News 7/15/20

Top News

A New York Times article says that a broken data system — which often includes fax machines as a primary means of communication — is hampering US COVID-19 response.

The article notes that:

• Nearly all lab results were reported digitally to public health departments before the pandemic, but a shortage of testing capacity and high payments brought in new lab companies that aren’t set up for public health reporting and they insist on using fax.
• Washington State’s health department brought in 25 National Guard members to perform manual entry of information that is not being sent electronically.
• The public health department of infection hotbed Harris County, TX was overwhelmed when its fax machine was “just shooting out paper” when a lab faxed hundreds of pages of test results all at once.
• Information that is sent outside of data feeds – by phone, email, snail mail, and fax – is often duplicated, sent to the wrong recipient, or missing important patient information. Nationally, 80% of test results are missing demographic information and half don’t have addresses. New federal guidelines, which recommend but don’t require that senders include such information, don’t take effect until August.
• Reporting test results in Austin, TX requires reviewing 1,000 faxes per day that arrive on average 11 days after the test was taken, making the results worthless for contact tracing. The health department is telling people who are experiencing symptoms to just assume that they are positive.

In related news, the White House is considering asking governors to send the National Guard into hospitals to help them collect daily COVID-19 information about patients, supplies, and capacity. The American Hospital Association is not happy with this news, saying that hospitals have cooperated with “evolving data requests” and suggesting that the Guard’s expertise could be better used elsewhere.

Reader Comments

From Livongo vs. Allscripts: “Re: CEOs. Tullman’s big mistake was keeping his existing executive team with the Eclipsys acquisition, and they didn’t understand the acute market. Black’s dbMotion acquisition was a disaster since it sold only to existing customers and many of them have dumped the whole thing for Epic. Black also purchased garbage products from NantHealth right after its owner bought Sunrise for his Verity hospital chain, after which Allscripts sunset the products and Verity filed bankruptcy and bagged out of the contract. The Healthgrid acquisition was good, but the McKesson acquisition was a disaster, sending the Paragon customers who could afford to switch to competitors. The Practice Fusion acquisition fueled Veradigm, which has done well, but it cost them $160 million in DOJ fines plus legal fees. I haven’t seen any announcement of new Sunrise or TouchWorks sales for a long time. Bottom line is that the industry seems to trust Tullman more than Black and somehow the board has for some reason allowed Black to remain after seven-plus years as the stock dropped 50%.”

From Gerald Aldini: “Re: management. I’ve been offered a promotion that would place me over my co-workers. Good idea or not?” Becoming the boss of your peers is certainly awkward, but more importantly, are you a builder or a leader? Which makes you prouder, sequestering yourself to create something amazing or being in charge of people who do so under your guidance? Rules-breaking artists won’t likely be happy taking a rules-enforcing job supervising other artists, regardless of the expanded authority, office, and paycheck that comes with that responsibility. I’ve had quite a few conversations with management peers over the years in which we secretly expressed a longing to return to our happy days of headphones-on programming, where our cubicles were a secret doorway to a universe of our own creation and we left our work problems behind when we headed home. Take the management job if you get that same satisfaction from convincing or coercing people to do what you want instead of what they want and love conference room arm-wrestling with peers over resources and priorities. One more piece of advice, which I took myself when I begrudgingly accepted a health system promotion from doing what I loved to taking a promotion doing something I didn’t even like — a co-worker will probably take the job if you don’t, so reporting to a former peer may be more distasteful than the other way around even if you don’t really relish the new job.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Jvion. The Suwanee, GA-based company delivers clinical AI solutions that allow providers and payers to manage unforeseen health risks, improve health outcomes through personalized recommendations, improve patient and member engagement, and reduce costs. These go beyond simple predictive analytics and machine learning to identify at-risk patients who are likely to benefit from specific interventions. The company’s product has been deployed by 300 hospitals across 50 health systems that report an average 30% reduction in preventable harm and annual savings of nearly $14 million. Specific use cases include hospital-acquired conditions, healthcare-associated infections, readmissions, bedside patient rescue, discharge optimization, patient experience, oncology care, and behavioral health. The company just released its solution suite for payers, which includes population health, cost and utilization management, behavioral health, and member activation and engagement. The company was recently featured in a New York Times article for its COVID-19 employer recovery package that predicts exposure and infection risk. Industry long-timer Jay Deady is CEO, so thanks to Jay and to Jvion for supporting HIStalk.

I found this recent YouTube video in which Duke University Health System’s chief analytics officer describes how the health system uses Jvion to manage falls and allocate resources.

