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May 14, 2020 News 9 Comments

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Cerner announces that its annual conference, scheduled for October 12-14, will be conducted as a virtual event.

The conference, one of Kansas City’s largest, is among 78 that have cancelled so far during the pandemic. City officials estimate that the cancellations will cost the local economy $137 million in lost hotel room bookings alone.


HIStalk Announcements and Requests

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None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Health Catalyst reports Q1 results: revenue up 28%; EPS -$0.06 vs. -$0.23, beating analyst expectations for both. The company said in the earnings call that uptake of its free, rapidly developed COVID-19 analytics package is strong, including its patient and staff tracking solution and capacity planning tool. Health Catalyst expects its professional services revenue to dip due to hospital financial challenges and says it may discount those services as a long-term partner. The company will consider acquisition of capital-struggling startups that have developed apps that could help hospitals with revenue, cost, or clinical quality.

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Health IT entrepreneur Tim Peck, MD launches Curve Health to help hospitals and nursing homes coordinate and manage patient care. Peck’s previous venture, Call9, shut down last summer after raising $34 million with help from investors that included 23andMe’s Ann Wojcicki and Ashton Kutcher.


Sales

  • Boston Children’s Hospital will implement KyruusOne provider data management and Kyruus ProviderMatch for Consumers.

People

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Wolters Kluwer moves Stacey Caywood, MBA, who is CEO of the company’s Legal & Regulatory division, to CEO of its Health business. She replaces health IT long-timer Diana Nole, MBA, who has joined Nuance as EVP/GM of its healthcare division.

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Trinity Health names Eileen Matzek, MBA (Amita Health) as CIO of Loyola Medicine (IL).

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Recently hired Haven Healthcare COO Mitch Betses will manage the company’s operations until a replacement is found for Atul Gawande, MD, who confirms that he will step down as CEO and transition to board chair. Betses is a pharmacist and has spent most of his career as EVP of CVS Health.

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Nordic promotes Sriram Devarakonda to advisory services managing director and practice leader; Ian Mamminga to SVP of managed services solutions; and Andy Mueller to SVP of managed services operations.


Announcements and Implementations

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True Women’s Health (MI) deploys a menopause virtual care and support app that it built using OptimizeRx’s RMDY digital health tools. The app provides educational videos, trackers, surveys, coaching and telehealth consults, appointment scheduling, and progress and symptom tracking.

NHS Trusts in southwest England will set up a temporary hospital using Epic software from Royal Devon and Exeter NHS Foundation Trust.

Change Healthcare offers de-identified COVID-19 claims data for analysis of disease progression, intervention effectiveness, and overall health system impact.

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HBI Solutions develops an EHR-friendly fall risk assessment algorithm for elderly patients.

Meditech adds Apple Health support to Magic and Client/Server, making the app usable by all of its customers.


Government and Politics

Thirty amicus briefs were filed from both sides of the political aisle with the US Supreme Court on Wednesday in support of the Affordable Care Act, which Republican state attorneys general and the White House are seeking to repeal. Economic scholars warn of the damage that would be caused by eliminating what could be the only health insurance option that is available to the 37 million newly unemployed Americans, along with the many billions of dollars worth of uncompensated care that struggling hospitals would be forced to provide.


COVID-19

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The New York Times looks at why some city hospitals were being overwhelmed with COVID-19 patients even as others had 3,500 open beds, sometimes under the same corporate umbrella of Health & Hospitals. Governor Andrew Cuomo concludes, “We don’t really have a public healthcare system. We have a system of hospitals.” Load-balancing challenges include moving unstable patients and overcoming the hospital ethos of treating every patient who arrives there. The state basically took over capacity and transfer management to fix the problem of competing, brand-obsessed “independent duchies” that couldn’t overcome their cultural differences to work together voluntarily.

Experts question the accuracy of COVID-19 testing numbers given the lack of federal reporting guidelines. Some states track the number of samples rather than the number of patients, some do not report racial or ethnic breakdown of cases and deaths, and others have switched methods midstream to make past versus present comparisons impossible. Virginia just started combining the results of viral tests and antibody tests, which is indefensible statistically and epidemiologically but expedient politically, with the chief of staff of the state’s Democratic governor (a pediatric neurologist) explaining that Virginia wants to move ahead of other states in its number of tests per capita. Virginia joins Colorado and Arizona in using the questionable numbers to justify re-opening and to allow bragging on improving testing numbers that still lag much of the developed world.

