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How the Pandemic is Changing Consulting Work (Survey Results)

April 20, 2020 News 8 Comments

Consultants responded to three questions:

  • What kind of consulting do you offer?
  • How has the pandemic affected your work, job, or firm?
  • How do you think your work will change once the pandemic is controlled?

Healthcare IT consulting

My company is seeing large reductions in revenue due to clients putting projects on-hold due to COVID-19. Luckily not all projects have stopped so the company is still generating revenue. My company has put a thoughtful, deliberate financial plan in place to preserve our company and jobs. The hope is that we’ll be able to ramp up quickly when COVID-19 is over or controlled. Our company has been transparent about the plan and is keeping us updated. All non-essential expenses have been cut; we are taking pay cuts temporarily (which will be paid back at a later time); we are required to take PTO; company has worked with our PE firm to secure additional cash. With all that, morale remains positive. Company is doing a good job of supporting working from home and staying connected to clients, increasing company connectivity through virtual fun events, etc.

From an IT perspective, we anticipate more M&A work since there may be more distressed hospitals looking for a savior; more telehealth / virtual visit strategy and plans; assistance with financial optimization.


Third party Cerner consultant

Working remote from home instead of on site Monday-Thursday. Project I am on is on hold until after Covid-19 settles down. There still are minor maintenance items, busy work, and weekly meetings. Really not much going on. My client has all its IS staff working from home as well.

Unsure. If this goes on for the 12-18 months to develop a vaccine, could be long time before I take another flight/on site on regular basis. Management already told us to not plan any travel until late June at the earliest. Client is in a hot spot that still has increasing cases. Contract is up in five months, so expect if nothing has changed most likely will not get renewed.


Epic analyst. I’m Boost (consultant through Epic)

It’s affected the work I’m doing day-to-day, but nothing beyond that. I had a steady gig with a long-time customer already (six years while I was at Epic in Madison, and three years in Boost with them since then). I already worked from home except for go-lives. If anything, the fact that other employees at my customer are now working from home has made my job better and easier. Normally, I don’t hear the water cooler talk or get pulled in to help with little things because they have someone sitting right next to them who can do it instead, and that’s just easier than messaging me on Teams or calling me. But now that no one is sitting right next to another analyst who can help, I get looped in on a lot more. It’s been nice! Also, as one of the quicker learners on our team, I’ve been the one to jump in on a lot of the new, highly integrated stuff we need to do for COVID. And normally I don’t do anything with our Infection Control module, but in the past week I’ve learned most of the workflows and data elements and am helping to take the load off our already-overworked, single infection control analyst. People like me who can be flexible, coordiinate across applications, and learn quickly are always in high demand. I’ve found that during a crisis like this, that’s even truer.

I hope my customer increases the opportunity to work from home so that some of the benefits I’ve seen will stick around. But I think that’s unlikely — they already offered work-from-home for 1-2 days a week depending on tenure. So overall, I don’t think it will change once life is back to normal (or whatever our “new normal” will be).


Sales and marketing consulting for vendors

Some of the smaller vendors we serve are struggling due to providers asking to defer payments, so in order to protect their teams from layoffs, they’ve reduced or cancelled our consulting contracts. Others have asked for reduced but continued work, but have asked us to defer our billing until their cash flow improves.  We’re taking the opportunity to focus on value-add content we can provide to vendors. This comes in the form of sales tips, marketing tips, or training ideas for their teams. We’re also exploring other ideas for services we could offer that would allow for a reduced presence of vendor personnel in a hospital or health system.

We expect that work will pick back up eventually, but it may take some time to get back to the client volumes we’ve been accustomed to. A lot of the work we do is remote anyway and has always been on Zoom or other video conferencing platforms, so in that regard it’s been an easy transition. It’s more about revenues stabilizing for the vendors so that they have money to spend on consulting work again.


Helping practices build high-performing remote care management

Increased: initial urgent response to expanding any existing telemed across the enterprise and/or rapid adoption from scratch. Decreased: existing chronic care management and remote monitoring have been pushed to the back burner, which is understandable. But overall, remote care management as a delivery vehicle will be a paradigm shift driven by micro and macro factors.

We expect demand to increase. Thanks to COVID, the interest in remote care has been thrust into the spotlight and the toothpaste is not going back in the tube. We believe practices and enterprises will quickly expand from simple video visits to the full suite of on-going remote care & perpetual patient management. Reimbursements are already in place, MACRA / MIPS & transition to value is already in place and COVID has put a spot light on the weaknesses of traditional episodic care. Integrating remote care into healthcare delivery will be a dominate theme in the next few years of healthcare consulting. Consider these entire categories that have multiple reimbursements each: televisits, e-visits, virtual check-ins, remote chronic care management, remote physiologic monitoring, transitional care management, principal care management, behavioral health integration, collaborative care management and oncology care management.


Clinical EHR optimization

We have less business overall, and our active projects are getting delayed. Clinical leads who normally partner with us are understandably getting called to the front lines.

There is a lot of pent up demand and we are expecting a big bounce once things get back to normal. We may have to grow our team if too many delayed projects need to re-start all at the same time.


Epic OpTime

I’ve now seen more internal emails circulating referencing lower hours or rate reductions, delayed or deferred projects, and providing information on COBRA, bench time, and offboarding. So clearly developing between just last week and this week. The firm has been communicating frequently, weekly calls scheduled presently. It seems the extended timeline of COVID is leading to more affected engagements than I realized, and presently I’m one of the lucky ones (knock on wood). Relatedly, in connecting with some former clients staff, it seems they may be seeing layoffs disguised as furloughs taking place. Last time I saw something like this was at an employer during the financial crisis last decade. Using layoffs predicated on anticipating expected financial hardship to remove staff that no one previously could be bothered to do the paperwork to track performance issues and terminate (or maybe just didn’t like them). Salaries and hiring were frozen as well, so it was a bit awkward when instead of a loss they cleared a large profit. They ended up paying bonuses to staff to make up for the bypassed annual increases. Oddly enough the staff terminated into a recession with a high unemployment job market (and were frequently still unemployed months later) never were offered their positions back when they started hiring again relatively soon after.

I find rate reductions to be sticky personally, so I wonder how much more downward pressure this might create. Working at a state institution presently I can view the staff salaries for my FTE colleagues, and, combined with the benefits they receive, we are getting progressively closer to where the risk/reward of the consulting lifestyle is rather narrow. I continue to see consultants (talented ones) take FTE roles as the margin on consulting pay shrinks. I wonder who will be left willing to travel, have generally inferior benefits, and have greatly reduced job security for only an extra 20% (after reducing for the higher insurance premiums, HSA contributions to cover that high deductible plan, and at this client anyway an actual funded generous pension!).


Epic consulting

I’m getting no engagements. Health systems have suspended their EHR projects, suspended or cancelled consulting engagements, and flights aren’t available to get people on site.

I’m guessing that at some future point in time (maybe Oct/Nov) there will be a HUGE demand for skilled and experienced Epic resources. By laying off folks and terming projects in flight, Epic users have, whether they understand it or not, chosen to upset the state of their install. Post this current world, sites with Epic will need to (very quickly) make changes to ensure they are capturing all the revenue they can AND update clinical workflows and related. AND, I suspect, they will all be reviewing most of their foundational views on the industry as a whole and how to leverage technology effectively (telehealth as an example).

Epic sites have been slow to embrace the 100% remote engagements because their mid-level managers have no idea how to work in that environment. I suspect that will change very quickly. Firms all across the country have spent countless dollars on building state of the art buildings and campuses to house their workers, yet for the last x number of weeks, those same workers have been working from home and overall the work is getting done and the world has not stopped spinning.


Managed services –tier two support

My firm has lost several big clients in the past few weeks. Some have been long existing clients. So far nobody has been laid off and they are trying to make sure that does not happen. I have a certification that is not that common, so I am hopeful that will help keep me employed.

I don’t believe things will return to normal for many months after the pandemic is controlled. As internal IT staff shifts back to the normal day to day of enhancements, quarterly updates I think our services will be as much in demand as they had been.


Interim management

Consulting gig cancelled with no plan to re-engage for the next year

Organizations are looking at priorities and margins. Telehealth has greatly disrupted how care will now be delivered


Epic

We are seeing some delays of new projects, with most existing projects converting to remote.

I think more organizations will realize it’s silly to spend the money on weekly travel to get consultants onsite. Hopefully more will consider full or partial remote arrangements.


Imaging

$15K of work evaporated in early March “postponed” until midsummer, when the clients felt they would have a better grip on available budget money would be available. Now that I am seeing layoffs left right and sideways, I am not counting on anything coming through at any time. I have also had a few potential clients ask me for an outline of what I felt needed to be done for them and how I would do it and after I submitted it for review they used what I submitted as a template to have the work done internally instead. Nice

It will easily take a year for things to settle down if not longer. Contract prices are going to be negotiated like never before with the low bidder (not necessarily he best candidate) getting the job if anyone gets it.


Implementations, optimization, and go-live support

All implementations, projects and go-lives have been delayed. Most consultants have now been moved to answer phones for MyChart and Telehealth support working remote.

Assume implementations and go-lives will move forward, still requiring support from consultants.


Epic principal trainer consultant

My most recent contract wrapped up March 31, and I was planning to travel internationally for six weeks. When I realized early-March that international travel was not going to happen, I began scrambling to try to find a new contract. A couple of projects I was submitted for are on hold, one project is going to be interviewing in the next few weeks, but there have been absolutely no new leads from my recruiting network in over three weeks. I am certified in multiple modules, have 8+ years of Epic experience and 5+ years of consulting experience, so I am used to receiving many leads if I have upcoming availability.

I think that hospitals will realize that much of the onsite work that has been done in the past can be done remotely, so there will be more remote options available. I have seen the trend shift towards that in the past three years in general. I also think that it may be more difficult for hospitals to budget money for consultants to assist with upgrades and staff aug because they will be trying to make things right with the clinical staff that had to have wages cut and were laid off due to drop in rev from surgeries, etc.


Mostly IT implementation, management and business strategy on occasion

The work is not slowed down. Clients converted their project teams to full remote work, consultants included. After reassessing priorities, all my projects will continue with no more than minor schedules changes. For one project the end users in an administrative department were converted to remote and so we will provide a remote go-live.

I anticipate that clients will go back to expecting onsite consulting support, but be more open to remote support.


Imaging: Operations, Clinical and Technology Services

Our firm has adapted to largely virtual consulting, which has had a much smaller impact to the substance of interaction as well as the quality of outcome (early feedback). In addition, the lack of need for travel buffers has RADICALLY improved our team’s focus and amount of actual work completed on a daily/weekly basis. While several clients have postponed and/or reduced scope of projects, much of the ongoing work is continuing. We believe this is due to the fact that most organizations realize that the current reduction in elective procedures will become a tsunami of work once we slowly “reopen” our businesses. Many in the ambulatory setting see this time as an opportunity to achieve important, but not previously urgent, initiatives.

I believe business as usual will be different for a very long time. Social distancing will be the norm going forward until we have all types of testing in place and ultimately a vaccine. In addition, the shift in engagement is changing people’s minds about what value face-to-face actual brings in working together and collaborating.


EHR implementations

We have switched to remote-only work. A number of clients have suspended or postponed ongoing projects, as well as a few cancellations. Furloughs have begun.

I feel that there will be some resumption of projects in the three to four months following control of COVID, but the recovery by most hospitals from the financial obligations / disaster imposed by COVID will take nine to 12 months, and non-critical IT projects will be on hold until providers are more comfortable with their finances.


Epic lab

The contracts for all of the Epic consultants with my major Canadian provincial healthcare system are not being renewed. New consulting opportunities have dried up. Normally I’m constantly being contacted by consulting firms and new roles are quick to find, especially in Beaker, but it’s been very tough right now.

Back to normal, but a rough time between now and then.


Epic clinicals

My firm has had some contracts canceled or postponed, but they’ve also continued to get requests for resources. They have implemented a hiring freeze and implemented an across-the board pay cut. My work on my current contract has not changed

Not sure. My contract runs into next year, and since my work hasn’t really changed, I don’t think that it will.


Epic analyst

Stayed the same. I already consulted entirely remotely for my customer for the past couple years. Projects (non COVID-19 related) are still moving forward, though a bit slower than normal. I am a bit worried about my contract being up soon.

I can’t imagine any org will feel that on-site consultants at the analyst level are necessary on a regular basis. Especially consultants who the org has worked with in the past (with proven results and work habits). Possibly for higher level work, where face time is a bit more important.

Epic clinical / advisory consulting

I’m an independent consultant and I’ve already lost one future contract for a project that the healthcare system deemed “elective” even prior to the pandemic. I think there’s potential to be brought on in a COVID capacity due to my relationship, but with hiring freezes, it’s all the more daunting. I always try to provide value-based consulting and I have continued to do so through the pandemic, but I have found myself trying to prove my value more so during my current contract to ensure it’s not seen as expendable. I hate this behavior in consultants, but find it all the more  necessary as active implementations are halting within other spaces at my current health system. My anxiety is definitely up. I’m hearing that the health system I work at has instituted the force majeur clause for several of their IT vendors. I have a couple outstanding invoices but am taking no news as good news for now.

The run-of-the-mill Epic-certified analyst-level consultant will move to managed care or salaried positions at lower rates with the big firms. There will be a market opportunity for firms to cash in on back-to-normal type activities. I expect management consulting will win many of the larger contracts, with the Epic consulting firms scooping up the staff aug opportunities with the new, cheaper work force. There will be more open IT positions as some clinical staff will have returned to floor. Obviously more remote work and less travel. That’s a given.


Epic analyst

Personally, I have gone from 75% remote to 100% remote. They have not involved me in very much COVID-related build, and the non-COVID work has started to dry up. We have been assured that they are not planning to let us go, but I am skeptical that they will be able to keep the current number of consultants when doctors and nurses around the country are seeing layoffs and pay cuts. I know I am one of the lucky ones, but I do live in constant fear of that luck running out.

I expect to be able to return to being on-site some of the time eventually. But I also expect the client to be trying to cut costs. Travel expenses and Epic optimization projects may be easy budget cuts, so I am anticipating either my contract ending early or just not being renewed. Now that WFH has been established and the IT sky didn’t fall, I hope that clients in general will be allowing their FTEs more remote time as part of “normal life” and that will also translate to more consulting projects that are 50% or more remote. In my experience, customers who are not WFH-friendly have an issue with trusting their team to get the job done when they are not being monitored in person. Maybe now they will realize that some folks are happier and more productive when they don’t need to spend hours every day commuting and dealing with office environments. Being open to WFH can allow you to hire and retain the best workers with the skills you need, regardless of their geographical location.


Epic OpTime

So far no change in my work, but at the beginning of March, all travel was suspended for three months. I’ve started totally remote and all staff at the client are also working from home through at least May. My firm has been communicating a great deal during the pandemic and not saying much at all. We received an email addressing benefits for those whose engagement was cut short, so that isn’t a good sign. They didn’t do much for those that are finding themselves without work.

I think it’s quite likely that we’ll be seeing more remote opportunities once they have worked with staff remotely and see the cost savings.