Listening: new from Everybody Loves an Outlaw, a Texas duo who can crank out Janis Joplin-like blues. I’m not a fan of slide guitar and handclapping bar songs so I pass on those, but their moodier songs hit the spot. I’m fascinated that Taylor kept laying down tasty guitar licks as Bonnie practically mounted him lustily on camera at the 2:20 mark before she redirected her passion back to the song “I See Red,” which describes killing a philandering lover.

Webinars

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

Sales

• FDA licenses access to the TriNetX global health research network for its Sentinel Program, which will give it access to de-identified, real-world data for monitoring the use and potential shortages of critical COVID-19 drugs.
• In England, the National Institute of Health and Care Excellence and Flatiron Health will study real-world evidence from Flatiron Health’s EHR database starting with a comparison of predicted versus actual survival outcomes. NICE produces evidence-based guidance for the National Health Service.

People

Chris Belmont, MBA (The HCI Group) joins Memorial Hospital at Gulfport as VP/CIO.

Direct Recruiters, Inc. promotes Kasey Kaiser and Josh Olgin to partner.

Apervita hires industry long-timer Miya Gray, MS (BrainScope) as SVP of customer success.

Meta Healthcare IT Solutions founder and CEO Sal Barcia, RPh, MS announces on LinkedIn that he is leaving the company after 29 years.

Announcements and Implementations

Surescripts announces that 21 healthcare organizations are live on its Clinical Direct Messaging service for transmitting Electronic Case Reporting of COVID-19, with another 18 sites in progress.

Amazon will conduct a health center pilot with primary care service provider Crossover Health, which will operate 20 Neighborhood Health Centers in five cities that will serve Amazon employees and their families. The first center will open in Las Colinas, TX and will offer extended hours to accommodate employee work schedules.

COVID-19

The White House orders hospitals to bypass CDC in their COVID patient data submissions, telling them to send their daily Excel files instead to CDC’s parent HHS to track hospital capacity, resources, and PPE availability. People sometimes forget that the sprawling HHS bureaucracy includes the alphabet soup of OCR, ONC, AHRQ, CDC, CMS, FDA, and NIH.

A CDC editorial in Tuesday’s JAMA Network calls for universal wearing of masks, saying that “the public needs consistent, clear, and appealing messaging that normalizes community masking” as a civic duty.

Quest Diagnostics admits that its average turnaround time for COVID-19 results has increased from 4-5 days two weeks ago to more than seven days now. The company also warned investors that Q2 revenue will be 6% lower because it is performing fewer more lucrative tests during the pandemic.

In one city in India, COVID-19 patients will be required to use city-issued electronic token to be admitted to private hospitals, whose beds the city wants to reserve for patients who have symptoms. Private IT firms developed the technology that an around-the-clock city team will use to assign tokens that contain a specific bed number.

In what could be a preview of sending kids back to school, a New York mom who kept bringing her child to an in-home daycare while waiting to receive her own COVID-19 test results spreads the infection to at least 16 people in four families, including six children, a sibling, seven parents, and two grandmothers. The mom was tested on a Tuesday and continued to bring her child to daycare every day until she received her results on Friday. She apologized for ignoring the quarantine, saying she had nobody else to care for her child, who also tested positive.

The public health department of Catawba County, NC does an amazing job of contact tracing in showing how a 20-person, mask-free family gathering led to 14 infections, with those symptom-free folks then spreading COVID to at least 41 people over just 16 days, including a bunch of co-workers, some beach trip companions, an 85-year-old neighbor, and some children. It’s probably safe to assume that the spread has gone further since.

Four former CDC directors say in a Washington Post op-ed piece that public health faces two opponents – COVID-19 as well as political leaders who are determined to undermine CDC’s work. They particularly dislike the White House’s threat to weaken CDC’s return-to-school guidelines, saying that “the only valid reason to change released guidelines is new information and new science, not politics” and observing that disdain for policies and practices that worked all over the world has led the US to have 4.4% of the world’s population but nearly 25% of its coronavirus infections.

Israel reports that 47% of the people who were diagnosed with COVID-19 last month were infected in schools, following a sudden decision to reopen them.

In Florida, Sunday’s huge jump to 15,300 new COVID-19 cases on Sunday may be due to Florida Department of Health data reporting backlogs. A Virginia lab that performs 10,000 to 13,000 tests every day for Florida residents says it can’t explain how state data showed 52,000 results from it on Sunday, of which 7,000 were positive, both numbers representing around half of the state’s total. Still, 16% of the state’s tests were positive, which indicates an increasing infection spread.

The Texas Tribune reports that hospitals are turning away COVID-19 patients and holding up ambulances for up to 10 hours at their EDs due to a lack of capacity.