A study finds that just 4.4% of the population of France, which was hit hard by COVID-19 with 27,000 deaths, has been infected, making it unlikely that countries can reach herd immunity to avoid a second wave of infection as social restrictions are eased

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CNBC interviews Epic CEO Judy Faulkner, who made these points in response to some inexpert questions:

  • Epic customers have increased their telehealth business by an average of 100-fold, with some going from 20 daily visits to 8,000.
  • The company analyzed its database of 100 million patients to see if any of 30 targeted drugs might protect patients against COVID-19, finding that none did. They will next look at outcomes from convalescent plasma therapy, the use of remdesivir, and whether patients who recovered from COVID can become infected again.
  • Faulkner says, “We were actually the originators of interoperability” in the early 2000s, first among Epic users, then with all EHR users via Share Everywhere.
  • Epic is working with an unspecified group to develop a phone-based “immunity passport” that indicates that the user has tested positive for COVID-19 antibodies (though the unmentioned challenge is that nobody has proven that the presence of those antibodies ensures immunity and quality of the tests is all over the place in the absence of FDA approval of the predominantly China-developed tests).
  • Asked about whether Epic will develop contact tracing phone apps, Faulkner cited a healthcare blog’s poll (presumably the one I just ran on HIStalk) that showed two-thirds of people wouldn’t participate.

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The state of Utah opts for contact-tracing app technology from Twenty, a social media startup that pivoted from developing a meet-up app to the Healthy Together app in just three weeks. Once out of beta, the app will become part of the state’s contact tracing program.

23andMe enlists hospitals to help it recruit patients for a study of severely ill COVID-19 patients. The consumer genetics testing company hopes to find genetic correlations that could explain why some patients become sicker than others.

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Collective Health, which offers insurance administration tools for self-funded employers, develops an evidence-based return-to-work app that performs worker risk assessment, screening, and testing.  The company notes that the app protects employees because their information isn’t shared with their employer, who only sees a completed “pass” that can be used to allow the employee to return to work.

Kaiser Health News shares a story of a restaurant worker who tested positive for COVID-19 in late March, after which her co-workers were notified immediately that they should self-quarantine. The woman’s second job was as a cafeteria cashier at University of Washington Medical Center, which did not notify co-workers or even require the infected employee to wear a mask while working. Employees of other hospitals say they either aren’t notified or aren’t told who the infected co-worker is, which means they don’t know the extent of their exposure.

President Trump tells employees of a medical equipment distribution center Thursday that COVID-19 testing is “overrated” in suggesting that the US’s world-leading number of cases is due to over testing. He said, “When you test, you have a case. When you test, you find something is wrong with people. If we didn’t do any testing, we would have very few cases.”

Australia’s NSW Health reduces patient wait time to receive negative COVID-19 test results from several days to several hours by using a text messaging bot to send them electronically to those who opt in.

Former National Coordinator CEO Farzad Mostashari, MD and former CDC Director Tom Frieden, MD, MPH say in a CNN editorial that the crisis-created bias toward action is encouraging tech companies like Apple and Google to push proximity-based contact tracing apps as an “overreaction of surveillance,” as low usage could then encourage the next step of hiding the apps or coercing users to run them. They say tech companies should improve the accuracy of information they allow on their social media platforms, open up access to de-identified user data to help public health officials understand the response to shelter-at-home and distancing strategies, and support human contract tracers, all while “first doing no harm.”


Other

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Strata Decision Technology’s newly launched National Patient and Procedure Volume Tracker shows that 55% fewer Americans sought hospital care in March and April at the 51 health systems studied. Some areas with the largest drops potentially involve life-threatening problems, such as cardiology and oncology. Volumes dropped by more than half for congestive heart failure, heart attacks, and strokes, raising again the ongoing question of what is happening with those patients. The health systems that were studied reported a staggering average revenue drop of $1.35 billion each in the two-week study period.

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Akron Children’s Hospital (OH) will use a $1 million donation to endow the country’s first chair in telehealth, to be held by CMIO and oncologist Sarah Rush, MD.


Sponsor Updates

  • Ellkay’s LKCOVID-19 lab connectivity package that supports testing, results, and state reporting processed 1.6 million COVID-19 tests in April.
  • Hyland offers free subscriptions to its ShareBase cloud-based sharing and collaboration tool.
  • Imat Solutions releases a new podcast, “Reliance EHealth Collaborative Leverages IMAT for COVID-19 Response.”
  • Veradigm will incorporate Specialty Patient Enrollment software from Surescripts into its AccelRx specialty medication fulfillment solution.
  • Optimum Healthcare IT publishes a white paper titled “ Targeted Training: Promoting EHR Efficiency.”
  • A 2020 US EMR Market Share report from KLAS highlights Meditech as one of two EHR vendors that saw significant market share growth in 2019.
  • Wolters Kluwer Health releases a new report, “Next-Generation Nurses: Empowered + Engaged.”