Full practice management consulting soup to nuts, EMR specialists

Because we are not solely reliant on our EMR consulting work alone, we’ve been very busy helping private practices with their layoffs and PPP loans. In 2009 when the economy collapsed, most of my income was Centricity consulting, I had to lay off most of my staff, it was crippling. The lessons I learned from that near financial ruin: 1. Have some recurring revenue, so we resell products we were already consulting on (I used to think being a pure consultant with no financial ties was admirable, now I realize it was naive!). 2. Diversify products, don’t be a single product consultant. We consult on several and sell/support Aprima. 3. Let your best customers know what this means to your business. My larger Centricity groups did not want to lose their access to me and my team, so we worked out ways to keep working that they could afford.

Because I made the necessary changes in 2010, I think we will be pretty close to back to normal when this is over.


Epic

My client was one of the first major hot spots and I asked to stop traveling near the end of February because I was concerned. Now everyone is required to work remotely. Contract extended.

Not at all


Epic inpatient

I was brought on for a hospital implementation, and a month into the contract, I was let go. I’m lucky that I worked as a FTE for a while so I can collect unemployment. I do believe with the stimulus contractors will be able to as well. Working in the consulting space we all should have a decent nest egg as contractors end unexpectedly a lot. I’m in the process of doing house projects, selling stuff I don’t need, and hoping we get back to a “normal” in July

I think companies will shift more consulting roles to remote to help cut down on travel costs.


Epic and Cerner

Projects that had a runway for continuation with a backlog of work, such as build or testing, have continued. But all new projects have been put on hold. Once the work that is scheduled is complete, then those projects will be put on hold pending next phase.

I think it will take a while for health systems to return to normal as they assess financials and timelines for projects. The bottom line I think a lot of consultants will be on the bench for the second and third quarters.


Cerner build and training

Moved to 100% work from home/remote. Still enough work with build to sustain through end of April 2020.

Shift to more remote work


Epic upgrades

100% shut down

Slow return to work as it is unclear on how soon hospitals will allow contractors back into their physical spaces.


Epic

My contract is still on remotely, but others have been paused.

Hopefully more health systems will be open to remote work.


Safety

Most projects on hold/delay. Some remote work, but very little.

More remote work versus travel to save on costs.


IT operations, Epic and Cerner PM and clinical consulting

Working remotely the time. Doing Zoom meetings and FaceTime calls.

I’m not sure. As a clinician, we still need to physically touch patients to collect samples and administer meds / therapies / procedures. Telehealth is part of the solution, but it isn’t the complete answer. As usual, payers are lagging behind the providers.


IT strategy and project management

Clients have stopped or suspended the strategy projects all together. The project management engagements have shifted from implementation of new/upgraded technology to telehealth related projects and it is 100% remote. The work on most everything else has been suspended indefinitely, primarily due to the unknown financial situation of the organizations upon returning to “normal.”

Some of the work will return, but I believe the financial impact to healthcare is going to be very significant and longer lasting than the pandemic. Capital is going to be scarce and priorities will be on maintaining financial stability. Unfortunately that will mean fewer projects for consultants for quite some time.


EHR

I remain 50% billable working for my customer remotely, which is enough to keep my employed through my company. The other 50% of my time is spent brainstorming on how we can transform our company and offer value to our customers in the new COVID world. Implementations, upgrades etc, will pick up again and companies that can prove that that can offer value remotely will stay in the game. We are learning that we don’t need to be Monday-Thursday travelers to continue to provide value, we have to tools to be just as effective and efficient from our home offices.

I have been as efficient 100% remote as I was when I was spending $2K a week traveling on site. I think we will beef up the at home technology, Video, VPN etc. for our staff and provide customers with a cost effective, safe alternative to flying a team on site every week.


Implementations, optimization, and support with Cerner software

Project on hold, most consultants furloughed. Some were asked to stay at reduced hours.

Unsure. Most but not all things can be done remotely from home.


Large EHR implementations

Nearly all projects have slowed / suspended, delayed, some cancelled. Furloughs for employees imminent.

Remote work will continue with travel at half pre-covid levels. Existing projects will be restructured due to budget impacts and new projects will take longer to approve


Epic application analyst

Currently unemployed

Have had multiple interviews from local hospitals/IDNs prior to pandemic. No follow-up calls / meetings scheduled at this point as hiring activity has stalled.


Healthcare IT management consulting

HIT consulting has already been down for the past two years given the disillusionment with the EHR investment and deteriorating health system margins. I am now on a project helping a clinical trial data management company develop AI use cases.

I don’t know. Doing work remotely is effective much of the time, but developing a deep relationship with the client still requires face-to-face time in various individual and group settings. I hope we get back to traveling and meeting as we did in pre-pandemic times but I’m not counting on it


Implementation, workflow analysis but not just for Epic

Basically, the pandemic has shut us down. We’re all working remotely, for longer hours because we’re all paranoid that if we don’t, we’ll get laid off. In the absence of consulting work, we’re doing a lot of cold calling to drum up opportunities in other areas that our firm has to offer. For example, we also offer online training that can be done remotely. This would be great for providers that are currently doing staff augmentation

I try not to think about it because it simply makes me depressed.


EMR

Delayed all projects to at least August and maybe out further. No layoffs yet

More remote work


Business and management consulting

Contracts cancelled or scope of work substantially reduced. New projects delayed.

Things will be slow to pick up. Customers will reevaluate priorities. Current project funnel will change substantially. Expect 12 to 18 months before any semblance of normalcy.


IT strategy, M&A, implementation, optimization, revenue cycle

Few projects are continuing. Expected work with post-implementation optimization and M&A conversions postponed indefinitely. University systems least impacted such as UK but that may change as states rethink budgets. Performance improvement, value-based care, PAMA AUC, and price transparency projects being pitched are not being sold.

Will likely depends on how fast business and regulatory requirements re-enage. There will be a large pool of consultants competing for same work, driving cost per hour and associated wages down even further than had occurred already. Some staff aug firms that cross industries might have overhead and corporate costs covered by industries less impacted than health care, such as federal, banking or similar. Private equity backers of many of the current consulting firms may seek to shed firms during the pandemic or afterward. Some firms will be shuttered. Private equity investors will be fewer and harder to find. Public firms that had acquired firms will have large write downs of goodwill, although this already happened in last few years as HITECH dollars ended.


Part-time contracting for a health system for MIPS

Dwindling down. It was going to dry up anyway until later in the year.

MIPS reporting may be easier for 2020 so less need for my support.


Epic

Personally, busier than ever building out COVID-19 related facility structure.

Back to a less urgent routine. Upgrades, optimizations, hopefully some new installs.


Epic Bridges consultant

I took a 21% pay cut to my overall compensation

Hopefully more remote work!


Analytics project management

No client travel, working 100% from home. Hoping clients continue with projects

Regular travel to a client will no longer be required. I see travel dropping to once a month.


Pharmacy informatics

lient is occupied by COVID-19 planning and isn’t readily available for questions, etc. I was already working remotely, but because of travel restrictions, no site visits or physical assessments can be done. I don’t think there has been a significant impact to the consulting firm — yet

Hopefully, the client will be able to be more engaged with the project. I will still be working remotely but anticipate I will be working more hours.


EHR implementation project management

Working from home 100%, which I have done periodically throughout my consulting career. My projects are all still a go with the occasional delay due to COVID-19.

If the pandemic is controlled sooner, my projects should be back on track and ready to go forward. If the pandemic takes longer, there is a possibility that all work will stop.


Strategic

Evaporated

The bigger question is will it ever return at all. The tail of this is wide and long and the possibility that much will not return. Even with a willingness to return to normal, there will be no funds and resources to carry on as before. With every corner of society impacted, the available $$$ have gone. What returns will be small, focused, and highly limited. Hopefully, the majority of any future healthcare spending will be on clinical expenditure and not in non-essential administrative crap


Monday Morning Update 4/20/20

April 19, 2020 News 3 Comments

Top News

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UW Medicine (WA) publishes its IT experience with COVID-19 in the journal Applied Clinical Informatics. The organization:

  • Participated in the hospital incident command system.
  • Moved to iterative implementations in some areas, such as escalating COVID-19 related EHR change requests.
  • Developed a real-time dashboard of critical metrics.
  • Worked with HR and local sites to develop internal email lists for specific areas and topic types, including a master list of EHR users for change notification.
  • Worked with groups that oversee community communication (websites, automated emails, appointment reminders, on-hold contact center telephone messages) to align messaging.
  • Created intranet and extranet pages to house COVID-19 resources, with the former including screening and testing algorithms, policies and procedures, and printable posters for clinics.
  • Developed workflows for specimen collection for the organization’s self-developed COVID-19 lab test to cover new areas (such as employee health) and to print labels for community organizations that still use paper and faxed orders.
  • Developed COVID-19 lab ordering under easily found synonyms and configured those orders and related interfaces to bypass the co-signature requirement.
  • Created a master order set that includes hyperlinks, lab orders, ICD-10 codes, billing codes, and discharge instructions.
  • Created a documentation template that includes a checklist of symptoms and risk factors, testing recommendations, and support for virtual visits.
  • Implemented a centralized lab results notification process since the lab is serving non-UW Medicine patients, using remote professionals to monitor an EHR inbox and communicate positive and inconclusive results and posting negative results within one hour on the patient portal for established UW Medicine patients.
  • Trained 500 primary care physicians in telemedicine, then extended the service to areas that serve vulnerable patients. This involved acquiring equipment, managing software licenses, supporting remote access, and integrating teleconferencing into Epic.
  • Masked the personal telephone numbers of providers who are conducting virtual visits remotely by using Doximity Dialer or the phone system’s call forwarding feature.
  • Set up ICU telemedicine carts with cameras to allow practitioners to conduct visits remotely and thus save PPE.
  • Supported surge planning by providing emergency-level system access, EHR changes, EHR expansion to new areas, and support for a drive-through testing site with cellular hotspots that were later replaced with microwave line-of-sight connectivity.
  • Supported teleworking by extending teleconferencing, VPN, and file-sharing tools and helped employees check out their desktop equipment for home use.
  • Fended off an increase in phishing attempts and malware.
  • Learned these three lessons: (1) integrating videoconferencing into the ambulatory EHR should have been given higher priority; (2) expanding the telemedicine solution would have helped, including ramping up training and installing more cameras; and (3) a larger supply of equipment to support teleworking and telemedicine would have been beneficial.

Reader Comments

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From Show Me The Shortage: “Re: LexisNexis COVID-19 drill-down of provider and hospital bed shortages. Seems like the socio info could be used for flattening the curve, or at least being proactive for prep for health crises.” I wondered how LexisNexis was getting the data to display at-risk populations, community shortages of critical care resources, and COVID-19 deaths (that’s the death map above). They aren’t, exactly – the age, comorbidity, and socioeconomic data is based on historical national percentile rankings, while the critical care resource shortage display is derived from comparing the high-risk population percentage with the known number of specialists, hospital beds, and ICU beds (it’s not a real-time snapshot). They don’t say where they’re getting COVID-19 death counts, but I assume it’s Johns Hopkins since they credit them as a dataset resource. It’s an interesting exercise in data presentation, but I would say it is questionably actionable in a pandemic crisis where none of the factors that are modeled can be changed in the short term. I also question the usefulness of dividing the data by county since we are hardly constrained by those virus-indifferent borders in seeking the closest medical care. All of this is the kind of information needed to plan a war, not fight one, and we are still massively failing in even basic public health execution, such as getting people tested and protecting providers with basic gear.

From Another Doctor Who: “Re: whole-body doctors. Here in the Midwest, doctors who can treat an entire human are not rare. I realize you are inured by loud reports of professionals behaving badly, but the good clinicians are not making noise. They are just practicing their trade and attempting to be human themselves. Here’s how I know I am surrounded by holistic physician colleagues: When I have a family or friend that needs a referral, I have multiple choices, even to the point of not referring too many to one person, matching up personality, and even type of humor (that’s a tricky one). Cynicism is usually an accurate worldview, but watch the availability bias. Ditto for our nurses; it is a team sport.” Some specialists are no doubt comfortable and skilled in handling general medical issues, but it probably relates to how long they’ve been out of residency and how far their specialty is from whole-body medicine (internal medicine is right on it, electrophysiology or diagnostic radiology, maybe not). My point is that doctors are not interchangeable, and our system of training and payment – not to mention the incessant onslaught of new medical knowledge and application — creates specialists whose bedside contributions in a pandemic may be limited. Regardless, you would rather have them than not, and it’s selfless of them to volunteer for dangerous duty that falls outside their chosen practice area.


HIStalk Announcements and Requests

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Two-thirds of hospital poll respondents are paying their EHR maintenance fees as usual, although another 25% are either asking their vendor for a break or are reducing or deferring payments by necessity.

New poll to your right or here: which terms would you apply to HIMSS? I can’t include all the possible options, so click the poll’s Comments link after voting and describe which I missed. I’m not looking for shade-throwing here – I’m genuinely interested in how industry people, especially HIMSS members and exhibitors, view their relationship with the organization. I’m happy to share my own views as a member, but perhaps I should save that until after the poll closes. 


Webinars

April 28 (Tuesday) 1 ET: “COVID-19: Managing an evolving patient population with health information systems.”Sponsor: Intelligent Medical Objects. Presenters: Julie Glasgow, MD, clinical terminologist, IMO; Reeti Chauhan, senior product manager, IMO. IMO recently released new novel coronavirus descriptors to help clinicians accurately record diagnoses and also created free IMO Precision COVID-19 Sets to help identify and analyze patients with potential or documented infection. The presenters will discuss these new tools and describe how to use them optimally.

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


Acquisitions, Funding, Business, and Stock

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A private equity firm sues Intel for failing to consummate a deal in which the firm intended to buy Intel’s Care Innovations remote patient monitoring subsidiary in early 2017. The complaint says that Intel signed an exclusive agreement to sell the business, but then used the private equity firm’s offer to negotiate a higher price from the eventual buyer, venture fund ISeed Ventures. The Intel-GE Care Innovations joint venture was formed in August 2010.


People

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University of Maryland Medical System promotes Joel Klein, MA, MD to SVP/CIO. He had served in the interim role since July 2019. 


Announcements and Implementations

Netsmart launches a telehealth solution for behavioral health, home health, hospice, senior living, and social services providers.

A peer-reviewed observational study of data from Glytec’s insulin management software finds that the mortality rate of hospitalized COVID-19 patients was much higher for patients who had a history of diabetes and uncontrolled hyperglycemia, confirming WHO’s determination of diabetes as a comorbidity that affects survival. More surprisingly, the study also found that 42% of patients who had no history of diabetes and who experienced inpatient hyperglycemia died in the hospital, which is seven times the death rate of patients who had neither diabetes nor hyperglycemia. The results are interesting, although not definitive due to the absence of proving causation versus correlation, the inability of the authors to review the longitudinal records of patients, the likely contribution of other comorbidities (how many of the patients who died also had heart disease?), and the limitations of looking only at particular hospitals whose policies, resource availability, and socioeconomic case mix might have skewed the results.

KLAS looks at three vendors of technologies related to social determinants of health in surveying a small number of customers (four to 12 organizations):

  • Healthify, which screens patients and creates a referral summary. Clients are seeing benefits, including better communications and identifying patient needs, but EHR integration is a challenge and ROI is hard to determine.
  • Aunt Bertha, which allows searching for community resources and tracking referrals. Clients report ROI and are enjoying the community organization relationships the system allows them to build. They would like to see better EHR integration. Clients report the highest satisfaction among the three products and 100% would buy it again.
  • NowPow, which supports referrals to community resources. Customers find value in it and 100% would buy it again.

