchers flying blind. The author says that EHRs “actively obstruct patient care” and are bound by proprietary interests and privacy rules from delivering their potential as a searchable national repository of real-time, de-identified patient data that could be used as a “storm-forecasting system” for research and treatment dissemination.
In colorful COVID-19 political news, Grants, NM Mayor Martin “Modey” Hicks (D) defies state law in allowing gun stores and golf courses to reopen, concluding, “We’re not doing it no more” and that “that business, by God, is essential to that individual.” Governor Michelle Lujan Grisham says she may file a cease-and-desist order since it is “like opening up a public pool and having a pee section.” The mayor has ordered businesses to call 911 if the governor’s “Gestapo” shows up over a “little bug.“ He then told reporters he was heading off for a round of golf, and finding the course closed, fired the city manager.
Sponsor Updates
- Audacious Inquiry will work with HL7 International to develop an HL7 FHIR implementation guide as part of their work with the SANER project.
- CRN gives Avaya a five-star rating in its annual Partner Program Guide.
- Black Book’s latest survey finds that Evident’s Thrive EHR has earned top client ratings in small hospital EHR user satisfaction for the tenth consecutive year.
- Murray County Medical Center (MN) and TCare implement CareSignal’s COVID-19 Companion text messaging app.
- Wolters Kluwer launches virtual conferences to support medical societies amid COVID-19 meeting cancellations.
- CereCore congratulates its Epic team on helping HCA Healthcare expand its telehealth capabilities.
Blog Posts
- How Training Initiatives Helped Empower and Prepare Baylor Scott & White Health for COVID-19 (Part 1) and (Part 2) (314e)
- How Healthcare is Falling Behind in a Digital Economy (Part 2) (AdvancedMD)
- COVID19 Preparedness and IT Pandemic Preparation (CI Security)
- Elements of Consideration During CDI Review of COVID-19 Patients (Artifact Health)
- Rapidly Expanding Capacity for the Coronavirus Pandemic and Beyond (Impact Advisors)
- Now Could Be the Time to Shift Your Contact Center to the Cloud (Avaya)
- ONC-CMS Final Rules, Part 4 – Implementation (Datica)
- Updated Star Ratings: How CarePort Can Help (CarePort Health)
- Improving ED and ACO Collaboration Through a Common Technology Platform (Collective Medical)
- CoverMyMeds Campus Update: Spotlight on Sustainability (CoverMyMeds)
- COVID-19 and Virtual Health Services – Commonly Asked Q&A (Culbert Healthcare Solutions)
- Despite Delay – No Time to Lose (Diameter Health)
- Combatting COVID: 5 Benefits for Text-Based Screening Tools (Dina)
Contacts
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Our Alteryx office in Irvine is in the same building as Kareo. A colleague that used to work there said they have around 300 or so in the Irvine office, so I imagine a fairly high percentage of their workforce was tested. Is everyone else as startled by the numbers as I am? That is a 9.6% infection rate, which is higher than what I would expect from a general population in an area that hasn’t been hit very hard (at least in terms of hospitalizations).
Honestly, I have given up on following a lot of these numbers day-to-day, but is that close to a standard held percent of the population that could be infected? Is there any information about the accuracy of this specific test?
You left out the first and perhaps most obvious key to a sound investment strategy…Spend less than you make, invest the rest. The remainder of the advice was spot on.
Sooooo even Cerner can’t figure out the VA. At a cost of $14000/veteran, this EHR attempt sounds like the old attempts to move the IRS off of its legacy platform.
People badmouth VA system but many MDs we worked with used it at a VA and say they prefer it to Epic or Cerner systems.
I assumed Millennium couldn’t be enhanced and customized to address AL existing military-specific capabilities in Stage 1. But not having basic e-prescribing capabilities (refills) that meet safety standards in 2020 in a multi-billion dollar EHR is alarming and a show stopper IMO given VA’s target population.
Likely execs on top of food chain @ Cerner and VA OK’d plan to go-live without refills without deep understanding of potential harm and disruption for millions of vets (many depend on lifetime of meds for chronic pain, injuries and illnesses) and their families.
Is Cerner e-Scribing deemed unsafe by VA same one used by commercial clients? Are VA standards too strict /unreasonable? Am I missing something here?
People like the VA system because it doesn’t have the same data capture and billing systems as those serving commercial insurers. It also doesn’t have the same central oversight of the local orgs that a big health system does. Thats one reason why vets from different areas have such different experiences and opinions of the VA.
I agree though that this particular screw up was probably caused by the exec team being told to go live without any real incentive to make sure everything works. That’s what happens when these things get politicized.
It would certainly be interesting to know what those VA standards are. Nothing in the linked document provides that level of detail.
Does it make anyone else nervous that Mayo didn’t enforce their own policy with regard to the visit by Vice President Pence? Seems anyone can misinterpret a requirement but it is up to the organization to enforce.
“What you put up with is what you stand for” is a good Judy-ism that applies here. In my personal experience it seems like the executives at big academics are hired to play politics. Mayo wasn’t going to embarrass Pence, even if it meant violating safety protocols. With this administration, the NIH would have suddenly decided for unrelated reasons that maybe Mayo doesn’t deserve the full $300M they enjoy in annual NIH funding.
If an airline attendant requested Pence to buckle seat belt on takeoff, he would not have balked and no one would have feared airlines would lose financial support in expecting compliance.
Somehow hospital rules – and recommendations of task force Pence headed – not taken as seriously as airline safety rules. Not sure what this says.