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Monday Morning Update 3/30/20

March 29, 2020 News 1 Comment

Top News

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Apple develops a COVID-19 screening website and app that it developed in a partnership with the CDC, the White House’s coronavirus task force, and FEMA.


Reader Comments

From Think Outside the Box: “Re: HIMSS conference. Here is a novel idea.” Here’s what TOTB recommends, which I’m excerpting a bit:

  • The vendor community could put on its own conference at cost.
  • Vendors could set up a non-profit that any vendor could join for $25. The group would assign officers who use their own contracting, project management, and marketing groups to run the conference to remove the profit and just pass on the cost to participants.
  • Include conference keynotes who matter, such as Bill and Melinda Gates, John Halamka, or Dr. Anthony Fauci, but no politicians and nobody who is selling a book.
  • Offer educational events intertwined with the vendor booths in small presentation areas.
  • Get hotels to participate and provide a reservation code, but allow participants to use whatever method they want to reserve rooms.
  • Make the conference four days long and allow any member of HIMSS to attend for maybe $100-$200.
  • Designate national and local non-profits to receive some of the proceeds, such as Doctors Without Borders, Red Cross, or groups providing healthcare for the homeless.
  • The vendor community needs to take ownership and control of this event. If HIMSS is really about advocacy, let them prove it by focusing on that instead of marketing and event planning. We need change the paradigm and take control of what can be done versus just complaining about HIMSS.

HIStalk Announcements and Requests

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Poll respondents most often name state government and health systems as doing a good job with the COVID-19 outbreak, but federal government earns far fewer mentions and the White House’s actions polarize readers.

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New poll to your right or here: for those working from home, what negative impact are you seeing?

I know COVID-19 is serious when Amazon tells me as a Prime member that my several items will take 3-4 weeks to arrive, which is probably longer than it took Sears to deliver catalog merchandise ordered on mailed order forms back in the 1960s.

The biggest worry I have about coronavirus is that frontline caregivers who are short on PPE, get little respect from their executive bosses, and expose their family members every day they come home from work will simply decide the job isn’t worth it and walk away. We can (eventually) figure out how to manufacture ventilators and lab tests, but they aren’t worth much without skilled, compassionate humans to operate them.


Webinars

April 15 (Wednesday) 1 ET: “Scaling front-line COVID-19 response: virtual education, screening, triage, and patient navigation.” Sponsor: Orbita. Presenters: Lawrence “Rusty” Hofman, MD, medical director of digital health, Stanford Health Care; Kristi Ebong, MPH, MBA, SVP of corporate strategy, Orbita. The presenters will describe how chatbots can be quickly deployed to streamline individual navigation to the appropriate resources, administer automated virtual health checks for monitoring and managing specific populations, increase access to screening and triage for high-risk populations across multiple channels (web, voice, SMS, and analog phone), and reach individuals in multiple languages.

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


Acquisitions, Funding, Business, and Stock

Bright.md raises $8 million in a Series C funding round, increasing its total to $20.5 million. The company’s SmartExam automates 90% of a primary or urgent care visit in which patients answer clinical questions online and their information is assembled into a view that allows providers to complete their encounter asynchronously in less than two minutes. The company offers hospitals free use of its COVID-19 screening tool.


People

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Cleveland Clinic promotes interim CIO Matthew Kull, MBA to the permanent job.


Announcements and Implementations

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Cerner offers clients new COVID-19 services: remote two-way patient observation, telehealth, a 24/7 nurse line, remote patient monitoring, waived fees for increasing emergency bed capacity, a digital infrastructure for field hospital support, and temporary IT support help for health systems with resource shortages.

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Kno2 offers free use of its patient record retrieval service to patient treatment organizations that don’t have a Carequality-connected EHR. The service requires only a browser and Internet connection to retrieve patient records in PDF and C-CDA formats or to send them to an EHR that supports Direct messaging.

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Mental health and behavioral practice software vendor Therapy Brands reports a one-week jump of 4,300% in virtual services as therapists move online for up to 100% of their sessions.

AMA adds new content for private practice physicians to its COVID-19 resource center: guidance for keeping practices in business, recommendations for managing non-urgent care services, and an update to its telemedicine guide.

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Online form vendor JotForm offers free accounts to coronavirus responders. The HIPAA-compliant online forms tool comes with a business associate agreement to allow collecting health information securely, obtaining patient signatures, sending files, and accepting payments. The regular subscription price is $29 to $79 per month.

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MDmetrix offers hospitals a free subscription to its COVID-19 Mission Control, which uses a data extract to provide visibility into number of patients screened, ICU escalation, ventilator use, and demographic and medical profiles of patients who are in serious condition.


Government and Politics

CMS suspends its requirement that pathologists view slides from within CLIA-licensed facilities, opening the door to digital telepathology.


COVID-19

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Abbott will start shipping a rapid detection COVID-19 test this week delivers positive results in five minutes and negative results in 13. The company says it can deliver 50,000 tests per day. The test runs on Abbott’s ID NOW platform.

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Henry Schein announces GA of a rapid point-of-care COVID-19 antibody test that gives results in 15 minutes from a pinprick blood sample. The rapid immunochromatography IgM/IgG test does not require any instrumentation. The results can be used to guide therapy in later-stage infection as well as to clear those who were previously infected and may be immune.

Cardiologists report that patients who are later found to be infected with COVID-19 are reporting with cardiac rather than respiratory symptoms, with a new study finding that 20% of COVID-19 patients who were hospitalized in Wuhan, China had evidence of heart damage that quadrupled their death rate.

Johns Hopkins University launches a convalescent plasma study of using treating COVID-19 patients with blood plasma from donors who have recovered from it, a procedure that has shown promise in the small number of cases studied.

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Ventilator experts in Southern California form the non-profit Co-Vents, which has mobilized a team and secured approved facilities to refurbish the estimated 20,000 warehoused ventilators that can be quickly returned to service. The founders have deep executive experience with Puritan-Bennett and other medical equipment vendors.

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The VA’s coronavirus response plan predicts that staffing shortages may reach 40% at the peak of the outbreak. It warns that facilities may run short of PPE, beds, ventilators, and morgue space.

New York City’s 911 system is already overwhelmed with 7,000 COVID-19 medical distress calls each day, forcing first responders – who are sent out without adequate PPE — to make the call about who to transport to crowded EDs and who to leave at home on their own. Paramedics say that 911 calls mostly involved respiratory distress or fever three weeks ago, but now those patients who were sent home from hospitals are experiencing organ failure and cardiac arrest.

PeaceHealth St. Joseph Medical Center (WA) fires a contracted ED doctor who had worked there for 17 years after he refuses to take down social media pleas for protective gear. Interestingly in a “who’s the good guy if anyone” sort of way, the compassionate doctor works for private equity-owned TeamHealth and the firing came from a not-for-profit Catholic health system that has a half-dozen executives who make more than $1 million per year.

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Verily’s Project Baseline issues a guidebook for running COVID-19  community-based testing sites under the a federally supported, state-directed program.

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Decreasing case counts allow China to close the first inpatient ward of the two temporary hospitals that it built in Wuhan to handle COVID-19 cases.

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The Army Corps of Engineers will turn Chicago’s McCormick Place convention center into a 3,000 bed COVID-19 hospital that will open by April 24.

The COVID-19 spending bill contains nearly $200 billion worth of hospital aid, to be administered by a small team at HHS that has experts worried about how efficiently and how equitably the taxpayer money will be handed out.

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A University of Washington tool projects the COVID-19 peak for each state and predicts that the national peak for hospital resource use will be April 14, with a national shortage of 49,000 beds and 14,600 ICU beds. New York’s peak resource use is expected next week on April 6, when it is predicted to experience a shortage of 35,000 hospital beds and 7,000 ICU beds. The projection says the US will see a total of 81,000 COVID-19 deaths if social distancing is continued, with the first wave of the epidemic ending by early June. My question would be whether we can trust the data that is being recorded and submitted for public use, especially given inadequate testing and patients who convalesce or die outside of hospitals. I also note that beds and ventilators are not allocated among hospitals from a central pool – regardless of the total supply in a given area, your chances of living or dying are affected by what’s inside your hospital’s four walls.

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The American Enterprise Institute think tank and former FDA Commissioner Scott Gottlieb, MD lay out a detailed plan for getting the country through the COVID-19 pandemic:

  • Phase I, where we are now, focuses on slowing the spread of coronavirus with school closings, working from home, and closing public spaces.
  • State-by-state reopening happens in Phase II, allowing normal life to resume in a phased approach with some degree of social distancing, improved public hygiene, limiting public exposure of high-risk patients (including those over 60), sending sick people home as point-of-care diagnostics make widespread testing available. People will be asked to wear non-medical face masks to reduce their risk of asymptomatic spread.
  • Phase III involves lifting distancing measures once broad surveillance is in place and COVID-19 drug treatments or a vaccine are developed.
  • Phase IV is to make sure the US isn’t as unprepared for the next infectious disease threat as it was for this one.

Florida Governor Ron DeSantis bars a reporter from a state coronavirus update after she asks for social distancing at the briefings.

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A hospital thoughtfully gives patients a handout that shows what their caregivers look like without their masks, reassuring them that they care about them even if their faces can’t show it.


Other

An article by family medicine doctor Megan Babb, DO says the COVID-19 pandemic is exposing the health system’s dirty secrets that lurk inside fancy buildings with state-of-the-art equipment. She concludes that non-doctors – healthcare administrators as profiteers or “wardens” — have controlled the healthcare narrative for too long and it is time for a takeover by “those who march in, not those who actively run out” during a crisis. She quotes anonymous doctors who report:

  • Hospital executives ordering caregivers to remove their masks when seeing patients.
  • A doctor who was placed on indefinite leave for complaining about a lack of instruction on how to separate infected and uninfected patients.
  • Hospital executives telling an ICU doctor that they are too busy to create a policy of which patients will get ventilators if there’s a shortage.
  • Hands-on clinical employees wondering why highly paid administrators aren’t missed when working from home.
  • An administrative team with no clinician members who announced that they alone will decide who gets PPE.
  • For-profit hospital administrators who said in January that money was too tight to buy PPE, but who were telling people to sell off stock because of what was coming.
  • A hospital CEO who told surgeons that no matter what the Surgeon General recommends, elective surgeries are not to be rescheduled under penalty of termination.
  • A doctor who overheard a hospital CFO telling the CEO that their bonuses would jump with higher COVID-19 insurance payments.

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PatientKeeper VP Barry Gutillig found the 150 “Coronavirus Pandemic Kits” that the company had ordered for HIMSS20 and delivered the mask and sanitizer packages to Carney Hospital (MA), the country’s first dedicated COVID-19 care center.

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Meditech Users Software Exchange cancels its 2020 MUSE Inspire Conference that was scheduled for May 26-29 at Maryland’s Gaylord National Resort & Conference Center, offering full refunds to attendees and exhibitors minus a $25 processing fee.

Several hospitals are laying off significant portions of their workforce – as much as 25% of their headcount – as their business declines while waiting for an expected COVID-19 surge.

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Sobering tweets.

Mirko and Valerio, 12-year-old twins from Sicily, entertain the world with some Coldplay during their quarantine.


Sponsor Updates

  • CI Security adds a work-from-home security policy assessment to its managed services offering.
  • GeekWire profiles the way in which University of Washington Medicine is using TransformativeMed’s Core Work Manager app to screen COVID-19 patients, monitor symptom checklists, track lab results and test status, and submit data to departments of health.
  • CarePort Health launches the COVID-19 Transitions of Care Hub as an educational resource for care teams.
  • Health Catalyst reports that multiple customer sites are already using its new COVID-19 solutions, and its open Data Operating System’s capabilities to meet evolving COVID-19 care demands.
  • Spok offers its current customers free licenses for some of its solutions during the COVID-19 crisis.
  • Redox releases its latest podcast, “COVID-19: Can Digital Health Help?”
  • StayWell partners with the American Heart Association to release a new video, “Coronavirus: What heart and stroke patients need to know.”
  • TriNetX prepares its Real-World Data Platform and global network of healthcare organizations to support COVID-19 clinical research.
  • Vocera’s Smartbadge wins the silver 2020 Edison Award in the medical communications and connectivity category.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Contact us.

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HIMSS20 Exhibitor Plans for HIMSS21

March 28, 2020 News 1 Comment

I received survey responses from 46 HIMSS20 exhibitors. Of those:

  • 16 won’t exhibit at HIMSS21.
  • 24 haven’t decided yet.
  • Four will exhibit but will spend less.
  • Two will exhibit and spend as much or more as they did for HIMSS20.

Below are excerpted comments from respondents.


After being an exhibitor since 1997, I have been questioning the value for some time. This is the straw that broke the camel’s back. I got my money back on the hotels not booked through HIMSS, but lost all my money on those booked through them. The money lost, lack of value, and lack of support from HIMSS makes me question why I should attend attend. I would love to see all the companies ban together and say “no more” to HIMSS. They can say all they want about being a not-for-profit, but they are all about the money. It would not be a great loss for the healthcare community.


We are a non-profit. The current stance is ridiculous and I am amazed at their gall to keep 100% of money for a show they cancelled. The brand damage and trust fail here is mindboggling to me. They are keeping funds for costs they didn’t incur on the backs of projects like mine. I’ve asked my project manager to organize with all of our partners to negotiate with HIMSS as a collective bargaining block.


Will we still attend even though we are boycotting as an exhibitor? Doubtful. Bring on HLTH.


How can HIMSS require exhibitors to use OnPeak for housing (to the extent of extreme penalty if we don’t) and require full pre-payment for all nights, then throw up their hands and say “we don’t object to hotels waiving cancelation policies?” Refusing to take responsibility with the specific travel company they require is deplorable. HIMSS also refusing to refund sponsorships, where they didn’t even expend any resources.


We were surprised that HIMSS didn’t offer some sort of incentive for signing up for next year. For example, they could have offered to roll over 10-20% of the booth fee. Even a small concession would have made us feel like they really understood the impact. If we were making the decision today, we would not pay big dollars for a booth in Las Vegas. Our total HIMSS conference expense – planning, marketing, travel, booth – is an eye-popping number, even more reason to rethink our strategy. I am really concerned that HIMSS will lose the small and mid-tier vendors, where much of the innovation is happening and what makes HIMSS conferences actually interesting.


We selected a smaller booth for HIMSS21 and are supposed to have a conference call with our HIMSS account rep at their request, but crickets from Chicago so far. The deposit is small enough to not force us to actually attend in Las Vegas. Depending on how HIMSS handles this situation, we may walk away from HIMSS altogether. There is no shortage of options for how we spend our marketing dollars and the ROI that HIMSS provides has been diminishing each year for the past handful of years.


We are stunned that HIMSS declined to credit monies paid for booth space for HIMSS20 to HIMSS21 as multiple organizations and conferences have done.


We committed a significant portion of our marketing budget to exhibit at HIMSS 2020 and to sponsor an event. We are told that both are non-refundable. We were also effectively threatened that if we did not book our attendees through OnPeak that we could be ejected from the conference and lose our exhibit. Like others, we originally booked independently, but switched to ensure that we did not run afoul of their policies. This means that we are now facing losing money on our prepaid hotel rooms, too. My question — are these policies applied to EVERY exhibitor or are there special deals cut for the biggest spenders? Also, why did HIMSS not have insurance in place to handle this?


We met yesterday and decided that if they don’t credit our fees, we will not be exhibiting next year.


It’s beyond outrageous that HIMSS is so badly managed that they don’t have catastrophic insurance to cover at least a partial refund of booth space. And also didn’t use their substantial negotiating leverage with OnPeak and Freeman to structure a contract that guarantees a partial refund. While HIMSS represented a good 10-15% of our 2019 leads (and 20-25% of our budget), my initial instinct is “never again.” It will be a large lift to convince us to go next year.