COVID-19

The World Health Organization warns that while COVID-19 serological tests can detect antibody evidence of previous infection, they cannot predict whether a given person is immune to re-infection. WHO says several countries believe they can incorporate presumed immunity from tests into their reopening plans, but nobody knows what the results mean and the rate of false negative results is concerning.

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FDA waives limitations on using digital health for treating psychiatric disorders such as obsessive compulsive disorder, anxiety, insomnia, depression, substance use, PTSD, autism, and ADHD, whether new conditions or created by the public health emergency. Developers must have tested their app, apply cybersecurity protection, and require the user to verify that they should contact a doctor before using. The exception, which will remain in place until the public health emergency ends, does not include apps that are intended to treat a specific psychiatric condition, that address conditions that may require urgent intervention, or that replace in-person or telehealth visits.

Kaiser Health News says that hospitals aren’t able to quickly repair broken ventilators or bring mothballed ones back into service because ventilator manufacturers don’t allow hospital biomedical engineers or third party service companies to repair them. Manufacturers make money from controlling who can service their machines, using software locks and internal-only manuals to prevent unauthorized repairs. These limitations have elicited a “right to repair” movement like the ones organized for cars, farm equipment, and cell phones that allow owners to fix their own devices or hire whoever they want to do so. One manufacturer has only two technicians available to service an entire state, which is a bottleneck in the pandemic.

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A report from the Johns Hopkins Bloomberg School of Public Health, with former FDA Commissioner Scott Gottlieb, MD as a co-author, lists public health principles for use by governors as they reopen their states. Excerpts:

  • The only epidemic control measure that is available in the absence of a vaccine continues to be social distancing combined with case-based interventions. Large-scale distancing measures will need to be reinstated if the epidemic’s growth returns.
  • A loosening of distancing measures requires meeting four criteria: (a) a 14-day day decline in new cases; (b) having enough diagnostic tests available to test, at minimum, every person who tests positive and their close contacts; (c) having adequate hospital capacity and personal protective equipment for healthcare workers; and (d) having enough people assigned to perform contract tracing for new cases.
  • State leaders must communicate clearly what is being done so that it is not taken as approval for an immediate return to normal activities.
  • Prolonged, close contact among people creates the highest risk and must be considered in deciding what to reopen – risky situations include people who travel or share meals together, religious services, family gatherings, cruises, prisons, and long-term care facilities.
  • Businesses still need to have people work from home or outside of large groups whenever possible. They should require employees to wear non-medical cloth masks, employ physical barriers where possible, keep people at least six feet apart, and continue paying employees who have been exposed or who are sick at home.
  • The risk of reopening schools is uncertain, and tele-education may need to be provided in any case to accommodate high-risk students and those whose parents want to keep them safe at home.
  • Risk of transmission in outdoor facilities such as parks, pools, beaches, and playgrounds is lower than indoor settings, especially if people maintain distancing.
  • Church services introduce high risk.
  • Mass transportation is high risk, but limiting it disproportionately affects under-resourced populations.
  • Mass gatherings, such as sporting events and conferences, should follow WHO guidance.
  • Re-opening should be separated into phases of 2-3 weeks to allow review of case counts, hospitalizations, and deaths.

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Farzad Mostashari, MD gives the epidemiologist’s view of where we are with coronavirus:

  • The number of new cases isn’t reliable because nobody is collecting when the patient’s symptoms began versus when the test results became available.
  • The high (and increasing) rate of positive tests (at nearly 20% nationally) probably means that only high-risk people are being tested, so we don’t know the extent of the pandemic.
  • New York City’s ED trend should be watched closely. 
  • New York City recorded 9,447 non-COVID deaths in just over one month versus the normal of 5,400.
  • Cases are being undercounted based on the ratio of cases to deaths, and deaths are being undercounted as well because it can take up to a month for a patient to die from coronavirus. He thinks new US cases are more likely running 400,000 per day versus the 30,000 that are being reported.

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A new NBC News / Wall Street Journal voter poll finds that:

  • 60% are worried that the government will lift stay-at-home measures too quickly and cause more deaths.
  • 32% worry that the restrictions will remain in place for too long, harming the economy.
  • 44% approve of the White House’s handling of the pandemic, while one-third of respondents are satisfied with the federal government’s efforts to provide COVID-19 tests and medical supplies.
  • CDC continues to earn a high level of public trust even though its public visibility has been nearly eliminated.

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The CDC’s failure to get a COVID-19 test rolled out quickly was caused by poor manufacturing processes that contaminated one of the test’s three components, according to an HHS review. FDA has concluded that CDC violated its own lab standards in failing to isolate the kit-making process. The kits were usable, but CDC took more than a month to remove the spoiled component. The CDC also made mistakes in choosing to include the problematic component at all (since it added little value but delayed rollout) and decided to make the kits themselves in Atlanta instead of using an outside contractor.

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Federal authorities arrest California internist Jennings Staley, MD for selling an undercover FBI agent a $4,000 “COVID-19 family treatment pack” that included hydroxychloroquine, azithromycin, anti-anxiety medications, IV drips, and use of a hyperbaric oxygen chamber. The doctor guaranteed the FBI agent that the kit would prevent or cure coronavirus, bragged about smuggling the hydroxychloroquine into the US from China, and sold the agent package upgrades that included Viagra and Xanax. He’s charged with mail fraud. The doctor also operates Skinny Beach Med Spa, which offers medical weight loss, testosterone and growth hormone treatments, laser hair removal, tattoo removal, face rejuvenation, vein removal, Botox, vampire facials, platelet rich plasma therapy  injections, hangover IVs, and body sculpting (that’s a lot of external medicine for an internal medicine doctor).

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Best tweet of the weekend.


Other

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Weird News Andy observes that a leopard was “spotted” (WNA is showing off that he knows that leopards don’t have stripes) in a hospital bathroom in India. It was captured safely and relocated.


Sponsor Updates

  • Cerner is collaborating with Fortified Health Security to offer managed security services to healthcare organizations, regardless of their EHR vendor.
  • Elsevier launches the COVID-19 Healthcare Hub for free access to toolkits, expert insights, research resources, and COVID-19 guidelines.
  • Wolters Kluwer will give AHIMA members access to a custom solution within the MediRegs Compliance Suite that includes content on federal regulatory changes to HIM professionals.
  • Meditech releases updated decision support and guidance for coronavirus.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, releases a the latest episode of its Critical Care Obstetrics Podcast, “Maternal Levels of Care.”
  • Pivot Point Consulting VP of Advisory Services Laura Kreofsky receives Consulting Magazine’s 2020 Women Leaders in Technology Award.
  • Redox releases a new podcast, “Digital Health Startup Advice with Dr. Roxie Mooney.”
  • The National Council for Prescription Drug Programs re-elects Surescripts CIO Mark Gingrich to its trustee board, and elects Director of Standards Tim McNeil and Manager of Clinical Informatics Larry King to two NCPDP workgroups.

Blog Posts


Contacts

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

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News 4/17/20

April 16, 2020 News 8 Comments

Top News

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Meadville Medical Center (PA) recovers from its second breach of the year as it brings its systems back online after a March 26 malware attack.

Its Meditech software was back up and running March 31.

The hospital suffered a payroll system breach in late January.


Reader Comments

From Doctor Who: “Re: specialists covering COVID units. Would you want to be one of those patients?” I would not want to be (for multiple reasons), but my takeaway is that we don’t have many doctors left who can treat an entire human rather than just their singular body part niche or who can do more than crank out repetitive, high-paying procedures. We’re putting medical students and residents on the front lines in assuming they have useful skills to offer despite their inexperience, yet many of their counterparts in practice who already have completed an MD degree, broad training, and then residency in ophthalmology, dermatology, pathology, etc. have been away from general patient care for so long that they are often not much good for anything beyond performing nurse aide work. The percentage of medical school graduates from the past 40 years who are still practicing and can confidently perform basic patient triage, stabilization, diagnosis, and management must be tiny. I would trade those COVID-draftee specialists for a good nurse who can monitor vital signs, keep the pumps and ventilators going, administer drugs and start IVs with skill, and keep me comfortable and feeling cared for.

From Afternoon Delight: “Re: favorite albums. Someone on Twitter asked for favorites. What are yours? I need new quarantine music.” It’s hard to pick just a few, but these are ones that were groundbreaking, have stood the test of time (meaning most are old), and that have enough beginning-to-end brilliance that I find myself listening all the way through. I included two live albums that show the musicianship of the band better than their studio originals.

  1. Close to the Edge (Yes)
  2. The Rise and Fall of Ziggy Stardust and the Spiders from Mars (David Bowie)
  3. Master of Reality (Black Sabbath)
  4. A Hard Day’s Night (The Beatles)
  5. Forever Changes (Love)
  6. 2112 (Rush)
  7. Dark Side of the Moon (Pink Floyd)
  8. The Doors (The Doors)
  9. Life’s Rich Pageant (R.E.M.)
  10. Doolittle (Pixies)
  11. Live at Leeds (The Who)
  12. Are You Experienced (The Jimi Hendrix Experience)
  13. One Night Only (Bee Gees)
  14. Odessey and Oracle (The Zombies)
  15. Selling England by the Pound (Genesis)

Webinars

April 28 (Tuesday) 1 ET: “COVID-19: Managing an evolving patient population with health information systems.”Sponsor: Intelligent Medical Objects. Presenters: Julie Glasgow, MD, clinical terminologist, IMO; Reeti Chauhan, senior product manager, IMO. IMO recently released new novel coronavirus descriptors to help clinicians accurately record diagnoses and also created free IMO Precision COVID-19 Sets to help identify and analyze patients with potential or documented infection. The presenters will discuss these new tools and describe how to use them optimally.

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


Sales

  • The California Department of Veterans Affairs will implement Netsmart’s MyUnity EHR to care for residents in its eight Veterans Homes.
  • Carle Health (IL) signs a five-year deal with Health Catalyst for its data and analytics software and services.
  • UK HealthCare (KY) selects virtual ICU software from Philips.
  • St. Elizabeth Healthcare will install radiology and breast imaging software from Sectra across its five hospitals and outpatient facilities in Kentucky and Ohio.

People

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Goliath Technologies names Karen Armor (5Nine) SVP of worldwide sales.

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Matt Williams (Loop Returns) joins Healthfinch as CTO.


Announcements and Implementations

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GE Healthcare and Microsoft retool software that was originally intended to debut at HIMSS into cloud-based monitoring software for COVID-19 patients in ICUs. The companies are offering the software for free, minus installation costs, through January.

Mayo Clinic (MN) develops a contact-tracing tool using EHR data that alerts staff if they come into contact with patients or staff members who have been diagnosed with COVID-19.


COVID-19

ProPublica finds that at-home deaths are skyrocketing in some cities, with the most likely causes being either COVID-19 or serious conditions that people didn’t report because of infection fears. New York City’s deaths outside of hospitals and nursing homes is running six times average. Detroit authorities responded to 150 “dead person observed” calls in the first 10 days of April versus the average of 40, almost all of those occurring in low-income neighborhoods. Some coroners are not listing COVID-19 as a contributing factor in the absence of a positive test even though CDC allows doing so, while some states are falling behind on death reporting due to low staffing and outdated computer systems. As with many aspects of coronavirus, we just don’t know.
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Verily assures senators that its COVID-19 screening website for California residents adheres to data protection standards, and adds that, despite criticism, it has no plans to open up the full platform to people who don’t have Google accounts.

UnitedHealth Group reports Q1 earnings of $5 billion on revenue of $64 billion, postulating that any higher costs of diagnosis and treating COVID-19 were more than offset by people who are cancelling their routine appointments and elective surgeries.

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UCSF Health develops a campus-wide COVID-19 dashboard that updates in near real time. I’m slightly surprised that it doesn’t include non-patient data such as availability of PPE, ventilators, drugs, and staff (including the number or percentage of staff infected or quarantined), but I’m guessing those metrics are monitored from a different dashboard.

The Washington Post highlights the approaches that health systems are taking to notify their employees of exposure to patients or staff with COVID-19. Mayo Clinic’s internal contact-tracing app seems to be unique, as most organizations mentioned in the article rely on ad hoc screening and testing methods with little to no transparency about cases, capacity, and PPE across their facilities. Meanwhile, CDC data suggest that at least 9,200 healthcare workers across the country have tested positive for COVID-19, 723 have been hospitalized, and 27 have died as of April 2.

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Wake Forest Baptist Health partners with Scanwell Health to launch an at-home antibody testing kit study in North Carolina that it hopes will give officials a better understanding of how prevalent the virus is in the community. The study will also incorporate syndromic surveillance technology from Oracle that will help to identify virus hot spots in nearly real time.

The FDA authorizes emergency use of a saliva test for diagnosing COVID-19 patients, which healthcare workers say will enable them to exponentially increase testing, save PPE, and limit staff exposure to the virus.

A Florida nursing home trade group asks Governor Ron DeSantis to give them immunity from negligence lawsuits that are related to COVID-19. The governor is already blocking media efforts to name facilities where residents have tested positive or to force nursing homes to disclose their resident deaths.

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The pandemic is causing financial problems for safety net hospitals that were already struggling with low-paying Medicaid patients. They are losing money from surgeries, losing employees to hospitals that are paying more to deal with the COVID-19 surge, and receiving little from the federal government’s stimulus plan whose payments are based on Medicare revenue rather than COVID-19 patient volume or extra costs.


Other

The American Medical Association and American Hospital Association create a cybersecurity guide for working from home.

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Researchers at MIT’s Computer Science & Artificial Intelligence Laboratory develop a router-like box that can be used to passively monitor COVID-19 patients at home. Ideal for seniors in assisted living facilities, the wall-mounted device is capable of monitoring movements, sleeping patterns, and breathing.

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Weird News Andy says this story isn’t as edgy after 26 years. A 76-year-old man in China who experienced lost vision in one eye and chronic headaches after being mugged 26 years ago is cured when surgeons remove a rusty 4-inch knife blade from his brain.


Sponsor Updates

  • The local paper profiles HCTec’s efforts to equip providers with telemedicine and optimized EHRs.
  • Gartner includes Imat Solutions in its “Healthcare Payer CIOs, Leverage Vendor Partners to Succeed at Clinical Data Integration Report.”
  • InterSystems releases a new episode of its PulseCast podcast, “Jeff Fried: A Deep Dive on Data Operationalization.”
  • Kyruus publishes a “Guide to Enabling Access During & After the COVID-19 Crisis.”
  • MerlinWave adds AxiaMed’s patient payment technology to its MWTherapy software for physical therapy practices.
  • Netsmart becomes a founding company of the Telewound Coalition.
  • HCTec creates HITComm, a LinkedIn group for healthcare stakeholders that focuses on sharing COVID-19 health IT solutions.
  • Zen Healthcare IT helps EHealth Exchange integrate AdVault’s digital advance care planning software with its health information network.

Blog Posts


Contacts

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

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News 4/15/20

April 14, 2020 News 14 Comments

Top News

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The FCC opens the application window for its $200 million COVID-19 telehealth cost reimbursement program.

Applications are completed on an eight-page fillable PDF form that is then emailed to the FCC.