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Currently there are "9 comments" on this Article:

  1. Epic/COVID-19: If Epic has really done rigorous analysis on 100 million patients and 30 drugs, don’t they owe it to the public health experts (and to public at large) to publish that information? Not like the fluffy, WordPress based blog that seems to be quickly hacked together and called the Epic Health Research Network. But something that follows some standard guidelines for clinical data analysis for observational studies and is reasonably peer reviewed! If they are planning on doing similar analysis for other therapies, they need to provide some insights into the methodology and protocols that will be followed (and perhaps seek some guidance/feedback from epidemiologists and public health experts).

    Same goes for the deterioration index mentioned in the conversation. If this index has really been successful in providing early alerts to front line clinicians at over 100 health systems (and has discriminated meaningfully between COVID-19 induced crash and other underlying cause of crash) and has been a factor in reducing COVID-19 related mortality (or even in reducing hospital stay or ventilator use etc) then that’s a huge success and breakthrough! Why not publish those results and performance of the index? Why not publish it so that other non-Epic hospitals can also use it and save lives?

    I am disappointed (but not surprised) that the CNBC host did not ask any of these common sense follow-up questions.

    At their last UGM, Epic announced with much fanfare the coming of Cosmos with at least 20 Million records (https://www.chilmarkresearch.com/epic-ugm-2019-blasts-from-the-past-and-a-look-into-the-future/). Is this where this research is happening? When did Cosmos jump five fold from 20 M records to 100 M records?

    • It takes time for for a fully vetted research paper analyzing 30 drugs on a new illness to be written, published and accepted by the scientific community. Time you don’t have in a fast changing crisis like this. Besides, Epic probably isn’t the group to do it. The ehrn seems to be a sort of quick analysis, a starting point for deeper research. You’re right, it’s meant to be a blog. It’s not an academic journal.

      Cosmos has been growing, last I heard it had close to 100 customers. If those are the bigger ones, they could easily hit half of the Epic patient population.

      You’re questioning the validity of Epic’s claims like you want a source, but Epic is the source. If Epic says they have 100 million patients in a research database, that some AI model is at 100 customers, or they’ve done some preliminary analysis on 30 drugs, you either have to take that at face value or leave it. Epic is the best source on what Epic’s doing. It sounds to me like you have an axe to grind, but in the meantime they’re throwing what resources they have at the biggest health crisis in a century and that’s just not good enough for you. If not this, what should they be doing?

      • Math: The only axe I have to grind is Paul Bunyan’s!

        FWIW, here are all the reasonably well-vetted papers that have been published in just one journal on COVID-19: https://www.nejm.org/coronavirus?query=main_nav_lg.

        Here’s a concrete example of doing it reasonably right: https://www.nejm.org/doi/full/10.1056/NEJMoa2012410?query=featured_coronavirus

        If Epic is indeed throwing everything that it, then they can do better, no? Maybe start by hiring a few real epidemiologists and medical informaticists? Maybe, create a real partnership with the research community by being open and transparent about its data models and methodologies?

        You are implying that we should take everything coming out of 1979 Milky Way at face value. You can’t be serious!

        • We see similar shoddy claims from Epic all the time now. Cleveland Clinic data shows fewer than 20% patients used Care Companion. But Judy called it as a success. At one point Judy chided competition for chasing golden apples. App Orchard has nearly a dozen Televisit companies but Epic decided to chase that golden apple with Twilio. How quickly it went down from “everything built here” and “Silicon Valley is clueless” to adoption of SV based technology while betraying App Orchard partners. Epic brings ZERO differentiation in the video visit.

          • Epic doesn’t need differentiaton in their video visits to be successful and valuable for their customers. They’ve already done the leg work to get through hospital bureaucracy and get clinicians using their products. Their products are the safe choice for administration and reliable enough to have staying power with users. Unless your product is stunningly better, people are just going to wait for Epic to release your functionality.
            Having a technical product in an app store is living on borrowed time. Have you ever noticed how Apple takes the good iPhone apps and puts the functionality in iOS? If your product is just an app in an app store, youre the first fish eaten whenever the sharks start getting hungry. The good thing is that Epic is slow and not hungry, but you still have to swim fast or be swallowed.

      • Math should check their math. The article that Elizabeth H. Holmes cites indicates that there were 31 Health Systems who had submitted data to Cosmos as of April 30, 2020. It covers 36 M patients, both numbers are roughly 1/3rd what Judy mentioned in the interview, and you parroted. Apparently Epic contradicts themselves when they talk about their work.