The chances for my company to exhibit dropped dramatically. HIMSS is a bizdev exhibition with way too many exhibitors and no proven ROI. Their decision to take our money for the 2020 exhibition that didn’t happen upsets me. We will probably skip the 2021 exhibition.


HIMSS told us the day before build-out that they were still moving forward. But come on, they knew they weren’t going forward – they were having internal discussions about how to cancel the show. It wasn’t until the next day, after our booth was built and we incurred the significant associated expenses, that they cancelled the show. And now, no refunds and no applying booth costs to 2021. I get that it will hurt them financially, but in today’s pandemic world, join the club, HIMSS.


They will not refund the sponsorship fee or move it to another option. They waited until all the booths were built. They could have at least told us prior to Freeman fees. Terrible business decision.


Shared risk, shared pain. HIMSS would do themselves considerable good by making an even modest effort to share the pain by offering some rollover credit for next year. That they have taken such a stark and corporate stance is a demonstration that this is not a member organization, it is a profit vehicle and nothing else. I’ll be in Las Vegas to visit friends and clients, but will not spend a dime with HIMSS.


With HIMSS not being willing to help exhibitors at all and Freeman not giving any refunds, we feel the risk is much higher than the reward for future HIMSS shows. It was our highest budgeted tradeshow and we will use the budget for alternative channels next year.


Taking the exhibit fees without any sort of credit was a horrible decision, valuing themselves over all others. We’ll likely just pull out.


I have already seen budget for HIMSS participation reduced by ~50%. Depending upon sales numbers, I expect to see the perceived value of HIMSS to be dramatically lower going forward. Customer feedback from our Customer Advisory Council regarding their future participation in HIMSS will have more influence.


Ridiculous that there are no refunds, so HIMSS profits from everyone’s misfortune. Inexcusable, unethical, and selfish. They’ll never see a dime of our money again.


We contract for a meeting room, not the exhibit hall. If we attend at all, we will send two or three people, not registered, but to meet clients offsite. We are also notifying Hilton corporate that since they didn’t offer a partial refund or credit that our 175 consultants won’t use any Hilton property when travel resumes. We purchased several thousand nights in 2019 and hope that an appeal to their corporate office might result in some accommodation. We would have felt slightly better if we heard that HIMSS leadership took dramatic pay cuts or are making other sacrifices to serve their members. Further, we will not pay for anyone to renew their HIMSS membership.


It’s a pity that HIMSS chose not to refund any money at all. I am thinking #NoMoreHIMSS.


There is a sense of outrage in the vendor community. We were briefed on the digital platform HIMSS is offering for “premier” vendors. More questions than answers and not clear that it will draw an audience. Will providers really spend time between now and June to visit a vendor landing page? HIMSS has made it clear their bottom line is more important than anyone that supports them. If we treated our customers the way they treated their customers, none of us would be in business. Shameful is the only word you can use to describe this arrogant move.


These are the things that really stuck with me in the aftermath of HIMSS. Poor (almost nonexistent) communication from HIMSS leading up to their decision to cancel. Freeman’s offer to refund any uninitiated services was moot since nearly everyone’s booth had already been installed (thanks for refunding that $500 cleaning fee, though!) The disjointed messages between HIMSS, OnPeak, and the hotels (they each kept pointing me to one of the others for answers). HIMSS is not a moneymaker for any of us, but always a good branding opportunity. However, this may have killed our appetite for the show moving forward.


We were already planning to stop after 15 straight years of exhibiting. The handling of the cancellation by both HIMSS and Freeman puts in the nail in the coffin. It’s probably frustration talking, but it makes me think twice about attending. HLTH may benefit from the fallout.


No refund is disappointing to say the least. We incurred additional setup costs with our exhibit firm due to the late date they decided to cancel. The least HIMSS could do is refund our fees so we can pay for the costs we incurred. This speaks volumes about HIMSS and their primary motivation. Very disappointing.


As a multi-year exhibitor with a with a corporate membership, our space for HIMSS21 was secured before the conference was cancelled. We had already planned to scale back; however, the expenses for a conference that never occurred, particularly for fully paid hotel stays, are hard to swallow. Seemingly oblivious to our losses, yet before news that we would be given no credit for what was spent, I received a contract to renew our corporate membership with the standard message “pay early for extra exhibitor points.”


It is likely we will not exhibit. I get their point, but I’m not sure I like how they worded their statement, as if they would have refunded us if they were only a for-profit. The law doesn’t prevent a not-for-profit to be flexible in contracts. They may have made us think about next year if they had offered at least some credit to next year.


We planned to make a big appearance this year because we were excited to win a KLAS category award for the first time. Instead, we lost a lot of money. Canceling it was the right call, but keeping our sponsorship money is a good reason for us to just attend instead of exhibit next year. Still waiting for our hotel rooms refund.


I get the lost fees for exhibiting. However, HIMSS taking over and controlling the hotels and losing all of those fees is excessive. If we could have made our own reservations instead of HIMSS controlling it all, we would have lost much less.


Every other event has offered to roll fees to a later date or offer a refund. It’s hard to believe the organizers would hide behind a not-for-profit status as an excuse. This is absolutely absurd for scrappy startups, for which HIMSS represents a huge investment.


The value of HIMSS materially and emotionally dropped down significantly. If we do attend, we will have a reduced presence.


Very disappointed in this decision. By not offering to at minimum apply some or all of this year’s cancelled booth investment to HIMSS21, HIMSS missed out in not only doing the right thing, but also in gaining greater likelihood that vendors will return to exhibiting at the show. I guess we can all only hope that next year returns to business as usual.


They should have refunded at least booth cost.


We will not exhibit again. We will make a decision as to whether we should attend based what the overall attendance looks to be. The exhibitor list is likely to drop significantly.


We had moved from a booth (1x) to a meeting space, which we will not be doing moving forward. We will continue to be an Emerald Sponsor, mainly for the badge and branding benefits. The money that we would have spent on a meeting room may go to smaller sponsorship, which provides badges. If we are going to buy badges, it makes sense to do a sponsorship and get some branding out of it.


News 3/27/20

March 26, 2020 News 1 Comment

Top News

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UC San Diego Health providers and researchers describe the tools they created in Epic to address COVID-19, including screening protocols, EHR templates, order panels, analytics, secure messaging, and video visit support.


HIStalk Announcements and Requests

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Three dozen companies that paid to exhibit at HIMSS20 have completed my survey to indicate their plans for exhibiting at HIMSS21. I’ll leave the survey open for another day or two, then summarize the responses — which include their detailed comments and observations — over the weekend. HIMSS20 exhibitors, please take a few seconds to jump in.

Listening: reader-recommended FKJ & Masego, who just fired up their instruments and free-styled a one-off electronic jazz composition that is pretty amazing and perfect for working from home background music. It gives me hope that while technology can enhance the creative process of talented individuals, it doesn’t have to replace it.


Webinars

None scheduled in the coming weeks. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

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Moxi hospital robot maker Diligent Robotics raises $10 million in a Series A funding round.


People

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Orlando Health names Marshall Denkinger, MD (Centura Health) to the new role of chief medical information and information technology / clinical engineering innovation officer.


Announcements and Implementations

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In Australia, Melbourne Health postpones its $75 million Epic implementation at three facilities as it focuses on treating COVID-19 patients.


Government and Politics

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A Strata Decision technology model of US health system shows that health systems will lose an average of $2,800 per COVID-19 case without an increase in Medicare reimbursement, with some of them likely to lose up to $10,000 per patient. Some of the higher cost involves nurses having to help each other with personal protective equipment, expanded room cleaning requirements, higher use of radiology procedures, and increased drug and supply costs.

The US coronavirus shutdown triggered 3.28 million new first-time unemployment claims last week, five times that of the previous highest week in 1982. A former Department of Labor chief economist say she expects 14 million Americans to lose their jobs. The number of healthcare-uninsured surely went up quite a bit in tandem.


COVID-19

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US COVID-19 deaths topped 1,000 on Thursday. Elmhurst Hospital Center (NY) had 24 deaths in 24 hours. New York EMS took 6,400 medical 911 calls on Wednesday, its highest number ever in exceeding the volume of September 11, 2001. New York State has 5,300 hospitalized patients and 1,290 ICU patients.

Epidemiologist Neil Ferguson, leader of the Imperial College London team whose grim COVID-19 projections got the attention of the UK and US governments a couple of weeks ago, issues brighter projections in which he expects that NHS will be able to cope with the expected peak of the epidemic in 2-3 weeks. His latest computer simulations — which take into account NHS’s capacity increases and restrictions on civilian movement – indicate that the country’s ICU beds will not be overwhelmed. Most remarkably, he has reduced his original UK estimate of 500,000 deaths to less than 20,000 and says that number could go much lower, adding that half of that expected total would have been older, sicker patients who would have died even without COVID-19. Ferguson had originally called for a quarantine of 18 months or more, but now says it looks like the virus spreads faster than expected, meaning that a lot of people have been infected without major issues. Ferguson was diagnosed with COVID-19 shortly after publishing the original report.

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Prisma Health (SC) receives emergency approval from the FDA to use an internally developed ventilator expansion device that allows one ventilator to be used for up to four patients. The health system has made the source code and 3-D printing specifications available for free here.

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New York Governor Andrew Cuomo says COVID-19’s strain on hospitals should be thought of in “ventilator days” given that a ventilated patient may require intubation for up to three weeks.

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Emile Bacha, MD, chief of Columbia’s cardiac, thoracic, and vascular surgery department, writes in a letter to colleagues that the hospital is struggling with being forced to ration care for pediatric cardiac surgery patients since the department has just one OR team, causing anxiety in the families of children who need surgery for septal defects a and heart valves. He says one cardiac surgeon and several cardiologists are sick with COVID-19 and that unlike long OR hours that create a positive result, the mixing of triage, ethics, and medicine is a mentally negative form of exhaustion.

The Federation of Sate Medical Boards offers free access to its physician database so that hospitals can easily verify physician credentials as they attempt to prevent staffing shortages.

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In the UK, vacuum cleaner manufacturer Dyson develops a ventilator within 10 days of being asked by Prime Minister Boris Johnson to help out. The company says the CoVent can be manufactured quickly to fulfill the government’s orders for 10,000 of the ventilators. Billionaire founder John Dyson will also donate 5,000 more units.

A Premier survey of 260 health systems conducted from March 16-20 finds that N95 respirators are their most pressing supply need, followed by hand sanitizer and surgical masks. Shortages of isolation gowns, viral swabs, and ventilators were also areas of concern.

Hospitals consider making all COVID-19 patients “do not resuscitate” regardless of family wishes because of the risk to staff who don’t have access to protective equipment.

The White House is reportedly preparing to assign each US county a color-coded COVID-19 risk status of low, medium, or high, to be optionally used by state governors in assigning or reducing mitigation measures. President Trump has said that business should return to normal in areas that haven’t had outbreaks and that it’s not necessary to perform widespread testing in those states.

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New York State seeks IT volunteers for COVID-19 technology SWAT teams, specifically looking for expertise in product management, development, hardware deployment, and data science. The state is hoping to recruit teams from tech companies, universities, non-profits, and research labs for 90-day service deployments.

A ProPublica investigative report finds that the CDC’s early response to coronavirus was chaotic and inconsistent, when it issued incomplete or conflicting guidance to public health agencies, rolled out buggy electronic questionnaires for screening airline passengers, and resorted to using Google Translate in airports due to a shortage of interpreters. A January 28 email from CDC Director Robert Redfield, MD said the virus was not spreading in the US and thus CDC concluded that the risk to the American public was low.


Other

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Cleveland Whiskey pivots to producing hand sanitizer for Cleveland Clinic.

Developers come together to create a Slack channel for physicians who are eager to share experiences and advice during the pandemic.

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Epic partners with a local childcare provider to convert the use of its former headquarters in Madison, WI to childcare space for UW Health employees. The company will also provide food services.

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The Scripps Research Translational Institute partners with health data aggregation company CareEvolution to launch an app-based study that will use health data from wearables to more quickly pinpoint the onset of viral illnesses like the flu and coronavirus.

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Bloomberg looks at the ways physicians are using social networks to share information about COVID-19, sometimes straining Facebook’s capacity to the point that its engineers have to fix click-to-join group codes.

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The Onion works best under time pressure, and in this case, it was prescient – GoFundMe’s coronavirus-related funding requests jumped 60% in a handful of days with requests from families who are unable to afford coronavirus-related hospital bills and funerals as well as those from the newly unemployed.


Sponsor Updates

  • Pivot Point Consulting names Andy Palmer director of its EHR practice.
  • Hayes Management Consulting postpones its 2020 MDaudit User Group Meeting to October 29-30 in Chicago.
  • InterSystems releases a new version of its Iris Data Platform.
  • CPSI offers users a COVID-19 Toolkit, which includes chatbots and WHO/CDC information, that it developed by QliqSoft.
  • CalvertHealth monitors coronavirus cases using Meditech’s Business and Clinical Analytics Solution.
  • Imat Solutions offers customers real-time data reporting and analytics in response to COVID-19.
  • Intelligent Medical Objects makes IMO Precision COVID-19 value sets freely available to customers.
  • Wolters Kluwer Health publishes an interactive COVID-19 search intensity map using its UpToDate clinical decision support tool.
  • Impact Advisors posts audio from a teleconference titled “Operationalizing Telehealth for COVID-19.”
  • Elsevier launches Veridata Electronic Data Capture for clinical trial research, and offers free access to help researchers studying COVID-19.
  • Nuance offers Dragon Medical users free COVID-19 documentation templates

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Contact us.

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News 3/25/20

March 24, 2020 News 3 Comments

Top News

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CMS offers exceptions and extensions for Medicare quality programs, with MIPS and MSSP reporting deadlines extended from March 31 to April 30 and no 2021 penalties for clinicians who don’t submit data. Q4 data submissions for hospital and post-acute care programs are now optional.


Reader Comments

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From Angry HIMSS Vendor: “Re: HIMSS20. I’m curious to know your thoughts and those of readers on the decision of HIMSS to not offer any refunds to vendors for booths, etc. Freeman is stating the same and many hotels have refused refunds on pre-paid rooms. HIMSS is doing a great deal of damage to their vendor relationships. As a result of this decision, we will not exhibit in Las Vegas.” My random thoughts, and readers are welcome to add theirs:

  • I doubt HIMSS has enough cash to offer exhibitor refunds. Their expenses start long before the conference and are irrecoverable, so it would be tough for them to eat that sunk cost, refund exhibitors, and then face another year before their main cash cow starts producing milk again.
  • It’s interesting that HIMSS invoked its force majeure contract clause in denying exhibitor refunds. It makes me wonder whether they have (and certainly should have had) that same clause in their own contracts with the convention center, Freeman, OnPeak, etc. to protect itself.
  • Many conferences learned the force majeure lesson after the SARS outbreak and added specific contractual language that included “commercial impracticability” instead of just “impossibility,” spelling out responsibilities in the event of travel restrictions, for example.
  • Some or maybe most cancelled conferences have refunded the registration fees of individual attendees. HIMSS instead issued a HIMSS21 credit, so those who aren’t interesting in attending that conference (or who can’t, for whatever reason) will lose their money.
  • The HIMSS conference will return to Orlando in 2022, which means HIMSS should have the leverage to insist on some kind of credit from those same Orlando hotels, the convention center, etc. It may be that such discussions are underway and maybe we will or won’t see adjustments to HIMSS22 charges as a result.
  • None of us know what kind of insurance HIMSS carries for conference-related risk and business interruption. However, a law review I read says that all four of the leading event cancellation policies now exclude coronavirus and contain no coverage for “enforced reduced attendance” that is related to flights and quarantines. However, HIMSS would have signed its policy long before the coronavirus threat, so it depends on the contractual language they use.
  • HIMSS is supposedly a member-centric non-profit, so it would be nice to see the financial picture of HIMSS20 after the dust has cleared, especially if it might get credits or refunds from its own suppliers.
  • HIMSS is within its legal rights to deny exhibitor refunds. The real question is how that decision will affect future conferences.
  • Despite the appeal of an online conference alternative and the commendably quickly created Virtual HIMSS20, most of the conference’s revenue is from the exhibit hall and most of its influence is due to networking, on-site partnership talks, vendor-customer meetings, and high-level agenda setting that just won’t work by staring at a screen. I’m not hearing much buzz about the virtual version, but then again its timing is unfortunately even worse than that of HIMSS20 since everybody is dealing with COVID-19.
  • Without the conference, what would remain of HIMSS would be a trade association, publishing, and marketing group with little to bind its diverse membership.