Non-profit healthcare provider sites that treat patients, schools, health departments, rural clinics, and skilled nursing facilities are eligible to have their expenses reimbursed for telecommunications and connected devices.

Awards are expected to be under $1 million per applicant, with the money being assigned on a rolling basis until the $200 million has been committed.


Reader Comments

From Just Laid Off by Allscripts: “Re: the US healthcare system. We like to believe that the public needs are best served when the organizations that provide the needs are run like businesses. Now we’re seeing the downside. While all healthcare organizations across the globe will struggle with the need to care for so many sick people, it seems beyond dysfunctional that hospitals might close or have to layoff healthcare workers because of not doing elective surgeries.” We also have the problem that most Americans couldn’t afford to pay modest healthcare bills even before the pandemic took income and health insurance away from millions of them. I’ve seen estimates that health insurance premiums will rise 40% or more next year, which takes us further down the death spiral of unaffordable premiums, unaffordable deductibles and co-pays, and health systems that expect to be paid richly for providing sometimes questionably necessary services. On the other hand, it wouldn’t surprise me if Americans get healthier over the short term as we reduce our contact with profit-maximizing providers and thus the dangers of overprescribing, overtreatment, elective surgery, and medical errors (the uptick in poor outcomes post-pandemic will be conveniently blamed on deferred maintenance). What we want or need as patients is incidental to whatever makes the cash registers ring. I would like to think that we as patients – which is everybody, not just all at the same time — will demand better, but most of us don’t have a lot of lobbyists and politicians in our pockets.

From Curves Flattened: “Re: COVID-19. Being sequestered accomplished the goal of flattening the curve. Well done!” My joy is restrained by the fact that “flattening the curve” is not the same as “reducing the area under the curve.” Drastic societal efforts so far were intended only to extend the timeframe over which people get infected and require hospital care. Your odds of being taken out by COVID-19 in the long term haven’t changed, other than maybe you get the chance to die unconscious on a ventilator instead of while gasping for air without one. We have no proven treatments and no vaccine. Meanwhile, our globally underperforming healthcare system isn’t the immediate problem – it’s that our world-leading logistics failed us in being unable to source and distribute COVID-19 tests, ventilators, and personal protective equipment.

From Tommy Hawk: “Re: webinars. I suggest that vendors, at least for the near term, allow webinar registration using non-corporate email addresses. This would allow those of us who are newly unemployed to continue our education and maybe our employment.” I agree, although for broader reasons. We make recordings of the webinars that we produce freely viewable on YouTube (I think we were the first to do this). We discourage webinar sponsors from requiring more than the absolute minimum of signup information since studies have shown a huge drop-off in registrants if you bug people to list their employer, job title, telephone number, buying timeline, etc. in ensuring a nagging contact afterward. I haven’t seen many webinars whose content would help a competitor, and I haven’t seen many companies whose competitive intelligence strategy consists of watching webinars. It reminds me of the old HIMSS conference days, when a few paranoid and mostly crappy companies posted sentries around their booth perimeter to shoo away non-providers who might be seeking out the nuclear secrets that were hidden inside.

From Seagull Soaring: “Re: HIStalk. My communication is a simple thanks and gratitude for all of your hard work on HIStalk. I read your site nearly every day and it makes me better at my job. You provide a great service. Thank you.” I’m gratified at the several recent messages like this one that came out of nowhere. Thank you for those who sent them. 

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From Michael Raymer: “Re: ventilators. Your original post led to finding our first large private donor. We will return the first ventilators to clinical use this week, three weeks after the initial idea. Thanks for your help! We need help continuing to identify ventilators. We have acquired almost 50 in one week.” Health IT long-timer Mike is the co-founder of the non-profit Co-Vents, which is refurbishing retired ventilators for clinical use to meet the short-term need.


HIStalk Announcements and Requests

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I’ve received some thoughtful answers from consultants about how their work is changing, as requested by a consultant reader who is struggling. Add yours to be included in my writeup later this week.


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.

April 28 (Tuesday) 1 ET: “COVID-19: Managing an evolving patient population with health information systems.”Sponsor: Intelligent Medical Objects. Presenters: Julie Glasgow, MD, clinical terminologist, IMO; Reeti Chauhan, senior product manager, IMO. IMO recently released new novel coronavirus descriptors to help clinicians accurately record diagnoses and also created free IMO Precision COVID-19 Sets to help identify and analyze patients with potential or documented infection. The presenters will discuss these new tools and describe how to use them optimally.  

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


Acquisitions, Funding, Business, and Stock

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Life sciences data and managed services vendor IntegriChain acquires the life sciences division of Cumberland, which provides managed services, advisory services, and systems integration for life sciences contracts, pricing, and revenue management.

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Marketing firm W20 acquires Symplur, a healthcare-specific social media tracking platform. W20 recently used the system to create a coronavirus media tracking tool for the California Life Sciences Association.


Sales

  • Highmark Health, Allegheny Health Network, and Gateway Health will implement Aunt Bertha, which connects people to social services that can help with food, housing, and transportation.

People

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Care team collaboration platform vendor Andor Health hires industry long-timer Raj Toleti, MS (Allscripts) as CEO and board chair.


Announcements and Implementations

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Henry Schein Medical offers providers free 90-day use of VisualDx, which enhances telemedicine visits with shared images and documents. 

QliqSoft adds patient and engagement content from Wolters Kluwer to its clinical collaboration and patient communication solutions.

ClaraPrice offers a service to help hospitals manage the ongoing reporting and payback of advance Medicare payments via the CARES Act.

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Epic announces in a second recent (and rare) press release that it has donated software and services to the temporary hospital that has been created in Meadowlands Exposition Center by University Hospital (NJ). Epic says its implementation took three days, with the first patient being admitted on the fourth day. The newly named Secaucus Federal Medical Station has beds for 250 non-COVID patients.


COVID-19

Former FDA Commissioner Scott Gottlieb, MD says in a Wall Street Journal op-ed piece that US employees may return to work as early as May, but employers should be prepared to offer onsite screening to detect infected but symptom-free workers. He says the rapid test platform of Cepheid is fast and requires less invasive swabbing, with other companies introducing similar machines. Gottlieb says that employers who can’t perform onsite testing should offer take-home tests or refer their employees to a local pharmacy or government program. He also recommends that employees who test positive continue being paid so they don’t have to choose between doing the right thing versus feeding their families.

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James Wright, MD, medical director at the private equity-owned Virginia nursing home that has seen 45 COVID-19 deaths among its residents so far, says that American society has chosen to warehouse its senior citizens in underfunded facilities that can’t afford adequate staffing and that are forced by economics to offer non-private rooms that don’t have access to the outdoors. His facility lost much of its staff as the outbreak began since most of them work multiple jobs and were ordered by their other employers to stop working there to avoid spreading the infection among facilities. More than 50% of the facility’s residents who tested positive have died. Wright concludes that “this will not be the last untreated virus to decimate our elders” and that “a publicly funded nursing home is a virus’s dream.”

A Harvard professor of epidemiology says that we don’t have enough data to determine who in the population might have developed coronavirus immunity. He speculates that most COVID-19 patients develop some degree of immune response, but its strength and duration is probably variable, and creating herd immunity requires a large percentage of people whose immunity is long lasting. The US’s low testing rate makes analysis impossible, but results from better-responding countries suggest that herd immunity isn’t significant. The bottom line is that scientists can’t predict immunity until widespread testing for both infection and antibodies is performed. In the absence of immunity, the only hope is a vaccine.

Preliminary evidence suggests that COVID-19 causes clotting events that can lead to thromboembolism, deep vein thrombosis, ischemic stroke, and possibly even cardiomyopathy. That may also explain why those patients go downhill so quickly from what seems like normal COVID-19 pneumonia. The presence of abnormal coagulation has been found to be predictive of pneumonia outcomes in COVID-19 patients, which could lead to recommendations that those patients be anticoagulated. 

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Analysis of the inpatient data of 1,000 hospitals by Allscripts subsidiary CarePort Health finds that COVID-19 mortality rates are about 10% overall, but 40% for those over age 85. A new finding from the analysis is that chronic kidney disease seem to increase death risk dramatically. More than half of patients who were hospitalized are under 65, while risk-adjusted death rates for men are 1.3 times that of women, both conclusions matching those of the CDC.

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Beaumont Health launches what it says is the country’s largest coronavirus serology testing program, where it hopes to test volunteers from its 38,000 employees to measure the incidence of antibody formation among people who had no COVID-19 symptoms. The health system will use the data in its return-to-work process and to identify possible donors for convalescent serum treatment. SVP/CIO Hans Keil, MBA, MA says the antibody test, which is not yet approved by the FDA, has been validated on 1,000 volunteers.

New York City increases its COVID-19 death count by 3,700 after including presumable coronavirus-related deaths that could not be confirmed because no tests were available. The city now reports more than 10,000 deaths.


Privacy and Security

Hartford Hospital (CT) announces that information about 2,400 patients was exposed in a February phishing attack in which hackers gained access to the email accounts of two employees. Several other healthcare organizations have reported similar attacks in recent months.


Other

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Sales of the stripped down Raspberry Pi computer, which starts at $35, set records as people teach themselves new skills at home and groups use them to create ventilator prototypes using hardware store components.

Doctors on the front lines of coronavirus are seeing their pay cut even as they are asked to risk infection, often without adequate PPE. This includes those whose compensation includes a significant component that is based on RVUs whose volume has been reduced with COVID-19 focus:

  • A California ED doctor who was forced to buy her own N95 masks on Craigslist will see her pay cut by at least 25%.
  • A New York ED doctor took a 10% pay cut and is expecting more.
  • The income of some specialists has dropped by 80% due to lack of procedures.
  • An urgent care company cut all salaries by 10% and confiscated all untaken PTO.
  • New York doctors are being asked to take unpaid positions at COVID-19 hotspot hospitals owned by NYC Health + Hospitals, while the organization is recruiting temporary nurses $10,000 per week plus travel expenses. 
  • Envision Healthcare will cut the pay of its doctors who work in areas that have lower patient volumes.
  • Alteon Health backed off some of its announced cuts after ProPublica reported its plans, but is still moving salaried doctors to hourly and then reducing their schedules.
  • Atrius Health is withholding pay for doctors and nurses or cutting it by 20%.

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In England, 99-year-old World War II veteran Captain Tom Moore, who hoped to raise $1,300 for the NHS’s coronavirus efforts by accepting donations for each 82-foot lap he completes around his garden using his walker, says he won’t stop even as donations have topped $3 million.

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Rio de Janeiro illuminates the Christ the Redeemer statue in medical gear on Easter Sunday to honor medical workers around the world who are battling coronavirus. Meanwhile, Brazil’s president, Jair Bolsonaro, maintains that coronavirus is “a measly cold,” asserts that it’s a media hoax intended to erode his political support, and says the virus is leaving Brazil on its own accord.


Sponsor Updates

  • Phynd will ingrate provider credentialing and privileges data from Symplr into Phynd 360, which allows organizations to publish provider  data and deploy consumer provider search tools.
  • TransformativeMed lists several health systems that are taking advantage of free use of its Cerner-integrated Core COVID-19 App for patient monitoring and data submission to health departments and the White House Coronavirus Task Force, among them UPMC, MedStar Health, UW Medicine, and Virginia Commonwealth University Health System.
  • Use of the EClinicalWorks Healow telemedicine app exceeds 1.5 million daily minutes amid the COVID-19 pandemic.
  • Montefiore St. Luke’s Cornwall Hospital (NY) and UPMC Western Maryland choose AHIMA’s compliant template library within Artifact Health’s mobile physician query platform.
  • Nuance names Avaya a top growth partner and, for the third consecutive year, its top producing channel partner.
  • Datica releases the latest edition of its 4×4 Health podcast, “ONC Final Rules on Information Blocking – Part 3.”
  • Mental Health Center of Denver implements CareSignal’s COVID-19 Companion text messaging app.
  • The Columbus business paper features the remote working strategies of CoverMyMeds.
  • 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 4/13/20

April 12, 2020 News 15 Comments

Top News

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Apple and Google will enhance their mobile devices with an API that will use Bluetooth to perform coronavirus contact tracing to help detect outbreaks.

The companies will release APIs next month that create interoperability between Android and IOS devices using apps from public health authorities. Following afterward will be the release of the full contact tracing platform.

The use scenario is this:

  1. User One carries their phone any time they’ are in public. They leave the app running.
  2. User One is assigned an anonymous, frequently changed identifier beacon.
  3. User One has close contact with User Two, who is also carrying their phone and running the app.
  4. User One tests for COVID-19. They manually enter their result into an app provided by a public health authority.
  5. User One gives their phone permission to upload a 14-day history of the identifier beacons with which they have had close proximity.
  6. User Two’s phone regularly downloads a list of identifier beacons from contacts who have tested positive.
  7. User Two’s phone alerts them that they have been exposed to someone who tested positive and tells them what they should do.

Obvious weak points of cellphone-based contact tracing:

  • Adoption in other countries that have tried this voluntary approach has been low (Apple and Google did not acknowledge that this technology wasn’t their original idea).
  • The app must be left running and the user must carry their phone everywhere.
  • The users must have smart phones; those with flip phones or no phones cannot participate.
  • Each person who tests positive must remember to enter their result.
  • Both contacts must be running the app. That means, given likely low adoption, that the odds of detecting a given exposure are tiny.
  • Bluetooth can detect proximity, but not the chances of exposure. It could record a contact anyone in nearby car or everyone behind doors in a hospital hallway.
  • People who don’t trust big companies like Apple and Google (especially the latter, given that its primary business model is using or selling user data), or who detest the concept of mass surveillance regardless of benefit, will likely opt out.
  • Public health systems must participate.
  • The US still lags in testing and results from some labs are delayed due to backlogs.

Reader Comments

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From Code Jockey: “Re: Epic consulting. Demand for my skills has evaporated as health systems have suspended EHR projects and cancelled contracting engagements. Given the 95% reduction in air carrier routes through September, there’s no way to get to their sites even if they need contractors. I’m now unemployed and trying to get a $17 per hour job at an Amazon warehouse. I’m wondering what people like me are doing – taking a break, shifting to other industries, or working remotely? What will consulting look like when this is all over, the former Monday to Thursday travel or 100% remote work? You also have Epic continuing to elbow into the contracting space. I wonder how the many staffing firms that have lined their pockets on the backs of contractors will be affected by the absence of engagements?” I offered to create a short survey for consultants to anonymously share how the pandemic has changed their work. Your thoughts might relieve some anxiety for people who are cooped up with little work available short term.

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From Financial Cannula Insertion: “Re: HIMSS20 hotels. Marriott Orlando Village is not refunding guests because they claim they were contractually guaranteed full payment by HIMSS. They’re keeping my ‘deposit’ of the full four nights that I prepaid. Here’s the email I received from the hotel GM.” The hotel says that HIMSS told it on multiple occasions that the conference would not be cancelled and asked that the hotel not release or resell any booked rooms. The hotel add that since the US had no travel advisories in place at the time the conference was cancelled (two days before FCI’s scheduled arrival), the cancellation was a HIMSS business decision that does not relieve it of honoring its vendor contracts. The GM says HIMSS signed a contract with all the Orlando hotels guaranteeing the attendee’s full payment. It’s interesting that HIMSS can legally guarantee payment terms on behalf of the actual customer, presumably by the online reservation terms specified by OnPeak since HIMSS doesn’t handle room bookings directly.

