Weekender 5/1/20

Weekly News Recap

• Arcadia acquires the assets of the Massachusetts EHealth Collaborative.
• A KLAS inpatient EHR bed win-loss report for 2019 shows big gains for Epic and Meditech, big losses for Allscripts and Cerner.
• Epic announces plans to add integrated telehealth to its product.
• VA OIG finds that the VA had not adequately planned its now-postponed first go-live, specifically in the areas of staffing, patient access given an expected 30% drop in provider productivity for 12-24 months, and missing functionality such as e-prescribing.
• Cerner’s Q1 beats earnings expectations, but falls short on revenue.
• Cerner offers health systems and researchers free access to the de-identified data of COVID-19 patients for developing epidemiological studies, clinical trials, and medical treatments.
• Facebook’s coronavirus symptom survey is sending results from 1 million users per week to Carnegie Mellon University for predicting disease spread and county-by-county impact.

Best Reader Comments

People badmouth VistA, 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. (Ann Farrell)

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. That’s 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. (IANAL)

Not knowing all the key ways it spreads or just how fatal it is if contracted. Because we don’t have the denominators, which are key to knowing any of the rates. Exacerbated because the only people approved for COVID testing have to have symptoms, so no total population stats are known. New data is coming in on the head counts of those with antibodies who never reported sick, which provides hope this isn’t as bad as we are led to believe and that the death rate is greatly lower across the population than modeled. And the urgency is bolstered by CDC’s original instructions on coding U07.1 as being the underlying cause for any death when present (or suspected if no testing done) with co-morbidities and end stage conditions. NY is getting excoriated because they forced nursing homes to take hospital discharges of patients with COVID, which resulted in double digit deaths in those locations, because they are filled with the at risk elderly. And it also adds to the death count numbers that probably would not have occurred. These types of factors inflate the actual COVID death rate, but even then, it is coming in quite low (most stats now are showing actual death percentage under 2% and most don’t even achieve 1% of everyone who gets it.) (Icon O. Klast)

Among the things that have changed with the emergence of COVID-19 is the number of Epic generated press releases. Have there been more this year than all of previously recorded time? (AnotherDave)

If MDs want to improve the ratio of physicians to administrators, maybe they should pressure their colleagues to open more US medical schools. (Commenter)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. O in Kentucky, who ask for hands-on practice tools for class IPads. She reported in early February, “My students have already benefited so much from this addition of resources. As we learn to use our Osmos, we are finding even more ways to use them for teaching and learning than we even knew were capable. They work amazingly with some older IPads that we had on hand. We were able to resurrect this technology and give it a new purpose. I have also been able to share them with other teachers in the school to check out and use so that all students at my school have access to this resource. Students are excited to do math, reading, writing, engineering, coding, problem solving, and so much more.”

The Milwaukee paper describes how Epic’s 200 culinary team employees, freed up from providing up to 7,000 meals per day to employees who are mostly working off campus, are serving food pantries, long-term care facilities, frontline healthcare workers, and at-risk groups in the Madison area. The company also donated 47,000 pounds of food to food pantries and long-term care facilities between mid-March and mid-April. Epic is also offering curbside grocery pickup for its employees, which allowed a local produce company to bring its laid-off staff back to work.

In England, an NHS anesthesiologist creates a flashcard app that allows mask-wearing clinicians to communicate with COVID-19 patients using predefined on-screen text and voice messages. Rachael Grimaldi, BM developed Cardmedic in 36 hours while on maternity leave. The free app is being used by NHS trusts and by hospitals in 50 countries and is being expanded to include 30 languages, sign language, illustrations, and downloadable PDFs.

Doctors in Germany organize a protest called Blanke Bedenken (“naked concerns”) in which they pose nude in pictures to illustrate how lack of PPE puts their lives at risk. One doctor posed with a sign that reads, “I learned to sew wounds. Why do I now need to know how to sew masks?”

The New York Post profiles NYU Langone Hospital Brooklyn maintenance mechanic Hans Arrieta, who maintains the hospital’s ventilation and water systems. He has self-isolated by sending his family to live with relatives.

Kansas City Chiefs right guard and Super Bowl ring-wearer Laurent Duvernay-Tardif, MD makes Sports Illustrated’s daily cover for answering the call of Quebec’s health ministry for medical and nursing students to help give caregivers relief. He hasn’t completed a residency yet, so his assignment is to administer medications to patients in a long-term care facility. He observes, “I realize that I’m privileged. I didn’t lose my job. I don’t have three kids at home and a Zoom meeting and home school to teach. I know a bunch of my friends are going through difficult times; many are physicians who I met in medical school. I have friends who are working in emergency rooms. One does triage and tests patients for COVID-19. Those people are on the front line, and they’re giving everything to protect us.”

Children’s Memorial Hermann pediatric plastic surgeon Phuong “P. Danger” Nguyen, MD writes and performs a public service announcement featuring the song “Stay at Home.” It’s a project of Help the Doctor, an all-surgeon band.

In England, police in a small village seek to give some “words of advice” to someone who is walking around town wearing a 17th century plague doctor outfit. Some residents were frightened, some were amused, and one was pragmatic: “If it’s not illegal and he can’t wear it now, when could he?” Plague doctors wore the black outfits for home visits during the Black Death, with the beak-like mask that was thought to filter the disease leading to the disparaging doctor term “quack.”

In Case You Missed It

• News 5/1/20
• EPtalk by Dr. Jayne 4/30/20
• HIStalk Interviews Chris Klomp, CEO, Collective Medical
• News 4/29/20
• Curbside Consult with Dr. Jayne 4/27/20
• Readers Write: Healthcare Crisis Underscores Strategic Importance of Strong IT Support
• HIStalk Interviews Krishna Kurapati, CEO, QliqSoft
• Monday Morning Update 4/27/20

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