From Misplaced Priorities: “Re: HIMSS20. In times of crisis, you see the true character of organizations and individuals. HIMSS is showing their true character — no refunds (understandable) and no rollover of exhibitor fees (not even partial rollover), just a bland note about all of the ‘good’ they do. I will be shocked if this doesn’t end up having a huge impact on exhibition and attendance next year. They have shown what their priorities are, and those priorities don’t include the exhibitors who pay their bills.” MP had their credit card company reverse the charge, but that doesn’t always work.

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From Major Force: “Re: HIMSS20. Keeping our $40K in booth fees with no credit for HIMSS21 even though the booth rates are increasing next year. We have thousands in hotel fees that we aren’t getting back even though HIMSS forced us to book through them. HIMSS thinks they are ‘critical to the industry,’ but there’s no way that we will exhibit in the same capacity going forward. They are leaning on vendors to bail them out. A survey is in order.” Obviously the HIMSS decision not to refund or credit any part of HIMSS20 exhibitor costs is riling folks everywhere. I have created a survey for HIMSS20 exhibitors and will publish the results.

From Aldonza: “Re: sponsoring your site. We’re spending more marketing dollars on online advertising now that tradeshows are effectively gone for the first half of the year, at least. Could you help us get started?” Yes. I’ve responded offline.

From Joe: “Re: the playlist you developed for a friend. Would you share that? Since working from home, I have more time to listen to background music now.” Spotify is the worst platform ever for user privacy because it shares everything publicly, including name and listening habits. I made a new account (hopefully minus my personal info) and recreated the playlist here. The playlist is personalized for its recipient and thus is a bit all over the place, but I’m sure I’ll make more and maybe share if anyone cares. In fact, here’s one I put together this afternoon with deeper and more mellow tracks – tell me if you hear something new you like since my day could use some brightening.


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

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The HCI Group will hire 500-600 people in the next few days to staff its telephone triage service for hospitals, where it takes COVID-19 related calls from consumers and directs them to the appropriate local resource.

Thoma Bravo calls off discussions of selling Imprivata for up to $2 billion, citing market volatility. The private equity firm paid $544 million for the healthcare security vendor in September 2016 and was looking for an EBITDA multiple of up to 20-plus on Imprivata’s $100 million in revenue.


Announcements and Implementations

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CareSignal offers hospitals free use of its no-app, text message-based COVID-19 education and support program, which sends daily CDC recommendations and updates to those who subscribe via text message. OSF Healthcare is an early user.

Redox and 14 digital health companies waive subscription fees through June for their COVID-19 related technologies.

Impact Advisors posts COVID-19 related best practices from the front line, as gleaned from its customers.


COVID-19

I’m interested in how COVID-19 deaths are being counted, especially given the common comorbidities and those patients who die outside of a hospital. I assume that health systems that use Epic or Cerner are documenting their inpatient deaths consistently and can produce accurate numbers, but I don’t necessarily trust government-sponsored groups to summarize and publish them accurately since they seem overly focused on avoiding public panic. We are probably also undercounting unrelated deaths that were due to capacity issues, like heart attack, trauma, and stroke patients who aren’t treated quickly by hospitals whose ICUs are overwhelmed by COVID-19 patients.

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Doctors from a state-of-the-art hospital in wealthy Bergamo, Italy say that solutions are needed for the entire population, not just for hospitals and their inpatients. They say the world hasn’t noticed that their outbreak is out of control, with overwhelmed hospitals and caregivers, lack of ventilators and personal protective equipment, lowered standards of care, restricting ICU beds for the patients most likely to survive, ignoring other critical patients, and having case counts exploding in prisons. They also note that hospitals might be the biggest COVID-19 carrier in infecting patients and employees. They recommend:

  • Using home care and mobile clinics to free hospital beds and keep those who are infected away from others.
  • Delivering oxygen therapy, pulse oximeters, and food to those who are mildly ill and can convalesce at home.
  • Setting up broad surveillance that uses telemedicine instruments to reserve hospitals for the most serious cases.
  • Protecting caregivers with adequate protective equipment.
  • Dedicating contained hospital areas to COVID-19 patients.
  • Maintaining lockdown, as China will probably see new outbreaks with its premature relaxation of restrictive measures in trying to restart its economy.

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Seattle Coronavirus Assessment Network will study how coronavirus spreads by delivering test kits to homes and picking up the completed test for laboratory delivery. The Gates Foundation-backed program is based on a previous Seattle flu study.

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In Spain, the local government turns a Madrid ice rink into a temporary morgue as the country’s death toll soars to 2,200 and public cemeteries stop accepting bodies because employees don’t have protective gear. The Spanish military found several care homes that had been abandoned with dead and dying residents inside, vowing to take action against those who are responsible. 

India’s government imposes a 21-day lockdown on its 1.3 billion citizens with “a total ban on venturing out of your homes.”

Initial optimism over what seemed to be a leveling off of COVID-19 in Italy yesterday was dashed Tuesday as the country reported 5,200 new cases, 743 new deaths, and a crude case mortality rate of 9.8%.

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Apple adds CDC’s COVID-19 screening questionnaire to Siri, invoked by saying, “Siri, do I have coronavirus?”

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Project N95 is launched to coordinate hospital mask, gown, and ventilator needs with global manufacturer capacity.

Former FDA Commissioner Scott Gottlieb, MD says New York’s epidemic curve won’t peak for another 3-4 weeks and it is sparing nobody except perhaps those under 20. He urges the federal government to get billions of dollars in economic assistance to hospitals and to stop talking about a quick end to social distancing while the virus still rages. New York’s cases have overtaken all of Iran’s and he expects New Orleans and Florida to follow because of their lax mitigation steps.

New York will begin testing whether people with an active COVID-19 infection can benefit from being injected with plasma from others who have recovered and developed antibodies, a World War I era influenza procedure known as “convalescent plasma.” Governor Andrew Cuomo also said that the state will try rigging ventilators to support two patients given its need for at least 30,000 more ventilators within 14 days and FEMA offering 400. He also says the state needs 140,000 beds for COVID-19 patients, for which it may resort to converting college dorms and hotels. New York State’s Tuesday morning report showed 26,000 cases, 3,200 people hospitalized, 756 ICU patients in ICU, and 210 deaths.

Liberty University (VA) President Jerry Falwell, Jr. welcomes up to 5,000 students to return to their dorms after spring break and orders faculty members to report to campus even though most classes have moved online. Falwell, who has downplayed coronavirus fears and speculated that it was created by North Korea, says students are safer being together on campus and that 99% are young and don’t have conditions that place them at risk. Virginia reports 290 confirmed cases and the Department of Health has urged residents to avoid public spaces, group gatherings, and use of public transportation.

President Trump says he wants to “open this country up” within two weeks, by April 12, noting that we don’t shut the country down for flu and automobile accidents that kill more people and promising on Twitter that people will practice social distancing and that “seniors will be watched over and protected & lovingly.”

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Aledade CEO Farzad Mostashari, MD warns that independent primary care practices are struggling financially with appointment cancellations, quarantined employees, and uncertainty over payment for conducting virtual visits even as bailouts are being discussed for hospitals that are paid more for the same visit.


Privacy and Security

Hackers publish the patient information of 2,300 patients of a London medical research company that is working on clinical trials of a COVID-19 vaccine after the company refuses to pay a ransomware demand.


Other

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Consulting firm Mitre and several companies form the COVID-19 Healthcare Coalition, a data-driven effort to study community mitigation efforts, identifying people who have been exposed and need testing, and helping health systems manage staff, space, and supply chains. Participants include Amazon Web Services, Arcadia.io, Athenahealth, CommonWell, Epic, HCA, Intermountain Healthcare, LabCorp, Mayo Clinic, Microsoft, Salesforce, Rush University System for Health, and University of California Health System. The agree to participate for the benefit of the country, to share plans openly, and to work for free. Co-chairs are Mitre Chief Medical and Technology Officer Jay Schnitzer, MD, PhD and Mayo Clinic Platform President John Halamka, MD, MS.

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UCSF launches a study in which emergency medical workers will wear Oura Rings to monitor their body temperature and other vital signs, with researchers hoping to be able to use their data to see if people who are infected with COVID-19 could be identified earlier to allow self-quarantine.

The hopefully hunkered down Weird News Andy wonders if the thieves made off with toilet paper, too. Wheeling Hospital (WV) reports that two boxes of N95 masks were stolen from its corporate health department.


Sponsor Updates

  • AdvancedMD publishes a new e-guide, “Making Telemedicine Seamless for Patients and Practices.”
  • Bright.md COVID-19 screening products help save thousands of provider hours during the pandemic crisis.
  • Diameter Health publishes a multi-part series on new ONC, CMS regulations.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Contact us.

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Monday Morning Update 3/23/20

March 22, 2020 News 6 Comments

Top News

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The UK government enlists the help of healthcare and consumer technology companies to address the coronavirus pandemic.

Companies in attendance at a high-level meeting include Babylon (symptom checking chatbot) and Thriva (at-home blood tests).

Startups that have reported surges in demand for their products there include Nye (secure doctor-patient message via telephone and video), Patchwork (matching doctors with available hospital work shifts), and Pando (WhatsApp-like teamwork and collaboration).


Reader Comments

From Mark: “Re: University of Arkansas Medical Sciences. Has a web page set up specifically for their employees on quarantine. Their concern was that their staff who test positive (and they test everyone daily!) and are quarantined, will need food, meds, and goods delivered to their houses while in quarantine. Any employee can use this. So if you are working long hours and don’t have time to shop for groceries, for example, you can visit the site and make a request. Great way to support their staff in this time of need. Kudos!” We are hopefully coming to the realization that lockdowns aside, the only way some of us will survive is if our caregivers and their families make their own sacrifices to remain on the job. We’re woefully short on ventilators, but even those aren’t worth much if we don’t have experts to run them. We have to figure out how to keep hospital employees healthy, get them back to work after exposure, and support them in ways that go beyond paying them on time.

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From Freeman Victim: “Re: HIMSS20 cancellation. Freeman is not refunding anything except booth disassembly. They are billing us for furniture rental through March 11 and we received an invoice today for handling the return of our booth, which was on top of the exorbitant shipping we had already paid. The original invoices didn’t spell out the policy for HIMSS cancellation, yet new ones include a policy of charging vendors full fees for services that were nod delivered. I know cancellation hurt them, but they could do a better job sharing that instead of squeezing exhibitors for every last penny in charging for services they didn’t actually deliver. I would encourage HIMSS to crack down on this, because if the event cancellation itself doesn’t cause exhibitors to question its overall value, Freeman’s handling of it will.” I assume that every cancelled conference is creating a mass of frustration and outright anger at the costs that won’t be refunded, whether simply billed anyway (Freeman) or rolled over as an unwanted credit for future services (HIMSS). It may be a tough sell for companies to sign up for HIMSS, Freeman, OnPeak, etc. all over again for next year, assuming there is a next year. The monetization of every conference moment and physical attribute has always seemed wildly excessive to me, so perhaps conferences — like other aspects of our economy and personal lives — will change positively following an unwelcome but necessary recalibration.


HIStalk Announcements and Requests

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The health system employers of respondents to last week’s poll are responding to expected overwhelming demand by reducing non-COVID-19 services and making physical changes to their facilities. Those who are delaying system implementations and upgrades are matched by those who are looking for new technologies to improve their services, with use of health IT consulting not changing. Readers also say they are ramping up telehealth capabilities and searching for workforce management tools.

New poll to your right or here: Which leaders are doing a good job in responding to the COVID-19 outbreak?

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Readers asked about Providence St. Joseph Health making MacGyver-like provider face shields from components foraged from local craft and office supply stores (the need to do so, while shameful, is out of scope for this mention). Providence has published instructions for creating face shields and a video showing volunteers how to sew face masks from Providence-supplied kits.

I’m being overwhelmed with companies that want me to mention their COVID-19 related technology rollouts. I will do so if: (a) the offering is free, seems broadly useful, and has limited strings attached; and (b) it can work for everybody and not just existing users of other company products. Enhancing an existing product is of interest only to current customers, and in that case, you don’t need me to notify them on your behalf.

Listening: new from Nada Surf, one of my favorite bands of all time. They’ve been playing alternative music together as an intact unit since 1990, with an easily identifiable sound that still stays fresh with each new album. I remembered the band while creating (“curating,” as the cool kids say) a multi-hour Spotify playlist for a friend who is social distancing all alone, but is preparing for a long drive to join family. She’s younger with accordingly different musical tastes and in need of something upbeat, so I chose for her Anderson .Paak, Arlissa, Birdy, Cassie, Shakira, Hinder, Leona Lewis, Radiator Hospital, Tennis, Vargas & Lagola, Alexandra Stone, and a few of my own unrelated favorites she’s never heard such as The Hives, Juliette & The Licks, and The Tragically Hip. Her playlist sits in Spotify adjacent to my unfinished work titled “HIMSS20.”


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.


Announcements and Implementations

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TransformativeMed offers Seattle-area hospitals free use of its COVID-19 / Core Work Manager. The product is already being used at UW Medicine, which says the application “is critical for our tracking of suspected and confirmed cases.” The Cerner-integrated app allows clinicians to track and segments lab tests and results, monitor symptom checklists, and submit information to the state health department.

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Experity offers urgent care clinics free use of its COVID-19 Check-in Triage app, which sends questions to scheduled patients via two-way messaging and then tells them how to proceed with their visit. Experity launched a year ago in merging Clockwise.MD, DocuTAP, and Practice Velocity.

Epic continues to update its “Managing Coronavirus Disease (COVID-19) with Epic” paper, which provides guidance on reporting capacity management, reporting nurse data and patient throughput, managing COVID-19 patients at an outpatient pharmacy, creating a training plan, and reporting on the outbreak for managers and leadership.


COVID-19

A reader comment spurred me to ponder whether the country’s haphazard public health reporting makes optimal use of data housed in the Epic and Cerner systems, which cover much of our bed capacity. It doesn’t matter when, where, or how COVID-19 testing was performed on individual patients – those systems track suspected and confirmed cases, they store the demographic and clinical information of patients, and they record the progression and outcome. Individual health systems are surely monitoring this information, but I don’t know if it’s being aggregated for review at the state and national level. We’re missing one significant denominator – the number of asymptomatic or previously infected people who didn’t seek medical attention from hospitals – but the trove of information otherwise is massive and complete.

Early CDC data analysis finds that COVID-19 hits younger people harder in the US than was seen in China and Italy. They also worry that a long incubation period means that seemingly healthy people are walking around spreading the virus before they know they are infected.

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Aunt Bertha creates FindHelp.org, which allows community members to search for and connect with personally vetted social programs such as financial assistance, food, and emergency services. Hospitals can add the information to their community resource sites. The Aunt Bertha team added 700 programs in four days and is adding hundreds each day. I interviewed founder and CEO Erine Gray a few months ago and the work they do is impressive even in normal times.