From Spumoni: “Re: HIMSS. I’m struggling with a path forward, as exhibitors seemed to be saying in your survey. Will travel return? Do I really want to sit shoulder-to-shoulder in sessions? Was the conference a boondoggle all along that was self-aggrandized by vendors along with their own importance? Meanwhile, I’m being bludgeoned by the pivot to online content delivery and life in the glow of Webex on a laptop.” It’s hard to predict the pent-up, post-isolation demand for big conferences in the potential absence of a coronavirus vaccine. People were always returning home sick even in past years, as my post-HIMSS18 poll found that 50% of respondents came home with a cold, flu-like symptoms, stomach problems, fatigue, headaches, or muscle aches. Beyond that is the economic question — is the considerable cost of attending and exhibiting worth it, especially given a year off to contemplate the value received? Or will it go back to exhibitors who mostly show up for fear they will look bad competitively if they don’t? Or will the conference irrecoverably lose critical mass with the near-certainty of fewer attendees, a sparser exhibit hall, and attendees who have grown comfortable conducting all aspects of their work remotely?

From Allscripts Sunset: “Re: Allscripts. Appears that it just hit five straight quarters without selling a Sunrise new logo deal.” Unverified.

From Allscripts Cuts: “Re: Allscripts. Word is that the board gave Black and Poulton six months in early March to cut $100 million per year in expenses. There was an expectation of laying off 1,000 to 1,500 people, but they likely used COVID to cut pay and travel to get layoffs into the 500-600 range. That will work only until full salaries return and travel picks back up.” Unverified.


HIStalk Announcements and Requests

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Most poll respondents have no personal experience with COVID-19, and thankfully few report the death of a family member, friend, or co-worker.

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New poll to your right or here, for hospital employees: which is true of your EHR maintenance fees as the pandemic cuts revenue? Click the poll’s Comments link after voting to explain.

Listening: Bachelor Girl, which I discovered while creating another playlist for my young friend (it includes Dua Lipa, James Bay, Florrie, Sia, and Hazel English). Bachelor Girl is an Australian duo that has been around for nearly 30 years, and what caught my attention was 1999’s “Lucky Me,” a cynical take on success that sounds more Nashville than Melbourne (it’s amazing that the lyric way back then says, “I’ve got so many friends on the internet, I could never be alone.” I’m also thrilling to the new album of the amazing Public Enemy and the best voice in rap, Chuck D, who raises goose bumps on 2007’s “Harder Than You Think.” 

A third-hand acquaintance (well educated, upper class, long list of health conditions) is experiencing cough, fever, and fatigue and was reluctantly sent home by his employer. Some of his co-workers – who as essential workers spend their work days in close office contact — have since tested positive for COVID-19. He has dawdled in sending in his own test samples and continues to convene multi-generational family and neighborhood gatherings and takes regular, unmasked trips to grocery and hardware stores. Bill Gates was right in describing STDs – it would be easy to stop communicable disease outbreaks if those who practice bad behaviors suffered the consequences immediately instead of later or didn’t harm others in the process of doing something stupid.


Health-Related Technologies That the Pandemic Has Made (Or Will Make) Mainstream

  1. Telehealth and its integration with EHRs.
  2. 3D printing of medical supplies.
  3. Chatbots that can help keep the worried well out of the ED (instead of the previous model of hoping to bring them in as paying customers).
  4. Remote patient monitoring and clinician backup.
  5. Videoconferencing and team collaboration platforms.
  6. Patient engagement for monitoring patients who are recovering at home or who can be discharged to lower-acuity settings.
  7. Patient check-in and waiting room avoidance.
  8. Public health reporting and data aggregation.
  9. Online education.
  10. Predictive models for hospital resource needs, patient outcomes, and pandemic spread.
  11. Virtual conferences.
  12. Clinician collaboration platforms for sharing best practices and crowdsourcing treatment options.
  13. Robotics for contact-free hospital room deliveries.
  14. Rapid online publication of research findings.
  15. Syndromic surveillance.
  16. Virtual mental health services.
  17. Medical equipment clearinghouses.
  18. Contact tracing.
  19. Virtual programs for home exercise, rehabilitation, and wellness.
  20. Imaging AI for detecting specific conditions.
  21. Analytics and predictive modeling.
  22. Supercomputer-powered rapid drug and vaccine research.
  23. Wearables and mobile devices for the rapid assembly of clinical study cohorts and collection of study data.
  24. Platforms to connect people with social services.
  25. Voice assistants, such as Alexa and Siri, that have been enhanced with tools to answer specific health questions or to allow summoning help.
  26. Apps for relaxation and mindfulness for people who are quarantined and anxious.
  27. Ordering and delivery apps for food, supplies, and prescriptions.
  28. Platforms for matching clinicians and volunteers with hospitals in need.
  29. Internet-connected digital thermometers for outbreak detection.

Got more to add?


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.

April 28 (Tuesday) 1 ET: “COVID-19: Managing an evolving patient population with health information systems.”Sponsor: Intelligent Medical Objects. Presenters: Julie Glasgow, MD, clinical terminologist, IMO; Reeti Chauhan, senior product manager, IMO. IMO recently released new novel coronavirus descriptors to help clinicians accurately record diagnoses and also created free IMO Precision COVID-19 Sets to help identify and analyze patients with potential or documented infection. The presenters will discuss these new tools and describe how to use them optimally.  

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


People

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MaineHealth SVP/CIO Marcy Dunn died last Monday. She was 65.


Announcements and Implementations

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OmniSys offers all pharmacists — who can now administer COVID-19 tests as authorized last week by HHS — free online training that describes how to order tests, apply for a state license, perform the nasal swab, bill payers, submit positive cases, and share the results with the patient’s other care providers. The company has also enhanced its cloud-based retail pharmacy EHR with tools for documentation, reimbursement, and care plan communication.

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Experian Health offers a free, regularly updated list of COVID-19 and telehealth payer polity alerts for hospitals, medical groups, and pharmacies, describing 1,140 changes in medical coverage policy changes. 


COVID-19

New York City reports that only 18,500 of its hospital beds are being used versus the 140,000 that experts feared would be required during the pandemic’s peak resource demand that happened this weekend. Hospitals are seeing declining ICU bed occupancy, hospitalizations stand at under 19,000, and the 2,800-bed emergency hospital that was created at Javits Center is treating just 300 patients. Officials credit residents of New York and nearby states for slowing the tide by staying home. Statistical experts say their surge projection models were likely thrown off by unreliable data from China and shorter than expected ICU stays. Meanwhile, physicians worry that the big drop-off in patients who normally seek hospital care for heart problems and strokes may indicate that they are fearful of going to the ED and are just suffering at home instead, possibly to their long-term detriment.

Mayo Clinic says that a COVID-triggered freeze on elective surgeries will trigger a $3 billion loss this year, forcing it to implement pay cuts and furloughs for salaried employees, freeze hiring, lay off contract employees, and stop some construction. 

Politico reports that Democratic lawmakers have written to White House Senior Advisor Jared Kushner to express concerns about the patient privacy implications of his rumored discussions with technology companies to collect COVID-19 public health surveillance data. A White House task force wants to develop a national coronavirus surveillance system that would provide a real-time view into hospital ED visits and bed capacity using “multiple private sector databases,” raising fears of a Patriot Act type encroachment on privacy. A government spokesperson says that neither Kushner nor the White House are aware of such a project, but Politico uncovered a memo written by three companies – Collective Medical, PatientPing, and Juvare – that Politico says was in response to an administration request on the feasibility of quickly gaining visibility into how many patients are seeking hospital care. 

The federal government’s distribution of the first $30 billion in emergency hospital grants raises the ire of some hospitals because payments are based on the volume of past Medicare billing amounts, not their coronavirus burden. Hospitals in lightly hit states, some of which continued to perform rofitable elective procedures, are being given 25 times the amount of money per COVID-19 case as those in New York. The formula also provides payments to providers who aren’t on the front lines, such as podiatrists and ophthalmologists. HHS said the goal was to get the money out quickly and it will focus the next round on providers who were most impacted by coronavirus.

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More evidence that New York City is unintentionally undercounting COVID-19 deaths – FDNY reports that cardiac arrest calls and DOAs have risen six-fold over the same period last year, which probably means that people who die of COVID are being counted instead as cardiac deaths. Italy saw the same six-fold increase in deaths, far more than the official COVID death counts.

A single long-term care facility in Virginia has recorded 40 deaths that are linked to COVID-19, with the medical director blaming lack of staff and equipment, low funding, and trying to isolate positive cases when people have lived in the same room for years. The facility is owned by private equity firm Tryko Partners, which operates 3,000 skilled nursing beds. 

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The US federal government is using daily, e-mailed hospital worksheets to visualize bed capacity, but Germany has a live map.

Florida is underreporting COVID-19 deaths because the state health department has decided to count only deceased state residents, omitting snowbirds and tourists who die in Florida.

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United Airlines and basketball player Steph Curry honor the 20 USCF clinicians who volunteered to serve on the front lines of New York City hospitals.


Other

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The 3,000-bed temporary hospital that was created in Chicago’s McCormick Place convention center will use Epic in a partnership that involves Epic, Rush University Medical Center, and the City of Chicago. Chicago’s Department of Health reached out to Epic early in the planning. 

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This seems HIMSS20 related and perhaps could be instructional to HIMSS. Burning Man Project cancels its annual Black Rock City gathering for 2020 due to coronavirus and will instead run a virtual version that it says “will likely be messy and awkward with mistakes.” It asks ticket-holders to consider donating part of their full refund to the project so it can continue to support its key programs, noting that “things are looking a little grim” in trying to run year-round programs when 90% of the project’s annual income comes from Black Rock City. Tthe group has already undertaken layoffs and pay cuts. Burning Man also observes that rolling over this year’s ticket sales as a credit for next year’s event is not practical because that simply “punts the financial challenges to a future date.” The group had cancellation insurance, but it doesn’t cover pandemics. The CEO recorded a personal, heartfelt message to explain the situation, an approach of unscripted humility and openness that stands in contrast to the HIMSS “strictly business” approach that makes it feel more like an us-versus-them vendor than a non-profit that wears its lofty societal aspirations on its suit sleeve. I’m not sure how many HIMSS members and exhibitors feel a personal attachment or loyalty to the organization or its goals as its global ambitions and expansion strategy has made it impossible to define a typical member.


Sponsor Updates

  • MDLive reports visits and user registrations increase to all-time highs with virtual healthcare as first-line defense in fight against pandemic.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, launches the “Clinical Concepts in Obstetrics” podcast.

Blog Posts


Contacts

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

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News 4/10/20

April 9, 2020 News 2 Comments

Top News

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Nature magazine describes the spur-of-the-moment decision by a Johns Hopkins University first-year PhD candidate to create a global COVID-19 tracking dashboard for fellow researchers. He developed the site in a handful of hours.

The Johns Hopkins University and Medicine COVID-19 case tracking site is drawing over one billion page views each day for its near-real time display of data from WHO, CDC, and other authorities. 

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Developer Ensheng Dong (second from left in the photo above) is a first-year graduate student in civil and systems engineering with a focus on disease epidemiology. He also holds MS degrees in statistics and geography. He used his experience building a geospatial mapping tool to track measles hotspots to create the coronavirus display.

Dong’s thesis advisor, who help create the dashboard, has told him that this year isn’t normal and that he should “prepare for a really boring second to fifth years.”


Reader Comments

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From Down In Flames: “Re: Allscripts. Big layoffs this week.” Here’s some of what I’ve heard from the folks who emailed me. None of this is confirmed, just what they told me:

  • The company laid off 5% of employees across the board (some say it was more than that, perhaps 10%).
  • Salaries of high-earning employees were cut for six months: $100-150K (15%), $151-225K (20%), $226-325K (25%), more than $325K (30%).
  • Merit and promotion raises have been deferred until 2021.
  • All contractors have been dismissed.
  • An austerity travel ban that has been in place since early January is now being blamed on COVID-19.
  • Bonuses that were accrued in 2019 will be paid “sometime soon.”
  • Clients aren’t paying their bills due to lack of profitable elective surgeries.

From Allscripts Employee: “Re: Allscripts layoffs. Playing Titanic deck musical chairs continues, as even teams that are hitting goals are hit with reorgs every nine months that seem to be solely to allow executives to justify their existence. The C-suite will blame everything on COVID-19 instead of their many poor business decisions over the years (Practice Fusion, Avenel). They didn’t even warn employees, many of whom would have gladly left and found other jobs given the chance.” 

From PE Watcher: “Re: Allscripts. Paul Black is out of runway. The low share price has private equity circling to buy it cheap, then sell off the parts of the business like Veradigm that might attract a cash buyer.” MDRX shares are at $6.69, down 30% in the past 12 months and down 29% since Paul Black took over as CEO in December 2012 (versus the Nasdaq’s loss of 1% and gain of 162%, respectively). The company’s market cap is just over $1 billion.

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From Exhibit Hall of Shame: “Re: HIMSS. Making a slight pivot.” An email from Hal Wolf that was forwarded to me says:

  • Exhibitors will be credited 25% of their total HIMSS20 payments, to be spread over HIMSS21 and HIMSS22 (15% and 10%, respectively).
  • Startup and University Row exhibitors will be credited their full payment, spread equally between the two future conferences.
  • Paid exhibitor and client booth badges can be used at HIMSS21.
  • Payments for optional events — such as the Universal Studio outing, awards gala, and CIO Forum — will be credited against optional events at HIMSS21.
  • Some hotels are giving refunds, some aren’t, and HIMSS is puzzled why some of them are telling people to contact HIMSS when it’s the hotel’s decision and cancellation policy that determines if refunds are offered.
  • HIMSS has cancelled employee raises and bonuses for this year.
  • HIMSS notes on its updated FAQ that it is considering changing its hotel deposit requirement through OnPeak to just one night.

From Accounts Prayable: “Re: HIMSS20. Another outrage — we just received an invoice for ads in the Show Daily handouts, poorly named in this case since they were not actually handed out.”


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.


Announcements and Implementations

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NYC Health + Hospitals extends its Epic system to the field hospital set up for COVID-19 patients at the Javits Center in Manhattan.

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Experian Health offers free access to a list of payer policy alerts related to COVID-19 and telehealth to help providers avoid payment delays.

Blessing Health System (IL) implements CareSignal’s COVID Companion educational text-messaging program for patients.

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Hyland Healthcare develops an enterprise version of its PACSgear server software for imaging capture and exchange.

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EMPI vendor Verato offers Telehealth Identity Bridge, which links a patient’s EHR and telehealth visits to give clinicians a full clinical history. The company offers health systems and health plans free use through the end of the year.


Government and Politics

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President Trump appoints VA Chief of Staff Pamela Powers to the additional role of deputy secretary, making her the top authority over the VA’s EHR modernization project. She takes over from James Byrne, who was fired in February for purportedly clashing with members of the leadership team. Powers is a US Air Force Academy graduate, holds masters degrees in military leadership and organizational management, and is a retired Air Force colonel and cyber communications officer. 

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CliniComp secures a $430 million contract to maintain parts of the DoD’s clinical information system while it migrates to Cerner. The San Diego-based health IT company previously sued the VA to protest its no-bid selection of Cerner and then sued Cerner for patent violations.