A CNBC article describes why Israel was so successful in the initial phase of the pandemic before fanning a viral resurgence by opening too soon:

• Universal healthcare coverage is offered, sold by four competing non-profit insurers, They all use the same technology, making public health surveillance easy.
• The country created a predictive model to identify high-risk people, then sent them SMS and phone messages and doctors to offer them telemedicine and home care.
• The largest of the insurers sent daily symptom questionnaires to members to identify potential hot spots early.

Other

Two people file a class action lawsuit against Teladoc Health, claiming that telehealth company hired a marketing firm to make robocalls that pitched Teladoc’s $30 monthly membership plan, which in their case involved dozens of calls made to their numbers that they had listed on the Do Not Call registry.

An observational and interview study of IT-involved people in nine healthcare organizations characterizes in broad terms how they see the relationship they have — or want to have — with their EHR vendor, with these categories:

• Marine drill sergeant. Healthcare organizations with limited knowledge or discipline expect their EHR vendor to force them to follow a standard implementation or configuration, especially if they have struggled previously with a heavily customized system that reflected illogical workflows.
• Mentor. The client wants the vendor to make non-binding recommendations based on their experience with other customers.
• Development partner. An organization that sees itself as an innovator chooses an EHR vendor that can develop new features to support their experimentation.
• Seller. The customer just wants to buy a system with minimal ongoing vendor contact.
• Parasite. A vendor with one dominant customer neglects its other customers to the detriment of both the vendor and the singularly important customer.

My take on this: the above EHR vendor categories highlight the industry’s change in which early (and mostly failed) inpatient EHR vendors encouraged customers to make programming demands to support their often illogical processes in the “we are special” heyday. It’s pretty remarkable that Epic has made the “marine drill sergeant” vendor role not only acceptable, but desirable (although Meditech arguably developed that role). Nobody would have predicted that young, healthcare-inexperienced EHR vendor employees could convince C-level executives with decades on the job to re-examine their processes that were often in place only because the hospital’s managers had never worked elsewhere and didn’t know any better. Epic’s brilliance is bribing clients (in the form of rebates) to follow best practices, applying pressure at the CEO/CFO level where those big checks made out to Epic are signed, and gaining buy-in for massive organizational changes using go-live pressure that keeps the customer from noticing that their long-protected Band-Aid is being ripped off.

Epic publishes yet another press release, which makes me wonder what’s changing in Verona since they had never run any until recently.

Tweet of the day.

Sponsor Updates

• Modern Healthcare lists in its “Best Places to Work 2020” list these HIStalk sponsors: CereCore, Health Catalyst, Impact Advisors, Imprivata, Nordic, Pivot Point Consulting A Vaco Co., PMD, Santa Rosa Consulting, Strata Decision Technology, and Surescripts.  
• The Chartis Group names John Wiest (Navigant) director of its performance improvement practice.
• Clinical Architecture will present during NCQA’s Digital Quality Summit July 22-23.
• Impact Advisors publishes a white paper titled “A Move to the Cloud Is Making ERP a Top Strategic Priority for Hospitals and Health Systems.”
• Clinical Computer Systems, developer of the Obix Perinatal Data System, releases a new Clinical Concepts in Obstetrics Podcast, “Peripartum Cardiomyopathy – The Fundamentals.”
• Ensocare will exhibit at ACMA’s virtual 2020 National Conference beginning July 15.
• Hyland Healthcare partners with Life Image to improve data and imaging access between providers and patients.

Blog Posts

• Why Physician Champions are Critical for Successful Epic Go-Lives (314e)
• What to look for in a revenue cycle management provider (Ability Network)
• Best Practices for Building a Telehealth Team Now (Access)
• Telehealth Challenges & How to Overcome Them in Your Practice (Part 1) (AdvancedMD)
• 5 Ways to Increase Revenue with Healthcare Business Analytics (Ingenious Med)
• Mitigating a post-covid-19 surge on imaging departments with joined tech (Agfa Healthcare)
• How ACOs Manage Beneficiaries with Complex Needs (Collective Medical)
• Customer Spotlight: How Hospital de la Concepcion is Using Analytics to Quickly Respond to COVID-19 (Dimensional Insight)
• It’s Time for a Better Check-In Solution (EClinicalWorks)
• Ready, Set, STOP! How to Discharge Difficult-to-Place COVID Patients (Ensocare)
• Why We Gave Hospitals Our Free COVID Dashboard and What Happens Next in Healthcare (EPSi)
• ESolutions’ Tool Helps Providers Manage New CMS Prior Authorization Requirements for Outpatient Procedures (ESolutions)

Contacts

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