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A Kaiser Health News data analysis finds that half of the counties in the US have no ICU beds, also noting that ICU beds per older resident vary widely. Experts note that hospitals with ICU beds cluster in high-income areas where patients have private health insurance. More positively, those rural counties are often located near larger cities– if you need an ICU bed, you care more about availability and distance than whether it’s in your county or someone else’s.

Cerner updates its COVID-19 response to include mandatory employee work from home through April 30 where possible, institution of an emergency pandemic time off policy, stopping all international and non-critical travel, and a 14-day quarantine at home for employees who have traveled to a high-risk location or have been in contact with someone who has.

Vice-President Pence’s statement about waiving state licensure limitations on telehealth doctors has created confusion, Politico reports, since only states can waive those restrictions, few have done so, and the federal government’s legal authority to preempt states is not clear. The Federation of State Medical Boards maintains a list of states that have waived licensure requirements in response to COVID-19, either for in-person encounters or for telemedicine. It’s still not legal for a doctor to conduct a virtual visit for a patient who is sitting in a state where the doctor isn’t licensed unless that state has waived its requirements. It would be so much easier if licensing was based on the doctor’s state rather than the patient’s.

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Teledentistry provider SmileDirectClub, which sells plastic teeth aligners, will open its 3D printing facility for creating COVID-19 supplies, such as face shields and respirator valves. The company, whose 3D printing capacity is among the country’s largest in producing 20 million mouth molds per year on 49 HP Jet Fusion 3D printers, asks medical supply companies that need help and are willing to provide STL 3D printing files to get in touch.

Italy reports that nearly 800 people died and 6,500 new cases were reported Friday, with 5,000 deaths so far. Spain had 1,400 deaths and 3,800 new cases as its case growth tracks to exceed that of Italy. Doctors in hospitals in Spain are sedating patients over 65 and then removing their ventilators to free them up for younger patients. Meanwhile, CDC continues to report US cases only Monday through Friday.

New York-Presbyterian Hospital reports having 558 COVID-19 inpatients as of Sunday morning, 20% of them in ICU and many more likely bound for there.

Health departments in New York City and Lost Angeles advise doctors to skip testing people with mild respiratory infections for coronavirus unless the results would change the clinical management of those patients. The recommendation acknowledges a strategy that is shifting from containment to slowing the transmission.

In another change in how COVID-19 is viewed, scientists call for quick development of a serological test to determine whether someone has been exposed to coronavirus and has developed some level of immunity as a result. That information will help drive public health decisions since if people can develop immunity after exposure (nobody knows that yet), they could return to work, including to healthcare jobs.

Former FDA Commissioner Scott Gottlieb, MD says this about the COVID-19 current state:

  • The best hope of having a therapy available by summer is antibodies. As such, bulk manufacturing should be ramped in parallel just in case something is found to work, allowing rapid rollout.
  • Efforts should be focused on widespread testing (such as point-of-care testing in physician offices) and serology to help understand coronavirus epidemiology.
  • We need as a nation to define the COVID-19 endpoint and develop a plan to get there rather than taking haphazard actions without federal leadership.
  • The US is seeing much higher numbers of young people having confirmed cases, with 56% of New York City’s being under age 50.

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FDA gives emergency authorization for molecular diagnostics firm Cehpeid to start shipping a 45-minute coronavirus test that will run on its 23,000 GeneXpert systems, of which 5,000 are in the US and are capable of running hospital tests 24×7.

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An ED doctor shares her hack for using a single ventilator to support up to four patients. She warns that such use is off-label, but also notes that anything goes in a disaster.

Just a note of who to believe on Twitter: people with expertise in data visualization, statistics, journalism, or medical practice still aren’t epidemiologists. Understanding COVID-19 from a public health perspective requires specific expertise. Choose your experts wisely and avoid the armchair kind. I also note that many non-healthcare tech folks are rushing out apps that do little to help with the coronavirus response – we have ample supplies of imitative symptom checkers and tracking maps, so please channel your talents into creating something more useful.


Privacy and Security

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I got a press release from telemedicine technology and services vendor Banyan Medical Systems about a free hospital COVID-19 offering, but note to the company: Bitdefender says your website is ironically infected with a virus of a different kind (a cryxos trojan).


Other

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Stanford Health redesigns lab reports in its MyHealth portal after several students complained that their reports indicated a negative coronavirus test result, only to be notified soon afterward that they were positive for COVID-19. Stanford explains that the first results listed are for normal seasonal coronavirus, but the COVID-19 test takes longer and positive results then trigger a phone call from a nurse instead of immediate release of results to the portal. One of the students who was fooled is the daughter of UCLA Director of Clinical Informatics and pediatrician Paul Fu, MD, MPH, who is self-quarantining after experiencing COVID-19 symptoms. He says other health systems are reporting similar problems with patient communication, adding, “One of the things that we focus on when we put information out through patient portals is to empower our patients to become partners with us in delivering healthcare. The other thing is to help them understand what the data means, and that how we present the data is clear and unambiguous.” Paul isn’t happy that his COVID-19 exposure probably came from his daughter since Stanford didn’t cancel its Family Weekend on February 27-28 and then abruptly sent students home without self-quarantine instructions since testing wasn’t available.

Idiots with too much free time on their hands are “Zoombombing” public Zoom meeting in then blasting pornography to participants. The default Zoom setting is that any participant can share their screen. The company urges hosts of large public meetings to change the default so that only they can share their screen. It also recommends that private meetings be set to invitation-only with a password required. Users also suggest disabling “Join Before Host,” enabling “Co-Host” to allow others to moderate, disabling “File Transfer,” and disabling “Allow Removed Participants to Rejoin.”

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NYC Health’s guide to sex and COVID-19 suggests not having sex with anyone outside your household, noting that “you are your safest sex partner” in advocating video dating, sexting, and chat rooms. It also helpfully notes that shared keyboards and screens should be disinfected after their use for those purposes.


Sponsor Updates

  • Bluefield Regional Medical Center (WV) uses Live Process software to notify managers of updated COVID-19 communication and guidance documentation.
  • Meditech announces event changes for March and April.
  • Spok appoints Christine Cournoyer (N-of-One) to its board.
  • CompuGroup Medical sets up a dedicated website and phone line for providers to request six months of free CGM ELVI Telemedicine.
  • Experity publishes “E/M Coding for the 2019 Novel Coronavirus (COVID-19).”
  • Relatient names John Glaser to its board.
  • Vizient awards a group purchasing contract to CI Security for managed detection and response cybersecurity services.
  • ROI Healthcare Solutions creates a virtual booth after the cancellation of several conferences.
  • Impact Advisors posts a white paper titled “Keeping Your EHR Implementation  On Track Amid COVID-19.”
  • StayWell creates a COVID-19 resource hub for patients, members, and communities.
  • The Dallas Business Journal features T-System’s efforts to offer providers COVID-19 documentation resources.
  • Voalte parent company Hillrom donates $5.5 million in medical devices for critical and intensive care to 25 hospitals fighting COVID-19.
  • PerfectServe offers clients free COVID-19 automated patient and family outreach software and free services to implement best practices.
  • Wolters Kluwer Epidemiologist Mackenzie Weise appears on a special PBS “NewsNight Conversations: Coronavirus.”
  • Zynx Health publishes new COVID-19 order sets and care plans.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Contact us.

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News 3/20/20

March 19, 2020 News 7 Comments

Top News

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The American Hospital Association, American Medical Association, and American Nurses Association jump on the federal government bailout train by asking for $100 billion to offset COVID-19 diagnosis and treatment.

Hospitals say they will lose revenue from delaying elective procedures and will spend more on training, supplies, and employee childcare.

The letter to Congress didn’t mention that insurers, including the federal government in the form of Medicare and Medicaid, will pay hospitals and doctors for providing care to COVID-19 patients.


HIStalk Announcements and Requests

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I’ve added a “comments” link to the bottom of every HIStalk post, a much-requested feature that allows reading or adding comments without scrolling back up.

Unrelated, outside of social distancing: need something interesting to eat with your canned soup? I made what I will modestly call “good” baguettes that were easy (no kneading), quick, and required just flour, water, salt, and yeast. They passed Mrs. H’s test of being crusty on the outside and soft (but not spongy) in the inside. You might as well have something homey while at home and make it smell good besides.


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.


Sales

  • Nebraska Health Information Initiative selects NextGate’s enterprise master patient index.
  • The Cardiovascular Center of Puerto Rico and the Caribbean will implement Medsphere’s CareVue EHR.
  • Topeka, KS-based HIE Konza will use Diameter Health’s data normalization and enhancement software to deliver de-duplicated CCDs to its members.

People

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MDLive names Chairman Charles Jones CEO, Christopher Shirley (Catasys) CFO, and Andy Copilevitz (Walgreens) COO.

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University of Washington Medicine pathology professor Stephen Schwartz, MD, PhD died Wednesday of COVID-19.


Announcements and Implementations

Children’s Hospital of The King’s Daughters (VA) implements analytics and data management software from Dimensional Insight.

Cobre Valley Regional Medical Center (AZ) rolls out Meditech Expanse, with consulting help from Engage.

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Health Catalyst will make available COVID-19 patient and staff tracking, public health surveillance, and staff augmentation support capabilities.

Jump Technologies makes its inventory management software available to hospitals for free for a limited time.

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Dina offers COVID-19 rapid response tools, including self-assessment of quarantined patients, remote monitoring of discharged and isolated patients and healthcare workers, patient self-assessment, and checking the health of staff members daily with text-based remote screening questions. 

Blue Shield of California offers its network hospitals a customizable COVID-19 Screener and Emergency Response Assistant for consumers. Mobile device or hospital website users answer questions whose answers direct them to the most appropriate medical setting. Blue Shield is covering the cost of implementation, which takes 48 hours, and three months of updates. The tool was developed by Gyant, which offers digital front door and patient engagement technology.

Allscripts announces its COVID-19 response, which includes a fast-tracked telehealth implementation plan for FollowMy Health, rollout of an EHR-agnostic automated triage tool, and employee travel restrictions.

Registry reporting vendor Iron Bridge offers free access to system to allow hospitals and labs to report COVID-19 cases to the CDC faster.

Verge Health offers free access to its Compliance Rounding solution that helps hospitals complete the COVID-19 CMS Infection Prevention Worksheet and CDC Hospital Preparedness Assessment

CompuGroup Medical offers free provider use of CGM ELVI Telemedicine, which allows them to collect patient information, share information, and provide care from anywhere.


Government and Politics

HHS will allow physicians to practice across state lines in an effort to prevent staffing shortages during the COVID-19 pandemic.

HHS asks for $21 million in additional 2020 funding for ONC to “support the emergency expansion of a patient lookup system to aid patients and COVID-19 medical response” via an online database.


COVID-19

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Former FDA Commissioner Scott Gottlieb, MD provides thoughts on COVID-19:

  • Therapeutic response involves three efforts: developing a vaccine (which he thinks will take two years), trying existing antivirals, and developing an antibody that can be given as a monthly injection to protect frontline healthcare workers and high-risk people.
  • He expects the epidemic to peak in late April and early May, with hopes that it will have run its course by July and will leave enough people who have recovered from it to create herd immunity. His biggest fear is that it will come roaring back in September and cause another epidemic that will last all winter.
  • Point-of-care diagnostics similar to the flu swab are needed to allow doctors to quickly quarantine people who are infected instead of waiting 24-48 hours (he says that test can be developed within three months). Then roll out widespread surveillance testing to see how the virus is circulating. He says the nation’s posture is not sustainable unless such surveillance can be put in place while waiting for a vaccine to be developed.

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Former National Coordinator and Aledade founder and CEO Farzad Mostashari, MD – who has strong syndromic surveillance experience — identifies issues with COVID-19 data collection and analysis, likening the current state of testing to giving a haphazard set of people a new drug, collecting information sloppily, and then trying to use that information to determine whether it works:

  • The public health value of counting positive tests is minimal without understand each individual’s condition, their source of exposure, and how they compare to those whose tests are negative.
  • The preliminary data that is being reported to the CDC is frequently missing hospitalization status, ICU admission status, death, and age. CDC does not know the denominator of how many people have been tested.
  • Labs should be required to submit aggregate information on every test they perform, not just those with positive results.
  • Sentinel testing needs to be performed.
  • A serosurvey is needed, where a random sample of households in a large city is tested and surveyed to understand the fatality and infection rates.
  • ED visits for cough, fever, and flu-like symptoms need to be studied to determine how many are COVID-19 related.

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Bill Gates address coronavirus in a Reddit “Ask Me Anything,” where he observes about COVID-19:

  • US testing is disorganized. The federal government needs to provide a questionnaire website for consumers that prioritizes the testing, such as making sure that healthcare workers and the elderly are tested first. 
  • Labs that perform COVID-19 testing need to be connected to a national tracking system.
  • Gates and his researchers feel that the Imperial College models are too negative given that China’s shutdown reduced case numbers that showed little rebound. The Imperial College models were based on influenza.
  • He expects treatments for COVID-19 to be available before a vaccine, which would keep people out of ICUs and off ventilators. The Gates Foundation is funding research on bringing all industry capabilities into play.
  • The Foundation is working on a plan to send test kits to people at their homes to try to offset the US’s disorganized testing.
  • He expects individuals to be assigned digital certificates to show that they have recovered, or when a vaccination is available, that they have received it.

Mitre urges the federal government to take immediate action to halt the short doubling time of new COVID-19 cases in the US:

  • Close all schools.
  • Give businesses incentives for allowing working from home.
  • Shut down all places of social gathering, including restaurants, bars, theaters, concerts, and sporting events.
  • Provide home food supplies to everyone who needs them.
  • Seal the US borders to all forms of traffic and transport.

Cerner temporarily closes its Realization campus after an employee tests presumptively positive for COVID-19.  The company had already announced a work-from-home policy for most employees.

National medical group Mednax comes under fire for telling clinicians that if they require a two-week quarantine following coronavirus exposure, they must use their sick leave or PTO.

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First Affiliated Hospital of Zhejiang University and Alibaba Health publish a 60-page, detailed COVID-19 prevention and treatment handbook that accumulates information gained from China’s outbreak.

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Healthcare workers at Providence St. Joseph Health in Washington fashion face shields out of supplies from craft stores and Home Depot, including marine-grade vinyl, industrial tape, foam, and elastic. The health system is evaluating the quality of material used for surgical tray liners in case they need to repurpose them for masks.

YMCAs in Memphis, TN convert into childcare facilities for healthcare workers and first responders.

US funeral homes are asking families to scale back or postpone funeral services, limit attendees, and conduct services virtually to comply with federal guidelines that limit gatherings of more than 10 people. The funeral homes are also increasing worker protection since nobody knows now long the coronavirus can live on the tissue of the deceased.

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Pulizter-winning cartoonist Mike Luckovich of The Atlanta Journal-Constitution posted this work.


Privacy and Security

Government officials in Massachusetts warn the public, particularly seniors, of COVID-19 testing scams: “Testing can only be ordered by a treating physician. We have heard about teams in white coats going door-to-door offering virus testing. This is NOT a valid offer. What they are really interested in is robbing the elderly or stealing their identity. And we have heard reports of callers pretending to be a nurse offering test results once they get a credit card number. These kinds of calls are also not for real.”

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Several ransomware hacker groups say they will refrain from attacking healthcare organizations during the pandemic.


Other

Telehealth services are being overwhelmed with a surge in patients that is stressing their technology and their supply of physicians. Cleveland Clinic reports a fifteen-fold increase in telehealth visits and is doing phone consults and recorded video visits to try to keep up. University of Pennsylvania has increased telehealth staffing from six to 60, but is running days behind, while Jefferson Health is receiving 20 times the number of virtual visits and is scrambling to enlist more doctors.