VA Secretary Robert Wilkie assures Congress that parts of the VA’s shift to Cerner remain on schedule, including development of the VA-DOD Joint Health Care Exchange and other interfaces, infrastructure upgrades, clinical workflow design, and integrated testing. The transition to Cerner’s scheduling system will be delayed.


COVID-19

A National Academies of Sciences, Engineering and Medicine report that was commissioned by the White House warns that no evidence exists to suggest that coronavirus spread will mimic flu by tapering off in the summer, noting that coronavirus is running rampant in countries that already have high heat and humidity. The authors conclude that the potential absence of seasonality, along with global lack of immunity to coronavirus, make it unwise to count on those factors in developing strategies.

HHS tells a House panel that the federal government’s supply of personal protective equipment is depleted and states will receive no more. The federal government has distributed 11.7 million N95 masks versus the 3.5 billion the administration had said were needed, while just under 8,000 ventilators were sent out. HHS employees say the allocation was based on population, not state requests, which has led to shortages that required states to lend equipment to each other.

The federal government asks its health officials to track COVID-19 deaths by race after several states report that disproportionately high percentages of African Americans are dying. Every one of St. Louis’s 12 COVID-19 deaths were African Americans, although the significance of that finding will require looking at the presence of chronic disease and social determinants of health.

A Black Book survey finds that nursing homes are underreporting COVID-19 cases because of lack of technology, heavy use of agency and per-diem workers, and lack of ability for long-term care providers to find out which other facilities have cared for COVID-19 patients. Hospitals are discharging COVID-19 patients into long-term and subacute care without having test results and 96% of nursing home respondents say that they no longer believe that their facility is the best place for housing elderly, susceptible people.

Executives at Detroit Medical Center’s Sinai-Grace Hospital (MI) send ED nurses home after they refuse to work because of understaffing. Two nurses were covering 26 patients, 10 of whom were on ventilators, and seven night shift nurses are covering up to 100 patients versus the proper staffing of 21 nurses per shift . After ordering the nurses off campus, the hospital held day shift nurses over to cover for them, extending their shift to 24 hours.

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Nearly 100 residents of a California nursing home that has been hard it by COVID-19 are evacuated after employees fail to show up for work for the second straight day. Officials say that 34 residents and 16 employees have tested positive for coronavirus.

Experts warn that US COVID-19 testing remains constrained and is not growing rapidly even as the number of cases skyrockets, leaving the only option as continued mass social distancing rather than identifying and quarantining those who are infected. A Nature review finds that universities that offer certified COVID-19 testing are not operating at full capacity because of lack of contracts between providers, incompatible EHRs, the FDA’s requirement that labs hold a CLIA certificate, and a lack of federal leadership. A director of UC Berkeley’s genomics institute offered hospitals a free alternative to the state health department tests – which had a backlog of 57,000 – but explains, “I show up in a magic ship with 20,000 free kits and CLIA and everything, and the major hospitals say, go away, we cannot interface with you.” Sutter Health turned down at least one academic provider of COVID-19 tests because no electronic interface exists and it wants to expand its own testing capacity. Boston Medical Center agreed to use tests from Boston University School of Medicine only after a bioinformatics graduate student wrote a script to connect orders and results to its EHR.

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With numerous protective measures still in place, the City of Wuhan, China reopens to outbound travel after a nearly three-month lockdown to prevent the spread of COVID-19.

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Amazon Web Services will partner with the Yale School of Public Health to offer 30 hours of online training to people interested in becoming volunteer health workers. The course will teach them how to work at drive-through COVID-19 testing sites, support homebound patients over the phone, and record vital signs in pop-up triage facilities.

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University of California, Irvine designs and creates 5,000 3D-printed face masks for UCI Medical Center.  Their low cost allows them to be discarded between patients as requested by clinicians.


Other

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UC San Diego Health physicians pilot an internally developed machine learning algorithm that enables radiologists to better screen for pneumonia on chest X-rays, which can also turn up potential COVID-19 cases.

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UW Medicine launches the DoD-funded HIPPOCRATIC app-based research project, which will use health and wellness data from 25,000 volunteers to inform the development of predictive analytics ahead of future outbreaks. Researchers also hope to better understand the feasibility of using a smartphone-based screening tool instead of drive-through screening and testing sites.

American Association of Nurse Practitioners cancels its annual conference in New Orleans, offering full refunds to registrants and exhibitors. AANP is cancelling all the hotel rooms in its block (it does not use OnPeak or other housing service) and will not charge the one-night deposit.

“If you want to recruit fake doctors, we’re ready. We can help hand you stuff.” Past and present TV doctors come together to thank healthcare workers on World Health Day.


Sponsor Updates

  • Microsoft publishes a case study titled “SyTrue offers AI-based healthcare solution at no charge to public health organizations to help them fight COVID-19.”
  • The Tampa Bay Business Journal honors Greenway Health SVP Karen Mulroe as one of its 2020 Top Corporate Counsel honorees.
  • Healthcare Growth Partners publishes “Health IT March 2020 Insights.”
  • Esse Health expands its use of CareSignal software to include a COVID-19 text-messaging program for patients.
  • PMD announces record adoption of its telemedicine platform in March.
  • Collective Medical’s product offerings meet new CMS ADT notifications conditions of participation.

Blog Posts


Contacts

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

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News 4/8/20

April 7, 2020 News 5 Comments

Top News

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Duke’s Margolis Center for Health Policy – along with former FDA Commissioners Mark McClellan, MD, PhD (the center’s director) and Scott Gottlieb, MD, former National Coordinator Farzad Mostashari, MD, and other participants – proposes a national COVID-19 surveillance system to allow the country to transition from universal stay-at-home orders to case-based, regional options. Recommendations:

  • Roll out rapid diagnostic testing everywhere and for every person with COVID-19 symptoms, allowing quick identification of those infected and of those at high risk (such as healthcare workers), and conduct random tests to detect small outbreaks.
  • Use the test-and-trace results to feed a national syndromic surveillance system that transparently reports outbreaks.
  • Conduct widespread serologic testing to identify immunity markers and to supporting making decisions about sending people who are immune back to work.
  • Require providers that receive federal coronavirus grant money to actively participate in the surveillance and response system.
  • Encourage standards-based lab results reporting (CDC, CMS, and ONC).
  • Incorporate ADT notices into the surveillance system for COVID-19 detection and for correlation to clinical observations, admissions, and transfers to ICU (CDC).
  • Publish daily summaries from the surveillance system at the metro area level.
  • Improve the use of technology to manage case-based isolation.
  • Develop a common platform to query data from hospital EHRs, HIEs, and CommonWell and Carequality (CDC, ASTHO, ONC, and OCR).
  • Help health systems and insurers manage patients who have tested positive (CDC).
  • Publish best practices and case management models to maximize the ability to treat new cases at home or in local isolation facilities (CDC).
  • Pay providers based on case outcomes (CMS and CDC).
  • Lead and fund projects to answer questions about asymptomatic spread, the impact of more refined physical distancing measures, the ability predict and influence case severity, and the role of children in transmission (CDC).

Reader Comments

From Anointed Two: “Re: HIMSS20 hotels. I can almost understand Marriott keeping one night’s deposit, but keeping the entire prepaid amount is inexcusable greed. I hope that we vendors remember how HIMSS and OnPeak did nothing to negotiate on our behalf when it comes to HIMSS21.” The hotel rather coldly told this reader this: “The agreement that the hotel entered with HIMSS was an advance payment of each attendee regardless of circumstances. The hotel will be retaining these prepayments.” The HIMSS rationale for requiring exhibitors to book hotels through OnPeak is that the convention center allocates exhibit hall space based on hotel rooms booked. I can confidently predict going forward that convention centers will have all the space any exhibitor could ever want given the dying conference business, not to mention that the HIMSS track record should be adequate to convince the convention center to not stiff it on space. All that aside, I don’t think the hotel policies have caused many gripes in the past, so unless another HIMSS conference is cancelled inside the no-refund window, it’s probably all moot anyway, although I would refuse on principle to book any Orlando hotel for HIMSS22 that screwed me for HIMSS20.


HIStalk Announcements and Requests

I tweaked my current poll about personal COVID-19 experience to include “presumed positive” in addition to “tested positive” (since testing availability is still a train wreck). It’s still not perfect but the best I can do without creating a multi-page survey that nobody would complete, but you can always add more descriptive comments after voting.


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

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Hospital operator Quorum Health files Chapter 11 bankruptcy as part of a pre-packaged plan to reduce debt. The company says its 23 hospitals and Quorum Health Resources subsidiary will continue to operate normally.

Companies that inserted mandatory arbitration terms in their business and employment agreements to avoid class-action lawsuits (Epic was the US Supreme Court test case for employers) are subverting the process they created after being overwhelmed with mass arbitration claims. Big companies – which assumed that people wouldn’t bother filing claims — are now refusing to pay the arbitration costs that they themselves specified. One law firm filed 6,000 arbitration claims on behalf of independently contracted delivery drivers for DoorDash, which balked at paying the $9 million in arbitration fees and then rewrote its terms to require using a particular arbitrator whose rates were lower. An unsympathetic federal judge ordered the company to pay the fees, saying, “Your law firm and all the defense law firms have tried for 30 years to keep plaintiffs out of court. And so finally someone says, ‘OK, we’ll take you to arbitration,’ and suddenly it’s not in your interest any more. Now you’re wiggling around, trying to find some way to squirm out of your agreement. There is a lot of poetic justice here.”


People

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Clinical AI vendor Jvion hires industry long-timer Jay Deady (Recondo) as CEO.

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Chris Aulbach, MS (Cognizant) joins CipherHealth as chief product officer.


Announcements and Implementations

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The American Medical Association publishes a  128-page physician guide for implementing virtual visits, which includes a section on evaluating related technologies.

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Santa Barbara Cottage Hospital (CA) goes live on PeriGen’s PeriWatch Vigilance automated maternal-fetal early warning system. Part of that system is a centralized acuity management tool that facilitates remote monitoring of laboring patients anywhere, providing flexibility for COVID-19 staffing.

HCA Healthcare and Google Health create the COVID-19 National Response Portal to allow hospitals to share pandemic metrics.

Audacious Inquiry launches the Situation Awareness for Novel Epidemic Response (SANER) Project, which is working on a specification to allow hospitals to send situational awareness reports to public health authorities.

Epic almost never issues press releases, but pushed out this one touting its telehealth capabilities. It calls itself “the nation’s largest electronic health records company,” which it certainly isn’t in terms of company headcount or revenue compared to Cerner, but perhaps is that among companies whose only business is selling EHRs. Novant Health went from 200 video visits per year to 12,000 per week, while NYU Langone Medical Center is conducting 6,500 virtual visits per day, more than 70% of its total. Another Epic update says the company’s EHR now includes two COVID-19 related patient registries to track known or suspected cases.


COVID-19

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Former FDA Commissioner Scott Gottlieb, MD tells CNBC that someone needs to take ownership of the surveillance and isolation program to get it in place by August, along with developing 1-2 drugs that can help treat COVID-19 patients with even modest success, to avoid having the economy stall at 80% of pre-coronavirus levels. He expects schools to reopen in the fall, but with added vigilance to detect local outbreaks, and reiterates that development of a vaccine is the ultimate solution at least 18 months down the road.

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National COVID-19 hospitalization numbers are trending down, as the curve-flattening seems to have worked in reducing demand for ICU beds and ventilators. Deaths are still increasing in New York as a lagging indicator (731 on Monday), but are expected to be lower than initial projections for both New York and the US.

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Amazon launches a hospital-only section of its Prime service for selling face shields, masks, thermometers, ventilators, exam gloves, and sanitizer. The company will verify the qualifications of potential buyers and will waive its commissions on purchases.

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Educational non-profit EDX and Harvard launch an free online course on ventilator use, hoping to help those clinicians who are reassigned to the ICU.

The New York Times explains why official coronavirus death counts are probably far below the actual numbers:

  • Coroners don’t have the tests they need to detect coronavirus.
  • Early cases in February and early March were likely listed as being due to pneumonia or influenza.
  • The system of filling out death certificates and the responsibility for doing so is inconsistent.
  • Also inconsistent is the reporting of deaths in which coronavirus is proven or suspected to be present, but not necessarily provable as the single cause of death.

HCA Healthcare-owned West Hills Hospital and Medical Center (CA) suspends a nurse for asking Facebook friends to donate personal protective equipment that her employer wasn’t providing. The hospital says she mentioned in a private chat group that her unit was treating COVID-19 patients only and those statements violated HIPAA and the hospital’s social media policy. She’s in quarantine after being exposed to the virus. An ED nurse at the same hospital said that he was also suspended after mentioning that he was working in a COVID-19 unit. Some healthcare workers are filing whisteblower lawsuits after being fired for issuing social media pleas for PPE.

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ICU nurses at Newark Beth Israel Medical Center (NJ) were so desperate for gowns and masks that they raised money on GoFundMe to equip themselves via Ebay purchases. Hospitals executives then suspended Olga Matievskaya, RN, BSN, the nurse who organized the campaign, for distributing unauthorized PPE.

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HHS OIG’s survey of 323 hospitals from late March lists their coronavirus-related concerns. President Trump dismissed the report in Monday’s coronavirus briefing, saying “it’s wrong” and scolding the inspector general on Twitter for not talking to “admirals, generals, VP, and others in charge” before publishing the hospital survey results. Hospitals report:

  • They are experiencing severe shortages of testing supplies and waiting seven or more days for results, limiting their ability to monitor the health of patients and staff.
  • Shortages of PPE are widespread, federal and state help is uncertain, and some vendors are price gouging.
  • Hospitals aren’t always able to meet staffing needs due to a people shortage, also worrying that exposure fears and burnout may contribute to short staffing.
  • Post-acute care facilities won’t accept hospital discharges until the patient tests negative for COVID-19, tying up acute care beds.
  • Hospitals are running out of IV poles, medical gases, linens, toilet paper, food, thermometers, disinfectants, and cleaning supplies.
  • They are worried about ventilator shortages that may force them to choose which patients get them.
  • Costs are increasing as revenues decrease with elimination of elective procedures, quickly depleting cash reserves.
  • Guidance from federal, state, and local authorities is ever-changing and inconsistent, and public misinformation is causing patients to show up unnecessarily.

This is well outside my area of expertise, but a New Jersey hospital needs PPE and asked me to forward contact information for anyone who has access to it. Email me and I’ll forward the information.

Cerner sent these hospital recommendations for dealing with COVID-19 patient surge, from St. Joseph’s Healthcare System (NJ) VP/CIO Linda Reed, MSN, MBA:

  • Review and implement the EHR vendor’s COVID-19 updates and packages.
  • Review telehealth documentation and education.
  • Prepare to develop lab interfaces for state surveillance.
  • Create daily dashboard reporting.
  • Review the IT requirements for opening surge beds in non-traditional areas.
  • Implement the new COVID-19 diagnosis and billing codes.
  • Prepare to support additional work-from-home technology needs.
  • Review government reporting requirements.
  • Use remote support tools to support desktops to limit trips to hospital units.
  • Prepare for updating EHR access to accommodate clinicians who are reassigned.
  • Use remote patient visualization technology to limit room entry.

Other

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A Florida business paper covers Orlando Health’s replacement of Allscripts Sunrise with Epic. Orlando’s other big health system AdventHealth, is also implementing Epic, replacing Cerner.