  2. That fluffy, hacked-together WordPress blog lhas the drug information you’re asking for. Who knows if Epic or one of the customers participating in Cosmos is working on submitting a paper for peer review.

    https://ehrn.org/prior-outpatient-medications-and-subsequent-covid-19/

    Please do your own research instead of ranting about Mr. Histalk’s summary of an article. Putting “Epic deterioration index” into Google also produced these articles from the first page of results, which includes healthy skepticism of the current effectiveness of the index for COVID-19 patients:

    https://www.statnews.com/2020/04/24/coronavirus-hospitals-use-ai-to-predict-patient-decline-before-knowing-it-works/
    https://www.beckershospitalreview.com/ehrs/stanford-tests-ehr-tool-that-can-predict-if-covid-19-patients-will-need-intensive-care.html
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5510649/

    I’m not sure why you were expecting anything more than fluff from a brief CNBC interview, which appears to be conducted by two reporters who have spent their careers reporting on business, not healthcare.

    • Elizabeth H. H. Holmes: If Epic or one or more of Cosmos customers are working on a rigorous paper for this, more power to them. That is exactly what we need.

      In the meantime, regarding the links that you provided:

      – the ehrn link: the write-up mentions 36 million records (and not 100 million as claimed in CNBC interview) – that’s a significant difference. And the information provided is meager and the level of analysis is worse than what I have seen in some of Medium posts done by folks with nothing except a couple of Coursera courses in statistics under their belt. Thus, I stand by my opinion of this being a quickly hacked together blog.

      – det index: the STAT article hits the nail on its head right in the first paragraph.

      “Dozens of hospitals across the country are using an artificial intelligence system created by Epic, the big electronic health record vendor, to predict which Covid-19 patients will become critically ill, even as many are struggling to validate the tool’s effectiveness on those with the new disease.”

      Reading through it further, the index is useless at worst or inconclusive at best. It is certainly not what was said in the interview that “We’ve been testing this in over a hundred health systems now, — said it works well”.

      If I had to take a guess, all these efforts are being made to inoculate Epic from criticisms that 8+ weeks into the biggest infectious disease crisis that our country has seen, from a data perspective, the EHR system that holds data for 60% of patients in the US, has provided no meaningful contribution.

      For example, most of the COVID-19 hot spots have been in areas dominated by Epic (NYC, Michigan-IL-WI corridor, California, New Orleans) – but have we seen any pooling of EHR data within those clusters for real-time reporting and analysis? The standard Epic/Judy line has been that other systems are not capable of data interop but that’s not a valid excuse here.

      In fact, it is mind-boggling to think that just days before COVID-19 fully hit the US, Epic was strongly making the anti-data interoperability case and was goading hospital execs to come out against it (talk about bad timing and something that should feature in Mr. HISTalk’s end of the year poll of worst decision made by a healthcare CEO).

      This is not ranting – just a fact based follow-up and questioning of things being said in the media. And if non-healthcare background of those two reporters is a problem, I am sure many healthcare beat reporters will be willing to sit down with Judy to chat through these things. Or maybe she should do a moderated r/IAmA.

      • Some of the things in your comment are just wrong. It’s just speculation because you’re on the outside looking in. I know for a fact from working with a few Epic customers doing this that they have regional dashboards that pull data across customers into a dashboard. You also haven’t considered that Epic does not own this data. They cannot force people to participate in data sharing. By that logic, why haven’t Apple and Google just figured out everywhere COVID has spread to? They have access to almost every smartphone on the planet? Seems like they’re not actually trying! But hey I guess Epic turning around help with ICD code imports, reporting registries, new reports to track ventilator and ICU bed capacity, and helping people ramp up telemedicine on a dime is just them “providing no meaningful contribution.” Let’s just ignore the fact that the federal government, who is supposed to be running this response, is HAVING CUSTOMERS USE THEIR EHR TO SUBMIT DATA IN AN EXCEL SPREADSHEET. But no, it’s the vendors fault for not unilaterally developing some amazing solution.

        Also, the “Epic was strongly making the anti-data interoperability case” narrative has a lot of traction without anything to really back it up. Epic asked for standards, not for a lack of interoperability. HHS ended up implementing Epic’s suggestions almost to a T. Not a single person on this website ever deconstructed Epic’s legitimate concerns about data security and privacy. It was a lot more fun to just rant incoherently against interoperability, while the other vendors used it to try and score cheap points without actually advancing interoperability in a meaningful way.







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