ProPublica looks at the role medical conferences have played in spreading COVID-19.

The New York Times calls the Zoom videoconferencing service “where we work, go to school, and party these days.” People are convening virtual birthday parties and cannabis hangouts, teens are referring to themselves as “Zoomers,” college students are using it for blind dates, it’s being used for virtual college graduations, and experts worry that it will turn into a Facebook-like cesspool of live online mass shootings and child porn that will force the company to moderate content. Zoom’s soaring share price values the company at $29 billion.


Sponsor Updates

  • Kyruus incorporates Gyant’s chat-based virtual assistant into its patient-provider routing and scheduling software.
  • Intelligent Medical Objects will release free COVID-19 terminology content and value sets to customers on March 26.
  • Omni-HealthData adds enhanced social determinants of health data to its health information management software.

Blog Posts


Contacts

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Health System Frontline Reports and Tips – Coronavirus Response

March 19, 2020 News No Comments

A large Midwest health system with a medical school:

Optional daily huddle from noon to 1 p.m. Monday thru Friday. We are all working remotely and can’t walk to desks to have a conversation, but have new challenges. A dedicated time to discuss any concerns has helped many times.

Continuity of command structure. Statistics show that as much as 30% absence rates could be realized. We have been asked to document our command structure at least three levels deep.


A Boston health system:

A patient does not exist in Epic until they have a visit or a bed. With new tents being added, lobbies being bedded, and new ICU beds being planned, Epic builders and managers, physicians, and leadership are working overtime getting it all built.

The command center has been fully operational for nearly two weeks.

Telemedicine visits were built and rolled out in record time, hundreds and hundreds of them Monday.

I am not sure anyone outside of the Epic world understands how much work this takes,  but it has all come together safely with the hope of improving the health of well-being of our providers and patients. I’m sure Epic was busy themselves supporting us and all the other hospitals (and my Epic contact was working at home, btw).

Keep on keeping on. Endless time at home nowadays to work, work, work.


Small, rural health system in the Pacific Northwest:

Agility matters. Stay hyper-informed about what is going on locally and nationally. Literally try to guess what is going to happen next and keep planning for worst-case scenarios, which so far have been proven to be the case every time.

Keep it simple. A quickly deployed 60-70% solution is better than nothing at all. Suboptimal is the new normal.

Focus on telehealth. Our system has a limited number of providers who cover wide geographic areas. The fact that some of them are either infected or self-quarantined means we have to figure out how to get them to be able to have access to patients from wherever they’re located.

Expect and plan for a big support overhead with telehealth and work from home from all levels of IT. Set expectations on support levels, be transparent in how you’re prioritizing support, and be evangelical about focusing on providers and patients.

Expect all of your technology partners to be fairly overwhelmed. If you are looking for hardware, you are going to have to be creative in your sourcing. Don’t be too proud to reinstall decommissioned hardware or to move things around between environments to the most critical areas such as networking or desktop provisioning/support. Also, look to the cloud.

Stay engaged with your clinical and operational leadership. Force your way into any and all planning and response meetings, ask for a seat on all incident response teams, and continually give risk assessments and rational resource constraints.

Dust off your disaster plans and business continuity plans. They can be a great guide for remote workforce management. Keep your CISO and compliance officer close at hand. Don’t do anything stupid in your rush to facilitate what your clinical and operations leadership needs to accomplish.


We have been a user of Webex for years. Didn’t realize we had a limit of 200 users until we started doing town halls for staff. Have asked Cisco to expand to 1,000 users, which should be enough.


North Carolina health system spanning urban and rural areas:

Big investment in telehealth capability – network upgrades, training Investments in telework for non-essential personnel. Dashboards to track cases in house, pending tests, supply projections, vent availability.


Bay Area system:

It’s a strange mix of prepared process and optimistic feeling. We’re doing everything right – ramping up work from home, limiting visitor access, etc. But there’s still a general business-as-usual vibe from everyone that feels almost a little surreal for me. I get that it’s a lot better than blind panic, but it still makes me wonder how well everyone is going to mentally adjust in a few days when it gets really bad. Still, I’m happy to be somewhere that started taking precautions very early.

This is not the time to be particular about work from home. Everyone who can should, with as little “proving” and red tape as possible. Just do it! Maybe people will be less productive — there’s a pandemic on, that’s what happens. For essentials who need to be in, try to at least spread out the load so the density is lessened.

Make sure you know what your reporting looks like when you exceed bed capacity NOW, instead of learning as it happens. Be prepared for helpdesk to be a pinch poin, and try to find ways to lessen their burden by socializing fixes to common problems.


National hospital system:

This past weekend, we conducted an IT checkout process for 300+ employees to ensure staff who we are sending home were well prepared. Lots of them were familiar with email access, but less so with a soft phone Avaya routing of their desktop phone to their computer (avoids using a second port off your switch when forwarding phones directly) and various other IT tips. This avoided a flood of calls to the IT help desk, letting us take calls from our hospitals as normal.

From a cleaning perspective, we are just now purchasing relatively inexpensive dry hydrogen peroxide cleaning devices that can clean airborne and surface viruses and other contaminants. This should allow us to have increased safety in rooms vacated by patients positive with the virus.


News 3/18/20

March 17, 2020 News 1 Comment

Top News

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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

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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.

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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

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LOINC publishes codes for COVID-19 lab testing.

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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.

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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

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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

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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.

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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

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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.

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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.

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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.

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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


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What Are Your Health System’s Coronavirus Reports and Tips?

March 16, 2020 News No Comments

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The US healthcare system is reacting to the coronavirus threat. For those who work in health systems, what have you learned, what IT advice can you share, and what are you seeing from the front lines?

Monday Morning Update 3/16/20

March 15, 2020 News 27 Comments

Top News

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The American Medical Association creates a CPT 2021 code for the SARS-CoV-2 novel coronavirus, which will allow tracking of cases. The code is available for immediate use.

AMA has also published “A Physician’s Guide to COVID-19.”

CDC and AMA have published a video interview with a highly cited physician who heads a hospital’s anesthesia and ICU departments in northern Italy. The interview calls out the death rate they have seen in Italy, which is minimal for younger people, but jumps to 8% for those aged 60-69, 34% for those 70-79, 44% for 80-89, and a likely statistical aberration of just 9.3% for those patients over 90. The doctor’s takeaway message is to increase ICU and ventilator beds now.


Reader Comments

From Beyond the Pale: “Re: Epic’s announcement to employees. Here’s the full text. Epic’s failure to invest appropriately in collaboration tools and its reliance on physical proximity positions them poorly to work from home. I worked several years for Epic in a leadership role, where I ardently defended them, but this is disappointing to see.” The email says those employees who can report to work on campus should do so. If that isn’t possible, then work from home is allowed for the two weeks starting Monday, March 16, but customer issues, project readiness meetings, or internal meetings may require coming to campus. The message seems mixed – you can work from home if you can’t come to campus, but you might have to come to campus anyway.

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From Joyous Boys: “Re: COVID-19. I would like to see you include more news about it that isn’t necessarily health IT specific.” Jenn told me she thinks it is a bit tone-deaf to stay in our non-COVID lane when we are pretty good at extracting truly insightful or newsworthy items. My counterpoint is that even though we stay on top of COVID-19 news that we could summarize efficiently, that kind of information is amply available elsewhere. I will let readers decide what if any changes are needed with a poll. HIStalk readership is high lately, so it’s good for me to understand what people are looking for. But as my life’s motto explains, I’m not looking for extra work.

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From Top Gun: “Re: HIMSS20. HIMSS was to let us know in 14 days about hotel and registration refunds. My team made reservations through the HIMSS site, so I didn’t do anything while I waited to hear. Since then, HIMSS updated its FAQ to say – without notifying anyone – that it’s up to individual hotels whether to offer refunds. Now that we’ve waited, hotels won’t refund anyone, and registration has rolled over to HIMSS21. What if we can’t go or won’t have as many attendees? I want my money back. I already swallowed flight costs for several people, and now I have to swallow hotel and registration as well? Anyone else mentioned this? I’m considering protesting the charges on my credit card.” Above are the original and current versions of that FAQ. I don’t quite get the “14 working days” (why 2.8 weeks?), but HIMSS said in the original item that “an advisement will be sent” and the replacement wording says only that HIMSS won’t object if the hotel wants to refund your payment and the hotel should be called as soon as possible. You could protest the charges (hint: say “billing error”) and the charge will probably be reversed, but that will last only until the credit card folks contact OnPeak, which will claim it did everything correctly and get the charge reinstated. If you didn’t have travel insurance that covers cancellation, you may be out of luck, even if you’re contemplating suing since there’s probably a force majeure clause hiding somewhere. At least non-exhibitor attendees had a theoretical but heavily discouraged option to book lodging on their own – the HIMSS exhibitor contract requires them to pay for two OnPeak rooms per 100 square feet of booth space.


HIStalk Announcements and Requests

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It’s a bit surprising that one-third of poll respondents – presumably healthcare people — are making no effort to avoid crowds and unnecessary travel, but I’ll generously assume that early voters from a week ago – or about a year in COVID-19 news – have since changed their practices to those of the majority. Or perhaps low-risk people, those who are blessed with youth and vigorous immune systems, don’t understand that such restrictions are intended to prevent them from inadvertently killing Grandpa or Grandma by introducing them to their microorganism tenants. 

I can’t even comprehend that I should be fresh off a return from a HIMSS20 trip right about now. The conference was cancelled just 10 days ago as I write this, but it seems like it’s been a couple of months. Meanwhile, interest in our webinars has picked up as an alternative to the HIMSS that never was, so ask Lorre nicely and she will extend her previously offered webinar discount.

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New poll to your right or here, for health system employees: what strategies have changed with COVID-19?

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We ran a mention last week from the local paper that United Community & Family Services (CT) was moving to Epic from Greenway Health’s Prime Suite, which the paper said was necessary because Prime Suite is being discontinued. That article was incorrect, as Greenway very kindly let me know – Greenway is still investing in the development of Prime Suite and has no plans to discontinue it. Prime Suite had 48 software releases in 2019 and last year saw the introduction of Prime Suite Reporting 2019 and Prime Suite v18.00.01.00. Thanks to Greenway for just alerting me nicely instead of going nuclear with indignation for assuming the local reporting to be accurate.

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I ran accidentally across a HIStalkapalooza video that recalled happier times when industry folks danced the night away, complete with fleeting thoughts that maybe I should do a scaled-back version at HIMSS21, assuming we emerge on the other side of COVID-19 and will need cheering up. Year-by-year highlights:

  • 2008, Orlando. A reception for 200 attendees in what was then the Peabody Hotel, with some outstanding food in an upscale setting. I was worried that nobody would want to attend, and figuring I should offer some kind of stage presentation, I quickly threw together the first HISsies voting to fill time.
  • 2009, Chicago. Trump Tower failed us a bit in being so expensive that we had to limit attendance, food cost was ridiculous so we could offer only a few passed snacks, and they neglected to provide a decent stage and sound system and thus few attendees could see or hear Jonathan Bush present the HISsies. But the view was fantastic and the attendees were fun.
  • 2010, Atlanta. We took over Max Lager’s pub, a bagpiper played outside, Judy Faulkner wore the “No Pie for Me” sash that I ordered to celebrate Neal Patterson’s pie-in-the-face HISsies win, Ross Martin did his “Meaningful Yoose Rap” live, and JB turned his allotted five minutes to present the HISsies into a long, crazy stage show on a day when ATHN shares had tanked.
  • 2011, Orlando. I first used the term “HIStalkapalooza” that year at BB King’s. JB did the awards again and we had a blues band.
  • 2012, Las Vegas. This is still my favorite because ESD sponsored the event and Brittanie Begeman was delightful to work with. We had last-minute panic when the venue we had booked closed its doors for good, leaving us to scramble to find a new place in First Food & Bar in the The Shops at the Palazzo (which is also closed now). See how many faces you recognize from the excellent video highlights reel. We had roses for the ladies, a DJ, the usual stage antics with JB as he drank a family-sized beer, two Elvis impersonators (a pro and Ross Martin as dueling Elvi), and probably the best food and drinks of any of the events. I watch that video every few weeks.
  • 2013, New Orleans. We headed to Rock ‘n’ Bowl, Ross and Kym Martin performed, JB’s performance was as wild as his shirt, we had a big-name zydeco band playing, and we ended with a bowling tournament. Video.
  • 2014, Orlando. Buses took folks to the House of Blues at Downtown Disney, we had the amazing Party on the Moon playing, and several entertainment booths were doing caricatures, magic tricks, and other fun stuff. Video.
  • 2015, Chicago. This was the first time we did the event on our own without allowing a single company to pay and thus call the shots to some degree. House of Blues Chicago was the best venue we’ve used with its opera boxes and lofty interior views. Party on the Moon was predictably outstanding and Judy Faulkner and Jonathan Bush presented each other with awards. Video.
  • 2016, Las Vegas. House of Blues hosted, JB did his Donald Trump imitation, and the band played on. Video.
  • 2017, Orlando. We ended the 10-year HIStalkapalooza run at House of Blues, whose box office got calls all week from folks thinking they could buy tickets and then trying to crash during the event when they heard the band rocking from outside. Party on the Moon, who loves our crowd, captured the final moment in the photo above as their set reached an explosive finish over the filled dance floor and the confetti blasted for the final time. Video.

Listening: new from reader-recommended Tame Impala. It’s a man rather than a band, following the modern configuration of one multi-instrumentalist guy recording the music tracks on his computer, making no money even with popularity since streaming pays next to nothing, and then grabbing some pick-up musicians to cash in by touring. He/they headlined Coachella last year with their brand of psychedelic music. I’m not sure how I feel about music being composed in computer-enhanced solitude since that sounds kind of deliberate and cold, but I like this OK and at least it doesn’t involve the “we’re a band” model of creativity by committee that usually isn’t sustainable.

The pandemic will get worse before it gets better, but imagine how it would be without the Internet and the ability it provides to to work from home, see patients remotely, inform the public, stash stay-at-home kids in front of streamed cartoons, and stay current on scientific developments. It has often brought out the worst in people (or perhaps just the worst of people), but let’s give some credit to Sir Tim Berners-Lee for inventing the World Wide Web in late 1990 that is benefitting the entire world now more than ever.


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

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WebMD Health acquires Merck subsidiary The StayWell Company, which offers employee well-being, patient education, and patient engagement platforms.


Announcements and Implementations

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QliqSoft releases a white-labeled COVID-19 patient screening and education tool package for hospitals that will need to manage an expected surge of patients.

A Black Book survey finds that EHR interoperability remains a challenge for hospital network physician practices, half of hospitals aren’t using outside patient information, and some hospitals are waiting for their current vendors to release solutions before buying anything new.

Another Black Book survey of 3,000 hospital nurses finds that their nearly universal dissatisfaction with EHRs in 2014 has swung to the positive. Nurses say that a hospital’s choice of EHR is among their top three criteria for deciding where to work, and nearly all of them say that EHR expertise is a highly sought employment skill. The hospital nurses ranked Meditech as the #1 EHR for nurse functionality and usability.

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DocClocker pitches its patient wait time app, saying it cuts down on potentially infectious patient waiting room time and allows them to make short-notice appointments for available slots. The company also offers a version for families waiting for OR updates, publishes current and average provider wait times, collects user reviews, and sends notifications of appointments and delays. 


Privacy and Security

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CI Security polled security experts to come up with a list of items to help control security risks for healthcare workers who are telecommuting. It includes a work-from-home security assessment questionnaire. I was thinking as I read this that it would be awful to send employees home to prevent spread of a virus only to be hit hard with the computer kind as a result.