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A Baltimore TV station covers the use by Lifebridge Health and Johns Hopkins of technology from Emocha to keep in touch with self-quarantined clinicians. It offers symptom reporting, asynchronous video check-ins to verify thermometer readings, and two-way messaging.

Verizon cancels making onsite Internet connectivity service calls for homes and businesses, with some users reporting they were given a date of November to regain connectivity.

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Miss England 2019, Bhasha Mukherjee, MBBS, shelves her overseas humanitarian work and returns to the UK to work at NHS’s Pilgrim Hospital. She explains, “When you are doing all this humanitarian work abroad, you’re still expected to put the crown on, get ready, look pretty. I wanted to come back home. I wanted to come and go straight to work.”


Sponsor Updates

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  • AGS Health spotlights employee Adelaide Rose’s mask-making efforts for hospitals in New Jersey.
  • Medsphere’s ChartLogic division adds integrated telehealth to its ambulatory EHR that allows patients to launch video rooms from its patient portal for a virtual evaluation.
  • Baxter Regional (AR) expands its use of EClinicalWorks technology to include virtual visit capabilities.
  • Access releases COVID-19 Rapid Response EForms, which allows hospitals to offer contactless registration by sending patients an online screening form and then pre-registration documents to complete and sign remotely.
  • Diameter Health partners with insurance technology company Clareto to improve underwriting and claims adjudication with data-cleansing technology.
  • Experity updates its travel screening questionnaire to help urgent care providers identify new cases of COVID-19.
  • Healthwise launches a Coronavirus Resource Center.
  • Datica releases a new podcast, “ONC Final Rules on Information Blocking – Part 2.”
  • CareSignal and Americares bring a new COVID-19 text messaging program to the uninsured.
  • Clinical Architecture joins the COVID-19 Interoperability Alliance.

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 4/6/20

April 5, 2020 News 5 Comments

Top News

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The FCC publishes details of the $200 million COVID-19 Telehealth Program, for which it will start accepting applications immediately.

The program will fully fund provider purchases of telecommunications, information services, and connected medical devices to provide remote services, with an emphasis on those that help low-income Americans and veterans.


Reader Comments

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From Recovering CIO: “Re: provider layoffs. As they start to hit, I wonder how the organizations of readers are looking at funding in the CARE Act as well as the FCC’s $200 million telehealth funding.” I’ve created a submission form for provider readers to tell us.

From Imburse Me First: “Re: hospitals. Do they have incentive to game insurers, Medicare, or the bailout program by claiming patients died of COVID-19 when they don’t know for sure?” I’m guessing hospitals have the theoretical incentive to overstate COVID-19 deaths (I was reading a wacky conspiracy theory about that on Twitter), but I’ll ask experts to weigh in. My question is how deaths are categorized as being caused by COVID-19 – have all those patients tested positively, and was COVID-19 the cause or was it an incidental condition? Shelter-in-place should have reduced deaths from car accidents and injuries, so shifts in the numbers for deaths from heart disease, cancer, stroke, respiratory disease, and diabetes might indicate creative coding, although most of those are also predictors of COVID-19 outcomes. Obviously this is not a good time to suffer from a serious non-COVID condition that requires medical or surgical intervention, and we may see problems down the road as a result.

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From Panama Jacques: “Re: your logo. Doctors should not be smoking – what a poor example for a healthcare site.” I’m happy for the recent uptick in readership, but it has sparked yet another round of smug observations from newbies who feel uncommonly blessed with perceptive powers. Your logo doctor smokes a pipe? The Monday Morning Update comes out Sunday? You’re biased for or against (insert any health IT vendor or political party here)? You write about music? Why are the news posts so long when I’m too busy to read it all? I started writing HIStalk four years before the first IPhone came out and haven’t changed it much since 2003. People have either kept reading it or they’ve moved on. Annual reader survey numbers for “reading HIStalk helps me do my job better” are always high (92% this year), so those folks apparently aren’t sweating the doc’s pipe or my periodically professed love for oddball music.

From Was A Community CIO: “Re: HIMSS20. Looks like a cash grab for OnPeak or HIMSS. Hyatt waived penalties for room cancellations due to COVID, but the charge remains on my card and Hyatt says they returned the money to HIMSS. Someone has my company’s money and I don’t think it’s Hyatt.” HIMSS says in the email thread that was attached that Hyatt didn’t send it money. I checked other conferences and it seems that OnPeak uses the credit card to hold the reservation, but it’s the hotel itself that actually charges your card for the initial deposit. In that case, I don’t know why Hyatt would have sent your refund elsewhere, which leads me to suspect they are the problem rather than HIMSS or OnPeak. I would probably dispute the charge with your credit card company since it shows Hyatt as the recipient. That will put the ball in Hyatt’s court.


HIStalk Announcements and Requests

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Most poll respondents report experiencing some negative effects in working from home, most commonly related to exercising less, feeling disconnected, or eating unhealthily.

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New poll to your right or here: what is your personal experience with COVID-19? Vote and then click the poll’s “Comments” link to tell us more.

Thanks to the following companies that recently supported HIStalk. Click a logo for more information.

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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.


Announcements and Implementations

PatientBond offers hospitals its digital engagement services at no cost through June 2020, providing a weekly patient education email campaign related to COVID-19 prevention, detection, and treatment.


COVID-19

The Trump administration is considering paying hospitals at Medicare rates for treating uninsured COVID-19 patients, taking the money out of the $100 billion that was designated for hospital relief. The government proposed such payments as an alternative for opening up the ACA insurance marketplace for the many millions of Americans who have lost their jobs in the past few weeks, but experts question how payment would be assigned when patients may receive treatments for conditions other than COVID-19 in a single hospitalization.

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The White House explains that the COVID-19 supplies it is bringing in from China and sending to states are actually going to commercial distributors for resale to the highest bidder, as the federal government does not want to disrupt the supply chain.

New York State virtually merges all of the state’s 200 hospitals into a single state system that will share staff, patients, and supplies under the direction of the state’s department of health. Challenges include how billing will work when a patient is moved to an out-of-network hospital, how staff can be moved to a distant facility without disrupting their families, and determining how hospitals pay each other for the resources they share.

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CNBC profiles the New York City “disease hunters,” who after 9/11 set up a syndromic surveillance system using data from hospital EDs. One of those involved was NYC Department of Health Assistant Commissioner Farzad Mostashari, MD (later National Coordinator, now CEO of Aledade), who looked at his old system on March 4 (the day before HIMSS20 was cancelled) and started tweeting about a high volume of patients with flu-like symptoms, when the city had only 100 confirmed COVID-19 cases. As with many public health projects, this one suffered from federal-state clashes, a heavy-handed yet underfunded CDC, and overall public health funding cuts in 2019.

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The first and best public health school in the world, Johns Hopkins Bloomberg School of Public Health, lists the “5 Ways the US Botched the Response to COVID-19.”

The Gates Foundation is testing seven coronavirus vaccines and is building manufacturing capacity for each of them to speed up any eventual production, even with the knowledge that one or two of them at most – and possibly none of them – will be found to be effective. He says the parallel process will waste a few billion dollars, but it’s worth it given the trillions of dollars that are being lost economically.

CDC rolls out COVIDView, an outbreak monitoring tool that displays key indicators that will be updated weekly. Sounds like a good idea, other than it’s late in the game and the infrequent updates limit usefulness. I truly don’t understand why the federal government isn’t tapping into the Cerner, Epic, and Meditech EHR databases that cover the vast majority of hospitals and a significant portion of their ambulatory operations, and instead is asking for daily worksheets to be emailed. Maybe epidemiologists just aren’t aware of the trove of real-time electronic data that hospitals are sitting on, or don’t have the right people demanding access to it.

Hospital staffing firms that are owned by private equity firms are cutting the hours and pay of their doctors as COVID-19 has reduced the demand for other services, especially elective procedures. Among them: TeamHealth, SCP Health, US Acute Care Solutions, Envision Healthcare, and Alteon Health. The latter laid off clinicians for 1-6 months and won’t guarantee hours for part-time employees, explaining in an internal email, “Anyone not willing or unable to share the burden will need to be terminated to preserve employment for those who really feel part of our team and care about their co-workers.” An anonymous ED physician who works for Alteon said. “Healthcare workers are being applauded in the streets and we are being stepped on by them.” Meanwhile, the wave of hospital layoffs and furloughs has turned into a tsunami as our screwy healthcare non-system finds itself under attack financially as well as microbiologically.


Other

Maryland-based contractor Cesar Capule, who was working on the Epic go-live at St. Agnes Hospital (WI), fell ill with COVID-19 symptoms during the project, was asked to self-quarantine at a local hotel, and eventually was admitted to the hospital’s ICU, where he was ventilated and died 17 days later on March 29. He was 49. I could find no further information about him.

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A Palo Alto news site describes how Stanford Health Care is using telemedicine to screen patients who are worried they have COVID-19, saving the health system PPE and potential provider exposure in having ED doctors do video screening of people in the drive-through testing location. Stanford is now doing 40% of visits virtually, 50 times its pre-pandemic volume.

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New Jersey’s governor calls for volunteer COBOL programmers (which he calls “cobalt”) to maintain the 40-year-old state systems that issues unemployment checks.

The New York Times profiles people who have moved to the US from other countries, but are going back because of our lack of universal healthcare, ineffective COVID-19 response, and overwhelmed hospitals in which even insured patients may not be adequately treated. Some had bought travel insurance as their primary healthcare coverage because US insurance is so bad.

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The chief medical officer of Scotland, who appears in TV public service announcements in which she urges people to stay home, is formally warned by police after being captured in a photo walking her dog outside her second home that is 45 miles from Edinburgh. Residents of that town are annoyed at visitors who are traveling to their second homes and walking outside, some of them relocating from cities to self-isolate in their vacation homes where goods and medical services are scarce. Others note that while she is being vilified, Prince Charles – who has tested positive for coronavirus – moved freely from London to Balmoral. It is indeed good to be (future) king.

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@drnic1 found this fun story. A bored, working-from-home astrophysicist in Australia is inspired by coronavirus to invent a necklace that sets off an alarm when the wearer touches their face. Not only did he inadvertently invent the opposite (the necklace alarms constantly until it detects a hand approaching the face), he also had to visit the ED to have the sensing magnets removed from his nose. His partner took him to the hospital where she works because “she wanted all of her colleagues to laugh at me.”


Sponsor Updates

  • Spok offers a video tribute to healthcare workers who are on the front lines of COVID-19, including a wall of thanks from employees.
  • Meditech extends its virtual visits offer to all customers for a six-month period.
  • Wolters Kluwer Health releases a new educational video, “Understanding COVID-19 and How to Stay Safe.”
  • The Chartis Group publishes an IS checklist for COVID-19.
  • Wolters Kluwer Health adds COVID-19 tools to Sentri7 (infection prevention rules and population of Notifiable Conditions for COVID-related lab tests and results) and Health Language Clinical Interface Technology (access to COVID-updated SNOMED CT and ICD-10 codes).
  • PerfectServe offers free software and services for Patient & Family Communication and free services to implement best practices for COVID-19 purposes.
  • Relatient offers a free download, “Using Patient Engagement Solutions to Communicate with Patients during the COVID-19 Pandemic.”

Blog Posts


Contacts

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

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News 4/3/20

April 2, 2020 News 3 Comments

Top News

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Health IT consulting firm CereCore lays off dozens of employees contracted to work for parent company HCA Healthcare, which has announced plans to cut costs in order to avoid its own layoffs.

The hospital operator has already seen several of its outpatient facilities close as procedure volume takes a nosedive in the wake of COVID-19.

The company’s senior leadership team will take a 30% pay cut for the duration of the pandemic. CEO Sam Hazen will donate his salary in April and May to the company’s charitable fund.


Reader Comments

From Slag Pile: “Re: hospital layoffs. How can this happen when they are staring down the barrel of crushing COVID-19 volumes?” Let us ponder the “only in America” healthcare system that we have allowed to be created, in which the million-dollar executives of architecturally imposing hospitals are responding to the most destructive health crisis in generations by firing their caregivers because of insufficient pandemic profit margins. I doubt any other country in the world would allow this to happen, but that’s true of nearly all aspects of US public health and healthcare delivery, where even hospices and nursing homes have been snapped up by private equity firms. We let healthcare become a big business, but then are surprised when it acts like one.

From Tilted Beret: “Re: HIMSS20 cancellation. This ‘interview’ with Hal Wolf is a fluff piece with no mention about refusing refunds, what it means to vendors and sponsors, etc. The ‘journalist’ is the director of content development for HIMSS – unbelievable!” I wouldn’t expect too many hardball questions or brutally honest answers when a HIMSS employee interviews the HIMSS CEO for a HIMSS publication, but maybe they could have put their collective heads together to come up with something more useful than to express “all about me” regrets that the HIMSS rebranding and new product announcements didn’t go as planned, that cancelling was the right call (which we now know), and a pitch for HIMSS Digital (which Hal says was already being worked on before HIMSS20). Hal also says that it’s a “great thing” that registration fees roll into HIMSS21, which is a less-great thing than getting your money back.

From YouveGotMailToIgnore: “Re: medication change request. Sent my specialist one through their portal. Before, the CMA would talk to the doctor and send an update back. Now the response is to schedule a telehealth visit. Maybe they are hurting for revenue, but it’s ironic since the last time I requested a telehealth visit I was denied.” My oft-repeated summary: people and companies will always choose the action that pays them the most. They didn’t need the money then, and now they do and insurance will pay – your preferences as a customer weren’t important then and they aren’t now. In fact, I should correct myself in calling a  patient a customer – unless you’re paying cash or have full discretion about who and how much your insurance pays, you aren’t really one.

From Administrator: “Re: patient surveys. The company that does ours sent a note telling us why we have to keep spending on sending these to patients during the crisis. Our clinicians would be fine if we stopped. Are revenue pressures forcing healthcare systems to try to get out of existing contracts or push for concessions?” I doubt most contracts contain customer “I can’t or really don’t want to pay” clauses that would render their contracts void or convince the vendor to renegotiate terms, but maybe readers can elaborate. I doubt anyone will do better than getting extended payment terms (with interest accruing).

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From AM: ”Re: 3D printing. One of our patients donated face shields to our family medicine office that he printed. Pretty cool, and makes me think it would be worthwhile to purchase a 3D printer for the office. People are doing really good things out there, including developing cleaning stations in shipping containers and the couple who had gourmet chocolates delivered to our office. Sometimes negative attitudes and people usurp all our energy, but it’s important to remember that there are so, so many awesome people in the world who keep us going during the stressful days, and we have had an endless run of those lately.” Instructions and design files are here. Everybody is noticing the sudden mainstreaming of virtual visits, but 3D printing will also earn a spot on the list of technologies that coronavirus will turn into a standard.

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From CopyPaste: “Re: ‘HIPPA.’ Even the government can’t spell it right all the time, at least in this Senate document.” We can only wish that this was the worst example of the federal government’s healthcare failings.


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

Startups are desperately trying to save their businesses in the suddenly terrible economy by remotely laying off masses of working-from-home employees.


People

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Healthcare analytics technology vendor Geneia promotes Heather Lavoie, MBA to president and CEO.


Announcements and Implementations

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CloudWave announces GA of OpSus Edge, on-site infrastructure technology designed to help healthcare organizations manage, secure, operate, and maintain critical applications.