Other

Health systems are using technology to conserve resources that will be needed for treating COVID-19 patients:

  • Online questionnaires and chatbots to allow people to determine if they may have coronavirus infection, which helps keep the “worried well” from showing up for testing and treatment.
  • Virtual visits.
  • Thermometers and pulse oximeters for symptomatic patients to take home, with daily follow-up.
  • Videoconferencing and messaging systems to help coordinate efforts and for consulting with other facilities.

The CEO of a South Korea technology company says the country’s success in beating back coronavirus has been aided by the use of big data and AI:

  • The government’s platform stores the information of citizens and resident foreign nationals, integrates all government services with that system, and populates other AI-based apps.
  • A positive COVID-19 test sends notifications to everyone in the area with that person’s travel details, activities, and commute maps for the previous two weeks.
  • Government-run health services are notified of the person’s contracts to allow tracking and testing.
  • The country has offered drive-through COVID-19 testing for weeks. It has performed 250,000 tests versus just 22,000 in the US, at a rate of nearly 5,000 tests per million people there versus 65 here. 
  • The drive-through labs are powered by 5G, and drivers are notified of the nearest testing location.
  • When someone who lives or works in a large building tests positive, the government sets up temporary medical centers to test everyone.
  • Distribution of masks and other supplies is managed via AI-based regulation. Residents can buy two masks at a time using their ID cards. Price gouging has not occurred.
  • The government is running all offices digitally, with employees working from home. 

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New York looks at a potential COVID-19 care demands for 170,000 hospital beds versus the 53,000 total and 19,000 available in the state, with Governor Andrew Cuomo saying that patients may need to be moved from the high-concentration lower part of the state to other areas. He is asking retired medical professionals to contact their old hospitals to see if they can help and deploying National Guard medics and medical students to pitch in. The Department of Health will monitor available beds, ventilator beds, and isolation units as well as ED activity.

I give this editorial recommendation a good chance of happening. A medical student and a physician epidemiologist urge the federal government to create a military-operated healthcare system for coronavirus to take the load off hospitals that are likely to be overwhelmed. They recommend that the US Public Health Service oversee the operation of setting up COVID-19 diagnosis and treatment centers outside of city centers, but easily accessible to them. The advantages are that the US military is very good at training and deploying people rapidly and they could oversee unused medical resources such as retired physicians and nurses, residents, and laypeople who could be quickly trained similar to emergency medical technicians. Such facilities could also innovate technology to provide ventilator support, which has been the most precious commodity worldwide.


Sponsor Updates

  • ACG Utah presents Health Catalyst with its 2019 Deal Maker of the Year Award.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, announces a reseller agreement with AlertWatch to distribute their maternal safety system.
  • PatientPing launches an educational website dedicated to CMS’s interoperability and patient access rule.
  • Pivot Point Consulting creates a checklist of key considerations for COVID-10 preparation and offers phone appointments to assist organizations with planning and configuration.
  • QliqSoft launches a COVID-19 virtual patient communication kit.
  • The CEO Forum Group features Waystar CEO Matt Hawkins in a radio interview.
  • Wolters Kluwer Health offers coronavirus tools and resources for clinicians and medical researchers.

Blog Posts


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Epic Cancels XGM 2020

March 13, 2020 News 2 Comments

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Epic cancels its Experts Group Meeting (XGM) 2020, which was expected to draw 9,000 attendees to Epic’s Verona, WI campus April 27 – May 8.

Epic is further responding to COVID-19 by:

  • Allowing employees to cancel or postpone non-essential business travel.
  • Expanding sick leave and work from home policies for employees who are experiencing symptoms or have elevated risk of complications.
  • Conducting large internal meetings virtually.
  • Offering users virtual options for training classes.
  • Serving food from campus cafeterias in individual to-go containers to prevent lines and modifying seating to reduce large gatherings in cafeterias.

Epic said in a statement, “We will miss seeing our guests at XGM this year, and are saddened that this change will impact the businesses in our community that help welcome and host the 9,000 guests who come to XGM. However, we felt that this decision was necessary to help slow the spread of COVID-19.”

News 3/13/20

March 12, 2020 News 4 Comments

Top News

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A New York Times article says the use of telemedicine in COVID-19 screening and treatment is increasing.

Use of virtual visits keeps people out of the ED or medical practice waiting rooms who are either exhibiting symptoms or who are susceptible to infection.

Upfront triage also minimizes the exposure of healthcare workers and the quarantine that would result.

NYU Langone Health is encouraging its self-quarantined doctors to continue their work by offering virtual visits, while Intermountain Healthcare is considering delivering virtual care for patients who have COVID-19 and chronic medical conditions and can be safely treated at home in avoiding the exposure of traveling nurses who could spread the infection.


Reader Comments

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From Andre: “Re: COVID-19. Our pediatrician’s practice has temporarily disabled appointment checking via MyChart, apparently since adding screening questions isn’t easy.” It will be a struggle to convince practices and their patients that medical office visits create risk for staff and fellow patients. This particular practice also invites patients to call in when they arrive in the parking lot, then wait for a call back to proceed directly to the exam room to avoid potential waiting room exposure.

From Jeebo: “Re: MIPS filing deadline. Have you heard anything about possible extensions?” I haven’t, but I don’t follow it as thoroughly as Dr. Jayne and others, so I will invite reader comments.

From Mitchell: “Re: Loews Hotels. Has decided not to give any refunds for HIMSS20. Seems like they are the only ones.”

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From Airman: Re: travel. Dulles is a graveyard, all international flights cancelled and business travelers on the sideline. The hotel was one-third full, restaurants were empty. It feels like 9/11 60 days out. We are headed for a major recession from what I have seen. I took this photo at 4:40 p.m., probably the busiest time of day under normal circumstances.” Layoffs have already started in all travel-dependent sectors and I’m sure restaurants and retail businesses will take a major hit as people stay home. The compound effect that in our screwy US healthcare non-system, all those folks will lose their health insurance (if they were even offered it or were able to afford it in the first place) and any diagnosis and treatment they require for COVID-19 or anything else is going to strain their own finances and the system in general. We had better keep delivery drivers for Amazon and grocery delivery services healthy since they may be our most valuable lifeline. We will have learned many hard lessons once this outbreak winds down, but some of them are for the long-term good.

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From Corey Spears: “Re: ONC’s rule. Since it is waiting for final formatting, I took the liberty of creating a bookmarked version, which is much easier to navigate since there are so many internal references.” Thanks. That makes it much easier to find items other than by searching.

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From Life at Veeva: “Re: working from home. My company, Veeva, is good at accommodating remote work, but also created this video to help employees who ordinarily work in our corporate offices.” The five-minute video is packed with a lot of good information, much of it instructions for those who are new to the Zoom videoconferencing app.


HIStalk Announcements and Requests

I’m pondering whether we’ll have a future shortage of asterisks needed to explain 2020 sports records that involved shortened seasons and cancelled tournaments.


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

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Health IT and consulting company Emids announces an undisclosed investment from BlueCross BlueShield Venture Partners. The Nashville-based company was acquired by New Mountain Capital last September.

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Amazon Care considers working with the Bill & Melinda Gates Foundation to deliver COVID-19 home testing kits in Seattle. Amazon has offered to come up with a logistics plan for delivery, free of charge, so that kits can be delivered within a few hours. Nose swabs in the kits would then be mailed to the University of Washington for analysis.

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B.Well Connected Health raises $16 million in a Series A funding round, increasing its total to $27 million. The company offers employees of subscribing companies a personal health record that is connected to hospitals, pharmacies, lab companies, and insurers; a gamified health journey; and a digital wallet for health expenses. CEO Kristen Valdes founded the company in 2015 after several years at disease management company XLHealth, which was acquired by UnitedHealthcare for $2.4 billion.

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Virtual cardiovascular care management solution vendor Heartbeat Health raises $8.2 million in a Series A funding round.

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From Cerner’s investment community meeting:

  • HealthIntent clients have been migrated to Amazon Web Services and Cerner-hosted CareAware customers will be migrated by the end of the year.
  • 90% of the company’s total revenue is recurring or highly visible.
  • Cerner expects its Works business to decline as a percent of revenues.
  • Core revenue growth will decline slightly due to EHR client attrition, but that will be partially offset by global and revenue cycle.
  • The company sees opportunity in the 30% of the market that runs non-current systems, most of them hospitals of greater than 200 beds.
  • Soarian and Millennium assets will be combined to form a revenue cycle offering and will be accessible via APIs, with about 18 months remaining on the three-year project.
  • Cerner sees three markets for data: life sciences, release of information, and payers. It says the EHR data it holds for provider clients represents one of the largest data assets in the world.
  • Mass tort lawsuits that require retrieving the medical records of thousands or millions of people have resulted in Cerner signing 65 law firms as clients for its HealthHistory business, which it says grew 30-40 times its revenue in one year.
  • HealtheIntent contains data from non-Millennium environments and has the advantage of refreshing itself every 17 seconds in the cloud.
  • Regional IDNs and community hospitals can make money participating in clinical trials, which isn’t a strong suit of Epic since it has mostly academic medical center clients. 
  • The company suggested that it will make acquisitions in the real-world evidence area.
  • Cerner has not yet seen a reduction in project activity due to COVID-19 and says it’s possible that demand for its services will increase.
  • The company says it is “incredibly disappointing” to lose customers to Epic, which is why creating a client success office was important. Those customers also will continue to run Cerner’s EHR for several years and will continue to use platforms such as HealthIntent and CareAware.

People

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Medical University of South Carolina hires Mark McMath, MBA (Methodist Le Bonheur Health) as enterprise CIO for information solutions.


Announcements and Implementations

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United Community & Family Services (CT) transitions to Epic from Greenway Health’s Prime Suite.

HIE-focused nonprofit The Health Collaborative selects Omni-HealthData’s cloud and analytics solutions.


Privacy and Security

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Hackers lure employees at several unnamed companies into opening emails purportedly from Vanderbilt University Medical Center (TN) that claim to have HIV test results in an attached file, which, when opened, prompts the recipient to download malicious software. Hackers have also engineered similar phishing campaigns that prey on COVID-19 fears, referencing CDC guidelines and safety measures.

An analysis of 1.2 million Internet-connected devices in hospitals finds that 83% run on outdated software, including Windows 7 and Windows XP.


Other

An opinion piece written by two Duke informaticists says that EHRs are ill suited for the COVID-19 pandemic due to poor information presentation, complexity that causes users to delay applying much-needed updates for months, and lack of public health reporting. They recommend that hospitals:

  1. Review their business continuity plan.
  2. Prioritize clinical system patch updates and enforce change control policies.
  3. Heighten cybersecurity vigilance.
  4. Deploy mobile apps that extend EHR capability to improve productivity and to guide management of COVID-19 patients.
  5. Use scribes to increase clinician efficiency.

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England’s NHS ramps up efforts to offer more COVID-19 care through online consultations, given that only half of practices have telemedicine capabilities. The health service has also launched a care management service with digital-first capabilities for patients in self-quarantine, and has increased testing capabilities from 1,500 patients a day to 10,000.

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The local news highlights the role the Avera ECare telemedicine network is playing in caring for COVID-19 patients virtually at 190 hospitals and 66 nursing homes across the country, particularly those in rural areas. Ten additional hospitals will go live with ECare’s services in the coming weeks.

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Chilmark Research is soliciting information from companies that are offering free COVID-19 related health IT solutions.

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The Onion sets the record straight on coronavirus.


Sponsor Updates

  • Provider data management software vendor Phynd reports a record year, adding six new health system customers in Q4 2019.
  • PatientPing launches an educational website dedicated to CMS’s interoperability and patient access rule.
  • Intelligent Medical Objects releases retrospective business updates.
  • Elsevier Clinical Solutions upgrades its ProspectoRx website.
  • Optimum Healthcare IT publishes a case study titled “Decentralized Epic Go-Live Success at Scripps Health.”
  • Ensocare Business Intelligence Engineer Matt Tweedy earns the Bob Cassling Service Excellence Award from parent company CQuence Health Group.
  • EPSi Associate Consultant Zac Steele joins the 2020 Millenial Cohort of the American Enterprise Institute’s Leadership Network.
  • CloudWave makes its disaster recovery solution available on Amazon Web Services.
  • Masimo will integrate Imprivata’s medical device access authentication technology into its Root and Iris hospital automation platform.
  • DataRobot and InterSystems partner to accelerate adoption of AI in healthcare.
  • CarePort Health supports CMS’ expanded commitment to care coordination in interoperability rule.

Blog Posts


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Working from Home Tips from HIStalk Readers – Avoiding Feeling Disconnected

March 12, 2020 News No Comments

Our company uses the Google suite, so we have instant messaging. But we also have buildings in multiple states and people that work in different buildings that need to work together, so it doesn’t really matter to me if you’re in the building a town away, another state, or home.


Communicate with colleagues via MS Teams, Outlook and phone.


ideo conference, chats, texts.


Talk on the phone vs. sending an email. Once an email thread gets beyond 3-4 responses, take the conversation out of email and schedule a 15-20 minute phone conference. This will expedite problem resolution and connect you with your peers more often!


Make all of the company web meetings you can. I’m one the few who seems ok with web cam, but even without this join and talk.


My team has a group chat on Teams that is very active and we also meet frequently on webex which keeps me connected at work.


Our team does a good job of using email to communicate ongoing issues. We use this method even when in the office, since a few team members are always out of the office traveling to clients.


Lots of phone calls. Some video conferencing. My kids are grown, so I do have to make an effort to go places. I power walk every day at the end of my day, that’s solitary too. And to everyone who says work from home is less productive, this is not my experience. I closed my brick and mirror office six years ago and I often have to log in and tell my employees to log off and go do life. We only have had one who took advantage. She was fired via video, that’s was a little weird. And I had FedEx pick up her assets.


Conference calls aren’t suited well for small talk. Take 3-5 minutes at start of small calls to just check-in about life. After being remote 10+ years, I have found this to make me feel more connected, and the calls are ultimately more productive because you feel connected.


Keep Slack and Zoom online and randomly video call colleagues to check in and discuss instead of using email.


More consciously leveraged the video capabilities through webex.


Lots of phone calls! Go outside for lunch.


Enjoy the bliss of solitude!


By talking on the phone with folks. I have never been a fan of texting, I prefer a quick phone call and human voice, when possible. I also use MS Teams for chat with some of my closer team members. I also like to just call to check in and say hi once in a while, see how life is, even if I don’t need anything for work. Just like you would if in the office at a water cooler. Our team also meets for happy hour or lunch about once a quarter, sometimes more often.


It really is impossible to replace the water cooler, but you can make an effort to stay involved. If I have the time, I will more often now pick up the phone and call someone when I have a question instead of emailing because it increases the odds we will chit chat for a couple of minutes which helps me to feel more connected. Additionally, we use our cameras when we have internal meetings to help with the face to face feel. And, I schedule morning coffee with a couple of co-workers who also get to work early. Before our days start to get busy, we turn on our cameras, drink coffee, and chat like we would do in the office – mixing work and personal life into our conversations.


Conference calls scheduled at regular intervals. Avoiding breaks in between that are too small to accomplish much. I prefer a few back-to-back meetings, with larger focus blocks (an hour or longer) where I can knock out larger tasks / follow-ups without being interrupted.


I feel connected. I have trouble disconnecting from work when I am working from home. I have to leave my space and close the door to get away from work at the end of the work day in order to disconnect.


Instant Messaging. It’s up 100% of the time I’m online and helps not only with communication, but also in keeping me accountable for being at my desk instead of doing laundry, etc. Also, scheduling lunch dates with friends to get me out of the house.


We use Slack collaboration software corporate wide to ensure everyone stays connected and have some “fun” Slack rooms in addition to work focused rooms. We pay attention to who is using this tool. If someone isn’t, we find out why quickly. It’s actually a part of our quarterly reviews. We also have multiple meetings a week using video conferencing. Twice a week with the entire team. That being said, we have experienced that some folks simply do not do well long term working remotely. Managers suddenly finding themselves managing new work from home employees due to Coronavirus should be aware this can be tough for some beyond the first week, and watch for signs of disengagement.


It is difficult because you are disconnected. Setting up regular video calls with colleagues, much the same as you would at the office. allow yourself to be interrupted by calls (Zoom is particularly good for this when talking to colleagues). If you live alone, get  o the coffee shop with your laptop or pad for an hour or so each day; go for a walk; just don’t sit in the house all day every day. I also talk to myself quite a lot – but that maybe something else altogether!


Jabber/IM coworkers.


Schedule video meetings. At least one. Think of it less as a “meeting” and more of a “staying connected.” Be more deliberate about the midday, not-work time you have at work. You still need that at home, too.


Jabber, Skype, MS Teams, my phone, and email. Lots of interaction with my client and/or company.


Some tips specifically for managers/leaders. Schedule more one-on-one meetings with your team members than you would usually have – like short (10 minute) check-ins every day or every other day – to take the place of them being able to stop by your desk or stop you in the hall with a question. Even if you are “available” via Slack or email, you will need to be more proactive about communication. All the advice about “don’t just sit around in your pajamas!” goes triple for people in leadership positions. Be able (in terms of your workspace and attire) to hop on a quick video call with your team at any point throughout the day – don’t fall into the trap of waiting until a scheduled call to pull yourself together. It will help maintain a sense of normalcy if you maintain your typical level of professionalism.


Social/catch up discussions as part of the meetings, i.e. be sure to avoid diving right into the meeting agenda before some personal discussions, to establish a sense of camaraderie.


Video-conferencing and phone calls over email as communication tools.


Chat is a good way to get in quick conversations and smiles with other remote employees. We also have an awesome internal forum called Remotely Interesting, that is geared to all remote employees. Keeps people connected with pictures of pets, daily routines, thoughts of the day, and podcasts.


Get out of the house when you can. The gym is my favorite, but with the virus going around, that’s getting harder. Walking around the neighborhood helps.


This is less of an issue for introverts ;). Use chat programs for quick questions that you would normally walk over to people’s desk for. The biggest issue I’ve seen having worked from home extensively in my past is that there are a number of managers who don’t know how to manage remote employees. Managers need to set clear expectations on what work needs to get done and by when and then trust employees to do that work without micromanaging. Have a daily check-in for the department scheduled if this is something new for you (a la a stand up in the Agile Methodology). Get a good sense of what each employee’s “blockers” are that they need resolved before they can move their work forward and work on resolving those quickly. As an employee, figure out what your own blockers are first thing in the morning after figuring out what you need to do that day and voice those items to people who can help resolve them.


Review internal websites for company updates. Listen to the radio to hear another human’s voice. Call into meetings. Video can feel awkward if the other end is not doing it, but suggest it anyway.


I try to see local teammates for lunch when possible. I try to allow time for chit chat with colleagues to keep a human element alive in our interactions.


Video chat with colleagues I’m working on projects with rather than just messaging. Also, step out of the house and work from a public space or coffee shop at least once a week if you can.


Skype and call folks on site during the day. For no reason, just to say hi or how about that Netflix show. Have coffee or lunch out with anyone at least once or twice during the week.


Use the telephone and actually make calls. IM or email enhances the disconnect. My thought is if I would have talked to them in person at work I will make an actual phone call.


To not feel disconnected from colleagues, have a “webcam always on” rule for meetings. Outside of work, you have to be more deliberate about planning. If you see an event like candle making or craft beer night that interests you, reach out to friends and invite them. Set up a standing happy hour or a night once a week where you and a couple friends rotate on who cooks and hosts. If you’re really social, go to a co-working space.


It is good to try to have your team online during a similar block of time so Instant Messaging and team meetings can keep everyone connected.


I have not found that to be a problem. My company has a large percentage of WAH employees. Either via Slack, text message, phone, or conference call, I usually speak to a couple of dozen people daily. However, I recognize that I could be the exception that does not need a lot of interactions to feel connected. I also recognize that I waste less time working from home. All of the hallway, lunchroom, water cooler chit-chat is minimized making for a much more productive day of work.


Fortunately my role has me on the phone with people all day long. I also use our internal “inmail” to touch base with my team mates and other friends in the company. However I set it on busy or do not disturb for at least two sets of two hours so I’m undisturbed.


I chat other coworkers throughout the day, hold weekly meetings with team members, and interact with others via Facebook and Twitter.


Text with colleagues… send appropriate memes. When in doubt, ask if you can have a call. I don’t find that I am any more connected with a web / video meeting” vs. phone call. Also, I like to take advantage of going for a walk in the community.


Of course it depends what you job is, but email and messaging should allow you to keep up and contribute. Texting if it is a normal activity already.


Chat with colleagues – make sore to have “adult” discussions. Maybe schedule a team meeting just to touch base.


Frequent online team meetings and a direct phone application the receives and makes phone calls that appear to originate at my office. In most cases, people I interact with don’t know or realize that I’m not in my office.


Mandate that all participants in any remote meeting have their cameras on – no excuses. This makes sure everyone comes to work in as professional a manner as they would when they come to the office.


Videoconferencing for most of my calls, lots of chat messaging throughout the day. And real person-to-person interaction – run out to get lunch at least a couple days a week to see some other humans.


I don’t. I am actually more comfortable this way. But I also spend time chatting with friends and family via the phone (remember, you can still just talk to people on them!), FaceTime / Skype, and through email and text. I’ve had some friends that were doing “digital happy hour” where they would all pour a drink (or four), get on a multi-person web conference, and just hang out. I hated it and stopped, but they’ve been doing it a few times a week for years now. Seems that they enjoy it. Use the extra time in your day (you’ll have it, I promise) to come up with something relevant to your work that actually improves connection to co-workers. Something specific. I’ve never been a “status update” person on my work, but since I’ve been home, I do it every day, and so does my entire team. It’s a cool form, it opens up discussion, it has room for non-important updates, which are usually filled with anecdotes, stories, jokes, etc. to make the others feel a bit more connected. But when we share them with each other, it does provide a bit of the Monday morning water cooler like connection to my colleagues.


Email, video capabilities within MS Teams, RingCentral or webex work well too. Take a break and hit the coffee shop or telecommute from a Starbucks of DD for an hour or two.


Requesting that people turn on video for web meetings feels much more connected than voice only. Scheduling more daily video check-ins to take the place of impromptu office chats. Go for a walk in your neighborhood and work with the windows open (weather permitting) so that you have less of a feeling of being locked away in a bunker.


Working from Home Tips from HIStalk Readers – Daily Routine

March 12, 2020 News No Comments

I try to sign in early and usually don’t end up taking a formal lunch. Working from home gives you the flexibility to do a little bit of everything, so be flexible. I get up and walk around, take the dogs for a walk, get some fresh air, and then crank out a project. It is very easy to start going stir crazy, especially if you’ve been on the couch for eight hours. I wake up, take a shower, grab a snack, and start working. When I need to, I take a break, run to the store, whatever. I get all work emails / notices to my cell as well, so it gives me some freedom. As long as I can get to a computer if needed, I can take care of any tasks that are needed.


Get up about the same time as usual. Follow usual morning routine. Start work at usual time. Take my usual lunch break. Work through the afternoon but take a walk in mid-afternoon. Stop working at usual time. Do not watch TV except the 30 minute noon news during lunch.


Work like crazy from dawn until mid morning, take some time to exercise on the elliptical or treadmill or outdoors, gather some nourishment, then do some household chores. Finish the day off with a flurry from 4-9.


Always, I mean ALWAYS put on shoes and a collared shirt. Make sure you’re in the mindset to work. Sweatpants doesn’t do this.


Wake up as if you are going into the office. Take a shower, dress in halfway decent clothes ,and be “in the office” early. Take a break for lunch, as usual, and work until the time you would arrive home if you are commuting. Think of the added productivity if you reduce your “commute” from, say, 30 minutes to 30 seconds!


830-5 every day.


I start work a bit earlier when working at home due to no commute, but otherwise follow the same general patterns I do at work.


I try to follow the same daily routine as if I am working in the office.


I’ve been doing this for seven years now. I get up and take a glance at IM and email just to make sure nothing urgent popped up overnight. I get dressed and actually prepare as it I might have to leave the house. I’m not in work clothes but I do style my hair. It just mentally changes my game.


Start and end at the same time. Make it clear to family and friends you are working and not to be interrupted


Wake up early, leave the house for a workout. Then get a cup of hot tea and triage messages, get a fruit-veggie smoothie and some breakfast and start highest acuity calls for the day. Take a mid-to-late afternoon break to take a walk and get away from the desk to help with transition away from work. After an evening with the family, occasionally get back online to finish anything up for the day.


Same as work. Keep the same times. Take a few more breaks since you work for a longer period of time.


Before working remotely, I’d average around 3,000-5,000 steps from being at work. After going remote, that went down to 500. I’ve had to force myself to get up such as taking some conference calls while pacing. I’ve also taken the time I used to commute and force myself to get up at the same time and exercise.


Make sure you get up and get ready for work, put on clothes, do your hair, etc.


Most important tip: don’t get sucked into doing the dishes, making shortbread, making pickles, etc.! Unless you are a chef, the kitchen is where dreams go to die.


Get up, get the kids ready for school, they are out the door at 7:35 a.m. Then I wash my face, brush my teeth, and drink a glass of cold water. Then I check my emails, LinkedIn, HIStalk, local newspaper. Around 9 a.m. I make breakfast and get back to work. To be honest, some days are so busy that I miss lunch, but usually I make a sandwich or a Trader Joe’s frozen meal. Kids get home at 3 p.m., greet them and make snacks. Back to work until 5 p.m.-ish.


When I work from home I get to work early, trading in my commute time for work time. This allows me to get off earlier, which I love. Same as when I am in the office, I start my day with coffee and email catch-up. I try to take short breaks to walk around the house for a few minutes every couple of hours in between meetings since I naturally sit more at home than when I am in the office. Since I am not eating lunch with co-workers, I will instead use the time to either take a walk or make a phone call to a friend or family member that I have put off.


I like to exercise first thing, then shower, make a real breakfast / coffee, etc. As close to my usual non-working-from-home-routine as possible. I stay in comfortable clothes, but change out of what I would sleep in, to help with the mindset / transition to focusing on work. I like to listen to the news (NPR or podcasts) while I make/ and at my breakfast to simulate a commute / transition to focusing on my day.


Dress differently, but email first when I am at my office or at my desk. I do get up to pet the dogs routinely when I am home.


Keeping office hours is key for me so my day stays on track, but also so I can take guilt-free breaks and my friends / family know when I’m available.


We require that our home-based employees work a predictable schedule that is worked out with their manager. We have multiple interactions each day with fellow team members.


Work from home, don’t live at work. You will find that you have much more time available. Tasks take less time to complete when distractions are reduced. Try to avoid the temptation of getting directly out of bed and sitting at your desk. Try to maintain personal spaces in your time that allow for breaks. It is not unusual for me to take a complete break during the day and go and do something quite different – shopping, cooking, reading, even watching sport – for an hour or so brings you back to your work refreshed.


After morning routine of getting kids to school, come home, put a load of laundry in the washer, prep my lunch, and sign on a few minutes before 8 a.m. I use productivity timers to build in breaks during the morning where I make tea, refill my water, or change over the laundry. If the weather is nice, I take a half-hour lunch, eat, and take the dog for a quick walk. After signing back on, I work through the rest of the day, taking a few breaks along the way. When I sign off at 4:30, I make notes for the next morning and shut down, including closing the door to the office so I’m not tempted to work on something later in the evening.


Treat every day like you’re going into work. Get dressed. Shower. Eat breakfast. Fix your hair. Do not get distracted by the house stuff you couldn’t do if you were at work. This is especially going to be true if the kids get stay-at-home orders from school If you’re used to a regular commute, make sure you treat that as “not at work time.” You can use that new found time to do the other things if you want.


I set an alarm and get up the same time every day. Either go to the Y or walk outside. Take a shower and get dressed when I get back. Getting dressed is key! I eat lunch and breakfast at my desk. If I don’t go for a walk in the morning, then sometimes I will take one during the day, if weather allows. I try to leave my desk and walk around the house at least every hour.


Following “normal” work hour schedule, and avoid working at all hours, since doing so implies that you’re available 24/7 and clients/co-workers begin to expect that. The biggest disadvantage of working from home is that you can’t socialize / connect with co-workers since you’re not just running into them in the hallway. Scheduling some catch up /social chatter time is always good during the phone calls, to ensure you’re in the know about the happenings that may be taking place while you’re remote.


I wake up at 6 a.m., do yoga / meditation, shower, and dress in business casual. Although it might be tempted to wear sweats at home, I’ve found that dressing professionally really helps get me in the correct headspace for work. I go to my home workspace and log in at 8.


Morning coffee, catch up on HIStalk, plan the day and hope to stick to the agenda!


Start work as soon as you can in them morning. It’s easy to fall in the habit of lounging around. And make sure you get walks outside. I aim for once in the morning and once at lunch. It’s easy to forget taking breaks and to get up and move.


Schedule times to get up and do something besides be at your computer. It’s not cheating on work; you’ll be more productive this way.


Follow the same morning routine – exercise / shower / etc. Get dressed. Don’t try to work in your PJs. It won’t work well for you. Stop promptly at the end of your day. Since you’re in the same physical space, it’s important to have that distinction.


I am not a good example! My goal is to shower by the time my husband gets home. One thing I do is prep dinner ingredients in the late afternoon to get a break from the desk and do something for me/family. I rarely eat at my desk so that I break up the day.


I schlep to work in my jammies with coffee in hand and shower at lunch time. Leave work on time and go walk the dogs! Cook for your family. You’re home! enjoy it.


I have the same routines if home or at the office.


Grab food and water and get to my computer ~5 min before my first meeting (8:30 a.m.) After the meeting, clean up from breakfast, stretch, and do any administrivia tasks while my mind wakes up. I block off after the morning meeting until lunch for my mind intensive work because I’m more awake and less likely to be distracted. On lunch, I mute all computer notifications and step away for an hour to eat, go on a walk, and clean up a bit. Post lunch I do less mind intensive things because I can’t concentrate as well. At the end of the day, I plan out what I’ll do the next day, clean up my work area and prep it for the next day (refill humidifier, clear off desk, set out anything I know I’ll use), and then I mute notifications and put my computer away. The most important part of the routine is to make yourself unavailable outside of normal working hours. This doesn’t mean turn your phone all the way off – you need a way to contact you – but you shouldn’t be checking your email / Slack notifications / work board. Set the boundaries between work and home or you’ll always feel stressed because you’re always “on.”


Try to keep the same business hour schedule as the rest of your team / company.


Wake up at 5:00. Go to the gym. Shower, breakfast, morning news. At my desk by 8:00. Work mostly all day, with no formal lunch break. Fruit and healthy grazing through the day. Workday is finished by 4:30-5:00. The biggest lesson for me was that it is important to have your workday start and stop. If you are not precise with that, your work and personal lives can get inextricably intertwined to the detriment of others in the home.


My office is upstairs, so every morning I take my purse and coffee upstairs as if I’m mentally going to work. I work from 8 a.m.- 12 noon, take one hour for lunch and do not eat at my desk – I go downstairs. I come back up promptly at 1 p.m. and then finish out my day at ~5:30 p.m. I also turn off my email notification so I’m not distracted.