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Swedish (WA) implements an app developed with Microsoft that helps staff track COVID-19 patients, and hospital capacity and supplies.

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OptimizeRx announces GA of TelaRep, giving physicians the ability to virtually consult with medical science liaisons about patient treatment plans.

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LiveProcess offers health systems free access to its COVID-19 Response Package, which includes a virtual situation center for shared awareness, coordination, and tracking. It is based on the company’s SaaS-powered LiveProcess Emergency Manager for emergency response.

Lumeris develops a free and open source model to predict COVID-19 hospitalizations, essentially creating a patient registry that requires about 60 minutes worth of user work. The authors say the model tested as being more accurate than others, in the process finding that another company’s model delivered results that were less accurate than simply guessing when applied to people under 65. It works with population health platforms from Cerner, Athenahealth, EClinicalWorks, and Epic. Lumeris SVP of analytics Michael Cousins, PhD was involved and he is a biostatistician with a ton of experience.

Health Catalyst offers free use of its Patient Safety Solution COVID-19 module and Capacity Planning Tools to healthcare organizations.

Premier, Stanford Medicine, and Resilinc form The Exchange at Resilinc, a cloud-based platform for hospitals to identify, locate, and exchange critical medical items during the COVID-19 outbreak. The group purchasing organization-agnostic system is accepting provider and industry group members at no cost.

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First Orion offers providers free use of its programmable Inform product, which allows them to show their organization’s name on Caller ID to avoid the 84% of calls – including medically critical ones — that aren’t answered by people because they don’t recognize the caller’s number.

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CPSI offers free access to TalkWithYourDoc.com, a new, standalone telehealth platform that was developed by its Get Real Health subsidiary.

KLAS finds that while organizations are highly satisfied with standalone Epic ambulatory implementations, those who use it via the Community Connect model of signing up with a host organization are less satisfied, although even then their satisfaction is about the same as that of competing ambulatory EHRs. Some Community Connect users fault Epic for allowing host organizations to sell a subpar offering, with some perceiving lower value even though Community Connect costs less than contracting directly with Epic.


Government and Politics

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The Department of Defense presses pause on its roll out of MHS Genesis to better enable its care teams to focus on treating COVID-19 patients. The Cerner-based EHR software has already gone live at eight sites. Original implementation plans had called for the system to be deployed in 23 waves through 2024.

The CDC seeks a new chief data officer.

The HHS Office for Civil Rights loosens HIPAA regulations to give healthcare business associates more leeway in sharing PHI “in good faith” during the pandemic.


Privacy and Security

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As remote workforces increase, Microsoft alerts several dozen hospitals to VPN infrastructure vulnerabilities that may attract ransomware attackers.


COVID-19

England’s NHS is considering developing a contact tracing app that alerts people if they have had recent contact with someone who later tested positive for COVID-19. Oxford researchers proposed such an app in a March 31 in Science, saying that it can help avoid mass quarantines while still helping contain coronavirus spread.

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Fred Hutchinson Cancer Research Center computational biologist Trevor Bedford announces the launch of the NextTrace project, which aims to help coordinate data from commercial, state, and academic testing labs and voluntary contact tracing data to better inform public health responses to COVID-19.

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A follow-up hospital supply survey from Premier finds that active care for COVID-19 patients creates a surge demand 17 times greater than typically seen for N95 respirator masks, nine times greater for face shields, six times for swabs, five times for isolation gowns, and three times for surgical masks.

New York City records its first COVID-related homicide victim, an 86-year-old hospital inpatient who was assaulted by another patient for breaking social distancing guidelines. Cassandra Lundy, a 32-year-old seizure patient with 17 previous arrests, was charged with disorderly conduct.

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The Army Corps of Engineers converts the Javits Convention Center in New York City to a care facility for 2,000 non-COVID-19 patients. Military personnel have also helped to transition the Billie Jean King National Tennis Center in Queens into a similar facility.

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The State of New York launches an online portal to connect healthcare facilities with volunteer healthcare workers. The portal is part of Governor Andrew Cuomo’s recently announced Central Coordinating Team, a hospital network that will help facilities share data, staff, and beds.

Health officials in China developed the country’s world-class infectious disease tracking system after the SARS outbreak that was supposed to prevent political meddling with outbreak detection, but local health officials who were afraid of sending bad news to Beijing withheld coronavirus information and overrode doctors, delaying the country’s response. Central health officials learned about the outbreak from whistleblowers who leaked internal documents rather than the early warning system. Later, local authorities minimized the severity of the situation, created narrowed reporting criteria, and required cases to be reviewed by bureaucrats before reporting them to Beijing.


Other

In what’s being touted as a world first, a medical team successfully delivers diabetes medication and receives a patient’s return blood sample via drone delivery to a remote island off the coast of Ireland.

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Several health systems in Wisconsin make headlines for continuing to sue patients for unpaid bills during the pandemic. Patients in default have reported being served papers by processors (without masks or gloves) as recently as March 28.


Sponsor Updates

  • Wolters Kluwer Health accelerates roll out of coronavirus alerting, reporting, and ICD-10 and SNOMED CT codes.
  • Frost & Sullivan recognizes Greenway Health with its 2020 North American Customer Value Leadership Award.
  • SyTrue will provide its SyHealth for Population Health solution free of charge to qualified public health organizations.
  • ComputerWeekly.com profiles Google Cloud CEO Thomas Kurian and the company’s efforts to support the fight against COVID-19.
  • Engage receives a five-star rating from Securance Consulting for the fifth year in a row as a Best Practice Meditech Hosting Provider.
  • Clinical Computer Systems, developer of the OBIX Perinatal Data System, offers free system configuration, connectivity, and licensing for customers who are setting up temporary units or isolation suites for COVID-19 patients, which includes pregnant women who need fetal monitoring.
  • Elsevier releases a new episode of its COVID-19 podcast, “Medical Informatics and COVID-19: Role and Utility of Hospital Digital Resources and Telemedicine in Managing the Pandemic.”
  • Imat Solutions enables real-time health data reporting and analytics for its customers in response to COVID-19.
  • InterSystems releases a new PulseCast podcast, “Lygeia Ricciardi: Prioritizing Patient-Centered Design.”
  • Intelligent Medical Objects publishes a new white paper, “Interoperability, information blocking, and the coming data tsunami.”
  • PatientKeeper announces GA of its Meditech-friendly Clinical Communications Suite Now.
  • Health Catalyst adds registry, dashboard, and capacity planning tools to its suite of COVID-19 solutions, and will soon add a new set of financial impact planning resources.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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News 4/1/20

March 31, 2020 News 6 Comments

Top News

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CMS issues coronavirus waivers and rules:

  • Physicians can bill for telehealth visits at the same rate as in-person visits.
  • Hospitals can bill for services that are performed outside their four walls, such as directing patients via telehealth to offsite screening locations.
  • CMS will pay for 80 additional services when provided via telehealth.
  • Hospitals can hire local clinicians.
  • Hospital physician assistants and nurse practitioners can practice without physician supervision as permitted by state law.
  • CRNA’s can work without being supervised by a physician.
  • Hospitals are allowed to provide personal services for medical staff, such as meals or laundry service, while they are working at the hospital.
  • Supervision of medical residents can be performed virtually.
  • Medicare will pay for respiratory equipment for any medical reason.
  • Hospitals will not be required to create written visitation policies for COVID-19 patients.
  • The time in which hospitals must give patients a copy of their medical record is increased.
  • Hospitals can triage patients in state-approved community settings in a “hospitals without walls” model, such as ambulatory surgery centers, hotels, and dormitories.
  • Hospitals can contract with ASCs to provide essential surgeries, for which Medicare will pay hospital rates.
  • COVID-19 testing can be performed in homes, dedicated testing sites, and other community settings.
  • Hospital EDs can perform COVID-19 tests at drive-through testing sites.
  • Ambulances can transport patients to a wide range of locations when other transportation is not appropriate, such as community mental health centers, FQHCs, physician offices, urgent care facilities, and ambulatory surgery centers.
  • Physician-owned hospitals can temporarily increase their number of beds, ORs, and procedure rooms.
  • Hospitals can provide physician practices with medical equipment and telehealth equipment and provide childcare services for workers.

Reader Comments

From Booth Happy Hour: “Re: HIMSS. Have they responded to your recap of HIMSS21 exhibitor plans?” No, and I wouldn’t expect them to since that wasn’t the point. I did the survey only because I was getting lots of exhibitor complaint emails and I don’t know how HIMSS is communicating individually with the 1,300 of the booth renters, especially the significant percentage of them that are vocally unhappy about being told to suck up their exhibit, hotel, and travel costs for the cancelled conference and return happily for another round in HIMSS21. HIMSS is no doubt busy dealing with the aftermath of HIMSS20, running Virtual HIMSS, frantically planning for HIMSS21, and trying to save the organization. Hopefully its transparency and humility will ramp up once the dust settles. Meanwhile, my body clock can’t comprehend that it was just three weeks ago today (as I write this on Tuesday) that the HIMSS20 exhibit hall would have been opening for the first day. I just read the book “A Short Stay in Hell” as urged by Mrs. HIStalk, and while I didn’t get much out of the rather depressing tome because I prefer quality entertainment such as “Tiger King,” today’s real world seems similarly never ending.


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.


Announcements and Implementations

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London’s 4,000-bed COVID-19 emergency treatment facility, Nightingale Hospital – created inside a convention center —  will run Cerner Millennium, extended from the implementation of Barts Health NHS Trust.


Government and Politics

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CMS asks hospitals to report their COVID-19 testing data to HHS. HHS also asks hospitals to report their bed and ventilator supply and COVID-19 patient counts by emailing a manual worksheet every afternoon. The electronic gaps in our public health and surveillance reporting are startling.


COVID-19

China ships the first of many shipments of COVID-19 emergency medical supplies to the US – 12 million gloves, 130,000 N95 masks, and huge numbers of masks, gowns, hand sanitizer units, and thermometers. An additional 22 flights are scheduled over the next two weeks. The government is paying for the flights, but a distributor is paying for its contents, 60% of which will be sold to the federal government and the rest to the distributor’s own private customers. We were sending respirator masks and protective suits to China just two months ago, so maybe we’re buying some of our own stuff back.

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New Yorkers crowd together in defiance of public gathering regulations to get their flag-waving selfies with USNS Comfort, missing the irony that their irresponsible actions might land them or someone else a coveted COVID-19 respirator spot.

European Union countries struggle to develop virus-tracking apps that do not infringe on personal rights or GDPR, noting the apparent success in Singapore and South Korea of using phone-based digital tracking of those who are infected. Poland is tracking people who are under home quarantine via an app, while Germany’s health minister demands a national debate on the ethics of using cell phone tracking technology.

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Google opens free access to several public COVID-19 datasets to researchers, accessible from its Google Cloud Console and its BigQuery ML.

Experts warn that the US’s fragmented health system will create financial hardship for patients who are tested for COVID-19, especially since it’s early in the insurance deductible year. Insurers have agreed to waive co-pays for the test itself, but visits to the ED to have the test performed, surprise bills from out-of-network EDs and contracted ED doctors will increase, and surprise billing protections were excluded from the federal government’s coronavirus bill after lobbyists for hospitals and physician staffing firms played “the COVID card.”

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Nursing homes are refusing to accept hospital patients until they test negatively for coronavirus, a practice that frustrates hospitals that are anxious to free up beds. Hospitals say it takes days to test patients who were not suspected of having COVID-19 even when tests are available, but nursing homes don’t usually have separate isolation areas and worry about fatality rates of up to 50% once coronavirus starts spreading inside their walls.

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Salesforce CEO Mark Benioff lays out his plan for combatting COVID-19. Few of his items are being discussed by the actual people in charge.


Other

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Intermountain Healthcare cuts the pay of physicians, nurse practitioners, and physician assistants due to “changing needs created by COVID-19.”

The New York Post reports that while frontline workers at Mount Sinai Health System are forced to beg for protective gear and wear garbage bags in its absence, CEO Kenneth Davis, MD was working from home in his six-bedroom, eight-bathroom Miami waterfront mansion, having been there since early March and advised to stay there by his doctor to avoid coronavirus exposure. He chose the $3.4 million Florida home over his $2 million one in Long Island and the $7 million one he owns in Aspen. Davis made over $12 million in 2017 and $6 million in 2018. Meanwhile, the hospital’s health network president is also in Florida, working from his oceanfront condo. I understand that much of what these guys do can be virtual, but somehow I expect more them given that they are both (a) doctors; and (b) health system leaders. Not to mention highly paid compared to the troops they’re sending into battle short on weapons against an enemy that targets not just themselves, but their familes.

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University Medical Center (TX) suspends an anesthesiologist who wore a respirator face mask in the hospital hallway as he was leaving an emergency intubation. The chief of anesthesia texted him: “UR WEARING IT DOWN A PUBLIC HALL. THERES NO MORE WUHAN VIRUS IN THE HALLS AT THE HOSPITAL THAN WALMART. MAYBE LESS.” (the all-caps styling and insistence on calling it “Wuhan virus” isn’t encouraging). Meanwhile, an anesthesiologist at Seattle hospital was also threatened with firing for wearing a surgical mask in the hall. Other hospitals have taken the opposite approach in requiring all caregivers to wear a mask in all hospital spaces. You would think that non-clinical hospital suits could find something more useful to do than fret over trained doctors protecting themselves in whatever way they feel is appropriate, or barring that, just work from home and stay out of the way of people who are saving lives in between watching them end.

The Department of Defense orders all medical and dental facilities to postpone elective procedures for 60 days.

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Hospitals in New Zealand will use 1000minds “knowledge codification” software – which scores patients to decide which of them get surgery – to guide ICU doctors in choosing which COVID-19 patients get an ICU bed. The software’s non-healthcare uses include businesses evaluating potential new products, shortlisting RFPs, selecting students for admission or scholarships, picking an engagement ring, evaluating job candidates, and choosing “best actress” type arts awards.

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The home of an Arkansas family practice medical resident who is separated from his wife and one-year-old as he treats COVID-19 patients is destroyed by a tornado. A friend started a GoFundMe with a goal of $2,500 that has raised $108,000 so far. The photo above was of Jared Burks, MD watching his son crawl for the first time as he came home after a two-week stretch, right before his home was destroyed while he was inside. Maybe those Mount Sinai executives can loan him one of their mansions.

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This is the cover of the current issue of The New Yorker.


Sponsor Updates

  • Arcadia helps to form the COVID-19 Healthcare Coalition.
  • Avaya expands free offers for work-from-anywhere apps to help businesses respond to the COVID-19 pandemic and protect employee health.
  • Bright.md adds B Capital General Partner Karen Page to its board.
  • Nordic offers free best practices and suggestions as responses to healthcare organization questions in its Ask Nordic service.
  • Meditech offers free, six-month access to its Scheduled Virtual Visits functionality to its patient portal customers.
  • Datica releases a new podcast, “ONC Final Rules on Information Blocking – Part 1.”
  • CI Security makes available a work-from-home security assessment.
  • CompuGroup Medical offers free telemedicine software to members of the Arizona Medical Association.

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 3/30/20

March 29, 2020 News 2 Comments

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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Medical 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 3 Comments

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 4 Comments

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 7 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.

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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


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


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Reader Comments

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