Getting ready like it is a usual day is HIGHLY RECOMMENDED. You don’t have to wear the best clothes, but look presentable. If you don’t, you run the risk of unexpected web / video conferences popping up and you are not looking the part. It also helps set a defining cadence just like you’d have in the office so you can more easily shut down when it is time.


Try to keep regimented; defined start / stop times


Get up, take a shower, get coffee and then go into “office.” Don’t plan to get other home tasks done during working hours.


Almost identical to my in-office routine, with the exception of no commute time.


Treat as normal work day. Take a lunch break or eat at your desk.


Same as you would with the office. Don’t break that routine – get up, prepare, and “go to work.” If your commute is longer, perhaps listen to the same radio show or podcast for the same time period. If it makes you feel better, dress the same, but I can honestly say this is the least regimented thing I stick to. Don’t stay in pajamas though — that will end badly for motivation.


Be disciplined – always create a to-do list and check things off as you go. This is even more important remotely than at the office.


In at 8 a.m. with coffee. Respond to priority emails first (I’m always checking email on my phone outside of work hours). Try to clean up my inbox as much as possible before jumping into calls. Before the end of the day, review what’s planned for the next day or two to make sure I’m prepped as needed. I’ve been working from home for almost 21 years and can’t imagine going back to an office.


Drop the kids off at daycare then come back and pour a cup of coffee, review my Outlook calendar and tasks for the day, catch up on the industry headlines, and then dive into work..


It’s as if I go to work each day, but my commute is a walk down the hall to a spare bedroom. I work only once I have taken care of my personal needs (shower, dress, eat, etc.). I take four complete breaks a day, including lunch. When I end my day, I formally end my day and do my best to disconnect from work, even if I am still playing on my computer. I actually invested in a ‘home’ computer so I can actually not feel compelled to log into anything when I am surfing, streaming, or gaming.


Get up and shower and dress casual but keep the same routine as if you were going to work. Don’t take calls in PJs.


Set a daily schedule of items to do. Take frequent breaks to get up, walk around, and go outside. Stick to my schedule, and when the day is done, close my computer and walk away. I try to think of my office space the same as a cubicle.


Working from Home Tips from HIStalk Readers – Software

March 12, 2020 News No Comments

Our company uses MS 365 plus a VPN for remote work. Our phone system is a ShoreTel VOIP solution. We cannot use personal systems for work.


Only that well-behaved software that can be used natively in a browser. Everything else has some idiosyncrasy. Leads to shouts of “It dropped me again.”


Whatever you use at the office. Don’t get fancy.


Skype.


Any web conference tool, favorite is Slack.


Webex works fine for meetings. ShareDrive + Teams for collaboration.


We use the same software that we use when working in the office. Only difference is a VPN connection into the office network.


We use 8×8 VOIP phones which includes IM and videoconference Internally. Externally we use GoTo products for accessing customers remotely.


Zoom is hands-down the only platform that never fails, is intuitive, and quick to get started.


My company uses Zoom for meetings. It works pretty well. We also VPN into our network.


Very enterprise specific. We use Virtual Desktops, so a remote user gets the same “computer” they have a work.


WebEx, secure text messaging,


My company recently switched to Microsoft Teams which, for me, is a must to keep in contact with my co-workers. However, it lacks some of the functionality needed for client meetings, so for those I stick with WebEx.


For our remote workforce, we use Citrix and VPN to provide remote access to all of our applications, both on premise and in the cloud. We use Okta for two-factor authentication. We use Zoom for video conferencing, and we typically supply staff with laptops and tablets with camera, audio, and some sort of headset. Those of us that use personal devices still use the same software to engage. We use Jabber for chat, but moving to a new platform for unified communications that will support mobile workers securely no matter where they are. (Dr. First Backline with RingCentral WIFI calling for clinical staff at the bedded facilities).


Slack or similar company wide collaboration software. We use Google Suite because it is easy to share / edit documents from anywhere, while still maintaining the proper permissions. And we have a Confluence based company wiki that is a key part of how we share information. We just created a Coronavirus Information page for all employees.


I use Office365 with all work files in Dropbox plus local external backup and additional cloud backup (loss of files is a disaster). The fastest bandwidth available also helps – I am fortunate to have Gigabit optical via FIOS. Meeting software is Zoom although I connect to whatever the other participants use. Most external meetings are done without video. A headset makes a huge difference.


Jabber or other instant messaging program for quick communication. Confluence for maintaining single location for file access.


Zoom. And any of the many online document collaboration systems (OneDrive or Google Docs). You have to start thinking outside the local computer and local network. Starting working on things in shared locations.


Video conference apps/software are extremely useful to feel more connected to colleagues and supervisors – I’ve used Skype, MS Teams, Zoom, and Webex, but I think Google offers something like these also.


The laptop from the client is already well outfitted. I add Toggl for timekeeping.


Zoom for meetings (less distracting in my opinion than Google meets since you can see everyone at once). If you work late, use f.lux to help your eyesight. Slack for communication (you can do a free trial).


Microsoft Office suite is my go to. Jabber for IM and phone.


Test the VPN / remote access software and web meeting software in advance of having a collaboration session. Some organizations do not have the bandwidth or licensing for all the potential remote access sessions, so be aware and have contingency plans (e.g., direct calling, call trees, sending documents in advance, use of other forms of web collaboration like Office 365). Stick with the software used by your employer that is supported and secured. You don’t want to break policy and place your company, customers, and self at risk.


The list of software I use is extensive, a blended set of local, enterprise and cloud-based applications. I also us a cobbled together unified communications system based on Microsoft.


Zoom, BlueJeans, Skype, Facetime.


Zoom – over any other web conference software.


We use MS Teams. Some of us use the video option and some of us (me and the majority of my teammates) don’t. Chrome browser.


Microsoft Teams is essential to staying connected and collaborating with my coworkers.


We use Zoom for conferences, Slack for communication, BaseCamp for project management.


Zoom and Skype for business are great for keeping in touch with your team.


Working from Home Tips from HIStalk Readers – Environment

March 12, 2020 News No Comments

Multiple monitors are essential and a quiet secluded space. Natural light is preferred, but supplemental ambient lighting can help. A good chair is helpful.


Lighting: natural light is best but use what you can so as not to diminish what you can see. Music: I find Jazz is best for a rationale rhythm.


Give yourself an office with a window if possible.


Separate desk location is key vs. working from kitchen table with lots of distractions. No music or TV…gotta focus!


Open desk area, lots of natural light.


I work at my kitchen table by a window which offers plenty of natural light. I listen to music when not on calls. I work in a hoodie when not on video sessions with clients.


A separate space dedicated for work. Be it a home office, or a temporary space setup to accommodate. I have found that working from the couch or recliner does not lead to me being as productive than working from a dedicated space.


Separate space, mutable phones if you have dogs or kids, conference calls can be challenging. But everyone usually pretty great about it. I have music streaming kind of low or NPR. something about the low murmur of other voices keeps me focused. Desk location is huge. I personally need to see outside so windows matter to me.


Create your own space in your house or apartment. A good spot is away from the kitchen!


An environment with natural light, perhaps by a window where you can see life outside. Make sure that if you’re taking video calls that you have good front-lighting and there is nothing crazy behind you; some people have desks that are extremely distracting and messy.


Set up an office-like experience. Have a desk and workstation away from traffic. Don’t sit on the couch or have the TV on. Use Webex or other conferencing software for meetings.


Know yourself. I need quiet, so I carve out dedicated space away from foot traffic and distractions. My wife also works from home and is productive with background television and radio.


Somewhere quiet at home. Having a desk at home works best. Avoid couch, kitchen table, etc.


Music is OK for some tasks, discouraged for others. For focused working, music without lyrics is best: Henri Texier is a favourite, also Pat Metheny, Herbie Hancock, Ahmad Jamal.


I have been working from home almost 100% for seven years now. Best environment for me is at my desk next to a large window. Sunlight lamp on (I live in the PNW). I don’t listen to a lot of music during the work day because I am on the phone a lot. I think a Bluetooth headset / earpiece is essential to being hands-free during those meetings.


For me, I need to be able to shut the door to eliminate distraction. I prefer to face the window so I have natural light and don’t feel so enclosed. Having two large monitors is a must. I love that my desk will convert from sitting to standing (you can get an add-on for your desk for under $200 on Amazon). I can get distracted easily so I do not keep a TV in my office and any music I play is “coffee shop” in nature on a low volume.


I need a space separate from my comfortable / living space – desk, kitchen table, etc., away from distractions and noise.


Desk location that is secluded. No printing unless necessary and a shredder if it is. Widescreen monitor helps with good lighting. Music is always an option. Alexa is my spell checker and office assistant for some things.


Natural light, classic music


We recommend that our employees have a dedicated office space that isn’t in their bedroom and where they can shut the door. A good internet connection is a requirement. We provide a special network device to provide the same level of security we have in our company office. Of course, we’ll flex on all things BUT security to meet special needs related to Coronavirus.


A dedicated space is ideal (if possible). It allows you to separate work from home in a way that helps with the routine. Natural light is really important, supplemented by high-temperature artificial light. Sound is very much a personal thing; sometimes none, sometimes podcasts, sometimes music – depending on the task at hand.


Natural light, instrumental / classical music, home office desk. No coffee shop background noise for me.


Anywhere can work: office, kitchen, coffee shop, co-work space, etc. You have to treat it like the office. Good headphones without anything playing are good at minimizing noises around you so leave them on even if you’re not “listening” to anything.


Plenty of light, facing window, a good chair, and proper ergonomics – a sit/stand desk if you can swing it.


Desk location with structured work hours, to ensure productivity. Of course it goes without saying that you need reliable internet access and appropriate hardware – laptop, phone (I prefer a non-mobile device for best sound quality), sound-controlled room, etc. with meeting- and communication-friendly software (Outlook). “Meeting friendly” convening software is desired, however, I haven’t yet discovered a good program / software, since Skype is not good quality.


A big monitor is cheap and essential. Plug a full-size keyboard into your laptop instead of the built-in version. Elbows at right angles to keep your wrists flat, which isn’t always possible on countertops or other non-desk surfaces. Make “going to work” like commuting, set an alarm, dress, be at your desk. I need a view to the outdoors to prevent cabin fever. Do your most important work first in the day. Stay out of the kitchen except at lunchtime and don’t eat at your desk – take lunch as an actual break.


Designate a room in your home for “work hours” and let any family / roommates know that this room is unavailable during these hours to avoid distraction. When I first worked from home years ago, I found that my significant other at the time expected me to manage household duties concurrent with the workday – this will NOT work, so set expectations early on.


I am fortunate to have a home office with a window and a door. Music is always on in the background, mostly smooth jazz to keep my mood smiling.


You to have a space where you can close the door. It helps keep everything separate. Also make sure situate yourself well for web meetings. A window behind you on a sunny day can make it hard for teammates to see you.


The couch, the dinner table, outside in non-direct sunlight during nice weather.


Set up a dedicated work space. Do what you can to make sure it’s ergonomically correct. You can end up with arm and back pain quickly.


Do not use overhead lighting. I only have a lamp on my desk and use a bulb that is near daylight colored. My desk is in a room that serves only as my office as to keep the stress contained. I have a window, which I highly recommend. I sit with my elbows at 90 degree angles and my forearms are supported by the arms of my chair. I have a docking station for my laptop and have two screens that sit at eye level.


Don’t work in your bedroom unless you must – the bed will be calling your name all day. If your bedroom is the best option, have a desk and make it feel like a work area. Also, plan your meals – prep them ahead if you can as if you were going to the office. You’d be surprised at what chunk of your time it takes to cook in the middle of the day.


Fortress of solitude, currently in the basement. Wired LAN connection. Gig speed internet service. Extra big monitor to extend to. 101 key keyboard a must.


When I am the only one home, I work in our open first floor as I feel I am not hiding in an office. It is nice to see the day. If there are others home with me I hide in my office room.


When I’m doing mind-heavy work, laptop plugged into two external monitors on a dedicated desk in a separate room. Music without lyrics or in another language so I don’t get distracted listening to the words. Lots of light but nothing hitting the screen that could distract me. When I’m doing other work/on meetings – plush rocking chair that has a small desk close by for food and drinks and surrounded by plants/out on the porch if it’s nice enough. The rocking helps me burn energy and stay focused when I’m on one of those meetings that I have to be on but I don’t have to do anything on.


Set a dedicated space that you can walk away from when not working. Natural light is the best and soft local radio station music helps keep you engaged while at home.


Ambient daylight, with my desk near the window. Winter is tough due to the short days and not much sunlight. No music. TV on, muted. Occasionally, talk radio is on as background noise.


I’ve been working from home for 11 years – I’ve set myself up with desk lighting rather than overhead, my stand-up desk faces a large window with a great view. I don’t do well with background music – it distracts me. I do make sure to have soft beds on my couch for my French Bulldogs to stay close! I also have a small mini refrigerator in my office and stock with water, snacks, etc. so I stay upstairs until lunch.


I use a dedicated space with a door that can be closed when I need to focus, lower the impact of noise from other areas of the house, and take a call or participate in a web meeting. A window and natural light can help one feel a little more connected to the world. Access to music can help some focus. Watching what you have in the background is important for web meetings. Using dual monitors is a productivity bonus and having the option for a standing desk is great too. With the standing desk, I prefer to have a padded standing area. Just like at work, focusing on ergonomics helps with productivity and the potential pains of your home work area (e.g., proper chair, chair height, desk / table height, foot rest, monitor height). I have a whiteboard that I can easily show from the webcam on my laptop but before I had that, I’d use the 3M sticky top flip charts (be sure your markers won’t bleed through to write on the wall, or if you’re concerned, use 4-5 layers).


Try to find a quiet, dedicated area, with good connectivity.


Separate work area from other daily activities. Try to make sure there is a caregiver for your children if they are also home – you can’t work and care for kids at same time. Make sure to turn off computer at end of day, otherwise, those “pings” from alerts are too tempting.


Dedicated home office with a good wired (not Bluetooth) headset.


Dedicated office space or kitchen table, with a window and soft music. No TV on.


Dedicated work space – not at kitchen table.


For heads-down work, quiet and secluded is best with no tv / distractions. If you have a desk, use it. If not, do not work somewhere where you commonly relax or recreate, as those habits will be picked up with work. For me, brighter is better, so natural light is always premium wherever I work. Quiet is also premium, so I where noise cancelling headphones a good chunk of my day. They also double as a Bluetooth headset.


Dedicated office – no distractions.


Office with a door. Dual monitors. I use my employer-provided iPhone and my own Apple AirPod Pros (the noise cancellation feature on the Pros is awesome) for all of my work calls. Wireless headset / earbuds are a must.


I’ve worked from home since 2014 and my best advice is to create a dedicated space for working. Ideally an office with a door so you can open it in the morning and close it in the evening, just like going to your workplace. You have to create a clear distinction between work time and personal time, and having a dedicated work space helps by creating a physical barrier.


Set up a dedicated workspace, don’t just move into a living room or kitchen. Make it a formal area in which you ‘work’ — otherwise, you may just end up being perpetually distracted. Also, consider it a commute and take the transition from home to work seriously. Take breaks. Go for a walk (alone, to maintain your distancing), do something else, stand up, the same way you’d do at an office. Fight the urge to carry your office throughout your home. Maintain your hours and normal work environment. Get a good lamp, get a good area to spread out your work. Make sure the angle of your monitor is not going to have a sun glare issue.


Sit somewhere that you can see out a window, ideally with a view where you can see people, cars, etc. going on outside. It’s easy to feel isolated when you don’t physically see any other people.


What Are Your “Working From Home” Tips?

March 11, 2020 News 11 Comments

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Many people are working from home for extended periods for the first time. If you’ve done it, what advice can you offer for those doing their jobs from home for a few weeks?

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